0001 1 THE STATE OF OHIO,.) ) SS: THOMAS J. POKORNY, J. 2 COUNTY OF CUYAHOGA.) 3 IN THE COURT OF COMMON PLEAS 4 CIVIL DIVISION 5 DELORES WOOD, etc., ) ) 6 Plaintiffs, ) ) 7 -v- ) Case No. 688279 ) C/A: N/A 8 ) HARBORSIDE HEALTHCARE, etc, ) 9 ) Defendants. ) 10 - - - - 11 TRANSCRIPT OF PROCEEDINGS 12 - - - - 13 APPEARANCES: 14 BLAKE A. DICKSON, ESQUIRE, 15 on behalf of the Plaintiffs; 16 17 THOMAS PRISLIPSKY, ESQUIRE,. RAPHEAL McLAUGHLIN, ESQUIRE, 18 on behalf of the Defendants. 19 20 21 22 23 24 Robert P. Lloyd, RMR, CRR 25 Official Court Reporter Cuyahoga County, Ohio 0002 1 THE STATE OF OHIO, ) ) SS: THOMAS J. POKORNY, J. 2 COUNTY OF CUYAHOGA. ) 3 IN THE COURT OF COMMON PLEAS 4 CIVIL DIVISION 5 DELORES WOOD, etc., ) ) 6 Plaintiff, ) ) 7 -v- ) Case No. 688279 ) C/A: N/A 8 ) HARBORSIDE HEALTHCARE, etc, ) 9 ) Defendant. ) 10 - - - - 11 TRANSCRIPT OF PROCEEDINGS 12 - - - - 13 14 BE IT REMEMBERED, that at the 15 September A.D., 2010 term of said Court, 16 to-wit, commencing on Tuesday, October 12, 17 2010, this cause came on to be heard before 18 the Honorable Thomas J. Pokorny, in Courtroom 19 No. 4B, Old Courthouse, Lakeside. 20 21 - - - - 22 23 24 25 0003 1 FRIDAY MORNING SESSION 2 OCTOBER 15, 2010 3 4 5 (Thereupon, the following proceedings 6 were held in part:) 7 - - - - 8 The PLAINTIFF, to maintain the issues 9 on their part to be maintained, 10 called as a witness, BARBARA 11 DARLINGTON, who, being first duly 12 sworn, was examined and testified as 13 follows: 14 - - - - 15 CROSS-EXAMINATION OF BARBARA DARLINGTON 16 MR. PRISLIPSKY: 17 Q. Good morning, ma'am. 18 How are you? 19 A. Good. 20 Q. Do you have a copy of your deposition with 21 you? We might need to refer to it today. 22 A. I don't have it with me, no. 23 Q. While Mr. McLaughlin is getting it, I want to 24 start out by asking you some questions. 25 Seems like you wear a lot of hats in your 0004 1 career; is that fair? 2 A. Yes. 3 Q. You run a consulting business? 4 A. Right. 5 Q. You also are the administrator of an adult 6 day-care center? 7 A. Small, small 35 slot, yes. 8 Q. You are offering your services as an expert 9 witness? 10 A. Yes, sir. 11 Q. And in terms of your services as an expert 12 witness -- you have been doing that for how many 13 years? 14 A. Since about 1998. 15 Q. And last year as an expert witness, you made 16 about $60,000 testifying and reviewing cases as an 17 expert? 18 A. That's probably pretty close to accurate, yes. 19 Q. About one-third your total income is derived 20 solely by offering your services as an expert? 21 A. Yes. 22 Q. Now, let's talk about some of the opinions you 23 have. 24 You mentioned one in your deposition that you 25 didn't mention today. You had said to the jury that 0005 1 the nurses fell below the standard of care, correct? 2 A. Yes. 3 Q. But it's your opinion, not only did they fall 4 below the standard of care, but they are, quote, 5 unquote, incredibly stupid? 6 MR. DICKSON: Objection. Can 7 we approach, Your Honor? 8 THE COURT: Overruled. 9 MR. DICKSON: Can we approach, 10 Your Honor? 11 THE COURT: No. Go ahead, 12 ma'am. 13 MR. DICKSON: Your Honor, this 14 has to do with a prior ruling that you made. 15 THE COURT: All right, 16 sidebar. 17 (Thereupon, a discussion was had 18 between Court and counsel at 19 sidebar.) 20 BY MR. PRISLIPSKY: 21 Q. Did you testify under oath, ma'am, at your 22 deposition that the nurses were incredibly stupid at 23 this nursing home? 24 A. I think what I testified to was that either 25 the facility was short staffed or the nurses were 0006 1 incredibly stupid. 2 Q. We're going to get to staffing in a minute. 3 Amy Johnson here, did you read her deposition? 4 A. No, I did not. 5 Q. Why not? 6 A. I didn't receive that deposition. You said 7 Johnson? 8 Q. Yeah. 9 A. That wasn't on my list. 10 Q. Director of nursing? 11 A. I did not receive that one, sir. 12 Q. You did not receive and read the deposition of 13 the head nurse at that nursing facility? 14 A. I don't believe I did. 15 Q. So you can't say whether she's the one who is 16 incredibly stupid, can you? 17 A. No. And, sir, may I just respond to that? 18 I was being a little facetious in the 19 deposition. I'm a nurse. I feel I can be critical 20 of nurses. I am critical of nurses every day because 21 I am a nurse myself. And I know the mistakes that 22 nurses make. But in this case -- 23 Q. You said it twice -- I'm sorry, you said it 24 twice in your deposition. 25 A. Right. I was just being facetious because I 0007 1 saw so many failures that it was amazing to me that 2 so many things could go wrong for one patient. 3 Q. Let's talk about your role as a nurse. So 4 what you're saying is you're critical not only of 5 Miss Johnson and the administration but also the 6 frontline nursing staff, correct? 7 A. Yes. 8 Q. The nurses who pass the medications, who do 9 the assessments, the nursing assistants who report to 10 the nurses, who bathe the residents, who clean the 11 residents, correct? 12 A. Correct. 13 Q. When is the last time you, ma'am, as a nurse, 14 a staff nurse, worked 40 hours per day in a nursing 15 home? 16 A. 40 hours per day? 17 Q. As a staff nurse, frontline nurse. 18 A. I gave out medications on Friday because the 19 nurses -- a nurse called out, and we needed a nurse 20 on 3 to 11, so I put on my lab coat and worked for 21 eight hours giving out medication. 22 Q. What was the question I asked you, ma'am? 23 A. You said 40 hours in a day. 24 Q. I'm sorry. 25 A. I don't think any of us work -- 0008 1 Q. I'm sorry, 40 hours per week. 2 A. Okay. 3 Q. When did your in your career, your 4 professional career that you discussed, offer your 5 services as a frontline nurse and work it full-time 6 40 hours per week as a frontline nurse in a nursing 7 home? 8 A. Oh, that's been awhile, in a 40 hour week, but 9 I do work, as I say, at Gateway as a nurse whenever I 10 am needed. 11 Q. 40 hours per week, ma'am. Have you ever 12 worked in a nursing home ever as a frontline staff 13 nurse for 40 hours per week? 14 A. Yes, sir. 15 Q. 30 years ago? 16 A. Oh, probably before I became the nursing 17 director in the nursing home, back in the '70s; yes, 18 sir. 19 Q. 30 years ago? 20 A. Yeah. 21 Q. Now, your job as an expert witness is to 22 review all of the material you receive, correct? 23 A. Correct. 24 Q. All of the medical records, right? 25 A. Right. 0009 1 Q. You discussed Mr. Wood and his condition. You 2 said that he helped his wife. He was incredibly 3 independent. Where did you get from? 4 A. Deposition testimony of his wife and his 5 daughter as well as the records from Marymount 6 Hospital. 7 Q. Well, you as an administrator -- you know I 8 was used to be an administrator, I assume. Did you 9 know that? 10 A. No. 11 Q. Okay. You, as an administrator, I take it 12 from time to time you will deal with patient's 13 families who obviously love their family members, but 14 at times may not be willing to accept those 15 individual's frailties; has that happened to you from 16 time to time? 17 A. Absolutely. 18 Q. When you reviewed Mr. Wood's medical records 19 from Marymount, did you get the impression that prior 20 to when he was at home he was debilitated? 21 A. He had some difficulty walking. He had to 22 walk with a walker and a cane, yes, sir. 23 Q. My question's specific: Did you get the 24 impression from the Marymount records that prior to 25 coming to Marymount he was debilitated? 0010 1 A. Well, I'm answering your question. He had 2 difficulty walking. He -- when he came into 3 Marymount, he, as I said before, had slightly 4 decreased protein and albumin levels meaning that his 5 intake wasn't as good as it could have been. 6 So he -- he was a rather poor eater. But he 7 was continent. He was, as I said, taking care of -- 8 helping take care of his wife. And, in fact, that's 9 in our record from Harborside as well. The therapist 10 commented on that, that he was the primary caretaker 11 for his wife at home. 12 Q. Did you know he also received home health 13 assistants from home health aides two times per week 14 at home? 15 A. Yes. 16 Q. I'm going to hand you -- 17 MR. PRISLIPSKY: Your Honor, may 18 I approach? 19 THE COURT: Yes. 20 BY MR. PRISLIPSKY: 21 Q. I'm going to hand you the record from physical 22 therapy at Marymount. Can you read to the jury the 23 highlighted portions, please? 24 This is at Marymount, and this is prior to the 25 time he's even in for surgery, correct? 0011 1 A. Right. 2 Q. What does that say? 3 A. It says, Cannot assess much, HHA, which 4 usually stands for home health aide. 5 Q. Home health aide? 6 A. Two times per week, room to room with -- 7 Q. Wheelchair? 8 A. Hard to read that, but it could be wheelchair. 9 Debilitated prior to surgery. Hard to read. 10 Q. What does it say level of orientation is? 11 A. Here it says times one. 12 Q. So when that individual assessed Mr. Wood -- 13 A. Can I see the date because the date is covered 14 up. 15 Q. Absolutely, ma'am. This is not a trick. 16 A. This was on 7/14, okay. Just wanted to check 17 the date. 18 Q. Okay. So when he was at Marymount, alert and 19 oriented times one, correct? 20 A. Yeah. I am just looking at this because he 21 had his surgery -- he was admitted to Marymount on 22 7/13. That assessment was done 7/14. Very often 23 following surgery in an elderly individual, they may 24 have a little bit of confusion. And, of course, we 25 would expect to see that he was debilitated. He just 0012 1 had surgery on his knee. 2 Q. Oh, so you're saying that said debilitated 3 after surgery? I swear you said it said before 4 surgery. 5 A. Let me see that record. 6 Q. Sure. 7 A. What it says is Cannot assess much. This is 8 the day following his surgery. 9 Q. What about debilitation? 10 A. Family home health aide two times per week; 11 room to room with wheelchair; debilitated prior to 12 surgery. 13 Well, yes, he was. He had that problem with 14 his knee. He was using a cane, and he was also using 15 a walker. 16 Q. So when Mr. Wood was at Marymount on the 13th, 17 was he oriented to the month and the place? 18 A. I don't have his record from the 13th. 19 This is his occupational therapy evaluation. 20 And at that point in time -- actually, the evaluation 21 date was the 14th. Again, right immediately 22 following his surgery. And it says, Alert and 23 oriented times two; person and year; not month or 24 place. 25 Q. Not month or place? 0013 1 A. And slightly hard of hearing. 2 Q. You talked about staffing. As an 3 administrator I take it that you prepare staffing 4 reports? 5 A. Certainly. 6 Q. Hours per patient data? 7 A. Yeah. 8 Q. Not very difficult to calculate, is it? 9 A. No. 10 Q. You take a look at the schedules; you take a 11 look at the time cards; you divide that by your 12 census and gives you the hours per patient data, 13 correct? 14 A. Correct. 15 Q. In this case, if you needed to do that you 16 could have easily have done it, correct? 17 A. Well, sometimes it's not so easy because the 18 calculation also has to take into account the 19 acuities of the residents that are on any particular 20 unit and then the staffing that's on any particular 21 unit. Sometimes staffing records -- I know at 22 Gateway they are only kept for about a year. So I 23 may or may not have been able to do that. 24 Q. We produced all of the schedules, ma'am. Did 25 you receive those? 0014 1 A. No. 2 Q. You know something about staffing at nursing 3 homes, don't you? 4 A. Oh, yes. 5 Q. Isn't it true that at your nursing home, at 6 your facility your own employees protested your 7 facility in 2003, a couple years before this 8 happened, because of short staffing, correct? 9 A. That was during a union contract dispute. We 10 were trying to settle our contract. 11 And what they did was they had a one-day 12 informational, because they couldn't strike, they 13 were still under contract, we were negotiating a 14 contract, and you're right. They did do that. They 15 protested, and they said that we were short staffed. 16 But I would hasten to add that I have been at 17 this facility for 14 years. We've never once been 18 cited for short staffing. And it's actually -- I'm 19 very privileged because the gentleman who owns the 20 facility allows me to staff much higher than the 21 State requirements for staffing. 22 Q. That's interesting because I did a little 23 search on your facility. 24 A. Right. 25 Q. And it looks to me that your facility is 0015 1 staffed lower than the average nursing home in New 2 Jersey. Are you aware of that? 3 A. It depends on what you're calling nursing 4 staff, but I know where I'm staffed. I know that 5 we -- we need 2.8 PPD as far as the State is 6 concerned, and we staff at 3.2. 7 Q. I didn't ask you what the State requires. 8 A. Right. 9 Q. I'm asking you your nursing home in comparison 10 to the rest of the nursing homes in New Jersey. Your 11 3.0 -- 12 A. Right. 13 Q. -- is below average across the State, isn't 14 it? 15 A. It is. I'll agree to that. 16 Q. Okay, all right. Let's talk about some of the 17 things in therapy. 18 Now, let's talk about not so much some of the 19 medical records in place. Let's talk about the 20 actual progress. 21 A. Okay. 22 Q. Or the actual clinical condition of Mr. Wood. 23 Did you look at that and do any kind of comparison to 24 see where he was before certain times and after 25 certain times? 0016 1 A. Yes. 2 Q. How did he do in physical therapy? 3 A. He did very well at the beginning, sir. He 4 was making very nice progress. As I said, it was his 5 expectation that he would be returning home and -- 6 and that was what his wife was expecting, his 7 daughter was expecting, and he was making very nice 8 progress with physical therapy, occupational therapy 9 and some speech therapy he was getting. 10 Q. When Mr. Wood was admitted to the nursing 11 home, how far was he able to walk? 12 A. May I just look that up. 13 Q. Absolutely. 14 A. I have the physical therapy records here. 15 Q. I have them here, ma'am. Looks to me six feet 16 times two. See where I have that highlighted? 17 A. Right, okay. 18 Q. Six feet times two. About my distance to your 19 distance, correct? 20 A. Right. 21 Q. In three weeks, how far was Mr. Wood able to 22 walk. 23 A. Well, let's see. 24 Q. About 100 feet? 25 A. I don't have that one right with me, but I -- 0017 1 I know that he made significant progress. 2 Q. So if I told you it was 100 feet that would 3 not be shocking to you? 4 A. No. 5 Q. So 100 feet, statistically, 1,000 percent 6 improvement for Mr. Wood in three weeks, fair? 7 A. He did very well in the beginning. 8 Absolutely. I agree with. 9 Q. Well, the entire time -- that was 100 feet at 10 the time of his discharge summary, wasn't it? 11 A. Well, all I can tell you is that there's notes 12 in occupational therapy -- 13 Q. I'm talking physical therapy, ma'am, not 14 occupational. 15 A. -- about his -- he was declining. He was 16 missing a lot of treatments and spent less time in 17 physical therapy. 18 Q. Stick with my question. 19 A. Right. 20 Q. Do you recall the discharge summary from 21 physical therapy that said he could walk 50 feet 22 times two, which would be about 100 feet, which would 23 be about 1,000 percent improvement in three weeks? 24 A. Yes. He could walk 50 feet times two, yes. 25 Q. And the way that that happens is through the 0018 1 dedication and the hard work of the therapy staff, 2 correct? 3 A. Absolutely. 4 Q. Let's talk about some of the questions and the 5 issues that you brought up about malnutrition, okay? 6 A. Yes. 7 Q. What did Mr. Wood weigh when he was at 8 Parma -- I'm sorry, at Marymount? 9 A. I only know that when he came into Harborside 10 he weighed 164 pounds. 11 Q. Well, he was weighed probably in a wheelchair 12 scale, correct? 13 A. We don't know what kind of scale he was 14 weighed in. Have no idea. 15 Q. Well, he couldn't have been weightbearing, 16 could he? 17 A. He was weightbearing as tolerated. He was 18 weightbearing as tolerated. So, yes, he was 19 weightbearing. 20 Q. Difficult to weigh a resident who just 21 underwent a knee replacement on a regular scale 22 weightbearing, true? 23 A. We don't know what kind of scale he was 24 weighed in. 25 Q. Well, let's assume he was weighed in a 0019 1 wheelchair scale. Those are notoriously inaccurate, 2 correct? 3 A. Not if you do it right. 4 Q. Well, let me ask you this. Did you bother in 5 this case to take a look at a snapshot, look at what 6 Mr. Wood weighed at Marymount, compare it to what he 7 weighed at Parma when he was discharged? 8 A. I know that his wife said his average weight 9 was around 150 pounds. He weighed a little bit more 10 than that when he got to Harborside. 11 Q. What was the question I asked you, ma'am? 12 A. I'm sorry? 13 Q. What was the question that I asked you? 14 A. You asked if I looked at his Marymount weight. 15 Q. Correct. Did you? 16 A. I'm not aware of his Marymount weight, but I 17 would assume it's somewhere around 150 pounds. 18 Q. Okay. How about 138? 19 A. That says kilograms, first of all, so that's 20 not accurate no matter how you look at it. And it 21 just says 138 kilograms. So that's not accurate. 22 Q. Pretty well, ma'am, that he didn't weigh 138 23 kilograms, which would be about 300 pounds, fair? 24 A. And sir, this to me looks like 158. I'm 25 reading it as 158. 0020 1 Q. Okay. 2 A. But it's very difficult to ascertain. See 3 that -- the 8 is kind of peculiar with this person 4 who is writing. So it looks like 158 kilograms. 5 Q. On your redirect -- I will find another spot 6 because I think it's actually documented in there 7 twice. 8 Let's assume, ma'am, that's 138 pounds, okay. 9 When Mr. Wood was admitted to the facility, one of 10 the issues that you had discussed on your direct 11 examination was that he was placed on this 12 supplement, correct? 13 A. It was ordered when he first came, yes, sir. 14 Q. And at your deposition did you know whether or 15 not he was taking that supplement or refusing it? 16 A. Well, it was day number -- let me just -- 17 Q. My question, ma'am, at your deposition, did 18 you know -- 19 A. Let's look at when it was discontinued, sir, 20 because I believe it was discontinued. 21 Q. As you look for that, do you remember in your 22 deposition if you remembered whether he was taking it 23 or refusing it was the question that I asked you? 24 A. I think that he was not taking it at all times 25 but it was -- it was discontinued very shortly after 0021 1 he came because the dietician felt -- and she was 2 correct -- that he was eating well. 3 THE COURT: Hold on. Hold 4 it. Ask another question, please. Just 5 answer his questions. Go ahead. 6 BY MR. PRISLIPSKY: 7 Q. Let me try this again. 8 A. Go ahead. 9 Q. At your deposition, ma'am, do you remember 10 whether you knew whether he was taking the supplement 11 or not? 12 A. I think I testified that he was refusing some 13 of them. 14 Q. Really? Let's turn to your deposition. 15 A. But I don't remember. 16 Q. Turn to page 84 of your deposition. You have 17 it there, no? 18 A. Yes. 19 Q. Bottom of the page, line 23. Let me know when 20 you get there. 21 A. 84. 22 Q. Yes. 23 A. Got it. 24 Q. Question: All right. Did you see any 25 indications in the record of the patient, Mr. Wood, 0022 1 refusing the supplement? 2 Your answer, on the next page is what? 3 A. I don't recollect that. 4 Q. Have you looked at the chart since, ma'am? 5 A. I didn't look at that specifically, no. 6 Q. I got it for you. 2CalHN would be the 7 supplement, correct? 8 A. Correct. 9 Q. What do the circles mean? 10 A. Well, an R would mean refuse. A circle means 11 it wasn't given. 12 Q. Okay. 13 A. So we don't know what it means. 14 Q. Well, typically -- 15 A. Does it have -- does it say an R? It may have 16 an R in some of those circles. 17 Q. Take a look. Any reason -- 18 A. I'm sorry, can you discern an R? 19 Q. Well, a circle means it wasn't given for one 20 reason. 21 A. For whatever reason it wasn't given. It could 22 have been unavailable. 23 Q. Or maybe the staff -- those incredibly stupid 24 nurses -- didn't want to give it to him? 25 A. For some reason it wasn't given. It's not 0023 1 documented as to why. 2 Q. Did you look, ma'am -- let's assume, Mr. 3 Wood -- now, by the way, you did see in the medical 4 records that Mr. Wood, according to the 5 documentation, which was documented, was eating 80 6 percent of his meals at Harborside, correct? 7 A. As I said, he was eating very well at the 8 beginning. It kind of tapered off towards the end. 9 Q. And he was actually placed on Megace, right? 10 A. From the beginning. He was on that when he 11 came from the hospital, yes, sir. 12 Q. And Megace, for the benefit of the jury, is an 13 appetite stimulator? 14 A. Yes. 15 Q. All right. Did you look, ma'am, to see what 16 Mr. Wood weighed when he went to Parma? 17 A. Yes. 18 Q. What was it? 19 A. 100 -- I think it was -- excuse me, 147 or 149 20 pounds. 21 Q. 149. 22 A. Okay. 23 Q. See that? 24 A. 149. 25 Q. Did you see any evidence of weights in the 0024 1 interim when Mr. Wood was at Harborside? 2 A. Yes. 3 Q. And what were they? 4 A. Let me just get to that. 5 Q. I have it here. 6 A. Oh, thanks. Yeah, he started at 164. 7 Q. That's what the -- that's what the record 8 says, but we also said it's possible that that is 9 incorrect. True? 10 A. It's possible but not likely. But it's 11 what -- it's what they recorded, but then he has a 12 weight of 152 and then 154 as of 8/9 and then 149 13 when he gets to the hospital. 14 Q. So he goes from presumably at Marymount, if my 15 recollection of those records are accurate, from 138 16 to 164? 17 A. That's the weight that was recorded at your 18 facility, Harborside. 19 Q. Okay. And Miss Wood said that that weight is 20 actually wrong, correct? 21 A. She said -- and I tried to say this before -- 22 that his normal weight was about 150 pounds. 23 Q. Okay. About 150 pounds. So 152, 152, 154, 24 Parma about 150, right? 25 A. Right. 0025 1 Q. So his normal weight was about 150 pounds, and 2 these weights are accurate, did he have a significant 3 weight loss at Harborside? 4 A. Again, it's your documentation that says that 5 he weighed 164 pounds. 6 Q. Answer my question. If Miss Wood -- because 7 you put a lot of stock in what the family said. If 8 their testimony and recollection of 150 pounds is 9 accurate, did he have a significant weight loss at 10 Harborside? 11 A. According to your record, he had a significant 12 weight loss. 13 Q. Okay. 14 A. That's your record. 15 Q. I'm going to try this again. Try to bear with 16 me. We will get through this. 17 I want you to assume that Miss Wood, the wife. 18 A. Right. 19 Q. When she testified and what she has in the 20 records, that you're understanding, that his normal 21 weight is about 150 pounds; are you with me so far? 22 A. Right. 23 Q. Okay. 152.6. 154.2. Assume that to be 24 correct, what I just told you, did he have a 25 significant weight loss at Harborside? 0026 1 A. And again, according to the documentation in 2 the record he had a significant weight loss. That's 3 the record -- 4 Q. So -- 5 A. -- that I was given. 6 Q. So then, let me understand this. When Miss 7 Wood says that his normal weight is 150 pounds, you 8 disregard that? 9 A. Well, Miss Wood didn't have him on the scale. 10 Harborside did. 11 Q. I see. So she obviously didn't understand her 12 husband that she lived with for 40 some years. And 13 when she told the dietician that his normal weight is 14 150 pounds, she obviously didn't know that; is that 15 what you're saying? 16 A. I'm saying that Harborside had a weight for 17 him of 164 pounds when he entered the facility. We 18 are going by the documentation in your record. Are 19 you trying to tell me that that was wrong, that was 20 an error? 21 Q. Well, ma'am, what does that record say that he 22 said his normal weight is, Miss Wood? 23 A. She also states that he always weighs 147. 24 Q. Okay. So when he gets to Parma, he's actually 25 two pounds heavier than what Miss Wood said his 0027 1 normal weight is? 2 A. Let me back up for one second. 3 THE COURT: No, no, no. No 4 backing up. You have to answer his question. 5 A. I'm sorry, I'm reading what you gave me to 6 read. 7 Q. I understand that. 8 A. And -- 9 THE COURT: Ask it again. 10 BY MR. PRISLIPSKY: 11 Q. So when Mr. Wood gets to Parma, the weight of 12 149 -- 13 A. Yes. 14 Q. -- is actually more than what Miss Wood said, 15 correct? 16 A. Yes. That's correct. 17 Q. Typically, ma'am, most 87-year-old people who 18 have appetite issues, because he's on Megace, don't 19 eat three times a day at home, do they? 20 A. I have no way of telling you what Mr. Wood ate 21 at home or didn't eat. I can just tell what you the 22 record says. And the records, as I told you, from 23 Marymount shows that he -- he did suffer from a 24 little malnutrition, yes. 25 Q. That's not the question I asked you. I said 0028 1 typically, ma'am, 87-year-old people who are on 2 Megace because they have appetite difficulties 3 typically do not eat three meals a day at home? Can 4 you answer that? Maybe you can't. 5 A. That's a difficult question to answer. I 6 think I have already answered it. He may have eaten 7 six small meals a day at home. I don't have a record 8 of what he ate at home. 9 Q. Now, you did review the Parma hospital 10 records, correct? 11 A. Yes. 12 Q. What does the term cachectic 13 A. Severely protein malnourished. 14 Q. Did you see the physicians at Parma describe 15 Mr. Wood as being cachectic? 16 A. I didn't see that word being used, no. 17 Q. Well, when you talk about nutrition, nutrition 18 is important for a patient to fight off an infection, 19 correct? 20 A. Absolutely right. 21 Q. Metabolism is important to fight off an 22 infection, correct? 23 A. Absolutely right. 24 Q. The patient's thyroid level is important to 25 fight off an infection, correct? 0029 1 A. Yes, somewhat. I would say that nutrition is 2 a lot more important than that but -- nutrition is 3 number one, yes. 4 Q. Who was managing Mr. Wood's thyroid level? 5 A. I would assume his attending physician, his 6 primary care physician would be doing that. 7 Q. And a patient with a poor thyroid level 8 management may have difficulty fighting off an 9 infection, true, or recovering from an infection? 10 A. What -- what -- I'm trying to follow you, but 11 there's two types of thyroid problems. Hypothyroid, 12 hyperthyroid. In hypothyroidism you will see weight 13 gain. In hyperthyroid, you know, you're losing 14 weight. 15 THE COURT: Hold on a 16 second. Let's do a sidebar, okay. 17 MR. PRISLIPSKY: Yes. 18 (Thereupon, a discussion was had 19 between Court and counsel at 20 sidebar.) 21 THE COURT: Take a five 22 minute break. Don't talk about the case. 23 Don't form or express any opinion thereon. We 24 will come back at five till, five till 12. 25 It's just a quicky. You can't go down and see 0030 1 Marty. 2 Everybody rise for the jury. 3 (Thereupon, a recess was had.) 4 - - - - 5 THE COURT: Let's continue 6 with the cross. 7 MR. PRISLIPSKY: Okay, Your 8 Honor. 9 BY MR. PRISLIPSKY: 10 Q. Miss Darlington, at break I had an opportunity 11 to find yet another record of Mr. Wood's weight. I 12 highlighted the date for it. Can you read to the 13 jury the date of that record and what his weight 14 says? 15 A. 7/6/05, and the weight was 138 pounds. 16 Q. Okay. 17 A. Well -- pounds. 18 Q. So if we compare 7/6/05 before he gets to 19 Marymount and Harborside and compare Parma records of 20 149.6 when he's admitted to Parma, did his weight go 21 up or go down? 22 A. By comparison his weight went up. 23 Q. I was asking you before the break about 24 metabolic needs. Metabolic needs for a patient with 25 an infection are extremely important, correct? 0031 1 A. Correct. 2 Q. Dr. Arrabi was managing Mr. Wood's metabolic 3 needs by virtue of his thyroid, correct? 4 A. Correct. 5 Q. Did you recall anywhere in the Parma medical 6 records where any of the physicians discussed Dr. 7 Arrabi's management of Mr. Wood's thyroid? 8 A. I don't recall. 9 Q. The history and physical, now, that is a 10 document, a note that as soon as a patient is 11 admitted to the hospital, the history and physical is 12 prepared, correct? 13 A. Correct. 14 Q. And if I'm bouncing this up and down, let me 15 know. I don't mean to do that intentionally. August 16 12, 2005, correct? 17 A. Day he went in, correct. 18 Q. The dose -- talking about his thyroid. The 19 dose is too low for his metabolic needs and his TSH 20 is considerably elevated, 15.73 -- what is UGM? 21 Units? 22 A. Yeah. 23 Q. Per milliliter. In reality, he is only taking 24 a pediatric dose of Synthroid. Do you see that? 25 A. Yes. 0032 1 Q. You see that one of the diagnoses that the 2 physician made -- 3 A. Right. 4 Q. -- was hypothyroidism, poorly replaced. Do 5 you see that? 6 A. Right, yeah. 7 Q. Now, let me ask you some questions turning to 8 the next area. Electrolyte imbalance. You call it 9 dehydration. 10 A. Well, they go hand in hand, yes. 11 Q. So if somebody says electrolyte imbalance, 12 it's the same thing as dehydration? 13 A. Right. 14 Q. Now, Mr. Wood had a diagnosis of renal 15 insufficiency, fair? 16 A. Yes. 17 Q. And renal insufficiency means that his kidneys 18 aren't working properly? 19 A. Right. 20 Q. And the way that you as a nurse would know 21 that is even taking a snapshot at a patient's labs 22 the BUN which is blood urea? 23 A. Right. 24 Q. And creatine are going to be elevated? 25 A. Correct, slightly, yes. 0033 1 Q. In Mr. Wood's case frequently he was 2 hospitalized even prior to getting to Harborside for 3 increased BUN and creatine or dehydration, correct? 4 A. He was, yes. 5 Q. In fact, March 30, 2005, four months before he 6 was admitted to Harborside, he was found to have 7 renal failure and dehydration, correct? 8 A. Correct. 9 Q. Where was he on March 30, 2005, in terms of 10 where he was being cared for? 11 A. I think he was at home. 12 Q. You're not suggesting to this jury, are you, 13 that Mr. Wood's family neglected him, are you? 14 A. No. 15 Q. His BUN was 52 and his creatine was 2.7 at 16 home, correct? 17 A. Correct. 18 Q. Probably because of his kidney disease? 19 A. Correct. He had some chronic kidney disease, 20 that's correct. 21 Q. On July 6, 2005, a week before he was admitted 22 to the hospital, his BUN again was 52 and his 23 creatine was 2.6? 24 A. Correct. 25 Q. Again, dehydrated. 0034 1 A. Slightly. Well, it shows the renal failure. 2 Q. Where was he on July 6th, 2005? 3 A. Where was he? Marymount. 4 Q. No, I don't think he got there until the 13th, 5 ma'am. 6 A. Oh, so that must have been from at home. 7 Q. You're not suggesting to this jury, are you, 8 that his family dehydrated him? 9 A. No. 10 Q. July 14th, 15th, 16th, he was at Marymount, 11 correct? 12 A. Right, the 13th through the 16th. 13 Q. Right. His BUN was 40, 41, 40, 38, all 14 elevated, right? 15 A. Right. 16 Q. His creatine 2.4, 2.6, 2.4, 2.1, all elevated, 17 right? 18 A. Right. 19 Q. Now, when he was at Harborside -- you talked 20 about some of those records that he had and -- leave 21 that there for a moment. He was receiving fluids 22 through a number of different sources, correct? 23 A. When -- excuse me? 24 Q. At Harborside, ma'am. 25 A. At Harborside? 0035 1 Q. Yes. Let me ask you -- I will just go 2 specifically. 3 A. Yeah. I'm trying to follow you with this. 4 Q. He was getting fluids with every meal. 5 A. Right. 6 Q. Probably water and coffee, correct? 7 A. Right. 8 Q. He was also getting fluids with every med 9 pass? 10 A. Right. 11 Q. And he probably had a pitcher of water, 12 correct? 13 A. Probably. We generally keep a pitcher of 14 water at the bedside, yes. 15 Q. By the way, July 14th, BUN 44, creatine of 16 2.4, they actually had to call in a consultation 17 because of his dehydration and renal insufficiency, 18 correct? 19 A. Right. 20 Q. Now, did you take a look at the lab that was 21 drawn on Mr. Wood on August 11th and by comparison -- 22 so that we have this little board. August 11th, 23 drawn right here after all of this diarrhea, after 24 all of these issues and all of these documentation 25 problems that you discussed, did you take a look at 0036 1 the lab that was drawn at Harborside and specifically 2 look at the BUN and creatine? 3 A. Yes, I did. I don't recall it right now, but 4 I did look at that. 5 Q. Do you remember where it was in relationship 6 to where he was at home and where he was when he was 7 at Marymount? 8 A. I don't recall. 9 Q. Let's take a look. This is going to be a 10 challenge. Let me see if I can put it up on this 11 one. 12 A. That will work. 13 Q. Are you able to see that, ma'am? 14 A. Yes. 15 Q. Everyone able to see those numbers? 16 Obviously, the higher the BUN, the higher the 17 creatine, the worse the kidney function, true? 18 A. True. 19 Q. At home, BUN at 52, right? 20 A. Right. 21 Q. All through Marymount, BUN of 40, 41, 40, 38, 22 right? 23 A. Right. 24 Q. He even received additional IV fluids at 25 Marymount, right? 0037 1 A. Yes, he did. 2 Q. What was his BUN at Harborside on the 11th 3 after all of this diarrhea and all of these metabolic 4 problems and all of this malnutrition, was it any 5 different compared to when he was at home and where 6 he was at Harborside? 7 A. Pretty much the same. 8 Q. How about his creatine, ma'am? 9 A. It was 2.1 according to this record. 10 Q. At home, 2.6. At Marymount, in the middle of 11 getting IV fluids, 2.4, 2.6, 2.4, 2.1. Identical, 12 correct? 13 A. Correct. 14 Q. Now, I'm going to ask you to make an analogy. 15 Sodium, salt, correct? 16 A. Right. 17 Q. I want you to assume that you have water, 18 saltwater, okay? 19 A. Right. 20 Q. And if I take away water from that 21 concentration, sodium goes up? 22 A. Right. 23 Q. That's essentially what dehydration is? 24 A. One of the mechanisms, absolutely. 25 Q. So if a patient was truly dehydrated, you 0038 1 would expect the sodium level to go up, would you 2 not? 3 A. Yes. 4 Q. What was Mr. Wood's sodium level on August the 5 11th, 2005, one day before he was discharged from 6 Harborside? 7 A. 135. 8 Q. Absolutely normal. 9 A. Right on the -- absolutely. That's their 10 normal, 135 to 148. 11 Q. And ma'am, you, I take it, as a nurse, when 12 you see a resident or you see a patient, one of the 13 things you look at are signs and symptoms of 14 hypovolemia? 15 A. Right. 16 Q. Hypovolemia, for the benefit of the jury, is 17 another fancy way of saying dehydration? 18 A. Right. 19 Q. Lack of volume in the body, right? 20 A. Right. 21 Q. Body is a fascinating thing, isn't it? 22 A. Oh, yeah. 23 Q. Let's make another analogy. A hose, let's say 24 we have got water going through a hose, okay? Are 25 you with me? 0039 1 A. Right. 2 Q. Let's say we decrease the flow of that water. 3 Let's make it dehydrate. You're going to expect the 4 flow of that water, the pressure, to decrease? 5 A. Yes. Slightly, yes. 6 Q. Same thing with a patient. 7 A. Right. 8 Q. With hypovolemia or dehydration you expect 9 hypotension or low blood pressure, true? 10 A. Most of the time. 11 Q. And the heart will actually try to make up for 12 that low blood pressure by beating faster, correct? 13 A. Most of the time. 14 Q. So what you see with hypovolemia is low blood 15 pressure and tachycardia or high heart rate, correct? 16 A. Yes. 17 Q. When he got to Parma, did he have either low 18 blood pressure or tachycardia, ma'am? 19 Feel free to take a look at your records. 20 A. Thank you. 21 Q. Parma hospital. 22 A. Right. I've got that hospital record here. 23 Q. 99 over 45, 112 over 59, 94 over 53, 116 over 24 54, which was right within Mr. Wood's baseline, 25 wasn't it? 0040 1 A. I think at least the 116 over 54, the 112 over 2 59, yes, yes. 3 Q. And his pulse never reached above 100 even at 4 ED, correct? 5 A. Well, according to that record, yes. 6 Q. Okay. So when we look at this, this doesn't 7 show any objective signs of dehydration or 8 hypovolemia, correct, the vital signs? 9 A. I'll agree to that. 10 Q. Now, let's turn our attention to actually what 11 happened with Mr. Wood while he was at the nursing 12 home and let's now talk about some of those issues 13 that you discussed, communication, okay? 14 A. Okay. 15 Q. He was admitted to Harborside on July 16th? 16 A. Right. 17 Q. On July 17th, there was a call to a physician, 18 Dr. Klene, correct? 19 A. Right. 20 Q. He was covering for Dr. Arrabi, true? 21 A. Right. 22 Q. And the reason that call was made is because 23 the nurses were concerned about a possible pneumonia? 24 A. Correct. 25 Q. How did that happen? Not the pneumonia. How 0041 1 did they become concerned? 2 A. I believe he had a slightly elevated 3 temperature; and when they listened to his lung 4 sounds, he was a little decreased. 5 Q. What's that called when a nurse listens to the 6 lung sounds and checks the patient's temperature? 7 A. Assessing. 8 Q. Oh, okay. And they acted on that assessing 9 and they called Dr. Klene? 10 A. And they even really wrote a really good note 11 about it, too. 12 Q. And, in fact, ma'am, if we take a look at the 13 notes, we have physician's order -- and we discussed 14 physician's order. 15 A. Right. 16 Q. And actually, it says in the physician's 17 orders, Dr. Klene for Dr. Arrabi, doesn't it? 18 A. Right. Dr. -- I think his -- 19 Q. Klene? 20 A. You pronounce it Klene. Thank you. When you 21 said Klene it was confusing me. 22 Yes, yes. 23 Q. I understand. So the nurses assessed Mr. 24 Wood, determined what he had was potentially life 25 threatening, intervened on his behalf and called the 0042 1 doctor? 2 A. Correct. 3 Q. Excellent care? 4 A. Yes. 5 Q. Now, are you aware of what Dr. Weed said 6 yesterday about Mr. Wood's INR? 7 A. No. 8 Q. I want to you assume that Dr. Weed testified 9 that Mr. Wood's INR kept getting out of whack -- 10 A. Yes. 11 Q. -- because of his C. diff. Does that make 12 sense? 13 A. Yes. 14 Q. Did the nurses do not only a reasonable job, 15 but how about a fantastic job of communicating Mr. 16 Wood's INR to Dr. Arrabi? 17 A. Yes, they did that quite well, and they got 18 reciprocal orders from the doctor, order changes, et 19 cetera. 20 Q. And if there's a physician who would be 21 responsible for putting all of these pieces together, 22 the INRs related to C. diff, that would be Dr. 23 Arrabi, wouldn't it? 24 A. There are -- absolutely. He was the primary 25 physician. 0043 1 Q. All right. Let's look at all these. July 2 17th, 2005, day collected, there's a note indicating 3 that Dr. Arrabi was advised of that, correct? 4 A. Right. That is July 17th you said? 5 Q. Yes, ma'am. 6 A. Okay. 7 Q. July 18th, also communicated to Dr. Arrabi, 8 correct? 9 A. Right. 10 Q. July 22nd communicated to Dr. Arrabi, right? 11 A. Right. 12 Q. I'm not going to go through every one, but 13 would you be surprised to learn that there may have 14 been -- I don't know -- a dozen or so interactions 15 between the nurses and Dr. Arrabi concerning the INR? 16 A. No. That is very standard. Happens every day 17 in my nursing home and whenever anybody's on coumadin 18 and we are monitoring their PT and INR. 19 Q. Didn't slip through the cracks then, did it? 20 A. No. 21 Q. I want to now talk about on August 4th, bring 22 up Mr. Dickson's chart, and I promise I'm not going 23 to write on it. 24 On August 4th, ma'am, you're aware that Nurse 25 Groeschke saw Mr. Wood, correct? 0044 1 A. Yes. 2 Q. Why? 3 A. Pain in his arm. He had a history of deep 4 vein thrombosis in the right arm, and it was really 5 kicking up. He had quite a bit of pain in that arm. 6 So she saw him on that day for that. 7 Q. How did that happen? 8 A. The nurses told her about it, and the patient 9 told her about it. 10 Q. But how did the nurses find out about it? 11 A. He must have -- he was -- he really had a lot 12 of pain in that arm that he suffered from for quite a 13 long time. So I'm sure he told them and -- 14 Q. They assessed him? 15 A. They assessed him and told the nurse 16 practitioner that he had that complaint, yes. 17 Q. I didn't mean to cut you off. 18 And they communicated with him? 19 A. Right. 20 Q. And on August the 4th Miss Groeschke sees Mr. 21 Wood, correct? 22 A. Yes. 23 Q. Now, you told the jury earlier that kind of 24 once you smell C. diff you know it? 25 A. Oh, yes. 0045 1 Q. The smell lingers? 2 A. Well, sometimes, yes, it can. 3 Q. Any indication in Nurse Groeschke's progress 4 note, the nurse practitioner, that she noted any 5 indication whatsoever of C. diff on August the 4th? 6 A. Right. There is no -- no note, no indication, 7 not even anything about diarrhea. 8 Q. Let's jump ahead to August the 7th, 2005. 9 There is no doubt, ma'am, even looking at the medical 10 records -- and I understand your criticisms of the 11 records -- this is no doubt in your mind there was 12 communication between the nurses and somebody with 13 prescriptive authority regarding Mr. Wood's stool? 14 A. Correct. 15 Q. Now, you read Dr. Arrabi's notes -- or his 16 deposition, excuse me, correct? 17 A. Yes. 18 Q. Did he say that when a nurse calls him and 19 just says, You know what, Doctor, we have a patient 20 with diarrhea, he is going to ask a lot of questions? 21 A. I -- I honestly don't recall what he said 22 about that. 23 Q. I have it, ma'am. 24 A. It was awhile ago. 25 Q. You had asked about whether the stools are 0046 1 formed, whether they are large, whether he has 2 abdominal pain, abdominal distention, has he been 3 eating, is he on an antibiotic currently, would you 4 expect a nurse practitioner to ask those types of 5 questions? 6 A. Some of them, yes. 7 Q. The good ones. 8 A. Well, I would ask if the patient has been 9 having a history of diarrhea. 10 Q. And did you recall what Dr. Arrabi said he 11 would do on August the 7th, if he was given the full 12 picture of Mr. Wood about the fact that he hadn't 13 been on an antibiotic, hadn't spiked a high grade 14 fever, was having intermittent stools, no abdominal 15 pain, no abdominal distention, had been eating, do 16 you remember what he said about that, whether he 17 would think that that was C. diff or not? 18 A. I don't recall what he said. 19 Q. He said in his deposition, ma'am: I take it 20 if we add all of that to the scenario, you're really 21 not think being C. diff, are you? 22 And his answer was -- do you remember -- no. 23 Let's assume that a nurse practitioner or a 24 doctor is thinking about C. diff. On August 7th, Dr. 25 Weed testified this is when really somebody should 0047 1 have been really thinking about C. diff. You are 2 familiar with the standard of care of a nurse 3 practitioner, correct? 4 A. Yes. 5 Q. You were familiar with how the physicians at 6 your hospital -- excuse me, nursing facility, 7 operate? 8 A. Correct. 9 Q. 50 percent of your physicians want to get a 10 confirmation of C. diff before they start Flagyl, 11 correct? 12 A. I think I testified to that in my deposition. 13 I said that it depends on how they practice, 14 absolutely, and that some will start it right away 15 and some will wait for confirmation of the test. 16 Q. Because there are problems with giving 17 patients antibiotics who don't need them? 18 A. Right. 19 Q. And Flagyl -- I probably take it you have 20 never tasted? 21 A. No. 22 Q. Probably -- well, not even probably. I assume 23 as a nurse practitioner, very difficult for a patient 24 to tolerate? 25 A. Yes. 0048 1 Q. So many physicians reasonable -- excuse me. 2 Let's ask nurse practitioners. Many reasonably 3 prudent nurse practitioners will wait before they get 4 a confirmed C. diff test before they start Flagyl, 5 correct? 6 A. Absolutely. 7 Q. Did you read Dr. Weed's discovery deposition, 8 ma'am? 9 A. No, sir. 10 Q. Well, I want you to assume, here's what he 11 said in his deposition -- so you didn't read it at 12 all? 13 A. No, I don't -- I didn't list that one before. 14 Q. So the plaintiffs' infectious disease expert 15 who -- 16 A. Oh, did you say -- 17 Q. Dr. Weed, ma'am. Harrison Weed from Columbus. 18 A. Oh, yes, I did, I'm sorry. 19 Q. Do you remember when Mr. McLaughlin in his 20 deposition asked him about when was Mr. Wood passing 21 from the point of survival to the point of 22 non-survival; and he said in his discovery 23 deposition, I don't know whether it was the 10th or 24 the 11th when he passed, you know, what they call the 25 point of less likely to survive than more likely to 0049 1 survive, but somewhere in there. I don't know 2 whether it was the 10th or the 11th. 3 So let's assume that his accurate testimony is 4 what he said in his discovery deposition, not at 5 trial after I gave my opening statement. 6 Now, on the 7th, this is collected, the C. 7 diff, correct? 8 A. Correct. Well, no, the C. diff specimen, I 9 think it went on the 10th. It went to 10th. It was 10 ordered on the 9th. It was collected on the 10th. 11 Q. I'm giving you a hypothetical, I'm sorry. 12 A. Oh, you said let's assume, okay. 13 Q. Yes. Let's assume the 7th when Dr. Weed said 14 that really the C. diff should have been considered. 15 Let's assume on the 7th the test is ordered, correct? 16 A. Okay. 17 Q. Takes, at times, as Dr. Weed testified to, I 18 want you to assume, a day to collect the sample, 19 fair? 20 A. Sometimes, yes. 21 Q. Takes us to the 8th, right? 22 A. Right. 23 Q. It's not a stat test like a blood test that 24 you -- 25 A. No. It takes a while, yeah. 0050 1 Q. Two days, maybe three days? 2 A. Yeah. 3 Q. So I want you to assume, ma'am, that it takes 4 three days for that test to come back from the 8th to 5 the 9th to the 10th to the 11th. 6 A. Okay. 7 Q. If Dr. Weed said clearly by the 11th, if he's 8 started on treatment, it's too late, you can't 9 disagree with that, can you? 10 A. I don't -- I don't -- I didn't disagree with 11 that and didn't even speak to that issue in my 12 report. 13 Q. And if he's accurate in his discovery 14 deposition when he said I can't even tell you if it 15 would have made a difference on the 10th, let's 16 assume it only takes two days to come back. 17 A. Right. 18 Q. You can't disagree with that either, can you? 19 A. No. 20 Q. Final issue, ma'am. 21 You have read the testimony of the family 22 members? 23 A. Yes, sir. 24 Q. It is your impression -- or is it your 25 impression that while Mr. Wood was at Harborside he 0051 1 had unrelenting diarrhea for that last week? 2 A. I didn't get that impression. I got the 3 impression that the diarrhea started on August 1st 4 and continued through the 12th. 5 Now, I got the impression from reading Mrs. 6 Wood's deposition that there were days in that time 7 period when he had quite a bit of diarrhea, but she 8 didn't say it was like every day, you know, where it 9 was 10 or 12 bowel movements. 10 Q. Did you get the impression from Miss Wood's 11 deposition testimony and her daughter's that Mr. Wood 12 frequently would have to lay in his stool for 13 extended periods of time? 14 A. I don't remember that honestly. 15 Q. I want you to assume that that may be the 16 testimony of some of the family members. 17 A. Okay. 18 Q. Ma'am, with infectious diarrhea that is not 19 attended to for extended periods of time that goes on 20 over and over and over and over, that nobody changes 21 him, what are you concerned about as an expert and as 22 a nurse? 23 A. I'm concerned about skin breakdown, 24 absolutely. 25 Q. Did you happen to take a look at the Parma 0052 1 hospital records when Mr. Wood was admitted to the 2 emergency department about his skin? 3 A. His skin was intact. 4 Q. And they checked him head to toe, did they 5 not? 6 A. Oh, yes, they did. 7 Q. Parma hospital: Skin, warm and try. No 8 evidence of rash, decubiti or lesions. What does 9 lesions or decubiti mean, ma'am? 10 A. Skin breakdown. Nothing noted. 11 Q. Explain how that happens. Let me ask -- 12 sorry, I didn't mean to interrupt up. 13 Let's assume you have a patient who has 14 diarrhea as we know he does. 15 A. Right. 16 Q. We know that he has had it now for 6, 7 days. 17 How does that patient go to the hospital with clean 18 intact skin with no breakdown, no redness, nothing? 19 How does that happen? 20 A. I will tell you. The CNAs took really good 21 care of this man. They kept him clean. They kept 22 him dry. And that -- that was good. I wasn't 23 critical of that at all. 24 Q. Great care, correct? 25 A. Right, right. They -- the CNAs really kept on 0053 1 top of that. 2 Q. And the nurses have to keep on top of the CNAs 3 to make sure their patients -- their residents who 4 live there are clean, dry, kept free from stool, all 5 of that, correct? 6 A. Correct. 7 Q. Those incredibly stupid nurses did their job 8 and prevented him from getting a breakdown, did they 9 not? 10 A. Well, I think it was more the CNAs, and I give 11 them a lot of credit. They have a difficult job. 12 MR. PRISLIPSKY: Thank you, ma'am 13 I don't have any other questions. 14 THE WITNESS: Okay. 15 (End of requested portion.) 16 17 18 19 20 21 22 23 24 25 0054 1 C E R T I F I C A T E 2 I, Robert P. Lloyd, Official Court 3 Reporter for the Court of Common Pleas, 4 Cuyahoga County, Ohio, do hereby certify that 5 as such reporter I took down in stenotype all 6 of the proceedings had in said Court of Common 7 Pleas in the above-entitled cause; that I have 8 transcribed my said stenotype notes into 9 typewritten form, as appears in the foregoing 10 Partial Transcript of Proceedings; that said 11 transcript is a partial record of the 12 proceedings had in the trial of said cause and 13 constitutes a true and correct Partial 14 Transcript of Proceedings had therein. 15 16 17 18 19 ---------------------------- 20 Robert P. Lloyd, RMR, CRR Official Court Reporter 21 Cuyahoga County, Ohio 22 23 24 25