1226 1 IN THE CIRCUIT COURT OF THE NINTH JUDICIAL CIRCUIT IN AND 2 FOR ORANGE COUNTY, FLORIDA 3 LAWRENCE M. DESTEFANO, 4 Plaintiff, 5 vs. CASE NO.: 48-2000-CA-007265-O 6 ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE 7 CORPORATION; ADVENTIST HEALTH SYSTEM/SUNBELT, INC.: ROLLINS 8 BEDFORD CORPORATION, d/b/a Sunbelt Healthcare & Subacute 9 Center; SHCC SERVICES, INC., and ORLANDO REGIONAL 10 HEALTHCARE SYSTEM, INC., 11 Defendants. 12 ------------------------------------------------------ 13 VOLUME X 14 The transcript of the proceedings held on 15 Thursday, October 20, 2005, beginning at 8:50 o'clock 16 a.m., at the Orange County Courthouse, Orlando, Florida, 17 Courtroom 19-D, before the Honorable Renee A. Roche, 18 Judge of the Circuit Court. 19 A P P E A R A N C E S: 20 WILLIAM G. OSBORNE, ESQUIRE 21 538 East Washington Street Orlando, Florida 32803 22 For the Plaintiff. 23 24 25 CENTRAL FLORIDA REPORTERS, INC. 1227 1 A P P E A R A N C E S: - CONT. 2 BRADLEY CONWAY, ESQUIRE 390 North Orange Avenue, Suite 3 Orlando, Florida 32801 4 For the Plaintiff. 5 TRACY MARSHALL, ATTORNEY and DYANA PETRO, ATTORNEY of 6 Gray Robinson, P.A. 301 East Pine Street, Suite 1400 7 Orlando, Florida 32801 8 For the Defendant/Adventist. 9 LARRY J. TOWNSEND, ESQUIRE and DAVID EVANS, ESQUIRE of 10 Mateer and Harbert, P.A. 225 East Robinson Street, Suite 500 11 Orlando, Florida 32801 12 For the Defendant/ORHS. 13 14 15 16 17 18 19 20 21 22 23 24 25 CENTRAL FLORIDA REPORTERS, INC. 1228 1 I N D E X - VOLUME X 2 TESTIMONY OF FRANCES WIEGAND 3 Direct Examination by Mr. Osborne 1229 Cross Examination by Ms. Marshall 1258 4 VIDEOTAPED DEPOSITION OF JOHN STEELY, M.D. 5 Direct Examination by Mr. Glick 1268 6 7 E X H I B I T S 8 Plaintiff's Exhibit Nos. 10 and 11 1229 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 THE COURT: Be seated, please. Mr. Osborne, CENTRAL FLORIDA REPORTERS, INC. 1229 1 call your next witness. 2 MR. OSBORNE: Plaintiff calls Frances Wiegand. 3 Your Honor, I'd like to move into evidence 4 Plaintiff's A, which is a trespass order, and also 5 Plaintiff's B, which is the Florida Hospital 6 records, which are stipulated in is my 7 understanding. Right, Counsel? 8 MR. TOWNSEND: Yes. 9 MS. MARSHALL: That's correct. No objection. 10 MR. TOWNSEND: No objection, Your Honor. 11 THE COURT: It would be admitted. 12 THE CLERK: 10 and 11, Plaintiff. 13 THE COURT: 10 and 11 for Plaintiff. 14 (Plaintiff's Exhibit Nos. 10 and 11 were 15 marked into evidence.) 16 FRANCES WIEGAND, 17 having been first duly sworn testified as follows: 18 THE COURT: State your name and spell your 19 name for the record, please. 20 THE WITNESS: Frances Wiegand, W-i-e-g-a-n-d. 21 THE COURT: Thank you. 22 DIRECT EXAMINATION 23 BY MR. OSBORNE: 24 Q Good afternoon, Ms. -- is it Wiegand? 25 A Um-hum. Yes. CENTRAL FLORIDA REPORTERS, INC. 1230 1 Q Thank you. In 1999 you worked for Florida 2 Hospital in risk management, didn't you? 3 A Correct. 4 Q And in terms of the -- in terms of the 5 corporations I've set forth in this document, corporate 6 structure, which entity did you work for? 7 A Adventist Health Systems. 8 Q Okay. So it would be the one with the 9 Dr. Black and Dr. Steely on it, the Adventist Health 10 Systems Sunbelt, Inc., Florida Hospital? 11 A Adventist Health Systems. 12 Q Okay. You're up on -- above that? 13 A With the -- Sunbelt with the Florida Hospital. 14 Q All right. So just so we're clear then in 15 terms of this corporate structure, you were on the 16 second tier down here, and you were an employee of 17 Adventist Health Systems/Sunbelt, Florida Hospital? 18 A Florida Hospital, correct. 19 Q Thank you. You can understand why somebody 20 would be confused about the corporate structure within 21 the Adventist Health System, correct? 22 MS. MARSHALL: Objection, speculation. 23 THE COURT: Sustained. 24 MR. OSBORNE: I'll withdraw the question. 25 BY MR. OSBORNE: CENTRAL FLORIDA REPORTERS, INC. 1231 1 Q You held that position in risk management 2 since 1985, correct? 3 A Yes. 4 Q You started in -- when you started with 5 Florida Hospital, you were in risk management and 6 patient relations, correct? 7 A Yes. 8 Q Your title in 1999 was risk management 9 coordinator? 10 A Yes. 11 Q Currently you work in risk management at 12 Winter Park Hospital? 13 A No. 14 Q Well, that's -- you obviously have been 15 updated since the time of your deposition then, correct? 16 A Yes. 17 Q Where do you work now? 18 A I'm at Florida Hospital Orlando, risk 19 management systems coordinator. 20 Q Okay, thank you. In risk management, you do 21 get involved with any incident where there is a claim or 22 a potential claim against the hospital or its related 23 entities, correct? 24 A Do you want to restate that? 25 Q Yeah. I'm talking about just what you do as a CENTRAL FLORIDA REPORTERS, INC. 1232 1 risk manager. You get involved where there's an 2 incident or a claim or a potential claim against the 3 hospital or related entities to Florida Hospital, 4 correct? 5 A To Florida Hospital? 6 Q To Florida Hospital. 7 A Yes. 8 Q All right. Just so I'm clear, you get 9 involved where there's an incident or a claim or 10 potential claim against Florida Hospital? 11 A Yes. 12 Q Okay. And I'm really again going back to the 13 time period 1999. That would have been true for that 14 time period as well, correct? 15 A Yes. 16 Q You were Florida Hospital's risk manager? 17 A One of them. 18 Q One of them? Okay. When you investigated 19 claims, you would take statements from witnesses from 20 time to time? 21 A You mean talk with the witnesses? 22 Q Take statements from people that are involved 23 in claims or potential claims? 24 A Yes. 25 Q Okay. You would review medical records? CENTRAL FLORIDA REPORTERS, INC. 1233 1 A Yes. 2 Q Talk with the staff involved? 3 A Yes. 4 Q Talk with the patient involved? 5 A Yes. 6 Q Your testimony in this case, Mrs. Wiegand, is 7 that you did not personally perform an investigation 8 into the truth of the allegations made against Larry 9 Destefano, correct? 10 A Yes, correct. 11 Q But you were involved in some aspects of the 12 situation? 13 A Could you restate that? 14 Q You were involved in some aspects of the 15 situation? 16 A That's too vague for me. 17 Q Pardon? 18 A I'm not sure what you mean by the situation. 19 Q Okay. The situation, meaning the allegations 20 that were made against Larry Destefano in September of 21 1999. You were involved in some aspects of that 22 situation? 23 MS. MARSHALL: Objection, vague. 24 THE COURT: Overruled. You can answer if you 25 can. CENTRAL FLORIDA REPORTERS, INC. 1234 1 A What do you mean by involved? 2 Q You did some things, you performed some acts 3 in relationship to the allegations that were made 4 against Larry Destefano? 5 A That's not clear enough for me to answer. 6 Q Pardon? 7 A That's not clear enough for me to answer. 8 Q Okay. Well, do you recall -- I'm going to ask 9 you to look at page 17 of your deposition, and this was 10 in regard to Mr. Destefano's case. And just look at 11 page 17, lines two through five, and see if that can 12 refresh your memory about what involvement -- I think I 13 was using your word. 14 A Do you want me to read it? 15 Q No, just read it to yourself and see if that 16 refreshes your memory about what I'm asking you about 17 being involved in this -- in some aspects of this 18 investigation. Didn't you in fact say that in your 19 deposition? 20 A I'm stating here that the Department of 21 Children and Family Services was involved in an 22 investigation. 23 Q All right. Let me take a look. Here's the 24 question. "Do you know in -- risk management did 25 perform such an investigation?" Answer, "I was involved CENTRAL FLORIDA REPORTERS, INC. 1235 1 just in the pieces I was involved with." Now, that's 2 you, isn't it? 3 A Correct. 4 Q Okay. So you were involved with some -- I'm 5 going to -- we're going to go through what those pieces 6 were, but you were involved with some pieces of the 7 investigation that you were involved with in this 8 matter, correct? 9 MS. MARSHALL: Objection, mischaracterizes the 10 testimony. 11 THE COURT: Overruled. 12 BY MR. OSBORNE: 13 Q I'm not trying to fight you on this. I'm just 14 trying to get through some background facts here. 15 A Right. To me it's unclear where you're going. 16 Q Well, let me be more specific and you'll know 17 exactly where I'm going. On September 24th, 1999, you 18 had a meeting with Larry Destefano? 19 A Yes. 20 Q You were involved at that point at least in 21 some part of this investigation because you had a 22 meeting with Mr. Destefano, correct? 23 A With him and several others. 24 Q Also in that meeting was Dr. Black? 25 A Yes. CENTRAL FLORIDA REPORTERS, INC. 1236 1 Q And Dr. Gramlich? 2 A Yes. 3 Q And the purpose for the meeting was to discuss 4 a plan of care for Mr. Destefano's mother and to obtain 5 consent for a blood transfusion she needed? 6 A Correct. 7 Q Had you previously been in contact with both 8 DCFS and the hospital attorneys that day to determine if 9 DCFS had intervened and could grant such consent? 10 A Yes. 11 Q Okay. You say that Dr. Black and Dr. Gramlich 12 asked for the meeting to obtain consent for a blood 13 transfusion? 14 A They asked for a meeting to obtain it, yes. 15 Q And it's the physician's and the hospital's 16 responsibility to obtain consent from the 17 legally-authorized person before you do a blood 18 transfusion, correct? 19 A The physician is to provide informed consent 20 to the legally-authorized person. 21 Q Right. And you knew Mr. Destefano was the 22 legally-authorized person to get consent for a blood 23 transfusion? 24 A Yes. 25 Q Okay. Now, this consent for blood transfusion CENTRAL FLORIDA REPORTERS, INC. 1237 1 is a very important issue, isn't it, to have consent? 2 A Yes. 3 Q All consents for treatment are important -- 4 bless you. All consents for treatment are important, 5 but consent for a blood transfusion is more -- is 6 separately important because the hospital has a separate 7 form for that, don't they? 8 A Yes. They have a separate form that the 9 legally-authorized person or the patient would sign. 10 Q Because there are risks involved when you have 11 a blood transfusion, aren't there? 12 A According to the literature. 13 Q And there could be -- I mean, you have the 14 potential for tainted blood, contaminated blood, so you 15 really want to make sure that the legally-authorized 16 person has given you consent before you transfuse blood 17 into someone who's not able to give consent themselves, 18 correct? 19 A I lost your question in that. 20 Q That was a long question, wasn't it? 21 A Um-hum. 22 Q You've already agreed with me that, that blood 23 consent is special because there are risks involved with 24 someone getting blood, correct? 25 A There's benefits and risks involved. CENTRAL FLORIDA REPORTERS, INC. 1238 1 Q I'm just asking you about the risks. Are 2 there risks involved? 3 A Yes. 4 Q And you need to have a consent because of 5 those risks, correct? 6 A We ask for a consent on any blood transfusion. 7 Q Now let me show you -- I'm going to show you 8 what's in evidence as Plaintiff's 10. And I'm going to 9 tell you that these are the records of the -- both 10 hospitalizations of that hospital involving 11 Mrs. Destefano. And I'm going to help you out a little 12 bit and give you a -- I'm going to find that consent 13 form for you. 14 MS. MARSHALL: There was a question about 15 whether your exhibits had the whole Florida 16 Hospital records, and I don't know if she'll need 17 anything, but I've had the Clerk pull ours that had 18 been marked and she may want to refer to those. 19 It's Defendant's Exhibit X. 20 MR. OSBORNE: I'm only going to show her two 21 documents, and I have them pulled separately. 22 MS. MARSHALL: Okay. 23 MR. OSBORNE: She can have them if she wants 24 to, but I'm not going to ask her to look at it. 25 BY MR. OSBORNE: CENTRAL FLORIDA REPORTERS, INC. 1239 1 Q Let me show you what is a part -- what I think 2 you'll recognize to be a part of the charting regarding 3 the blood consent, the blood transfusion consent form. 4 What's the date of this consent form? 5 A The 9/24/99. 6 Q And it was signed by Mr. Destefano as POA, 7 power of attorney, on 9/24/99, correct? 8 A Slash sign. 9 Q Slash sign, correct. And it was -- what was 10 the time of the signing? 11 A 2140. 12 Q And give us that in non-military time. 9:40 13 in the evening? 14 A Yes. 15 Q Okay. 16 A P.m. 17 Q Correct. Isn't it true, Mrs. Wiegand, that at 18 the time that you -- well, let me ask this first. You 19 were there when this consent was signed? 20 A Yes. 21 Q Okay. Isn't it true that at the time this 22 consent was requested that the hospital had already 23 given Ms. Destefano a transfusion of two units of blood 24 without any consent being found or obtained? 25 A I'd have to look at the medical record. CENTRAL FLORIDA REPORTERS, INC. 1240 1 Q Let me give you another part of the medical 2 record to look at. Take a look at those pages. And do 3 you recognize those pages to be a part of the hospital 4 charting of 9/24/99? 5 A Yes. 6 Q And even though it's hard to read, you can 7 tell from looking at -- these are basically nurse's 8 notes of -- indicating a blood transfusion on this first 9 page, correct? 10 A Correct. 11 Q And it's hard to read the first one. I'll 12 represent to you it's 0200, but we can read 0200 and the 13 corresponding time there, can't we, about a blood 14 transfusion? Take a look at the 0200 and just publish 15 for the jury what that says. 16 A It's the very top one where there's a hole, it 17 looks like 2400. 18 Q Look at the one we can read. Just look at 19 0200 there. 20 A 0200? 21 Q Correct. Read what it says there. 22 A Second unit of RBCs infusing. 23 Q And what are RBCs, red blood cells? 24 A Um-hum. 25 Q What's the next page say, 0400? CENTRAL FLORIDA REPORTERS, INC. 1241 1 A Second unit RBCs. 2 Q Now, just so we're clear, 0200 is 2:00 o'clock 3 in the morning on the 24th? 4 A Incorrect. 5 Q What's the date of that? 6 A It starts at 2400. It's dated 9/24. When 7 it's 2400, we would use 9/24, and then it goes over to 8 9/25. It would be 9/25 at 0200. 9 Q Each of these pages, ma'am, is marked on the 10 bottom of it 9/24/99, correct? 11 A Correct. 12 Q And if you look at the last page on this 13 document, you'll find a 1640 entry, won't you, where it 14 says risk management working on getting consent for 15 blood? Do you see that? 16 A Correct. 17 Q Now, that is 1640 on 9/24/99, correct? Look 18 at the bottom of the page. 19 A It would be the first page. That's before 20 this other page because on 2400 it says please see 21 supplemental notes, and that would match the 2400. 22 These are not stapled in correct order. 23 Q Each of these is dated 9/24/99, is it not, 24 ma'am? 25 A Correct, but 9/24 is at 0 -- at -- where it CENTRAL FLORIDA REPORTERS, INC. 1242 1 says 1640, that would be the 24th at 1640. At 2400 it 2 says please see supplemental nursing notes, and that's 3 9/24 at 2400. You have them stapled in the wrong order. 4 The first stapling should have been the one that 5 said -- there's a -- where somebody had put their three 6 pages through. So the first sheet -- you have them in 7 the wrong order. Do you want -- you must have given me 8 the last page first. 9 Q Take a look in the hospital records there and 10 see what order they're in there. 11 A This page is before that one. But oftentimes 12 when they make copies of the record, because the sheets 13 are together, they would put the supplemental -- it 14 being in front of this wouldn't mean anything. 15 Q That's in the same order in that file as it 16 is -- 17 A Right, it wouldn't mean anything. It's not in 18 the right order. Also, you want to look at the blood 19 transfusion form. Do you have a blood transfusion 20 consent, not the consent the blood transfusion form, in 21 here? 22 Q It should be in here. 23 A It is dated 9/24, first unit of blood. And 24 this is what's -- this is what's on the blood, unit of 25 blood, it comes with it. And it shows that this was at CENTRAL FLORIDA REPORTERS, INC. 1243 1 2230 on the 24th they started administering it because 2 they actually do the times. You know, you monitor the 3 patient. First unit of blood and then the second unit 4 of blood on 9/25, 0200, which matches -- the 0200 is the 5 second unit of blood. 6 So the patient received the first unit of 7 blood on 9/24 at 2220 is when they verified, you know, 8 'cause we have to go through the verification process to 9 make sure the right patient, right blood. And then it 10 was started at 2230. 11 Q Okay. 12 A And then it was the second unit, 0200. So the 13 supplemental notes match this. Because at 2400 on 9/24 14 is her supplemental note and it would be 9/24. They 15 would not cross out 9/25 and put 9/25 so this all 16 matches. 17 Q You can understand my confusion by looking at 18 the page, though, can't you? 19 A Oh, sure. 20 Q Okay. 21 A If you just assume that the record was on that 22 order. 23 Q Okay. Thank you, ma'am. 24 A See, the blood transfusion was given after the 25 blood consent. CENTRAL FLORIDA REPORTERS, INC. 1244 1 Q I stand corrected. Thank you, ma'am. 2 Let's go back about your risk management 3 duties. In terms of getting this blood transfusion, did 4 you have any discussion with Mr. Destefano about these 5 allegations that had been made against him? 6 A Ask me that one more time. 7 Q At the time that you had this meeting with 8 Mr. Destefano, did you have any discussion about the 9 allegations that had been made against him at Sunbelt? 10 A Mr. Destefano brought that up in the meeting. 11 Q Didn't he ask you that he wanted you to 12 investigate those allegations? 13 A No. 14 Q At any time did Mr. Destefano ever ask you 15 that -- ask you to investigate the allegations that were 16 made against him by the Sunbelt employees? 17 A No. 18 Q You never had a meeting with him where he 19 actually just asked you to please investigate these 20 allegations to determine if they were true or false? 21 A No, because I don't have jurisdiction over 22 what occurs at Sunbelt. 23 Q Okay. 24 A And I explained that to him. 25 Q After that meeting with Mr. Destefano, you CENTRAL FLORIDA REPORTERS, INC. 1245 1 discussed this matter, his situation with someone in 2 leadership, within leadership position with Sunbelt, 3 didn't you? 4 A I passed a message per his request. 5 Q You do know who Dr. John Steely is, don't you? 6 A Know him? I've heard of him, if that's what 7 you mean. 8 Q You in fact tried to contact him on the 24th 9 of September regarding obtaining a consent for the blood 10 transfusion, didn't you? 11 A Correct. 12 Q Trudy Stebilla was also -- was the risk 13 management coordinator at that time, wasn't she? 14 A Yes. 15 Q The Destefano -- now I'm saying it. The 16 Destefano case was mainly her responsibility, but you 17 were helping her out with this, correct? 18 A She was unavailable at that time. And when 19 there was a, you know, request to determine who could be 20 the legally authorized person to make consent, I was the 21 one that assisted with that. 22 Q You had contact with Mr. Destefano on several 23 occasions during 1999 and 2000, did you not? 24 A Contact? 25 Q Just where you would see him and talk to him. CENTRAL FLORIDA REPORTERS, INC. 1246 1 A Out on the street? 2 Q Yes, ma'am, where he was picketing. 3 A Yes. 4 Q And he was never rude to you, was he? 5 A No. 6 Q You never remember him being rude to anybody, 7 do you? 8 A No. 9 Q When his mother came back to Florida Hospital, 10 there was a sitter with Mrs. Destefano at all times, 11 wasn't there? 12 A I can't speak on that there was a sitter at 13 all times. 14 Q Do you remember giving this testimony at page 15 49 of your deposition, line two through six, please? 16 A Yes. 17 Q So does that refresh your recollection that 18 there was a sitter with his mother? 19 A There was a sitter in the room the day I was 20 there. 21 Q Okay. 22 A And I can only speak to the day I was there. 23 Q Okay. 24 A Your question was too general. 25 Q Thank you. In fact, he asked you about it, CENTRAL FLORIDA REPORTERS, INC. 1247 1 about the sitter being in the room, didn't he, why do I 2 have a sitter in my mother's room? 3 A Yes. 4 Q The sitter was there to monitor his 5 interaction with his mother, wasn't the sitter? 6 A That's not what I said. 7 Q Pardon me? 8 A That was not what I said. 9 Q If the sitter's not there to monitor someone's 10 behavior, why do you have a sitter at all? 11 A Well, the sitter is there for different 12 reasons, sometimes patient's safety. If a patient has a 13 tendency due to their diagnosis, we sometimes have them 14 there if they're a potential for falling. There's 15 different reasons. There's multiple reasons we would. 16 Q Do you know what the diagnosis was for this 17 entry? There were two diagnoses for this entry at this 18 hospitalization. One was Alzheimer's and the other one 19 was to protect family member. 20 If that was the diagnosis, that sitter was 21 there to protect Mrs. Destefano from her son, isn't that 22 true? 23 MS. MARSHALL: Objection, lack of foundation. 24 THE COURT: Sustained. 25 BY MR. OSBORNE: CENTRAL FLORIDA REPORTERS, INC. 1248 1 Q I'm going to read to you -- publish to you 2 from the document you've got in front of you here, first 3 of all from the progress notes at the admission. 4 Patient admitted to ORMC. Seen there for evaluation of 5 questionable sexual abuse regarding son with mother. 6 Then on the admit note on the order sheet it 7 says admit to Florida Hospital. Diagnosis, protection 8 from family members, Alzheimer's. Do you want to look 9 at these to confirm that? First page and the second 10 page. 11 A That's what's written ordered by a physician 12 or by someone whose handwriting I can't read. 13 Q That's usually the case, correct? 14 A I can't tell who signed this. 15 Q Okay. Thank you. So you would agree with me 16 that -- and the second -- the next thing on here is -- a 17 part of the order sheet is an order for one-on-one 18 sitter, is that correct? 19 A That is what's on the order sheet. 20 Q Okay. Also talks about HRS consult for 21 clarification of guardian status, correct? 22 A That's what's written on the order sheet. 23 Q So you would agree with me that the reason 24 that the sitter was in there was to protect 25 Mrs. Destefano from her son, correct, according to these CENTRAL FLORIDA REPORTERS, INC. 1249 1 records? 2 A I did not see where there was an order for 3 protection against son. 4 Q Well, it said here patient admitted from ORMC. 5 Seen there for evaluation of questionable sexual abuse 6 between son with his mother. And then we've got a 7 diagnosis of protection from family members, and then 8 we've got a one-on-one sitter. 9 If you read all that together, there's only 10 one conclusion you can draw, isn't there, that the 11 sitter was there to protect Ms. Destefano from her son, 12 isn't that true? 13 A You'd have to defer to the physician who wrote 14 that order. 15 Q You've been a how-many-year risk manager with 16 Florida Hospital? 17 A 20 years. 18 Q And you can't deduce from that document after 19 20 years of experience as a risk manager that -- putting 20 that together that Florida Hospital had the sitter in 21 there to protect her from her own son? 22 A It says it was a one-to-one sitter there. 23 Q You would agree with me that the conclusion -- 24 the only conclusion you can draw was that sitter was 25 there to protect the patient from her own son? CENTRAL FLORIDA REPORTERS, INC. 1250 1 A The order says one-to-one sitter and does not 2 give the purpose. As a risk manager, I don't jump to 3 conclusions if it's not written in an order. 4 Q The sitter was in there because of the 5 allegations made to DCFS, isn't that correct? 6 A The sitter was in there for allegations. 7 Q Because of the allegations made by Sunbelt to 8 DCFS? 9 A I can't speak to that. 10 Q Well, let me ask you if you remember this 11 question and answer at page 50 of your deposition on May 12 28th, 2003. Question, "Okay. Now, when he -- what did 13 he say? Did he say why is there a sitter in the room?" 14 Answer, "Yeah, just asked." Question, "What did you 15 say?" Answer, "I said because -- for safety sake. 16 She's Alzheimer's and also because DCFS is involved." 17 Do you recall that testimony? 18 A Yes, I do. 19 Q Is that still your testimony today? 20 A Yes, it is. 21 Q And you knew DCFS was called because of 22 allegations made about Mr. Destefano being sexually 23 inappropriate with his mother, don't you? 24 A There was allegations. 25 Q Okay. We can agree that the sitter was not CENTRAL FLORIDA REPORTERS, INC. 1251 1 there at Mr. Destefano's request, can't we? 2 A Yes, we can agree with that. 3 Q We can agree that the sitter was not there 4 with his consent, can't we? 5 MS. MARSHALL: Objection, lack of personal 6 knowledge. 7 THE COURT: Sustained. 8 BY MR. OSBORNE: 9 Q In fact, he asked you about it, and you told 10 him the sitter would be there at all times, didn't you? 11 A That's what the order said, one-to-one sitter. 12 So according to the order, and we carry out the 13 physician's orders, yes. 14 Q The sitter was there to monitor his 15 interaction with his mother? 16 A I would not say that. 17 Q During the entire second hospitalization of 18 Mrs. Destefano at Florida Hospital, this sitter was in 19 the room at all times when Mr. Destefano was there, 20 correct? 21 A I can only speak to the time when I was 22 involved. 23 Q Okay. Well, if that order was carried out, 24 that would be the case, wouldn't it? 25 A If there's a physician's order there, it would CENTRAL FLORIDA REPORTERS, INC. 1252 1 be followed. 2 Q So he would not have had one moment of privacy 3 with his mother the entire time she was in the hospital 4 if that order was followed, correct? 5 A I can't really speak to that. 6 Q Did you know that even when the doctors said 7 it was okay for Mr. Destefano to take his mother in a 8 wheelchair to the garden, that the sitter was with him 9 at all times? 10 A According to the order, it says one-to-one 11 sitter. 12 Q Okay. Let me ask you to see if you can find 13 the document, if you don't mind me showing you. I think 14 I saw it on top of one of these exhibits. This document 15 right there. Before we get to this document, you've got 16 the file in front of you. 17 MR. OSBORNE: And I'll be glad to bring out 18 the other document if you'd like, Ms. Marshall, so 19 she can have both of them there to look at your 20 copy of the records. 21 BY MR. OSBORNE: 22 Q But taking a look at that document, can you 23 find -- the entire hospital document, if you -- can you 24 find a consent for treatment by Mr. Destefano for the 25 hospitalization that began on the September 22nd? CENTRAL FLORIDA REPORTERS, INC. 1253 1 A You mean look through the medical record? 2 Q Yes, ma'am. Can you see if you can find a 3 consent for that? And keep the other documents separate 4 that I gave you so we can talk about that next. 5 A How can I assure -- 6 MS. MARSHALL: Objection, Your Honor, 7 relevancy. 8 THE COURT: Let's get -- let's get a question. 9 Have you asked a question? 10 MR. OSBORNE: I did. I asked a question. 11 THE COURT: Okay. Well, no, you didn't. You 12 said can you see if you can find a consent, and 13 keep the document separate so that we can talk 14 about it next. 15 MR. OSBORNE: All right. Let me ask a 16 question. 17 BY MR. OSBORNE: 18 Q Isn't it true that Larry Destefano never 19 signed a consent for the hospitalization of September 20 22nd? 21 A I can't speak -- 22 MS. MARSHALL: Objection, relevancy. 23 THE COURT: Where are you going with this? 24 MR. OSBORNE: Just one question. We've been 25 talking about consents for blood transfusions. Now CENTRAL FLORIDA REPORTERS, INC. 1254 1 we're talking about if he even consented for 2 treatment to occur in the hospital. 3 THE COURT: Sustained. 4 BY MR. OSBORNE: 5 Q You can stop looking, ma'am. You're not aware 6 of any allegations of sexual or physical abuse by 7 Mr. Destefano upon his mother at Florida Hospital, are 8 you? 9 A I'm not aware of any allegations? 10 Q I'll do it again. You are not aware of any 11 allegations of sexual or physical abuse by Mr. Destefano 12 upon his mother while she was at Florida Hospital? 13 A While she was at Florida Hospital? 14 Q Correct. 15 A You mean while she was a patient, that there 16 was an allegation that abuse occurred while -- as an 17 in-patient at Florida Hospital? 18 Q Either. 19 A I want to be real clear. 20 Q Yeah, either sexual or physical abuse. 21 A While an in-patient? 22 Q While an in-patient. 23 A That occurred during that time frame? 24 Q I think that's what I'm saying. 25 A No. CENTRAL FLORIDA REPORTERS, INC. 1255 1 Q Okay. You're not aware of any allegations 2 that Mr. Destefano poured water down his mother's 3 throat? 4 A No. 5 Q That he forced her to walk? That he forced 6 her to walk? 7 A No. 8 Q That he kneed her in the back? 9 A No. 10 Q That he caused her dress to go come off by 11 dragging her around the room? 12 A No. 13 Q And you don't recall meeting with Dr. Steely 14 where these type of allegations I just mentioned to 15 you -- that you were at a meeting with Dr. Steely where 16 these things were discussed, were you? 17 A No. 18 Q Do you know Dr. Milhone (ph)? 19 A Dr. Milhone? 20 Q Do you know who that is? 21 A That name sounds familiar. 22 Q He was the director of the family residency 23 program back in 1999. 24 A I can't say if he was there at that time or 25 not. CENTRAL FLORIDA REPORTERS, INC. 1256 1 Q I want you to find the letter that I showed 2 you, the, the one you got right in front of you there. 3 This is a letter signed by Dr. Steely. And it's a to 4 whom it may concern letter dated September 22nd, 1999. 5 Just take a look at that, and I want to ask you if 6 you've ever seen that before? 7 A Not prior to my deposition. 8 Q Okay. Not prior to your deposition? Did you 9 go with the director of the family residency program, 10 Dr. Milhone, to see Dr. Steely on September 22nd, 1999? 11 A No. 12 Q Did you and Dr. Milhone ask or tell Dr. Steely 13 to write this to whom it may concern letter? 14 A No. 15 Q Did you ask Dr. Steely to make notations in 16 this letter that Mr. Destefano would place his knees in 17 his mother's back? 18 A No. 19 Q That he would pull her arms upwards so she 20 would stand? 21 A No. 22 Q That he continuously put water in her mouth 23 until she began to gag? 24 A No. 25 Q And he would literally drag his mother for a CENTRAL FLORIDA REPORTERS, INC. 1257 1 walk until she became exhausted and the heel ulcer began 2 to bleed? 3 A No. 4 Q You're absolutely sure about all that? 5 A Yes, I'm sure. 6 Q Did you ever have this document in your hand 7 before your deposition where you actually saw it? 8 A The attorneys showed it to me. 9 Q I mean before your deposition. 10 A No. 11 Q Okay. Do you have any idea how this document 12 was transferred from Dr. Steely over to Sunbelt? 13 A No. 14 Q Do you have any -- taking a look at the fax at 15 the top there, do you have any idea about who faxed this 16 document from Sunbelt? 17 A No. 18 Q Do you know that fax number to be the DCFS fax 19 number in the upper right? 20 A No. 21 Q If Dr. Steely were to testify to the contrary, 22 that indeed you were there with the director of the 23 family residency program when this letter was dictated, 24 would he be just wrong? 25 A He would be wrong. CENTRAL FLORIDA REPORTERS, INC. 1258 1 Q Are there two Frances Wiegands at Florida 2 Hospital risk management? 3 A No. 4 MR. OSBORNE: Thank you. No further 5 questions. 6 THE COURT: Cross, Ms. Marshall? 7 - - - - - 8 CROSS EXAMINATION 9 BY MS. MARSHALL: 10 Q Good afternoon, Ms. Wiegand. What does a 11 sitter do? 12 A A sitter sits and observes the patient. 13 Q Do they interfere with any contact between the 14 patient and a family member? 15 A No, they would just sit there and observe a 16 patient. 17 Q Do they talk to them or tell the family member 18 what they can and can't do? 19 A No. 20 Q Okay. So they just kind of sit quietly in the 21 corner and observe? 22 A Yes. If the patient was like trying to get up 23 out of the bed, they would let the nurse know. 24 Q With an Alzheimer's patient, is it uncommon to 25 have a sitter in the room? CENTRAL FLORIDA REPORTERS, INC. 1259 1 A No, not if they're at risk for trying to get 2 up. 3 Q Okay. During the, the brief contact that you 4 had with Mr. Destefano, did he have any other complaints 5 other than the fact that there was a sitter in the room 6 that you can recall? 7 A He complained that he was accused of kissing 8 his mother. 9 THE COURT: Is that -- excuse me. 10 BY MS. MARSHALL: 11 Q Did he ever -- 12 THE COURT: You need to speak up for the jury 13 just a little bit. 14 THE WITNESS: I'm sorry, can you hear me? 15 THE COURT: Because I know if I'm having 16 trouble hearing you, they might be also. Speak up. 17 A He mentioned in our meeting that he had been 18 accused of kissing his mother. And he complained when 19 we were in the room that the bed was too low and he had 20 a hard time bending over to give her a kiss. 21 Q Okay. And there was a -- why was the bed in a 22 low position? 23 A If she got up, it's better to be very low 24 'cause then it prevents injury, you know, if you're on 25 the low position. It's a fall prevention intervention CENTRAL FLORIDA REPORTERS, INC. 1260 1 we have, you know, for patients who have Alzheimer's and 2 others who try to get up. 3 Q And just to be ultra clear on those nursing 4 notes, is it fair to say that the page one on September 5 19th -- or September 24th, 1999, is -- the one that says 6 patient notes at the bottom, page one, is that correctly 7 read as page one? 8 A You mean page -- I'm sorry, I don't see page 9 numbers. 10 Q Well, when you're looking at patient notes for 11 September 24th, 1999, do you start with the one that 12 says patient notes? 13 A You mean the one that's the 2400, 0200 one? 14 Q The one that is -- that just says patient 15 notes at the bottom, that doesn't say supplemental 16 patient notes. 17 A Oh, right. You mean like -- okay. This says 18 1400, 1640, that one -- 19 Q Yes. 20 A -- 1800? Yes. 21 Q That's page one? 22 A Yes. You would assume it's page one 'cause 23 you don't number number one. 24 Q And then you go to the supplemental patient 25 notes, correct? CENTRAL FLORIDA REPORTERS, INC. 1261 1 A Correct. 2 Q And then at the end of this -- and actually at 3 the end on the one that says patient notes, it says see 4 supplemental nursing notes, correct? 5 A Right, yes, 2400. 6 Q And then you go to the next -- the next 7 supplemental patient notes, and it says please see 8 supplemental nursing notes, page two? 9 A Correct, page two. 10 Q And then you go to the last page, and that's 11 when the blood transfusion is -- or the second 12 transfusion is starting? 13 A Yes, yes, 0400. It follows the time frame, 14 0200, 0400. 15 Q Just tell us in general, how do nurses chart? 16 A Nurses chart -- we have eight-hour and 12-hour 17 shifts. And the nurses will chart -- let's say if you 18 come in like at 7:00 p.m. or -- 7:00 p.m. if you're on a 19 12-hour shift, 11:00 p.m. if you're on an eight-hour 20 shift, they would chart that day the 24th. 21 Q So in the middle of the night they're charting 22 for the previous day? 23 A And it would keep on that date. It's -- the 24 7:00 a.m. shift, that's when they change the date at 25 that time. Take, for example, the 24th. The 7:00 a.m. CENTRAL FLORIDA REPORTERS, INC. 1262 1 shift would start dating it the 25th. 2 Q So instead of the time changing at midnight, 3 they change it at 7:00 a.m.? 4 A Right. And they just keep the hours going so 5 you know that the 24th -- and you just keep watching the 6 hour time, right. They don't all of sudden mark it out 7 'cause half the time your notes will have the before 8 midnight, the after midnight and that would be 9 confusing. 10 So they put, you know, between -- when they 11 come off their shift time, and then they just keep it 12 going. So it's 7:00 a.m. when you'll see the date 13 change, and it's consistent throughout the day. 14 Q Okay. How many years have you been working at 15 Florida Hospital? 16 A 20 years. 17 Q And has most of that time been spent in the 18 risk management department? 19 A Yes, it has. 20 Q Are you the person at Florida Hospital that 21 has been at risk management the longest? 22 A Yes, I have. 23 Q Okay. And do people at Florida Hospital 24 associate you with the risk management department? 25 A Yes, they do. They always think of Frances. CENTRAL FLORIDA REPORTERS, INC. 1263 1 Q When people say risk management, they think of 2 Frances? 3 A Correct. 4 Q From looking at Mrs. Destefano's charts, from 5 both her first visit and her second visit, can you tell 6 which floor she was on? 7 A The first visit or the second visit? 8 Q Both. 9 A Okay. Well, I remember her being on the ninth 10 floor during the second visit when I was there on the 11 24th. She was admitted the -- this is the second chart, 12 pardon me. 13 Q Well, let me just ask you, you remember that 14 she was on the ninth floor the second time she came 15 back? 16 A Yes, yes. 17 Q And how -- from a risk management standpoint, 18 how do you divide up your duties? 19 A We divide up by service lines and by nursing. 20 Each risk manager is assigned two nursing units. 21 Take -- for example, I was assigned and I covered the 22 labor and delivery areas, the mom and baby program, and 23 the neuro ICU. ICU and the brain attack program, that 24 was my main areas that I covered. 25 Q From 1999? CENTRAL FLORIDA REPORTERS, INC. 1264 1 A Um-hum. 2 Q In 1999 who was the risk manager that covered 3 the ninth floor? 4 A The ninth floor, that's the med/surg line. 5 That would have been Trudy Stebilla. 6 Q Okay. Now, if you were called regarding a 7 patient who is not on one of your floors, what would you 8 do with that phone call? 9 A Because I was there so long, they'd always 10 call and ask for Frances regardless. And so I would say 11 what floor are they from, and then I would transfer it. 12 Because we had a list of who was assigned to what, so I 13 would transfer it. I would say what floor is the 14 patient on? I would transfer to the risk management 15 coordinator who was actually assigned to that floor. 16 Q Did you ever talk to Dr. Steely regarding 17 Mrs. Destefano? 18 A He called one time. It was several months 19 later. And I said, you know, where had the patient 20 been? And I transferred it to Trudy Stebilla. 21 Q Now, if there is -- well, let me just ask you 22 this. How does risk management differ from case 23 management? 24 A Okay. Risk management deals with, I know this 25 sounds general, identifying risks, which means we deal CENTRAL FLORIDA REPORTERS, INC. 1265 1 with preventing medical errors. We deal with patient 2 safety initiatives to make sure the patient, you know, 3 receives good care and the right medicine, you know. 4 And we also deal with consent issues, to make 5 sure according to Florida law that the consents are 6 being done appropriately, have the right person sign the 7 consents and end-of-life issues. 8 Q And what do case managers do? 9 A Case management, their big focus is discharge 10 planning. And they deal with any family issues, any 11 social issues, any economic issues. Because sometimes 12 when a patient comes in, they become debilitated for 13 whatever, their disease diagnosis, and they have to deal 14 with that. 15 They deal with -- whenever there's any family 16 discord or there's dysfunction or there's just not the 17 resources there for the patient, they work on all those 18 issues. 19 Q Okay. If there was a concern that a family 20 member, caregiver didn't have the experience or the 21 knowledge to care for a patient who was going to be 22 discharged, who would get involved in that? 23 A Case management would. 24 Q Okay. You said that you dealt with the -- 25 getting the consent form for the -- or getting the CENTRAL FLORIDA REPORTERS, INC. 1266 1 consent signed by Mr. Destefano for the transfusion, is 2 that correct? 3 A I'm sorry, one more time. 4 Q You dealt with getting the consent? 5 A Yes. 6 Q Was that a problem? 7 A It was a problem, meaning to get it -- well, 8 the question was who could sign the consent form because 9 they said DCFS was involved. And so we just needed 10 clarity if the next of kin -- or, you know, that 11 Mr. Destefano still had the ability to sign for consent 12 or if DCFS had taken over temporary guardianship. So 13 they called for clarification. 14 Q Okay. During this time period where was 15 Mr. Destefano? 16 A He was outside picketing. 17 Q Okay. So you couldn't just go in to -- once 18 you figured that out, that it was him that had to sign 19 it, did you just go in Mrs. Destefano's room and ask him 20 to sign it? 21 A He wasn't in the room. 22 Q Okay. What did you have to do? 23 A I called the Family Health Center, and my 24 understanding Dr. Steely was on. So I called and 25 Dr. Steely had -- was already off service so -- CENTRAL FLORIDA REPORTERS, INC. 1267 1 Dr. Black was covering, so I spoke to Dr. Black about 2 needing to obtain informed consent. He needed to speak 3 with Mr. Destefano and discuss benefits and risks of 4 blood transfusion and he would do that. 5 And so he was picketing, you know, that 6 afternoon. So we set up a meeting right around 7:00 7 o'clock for the physicians to meet with Mr. Destefano on 8 the ninth floor. 9 Q So you had to wait until he got done picketing 10 for the day before you could have that meeting? 11 A Correct. 12 MS. MARSHALL: Okay. I have no further 13 questions. 14 THE COURT: Mr. Townsend? 15 MR. TOWNSEND: No questions, Your Honor. 16 THE COURT: Redirect? 17 MR. OSBORNE: None, Your Honor. 18 THE COURT: Ma'am, thank you very much. 19 You're excused. Mr. Osborne, call your next 20 witness. 21 MR. OSBORNE: I call Dr. John Steely by 22 videotaped deposition. 23 THE COURT: And how long is this deposition? 24 MR. OSBORNE: An hour and 31 minutes. 25 THE COURT: We will not complete this, but we CENTRAL FLORIDA REPORTERS, INC. 1268 1 will get started. 2 MS. MARSHALL: Your Honor, I think the rest of 3 the videos are a little better edited. That one 4 was difficult. 5 THE COURT: Let's hope so. 6 (Whereupon the videotaped deposition of Dr. 7 John Steely was played for the Jury.) 8 JOHN STEELY, M.D., 9 having been first duly sworn testified as follows: 10 DIRECT EXAMINATION 11 BY MR. GLICK: 12 Q Good afternoon, Doctor. Could you please tell 13 us your name and your business address for the record, 14 please? 15 A Sure. My name is Dr. John Hugh Steely. And 16 my office address is 515 Lauchwood, L-a-u-c-h-w-o-o-d, 17 Drive, Laurinburg, North Carolina, 28352. 18 Q And what is your specialty, Doctor? 19 A Family practice. 20 Q Have you ever practiced medicine at Florida 21 Hospital in Orlando, Florida? 22 A Yes, during my training period. 23 Q And when was that? 24 A From August of '99 to June of 2002. 25 Q So you started there in August of 1999? CENTRAL FLORIDA REPORTERS, INC. 1269 1 A Yes, I think. 2 Q Doctor, let's -- I want to ask you some 3 questions now. You are represented at this deposition 4 by Tracy Marshall of the Gray, Robinson firm, is that 5 accurate? 6 A Correct. 7 Q And it is my understanding that you no longer 8 work at Florida Hospital? 9 A That is correct. 10 Q The place you work at now, is that an 11 Adventist Health System hospital? 12 A No. 13 Q In preparation for this deposition, did you 14 have the opportunity to speak with Mrs. Marshall? 15 A A couple -- a few times, yes. 16 Q And on those few occasions, about how long in 17 total would you say you spent with Mrs. Marshall in 18 preparing for your testimony here today? 19 A I met with her briefly yesterday for about an 20 hour, and then I have had a few phone calls that lasted 21 just a few minutes. I don't know the exact number or 22 the extent of how long the conversations lasted. 23 Q What is your -- what are the terms of your 24 engagement or your fee arrangement with Mrs. Marshall? 25 A I think it's all covered through the Adventist CENTRAL FLORIDA REPORTERS, INC. 1270 1 Health System since this occurred during while I was in 2 their employment. 3 Q Do you feel that you have an allegiance to 4 them? 5 A I mean, they were the one that provided my 6 training for my residency program so -- 7 Q Do you feel you owe them something? 8 A I don't know if I necessarily owe them 9 anything. I mean, I worked very long hours as a 10 resident for them for basically nominal fees. But they 11 did offer my training so that I could obtain my 12 certification and my necessary training. 13 It is kind of like an alma mater school, sure. 14 But I guess as much as you would owe your law school or 15 wherever you did your first year, an allegiance like 16 that. 17 Q All right. Do you -- are you here today 18 obviously to testify, and you've been asked to be here 19 today, but you obviously want to help the Adventist 20 Health Systems in this case? 21 A I, I just want to answer that, you know, I 22 have a deposition that I have to testify to. That's all 23 I really want to do. 24 Q All right. Now, during September of 1999 at 25 Florida Hospital, at that time you were a first-year CENTRAL FLORIDA REPORTERS, INC. 1271 1 resident, is that correct? 2 A An intern, uh-huh. 3 Q First-year intern as opposed to first-year 4 resident? 5 A Well, as an intern, basically it's the same 6 thing, but for certain -- for most primary cares there 7 are other specialty places, especially surgery. They 8 require you to do an internship, and then they may have 9 a four or five-year residency program, but a first 10 year -- I was in my first-year residency. 11 Q And I think you told us earlier in the 12 deposition you started in August of 1999. So at the 13 time that Mrs. Destefano was in the hospital, you had 14 been there about a month? 15 A Yeah, a month. Yeah, correct. 16 Q And as the first-year resident, there are 17 people that you work under, is that correct? 18 A Correct. 19 Q There would be a senior resident? 20 A Correct. 21 Q Who was at that time Dr. Ronald Black? 22 A I believe so. 23 Q And there was an attending physician? 24 A Correct. 25 Q And who was that, if you remember? CENTRAL FLORIDA REPORTERS, INC. 1272 1 A I believe it was Maneush Manicheri. 2 Q Would there be anybody else on your team or 3 would those be your only two supervisors? 4 A Those would be my only two supervisors. There 5 was another intern, but I don't remember who it was. 6 Q Okay. But he or she would be -- 7 A Equal to me. 8 Q -- equal to you, parallel to you? Okay. And 9 as a first-year intern or resident, how many hours would 10 you work a day? 11 A A day? 12 Q During a 24-hour period, what would you 13 average, or a week, however you can best quantify it. 14 A Well, depending on call, probably a 12-hour 15 day. And then you would have a call where you would be 16 there the rest of the night up until afternoon the 17 following day, and that would probably occur once or 18 twice a week. So within a week's period, if I didn't 19 have the weekend probably 75, 80 hours. 20 Q And at that time were you married? 21 A Yes. 22 Q And did you have any children at that time? 23 A No. 24 Q Do you have children now? 25 A I do. CENTRAL FLORIDA REPORTERS, INC. 1273 1 Q And how many children do you have now? 2 A Two. 3 Q And -- okay. 4 A You're talking about when I was a first-year 5 resident intern? 6 Q Yes, a first-year intern. 7 A Yeah, I didn't have any children. 8 Q Was your wife pregnant at that time or -- 9 A No. It was during the deposition that she was 10 pregnant. 11 Q All right. Now, you obviously -- well, let me 12 ask you this question. I'm not sure it's obvious. Do 13 you recall Carolina Destefano? 14 A I recall -- I mean, faintly, but I don't have 15 a real recollection. I mean, I reviewed my testimony. 16 I just remember that she just looked younger than what 17 her age was. That's about what all I remember. 18 Q Do you remember she was a very ill woman with 19 Alzheimer's disease? 20 A Correct, yes. 21 Q And as part of your duties as a first-year 22 resident, you did provide care to her and treat her as a 23 doctor? 24 A During her hospitalization, yes. 25 Q That was the September 15th to the 19th CENTRAL FLORIDA REPORTERS, INC. 1274 1 admission of 1999? 2 A I -- actually I didn't take care of her over 3 the weekend. 4 Q Okay. 5 A Just during the week. I had the weekend off. 6 Q But during that -- 7 A Hospitalization. 8 Q -- hospitalization? And it's my understanding 9 that was the only admission that you saw her on? 10 A Correct. 11 Q All right. And, Doctor, by the way, we have 12 here on the table here, we have the Florida Hospital 13 records, which is the grey or light blue binder there, 14 right there. We have the Sunbelt Nursing Home records. 15 We have the Department of Children and Family Service 16 records, and we have the depositions of Dr. Black, 17 Frances Wiegand and Kendra Blythe, who we believe was 18 the short-haired, short red-haired nurse that you were 19 referring to. By the way, did you ever determine that 20 that was Kendra Blythe? 21 A I don't know. 22 Q Doctor, during that admission of September 23 1999, did you ever personally witness, with your own 24 eyes witness Larry Destefano abuse his mother? 25 A No. I think I testified in the last CENTRAL FLORIDA REPORTERS, INC. 1275 1 deposition. 2 Q And if you did, you would have reported that 3 to the Department of Children and Family Services? 4 A Correct. 5 Q Did you ever witness Mr. Destefano personally 6 engage in rough behavior with his mother? 7 A No. 8 Q Did you ever witness Mr. Destefano do any of 9 these acts towards his mother? Did you ever witness 10 Mr. Destefano knee his mother in the back, place his 11 knee in his mother's back? 12 A No. 13 Q Did you ever witness Mr. Destefano drag his 14 mother across the room or the hallway? 15 A No. 16 Q Did you ever witness Mr. Destefano either 17 force feed or force water or another liquid down his 18 mother's mouth or throat? 19 A No. 20 Q As a matter of fact, you never witnessed 21 Mr. Destefano act inappropriately towards his mother in 22 any way while in your presence? 23 A Correct. 24 Q All right. Now, Doctor, there came a time 25 after Mrs. Destefano was transferred to Sunbelt Nursing CENTRAL FLORIDA REPORTERS, INC. 1276 1 Home that you had occasion to draft a letter which was 2 labeled Exhibit 82 in Mr. Destefano's deposition, and 3 we've already had it marked as Exhibit No. 1 to your 4 deposition. 5 Do you have that in front of you, right, 6 Doctor? 7 A Correct. 8 Q And I'm going to ask you at this time if you 9 could go ahead and read the letter. 10 A Okay. I first came into contact -- 11 Q Look, look, before you even get to that, 12 Doctor, the top -- and I realize that there is -- part 13 of this is faint, but I believe the top says to whom it 14 may concern? 15 A I believe so. 16 Q Can you tell me why it was that you addressed 17 it that way? 18 A They just -- they had asked me to write a 19 letter on -- and I didn't really have any specifics on 20 what I was writing the letter for. They just said they 21 needed a letter of what I had seen or what had been told 22 to me while I was caring for her. So I didn't know 23 anybody to make it out to specifically. 24 Q Okay. Again, this Frances Wiegand, she was 25 risk management for who? CENTRAL FLORIDA REPORTERS, INC. 1277 1 A Florida Hospital. 2 Q All right. That was your understanding? 3 A That was my understanding. 4 Q Okay. Go ahead, Doctor. 5 A Okay. R-e, I guess I'm not sure what the 6 first word is. It just says Carolina Destefano. 7 Q Right. 8 A September 22nd, 1999. I first came into 9 contact with Ms. Destefano and her son on her admission 10 to Florida Hospital on September 15th, 1999. Her son 11 had several questions regarding quality of life, 12 prognosis and treatment for Alzheimer's disease, power 13 of attorney and euthanasia. We discussed these matters 14 to satisfaction at the time. I informed the son that 15 euthanasia is illegal in the state of Florida. 16 Q Let me stop you there, Doctor. Mr. Destefano 17 didn't want his mother euthanized, did he? 18 A Correct. 19 Q Okay. He did not, in other words? 20 A Right, he did not. 21 Q Okay. Go ahead. 22 A Okay. It is illegal in the state of Florida. 23 His major focus issued on the quality of life for his 24 mother as an Alzheimer's patient and wanting to follow 25 her living will. I ordered that Hospice be involved, as CENTRAL FLORIDA REPORTERS, INC. 1278 1 well as the chaplain service in this discussion. As 2 part of the Hospice evaluation, I believe wound care 3 specialists examined and began treating her for two 4 perianal and left heel decubitus ulcers. 5 Mr. Destefano wanted to make it explicitly 6 clear that she had already developed these lesions while 7 in the care of the State of Arizona. During the eight 8 months he cared for her in Arizona, he did everything in 9 his power to make these ulcers heal. He asked if I 10 would write this in her chart so that no one would be -- 11 Q Suspicious? 12 A I can't really read that. -- him abusing her. 13 Q At this time, do you have a firm recollection 14 of Mr. Destefano asking you that, to write it in the 15 chart so that no one would be suspicious of him abusing 16 her? 17 A No, I don't. 18 Q Okay. Please read on, Doctor. 19 A Over the next two days, Mrs. Destefano's 20 condition improved. I assured Mr. Destefano he could 21 something -- 22 Q Leave to find housing? 23 A -- to find housing for them. Several of the 24 nursing staff reported that Mr. Destefano was 25 interfering with his mother's care and that the care he CENTRAL FLORIDA REPORTERS, INC. 1279 1 provided seemed inappropriate. They could not say it 2 was, something, abuse, but perhaps that son did not 3 know. 4 Q Is that flagrant abuse? 5 A I can't make any words out to be honest. 6 Q Okay. 7 A Nevertheless, I wrote an order that the son 8 not participate in care unless directed and educated by 9 nursing and physical therapy. Some examples reported 10 that he would place his knee in her back and pull her 11 arms upwards so that she could stand continuously. 12 Q Inserted? 13 A I don't know, something to her mouth until she 14 began to gag so that she would reflexively swallow and 15 would literally -- 16 Q Drag? 17 A -- something his mother to walk until she 18 became exhausted and her heel ulcer began to bleed. I 19 cannot in good faith -- I don't know what that word is, 20 that Mr. Destefano abuses his mother. However, in my 21 dealings with him in regarding her care with him, 22 Mr. Destefano appeared angry and defensive. 23 Q And is that your signature at the bottom of 24 the letter? 25 A I believe so. CENTRAL FLORIDA REPORTERS, INC. 1280 1 Q Okay. It says, sincerely, John H. Steely, 2 M.D.? 3 A And Family Practice. 4 Q Florida Hospital Family Practice Residency? 5 It is clearly typed John H. Steely, M.D., but my 6 question to you is are you certain that this is your 7 signature on there? 8 A It looks like my signature. 9 Q Okay. Do you remember signing the letter? 10 A I remember signing the letter. 11 Q But it seems to me, Doctor, that you're not 12 absolutely certain today that that's your signature. 13 A Well, that's my signature. 14 MS. MARSHALL: Object to the form. 15 BY MR. GLICK: 16 Q Okay. You're sure of that? 17 A I'm sure. 18 Q Okay. All right. Now, the letter is dated 19 September 22nd, 1999. Is that the date that you wrote 20 the letter? 21 A I don't remember. 22 Q Okay. Well, it certainly had to be on that 23 date or some date after. You wouldn't have written it 24 before September 22nd, 1999? 25 A Correct. There seems to be a date stating CENTRAL FLORIDA REPORTERS, INC. 1281 1 that it was faxed on September 24th so -- 2 Q Yeah. And I want to ask you some questions 3 about that, Doctor. Now, at this time, September 22nd, 4 1999, let's see, she was in Florida Hospital from 5 September 15th to September 19, 1999. So on September 6 22nd, she would not have even been in Florida Hospital 7 anymore? 8 A Correct. 9 Q And she would not have been a patient of 10 yourself? 11 A Correct. 12 Q As a matter of fact, at that time, Doctor, she 13 had already left Sunbelt Nursing Home? 14 A I don't know. 15 Q She was in Sunbelt the 19th, the 20th and the 16 21st? 17 A I don't know. 18 Q Is this even part of your medical record, this 19 letter? 20 A I don't know. I was just -- I was asked by my 21 program director and someone from risk management to 22 write this letter of what I had seen but without any 23 really specifics on what it was for. 24 Q Okay. And the program director was who? 25 A Richard Milhone. CENTRAL FLORIDA REPORTERS, INC. 1282 1 Q Now, when we took your deposition the first 2 time, did you -- you told us somebody from risk 3 management asked you to write this letter. You didn't 4 mention Dr. Milhone. 5 A Right. 6 Q And why was that? 7 A I may have not remembered. 8 Q All right. And, Doctor, if at any time you 9 want to look in the medical record, it's the closest 10 binder to you on the table. It's just a few feet away. 11 Please feel free to look in the record. 12 A Okay. 13 Q Doctor, did you of your own free volition 14 write this letter of September 22, 1999, which has been 15 marked as Exhibit 1? 16 A I'm sorry, can you repeat that again? 17 Q Yes. Doctor, of your own free volition, did 18 you write this letter? 19 A This letter marked -- 20 Q As Exhibit 1. 21 A Yeah, I was asked to write this letter. 22 Q Okay. And when you say asked, by Frances 23 Wiegand and Mr. -- Dr. Milhone? 24 A Correct. 25 Q Was it more of an order than a request? CENTRAL FLORIDA REPORTERS, INC. 1283 1 A Yes. They asked me to just write a letter. I 2 don't remember actually being ordered. They just asked 3 me to write a letter. I did it because I really didn't 4 know what the context of writing the letter at the time 5 was. 6 Q Okay. Did you feel that as a first-year 7 resident, only being on the job for about a month or so, 8 that if the -- if a person from risk management at 9 Florida Hospital and Dr. Milhone -- what was his 10 position again, Dr. Milhone? 11 A He was the director. 12 Q All right. The director of the program that 13 you were in, right? 14 A Correct. 15 Q If they asked you to do something, then you 16 had better do it? 17 A Correct. 18 Q And I think you've already told us in this 19 deposition, at that time all you recall them telling you 20 was write a letter about what you observed with Larry 21 Destefano and his mother? 22 A Correct. 23 Q They didn't tell you that there had been any 24 allegations about Mr. Destefano at that time or 25 anything -- or anything un -- or anything unfavorable CENTRAL FLORIDA REPORTERS, INC. 1284 1 about Mr. Destefano? 2 A Yes, not that I recall. 3 Q Okay. Is it possible that they told you some 4 more things but you just don't remember them at this 5 time? 6 A Like I said, I believe I wrote the letter just 7 out of general context because I was asked to do so. I 8 didn't know the context of why, and I didn't know that 9 she had been discharged from Sunbelt at the time. 10 Q Okay. Well, I mean, she was -- okay. Well, 11 she was -- 12 A Because he just told me when she got out, I 13 remember. 14 Q All right. Now, I'm still somewhat puzzled, 15 Doctor, as to -- I understand why you wrote the letter. 16 I mean, somebody had told you to write it so you wrote 17 it, right? 18 A Correct. 19 Q What I'm trying to understand is at that time 20 Mrs. Destefano was no longer a patient of yours, she was 21 no longer a patient of Florida Hospital's, and do you 22 know what the reasoning was for risk management having 23 you write that letter? 24 A No. 25 Q I realize you were only a first-year resident, CENTRAL FLORIDA REPORTERS, INC. 1285 1 but didn't you -- weren't you somewhat curious? Didn't 2 you want to ask them, you know, why am I writing this 3 letter? 4 A Yes, I was curious, but I was a first-year 5 resident. I had been there maybe, you know, two months. 6 I surely didn't want to stir any waves or tell my 7 residency program director or people who were in charge 8 of the hospital, no. 9 Q Now, did before -- well, let me ask you this. 10 Did you personally type this letter, the Exhibit 1, the 11 September 22nd, 1999 letter? 12 A I don't remember. 13 Q All right. Do you remember if you -- 14 A Either I or my wife may have typed it for me. 15 Q Okay. All right. 16 A Or not my wife, I think I typed it myself. 17 Q Okay. And did you prepare -- was this a final 18 draft? I mean, were there drafts of the letter before 19 or did you just type this right out just like this? 20 A I don't recall. 21 Q All right. I mentioned -- you mentioned 22 earlier in your first deposition that you were not a 23 good typist, but there doesn't seem to be any mistakes 24 in this letter. 25 A Correct. CENTRAL FLORIDA REPORTERS, INC. 1286 1 Q And do you recall how long it took you to type 2 it? 3 A No, I don't. 4 Q Did you write the letter at home? 5 A I don't recall. 6 Q Did you -- was it out of a computer or an 7 old-fashioned typewriter? 8 A I don't remember. I think it was -- no, I 9 don't recall. I don't recall. 10 Q Would this have been -- could this have been 11 the same or similar like an electronic medical record 12 that you used at the hospital? 13 A No, because the electronic medical record, all 14 of the notes had to be co-signed by the attending before 15 you could sign off and print. 16 Q Okay. 17 A But there were computers at the hospital in 18 the residency program that I could have used. 19 Q Okay. So you don't remember where you wrote 20 the letter? 21 A Correct. 22 Q But this was personally typed by you as 23 opposed to dictated into a machine of some kind? 24 A Correct. 25 Q That part you do remember? CENTRAL FLORIDA REPORTERS, INC. 1287 1 A I do remember. 2 Q All right. But you don't remember where or 3 what type of instrument was used? 4 A Correct. 5 Q Okay. Could it have been at the clinic that 6 you typed the letter? 7 A It could have. 8 Q Okay. Were you aware where risk management's 9 office was in the hospital? 10 A Not at the time. I think they are on the 12th 11 floor of the tower now. 12 Q Do you remember if -- whether, yes or no -- 13 strike that. 14 Do you remember if you wrote the letter in the 15 risk management office? 16 A I don't recall. 17 Q Okay. Do you recall if, when you wrote this 18 letter, anybody was assisting you in writing this 19 letter, such as somebody from risk management? 20 A I don't recall. 21 Q Okay. Do you recall if anybody from risk 22 management actually dictated this letter to you? 23 A No. 24 Q No, you don't recall or they did not? 25 A No, no one told me what to write. CENTRAL FLORIDA REPORTERS, INC. 1288 1 Q Okay. Did Frances Wiegand or somebody from 2 risk management give you the parameters of the letter, 3 the things you should include or not include, whether 4 they dictated it or not? 5 A No. As I said, at the time I really didn't 6 know any specifics regarding the letter. I was just 7 asked to write a letter saying what I had seen. 8 Q Okay. All right. Now, did the -- you talked 9 earlier about the -- anything that you did on the 10 electronic medical record having to be co-signed by the 11 attending physician. 12 A Correct. 13 Q Did this have to be approved by anybody? Did 14 the letter of September 22nd, 1999, have to be approved 15 by anybody? 16 A No. 17 Q All right. Now, what you are telling us, 18 Doctor, is that this letter is -- was not dictated to 19 you by anybody? In other words, you are the author of 20 this letter? 21 A Correct. 22 Q All right. And you are the actual typist of 23 this letter? 24 A I believe so. 25 Q All right. You think it may have been your CENTRAL FLORIDA REPORTERS, INC. 1289 1 wife? 2 A No. My wife didn't type -- like I said, I 3 don't think anybody typed it for me. 4 Q Okay. Your best recollection is that you 5 typed it? 6 A My best recollection is that I typed it. 7 Q And now, after the -- after you finished the 8 letter, I assume that you came out on a printer of some 9 kind? 10 A I would imagine so. 11 Q And did you keep a copy of the letter? 12 A No, I didn't. 13 Q Earlier -- and I apologize for this, Doctor. 14 You told me at your last depo, you turned this over to 15 risk management then? 16 A Correct. 17 Q All right. Now, tell me about that, Doctor. 18 When you -- how long after you were instructed by risk 19 management to write this letter did you go ahead and 20 actually write it? 21 A I don't recall. 22 Q Was it a matter of minutes or hours or days 23 or -- 24 A I don't recall. 25 Q Okay. Did -- when you finished the letter, CENTRAL FLORIDA REPORTERS, INC. 1290 1 what did you do with it? 2 A I turned it over to the risk management. 3 Q Okay. Do you remember at that time, did you 4 go up to their office or did you call them and tell them 5 to come get it or -- 6 A I don't remember. 7 Q Do you recall who specifically at risk 8 management you gave the letter to? 9 A I don't know. 10 Q Do you remember, whoever it was at risk 11 management you gave the letter to, if you had any 12 conversation with them at that time as to what was 13 the -- 14 A The reason? 15 Q -- the reason for the letter? 16 A I don't recall. 17 Q Or what was going to be happen to the letter, 18 what it was going to be used for? 19 A No. 20 Q Okay. Since that time, Doctor, have you 21 learned what the reason was for you authoring this 22 letter? 23 A Could you be more specific? 24 Q Yes. Have you learned -- have you learned why 25 you were asked to write this letter? CENTRAL FLORIDA REPORTERS, INC. 1291 1 A Following my deposition there was -- yes. 2 Q Okay. And who did you learn that from? 3 A I don't remember. 4 Q Okay. And what did you learn? 5 A I don't recall. I think it might have been in 6 a discussion with my attorneys. But again, I can only 7 speculate. 8 Q Okay. In this discussion with your attorneys 9 at that time, I don't -- I don't want you to tell me 10 about that. But if you learned the reason why you were 11 asked to write this letter from anybody else or from any 12 other source, from any documentation, please tell us at 13 this time why you were caused to write the letter. 14 A Okay. I don't recall. 15 Q Let's start by examining the content of the 16 letter, if we can. And I want to go over the examples 17 in the letter of -- and the letter I'm referring to is 18 the September 22nd, 1999 letter regarding inappropriate 19 care. And the first mention of it there is he would 20 place his knee in her back and pull her arms upwards so 21 she would stand. Do you see that? 22 A Yes. 23 Q All right. And the next one is continuously 24 inserted food in her mouth until she began to gag so 25 that she would reflexively swallow. Do you see that? CENTRAL FLORIDA REPORTERS, INC. 1292 1 A Yes. 2 Q And the third one is and would literally drag 3 his mother for a walk until she became exhausted and the 4 heel ulcer began to bleed. Do you see that, Doctor? 5 A I don't see the dragged part because of the 6 copy, but I see the walk until she became exhausted. 7 Q Okay. And can you see and would literally? 8 A I see and would literally, and then I don't 9 see the next word. 10 Q Let me see. And would literally, okay. And 11 you see something, mother for a walk until she became 12 exhausted? 13 A Correct. 14 Q All right. Would it make sense to you that 15 that word was dragged? 16 A Yes. 17 Q Okay. All right. And let me -- before we go 18 any further, let me ask you, it says earlier -- in the 19 few lines up it says several of the nursing staff 20 reported that Mr. Destefano was interfering with his 21 mother's care and the care he provided seemed 22 inappropriate. 23 At this time are you able to tell us the names 24 of the nurses, the nursing staff who reported that to 25 you? CENTRAL FLORIDA REPORTERS, INC. 1293 1 A No, I can't recall. 2 Q When you were doing your investigation trying 3 to locate the nurses who may have reported any of these 4 allegations to you, did you recognize any of the nurses? 5 A No, I didn't. 6 Q Isn't it true, Doctor, that there was actually 7 only one nurse who made any report to you whatsoever? 8 A Perhaps so. I don't recall. 9 Q Okay. All right. And now, the -- there is a 10 note in the -- that you were referred to in your first 11 deposition, and I have marked this as Exhibit No. 2 to 12 this deposition. I'm going to hand it, along with a 13 copy to your lawyer, Mrs. Marshall. 14 All right. And I want you to take a look at 15 the upper right-hand corner, and correct me if I'm 16 wrong, I'm going to read that to you. It says son at 17 bedside, responds to touch only. And then there's a 18 signature that we have discovered as Kendra Blythe's 19 signature. And then it says son forcibly walking mother 20 who was slumped over to the waist, and then again signed 21 by Kendra Blythe. Is that how you would read it, 22 Doctor? 23 A Yes. 24 Q All right. And I want you to -- I'm going to 25 now, Doctor, ask you to if -- Mr. Destefano, can you CENTRAL FLORIDA REPORTERS, INC. 1294 1 hand him that, the Florida Hospital records? Those are 2 the Florida Hospital records. 3 A Thank you. 4 Q And I want to ask you, Doctor, now -- first of 5 all, let me ask you this. Do you believe that this note 6 of Kendra Blythe's provides a basis -- provided a basis 7 for your letter of September 22nd, 1999? 8 A I'm sorry, can you repeat that question again? 9 Q Okay. Well, in your note of September 22nd, 10 1999, you state that some examples reported that he 11 would place his knee in her back and pull her arms 12 upwards so she would stand; second, continuously 13 inserted food in her mouth until she began to gag so 14 that she would reflexively swallow and would literally, 15 and we've believe the word is dragged his mother for a 16 walk until she became exhausted and the heel ulcer began 17 to bleed. 18 Is that the note here from Kendra Blythe, that 19 is Exhibit 2 to this deposition, the -- a basis in your 20 mind for the statements that you made in your letter of 21 September 22nd, 1999? 22 A The basis I made for my statements is what she 23 had told me -- 24 Q Okay. 25 A -- or that I remember her telling me at the CENTRAL FLORIDA REPORTERS, INC. 1295 1 time and remember that she kind of demonstrated what was 2 done. I mean, that's how I remember it. 3 Q Okay. This was the red-haired nurse? 4 A I believe so, yes. 5 Q All right. Well, let me ask you this, Doctor. 6 Is there any basis -- is there any documentation in the 7 Florida Hospital records that you are aware of where a 8 nurse, or anybody else besides yourself, has documented 9 any of those allegations; in other words, the allegation 10 of placing his knee in his mother's back and pulling her 11 arms upward, continuously inserting food in her mouth 12 until she began to gag so that she would reflexively 13 swallow, and would literally drag his mother for a walk 14 until she became exhausted and the heel ulcer began to 15 bleed? 16 Doctor, without reviewing the entire record, 17 are you able to -- do you recall there being any 18 documentation in that record whatsoever of those 19 allegations? 20 A I'm not able to recall. 21 Q All right. Doctor, you've now had an 22 opportunity to review the Florida Hospital records of -- 23 from September 15th, 1999. And have you -- by looking 24 through the record, have you found any documentation by 25 anyone other than yourself that Mr. Destefano either CENTRAL FLORIDA REPORTERS, INC. 1296 1 placed his knee in his mother's back, continuously 2 inserted food into her mouth until she began to gag, or 3 would drag his mother for a walk until she became 4 exhausted and her heel ulcer began to bleed? 5 A No. 6 Q Okay. All right. Now, Doctor, let me refer 7 you to the note, the Exhibit No. 2 -- well, strike that. 8 Let me ask you this. 9 The -- you've told us earlier in this 10 deposition that it may not have been several nurses, but 11 it may have been one nurse from the nursing staff. And 12 would that one nurse have been the red-haired nurse? 13 A I would -- I can only -- I can't recall. I 14 would guess, I would surmise, yes. 15 Q All right. And if the -- I want you to now 16 take a look at Exhibit No. 2, which is Kendra Blythe's 17 note, and I believe identified as the red-haired nurse. 18 A Okay. 19 Q And I want you to assume, Doctor, that 20 Ms. Blythe has testified in this case that she does not 21 recall telling you anything beyond what is noted in her 22 note of Exhibit No. 2. 23 That being the case, Doctor, from whom did you 24 get the information that Mr. Destefano was placing a 25 knee in his mother's back and pulling her arms upwards, CENTRAL FLORIDA REPORTERS, INC. 1297 1 continuously inserting food in her mouth until she began 2 to gag, and dragging his mother for a walk until she 3 became exhausted? 4 A Beyond the nurse, that's the one who told it 5 to me. I remember 'cause she just kind of demonstrated 6 it to me so I would have an understanding. 7 Q And that's the red-haired nurse? 8 A I believe so. 9 Q Okay. It might have been some other nurse? 10 A I don't recall. 11 Q Okay. If that -- if that is the -- if Kendra 12 Blythe is the red-haired nurse, and she has said she 13 does not recall telling you anything beyond what she 14 notes in her Exhibit 2, she would be mistaken? 15 A I, I would have to guess. That's all I 16 remember her telling me. 17 Q Well, Doctor, I want you to assume that Kendra 18 Blythe, the red-haired nurse, has testified she does not 19 recall telling you anything beyond what she notes in 20 Exhibit No. 2. You have told us that one nurse, at 21 least one nurse gave you the information that you have 22 put in your September 22nd, 1999 letter. 23 My question to you is if Kendra Blythe, the 24 red-haired nurse, did not give you that information, 25 which is what she testified to, how is it that you got CENTRAL FLORIDA REPORTERS, INC. 1298 1 the information, the allegations that went into your 2 September 22nd, 1999 letter? 3 A As I stated earlier, the nurse that was taking 4 care of Mrs. Destefano just reported that to me on 5 morning rounds, and that's when I made a documentation 6 in the record. I don't know if she cannot remember or 7 recall what had happened, but all I can recall is the 8 nurse telling me that. So I documented it in my chart 9 at the time I was told. 10 Q Okay. All right. Now, you documented it in 11 the chart. Where did you document it in the chart? 12 A What I just put was son is providing 13 inappropriate care. 14 Q Now, where is that? In your -- 15 A In that weekend check-off note that I -- 16 Q The stand-alone note? 17 A The stand-alone note for whoever was oncoming. 18 At the time I didn't suspect that it was anything 19 abusive. And so I documented it in the order just to 20 have nursing or PT to instruct the patient because I -- 21 we didn't feel that it was a malicious act on 22 Mr. Destefano's part. 23 Q Okay. But you didn't document those specific 24 allegations? 25 A No, not those specific allegations, but that's CENTRAL FLORIDA REPORTERS, INC. 1299 1 what I remember, but just because of the way the nurse 2 had demonstrated it to me. 3 Q All right. Okay. You said the nurse 4 demonstrated to you. You said that she demonstrated, 5 and you kind of used your hands a little bit before, of 6 Mr. Destefano picking up his mother and putting his knee 7 to brace her. Is that what it was kind of thing? 8 A Correct. From what I recall that the nurse 9 has said that she just -- I remember to have her hands 10 kind of do this, and he was just using her neck to help 11 prop her up. And that's, that's what I remember her 12 telling me. But she didn't -- again, it wasn't felt to 13 be, you know, abusive at that potential time so -- 14 (Whereupon the videotaped deposition of Dr. 15 Steely was suspended, after which the following 16 proceedings were had.) 17 THE COURT: All right. Let's call it a day 18 right here. All right, Ladies and Gentlemen, I 19 will take you at your word that we can start early 20 tomorrow morning. Now, the earliest that we can 21 possibly start -- because they do not allow members 22 of the public to enter the courthouse until 7:30, 23 so we're probably optimistic if we say we can start 24 at quarter 'til 8:00, but let's let that be our 25 goal. So get up here just as quickly as you can. CENTRAL FLORIDA REPORTERS, INC. 1300 1 I would suggest getting in line, although 2 Fridays are usually a little slower, maybe getting 3 in line no later than 7:30, and we'll get started 4 just as soon as you get here. And this evening we 5 will be in recess. 6 (Whereupon the Jury exited the courtroom.) 7 COURT DEPUTY: You may be seated. 8 THE COURT: All right. Let's get started with 9 evening's agenda then. And we will begin with the 10 deposition of -- completing the ruling on the 11 objection -- objections in the deposition of 12 Dr. Krop. And according to my notes, we left off 13 somewhere around page 32 or so. 14 MS. MARSHALL: Correct. 15 THE COURT: Okay. So it was all resolved on 16 page 32? 17 MR. TOWNSEND: Yes. Can we have just a second 18 here, Your Honor, to get caught up here? 19 THE COURT: Okay. 20 MR. TOWNSEND: Your Honor, I'm not sure 21 whether we got a ruling on this, but if you look 22 at -- page 31 was the objectionable question. 23 MR. OSBORNE: Judge, you did rule on that. 24 And you ruled that you're only going to line up 25 that one line, "So I probably -- my diagnosis is CENTRAL FLORIDA REPORTERS, INC. 1301 1 even more conservative than those two." 2 THE COURT: That's right, I recall that. 3 MR. OSBORNE: That's the last thing you said. 4 MR. TOWNSEND: Your Honor, I would just like 5 to be heard very briefly on that one. The 6 statements that I have a problem with start at line 7 25 on page 31 where it says, "Dr. Cerra actually 8 diagnosed a major depression. And Dr. Danziger 9 diagnosed him as a depressive disorder NOS." 10 He can certainly -- this doctor can certainly 11 rely on what other experts have done, but to 12 testify what the other experts' actual diagnosis 13 was is hearsay. We cannot cross-examine that. 14 They have withdrawn Dr. Cerra as a witness. 15 He will not be testifying in this trial. And so I 16 don't have a problem with things that they can rely 17 on, but they don't rely on other people's 18 diagnosis, not psychologists, that are making this 19 diagnosis. 20 So this is hearsay. This is like 21 bolstering -- this is like bringing in the 22 testimony of two other experts through this expert 23 who are diagnosing a psychological problem. 24 THE COURT: How about that, Mr. Osborne? 25 MR. OSBORNE: Judge, the one -- Dr. Danziger CENTRAL FLORIDA REPORTERS, INC. 1302 1 is their doctor. He's going to be coming in here 2 to testify. He's not bolstering his opinion. He's 3 just saying what they are. I asked him at line 17 4 does he customarily rely on opinions of other 5 experts in assisting and formulating in your 6 opinions. Sure. All he says is stating what they 7 said. He's not saying -- you've taken out the line 8 about his being more conservative. 9 It's just a statement of fact that if you do 10 that, and he's putting what his diagnoses are in 11 there. He's not doing it to bolster himself. He's 12 just saying that he reviewed that and that assisted 13 him in formulating his opinion. 14 THE COURT: On further reflection, I'm going 15 to sustain that objection. Those lines will be 16 stricken. 17 MR. TOWNSEND: That would be lines -- page 31, 18 line 25? 19 THE COURT: Yes. No, it's actually -- line 24 20 begins with that also was indicated. 21 MR. TOWNSEND: Yes, ma'am. And that'll be 22 through page 32? 23 THE COURT: Line three. 24 MR. TOWNSEND: Line three? 25 THE COURT: And picking up with all these CENTRAL FLORIDA REPORTERS, INC. 1303 1 certainly. 2 MR. TOWNSEND: Thank you, Your Honor. The 3 next one is Ms. Marshall's. 4 MR. OSBORNE: Don't we now have to delete line 5 17 through 23? 6 MR. TOWNSEND: That's fine with me. 7 MR. OSBORNE: I mean, it doesn't make any 8 sense without the other language in there. 9 MS. MARSHALL: On page 31? 10 MR. OSBORNE: 32. 11 MR. TOWNSEND: It appears that the next one is 12 Ms. Marshall's on page 37. 13 MR. OSBORNE: Do we agree on that one? 14 MR. TOWNSEND: Yes, yes. I'm sorry, Bill. 15 That's fine. 16 THE COURT: Page 37? 17 MR. TOWNSEND: That's where I see the next 18 one. 19 MS. MARSHALL: 37 I'll withdraw, line ten. 20 MR. TOWNSEND: I will also withdraw line 14. 21 THE COURT: 39? 22 MR. TOWNSEND: Oh, Your Honor, I'm sorry. 23 There is a line at page 37, line 24, which I 24 think -- in light of the ruling you just made that 25 says, "Which again, both Drs. Cerra and Danziger CENTRAL FLORIDA REPORTERS, INC. 1304 1 indicated in their diagnosis." 2 THE COURT: Same ruling. 3 MS. MARSHALL: Which line is that, Larry? 4 MR. TOWNSEND: That's line 24, starts with 5 which again. 6 MS. MARSHALL: Which page? 7 MR. TOWNSEND: 37. 8 MS. MARSHALL: Line 24? 9 MR. TOWNSEND: Next is page 39, Your Honor. 10 THE COURT: That's that objection I think, 11 isn't it, Ms. Marshall? Isn't that what you're 12 objecting to there? 13 MS. MARSHALL: No, what I'm objecting to is 14 that -- 15 THE COURT: Oh, okay. 16 MS. MARSHALL: The part -- and starting on -- 17 you have to actually read page 38 starting at line 18 18. 19 THE COURT: Oh. 20 MS. MARSHALL: And that's the sentence, he 21 says, "He will only be satisfied once there is a 22 trier of fact in indicating that he was wronged in 23 this case. So depending on the outcome, I would 24 say that would certainly help if the outcome is 25 favorable and if he feels somehow that others view CENTRAL FLORIDA REPORTERS, INC. 1305 1 his situation the same way he views it. So in that 2 sense, the litigation or the resolution of the 3 litigation certainly could be helpful. But this is 4 going to be long standing given how" -- 5 THE COURT: What is your objection to that? 6 MS. MARSHALL: My objection is that to say 7 that he's going to be better if you guys -- if you, 8 jury, award him -- find in his favor is not proper. 9 And there is a -- this one was admittedly a more 10 extreme case, but in this case, the Pier 66 Company 11 case versus Poulos, it was a wrongful discharge 12 case. 13 And basically the expert got on and testified 14 that, you know, if she didn't prevail she was going 15 to be suicidal obviously is a more extreme 16 position, but I think that the concept is the same 17 as -- that the experts shouldn't be getting on -- 18 there on the stand saying that, you know, he's 19 going to be better if he's vindicated, if he wins 20 this trial basically is what the -- what the 21 psychologist was testifying to. 22 THE COURT: Just a minute, let me read it. 23 That's a relevancy ruling. I believe the prejudice 24 would outweigh the probative value. 25 MR. OSBORNE: Can I be heard on that? CENTRAL FLORIDA REPORTERS, INC. 1306 1 THE COURT: Let me just say this. I'm not 2 persuaded by this case. I'm going to overrule that 3 objection and allow that testimony to come in. 4 MS. MARSHALL: Okay. The next one I believe 5 is -- 6 THE COURT: Page 83. 7 MS. MARSHALL: -- 83. 8 THE COURT: Okay. Now, here you are examining 9 Ms. Marshall's -- 10 MS. MARSHALL: Correct. 11 THE COURT: -- witness? And this is your 12 objection, Mr. Osborne? 13 MR. OSBORNE: Yes, Your Honor. 14 THE COURT: And I've read this previously 15 concerning his sort of self-reporting I guess 16 of -- or warning in advance that he may lose his 17 temper and the question, is that consistent. 18 MR. OSBORNE: Judge, I'm sorry, there is one 19 on page 68 that wasn't highlighted. 20 THE COURT: Okay. 21 MR. OSBORNE: Page 68, line three. 22 THE COURT: Well, let's take this one first, 23 if you don't mind, because I've already got myself 24 into it here. This is you questioning him, 25 Ms. Marshall? CENTRAL FLORIDA REPORTERS, INC. 1307 1 MS. MARSHALL: Correct. 2 THE COURT: "Is that consistent with somebody 3 who self-reports themselves as being someone who 4 never lets their anger get out of control? I'm not 5 even sure I understand that question, but maybe 6 it's context. 7 MR. OSBORNE: Judge, I object 'cause it's the 8 same question she asked at line seven, except this 9 time it was argumentative and repetitious. 10 THE COURT: Mr. Osborne -- 11 MR. OSBORNE: Judge? 12 THE COURT: -- that objection is overruled. 13 All right. Let's go backward to 60 -- what is it? 14 MR. OSBORNE: 68, line three. 15 THE COURT: Three? This is your objection, 16 Mr. Osborne? 17 MR. OSBORNE: Yes, Your Honor. That's a -- 18 anything's possible. 19 MS. MARSHALL: Well, I think that that's 20 a -- okay, withdrawn. 21 THE COURT: Withdraw the question? 22 MS. MARSHALL: Yes. 23 THE COURT: Okay. Thank you. 24 MR. OSBORNE: That would be lines one through 25 15? CENTRAL FLORIDA REPORTERS, INC. 1308 1 MS. MARSHALL: Correct. 2 THE COURT: Page 85? 3 MR. TOWNSEND: Your Honor, in light of 4 that -- never mind, I apologize. 5 MS. MARSHALL: 85 withdrawn. 6 THE COURT: Withdraw the question? 7 MS. MARSHALL: Withdraw the objection. 8 THE COURT: Oh, that's your objection, I'm 9 sorry. 10 MS. MARSHALL: Well, I was moving to strike 11 his answer as being unresponsive, but I'll withdraw 12 that. 13 THE COURT: Okay. So 92, this is your 14 objection, Mr. Osborne? 15 MR. OSBORNE: Yes, Judge. I've got -- I 16 objected here, calls for speculation but -- 17 THE COURT: Let me read the question, hold on. 18 Okay. 19 MR. OSBORNE: Here I object, calls for 20 speculation, but I'm going to have a -- when we get 21 to it an objection to all the questions about 22 gonorrhea because he had gonorrhea when he was 19, 23 and then he was -- and he didn't tell Dr. Krop 24 that. So he went into his big discussion about 25 gonorrhea. CENTRAL FLORIDA REPORTERS, INC. 1309 1 MS. MARSHALL: Your Honor, he was -- the point 2 was there was a number of questions where he was 3 specifically asked have you ever had a psychiatric 4 exam, have you ever had a sexually transmitted 5 disease, and he chooses what to answer and what not 6 to answer. This was something that was easily 7 verifiable. And, you know, this is his doctor that 8 he picks and chooses what he decides to tell and 9 disclose to him. 10 That goes to the overall validity of this 11 psychological evaluation, which absolutely depends 12 on what the patient is willing to share with the 13 psychologist. 14 THE COURT: Mr. Osborne? 15 MR. OSBORNE: Your Honor, it's 90.403, 16 prejudicial value outweighs the probati