erri Schiavo Trial Transcript October 11, 2002

pages 88-171


88

1 A. They refuse to eat or drink, generally. They

2 become withdrawn.

3 Q. What else?

4 A. Refuse treatments, medications.

5 Q. Have you ever encountered a patient for no

6 good reason suddenly expire?

7 A. Perhaps, I have. It doesn't -- I can't recall

8 a particular instance, but I am sure that has occurred.

9 Q. Nothing comes to mind?

10 A. No.

11 Q. If Terry pressed her leg against someone's

12 hand on command, would that surprise you?

13 A. Yes.

14 Q. Does that seem consistent with your experience

15 of Terry?

16 A. Yes.

17 Q. Have you run any Evoked Sensory Potential

18 tests on her?

19 A. I have not done those tests, but I understand

20 those tests were done.

21 Q. Who ordered those?

22 A. I recall, when I first undertook her care,

23 that she had had those tests done. I vaguely remember

24 reading a report to that effect.

25 Q. Were they done --






89

1 A. And I don't know what the results were.

2 Q. Do you remember how much earlier they had been

3 done?

4 A. Yeah. It could have been shortly before I

5 undertook her care. But I do remember that those tests

6 were done, and I couldn't tell you the results. But

7 since you brought it up, there is some vague memory in

8 my mind that I have seen that in some portion of the

9 records that I reviewed.

10 Q. So there is some recorded evidence of how

11 acute her eyesight is, for example?

12 A. Perhaps, there is. Those tests were done and

13 I don't know the results, no.

14 Q. They don't really have a bearing on the orders

15 that you wrote for Terry?

16 A. The results of those tests were reviewed by

17 the neurologist, Dr. Barnhill, who gave an

18 interpretation. I do not interpret those tests or

19 understand those tests very well. It's a very

20 specialized area. I think that the neurologist would be

21 the one to answer those questions.

22 Q. Dr. Gambone, last June, June 18, 2001, you

23 filed an affidavit in this case saying that you had

24 examined Terry on June 14 and that she continued to be

25 in a persistent vegetative state. Do you remember that?






90

1 A. When was this?

2 Q. Last summer, June of 2001.

3 A. Yes, I did.

4 Q. Did Mr. Felos ask you to file this affidavit?

5 A. Yes.

6 Q. When you examined her on June 14, was that a

7 ten-minute examination where you basically just checked

8 her out again?

9 A. I don't recall the amount of time that I spent

10 on that occasion. I would have to review my notes and

11 maybe I could give you some idea how much time I spent.

12 Q. Did you bring your notes with you today?

13 A. No, I didn't.

14 Q. Is the one hour during the initial examination

15 the longest period of time that you ever spent with her?

16 A. Yes, it is.

17 Q. Was there anything unusually lengthy about

18 your examination of her on June 14, 2001?

19 A. I don't recall the amount of time spent at

20 that point in time.

21 Q. Sitting here today, you're saying you don't

22 recall?

23 A. I do not recall.

24 Q. Do you know for what purpose you were asked to

25 examine Terry on June 14, 2001?






91

1 A. Yes. To verify that there had been no change

2 in her condition since my prior examination.

3 Q. And what did you do to satisfy yourself there

4 had been no change?

5 A. Again, I would ask to review my notes and I

6 could tell you exactly what I did at that point in time.

7 Q. You physically did see her, though?

8 A. I assume. If I signed it saying I did, I did.

9 Q. You have no independent recollection today?

10 A. No.

11 Q. When you first assumed her care you entered a

12 DNR order on her chart, right?

13 A. Yes.

14 Q. What does the DNR stand for?

15 A. Do not resuscitate.

16 Q. What is the medical effect of the DNR? What

17 does it mean?

18 A. It means that if someone's heart would stop or

19 they were to stop breathing, that resuscitation would

20 not be attempted.

21 Q. Why did you enter the DNR order on her chart?

22 A. That was done at the request of Mr. Schiavo,

23 the healthcare surrogate.

24 Q. Mr. Schiavo is the healthcare surrogate.

25 Mrs. Schiavo, you mean?






92

1 A. Yes.

2 Q. And who was that?

3 A. Michael Schiavo.

4 Q. Has she experienced any sort of cardiac

5 distress or crisis since she has been under your care?

6 A. No, she has not.

7 Q. She's pretty safe, isn't she?

8 A. Yes, she is.

9 Q. If someone could be trained to feed her by now

10 and if you could concoct a sufficient nutritious routine

11 for her, would she be able to survive?

12 A. If she was able to swallow?

13 Q. Yes. Uh-huh.

14 A. If she was able to swallow and someone was

15 able to feed her, yes, she could survive.

16 MS. ANDERSON: May I have just one moment?

17 THE COURT: Yes.

18 BY MS. ANDERSON:

19 Q. Dr. Gambone, I want to show you some

20 videotape. Have you reviewed any of the videotape

21 examinations?

22 A. No, I have not.

23 Q. I want to show you some of the videotapes and

24 ask you a few questions. That is monitor right there on

25 your stand. If you would, take a look at them. I will






93

1 play segments and ask you some questions, if you don't

2 mind.

3 THE COURT: Will you identify videotape?

4 MS. ANDERSON: Yes. We are going to -- it is

5 the Hammesfahr examination, 11/25 to 11/26.

6 MR. FELOS: Excuse me, Your Honor. Stop it

7 for a second. Your Honor, these tapes were made

8 with a time code to specifically be time coded so

9 we could identify portions of the tape that were

10 being played. I don't see any time code on these

11 tapes which would give me an opportunity, then, to

12 identify them in relation to the

13 two-hour-five-minute video.

14 MS. ANDERSON: The time is 11:25 to 11:26.

15 When digitized, the time code dropped off for a

16 technical reason I don't understand.

17 THE COURT: So the master tape, if you will,

18 has the time code on them?

19 MS. ANDERSON: Yes.

20 THE COURT: So for the purpose of what you are

21 showing Dr. Gambone, you are going to supplement

22 what he is seeing with the time code?

23 MS. ANDERSON: Yes. I'm telling you that it

24 was 11:25 a.m. to 11:26 a.m.

25 MR. FELOS: Your Honor, I do notice something






94

1 not on the tape itself on the pause. It's there on

2 the upper right, which I didn't see when the type

3 was played first. I request that the tape be

4 continued to play in this format so it will just

5 play with the time code as it is now.

6 MS. ANDERSON: I cannot command electronics,

7 Mr. Felos. It is what it is. I think what he is

8 talking about, Judge, is in the upper right-hand

9 corner. I do not understand the technology of the

10 digitization. But I'm telling you, 11:25 a.m. to

11 11:26 a.m.

12 THE COURT: Ms. Anderson, I am not finding

13 fault with you that you do not understand that

14 because that would be a double standard. I'm

15 assuming what I am seeing here, if I look at it or

16 you look at it, is what Dr. Gambone is seeing.

17 MS. ANDERSON: Yes. All of these monitors

18 have exactly the same imagine. The court

19 technology office set this up for us. You were

20 very helpful. You have one. Did you know that?

21 THE COURT: I do know that. They have done a

22 fine job.

23 MS. ANDERSON: May we continue, Your Honor?

24 THE COURT: You certainly may.

25






95

1 BY MS. ANDERSON:

2 Q. Is that typically what you see when you go to

3 see Terry?

4 A. Yes, it is.

5 The following testimony is from the audio
portion

6 of the video.)

7 "Hi, Terry. I am Dr. Hammesfahr. How are you

8 doing?"

9 "Hi, it's mommy. "Hi, Baby. How are you?

10 Hi. Hi. Is that better? You know mommy has to fix you

11 before -- how is that? Put your head back. Is that

12 okay? How do you feel? How do you feel. What? How's

13 my girl? How is my girl, huh?"

14 BY MS. ANDERSON:

15 Q. Dr. Gambone, did Terry appear to be reacting

16 to her mother?

17 A. She appeared to be reacting. I can't say for

18 sure, but I think that was the reaction to her mother.

19 I made notice that I have had that same reaction before.

20 Q. You recognized her mother in that clip, didn't

21 you?

22 A. Yes.

23 Q. And her mother was right in front of her face,

24 right?

25 A. Yes.






96

1 Q. And Terry appeared to smile, didn't she?

2 A. Again, I'm not an expert in brain stem

3 reactions of either reaction, auditory reactions --

4 Q. No. I'm just asking your familiarity with

5 Terry Schiavo's face.

6 A. All I can tell you is that Terry did not

7 respond to me in that same fashion. And whether others

8 who cared for her, I was not aware that they were having

9 similar reactions.

10 Q. No. I understand. I'm just saying this clip

11 that we've just seen, did it appear to you, Dr. Gambone,

12 that she smiled at her mother and recognized her

13 mother's face?

14 A. Again, I can't say for sure, but there was a

15 reaction.

16 Q. There was a re- --

17 A. Reaction. Whether that was a cognitive

18 reaction or a reaction of emotion, no, I couldn't say

19 that. I think we're doing this on primitive brain stem

20 reflexes that I am not familiar with and would be best

21 evaluated by an experts in this area.

22 Q. Did it look to you as though she had a change

23 in facial expressions?

24 A. There was definitely a change in her facial

25 expressions from her resting state.






97

1 Q. Okay. Can we go to Page 02. This is from the

2 Hammesfahr examination. It's 11:30 a.m. to 11:34 a.m.

3 Would you take a look at this one, Dr. Gambone?

4 A. (Witness complies.)

5 Q. Dr. Gambone, did Terry appear to react to that

6 loud bit of piano music?

7 A. Again, there was a definite change from her

8 basic state. But was that a feeling, was that an

9 emotion, or was that a cognitive or cognizant activity?

10 I couldn't say. And I think I would have to rely on

11 other experts who have observed patients like this, on

12 their opinion.

13 Q. Now, in your experience, patients who are

14 brain injured will sometimes take a while to process a

15 command, won't they, that you give them?

16 A. That's correct.

17 Q. Simply by the nature of the injury, it takes a

18 little while to get the information processed and get it

19 back out in response, right?

20 A. That's correct.

21 Q. So the fact that she doesn't immediately

22 respond given her level of brain damage is not

23 dispositive of the issue, is it?

24 A. I'm not sure that I can answer your question.

25 Q. The fact that Terry may appear to respond in a






98

1 delayed fashion to the stimulus does not mean that she

2 does not have cognitive awareness, correct?

3 MR. FELOS: Your Honor, I object. That's a

4 very technical question. I don't think there is a

5 foundation for the question to assume that there

6 was a response, number one. Number two, I think

7 the witness has, on a number of occasions,

8 expressed what he feels is a lack of expert

9 competency.

10 THE COURT: Well, he can struggle with this

11 one, too. I think it's an appropriate question.

12 Doctor, do you remember the question?

13 THE WITNESS: Yes. Again, I am still

14 concerned that what we are observing in these films

15 are evidence of presumptive reflexes that occur to

16 anyone in this particular state given certain

17 stimuli, auditory stimuli, visual stimuli, and does

18 not necessarily mean that there is cognitive

19 awareness. Even if it's slow or not, I don't think

20 that's going to make a difference.

21 BY MS. ANDERSON:

22 Q. So if she appeared to you to laugh at that

23 music, that would be a reflex, that would be a laughing

24 reflex?

25 A. I felt there was some indication of






99

1 expressions that were different than her baseline

2 appearance, for sure. If you want to call it a laugh.

3 And a laugh, again, suggests that you gave some thought

4 to what was said, you thought you appreciated it and

5 found it funny. But I really don't want to say the word

6 "laugh." There was a response.

7 Q. And that response would be the laughing reflex

8 response to the music. Is there a name for what you are

9 talking about?

10 A. Again, you are pressuring me to give answers

11 which I don't have the expertise to give you. There is

12 no such thing that I know of of a laughing reflex, so

13 I'm not going to say to you this is a laughing reflex.

14 But there are terms for this type of reflex and I think

15 you will have to rely on your experts.

16 Q. I appreciate what you are saying, Dr. Gambone,

17 I'm just asking in your opinion.

18 A. I agree. There is definitely a change from

19 the brain baseline.

20 Q. Page 805. This is 12:24 a.m. to 12:26 a.m.

21 "Can you close your eyes and keep them closed.

22 Close your eyes. Close your eyes. I'm on this side of

23 the room here and your mother is over here. If you can

24 feel this, I want to you look at your mother. Not me

25 at, your mother."






100

1 MR. FELOS: Excuse me, Your Honor. I know

2 that playing this tape -- or as this tape is being

3 played there seems to be a continuous stream of

4 audio and then there is a pause, and I would like

5 to inquire.

6 Are we seeing a continuous stream of tape for

7 this time period or has it been edited in any way?

8 MS. ANDERSON: No. It is continuous.

9 MR. FELOS: Do you know why the audio is not

10 continuous?

11 MS. ANDERSON: The audio is how the

12 videographer did that.

13 MR. FELOS: I'm justing inquiring about that,

14 Your Honor.

15 "You want to get a little closer. Again, you

16 feel it. You want to you look at your mother.

17 Don't look at me. Can you feel that? Don't look

18 at me. Open your eyes. If you feel it, look at

19 your mother."

20 "I'm going to try something a little harder.

21 If you can feel this, I want you to look at your

22 mother. Can you look at your mother now? Say

23 something so she knows where you are."

24 "Terry, it's mommy. Over here, Honey. Mommy.

25 Can you look over here at mommy. I'm over here.






101

1 I'm over here. Can you look over here at mommy.

2 Over here. Now, look at me. Terry, look at me.

3 Good."

4 Now, Terry I'm going to tap you with a sharp

5 piece of wood. This is a hammer with a sharp piece

6 of wood. If you feel it, I want to you look at

7 your mother, not at me. Look at your mother if you

8 feel it. Good. Now, look at me. I'm going to

9 hold your eyes open for a second. Can you look at

10 me? Can you look directly at me?"

11 "Look at me. Now look at your mom. Good.

12 Excellent. Terry, look at me. Right over here.

13 Terry, open your eyes up. Open your eyes. Terry,

14 open your eyes. Very good. Good. Good job. Good

15 job young lady. Good job. Now, what I need you to

16 do is close your eyes. Close your eyes real tight.

17 Close your eyes. Close them closed tight. Keep

18 them closed. Okay. Now keep them real closed.

19 Now I want to you open your eyes real wide. Open

20 them real wide. Good job. Very good. Good job.

21 Very good."

22 "Now I want to you open your eyes real wide,

23 real wide. Open them real wide for me. Real wide.

24 Yeah, I saw that. Good job. Now open your eyes

25 real wide. Give me a real big stare. A real big






102

1 stare. Can you open them real wide for me. Terry,

2 open them real wide for me. Real wide keep them

3 moving. Okay. Give me a real wide stare. Can you

4 do that?"

5 BY MS. ANDERSON:

6 Q. Dr. Gambone, did you notice Terry at one point

7 raising her eyebrows, opening her eyes wide?

8 A. Yes. And I noticed that on my visits to her

9 she did have that mechanism to open her eyes wide.

10 There have been occasions she just bombarded someone in

11 the hall. A nurse writes that observation and I would

12 see that same response without any --

13 Q. Any prompting?

14 A. Yes, any prompting. So that is a tough call

15 for me to know whether it's the relationship.

16 Q. Did you see her also rapidly and then closed

17 her eyes after Dr. Hammesfahr's prompt on that tape?

18 A. No, because she blinked so much and her eyes

19 moved so much it was very difficult for me to see the

20 relationship. And just by my own examination of her, if

21 I were to say something, eventually -- this isn't like

22 you get that reaction, but I think it's a consistent

23 response. And, again, in my observations with her on

24 the right side she has a greater movement to the right.

25 Q. Did you know if she had a history of lazy eye?






103

1 A. No, I didn't know that.

2 Q. Mr. Schiavo didn't tell you that?

3 A. If he didn't, I don't recall that.

4 MS. ANDERSON: Let's play H-7.

5 MR. FELOS: Excuse me, Counsel. Which one is

6 that.

7 MS. ANDERSON: 312 to 314.

8 "Okay. Terry, one last time. Okay. Great.

9 We're all done."

10 BY MS. ANDERSON:

11 Q. Dr. Gambone, did you see at the very beginning

12 of that clip she raised her leg and elevated it?

13 A. Yes.

14 Q. Have you ever observed that?

15 A. No, I have not observed that.

16 Q. Do you know how that would come about?

17 A. Yes. It may very well be a spinal or low back

18 reflex.

19 Q. That would cause her, while she is lying on

20 her back, to raise her leg?

21 A. I didn't see her do that before.

22 Q. Okay. Fair enough.

23 MS. ANDERSON: I need one minute, Your Honor.

24 THE COURT: Yes.

25 MS. ANDERSON: May have one?






104

1 THE COURT: Yes.

2 MS. ANDERSON: This is part of Dr. Crawford's

3 examination of Terry. In you turn to the last time

4 on the tape, George, it's 1:8 to 6:45.

5 MR. FELOS: 1:48 to 6:45?

6 MS. ANDERSON: Right, the count.

7 MR. FELOS: Okay.

8 THE COURT: Ms. Anderson, is that the time?

9 MS. ANDERSON: No. It's the counter.

10 "Terry, all right. Hi. Hi, Baby. Hi. Hi.

11 How are you? How is your cold? How is your cold,

12 Sweetheart? Rubber. Rubber. Did you have coffee?

13 Did you have coffee? Huh? You feel better? Huh?

14 You want to go home? You still have a cold? You

15 still have a cold?"

16 "Can you say coffee? You want coffee? Is

17 your cold any better? Are you still sleepy? Are

18 you still sleepy? I bet you are. You feel better?

19 Is your cold any better? Huh. You have the air

20 conditioning turned down a little bit. Yeah. Are

21 you okay today? Are you tired?"

22 "Dad is here. Yeah. He came to see you

23 today. You feel better? Huh. You feel better?

24 What? What? What? Now you have a hiccup. Yeah.

25 Okay. You've got the hiccups. It's just the






105

1 hiccups, sweetheart. It's okay. It's just the

2 hiccups. It's just the hiccups. Okay. All right.

3 Yeah. It's okay. Do you need your coffee? Huh?

4 You sound better. Yeah, you do. You sound better.

5 You look a little tired. Are you okay? Huh?

6 BY MS. ANDERSON:

7 Q. Dr. Gambone, were you present when

8 Dr. Crawford examined Terry?

9 A. No, I was not.

10 Q. Do you know if Terry had a cold on the day he

11 examined her?

12 A. No, I have no -- I don't know what day it was.

13 Q. It was July 9.

14 A. July 9, if she had a cold? I'm not -- I

15 wasn't aware of it.

16 Q. Were you present on July 9 when Dr. Bambakidis

17 examined her?

18 A. No, I was not.

19 Q. Were you present during any of the

20 examinations?

21 A. No, I wasn't.

22 Q. All right. Now, on this video I showed you,

23 that piece of Dr. Crawford's examination, did you

24 observe a change in Terry's face again when she saw her

25 mother?






106

1 A. Yes.

2 MR. FELOS: Objection to the form of the

3 question. There is no foundation that she saw her

4 mother.

5 THE COURT: Overruled.

6 MS. ANDERSON: Thank you, Your Honor.

7 BY MS. ANDERSON:

8 Q. Go ahead.

9 A. There was a change in her face. And there are

10 changes in her face, at least changes that I have

11 observed myself.

12 Q. Does her face change when she perceives you

13 are in the room? Does she do that to you?

14 A. No, she does not. She has done that when I am

15 observing her and there is no reason for her to make

16 those expressions. I have observed those expressions.

17 Q. I thought you said that her expression was

18 unchanging. That you've never have seen --

19 A. At first, there was, not dramatically so.

20 When I first saw her, there was a lot more fleshy

21 muscle. That is the movement of the head and opening of

22 the eyes very wide, the movement of the mouth. I had

23 not heard her moan, but the other nurses have reported

24 that.

25 Q. You have never heard that?






107

1 A. No, but it's very similar to snoring.

2 Q. Similar to snoring?

3 A. Right.

4 Q. You didn't perceive any changes in modulations

5 in the vocalizing?

6 A. It was some change in modulation, but I

7 wouldn't consider it a speech.

8 MS. ANDERSON: To H-09. This clip runs in

9 Dr. Hammesfahr's exam from 2:50 p.m. to 2:52, so

10 this is a short clip.

11 BY MS. ANDERSON:

12 Q. Dr. Gambone, what was Dr. Hammesfahr doing?

13 A. I believe that he was auscultating the muscles

14 of the neck.

15 Q. He was listening to her carotid arteries?

16 A. That's correct.

17 Q. Auscultation is a fancy medical term for

18 listening?

19 A. Yes.

20 Q. Did you do that when you examined her?

21 A. Yes, I did.

22 Q. Do you always do it when you physically

23 examine her?

24 A. No. But when I examined her, there was an

25 examination that was done.






108

1 Q. Now, he also had a stethoscope up on her

2 temples. What was he doing there; could you tell?

3 A. He was also, possibly, listening to her signs.

4 Q. Thanks.

5 MS. ANDERSON: This is the same clip.

6 "Very good. Good. Are you Terry Schiavo?

7 Now, it's easier to sit, so we will sit her from

8 here to here. Look back here. Can you close your

9 eyes tightly? Keep them closed. Keep them closed.

10 Good."

11 BY MS. ANDERSON:

12 Q. Dr. Gambone, did you see that part of the tape

13 where Dr. Hammesfahr asked her to keep her eyes closed

14 and he tried to pull them apart? Did you see that?

15 A. Yes.

16 Q. Did you ever attempt that particular little

17 procedure with her?

18 A. Yes, I have, and I have gotten similar

19 responses.

20 Q. You have gotten a similar response?

21 A. Yes.

22 Q. You told her on command to keep her eyes

23 closed?

24 A. No. I'm saying I told her to open her eyes

25 and she keeps them closed.






109

1 Q. In this particular instance when he told her

2 to close them and tried to open them. That was my

3 question. Did you ever try to do that?

4 A. No.

5 Q. Would you agree if she was squeezing her eyes

6 shut and keeping them shut in response to his command,

7 that would be evidence of cognitive awareness?

8 A. Again, I am very doubtful about the

9 relationship of his voice to the response.

10 Q. So you are doubting the procedure?

11 A. Yes, because she has these repetitive

12 movements over and over and over again. Her eyes are

13 open, they are shut. And that command may or may not be

14 the reason for that. If you are there long enough and

15 you say things over and over again, one of these times

16 they're going to happen.

17 Q. But you have never given the command to her to

18 keep her eyes shut and keep them shut?

19 A. No, I have not.

20 Q. Now, what efforts have you made as her

21 treating physician to improve her medical condition?

22 A. I'm not sure what you're getting at.

23 Q. Help her get better, to help her recover

24 neurological function.

25 A. Her condition is one that there is no






110

1 recovery.

2 Q. And so -- go ahead.

3 A. The damage that is in the brain is not

4 repairable.

5 Q. So the answer to my question is nothing?

6 A. The answer is not nothing. The answer is to

7 us providing the medical care for the treatment and

8 medical problems that might occur to cause her the

9 problems. Adjusting the tube feeding, the problems that

10 arise on tube feeding, handling those.

11 Q. Of course, I'm not speaking about medical

12 bumps along the road. I'm asking you as her treating

13 physician. What steps you have taken to help her

14 recover neurological function?

15 A. I have obtained consultations with other

16 physicians, consultations with therapists. And there

17 was nothing that anyone suggested that I could do to

18 improve her condition.

19 MS. ANDERSON: Thank you, very much. May I

20 have just a moment, Your Honor?

21 THE COURT: Yes.

22 MS. ANDERSON: Your Honor, I'm through except

23 this last little inquiry.

24 BY MS. ANDERSON:

25 Q. What is Trivco Enterprises?






111

1 A. Trivco Enterprises?

2 Q. Yes.

3 A. It is a liability company that I own.

4 Q. And its business is buying out the estate of

5 deceased people?

6 A. No.

7 Q. What is the business?

8 A. The business is investments.

9 MS. ANDERSON: Okay. I have no further

10 questions at this time, Your Honor.

11 THE COURT: Thank.

12 Mr. Felos, do you have anymore questions of

13 this witness?

14 MR. FELOS: Yes, I do, Your Honor.

15 THE COURT: How long do you expect?

16 MR. FELOS: I expect at least an hour.

17 THE COURT: Okay. Maybe we should take a

18 break.

19 Dr. Gambone, I will instruct you not to

20 discuss this case or your testimony with anyone.

21 You are instructed not to associate with anyone

22 during this and not discuss the case.

23 Okay. Let's take a luncheon recess.

24 (Whereupon, a luncheon recess was taken after

25 which the following proceedings transpired.)






112

1 THE COURT: Okay, Mr. Felos.

2 Dr. Gambone you are still under oath.

3 CROSS-EXAMINATION

4 BY MR. FELOS:

5 Q. You were asked on cross-examination,

6 Dr. Gambone, about taking vital signs, whether you take

7 vital signs of Terry and also blood pressure readings.

8 The blood pressure readings that you took -- that were

9 taken before you by the nursing staff of Terry Schiavo,

10 they were within the normal range?

11 A. Yes, they were.

12 Q. For a patient like Terry, with a blood

13 pressure reading of 96 over 65, 107 over 78, and 101

14 over 71, would you consider those normal readings?

15 A. They would be within the normal range of

16 someone in Terry's condition.

17 Q. Now, has Terry had a bed sore in 12 years, to

18 your knowledge?

19 A. Not that I'm aware of.

20 Q. Would you consider Terry a total-care patient?

21 A. Yes, she is total-care.

22 Q. What has to be done on a total-care patient to

23 prevent the skin surface from breaking down?

24 A. Continual turning at a minimum of every two

25 hours. The areas of pressure needs to be relieved.






113

1 Q. And the areas where Terry has contractures in

2 her arms, what is needed to be done there to prevent

3 breakdown of the skin?

4 A. They would use a positioning device or some

5 soft material to prevent the bones from causing pressure

6 areas and the breakdown of skin.

7 Q. Does that involve movement of her arms?

8 A. Yes. The staff would have to move her arms,

9 yes.

10 Q. Uh-huh.

11 MS. ANDERSON: Judge, I'm having a little

12 trouble hearing the very end of Dr. Gambone's

13 answer.

14 THE COURT: Did you wear it out?

15 MS. ANDERSON: I think I wore it out. But I

16 am having trouble hearing the very end of

17 Dr. Gambone's answers.

18 THE COURT: Don't hesitate to ask and we will

19 have him repeat it. We will have the court admin'

20 look at these.

21 BY MR. FELOS:

22 Q. Dr. Gambone, make sure you keep your voice up.

23 A. Yes, I will.

24 Q. Okay. Thank you.

25 If you believe that Teresa Schiavo would






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1 benefit from physical therapy provided by the physical

2 therapist, would you recommend that?

3 A. Yes, I would.

4 Q. Have you recommended that?

5 A. I have not received a report from the physical

6 therapist suggesting therapy.

7 Q. Now, you picked up her care in 1998 from

8 Dr. Mulroy?

9 A. That's correct.

10 Q. In the two or three -- upon picking up her

11 care, you reviewed her medical records?

12 A. Yes, I did.

13 Q. And those medical records that you reviewed,

14 were those from the inception of her care after this

15 trauma in 1990?

16 A. The information was not complete, but it was

17 sufficient information to obtain a history of what had

18 happened prior. There was some evaluation.

19 Q. Do you know whether Dr. Mulroy had her in

20 physical therapy?

21 A. I don't recall.

22 Q. In fact, the recommendations or the evaluation

23 of a physical therapist -- I believe you testified no

24 physical therapy was needed; is that correct?

25 A. That's correct.






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1 Q. You were asked some questions about

2 swallowing. Would you agree that the ability to handle

3 saliva is common among vegetative patients?

4 A. Handle it in what way?

5 Q. Being able to swallow your own saliva.

6 A. Are you talking about original saliva or some

7 type of reflex movement or just saliva by gravity going

8 down the esophagus?

9 Q. I'm talking about the involuntary swallowing

10 reflex.

11 A. Yes.

12 Q. Do you know whether vegetative patients

13 usually maintain involuntary swallowing reflexes?

14 A. There is a reflex, yes, in which saliva would

15 be removed.

16 Q. In your review of Terry Schiavo's medical

17 records, were you aware that swallowing studies were

18 performed on her?

19 A. Yes.

20 Q. What do you recall the results of those

21 studies were?

22 A. The results of those studies revealed that she

23 could not swallow.

24 Q. Now, when you said they revealed she could not

25 swallow, they actually place not a liquid, but a






116

1 substance in the throat, don't they?

2 A. Yes, they do.

3 Q. Has Terry Schiavo ever had pneumonia?

4 A. I believe she has, but she did not have

5 pneumonia while she was under my care, that I knew of.

6 Q. You were asked some questions, I believe,

7 about Hospice, referring to Hospice and a six-month

8 standard. Would you disagree that the rule of thumb

9 that you talked about before for Hospice eligibility is

10 a six month life expectancy if the disease follows its

11 normal course?

12 A. That's correct.

13 Q. If Terry Schiavo's disease followed its normal

14 course, in other words, without intervention of her

15 artificial life support, would she die within six

16 months?

17 A. Yes, she would.

18 Q. Now, I want to ask you about the last

19 urinalysis. I believe you testified, and correct me if

20 I am wrong, on your cross-examination that the last

21 urinalysis performed on Terry was pursuant to court

22 order. I would like you to look at the -- I think it's

23 Petitioner's Exhibit 2, which are the studies that you

24 wrote about a week or so ago pursuant to court order.

25 A. Yes.






117

1 Q. Now, correct me if I am wrong, but were you

2 asked to do blood work on those studies or to do a blood

3 workup?

4 A. Yes.

5 Q. Was there any urinalysis done pursuant to --

6 is there any urinalysis reflected on those records?

7 A. No, there's not.

8 Q. Why did you request a urinalysis be performed?

9 A. The nurses had complained that Terry was

10 moaning from time to time, and their thought was the

11 moaning was related to problems with the feeding tube.

12 But there could be other causes. She was checked for

13 constipation, and that was not the problem. So a urine

14 was done to check for infection.

15 Q. That's what revealed the urinary tract

16 infection that she had just a couple weeks ago?

17 A. Yes. These tests came coincidental with what

18 was court ordered to what I ordered. It happened pretty

19 much in the same day or just a few days.

20 Q. Just to clarify your prior testimony. The

21 urinalysis that you ordered a couple weeks ago in which

22 the urinary tract infection was discovered, it was not

23 done pursuant to court order, was it?

24 A. I don't believe so. It was just coincidence

25 they were ordered at the same time.






118

1 Q. You weren't asked about Terry's CAT scan that

2 was recently performed on your cross-examination. I

3 would like you to take a look at Petitioner's Exhibit 3,

4 which are the results of the CAT scan study performed on

5 July 2, 2002.

6 MS. ANDERSON: Excuse me, Your Honor. Is

7 Mr. Felos going to offer these into evidence?

8 THE COURT: No, he is not. He is just asking

9 him if he recognizes them.

10 Let me ask a question, if I might.

11 I believe on cross-examination we talked about

12 CT scan. You are talking about a CAT scan. They

13 are one in the same; is that correct?

14 MS. ANDERSON: I understand.

15 MR. FELOS: Yes.

16 MS. ANDERSON: It's cumulative tomography.

17 BY MR. FELOS:

18 Q. Dr. Gambone, are you familiar with

19 Petitioner's Exhibit 3 that I'm having you review?

20 A. Yes. I did see that report.

21 Q. And how did you receive that report?

22 A. How I did receive that report?

23 Q. Yes.

24 A. Meaning what?

25 Q. Well, I mean, who sent it to you; do you






119

1 recall?

2 A. If I could look at the report again. This

3 report was sent to my office in Tampa.

4 Q. Do you recognize this as part of

5 Terry Schiavo's medical records?

6 A. Yes.

7 MR. FELOS: Your Honor, I would like to

8 introduce this into evidence as Petitioner's

9 Exhibit Number 3.

10 THE COURT: Is there an objection?

11 MS. ANDERSON: No objection, Your Honor.

12 THE COURT: It will be so received.

13 BY MR. FELOS:

14 Q. Now, in talking about on cross-examination you

15 had, I believe, testified that you believed the CT scan

16 showed most of Terry's brain was gone. I want to read

17 to you a portion of Petitioner's Exhibit 3 in evidence

18 and ask you if you remember that.

19 MS. ANDERSON: Your Honor, this is very

20 improper for what Mr. Felos is doing. If he is

21 attempting to refresh Dr. Gambone's recollection,

22 he needs to let Dr. Gambone look at that CT report

23 and refresh his own recollection and let him

24 question, then, about it. What he is doing now

25 should be on redirect, not cross. He is going






120

1 about it backwards. He is, in effect, testifying;

2 Mr. Felos is. So I object to this manner of

3 dealing with this document.

4 MR. FELOS: Your Honor, this has been accepted

5 into evidence. This CT scan was a matter brought

6 up on cross-examination. I certainly have a right

7 to read from the exhibit and ask the witness a

8 question.

9 THE COURT: But it's in evidence. If you are

10 going to introduce it into evidence, I will read

11 it. If you want to hand it to the witness and ask

12 him if he agrees with it, that's fine. But I'm not

13 going to let you stand up there and read it into

14 the record and ask him if it's okay.

15 MR. FELOS: Well, Your Honor, we have had

16 earlier today, in essence, part of the Respondents'

17 case be read into the record; what was appearing on

18 the videotape and questions asked of the witness.

19 THE COURT: Well, it's pretty hard to ask a

20 witness a question about a piece of video and not

21 ask him to look at it. But that's exactly what

22 they did. They played the video, he looked at it,

23 and they asked him questions.

24 So hand him the document, let him look at it,

25 and you as him questions. We will treat you just






121

1 like we treated Ms. Anderson.

2 BY MR. FELOS:

3 Q. Dr. Gambone, in reviewing the CAT scan report,

4 is there anything that would support your previous

5 testimony that there was little or no brain in

6 Terry Schiavo's cerebral hemispheres?

7 A. Yes.

8 Q. Would you read that portion, please?

9 A. The impression from the radiologist was

10 "Defuse encephaloneuralgia and infarction consistent

11 with anoxia. Number two, hydrocephalus ex vascular.

12 And, three, neuro simulator present."

13 Q. If you can, read the sentence starting with

14 there.

15 A. In the discussion the radiologist reports --

16 MS. ANDERSON: Wait, Your Honor. Mr. Felos

17 has not asked the witness a question. He is asking

18 him now to read the document into evidence.

19 MR. FELOS: Well, I can't ask the question

20 until I have him read that.

21 MS. ANDERSON: He is not asking a question.

22 THE COURT: Him reading the document is no

23 different than you reading the document in the

24 record. Ask him a question based upon the

25 document. I am going to read the document before I