901 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 VIII 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. 902 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. 903 1 I N D E X - VOLUME VIII 2 VIDEOTAPED DEPOSITION OF RONALD BLACK, M.D. 3 Direct Examination - Cont. by Mr. Glick 905 Cross Examination by Ms. Marshall 913 4 Cross Examination by Mr. Townsend 944 Redirect Examination by Mr. Glick 944 5 VIDEOTAPED DEPOSITION OF RACHEL BEAN 6 Direct Examination by Mr. Conway 953 7 8 E X H I B I T S 9 Plaintiff's Exhibit No. 9 947 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 CENTRAL FLORIDA REPORTERS, INC. 904 1 THE COURT: What is it that you'd like to take 2 up? 3 MR. OSBORNE: It's not my issue, Judge. It 4 deals -- it's Florida Hospital's issue about Kelly 5 Pipkin's deposition, which I thought we had solved, 6 but they have some other excerpts that they were 7 objecting to being included. 8 THE COURT: Is Ms. Pipkin next? 9 MR. OSBORNE: She will be tomorrow. We have 10 to resolve this and send it out to have the edit 11 so -- 12 THE COURT: Let's right do it around noon 13 then. Are you all unpacked and ready to go now? 14 MR. EVANS: Yes, Your Honor, we are. 15 MS. MARSHALL: Yes, Your Honor. 16 THE COURT: Mr. Osborne. We're going to go 17 late tonight. 18 COURT DEPUTY: Please rise for the jury. 19 (Whereupon the Jury entered the courtroom.) 20 THE COURT: Good morning. Please be seated. 21 The Court recognizes the presence of the jury. 22 Please continue with the videotaped deposition. 23 And that was the videotaped deposition of 24 Dr. Ronald Black. 25 (Whereupon the playing of the videotaped CENTRAL FLORIDA REPORTERS, INC. 905 1 deposition of Dr. Ronald Black was resumed.) 2 DIRECT EXAMINATION - CONT. 3 A I believe this is a -- what we call a face 4 sheet. Basically a face sheet is a standard form in a 5 hospitalization that lists patient's name, address, 6 insurance information, admitting diagnosis, date of 7 admission and things like that. It's used primarily for 8 billing purposes by the hospital at future days. And 9 it's a way to conveniently put all of the required 10 information to contact an insurance company in one spot 11 for folks that are tasked with that job. 12 Q Part of that is highlighted in pink. We'll 13 mark this for the record as Exhibit 2 to the deposition. 14 A Okay. 15 Q What is the admitting diagnosis on there? 16 A The admitting diagnosis is -- it says rectal 17 and anal hemorrhage and has an IDC-9 code, which is the 18 standard coding tables published by Medicare. And it 19 says 5. -- it says 569.3, which corresponds to anal and 20 rectal hemorrhage. 21 Q Is there anything else highlighted there? 22 A Oh, highlighted above it says rectal bleed, 23 comma, protective CU, which I'm not sure what the CU 24 stands for. 25 Q Do you know if that could mean protective CENTRAL FLORIDA REPORTERS, INC. 906 1 custody? 2 A I don't have a clue what that means. 3 Q All right. Doctor, do you recall when -- 4 after Mrs. Destefano was discharged from Sunbelt, do 5 you recall having any discussions with a Frances Wiegand 6 from the risk management department? 7 A I recall having a discussion with someone from 8 the risk management department. Presumably if you say 9 it's Frances Wiegand, then I won't argue. 10 Q All right. And can you tell me what the 11 nature -- what was said in that discussion? 12 A I can tell you a general -- a general 13 recollection. I don't recall any details per se. As I 14 recall, it was a discussion with Mrs. -- with someone 15 from risk management. Primarily what I would describe 16 as a fact-finding meeting. You know, we -- again, 17 standard procedure in the hospital -- in any hospital is 18 we've had this complaint, what did you see, you know, 19 what did you hear kind of thing. 20 Q Did -- after that was there a meeting then 21 with that person from risk management, yourself, 22 Mr. Destefano and perhaps some other people? 23 A I believe so, yes. 24 Q All right. And do you recall at that meeting 25 Mr. Destefano being adamant about getting a retraction CENTRAL FLORIDA REPORTERS, INC. 907 1 of the statements that were made against him? 2 A Oh, absolutely. I will say every, every 3 encounter I had with Mr. Destefano after the 19th of 4 September, he was adamant about getting retractions of 5 the statements made. 6 Q Now, Doctor, did you ever speak with the 7 Department of Children and Family Services? 8 A No, I did not. Not to my recollection, no. 9 Q How about the police? 10 A No. 11 Q I want to just ask you a, a few questions 12 about disimpaction. 13 A Okay. 14 Q Is it proper for a layperson if they're the -- 15 their parent or their -- whoever they're caring for is 16 the primary caregiver and, and the patient is at home 17 and, and needs to be disimpacted, as long as the person 18 is trained to do it, is there anything wrong with 19 the -- with the son or daughter or relative doing 20 disimpaction? 21 A No, not necessarily. 22 Q How about if the -- if the person is actually 23 in a nursing home where there are skilled professionals 24 such as RNs or other types of nurses to do the 25 disimpaction, would it then be inappropriate for the, CENTRAL FLORIDA REPORTERS, INC. 908 1 the relative to go ahead and do it in the nursing home? 2 A It would be -- it's extremely unusual, I will 3 say that. Whether or not it's inappropriate, that's a 4 question if you ask 100 different health care 5 professionals, you get 50 different answers. 6 It's, it's always something which is -- it's 7 unusual, you know. It's, it's unusual for -- even 8 somebody, when they're cared for at home, it's unusual 9 for people to be that proactive in a hospital setting or 10 in a nursing home setting for that matter. It doesn't 11 mean it doesn't happen but, but it is unusual. Is it -- 12 is it unacceptable, not necessarily. Honestly that's 13 a -- that's a loaded question. 14 Q Well, let me ask you this, Doctor. I just 15 want to clear it up. I want you to assume that when, 16 when Mr. Destefano was Mrs. Destefano's primary 17 caregiver -- 18 A Uh-huh. 19 Q -- and when he was at her home or when they 20 were at their home together, she needed to be 21 disimpacted, and I want you to assume that there was no 22 one else to do the disimpaction. And I want you also to 23 assume that Mr. Destefano was trained in, in doing the 24 proper method of disimpaction. Would it be 25 inappropriate for him to do that to his mother at home? CENTRAL FLORIDA REPORTERS, INC. 909 1 A No. 2 Q Okay. Doctor, do you -- 3 A And I would also say it's not necessarily 4 inappropriate to do it in a hospital setting. It is 5 unusual. 6 Q In a -- in a hospital? 7 A In a hospital or a nursing home facility. And 8 I will tell you my, my personal experiences. When 9 something like that happens, when somebody is very 10 involved in the -- in the care of a loved one to a 11 degree that is usually much greater than typically 12 encountered, it raises eyebrows. You know, people, 13 people look at -- look at that with, with a perception 14 of, wow, it's really, really unusual. 15 Does, does that mean it's abusive? Absolutely 16 not but it's unusual, you know. Whether or not it's 17 wrong or not, that's something that I think has to be 18 made on an -- on an individual basis. 19 Q Do you remember a Dr. Mark Olson? 20 A Yes, I do. 21 Q What was his job at, at Florida Hospital? 22 A He was one of the associate clinical 23 professors at the family practice residency. He had 24 several capacities, but one of the things, he oversaw 25 the family -- what we call the family medicine service, CENTRAL FLORIDA REPORTERS, INC. 910 1 which was internal medicine service primarily. 2 Q Were you under him there? 3 A At varying times, yes. 4 Q Okay. 5 A In a typical residency you're under the, the 6 supervision of no one person at any given time primarily 7 because you want to learn from as many people as 8 possible, but I did train under him. 9 Q And do you remember Dr. Steely? 10 A Yes, I do. 11 Q What, what was his -- professionally what was 12 his relationship with you? 13 A Dr. Steely was a, a year behind me in the 14 residency, and professionally we worked together on 15 several various services in the hospital. Typically 16 most of the time when we worked together I was working 17 with him in a supervisory capacity. 18 Q Other than handwriting your notes back then, 19 which we, we see you have a lot of handwritten notes, if 20 you wanted to have something typed up, how would -- how 21 would you go about doing that back then at Florida 22 Hospital? 23 A Actually at Florida Hospital there was -- were 24 dictation phones throughout the hospital. So that we 25 could pick up a dictation phone and dictate a note and CENTRAL FLORIDA REPORTERS, INC. 911 1 have it transcribed. And then any dictation was, was 2 typically -- well, it has to be reviewed and then signed 3 within a certain -- a certain specified time period in 4 order -- that's mostly to try and avoid any errors. And 5 also it's usually a requirement for hospital privileges 6 in most hospitals in the country. 7 Q Just a couple more things, Doctor. One thing 8 was -- I just want to go back to disimpaction. I forgot 9 one question. 10 A Uh-huh. 11 Q Do you remember at any of the meetings or 12 conversations with Mr. Destefano that he volunteered the 13 information that he would disimpact his mother at home? 14 A Yes, I do. 15 Q Now, if a -- if there was a person at Florida 16 Hospital who needed to be transferred to a nursing home, 17 would they normally be transferred to Sunbelt? 18 A Not necessarily. There were actually several 19 nursing facilities throughout the, the city that we 20 would transfer patients to. Several of the patients 21 but, but in no means all or even the majority of the 22 patients would be transferred to Sunbelt. 23 Q If there was a transfer to Sunbelt, how would 24 it be accomplished? 25 A Typically we, we would write an order in CENTRAL FLORIDA REPORTERS, INC. 912 1 the -- in the chart, in the doctors' orders, and either 2 the unit secretary or case management or a person 3 assigned to the case would make the necessary 4 arrangements and call the facility and make sure there 5 is a bed available and the patient would be transferred 6 over. 7 Q All right. And doctors like yourself would do 8 work at both facilities? 9 A Correct. The, the senior residents in the 10 program. Of note, the -- if a doctor -- I took care of 11 a patient in the hospital, it would not necessarily mean 12 I would be responsible for that patient's care in the 13 nursing facility either. It was assigned on a 14 rotational basis. Primarily it was to even out the 15 workload. 16 Q Would, would records, medical records go back 17 and forth between Florida Hospital and Sunbelt on a 18 patient? 19 A Not necessarily. There was not a -- what I 20 would call a, a freely open channel of communication in, 21 in the sense that they're, they're two different medical 22 facilities. So you would have to -- have to request 23 records from one to the other typically. There were 24 times when the, the rules were bent a little bit, you 25 know, and records did go with a patient, but that was by CENTRAL FLORIDA REPORTERS, INC. 913 1 no means standard operating procedure. 2 Q What was your understanding of the 3 relationship between Florida Hospital and Sunbelt? 4 A My understanding of the relationship was that 5 Florida Hospital and the nursing -- Sunbelt Nursing Home 6 were both owned by Sunbelt Corporation, and as such 7 worked independently but closely with one another. And 8 I may be wrong on that. That's, that's just my 9 understanding. 10 Q Okay. 11 A But the hospital to my understanding did not 12 own the nursing home or vice versa. They were in the 13 same corporate family. 14 MR. GLICK: All right. Doctor, I don't have 15 any other questions. Thank you. 16 THE WITNESS: Okay. 17 MS. MARSHALL: I have a couple. 18 - - - - - 19 CROSS EXAMINATION 20 BY MS. MARSHALL: 21 Q Dr. Black, when you -- do you recall seeing -- 22 MR. TOWNSEND: Excuse me. Tracy, would you 23 just identify yourself for the record before you 24 start questioning? 25 MS. MARSHALL: I'm sorry. I'm Tracy Marshall CENTRAL FLORIDA REPORTERS, INC. 914 1 representing Adventist and Sunbelt and the other 2 Adventist entities. 3 BY MS. MARSHALL: 4 Q Dr. Black, do you -- do you recall seeing 5 Mrs. Destefano from the time period of September 15th, 6 1999, through September 19th, 1999, while she was at 7 Florida Hospital? 8 A Not with certainty. I know that I saw 9 Ms. Destefano. If I had not been involved with her care 10 in the nursing home and subsequently discussions with 11 Mr. Destefano and all the subsequent events, I probably 12 would not have recalled that at all. 13 Q Okay. I think you -- 14 A So -- 15 Q Sorry. Go ahead. 16 A I can't separate to, to say yes, absolutely I 17 remember during that visit. I do remember -- I do 18 remember vividly, though, that -- I shouldn't say 19 remember, the absence of, of memory. I don't remember 20 any details that would stand up in that period of time 21 to make sense. 22 Q Was Dr. Steely her primary -- the primary 23 person that she would have dealt with at Florida 24 Hospital during that time? 25 A Yes. CENTRAL FLORIDA REPORTERS, INC. 915 1 Q Okay. And you were in a supervisory role, I 2 think you said, over Dr. Steely? 3 A Yeah. Typically what would happen is on a 4 typical service there would be a number of patients, 5 typically 20, 25 patients that would have a team we 6 would round on. Typically I would supervise four 7 residents and then we would both be responsible for the 8 care of, you know, seven or eight patients. And then I 9 would supervise the whole tomato and try and help, help 10 people out and answer procedural questions and give 11 advice if there -- if there was a question on how care 12 was being administered. 13 Q In, in your role in that supervisory function, 14 would you have had the reason to read a patient such as 15 Ms. Destefano's chart from start to finish? 16 A From start to finish? No, rarely. The, 17 the -- and I will clarify that a little bit. Typically 18 what would happen is the first year residents would 19 round on the patients, would write progress notes 20 updating the patient's medical condition daily. Then 21 the medical team, including the attending physician, 22 myself, all of the first-year residents would round on 23 each patient, go over the case, discuss different plans 24 for care -- discuss different plans for care and, and, 25 you know, different plans of action. So to actually CENTRAL FLORIDA REPORTERS, INC. 916 1 read the chart physically would not be a, a typical 2 thing. There are times when I would, but usually no. 3 Q Okay. 4 A But all the -- all the details of the case 5 would be discussed. And it was common knowledge amongst 6 everybody on the team who was administering care. 7 Q You stated earlier that the allegations that 8 Mr. Destefano had kneed his mother in the back, dragged 9 her across the room causing her dressing to come off and 10 poured water down her throat while at Florida Hospital, 11 that you didn't become aware of those allegations until 12 after she was discharged from Sunbelt, correct? 13 A I would say, yes, I believe that is correct, 14 yes. 15 Q Okay. Sometime around in that -- 16 A I didn't -- I didn't become aware of any 17 allegations until to my recollection the morning of when 18 she was transferred out which was, I think -- 19 Q The 21st. 20 A -- the 21st. 21 Q Okay. Do you know whether any of those 22 allegations were contained in the Florida Hospital 23 charts and statements made by Dr. Steely or by the 24 nurses that took care of Mrs. Destefano while she was at 25 Florida Hospital? CENTRAL FLORIDA REPORTERS, INC. 917 1 A No, I don't. I will say I do not -- to my 2 recollection, there were no allegations that were voiced 3 during that period of time that I ever heard about. 4 Q Okay. Let me -- 5 A To say whether or not they were documented in 6 the record, I can't say. As I just said, if they were I 7 never saw them. 8 Q And would you have any reason to see them for, 9 for what you were doing for her at that period of time? 10 A Only if there was -- the only reason I would 11 have to see them if there were concerns -- allegations 12 raised, which there were not. 13 Q Okay. Let me show you two notes that come out 14 of the Florida Hospital charts. 15 A Okay. 16 Q Okay. The first one is a notation that is 17 made by Dr. Steely on September 17th I believe. 18 A Uh-huh. 19 Q All right. And can you read the highlighted 20 portion for the record? 21 A It says nursing believes son providing 22 inappropriate care from not knowing how and is 23 interfering with care of patient in hospital. 24 Q Do you have any reason to believe that that 25 notation was not made by Dr. Steely on the -- on the CENTRAL FLORIDA REPORTERS, INC. 918 1 date that it is indicated on that document? 2 A Nope. 3 Q Okay. Have, have you worked with Dr. Steely 4 in the past? 5 A Have I worked with him in the past? Yes. 6 Q Yes. 7 A Yes. 8 Q Have you ever known for him to falsify 9 documents or to make notations in the chart of facts 10 that did not actually occur? 11 A No. In fact, all of my work with Dr. Steely 12 is -- my experience has been he's an honorable 13 physician. 14 Q Okay. And so -- 15 A I never had any reason to doubt his integrity. 16 Q Okay. I take it from your previous testimony 17 that Dr. Steely's concerns were not brought to your 18 attention, correct? 19 A Not to my recollection, no. In fact, I, I 20 will -- I can testify that's to my knowledge the first 21 time that I've seen that note. 22 Q Okay. So when, when Mrs. Destefano was 23 transferred to Sunbelt, did you have the benefit of her 24 Florida Hospital records at that time? 25 A Not to my recollection. I can't -- I can't CENTRAL FLORIDA REPORTERS, INC. 919 1 say for certainty that it -- I can't recall. I did have 2 the benefit of knowledge of her care, but whether or not 3 that was from my own personal knowledge, from what I had 4 done literally days before versus reading her chart in 5 the hospital, I can't say. 6 Q Okay. Did, did there -- did there come a time 7 after September 21st, 1999, that you had a discussion 8 with Dr. Steely about Mrs. Destefano? 9 A Yeah, several times. 10 Q Okay. Do you know when those discussions 11 occurred? 12 A I can't say with certainty, no. It was 13 after -- there were probably several. I would say 14 probably for the remainder of the year -- 15 Q And -- 16 A -- and even into the next year. 17 Q And during those discussions did, did 18 Dr. Steely bring it to your attention that there had 19 been concerns about -- from back when she was at Florida 20 Hospital about the interaction between Mr. Destefano and 21 his mother? 22 A Yes. 23 Q And did you have any reason to believe that 24 Dr. Steely was making those things up? 25 A No. CENTRAL FLORIDA REPORTERS, INC. 920 1 Q Do you remember what the -- what those 2 concerns were that, that Dr. Steely brought to your 3 attention? 4 A No, I don't actually. 5 Q Okay. 6 A Other than there were allegations of -- again, 7 what we alluded to previously, of what -- unusual 8 interactions. 9 Q Such as -- such as what? 10 A Well, such as what we talked about with the -- 11 with the disimpaction, and I will go on to say that an 12 unusual level of involvement in the care of 13 Mrs. Destefano by her son. 14 Q As a doctor, is that -- 15 A And more than -- more than typically seen. 16 Q As a -- as a doctor, if you have a son or 17 daughter who is overly involved in the care giving 18 of a -- to a patient, can that interfere with what you 19 do as a doctor? 20 A With what I do, no. In fact, typically I try 21 and accommodate someone's wishes to care for their loved 22 ones as much possible. I will say from my standpoint 23 it's -- no, it doesn't really affect me one way or the 24 other. 25 Q Can it interfere with the care that the nurses CENTRAL FLORIDA REPORTERS, INC. 921 1 provide to the patient? 2 A Potentially. It depends on the nurse. 3 Q Was that the -- did Dr. Steely ever discuss 4 that with you, that being the situation with 5 Mrs. Destefano and Mr. Destefano? 6 MR. GLICK: Object to the form, time frame. 7 A I can't recall any. 8 Q Okay. You don't remember having any 9 discussions with him about that? 10 A Not to my recollection. 11 Q You, you stated I believe when Mr. Glick was 12 asking you questions that you had a suspicion about what 13 the cause of the blood in the stool was. 14 A Uh-huh. 15 Q What, what were those suspicions? 16 A Well, at the time my suspicion was I knew that 17 Mrs. Destefano had a history of severe constipation and 18 impaction. And I knew that she'd been disimpacted in 19 the past. Whether, whether it was by Mr. Destefano or 20 by a nurse, I couldn't tell you. But I had known from 21 rounding with Dr. Steely in the hospital with her care 22 that that had been an ongoing issue. 23 Disimpaction in itself can cause microscopic 24 bleeding, as can constipation actually. The -- you 25 know, that by no means says that that's the cause. That CENTRAL FLORIDA REPORTERS, INC. 922 1 was my suspicion -- 2 Q Did you ever -- 3 A -- but never proved it. 4 Q Did you ever voice those suspicions to anybody 5 at Sunbelt, any of the nurses or anything? 6 A I can't recall. I believe I documented it on 7 the chart, though. Yeah, I did. In the note, Exhibit 8 1-D, I actually wrote the patient has frequent 9 impactions. Presumably, presumably could account for 10 the bleeding but further evaluation is clearly needed. 11 Q So you drew a correlation or a possible 12 correlation between the bleeding and disimpaction? 13 A Yes. Yeah. But again, didn't -- did not 14 prove that that's what does it. 15 Q I understand. But that could be a, a 16 possible -- 17 A Absolutely. 18 Q -- cause? 19 A And again, just on a side note, the thinking 20 process that occurs when you have a symptom such as 21 rectal bleeding or even a chronic cough, anything, you 22 make a mental list. You try and think of everything you 23 can think of that would cause it. And the first thing 24 you do is to figure out, okay, what could cause it and 25 would kill you. That's what you rule out first. CENTRAL FLORIDA REPORTERS, INC. 923 1 And you say, okay, what's left? My patient 2 isn't going to die. What are the most likely 3 possibilities? And then you whittle down -- go down the 4 list. That's why doctors order tests so many times. 5 Q Dr. Black, Mr. Glick showed you an affidavit 6 that has been signed by you. 7 A Yes, ma'am. 8 Q When was that signed? 9 A It's dated May 24th of 2003. 10 Q Did you prepare that affidavit or did 11 Mr. Glick? 12 A Mr. Glick prepared this -- 13 Q Okay. 14 A -- or someone in Mr. Glick's office prepared 15 it. 16 Q When you signed that affidavit, did you have 17 the benefit of having copies of any of the Florida 18 Hospital records or the Sunbelt records? 19 A I don't believe so. I can't recall if -- 20 THE WITNESS: Did you send any records? 21 MR. GLICK: I believe we sent the -- well, 22 yes. I think we, we did send the -- those, those 23 four exhibits. I think we did fax it. 24 THE WITNESS: You did. I apologize, I do 25 remember that now. CENTRAL FLORIDA REPORTERS, INC. 924 1 BY MS. MARSHALL: 2 Q What documents did you have the benefit of? 3 A The documents that I had were the 4 hospital -- I'm sorry, the nursing home admission sheet 5 and I believe the note, the Exhibit 1-D note. 6 Q So you had excerpts from the Sunbelt records? 7 A Yes, ma'am. 8 Q But you did not have the complete records, 9 correct? 10 A No, ma'am, did not. 11 Q And as you -- and today, have you read through 12 the complete Sunbelt records to refresh your 13 recollection about anything that occurred back in 1999? 14 A The complete record? 15 Q Yes. 16 A No, I haven't read through the complete 17 record. I have read portions of it, primarily the, the 18 notes I've written and places where -- you know, where I 19 was mentioned, primarily trying to trigger my memory of 20 events. But I haven't read the complete record, no. 21 Q And you haven't reviewed the records from 22 Florida Hospital for the time period of September 15th, 23 1999, through September 19th, 1999? 24 A No, ma'am. I haven't reviewed any records 25 from Florida Hospital except for what you just showed me CENTRAL FLORIDA REPORTERS, INC. 925 1 a moment ago. 2 Q And have you reviewed any of the records from 3 Florida Hospital for the time period of September 22nd, 4 1999, through October 5th, 1999? 5 A Briefly. I did review some of those records 6 again just a few hours ago actually, again to refresh my 7 memory of the sequence of events. 8 Q Okay. 9 A And I did not read through the whole record, 10 just the -- again, the portions of my notes and actually 11 some of Dr. Gramlich's (ph) notes. Dr. Gramlich's notes 12 I've reviewed, also. 13 Q When you -- when you signed the affidavit in 14 19 -- in 2003, that was approximately four years after 15 those events occurred, correct? 16 A Yes, ma'am. 17 Q And when you stated that in, in your affidavit 18 that I heard these -- and I'm again reading from 19 paragraph five, when we're talking about the allegations 20 that Mr. Destefano had kneed his mother in the back, 21 dragged her across the room causing her dressing to come 22 off and poured water down her throat while at Florida 23 Hospital, but I heard these allegations for the first 24 time weeks or even months after Ms. Destefano left 25 Sunbelt. CENTRAL FLORIDA REPORTERS, INC. 926 1 A Uh-huh. 2 Q Can you -- do you know whether it was days, 3 weeks or months when these allegations -- when you 4 became aware of these allegations? 5 A No, I don't know if it was days, weeks or 6 months. 7 Q All right. 8 A I, I do recall clearly that the first time I 9 heard any allegations to my memory was after the 21st 10 when I evaluated Mrs. Destefano in the Sunbelt Nursing 11 Home. And I -- the reason I remember that so clearly 12 is, as I mentioned before, it was something that was so 13 out of -- it was unexpected. It surprised me. 14 Q Let me show you a couple more documents out of 15 the Florida Hospital chart. I'll give you -- 16 A This is the -- from the first admission? 17 Q Yes. 18 A Okay. 19 Q Have you ever seen that document before? 20 A I don't believe so, no. 21 Q Were -- and I believe that it's dated. Can 22 you tell me when it's dated? 23 A Yes, ma'am. It's -- well, there is a date of 24 November 11th of '99. Below that is a date of November 25 15th of '99 at the time, and then it says reprinted and CENTRAL FLORIDA REPORTERS, INC. 927 1 a date of 12/8/99. The, the left side of the page is a 2 little bit obliterated so I can't tell what the dates 3 correspond to. I believe what it says is dictated 4 November 11th, '99, transcribed November 15th of '99, 5 and then reprinted on the 8th of December of '99 -- 6 Q Okay. 7 A -- I believe, but I can't -- 8 Q Do you recall ever having discussions with 9 Dr. Steely about the contents of this memo? 10 A Contents of this? 11 Q Correct. 12 A I'm sorry. Clarify. In what context? 13 Q Well, the -- if I could just have it back for 14 a second. 15 The document states that nursing had reported 16 that son was very rough in his care of the patient. And 17 it was written that he would not have any contact unless 18 instructed or observed by nursing. 19 Did you -- did you ever discuss that statement 20 or anything similar with Dr. Steely? 21 A Not that I can recall. I, I did have 22 discussions at various points, you know, again after 23 the -- after she came back in the hospital for the 24 second admission about inappropriate care. I don't 25 recall ever discussing with Dr. Steely any restrictions CENTRAL FLORIDA REPORTERS, INC. 928 1 to access or anything like that, no. 2 Q After she came back to Florida Hospital, do 3 you know if Dr. Steely had any involvement in her care 4 at that point? 5 A I don't believe he did. And if I remember 6 correctly, she was -- Mrs. Destefano was admitted back 7 on to a different service. What I mean by that is when 8 she was admitted the first time, it was on the internal 9 medicine service, which was made up of a team of senior 10 residents and first-year residents. 11 When she was -- came back for the second 12 admission, she was placed on the family practice 13 service, which was a different service comprised 14 entirely of senior resident physicians and -- which is 15 my recollection. If that is the case, then Dr. Steely 16 would not have been qualified to care for her for that 17 second admission and would not even have come in 18 contact. 19 Q Was it fair to say that it was your decision 20 to transfer Mrs. Destefano to ORMC on the 21st, 21 September 21st? 22 A Yes, it is. 23 Q And -- 24 A It was my decision. I did -- I will say that 25 the decision to transfer to ORMC was made -- again given CENTRAL FLORIDA REPORTERS, INC. 929 1 on the advice of some of the nursing staff, the senior 2 nursing. But my statement was that I take 3 responsibility for the decision to transfer to that 4 facility. 5 Q Do you believe that that was the appropriate 6 decision under the circumstance? 7 A I'm not sure. If I was -- if I was faced with 8 the same decision today, would I do the same thing? I 9 don't know. I would probably -- I might, I might not. 10 I would ask more questions. 11 At the -- at the time I was still a fairly 12 young physician. I was in a difficult situation. And I 13 did make -- I made the decision. I will state that in 14 all of the care that I gave to Mrs. Destefano, all my 15 contact with her, and I think I've mentioned this to 16 Mr. Destefano, that's the only question in, in my mind 17 that I've asked myself since, did I do the right thing. 18 MR. GLICK: We need to change tapes. 19 MS. MARSHALL: Okay. 20 VIDEOGRAPHER: This concludes tape number one. 21 Off the record 4:45. 22 (Whereupon the videotaped deposition was 23 paused, after which the following proceedings were 24 had.) 25 THE COURT: That's not the conclusion? CENTRAL FLORIDA REPORTERS, INC. 930 1 MR. OSBORNE: No. 2 MS. MARSHALL: He's putting in another tape. 3 (Whereupon the playing of the videotaped 4 deposition of Dr. Black was resumed.) 5 A So just to clarify, in hindsight, was that the 6 right decision or not, I honestly don't know the answer. 7 In the same situation I -- would I do the same thing 8 again, I don't know. Did -- in one -- in one aspect I 9 would say probably not because it didn't 10 accomplish anything except an, an extra trip across 11 town. And she still ended up back in the Florida 12 Hospital system and still had to deal with whether or 13 not -- where, where she could be placed. So in that 14 sense, I was -- I don't think it was a good decision. 15 However -- 16 Q Well, do you believe that it was appropriate 17 to get her out of Sunbelt where these altercations had 18 occurred between Mr. Destefano and the nurses? 19 A Absolutely. I stand by that decision. And 20 again, the sole reason that a decision to transfer was 21 made, the sole reason was in an attempt to reunite the 22 health care proxy with the patient. 23 Q You -- 24 A The decision also to go to the hospital was 25 made because of the -- rectal bleeding could be CENTRAL FLORIDA REPORTERS, INC. 931 1 evaluated and all that -- all -- you know, to find out 2 what was going on. But if it had not -- in a situation 3 where the altercation had not arisen, then typically she 4 would have been sent to the, the emergency room, 5 evaluated and probably transferred back the same night 6 after testing had been done. 7 Q You stated before that when you came into 8 Sunbelt on that day, that the nurses were upset, 9 correct? 10 A Yes, ma'am. 11 Q How many nurses are you talking about? 12 A To my recollection, there was -- I can't -- 13 there was at least two, but I don't recall precisely how 14 many there were. 15 Q And by, by upset, what do you mean? 16 A I mean that a combination of -- they were 17 one -- at least one of the nurses was visibly upset 18 because of what I would describe as anxiety. Because, 19 as I mentioned, she had made a statement that she was -- 20 had felt fear for her safety and had, had that sort of 21 anxiety that, that you would expect from somebody who's 22 been scared out of their wits and then was calming down, 23 so to speak. 24 Q Did you believe that that -- that what you 25 observed was, was feigned or that she was making up her CENTRAL FLORIDA REPORTERS, INC. 932 1 fear in any way? 2 A No. I had no reason to believe that. But 3 there was also -- there was also a combination of that. 4 There was anger. They were still quite upset, as 5 anybody would be after an altercation I would imagine. 6 And there was -- I would say primarily those are the two 7 overriding emotions. That's the simplest way to 8 describe it. 9 Q In Exhibit No. 1 -- I think it's 1-C -- 10 A Uh-huh. 11 Q -- is that correct? 12 A Yes, ma'am. 13 Q In the note regarding the blood, bright red 14 blood noted on pad per RN, what does it say after that? 15 A It says -- well, there's a mark with a line 16 that says error with my initials over it. And then it 17 says mildly distended. 18 Q What does that mean? 19 A It means that when I examined Ms. Destefano 20 and examined her abdomen, that her abdomen was mildly 21 distended and it was bloated a little bit. Again, there 22 was an attempt to try and figure out where the bleeding 23 was coming from. 24 With significant intra-abdominal problems, you 25 can have anything from tenderness. You can have CENTRAL FLORIDA REPORTERS, INC. 933 1 actually a fairly severe distension. There's actually 2 five or six different things that you look for. The 3 only positive finding was mild distension, which in and 4 of itself doesn't really point to a diagnosis. But 5 implicit in that statement was everything else was not 6 found. 7 There was no -- you know, she didn't jump to 8 the ceiling when I pressed her belly. There was no 9 specific point that was tender. There was no perineal 10 signs or anything like that so -- 11 Q Did you ever request to see the blood pad that 12 the nurses had told you had, had blood on it? 13 A I can't recall. I would -- I would like to 14 think my usual practice would, would be that I did, but 15 I have no memory of that. 16 Q Well, would it have been your usual practice 17 if you asked for it and they said it's the one that's 18 still there that doesn't have any blood on it or that 19 there is no other -- if they would have said something 20 that they couldn't produce it to you, that you would 21 have made a note of that as well? 22 A It depends. And I will clarify the answer. 23 There are two questions there I think. If they could 24 not produce the pad, then not necessarily would I 25 document that. Simply because if, if somebody has CENTRAL FLORIDA REPORTERS, INC. 934 1 bleeding or, or something on a pad and, you know, they 2 call a physician and I get there two hours later, I 3 don't expect the patient to lay there on a dirty pad. 4 And typically I don't expect them to save it off to the 5 side for many reasons. Primarily it would be unsafe to 6 have a blood-soaked towel laying around. 7 The -- if there was a -- if there was a 8 thought that they should have been able to produce the 9 pad and couldn't, if it had struck me as unusual that we 10 don't have this pad and I couldn't find it or anything, 11 that I probably would have written down, you know. But 12 there was no sense on my part that there was any -- 13 anything of that nature was occurring. 14 Q Did you find it unusual that the blood that 15 they had talked about was not on the pad that she was 16 lying under when you examined her? 17 A Not necessarily. You know, if she was lying 18 on a pad and there was no blood there, I suspect my, my 19 natural inclination now would be to say, well, they must 20 have changed the pad. 21 Q And you don't recall one way or the other 22 whether or not you asked for it? 23 A I don't recall. 24 Q You talked before about reporting suspected 25 abuse. CENTRAL FLORIDA REPORTERS, INC. 935 1 A Uh-huh. 2 Q Do you recall that testimony? 3 A About the mechanics of reporting suspected 4 abuse? 5 Q Correct. 6 A Yes, ma'am. 7 Q And do you have an understanding as a 8 physician in Florida what your obligations were to 9 report any kind of suspected abuse? 10 A Yeah. The obligation was by law that -- and 11 it's not just -- actually it's most states in this 12 country -- if you suspect abuse, you're obligated by law 13 to report suspicion of abuse. 14 It's important to recognize there's no 15 implicit accusation which is made in a report. Now, 16 it's easy for me to say. I have never been -- to have a 17 report -- you know, had somebody report that I was 18 abusive. But the way the law is written is -- states, 19 in Florida anyway, you know, is you're required to 20 repute -- or report suspected abuse even if you have no 21 proof. You have to report the suspected abuse primarily 22 so an investigation can occur. 23 You know, as I stated previously, that can 24 raise substantial difficulties in that if I wanted to go 25 accuse say Michael Jackson of, of abuse, there's an CENTRAL FLORIDA REPORTERS, INC. 936 1 investigation and you have to -- all of the negative 2 impacts that that has on a person's life comes with it. 3 But if there's a suspicion, if there is even a 4 reasonable -- what's the word I'm looking for? If 5 there's a reasonable concern, even if you don't suspect 6 somebody of abuse but there is concern that it may be a 7 possibility, you're obligated by law to report it. 8 Q Did you participate in any way with Sunbelt's 9 decision to call HRS in this -- in this circumstance? 10 A I can't recall. I can't recall. I can't 11 recall. I could speculate and say that if, if they 12 reported -- if one of the nurses had said I think 13 there's abuse occurring and they told me they were going 14 to report it, then I would have done everything I could 15 to help them in gathering evidence and to report the 16 case. 17 And the reason why is again because it's what 18 the law says, but also because of the nature of abuse, 19 there's so much -- it's so hard to prove abuse. It is 20 so hard that you have to take every accusation or every 21 suspicion with the -- unfortunately with the -- with the 22 stance of guilty until proven innocent, which is 23 contrary to what everybody believes is right. But it's 24 designed that way to protect the innocent, the people 25 that are being abused. CENTRAL FLORIDA REPORTERS, INC. 937 1 Q In your years of practice, is it common to see 2 a grown adult man in bed with his elderly parent? 3 A Is it common? No. Does it occur? Yes. 4 Q How many times have you observed that? 5 A Zero. 6 Q What about -- would that be something you 7 would find to be unusual? 8 A Depends on the context. So I don't -- I don't 9 believe I could really answer that question. If 10 somebody was, was -- let me back up. 11 I've seen cases where family members have been 12 in bed with patients, even non-family members have been 13 in bed with patients, and I haven't given it a second 14 thought because there was a -- it was obvious to myself 15 and frankly everybody on the staff that there was -- 16 there was nothing suspicious about it, you know what I 17 mean? It was -- it was somebody who was supportive of 18 the patient or trying to comfort him or something like 19 that. So that's why -- to answer your question, it 20 depends on the context, you know. 21 Q Well, if it -- if it occurred in the context 22 where somebody was not comfortable that that was the 23 situation, would that be something that, that you feel 24 might be appropriate to report to HRS? 25 A If somebody -- well, not necessarily. If CENTRAL FLORIDA REPORTERS, INC. 938 1 somebody said that there was -- you know, I think 2 something unusual is occurring, that -- something 3 unusual does not constitute suspicion of abuse, okay? 4 Would that be unusual? Yeah. You could make a strong 5 argument that, that it's unusual to find a grown man 6 laying in bed with his mother. 7 You can make an argument that it's unusual to 8 find a person who's actively involved with somebody who 9 took care of their mother to the point that they're 10 disimpacting or doing procedures that normally people 11 have an aversion to do on people they don't know, you 12 know. Does that constitute abuse or suspicion of abuse? 13 Not necessarily. 14 And I think it's an important clarification. 15 Whatever the nurses saw in the nursing home to them not 16 only made them uncomfortable, but if, if they suspected 17 abuse, they saw something that made them go the extra 18 step and say not only am I uncomfortable, but I think 19 there's something that needs to be investigated here. 20 Those are two mutually-exclusive events, okay? 21 There's a lot of -- I've taken care of in my career a 22 lot of patients or a lot of people who are incredibly 23 unusual and never once thought that, well, there's an 24 abuse occurring here. I've taken care of patients where 25 I have thought that, and when I thought that I reported CENTRAL FLORIDA REPORTERS, INC. 939 1 it. But the two don't necessarily have to occur 2 together. 3 Q Well, would you agree that, that if, if the 4 nurses at Sunbelt observed behavior that made them 5 uncomfortable, that they felt was unusual, that they 6 thought might be abuse, that they had a duty to report 7 it -- 8 A Absolutely. 9 Q -- to the appropriate authorities? 10 A Absolutely. That's the key. 11 Q Do you know how long Mrs. Destefano had 12 Alzheimer's? 13 A No, I don't. Although, based on my clinical 14 opinion at the time, it was evident that it was fairly 15 advanced Alzheimer's. Typically there would have been 16 several years -- 17 Q Are you -- 18 A Typically on the order of probably between 19 seven to ten years I would guess just based on my 20 clinical opinion and experience. 21 Q Are you familiar with the declaration and 22 durable power of attorney concerning medical decisions 23 that is I believe in her Sunbelt file? 24 A Let me find it. Are you talking about the 25 specific form or the, the document? CENTRAL FLORIDA REPORTERS, INC. 940 1 Q The document itself. 2 A Yes, I am. 3 Q Okay. Did you find that in there? 4 A I'm still looking. Yep. Okay. 5 Q Okay. That document is dated February 2nd of 6 1999? 7 A Uh-huh. 8 Q At that point in time, do you know whether 9 Mrs. Destefano would have had the mental capacity to 10 consent to somebody else making decisions on her behalf? 11 A Do I know? No. I could speculate. 12 Q Well, based on what you know about Alzheimer's 13 and how long it takes someone to progress to that state 14 and the state that she was in in September of 1999, do 15 you think in February of 1999 she would have had the 16 mental capacity to consent to giving somebody else her 17 power of attorney to act on her behalf? 18 A Assuming that her dementia was secondary to 19 Alzheimer's disease, then I would say, no, it would be 20 highly unlikely. If her dementia was from some other 21 condition that was not necessarily chronic, such as a 22 stroke or microinfarction or, or some more rapidly 23 progressive dementia, then it would be possible. So I 24 can't answer that question. 25 Q What -- and that's what I want to get at. CENTRAL FLORIDA REPORTERS, INC. 941 1 What allegations are you referring to? 2 A That I don't believe that Mr. Destefano had 3 abused his mother either physically or sexually based on 4 my observations of the clinical evaluation and just the 5 interactions I had with Mr. Destefano. 6 Q Do you have any opinion one way or the other 7 whether he was in fact in bed with his mother in a prone 8 position? 9 A No, I don't have an opinion to that. 10 Q Do you have any opinion one way or the other 11 whether he was kissing his mother on the lips for an 12 extended period of time? 13 A I do not. And I'll clarify it. I never once 14 saw any of the allegations that you've mentioned or have 15 been mentioning in these proceedings. I never saw 16 personally any of it. Every -- everything that I had 17 been told was told to me by a second or even third 18 party. So I never saw these interactions that, that 19 were discussed or addressed. 20 Q The nurses' notations that are in the Exhibit 21 No. 1, which I believe are to the end -- 22 A Hang on a second. This one? 23 Q Correct. Yes. 24 A Okay. 25 Q And I believe that they are dated the 21st of CENTRAL FLORIDA REPORTERS, INC. 942 1 September. 2 A There's actually a page that starts on the 3 19th. 4 Q Okay. 5 A Then it goes the 20th, 21st, 20th, 20th, 20th, 6 21st. 7 Q Did you at any time ever review the nursing 8 notations to get an idea about what had happened or what 9 was alleged to have happened with regards to 10 Mrs. Destefano? 11 A I believe that I did, but I can't -- I can't 12 say for certain. I believe that I read the notes. I 13 don't remember if I read them after the fact at the time 14 I showed up in the nursing home or subsequently. I 15 can't recall. 16 Q Well, what I'm getting at is that there 17 are -- there are notations by three nurses who say I saw 18 this. It's written in the first person about what they 19 observed. And I'm just trying to understand your 20 testimony that you said that you never spoke with 21 anybody who actually witnessed any of the events that 22 were alleged to have occurred on the 20th and the 21st. 23 A Okay. I can't say with certainty if I 24 reviewed those or not. I, I believe that the, the 25 allegations that I wrote in my note to my recollection CENTRAL FLORIDA REPORTERS, INC. 943 1 were based on discussions primarily with the -- with the 2 nurses staff. 3 Q And do you -- 4 A And I had heard these allegations. Whether or 5 not I read them or whether or not they were discussed -- 6 told to me by the nurses I can't recall. 7 Q And you don't recall -- or do you recall who 8 specifically -- which nurses, their names, that you 9 talked to? 10 A No, I'm sorry, I can't recall. In fact, I 11 wouldn't even know their names if they weren't written 12 in the chart and you guys hadn't asked me those 13 questions. 14 Q Do you have any recollection of having any 15 conversation with Rachel Bean? 16 A Specifically? 17 Q Yes. 18 A I can't say. I don't even remember what 19 Rachel Bean looks like or who she was. I do remember I 20 spoke with the director of nursing there. 21 Q That was Rachel Bean. 22 A Okay. Then I would say I did speak to her. 23 Q And do you recall what she told you? 24 A Specifically, no, other than I recall that she 25 expressed the concerns of, of what these allegations had CENTRAL FLORIDA REPORTERS, INC. 944 1 been. I did discuss with her the dilemma of trying 2 to -- you know, the problems that arose by having 3 Mr. Destefano not able to come on the property and 4 trying to resolve, you know -- reach an equitable 5 solution to, to, you know, reunite Mr. Destefano with 6 his mother's care and get her to a facility where, where 7 there could be mutual trust between the, the healthcare 8 proxy and the caregivers which had been pretty much 9 destroyed after the altercation. 10 - - - - - 11 CROSS EXAMINATION 12 BY MR. TOWNSEND: 13 Q Dr. Black, do you recall ever having any 14 discussions with anyone at Orlando Regional Medical 15 Center in connection with Mrs. Destefano? 16 A No, sir. 17 MR. TOWNSEND: That's all I have. 18 MR. GLICK: Just very few. I have about three 19 or four follow-up questions, Dr. Black. 20 THE WITNESS: Okay. 21 - - - - - 22 REDIRECT EXAMINATION 23 BY MR. GLICK: 24 Q Doctor, the -- I wanted to talk to you. We 25 talked on cross-examination a little bit about whether CENTRAL FLORIDA REPORTERS, INC. 945 1 if the nurse has a concern or a suspicion and different 2 circumstances under which they should call DCFS or 3 report suspected abuse. 4 Is it your understanding, Doctor, that a 5 person has to have a good faith belief that abuse has 6 occurred or might occur before they report it? 7 A A person has to have a good faith belief that 8 abuse might occur or has occurred or that there is 9 suspicion of basically a risk to safety to an innocent 10 party. 11 Q All right. Doctor, you mentioned that there 12 was anger, emotions of the nurses -- of at least of two 13 of the nurses you said were -- they were visibly upset, 14 anxiety, anger. 15 A Uh-huh. 16 Q Do you remember which of the two was angry and 17 which -- or was it a combination? 18 A I can't recall. 19 Q Okay. 20 A And again, I want to clarify that. It wasn't 21 necessarily anger directed at anybody. It was the type 22 of anger that you see when people have a fight and 23 they're trying to calm down, you know. It was the anger 24 that, that -- of being involved in an altercation that 25 made them clearly uncomfortable, you know. CENTRAL FLORIDA REPORTERS, INC. 946 1 Q Okay. 2 A And they were -- they were just upset, trying 3 to get over it. 4 Q As far as what Ms. Marshall asked you about 5 Rachel Bean, and then she clarified for you that Rachel 6 Bean was the director of nursing, and you had -- you 7 were unclear about exactly what she said to you. But 8 what you wrote down that she said to you in your note, 9 your progress note of 9/21/99, which is marked as 1-D -- 10 A Uh-huh. 11 Q -- where it says called by director of 12 nursing, reports the following, that's what the director 13 of nursing told you, correct? 14 A Correct. And that note -- I wrote -- I had 15 the discussion with the director of nursing and wrote 16 the note within 20 minutes, you know. 17 Q Okay. 18 A So I will testify the note was written with 19 the, the allegations and the conversation clearly in my 20 head. If I hadn't had that note to refer to, I don't 21 know if I would have been able to remember 90 percent of 22 what was said. 23 MR. GLICK: No more questions. Thank you, 24 Doctor. 25 THE WITNESS: Thank you. CENTRAL FLORIDA REPORTERS, INC. 947 1 (Whereupon the videotaped deposition of Dr. 2 Black was concluded, after which the following 3 proceedings were had.) 4 THE COURT: Mr. Osborne, call your next 5 witness. 6 MR. OSBORNE: It will be Rachel Bean by 7 videotaped deposition. 8 THE COURT: How long is that deposition? 9 MR. OSBORNE: It is five hours. Judge, I 10 would like to move into evidence the affidavit of 11 Dr. Black that was discussed in his deposition. 12 THE COURT: Any objection? 13 MR. OSBORNE: One of the exhibits. 14 MS. MARSHALL: No objection. 15 MR. TOWNSEND: No objection, Your Honor. 16 THE COURT: It would be admitted. 17 THE CLERK: Plaintiff's 9. 18 (Plaintiff's Exhibit No. 9 was marked into 19 evidence.) 20 THE COURT: How are you doing, folks? Do you 21 want to get into this a little way and take a five 22 or ten-minute break or would you like to take a 23 break now? 24 JUROR: Can we take a break? 25 THE COURT: Sure, let's take a break. Five or CENTRAL FLORIDA REPORTERS, INC. 948 1 ten minutes, folks. 2 (Whereupon, there was had a recess from 10:05 3 o'clock a.m., to reconvene at 10:10 o'clock a.m., 4 outside the presence of the Jury.) 5 THE COURT: Two things. Be seated. First of 6 all, we brought up a pot of coffee to make coffee 7 so they're going to have coffee with them. At this 8 point I think they deserve that. Second, I need to 9 find some time here for this case. And one thought 10 that I had is let's ask -- let's consider asking if 11 they will have -- agree to a 30-minute lunch. And 12 the way we would do that is -- and I simultaneously 13 asked support personnel for their agreement in that 14 regard. 15 That is a real hardship on them. I usually 16 don't do that. I'll talk to you about it 17 privately. I'm not asking you to say right now. 18 If we do do that, I would offer them that we'll 19 have pizza brought up for them or a variety of 20 sandwiches. And I think that you all can probably 21 split that and ask your paralegal or your paralegal 22 or your office to have that waiting at 12:00 23 o'clock. So anybody have any problems with that, 24 finding some more time today and tomorrow? 25 One juror's already whispered in the deputy's CENTRAL FLORIDA REPORTERS, INC. 949 1 ear that she's got a child's birthday party 2 tonight. It's going to be real hardship for her to 3 go late. We hate for people to miss things like 4 that so we need to make up some time. Any 5 comments, question? 6 MS. MARSHALL: That's fine. 7 MR. OSBORNE: That's fine. 8 MR. TOWNSEND: We're all right, Your Honor. 9 THE COURT: I may step back there, tell them 10 they may have coffee, make them that offer. 11 Anybody have any objection? 12 MR. OSBORNE: No, ma'am. 13 MS. MARSHALL: No, Your Honor. Do you want us 14 to take care of getting lunch ordered today? 15 THE COURT: Let me get the word from them. 16 And if I give you the yes, will you take care of it 17 today? Is that all right that these folks take 18 care of today and you will reimburse them for a 19 third of it? Any problem with that? 20 MR. OSBORNE: That's fine. 21 MR. TOWNSEND: We would keep a running tab, 22 we'll divvy it all up at the end. 23 THE COURT: Okay. Thank you very much. 24 (Off the record discussion was had.) 25 THE COURT: Please be seated. Yes, the jury CENTRAL FLORIDA REPORTERS, INC. 950 1 would very much like to do that. And in fact they 2 asked me if we could start early. They said they'd 3 come in at 6:00 in the morning. Now, I don't think 4 I'm willing to do that, but I think that we can 5 find some time. 6 And I just would ask that the arrangements be 7 made to get, you know, sandwiches, a variety of 8 sandwiches or pizza or something and sodas, just 9 different sodas and water to bring in to them. All 10 right. Let's get started. 11 MS. MARSHALL: Your Honor, before we start -- 12 THE COURT: Hold on, Alan. 13 MS. MARSHALL: I think the video of Rachel 14 Bean is five and a half hours, which I think puts 15 us at 4:30. We have one witness that we're going 16 to have here before that in case we get done early, 17 and I just -- from a scheduling standpoint, how 18 long are we going tonight? 19 THE COURT: Well, I would like to go late 20 tonight, but I'm getting some motion back there 21 that that's really going impose on at least one, 22 maybe two jurors. So I guess -- I don't know. 23 I'll inquire -- I'll bring them in here and inquire 24 and then we'll decide about -- it may be that we 25 can't get past 5:30 tonight. Late is bad for them, CENTRAL FLORIDA REPORTERS, INC. 951 1 early is okay with them. So I think you're 2 probably -- what witness? 3 MS. MARSHALL: Frances Wiegand. 4 THE COURT: And you expect her to take longer 5 than an hour? 6 MR. OSBORNE: No, I don't. She's a 7 relatively -- she's probably a 30-minute witness. 8 THE COURT: If we start now and we go and take 9 30 minutes for lunch, it's 10:15, do the math. 10 When are you going to finish? 11 MS. MARSHALL: It gets us right around 4:15, 12 4:30, that's what I'm saying. So we'll be done 13 with Frances at quarter 'til 5:00, 5:00 o'clock. 14 And I want to know -- I was inquiring whether we 15 should plan on somebody else here for after that. 16 MR. OSBORNE: We have the Dr. Steely video we 17 can plug in at the end of the day if we have time. 18 THE COURT: Yes. Then the answer is no. 19 Bring them in, please. 20 MS. MARSHALL: Okay. Thank you. 21 (Whereupon the Jury entered the courtroom, 22 after which the following proceedings were had.) 23 THE COURT: And be seated. I don't want to 24 put you on the spot or anything, Ladies and 25 Gentlemen, but I do sense that -- is there some CENTRAL FLORIDA REPORTERS, INC. 952 1 hardship or an issue about staying past 5:30 2 tonight with any of you? 3 JUROR: Yes. 4 THE COURT: May I inquire into what that is, 5 ma'am? 6 JUROR: My granddaughter picks me up, and she 7 has to be at school at 6:30. 8 THE COURT: Do you have any other way home? 9 JUROR: I might be able to get -- 10 THE COURT: I'd ask you to inquire about that 11 over the break, please. Yes, ma'am? 12 JUROR: I cook for my children. By the time I 13 get home it's 6:30 and a hungry bunch of people 14 waiting for me. 15 THE COURT: Anybody else? Yes. 16 JUROR: I have an appointment at 6:30 but -- I 17 can stay 'til 6:00 but that would be it. 18 THE COURT: Yes? 19 JUROR: My daughter's birthday is today so -- 20 THE COURT: And your daughter is 13? 21 JUROR: Yes. 22 THE COURT: And what have you got planned for 23 her? 24 JUROR: Just a little -- 25 THE COURT: You're having people to your house CENTRAL FLORIDA REPORTERS, INC. 953 1 and family? 2 JUROR: Just family. 3 THE COURT: All right. Thank you very much. 4 Let's go. 5 (Whereupon the playing of the videotaped 6 deposition of Rachel Bean was commenced.) 7 RACHEL BEAN, 8 having been first duly sworn testified as follows: 9 DIRECT EXAMINATION 10 BY MR. CONWAY: 11 Q Would you mind stating your full name for the 12 record? 13 A Sure. It's Rachel Bernadette Bean. 14 Q Where -- what's your date of birth and your 15 Social Security number? 16 A 8/13/69. 009-48-0372. 17 Q And where were you born? 18 A St. Albans, Vermont. 19 Q And how long have you lived in St. Albans, 20 Vermont? 21 A I lived there for probably 20 -- 28 years on 22 and off. 23 Q Did you -- did you go to school in Vermont? 24 A Yes. 25 Q Where did you go to school? CENTRAL FLORIDA REPORTERS, INC. 954 1 A I went to St. Albans City Elementary School, 2 and then I went to Bellows Free Academy High School. 3 Q And that's in all -- both in St. Albans? 4 A Yes. 5 Q And where did you go to college? 6 A I went to the University of Vermont. 7 Q Okay. And what year did you graduate from 8 college? 9 A 1996. 10 Q What was your degree in? 11 A Associate's degree in nursing. 12 Q So that would be -- would that be an 13 Associate's of Sciences or -- 14 A Uh-huh. Of Science, yes. 15 Q And did you continue your education from 16 there? 17 A I've taken continuing education courses 18 required by different states that I've been licensed in, 19 but I have not furthered for my BSI, no. 20 Q Okay. So at this point your, your formal 21 education is an Associate's in Sciences -- 22 A Uh-huh. 23 Q -- and, and then you've continued on with the, 24 the courses that are required to maintain your nursing 25 license? CENTRAL FLORIDA REPORTERS, INC. 955 1 A Correct. 2 Q Okay. And how long have you been a nurse? 3 A Since 1996. 4 Q Since '96? And let me start with, while in 5 college, did you do any internships that involved your 6 nursing degree? 7 A Well, we did clinical work that was required 8 by the university and it was part of our schooling. 9 Q Okay. When you graduated where, where was 10 your first job? 11 A I worked at Star Farm as a graduate nurse. 12 Q And what were your duties there? 13 A I worked the night shift, basically was in the 14 role of a charge nurse for a long-term care unit. 15 Q Okay. And where is that located? 16 A In Burlington, Vermont. 17 Q And how long did you work there? 18 A I worked there until I obtained my license, so 19 it was approximately a month. 20 Q And when you obtained your license, does that 21 mean -- tell me how you obtained your license. 22 A You have to take an NCLEX, which is a nursing 23 board -- 24 Q Uh-huh. 25 A -- and once you take that, then if you pass, CENTRAL FLORIDA REPORTERS, INC. 956 1 you become a registered nurse. 2 Q Does that also involve any type of background 3 check or is it just a written examination that you 4 either complete or -- 5 A It's a computerized examination. 6 Q Okay. And were you able to pass that the 7 first time around? 8 A Yes. 9 Q Okay. Once you received your nursing license, 10 what did you do? 11 A Actually we looked into moving to Florida. 12 Q And how long -- you said you were down here 13 about a week? 14 A We just came here to visit. We helped her 15 move her belongings down here and just kind of looked 16 around, looked at the area, and I decided that it wasn't 17 for me -- 18 Q Uh-huh. 19 A -- and we went back home. 20 Q And -- 21 A It was just a visit anyway so the intention 22 was to go back home. 23 Q Then you went back to St. Albans? 24 A Uh-huh. 25 Q What -- did you find employment there? CENTRAL FLORIDA REPORTERS, INC. 957 1 A Uh-huh. 2 Q Where did -- 3 A I went to work at Red Stone Villa. 4 Q Okay. What, what type of facility is that? 5 A At that time it was a 30-bed. It was a 6 Medicaid long-term facility. 7 Q Were there a certain type of patients there or 8 was it for anybody with medical needs? 9 A No, it wasn't a rehab facility at that time. 10 So basically it was for the elderly who their families 11 couldn't care for them at home anymore or they couldn't 12 care for themselves, so they would come and live there. 13 Q Is that what people typically call a nursing 14 home or is there -- 15 A Yeah. 16 Q -- something -- 17 A Yes. 18 Q Okay. How long did you work there? 19 A I worked at Red Stone -- I went there in June 20 of '96 and left in October of '96. 21 Q Okay. And why did you leave? 22 A Well, I was bored being that it was a 30-bed 23 facility and there really wasn't a lot going on as far 24 as using my skills. 25 Q Uh-huh. CENTRAL FLORIDA REPORTERS, INC. 958 1 A So I decided to do some home care, and I was 2 doing home care with -- working at the nursing home and 3 decided that I really liked the home care. And it gave 4 me a little more freedom with my family, having six 5 children. I was able to schedule my hours when I wanted 6 to work. 7 Q So the home care was on top of your job at the 8 nursing home? 9 A Right. I, I did both for just a few weeks and 10 decided that I really liked the home care, and it gave 11 me the flexibility that I needed with my family. 12 Q Now, did you do the home care through an 13 agency of some type or was that something that you -- 14 A Vermont -- 15 Q -- did on your own? 16 A Yeah, Vermont doesn't have an agency per se as 17 Florida does. It's a visiting nurse association, and 18 they have a branch called Care Connection, which they 19 employ nurses to do home care. 20 Q So is that a -- explain to me how that works. 21 How do you find the patients and how do the patients 22 find you? 23 A Well, the patients generally -- most of them 24 would be in the hospital. And then the hospital would 25 do a VNA referral and according to state guidelines -- CENTRAL FLORIDA REPORTERS, INC. 959 1 and I'm not exactly sure what their guidelines are. 2 Q Uh-huh. 3 A I didn't work in that field. But if they 4 qualified for home care, then when you worked for Care 5 Connection, then they set you up with the cases. 6 Q Who would pay you? Would the patient pay you 7 or -- 8 A No. 9 Q -- would -- 10 A Care Connection. 11 Q Okay. And how long -- there was kind of a 12 transition there? 13 A Uh-huh. 14 Q Did you start doing that full time? 15 A Uh-huh. 16 Q Okay. And when did that happen approximately? 17 A As soon as I decided that that's what I wanted 18 to do when I left Red Stone. 19 Q Okay. And how long did you do that? 20 A I did that until February of '97. 21 Q What did you do in February of '97 that 22 changed? 23 A Moved to Florida. 24 Q Where did you move to? 25 A We moved to Longwood. CENTRAL FLORIDA REPORTERS, INC. 960 1 Q Okay. Did you locate a job? 2 A Yes. 3 Q Where did you start working? 4 A I started to work for an agency, it's no 5 longer in business, MPS. 6 Q What's that stand for? 7 A I really don't -- I really don't know. 8 Q Okay. What did you start doing for them? 9 A I worked in local nursing homes. 10 Q Was that a contract job where you worked for 11 them and they would tell you where you were needed? 12 A Well, we -- I didn't sign any type of 13 contract. Basically I could work whenever they had 14 work. They would call me and tell me what shifts they 15 had available, and I would say yes if I was available. 16 Q Okay. So is that an agency that has ties to 17 local hospitals and nursing homes, and when they need 18 extra help that they're not able to have, they bring you 19 in? Is that the way it works basically? 20 A Well, they're not tied to anybody. They're 21 independent. 22 Q Uh-huh. 23 A But what they do is they -- basically like all 24 the other agencies, they go around with their 25 information to different nursing homes, hospitals, CENTRAL FLORIDA REPORTERS, INC. 961 1 wherever and hand out their information and say, you 2 know, if you need staff, give us a call. 3 Q It's kind of like a temp agency? 4 A It's not really like a temp agency like you 5 would go for secretarial work -- 6 Q Uh-huh. 7 A -- but it's agency oriented. 8 Q Okay. How long did you work for them? 9 A I worked for MPS until I moved back to 10 Vermont. 11 Q And what period of time was that? 12 A I worked for them from February, and I have to 13 get my year right, '97, until May of '97. 14 Q Okay. And then you moved back to Vermont? 15 A Uh-huh. 16 Q Why did you move back? 17 A I hated Florida. I was very homesick. I was 18 very close to my father and he was in Vermont, and he 19 was a very big influence and in, in my life and very 20 helpful with my children. 21 Q Okay. Okay. So you moved back with the 22 family to, to Vermont? 23 A Uh-huh. 24 Q And what did you do from there? 25 A Well, I -- Red Stone where I had worked prior, CENTRAL FLORIDA REPORTERS, INC. 962 1 they were in a transition where their day coordinator 2 had left, and the new person had to give a notice so 3 they didn't have anybody. So I filled in for them and 4 worked per diem for them. 5 Q How long did you do that? 6 A I worked per diem for them -- I went back in 7 May, and I worked for them per diem until about October. 8 Q And was that on a specific shift or did you 9 just -- 10 A Whenever they needed me. 11 Q Whenever they needed you, okay. Was that full 12 time then? 13 A No, because I also, also picked back up with 14 Care Connection. 15 Q Okay. Same agency as you were with -- 16 A Uh-huh. 17 Q -- before? 18 A Not an agency -- 19 Q Right, right. 20 A -- but same company. 21 Q Okay. Did there come a time when you were 22 full time in either field? 23 A Not with them. Actually a friend of mine that 24 I had gone to nursing school was working at Verdell 25 Village, and her director of nursing had asked her to CENTRAL FLORIDA REPORTERS, INC. 963 1 call me to come and work for them. 2 Q And what's Verdell Village? 3 A It's a long-term care facility, but it's also 4 a rehab subacute. 5 Q What type of rehab do they do? 6 A They do a lot of ortho patients, people that 7 have had heart surgery, respiratory. 8 Q So at Verdell, is there a little bit more of a 9 cross-section of people with different needs? 10 A Yes. 11 Q So it's not the same as where you were before, 12 which was mainly a nursing home? 13 A Right. 14 Q Okay. But were there people in there long 15 term that you would classify as nursing home patients? 16 A Yes. I actually went to work on a 17 dementia/Alzheimer's unit that was a specialized unit. 18 Q Okay. And that was reserved just for people 19 with Alzheimer's and dementia? 20 A Yes. 21 Q How long did you do that? 22 A I worked there for 15 months. 23 Q 15 months? And that was the whole time you 24 were at Verdell? 25 A Yes. CENTRAL FLORIDA REPORTERS, INC. 964 1 Q Okay. While you were at Verdell, were you 2 also doing the home care? 3 A I did it a little bit. I became pregnant at 4 that time for my last child, and it was a very difficult 5 pregnancy and I was hospitalized many times -- 6 Q Uh-huh. 7 A -- so I had to cut back actually on both 8 positions. So I worked the minimal amount that I needed 9 to to pay my bills and get by. 10 Q Okay. During that time that you were working 11 for Del -- for Verdell -- 12 A Uh-huh. 13 Q -- you were also doing the home health care. 14 Were there any job -- other jobs that you were doing? 15 A No. 16 Q Okay. Did there come a time when you moved 17 again? 18 A Yes. 19 Q Okay. When was that? 20 A We came back to Florida in November of '98. 21 Q Okay. And was Mr. Bean able to find a job 22 right away? 23 A Actually I found a job before he did. My, my 24 mother lived here and she had sent the Orlando Sentinel. 25 So I filled out my resume and sent it to some places, CENTRAL FLORIDA REPORTERS, INC. 965 1 and I went to Lake Highlands in Clermont. 2 Q And what is Lake Highlands in Clermont, what 3 is that? 4 A It's a 180-bed. It's a long-term care 5 facility. It's an Alzheimer's unit. It at that time 6 also had an assisted-living patient and a rehab unit. 7 Q Were these -- again, would this be what is 8 commonly referred to as a nursing home? 9 A Yes. 10 Q Okay. And let me back up a second. Had your 11 mom lived down here the entire time -- 12 A Yes. 13 Q -- since that first move that we talked about? 14 A Yes. 15 Q Okay. In the Orlando area? 16 A She lived in Longwood, yes. 17 Q Okay. So did you accept that job? 18 A Yes, I did. 19 Q And how long did you work there? 20 A I went to work for Lake Highlands, it was at 21 the end of November, and I worked there until March of 22 the following year. 23 Q So that would be March of '99? 24 A '99, yes. 25 Q Okay. Now, March of '99 you make a job CENTRAL FLORIDA REPORTERS, INC. 966 1 change? 2 A Yes. When I went to Lake Highlands, I was 3 working as a 3:00 to 11:00 supervisor Monday through 4 Friday, and it was very difficult when my children were 5 in school because basically Monday through Friday I 6 didn't see them. And it was also in Clermont, which was 7 a little bit of a commute -- 8 Q Uh-huh. 9 A -- so -- 10 Q You were living where? 11 A I was living in Orlando. I lived on Orange 12 Blossom Trail. 13 Q Okay. So you're kind of the downtown Orlando 14 area and you're having to commute to Clermont every day? 15 A It was North Orange Blossom Trail -- 16 Q Okay. 17 A -- so it was the Rosemont area. 18 Q Okay. And you said you were working as a 19 supervisor. 20 A Uh-huh. 21 Q What, what did that entail? What, what were 22 your responsibilities? 23 A Basically I was in charge of the entire 24 building on the 3:00 to 11:00 shift. At that time the 25 director of nursing, everybody else had gone home. So CENTRAL FLORIDA REPORTERS, INC. 967 1 my responsibilities were to supervise the building, make 2 sure the staffing was adequate. Any new admissions, I 3 helped with that process. If there were any families 4 coming to tour, I would tour the families. 5 Q Director of nursing, that's a title that 6 applies to, to one person? 7 A Yes. 8 Q Okay. And that person is usually on the 7:00 9 to 3:00 shift? 10 A They, they really don't work 7:00 to 3:00. 11 That would be nice hours, but your hours aren't set. 12 It's a salaried position so you work for the needs of 13 the facility. So some days you may come in at 8:00 and 14 you can stay 'til 8:00 at night. And then another day 15 come in at 8:30, 9:00 and work until 5:30. It all 16 depends on what's going on in the building. 17 Q So that's a very -- even though director of 18 nursing is a supervisory job, that's a very different, 19 different set-up than for any of the other nurses who 20 worked 7:00 to 3:00, 3:00 to 11:00 or 11:00 to 7:00? 21 A Yes. 22 Q Okay. And again, that's kind of -- is that -- 23 would you describe that as more of a managerial position 24 where you've just got to be there when you've got to be 25 there? CENTRAL FLORIDA REPORTERS, INC. 968 1 A Yes. Versus a supervisory position, yes. 2 Q Okay. And at that time you were in a 3 supervisory position but not director of nursing? 4 A Correct. 5 Q Okay. And how long did you work there? 6 A I -- at Lake Highlands? 7 Q Yes. 8 A I left there in March of '99 -- no, 2000 -- 9 I'm sorry. Yes, '99. I'm just confused about the year. 10 '99. 11 Q That's okay. What did you do from there? 12 March of '99 job change, where did you go from there? 13 A Well, actually in February of '99 I applied 14 for an assistant director of nursing position at Regents 15 Park in Winter Park. 16 Q And what type of facility is that? 17 A That's a 120-bed. It's a -- one unit is a 18 long-term care unit which would have patients who would 19 stay there because their families couldn't take care of 20 them or they couldn't take care of themselves, some 21 Alzheimer's, dementia patients on that unit. The other 22 unit was a subacute unit, so people would come in for 23 therapy with the goal to go home. 24 Q Uh-huh. What was your position? 25 A Assistant director of nursing. CENTRAL FLORIDA REPORTERS, INC. 969 1 Q And so what were your hours? 2 A Once again, like the director of nursing, you 3 really -- you don't have set hours. 4 Q It's just you need to be there when you need 5 to be there? 6 A Right. 7 Q And did you always work directly with the 8 director of nursing or did you have I guess overlapping 9 responsibilities? 10 A Well, the director of nursing when I went to 11 Regents Park was in the process of retiring, so I -- she 12 took a lot of vacation -- 13 Q Uh-huh. 14 A -- so most of the time I was responsible for 15 the building in her absence. 16 Q Did you at some point become the director of 17 nursing? 18 A Not at Regents Park, no. 19 Q Okay. How long did you work at Regents Park? 20 A I worked at Regents Park from February of '99 21 to May of '99. 22 Q And as assistant DON, is that salaried or is 23 that hourly rate? 24 A Salary. 25 Q Salary? Okay. So we're coming up to another CENTRAL FLORIDA REPORTERS, INC. 970 1 job change? 2 A Yes. 3 Q When was that? 4 A That was in May of '99. 5 Q May of '99? And what -- where did you go from 6 there? 7 A To Sunbelt. 8 Q And what position were you hired on for at 9 Sunbelt? 10 A Director of nursing. 11 Q Did that -- was that a position that you 12 sought or did somebody know about you and seek you for 13 that job? 14 A Well, actually when I was at Regents Park, we 15 had our annual state survey, and one of the surveyors 16 had recommended that I look for a director of nursing 17 position. And my director of nursing had resigned at 18 Regents Park, but that position was filled prior to my 19 even coming there. So -- and she recommended that I 20 look for a director of nursing position, too, so I 21 applied at Sunbelt. 22 Q Would that be a higher-paying job? 23 A Yes. 24 Q Okay. More responsibility than, than where 25 you were before? CENTRAL FLORIDA REPORTERS, INC. 971 1 A Yes. 2 Q What -- I know you've had some varied, varied 3 experience in your nursing career. Do you feel like you 4 had a lot of experience with Alzheimer's and dementia 5 patients? 6 A Yes, because when I worked at Verdell, I 7 worked on a locked Alzheimer's/dementia unit which was 8 the only, only unit in the state like that, pretty much 9 has been the only unit that I've ever seen like that 10 wherever I have worked. 11 Q Did you ever do any emergency care or trauma 12 care in your nursing career? 13 A No. 14 Q Okay. So most of it involves people that have 15 already been admitted and need, need ongoing care? 16 A Yes. 17 Q Okay. So did you say May of '99 Sunbelt is 18 when you started? 19 A Yes. 20 Q Okay. And you stepped in as director of 21 nursing? 22 A Yes. 23 Q Was there a period where you had to -- kind of 24 a transition period where you get in there and, you 25 know, you get to learn your staff and, and become aware CENTRAL FLORIDA REPORTERS, INC. 972 1 of any problems that you need to correct or do you just 2 jump right in and get to work? 3 A Well, when I went to Sunbelt there wasn't a 4 director of nursing there, so it wasn't like I had 5 somebody to transition with or to orient with. 6 Basically it was tag, I'm it. 7 Q Who was taking care of the obligations that a 8 director of nursing would be responsible for? 9 A They had corporate nurse consultants who would 10 come into the building, and at that time there was a 11 lady there named Pat. And, I'm sorry, I can't remember 12 her last name. 13 Q When you stepped in there, was it fairly 14 organized or did you have a lot of work on your hands 15 because there was no previously-employed director of 16 nursing? 17 A Well, there was a director of nursing there. 18 I'm not sure how long she had been gone prior to my 19 coming there. And like I said, they did have the 20 corporate nurse who was there. It's like any other 21 building, they had issues. 22 Q Uh-huh. 23 A They needed some guidance. 24 Q And did you step in and start addressing those 25 issues as soon as you started? CENTRAL FLORIDA REPORTERS, INC. 973 1 A Yes. 2 Q Who, who was working with you? Did you have 3 an assistant director of nursing? 4 A When I went there, there was not an assistant 5 director of nursing. I did hire somebody for that role. 6 Q Okay. Who did you hire for that role? 7 A Alicia Mosley. 8 Q And so she was directly under you? 9 A For a period of time, yes. 10 Q Okay. How long was she the assistant director 11 of nursing? 12 A She was the assistant director of nursing I 13 want to say approximately two months. 14 Q Two months? So that means May, June, maybe 15 July is when -- roughly? And I'm not going to hold you 16 to it. 17 A Roughly. 18 Q Okay. Did, did she quit? How did -- how did 19 you lose her? 20 A She didn't quit, but she also had many 21 children. She had seven children, and she was living in 22 the Lessburg area and it was quite a commute. And we 23 needed a weekend supervisor and those hours worked 24 better for her, so she became our weekend supervisor. 25 Q And supervisor again is, is different from an CENTRAL FLORIDA REPORTERS, INC. 974 1 assistant director of nursing? 2 A Yes. 3 Q Okay. Was there somebody else that came on as 4 assistant DON? 5 A Actually we never filled the role, the actual 6 role of assistant director of nursing. Generally you 7 have to be an RN to be an assistant director of nursing, 8 and the assistant director of nursing usually has a 9 slash staff development title. We had hired a staff 10 development person when Alicia was in the role of 11 assistant director of nursing, so that persons was an 12 LPN -- 13 Q Uh-huh. 14 A -- so they technically couldn't be assistant 15 director of nursing. 16 Q So who stepped in to fill the responsibilities 17 that, that she wasn't going to cover anymore? 18 A Well, Alicia was also the nurse manager of the 19 subacute unit, so basically I just hired a subacute 20 nurse manager. 21 Q To do which job? 22 A To do -- to manage the unit, which is 23 basically what Alicia had been doing. 24 Q Okay. And who was that person? 25 A Mary Thornton. CENTRAL FLORIDA REPORTERS, INC. 975 1 Q Okay. What was her title? 2 A Nurse manager. 3 Q Okay. And what were her responsibilities as 4 compared to yours? 5 A Well, Mary was just responsible for the third 6 floor for her unit. She was responsible for staffing. 7 We actually had somebody that did the staffing, but she 8 was responsible -- if there wasn't a nurse there, then 9 she would have to work on the floor. She was 10 responsible for the matrix and roster and the census 11 condition. 12 Q Uh-huh. Did she have -- did she play any role 13 in patient care? 14 A She would do patient care if, if it was 15 needed. 16 Q Uh-huh. And the same question for you. What, 17 what were your responsibilities? 18 A Well, I was responsible for the entire nursing 19 staff. I was responsible for the nursing budget, 20 staffing, any family issues, concerns. 21 Q Uh-huh. And did you step in and do any type 22 of patient care? 23 A When it was needed, yes. 24 Q Okay. Was there anyone else under Mary 25 Thornton in, in, in a supervisory position? CENTRAL FLORIDA REPORTERS, INC. 976 1 A Not, not really in that aspect. I mean, we 2 had an evening supervisor, but they weren't directly 3 under Mary Thornton, no. And she had charge nurses that 4 worked underneath her on the unit. 5 Q And would these be the nurses that -- a charge 6 nurse is what, the person in charge of that shift? 7 A They give them the role of charge nurse. 8 Basically they're in charge of supervising the CNAs that 9 are doing patient care. They're responsible for 10 medications, treatments, documentation. 11 Q Okay. And how long were you at Sunbelt? 12 A I was at Sunbelt until December of '99. 13 Q May '99 to December of '99? 14 A Uh-huh. 15 Q And was Mary Thornton there the entire time? 16 A Mary Thornton came to Sunbelt I want to say 17 the end of June, beginning of July. I'm not exactly 18 sure, but it was around that time period and she left in 19 December. 20 Q Did you hire her directly? 21 A Yes. 22 Q Now, and is that a process where people submit 23 resumes and you review them -- 24 A Uh-huh. 25 Q -- and you do interviews -- CENTRAL FLORIDA REPORTERS, INC. 977 1 A Uh-huh. 2 Q -- and decide who the best person is? 3 A (Deponent nods head.) 4 Q Okay. Did you know Mary Thornton prior to her 5 coming to interview at Sunbelt? 6 A Mary Thornton worked at Regents Park. I knew 7 her briefly. I never really worked with her because she 8 was an evening nurse. 9 Q Did you ever socialize with her prior to that? 10 A No. 11 Q Okay. Okay. So December '99 you resigned? 12 A Yes. 13 Q You were not terminated? 14 A No. 15 Q Okay. Where did you go from there? 16 A I had applied -- prior to my leaving Sunbelt 17 had applied for a position at Westminster Care of 18 Orlando. 19 Q Where is that? 20 A Downtown Orlando, I believe off of Michigan 21 Avenue or Michigan Street. 22 Q And what type of facility is that? 23 A I believe it's like a 420-bed building. It's 24 a huge building and it's long-term care, rehab, 25 Alzheimer's. CENTRAL FLORIDA REPORTERS, INC. 978 1 Q Were there also meetings that had to do with 2 Mr. Destefano's picketing? 3 A Not really meetings. I mean, I would go to 4 Chuck's office and we would discuss many things, that 5 being one of them. I mean, it wasn't like specific 6 meetings designed to talk about Larry, no. 7 Q Okay. And where is Mr. Sherer's office in 8 relation to you? 9 A My office was on the third floor in the front 10 of the building facing Bedford Road. Chuck's office was 11 on the first floor in the front of the building, also 12 facing Bedford Road. 13 Q Okay. 14 A It was kind of on the corner of Florida 15 Hospital. 16 Q The discussions involving Mr. Destefano's 17 picketing, were those what you would characterize as 18 just kind of general discussions? In other words, you 19 and Mr. Sherer would discuss the daily business at 20 Sunbelt, and were those conversations just a part of 21 that general discussion or were they more focused? 22 A It would depend on what Larry's behavior was 23 that day. 24 Q Okay. And so what did you do from there? 25 A Well, I had a vacation planned with my CENTRAL FLORIDA REPORTERS, INC. 979 1 husband. We were going on a cruise, so I kind of kicked 2 back and we went on our cruise. I worked a little bit 3 per diem for a facility in Leesburg, Lakeport Square. 4 Q When did you start doing that? 5 A I went at Lake Park Square -- I worked for 6 them a couple times in December and a couple times in 7 January. 8 Q And that was just as needed, right? 9 A Uh-huh. 10 Q Okay. Hourly rate? You were paid hourly? 11 A Oh, yes. I thought you were going to ask me 12 what it was. Oh, God, I don't remember. 13 Q And did you receive full-time employment at 14 some point after that? 15 A Actually Vitas, the in-patient Hospice unit, 16 the director there had contacted me about coming to work 17 for her. 18 Q And where is that? That's Winter Park? 19 A It was at Winter Park Hospital. 20 Q And did you go to work full time there? 21 A Yes, I did. 22 Q When was that? 23 A I went there February of 2000. I'm in the 24 right year now? Yes. February of 2000, yes. 25 Q And what was your position there? CENTRAL FLORIDA REPORTERS, INC. 980 1 A I actually was hired just to be a staff nurse, 2 but then when I got there, they asked if I would do the 3 admission and discharge process for them. 4 Q That would involve admitting new patients and 5 getting a history on them? 6 A Basically I would go into the hospital at 7 Winter Park when there were referrals, and I would 8 explain the Vitas program to them. 9 Q Okay. And, and then -- and what type of 10 patients did -- are in this facility? 11 A The patients that come to the Vitas in-patient 12 unit are either patients that are -- they would come in 13 for symptomatic control. They would have pain 14 management issues or maybe some respiratory issues or 15 come in for a procedure. They would -- it would be 16 short-term stay. Stabilize them, they'd go home, and 17 they would come in end of life. 18 Q Okay. We're back on the record, Rachel, and I 19 want to -- where we left off was your employment with 20 Vitas. What was your, your duty there, your job title? 21 A I did the admissions and discharge process. 22 Q Okay. Does that involve any hands-on patient 23 care or is that just kind of intake and, and discharge? 24 A When we were slow I did -- I did hands-on 25 patient care, yes. CENTRAL FLORIDA REPORTERS, INC. 981 1 Q Okay. Were you on a specific shift at Vitas? 2 A I worked 1:00 p.m. to 9:00 p.m. 3 Q Okay. Those are different hours for a nurse. 4 Is that -- is that just the way they had it set up 5 there? Was there a specific -- a difference in your job 6 position as opposed to the regular nursing staff? 7 A They set it up that way because a lot of times 8 the doctors will round and they'll make a referral and 9 it will be later in the day, so that there would be 10 somebody who could explain the actual process to the 11 program. There would be somebody there, and when they 12 did come to the unit, there would be a familiar face to 13 settle people in. 14 Q So your job was very specific at Vitas? 15 A Yes. 16 Q Okay. How long did you work there? 17 A I worked at Vitas until September or October 18 of that following year, so in the year 2000, yes. 19 Q Was that a salaried position or was that 20 hourly rate? 21 A When I was on the unit I worked hourly, but I 22 was then promoted to a nurse manager, which became 23 salaried rate. 24 Q Okay. When you were -- when were you promoted 25 to nurse manager? CENTRAL FLORIDA REPORTERS, INC. 982 1 A In August of 2000. 2 Q And did that require a difference in your job 3 description, your, your job responsibilities? 4 A Yes, because I actually -- I left the unit -- 5 I didn't work on the unit anymore. I went to a main 6 office, and I was responsible for a nursing home team. 7 Q And what did you do there? 8 A Basically I was in charge of the care planning 9 process for -- there were many nursing homes that I was 10 responsible for. We had a, a group of nursing homes. I 11 had a team that worked under myself. I had a chaplain 12 and a social worker, nurses, CNAs. And I was just 13 responsible for the day-to-day care, and I would go to 14 the different facilities and check up on the patients 15 that we had. 16 Q How many different facilities? 17 A I want to say I probably had maybe 20 18 facilities. 19 Q All in Orlando or around the state? 20 A In Orlando. 21 Q Okay. So kind of sum up your job for me at 22 that point. Was it kind of an administrative position 23 overseeing these roughly 20 nursing homes? 24 A Yes. 25 Q Was it primarily focused on staffing and, and CENTRAL FLORIDA REPORTERS, INC. 983 1 that type of thing? Tell me exactly what you were 2 responsible for doing. 3 A I was responsible to check actual medication 4 orders that residents had in their facility to make sure 5 that they were appropriate as far as proper pain 6 management. We had a formulary to make sure that we 7 were using enough formulary. We would do -- we have a 8 team meeting weekly where we would discuss all the 9 residents on our caseload. 10 I would go to different nursing homes and have 11 meetings with their staff and family members. A lot of 12 people don't understand the concept of Hospice, and it 13 is a tough time for families -- 14 Q Uh-huh. 15 A -- to go through, so kind of to be a support 16 system to help those families. 17 Q How long did you do that, that specific job? 18 A I was there a couple months. 19 Q A couple months? And then what? 20 A As you can see, I had a very hard time dealing 21 with my father's death and being around people that were 22 dying constantly. That was the whole focus. It was a 23 very difficult time so I resigned. They did ask if I 24 would just take a leave of absence and come back, and I 25 just, just didn't feel like at that time in my life that CENTRAL FLORIDA REPORTERS, INC. 984 1 I could deal with any more death. 2 Q When was that roughly? 3 A That was in -- it was like the end of 4 September of 2000. 5 Q What did you do from there? 6 A I was offered a position at Rio Pinar as a 7 nurse manager. I went to their building, did my 8 orientation there and felt their standards weren't up to 9 my standards and declined the position. 10 Q Where is Rio Pinar? 11 A It is on the east side of Orlando. 12 Q Is that a nursing-home-type facility? 13 A Yes. 14 Q Okay. Large or small? 15 A I believe they're like 150, 60 beds, right 16 around there. Don't quote me. It's a larger facility. 17 Q That's okay. And again, you know, I'm not 18 going to hold you to -- if it's 150 and it's really 155, 19 you can approximate, it's not a problem. Did you -- did 20 you work there at all? 21 A Well, I was supposed to be on orientation. 22 And when I went for my orientation, there was nobody to 23 orient me. So -- 24 Q Uh-huh. 25 A -- for a couple days I was kind of thrown into CENTRAL FLORIDA REPORTERS, INC. 985 1 the position, yes. 2 Q And so about how many days did you work there? 3 A Actually on -- in that position? 4 Q Right. 5 A Minus the facility orientation, maybe two 6 days. 7 Q And then you resigned? 8 A Yes. 9 Q And what did you do from there? 10 A I went to work for Children's First. 11 Q And where is that located? 12 A They were in Winter Park. I know they've 13 moved, and I'm not sure where they're at now. 14 Q And what does Children's First do? 15 A It's pediatric home care. 16 Q Is that similar to what you were doing in 17 Vermont where you're going into homes and taking care of 18 children? 19 A Yes. 20 Q That's an agency? 21 A Not really an agency, no. I wouldn't classify 22 that as a typical agency, no. 23 Q Explain to me how -- you go and you say I want 24 to work for you and you're a member of their 25 organization? CENTRAL FLORIDA REPORTERS, INC. 986 1 A Uh-huh. 2 Q And then how do you get your patients? How do 3 you get your home care patient? 4 A They have, similar to Care Connection, 5 children that have been in the hospital, discharged. 6 They go home, and depending on their needs are, some are 7 in the actual homes with their families. Others are 8 children that are in foster care and they live like in a 9 group home setting. So they have cases and they assign 10 you the different cases depending on what your skills 11 are. 12 Q So is that something -- your job might be 13 different every day? 14 A Yeah, you would go to different people. 15 Q Okay. How long did you do that? 16 A I worked for them until about February of 17 2001. 18 Q February of 2001 -- 19 A Uh-huh. 20 Q -- another job change. You resigned? 21 A Well, prior to that I took on another position 22 as a favor to an administrator that I had known -- 23 Q Uh-huh. 24 A -- but I stayed with Children's First and just 25 did some weekend work. CENTRAL FLORIDA REPORTERS, INC. 987 1 Q Okay. So that was kind of part time with 2 Children's First at that point? 3 A Right. I -- with them it's not like part 4 time, full time. You basically work whatever 5 you -- whatever you choose. If you want to work 20 6 hours a week, you can. If you want to work 70 hours a 7 week, the availability is there. 8 Q Okay. So this other position that you take 9 on -- 10 A Uh-huh. 11 Q -- where is that? 12 A It's at Tandem of West Altamonte. 13 Q And what is that? 14 A It's a subacute long-term care facility. 15 Q Again, is this what most people know as a 16 nursing home? 17 A Yes. 18 Q Okay. How many beds? 19 A We were 116 beds. 20 Q And what was your position there? 21 A I went there as the interim director of 22 nursing for 30 days until the director had given her 23 notice at another facility. It was just supposed to be 24 a 30-day period, but the administrator asked me to stay 25 on as the subacute nurse manager/assistant director of CENTRAL FLORIDA REPORTERS, INC. 988 1 nursing. 2 Q So at that point you would be right under the 3 director of nursing? 4 A Yes. 5 Q Okay. Who, who was the person that brought 6 you into it? 7 A Jeff Cleveland. 8 Q And, I'm sorry, what was the name of it again? 9 A Tandem Health Care. 10 Q Tandem? How long did you do that job? 11 A I worked at Tandem until -- we're in 2002 12 right now, so it was March of -- end of March of 2002. 13 Q Okay. Salaried position again? 14 A On and off. 15 Q How does that work? 16 A It started out as a salary position, but the 17 hours -- it was many hours and they varied. It depends. 18 And I was getting very tired, and it was working out to 19 like three dollars an hour, so the administrator made me 20 hourly so I wouldn't leave. 21 Q You weren't even making minimum wage? 22 A Not with the hours you put in. 23 Q So at that point they, they switch you to an 24 hourly rate? 25 A Yes. CENTRAL FLORIDA REPORTERS, INC. 989 1 Q And that was across the board? Just whatever 2 hours you worked you put down -- 3 A Right. 4 Q -- and you got paid for that? 5 A Uh-huh. 6 Q Okay. And how long did you have that 7 position? 8 A Until March of 2002. 9 Q And what would you say your major 10 responsibilities were as assistant director of nursing? 11 A Most of my responsibilities were linked to the 12 unit. I managed -- it was a 56-bed subacute unit. So 13 we would have ortho patients, cardiac patients, 14 respiratory patients. I would oversee the day-to-day 15 operations of the unit. 16 Q Were there any individuals that -- 17 Alzheimer's, dementia, that kind of thing or were these 18 mostly rehab type injuries and -- 19 A The unit was designed for a rehab unit, but as 20 everybody knows, the elderly are living longer and 21 longer and many of the elderly have dementia-type 22 symptoms. So they would come in as a rehab patient, but 23 they could have dementia. That was, you know, a good 24 possibility that they had some type of dementia. 25 Q Were these some of the same responsibilities CENTRAL FLORIDA REPORTERS, INC. 990 1 that you had at, at Sunbelt -- 2 A Uh-huh. 3 Q -- just managing the day-to-day goings-on of 4 the facility? 5 A Yes. 6 Q Nurses, shifts, problems? 7 A Yes. 8 Q And how long did you do that? 9 A Until March of 2002. 10 Q And what did you do in March of 2002? 11 A I, I was getting very tired at Tandem. It 12 would -- it wouldn't be an abnormal day to work 24 hours 13 straight. We were very short staffed. The agency 14 didn't -- wouldn't show up and I would be stuck there. 15 So I decided that it was just at that time in my life 16 too much for me with my children. So I went back to 17 Lake Highlands in Clermont, which is Westminster Care of 18 Clermont now. 19 Q Which is where you started when you first 20 moved down? 21 A Right. 22 Q Okay. And were you commuting again from 23 Orlando to Clermont? 24 A Well, no, because I live in Apopka now. 25 Q So you lived closer? CENTRAL FLORIDA REPORTERS, INC. 991 1 A Right. And there's the 429 so it's quicker. 2 Q What was -- what position did you hire on at 3 Lake Highlands? 4 A As a day charge nurse. 5 Q And so what would your responsibilities be in 6 that? 7 A Medications, treatments, documentations, 8 admissions. 9 Q So a little bit more hands-on than what you 10 were previously doing? 11 A Yes. 12 Q Okay. Were you responsible for assigning 13 shifts to individual nurses or was it -- was it all 14 patient care? 15 A It was all patient care. 16 Q Okay. And was that a 40-hour a week job? 17 A Yes. 18 Q Full time? 19 A Yes. 20 Q Salary or hourly? 21 A Hourly. 22 Q And how long did you do that? 23 A I did that until we moved back to Vermont in 24 May of this year. 25 Q May 2002 -- CENTRAL FLORIDA REPORTERS, INC. 992 1 A 2. 2 Q -- you moved to Vermont? And why did you move 3 back to Vermont? 4 A Because I finally convinced my husband to go 5 back. 6 Q Was he ready for that or did that take some 7 work? 8 A It took a lot of work. 9 Q Okay. And did you have a job lined up there? 10 A Kind of. My friend worked at the -- Fletcher 11 Island, which is our major medical center there. And 12 they're like everybody else, they're desperately short 13 staffed. And I was told if I wanted a position, I could 14 come back and work there. 15 Q So you didn't have any worries about being 16 able to go back and get employment? 17 A No. 18 Q Okay. And was your husband still working for 19 the same trucking agency? 20 A He was still at RPS, yes. 21 Q Okay. And again, this is a leasing situation 22 so -- 23 A No. 24 Q -- it was a matter -- tell me how that worked. 25 A He's an actual employee of Roadway. CENTRAL FLORIDA REPORTERS, INC. 993 1 Q Okay. And is that different from the original 2 situation where we talked about where he could drive 3 from anywhere? 4 A That was RPS. 5 Q Right. 6 A Many years before, yes. 7 Q So what did he do about his job down here? 8 A Well, being that Vermont is a very small state 9 and their terminal basically has six drivers -- the 10 reason he didn't want to go back, he didn't want to give 11 up his pension and everything that he had worked so hard 12 for. 13 And my same friend who worked at the medical 14 center there had called me and said that Roadway had an 15 opening. So I told him about it, and he called just to 16 prove me wrong, that they didn't and they did. And he 17 flew to Vermont two days later for an interview and they 18 hired him. 19 Q Job change for him? 20 A No. 21 Q Transfer? 22 A You technically can't transfer because it's a 23 union company, so basically you go back to the bottom of 24 the wage scale. 25 Q Benefits still? Do they cross with you? CENTRAL FLORIDA REPORTERS, INC. 994 1 A Yes, he still gets his benefits. 2 Q Okay. And so when did you move to Vermont? 3 A We -- my whole family left for Vermont on May 4 30th of 2002. 5 Q All at the same time? 6 A Yes. 7 Q Okay. And is that the job that you went to do 8 up in Vermont, the one that you were talking about with 9 your friend? 10 A I went to Fletcher Island, hospital setting, 11 something that I had never done before. Probably a good 12 thing because the hospital wasn't for me. I had been a 13 long-term care nurse since day one. And a position 14 came -- was opened at Burlington Health and Rehab for a 15 director of nursing. 16 And at the time I had just called looking for 17 a regular RN floor position, and I talked to the 18 administrator about that. And when I went in for the 19 interview, she offered the director of nursing position 20 to me. 21 Q How long were you at Fletcher roughly? 22 A Not even two weeks. Not even two weeks. 23 Q That was hourly rate? 24 A Hourly, yes. 25 Q And so you were hired on as director of CENTRAL FLORIDA REPORTERS, INC. 995 1 nursing? 2 A At Burlington Health and Rehab, yes. 3 Q Same type of responsibilities as you 4 encountered before as director of nursing? 5 A Yes. 6 Q Okay. And what type of facility is that? 7 A We are 168 beds. We have four different 8 units. We have a long-term care unit. We have a 9 subacute rehab unit. We have an Alzheimer's/dementia 10 unit, and we have a geri-psych unit. 11 Q What are your hours now? As needed? 12 A Yeah. 13 Q Salaried? 14 A Yes. 15 Q That -- that's current? We're up to date now? 16 A Yes, we're current. 17 Q Okay. Bring you back down to, to Florida. 18 While you were working at Sunbelt, did you have any 19 close friends in this area? 20 A Yes, yes. 21 Q Were they people that you worked with? 22 A One person was somebody that I had worked 23 with, yes. 24 Q Which person is that? 25 A Vanessa Munos. CENTRAL FLORIDA REPORTERS, INC. 996 1 Q And she worked at Sunbelt as well? 2 A Yes. 3 Q What was her position there? 4 A She was staff development. 5 Q Okay. Would you say that you and Mary 6 Thornton were -- developed a friendship during the time 7 that the two of you were at Sunbelt? 8 A I would say that we developed a working 9 alliance. We were not friends outside of the building. 10 Q Okay. So you never had an occasion to 11 socialize outside of your, your work atmosphere? 12 A Only at work functions. 13 Q Okay. So everything -- any event that was 14 outside of the actual facility was generally a 15 work-related event? 16 A Yes. 17 Q Okay. Do you remember Carol Boze? 18 A Yes. 19 Q Do you remember Deborah Jarrell? 20 A Yes. 21 Q Margarita Walters? 22 A Yes. 23 Q Do you remember most of the staff that was 24 working there during this period of time? 25 A Yes. CENTRAL FLORIDA REPORTERS, INC. 997 1 Q Okay. Did you ever meet a nurse named Kelly 2 Pipkin? 3 A No. 4 Q How about Lillian Folley? 5 A No. 6 Q Who hired you at Sunbelt? 7 A Chuck Sherer. 8 Q Okay. Do you have a lawyer? 9 A Yes. 10 Q Who is your lawyer? 11 A Mason Grower. 12 Q Mr. Grower is representing you from here on 13 out? 14 A Yes. 15 Q Okay. Do you intend for Mr. Grower to 16 represent you from here on out? 17 A Yes. 18 Q Okay. 19 MR. GROWER: Actually let's do this. Let me 20 change my instruction on that. You can answer. 21 A Well, if it clears anything up, I thought 22 Mr. Grower was my attorney all along. So I was under 23 the assumption that he was my attorney. 24 Q Okay. From which point -- from what point? 25 A From the very first day that I was contacted CENTRAL FLORIDA REPORTERS, INC. 998 1 regarding this case. 2 Q And do you mean in terms of setting the 3 depositions or even prior to that? We had depositions 4 set in February of this year. 5 A I would say it would have been then if that 6 was the first time you -- 7 MR. GROWER: That was your impression? 8 A That was my impression. I thought that 9 Mr. Grower was my attorney. Why else would he be 10 calling me? 11 Q Okay. So that -- that's the first point that 12 you remember thinking that you were represented by 13 Mr. Grower? 14 A Yes. 15 Q Okay. We talked about chain of command at 16 Sunbelt. It was you, Mary Thornton, and was there 17 anybody else under Mary Thornton? 18 A Well, all of her nursing staff was under her. 19 Q When you were at Sunbelt roughly, and I know 20 we talked about this earlier, your hours varied, but 21 approximately what time during the day would you try to 22 be present? 23 A We would have a morning meeting at 9:15, so I 24 would always be there by 9:15. 25 Q And you would be there for changing of the CENTRAL FLORIDA REPORTERS, INC. 999 1 shifts from -- so you had 7:00 to 3:00, 3:00 to 11:00, 2 and 11:00 to 7:00? 3 A Uh-huh. 4 Q And you would be there for the 7:00 to 3:00, 5 3:00 to 11:00 shift change? 6 A Yes. 7 Q Okay. When was the first time that you 8 remember, if you remember, meeting Carolina Destefano? 9 A I believe it was the morning of the 21st. It 10 was -- the very first morning that I met Larry was the 11 first morning I met his mother. It was the same time. 12 Q So you weren't involved in, in any of her care 13 prior to the 21st? 14 A No. 15 Q Okay. Were you even aware of her? 16 A I knew that she had been admitted -- 17 Q Right. 18 A -- but that was -- I mean, we go over who the 19 admissions are. 20 Q So you know who your patients are, but you're 21 not involved in the, the day-to-day care of them unless 22 there's some type of problem, is that fair? 23 A Correct. 24 Q Okay. So on the 21st, what got you involved 25 with Carolina Destefano? CENTRAL FLORIDA REPORTERS, INC. 1000 1 A Well, I was just about ready to knock on Mary 2 Thornton's office door, and my cell phone rang and it 3 was Mary. 4 Q And where is Mary's office? 5 A Her office was on the third floor by the very 6 first nurse's station. 7 Q Is it close to your office? 8 A It's a few doors down, yes. 9 Q You're about ready to knock on the door -- 10 A Uh-huh. 11 Q -- and your cell phone rings? 12 A Uh-huh. 13 Q You're right outside her door? 14 A Uh-huh. 15 Q What does she tell you? 16 A She was very upset, so obviously I hung the 17 phone up and went into the office. I was right there. 18 Q Was she able to tell you on the phone what she 19 was upset about? 20 A No. 21 Q What, what did she tell you exactly? I mean, 22 just -- 23 A Well, I mean, I was just knocking on the door 24 when the phone rang, so I shut the phone off and went 25 in. CENTRAL FLORIDA REPORTERS, INC. 1001 1 Q Instantaneous conversation, I'm here -- 2 A Right. 3 Q -- hang up and then you go into her room, 4 right? 5 A Correct. 6 Q What does she tell you when you get in there? 7 A She said that we had a resident whose son was 8 very upset and that he was yelling at her and backing 9 her up. Her office was very small. It was like a 10 two-by-two room. And, you know, he was coming forward, 11 yelling at her. He was very upset about a dressing. 12 And that she was afraid of him. 13 Q Did she tell you why he was upset about the 14 dressing? 15 A I really don't remember if she told me exactly 16 why. She was just -- she was very upset and said that 17 he had gone down to the room. So I said, well, let me 18 go down to the room and talk with him. 19 Q Okay. Did you ask her why she was afraid of 20 him? 21 A She had told me that he was yelling at her and 22 backing her up against the wall, so I would assume that 23 that would be frightening to any -- anybody. 24 Q And did she go into any of the -- any of the 25 information about the dressing? CENTRAL FLORIDA REPORTERS, INC. 1002 1 A No. She just said he was upset about a 2 dressing. 3 Q Okay. So at that point all you know is it's 4 something to do with a dressing and, and Mary Thornton 5 is afraid of Mr. Destefano -- 6 A Uh-huh. 7 Q -- is that fair? 8 A Yes. 9 Q Okay. What did you do from there? 10 A Mary and I went down to the room and -- 11 Q How far away is the room from Mary's office? 12 A Maybe three, four doors down. 13 Q Okay. If you walk out of Mary's office, which 14 way do you go to Ms. Destefano's room? 15 A To the left. 16 Q To the left? 17 A Right. 18 Q It's just a few doors down? You don't have to 19 go through any other doors to get there? 20 A No. 21 Q Okay. What happened when you get there? 22 A The door was closed. And I knocked on the 23 door and there was no answer. So I opened the door and 24 went to enter the room and at that time saw Larry 25 leaning over his mother holding her face, kissing her in CENTRAL FLORIDA REPORTERS, INC. 1003 1 a way that you don't kiss your mother. 2 Q Okay. The door was completely closed? 3 A When we -- yes. The door was completely -- 4 Q The door -- 5 A -- closed and I opened the door, yes. 6 Q Okay. Where was Mary? 7 A Mary was standing behind me. 8 Q Right behind you? 9 A That's fair to say, yes. 10 Q Can you describe for me how the room is laid 11 out? 12 A Sure. 13 Q And if you like, you can draw it, whatever 14 is -- do you want to draw it out or do you want to -- 15 A That's okay. I can just -- I'll work well 16 with my hands. 17 Q Okay. 18 A When you open the door and the bed would be -- 19 this would be the bed like this. The head of the bed 20 would here and the foot of the bed here. And the 21 resident was lying on the bed, and he was leaning over 22 his mother. 23 Q Okay. Is -- the head of the bed is, is 24 against the wall? 25 A Yes, to the left against the wall. CENTRAL FLORIDA REPORTERS, INC. 1004 1 Q And where is the door in relation to the head 2 of the bed? 3 A When you open the door up, you can see full 4 view of the room. It was a single room. 5 Q Okay. Which way does the door open up, to the 6 left or to the right? 7 A It would open in. Oh, you mean which -- I'm 8 sorry. The handle of the door was to the left. 9 Q To the left? So it was -- 10 A So you'd open the door. It would open like 11 this. 12 Q So as you're in the hallway, the handle of the 13 door is on the left side? 14 A Yes. 15 Q And you open it up, and if the door was all 16 the way open, what would you see from the doorway? 17 A You could see -- 18 Q The head of the bed? 19 A You could see the entire room. 20 Q Okay. Was there a curtain drawn around the 21 bed? 22 A No. 23 Q Was anybody else in the room? 24 A No. 25 Q Just Mr. Destefano, his mother, you, and then CENTRAL FLORIDA REPORTERS, INC. 1005 1 Mary Thornton behind you? 2 A Yes. 3 Q How long did this kiss last? 4 A I can't tell you exactly. I mean, ten, 15 5 seconds. 6 Q Okay. 7 A I wasn't timing it. I was standing there in 8 disbelief. 9 Q Right. And I understand that, so I'm not 10 going to get it down to a second. What I want is your 11 best recollection. 12 A Uh-huh. 13 Q So if ten or 15 -- 14 A When you're in a situation like that, it seems 15 like eternity. 16 Q Okay. You think ten to 15 seconds is a best 17 guess? 18 A Yeah. 19 Q Okay. During that ten to 15 seconds, what 20 were you and Mary doing? 21 A I looked back at Mary and gave her a look like 22 are you seeing what I'm seeing? And then at that time 23 Larry realized we were there. He jumped up from the 24 bed, walked over to the door. I introduced myself. He 25 allowed me to come in and shut the door on Mary's face. CENTRAL FLORIDA REPORTERS, INC. 1006 1 Q He didn't hear you come in? 2 A No. 3 Q And he didn't hear you -- 4 A I don't know if he heard me. 5 Q Let me ask you this way. You stated earlier 6 that you knocked? 7 A Uh-huh. 8 Q There was no response? 9 A Uh-huh. 10 Q And you went ahead and opened the door? 11 A Uh-huh. 12 Q Did it appear to you that as you opened the 13 door that he heard you knock or heard you come in? 14 A I can't imagine that he heard me because why 15 would -- why would you continue with that behavior and 16 why wouldn't you have stopped and come to the door? So 17 if I have to presume something, I would say no, he did 18 not hear me. 19 Q So your best guess is that he was not aware 20 that you and Mary Thornton were there in the room? 21 A Correct. 22 Q Okay. When he did become aware of you, what 23 were his reactions? 24 A He jumped up from the bed. He walked over to 25 the door. I introduced myself. He allowed me to come CENTRAL FLORIDA REPORTERS, INC. 1007 1 in, and he shut the door on Mary Thornton's face. 2 Q Did he appear to be startled or afraid or 3 embarrassed? And you can substitute any word you want. 4 A I mean, he just jumped up and walked over. I 5 mean, at that point I was still kind of in a state of 6 shock from what I had seen. 7 Q Did you ask him what he was doing? 8 A No. I introduced myself. He let me in. I 9 said I understand that there's some problems. How can I 10 help you? 11 Q Okay. You said that he shut the door on Mary 12 Thornton? 13 A Uh-huh. 14 Q Is the door completely closed now? 15 A Completely closed. 16 Q And I'm assuming you have no idea where Mary 17 is, whether she's still outside the door or -- 18 A No. I knew he, he had shut the door. 19 Q Okay. Did you know whether she was out there 20 waiting for you? 21 A No, I didn't know if she was there or not. 22 Q So what did he say to you in terms of your 23 offer to resolve whatever problems existed? 24 A He was upset about a dressing that -- he said 25 he had been in the night before and that the dressing CENTRAL FLORIDA REPORTERS, INC. 1008 1 was not on his mother's ankle and that he was upset 2 about that. And that he had had the nurse sign a piece 3 of paper stating that the dressing wasn't there. 4 And I tried to explain to him that we -- 5 generally the -- you document in the medical record that 6 type of information. And our policy is not to just sign 7 people's documents that float all around where -- you 8 know, wherever they may go. 9 Q Did you know at that point -- and I don't mean 10 now, but I mean -- and take yourself back to that 11 moment. Did you know at that moment which nurse signed 12 this document? 13 A I'm not sure if he used her name or not. 14 Q Okay. 15 A I'm not sure. 16 Q Had you seen that note yet? 17 A I didn't even know anything about it until I 18 went into the room and he explained that to me. 19 Q Okay. So Mr. Destefano is, is the first 20 person that made you aware that a note had been signed? 21 A Yes. 22 Q Okay. And you're not sure whether he told you 23 who it was that signed the note or not? 24 A No. 25 Q Okay. Do you know if Mary Thornton knew about CENTRAL FLORIDA REPORTERS, INC. 1009 1 that note at that point? 2 A No, we didn't have any discussion. All I knew 3 was that there was a family member down in the room who 4 was very upset about a dressing. That was all that I 5 had known. 6 Q So when you say no, you don't know whether she 7 knew? 8 A No. 9 Q Okay. 10 A To this day I don't know if she knew. 11 Q Okay. So what were the discussions then that 12 flowed from this note? He tells you that he had this 13 note signed and you tell him, well, that's not the way 14 we do things. 15 A Uh-huh. 16 Q Where did it proceed from there? 17 A He began to get very angry and his voice began 18 to get louder, and I could tell that the situation was 19 escalating. He said, well, if your nurses don't sign 20 it, then I'll get every resident in this building to 21 sign it. I'll go to every resident. 22 I said, well, you can't do that. That's 23 infringing on people's rights. They live here. This is 24 their home. And he said, well, I don't care. Then I'll 25 go out into the streets. I'll get somebody. Then he, CENTRAL FLORIDA REPORTERS, INC. 1010 1 he -- that was his Constitutional right. He started 2 jumping back and forth with his conversation. 3 He then told me that we weren't giving good 4 care and that his mother had an -- there was blood on 5 the bed pad from an open area because we weren't giving 6 her good care. 7 Q And had you -- you had not given Carolina 8 Destefano any care prior to this, right? 9 A I had never seen her prior to this. 10 Q So this was the first time that you see 11 Ms. Destefano? And you hadn't reviewed her medical 12 charts at any point? 13 A Not at all. 14 Q Okay. When he mentions the blood, what do you 15 do? 16 A I said oh. It surprised me. And I said, 17 well, then let's take a look at your mother's bottom. I 18 got on a pair of gloves and pulled the sheets back and 19 turned her up on her side and looked at her bottom. 20 Q Okay. Was she laying on her back at that 21 point? 22 A I believe that she was on her back, yes. She 23 was very contracted. In order to get her up on her 24 side, I'm sure she would have to be propped by pillows, 25 that she wouldn't be able to sustain that position by CENTRAL FLORIDA REPORTERS, INC. 1011 1 herself. 2 Q Did you do that yourself or did Mr. Destefano 3 help you with that? 4 A He may have helped me. I really don't 5 remember. 6 Q Okay. Did you observe any blood? 7 A There was a little bit of red blood on the 8 pad, yes. 9 Q Do you remember what part of the pad that was 10 on? 11 A I'm not sure. 12 Q Okay. 13 A I mean, if you ever laid on a bed pad, a bed 14 pad is here, there and everywhere in the bed. I mean, 15 it's -- 16 Q Well, let me do this then. Describe the size 17 of the bed pad for me approximately. 18 A It's a normal bed pad. It's probably that 19 big. I mean, I didn't -- 20 Q And I know there are different size bed pads. 21 Is this one of the larger ones or one -- a very small 22 one? 23 A No. It would be a regular size pad that you 24 would use to absorb anything or to help -- we use the 25 pads to lift people up to prevent shearing from the bed CENTRAL FLORIDA REPORTERS, INC. 1012 1 and to prevent pulling on somebody. 2 Q So it would have been one of the pads that's 3 strong enough to hold the weight of the person? 4 A Yes. 5 Q Okay. What was the, the approximate size of 6 the blood stain? 7 A It was just a little drop. I mean, it wasn't 8 any big amount. 9 Q When you say a little drop, can you -- the 10 size of a dime, the size of a quarter? 11 A No. I can't tell -- 12 Q Baseball? 13 A I mean, if I can remember, I would say it's no 14 bigger than a dime. 15 Q Okay. Was it a round blood stain or how would 16 you characterize it? I mean, if you had to describe it 17 for me, tell me -- 18 A That many years ago -- 19 Q Uh-huh. 20 A -- I can't de -- I can't. 21 Q Okay. The location of the blood stain -- I 22 know you told me you can't place it on the pad 23 necessarily because you don't remember, is that right? 24 A Yeah. 25 Q Okay. CENTRAL FLORIDA REPORTERS, INC. 1013 1 A I mean, that's fair to say. 2 Q And I'm just making sure that I've got what 3 you're telling -- 4 A Right. 5 Q -- me correct. Can you place it in terms of 6 where on your body that blood stain would have come 7 from, do you know? 8 A Well, the pad was located -- it would be from 9 mid-back to right here. 10 Q Uh-huh. 11 A So, I mean, it would be under her bottom. 12 Q Okay. 13 A That would be the position. 14 Q Is the best of your recollection that it was 15 somewhere under her buttocks? 16 A Yes. 17 Q Okay. Were you able to locate a source of the 18 blood? 19 A No. In looking at her bottom and having six 20 kids and seeing many, many diaper rashes over the years, 21 her bottom looked to me like a normal diaper -- like a 22 diaper rash, excoriated area, and it had ointment on her 23 bottom. There wasn't any area on her bottom where you 24 could see that there had been blood or anything like 25 that. CENTRAL FLORIDA REPORTERS, INC. 1014 1 Q Okay. Did you have any suspicions about where 2 the blood might have been coming from? 3 A Let me look in the record. 4 Q Sure. 5 THE WITNESS: If I can find where the Sunbelt 6 notes start. For Sunbelt, is it located at the 7 front? I'm sorry. I have a hard time looking 8 through this file. 9 MR. GROWER: I think there's some notes behind 10 9/21. 11 THE WITNESS: I'm trying to find nurses' 12 notes. Here they are, sorry. 13 A I did ask Larry at that time if his mother had 14 had hemorrhoids, and he had told me no, that she had an 15 open area that we had caused to bleed. 16 Q Okay. Did you -- were you able -- based on 17 your examination of her, were you able to confirm that? 18 A There wasn't an open area on her bottom, no. 19 It was like a diaper rash. And I did not check her for 20 hemorrhoids, no. 21 Q Okay. So is it -- at that point after 22 examining her, seeing that -- the small spot of blood on 23 the pad, what did you do from there based on the fact 24 that you saw this piece of -- or a small stain? 25 A Well, at that time Larry was very angry, and CENTRAL FLORIDA REPORTERS, INC. 1015 1 I'm in a room with him and felt very intimidated, so I 2 suggested we go look at the chart. He wanted to see 3 this documentation, and he wanted to know that the nurse 4 had put it in the nurses' notes. So we left the room. 5 Then we went to the nurses' station. 6 Q Now, when you say this, do you mean -- we're 7 talking about again the -- talking about the dressing -- 8 A Yes. 9 Q -- going back to the dressing? 10 A Yes. 11 Q Okay. 12 A So we walked back to the nurses' station and I 13 retrieved the chart. And when I opened the chart, there 14 was not a nurses' note in the chart, which made Larry 15 even more angry. And he started banging his fists on 16 the counter and backing me up against the corner yelling 17 that there wasn't any documentation in the chart. Where 18 is it? Where is it? 19 Q And where, where were you when this was 20 occurring? 21 A At the nurses' station. 22 Q Okay. Is that located in the -- in the -- in 23 the central area? 24 A That would have been the first nurses' 25 station. We were at the second nurses' station, which CENTRAL FLORIDA REPORTERS, INC. 1016 1 would be right outside from my office. 2 Q Okay. And is that where all the patients' 3 charts are kept? 4 A Yes. 5 Q Okay. Did you know at that point what 6 dressing Mary Thornton and Mr. Destefano were even 7 talking about? 8 A I believe that he told me that it was the 9 dressing on her ankle, and if I -- if I can remember 10 properly, I believe that we even looked at the area. 11 Q While you were in the room? 12 A In the room. 13 Q The ankle? 14 A Yes. 15 Q And do you remember if it was dressed at that 16 point? 17 A I don't recall -- I don't think that it was. 18 Q Okay. 19 A I can't be 100 percent. 20 Q Do you recall your impressions of the wound on 21 her ankle? Did it look serious? Did it look okay? 22 A I believe it was a stage two. I mean, it 23 didn't look infected or anything. I mean, there's no 24 decubitus that is okay. It's not an okay thing. 25 Q Right, right. CENTRAL FLORIDA REPORTERS, INC. 1017 1 A But it, it wasn't infected. 2 Q Was there any -- was there a source of blood 3 coming from it that you can recall? 4 A No, no. 5 Q Okay. Do you recall whether it was oozing 6 some type of other fluid? 7 A No. I don't believe so, no. 8 Q Okay. Did you observe or were you aware of 9 any other cuts or openings on her body that would have 10 caused that blood stain? 11 A No. 12 Q Okay. How thoroughly did, did you take a look 13 at her? When you rolled her over, was it just to look 14 at her buttocks and make sure that everything was okay 15 there? 16 A Right. I mean, when somebody's claiming that 17 your facility caused an open area to somebody's bottom, 18 I mean, that's a pretty serious allegation. So I turned 19 her over and looked at her bottom and there was not an 20 open area. 21 Q So you were able to verify that there was no 22 open area? 23 A Correct. 24 Q Okay. So now you're now at the nursing 25 station and you're having this conversation with Larry, CENTRAL FLORIDA REPORTERS, INC. 1018 1 and is he loud? 2 A Very loud. 3 Q Okay. And does he seem to be upset with you 4 or the situation? 5 MR. GROWER: Form. 6 A I can't speculate who he was upset with. 7 Q Okay. 8 A He was just upset. 9 Q Okay. And, and what was he saying to you? 10 A He was yelling that the documentation wasn't 11 there, and he was banging his fist on the counter 12 wanting to know why it wasn't there and coming toward 13 me. 14 Q And at that point do you remember if you knew 15 who signed the note? 16 A I'm not sure -- 17 Q Okay. 18 A -- at that point. 19 Q Okay. What happened next? 20 A Well, I mean, he was yelling so loudly that 21 people were coming out into the hall, residents, staff. 22 And I told him he needed to quiet down, you know, that 23 this was a nursing home, and he couldn't behave that 24 way. He just continued to yell, and he ended up going 25 back down toward his mother's room and he was -- almost CENTRAL FLORIDA REPORTERS, INC. 1019 1 as if he was running down the hall and he was yelling. 2 And at that time I went into my office and I called 911. 3 Q Who, who was there at the nurses' station 4 while you're looking at the chart to see if the lack of 5 dressing or dressing had been charted? Who was present, 6 you, Larry and -- 7 A I mean, there was nurses there. I mean, I 8 can't tell you exactly who was there. I do know that 9 Val Tomlin was there. But other than that, I mean, at 10 that point you have somebody who is irate. They're 11 yelling at you. They're out of control. You're really 12 not concerned with who's around. 13 Q You're paying attention to what's going on 14 instead of who was there? 15 A Absolutely. I didn't know if I was going to 16 get hit. I didn't know what was going to happen at that 17 time. 18 Q Do you remember if Mary Thornton was there? 19 A I don't know if she was there at first. I 20 know that she ended up coming to the nurses' station 21 because of all the yelling. 22 Q Did she arrive at the nurses' station before 23 you called 911? 24 A Yes. 25 Q Okay. And how far is your office from the CENTRAL FLORIDA REPORTERS, INC. 1020 1 nursing station? 2 A It's diagonal to the nurses' station. It's 3 right there. 4 Q Right there? Okay. Who was in your office 5 when you called 911? 6 A I believe Mary came in there, my staffing 7 coordinator. Her office is directly outside the door. 8 I'm not sure who else was there. 9 Q And do you remember what your -- what your 10 complaint to 911 was? 11 A Yes, that I had a family member who was out of 12 control, yelling and was afraid that he may become 13 violent. 14 Q Okay. How long did it take for -- was it 15 OPD -- 16 A Yes. 17 Q -- Orlando Police Department? How long did it 18 take for them to show up? 19 A At that point it seemed like forever, but I -- 20 I'm sure it wasn't. I really don't know how long. It 21 just seemed like a long time. 22 Q Okay. Were there any other conversations that 23 happened between you and Larry between your initial call 24 to 911 and when they arrived? 25 A No. CENTRAL FLORIDA REPORTERS, INC. 1021 1 Q Okay. Do you know where he was during this 2 period of time? 3 A He went back to his mother's room. 4 Q Was any -- do you know if anybody else was in 5 there other than Larry and his mother? 6 A Not that I know of, no. 7 Q And what did you do? 8 A While I was in my office, I called 911, and 9 then I called Chuck Sherer because he wasn't in, and I 10 needed to let him know what was going on in the 11 building. 12 Q Okay. You reached him by cell phone? 13 A I believe he was at the corporate office. 14 Q Okay. But did you get him by cell phone or 15 pager or how did you get ahold of him? 16 A I believe I called the office and they got him 17 for me. 18 Q Okay. And what did you relay to him? 19 A I just told him that we had a family member 20 who was very upset about a dressing change and that he 21 was yelling. He was out of control. I didn't tell him 22 anything else at that point because he just -- I was 23 waiting for the police to arrive, and he said he was on 24 his way. And I said that there was more we needed to 25 discuss when he got there and that was the conversation. CENTRAL FLORIDA REPORTERS, INC. 1022 1 Q Was, was -- how long did it take Mr. Sherer to 2 get there roughly? Was he there promptly? 3 A I'm not sure because the police arrived, and I 4 had to go through everything with them and we did the 5 trespass warrant. It was a while because by the time he 6 got there the police were gone so -- 7 Q Okay. You handled everything by the time 8 Mr. Sherer got there? 9 A Uh-huh. 10 Q Okay. And when he got there, did you give him 11 all the information, just kind of relay it to him -- 12 A Uh-huh. 13 Q -- as you are to me? 14 A Yes. 15 Q Okay. How many officers from Orlando Police 16 Department showed up, if you remember? 17 A It at least two. I don't know if there was 18 any more. I know there was at least two. 19 Q Okay. Was Mary Thornton waiting with you in 20 your office while OPD was on the way? 21 A I'm not sure. I don't -- I don't remember. 22 Q Okay. Were there discussions about what was 23 going on with you or any of the other staff while you 24 were waiting for OPD to get there? 25 A Well, I called Chuck. And then by the time I CENTRAL FLORIDA REPORTERS, INC. 1023 1 got off the phone with him the police were there. 2 Q Okay. When did you become aware of 3 the -- when was the first time you saw the note? 4 A I never saw the note. 5 Q Okay. Have you seen the note to this date? 6 A No. 7 Q Okay. When you discovered that the dressing 8 change had not been charted -- 9 A Uh-huh. 10 Q -- what did you do? 11 A I called the nurse, Carol Boze, and told her 12 she needed to come in and make a late entry. 13 Q Where, where did you get ahold of her? 14 A At her home. 15 Q Okay. And do you remember roughly what time 16 that was? 17 A No. It would have been after all this 18 happened. 19 Q So it would have been after OPD came -- 20 A Right. 21 Q -- and left and all that? 22 A Right. 23 Q Okay. Did she come in when you called her? 24 A I'm not sure exactly what time it was. I know 25 she was working that evening, so she may have just come CENTRAL FLORIDA REPORTERS, INC. 1024 1 in early for her shift. I'm not sure exactly what time 2 it was. 3 Q Do you remember what shift she was on? 4 A She worked the 3:00 to 11:00 shift. 5 Q Was that the shift that she always worked or 6 did, did nurses kind of switch around a bit? 7 A She generally worked 3:00 to 11:00, but there 8 are times that people would need to switch a shift and 9 she would cover the day shift for somebody. 10 Q Okay. So you're not sure what time she came 11 in to make that -- 12 A No. 13 Q -- those notations in the -- in the chart? 14 A No. 15 Q Okay. Were you upset with her for not making 16 the notation when she should have? 17 A I wasn't upset with her, but I explained to 18 her that, you know, when something like this happens you 19 need to, to document that. And I think it's the biggest 20 problem with nursing anywhere in the United States is 21 people don't document. And if it's not there, well, 22 then it creates a problem like this did. 23 Q So as part of, you know, a nurse's duties, is 24 it fair to say that charting accurately is paramount, 25 very important? CENTRAL FLORIDA REPORTERS, INC. 1025 1 A Documentation, yes, is very important. 2 Q Okay. Let me ask you about some of the 3 notations in general. Generally as a nurse when do you 4 put in the chart things -- procedures that you performed 5 on a patient? Would you do that contemporaneous to when 6 you do it or would that be impossible? Do you do it 7 right after you do it? 8 A It all depends on what the situation is. I 9 mean, ideally everybody would like to do their 10 documentation in a timely fashion but nurses are 11 overworked. You have eight hours in a shift to complete 12 what you need to complete, and the, the main thing is 13 that you get people their medications and you do your 14 treatments and you do the actual hands-on care, and that 15 means that documentation generally becomes the last 16 thing on a list to do. 17 So, I mean, it depends on the situation. If 18 you have somebody having a heart attack, you're going to 19 take care of that situation and you're going to go back 20 later and you're going to do the documentation. 21 Q Okay. 22 A It's all situation based. 23 Q Now, if you -- if you do a procedure on a 24 patient now, would you normally wait until the end of 25 the shift to, to make all the notes or would you just do CENTRAL FLORIDA REPORTERS, INC. 1026 1 them as soon as reasonably possible? 2 A Generally nurses do their documentation at the 3 end of the shift. 4 Q Okay. So, so the common practice is just to 5 wait 'til the end of the shift and then do the 6 notations? 7 A It's not that it's a common practice. It's 8 generally the only time that you have to do it. And 9 generally you're ending up going into another shift just 10 to get your documentation done. 11 Q Okay. When you do the documentation at the 12 end of the shift -- let's say you're 7:00 to 3:00 and 13 you're doing your, your nursing chart at say 2:30. What 14 time do you put down in terms of your notes? 15 MR. TOWNSEND: Object to form. 16 MR. GROWER: Join. 17 A Generally you are -- the standard of practice 18 is that you would document 2:30 as the time that you're 19 putting in the entry, and then whatever you're referring 20 back to you would put it at that time. 21 Q So if I -- November 1st, 1999, at 10:30 I do 22 something on a patient but I'm not able to chart it 'til 23 3:00, my note would read 11/1/99, 3 -- 3:00 p.m., but 24 then in my actual narrative is where I would put this 25 morning at such and such a time I performed this, this CENTRAL FLORIDA REPORTERS, INC. 1027 1 and this? 2 A Yes. 3 MR. TOWNSEND: Object to form. 4 BY MR. CONWAY: 5 Q Okay. Were you able to -- prior to writing 6 your own notes in Ms. Destefano's file, were you able to 7 review the file? 8 A When I wrote my note, I didn't even have the 9 chart. I just had the nurse's notes, which is a pad of 10 paper and you can just write your entry. 11 Q Okay. Tell me how that works. 12 A Normally a nurse would, would document and 13 have the, the chart with them, but in this course of the 14 day many things happened. I had the incident with 15 Larry. I had the incident with the police. I had the 16 incident of calling in to HRS. By the time it came time 17 to document, I wanted to write my note and go home. So 18 I just wrote my note and that was that. 19 Q Where did you write the note? 20 A On the nurses' notes. 21 Q Okay. That -- that's where I'm getting lost. 22 The nurses' notes and the chart, two different things? 23 A You put a nurses' note into a chart, but 24 generally nurses' notes come in a packet, nurses' notes. 25 Q Uh-huh. CENTRAL FLORIDA REPORTERS, INC. 1028 1 A You would rip those sheets off, do your notes, 2 throw them in a chart. 3 Q Okay. These notes are back to back. On the 4 notes that you referred from Sunbelt -- 5 A Uh-huh. 6 Q -- they're back to back? So just in terms of 7 me clarifying how you guys did things, you got the first 8 one, 9/19/99? 9 A Uh-huh. What I'm trying to explain to you is 10 when I wrote my nurses' notes, I grabbed a packet of 11 nurses' notes. 12 Q Okay. And that -- that's what I'm getting at. 13 A That's what I did. 14 Q Uh-huh. 15 A When the nurses document, they would have a 16 chart. 17 Q Okay. 18 A Does that -- 19 Q And then so how do you mesh your notes with 20 the chart? 21 A Well, I wouldn't -- I would put my notes in 22 there, but I don't -- I wouldn't review what somebody 23 else wrote to write a nurses' note. This is my nurses' 24 note. This is my documentation. So it doesn't matter 25 to me what somebody wrote the shift before. CENTRAL FLORIDA REPORTERS, INC. 1029 1 Q Okay. So at -- at the point where you write 2 this -- the 9/21 -- 3 A Uh-huh. 4 Q -- at 4:00 p.m. -- 5 A Uh-huh. 6 Q -- you had -- 7 A I had nurses' notes. 8 MR. GROWER: I'm sorry, you said uh-huh. Yes 9 to 4:00 p.m.? 10 THE WITNESS: Yes to 4:00 p.m. 11 BY MR. CONWAY: 12 Q You hadn't reviewed any notes? 13 A No. 14 Q Okay. And at 4:00 p.m. on 9/21/99, did you 15 know at that point -- and I know this is hard, but if 16 you need to take a second, go ahead. Did you know at 17 4:00 p.m. on 9/21/99 which nurse signed Mr. Destefano's 18 note regarding the wound or the dressing? 19 A Yes, because I had already called Carol Boze 20 in to come in and do her late entry note. 21 Q Okay. Let me jump ahead again and pick up 22 where we left off. On the 21st, the bed pad, when you 23 moved Carolina Destefano and you saw the, the red stain, 24 the red blood stain, did it appear fresh? 25 A It, it was bright red. CENTRAL FLORIDA REPORTERS, INC. 1030 1 Q Did it appear to be moist or did it appear to 2 be dried? 3 A It just looked like a bright red stain. 4 Q Okay. 5 A I didn't touch it or, or anything like that. 6 Q Other than that, you don't have any impression 7 of whether it appeared to be recent or old or -- 8 A Well, I mean, if you're talking old like in a 9 day old, no. I mean, recent as in probably a few hours 10 I would say, yes, but I'm not an expert in that area -- 11 Q Right. 12 A -- so -- 13 Q Okay. How often are the bed pads changed? Is 14 that a routine changing or is it just as needed? 15 A Well, they would be changed every day when, 16 when the bed is changed and, and remade or when it's 17 soiled. 18 Q Okay. Have you seen the bed pad since that 19 day? 20 A No. 21 Q Have you seen photographs or videos of it or 22 anything like that? 23 A No. 24 Q Okay. Would you remember that bed pad if you 25 saw it? CENTRAL FLORIDA REPORTERS, INC. 1031 1 A Would I know if it was that pad? No, there's 2 no way to know that. 3 Q Okay. At what point in the day did you save 4 that bed pad for, for Orlando Police Department? 5 A It wasn't like it was saved. When 6 Mrs. Destefano was transferred to the hospital, her 7 things were just left in the room. The room was as-is. 8 And then later on in the day I received a call, and I 9 don't know at what time or even from who. It was 10 somebody from Orlando Police Department saying that they 11 would come and retrieve the pad. 12 Q Okay. And did you then go and do anything to 13 preserve that pad? 14 A I don't believe that I did, no. 15 Q What did you do? 16 A I believe I let Mary Thornton know, but I'm 17 not -- I can't remember. 18 Q Okay. 19 A So many years ago. I, I don't know. 20 Q Okay. Let, let me just walk through it one 21 question at a time, so I apologize if I'm asking you 22 questions that seem ridiculous to you. Did you hand it 23 over to Orlando Police Department? 24 A I, I don't remember. 25 Q Okay. CENTRAL FLORIDA REPORTERS, INC. 1032 1 A I don't know if somebody brought it to me and 2 I gave it or if they came and somebody else did. I don't 3 remember. 4 Q Okay. Well, let me back up then. You 5 received a phone call from, from somebody identifying 6 themselves as Orlando Police Department, and they said 7 what to you? 8 A That they were going to come and get the bed 9 pad. 10 Q Okay. And what did you do with that 11 information? 12 A I don't remember. 13 Q Okay. 14 A I don't remember if I told Mary, I don't 15 remember. 16 Q Is it possible that you got the bed pad or are 17 you sure you did not do that part? 18 A I don't know. I don't remember. 19 Q Okay. Can you be specific about anything in 20 between the phone call that you got from OPD and the 21 time that somebody showed up from Orlando Police 22 Department to pick it up? 23 A I, I really don't remember. 24 Q Okay. 25 A I don't want to tell you something that isn't CENTRAL FLORIDA REPORTERS, INC. 1033 1 true. 2 Q I understand. Were you there when, when OPD 3 arrived to pick up the bed pad? 4 A I don't know. I can't -- I can't remember 5 what happened. I mean, I can look through my nurses' 6 note to see if I put anything. All I have here is that 7 I talked to Officer Padilla, I guess is how you say the 8 name, and that they would be coming to the facility to 9 retrieve the pad with blood on it for evidence. 10 Q And that -- that's all you remember about 11 that? 12 A That's it. 13 Q Okay. 14 A And that was at 6:30 at night. 15 Q Do you know how the Orlando Police Department 16 knew that there was a pad that had blood on it? 17 A I'm sure, sure that I had told them when they 18 came. 19 Q Told who? 20 A The police officers when they came to do the 21 trespass warrant. 22 Q Let's ask -- the first one is, do you recall 23 what time that morning OPD showed up for the trespass 24 roughly? 25 A Well, the incident happened at 9:00, so it was CENTRAL FLORIDA REPORTERS, INC. 1034 1 sometime after 9:00. 2 Q Shortly after 9:00? 3 A I'm not sure. 4 Q Okay. 5 A It was after the incident with, with Larry. 6 Q And do you remember which officer you -- 7 actually let me ask you this first. What, what did you 8 tell any of the OPD officers in regard to the pad? 9 A If I told them anything, I would have told 10 them that there was blood on the pad, and that I checked 11 his mother because he had stated that we had caused a 12 pressure area. And when I checked her, there was not a 13 pressure area but there was some blood on the pad. 14 Q Okay. Did you advise any of those OPD 15 officers about the kiss that you had observed? 16 A I believe so, yes. 17 Q Okay. Do you know if it was one, two or all 18 of them? 19 A Well, when, when the officers came, they were 20 in my office together. So if there were two or three, 21 it would have been everybody at one time. 22 Q So a general discussion where you're saying, 23 geez, officers, that is what was going on? 24 A Yes. 25 Q Okay. And can you recount for me as best as CENTRAL FLORIDA REPORTERS, INC. 1035 1 possible what you told them when they showed up? 2 A Okay. I told them that I came in to work. My 3 cell phone rang. I was at Mary Thornton's door just 4 getting ready to knock on the door. I went in. She 5 told me that we had a resident's son who was very upset 6 about a dressing and that he was down in the room, that 7 we walked to the room. 8 I knocked on the door. There was no answer. 9 I opened the door. That's when I saw Larry leaning over 10 his mother kissing her in a way that was inappropriate 11 to be kissing your mother. And that when he realized we 12 were there, that he jumped up and he came over to the 13 door, allowed me to come in. I introduced myself, and 14 he shut the door on Mary's face. 15 And then I continued to tell him how Larry and 16 I had discussed about the dressing change and how he had 17 had a nurse sign that documentation and how I said that 18 that's not our policy. And that he became very upset 19 and stated that he would have the residents sign the 20 documentation next time. And I said that he couldn't do 21 that, that would be infringing on their rights. 22 And then he said he would get people from the 23 street to sign it. He -- it didn't matter who it was. 24 He'd get somebody to do it. 25 Q Did you also tell him about examining his CENTRAL FLORIDA REPORTERS, INC. 1036 1 mother and -- 2 A Yes. That had come after. Then he had told 3 me about that we had caused her to bleed because there 4 was an open area on her bottom that we caused that we 5 hadn't taken care of. So I put my gloves on, turned his 6 mom over, examined her. And what I found was an 7 excoriated bottom, like a diaper rash that had ointment 8 on it, and there was some blood on the pad. 9 Q What did the officers say about the, the kiss 10 that you observed? 11 A They just took the information. I mean, I 12 relayed the information and they took the information. 13 Q Did they ask you any questions about it? 14 A Well, they asked me what I had seen. 15 Q Uh-huh. Did they -- did they follow it up? 16 Did they want to know specifics in terms of, you know, 17 how long was the kiss, what was the kiss like or are 18 they just taking the basic information and writing it 19 down? 20 A I believe that they just took the basic 21 information because at that point we were in my office 22 and Larry was down in the room with his mother. And 23 they asked me to go down to the room and ask him to come 24 up to my office because they didn't want to go in the 25 room and discuss this with his mother. CENTRAL FLORIDA REPORTERS, INC. 1037 1 Even though she having Alzheimer's and was 2 very end stage and appeared to not know what was going 3 on, you never know what people know and what they're 4 hearing. 5 Q Uh-huh. 6 A So I went to the room and asked Larry to come 7 up to my office, at which time he wouldn't. He said he 8 would discuss it in the room. And the officers then 9 went to the room and they were able to have Larry come 10 outside to the courtyard where they served him about a 11 trespass warrant. 12 Q Were you present for that part when they 13 brought him out to the courtyard? 14 A I don't know if I went to the room or not with 15 them. I'm not sure. 16 Q Were you present in the room when, when they 17 went to talk to, to Larry? 18 A That's what I said, I'm not sure. 19 Q Okay. 20 A I don't remember if I went down or not. 21 Q When you were telling the officers about the 22 kiss that you observed, were they writing it down? 23 A I don't -- I don't remember. I don't -- I 24 don't remember if they did or not. 25 Q Did you ever see any of the OPD officers take CENTRAL FLORIDA REPORTERS, INC. 1038 1 notes in regards to what you were telling them? 2 A I know that they were writing things because 3 they wrote the trespass warrant, but I don't know what 4 else that they were writing. 5 Q Okay. You know they wrote the trespass 6 warrant because you saw that? 7 A I signed it, yes. 8 Q Okay. Do you believe that there were other 9 things that they wrote in addition to the trespass 10 warrant? 11 A I don't remember. 12 Q Okay. Earlier you described the room that 13 Carolina Destefano was in, door handle on the left, so 14 it obviously opens to the right. Where is the bathroom 15 located in her room? 16 A I believe the bathroom was to the left when 17 you come in. 18 Q So it would have been immediately there as you 19 open the door? 20 A Off to the left, yes. 21 Q Okay. And there was room on either side of 22 her bed so that people could provide care for her, 23 right? 24 A Correct. 25 Q So her bed would have been in the middle of CENTRAL FLORIDA REPORTERS, INC. 1039 1 the room but in between the end wall of the bathroom and 2 then the other side? 3 A Say -- explain it again, I'm sorry. 4 Q Can, can you draw the layout of, of the room? 5 A Sure. This would be the door. This is the 6 door. I'm not great at drawing. And then the bathroom 7 sets off like this, and then the bed is like this and 8 then this is the wall. That would be the layout of the 9 room. 10 Q Okay. So as you open the door, if you're 11 standing in the doorway -- 12 A Uh-huh. 13 Q -- because the bathroom is here -- 14 A Uh-huh. 15 Q -- can you see the head of the bed or do you 16 have to walk in before you can see the head of the bed? 17 A We could see everything that was going on when 18 you opened the door. I don't know if we started to 19 enter the room or not. 20 Q Do you mind just -- if you'd just date that. 21 A Sure. 22 Q As you open the door -- 23 A Uh-huh. 24 Q -- I'm going to ask you about the kiss that 25 you observed. CENTRAL FLORIDA REPORTERS, INC. 1040 1 A Uh-huh. 2 Q Describe it for me. 3 A He was holding on to his mother's face and his 4 mouth was on her mouth. And it was for a period of time 5 which is much longer than you would kiss your mother. 6 Q Was he holding her face with both of his hands 7 or one? 8 A I believe he was holding with both hands. 9 Q And what side of the bed was he on? 10 A He was on the left side of the bed. 11 Q Left side as you're looking at it from what 12 position? 13 A From the door. 14 Q So if you walk through the door, was he 15 closest to you or is he on the other side? 16 A Closest to me. 17 Q Okay. Was his back to you? 18 A He was kind of at an angle. 19 Q Okay. Was he standing on both feet or was he 20 sitting on the bed? 21 A I believe he was like hunched over. I don't 22 know if his knees were on the bed or if they were on the 23 floor. 24 Q And you said that his mouth was on her mouth? 25 A Uh-huh. CENTRAL FLORIDA REPORTERS, INC. 1041 1 Q And I'm going to ask you to be very specific, 2 okay? 3 A That's fine. 4 Q Both mouths were open? 5 A Well, I don't know if, if her mouth was open 6 or not. I don't know if his mouth was open or not. I 7 know that his mouth was on her mouth for a long period 8 of time. I don't know if mouths were open or -- 9 Q Okay. And that's what I'm getting to is what 10 exactly did you see because you said there was an 11 inappropriate kiss, and I want to find out what you 12 think is inappropriate about it. 13 A Well, I just know that I have five sons, and 14 if any one of my sons ever kissed me like that, that 15 it's inappropriate. 16 Q Okay. Were his lips on her lips? 17 A Yes. 18 Q Okay. Did you see his tongue in her mouth? 19 A I didn't see anything -- didn't see that. All 20 I saw was his lips were on her lips. 21 Q Okay. Clearly on the center or off to the 22 side either way? 23 A No, he was -- lips to lips. He was -- 24 Q And while he was kissing her that way, did he 25 have still her face in his hands? CENTRAL FLORIDA REPORTERS, INC. 1042 1 A Yes. 2 Q Did he appear to be aroused? 3 A I didn't notice. 4 Q Okay. Was Mary Thornton observing the same 5 thing that you observed? 6 A She was standing right behind me. Yes, she 7 was. 8 Q Okay. When you say she was standing right 9 behind you, I'm trying to determine was she off to the 10 right or off to the left? Was she looking around your 11 head or did she have a clear shot, if you know? 12 A Mary Thornton is much taller than myself, so 13 whether she was standing behind me or to the side of me 14 she could -- she had a clear view. 15 Q Did you guys talk about this after -- at some 16 point later in the day? 17 A We discussed it, yes. 18 Q When was the first time you had to discuss it? 19 Because I know you went in there alone. 20 A Uh-huh. 21 Q Mary Thornton stayed out. 22 A Uh-huh. 23 Q When were you able to discuss this with Mary 24 Thornton? 25 A I believe the first time we discussed it was CENTRAL FLORIDA REPORTERS, INC. 1043 1 after the police had left. 2 Q Do you know approximately what time that would 3 have been? 4 A No. 5 Q Do you know where you discussed it? 6 A It could have been my office. It could have 7 been Chuck Sherer's. I'm not sure. 8 Q Was Chuck Sherer present when you discussed 9 it? 10 A He was present during a discussion. I don't 11 know if it was that particular time or -- I mean, there 12 was multiple discussions with Chuck and Mary that day 13 about the incidents of the day. 14 Q Did it seem to you that what Mary saw was 15 exactly the same as what you saw? 16 A I can't speak -- 17 Q What, what I'm asking you is based on your 18 conversation, what Mary told you and what you told Mary, 19 did it appear to you that she saw the same thing you 20 saw? 21 A Absolutely. 22 Q Okay. Did she add any detail that you didn't 23 observe? 24 A No. 25 Q When Mr. Destefano shut the door, was she able CENTRAL FLORIDA REPORTERS, INC. 1044 1 to block the door from shutting all the way or did the 2 door just completely shut and she was out of the 3 picture? 4 A She was completely out of the picture and the 5 door was closed. 6 Q So she wasn't able to block the door and peek 7 back in? 8 A She probably could have, but the door was shut 9 in her face. She had already had one altercation with 10 Mr. Destefano, and she just stayed out of the room. 11 Q Okay. Did OPD -- did they advise you to 12 contact any other agency in regard to what you had seen? 13 A I don't remember if they did. I'm sure I told 14 them I was calling HRS. We're mandated by the State to 15 do that. 16 Q Did you feel at the time that you observed the 17 kiss that that's what you had to do? 18 A Yes. 19 Q You knew at that moment that's what you were 20 going to do? 21 A Yes. 22 Q Okay. Did you have any discussions with Mr. 23 Sherer about that? 24 A Yes. I discussed with him that I would be 25 calling. CENTRAL FLORIDA REPORTERS, INC. 1045 1 Q Did he condone that or did he take a position 2 one way or the other? 3 A He agreed that it needed to be reported. 4 Q Okay. Do you know approximately when you 5 reported it to HRS? 6 A No, but I'm sure in here there's a report of 7 what time. And I don't think it's in the nurses' notes. 8 It may be. 9 Q We can actually go back to that, Rachel. If 10 you want to find it now, you're welcome to. 11 A I'm not sure. I know that I called them again 12 later in the afternoon. 13 Q And that was my next question. 14 A I had two conversations with them that day. 15 Q Two that day? 16 A I believe it was that day, I believe. I would 17 have to look at the record. 18 Q Okay. How many phone calls in all? 19 A I'm not sure. I would have to, to look back. 20 Q Why don't you go ahead and look and tell me 21 how many times you -- you know, you discussed it with 22 HRS. 23 A Right, but there was twice that I had, had 24 called. 25 Q Is twice what you remember? CENTRAL FLORIDA REPORTERS, INC. 1046 1 A I'm not going to give you an exact because I'm 2 not sure. 3 Q And those are the two conversations that you 4 recalled earlier? 5 A Yes, that are in the chart. 6 Q Okay. 7 THE COURT: All right. Let's take our break 8 now, please. All right, Ladies and Gentlemen, I 9 believe if you will step out into the jury room 10 you'll have lunch there. We'll try to keep it to 11 30 minutes and we'll see you at that time. Thank 12 you. 13 (Whereupon the Jury exited the courtroom.) 14 THE COURT: Well, be seated. That -- this is 15 certainly going to be an excruciating five hours. 16 At least 20 minutes of that should have been edited 17 out. Why we needed to know about her husband's job 18 and the to'ing and fro'ing is -- absolutely escapes 19 me. And apparently you don't understand the 20 mentality of jurors and the extent of their 21 patience on things like this. 22 I hope that if you see fit at some point to 23 fast forward, now we're into the meat of it 24 finally, that you will do that. But that was 20 25 minutes of wasted time. CENTRAL FLORIDA REPORTERS, INC. 1047 1 MR. OSBORNE: All I can say, Judge, is those 2 designations were agreed to by the parties and 3 it's -- 4 THE COURT: Well, given the amount of time 5 that those people are going to have to spend with 6 us, I think we need to be a little bit more 7 considerate of them. Court is in recess for 30 8 minutes. 9 (Whereupon, there was had a recess from 12:02 10 o'clock p.m., to reconvene at 12:32 o'clock p.m.) 11 * * * * * 12 Continued to Volume IX 13 14 15 16 17 18 19 20 21 22 23 24 25 CENTRAL FLORIDA REPORTERS, INC. 1048 1 C E R T I F I C A T E 2 STATE OF FLORIDA) 3 COUNTY OF ORANGE) 4 I, SHARON L. TRAMONTE, R.M.R., certify that I was 5 authorized to and did stenographically report the 6 foregoing proceedings and that the transcript is a true 7 and accurate record. 8 Dated this 23rd day of May, 2006. 9 10 11 ___________________________________ 12 SHARON L. TRAMONTE, R.M.R. 13 14 15 16 17 18 19 20 21 22 23 24 25 CENTRAL FLORIDA REPORTERS, INC.