Direct and Cross of Expert Witness Doctor

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Q. Could you state your name and spell it for the record, please?
A. My name is Ida Androwich, Ida, Androwich.
Q. What is your business address?
A. 2160 South First Avenue, Maywood, Illinois 60153.
Q. And your home address?
A. 719 Arlington Road, Riverside, Illinois 60546.
Q. Just a little background. Let me get your CV out here. Before I start, should I address you as Dr. Androwich?
A. That's fine.
Q. This is the discovery deposition of Ida Androwich taken by agreement of the parties, basically.
Doctor, we're going - I'm going to be asking you some questions and Mr. Marwaha's attorney may be asking you a few questions afterwards, about your review of a case that we're here for today. If there are any questions that you do not understand that I pose, I want you to tell me so that I can rephrase it.
A. Okay.
Q. If it calls for a yes - you've probably been deposed before. If it calls for a yes or no, just say yes or no so the record is clear. Many people will nod their heads as you're doing right now, but that's okay. You do understand?
A. Yes.
Q. With that out of the way, let me get to just your basic involvement in this. How were you contacted?
A. I was contacted by Ms. Odarczenko.
Q. Do you know how she got your name?
A. We had worked together in the past.
Q. So, you have reviewed other matters for her in the past?
A. One other matter.
Q. One other matter. Do you know how she originally - did you know her personally in any way before that other matter?
A. No. In fact, I started out in the other matter with a different attorney from this firm whose name I do not recall.
Q. Okay.
A. Nor do I recall how he got my name in the first place.
Q. Did that matter - did that resolve itself, that matter?
A. I believe it did.
Q. That was a nursing home case?
Q. What type of case was it? Let me ask you that?
A. It was a patient in her own home.
Q. Home healthcare case?
A. Uh-huh.
Q. Yes?
A. Yes.
MS. ODARCZENKO: You have to give a verbal answer.
Q. You rendered opinions in that matter?
A. Yes.
Q. Did you give a deposition in that matter?
A. Yes.
Q. Do you' remember the name of that case?
A. I do not recall.
Q. How long ago was that?
A. I would say two or three years ago, possibly four years ago.
Q. How long have you been acting as an expert Witness in nursing care matters?
A. That was my only experience. I have had other opportunities but did not take the case.
Q. Okay. So, this is your second time you've acted in an expert witness capacity?
A. Yes.
Q. It looks like your notes, you - the first?ote you have is August 5th, 1999. Is that correct? Do you want me to mark this - do you have a copy of your own notes?
A. I have a copy.
MR. WOHLBERG: I'll mark this as Androwich Exhibit Number 1.
MS. ODARCZENKO: Handwritten notes?
MR. WOHLBERG: Handwritten notes. Looks like two pages.
MS. ODARCZENKO: No. The second sheet is something prepared at a different time.
MR. WOHLBERG: Just one page.

(Androwich Exhibit Number 1 was.: marked for identification.)

Q. It looks like you're checking your calendar. Please do.
A. I was going to see if you wanted exactness.
Q. Yes. That would be great.
A. I have something written on July 20th.
Q. Okay. Can you make out what that is?
A. It looks like it's to return a call to Sonia.
Q. Okay.
A. And I was - actually, I was in Europe two weeks in June, at the end of June, so - and I see no. other notice.
Q. Okay.
A. Actually, I think - I think we may have talked earlier in July.
Q. And that's not anything written, just what you recollect?
A. Yes.
Q. Do you remember what you talked about in early July?
A. My recollection of our conversation was that she outlined the case and asked if it was something that I would feel qualified to take on and send - and then she was going to send me materials to review.
Q. On July 20th, do you know what you - that's just a note that she had called you?
A. Right.
Q. You probably didn't hook up at that time?
A. Actually, there were two times I was going out of town, and it could have been that July 20th was our first conversation because I did some grant reviews the week of the - I remember saying, if I'm going to read it, I'll need it before this date or I can't read it for a week.
Q. Okay. When did you get the material to review?
A. I do not - I actually think I had it sooner, but I did not realize I had it.
Q. Let me call your attention to your own notes here. It look like on the right-hand corner it says, “Primary review, 7-30.” Would that help your recollection?
A. was going to say I have a note on 7-30, record renew.
Q. Okay. It looks like you first looked at any material -
A. Yes. Yes. That would be the first time I looked at any material.
Q. On 7-30?
A. Uh-huh.
Q. Yes?
A. Yes. Sorry.
Q. That's okay. It takes a little while to get used to that. The other - just as an aside because it's hard for the court reporter to take down when we're both talking at one time, I will try not to interrupt. Wait until I'm done and you answer, and I'll wait until you give a complete answer so we're not talking over each other.
A. Yes.
Q. It looks like you did a literature search on 8-4.
A. Yes.
Q. And a secondary review on 8-5.
A. Yes.
Q. Now, looking at here, it looks like you reviewed Dr. Bushman's deposition transcript; is that correct?
A. Yes.
Q. Did you review - okay. Did you ever see this document - let me go back. I've been furnished today your notes. Another page looks like a charting of probably Anna Prairie. And then - let's see here. An administrative review of the nursing home from 1993.
MS. ODARCZENKO: That's an excerpt from the P&P manual.
Q. Did you review this P&P manual?
A. I did today.
Q. And obviously the P&P manual of ′96 you just looked at today also; is that correct?
A. Yes, that is correct.
Q. I've also been handed a couple of articles, the first of which I'm going to mark this as, probably should -
MS. ODARCZENKO: Androwich Number 2.
MR. WOHLBERG: Androwich Number 2.
(Androwich Deposition Exhibit Number 2 was marked for identification.)
Q. Why don't you just tell me what that is.
A. This is an article that I found that actually doesn't necessarily have relevance to this case. I found it and was going to give it to Sonia.
Q. So, Androwich Number 2 doesn't really relate to this case?
A. No. Other than globally. It's about nursing home and quality of care.
Q. Did you rely on this article in any way?
A. No.

(Androwich Deposition Exhibit Number 3 was marked for identification.)

Q. That was Number 2. Let me show you Androwich Number 3. Tell me what that material is.
A. This is material that I got off of our bibliographical database. It is about the Joint Commission on Restraints, and I did not actually rely on this article or completely read this article. I pulled it off and was going to give it to Ms. Odarczenko for future reference.
Q. All right. So, it doesn't really bear on this case, correct?
A. Correct.
MR. WOHLBERG: It looks like there is two more here. I'll mark them 4 and 5

(Androwich Deposition Exhibits Numbers 4 and 5 were marked for identification.)

Q. I've already got 4. 4 is entitled ACP Journal Club.
A. Yes.
Q. Ill let you explain.
A. This is the American College of Physicians Journal Club, and there is a move in healthcare to what is called evidence-based practice. Most recently there are a number of groups that are synthesizing the literature from large randomized control trials and putting those literature research syntheses, making them available to practitioners. The Cochran Collaboration is one such group. The American College of Physicians has what they call evidence-based medicine.
Q. Okay.
A. And when I was searching and doing my literature review, I came across this, and this was of interest in that it confirmed some of my thinking about the -
Q. Why don't you point, while we're on it, to the areas that confirm your thinking.
A. Well, the -
Q. Do you have your own -
MS. ODARCZENKO: I'll give you my copy.

Q. And I'll look at this and I'll follow along.
A. It is fairly accepted that a risk with a patient being in atrial fibrillation is multiple microemboli, and there is good evidence in the literature such as this and there is one other article that I thought I had today that I do not have that demonstrates that you can reduce the relative risk of emboli by using anticoagulation therapy when a patient has atrial fibrillation. That is, of course, if there are no indications that would warrant you not using anticoagulation therapy. So - but there is an increased risk, and particularly in elderly patients, of emboli with atrial fib and not anticoagulation therapy.
Q. Would this be in the purview of a nurse to like - I mean you obviously can't prescribe medicine or anticoagulation drugs.
A. Right.
Q. Are you giving any opinion medically in this case?
A. I am reading the literature as an intelligent person might do and having an understanding of that. I would not attempt to diagnose in a given situation.
Q. So, where would this fit in with any of your - would it support in any way any of your opinions you've expressed?
A. When I first started reviewing this case, I was wondering why she was not on anticoagulation in terms of - because it occurred to me that her death could have - if she had been in atrial fib, her death could have easily been caused by an emboli, and that is in nursing textbooks. That is kind of a fact that is available. It wouldn't be that I would be making a diagnosis that that was what her death was caused by, but that is kind of out there.
Q. Okay. You're not saying - you're not giving an opinion that - you're just saying this is what's in the literature?
A. Right.
Q. You're not giving your imprimatur, your nursing opinion as to this cause?
A. Right.
Q. Or any cause of death? 3
A. Right.
Q. And this is more as a aid to your attorney or your -
A. Or to my understanding or as a aid to the attorney, just -
Q. Okay. Let me show you what's been, marked. as Exhibit Number 5. This is called “Review of the literature on falls among the elderly.”
A. Okay.
Q. You have a copy?
A. Uh-huh.
Q. Tell me, did you rely on this in any way in giving your opinions?
A. I relied on this, and this was an article that I had looked over in the past, and I found it because I wanted to support my belief that there is a body of research that indicates that restraints do not always prevent injury in the elderly. And the same with side rails. It's not clear that because some patients that have side rails up or have restraints, studies have shown that they can actually be - have - sustain greater injuries as they try to climb over the side rails. So, I wanted to find the documentation of that.
Q. Did you rely - in what portion of your opinions would this come into play, this article - that you relied on, and if you - you may want to look at your own opinions.
A. Where is a copy of my opinions?
MS. ODARCZENKO: I've got them right here. Do you want to mark a copy, Mark?

(Androwich Deposition Exhibit Number 6 was marked for identification.)

Q. Do have you a copy?
A. Yes.
Q. I'm going to mark my copy, and I'll just start with her opinions. I made a copy of that. I've got a copy and I'll keep it. Androwich Exhibit Number 6.
I'm going to show you, beginning at Page 6 of - you just take a look at that. Is this a copy of your opinions?
A. Yes.
Q. Take a look at this document.
A. Yes, that is a copy of my opinions.
Q. Aside from this little note, which is my handwriting, does it appear -
A. It appears to be the copy of my opinions.
Q. If you would just point out what you relied in this particular Article Number 5, where you relied on that, in which portion of your opinions?
A. In the second paragraph on Page 7 I have my opinion on the use of restraints.
Q. Okay.
A. This article was not the only thing that helped me to form that opinion.
Q. Okay.
A. But it was validation, as it were.
Q. Okay. I'm going to come back to this. Let me jump back.
Were there any other matters that you had that you've relied on in this matter? You mentioned another article that you may have.
A. The other article is a synopsis of the body of research about using anticoagulation therapy in cases of atrial fibrillations.
Q. So, you're not giving an opinion of causation in her death, are you? I think we established that.
A. No, I am not. However, the physiology - s a nurse also learns physiology and the understanding -
Q. I understand.
A. - and the understanding of how the human body works in an attempt to understand and predict what might be happening with a patient.
Q. Would it be fair to say that - do you remember the title of that other article?
A. I don't. It was a synopsis.
Q. Are you going to furnish that to your attorney?
A. I can furnish that if you would like it.
Q. If you would.
And Sonia, if you would get that additional article to me, I would appreciate it.
MS. ODARCZENKO: Sure. I think she's indicated it didn't really form the basis of her opinions, just understanding.
Q. Is that a fair capsulization of what your attorney just said?
A. Right.
Q. It's background material but it's not a basis of any opinion?
A. No, because I was not making an opinion of whether she should or should not have been on anticoagulation therapy.
Q. Now, are there any other documents that you have other than the records you reviewed, other than these ones we've just gone over?
A. None that I can recall.
Q. Do we have everything here that - any articles that you have used in evaluating this case?
A. Yes.
Q. They are all here today other than the one you just mentioned?
A. Yes.
Q. Now -
A. And -
Q. Go ahead.
A. May I clarify that?
Q. Sure.
A. I reviewed other documents other than these two, and I believe they are listed.
Q. On - A.
A. On this document.
Q. Let's get back to Document Number 1.
MS. ODARCZENKO: Androwich Number 6.
THE WITNESS: I had not at the time I wrote this paper out.
Q. Why don't you tell me where you are referring.
A. On Page 8, I reviewed the medical records from Snow Valley, Bethany Methodist, Good Samaritan, and? Edwards and the transcribed depositions of Marty Gibbs, Deborah Pesek, Dr. Marwaha, Dr. Mary Beth Bushman, and Dr. William Breall.
Q. Is that the total of documents that you have reviewed?
A. Yes.
MS. ODARCZENKO: And the materials that she reviewed today.
Q. And these materials here?
A. Right.
Q. Now -
A. To the best of my recollection.
Q. Let me go back briefly to the case that you worked with prior to this with Ms. Odarczenko.
A. Yes.
Q. Do you remember the name of your client, the party that you represented or were giving an - opinion for?
A. I do not.
Q. Do you know, was it in Cook County, this case?
A. I believe it was.
Q. Can you get -
A. I believe it was.
Q. Can you get me that information?
MS. ODARCZENKO: What the name of the case was?
MS. ODARCZENKO: If I can remember it. I, mean I don't -
MR. WOHLBERG: You have some record?
MS. ODARCZENKO: I keep old case lists, but I don't keep it by who I worked with or where it was a venue. I have my closed file list. That's all I have to work off of. It was a nurse.
MR. WOHLBERG: It was a nurse?
MS. ODARCZENKO: It was an individual nurse.
MR. WOHLBERG: And it was in Cook County? You're not sure?
MS: ODARCZENKO: I want to say it was.
MR. WOHLBERG: But you're not sure?
MS. ODARCZENKO: I'm not sure.
MR. WOHLBERG: Would you do that?
MS. ODARCZENKO: I'll look, but I - like I said, I don't maintain my records that way.
Q. Do you maintain your records?
A. I might have a billing record, but then - I might. I might be able to locate that.
MS. ODARCZENKO: Off the record.
(Discussion off the record.)
Q. I would ask of Dr. Androwich -
A. I would not have maintained any of the case records.
Q. Not the records?
A. Okay.
Q. But if you have a bill -
A. I might have had the name of the case.
Q. If you would do that.
A. Okay.
Q. And I would ask you to do that and furnish that to your attorney. Because you did give a deposition like this -
A. Uh-huh.
Q. - is that correct?
A. Yes.
Q. Do you remember the issues in that case?
A. The issues in that case were the monitoring - this was a 24-hour live-in homemaker, and the issue related to her monitoring the patient who was in her home.
MS. ODARCZENKO: Off the record.

(Discussion off the record.)

Q. Hopefully, you will have a billing record of that. That would be the easiest way to do it. If you could do that, I could do the rest.
A. Uh-huh.
Q. So, you will make an effort to locate the billing record?
A. Yes.
Q. And that was a smoking in bed case; is that correct?
MS. ODARCZENKO: The case name is Anderson versus Traycee Home Healthcare, T-r-a-y-c-e-e.
MR. WOHLBERG: Thank you.
MS. ODARCZENKO: I can't tell you who the plaintiff's attorney was. They changed in the middle. At some point in time Bill Yeager was involved.
THE WITNESS: So, you don't need anything from me?
MR. WOHLBERG: I don't think so.
THE WITNESS: And that other document, do you want that?
MS. ODARCZENKO: The article?
Q. The article, yes.
A. Okay.
Q. I guess it's probably irrelevant, but if you did look at it. Okay.
Now, let me start with your - you give an opinion on Page 7 that based upon your review of the records, there is no evidence that Anna Prairie was pulled from her bed, and there was no history of her being pulled from her bed. Do you stand by that opinion today?
A. I had said earlier today that I would have amended this to read no evidence other than her saying that she was pulled from her bed.
Q. Is there any evidence that would suggest that she was not pulled from her bed?
A. I would consider that the woman who allegedly was doing the pulling was identified by the personnel as being unable to walk or to have the physical strength to pull this patient from the bed. I - just in terms of the setup and the fact that she - because she could not walk, she would have been in a chair, I think it would be difficult for this to have occurred from the testimony that I read. I also - even though there was an individual in the nursing home that was believed to be taking sheets or lap robes from some of the bedrooms, that's a very different thing than pulling someone out of bed. And there was never a history of anyone ever saying that this person had tried to pull someone out of bed. I think the only thing that anyone ever said was that she had taken a lap robe. Plus, I think that Anna Prairie was relatively recently admitted to the nursing home and had fallen - I also think that had she been pulled out of bed, she would have sustained an injury perhaps greater than - nothing was fractured. I would find it difficult to imagine that a 103-year-old woman was pulled out of the bed and not sustained a fracture, which she did not.
Q. Is that an opinion or is that -
A. That is my opinion.
Q. What do you base that on?
A. Just my years of working with patients and seeing them fall and -
Q. Are you saying that everybody that falls out of a bed of an age of 103 will sustain a fracture?
A. No.
Q. More likely than not?
A. No. I think that in my opinion, someone that would have been pulled out of a bed would be likely to have sustained injuries greater than what I believe Anna Prairie sustained.
Q. So, is it your opinion that this didn't happen? Is it your opinion that Anna Prairie was lying when she told Dr. Marwaha in the history she gave him in the hospital that she was pulled out of bed?
MS. ODARCZENKO: Objection to the form of the question. I don't think that this witness or any witness is capable of determining whether or not Mrs. Prairie was lying. She could testify to the orientation and so forth, but she - no one can say whether or not Anna Prairie was lying. It's not a proper question.
MR. WOHLBERG: I think it is.
Q. Do you believe - are you choosing to disbelieve the history that she gave to the emergency room nurse at Good Samaritan Hospital and to her treating physician, Dr. Marwaha, that she was pulled out of bed by a third party at the nursing home?
MS. ODARCZENKO: Same objection as to form. You can answer.
THE WITNESS: In my opinion - and I certainly don't think she was deliberately lying. In my opinion, I think it would be more likely that she was confused about what might have happened than that the event of her being pulled out of bed actually occurred.
Q. What are you basing that on, that she was confused?
A. Because I have seen a number of elderly people in a new environment -
Q. I don't mean to - well, go ahead.
MS. ODARCZENKO: That's the basis of her opinion. Let her finish her answer.
Q. Go ahead.
A. - where they have been confused. The patient might have come in the room or taken the blanket. That may have distressed Anna. And she may have remembered that. I think it is unlikely because although there was this patient, I don't - it was pretty well documented that she was in a geri-chair and did not have the strength to pull someone out of bed.
Q. Does it matter -
A. Well, I think - so, I think it's unlikely that it happened from that standpoint that you don't have anyone saying there was a strong patient going around pulling people out of bed. There were people that were testifying that this woman could not walk and was not strong enough to pull anyone out of bed.
The second thing is that I think that were she pulled out of bed, she might have sustained a different kind of injury.
Q. What injury did she sustain?
A. It said that her legs were bruised.
Q. Okay. And -
A. And hurt. So, that - that was the injury that I noted that she sustained.
Q. And you're saying that isn't consistent with being pulled out of bed by another patient?
A. In my opinion, if you're pulled out of bed, you're not as apear to be able to break your fall as if you slip. And so you would fall harder.
Q. Okay. And that's within a reasonable degree of nursing certainty that you're giving that opinion?
A. Yes.
Q. Would it make a difference to you that the person that was identified as Vivian - does it make any difference who it was? What if it was another party in that nursing home that came in and did this?
MS. ODARCZENKO: I'm going to object to the form of the question because I don't think that that is within this witness' expertise. She's here to testify to nursing standards. If you want to ask her those kinds of questions, that would be appropriate, but speculation about how the injury - how the accident occurred, that's not within this witness' purview. She's not here as a. reconstructionist.
MR. WOHLBERG: That's one of the opinions she just gave, so I think that she doesn't believe that this happened as, I mean, stated in the record, as given in the history of the patient.
MS. ODARCZENKO: That Vivian did this?
MS. ODARCZENKO: That was the question you asked her.
Q. What I'm saying, does it make any difference to you, would it make any difference in your opinion if it wasn't Vivian but some other person who was where they shouldn't been in the nursing home?
MS. ODARCZENKO: Read that back.

(The requested portion of the record was read.)

MS. ODARCZENKO: If you understand the question, go ahead and answer.
THE WITNESS: Well, obviously with respect to Vivian's weakness, that wouldn't be the case. I think that if she were pulled out of bed, her injuries would have been more severe. That is my opinion.
Q. So, even if it wasn't the person known as Vivian in the geri-chair and some other Alzheimer's patient, for example, who came in and pulled her out, you're saying that the identity of the person. isn't important; the injury is what you're basing your opinion on that this didn't happen this way, that if she, indeed, was pulled out by Vivian or some other person in that nursing home, that her injuries would have been different, to a reasonable degree of nursing certainty?
A. That is true. And - that is half of my opinion, the injuries. Half of it is because Vivian was the one that was identified as being the person would be the fact that it was documented that Vivian didn't apparently have the ability, nor had she had a history of doing anything to patients.
Q. But I would think - would you agree that being pulled out of bed or pulling blankets out of bed could lead to somebody holding onto their blanket and being pulled along with it?
A. Yes.
Q. You wouldn't dispute that?
A. I would not dispute that, right.
Q. And you have read Deborah Pesek's deposition that Vivian did have a long history of doing it prior to this?
A. It seems to me she was taking folded lap robes. Not necessarily - there, again, if this were a tug-of-war where this patient was holding - onto a blanket, if you think of yourself as trying to get out of bed and slipping or fainting and the injuries you might sustain or holding onto a blanket that someone was pulling and then crashing to the floor, it seems to me that if that were the case in a 103-year-old woman, there would have been a greater injury.
Q. And -
A. In my opinion.
Q. Once again, what injury would she have sustained?
A. Well, not should have. I would hope that she wouldn't, but I would expect that there very likely would have been a fracture.
Q. To what area of the body?
A. I don't know. I mean I - that is hypothetical, but it would seem that she - much of her hospital stay following the fall was not surrounding the injury and the fall, and she was returned to the nursing home in a few days. It wasn't that she was in traction. It wasn't that she had fractured a Lip. It wasn't that there was a great deal of concern about an injury from the fall.
Q. Okay. You acknowledge, though, that your review of the records revealed that the only evidence that was - I mean, that Anna Prairie did tell Dr. Marwaha and the emergency room nurse the history of being pulled out of bed?
A. Yes.
Q. And you have taken those facts into consideration in your opinion?
A. Yes.
Q. Was there any reason to doubt “ - was there any evidence that you saw that Anna Prairie was confused on the date she was” injured on June 5th when she was taken to Good Samaritan Hospital?
A. No. Anna Prairie had - as I recall, her vision was somewhat diminished, and she was somewhat hard of hearing. So, she did have sensory deficits that in addition to her - sometimes elderly people are confused not because they don't have the cognitive skills but because their sensory input is faulty due to -
Q. Did you see any evidence, other than that she was hard of hearing and where did you find she had visual problems, what record?
A. I believe that was in -
Q. Go ahead.
A. In her record.
Q. You want to review this? Do you know where you found that?
A. Is there an original nursing home assessment, detailed assessment? That is my impression.
Q. Okay. While she's looking -
MS. ODARCZENKO: She wore glasses?
THE WITNESS: The answer to your question, I did not see in the record evidence that she was confused.
Q. Let me put it this way. To a reasonable degree of nursing certainty, did you see any evidence that when she was taken to Edwards Hospital, she was in a state of confusion?
A. No. However, her blood pressure was extremely low and her heart rate was very rapid, and that in and of itself could lead to some low level of anoxia or confusion.
Q. But you don't know from reading Dr. Marwaha's deposition and your review of the records, you did not find any evidence of that, did you?
A. No. I said I did not.
Q. Okay. And there was no evidence in the records that she was indeed suffering from anoxia?
A. The - the only evidence would be when she got to the hospital, her heart rate was very rapid and the blood pressure in the nursing home was low.
Q. Was there any notation of anoxia?
A. Well, it wouldn't be the kind of -
Q. Did you see anything in the records?
A. No.
Q. With regard to the restraint, your opinions regarding restraint, what - is it your opinion to a of nursing certainty that the use of restraints or failure to use restraints in Anna's case was within the nursing standard of care?
A. Yes.
Q. Their procedure. Okay. You did see that there was a RAP -
A. Yes.
Q. sheet when she entered the hospital?
A. Uh-huh.
Q. Yes?
A. Yes, I did.
Q. And that showed a risk of falls, fairly high risk, was it not?
A. That is true. I would also say that anyone of the age of 103 that was in a nursing home, I would - couldn't imagine they would not be indicated as a high risk for falls. So, I don't think there was anything particularly unusual about her situation other than her age and her fragility.
Q. Now, you would agree that if she had some type of restraints, either side rails up let's take side rails first. That she would not have been able to be pulled out of bed, assuming that she was?
MS. ODARCZENKO: I'm going to object to the form of the question.
MR. WOHLBERG: Okay. You can answer.
MS. ODARCZENKO: I don't believe it comports with the facts of the case. She wouldn't agree to the use of restraints.
MR. WOHLBERG: I'm sorry?
MS. ODARCZENKO: You're asking if the restraints had been up
MR. WOHLBERG: They were not up.
MS. ODALCZENKO: That is correct because Anna Prairie wouldn't consent. Your question assumes facts that are not part of the record. It's an incomplete hypothetical.
Q. Let's was Anna Prairie ever involved in consenting or not consenting to the handrails?
A. Maybe I could make a distinction in terms of the difference - I mean there is levels of restraints, and side rails, usually restraints are not necessarily considered side rails. They are considered something where the patient is actually physically tied.
Q. Okay.
A. Okay. Now, this particular article that we - had identified on Page 50 -
Q. Which one? Exhibit Number -
A. This is the article by Roski (phonetic spelling).
Q. I've got it.
MS. ODARCZENKO: Androwich 6.
Q. Okay.
A. In the third paragraph down, I have starred that.
Q. What page?
A. Page 50. It says, “Side rails up, call light in reach approach is unlikely to be effective in preventing falls if patients try to get out of bed unassisted.” There is, in fact, evidence that sometimes a patient who is determined to get out of bed can do themselves more harm by trying to climb around side rails.
Q. Okay.
A. So, I don't think that based on the research there is a clear, clear body of knowledge. As far as actual restraints go -
Q. Let me stop you before we get into the actual restraints. The side rails up, what is the standard of care with regard to putting side rails up in a patient of Anna Prairie's age and her capacity at the time of her entrance into Snow Valley Nursing Home? I'm not talking about research that may indicate to the contrary. But what accepted - what the accepted standard of care in ′95 was. When was this article?
MS. ODARCZENKO: I think you might want the standard of care in ′94.
Q. For ′94.
A. I'm not actually sure when these studies were done.
Q. This looks like an article that was done in 1998. 1998.
A. Right. A lot depends - it depends on the judgment of what the patient is doing. In a patient that's getting in and out of bed a lot, you would not.want to inhibit their ability to get in and out of bed. A patient that could benefit From a reminder like a side rail, a side rail would be preferable.
Q. What given your understanding of Anna Prairie's condition at that time and her risk assessment, RAP that they did upon her entrance, would it be your opinion that the issue of the side rails to a reasonable degree of nursing certainty, that side rails in that particular situation was the preferred method of dealing with Anna Prairie and her condition back in 1994?
MS. ODARCZENKO: Do you want the question read back?
THE WITMESS: If you could.
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