Page 1 1 CIRCUIT COURT OF MILWAUKEE COUNTY 2 · so basic, but it helps me to have an idea of where...

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CIRCUIT COURT OF MILWAUKEE COUNTY STATE OF WISCONSIN

* * * * * * * * * * * * * * * * * * * * * * *

EMMA JACKSON and JOHN JACKSON, Plaintiffs,

and

KATHLEEN SEBELIUS, SECRETARY OF THE DEPARTMENT OF HEALTH & HUMAN SERVICES,

Involuntary Plaintiff,

vs. Case No. 11-CV-13118

GRACE HOME, INC., GRACE LIVING SERVICES, INC., PREMIER INSURANCE COMPANY,

Defendants.

* * * * * * * * * * * * * * * * * * * * * * *

DEPOSITION OF ALEX COLE

TAKEN AT: SIESENNOP & SULLIVAN 200 North Jefferson Street LOCATED AT:

Milwaukee, Wisconsin November 19, 2012

9:00 a.m. to 11:55 a.m.

* * * * * * * * * * * * * * * * * * * * * * *

REPORTED BY ANNICK M. TRIMBLE REGISTERED PROFESSIONAL REPORTER

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Veritext Ray Reporting 800-472-0445 414-347-5599

Ex 20-001

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A P P E A R A N C E S:

CENTOFANTI LAW, S.C. , by Ms. Kelly L. Centofanti 10144 North Port Washington Road, Mequon, Wisconsin

Suite F 53092-5796

(262) 241-1900 [email protected]

Appearing on behalf of the Plaintiffs.

SIESENNOP & SULLIVAN, by Mr. W. Patrick Sullivan 200 North Jefferson Street #200 Milwaukee, Wisconsin 53202-5900 (414) 223-7900

[email protected] Appearing on behalf of the Defendants.

I N D E X

Examination by: Page:

Ms. Centofanti 4

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Ex 20-002

mailto:[email protected]




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E X H I B I T S

Exhibit Description Page Marked/Identified

1 Diagram .. 24 / 24

2 Diagram .. 24 / 24

3 Falls Prevention Program .. 24 / 24

4 Time sheet record. 119 / 120

5 Nursing Manual Index . 122 / 122

6 Care plan 124 / 125

(The original exhibits were attached to the original transcript.

all counsel.) Copies were provided to

(The original transcript was delivered to

Attorney Centofanti.)

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Ex 20-003

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TRANSCRIPT OF PROCEEDINGS

GAIL M. EHARDT, called as a witness

herein, having been first duly sworn on oath,

was examined and testifies as follows

E X A M I N A T I O N

BY MS. CENTOFANTI:

Q Would you state your name for the

record, please.

A Alex Cole.

Q And tell us where you work.

A I work at the Grace Home.

Q And what do you do there?

A I'm currently the director of nursing there.

Q And how long have you been the director of

nursing?

A Since February of 2012.

Q So the woman I see as director of nursing on

the materials, I think it's Jo Parker?

A Parker

Q Parker? She's no longer the director of

nursing.

A Correct.

Q Does she still work at Grace Home? No.

Okay. A

Q And you have been, as I understand it,

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Ex 20-004

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with Grace Home since March of '08?

A Correct.

Q When we asked for information about people who

might have knowledge of Mickey Jackson

fall,

Emma Jackson, I don't know if you knew her

nickname is Mickey. I'll just refer to her as

Mickey because that's what I' m used to. If I

start trying to say Emma I'll use the wrong

name for sure. They said you had knowledge of

her fall along with Casey Mann? Was she

still at Grace Home?

A No.

Q She was listed as the administrator?

A Yes.

Q Who's the administrator now?

The administrator now is Dana Marlin.

With an M?

A

Q

A Correct.

Q Another person listed was Jamie Kraft who we're

talking to later today

Uh-huh.

-

A

Q - - and Jo Parker. Do you know of anybody

else who has knowledge of Emma Jackson’s fall?

A Not that I can recall, no.

Q Tell me what knowledge you have of the fall,

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Ex 20-005

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A

what you remember as you sit here.

I remember sitting at the nurse's station

and - - and I can't recall who it was that came

and told me that Emma,

calling her Emma because that's how I

remember her.

That's okay.

talking about

and I'm going to be

Q As long as we know who we're

-

A Right.

Q - - we're good.

A Correct. That Emma had fallen, and I went

down the hallway into her room and she was

laying on the floor in her room.

Q Maybe the best way to start is if you could

give me a little bit of a layout of Lutheran

Home. I'm mostly interested in her room,

nurse's station,

that connect those three.

you can do?

Sure.

dining room, and the halls

Is that something

A Okay. Here's the nurse's station right

here.

Q Could you put an NH in it?

MR. SULLIVAN: NS.

BY MS. CENTOFANTI:

Q Oh, yes.

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Ex 20-006

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A NS. Okay. Here's the nurse's station. This

is the hallway. The dining room would probably

be right here. (Marking.)

Q And you wrote DR in there.

A Right. Then you go down the hallway and

Emma’s room was here. (Marking.)

Q And you can just write Emma’s room in there.

MR. SULLIVAN: I thought it was on

the other side.

THE WITNESS: You go down - - oh, it

was. I'm sorry. It's on this side. You go

down the hallway and here's Elvira's room.

BY MS. CENTOFANTI

Q It's going to be a collaborative effort today.

MR. SULLIVAN: Accuracy is what we

strive for.

MS. CENTOFANTI: Exactly. We have no

pride.

THE WITNESS: Okay.

BY MS. CENTOFANTI

Q Okay. Now, did the hallway go on or was she at

the end?

A No, the hallway went on for maybe one or two

rooms.

Q Can you just draw the hall going on?

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Ex 20-007

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A Here's another - - I'll just do that.

Q Okay. And then the hall dead-ends?

A Then it dead-ends, yes.

Q Okay.

A And it goes -

Q There's a right-hand turn?

A Uh-huh.

Q Okay.

going in other directions,

wing?

And are there other halls like this

or is this the whole

A No. There's one hall that would be jutting out

this way.

You can just draw the hall in,

end of the paper, that's fine.

to get a feeling for the layout.

then for that wing that she was in?

Yeah.

room,

(Pointing.)

Q just go to the

I'm just trying

Is that it

A There's two hallways that have resident

then resident's room, then off of this

section is just offices.

Just point an arrow and write offices and then

we'll kind of know that offices are over there.

(Pointing.)

Q

A (Witness complies.)

Q I'm thinking of Grace Home as a much bigger

facility. Are there rooms for patients

elsewhere?

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Ex 20-008

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A Oh, yes. There are three other long-term care

units.

Q But this is one unit.

A This is one unit.

Q And what's it called?

A The rehab unit, 3 East.

Q Okay. Thank you. I know this probably seems

so basic, but it helps me to have an idea of

where she was. So when you - - when someone who

you don't remember came and told you that

Emma had fallen you were at the nurse's

station.

A Right.

Q You went down the hall and then you went in her

room.

A Correct.

Q What did you see?

A I saw Emma laying on the floor.

Q And where was she?

A She was almost to her recliner.

Q Okay. Can we do a separate drawing? This

would be the room, and just make a box with the

room and I suppose there's a bed and maybe the

recliner that you mentioned and the doorway.

A The bed is here, the recliner was here, the

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Ex 20-009

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bathroom is over here, and the doorway is here,

and I saw Emma here laying on the floor.

(Marking.)

Q You put the door there.

though,

Uh-huh.

It's on the wall,

it's a square area, right?

A

Q Okay. Write "door.

MR. SULLIVAN: Yeah, you don't fall

into the room.

MS. CENTOFANTI: Sometimes they have

little anteroom things or something.

MR. SULLIVAN: Yeah.

BY MS. CENTOFANTI:

Q Okay. So you labeled the bathroom "BR," you

wrote "recliner " and "bed" on those things,

"door" on the door, and an "X" is where she was

lying.

A Uh-huh.

Q Was anyone in there with her?

A Yes. Jamie Kraft was in there with her.

Q And what did - - what's the next thing that

happened once you walked in the room?

A Well,

believe it was Jamie that said Emma fell. Is

there anything else Mary told you?

of course I said, "What happened," and I

Q

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Ex 20-010

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A I cannot recall. It was such, such a long time

ago that I can't remember. I remember, you

know, Jamie saying she fell and then I assessed

her.

Q And was Jamie with Emma when Emma fell?

MR. SULLIVAN: Let me object to the

form of with, but go ahead.

THE WITNESS: Jamie had been walking,

helping Emma down the hallway. Mary was

following Emma with a wheelchair. Emma was

walking down the hallway after breakfast and

Jamie - - Jamie was walking and she walked - - she

walked Emma to her room and then Emma could

be independent in her room, so I believe Mary

left the wheelchair outside and Emma went on

into her room.

BY MS.

Okay.

Yes.

CENTOFANTI:

Q And was that appropriate in your view?

A Jamie - - Jamie, you know, assisted her into

the doorway of her room and she was deemed to

be independent in her room.

Q Now, if we can go to, just a minute, I'll tell

you which page. If we can go to 234 of the

chart, 234 is page 1 of what?

A 234 is page 1 of her event.

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Q I'm familiar with records in nursing homes

called incident reports.

That's A -

Q Same thing?

A Yes.

Q Okay. And it appears that you're the person

who completed this form?

A Correct.

Q Can you tell me when you did it?

A I did it the date it happened.

Q And it appears it's a computer form?

A Correct.

Q So let's pause for a second and tell me how the

charting is handled at Grace Home. Some

homes are still doing handwritten charts and

some are fully electronic and some are

We're

-

A -

Q - - in transition.

A We're electronic.

Q So where would the computer be that you would

use for this, at the nurse's station?

A Correct.

Q Are they stationed elsewhere around the

facility or only at the nurse's station?

No. A On that particular unit there are, I

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Ex 20-012

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believe, two computers situated at the nurse's

station and then you go down this hallway where

the offices are,

three computers back there.

So people can go back there

and in the back room there are

Q -

A Correct.

Q - - and enter - - okay. So you would have gone

to one of those five computers.

A Uh-huh.

Q And you would have pulled up event report -

A Correct.

Q - - the form, and then you would have filled it

out.

A Correct.

Q Do you think you did it the same day?

A Yes.

Q Okay. So it looks like from the report that

you had done an assessment.

A Uh-huh.

Q Is that correct?

Did her vital signs,

By the way, were you

A uh-huh.

Q - - what was your position

in the nursing home on that shift? Were you

the shift nurse?

A I was the nurse manager.

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Ex 20-013

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Q Okay. Is that like a shift nurse or is that

above a shift nurse or doesn 't Grace Home

use shift nurses?

A Well, I don't know what you're talking about

shift nurses.

Q Okay.

A Are you talking about supervisors? I -

Q A better way for me to ask it,

would be tell me the hierarchy of people on

staff during that shift.

Okay.

a clearer way

A There's nursing assistants, staff nurses

that work the unit, and then a manager who

would be me.

Q Okay. Are staff nurses LPNs or RNs?

A They can be either.

Q Okay. And how many of each would be on duty at

the time, during this particular shift? I

guess this is the a.m. shift.

A Depending on our census at that time I can't

give you a correct exact number.

assistants and two to three staff nurses

besides myself.

Five nursing

Q Fair enough. And I'm not trying to do the math

on whether your staffing equals your census,

that wasn 't the point of the question. I was

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Ex 20-014

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just trying to get an idea of who was there.

A Uh-huh.

Q How many rooms are on that unit?

A It's a 45-bed unit.

Q One person to a room or two?

A No, it's one person and they're all private

rooms.

Q Okay. All right. So you had done an

A

a s s e s s m e n t o f E m m a a t

t h e t i m e o f h e r f a l l .

U h - h u h . A n d i f n o . Q - - you have to answer verbally yes or

A Oh, I'm sorry.

Q She could take that as a uh-uh -

A Right.

Q or an uh-huh and she does her best,

know

Yes.

- - but you

-

A

Q - - you want to do verbal answers.

A Yeah.

Q I'll try to remind you, and don't take it as a

criticism. Everybody does it.

A Okay.

Q So let's just go through this. On the first

page you check that her left hip was hurting.

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Ex 20-015

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A Uh-huh.

And what's your understanding of why she was in

the rehab unit?

Q

A Well, I believe she was there, and I can't

totally recall, I think she had a pelvic

fracture.

Q And that's okay if you don't remember.

trying to find out what you do remember.

have you reviewed to prepare for today?

Just the event.

This

I'm

What

A

Q -

A I reviewed that,

Did you review anything else in her chart or

her records?

yes.

Q

A No. The event and I believe that's all.

Q No other -

MR. SULLIVAN: To be fair she did

look at the care plan.

MS. CENTOFANTI: Okay.

THE WITNESS: Oh, that's right, yeah.

MR. SULLIVAN: Those are the things I

showed her.

MS. CENTOFANTI: All of the care

plans or one version?

MR. SULLIVAN: I know the snapshot

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for sure,

place an 12/10 or 12/9 when she came back,

probably those two.

and probably the one that was in

BY MS. CENTOFANTI:

Q We'll get to that a little bit later.

A Okay.

Q But that's all that you looked at?

A Uh-huh, yes, yes.

Q All right. So I think she was in there

rehabbing for a right hip problem and maybe

pelvic fractures too,

according to this sheet the left hip is what,

where her pain was.

Correct.

but not the left hip, so

A

Q Okay. And then I see on a scale of one to ten

you rank the pain at about a six. How would

you make that determination?

A Well, she wasn 't in excruciating pain. You can

see ten is excruciating pain. She was not on

the floor moaning and...

Q And then let's go up a little ways. "What was

resident doing just prior to fall?" Could you

just read in what you put there?

A "Ambulating back to her room with walker and

one nursing assistant following with wheelchair

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Ex 20-017

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after breakfast."

Q And then on page 235,

form you appear to have done some physical

assessment.

Uh-huh.

the second page of this

A

Q Perhaps you could tell me the significance of

the things that you checked?

A Well, she - - I checked her rotation of her

feet, and you can usually tell if someone has a

Q

fracture or a problem by if they have an

internal or external rotation.

So you suspected what?

I suspected

so you know,

A - - well, I can't diagnose anything,

I did not truly know if she had a

fracture. I'm not able to diagnose that.

Q And I'm not trying to put you on the spot -

A Right.

Q and have you be a doctor,

reasons you do the assessment that you did is

to see if her hip's broke

- - but one of the

-

A Right.

Q - - right?

A Exactly.

Q And although you can't diagnose, you are there

because of your training and experience.

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Ex 20-018

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A Correct.

And if it seemed like nothing was wrong there

would have been no need to call an ambulance,

and that's what you're determining.

Q

A Right.

Q So you were concerned that there might be a

broken hip.

Uh-huh, A correct, yes.

Q I notice you did a neurological check too and

apparently she was conscious?

A She was.

Q And stepping away from your event report for a

moment, in general do you remember Emma

Jackson as we sit here today? Can you picture

her?

A I can picture her,

Can you picture her before the fall that we're

talking about?

Uh-huh,

yes.

Q

A yes.

Q And can you picture her on the floor when the

fall happened?

A Yes.

Q And then I know she came back to Grace Home

after the surgery for the, what was -

A Correct.

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Q - - the broken left hip.

A Correct.

And can you picture her after that?

Yes.

Okay.

Q

A

Q Can you tell me what her mental state

was?

A I believe she was alert and oriented.

Q I noticed a couple things in the records where

it mentioned a little bit of memory problem,

but other places where it said, you know, she

can make her needs known, she's pleasant, she

visits.

A She could.

Q She was mentally there?

She was mentally there.

some,

A She might have had

like you said, episodes of forgetfulness,

but...

Q Like all of us do.

A She could answer our questions appropriately.

Q Okay. And do you remember if she was a

pleasant lady or a nonpleasant lady?

A I believe she was pleasant.

Q And then on 236 it looks like you do some more

assessing.

Uh-huh, A yes.

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Q And it states near the bottom of 236 that the

fall was witnessed and she did not hit her

head?

A Correct.

Q And the significance of that is what?

A Well, if she would have hit her head we would

have been concerned with a head injury, head

trauma, and she did not hit her head.

Q And then on page 237 there's a question which

states,

time of the fall," and you said,

what does the next part mean?

Wheelchair follower.

"Was adaptive equipment in use at the

"Walker, " and

A

Q And what does that mean?

A That means that the nursing assistant was

following her, Emma, who was walking with her

walker,

her with a wheelchair.

And would the assistant,

Mary.

and the nursing assistant was following

Q and I guess it was

A Right.

Q Would she be pushing the wheelchair or

would she be pulling it behind her? That

you'll have to ask Jamie. A I do - - do not

know what exactly Jamie was doing at the time,

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how she was following her.

Q But what - - and forget the Emma and Jamie

part, what does wheelchair follower mean to you

as a nurse manager RN, now DON?

A Okay. A wheelchair follower to me means it can

mean two things, either they were walking

behind,

behind the resident or a nursing assistant was

actually holding onto the resident and grabbing

the arm of a wheelchair and walking down the

either a nursing assistant was walking

hallway.

Q But when it's listed as an order , wheelchair

follower, what are the aides supposed to do?

Which of those?

A I would say the most - - most times they are

pushing the wheelchair behind the resident.

Q And what is the purpose of a wheelchair

follower?

A In case the resident would get tired due to

walking a long distance that wheelchair is

right there for them to sit in.

Q So a wheelchair follower isn

like a supervision or assistive one

supervision?

Well,

't the same as a,

A it could be considered supervision,

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because you are there with the resident.

You're supervising her walking.

Q Okay. All right. So then, "Did resident

complain or experience any of the following

prior to the fall?" This is still on 237 near

the bottom, and the one that you chose was

stated, "She lost her balance. Is that

correct?

A Correct.

Q So that means the others in that column did not

apply?

A Correct.

Q Do you remember prior to the fall if Elvira had

balance problems?

A I do not remember.

Q On page 238 there's a section, "Indicate

current measures in place, safety measures in

place. Again, you checked, "Adaptive

equipment"?

A Correct.

Q Do you know what that means?

A Her walker.

Q And does that mean none of the others applied?

A I do not believe they did.

Q I'm going to mark the diagram that you drew,

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Ex 20-023

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thank you, as Exhibit 1, and I'm going to mark

your diagram of the room as Exhibit 2. I'm

getting behind on my housekeeping here. And

then we're going to mark as Exhibit 3 the Falls

Prevention Program.

(Exhibit Nos. 1 -3 marked for identification.)

BY MS. CENTOFANTI:

Q Is that a document you've seen before?

A Yes.

Q Can you tell me what it is?

A It's our policy for fall prevention.

Q And what does that mean, a policy? Is it a

rule, is it guidelines, is it what you have to

do?

A It is - - it's a policy, rules.

Q Is it mandatory to follow or advisory?

A I would say it's advisory and it depends on the

resident. It depends on the resident. Not

everyone in our facility has all of these

interventions.

Okay. Q One thing I didn't notice in the chart,

but maybe I missed it, was a fall assessment of

Emma. I've noticed in many facilities

there's a separate sheet that's a fall risk

assessment. Does Grace Home have such a

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Ex 20-024

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document?

A We do in the computer system.

Q Do you know if it's in this chart?

A Shift nurses -

Q Well, let me back up. Do you know if it was -

if one was done for Emma?

A I cannot recall.

Q Okay. Maybe we should take a minute and is

that something you can check for easily to see

if it's in there? Maybe I just missed it.

A And a lot of times these fall risk assessments

are in the computer.

we do them on there,

them in the chart.

They're computerized and

but we don't really have

Q Ah.

A So the fall risk assessments are in the

computer for anybody to bring up.

Q We'll have to get that then, because we asked

for the entire, you know, everything related

to -

A Okay.

Q - - Emma.

A Yeah, we usually do a fall risk assessment upon

admission. I don't see it in here.

Q Can you just look at the last page of your

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Ex 20-025

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records and tell me what number it is, the last

page in the book?

MR. SULLIVAN: The last number in the

bottom.

BY MS. CENTOFANTI:

Q Just tip up the last page and see what it says.

A TLH0683.

Q Okay. So we're going to have to maybe go to

Grace Home and get everything out on Emma

that wasn 't provided.

MR. SULLIVAN: Well, it sounds like

the only thing that possibly wasn 't provided

was the fall risk assessment if it's in the

computer.

CENTOFANTI: So far.

SULLIVAN: Yeah.

CENTOFANTI: I mean, now we know

one thing wasn 't provided when we asked for

everything, so it could be there's other

things -

MR. SULLIVAN: When you say we're

going to need to go to Lutheran Home what do

you mean by that? I'm going to go there.

CENTOFANTI: Well, probably you.

SULLIVAN: Yeah.

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Ex 20-026

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MS. CENTOFANTI: But I want to be

sure I have every piece of paper -

SULLIVAN: Well, so do I.

CENTOFANTI: - - regarding Emma

Jackson

MR. SULLIVAN: I understand, and I

made that request and it sometimes happens at

nursing homes with computerized records, and

you know they're not in the litigation business

so they don't always understand, but I

appreciate your concern and we will get that

document or any others that we identify.

MS. CENTOFANTI: I guess that's my

point.

SULLIVAN: Yes.

CENTOFANTI: We have to figure

out a way to do a search in the computer, you,

to do a search in the computer. I don't think

I should have to, you know, ESP figure out what

all documents there are. I happen to think of

this one because it's a common form and I was

surprised that it wasn 't there and it's a fall

case, so -

SULLIVAN: Right.

CENTOFANTI: - - that matters.

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Ex 20-027

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SULLIVAN: Sure.

CENTOFANTI: But I'd like any

others even if I don't think of them.

Otherwise I suppose I'll have to go through all my

other nursing home cases and dictate a

letter to you listing every possible form.

MR. SULLIVAN: No, you don't want to

do that.

MS. CENTOFANTI: Okay. So you'll do

that for me.

MR. SULLIVAN: I'll do the best I

can.

MS. CENTOFANTI: Okay. That makes me

kind of uninclined to finish the dep when I

don't have the critical documents, but I think

we should go on while we're here.

SULLIVAN: Yeah.

CENTOFANTI: But I may need to

question her again when I have -

MR. SULLIVAN: Sure. We'll cross

that bridge once we get there.

MS. CENTOFANTI: Okay.

THE WITNESS: I'm hoping I find it in

here. It could be in here yet. Who knows.

Maybe.

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Ex 20-028

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MR. SULLIVAN: Let's do this. Let's

let Attorney _______ continue, and I can

flip through while you're answering other

questions.

BY MS. CENTOFANTI:

Q Let's go back to Exhibit 3. So we can't find

the fall - - it says procedure - - it says policy

or I mean under procedure it says, "Assessment,

all residents will be assessed for their fall

potential upon admission, quarterly, and with

each change of condition.

We looked for that and we couldn't find

it, but you think it does exist.

A Yes.

Q Okay. The next one it says, "Interventions for

each criteria will be identified and included

on the care plan and the care card," and we're

going to get to the care plan in a moment, but

tell me what the care card is.

A The care card is for nursing assistants to

follow. It's their care plan. It is in the

room behind the door and they are to look at

that care card when they come onto - - onto the

shift and make sure there are no changes or any

new interventions, and if they are that will be

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Ex 20-029

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documented on the care card.

Q Okay. That would be another document that I

would want.

MR. SULLIVAN: Assuming it still

exists.

MS. CENTOFANTI: Assuming it still

exists.

MR. SULLIVAN: I think if you follow

up you're going to find they aren't maintained.

BY MS. CENTOFANTI

Q So that's thrown away now?

A Correct. It's not a permanent part of the

chart.

Q What I wondered was how the aides find out what

they're supposed to do, and is that how?

A That's how, report is how they find out too, in

the morning they're given report.

Q And that's verbal, right?

A Correct.

Q Not recorded?

A No.

Q Not retained.

A No.

Q Are there notes, though, like change of shift

notes that are left from one shift for the next

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Ex 20-030

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shift?

A There are. It's -

Q And what are those called at your facility?

A We call them 24 hour report book.

Q And is that retained?

A It is only retained for approximately 12 months

and then they're discarded.

Q So as we sit here today we cannot see what the

care card for Elvira Peters prior to her fall

said.

A We cannot.

Q And we cannot see the 24 hour report book.

A We cannot.

Q And unless the person doing report on the prior

shift remembers, we won't know what was said to

Mary -

A We will not.

Q Okay. So the aides don't look at the full care

plan?

A Generally, no, they do not. They have their

care card. That is their care plan.

Q Who prepares the care card?

A The staff nurses on the unit.

Q So yourself at that time?

A Generally I wasn't involved in preparing the

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Ex 20-031

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care card. The staff nurses do that. They -

they call the doctors, they are - - they do the

Q

day-to-day activities on the unit.

Do you know who was the staff nurse at the

time?

A No, I do not.

Q So the staff nurse doesn 't prepare the care

plan, though, correct?

A The staff nurse, if she's an RN, yes, they do

the care plan. The third shift supervisors

really had a lot of input in preparing the

care - - the care plan also.

Q And then they just copied from the care plan to

the care card?

A Correct.

Q They don't have discretion to change what's

required, they just transfer it from the care

plan to the care card?

A Oh, they can - - the staff nurses can change on

the care card too, yes, if there's a therapy

Q

recommendation the staff nurses generally will

make that change on the care card.

So even though we have the care plans,

know what the care card said.

Correct.

we don't

A

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Ex 20-032

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Q So - - well, we'll get to the care plans in a

minute because let's finish with this first,

then we'll get to the care plans. Under

Protocol For Resident Fall, first thing it says

is,

for injury and notify whoever it's appropriate

to notify."

correct?

"A licensed nurse will assess the resident

That was you and you did that,

A Correct.

Q The second one states,

will be completed in Matrix."

That's what I was talking

That's

"The events assessment

A - - that's that.

Q -

A The event assessment.

Q So Matrix was your computer system -

A Correct.

Q - - at that time?

A Correct.

Q And now.

A Correct.

Q And then it says, "The care plan will be

updated with appropriate interventions.

A Correct.

Q Did you do that?

A I do not recall. I know that since she was

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Ex 20-033

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sent to the hospital we had to wait to see

what - - what the problem was and if she was

coming back and.

Q Good point.

A Uh-huh.

Q The next one has to do with a head injury,

which didn't apply here, correct?

A Correct.

Q The next one says,

initiated for all falls resulting in

hospitalization.

hospitalization,

"An investigation will be

This was a fall resulting in

true?

A True.

Q Was an investigation initiated?

A I believe it was, but that would have went to

Jo Parker and the administrator. Myself, as

the DON, I have to investigate falls and -

Q Now.

A Correct.

Q But you weren't the DON then.

No.

Okay.

A

Q Do you remember if an investigation was

done, because I would think you would have been

talked to or part of the investigation.

A I don't believe I was talked to. I know that

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they - - they read the event and it went to Jo

Parker d

you know, that really was all - - all

I was involved with.

Q And then the next one states, "Daily the

interdisciplinary team will review falls during

morning report, and the interdisciplinary

committee consists of nurse managers, social

workers,

the purpose of this review is to assure that

all appropriate interventions are being

therapy, and recreation therapy, and

utilized to prevent resident falls.

A

Do you remember that taking place?

I recall us discussing her fall at report,

since she was in the hospital, like I said,

were waiting for her to come back to see what

but

we

our interventions would be at that time.

Q I read the last line on Exhibit 3 to refer to

preventing resident falls in general,

quality control, let's learn from this sort of

idea.

Yes,

more of a

Do you agree?

A but everybody's fall is individualized,

so...

Q When you say you remember talking about it at

report, who else would have been at that

report?

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A I cannot recall specifically what managers were

there. I do not remember if Jo Parker was

there. The administrator would come

occasionally. I don't recall if she was there.

I - - I can't really tell you as a matter of

Q

fact who was there.

I thought maybe you could picture it if you

remember it.

A No. I can't remember who was there. It

happened many years ago, you know.

Q That's okay. And I don't mean to be critical.

I just need to know what you remember.

A Okay.

Q If when we're at trial it would be bad if you had

a very deep memory of that and I didn't ask about

it.

A Okay.

Q So I know you won't be testifying about that at

trial because you don't remember.

A Right.

Q So that's why I ask.

A Uh-huh.

Q So you have never seen any document about

the - - any investigation involving Emma

Jackson’s fall.

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Ex 20-036

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A No.

Q And you don't know anything about one.

A No.

Q My statement's correct.

A Correct.

Q Now let's talk about care plans. Can you give

me a basic lesson in what a care plan is?

A A care plan paints the picture of a resident,

what their needs are, what we do for them, you

know,

therapy involved,

nursing's involved.

it's interdisciplinary. There are

dietary services involved,

It kind of is a cumulative

effort of all of the different departments

to - - as to what care we will be providing for

Q

our residents.

And who makes the entries in the care plan? I

can make the entries A - - actually, at the

Grace Home I can make entries, LPNs can make

entries, RNs can make entries, supervisors.

Q No aides.

A No.

Q No CNAs.

A No.

Q Okay. Does the MDS come before the care plan?

A Actually, there is a - - we have to do what we

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call a temporary care plan,

MDS is completed then the permanent care plan

is

and then after the

- - I shouldn't say permanent, then the first

care plan is originated and then we go off of

that and make any changes, interventions that

are necessary.

Q Okay. So if we could have the chart back in

front of her, so there's a temporary care plan

that would be before the MDS, so let's start

with that.

A Okay.

Q And I couldn't tell which one that was in here

because I just didn't know. I didn't see one

called temporary.

A Yeah, and it's really not. They're added onto,

you know, you might do, like let's take this

problem.

Q Which page are you on?

A This is page 1 of 14 of the care plans.

Q What big Bate stamp page?

MR. SULLIVAN: 264.

BY MS. CENTOFANTI:

Q Okay. So that's the first care plan, right?

A Right. This is a psychosocial well-being

problem, and this is done by social work.

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Q The - - so care plans are organized by problems?

A Correct.

Q Okay. So you're just, as an example -

A Right.

Q - - talking about the top problem on the care

plan page 264.

A Right.

Q Okay. Go on.

A Okay. This - - this can either be by social

services, nursing can input into it, activities

can input into it. It's these problems are,

like I said,

So let's go to the care plan for the first

admission.

multidisciplinary.

Q

This one says admit date 12/09, so

that would be the second admission after the

surgery.

A Okay.

Q Let's find the admit date. It was the middle

of November, 14th or 15th or something like

that.

A Do you have another section in here for care

plans? Because I do not see - - I see problem

start date 12/10/2008, 12/9. What was the date

you said?

Q It would be 11 something.

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Ex 20-039

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MR. SULLIVAN: With a 14 or 15.

BY MS. CENTOFANTI:

Q 11/14. I didn't find any dated admit date

11/14. There's quite a few in here. There's

like 24 or 25 care plans in there, but they all

say admit date 12/09, so I'm very interested in

seeing the one from the first admission.

MR. SULLIVAN: Snapshots.

THE WITNESS: Oh, 11/17/2008?

BY MS. CENTOFANTI:

Q You have an admit date of 11 -

MR. SULLIVAN: Snapshot.

THE WITNESS: We have a snapshot of

it.

BY MS. CENTOFANTI:

Q What page are you on?

MR. SULLIVAN: We're in the 460s

right now. 11/14 snapshot date, 056.

BY MS. CENTOFANTI:

Q 0 -

MR. SULLIVAN: 056. I'm sorry, 0456.

THE WITNESS: 0456.

BY MS. CENTOFANTI:

Q So the admission date when a new patient comes

in would probably trigger a care plan, right?

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A Correct.

Q So that one still says admit date 12/09 on page

456.

A You know what I think what probably happened

was this went, when she was readmitted it

brought the readmission date up here.

Q So the care plan from before the fall is gone?

A No. This is the actual care plan,

they're admitted again I think the computer

probably just generated that as the new

admission date.

but when

Q Hmm.

A I cannot be entirely sure, but I think that

that's what happened.

Q So each stay sort of disappears when another

stay happens?

A Well, on the face sheet it will give you the -

the admission date and then the new admission

date and whatever, but maybe Matrix does this

where, you know, when someone is admitted they

give the original first admission date.

Q Well, I think we should add that to the list of

things that we'd like to know, because I went

through every piece of paper in this multipage

chart and no - - no care plans dated her

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admission date or any date except 12/9/08.

A Huh, but then, yes, here it says the start date

of 11/4/2008.

Q Problem start date.

A 11/14.

Q Now, I notice there's something called a

snapshot date. Can you tell me what that

means?

A The snapshot is a picture of the care plan in

that time frame,

So as people make changes the care plan

changes?

the snapshot date.

Q

A Uh-huh.

Q Is that a yes?

A Yes.

Q But I see there's snapshots for every day she

was there, so that means that they must be

kept, there must be multiple copies, because

the 11/14 snapshot doesn 't have the things on

it that the,

That implies to me there's separate files,

because if it was truly writing over it you'd

you know, the 11/28 snapshot has.

only have one version on any day.

A Well, see, what happens is you can make

changes. You can go in the Matrix system and

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make changes at any time, so you know, you

know, what you might have put 11/14/2008, if it

changes on the next day that's going to be

gone.

Q So you actually delete things in there?

A We can - - I don't think we delete them. We -

we DC them,

So it would still be on there,

say DC?

discontinued.

Q it would just

A Correct.

Q So if we go to page, on the one you've picked,

the snapshot date of 11/14/08, starts on page

456, let's go to page 457, impaired mobility,

that would be the -

A Wait a minute. Moving the wrong way.

Q The problem area we'd be concerned with would

be impaired mobility, true, regarding the fall?

A Correct.

Q So it says problem start date,

assuming that's because that'

admitted.

11/14, and I'm

s the day she was

A Uh-huh.

Q Is that right?

A If that's the admission date.

Q And then the goal, and who determines the goal

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target date?

A The goal - - goal target date, generally as a

rule of thumb the goal target date is put in

three months. We have three months to - - to do

a target date.

Q So kind of an arbitrary.

A Correct.

Q Okay. Sounds like making plans to lose weight,

you always give yourself a few months.

Then it states,

remain in a safe environment as evidenced by no

falls and no injuries.

"The goal is resident will

A Correct.

Q So that's a goal, not a how to do it, but what

the goal is.

A Uh-huh.

Q And then under approach, what does the approach

mean in general?

A Approach means it's what you're going to do for

the resident, yes.

Q Okay. So the first approach, and I see there's

two boxes in here, so I'm assuming those are

separate approaches?

A Correct.

Q The top one says, "Notify MD and therapy of any

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change in mobility.

What does that mean?

A That means if there was any change in her

mobility status you have to notify the doctor

and the therapy, physical therapy.

Q So we would find that in the chart elsewhere if

that was done?

Correct.

And then

A

Q - - and who would have entered that?

A I don't recall who would have entered that.

Q I guess I could ask it better. I don't mean a

name, I mean a category of person.

A Oh, nursing.

Q Okay. And then we have a line and then we have

a different approach, and could you just read

that for me, because I don't know what all the

abbreviations mean, so read slowly, please.

A Okay. "Transfer with assist, supine to sit

with head of the bed slightly elevated with one

person 50 percent extensive assist."

Q Okay.

That's therapy terminology.

Okay.

Let's stop. What does that mean?

A

Q

A So this, apparently, came off of a therapy

recommendation and that's their terminology.

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Ex 20-045

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One - - one assist, 50 percent.

Q Okay. So one person?

A Right.

Q And does that mean they're doing 50 percent of

the work?

A Correct.

Q Meaning she's going to -

A She's going to assist.

Q Mickey, Emma’s going to assist.

A Correct.

Q But they have to do 50 percent.

Correct.

Okay.

A

Q Go on.

A "Sit to supine with 50 percent extensive assist

primarily to lift legs up on the bed. And then

sit to stand, one assist, 25 percent extensive

assist, transfer with wheeled walker 50

percent, wheeled walker 50, more than 25

percent extensive assistive one. Hold

ambulation until further assessed by PT."

Q Okay.

A So these were - - were recommendations sent down

by therapy.

Q And when it says, "Extensive assist," I'm

assuming that's different than assist. Do you

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A

know the difference?

Extensive assist is you have to do quite a deal

for the residents. There is limited assist,

there's moderate assist, and there's extensive

assist. Extensive is the highest.

Q Okay. Even though it only says 25 percent.

A Right. Wheeled walker 50, transfer with

wheeled walker 50 - - oh, they're saying 50 -

25 -

Q It looks like greater than, doesn 't it.

A "Greater than 25 percent extensive assistive

one. Hold ambulation until further assessed by

PT."

Q And then - - so okay. Go on.

A "Patient is weight bearing as tolerated, right

lower extremity.

Q And what does weight bearing as tolerated mean?

Means as much as she can tolerate.

Painwise?

A

Q

A Painwise, correct, or, you know, how much

weight she's bearing on that leg before she

feels some discomfort.

Q Go on.

A "Keep pillow between legs when in bed and

especially for rolling to left on right side,

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Ex 20-047

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would benefit from bedside commode until able

to ambulate.

Q And then what does it mean, "Flow sheet: ADL"?

A Flow sheet ADL,

The top box in this section said,

General."

hmm.

Q "Flow sheet:

A You know, and that's Matrix' s system too.

They - - they will have flow sheet general

where - - where this information would appear,

and I believe they're talking about the care

plan and they're talking about for the ADL

status to be on the care card.

Flow sheet equals care card? Q

A Care card and care plan.

Q So wherever I see flow sheet it means care card

and care plan?

A Not all the time the card care, no. The flow

sheets for ADLs would just be the care plan and

the care card.

Q And then what does, "Q shift-every shift,"

mean?

A Well, Q shift means every shift. Q shift,

that's just an abbreviation. Q is an

abbreviation for every.

Q Okay. So that means this is all the time.

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Ex 20-048

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A Correct.

Q Now, from this information that we just read

what part, in your opinion, in good nursing

practice would be put on the care card for the

LPN, or I mean the CNAs?

MR. SULLIVAN: Object to the form.

Go ahead.

THE WITNESS: All of this information

as far as how she's supine to sit with head of

bed slightly elevated, all of this would be on

the care card.

BY MS. CENTOFANTI:

Q Okay. And that's how the CNAs would know -

A Correct.

Q - - that she can't walk until she's further

assessed by PT.

A Correct.

Q Okay. Now, move on a couple of pages, if you

go to 461.

MR. SULLIVAN: 461, go that way.

THE WITNESS: Here.

BY MS. CENTOFANTI:

Q On 461 we have, "Potential for injury safety.

That's another problem. Can you just talk to

me about that a little bit, what that means?

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Ex 20-049

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A Potential for injury and safety is, you know,

we don't, certainly do not want Emma to get

injured or be unsafe, so this is a problem that

eludes to that.

Q I see sometimes in cases where the person has

cognitive issues sometimes there's a lot of

concern about that because they don't have the

ability to look out for their own safety. That

wasn't the case with Emma, was it?

A I don't believe so.

Q So as we look on this page 461 I see that

there's a supportive device noted and that

says, "Wheeled walker.

A Correct.

Q And that's on 11/14/08, correct?

A Correct.

Q Is that something that would be put on the care

card?

A If she indeed is using a wheeled walker that

would be on the care card.

Q Okay. Help me understand. I thought because

it was written here it would mean she's

supposed to use it.

Supportive devices wheeled walker,

uh-huh.

Am I reading that wrong?

A correct,

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Q So somebody in nursing would have put this in

here.

Correct. A

Q Saying, "Supportive devices determination

Wheeled walker.

A Correct.

Q So tell me what that means to the CNA.

A To the CNA that would mean that, you know, if

she was being transferred she might need to

bear weight onto that wheeled walker, but not

generally use it. There are times when we have

people just bear weight with a walker, not walk

with it.

Q Because if we go back to 457 it says, "Hold

ambulation until further assessed," and it just

says, "Transfer with wheeled walker.

A Right.

Q So you're saying they 'd read the two sections

in conjunction.

A No. It would be that on the care card it would

have said, "Transfer with walker, " but they

know that it says, "No ambulation.

Q Okay.

A That's on, specifically on the care card.

Q Now let's go to 541.

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Ex 20-051

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(A discussion held off the record.)

BY MS. CENTOFANTI:

Q So we're on 541 now and this is another care

plan, isn 't it.

A Correct.

Q It still has admit date 12/09/08.

A Yeah, but you see the problem start date.

Q Right. And I see the snapshot date of what?

A 11/24.

Q Okay. So now let's go to impaired mobility,

which is on 543. Are you there?

A Correct.

Q And it looks to me like everything we read in

the prior care plan, the snapshot of 11/14/08

is here,

change in mobility,

into the transferring,

including notify MD and therapy of any

and then when we go down

that looks like it's all

pretty much the same,

percent extensive assist.

Uh-huh.

sit to stand one 25

A

Q The weight bearing as tolerated, the pillow

between the legs, the bedside commode, that's

all stuff that we had in there on 11/14, true?

A Uh-huh.

Q You have to answer yes or no.

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Ex 20-052

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MR. SULLIVAN: Yes or no.

THE WITNESS: Yes.

BY MS. CENTOFANTI:

Q But we have some new things added now. Do you

see that?

A 11/15, bed mobility extensive assist, 11/15

transfers extensive assist.

Q Yes. Those are two new items that are on this

11/24 version that were not on the 11/14

version.

A Correct.

Q And what does FRC mean? It's after extensive

assist on both lines.

A FRCRN, huh.

Q Could those be initials?

A It could be initials, yes, but usually we do

not, you know, do that. We - - we usually do

not put any initials here. FRC, huh.

Q I thought it might be some certification that I

didn't know about. You don't know.

A I don't know.

Q RN, I'm assuming, is RN.

A Correct.

Q But you're saying that's unusual to have those

there?

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Ex 20-053

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A Oh,

So does this mean she's getting worse or

better?

yes.

Q


Go ahead.

THE WITNESS: It means now she can

transfer with extensive assist where what did

the other one say?

BY MS. CENTOFANTI:

Q It's what was above it right on the same sheet.

A Okay. Huh. I think it really means that she's

the same.

Q Okay. Let's move on then, go to page 550.

Again it says, "Admit date 12/09/08," and it

says, "Snapshot date 11/25/08." Are you there?

A Correct.

Q Let's go to 553 to our problem of impaired

mobility.

A Okay.

Q Do you see that the square we've been reading

from under the approach regarding mobility is

getting longer and longer?

A I do.

Q It looks to me that everything we've read into

the record so far, including the 2/11/15

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Ex 20-054

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entries by FRC that we don't know what that is,

they're still there. Are you with me?

A Yes,

And then we have some new things.

read those into the record slowly,

with the abbreviations?

I am.

Q Can you just

helping me

A Okay. Starting from 11/25?

Q Yes, please.

A "11/25 transfers limited assistive one, " I

think is a typo here, supposed to be with

wheeled walker.

Q And we have that FRCRN thing again.

A Wow.

Q Don't know what that is, right? Okay. Go on.

A "11/25, ambulate, ambulate limited assist times

one with wheeled walker to and from dining room

with wheelchair follow.

Q Okay. Let's stop for a moment. I know there's

more, but I want to talk about the transfers.

Now it says,

Before we had extensive.

Improved.

Okay.

"Limited assist times one.

So limited is -

A

Q And then tell me what this means,

"Ambulate limited assist times one with wheeled

walker to, from dining room with wheelchair to

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Ex 20-055

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follow. What would that look like if I'm

standing there watching them go, watching

Elvira go by from her room to the dining room?

A Okay. That would mean that Emma would be

walking and there would be a nursing assistant

following her with a wheelchair in case she got

tired or needed to sit, that wheelchair would

be right behind her.

Q So the aide's pushing the wheelchair.

Correct.

So it's aide

Uh-huh.

A

Q , wheelchair, Emma.

A

Q Is that a yes?

A Yes. With a wheeled walker.

Q Yes. So it would be aide, and in front of the

aide would be the wheelchair and in front of the

wheelchair would be Emma and in front of Elvira

would be the wheeled walker that she'd be

pushing.

A Correct.

Q So there isn't another person next to her -

A Not -

Q - - per this order.

A Not that I believe.

Q Okay. And I'm assuming that what you've just

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Ex 20-056

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read in would be on the care card so that the

aides knew what to do.

A Yes, it certainly would.

Q Now, go on to the next line.

A Okay. "Limited assist times one, to and from

bathroom with wheeled walker,

transfers and ambulation. What

does

gait belt using

Q - - so the bathroom limited assistive

one to and from bathroom with wheeled walker,

and the bathroom's in her room as you showed us

in the diagram you've so kindly drew for us,

and then it says,

transfers and ambulation.

quotation marks are on there?

"Gait belt use during

Any idea why the

A I have no idea.

Q Does that mean something?

A No. No. I - - I'm still puzzled by FRCRN.

Q Yeah, I was hoping you'd be able to tell me

what that was.

So what does gait belt use during

transfers and ambulation mean?

A Well, gait belt use means there should be a

gait belt around the resident when they're

transferring and ambulating her.

Q And can you give me the rundown on what a gait

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Ex 20-057

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belt looks like, how it works?

A A gait belt is a belt that goes around the

resident,

hold onto that gait belt,

the time when that was

snaps around the resident, and you

and I wasn 't there at

- - when they were

walking, when Jamie was walking with her, so I

really don't know if the gait belt was on, I

cannot recall, and Jamie was assisting her in

pulling the wheelchair behind her.

Q So does gait belt use mean they just have it on

or does it mean somebody's supposed to be

holding onto the gait belt?

A Somebody is supposed to be holding onto her.

Because putting it on doesn't mean anything if

it you don't hold onto her.

Q

A Correct.

Q And then I assume is it worn all the time or

No.

No,

-

A

Q okay.

A No. That would be uncomfortable for them to

have to wear that.

Q Okay. So on snapshot date 11/25 that's -

A

that's what we have for dealing with the

impaired mobility.

Yes.

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Ex 20-058

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Q And one more thing about this snapshot date, that

means that's what it said in the computer on that

date?

A Correct.

Q So how come we can't find one with the correct

admission date?

A You know, I - - I don't know what to tell you

regarding that.

MR. SULLIVAN: If you know, you know.

If you don't, you don't know. That's your

answer.

THE WITNESS: I don't know.

MR. SULLIVAN: Okay.

BY MS. CENTOFANTI:

Q Do you see why it's puzzling?


THE WITNESS: Yes.

BY MS. CENTOFANTI:

Q Is there a paper copy or paper file kept at

your facility? Could they have been printed

out each day and kept and that's why we have a

snapshot of that day?

A No.

Q No paper.

A No. We are - - we have electronic charting now

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Ex 20-059

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and we do not - - it's in the computer.

Q So the only paper would be the care card.

A Correct.

Q And isn 't that actually a piece of paper?

A Yes, it is.

Q It's not a chalkboard.

A No. It's a piece of paper that goes behind the

Q

door in the resident's room.

And is it replaced every day or is it added to

like the care plan's added to?

It's added. A When there are any changes it's

added to.

Q And is it something that's spit out of the

computer or is it handwritten?

A It's handwritten.

Q Can you give me an idea of what different

sections it has or how it's laid out?

A It has their ADL status, which means their

activities of daily living, their bowel and

bladder status, their skin condition, their

mobility status, the assistance they need,

grooming, all of that is on there.

Q And the aides know, I'm assuming, to look for

the newest entries.

A They do, they do. In fact, we erase the old

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Ex 20-060

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entries and put the new ones on there.

Q Oh, it's in pencil.

A It is, it is. It's in pencil.

Q Ah. Oh, so the old parts would be erased.

A Correct.

Q And the only other paper then would be if there

was your 24 hour report book.

Correct.

And that,

No.

A

Q you said, isn't kept very long.

A

Q Okay. Let's move onto page 580. This is

snapshot date 11/29, which would have been the

day before, two days before her fall. Her fall

was on 12/1.

A Yes.

Q And again, this is admit date 12/09/08, and

let's go to page 583 , which is the impaired

mobility part of that care plan.

there?

I am.

Are you

A

Q Okay. So we don't have any change in the first

two columns or the top part about notifying the

doctor and therapy of any change in mobility, but

our next box that we've been talking about on

these different care plans is once again a

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Ex 20-061

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little bit longer. Do you see that?

A Correct.

Q So last time on the snapshot of the 25th we read

through gait belt use during transfers and

ambulation.

A Uh-huh.

Q Are you with me?

A I am.

Q Now we have a new date,

that entry in?

"11/28/08,

and could you just read

A transfer and ambulate independently

with wheeled walker in room during the day,

ambulate with wheeled walker with standby

supervision to dining room for

meals, wheelchair from room. So

in her room she's

remove

Q -

A Independent.

Q - - apparently independent. So she's making

progress, so that's good.

A Yes.

Q And the last line, "Remove wheelchair from

room, " that seems pretty obvious, but tell me

what that means to you.

A That means they don't want her using the

wheelchair in her room.

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Ex 20-062

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Q So it shouldn't be in there at all.

A Correct.

Q And then read that middle line for me and tell

me what that means. Read it first and then we

can talk about it.

MR. SULLIVAN: Beginning with

ambulate?

MS. CENTOFANTI: Yes.

THE WITNESS: "Ambulate with wheeled

walker with standby supervision to dining room

for meals.

BY MS. CENTOFANTI:

Q Okay.

A "Remove wheelchair from room.

Q Okay. So ambulate with wheeled walker, that

means going to and from the dining room for

meals she's supposed to walk with the wheeled

walker.

A Correct.

Q Three days earlier it had been with wheelchair

to follow, but now instead of saying with

wheelchair to follow it says with standby

supervision to dining room for meals. What

does standby supervision mean?

A It means that you have to be there in case she

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Ex 20-063

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would fall.

Q Okay. And when you say be there, be where?

A You have to be, you know, beside her, behind

her, whatever, you're in near proximity to her.

Q Okay. So if she starts to wobble you could

grab her.

A Correct.

Q It doesn 't say anything about gait belt, does

it.

A No.

Q So do you think that if Mary had the wheelchair

between her and Emma that she was standby

supervision?

MR. SULLIVAN: Object to the form,

where, at what point in time?

BY MS. CENTOFANTI:

Q Let me start over. If indeed Mary was

following Emma, so there was wheeled walker,

Emma, wheelchair pushed by Mary does that in

your mind fulfill the requirement of standby

supervision?

A She was in close proximity to her.

So that's close enough.

Uh-huh,

Q

A yes.

Q It doesn't seem like she'd be able to get

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Ex 20-064

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around from behind the wheelchair to grab her

if she started to wobble.

A And as I said, I don't know where Mary was.

Q I know. We're assuming she' s behind - - pushing

the wheelchair, that was my question.

A Okay.

Q Assume Jamie was pushing the wheelchair.

A Okay.

Q And then there's Emma in front of the

wheelchair and then there's the walker.

Uh-huh. A Yes, she could - - I think she could

have grabbed hold of Emma.

Q So you're comfortable with that as an

appropriate interpretation of the care plan.

If that's where Jamie was.

Right.

A

Q

A Yes.

Q And we'll talk to Jamie and figure that out.

I'm just asking you what your thought is

because I'm talking to you before Jamie, so -

A Okay.

Q - - if Mary was pulling the wheelchair behind

A

her that also was acceptable to you?

I do believe that Jamie could have gotten a hold

of her if she would start to fall.

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Ex 20-065

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Q So wherever Jamie was with the wheelchair that

doesn't change your opinion that -

A I believe that Jamie was in close proximity to

Emma.

Q And that's okay.

A Uh-huh.

MR. SULLIVAN: Yes?

THE WITNESS: Yes.

BY MS. CENTOFANTI:

Q What about the fact that apparently the fall

took place at the end of the trip from the

dining room back to her room?


I'm sorry, go ahead and finish.

THE WITNESS: I can -

MR. SULLIVAN: Are you finished?

Okay. Object to the form.

MS. CENTOFANTI: What's wrong with

the form?

MR. SULLIVAN: Well, it assumes facts

not in evidence.

BY MS. CENTOFANTI:

Q I think you told me that the fall took place

after she got back to her room from the dining

room.

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Ex 20-066

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A She was in her room.

Q And they had just gotten back, apparently,

because Jamie was right there with her -

A Correct.

Q - - with the wheelchair.

A Correct.

Q So the wheelchair was in the room?


Misstates her testimony.

THE WITNESS: No. The wheelchair was

not in the room. I believe Jamie parked the

w h e e l c h a i r o u t s i d e

i n t h e h a l l w a y . B Y

M S . O k a y . t h e

r o o m .

CENTOFANTI:

Q I thought you said she was - - it was in

No, okay.

A No.

Q So the wheelchair was outside,

just gotten back from breakfast.

They had.

but they had

A

MR. SULLIVAN: ______, when you get

a spot I could use a bio break.

MS. CENTOFANTI: This is fine.

(Short break was taken.)

BY MS. CENTOFANTI:

Q And then if we look through the rest of these,

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Ex 20-067

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and you don't have to turn to it,

represent that it's true more

additions in there.

I'll just

, we don't have any

A True.

Q No more changes.

A Correct.

Q Okay. Now, if you could turn to 233 is this

what's considered nursing notes in your

facility?

A Progress notes.

Q These are progress notes?

A Correct.

Q I see they're called resident progress notes,

but -

A They are nursing notes.

Q Okay. So that explains why I couldn't find

nursing notes. These are the nursing notes?

A Sure. If you see here it says, "Discipline

nursing.

Q Uh-huh, got it. I just wanted to be sure there

wasn't something else. There isn 't. Okay.

Now, if we look at page 233 the notes are kind

of confusing to me because there's some notes

out of order. And I wanted to talk about how

the computer program works. When you add a

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Ex 20-068

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note you're adding it at the end of all the

prior ones, correct?

A Correct.

Q And I - - as I understand at least other nursing

home systems you can't go back and change

unless it marks that there's been a change.

A Correct.

Q And that's nursing protocol, correct?

A Correct.

Q I mean, even if it was handwritten you're

supposed to initial it and put when the change

was made, so if you look on page 233 we have

several entries by you, but let's start at the

top. 12/1/08 at 2:10 p.m., "Staff nurse called

hospital and resident admitted to hospital with

pelvic fracture. And that's you who made that

entry, true?

A Correct.

Q And then the next entry is the same date, but

10:40 a.m.

A Correct.

Q And it states what? Would you just read it in?

A "Ambulance here to transport resident to

Froedtert ER for evaluation of pain to left

hip.

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Ex 20-069

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Q And that was you again.

A Correct.

Q And the next one, the date and time?

A Okay. The date and time is 12/01/2008, 9:31

a.m., "Dr. Stevens, orthopedic surgeon

contacted and ordered resident to be sent to

Froedtert ER for eval, evaluation, husband and

resident aware, Dr. Malone’s office updated."

Q And that's you again.

A Correct.

Q And the next one?

A The next one is 12/01/2008, 9:29.

Q And it lists the vitals, so you don't have to

read them all in.

A Yes.

Q And that was you.

A Correct.

Q And then the next one is 9:21 a.m.,

True.

Same day.

true?

A

Q And could you just read that, and

try to read slowly because we tend to read

really fast and she has to take it all down.

A Okay. "Resident ambulating back to her room

from breakfast with walker and one nursing

assistant following with wheelchair. When she

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Ex 20-070

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got to her room she lost her balance and fell

on her left hip. Resident able to move her

legs up and down with some limitation noted to

her right hip which she had a right

arthroplasty on 11/10/08. She did state she

had a hip replacement 14 - - 14 years on the

left hip.

Q Probably means years ago, right?

A Correct.

Q That's all right.

A "Resident assisted to a standing position and

did complain of pain to her left hip, assisted

to a lying position in bed and resident did

complain of increased pain to the left hip area

and slight internal rotation is noted. Call

placed to Dr. Ignace to update, will return

call."

Q So when I - - when you read that first line,

when she got to her room she lost her balance

and fell on her left hip, that's what gave me

A

the impression earlier that the fall happened at

the end of the trip from the dining room to the

room.

No.

Okay. Q

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Ex 20-071

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A It happened in her room.

Do you know how much time elapsed between

getting back to the room from the dining room

Q

and when the fall happened?

A No, I do not.

Q I mean, could it have been an hour?

A When she was walking down the hallway?

Q Right.

A No, no.

Q Tell me what your impression is. I mean, this

is your note.

A Well, my impression is she was - - she was

walking from breakfast and back from breakfast

and, you know, it maybe might have taken her

five minutes or so.

Q Five minutes or so for what?

A To walk down the hallway.

Q From dining room to her room.

A Uh-huh, uh-huh.

Q Correct?

A Uh-huh, correct.

Q This makes it sound like they're walking back

from the dining room, they got to the room and

she fell. Do you agree?


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Ex 20-072

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THE WITNESS: But in the event, I put

she fell in her room, and that's exactly where

she fell.

BY MS. CENTOFANTI:

Q Yeah, we talked about that. I understand, but

now I'm - - and I know you drew it on the map,

but I'm just trying - - I mean, you would chart

accurately.

A Correct.

Q And you probably charted this around the same

time you filled out the event form, true?

Probably before you filled out the event form.

A I can't recall which came first.

Q Okay. But you'd agree that it says when she


on her left hip?

MR. SULLIVAN: We'll stipulate that's

what it reads. That's what it says.

THE WITNESS: Correct.

BY MS. CENTOFANTI:

Q Would you agree with me that that does sound

like it happened when they got to the room, not

later?

A I think it could be, and in anybody's

interpretation resident ambulating back to her

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Ex 20-073

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room from breakfast with walker and one nursing

assistant following with wheelchair when she


on her left hip.

room, when she got inside.

have put inside of her room,

got in by her room she fell,

I meant when she got to her

I suppose I should

but I put when she

meaning in her

room.

Q I know you didn't see it happen.

A Correct.

Q So you were told what happened.

Correct.

By

A

Q - - by Mary.

A Correct.

Q And I'm trying to understand, since you didn't

see it, what you were told that made you write

it slightly different in the two situations.

Doesn't mean it's a bad thing, I'm just trying

to understand, because that is what I read that

made me think it seemed like they were walking

back, they get to the room, boom, she falls

down.

A No, and that's not what happened.

Q And why is it you're so sure of that?

A Because when I entered the room Emma was in

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Ex 20-074

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the room on the floor next - - by her recliner.

Q So that makes you think she'd been in the room

a long time?


BY MS. CENTOFANTI:

Q Trying to understand why her being by the

recliner makes a difference to this issue we're

talking about. Just explain that to me.

A I do not think she'd been in her room for a

long time. I, you know, I came in the room,

found her on the floor, and Jamie was in the

room.

Q Do you believe Jamie was in the room because

she had just gotten back from breakfast with

Emma?

A Yes.

Q So we're not talking about Emma had been back

from breakfast, Jamie was gone, came back and

now Emma fell.

A No.

Q It was part of the process of coming back from

the dining room.

A Correct.

Q We're quibbling over whether it happened in the

doorway or inside the room, but it was at the

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Ex 20-075

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end of the coming back from breakfast.

A Correct.

MR. SULLIVAN: I'll object. I don't

think we're quibbling. We're pretty sure where

it happened, so I'll object to the form.

THE WITNESS: Yes.

BY MS. CENTOFANTI:

Q Yes, meaning it was - - it was somewhere

between - - it was at the end of the coming back

A

from the dining room and it was somewhere

between the doorway and in the room.

Yes.

Okay. Q Then the next note is a day earlier,

taking your attention back to 233, and this

isn 't you. It's an LPN named Kimberly Tanner.

A Wait a minute now. Oh, here.

MR. SULLIVAN: Yeah.

THE WITNESS: Okay. Do you want me

to read that?

BY MS. CENTOFANTI:

Q Well, first I want to talk about if it's out of

A

order or are we going in descending?

This is the first

page,

- - this is the first on this

11/30/08, and then this is my charting,

so there was no charting on the 31st.

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Ex 20-076

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Q So it starts at the bottom and goes up.

Correct.

Okay.

Correct.

Yes,

A

Q So that is the call from yesterday.

A

Q and could you read that in for us then,

11/30, 8:30 a.m., and then if you could read

and help with some of the abbreviations.

A Okay. "Alert and oriented."

Q What's MCR? Starts with,

A Medicare.

Q What does that mean?

A We do - - we do Medicare charting.

Q I don't know what that is. What's Medicare

charting?

A Medicare charting is residents who are on the

rehab unit we have to do specific charting on

those people once every day,

that this is her Medicare charting for the day.

And does that have to do with Medicare's

requirement that they're making progress and they

only have 90 days on rehab?

Yes.

Okay.

so she's noting

Q

A

Q Got it. All right. Go on. Thank you.

A "Alert and oriented times three, expresses

needs/wants well, denies pain at this time, PRN

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Ex 20-077

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analgesic use times three in last week for

right hip pain, antibiotic in progress for UTI,

no ADRs noted."

Q What's an ADR?

A "No ADRs noted."

Q I know about ADLs.

A Yeah. No ADRs noted.

Q That makes me think of that abbreviation book

that's called "20,000 -

A Correct.

Q - - "Ways to Make Mistakes" or something.

A Correct.

Q Okay. So go on. We don't know what ADRs are.

A Yeah, and if I think about it I probably could

put it together, but, "Denies any urinary

complaints, ambulates independently in room

with standby supervision in hallways, extensive

assist times one with lower body cares and

limited assist times one with upper body ADLs,

which means activities of daily living,

"continent of bowel and bladder, performs

hygiene at sink by self, appetite and oral

fluid intake remain good, will continue to

monitor.

Q So she was doing pretty well, I think we'd say.

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Ex 20-078

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A Yes.

Q Not - - not all the way there yet, but getting

better.

A Yes.

Q Did you see Emma Jackson prior to December 1

of '08 as a fall risk?

A Well, we had her - - we had care plans for

impaired mobility, and she was recovering from

hip surgery, so yes.

Q One of the things I was trying to figure out,

and maybe you can help me with, is where the

physician orders were in here regarding her

moving. Before you look let me explain what I

know and maybe you can tell me there isn 't

anything else. I saw that the doctor stated

weight bearing as tolerated in the discharge

summary from the hospital. I could be

paraphrasing, but weight bearing as tolerating,

full hip precautions, something like that? Do

you know what full hip precautions mean?

A Yes,

Could you tell me what that means?

You're not going to

yes.

Q

A - - you're not going to

ambulate that resident, you're going to use,

like they said, pillows between the legs,

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Ex 20-079

1

you're not going to bend the hip or the knees,

things like that.

Q Okay. So that sounds to me like a phrase that

all of you in the industry know what it means.

A Correct.

Q No mystery to that.

A Correct.

Q But I was wondering if who decides when she can

walk with the wheelchair, when she can only

walk with the walker.

A Therapy.

Q That's physical therapy?

A Correct.

Q So maybe we could find the physical therapy

notes. What pages do you have?

A I have TLH0370, TLH0371.

Q That's okay, you don't have to give me all of

them.

A Okay.

Q In fact, they start on, if we could go to 365.

A These are going up.

MR. SULLIVAN: There's 365.

BY MS. CENTOFANTI:

Q Okay. So we don't need to look at that, I just

wanted to get to the very beginning. So these

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Ex 20-080

1

are Froedtert records that are included. You

get sent some records from the hospital with a

patient?

A Yes,

And they get scanned into your system since

you're paperless?

we do.

Q

A Yes, they do.

Q Now, these are from admit date 12/9/08 again,

so I don't see where the records are from him

before the fall happened. Because this is all

12/9/08, although, if we go to - - well - - oh,

you've got them?

MR. SULLIVAN: In that 0162 there's

is a whole slew of them.

BY MS. CENTOFANTI:

Q Okay. So there's a discharge summary dated

11/12/08. Let's just look on page, are you

near 164?

A Yes.

Q If you look about halfway down the page to

discharge instructions.

A Yes.

Q In number 2 there is the language I was talking

about that wasn't correct totally as I stated,

but I think it means the same thing. I'll read

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Ex 20-081

1

it and you tell me if I read it wrong.

"She may remain weight bearing as

tolerated on the right lower extremity and

should observe total hip precautions. That's

no surprise to you. That's a typical rehab

patient, right, they had a hip replacement and

here they are -

A Correct.

Q - - and that's what you do.

Okay. All right. Now let's go back to

370. Are we looking at the PT therapy

recommendations?

A We are.

Q Is this what you - - where you would go to find

out what therapy says for -

A Yes.

Q - - a patient?

A Yes.

Q And can you tell me logistically how it works?

Do you get this sheet given to you or do you

know to go to the computer to see? How does it

A

g e t f r o m t h e r a p y ' s n o t e s t o t h e

c a r e p l a n ? B r o u g h t d o w n f r o m

t h e r a p y t o t h e n u r s e ' s u n i t . B y

h a n d ? B y h a n d .

Q

A

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Ex 20-082

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Q So this piece of paper, 370?

A Correct.

Q Would be brought to the nurse's station.

A Correct.

Q And then what?

A And then whoever the form is handed to, that

nurse, that nurse will document this in the

care plan and the care card.

Q Okay. Whoever happens to be on duty when it's

brought down.

A Correct.

Q So the PT people don't use the computer?

A They don't - - I don't believe they have access

to our Matrix, no, they do not.

Q I kind of suspected that by the handwriting,

and you can sort of imagine what the physical

therapy people, they're working with the

clients and writing things down as they go. So

this first one dated 11/14/08, that appears to

be their first visit with her.

A Correct.

Q Maybe you can read the writing better than I.

Can you read that slowly for us?

A Okay. It says, "Mickey moves supine to sit

with head of bed slightly elevated with one

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Ex 20-083

1

extensive 50 assist, 50 percent assist," and

then it says, "Goes from sit to supine," it

doesn't really say go, but, "Sit to supine with

one extensive assist 50 percent primarily to

lift legs up onto bed and then sit to stand

with one extensive assist 25 percent, transfer

with wheeled walker with one extensive 50 to 25

percent assist, hold ambulation until further

assessed by PT. Patient is weight bearing as

tolerated, right lower extremity, keep pillow

between legs when in bed and especially for

rolling to left or right sides. Patient would

benefit from bedside commode until she is able

to ambulate.

Q Okay. And then the next one we have from PT is

11/25/08 and that would be page 371. So they

don't - - they are not working with her every

day, apparently?

A Well, they are working with her every day.

Q Okay. Why - - why are there not other sheets?

A I - - I don't know.

Q Okay. So the next one that's brought down is

page 371, which is 11/25/08, and can you tell

us what that states?

A Okay. It says, "Use gait belt."

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Ex 20-084

1

Q And that's in quotes.

A It is.

Q Does that have any special significance because

the quote marks are on it?

No.

Okay.

A

Q Go on.

A "Transfers limited assistive one with wheeled

walker. Ambulation, 25 percent extensive one

with wheeled walker, " and that extensive one

means extensive assisted one.

Q Thank you.

A "With wheeled walker to walk to and from dining

room with wheelchair follow, 25 percent

extensive one, again means extensive assistive

one,

And then we have another one,

and that's dated 11/28/08.

"to and from the bathroom."

Q it's page 372,

Can you read that

in for us?

A "Emma can transfer, ambulate independently

with wheeled walker in room during day."

Q And during day is underlined?

A Correct.

Q Apparently stressing -

A Yes.

Q - - just during the day - -

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Ex 20-085

1

A Yes.

Q - - would you agree?

A Yes.

Q Okay. Go on.

A "Ambulate with wheeled walker with one standby

assist to dining room for meals.

Q Does SBS mean standby assist, that's the same

as standby supervision?

A Standby supervision, yeah, sorry.

Q Are those interchangeable in your mind or is it

separate?

A No, it's standby supervision.

Q And does that mean something different than

standby assist? I'm not trying to pick at you,

I'm just wanting to understand if they're

different. Because I notice sometimes it says

SBA and sometimes it says SBS. I don't mean on

her notes, but just in general.

A It means the same thing.

Q Because I was thinking standby supervision

would sort of apply that you watch but you

don't help, which that' s stupid.

A Right, right.

Q Okay. All right. Go on.

A And then, "Please remove wheelchair from

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Ex 20-086

1

patient's room.

Q And the next one on 373 jumps to 12/9, which

would be the second admission,

the 11/28 was the last word before the fall,

agreed?

so it looks like

A Agreed.

Q So as far as filling out the care plan for

impaired mobility, it's the PT sheets that

we've just read in that decide what -

A Therapy recommendations, correct.

Q Okay.

go to the care card and that's how the aides

know what they're supposed to do.

Correct.

All right.

And from there then the care plan would

A

Q So - - and I'm assuming if the

problem we were talking about was nutrition

you'd have something in here from the dietary

department and that would be where the

information would come from.

A Correct.

Q So there isn't anyplace else information is

coming from here in the Emma Jackson case for the

impaired mobility problem area.

No.

Okay.

A

Q My statement's correct.

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Ex 20-087

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A Correct.

Q Okay. If you could turn to page 426, please.

You're there?

A I'm there.

Q Can you tell me what this -


BY MS.

Okay.

CENTOFANTI:

Q What is this, that we're on, page 426?

A This is the therapy, this is their treatment

plan in summary.

Q So this is also physical therapy.

A Correct.

Q This is their working notes.

A These are their notes,

Not the orders that they send down to you.

No.

Okay.

yes.

Q

A

Q

A No.

Q So they're a little hard to read and maybe

we'll be able to get them interpreted by the

physical therapist when we take their

deposition, but could you look at 11/28 and see

if you could help me interpret what that reads?

It seems like it starts with,

A Yes. "ADL, patient had light on to, " I don't

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Ex 20-088

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know what that -

Q "To use toilet," maybe? It just seems odd that

the therapist -

A Light - - oh, "Patient had light on to use

toilet."

Q So maybe when they got there to do therapy -

A The call light was on, maybe.

MR. SULLIVAN: Just for the record

it's difficult to read what that says,

you're doing your best.

BY MS.

Right.

so

CENTOFANTI:

Q We're not going to hold you to this.

MR. SULLIVAN: It's not in stone.

BY MS. CENTOFANTI:

Q I think you can do better than me because you

at least know what some of the abbreviations

are there. The next part?

A "Bed mobility, " I think that's an "I" for

independent, but I can't be sure.

Q Okay. Go on.

A "Ambulates with wheeled walker to bathroom with

standby assist." That looks like, "Toileted."

I don't know what that is either.

Q Okay.

A "Ambulates" - -

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Ex 20-089

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Q I think it might be another independent there,

"Toileted independently,

Maybe.

Okay.

perhaps.

A

Q Go on.

A "Ambulates to - - ambulates to."

Q It's okay if you can't figure it

out. I don't know what that "Sat

and washed lower.

A - - that word is there.

MR. SULLIVAN: "To sink, sat and

washed upper body.

THE WITNESS: Okay.

BY MS. CENTOFANTI:

Q Something, "Hygiene"?

A "Hygiene independent. Stood with standby

assist for peroneal - - peri area.

Q Uh-huh.

A "Independently. Dressed upper body

independently,

adaptive equipment.

Thank you very much.

lower body limited assist for

Q And then below that,

"Subjective response to treatment"?

A "Ambulates with wheeled walker to breakfast

with wheelchair follow.

Q Okay. Notice I'm not asking you to help me

with the 25th and 26th, but I would like you to

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Ex 20-090

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help me with 12/1, the last column on the

right.

A ADL.

Q This is a PT that has a little bit better

handwriting.

A "Patient able to ambulate to bathroom with

walker,

independent bed mobility, washed upper body and

lower body sitting at sink with supervision,

independent in room during the day,

dressed, standby assist with upper extremities,

standby assist with - - no, standby assist

with - - with assist for lower body dressing.

Grooming and hygiene independently

independent with supervision.

And then the next square down is,

-

Q "Subjective

response to treatment."

A "Patient wants to talk about" -

Q I think HV is home visit, but -

A Could be.

Q I know that the home visit was scheduled.

A I don't know if that's a V or an X. I was

thinking history, but I don't know why that

would be in there also.

Q Okay. Well, we're not sure then. And then it

says, "Discharged to hospital."

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Ex 20-091

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A Correct.

Q Okay.

MR. SULLIVAN: Just for the record I

think that's an OT note, occupational therapy.

CENTOFANTI: Ah, could be.

SULLIVAN: Yeah. You can tell

the way they're talking about -

THE WITNESS: The ADLs.

MR. SULLIVAN: - - ADLs is OT stuff,

and it says "OTR" next to all the names.


MR. SULLIVAN: In the top it's

checked off in the box "OT."


BY MS. CENTOFANTI:

Q Given all those things I think I'd have to say

you're right. So would there be a PT daily

treatment summary somewhere too? Because this

was all I could find, but maybe that's all she

was getting, was, you know, OT was kind of

both.

A Correct, and many times we don't even see

these. That's - - those are their records,

so.

Q All right. Now I'm going to back us way up to

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MS

MR

Ex 20-092

1

the MDS, if you could go to 36. I guess 33 was

actually the very beginning. All right. Now

you're probably getting the hang of how this

works. Can we start with kind of a summary of

what an MDS is and what it's for?

A Okay. The MDS is - - it stands for "minimum

data set," and it is a picture of the

resident's functioning in all different areas.

Q So the one at page 33, I was trying to figure

out what the date of them was, and if you go to

page 35 up in the top left column, number 3 it

says, "Assessment reference date." Is that the

date that the assessment's being done,

11/20/08?

A That's the date that - - there is a time frame

that they are referencing, so it would be from

11/14 is the admission date to 11/20.

Q Okay. So it's a seven day.

A It's a seven-day period.

Q To look back.

A Correct.

Q So why is this done?

A It is done as a part of, you know, it's the

government, actually, mandates that we do this

on all of the residents and it really is a

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Ex 20-093

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generation, the care plan is generated off a

lot of this information.

Q And who fills it out?

A We have Medicare nurses that do that.

Q Really.

A Uh-huh.

Q Employed by Medicare or employed by you

No.

them

-

A They're employed by us, but we call

- - we call them MDS nurses.

Q So if we go to the end of this one,

going to go back to the beginning,

just go to page 39.

Okay.

It says,

coordinator.

and we're

but if we

A

Q "Signature of RN assessment

Can you tell who that is?

A I'm sorry, I can't.

Q Would that be your Medicare nurse?

It would,

MDS nurses.

A it would be our MDS nurse, one of our

It might be, let me see if I can

get it here. And I'm just surmising this , but

it looks like it's Drew Schwartz

our Medicare nurses.

Okay.

, who is one of

Q And remember, this was back in '08, so

was she there then?

A She's worked there longer than I have, so yes.

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Ex 20-094

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Q All right. So where does whoever the MDS nurse

is who fills this out, where does she get the

information?

A Oh, she does it through interviews, she does it

through looking at notes, you know, there are

various, she would look at rehab notes, she

would talk to the resident herself, she would

talk to dietary, she would talk to, you know, a

lot of different departments to gather all this

information besides the resident.

Q So they have to be done within seven days of

admission? Am I -

A Correct.

Q - - right on that? And then every seven days

there after or not that often? I know you're

not the MDS nurse.

A No, I'm not. And I've done MDSs , but I can't

remember the time frame anymore.

Q There is some requirement of some amount.

A Oh, definitely.

Q It sounds like your lawyer knows and he's just

dying to tell us.

MR. SULLIVAN: If you want to go off

the record.


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Ex 20-095

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BY MS. CENTOFANTI:

Q So when we look at this very intense form with

a lot of information I notice there's a

physical functioning and structural problem

section on page 36. It's the bottom half of

the right column. Pat didn't have a tab there,

so it's probably not all that important.

A Okay. You're talking about the ADL status.

Q G, yeah, Section G.

A Okay.

Q So let's just go through that to make sure I

understand how to read it. It gives codes to

fill in, right?

A Correct.

Q So on the 26th when this MDS nurse was filling

this out,

it probably was done on the 20th but on the

reference

although it's signed on the 26th , but

-

A Right, but you have - - you have seven days to

complete it, so that's why it was signed on the

26th. You have to be done with this MDS on the

26th.

Q So she was admitted on the 14th.

Right.

So this is

A

Q - - meets the regulations - -

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Ex 20-096

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A Correct.

Q - - because she did it on the 20th?

A Correct.

Q Okay. So what I'm trying to get at is what

snapshot in time these codes on page 36 refer

to.

A They refer from admission, 11/14, to 11/20.

Q Okay. Thank you. So it's pretty simple,

because most of them are - - are 8s that we're

concerned with, walking in room or walking in

corridor.

A Right.

Q They're 8s, which is it didn't occur.

A Correct.

Q And that's because she wasn't walking yet.

A Correct.

Q So then let's go to the next one. Actually, go

to page 41, please.

A (Witness complies.)

Q I couldn't tell if this was part of the MDS or

where it came from, because it's -

A This is part of the MDS.

Q Okay. Is it part of this one we did already

that has a signature line on it?

A Correct, uh-huh.

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Ex 20-097

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Q It's just sort of stuck on thereafter the

signature.

Well,

See,

A there, yeah, it's section - - Section T.

this is S and this is Section T.

Q Okay. So this one also talks about walking,

and this one has that she walked 26 to 50 feet

without sitting down during an episode of

physical therapy.

A This is therapy. Therapy does this section.

Q The reason I'm bringing it up is because the

assessment said she hadn't walked in a room or

in the corridor for the entire time period of

the MDS, and here it talks about how far she

walked.

A In therapy, in therapy. Therapy might be

walking her up there, but we are not walking

her on the unit.

Q Oh, I thought the MDS is what her capabilities

were.

A It is, and her capabilities in therapy, which

is this section, could have been that.

Q Okay.

A I can't speak for what therapy put in their

section.

Q So therapy fills this part out.

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Ex 20-098

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A Correct.

Q Okay. Then go to 43. And this is an

assessment protocol, which I didn't see

connected to the other minimum data sheets, the

other versions of it.

or is this also part of the MDS?

This is part of the required MDS.

Is this a special thing

A These are

called RAPs.

Q So tell us how that fits.

A Okay. If you see this Section V here these

are -

Q Which is page 43.

A Yes. These are all the different sections that

have triggered us to do a RAP, cognitive loss,

ADL, psychosocial, nutritional, dehydration,

dental, and pressure ulcers all have triggered,

so then you kind of have to allude to why these

areas have - - have major concerns or not major

concerns, but concerns.

Q And -

A So -

Q - - it's signed by the RN coordinator for the

RAP assessment process.

A Correct.

Q And who is that?

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Ex 20-099

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A I believe that's Drew Schwartz s signature.

Q So it would be the same -

A Correct.

Q - - person as the MDS nurse.

A Correct.

Q In other words, the MDS nurse would fill this

out also.

A Yes.

Q So they do the MDS.

A Yes.

Q Get the picture of the resident.

A Right.

Q And then they check the changes on the RAP

sheet.

A The computer does.

Q Oh, the computer.

A The computer generates.

Q Ah.

A The computer generates all these triggers.

Q This is Matrix?

A Matrix, and any system would do that.

Q Okay. So it isn't the MDS nurse deciding which

ones to check, it's the system.

A Correct.

Q Ah.

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Ex 20-100

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A By the answers that she put in the MDS.

Q So this is part of the Medicare oversight

thing.

A It's part of all of the residents, any long

term resident would have - - we have to do this

on them also.

Q Even if they're private pay?

A Oh, correct.

Q Oh.

A Yes.

Q Okay. So when something is checked, like for

example, ADL functional/rehab potential then it

says, "See RAP summary.

A Correct.

Q And that's why we have a RAP summary following.

A Correct.

Q So the one we're interested in then on page 44

is number 5, ADL/functional rehabilitation

potential, and do you see where it says, "Start

date

A 11/26?

Q And then it says ARD and that's another date.

What's that?

A Assessment reference date.

Q Okay. And the reason is because it was - -

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Ex 20-101

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A An admission assessment Medicare five day

assessment.

Q Okay. So who - - who gets this and who reads

it?

MR. SULLIVAN: This being this page?

BY MS. CENTOFANTI:

Q Yes, the page we're talking about, 44.

MR. SULLIVAN: 44.

THE WITNESS: It is in the computer.

We - - we do not have all these RAPs in the

computer. I mean, we do not have all these

RAPs in the chart.

the nurses to read.

BY MS.

They're in the computer for

CENTOFANTI:

Q You're right. I misspoke when I said who gets

this. What I should say is who uses the

information for something and what is that

something?

A Okay. The nurses use this information to care

plan and to, you know, put it on the care card

and.

Q Okay. So before when we were going through the

care plans we were focusing on the impaired

mobility part and all the things added on that

were from PT. Or I should say therapy because

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Ex 20-102

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it might have been OT, but -

A Uh-huh.

Q - - therapy?

A Uh-huh.

But are you saying there could be things that

come through the MDS and the RAP that gets to

the care plan?

Q

A Correct.

Q It just didn't happen to in our situation.

A Well,

therapy had did those on the care plan,

So it just

they might have already noted that

so.

Q -

A So it kind of was unnecessary for nursing to go

and document the same thing that was already

documented through the therapy recommendations. So

can you read in the RAP summary for us?

For the ADL?

Yes,

Okay.

Q

A

Q on page 44, number 5.

A "Triggered related to - - related to

needing extensive assist with ADLs and

transfers and mobility.

of degenerative joint disease of right hip and

was having difficulty walking and had elective

hip surgery.

Resident has diagnosis

She is here following her right

hip - - her right total hip arthroplasty. She

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Ex 20-103

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is attending PT and OT. Patient is working on

strength and endurance and mobility transfers.

Occupational therapy is working on ADLs and

strengthening and safety while performing her

ADLs.

Q I think it might have been, "PT is working on

strength and endurance,

abbreviations, sentence

says, She's attending

" another one of those

because the second, next

A - - no. Well, it could be PT.

"PT is working on strength, rather than

patient. PT is working on strength and

endurance and mobility transfers. OT is

working on ADLs and strengthening and safety

while performing her ADLs. She does have some

missing teeth,

with set for oral care and she will perform.

Primary mode of transportation is per

broke teeth. Staff will assist

wheelchair which staff will assist with

propelling. Staff will proceed with plan of

care.

Q And then I think you've indicated because it

says Drew Schwartz, RN at the end of it, doesn't

it.

A It does.

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Ex 20-104

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Q So the computer doesn 't write the part you just

read, right?

A No. Drew Schwartz would have wrote that.

Q So the computer triggers it and then she knows

she has to write one.

A Correct.

Q She would have probably known anyways because

she knows what she's doing and she filled out

the MDS, but the computer would prompt it.

A Correct.

Q Okay. Now, I didn't see any more of these RAP

sheets later on in the file, but I saw quite a

few more MDS forms.

A You're only required to do RAPs with the first

MDS. This would be the five-day MDS. You're

only required to do RAPs with that one.

Q I see. So let's go to 50 - - well, maybe you

can help me

understand. the RAP

ended on page 47, Yes.

Okay.

Okay. So the end of

it looks like to me.

A

Q Then we have, looks like kind of a

little mini MDS on page 48 and 49.

A Okay.

Q And that says, it has a discharge date on it,

but that's all. Can you tell me what this is?

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Ex 20-105

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A This is the discharge tracking form. When

someone is discharged to the hospital we have

to just do this little document here. It is

certainly not an MDS, it's just called the

discharge tracking form, and we have to fill

that out in cases like this.

Q Okay. Thanks. I couldn't figure out what that

was. Then we have page 50, and is that another

little special form, because it says, "Basic

assessment tracking form, " and then it has a

whole bunch of signatures on it all dated 12/1.

And I noticed, if you don't mind me climbing

over here and pointing, I noticed that number 7

is checked, and maybe that will help.

A "Medicare 14-day assessment."

Q Does that mean that this page we're looking at,

page 50, goes with this next MDS, which is the

14-day assessment?

A Yes.

Q Okay. So that means starting on page 51 it

says, "Assessment reference date 11" -

A Where?

Q That's okay. It says, "Assessment reference

date 11/27/08," so that would be - - that would

be 13 days postadmission.

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Ex 20-106

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A (Nodding.)

Q So does that mean it's how she was from the

20th to the 27th or from the 27th later?

A It means that - - now, she was admitted? What

Q

was the date she was admitted?

The 14th.

The 14th.

Okay.

So this

A So you count 14 as Day 1.

Q

A - - this time frame the MDS observation

period was from 11/27/08. It would be from the

last assessment, so the last assessment was -

the last assessment was dated 11 - - let me see

their assessment reference date. 11/20. Okay.

So then you'd do this one and the next

assessment is the 14 day, and that really

starts from the ending of this first MDS,

it's another seven day time frame.

So it's which dates,

so

Q just to make sure we have

that?

A So this is - - the assessment reference date on

this would be 11/27, so it would be 11/21.

Q Okay. Good. So got it. So then if we go to

page 52 again to the ADL section -

A Correct.

Q - - we see that instead of 8s for walking in

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Ex 20-107

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room and walking in corridor we have - - are you

there?

A Yes.

Q Maybe you could just tell me if I read this

wrong. It says the first column is - - it's the

number 3, which is two plus persons physical

assist.

A Uh-huh.

Q And the second column is -

A Support.

Q And what does the first one say up there?

Support is Column B. What's Column A, self

perform, maybe?

A Self performance.

Q Okay. So for self performance in walk in room

she has a three, which is two plus persons

physical assist, and for walking corridor she

has the same thing, and then for support for

walk in room it's one person physical assist

and for walk in corridor it's one person

physical assist.

A Correct.

Q Am I reading that right?

A Correct.

Q And then we have locomotion off unit - -

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Ex 20-108

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A Yes.

Q - - and on unit. To me the corridor and the on

and off unit seems to be the same thing.

there some nursing home definition of that that I

don't know?

No.

Is

A For locomotion on the unit she has a

three, which is two person extensive assist,

and then locomotion off the unit is a four,

which is dependent, dependent, so she -

because she's going a longer distance she

really can't, you know, we totally move her.

Q And off unit would mean -

A Therapy.

Q - - off of the picture you drew.

A Yes.

Q Which was Exhibit 1, off the unit.

A Correct.

Q That's going to therapy.

A That's going to therapy upstairs.

Q Or if she'd have a doctor appointment, that's

really off unit, right?

A Correct.

Q Okay. Good. And that one on page 54 is dated

12/1/08, which had confused me, but I think now

I understand that they can sign it and finish

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Ex 20-109

1

it later.

A Seven days they have, seven days.

Q They've done it, but they -

A Right.

Q She wouldn't have been changing those

numbers -

A Oh, no.

Q - - after that first date.

A No.

Q She can just sign it later.

A Right, yeah.

Q It seems like they're always signed a lot later

than they're finished. Do you know why that

is?

A Because actually you have - - you have seven

days to gather all of your information and then

you have the seven other days to complete the

entire MDS and to sign it.

Q But it still has to be for the data that they

gathered before that deadline date.

A Yes, for the assessment reference date, those

seven days.

Q And then we have one more on page 57, and this

one is the one we just talked about, the last

day of MDS observation period was the 27th.

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Ex 20-110

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This one says the 20th, so I think they were

maybe out of order?

A They were out of order.

Q So that's an even earlier one, right?

A Correct.

Q So there wasn

this 12/27 observation period one.

Uh-uh,

't one done before the fall after

A no.

Q And that's because another seven days had, or

14 days had not elapsed.

A Correct. It wasn 't time for the next MDS.

Q So the most that - - the MDS closest to her fall

was the one 11/27/08.

A Yes,

The other ones we have in here were after her

readmission.

that would be correct.

Q

A Right.

Q There was one other thing I didn't understand

about the MDS. There's probably a lot of

things I don't understand, but one thing I

noticed, can you go to page 41, back to 41,

please?

A Okay.

Q That was, I think you told me, filled out by

therapy?

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Ex 20-111

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A Uh-huh.

Q Can you just keep your finger there and go to

70?

A Okay.

Q I noticed those are both called, "Walking when

most self sufficient," and the first one on

page 41 that we talked about is filled out, but

they didn't fill this one out here. Is that

because they're not needed in every MDS?

A I can't answer as to why they did not fill that

out.

Q Okay. Now let's go to 93.


BY MS. CENTOFANTI:

Q So you're at page 93?

A I am.

Q This is something called a Cognitive

Performance Level Calculator. Are you familiar

with this?

A Well, social worker - - the social work

department does this.

Q I found it very confusing. Are you able to

talk about it or do you not know how it works?

A I really can't talk about this. They - - they

do the cognitive performance calculator. In

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Ex 20-112

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fact, Wendy Dean, the social worker, did this

one, so I really...

Q If you look down, it says, "Levels 1 to 3

interviewable, " and, "Levels 4 to 7

noninterviewable. I'm kind of surmising that

that means if you score out at a one to a three

you're mentally okay? Does that make sense to

you?

A It does.

Q And it looks like she has a two, if we look way

up at the top, CPS score two?

A Okay.

Q I was hoping you could help me understand how

they got to it, but -

A No, I can't.

Q - - your memory of her was consistent that she

A

would have been in the interviewable category?

Yes.

Okay. Q Could you go to 175? Sorry, 174. This

is a Froedtert record - - hold on while I try to

get the date. The point of this sheet was that

it mentions balance problems, and I was

wondering if you agree that she had balance

problems.

MR. SULLIVAN: Object, foundation.

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Ex 20-113

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THE WITNESS: I really couldn't

attest to that.

BY MS. CENTOFANTI:

Q Does a hip replacement alone cause balance

A

problems for patients?

It can.

surgery,

Some people do really well after

you know, it all depends on the

individual.

Q In fact, you probably don't know this, but the

hip injury that she was operated on for that

brought her to Grace Home was because she

fell, so -

A Uh-huh.

Q And then these records also indicate that she

was brought to Grace Home via ambulance on a

cot and not in a wheelchair. Would that make

any difference to your view of her as a fall

risk? We don't have the fall assessment sheet

here, so.

A Right. No.

Q That doesn 't make any difference?

A No.

Q Okay. So as you sit here do you have a memory

of what the fall assessment sheet would say for

her, what it said for her?

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Ex 20-114

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A Well, I can't tell you exactly what the

document said, but it - - it has a fall risk

number. You - - you go through these categories

and there's a certain number that deems you a

fall risk. If you hit that number ten or above

you're a fall risk.

Q And you don't remember where she was.

A No.

Q And as we sit here talking about her and

looking at some of the records does that

refresh your memory at all about whether she

was a fall risk at all when she was admitted?

When she was admitted I would say she was a A

fall risk.

Q And how about on the date of her fall, 12/1/08,

any recollection whether you would classify her

as a fall risk on that date?

A Well,

room as therapy deemed her to be independent,

but she required supervision in the hallway,

I do believe she was independent in her

so

there was potential for fall.

Q Let's go to 194. This is called the Patient

Transfer Form?

A Uh-huh.

Q Yes? Sorry, you need to answer verbally.

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Ex 20-115

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MR. SULLIVAN: Say yes if it's - - if

your answer's yes, if you know.

THE WITNESS: I'm trying to see where

this is from.

BY MS. CENTOFANTI:

Q It's signed by you right under that block of

writing there.

MR. SULLIVAN: It's dated 12/1/08.

BY MS. CENTOFANTI:

Q Right here, that's you, I think.

A Okay.

Q Right?

A Okay. Yes.

Q Just take your time and read it, but it's page

194, and if you could just read it, just kind

of look it over, and then tell me when you're

ready to talk about it.

A Okay. We have a new transfer form now, so this

is - - this is just one-sided, okay.

Q All right. So could you tell us what that is?

A That is when you transfer a resident out of the

facility you fill that form out in the

computer.

Q And it's page 194 and it' s called a Patient

Transfer Form.

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Ex 20-116

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A Form, correct.

Q So you filled it out?

A Uh-huh, I did.

Q Can we just start at the top, looks like you

have her name and a health insurance number,

her address. That apparently is her home

address?

A This is not my writing at the top.

Q Okay.

A This is not me.

Q Okay.

A This was the unit secretary.

Q Okay. How about on the right-hand side where

it says, "Nursing evaluation, " there's some

numbers, 9, 10, 11, do you see those?

A I do.

Q And number 17 is,

that be something you would have checked and

filled out?

"Ambulatory status. Would

A Yes.

Q So what did you check?

A I put walk - - walks with assistance.

Q And do you know where you got that information?

A I can't recall.

Q Okay. And then under 19 it says, "Appliances

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Ex 20-117

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or supports, " and you wrote?

A Walker.

Q And then number 20 is nursing assessment and

recommendations. Before you read that can you

tell us what the purpose of that would be?

A Well, that is to give a picture of what the

resident was capable of doing.

Q And in fact,

the patient transfer form is that wherever she is

going to has

I should back up. The point of

-

A They have information.

Q Okay. So this is what travels with her -

A Uh-huh.

Q - - apparently; is that right?

A Uh-huh.

Q Yes?

A Yes, it is.

Q Okay. Could you read what you wrote under

number 20?

A "Resident ambulating back to her room after

breakfast with walker and nursing assistant

following with wheelchair. When she reached

her room she lost her balance and fell onto her

left hip, complained of increased pain to left

hip with slight internal rotation of left

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Ex 20-118

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foot," and then her vital signs.

Q And if you could just back up a minute, it -

you said following with wheelchair and I think

there's a word between following and with. I

thought that might say behind, but -

"Resident ambulating following, it most likely

says, "behind with wheelchair.

Q I notice you do a lot better interpreting your

own handwriting than some of the others. And

then it has your name and it says, "RN

manager.

A Correct.

Q Does this refresh your recollection at all that

it says, "Resident ambulating back to her room

after breakfast"? That supports the idea that

the fall was at the end of the trip from the

dining room to the room.

A Correct.

Q I ' d l i k e t o s h o w y o u w h a t

w e ' r e g o i n g t o m a r k a s

E x h i b i t 4 . ( E x h i b i t N o . B Y

M S .

4 marked for identification.)

CENTOFANTI:

Q This is a document that is also very confusing

to me. Could you tell me what it is?

A This is punching, punching in and out.

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Ex 20-119

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Q So this is a time sheet record of some sort,

correct?

A Right.

Q Can we go to, maybe turn the page and go to

what's called page 1?

A Okay.

Q It looks like this? I just want you to help me

be able to interpret, first I should ask this,

are you able to help me make sense of this?

A Well,

anything to do with these documents,

Because

to tell you the truth, I never had

nothing.

Q - - and you don't punch in.

A I do not punch in, so I did not, as a manager I

did not have anything to do with these

documents.

Q Let's just see how it goes with a couple of

questions and if it's hopeless I'll find it out

from somebody else, but it apparently lists an

employee and this one happens to be Amy Timm?

A Correct.

Q And then it says, "Period rule Do you know

what that means?

A No, I do not.

Q And then it says, "RN," which apparently is

what she is.

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Ex 20-120

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A Correct.

Q And if we go back to the left of her name it

says, "149." That must be, it says, "In, " when

she punched in?

A But there are no, you know, I don't know if

that's a time.

Q Right. It's confusing because -

A I think that might be her number.

Q Okay.

A Because you see how the times are specifically

designated as 14:00, 22:28, 8:00, so I do not

think that is a time there. I think that is -

might be an employee number.

Q That would help make it more understandable. And

it looks like way on the right where it says

total hours is how many hours they worked.

Eight.

Yeah.

Uh-huh.

A

Q

A

Q So 14 to 22:28,

hours if they had some lunch break or something in

there.

I guess that could be eight

A Sure.

Q That's it. I just wanted a little help with

that.

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Ex 20-121

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SULLIVAN: Did you mark that?

CENTOFANTI: I did, as 4.

SULLIVAN: Thanks. And then I'm

going to show you what I'm going to mark as

Exhibit 5.

(Exhibit No.

BY MS.


CENTOFANTI:

Q And if you could just open that and tell me

what it is.

A Nursing Manual Index. I believe this is our

policy manual.

Q So where is the policy manual in your facility?

Is it in the computer or is it written?

A It's in the computer.

Q So if somebody wants to look at, going to the

bottom of the first page, notice of removal of

human corpse, if you wanted to look at that

policy you'd just type in 1037?

A You'd have to go to the actual policy manual,

and yes, type in 1037 and it should come up.

Q So there's a folder or a file -

A There's a file.

Q - - and it has a whole bunch of stuff in it.

A Policies.

Q Yeah. Are you involved in making the policies?

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MR

MS

MR

Ex 20-122

1

A I'm involved in make the policies, but Lori

Dorn, the ADON, she goes through them

and -

Q She's the assistant director of nursing?

A Correct, right.

Q So you're the DON, so -

A Right.

Q - - she reports to you.

A C o r r e c t . A n d y o u

d e l e g a t e t h a t t a s k

t o h e r . C o r r e c t .

O k a y .

Q

A

Q If you could just take a couple of

minutes, and we can go off the record while you

do it, I'd just like you to circle any policies

in this document,

anything to do with mobility,

fall safety,

sorts of things,

the headings that would have

fall prevention,

walking with supervision, those

just circle them with a circle

and then I'll know which ones I need to get.

MS. CENTOFANTI: We can go off the

record.


(Short break was taken.)

BY MS. CENTOFANTI:

Q So you've marked some for me and I won't waste

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Ex 20-123

1

time going through that, but I very much

appreciate you doing that.

A Okay.

Q Do you think that if I request the circled

items from your lawyer and he gets them from

the nursing home will I be able to tell if they

have changed since December 1 of '08?

A Yes, you will.

Q Okay.

A Because it'll say, "Revised."

Q Okay.

you tell me when they were revised,

have that memorized.

Right.

Okay.

So I don't have to worry about having

as if you'd

A

Q Then the last thing, maybe last thing,

don't get too excited.

MR. SULLIVAN: Never trust a lawyer

when she says last.


(Exhibit No.

BY MS.


CENTOFANTI:

Q I am going to give you what I've marked Exhibit

6. This is what we've marked as Exhibit 6.

The numbers aren't matching up, but this is

very puzzling to me, Alex, because it's like a

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Ex 20-124

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care plan on steroids. It isn't in the chart,

we never saw this version in the chart, and it

seems to be two different care plans. If you

look at the front that one has, if you look up

in the upper right corner, date range 11/14/08

to 12/8/08.

A Yes.

Q And if you look down at the bottom that's page

1 of 11, so if we backtrack we get to the start

of a different date set. Eventually you get to

page 1 of 15 and that's date range 12/09/08 to

3/15/09. That would be after she was

readmitted, right?

A Correct.

Q Did you find that spot?

A Yes. I think you're right here.

Q Yes. So that section that is after the surgery

that this fall caused, we're not concerned

about that today, so we can - - don't have to

look at that part.

A Okay.

Q But this other part, I'm trying to understand

and take a minute and look at it, this 1

through 11 date range 11/14/08 to 12/08/08, can

you tell me what this is that we're looking at?

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Ex 20-125

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A Well, these are care plans when she was

admitted.

Q Let me explain my question better, and I'm

sorry that I didn't explain it better. You

know, I'm already troubled by the fact that we

don't have one that states the November 14

admit date. We've talked about that already.

And I think I understand from going through the

chart and all the numerous versions of the care

plan that they're snapshots, apparently, of the

date the change was made.

A Snapshots in time of the care plan.

Q Right.

A Right.

Q So those must be separate computer files,

because -

A Correct.

Q - - if it - - if it totally rewrote what was

there before or just added you'd only have one

care plan.

A Right.

Q But you have a whole bunch of them.

A Correct.

Q 25 or so.

A So I do believe anytime you make changes it

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Ex 20-126

1

saves the old - - the old whatever you - - the

old entry, it saves the old entry and then you

have the new entry.

Q Right. Apparently, because you said you didn't

print - - you don't print them out every day.

A Correct.

Q But yet we still have separate ones.

A Correct.

Q That doesn 't fix the problem of why we don't

have the correct admit date, but we've probably

beaten that to death already, agreed?

A Agreed.

Q So now we have something here that didn't

appear in the chart because we didn't see this

version of it in the chart, and at the top it

says, "Care plan history, " and then we have

that date range.

A Correct.

Q Do you know anything about this?

A Well, I know that the care plan history is like

I said, it's when we - - we did the care plan

but then changes needed to be made,

discontinued the first changes and entered the

changes that were relevant at that period of

time.

so then you

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Ex 20-127

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Q Okay. What's kind of confusing to me is I

would think if you printed a care plan history,

and I'm not saying this is right, it's just

that I don't know, you'd think it would look

like the last care plan we looked at from that

admission up to the date of her fall, because

every - - it would have all the new information

in it, but this one looks quite different. It

has a lot of different information on it that

the other one doesn't. So do you know - - have

you ever seen one of these before?

A I've never seen it look like this, but I've

never seen it printed with all the changes.

I've never ever seen all the changes, you know,

in one document.

Q So you don't know why this one has - - this one,

which is presumably the summary of the care

plan through the date of her fall,

than the last care plan to the date of her fall

that we looked at in her chart.

Correct.

No idea.

No.

is different

A

Q

A

Q Okay. Let's go to page 3. And it's got little

pages in the corner here.

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Ex 20-128

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A Right.

Q This is where we're at the impaired mobility

part. It's hard to follow , but you have to

look at the bottom of the page because this is

three, so when you want to go on you have to

find page 4, which is the prior page, not the

following page. I'll let you find page 4,

which I think is the other way, and then you

can kind of see both of them.

A Okay.

Q You can see that on this nice weekend I was

figuring out these documents. Okay. So on

page 3 it's the problem start date of impaired

mobility, that's - - that's where we're at. Are

you both with me?

A Yes.

Q So far on page 3 it looks like we're reading

the same information that we read as we worked

our way through the care plans,

True.

Now,

true?

A

Q if you go to 4, page 4.

A Okay.

Q Starting at the top, again, it looks pretty

much like the same thing, right?

A Correct. There's the FRCRN again.

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Ex 20-129

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Q And it says Felisha Meyer.

A Oh, okay.

Q Could be Felicita Meyer. Does she have

another last name, maybe?

A She doesn 't work there anymore.

Q Oh, maybe that isn 't right, but it's kind of a

coincidence, isn't it.

A It is.

Q Now, here it says who edited it, so that's

interesting. Tell me what you think that

means.

A Edit reason, "None entered."

Q But above that, "Edited:"

A Huh.

Q Can you just read that line, "Edited:"?

A "Edited: 11/29/2008," is that what you're

talking about?

Q Yes, and then -

A "Felicita Meyer, RN, edit reason, none

entered."

Q Do you know anything about this, you know, who

made the changes?

A No.

Q It appears that when changes are made the

computer keeps track of who did it. Would you

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Ex 20-130

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agree?

A I would agree.

Q That is a person who did work at your facility

once?

A Yes.

Q And then it looks like it repeats everything

again. Would you agree? You can take your

time.

A Yes, it does.

Q And that other section has an edited date of

11/25/08, doesn't it.

A It does.

Q Then if we find our way to page 5, and I think

we're kind of going backwards, which is very

confusing, we'll see that Felisha made changes

on 11/17 and on 11/25, correct?

A Yes.

Q But it's all information we did read already.

A It is.

Q And then if you can go to page 6, way at the

top there's one last little part and that's the

beginning of the impaired mobility entries and

that's a Stephanie Thompson. Do you

know her?

A I cannot recall who Stephanie Thompson

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Ex 20-131

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was.

Q And it says created, not edited. Do you know

anything about that?

A Well, I think created would be when it was

first implemented.

Q That was kind of my guess too.

you can tell me about this document that you've

never seen before?

Anything else

A No.

Q Who do you think figured out how to get this

out of the computer if it wasn't you?

I have no idea.

I bet it was Pat.

Pat?

A

Q Are you a computer genius,

MR. SULLIVAN: I am not. I'm still

trying to - - never mind.

BY MS. CENTOFANTI:

Q Did you ever talk to Emma Jackson about the

fall? I know you assessed her at the scene,

but did you have any conversation with her that

you remember?

A I'm sure I had a conversation with her

cannot remember the specifics. I'm

sure she said she fell and, assessed

her and

, but I

I, you know,

you know, I

- - but it was so long ago that

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Ex 20-132

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I cannot remember what the conversation was.

Q So to be clear, you probably talked to her, but

you cannot tell me what you and - - if you and

A

her spoke and if you did what it was about.

Exactly.

No idea. Q

A No.

Q Did you ever talk to any of her family members?

A No, I did not.

Q Did you talk to anyone else about her fall?

A No.

Q Other than Mary.

A Mary, the CNA that was in the room.

Q And have you told me everything you remember

about that conversation?

A Yes,

And we talked about the investigation.

have no memory of if there was one or if

there was what you said.

I have.

Q You

- - if

A Right.

Q Or what it found.

A Correct.

Q No idea.

A No.

Q Anything else you know about Emma Jackson that

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Ex 20-133

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we haven't covered yet today?

A No.

Q You know,

want to know if I asked.

Not to my recollection.

Nice lady?

like something crazy that I would

A

Q

A Nice lady.

Q Mentally there?

A Yes.

Q That's all I have.

MR. SULLIVAN: Very good.

(Proceedings concluded at 11:55 a.m.)

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Ex 20-134

1

STATE OF WISCONSIN )

) ss.

COUNTY OF MILWAUKEE )

I, ANNICK M. TRIMBLE, RPR, Notary Public

in and for the State of Wisconsin, do hereby

certify that the preceding deposition was

recorded by me and reduced to writing under my

personal direction.

I further certify that said deposition

was taken at SIESENNOP & SULLIVAN, Milwaukee,

Wisconsin, on the 19th day of November, 2012,

commencing at 9:00 a.m.

a.m.

and concluding at 11:55

I further certify that I am not a

relative or employee or attorney or counsel of

any of the parties, nor a relative or employee

of such attorney or counsel, or financially

interested directly or indirectly in this

action.

In witness whereof, I have hereunto set

my hand at Milwaukee, Wisconsin, this

4th day of December, 2012.

ANNICK M. TRIMBLE, RPR - Notary Public

in and for the State of Wisconsin

My commission expires October 6, 2013.

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Ex 20-135

[& - 4th] Page 1

& & 1:8,18 2:7 135:9

0

11/27 107:21 11/27/08 106:24

107:10 111:13 11/28 42:20 87:4

88:22 11/28/08 62:11

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135:11 12 31:6 12/01/2008 70:4,12 12/08/08 125:24 12/09 39:14 40:6

41:2 12/09/08 52:6 54:14

61:16 125:11 12/1 61:14 91:1

106:11 12/1/08 69:14

109:24 115:15 116:8

12/10 17:2 12/10/2008 39:23 12/27 111:7 12/8/08 125:6 12/9 17:2 39:23 87:2 12/9/08 42:1 81:8,11 120 3:8 122 3:10,10 124 3:11 125 3:11 13 106:25 13118 1:10 14 38:19 40:1 71:6,6

106:15,18 107:7,15 111:10 121:20 126:6

11/26 101:21 14:00 121:11 14th 39:19 96:23

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116:24

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96:21,22 27th 107:3,3 110:25

262 2:4

0 40:20 0162 81:13 0456 40:21,22 056 40:18,21 08 5:1 79:6 94:23

2:10 69:14 3

124:7

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3/15/09 125:12 31st 76:25 33 93:1,9 35 93:11 36 93:1 96:5 97:5 365 80:20,22 370 82:11 83:1 371 84:16,23 372 85:16 373 87:2

1 1 3:4 11:24,25 24:1

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106:21 107:12 117:15 125:9,24

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42:19 43:19 52:23 53:9 93:17 97:7

11/14/08 43:12 50:15 52:14 83:19 125:5,24

11/14/2008 43:2 11/15 53:6,6 11/17 131:16 11/17/2008 40:9 11/20 93:17 97:7

107:13 11/20/08 93:14 11/21 107:21 11/24 52:9 53:9 11/25 55:7,9,15

58:22 131:16 11/25/08 54:15

84:16,23 131:11

19th 135:10 2

2 3:5 24:2 81:23 2/11/15 54:25 20 118:3,19 20,000 78:9 200 1:19 2:8,8 2012 1:20 4:16

135:10,21 2013 135:25 20th 96:17 97:2

107:3 111:1 223-7900 2:9 22:28 121:11,20 233 68:7,22 69:12

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25th 62:3 90:25 26 98:6

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Ex 20-136

[5 - approach] Page 2

5 48:24 78:8

abbreviations 45:17 55:6 77:7 89:16 104:8

ability 50:8 able 18:15 48:1

57:18 64:25 71:2 84:13 88:20 91:6 112:22 120:8,9 124:6

acceptable 65:23 access 83:13 accuracy 7:15 accurately 73:8 action 135:18 activities 32:3 39:10

60:19 78:20 actual 41:8 122:19 adaptive 21:10

23:18 90:19 add 41:22 68:25 added 38:15 53:4

60:9,10,11,12 102:24 126:19

adding 69:1 additions 68:3 address 117:6,7 adl 48:3,4,11 60:18

88:24,25 91:3 96:8 99:15 101:12,18 103:17 107:23

adls 48:18 78:6,19 92:8,9 103:20 104:3 104:5,14,15

administrator 5:13 5:15,16 34:16 36:3

admission 25:24 29:10 39:14,15 40:7 40:24 41:111818 , , 41:21 42:1 43:24 59:6 87:3 93:17 95:12 97:7 102:1 128:6

abbreviation 48:23 40:6,11 41:2 52:6 54:14 61:16 81:8 126:7 127:10

admitted 41:9,20 43:21 69:15 96:23 107:4,5 115:12,13 126:2

adon 123:2 adr 78:4 adrs 78:3,5,7,13 advisory 24:16,17 ago 11:2 36:10 71:8

132:25 agree 35:20 72:24

73:14,21 86:2 113:23 131:1,2,7

agreed 87:5,6 127:11,12

ah 25:15 61:4 92:5 100:18,25

ahead 11:7 49:7 54:5 66:14

aide 56:11,15,16 aide's 56:9 aides 22:13 30:14

31:18 37:20 57:2 60:23 87:12

alert 20:7 77:8,24 allude 99:17 ambulance 19:3

69:23 114:15 ambulate 48:2

55:15,15,24 62:11 62:13 63:7,9,15 79:24 84:14 85:19 86:5 91:6

ambulates 78:16 89:21,25 90:5,5,22

ambulating 17:24 57:24 70:23 73:25 118:20 119:6,14

ambulation 46:20 47:12 51:15,22 57:7 57:13,21 62:5 84:8

admit 39:14,18 40:3 ambulatory 117:17 amount 95:19 amy 120:19 analgesic 78:1 annick 1:24 135:3

135:23 answer 15:11 20:19

52:25 59:11 112:10 115:25

answer's 116:2 answering 29:3 answers 15:19 101:1 anteroom 10:11 antibiotic 78:2 anybody 5:22 25:17 anybody's 73:24 anymore 95:18

130:5 anyplace 87:21 anytime 126:25 anyways 105:7 apparently 19:10

45:24 62:18 66:10 67:2 84:18 85:23 117:6 118:14 120:18,24 126:10 127:4

appear 18:3 48:9 127:14

appearing 2:5,10 appears 12:6,11

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Ex 20-138

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Ex 20-139

http://centofantilaw.com/

http://centofantilaw.com/

[computer - delivered] Page 5

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Ex 20-141

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Ex 20-142

[forms - hip] Page 8

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17:12 19:7 20:1 69:25 71:2,4,6,7,12 71:14,20 73:16 74:4 78:2 79:9,19,20 80:1 82:4,6 103:22 103:24,25,25 114:4 114:10 118:24,25

handwriting 83:15

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g h 3:1 hackbarth 70:5 half 96:5 halfway 81:20 hall 7:25 8:2,11,13

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7:12,21,23 11:9,11 13:2 22:11 67:12 72:7,17 115:20

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g 96:9,9 gail 1:17 4:2,9

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gather 95:9 110:16 gathered 110:20 general 19:13 35:18

44:18 48:6,8 86:18 generally 31:20,25

32:21 44:2 51:11 generated 41:10

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home 1:11 4:11,23 5:1,11 6:16 8:23 12:14 13:23 14:2 19:23 24:25 26:9,22 28:5 37:18 69:5 91:18,20 109:4 114:11,15 117:6 124:6

homes 12:1,15 27:8 hopeless 120:17 hoping 28:23 57:18

113:13 hospital 34:1 35:14

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hospitalization 34:11,12

hour 31:4,12 61:7 72:6

hours 121:16,16,21 housekeeping 24:3 huh 5:21 8:7 10:6,18

13:9,19,21 15:2,10 15:16 16:1 17:8 18:5 19:8,19 20:25 34:5 36:22 42:2,13 43:22 44:16 50:25 52:20,24 53:14,18 54:11 56:12 62:6 64:24 65:11 66:6 68:20 72:19,19,21 90:16 94:6 97:25 103:2,4 108:8 112:1 114:13 115:24

hip's 18:20 121:19 130:14

human 1:8 122:17 hurting 15:25 husband 70:7 hv 91:18

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48:9 49:2,8 87:19 87:21 94:2 95:3,10 96:3 102:17,19 110:16 117:23 118:11 128:7,9 129:18 131:18

initial 69:11 initials 53:15,16,18 initiated 34:10,14 injured 50:3 injuries 44:12 injury 21:7 33:6

34:6 49:23 50:1 114:10

input 32:11 39:10 39:11

inside 74:5,6 75:25 instructions 81:21 insurance 1:12

117:5 intake 78:23 intense 96:2 interchangeable 86:10

interdisciplinary 35:5,6 37:10

interested 6:16 40:6 101:17 135:17

interesting 130:10 internal 18:11 71:15

118:25 interpret 88:23

120:8

90:2,17,18 91:13 index 3:10 122:10 73:25

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29:15,25 33:22 35:10,16 38:5

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37:11,11,12 122:25 123:1

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57:13,15 60:16 119:15 128:22 132:12 133:6,23

identification 24:6 119:21 122:6 124:20

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52:10 54:17 58:24 61:17 79:8 87:8,23 102:23 129:2,13 131:22

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72:10,12 improved 55:22 incident 12:2 included 29:16 81:1 including 52:15

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118:24 independent 11:14

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independently 62:11 78:16 85:19

items 53:8 124:5 j

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k kathleen 1:7 kathy 5:16 keep 47:24 84:10

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17:21 20:9 49:25 62:1 88:19 91:4 105:22 106:3,9 121:24 128:24 131:21

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11:1 22:20 61:9 75:3,10 101:4 132:25

longer 4:20 54:22,22 62:1 94:25 109:10

look 16:18 25:25 29:22 31:18 50:8,11 56:1 60:23 67:25 68:22 69:12 79:13 80:24 81:17,20 88:22 93:20 95:6 96:2 113:3,10 116:16 122:15,17 125:4,4,8,20,23 128:4,12 129:4

looked 17:7 29:12 128:5,20

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94:2 95:9 96:3 110:12 111:19 119:8 128:9

lower 47:16 78:18 82:3 84:10 90:8,18 91:9,12

lpn 49:5 76:15 lpns 14:14 37:18 lunch 121:21 lutheran 1:11,12

4:11,23 5:1,11 6:15 8:23 12:14 14:2 19:23 24:25 26:9,22 37:18 114:11,15

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leg 47:21 legs 46:15 47:24

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55:20,21,24 57:5,8 78:19 85:7 90:18

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119:21 122:6 123:25 124:20,22 124:23

marking 7:3,6 10:3 marks 57:14 69:6

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matching 124:24 materials 4:18 math 14:23 matrix 33:11,15

41:19 42:25 83:14 100:20,21

matrix's 48:7 matter 36:5 matters 27:25 mcr 77:9,9 md 44:25 52:15 mds 37:24 38:2,9

93:156 94:9,18,19 ,, 95:1,16 96:15,21 97:20,22 98:13,18 99:6,7 100:4,6,9,22 101:1 103:6 105:9 105:13,15,15,22 106:4,17 107:9,16 110:18,25 111:11 111:12,19 112:9

mdss 95:17 meals 62:14 63:11

63:17,23 86:6 mean 21:12,14 22:3

22:6 23:23 24:12 26:17,23 29:8 36:11 44:18 45:2,11,12,17

marked 3:2 24:6 48:3,21 49:5 50:22 51:8 53:12 54:2 56:4 57:16,21 58:10 58:11,14 63:24 69:10 72:6,10 73:7 74:18 77:11 79:20 86:7,13,17 102:11 106:16 107:2 109:12

meaning 46:7 74:7 76:8

means 21:15 22:5 23:10,21 42:8,17 44:19 45:3 47:18 48:15,22,25 49:25 51:7 54:6,11 55:23 57:22 59:2 60:18 62:23,24 63:4,16,25 71:8 78:20 79:22 80:4 81:25 85:10,14 86:19 106:20 107:4 113:6 120:22 130:11

meant 74:4 measures 23:17,17 medicare 77:10,12

77:13,15,18 94:4,7 94:17,22 101:2 102:1 106:15

medicare's 77:19 meets 96:25 members 133:8 memorized 124:13 memory 20:9 36:15

113:16 114:23 115:11 133:18

mental 20:5 mentally 20:14,15

113:7 134:8 mentioned 9:24

20:9 mentions 113:22 mequon 2:4

45:21 46:4 47:17 46:9 83:24

middle 39:18 63:3 milwaukee 1:1,19

2:8 135:2,9,20 mind 64:20 86:10

106:12 132:16 mini 105:22 minimum 93:6 99:4 minute 11:22 25:8

33:2 43:15 76:16 119:2 125:23

minutes 72:15,16 123:13

missed 24:22 25:10 missing 104:16 misspoke 102:15 misstates 67:9 mistakes 78:11 moaning 17:20 mobility 43:13,17

45:1,4 52:10,16 53:6 54:18,21 58:24 60:21 61:18,23 79:8 87:8,23 89:18 91:8 102:24 103:21 104:2,13 123:16 129:2,14 131:22

mode 104:18 moderate 47:4 moment 19:13 29:18

55:18 monitor 78:24 months 31:6 44:4,4

44:9 morning 30:17 35:6 move 49:18 54:13

61:11 71:2 109:11 moves 83:24 moving 43:15 79:13 multidisciplinary

39:12 multipage 41:24 multiple 42:18

mickey 5:4,6,7,23 mutual 1:12 mystery 80:6

n n 2:1,15 4:5,5 name 4:7 5:9 45:12

117:5 119:10 121:2 130:4

named 76:15 names 92:10 near 21:1 23:5 64:4

81:18 necessary 38:6 need 19:3 26:22

28:18 36:12 51:9 60:21 80:24 115:25 123:19

needed 56:7 112:9 127:22

needing 103:20 needs 20:11 37:9

77:25 nelson 76:15 neurological 19:9 nevel's 100:1 nevels 94:21 104:23

105:3 never 36:23 120:10

124:17 125:2 128:12,13,14 132:8 132:16

new 29:25 40:24 41:10,18 53:4,8 55:4 61:1 62:9 116:18 127:3 128:7

newest 60:24 nh 6:22 nice 129:11 134:6,7 nickname 5:6 nodding 107:1 noninterviewable 113:5

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numbers 110:6 117:15 124:24

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nurse's 6:2,17,20 7:1 9:11 12:21,24 13:1 82:23 83:3

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okay 4:25 6:7,20 7:1 118:12,18 120:6 121:9 123:12 124:3 124:9,11,15 125:21 128:1,24 129:10,12 129:22 130:2

old 60:25 61:4 127:1 127:122 ,,

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personal 135:7 persons 108:6,16 peters 1:5,5 5:4,5,23

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plan's 60:10 plans 16:24 32:23

33:1,3 37:6 38:19 39:1,22 40:5 41:25 44:8 61:25 79:7 102:23 125:3 126:1 129:19

physical 18:3 45:5 20:22

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policy 24:11,12,15 29:7 122:11,12,18 122:19

port 2:3 position 13:22 71:11

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record 3:8 4:8 52:1 54:25 55:5 88:6 89:8 92:3 95:24,25 112:13 113:20 120:1 123:13,21,22 124:19

recorded 30:20 135:6

records 12:1 16:14 20:8 26:1 27:8 81:1 81:2,9 92:23 114:14 115:10

recovering 79:8 recreation 35:8 reduced 135:6 refer 5:6 35:17 97:5

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quotes 85:1 r

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r 2:1 range 125:5,11,24

127:17 rank 17:16 rap 99:14,23 100:13

101:13,15 103:6,16 105:11,19

raps 99:8 102:10,12 105:14,16

reached 118:22 read 17:23 35:1,17

45:15,17 49:2 51:18 52:13 54:24 55:5 57:1 62:4,9 63:3,4 69:22 70:14,20,21 70:21 71:18 74:19 76:19 77:5,6 81:25 82:1 83:22,23 85:17 87:9 88:19 89:9 96:12 102:13 103:16 105:2 108:4 116:14,15 118:4,18 129:18 130:15 131:18

reading 50:23 54:20 108:23 129:17

readmission 41:6 111:16

readmitted 41:5 125:13

reads 73:18 88:23 102:3

ready 116:17 really 25:13 32:11

35:2 36:5 38:15 54:11 58:7 70:22 84:3 93:25 94:5 107:15 109:11,21

q quality 35:19 quarterly 29:10 question 14:25 21:9

28:19 65:5 126:3 questions 20:19

29:4 120:17 quibbling 75:24

76:4


Ex 20-149

[regarding - says] Page 15

registered 1:25 regulations 96:25 rehab 9:6 16:3

77:16,21 82:5 95:6 101:12

rehabbing 17:10 rehabilitation

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103:19,19 relative 135:14,15 relevant 127:24 remain 44:11 78:23

82:2 remember 6:1,2,6

9:10 11:2,2 16:7,8 19:13 20:20 23:13 23:15 34:22 35:12 35:23 36:2,8,9,12 36:19 94:23 95:18 115:7 132:21,23 133:1,14

remembers 31:15 remind 15:21 removal 122:16 remove 62:14,21

63:14 86:25 repeats 131:6 replaced 60:9 replacement 71:6

82:6 114:4 report 13:10,17

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reported 1:24 reporter 1:25 reports 12:2 123:8 represent 68:2 request 27:7 124:4 required 32:17 99:7

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resident's 8:18 60:8 93:8

residents 29:9 37:15 47:3 77:15 93:25 101:4

response 90:21 91:16

rest 67:25 resulting 34:10,11 retained 30:22 31:5

31:6 return 71:16 review 16:13 35:5,9 reviewed 16:9,12 revised 124:10,12 rewrote 126:18 richmond 130:1,3

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8:6 9:13 10:5 15:8 15:15 16:20 17:9,10 18:17,21,22 19:5 21:21 22:21 23:3 27:24 30:18 36:20 38:23,24 39:4,7 40:18,25 43:23 46:3 47:7,15,25 51:17 52:8 54:10 55:14 56:8 65:16 67:3 71:4,4,8,10 72:8 77:23 78:2 82:3,6 82:10 84:10,12 86:23,23,24 87:15 89:12 91:2 92:17,25

resident 8:17 17:22 96:13,19,24 97:12 100:12 102:15 103:22,24,25 105:2 108:23 109:21 110:4,11 111:4,17 114:20 116:6,10,12 116:20 117:13 118:14 120:3 121:7 121:15 123:5,7 124:14 125:5,13,16 126:13,14,21 127:4 128:3 129:1,24 130:6 133:20

risk 24:24 25:11,16 25:23 26:13 79:6 114:18 115:2,5,6,12 115:14,17

rn 22:4 32:9 53:22 53:22 94:14 99:22 104:23 119:10 120:24 130:19

rns 14:14 37:19 road 2:3 rolling 47:25 84:12 room 6:12,13,16,17

7:2,6,7,12 8:18,18 9:15,22,23 10:9,22 11:13,14,16,20,21 13:3 15:5 17:24 24:2 29:22 55:16,25 56:3,3 57:10 60:8 62:12,14,15,16,22 62:25 63:10,14,16 63:23 66:12,12,24 66:25 67:1711,15 ,, 70:23 71:1,19,22,23 72:1331818,23,23 , , , , 73:2,15,22 74:135 ,, 74:6,7,8,21,25 75:1 75:2,9,10,12,13,22 75:25 76:10,11 78:16 85:13,20 86:6 87:1 91:7 97:10 98:11 108:1,15,19

93:2 95:1,14 96:6

133:13 rooms 7:24 8:24

15:3,7 rotation 18:8,11

71:15 118:25 rpr 135:3,23 rule 24:13 44:3

120:21 rules 24:15 rundown 57:25 rusch 4:18,19,20

5:22 34:16 35:2

115:19 118:20,23 119:14,17,17

36:2 s

s 2:1,9,9 3:1 98:4 s.c. 2:2 safe 44:11 safety 23:17 49:23

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sat 90:8,9 saves 127:1,2 saw 9:18 10:2 79:15

105:12 125:2 saying 11:3 47:8

51:4,18 53:24 63:21 103:5 128:3

says 26:6 29:7,7,8 29:15 33:4,21 34:9 39:14 41:2 42:2 43:19 44:25 46:24 47:6 50:13 51:14,16 51:22 54:14,15 55:20 57:12 63:22 68:18 73:14,18 82:15 83:24 84:2,25 86:16,17 89:9 91:25 92:10 93:12 94:14 101:13,19,22 104:9 104:23 105:24 106:9,21,23 108:5 111:1 113:3 117:14


Ex 20-150

[says - start] Page 16

120:21,24 121:3,3 121:16 124:18 127:16 130:1,9 132:2

sba 86:17 sbs 86:7,17 scale 17:15 scanned 81:5 scene 132:19 scheduled 91:20 score 113:6,11 search 27:17,18 sebelius 1:7 second 12:13 18:2

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secretary 1:7 117:12 section 8:19 23:16

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sections 51:18 60:17 99:13

see 4:17 9:17 17:15 17:19 18:20 25:9,24 26:6 31:8,12 34:1 35:15 38:13 39:22 39:22 42:16,24 44:21 48:15 50:5,11 52:7,8 53:5 54:20 59:15 62:1 68:13,18 74:9,16 79:5 81:9 82:21 88:22 92:22 94:19 98:4 99:3,10 101:13,19 105:11 105:17 107:12,25 116:3 117:15 120:16 121:10 127:14 129:9,11 131:15

seeing 40:7 seen 24:8 36:23

128:11,12,13,14

117:25 119:7,10,14 self 78:22 108:12,14

108:15 112:6 send 88:15 sense 113:7 120:9 sent 34:1 46:22 70:6

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services 1:8,12 37:11 39:10

set 93:7 104:17 125:10 135:19

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she'd 56:18 64:25 75:2,9 109:20

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sheets 48:18 84:20 87:8 99:4 105:12

shift 13:23,24 14:1,2 14:3,5,10,17,18 25:4 29:24 30:24,25 31:1,15 32:10 48:20 48:20,22,22,22

short 67:23 123:23 show 119:19 122:4 showed 16:22 57:10 side 7:9,11 47:25

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somebody 51:1 58:13 120:18 122:15

somebody's 58:11

signature 94:14 40:21 66:14 86:9 94:16 113:19 115:25 126:4

sort 35:19 41:15 83:16 86:21 98:1 120:1

sorts 123:18 sound 72:22 73:21 sounds 26:11 44:8

80:3 95:21 speak 98:23 special 85:3 99:5

106:9 specific 77:16 specifically 36:1

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125:15 square 10:5 54:20

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staffing 14:24 stamp 38:20 stand 46:16 52:18

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39:23 42:2,4 43:19 52:7 64:17 65:25 69:13 80:20 93:4 101:19 117:4 125:9

sorry 7:11 15:13


Ex 20-151

[start - therapy] Page 17

started 65:2 starting 55:7 106:20

129:23 starts 43:12 64:5

77:1,9 88:24 107:16 state 1:2 4:7 20:5

71:5 135:1,4,23 stated 23:7 79:15

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station 6:2,17,20 7:1 9:12 12:21,24 13:2 83:3

stationed 12:23 status 45:4 48:12

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stay 41:15,16 stephanie 131:23,25 stepping 19:12 steroids 125:1 stipulate 73:17 stone 89:13 stood 90:14 stop 45:21 55:18 street 1:19 2:8 strength 104:2,7,11

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6:23 7:8,15 10:8,12 11:6 16:17,21,25 26:3,11,16,21,25 27:3,6,15,24 28:1,7 28:11,17,20 29:1 30:4,8 38:21 40:1,8 40:12,17,21 49:6,20 53:1 54:4 59:9,13 59:16 63:6 64:14 66:7,13,16,20 67:8 67:20 72:25 73:17 75:4 76:3,17 80:22 81:13 89:8,13 90:9 92:3,6,9,12 95:23 102:5,8 113:25 116:1,8 122:1,3 124:17 132:15 134:11 135:9

summary 79:17 81:16 88:10 92:18 93:4 101:13,15 103:16 128:17

supervising 23:2 supervision 22:23

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supine 45:18 46:14 49:9 83:24 84:2,3

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sure 5:9 6:20 17:1 27:2 28:1,20 29:24 41:13 68:18,20 74:24 76:4 89:19 91:24 96:11 107:18 121:23 132:22,24

surgeon 70:5 surgery 19:24 39:16

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supposed 22:13 14:4,7 19:18 33:12 35:23 39:5 48:10,11 61:24 65:20 75:8,17 81:23 87:16 92:7 96:8 102:7 115:9 130:17

talks 98:5,13 target 44:1235 , , , task 123:10 team 35:5 teeth 104:16,16 tell 4:10 5:25 11:22

12:9,13 14:9 18:6,9 20:5 24:10 26:1 29:19 36:5 38:12 42:7 51:7 55:23 57:18 59:7 62:22 63:3 72:10 79:14,22 82:1,19 84:23 88:5 92:6 94:15 95:22 97:20 99:9 105:25 108:4 115:1 116:16 116:20 118:5 119:24 120:10 122:8 124:6,12 125:25 130:10 132:7 133:3

temporary 38:1,8 38:14

ten 17:15,19 115:5 tend 70:21 term 9:1 101:5 terminology 45:22

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thanks 106:7 122:3 therapist 88:21 89:3 therapy 32:20 35:8

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talking 5:20 6:8

systems 69:5 t

t 3:1 4:5 98:3,4 tab 96:6 take 15:14,21 25:8

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taken 1:18 67:23 72:14 123:23 135:9

talk 37:6 49:24 55:19 63:5 65:18 68:24 76:21 91:17 95:7,8,8 112:23,24 116:17 132:18 133:8,10

talked 34:24,25 73:5 110:24 112:7 126:7 133:2,17


Ex 20-152

[therapy - uh] Page 18

52:15 61:23 80:11 80:12,14 82:11,15 82:23 83:17 87:10 88:9,11 89:6 92:4 98:8,9,9,15,15,15,20 98:23,25 102:25 103:3,11,15 104:3 109:13,18,19 111:25 115:19

therapy's 82:22 thing 10:21 12:4

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think 4:18 13:15 16:5 17:9 27:18,20 28:3,15 29:13 30:8 34:23 41:4,9,13,22 43:6 54:11 55:10 64:11 65:11 66:23 73:24 74:20 75:2,9 76:4 78:8,14,25 81:25 89:15,18 90:1 91:18 92:4,16 104:6 104:22 109:24 111:1,24 116:10 119:3 121:8,12,12 124:4 125:16 126:8 128:2,4 129:8 130:10 131:13 132:4,10

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times 22:15 25:11 51:11 55:15,20,24 57:5 77:24 78:1,18 78:19 92:22 121:10

tip 26:6 tired 22:19 56:7 tlh0370 80:16 tlh0371 80:16 tlh0683 26:7 today 5:20 7:14 16:9

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total 82:4 103:25 121:16

totally 16:5 81:24 109:11 126:18

track 130:25 tracking 106:1,5,10 training 18:25 transcript 3:21,24

4:1 transfer 32:17 45:18

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transferred 51:9 transferring 52:17

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transition 12:18 transport 69:23 transportation

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turn 8:6 68:1,7 88:2 120:4

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type 122:18,20 typical 82:5

trip 66:11 71:22

typo 55:10 u

uh 5:21 8:7 10:6,18 13:9,19,21 15:2,10 15:14,14,16 16:1 17:8 18:5 19:8,19 20:25 34:5 36:22 42:13 43:22 44:16 50:25 52:20,24 56:12 62:6 64:24 65:11 66:6 68:20 72:19,19,21 90:16 94:6 97:25 103:2,4 108:8 111:8,8 112:1 114:13 115:24 117:3 118:13,15


Ex 20-153

[uh - words] Page 19

ulcers 99:16 uncomfortable 58:20

underlined 85:21 understand 4:25

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wheeled 46:17,18 47:7,8 50:13,19,24 51:5,10,16 55:11,16 55:24 56:14,18 57:6 57:9 62:12,13 63:9 63:15,17 64:18 84:7 85:7,9,12,20 86:5 89:21 90:22

whereof 135:19 wing 8:10,16 wisconsin 1:2,19 2:4

2:8 135:1,4,10,20 135:23

witness 4:2 7:10,19 8:22 11:8 16:20 28:23 40:9,13,22 49:8,21 53:2 54:6 59:12,17 63:9 66:8 66:15 67:10 73:1,19 76:6,18 90:11 92:8 92:11,14 97:19 102:9 114:1 116:3 135:19

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versions 99:5 126:9 view 11:18 114:17 visit 83:20 91:18,20 visits 20:12 vital 13:21 119:1 vitals 70:13 vs 1:10

w w 2:7 wait 34:1 43:15

76:16 waiting 35:15 walk 49:15 51:12

63:17 72:17 80:9,10 85:12 108:15,19,20 117:22

walked 10:22 11:12 11:13 98:6,11,14

walker 17:24 21:11 21:17 23:22 46:17 46:18 47:7,8 50:13 50:19,24 51:5,10,12 51:16,21 55:11,16 55:25 56:14,18 57:6 57:9 62:12,13 63:10 63:15,18 64:18 65:10 70:24 74:1 80:10 84:7 85:8,9 85:12,20 86:5 89:21 90:22 91:7 118:2,21

walking 11:8,11,12 21:16 22:6,7,10,20 23:2 56:5 58:6,6 72:7,13,22 74:20 97:10,10,15 98:5,16


Ex 20-154

[work - yesterday] Page 20

14:12 38:25 46:5 112:20 130:5 131:3

worked 94:25 121:16 129:18

worker 112:20 113:1

workers 35:8 working 83:17

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worn 58:17 worry 124:11 worse 54:2 wow 55:13 write 7:7 8:20 10:7

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written 50:22 122:13

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x x 2:15 3:1 4:5 10:16

91:21 y

yeah 8:17 10:8,12 15:20 16:20 25:23 26:16,25 28:17 38:15 52:7 57:18 73:5 76:17 78:7,14 86:9 92:6 96:9 98:3 110:11 121:18 122:25

years 36:10 71:6,8 yesterday 77:3


Ex 20-155

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