"She is calm, she is peaceful, she is resting comfortably. ... Her lips are not chapped, they're not bleeding. Her skin's not peeling. Frankly when I saw her ... she looked beautiful. In all the years I've seen Mrs. Schiavo, I've never seen such a look of peace and beauty upon her."

(Terri's Brother: Felos in Love With Death)

"I saw no evidence of any bodily discomfort whatsoever," said George Felos, the attorney of Michael Schiavo, after visiting the hospice Monday.

(Strange Side Rituals at Schiavo's Hospice)

Excerpt from: http://libertytothecaptives.net/felos_recast_holocaust_terrisdeath.html

http://pub50.bravenet.com/forum/4293122219

This is a forum that right now free of Michael Schiavo Trolls.  Please
feel free to read and post messages to this board.  It is best if you
post factual information regarding the Schiavo case.  Information not
generally know in the media in also very helpful.  Feel free to spread
this link out the your family and friends.

There is also the Topix Terri Schiavo message board.

http://www.topix.net/forum/news/terri-schiavo

Ths forum however is overrun by Michael schiavo trolls.  If you post
anything in defense of Terri's life, you will get unmercifully attacked.

Some of you might be aware that I have been posting to alt.suicide.holiday and
alt.suicide.methods since the beginning of the year. A poster started a thread
called, "Voluntary Euthanasia Should Be Available." Below is my response.

Involuntary Euthanasia is already "available."

Terri Schindler Schiavo wanted to live but Judge Greer (who attained
and kept his position with the help of his Scientologist campaign
manager) issued a court order to remove all food and water from a woman
that he decided was not worth rehabilitating with the money awarded to
her for this purpose.

(The media lied and said that Terri Schiavo died due to Greer's court
order to have her feeding tube removed. The final, amended court order
that killed Terri Schiavo against her will called for the removal of
nutrition and hydration, which includes naturally delivered food and
water, not medical treatment.

Below are links to affidavits that reveal Terri Schaivo passionately
communicated her desire to live. Judge Greer ignored these affidavits
and issued a court order that called for-- not the removal of "medical
treatment"--but rather, the denial of all forms of food and water.

http://www.libertytothecaptives.net/barbara_weller_declaration.html
http://www.libertytothecaptives.net/suzanne_vitadamo_declaration.html

Here is an article about Greer's Scientologist Campaign Manager:
http://libertytothecaptives.net/greer_scientologist_manager.html

Illegal Court Order that Killed Terri Schiavo
http://libertytothecaptives.net/greer_illegal_feb25_court_order.html

--
___________________________________________________
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http://www.ipetitions.com/petition/StopAbuseofPublicTrust/index.html



http://www.petitiononline.com/greer04/petition.html

The Florida Political Probe Petition to Gov. Jeb Bush has been formally
activiated, requesting the Governor to appoint a special prosecutor to
investigate the 2004 election campaign of Judge George W. Greer. In
addition to your phone calls, faxes and e-mails to Gov. Bush's office,
please circulate this petition among your groups, family and friends so
that we may present this petition to the Governor Governor Contact Info:
850-488-4441 (phone)
850-487-0801 (Fax)

e-mail: jeb.bush@...

The following message was received from Hospice Patients Alliance
patientadvocates@...


To: Hospice Patients Alliance <patientadvocates@...>
Subject: Vegetative Patient Shows Signs of Awareness, Study Says
Date: Thursday, September 07, 2006 7:37:59 PM

Hi,

Anyone who followed the real facts  behind the Terri Schindler Schiavo
case and her court-ordered execution will find confirmation (of the
possibility that Terri WAS aware) within this article.  Top neurologists
found that Terri was NOT in a vegetative state as contrasted with those
neurologists who were hand-picked physician/euthanasia supporters (they
had an agenda).  More and more cases are showing that patients may
recover given proper attention and therapy, even after 20 years in a
coma in some cases.

Ron Panzer
for HPA

************************



Vegetative Patient Shows Signs of Awareness, Study Says
By BENEDICT CAREY  NY Times  September 7, 2006
http://www.nytimes.com/2006/09/07/health/07cnd-brain.html?hp&ex=1157688000&en=9c
e8b8e9db2cd104&ei=5094&partner=homepage



A severely brain-damaged woman in an unresponsive, vegetative state
showed clear signs of conscious awareness on brain imaging tests,
researchers are reporting today, in a finding that could have
far-reaching consequences for how unconscious patients are cared for and
diagnosed.

In response to commands, the patient’s brain flared with activity,
lighting the same language and planning regions that are active when
healthy people hear the commands. Previous studies had found similar
activity in partly conscious patients, who occasionally respond to
commands, but never before in someone who was totally unresponsive.

Neurologists cautioned that the new report characterizes only a single
case, and did not mean that unresponsive brain-damaged people were more
likely to recover or treatment was possible. The woman in the study
could not communicate with the researchers, and there was no way to know
whether her subjective experience was anything like what healthy people
call consciousness. The woman was injured in a traffic accident last year.

Yet the study so dramatically contradicted the woman’s diagnosed
condition that it exposed the limitations of standard methods of bedside
diagnosis. And its findings are bound to raise hopes for tens of
thousands of families caring for unresponsive, brain-damaged patients
around the world — whether those hopes are justified or not, experts said.

“One always hesitates to make a lot out of a single case, but what this
study shows me is that there may be more going on in terms of patients’
self-awareness than we can learn at the bedside,” said Dr. James Bernat,
a professor of neurology at the Dartmouth Medical School, who was not
involved in the study. “Even though we might assume some patients are
not aware, I think we should always talk to them, always explain what’s
going on, always make them comfortable, because maybe they are there,
inside, aware of everything.” Dr. Bernat added that brain imaging
promised to improve the diagnosis of unconscious states in certain
patients, but that the prospect of imaging could also raise false hopes
in cases like that of Terri Schiavo, the Florida woman who was removed
from life support and died last year after a bitter national debate over
patients’ rights.

Ms. Schiavo suffered far more profound brain damage than the woman in
the study and was unresponsive for some 15 years, according to
neurologists who examined her.

The journal that published the new paper, Science, promoted the finding
in a press release, but also added a “special note” citing the Schiavo
case and warning that the finding “should not be used to generalize
about all other patients in a vegetative state, particularly since each
case may involve a different type of injury.”

The brain researchers, led by Adrian Owen at the Medical Research
Council Cognition and Brain Sciences Unit in Cambridge, England,
performed scans on the patient’s brain five months after her accident.
The imaging technique, called functional M.R.I., reveals changes in
activity in specific brain regions. When the researchers spoke sentences
to the patient, language areas in her brain spiked in the same way
healthy volunteers’ did.

When presented with sentences containing ambiguous words, like “The
creak came from a beam in the ceiling,” additional language processing
areas became active, as in normal brains. And when the researchers asked
the woman to imagine playing tennis, or walking through her house, they
saw peaks in the premotor and other areas of her brain that mimicked
those of healthy volunteers.

“If you put her scans together with the other 12 volunteers tested you
cannot tell which is the patient’s,” Dr. Owen said in an interview.
Doctors from the University of Cambridge and the University of Liege in
Belgium collaborated on the research.

Dr. Nicholas Schiff, a neuroscientist at Weill Cornell Medical College
in New York, said that the study provided “knock-down, drag-out”
evidence for conscious activity, but that it was not clear “whether
we’ll see this in one out of 100 vegetative patients, or one out of
1,000, or ever again.”

The study authors reported that, 11 months after her injury, the patient
exhibited a potential sign of responsiveness: she tracked with her eyes
a small mirror, as it was moved slowly to her right. This may mean that
the young woman has been in transition from an unresponsive, vegetative
state to a sometimes-responsive condition known as a minimally conscious
state. An estimated 100,000 Americans exist in this state of partial
consciousness, and some of them eventually regain full awareness.

The chances that an unresponsive, brain-damaged patient will eventually
emerge depend on the type of injury suffered, and on the length of time
he or she has been unresponsive. Traumatic injuries to the head, often
from car accidents, tend to sever brain cell connections and leave many
neurons intact. About 50 percent of people with such injuries recover
some awareness in the first year after the injury, studies find; very
few do so afterward. By contrast, brains starved of oxygen — like that
of Terri Schiavo whose heart stopped temporarily— often suffer a massive
loss of neurons, leaving virtually nothing unharmed. Only 15 percent of
people who suffer brain damage from oxygen deprivation recover some
awareness within the first three months. A 1994 review of more than 700
vegetative patients found that none had done so after two years.

The imaging techniques used in the new study could help identify which
patients are most likely to emerge — once the tests are studied in
larger numbers of unconscious people, said Dr. Joseph Fins, chief of the
medical ethics division of New York Presbyterian Hospital-Weill Cornell
Medical Center.

Without this context, Dr. Fins said, the imaging tests could create some
confusion, because like any medical tests they may occasionally go
wrong, misidentifying patients as exhibiting consciousness or lacking
it. “For now I think what this study does is to create another shade of
gray in the understanding of gray matter,” he said.



--
___________________________________________________
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Affidavit of Carla Iyer:

http://libertytothecaptives.net/affidavit_of_carla_iyer.html



> ----- Original Message -----
> From: "Lisa Ruby" <Commissioned@...>
> To: forthelifeofterrischiavo@yahoogroups.com
> Subject: [forthelifeofterrischiavo] Carla Iyer on Hannity & Colmes
> Date: Mon, 04 Sep 2006 23:21:55 -0500
>
>
> Carla Iyer on Hannity & Colmes
>
> http://www.youtube.com/watch?v=A_PewbTb_A4
>
>
>
> --
> ___________________________________________________
> Play 100s of games for FREE! http://games.mail.com/

>


--
___________________________________________________
Play 100s of games for FREE! http://games.mail.com/

Carla Iyer on Hannity & Colmes

http://www.youtube.com/watch?v=A_PewbTb_A4



--
___________________________________________________
Play 100s of games for FREE! http://games.mail.com/

Copied from Ron Panzer's Hospice Patients Alliance newsletter:

Hi,

Some of you did not receive the prior email with the mailing address for
Carla Sauer Iyer, RN.  Please send your donations to her ($5  $10 or
more) at:


Carla Iyer R.N.
502 Sugar Creek Drive
Plant City, Florida 33563

for another story about her victory (at the Board of Nursing) against
those who tried to harm her for standing up for life, see:
http://www.lifenews.com/bio1715.html

Thanks for supporting those who have stood up for LIFE!


If people contemplate and really see the sanctity of life, their
"quality of life" arguments fall away and they will understand that we
are here to care for each other, not to kill each other. Caring, and not
convenience, is the sign of a civilized and just society!


Ron Panzer
for Hospice Patients Alliance
http://www.hospicepatients.org



*************************************************
> ----- Original Message -----
> From: "Lisa Ruby" <Commissioned@...>
> To: forthelifeofterrischiavo@yahoogroups.com
> Subject: [forthelifeofterrischiavo] Carla Suer Iyer, RN needs help to pay
attorney bills
> Date: Mon, 21 Aug 2006 22:26:54 -0500
>
>
> This letter was written by Ron Panzer for the August 21, 2006 edition of the
> Hospice Patients Alliance newsletter
>
> Note:  Carla Sauer Iyer, RN was targeted for revocation of her nursing
> license, basically destroying her ability to earn a living as a nurse.
> A hearing was held and finally, the case/complaint was dismissed.  YET,
> she still needs our help to pay for the attorneys she had to hire to
> defend her case.  I urge you to please send her anything you can:  $5
> $10 or more.  She is an example of a nurse who has stood up for life and
> paid a price.  -  Ron Panzer, Pres., HPA
>
>
> http://www.bradenton.com/mld/bradenton/15305666.htm
>
> Nurse won't lose license for discussing Schiavo case on TV
> Associated Press
>
> TALLAHASSEE, Fla. - A registered nurse who discussed Terri Schiavo's
> condition on television last year won't lose her license, a Florida
> Board of Nursing panel ruled.
>
> The Panel of Probable Cause, a two-member board, dismissed a complaint
> Thursday against Carla Sauer-Iyer, 42, of Plant City.
>
> She had raised concerns in a CNN interview about the brain-damaged
> woman's welfare at the Largo convalescent center where she treated
> Schiavo in the 1990s and in two legal depositions. The March 2005
> interview came during the last rounds of legal battles before Schiavo
> died after her feeding tube was removed.
>
> A lawyer representing the Department of Health said rules requiring
> nurses not to disclose patient information also require them to report
> "apparent neglect and abuse" of patients.
>
> "The obligation to protect the patient must prevail," said Assistant
> General Counsel Kathryn Price told the panel and recommended it reverse
> its previous vote which found probable cause to act against the nurse.
>
> In May, the Health Department filed an administrative complaint against
> Sauer-Iyer for disclosing confidential information about Schiavo, who
> doctors said was in a persistent vegetative state. The Health Department
> changed its position after Gov. Jeb Bush's office sided with Sauer-Iyer.
>
> She became an ally of Bob and Mary Schindler, Schiavo's parents. They
> battled their daughter's husband, Michael Schiavo, over the removal of
> the feeding tube.
>
> Michael Schiavo said the nursing panel was merely responding to pressure
> from the governor.
>
> "When the governor, who commanded the Department of Health, tells his
> people to get this case dismissed, it's going to be dismissed," he said.
>
> Sauer-Iyer said justice was served.
>
> "I would do it again under personal risk," she said.
>
> --
> ___________________________________________________
> Play 100s of games for FREE! http://games.mail.com/

>


--
___________________________________________________
Play 100s of games for FREE! http://games.mail.com/

This letter was written by Ron Panzer for the August 21, 2006 edition of the
Hospice Patients Alliance newsletter

Note:  Carla Sauer Iyer, RN was targeted for revocation of her nursing
license, basically destroying her ability to earn a living as a nurse.
A hearing was held and finally, the case/complaint was dismissed.  YET,
she still needs our help to pay for the attorneys she had to hire to
defend her case.  I urge you to please send her anything you can:  $5
$10 or more.  She is an example of a nurse who has stood up for life and
paid a price.  -  Ron Panzer, Pres., HPA


http://www.bradenton.com/mld/bradenton/15305666.htm

Nurse won't lose license for discussing Schiavo case on TV
Associated Press

TALLAHASSEE, Fla. - A registered nurse who discussed Terri Schiavo's
condition on television last year won't lose her license, a Florida
Board of Nursing panel ruled.

The Panel of Probable Cause, a two-member board, dismissed a complaint
Thursday against Carla Sauer-Iyer, 42, of Plant City.

She had raised concerns in a CNN interview about the brain-damaged
woman's welfare at the Largo convalescent center where she treated
Schiavo in the 1990s and in two legal depositions. The March 2005
interview came during the last rounds of legal battles before Schiavo
died after her feeding tube was removed.

A lawyer representing the Department of Health said rules requiring
nurses not to disclose patient information also require them to report
"apparent neglect and abuse" of patients.

"The obligation to protect the patient must prevail," said Assistant
General Counsel Kathryn Price told the panel and recommended it reverse
its previous vote which found probable cause to act against the nurse.

In May, the Health Department filed an administrative complaint against
Sauer-Iyer for disclosing confidential information about Schiavo, who
doctors said was in a persistent vegetative state. The Health Department
changed its position after Gov. Jeb Bush's office sided with Sauer-Iyer.

She became an ally of Bob and Mary Schindler, Schiavo's parents. They
battled their daughter's husband, Michael Schiavo, over the removal of
the feeding tube.

Michael Schiavo said the nursing panel was merely responding to pressure
from the governor.

"When the governor, who commanded the Department of Health, tells his
people to get this case dismissed, it's going to be dismissed," he said.

Sauer-Iyer said justice was served.

"I would do it again under personal risk," she said.

--
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Violations of Florida Statutes against Terri Schiavo


“Somebody some day will say ‘this is illegal.’  By then be sure the orgs
[Scientology organizations] will say what is legal or not."


- L. Ron Hubbard, Hubbard Communications Office Policy Letter, 4 January 1966,
“LRH Relationship to Orgs

744.3215 Rights of persons determined incapacitated.

http://www.flsenate.gov/statutes/index.cfm?App_mode=Display_Statute&Search_Strin\
g=&URL=Ch0744/SEC3215.HTM&Title=-%3E2003-%3ECh0744-%3ESection%203215



(1) A person who has been determined to be incapacitated retains the right:


(a) To have an annual review of the guardianship report and plan.

(VIOLATED – Her husband/guardian has failed to file such plans for a number of
years. During the years in which he DID submit the required plan, he entered
“NONE” as his plan of action.)


(b) To have continuing review of the need for restriction of his or her rights.
(VIOLATED – The guardian courts have not required her husband/guardian to file
such reports mentioned above and no consistent continuing review has taken place
because of that.)


(c) To be restored to capacity at the earliest possible time.
(VIOLATED – Terri Schiavo has not received therapy since prior to the 1992
medical malpractice settlement in her favor which was intended to facilitate
such therapy.)


(d) To be treated humanely, with dignity and respect, and to be protected
against abuse, neglect, and exploitation.
(VIOLATED – deliberate acts of omission [including humane care and food and
water] are considered felony abuse under the law.)


(e) To have a qualified guardian.
(VIOLATED – her husband/guardian is no longer qualified for his failure to
comply with Florida law requiring annual review of guardianship, failure to
properly maintain the property of the ward, failure to comply with the ward’s
retained rights to necessary services and living in open adultery which is a
misdemeanor under Florida law.)


(f) To remain as independent as possible, including having his or her preference
as to place and standard of living honored, either as he or she expressed or
demonstrated his or her preference prior to the determination of his or her
incapacity or as he or she currently expresses his or her preference, insofar as
such request is reasonable.

(VIOLATED – Terri Schiavo is wrongfully confined to a Hospice facility and
further confined to a single room without social interaction, stimulation and
human company.) See: Scientology Doctrine: Michael Removed Terri From Society



(g) To be properly educated.

(VIOLATED – Terri has not received speech therapy which could enable her to
communicate more effective and to manage table food. She has not received help
in learning any other protocol (such as blinking) to assist her in communicating
more effectively.)


(h) To receive prudent financial management for his or her property and to be
informed how his or her property is being managed, if he or she has lost the
right to manage property.
(VIOLATED – Terri’s medical management fund has been all but depleted on legal
fees in the pursuit of her death. More than half a million dollars has been paid
to one attorney in particular. There is no evidence that Terri would have
managed her funds in this way nor given any consent to such.)


(i) To receive necessary services and rehabilitation.
(VIOLATED – Terri Schiavo has not received proper physical, occupational, speech
or range of motion therapy. She has been denied treatment for simple infections
and she has been denied hospitalization necessitated by serious illness.)


(j) To be free from discrimination because of his or her incapacity.
(VIOLATED – Terri Schiavo has been denied due process in both the guardianship
and federal courts.)


(k) To have access to the courts.
(VIOLATED – See above.)


(l) To counsel.
(VIOLATED – Terri Schiavo was never represented during the duration of the
guardianship proceedings and did not have a Florida required Guardian ad Litem
assigned to represent her during the majority of the proceedings.)


(m) To receive visitors and communicate with others.
(VIOLATED – Terri’s visitor list is strictly managed by her husband/guardian who
has, a number of times, barred her family, her friends and her spiritual counsel
from visiting her, without the court’s prior approval and on personal whim.)


(n) To notice of all proceedings related to determination of capacity and
guardianship, unless the court finds the incapacitated person lacks the ability
to comprehend the notice.
(VIOLATED – Terri has not been legally represented in any of the guardianship
proceedings and has received no counsel.)



(4) Without first obtaining specific authority from the court, as described in
s. 744.3725, a guardian may not:


(a) Commit the ward to a facility, institution, or licensed service provider
without formal placement proceeding, pursuant to chapter 393, chapter 394, or
chapter 397.

(VIOLATED – Terri was admitted to a Hospice facility in 2000 without prior court
approval and in violation of Federal laws pertaining to Hospice confinement
qualifications.)


(b) Consent on behalf of the ward to the performance on the ward of any
experimental biomedical or behavioral procedure or to the participation by the
ward in any biomedical or behavioral experiment. The court may permit such
performance or participation only if:



1. It is of direct benefit to, and is intended to preserve the life of or
prevent serious impairment to the mental or physical health of the ward; or



2. It is intended to assist the ward to develop or regain his or her abilities.

(VIOLATED – Terri Schiavo was subjected to experimental implant surgery in 1993
without prior court approval and without recommendation of her attending
physician. Additionally, she was transported across state lines for said
surgery. Additionally, follow up care was never provided and no further
maintenance services have ever been provided for the implanted electrodes.)



(c) Initiate a petition for dissolution of marriage for the ward.



(d) Consent on behalf of the ward to termination of the ward's parental rights.



(e) Consent on behalf of the ward to the performance of a sterilization or
abortion procedure on the ward.



744.2025 Change of ward's residence.

http://www.flsenate.gov/Statutes/index.cfm?App_mode=Display_Statute&Search_Strin\
g=&URL=Ch0744/SEC2025.HTM&Title=-%3E2003-%3ECh0744-%3ESection%202025



(1) PRIOR COURT APPROVAL REQUIRED.--A guardian who has power pursuant to this
chapter to determine the residence of the ward may not, without court approval,
change the residence of the ward from this state to another, or from one county
of this state to another county of this state, unless such county is adjacent to
the county of the ward's current residence. Any guardian who wishes to remove
the ward from the ward's current county of residence to another county which is
not adjacent to the ward's current county of residence must obtain court
approval prior to removal of the ward. In granting its approval, the court
shall, at a minimum, consider the reason for such relocation and the longevity
of such relocation.

(VIOLATED – Terri Schiavo was moved to a Hospice facility in 2000 by her husband
without prior court approval. The Hospice House in question was served by his
attorney, George Felos, in the capacity of Chairman up until that same time.)





744.3145 Guardian education requirements

http://www.flsenate.gov/Statutes/index.cfm?App_mode=Display_Statute&Search_Strin\
g=&URL=Ch0744/SEC3145.HTM&Title=-%3E2003-%3ECh0744-%3ESection%203145



(4) Each person appointed by the court to be a guardian must complete the
required number of hours of instruction and education within 1 year after his or
her appointment as guardian. The instruction and education must be completed
through a course approved by the chief judge of the circuit court and taught by
a court-approved organization. Court-approved organizations may include, but are
not limited to, community or junior colleges, guardianship organizations, and
the local bar association or The Florida Bar.

(VIOLATED – See Above.)



798.01 Living in open adultery

http://www.flsenate.gov/Statutes/index.cfm?App_mode=Display_Statute&Search_Strin\
g=&URL=Ch0798/SEC01.HTM&Title=-%3E2003-%3ECh0798-%3ESection%2001



Whoever lives in an open state of adultery shall be guilty of a misdemeanor of
the second degree, punishable as provided in s. 775.082 or s. 775.083. Where
either of the parties living in an open state of adultery is married, both
parties so living shall be deemed to be guilty of the offense provided for in
this section.

(VIOLATED – Michael Schiavo has cohabitated and fathered children with another
woman while still married to Terri Schiavo.)


825.102 – Abuse, Neglect and Exploitation of Elderly Persons and Disabled
Adults.

http://www.flsenate.gov/statutes/index.cfm?App_mode=Display_Statute&URL=Ch0825/t\
itl0825.htm&StatuteYear=2003&Title=%2D%3E2003%2D%3EChapter%20825



(1) "Abuse of an elderly person or disabled adult" means:



(a) Intentional infliction of physical or psychological injury upon an elderly
person or disabled adult;

(VIOLATED – Physical injury by denial of simple procedures to alleviate painful
contractures of the hands and possible disfigurement because of said
contractures. Psychological abuse in denial of company, stimulation, acts of
caging.)



(b) An intentional act that could reasonably be expected to result in physical
or psychological injury to an elderly person or disabled adult; or

(VIOLATED – Intentional denial of treatment for simple infection with the
knowledge that doing so would hasten death – 1993.)



(c) Active encouragement of any person to commit an act that results or could
reasonably be expected to result in physical or psychological injury to an
elderly person or disabled adult.

(VIOLATED – By instructing caregivers not to provide relief of contractures; by
instructing doctors not to treat for simple infection.)



A person who knowingly or willfully abuses an elderly person or disabled adult
without causing great bodily harm, permanent disability, or permanent
disfigurement to the elderly person or disabled adult commits a felony of the
third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.



(2) "Aggravated abuse of an elderly person or disabled adult" occurs when a
person:



(a) Commits aggravated battery on an elderly person or disabled adult;



(b) Willfully tortures, maliciously punishes, or willfully and unlawfully cages,
an elderly person or disabled adult; or

(VIOLATED – Denial of human comfort and spiritual comfort at personal whim.
Terri Schiavo is also wrongfully caged, kept confined to a single room and
without stimulation or ability to be taken outside.)



(c) Knowingly or willfully abuses an elderly person or disabled adult and in so
doing causes great bodily harm, permanent disability, or permanent disfigurement
to the elderly person or disabled adult.

(VIOLATED – See above.)



A person who commits aggravated abuse of an elderly person or disabled adult
commits a felony of the second degree, punishable as provided in s. 775.082, s.
775.083, or s. 775.084.



(3)(a) "Neglect of an elderly person or disabled adult" means:



1. A caregiver's failure or omission to provide an elderly person or disabled
adult with the care, supervision, and services necessary to maintain the elderly
person's or disabled adult's physical and mental health, including, but not
limited to, food, nutrition, clothing, shelter, supervision, medicine, and
medical services that a prudent person would consider essential for the
well-being of the elderly person or disabled adult; or

(VIOLATED – Denial of treatment of simple infection which would, admittedly,
hasten death, removal of food and water, denial of medicine.)



2. A caregiver's failure to make a reasonable effort to protect an elderly
person or disabled adult from abuse, neglect, or exploitation by another person.

(VIOLATED – The results of a 1991 bone scan, indicating multiple and serious
trauma to Terri’s body were never reported or investigated by her
husband/guardian.)



Neglect of an elderly person or disabled adult may be based on repeated conduct
or on a single incident or omission that results in, or could reasonably be
expected to result in, serious physical or psychological injury, or a
substantial risk of death, to an elderly person or disabled adult.



(b) A person who willfully or by culpable negligence neglects an elderly person
or disabled adult and in so doing causes great bodily harm, permanent
disability, or permanent disfigurement to the elderly person or disabled adult
commits a felony of the second degree, punishable as provided in s. 775.082, s.
775.083, or s. 775.084.



(c) A person who willfully or by culpable negligence neglects an elderly person
or disabled adult without causing great bodily harm, permanent disability, or
permanent disfigurement to the elderly person or disabled adult commits a felony
of the third degree, punishable as provided in s. 775.082, s. 775.083, or s.
775.084.



825.103 Exploitation of an elderly person or disabled adult; penalties.

http://www.flsenate.gov/Statutes/index.cfm?App_mode=Display_Statute&Search_Strin\
g=&URL=Ch0825/SEC103.HTM&Title=-%3E2003-%3ECh0825-%3ESection%20103



(b) Obtaining or using, endeavoring to obtain or use, or conspiring with another
to obtain or use an elderly person's or disabled adult's funds, assets, or
property with the intent to temporarily or permanently deprive the elderly
person or disabled adult of the use, benefit, or possession of the funds,
assets, or property, or to benefit someone other than the elderly person or
disabled adult, by a person who knows or reasonably should know that the elderly
person or disabled adult lacks the capacity to consent.


(2)(a) If the funds, assets, or property involved in the exploitation of the
elderly person or disabled adult is valued at $100,000 or more, the offender
commits a felony of the first degree, punishable as provided in s. 775.082, s.
775.083, or s. 775.084.

(VIOLATED – Funds that were awarded to Terri Schiavo have been embezzled [with
Judge Greer's approval] by Michael Schiavo to pay his legal fees. These funds
were awarded to Terri Schiavo as a medical management/rehabilitation settlement
and remain her property. Her guardian has all but wasted her entire estate on
his own legal pursuits.)





Universal Declaration of Human Rights



Adopted by UN General Assembly Resolution 217A (III) of 10 December 1948

http://fletcher.tufts.edu/multi/texts/UNGARES217A.txt



Article 3

Everyone has the right to life, liberty and security of person.



Article 5

No one shall be subjected to torture or to cruel, inhuman or degrading treatment
or punishment.



Article 6

Everyone has the right to recognition everywhere as a person before the law.



Article 7

All are equal before the law and are entitled without any discrimination to
equal protection of the law. All are entitled to equal protection against any
discrimination in violation of the Declaration and against any

incitement to such discrimination.



Article 17

1. Everyone has the right to own property alone as well as in association with
others.



2. No one shall be arbitrarily deprived of his property.



Article 18

Everyone has the right to freedom of thought, conscience and religion; this
right includes freedom to change his religion or belief, and freedom, either
alone or in community with others and in public or private, to manifest his
religion or belief in teaching, practice, worship and observance.



Article 25

1. Everyone has the right to a standard of living adequate for the health and
well-being of himself and of his family, including food, clothing, housing and
medical care and necessary social services, and the right to security in the
event of unemployment, sickness, disability, widowhood, old age or other lack of
livelihood in circumstances beyond his control.
Other Items/Questions



777.04 Attempts, solicitation, and conspiracy.

http://www.flsenate.gov/Statutes/index.cfm?App_mode=Display_Statute&Search_Strin\
g=&URL=Ch0777/SEC04.HTM&Title=-%3E2003-%3ECh0777-%3ESection%2004



877.02 Solicitation of legal services or retainers therefore; penalty.

http://www.flsenate.gov/Statutes/index.cfm?App_mode=Display_Statute&Search_Strin\
g=&URL=Ch0877/SEC02.HTM&Title=-%3E2003-%3ECh0877-%3ESection%2002



(2) It shall be unlawful for any person in the employ of or in any capacity
attached to any hospital, sanitarium, police department, wrecker service or
garage, prison or court, or for a person authorized to furnish bail bonds,
investigators, photographers, insurance or public adjusters, to communicate
directly or indirectly with any attorney or person acting on said attorney's
behalf for the purpose of aiding, assisting or abetting such attorney in the
solicitation of legal business or the procurement through solicitation of a
retainer, written or oral, or any agreement authorizing the attorney to perform
or render legal services.

(VIOLATED: Felos/Bushnell’s relationship with Hospice.)




733.504 Removal of personal representative; causes for removal.

http://www.flsenate.gov/Statutes/index.cfm?App_mode=Display_Statute&Search_Strin\
g=&URL=Ch0733/SEC504.HTM&Title=-%3E2003-%3ECh0733-%3ESection%20504



A personal representative may be removed and the letters revoked for any of the
following causes, and the removal shall be in addition to any penalties
prescribed by law:

(3) Failure to comply with any order of the court, unless the order has been
superseded on appeal.

(5) Wasting or maladministration of the estate.



Also see: Judge Greer's Violations of Florida statutes and judicial canons

Very Good Reasons to Investigate Michael Schaivo

acknowledgements: copied from Free Republic post by pc93

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Posts Free Republic Deleted Regarding Scientology and Terri Schiavo

Recently someone emailed me with a question regarding the Terri Schiavo case. I
retrieved my answer from the data contained in the posts I saved from my time at
Free Republic in 2004. Since some of my posts cover material not mentioned in
website articles, I decided to post them to the internet.

http://libertytothecaptives.net/scientology_terri_schiavo_freerepublic.html

Lisa Ruby







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This letter was written by Ron Panzer of Hospice Patients Alliance

Dear friends,

Carla Iyer, RN is a dedicated, hardworking nurse who tried so hard to
protect Terri Schiavo.  She directly cared for Terri when Terri was in a
nursing home, noting that Terri spoke understandable words, was able to
swallow some foods and that it was Michael Schiavo who forbade any
rehabilitation or therapy to help Terri.  She has told us that nursing
notes she and many other nurses wrote would be removed from Terri's
medical record by Michael Schiavo if there were any records of Terri's
ability to speak, swallow or do just about anything.

Carla provided (at the request of Governor Jeb Bush of Florida) an
official "AFFIDAVIT" detailing some of her observations during that
time.  Now, she is being targeted by the Florida Department of Health to
try and take away her hard-won license as a registered nurse, basically
seeking to harm her and her family financially, and to tarnish her
reputation as a dedicated nurse!  We need MORE nurses like Carla Iyer,
RN ... not fewer!  But the Florida Dept of Health is pro-death,
pro-killing of the disabled and has supported the killing of patients
such as Terri Schiavo.

How have they (the Florida Dept of Health) supported the killing of
patients such as Terri Schiavo?  They have never taken action against
those agencies and individuals who contrary to the laws of Florida and
the USA that forbid killing of patients.  They have never taken action
to protect these patients from harm in those settings where they are
harmed.  They have failed to act by stopping the ILLEGAL placement of
Terri Schiavo in a hospice facility (the corrupt Hospice of the Florida
Suncoast) when Terri Schiavo was NOT terminal!

Why is that hospice "corrupt?"  It is corrupt because it was found
officially, formally by the U.S. Dept of Justice to have illegally,
wrongly billed Medicare for millions of dollars in services.  It is
corrupt because it has a practice and policy of admitting patients who
are NOT terminal when they are ONLY supposed to take in TERMINAL patients!

Hospice of the Florida Suncoast represents the very worst in hospice
today: a hospice that is actively willing to kill disabled patients and
to actively seek out such patients (as they did in the Terri Schiavo
case) for the purpose of killing them with court approval (through their
connections to judges who are pro-death and killing of patients).  This
Hospice of the Florida Suncoast is actively seeking to incorporate forms
of killing patients into hospice practice: terminal sedation misused to
end the lives of patients and/or assisted suicide or euthanasia.  What
they did to Terri was intentional killing/euthanasia.  And Michael
Schiavo as well as Judge Greer, Judge Baird, attorney George Felos and
others conspired together to kill her (all under the cloak of "legality"
condoned by black-robed, black-hearted judges).

Carla Iyer, RN is fighting for her license and her family's welfare!  We
urge you to take the time NOW to send $5 or $10 or anything you can
spare to help pay for Carla Iyer, RN's legal expenses.  Many of you have
asked in the past, "what can I do to stop these killings?"

Well, here is one thing you can do that is absolutely clear, absolutely
needed, and will help protect one of the nurses I respect so much for
their prolife stand and adherence to the original standards of care.
Carla Iyer, RN should be applauded and given an award by the Dept of
Health for showing what real nursing is about!  Instead they are seeking
to destroy her financially.  Please help!

I have sent a donation to her legal fund.  I am asking that you also
mail her a check to help her now.

Carla's mailing address is:

Carla Iyer R.N.
502 Sugar Creek Drive
Plant City, Florida 33563
Riyer@...

Thanks so much for stepping up and doing the right thing by mailing her
a check now when it is really needed.

-  Ron

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From:   Hospice Patients Alliance <patientadvocates@...>
[Add to Address Book]
To:  Hospice Patients Alliance <patientadvocates@...>
Subject:  Nurse Carla Iyer now being targeted by Florida Dept of Health to take
away her nursing license for speaking the truth about Michael Schiavo's attempts
to kill Terri!
Date:  Tuesday, June 27, 2006 4:21:41 PM  [View Source]

It is clear, and has been clear, that all along, the bureaucracy in
Florida is decidedly ANTI-life, anti-patient rights and stands with
those who wish to euthanize patients who are cognitively impaired or
disabled, such as Terri Schindler Schiavo.  In case after case, instance
after instance, the Florida courts, government departments have ruled
unfairly and acted improperly to ignore all the evidence of criminal
activity which occurred, violating numerous laws in the Schiavo case.
Now, a brave nurse who spoke out to reveal the truth about how Terri was
targeted for years, is also being attacked by those who should be
praising her for standing up for the original nursing standards of care:
working to protect the lives of patients and for the original adherence
to a sanctity of life ethic within health care.

This is truly a horribly unfair abuse of power, power used in its worst
way to victimize those who truly serve the patients' interests!
       - Ron Panzer

***********************


EXCLUSIVE - Schiavo Nurse's License in Jeopardy For Giving Interview
http://www.northcountrygazette.org/articles/062506SchiavoNurse.html
By June Maxam  North Country Gazette


When a nurse employed at Palm Garden of Largo Convalescent Center in
Largo, gave an interview last March to CNN about the conduct of Michael
Schiavo towards his ward and wife, she didn't expect that her nursing
license would be placed in jeopardy or that her First Amendment rights
would be violated.

When legal counsel for Gov. Jeb Bush asked Carla Iyer to give an
affidavit to aid in the Governor's defense of Schiavo's lawsuit against
him challenging the constitutionality of Terri's Law, she didn't expect
retaliation by a state agency against her that would result in the
revocation of her nursing license and single her out for speaking out
against Michael Schiavo.

Although the Florida Department of Health has claimed that there is no
probable cause to discipline Michael Schiavo for submitting a fraudulent
application for guardianship and falsifying his academic credentials,
according to an administrative complaint and proposed settlement
agreement served upon Carla Sauer Iyer, a former caregiver of Terri
Schiavo, DOH is seeking to permanently revoke Iyer's nursing license and
impose administrative costs not to exceed $1,683.49.

[go online for excellent article detailing this horrific and
discriminatory retaliation against a nurse who has stood firm FOR the
nursing standards of care and for life and who is being targeted by
those who care nothing about protecting the lives of patients.  -  R.P.]


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21 I submit the article is hearsay. Also, even

22 if it weren't hearsay, I am renewing my prior

23 objection, Your Honor, that this court has

24 overruled as to the other medical articles in that

25 it's not proper to use on direct examination.






207

1 As to the patent, what I have for Exhibit

2 Number 15 is a printout from a website.

3 MS. ANDERSON: It's on the United States

4 Patenting Trademark office's official website, is

5 what that is, and he authenticated it.

6 MR. FELOS: Well, the point is for

7 authentication. If it's supposed to be

8 self-authentication, it requires the signature of

9 the public official, Your Honor, so it's not

10 self-authenticating.

11 MS. ANDERSON: Dr. Hammesfahr authenticated

12 it.

13 THE COURT: I'm going to receive the other one

14 subject to that same motion to strike. I'm

15 troubled by the patent since I don't understand

16 what a patent is supposed to tell me.

17 MS. ANDERSON: Okay.

18 THE COURT: To me, you make a new procedure.

19 If the new procedure works, that means you pull the

20 trigger and the hammer falls, it works. But I

21 don't know what that tells me about it's science in

22 the relevant scientific community. My guess is

23 that there are medical patents out there that, you

24 know, are abandoned, for want of a better word.

25 MS. ANDERSON: Oh, sure. But one of the






208

1 things that you also have to consider hearing is

2 efficacy. That's one of the issues that the Second

3 DCA wants to know about, probable efficacy. And we

4 will address that again with Dr. Hammesfahr later

5 on.

6 THE COURT: But, again, how does a patent --

7 you have -- since I don't know what a patent means.

8 MS. ANDERSON: It tells you new. Now, again,

9 that's one of the things that the Second DCA said

10 that establishes, new. That's what that does at a

11 minimum.

12 I'm not saying, Judge -- well, whatever

13 Mr. Felos thinks I'm saying. All I'm saying is

14 Dr. Hammesfahr applied for and received a patent

15 from the United States government for new medical

16 therapy. Maybe he will tell the Second DCA

17 something about new, and if we read it, it will

18 tell them something about efficacy.

19 MR. FELOS: Your Honor, this patent also

20 contains hearsay within hearsay.

21 MS. ANDERSON: Like trial transcripts is a

22 public record.

23 Judge, can we move on? Have you made your

24 ruling?

25 THE COURT: No, I haven't. I'm still






209

1 wrestling with it.

2 Does the witness have the documents you wish

3 to be received or are they in your book?

4 MS. ANDERSON: The patent. You have them in

5 the evidence, if that's what you're asking.

6 THE COURT: You wish to bring into evidence

7 what exhibit?

8 MS. ANDERSON: It's in the book.

9 THE COURT: You will need to give me those

10 numbers.

11 MS. ANDERSON: The patent is exhibit?

12 THE COURT: Fifteen.

13 MS. ANDERSON: The article is exhibit?

14 THE COURT: Seventeen.

15 (Whereupon, the documents referred to were
received

16 in evidence as Respondents' Exhibit Numbers 15 and 17.)

17 BY MS. ANDERSON:

18 Q. Dr. Hammesfahr, would you read the exhibit

19 numbers on the article that you have in front you?

20 A. Twenty-four, 28, 25, 30, 32, 33, 34, 35, 40,

21 41, 42, 44, 45, 46, 47, 50, 54, 58, 64, 72, 74, 75, and

22 76.

23 Q. What effects did calcium channel blockers have

24 on vasospasm?

25 A. Certain calcium channel blockers were the






210

1 first to identify the use of treating vasospasm. Some

2 are very effective and some are less effective.

3 Q. What are Statins?

4 A. Statins were drugs that were originally

5 thought to treat cholesterol, high cholesterol, lower

6 cholesterol, thus decreasing cholesterol plaque

7 formation in helping to prevent stroke. But also

8 orthometric oxide relieves the body and thus having

9 immediate effect on the blood vessels by increasing

10 blood flow due to nitroglycerin and nitric oxide release

11 and changes.

12 Q. Do you use calcium channel blockers in and

13 stanton in your therapy?

14 A. Yes, we do.

15 Q. Are there other types of drugs that you use?

16 A. Yes, they are.

17 Q. What are they?

18 A. They are medications called ACE or ARB

19 medications. Those are two families of medications that

20 work on the nitroglycerin/nitric oxide pathway to the

21 body and enters into the converting enzyme pathway and

22 its component pathways.

23 Q. Now, angiotensin, as you said to me, as a

24 layman, is a drug that has the effect of lowering the

25 blood pressure. Am I not understanding that correctly?






211

1 A. Yes, it does. All vasodilators can lower

2 blood pressure if used in a higher dose because they

3 dilate blood vessels and lower blood pressure. So you

4 can lower blood pressure with any of these medications,

5 although, you don't have to to treat the underlying

6 disorder.

7 Q. Now, have you had success in recovering

8 cognitive function in your patients?

9 A. Yes. We have had improvement in the cognitive

10 function of the patient.

11 Q. Are there any examples of that in the

12 courtroom today?

13 A. Yes, they are.

14 Q. Can you tell the court -- can you identify the

15 patients in the audience today and tell the court

16 briefly what condition that patient was in when he first

17 presented to you?

18 A. Well, Miriam Sapiro, who's in a blue-green

19 outfit back by the column, had had a head injury and she

20 had difficulties with concentration, severe migraines.

21 Was one of our first patients that actually went on

22 these medications and has done very well since then, is

23 living independently.

24 Q. Was she not living independently when she

25 first came to you?






212

1 A. She was having a great deal of difficulty

2 living independently before we started.

3 Q. Has her cognitive function improved?

4 A. Oh yes.

5 Q. And do you have her evaluated how?

6 A. We have her evaluated with respect to

7 neuropsychological testing.

8 Q. Outside of your office?

9 A. Yes.

10 Q. By someone else outside of your office?

11 A. Yes.

12 Q. What else?

13 A. Robin Robinson is in the first row wearing

14 gold. She brought her father to me eight years after a

15 stroke. He was partially paralyzed. And he was a

16 psychologist, a professor of psychology, who was no

17 longer able to live independently. He started was on

18 medication. She kept a diary of three weeks during the

19 time frame when he cognitively -- he came in in a

20 wheelchair and walked home out of the wheelchair.

21 He has also had major cognitive improvements.

22 Three months later, he got out of the wheel chair, was

23 able to walk up and down steps, going to support

24 meetings. And also, he would live independently. Was

25 living in a non-independent status, was able to go home






213

1 for three or four months in an independent status. It

2 was eight years after his stroke.

3 Q. Eight years?

4 A. Eight years that I started treating him after

5 his stroke.

6 Q. Now, let me ask you a question about years

7 from original injury. In your experience with this

8 vasodilation therapy, does it make a difference how far

9 out from the injury the patient might be?

10 A. Yes, there is a difference.

11 Q. What is the difference?

12 A. Well, it's best to treat somebody who's having

13 a stroke the moment that they're having it, or within

14 the first hours or days or weeks. The farther out you

15 are, there is going to be more difficulty in getting the

16 same level of improvement as if you could see somebody

17 while they are having the stroke.

18 Q. Now, is that true -- or is there a point where

19 the patient reaches maximum medical improvement?

20 A. Yes, there is.

21 Q. And is there a consensus in the literature on

22 what that point is?

23 A. Yes, there is.

24 Q. What is that?

25 A. The general consensus of the published






214

1 reports, one done in Copenhagen recently of 1,200 --

2 1,197 patients is that by three month the person has

3 essentially reached the plateau stage beyond which

4 functional recovery is unlikely.

5 Q. And has that been your experience?

6 A. Well, that's been my experience prior to using

7 something like hyperbaric or vasodilators, yes. It

8 might go a little longer, six months or nine months, but

9 then you are having very little improvement.

10 Q. Now, if a patient is one year out or five

11 years out, is there any difference in terms of that

12 recoverability factor?

13 A. Well, you know, we're seeing -- it's sort of

14 like -- the concept is sort of like having a knee injury

15 with a torn cartilage. Once you have a torn cartilage

16 and you have your injury, you are either going to limp

17 around for a while and either recover or not recover.

18 If you don't recover, you will continue to limp until

19 you have some sort of a definitive treatment, like

20 surgery, and then you will start to feel better.

21 So in medicine, the concept of maximum medical

22 improvement is the degree of improvement that you will

23 get with whatever therapies you are on at that point.

24 Once you start a new therapy, there will be a new type

25 of maximum medical improvement. So a patient one year






215

1 out or five years out will still have improvement once

2 they start, in our case, vasodilators, hyperbaric, or

3 other therapies out there now.

4 Q. So you're not saying that a patient who's four

5 years out will be a better candidate for recovery than a

6 patient who is seven years out?

7 A. Well, we've had dramatic recoveries in

8 patients, dramatic sometimes right away and sometimes

9 over a year or two or three years. A patient can be a

10 year out as well as ten years or longer.

11 Shawn, back there, is a young man with

12 cerebral palsy approximately 13 years before I started

13 treating him. He could walk slightly before I started

14 treating him. His mother just told me today, a year

15 into treatment, he is walking to about five classrooms.

16 So you can get major improvements in patients

17 who have been plateaued for a very long period of time.

18 It's just like heart disease. If you don't treat a

19 person with medication after their heart attack, and

20 then three, five, ten years later start treating with

21 nitroglycerin or ACE inhibitors or calcium channel

22 blockers, you're going to see improvement in those

23 patients.

24 Q. And a common thread is vasospasm?

25 A. The common thread is increasing oxygen






216

1 delivery to the tissues. And whether that's done by

2 increasing blood flow through damaged blood vessels with

3 the medication ACE inhibitors or nitrates or calcium

4 channel blockers dilates damaged blood vessels and

5 allows improved blood flow to those areas, or whether

6 you do it through hyperbaric or whether you do it

7 through some other mechanism. There are many mechanisms

8 to increase that blood flow to the area or increase

9 oxygen delivered to the area.

10 And, of course, the more of these things you

11 do, the better. You can actually mix certain

12 modalities; hyperbaric and vasodilators with other

13 modalities out there.

14 Q. So the common thread is not vasospasm, the

15 common thread is reducing inadequate oxygenation to the

16 brain?

17 A. The common thread to getting people better is

18 increasing and improving the oxygen delivery and the

19 metabolism of those damaged nerves in number. You can

20 do that through a variety of mechanisms of which

21 vasodilation might increase the blood flow is one.

22 Hyperbaric is another one.

23 There are medicines that are used routinely in

24 certain patients that work strictly on metabolism. In

25 children, it's Ritalin, and that can be used for






217

1 brain-injury patients, too, working, again, on the

2 damaged nerves in number but working different

3 mechanisms. So there are many mechanisms to make that

4 number start to function again or to make certain cells

5 in that area to function again.

6 Q. What is a working definition of a reflex

7 action?

8 A. A reflex action is an action which is

9 essentially not under unconscious control. In fact,

10 it's difficult to have conscious control over that

11 action. It's fleeting. It's very rapid. It's

12 generally involved with self-protection of the body and

13 it's very rapid unconscious response.

14 Q. Do people who do not have brain injuries

15 exhibit reflexes?

16 A. Yes.

17 Q. As a neurologist, what does intact reflex

18 responses tell you?

19 A. Reflexes are of several different levels.

20 They essentially go from some part of the body that

21 interacts with the outside world, like the arm or the

22 foot or the eye to the spinal cord and then back to the

23 arm or the foot, or they may go on to the brain, then

24 back out. So you have different levels of reflex

25 activity.






218

1 The presence of the reflex simply tells you

2 that circuit that goes to the spinal cord or to the

3 brain and then back is intact. The health risk or how

4 active that reflex is gives you other information how it

5 deals with the nervous system or how injured it may be.

6 Q. What is the threat reflex?

7 A. The threat reflex is a self-protection reflex.

8 It's generally done through vision. It's something

9 coming rapidly towards your field of vision with a

10 blockage, of some sort, to light, and your eyes grab it

11 and may startle or jump to it.

12 Q. What is the startle reflex?

13 A. Startled reflex is a reflex of which the body

14 is trying to protect itself of something it doesn't

15 expect. So it's similar to the threat response, but

16 it's more of a total body response. So, usually it

17 involves the body withdrawing as close as it can from

18 the world around it and having the physical jump in that

19 you can frequently see.

20 Q. A twitch?

21 A. A twitch. Again, instantaneous.

22 Q. What is the Saccades, S-a-c-c-a-d-e-s, reflex?

23 A. Saccades are very quick motions of the eye

24 that the eye uses to find something it wants to look at

25 in fixing. So it's essentially a twitch of the eye






219

1 bringing the pupils directly at something.

2 There is a very common reflex that deals with

3 tracking called nystagmus in which you have twitches.

4 It occurs when we are driving on the road and somebody

5 is staring off and watching trees go by. You'll watch

6 the eye, it will twitch back and forth. It twitches and

7 picks up a tree, then moves slowly and follows the tree,

8 then twitches, follows another tree. You find it

9 through a very rapid psychotic movement and then

10 tracking it until it gets to the next one.

11 Q. How is the Saccades reflex related to brain

12 injury, if at all?

13 A. Well, you can have -- if you have -- because

14 it is a reflex, if you have a circuit that goes between

15 the eye and the control of mechanism of the eye muscles

16 injured or interrupted, you will lose that Saccadic

17 twitch into the direction of where the entry may be.

18 THE COURT: Why don't we use this as a time

19 for a break. We have been here for almost two

20 hours.

21 Doctor, I'm going to caution you. You are

22 still a witness on the witness stand. Please don't

23 talk to anybody during this break about the case,

24 about your testimony, or about what you intend to

25 testify about.






220

1 Let's take 15.

2 (Whereupon, a short recess was taken after

3 which the following proceedings transpired:)

4 BY MS. ANDERSON:

5 Q. Dr. Hammesfahr, I would like to hand you what

6 I have premarked as Exhibits 77 and 88. Eighty-eight is

7 from Lancet and 77 is from the New England Journal of

8 Medicine.

9 MS. ANDERSON: May I approach?

10 THE COURT: Yes, ma'am.

11 BY MS. ANDERSON:

12 Q. I'll ask you if you recognize those article or

13 articles?

14 A. Yes, I do.

15 Q. Are they articles that you have reviewed as

16 part of your ordinary medical practice in preparation

17 for testifying in this case?

18 A. Yes, I have.

19 Q. How do those articles relate to changes in the

20 last two years?

21 A. Well, they're incredibly important. The HOPE

22 Trial and PROGRESS Trial. They deal with the use of ACE

23 inhibitors in patients with strokes. They essentially

24 show that these medications should be given to all

25 patients who are at risk of having a stroke or have






221

1 previously had a stroke. Those who previously have had

2 a stroke are at high risk for a second stroke.

3 These are medicines whose side-effect is for

4 lowering the blood pressure, but that the improvement in

5 patients is so dramatic than those who don't get it that

6 even patients with low blood pressure should be given

7 these medicines, and it's safer to give them to patients

8 with low blood pressure than for them to live without

9 these medicines because of the affect on the brain, the

10 blood pressure in the brain.

11 Q. The P in PROGRESS stands for Perindopril,

12 P-E-R-I-N-D-O-P-R-I-L, right?

13 A. Correct.

14 Q. And what is the pharmacological effect of

15 Perindopril?

16 A. Perindopril is a violator of blood vessels.

17 Q. The results from -- were these studies

18 international in scope, by the way?

19 A. These studies were international in scope,

20 yes.

21 Q. How many patients overall?

22 A. The Progress seven -- 6,405 patients from 172

23 centers in Asia, Australia, and Europe were involved.

24 In the Hope study, 9,297 high risk patients were

25 involved.






222

1 Q. And do those research results represent a

2 C-change in the treatment of stroke?

3 A. Yes, they do.

4 Q. In what sense?

5 A. They essentially represent C-change in that is

6 now understood that medication can be used to increase

7 blood flow or to maintain blood flow to the brain and

8 that these medications will help those who had a stroke

9 or are at risk of a stroke. They change entirely our

10 approach from trying to stop an embolism, a clot from

11 going to the brain to trying to improve and maintain the

12 blood flow in the brain. And by improving or

13 maintaining blood flow to the brain, preventing stroke

14 or preventing other vascular injuries and actually

15 causing improvement in a variety of different ways.

16 Q. Previously, a patient presented in an

17 emergency room in the immediate aftermath of a stroke or

18 during a stroke, what was the proper treatment with

19 regard to trying to control blood pressure?

20 A. Controlling blood pressure in a patient with a

21 new stroke previously has not had a very good consensus.

22 Some people have tried to allow the blood pressure to

23 rise to a new level. Others have allowed the blood

24 pressure to rise, but not to dangerous levels. Of

25 course, they obviously define dangerous in a different






223

1 manner than those who allow blood pressure to go to any

2 level at all, and others have tried to lower blood

3 pressure to a more normal range. So there's not been a

4 good unified consistent consensus among the people.

5 Q. Does the results shown in the Progress Trial

6 and Hope Trial have an impact on the treatment of acute

7 stroke?

8 A. There's already impacting being seen from

9 these studies. As other studies are now primarily from

10 Europe, the centers associated with this original study,

11 are now reporting that they're advocating the use of

12 these medicines in the emergency room setting at the

13 time of original hospitalization. They are actually in

14 the process reporting these studies. Some of these

15 studies are in literature now.

16 Q. And has this information since its published

17 in the New England Journal been adopted as treatment

18 protocol in the United States?

19 A. I think there is a great deal of consensus

20 among specialists in the U.S. that this is true and

21 accurate and correct information, so it was published in

22 the New England Journal. How individual physicians

23 practice, though, is dependent upon that specific

24 physician as he sees that specific patient in front of

25 him.






224

1 Q. Dr. Hammesfahr, can you briefly, very briefly,

2 walk us through the treatment of new patients that you

3 treat?

4 A. Well, most of our patients --

5 MR. FELOS: Well, I object, Your Honor. The

6 question is vague. "New patient", new patient for

7 what?

8 THE COURT: I'm assuming it's for him.

9 BY MS. ANDERSON:

10 Q. New patient for you. Did you understand that

11 to be my question?

12 A. Yes, I do.

13 Q. Okay.

14 MR. FELOS: Your Honor, I object. I meant in

15 terms of ailment to the patient. What ailment are

16 we talking about?

17 THE COURT: Let's find out. But my guess is

18 he is going to tell us what this patient is

19 suffering from, because, otherwise, his answer

20 would make no sense at all.

21 BY MS. ANDERSON:

22 Q. Suppose a person comes to you as a new

23 patient. This patient has a brain injury of some

24 variety. What would you do for the patient?

25 A. We only primarily treat one disease now. We






225

1 primarily treat one type of a disease, presumably that's

2 neurovascular disease. The cause of the neurovascular

3 disease may vary, but neurovascular is neurovascular;

4 vascular disorders of the nervous system.

5 Now, a vascular injury to the brain or the

6 spinal cord can occur because of infection or can occur

7 because of embolism or anoxia or hypoxia or trauma, but

8 you're still left with injury to the nervous system from

9 that original problem and you're also left with a blood

10 vessel injury, which is similar from brain injury, but

11 different. So the etiology of what we treat is

12 important, but what we treat is actually the same

13 disease across the board with minor variation based upon

14 the actual cause of that disorder or etiology of that

15 disorder.

16 Q. So, in terms of your therapeutic concerns, it

17 matters not if the patient is a near drowning victim or

18 a heart attack victim or a stroke victim; is that what

19 you're saying?

20 A. It has -- in general, it does not matter.

21 There are some specific exclusions or exceptions that we

22 will look for. And it does matter with respect to their

23 long-term management.

24 Now, the cause of the injury -- the cause of

25 the treatment, the cause of the injury will alter the

226

1 long-term maintenance regimen results of that patient

2 dramatically. But with respect to the initial three

3 weeks, three months, or two years, it doesn't make that

4 much difference what is the cause of the disorder.

5 Q. Let's suppose the patient who has suffered a

6 cardiac arrest for a period of five months and as a

7 result has been diagnosed as suffering from anoxic

8 encephalopathy, what would your treatment protocol

9 dictate that you do?

10 A. Well, the treatment protocol varies with a

11 careful history, careful physical examination, a review

12 of other medical records, CAT scan evaluation or MRI

13 evaluation, obtaining an EEG or review of previous EEG

14 records. We generally also videotape our patients

15 during their initial evaluation.

16 Q. Now, is a CAT scan the same as a CT scan?

17 A. Yes, it is.

18 Q. Why do you have a CAT scan done?

19 A. We have a CAT scan done for a lot of different

20 reasons. Partially, it's to identify whether there are

21 other things that may be slowing the patient's expected

22 recovery.

23 Q. Such as?

24 A. Hydrocephalus, where there's accumulation of

25 spinal fluid inside of the brain.






227

1 Q. Why does that occur? Why does the brain

2 retain cerebral spinal fluid?

3 A. The brain can retain it because of scar tissue

4 that results at the time of the original accident.

5 Spinal fluid is made in the center of the brain and then

6 drains out into the spinal cord through very small,

7 almost pinhole-sized passageways. Injuries, strokes,

8 like anoxia encephalopathy, can result in chemicals

9 released into the spinal fluid that causes scarring,

10 trapping the -- or closing partially off that pinhole,

11 causing fluid buildup inside of the brain. That fluid

12 buildup causes pressure in the brain, damaging the

13 brain, as well as cutting off some of the normal blood

14 flow, blood flow patterns inside of the brain.

15 Q. What effects does vasospasm therapy, or your

16 therapy, have on fluid retention in the brain?

17 A. I'm not sure that it has much affect on fluid

18 retention in the brain. That would be sort of a

19 secondary problem that within treating you get the best

20 results in the patient.

21 Q. Can it been treated?

22 A. Yes, it can.

23 Q. How is it treated?

24 A. It can be treated through a variety of ways.

25 One of the ways is giving a mild medication, it's a type






228

1 of diuretic, Acetozalamid. Acetozalamid, it helps cuts

2 down the amount of spinal fluid production, so it allows

3 the drainage to occur that is naturally occurring by

4 cutting down some of the production and bringing things

5 back in balance.

6 Q. Are there other causes besides the scarring

7 over the pinhole drain hole in the brain that would

8 cause fluid retention in the brain?

9 A. Well, you could have a sort of chemical

10 meningitis in the middle of the brain brought on by the

11 release of chemicals from the stroke at the time, or

12 anything else, such as wires through the brain, can

13 frequently can cause infections in the center of the

14 brain which only show up in the spinal fluid tissue

15 there and it could cause some scar tissue, as well. But

16 there are things to look for, too, on the CAT scans.

17 Q. After you have taken a history and have done a

18 physical examination, ordered the radiological, what do

19 you do?

20 A. Monitoring the injury site, we use also a

21 carotid ultrasound and a Transcranial Doppler artery

22 ultrasound.

23 Q. What are you looking for with those tests?

24 A. The carotid artery and Transcranial Doppler

25 artery ultrasound are designed to look for the presence






229

1 of vasospasm in the specific blood vessels of the brain.

2 It gives us a guide for whether vasospasms are present

3 and also gives us a future guide for what medications to

4 use and how to use it on that patient.

5 Q. Now, you treat many patients who have come to

6 you with a diagnosis of persistent vegetative state?

7 A. Yes, I have.

8 Q. Do you recall how recently?

9 A. Within the last year.

10 Q. Have you been able to assist that patient or

11 those patients?

12 A. Most, we have. One, we have not.

13 Q. Do you have an explanation for the one

14 failure?

15 A. Yes.

16 Q. What is it?

17 A. Well, she came to us with many recurring and

18 ongoing urinary tract infections and pneumonias. We had

19 to -- you know, those infections made the administration

20 of the medications difficult or almost impossible. So

21 we had to -- we tried it with her briefly, repetitively,

22 between bouts of infections, but were never able to

23 actually put her on a full trial or course of

24 medications and had to stop our treatment of her until

25 those infections got controlled, which they never did.






230

1 Q. The infections existing elsewhere in the body

2 will have this effect of interfering with your program

3 medications?

4 A. Low level infection, mild infections do not.

5 Very serious infections do. Very serious infections can

6 cause the blood pressure to lower. The risk of lowering

7 blood pressure are strokes with or without those

8 medications. I'm talking about low or below normal

9 levels.

10 Q. What is the range of normal blood pressures?

11 A. Blood pressures range, you know -- the general

12 range of normal is 110 to 140 over 70, 75. Most people

13 being approximately 70, for the bottom number, 75. One

14 hundred and twenty to 140 for the top number.

15 Q. Would 90 over 60 be considered an abnormal

16 blood pressure number?

17 A. Ninety over 60 would be considered abnormal

18 blood pressure in that patient who does not routinely

19 have that blood pressure or does neurologically better

20 at a higher blood pressure.

21 Q. And the same would be true for 90 over 70?

22 A. Yes.

23 MS. ANDERSON: May I approach, Your Honor?

24 THE COURT: Sure.

25






231

1 BY MS. ANDERSON:

2 Q. Dr. Hammesfahr, I have handed you Exhibit 27,

3 23, 25, 26, 31, 38, 39, 43, 48, 49, 51, 52, 53, 57, 59,

4 61, 62, 63, 65, and 73.

5 Do you recognize these various abstracts?

6 A. Yes, I do.

7 Q. And do you recognize them as coming from

8 authoritative sources?

9 A. Yes, I do.

10 Q. What do these -- what does this second group

11 of abstracts concern?

12 A. They concern the use of vasodilators in blood

13 flow studies, essentially. They also discuss, to some

14 degree, experimental design.

15 MS. ANDERSON: Your Honor, I'd move those

16 exhibits into evidence at this time.

17 MR. FELOS: Your Honor, I renew my objection.

18 THE COURT: These are exhibits which I assume

19 are talking about blood flow design.

20 MS. ANDERSON: No. The use of drugs and blood

21 flow.

22 BY MS. ANDERSON:

23 Q. Did you just say blood flow design,

24 Dr. Hammesfahr?

25 A. No. There are one or two here that deal with






232

1 experimental design of clinical studies. To have a

2 double blind study or not to have a double blind study.

3 Do you need to have a double blind study. The rest of

4 them deal with the correlation between vasodilators and

5 blood flow. There are a variety of different

6 techniques.

7 THE COURT: What's, in general, dealing with

8 the testimony of the source?

9 BY MS. ANDERSON:

10 Q. Okay. Can you read where these articles or

11 abstracts were published?

12 A. These abstracts come from the National Library

13 of Medicine, and they include abstracts from The

14 American Journal of Cardiology, The New England Journal

15 of Medicine, The American Journal of Cardiology again,

16 Stroke, Lancet, archives.

17 THE COURT: I will accept these as in the

18 whole lot with the earlier ones that we received,

19 the magazines that were previously not identified

20 by other physicians.

21 MS. ANDERSON: That will fine. Thank you,

22 Judge.

23 THE COURT: Once again, may I have those

24 numbers, Doctor? Doctor, could you read the number

25 of those exhibits?






233

1 THE WITNESS: Sure. Twenty-seven, 23, 25, 26,

2 31, 38, 39, 43, 48, 49, 51, 53, 57, 59, 60, 61, 62,

3 63, 65, and 73.

4 THE COURT: Ms. Anderson, do you want those

5 marked for identification by this Court?

6 MS. ANDERSON: The ones that you have I would

7 consider to be offered to the Court for admission.

8 MR. FELOS: Your Honor, I have one question.

9 The first time Attorney Anderson read the list, I

10 wrote down 52. I don't know if I wrote that down

11 in error, but I didn't hear Dr. Hammesfahr mention

12 52. I want to clarify. Is there a 52?

13 THE COURT: I do not have 52 either, no.

14 THE WITNESS: I have 52 here, though.

15 MS. ANDERSON: Yes, 52 was intended to be part

16 of that.

17 THE COURT: I made a mistake. I'm sorry.

18 MS. ANDERSON: The title of 52 really is not

19 anything that I can pronounce.

20 THE COURT: Don't look at me.

21 BY MS. ANDERSON:

22 Q. It's 99 -- what is 99 M T-C-H-M-P-A-O?

23 A. It's a form of technetium which is used for

24 spec scans. It's a tracer to look at blood flow in the

25 brain as well as function in the brain done with






234

1 technetium in a spec scan.

2 Q. So that collection of numbers and letters in

3 the title refers to the tracer, the radiological tracer?

4 A. Correct.

5 THE COURT: Mr. Felos, I'm assuming you have

6 copies of these?

7 MR. FELOS: Yes, I do.

8 MS. ANDERSON: Yes, I have provided him with

9 copies of all of the exhibits.

10 BY MS. ANDERSON:

11 Q. Doctor, what does the term, decerebrate,

12 D-E-C-E-R-E-B-R-A-T-E, mean? Decerebrate.

13 A. Decerebrate is a term used properly in coma

14 patients; although, people will use it outside of a

15 patient with a coma. Essentially, it means that their

16 arms are extended straight, slightly internally rotated,

17 their hands are clinched, and their legs are straight in

18 front of them and their feet are sort of pushing down

19 like on a gas pedal with their back straight.

20 Q. Is that a rigid posture?

21 A. Yes, it is.

22 Q. And that is -- in other words, you could

23 not -- if you put the leg up, it would not bend at the

24 knee?

25 A. Correct.






235

1 Q. And is that a permanent indicator of a coma?

2 A. No. No. It is found in patients with coma

3 and it's found in patients who have massive injuries to

4 the cortex of the brain such that that area doesn't

5 function. But it is not -- it is not a prognostic sign.

6 It does not foretell the future. It simply foretells

7 the state at the time that you are examining them at

8 that moment.

9 Q. And it involves both the arms and legs?

10 A. Straight, yes.

11 Q. What is decorticate?

12 A. That, again, is a term reserved properly for

13 patients in coma. Although, it's frequently implied to

14 patients who are not in coma. But it is a condition

15 where patients have their legs extended and are rigid

16 and their arms flexed and their wrists flexed like this

17 (indicating).

18 They even get those same body positions, but

19 not being coma. And in that situation, it is not

20 properly called decorticate or decerebrate. Many of our

21 stroke patients have that sort of situation and come to

22 our office walking with those body positions that leaves

23 them half their volume. Again, it is more properly

24 termed due to spasticity.

25 Q. Spasticity?






236

1 A. Due to spasticity. And there are

2 characteristics of a spastic arm and spastic legs that

3 results in that type of posturing or that type of

4 holding the body in that fashion.

5 So properly termed, it's only seen in coma;

6 however, it has sort of spilled into the general

7 community to refer to anybody with that type of body

8 condition, decorticate or decerebrate, whether there is

9 coma or not present.

10 Q. Now, have you ever treated a patient with

11 contractures?

12 A. Yes.

13 Q. Has your treatment had any affect on

14 contractures?

15 A. Oh, certainly.

16 Q. Does it always have an affect on contractures?

17 A. More usually than not, yes, it is does. In

18 fact, that's a significant problem for us.

19 Q. A significant problem?

20 A. Well, as a patient is starting to walk, if

21 they had been using spasticity to hold their legs up, as

22 they start to reflex their body, they may mistake their

23 step. We have had some people actually break legs or

24 hips from tripping as they start to regain the ability

25 to walk and the spasticity reduces. The same thing goes






237

1 to the arms; we have had broken arms.

2 Q. Why would vasodilator therapy have an affect

3 on contractures?

4 A. Contractures are essentially a type of reflex

5 to the body. When the body doesn't give brain control,

6 or proper brain control, down to the arm or the leg, the

7 strong muscles of that extremity -- all of muscles

8 contract. But the strongest muscles contract harder

9 than the weaker muscles and pull the arm into a flexed

10 position and the legs go into an extended position. And

11 that's simply because all of the muscles are

12 contracting.

13 But the muscles in the arm being the strongest

14 are the biceps, the muscles that are involved in

15 flexion. In their hand, of course, is gripping flexion.

16 In the leg, the muscles that are strongest are those

17 that are involved in holding your body up against

18 gravity while walking. So those are the ones that

19 extend and straighten the legs.

20 Q. What are those?

21 A. The hamstrings or hip extensors are the

22 strongest, and all of the muscles involved in

23 straightening the leg and the foot are the strongest.

24 So when you start to improve brain function,

25 one of the things that the brain starts to do is cut






238

1 down the amount of abnormal contractions in the body,

2 then the spasticity starts to reduce itself so that the

3 arm starts to become more flexible and more pliable as

4 does the leg.

5 Q. Now, are contractures generally considered to

6 be permanent?

7 A. I mean, that's tough to answer. Because,

8 generally, a person who has had a stroke has

9 contractures. Yeah, they will tend to have a tendency

10 towards contractures. But with proper physical therapy,

11 those contractures can usually be prevented, or

12 prevented to a large degree.

13 Q. If they occur -- let's say there has been no

14 physical therapy and the patient is severely contracted.

15 Is it the conventional wisdom that contractures can only

16 be released with surgery?

17 A. No.

18 Q. Can you use physical therapy to release

19 contractures?

20 A. Certainly, you can use physical therapy. Most

21 commonly, physical therapy. And after that, medications

22 are either installed in a pump or we release medication

23 into the body continuously, which are muscle relaxers

24 for spasticity, or as pills. And there are other

25 techniques, including surgery, that we can use.






239

1 Q. Now, as part of your work in this case, did

2 you have occasion to observe Terry Schiavo without

3 actually examining her?

4 A. Yes, I did.

5 Q. Okay. Do you recall how many times you

6 observed her?

7 A. I think it's only once.

8 Q. Do you remember how long you observed her?

9 A. It was probably for half an hour to 40

10 minutes.

11 Q. Were her parents present during that

12 observation?

13 A. Her father was present, yes.

14 Q. Now, in addition to observing her, did you

15 physically examine her?

16 A. I guess I did.

17 Q. Do you recall what time of day your

18 examination of Terry began?

19 A. It started sometime in the morning.

20 Q. And when did it conclude approximately?

21 A. Probably around 3:00 in the afternoon.

22 Q. Why did you take so long to examine her?

23 A. Examining patients with brain injuries takes a

24 long time.

25 Q. Why?






240

1 A. There are a lot of reasons it takes a long

2 time. One of them is that you have to observe them.

3 You have to observe them over time and you have to

4 observe them with respect to people around them.

5 Second, they don't process the way the rest of us do.

6 So you can't go through examinations very rapidly. You

7 have to give them time and do different parts of the

8 exam very slowly and, very frequently, repetitively

9 while you try to identify how their body is working and

10 what can be done about it.

11 Q. So it simply takes -- it has to be a slower

12 exam; is that what you're saying?

13 A. It takes a long time. It's not just -- the

14 examination is a little bit different for the

15 brain-injured than for the average person that comes

16 through the door. Because of the communication problems

17 or language problems, you don't know if they understand

18 language, how they understand language. Do they

19 understand every word or do they come and go? You don't

20 know usually how well they see, what areas they can see

21 your body, and what areas they can't.

22 When you give them a command, they may not

23 respond to that command not right away. So you have to

24 observe them quite a while to see if they do respond

25 because there is a consistent delay. There is just a






241

1 lot more than your average patient.

2 Q. Now, were Mr. and Mrs. Schindler present

3 during your examination of Terry?

4 A. Yes, they were.

5 Q. Was Mr. Schiavo also present?

6 A. He was present for about half of the

7 examination, yes.

8 Q. Did you examine -- in addition to doing the

9 clinical examination, did you also look at the CT scan

10 of her brain done in July of this year?

11 A. Yes, I did.

12 MS. ANDERSON: Now, at this time, Your Honor,

13 I would like to start the videotape and have

14 Dr. Hammesfahr tell us how he proceeded in

15 examining her. It should appear on that screen on

16 the witness stand.

17 THE COURT: Now, contrary to what we will be

18 viewing, are you going to have him explain?

19 MS. ANDERSON: In some portions, I will have

20 him explain what we are seeing. There shouldn't be

21 a problem with volume control or technical problem.

22 But if it gets to be a problem, we will have him

23 stop the tape.

24 THE COURT: Is it too loud or too soft?

25 MS. ANDERSON: The volume control, I think, is






242

1 in a difficult place. If we are having trouble, it

2 sounds like gibberish, I will stop the tape.

3 BY MS. ANDERSON:

4 Q. Now, Dr. Hammesfahr is that what you saw when

5 you entered the room?

6 A. This actually occurred right before I entered

7 the room, as I recall. I don't have the audio. You can

8 tell when I entered the room with the audio. We had

9 this initially set up so that the videographer and

10 Mr. Schiavo were in the room. They were in the room

11 prior to me entering the room. Mr. Schiavo was not.

12 That's Mrs. Schindler. Then, I entered the room.

13 Q. What was the point of having -- was it her

14 father who was in the room?

15 A. No. I think it was Mr. Schiavo. I don't

16 think Mr. Schindler was in the room at that time.

17 Q. So Mr. Schiavo was in the room with Terry?

18 A. Right.

19 Q. What is that?

20 A. I don't hear it very well.

21 Q. Is that better?

22 A. Yes.

23 Q. What's that background noise that we are

24 hearing in this tape?

25 A. That's radio in the background.






243

1 That little blinking to this loud noise, that

2 is a little startle reflex that she has. She has a

3 facial quick-darting reflex when she glances to the

4 left, which is an orienting visual reflex.

5 Q. What is an orienting visual reflex?

6 A. It's a reflex designed to help identify

7 potential threats from the environment or things

8 happening. It occurs when a person -- for instance,

9 when you're driving, a person walks in your peripheral

10 vision, your eyes will dart to that side. Or, if you

11 heard a loud sound, you might dart to the side. It

12 happens momentarily.

13 Then from that point forward, if you continue

14 to look in the area, that's cognitive or voluntary.

15 Q. The initial glance --

16 A. The initial glances are reflex. But after

17 that first few milliseconds, if they continue to sustain

18 their gaze in a direct area, that's voluntary motion.

19 What was interesting is after you came in

20 here, she was having very little response to the people

21 around her, although maybe having some awareness to

22 music. It's hard to tell at this point.

23 Q. Here it appears as if she had gone to sleep?

24 A. We should continue.

25 This is interesting because right there, at






244

1 that sound, she had a response to that. I think that's

2 very interesting when you start to compare her to her

3 response to other people. She had not much response to

4 background music, not much response to Mr. Schiavo's

5 size.

6 Here she is hearing sounds. This is an

7 orientating cognitive awareness. She is aware of

8 background noises. She's hearing voices she wasn't

9 aware of. She stopped having sort of random motions and

10 she looked off to the left and then decides to ignore

11 it, based on this type of behavior.

12 Q. So the glance to the left to assess the threat

13 is reflexive?

14 A. Only if it lasts for maybe a quarter of a

15 second, beyond that it's voluntary.

16 Okay. Again, no response to sound. That's a

17 startle reflex. Again, very temporary.

18 MR. FELOS: Your Honor, I object. Yesterday

19 we had the time codes on. Can he do that today so

20 at least that would allow me to identify the

21 portions of the tape to which Dr. Hammesfahr is

22 referring?

23 THE VIDEOGRAPHER: This is 11:16 a.m.

24 MS. ANDERSON: Is this a VHS?

25 THE VIDEOGRAPHER: No. This is from the






245

1 laptop. This is one segment of 30 minutes 12

2 seconds. Starts at 11:16 and goes to 11:46.

3 MR. FELOS: Can we display it in this fashion

4 because we can identify what segment that's from

5 and what the code is from that segment?

6 MS. ANDERSON: The laptop doesn't show, so

7 Dr. Hammesfahr won't be able to do it.

8 THE VIDEOGRAPHER: We are having a problem

9 with the videotape and we had to run that over the

10 lunch. The videotape has the actual time of day on

11 it.

12 MR. FELOS: I don't need the actual time of

13 day, Your Honor. What is being displayed now is

14 the code for this segment of tape from 11:16 to

15 11:46, and it has the time code on it. All I

16 can -- I don't care what the reference is as long

17 as we have the reference, then we can identify

18 portions to which he is referring.

19 THE VIDEOGRAPHER: If I can play it back on

20 full screen. The actual image of Terry would be

21 substantially smaller and more difficult to detect.

22 THE COURT: Well, I don't know who that is

23 that's talking.

24 MS. ANDERSON: I'm sorry. This is Tom

25 Broderson of my office.






246

1 He makes a valid point that if the image is

2 minimized in order to capture of the elapsed time,

3 you are going to lose a lot of detail. Her eye

4 movement, for example, other parts.

5 THE COURT: So we had an ability to do it on

6 full screen?

7 MS. ANDERSON: Yes, on the digitized version.

8 But the running time, it's actual time of the day

9 of the clock. The date stamp, time stamp is on the

10 VHS, which is what I thought we were running.

11 THE VIDEOGRAPHER: If I may suggest. I have

12 some very rough notes on the contents that I can,

13 from time to time, tell you what minute, time of

14 day that pertains to, relatively close.

15 THE COURT: Well, the issue we had before was

16 using edited portions of the tape, and we needed

17 some basis to identify.

18 Mr. Felos, if this is the full tape, what's so

19 critical about having a particular time?

20 MR. FELOS: Well, Your Honor, I can identify

21 the portion of the tape and say, Dr. Hammesfahr,

22 you found that the patient did so and so at 11:32.

23 Wasn't that a hiccup or something like that. If we

24 have that, we have the opportunity to go back to

25 the tape at that time and review it.






247

1 MS. ANDERSON: If we are running digital

2 images, if Mr. Felos wishes, he can ask if that

3 this image can be brought to this format. It will

4 give us the elapsed time over in a corner.

5 MR. FELOS: I hate to keep interrupting the

6 presentation to see what is the time.

7 MS. ANDERSON: Well, the object here, of

8 course, is for the Court to be able to see the

9 maximum amount of information during this

10 examination.

11 MR. FELOS: In the same token, if

12 Dr. Hammesfahr feels we need to expand the picture

13 at any particular point of time, he could request

14 to do that at that time.

15 THE COURT: Do you want to watch the

16 secondhand, Mr. Felos?

17 MR. FELOS: I don't wear a watch.

18 MS. ANDERSON: Well, Mr. Broderson tells us he

19 might have that fixed over lunch.

20 THE COURT: Well, let's cross our fingers.

21 But my guess is that this particular portion will

22 take us to lunch.

23 MS. ANDERSON: Will take us to lunch?

24 THE COURT: Yes. That would be my guess.

25 MS. ANDERSON: Oh, yes. This leading time






248

1 before Dr. Hammesfahr comes in the room and begins

2 to work with her lasts about seven minutes, and

3 we're five minutes into it.

4 THE COURT: But wasn't this tape something

5 like 30 minutes?

6 MS. ANDERSON: It was a 30-minute segment. So

7 just run this one straight through?

8 THE COURT: I'm not telling you how to present

9 your case.

10 MS. ANDERSON: Is that what you're
suggesting?

11 THE COURT: Well, my thought is we should be

12 breaking around 12:20, plus or minus, for lunch.

13 MS. ANDERSON: Okay.

14 THE COURT: And my thought is this tape would

15 take us there.

16 MS. ANDERSON: That should satisfy Mr. Felos

17 because this will be within the first 30-minute

18 block of the entire examination.

19 THE COURT: I'm not certain it satisfies, but

20 I think it will certainly minimize whatever concern

21 he has.

22 MS. ANDERSON: Very good.

23 BY MS. ANDERSON:

24 Q. Continue, Dr. Hammesfahr.

25 A. That little glance she just had there was an






249

1 auditory reflex. You heard a quick sound.

2 Q. What was that, a radio sound, or what was it?

3 A. That was some sound in the background of the

4 room. Probably when I walked into the room or

5 something. Some sound from the background.

6 She is hearing voices, and you can see she is

7 becoming more aware. She is actually waking up and

8 becoming more aware of that sound. That's not

9 reflexive. The reflexes that I already talked about

10 were just quick twitches. That's what reflexes are.

11 Most of the sound during this time occurred,

12 this background, random sound beyond the radio occurred

13 towards the left where she was looking. That was where

14 Mr. Schiavo and myself were standing or sitting. That's

15 where the doorway was.

16 That's a startle reflex. She is starting to

17 wake up. You see how quick the reflexes are there, just

18 a twitch of the eye or of the face, that's just normal,

19 how it is for any of us. She hears more sounds, becomes

20 more aware. She became more aware.

21 MS. ANDERSON: Can you hold that for just a

22 minute, the volume?

23 BY MS. ANDERSON:

24 Q. Her eyes move to the left and then back to the

25 right in that segment we just saw. Did you observe






250

1 that?

2 A. Right.

3 Q. What do you call that?

4 A. Well, she is just waking up and becoming more

5 aware of her surroundings. Reflexes have the

6 characteristic that they happen each and every time.

7 They are under some cognition and voluntary control. So

8 when you hear repetitive sounds -- we don't startle

9 every time we see somebody walk in the room. We might

10 actually have our eyes glance, but we don't startle each

11 time. That control, that startle reflex, is a voluntary

12 or cognitive activity as you are aware of your

13 surroundings.

14 She startled earlier on much more frequently.

15 She is startling much less frequently now. Even now as

16 we begin to talk to her, she is aware. Her eyes looking

17 to the left and then she brings her eyes back more to

18 me.

19 Now, watch that. That's not a reflex. She

20 looked at her; she changed her facial expression.

21 Q. Her mother, you mean?

22 A. Yes. With her mother. She persistently

23 changed her facial expressions. She does not have the

24 startle or orienting reflexes. She is bringing her gaze

25 consistently towards her mother, in her general

122

1 rule. So the fact that he reads it into the record

2 didn't pertain to anything except that it takes us

3 longer to conclude his testimony.

4 BY MR. FELOS:

5 Q. Do you see any notation in that report

6 specifically regarding the amounts of brain matter in

7 Teresa Schiavo's cerebral hemisphere?

8 A. Yes.

9 Q. What is that in the discussion provided by the

10 radiologist?

11 A. He reports there is a small amount of brain

12 substance remaining in the cerebral hemisphere, mainly

13 in the anterior temporal lobes.

14 Q. Thank you, Dr. Gambone.

15 Now, would you call yourself a general

16 practitioner, Dr. Gambone?

17 A. I would call myself a specialist in internal

18 medicine and geriatric medicine.

19 Q. Do you consider yourself a specialist in

20 neurology?

21 A. No, I do not.

22 Q. And is it common for an internist to rely on

23 the opinions of expert doctors in the course of their

24 treatment of a patient?

25 A. That is correct, extremely in unusual






123

1 conditions.

2 Q. I believe you were -- I believe you testified

3 on cross-examination that you partially relied on

4 Dr. Barnhill's opinion as to Terry Schiavo being in a

5 vegetative state. In your review of your medical

6 records, prior to your and Dr. Barnhill seeing the

7 patient, had you ever seen any other reference to that

8 event?

9 A. Yes, I believe I did. And if you asked me

10 where I saw that, I'd probably have difficulty without

11 having the record.

12 Q. I would like to show you Petitioner's Exhibit

13 4 marked for identification, which is a discharge

14 summary from Mediplex Rehab in Bradenton.

15 MS. ANDERSON: Judge, I move to strike that

16 last bit of testimony from Mr. Felos. He needs to

17 approach the witness with the document and ask him

18 if he recognizes the document and ask him how he

19 recognizes it. He doesn't need to make a speech

20 about what they are ahead of time.

21 MR. FELOS: Your Honor, I'm not giving a

22 speech. I'm just identifying the title of the

23 document I am showing him.

24 THE COURT: A normal question is, do you

25 recognize this? What is it? Then, it's






124

1 identified. You have already identified it in your

2 question. Say what it is.

3 I am going to grant the Motion to Strike and

4 allow to you rephrase the question.

5 BY MR. FELOS:

6 Q. Do you recognize the document I just handed

7 you which is marked Petitioner's Exhibit 4?

8 A. Vaguely. This happens to be part of the

9 documents that I reviewed when I took over her care in

10 1998.

11 Q. Do you recognize that as part of

12 Terry Schiavo's medical chart and records?

13 A. Yes, I do.

14 Q. Thank you.

15 MS. ANDERSON: Mr. Felos, I would like to have

16 a copy of that exhibit.

17 MR. FELOS: Your Honor, I'd move to introduce

18 Petitioner's Exhibit 4 into evidence.

19 THE COURT: Is there an objection?

20 MS. ANDERSON: If I may take a moment, Your

21 Honor, to look at this.

22 THE COURT: Yes, ma'am.

23 MS. ANDERSON: These are -- part of this

24 exhibit that I have been handed is a duplicate.

25 There are two copies of the discharge summary.






125

1 It's also jumbled up there, actually.

2 No objection, Your Honor.

3 THE COURT: Thank you. It would be so

4 received.

5 (Whereupon, the document referred to was

6 received in evidence as Petitioner's Exhibit Numbers 3

7 and 4.)

8 BY MR. FELOS:

9 Q. Now, I believe you mentioned that -- we

10 discussed on your cross-examination that you discussed

11 Terry's additional care with the staff at the Hospice;

12 is that correct?

13 A. That's correct.

14 Q. Do you recall -- you were asked a question, I

15 believe, "Do you ever see Terry's mother with Terry",

16 and you said no.

17 A. That's correct.

18 Q. Do you recall seeing any record in the -- any

19 record in the Hospice medical notes regarding Terry's

20 mother visiting her?

21 A. I do not recall offhand.

22 Q. Let me show you part of Respondents' exhibit

23 introduced into evidence, Hospice medical records, and

24 ask you if that refreshes your recollection?

25 MS. ANDERSON: Judge, that's a problem. This






126

1 is not the way you refresh somebody's recollection.

2 If he has a question about a specific page in

3 Respondents' Exhibit 12, he needs to draw

4 Dr. Gambone's attention to it and ask the question.

5 But he is asking -- he's, in effect, suggesting to

6 refresh of his recollection, and that's improper

7 because Dr. Gambone hasn't indicated that looking

8 at that would refresh any recollection he might

9 have that he no longer has. It's a different

10 animal, is what he is doing.

11 THE COURT: He is asking him to look at this

12 and see if he can refresh his recollection.

13 MS. ANDERSON: He hasn't indicated that his

14 recollection needs refreshing, which is a necessary

15 predicate.

16 THE COURT: He said, "I don't remember."

17 That's the standard predicate answer to may I

18 refresh your recollection.

19 MS. ANDERSON: And, then, there is the

20 intermediate step, "if you look at this record,

21 would it refresh your recollection." I haven't

22 heard him say that it would.

23 THE COURT: Okay. Why don't you say that,

24 Mr. Felos?

25 BY MR. FELOS:






127

1 Q. Regarding Page 58 of Respondents' Exhibit, I

2 would like you to take a look at this and ask you if it

3 would refresh your recollection?

4 A. This is -- I don't recall this particular

5 passage.

6 Q. Okay. Would you be surprised, Dr. Gambone,

7 that there are many entries in the hospital's medical

8 records regarding visits of Mrs. Schindler to her

9 daughter?

10 A. It would not surprise me.

11 Q. Would it surprise you there are many entries

12 in the Hospice medical notes regarding Mrs. Schindler's

13 visits with her daughter?

14 A. I would think, yes.

15 Q. Would it surprise you that those records

16 reflect that Terry is not responsive to the mom?

17 A. On the video, it's not what I would expect.

18 Q. Regarding Terry's teeth, you testified that a

19 dentist saw Terry; is that correct?

20 A. Yes.

21 Q. And you received a report of his findings?

22 A. Yes.

23 Q. Did the report evidence any problems with her

24 teeth?

25 A. No.






128

1 Q. Now, I believe you testified on

2 cross-examination that you didn't believe that a

3 hygienist, dental hygienist, came out afterwards and

4 cleaned her teeth. Are you aware that a dentist -- do

5 you know whether or not the dentist came out afterwards

6 and cleaned her teeth?

7 A. If the dentist did, I wasn't aware of it.

8 Q. Now, you were asked about the will to live.

9 This is this part of the survival instinct?

10 A. I would think so.

11 Q. Now, you were asked questions about

12 responsiveness and whether responsiveness in a patient

13 indicated or contraindicated a vegetative condition.

14 Would it make a difference in that answer as to whether

15 the response was involuntary as opposed to meaningful?

16 A. Yes, it would make a difference.

17 Q. Would an involuntary response to a stimulus,

18 which is the environment, contraindicate a vegetative

19 condition?

20 A. No.

21 Q. Now, I believe you were asked "would you be

22 surprised if Terry lifted her leg on demand if I pressed

23 her leg," and I believe you stated you would. Would you

24 be surprised that -- would you be surprised if that --

25 let me rephrase that.






129

1 Could a press of her leg coincide with an

2 involuntary action or movement on the part of Terry?

3 A. That's correct.

4 Q. Would that be particularly surprising?

5 A. No.

6 Q. You mentioned that there is a DNR order in

7 Terry's chart.

8 A. That's correct.

9 Q. Do you know whether there was a DNR order in

10 her chart before you took over her care?

11 A. I believe that there was a DNR order before I

12 took over her care. I am not positive.

13 Q. Do you know a presumptive audio oriented

14 process?

15 A. No.

16 Q. Now, you were shown various portions of the

17 videotape examinations on Terry. Do you recall when the

18 video starts that music is playing?

19 A. Yes.

20 Q. Did you see any reaction of Terry initially

21 when the music was playing?

22 A. Movements of her head and eyes are movements

23 which I have observed her make without any music or

24 interaction.

25 Q. To your knowledge, does Terry have a -- to

130

1 your knowledge does Terry have a startle reflex?

2 A. Yes.

3 Q. What is a startle reflex, Dr. Gambone?

4 A. To respond to stimuli, to loud sounds or a

5 painful reaction is a startle response.

6 Q. There is a portion of the tape where Terry was

7 moaning while her mother was by the bedside. Do you

8 recall that?

9 A. Yes, there was a noise. On one video, there

10 was nasal sounds. I wasn't clear if -- I called it

11 snoring. I wasn't sure if it was related to her cold,

12 if it was a moan, or snore or nasal congestion.

13 Q. Do you know for a fact whether Terry had a

14 cold in 2002?

15 A. No, I don't know that for a fact.

16 Q. During the time that -- and correct me if I am

17 wrong, but was Terry's -- was Terry's mom making

18 physical contact with Terry during the time that you saw

19 her moan?

20 A. I believe so. She was off to the left of the

21 screen. I failed to see where her hands were at times.

22 Q. Would it surprise you that these tapes review

23 numerous occasions where Terry's mother kisses her and

24 asks her questions when there is no moaning?

25 A. Yes. According to the nurses, she does moan






131

1 all the time.

2 Q. Now, you were asked to listen to her carotid

3 arteries?

4 A. Yes.

5 Q. And what was the result of listening to her

6 carotid arteries? Did you find anything wrong?

7 A. No, I did not.

8 MR. FELOS: I have no further questions, Your

9 Honor.

10 THE COURT: Thank you.

11 Anything further, Ms. Anderson.

12 MS. ANDERSON: Just a few, Judge.

13 RECROSS-EXAMINATION

14 BY MS. ANDERSON:

15 Q. Would it be unusual if the dentist cleaned a

16 Hospice patient's teeth?

17 A. I couldn't answer that.

18 Q. Has that ever happened, in your experience?

19 A. Has the dentist come in and cleaned the person

20 in Hospice's teeth?

21 Q. Yes.

22 A. I haven't had that much experience with

23 Hospice. I couldn't comment on what their policy is to

24 clean the teeth.

25 Q. I can't hear you.






132

1 A. I don't know what their policy is, procedure

2 on teeth cleaning, the dentist.

3 Q. At nursing homes, would it be unusual for a

4 dentist to clean the patient's teeth?

5 A. No. Again, not unusual, because some of the

6 patients are very difficult and would require the

7 dentist's expertise.

8 Q. As the attending physician, would you be

9 informed if the patient's teeth were cleaned?

10 A. Only if medication were required for sedation.

11 Q. Have you ever --

12 A. Or antibiotics, or something that involved an

13 order. But just routine cleanings that are done on a

14 routine basis, I'm not sure.

15 Q. I think you said earlier that you are not sure

16 if the State's regulation are not the same for nursing

17 home?

18 A. They are not. As far as the dental, I'm not

19 sure what their policy and procedure is. I know they

20 are not regulated by the State, so they are different.

21 Q. Has anyone at Hospice ever informed you that

22 Terry's teeth were cleaned?

23 A. No.

24 Q. Did you ever see a chart notation that Terry's

25 teeth were cleaned as a result of this examination in






133

1 2002?

2 A. No.

3 Q. Okay. You said here that they received a

4 report from the physical therapist suggesting the

5 viability of therapy for her?

6 A. That's correct.

7 Q. Has the physical therapist ever seen Terry?

8 A. Yes, the physical therapist has seen Terry.

9 Q. No. I'm talking about -- forgive me. I

10 confused you.

11 While she has been at Hospice, has a physical

12 therapist ever seen Terry?

13 MR. FELOS: Your Honor, I have got -- this may

14 be within the scope of cross-examination, but not

15 recross. The scope of recross are just new matters

16 that are brought up on redirect. I didn't bring up

17 any new matters on redirect.

18 MS. ANDERSON: He certainly did. That

19 particular item right there was on his item of

20 redirect.

21 MR. FELOS: That was not on the subject that

22 was redirect from cross-examination. Recross is

23 limited to new matters that I brought up.

24 THE COURT: Well, new matters aren't supposed

25 to be brought up in redirect. I'm giving both






134

1 sides fair latitude in this proceeding. I examine

2 that you certainly brought up physical therapy.

3 BY MS. ANDERSON:

4 Q. Let me make sure that we are communicating.

5 I'm speaking about Terry's time at Hospice.

6 A. Correct.

7 Q. Since she has been at Hospice, has she been

8 seen, and by seen, I mean evaluated by a physical

9 therapist?

10 A. I believe that she was seen for an evaluation

11 for therapy.

12 Q. Now, was she has not received any physical

13 therapy?

14 A. No.

15 Q. Okay. And the chart that I directed your

16 attention to earlier where you signed it and said that

17 the husband declined the evaluation, is that the second

18 evaluation?

19 MR. FELOS: Your Honor, if I can object. I

20 asked him a question on redirect about the husband

21 and physical therapy. That was a matter on

22 cross-examination. I didn't bring it up on

23 redirect. She is just cross-examining the witness

24 again.

25 MS. ANDERSON: He has opened the door about






135

1 this physical therapy by asking this question.

2 MR. FELOS: That does not open the door for

3 her repeating cross-examination.

4 THE COURT: Well, it's -- I'm going to give

5 her a little latitude, Mr. Felos. I am not going

6 to allow her to go right back through her

7 cross-examination, of course.

8 BY MS. ANDERSON:

9 Q. You are saying you think Terry was evaluated

10 by physical therapist when she came into the hospital?

11 A. Yes.

12 Q. And sometime after that you have this

13 conference in which the husband declined the evaluation

14 for physical therapy?

15 A. The note that you referred to were date

16 April 20, 1998, okay.

17 Q. Right.

18 A. And that's when I had indicated that after

19 speaking with Michael, he declined another evaluation.

20 That was not Hospice.

21 Q. Now, you said that she did have some

22 swallowing tests.

23 A. Yes.

24 Q. What year?

25 A. I don't recall the exact year.






136

1 Q. More than ten years ago?

2 A. Again, I don't recall the exact dates or times

3 so I'm not going to guess.

4 Q. You haven't ordered any swallowing tests,

5 though, in the last four, four-and-a-half years?

6 A. No. Now, she has been evaluated by a speech

7 therapist who did not recommend a swallowing test

8 because the bedside examination suggested she was high

9 risk for aspiration. That's why the tests were not

10 ordered.

11 Q. And there is a charted entry on that?

12 A. Yes.

13 Q. What's the date of that chart entry?

14 A. I would have to go back in the record and pull

15 it out.

16 Q. That was since she has been at Hospice?

17 A. The -- I definitely -- this was when she was

18 at the Gardens, and I don't believe it was revisited at

19 Hospice.

20 Q. Basically, she hasn't seen any therapists

21 since she has been at Hospice, right?

22 A. I can't answer that question.

23 Q. To your knowledge?

24 A. It's not -- it's not a matter of not seeing,

25 but did she receive therapy because evaluations are done






137

1 and screenings are done to see if someone will benefit

2 from therapy.

3 Q. Has she been evaluated?

4 A. Yes, she received evaluations.

5 Q. When she got to Hospice?

6 A. Yes.

7 Q. But she received no therapy since then?

8 A. Yes, that's correct.

9 Q. My last question, Doctor. The second

10 urinalysis that was just done, you know, was done

11 because Terry made complaints of pain. The nurses

12 called you or --

13 MR. FELOS: There was no testimony, Your

14 Honor, that Terry made complaints of pain.

15 THE COURT: Well, she can ask the question and

16 the witness may say yes or no depending upon the

17 question that she is entitled to frame.

18 BY MS. ANDERSON:

19 Q. And by complaints of pain, I'm talking about

20 her moaning.

21 A. What I can tell you is, first of all, it was

22 the nurse practitioner who was involved. So I wasn't

23 involved in some of this transmittal of information.

24 But beyond that, the complaint was of moaning. And the

25 nurse who reported the increase moaning felt there was a






138

1 change in condition that should be reported for a

2 medical evaluation. And after discussions with the

3 nurses, I found they were concerned about the feeding

4 tube, problems with the feeding tube. They had it

5 checked for connection problems. That was noted. And

6 then, after some adjustments in the tube, it did seem to

7 change the situation. And urine was collected and

8 infection was found.

9 Q. Well, somewhere along the line, some medically

10 trained person interpreted that change in her condition

11 as evidencing pain or discomfort, correct?

12 A. As a response to irritation in the bladder.

13 This moaning could be, you know, ideal with bringing

14 treatment for many causes. And in long-term care, the

15 various individuals may have different responses in her

16 care. Moaning suggested there was a change of

17 condition.

18 Q. That somebody interpreted as a pain response?

19 A. Yes, that was her interpretation.

20 MS. ANDERSON: That was my question. Thank

21 you.

22 No further questions, Your Honor.

23 THE COURT: Anything further of this witness?

24 MR. FELOS: No, Your Honor.

25 THE COURT: Thank you. Dr. Gambone, you may






139

1 stand down.

2 Okay. Anything further for us to pick up this

3 afternoon?

4 MS. ANDERSON: Not this afternoon, Your Honor.

5 THE COURT: Who would be your witness on

6 Monday.

7 MS. ANDERSON: Dr. Hammesfahr.

8 THE COURT: Due to the fact that we would

9 probably be playing the entire video of his

10 examination, would it be prudent to start it at

11 9:00.

12 MS. ANDERSON: It's entirely up to you, Judge.

13 Immaterial to me.

14 THE COURT: Well, I'm trying to be

15 accommodating to the lawyers.

16 MS. ANDERSON: Are we having the time change

17 this weekend?

18 THE COURT: No. I don't think so.

19 MS. ANDERSON: It's next weekend then.

20 THE COURT: Mr. Felos, what are your thoughts

21 about Monday?

22 MR. FELOS: Your Honor, if we are to see two

23 hours and 50 minutes of the videotape, it might be

24 a good idea to start a little bit earlier. If

25 Ms. Anderson has no objection, why don't we stand






140

1 in recess until 9:00 a.m. Monday morning.

2 I would like to enter Petitioner's Exhibits 3

3 and 4 that were accepted into evidence and also

4 introduce into evidence Petitioner's Exhibits 1 and

5 2 which were Dr. Gambone's Comprehensive Medical

6 Examination and the report.

7 MS. ANDERSON: Wait a minute. What are we

8 doing?

9 THE COURT: He is wishing to place Exhibits 3

10 and 4, which I have already received into evidence;

11 although, I don't have physical possession of them.

12 I was going to ask you about your Exhibit 12,

13 although I don't have physical possession of it.

14 MS. ANDERSON: It's in the book and copy that

15 Dr. Gambone testified from right there.

16 THE COURT: Do you wish me to have this copy?

17 MS. ANDERSON: Judge, the duplicates are in

18 the book. And for your convenience - so I can take

19 this copy back - if you wish, we could take the

20 ones in the notebooks as the official ones.

21 THE COURT: So let me have your Exhibits 3 and

22 4, which I have already received.

23 MR. FELOS: That's Exhibit 3, and I have to

24 locate 4, Your Honor.

25 MS. ANDERSON: Judge, you have admitted






141

1 Petitioner's 3 and 4.

2 THE COURT: Yes, ma'am, and your 12. Now

3 Mr. Felos wishes also, at this time, to introduce

4 Petitioner's Exhibits 1 and 2, which I believe he

5 said Dr. Gambone had identified.

6 MR. FELOS: Yes, his Comprehensive Medical

7 Evaluation of the results of the recent health

8 screening.

9 THE COURT: Is there an objection?

10 MS. ANDERSON: I have no objection to their

11 coming in.

12 THE COURT: Thank you.

13 (Whereupon, the document referred to was

14 received in evidence as Petitioner's Exhibit Numbers 1

15 and 2.)

16 THE COURT: Okay. Anything further?

17 MR. FELOS: No, Your Honor.

18 THE COURT: All right.

19 MS. ANDERSON: Will this room be secured over

20 the weekend or no?

21 THE COURT: My guess is nobody is going to

22 leave anything anyway. Are you? I'm talking about

23 your files.

24 MS. ANDERSON: No. I will take the files out

25 of the courtroom.






142

1 THE COURT: You are going to take yours?

2 MR. FELOS: Yes.

3 THE COURT: I will take mine, also. Until

4 9:00 a.m. on Monday.

5 THEREUPON, the hearing terminated until
9:00

6 a.m. Monday morning.

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25






143

1 CERTIFICATE OF REPORTER

2 STATE OF FLORIDA )

3 COUNTY OF PINELLAS)

4 I, TONYA H. MAGEE, RPR, Registered Professional
Reporter, Notary Public, State of Florida at Large:
5
DO HEREBY CERTIFY that the foregoing proceedings
6 were taken before me at the time and place set forth
in the caption thereof; the proceedings were
7 stenographically reported by me in shorthand, and the
foregoing pages, numbered 1 through 142 inclusive,
8 constitute a true and correct transcript of my said
stenographic notes.
9
I further certify that I am not a relative,
10 employee, attorney, or counsel of any of the parties,
nor relative or employee of such attorney or counsel,
11 nor financially interested in the outcome of the
foregoing action.
12

13 IN WITNESS WHEREOF, I have hereunto affixed my
official signature this 23rd day of January, 2003,
14 at Clearwater, Pinellas County, Florida.

15 _________________________
TONYA H. MAGEE, RPR
16 Court Reporter and
Notary Public, State of
Florida
17

18 Acknowledged before the undersigned
this day of January, 2003,
19 by Tonya H. Magee, who is personally
known to me.
20
_______________________________
21 Notary Public, State of Florida

22

23

24

25






144

1

2 IN THE CIRCUIT COURT OF THE
SIXTH JUDICIAL CIRCUIT IN AND FOR
3 PINELLAS COUNTY, FLORIDA
PROBATE DIVISION
4

5 IN RE: THE GUARDIANSHIP OF File No.90-2908-
GD-003
THERESA MARIE SCHIAVO,
6 Incapacitated. APPEAL
___________________________________// VOLUME II
7
MICHAEL SCHIAVO, as Guardian of the
8 person of THERESA MARIE SCHIAVO,

9 Petitioner/Appellee,

10 vs.

11 ROBERT SCHINDLER and MARY SCHINDLER,

12 Respondents/Appellants.
________________________________________________//
13

14 BEFORE: The Honorable GEORGE W. GREER

15 PLACE: Pinellas County Courthouse
315 Court Street North
16 Clearwater, Florida

17 DATE: October 14, 2002

18 TIME: Morning Session

19 REPORTED BY: TONYA H. MAGEE, RPR
Court Reporter and Notary
Public
20 Sixth Judicial Circuit
___________________________________________
21
HEARING
22 ___________________________________________

23 Pages 144 - 273

24 ROBERT A. DEMPSTER & ASSOCIATES
P.O. BOX 35
25 CLEARWATER, FLORIDA 34618-0035
(727) 443-0992






145

1 A P P E A R A N C E S:

2

3 GEORGE J. FELOS, ESQUIRE
595 Main Street
4 Dunedin, Florida 34698

5 Attorney for the Petitioner/Appellee.

6

7

8 PATRICIA FIELDS ANDERSON, ESQUIRE
447 Third Avenue North, Suite 405
9 St. Petersburg, Florida 33701

10 Attorney for the Respondents/Appellants.

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1

2 P R O C E E D I N G S

3 THE COURT: Yes, ma'am?

4 MS. ANDERSON: Are you ready?

5 THE COURT: Yes, sir.

6 MS. ANDERSON: The Respondents call Dr.

7 William Hammesfahr.

8 MR. FELOS: Your Honor, before we take

9 testimony, I want to address something.

10 THE COURT: Very well, Mr. Felos.

11 MR. FELOS: Your Honor, before we embark on

12 today's adventure, I'm a little concerned about the

13 timing, and I think it would be wise and helpful to

14 have a little blueprint.

15 As the Court knows, under the unique situation

16 of this proceeding, we have one day allocated for

17 each physician. It's my understanding that we're

18 going to be seeing the entirety of Dr. Hammesfahr's

19 examination, which was two hours 50 minutes, on the

20 second day. I believe Dr. Maxfield was there on

21 the next day and so was Dr. Hammesfahr. That was

22 an extra 40 minutes. That's part of his

23 examination. We may be seeing three-and-a-half

24 hours of tape.

25 Of course, I'm sure we will not be seeing it

147

1 continuous; the tape is going to break, questions

2 are going to be asked. I think it would be

3 extremely unfair to the Petitioner to turn over

4 cross-examination at seven or eight o'clock tonight

5 when you have had eight or nine hours taken on

6 direct examination.

7 I think before we start, perhaps we can hear

8 how long the expected direct examination will be

9 and get a little idea of how we're going to proceed

10 time-wise today. I just don't think it's fair to

11 have nine or ten hours of direct and redirect

12 examination, which leaves me only a couple hours of

13 cross-examination sometime in the wee hours.

14 THE COURT: I thought we had this discussion a

15 few days ago.

16 MS. ANDERSON: Now, if it helps the Court --

17 we did, Your Honor. We did discuss this. If it

18 helps, Dr. Maxfield will be testifying tomorrow and

19 I do not expect his testimony to be as lengthy.

20 But I do predict turning Dr. Hammesfahr over to

21 Mr. Felos for cross-examination sometime probably

22 mid afternoon. He'll have time for cross.

23 MR. FELOS: Mid afternoon would be -- that's

24 fine. I just didn't want to find myself here at

25 eight o'clock at night starting my






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1 cross-examination.

2 THE COURT: All right. Dr. Hammesfahr.

3 THE BAILIFF: Stand here, if you would, sir,

4 face the judge and take your oath.

5 THE COURT: Do you solemnly swear the

6 testimony you will give in this cause will be the

7 truth, the whole truth, and nothing but the truth

8 so help you God?

9 THE WITNESS: I do.

10 THE COURT: Thank you, sir.

11 THE BAILIFF: Thank you. Have a seat, please.

12 Please, speak in a loud clear voice for the court.

13 MS. ANDERSON: Your Honor, may I approach the

14 witness and give him a bottle of water?

15 THE COURT: Sure.

16 DIRECT EXAMINATION

17 BY MS. ANDERSON:

18 Q. Dr. Hammesfahr, would you state your name and

19 spell your last name for the benefit of the court

20 reporter, please.

21 A. William Hammesfahr, H-A-M-M-E-S-F-A-H-R.

22 Q. Would you tell the court briefly about your

23 education.

24 A. Was accepted to medical school directly from

25 high school as part of the Northwestern Honors Program






149

1 of Medical Education, six-year medical program in which

2 we did two years of undergraduate medical work followed

3 by four years of medical school.

4 Q. When did you enter Northwestern Medical

5 School?

6 A. I entered in 1976. I graduated in 1982. From

7 there I went into training for neurosurgery and

8 neurology at Medical College of Virginia. I trained in

9 neurosurgery and neurology until approximately 1988.

10 The position including C-level positions in neurosurgery

11 as well as neurology.

12 I underwent fellowship training in EEGs at the

13 same time and also Transcranial Doppler examinations at

14 the same time.

15 Q. Is that part of your post-residency training

16 in EEG and Transcranial Doppler?

17 A. No. It was done as part of my residency

18 training because I was in both departments and we worked

19 together for much of the time. In neurosurgery we would

20 work close with neurology and vice versa. When I went

21 into neurology, I had the freedom to do post-residency

22 training work in addition to my residency duties in

23 neurology.

24 Q. And so you left the medical college in

25 Virginia in 1988 when you completed that training?






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1 A. Correct.

2 Q. Is that associated with the any university?

3 A. It is the Medical College of Virginia, which

4 is associated with Virginia Commonwealth University in

5 Richmond, Virginia.

6 Q. Are you board certified in any area of

7 medicine?

8 A. I'm board certified in pain management as well

9 as in neurology.

10 Q. Are you licensed to practice in your area of

11 specialty?

12 A. I am licensed to practice medicine in Virginia

13 and California and Florida.

14 Q. Are you presently in practice?

15 A. Yes, I am.

16 Q. Where are you in practice?

17 A. In Clearwater, Florida.

18 Q. Now, have you lectured in any field of

19 neurology?

20 A. Yes, I have.

21 Q. On what topics have you lectured?

22 A. I have lectured on spinal injuries, brain

23 injuries, stroke and mistreatment, vascular injuries of

24 the brain and mistreatment, the use of Transcranial

25 Doppler to guide therapy, and the use of computerized






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1 EEGs to guide therapy. That's the bulk of the

2 treatments, with certain minor variations. Some dealing

3 with case studies and some dealing with stroke

4 prevention crisis.

5 Q. Now, have you ever given any lectures for

6 which the attendees were awarded continuing medical

7 education credits?

8 A. Yes, I have.

9 Q. How many times?

10 A. I'm not sure. I have done it many times.

11 Q. Do you recall where?

12 A. Well, I have given it at the National Practice

13 Update Convention in Orlando. I believe that was two

14 years ago. I have given it at Family College

15 Osteopathic Practices Convention, state of Florida,

16 several times. Each of those were generally two to four

17 hours lectures. I have given it at the University of

18 Florida. I have given it at a series of other major

19 universities.

20 I have done several national conventions

21 including applied autonomic disorders, reflex sympathy

22 disorders and also International Hyperbaric Conference

23 that deals with cerebral palsy and treating cerebral

24 palsy.

25 Q. In the course of your practice, have you ever






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1 been invited to be a research grantee for the United

2 States Department of Education?

3 A. Yes, I have.

4 Q. Do you recall -- how long did you do that?

5 A. Well, I believe I'm still on the list;

6 although, I think they have dissolved that committee

7 over the last couple years. I was first on the list, I

8 think, around -- I'm not sure. In the early or mid 90s.

9 Q. Did you actually conduct random studies?

10 A. Yes, I did.

11 Q. Do you have any specialized knowledge in some

12 particular aspect of neurology?

13 A. My area of specialty is brain injury and

14 vascular diseases. Historically, it's also involved

15 pain management and also the use of ultrasound and

16 electronic monitoring of the nervous system.

17 Q. During the course of your practice, have you

18 ever had occasion to treat patients diagnosed with

19 anoxic encephalopathy?

20 A. Yes, I have.

21 Q. Can you estimate how many?

22 A. Probably about 100 that were treated for

23 technique. Before that, I have treated many over the

24 course of the years prior to using vasodilators with

25 these types of patients, but I'm not really exactly






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1 sure, you know, how many that is. It may be more.

2 Q. What does anoxic mean?

3 A. Anoxic means without oxygen.

4 Q. And how does that differ from hypoxic?

5 A. Well, it really doesn't differ from hypoxic.

6 Anoxia and hypoxic encephalopathy both deal with the

7 difficulty of getting oxygen to the brain, so there is

8 really no major difference with respect to the pathology

9 that occurs with the brain itself.

10 Q. Encephalopathy means what?

11 A. Encephalopathy means disorder or disease of

12 the brain.

13 Q. So anoxic encephalopathy does not tell you

14 what structures in the brain have been affected or

15 damaged, correct?

16 A. It's a general term. So anoxic suggests there

17 has been a lack of oxygenation of the brain for whatever

18 reason. That can be due to carbon monoxide poisoning,

19 where a person inhales a gas other than oxygen. Or, it

20 could be something like a cardiac arrest or lack of

21 blood flow to the brain.

22 Hypoxic encephalopathy is really essentially

23 the same thing. Hypoxic encephalopathy generally means

24 that diffusely in the brain, the brain has been injured.

25 So it tends not to be localized to one specific point,






154

1 although, injuries can be very severe, affect the entire

2 brain, or a very minor and swollen areas.

3 Q. And would those both be called encephalopathy?

4 A. Yes, they would. Encephalopathy correlates to

5 a diffuse injury. You could have widespread diffuse

6 injury or more localized areas, but patterned throughout

7 the brain diffusely.

8 Q. Now, have you also had occasion through the

9 course of your practice to treat patients who have

10 suffered stroke?

11 A. Yes, I have.

12 Q. How many?

13 A. Well, again, that's tough to answer. Most of

14 my work from about 1995 has been dealing with the use of

15 vasodilators and stroke patients. So from that time, I

16 would estimate two to 3,000 patients. Slightly more, if

17 possible.

18 Before that we treated a lot of stroke

19 patients through the emergency room or through general

20 referrals or in hospitals where stroke is a common

21 disorder.

22 Q. Is stroke linked in any way to a heart attack?

23 A. Stroke can be linked to heart attacks, yes.

24 Q. How could it been linked?

25 A. There are two main mechanisms that a stroke is






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1 linked to heart attacks. The first is that after a

2 heart attack, the heart is damaged. Small blood clots

3 forming can break off and cause injuries to one or many

4 different blood vessels in damage the brain tissues from

5 those blood vessels.

6 Q. Would that be called an embolic stroke?

7 A. That's usually called an embolic stroke, yes.

8 Q. Caused by a brain embolism?

9 A. Right. An embolism, being a small clot that

10 has gone off to the brain.

11 The second type of a stroke that tends to

12 occur is when you have a drop of blood pressure that is

13 sudden and beyond the ability of the body to compensate.

14 That causes a lack of blood flow to the brain, and that

15 lack of blood flow results in anoxia or hypoxia to the

16 brain or lack of oxygen delivered to the brain, which

17 causes brain injury.

18 Q. When you say "lack of oxygen" or a reduced

19 amount of oxygen to the brain causes injury, what does

20 the brain do? How does that injury manifest itself?

21 A. Well, in all strokes from any cause, whether

22 it's from cardiac arrest or it's from anoxia or hypoxia

23 or a drowning, in all strokes common things happen. The

24 first thing that happens is you have a lack of oxygen

25 delivered to the tissue. That itself causes damage to






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1 the tissue.

2 Q. What happens? Does it shrivel up?

3 A. Different areas of the brain, different things

4 happen in it. Certain areas of the brain are more

5 sensitive to lack of blood flow than other areas of the

6 brain, or lack of oxygen. So those would be injured

7 first. There is going to be areas to the brain that are

8 injured more and areas to the brain that are injured

9 less in these types of episodes.

10 Q. What are the more sensitive structures in the

11 brain with regard to blood flow?

12 A. The more sensitive areas are areas that deal

13 with memory and concentration. And then the cortex of

14 the brain in the cerebral hemispheres are less

15 sensitive. Areas that deal with communication are more

16 sensitive than areas that deal with strength. But they

17 have -- they are various different scenarios in these

18 different areas. Then what happens is that that tissue

19 itself may die. Other areas of the tissue become

20 injured and may be able to survive. And then other

21 areas will sort of go into hibernating state and other

22 areas will continue to function.

23 Then, the second thing that happens is the

24 blood vessels. The blood vessels leading to that area

25 can be damaged just like the nerves can be damaged.






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1 When the blood vessels become injured, they narrow or

2 constrict and they try to stay narrow and constricted.

3 There's a loss of normal blood flow, normal vascular

4 function, which means that the blood vessels starve the

5 brain of oxygen.

6 In the normal person, there's something called

7 autoregulation, where the blood vessels will try to open

8 up again or open up at certain times.

9 Q. Is that autoregulation the body's attempt to

10 overcome this infection?

11 A. Yes, it is. But in the injured brain, you

12 lose autoregulation. So these blood vessels don't tend

13 to open back up, nor do they tend to compensate properly

14 for poor blood flow to the area. And once the blood

15 vessels become injured, then tend to say narrow.

16 Q. The blood vessels themselves?

17 A. The bloods vessels themselves.

18 Q. Now, have you devised a therapy to expand

19 those blood vessels?

20 A. Yes, I have.

21 Q. And can you tell the court, in brief, what

22 that therapy consists of.

23 A. Well, the therapy really consists of standard,

24 time-tested, and long-term understandings of the blood

25 vessels and how they respond and how to treat them.






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1 It's well understood these blood vessel disorders that

2 arise after an injury exit. They have been identified

3 in cardio disease. They have been identified in stroke

4 and brain injury. They have been identified in skin

5 injuries, kidney injuries, everywhere in the body.

6 The principles of what I talked about, as far

7 as injury, are well identified and well observed over

8 the last 50 to 100 years.

9 Q. And is there anything special about blood

10 vessels in the brain as opposed to other parts of the

11 body?

12 A. Well, the blood vessels in the brain are

13 slightly different than -- the blood vessels themselves

14 are not different from elsewhere in the body, but there

15 are some unique characteristics to the brain that has

16 made this standard application of vasodilators to the

17 brain more difficult.

18 Q. What are those differences?

19 A. There are really several differences. The

20 first one is that there is something called the blood

21 brain barrier, which is a chemical sheeting or coating

22 around blood vessels that tends to prevent medications

23 from going into the tissue and then affecting the blood

24 vessels from the outside of the tissue.

25 Q. So if you would administer the patient






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1 medication with a shot, the blood brain barrier would

2 prevent the medication from reaching the brain tissue?

3 A. That has been the thought over the last 30 or

4 40 years that that's what's happening.

5 Q. And how did you get around this problem, if

6 you were able to get around it?

7 A. Well, we actually made a very unusual and odd

8 observation about 1994, and that was that we had an

9 large number of patients with brain injuries that were

10 part of my practice. We also had what was then and

11 still is very new technology in the office. Several

12 types of new technology. But for these purposes, what

13 turned out to be most important was a special type of

14 ultrasound that looks at the blood vessel diameter

15 inside of the brain.

16 Up until 1994, it was thought there weren't

17 many medications that could actually affect the blood

18 vessels inside of the brain other than medication that

19 narrowed blood vessels due to the oxygenation after

20 stroke patients.

21 Q. Did you determine that your patients were

22 victims of cerebral vasospasm?

23 A. It was thought that these patients -- that

24 many of these patients had a brain injury but that they

25 also had vasospasm on their examination, yes. And the






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1 reason for that was that they had severe migraines.

2 Q. How did a migraine related to vasospasm?

3 A. Patients with chronic migraines after an

4 accident with brain injury, what happens in a migraine

5 is blood vessels constrict. When it constricts to a

6 very high rate, other blood vessels may actually dilate

7 and it could cause the pain of a headache.

8 Q. Why would another area dilate?

9 A. Back in 1994, the understanding of a migraine

10 was that a blood vessel would constrict, pinning off

11 some of the blood flow to the brain, then the brain

12 would release carbon monoxide around the area of the

13 blood vessel and that would cause the blood vessel to

14 dilate.

15 When the blood vessel would dilate more than

16 it was necessary to compensate for the lack of blood

17 flow to the area and that overdilation causes headache.

18 So what would happened was medications that were

19 designed to treat migraine were designed to make the

20 blood vessel narrow and cut down the pain.

21 Q. So the conventional treatment therapy for

22 migraine back in 1994 was to use vaso-constricting

23 drugs?

24 A. Correct.

25 Q. And you noticed in your patients this unusual






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1 phenomenon of migraines plus brain injury; is that what

2 happened?

3 A. Correct. What happened was we had a series of

4 patients. I did a lot of work for Social Security and I

5 also did a lot of work for people involved in severe

6 auto accidents. So there was long before treatment, an

7 evaluation stage they had gone on for many years.

8 Patient with Social Security were disabled for over one

9 year and were expected to be permanently disabled for me

10 to treat them.

11 What we found is that a lot of these patients

12 had migraines or partial paralysis or weaknesses and

13 balance problems and memory problems. We tried to find

14 a new technique to control their headache. Not new to

15 me, but, rather, there were a series of anti-migraine

16 medications, like Imitrex, that had just come to

17 market.

18 Q. Now, were those vasodilators?

19 A. These are vasoconstrictors. Now, these

20 patients who are on Social Security for chronic

21 migraines or brain injuries for up to 17 years, and they

22 have tried a lot of different medications. So at that

23 time I didn't think any of the new medications coming

24 out would treat their headaches. Rather, what I thought

25 we would do is monitor a series of these patients with






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1 different testing techniques, try out different

2 medications on them while being monitored. And we would

3 identify the proof that might be seen on one set of

4 tests and the proof that might be seen in some patients

5 in other tests, we would then generate a cocktail.

6 Q. What do you mean by "cocktail?"

7 A. In medicine, it's common when you deal with

8 patients who are having very severe problems to use two

9 or three or four medications in that patient to treat

10 the medical problem. No single medication will do the

11 trick, so you have to try to use several different

12 medications.

13 Q. In conjunction, you mean?

14 A. In conjunction, correct. We actually see that

15 in a lot of blood pressure medicines and cardiology

16 medicines where there will be two or three medicines

17 combined in a single pill.

18 Q. And your reason for devising this cocktail was

19 what?

20 A. To stop pain.

21 Q. By dilating the vessels?

22 A. No. It was to stop pain by trying to find

23 medications that would stop these people's pains. It

24 was not to dilate the blood vessel, because the standard

25 thinking at that time was that the blood vessel






163

1 constricted and it later expanded and caused the

2 headache. So what we were seeing, in theory, was that

3 the blood vessels were already dilated at the time of

4 the migraine and causing the headache. So, we were

5 looking for only pain relief.

6 Q. So by the time the pain manifests itself, the

7 thinking at the time was the blood vessels were already

8 compensated and dilated?

9 A. Correct.

10 Q. So when you try these cocktails, what did you

11 discover?

12 A. Well, we never got to a cocktail. What

13 happened was we had six patients in our office at one

14 time, gave them Imitrex. Another six get a new medicine

15 called Toradol.

16 Q. Toradol?

17 A. Yes. It's T-O-R-D-A-L.

18 We use medicine that have very short onset of

19 action and they use patients who are very severely

20 disabled from the brain injuries and need help walking

21 to get to the exam table or testing table or they would

22 need to be brought in in a wheelchair.

23 Q. Was there speech discernible?

24 A. Many of them had severe difficulty speaking.

25 Many had severe weakness in one arm or leg. They had






164

1 balance problems where they couldn't walk unassisted;

2 they would fall into walls when they were walking.

3 Something of that nature.

4 Most of them are had neuropsychology tests

5 done on them before us for many years documenting severe

6 brain injuries. If you spoke to them and gave them

7 instructions, sometimes they wouldn't understand these

8 instructions when it came to caregivers.

9 Q. What happened when you began -- well, first of

10 all, how did you decide to treat these patients?

11 A. Well, what we did was put them on a monitor,

12 electronic monitor with evoked potential, or EEGs,

13 computerized EEGs, or Transcranial Doppler, and gave

14 them the medicine, the Imitrex or Toradol.

15 Q. When you say you had them on a monitor, you

16 had them hooked up on the machine and gave them the

17 drugs?

18 A. Correct.

19 Q. What was the purpose of that?

20 A. Well, this is typically a standard technique.

21 Again, my background was extensively surgery in the

22 intensive care unit and medicine. In this fields, it's

23 common to monitoring ongoing monitoring of the patient

24 or serial monitoring the patient with technology to help

25 to give you an indication early on whether or not having






165

1 proven that from a technique that you are applying to

2 that patient.

3 Q. And you would be able to tell that from the

4 monitor and device that you're using?

5 A. Sure. This is just like using an EKG monitor

6 in the emergency room or in an ICU. You might have a

7 blood oxygen monitor as well as an EKG monitor as well

8 as a blood pressure monitor. The idea of monitoring the

9 medication's effect is the standard part of the medicine

10 when you have to deal with customizing doses and also

11 trying to look what you're trying to deal with, the

12 effect of.

13 Q. So what happened?

14 A. Well, the patients who had Imitrex, we gave

15 them the medicine, we watched them, and their blood

16 vessels constricted just like which thought and

17 understood Imitrex should work. The patients with head

18 injuries, they became very confused. And

19 neurologically, they worsened.

20 Q. And what did you do for them?

21 A. That's what we expected from Imitrex.

22 Imitrex, in fact, has had a lot of research since then

23 that talks about -- that wasn't around at the time, that

24 talks about the narrowing of the blood vessels and

25 patients with heart disease, Imitrex can actually put






166

1 them into a heart attack.

2 So we got what we expected. We saw the

3 ultrasound that showed further narrowing. The headache

4 did go away quite dramatically, so that was a very

5 effective tool. But they frequently got worse in

6 minutes. They had trouble to where they couldn't get

7 onto the table and couldn't get off the table without

8 having help. They returned from normal to not normal.

9 Q. And, then, what did you decide to do?

10 A. Well, we also gave Toradol on the same day to

11 other patients. Again, this is the using the same kind

12 of monitoring. Toradol, at that time, was a shot, so it

13 had very rapid action. Toradol did something very

14 unexpected.

15 Q. What was that?

16 A. What it did was it relieved the headache

17 entirely, but it did it through a different mechanism

18 than Imitrex, which had never been reported before. The

19 mechanism was that it made the blood vessels dilate

20 inside of the brain.

21 Q. So this initial set of patients, you used a

22 vasoconstrictor among one group of patients. And on the

23 same day gave the other group of patients a vasodilator.

24 A. Correct. But that's not what we meant to do.

25 Toradol wasn't known to be a vasodilator at the time we






167

1 gave it. It was known to be a medicine like Motrin, a

2 anti-headache medicine. It was not thought to be a

3 vasodilator.

4 Q. So you had this unexpected result. And how

5 did you proceed?

6 A. Well, it was unexpected. It meant that if

7 this -- it meant that even if Toradol worked by

8 vasodilating or Toradol had a different mechanism of

9 acting, we then went to a second set of categories of

10 medicine, which were vasoconstrictors on one side, like

11 Imitrex, and were standard anti-migraine medicines,

12 Ergotamines, E-R-G-O-T-A-M-I-N-E-S, caffein. It is a

13 series of very strong, very short-acting medications

14 that are used to constrict blood vessels and relieve

15 migraines, commonly.

16 On the other hand, we used some very

17 short-acting vasodilators that were known to be

18 vasodilators for patients. We got the same exact same

19 results all over again.

20 Q. The what results?

21 A. We got the same results that we got with the

22 first one. Within ten or 15 minutes, those given the

23 vasoconstrictor, the headaches would leave. The

24 Transcranial Doppler would show worsening, meaning more

25 narrowing of the constriction, which is the understood






168

1 mechanism of how these medicines worked. The headache

2 went away, but the patient, in front of us,

3 deteriorated. They would develop abnormal reflexes,

4 balance problems, thinking problems. They were quite

5 dramatic.

6 Q. And what happened with the vasodilation

7 patients?

8 A. With the other group, we had an equally

9 dramatic effect. The ultrasound, again, showed

10 dilation of the blood vessels. The patients themselves

11 had a dramatic improvement. They would eventually clear

12 up in front of you. They could understand and follow

13 commands, which they had troubling doing before. They

14 could get up and down from chairs.

15 We do a test, which is standard in neurology,

16 called a Romberg and Tandem Gait. A Romberg examination

17 is where a person stands at attention with their heels

18 and toes together and closes their eyes. You

19 essentially see how their balance is. It's a sign of

20 neurological injury for those who sway and have balance

21 problems.

22 The other test that goes with that is a tandem

23 gait. A tandem gait is what the police officers use for

24 drunk driving tests where you have a person walking a

25 straight line. These persons, prior to getting the






169

1 vasodilator, could not do that. When they got the

2 vasodilator, 15 to 20 minutes later, were able to do

3 those tests, for the most part, without difficulty,

4 being able to walk around unassisted. Then, when they

5 eventually wore off, the ultrasound, again, worsened.

6 They couldn't do those tests again.

7 The same thing happened with the Imitrex group

8 and vasoconstrictors. They couldn't do it. When they

9 started, it got worse and then returned to their

10 baseline as the medication wore off.

11 Q. Over the years -- this happened in '94?

12 A. Yes. So this meant that you have migraine, in

13 at least these patients, was not correct. What was

14 really happening was that the migraine was more like a

15 heart attack.

16 In a heart attack, the beginning of a heart

17 attack, the patient has a narrowing in the blood

18 vessels. And the blood vessels downstream dilate to try

19 to make a vacuum to pull blood through that narrow area.

20 Q. As the bottom overcoming the narrowing?

21 A. Correct. In that heart attack, the dilation

22 causes pain, chest pain. What you do with those

23 patients is give them a vasodilator, nitroglycerin, and

24 the pain goes away. As the blockage opens up, the

25 downstream areas dilate to compensate to return to






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1 normal size. As they return to normal size, the pain

2 goes away.

3 When we use nitroglycerin on these brain

4 injured patients, we saw the same phenomenon happen. As

5 in Toradol or other vasodilators, we saw proof: The

6 heart attack patient started feeling brief better; we

7 saw the pain go away; we saw the neurological exam

8 improve.

9 Q. How, over the years, have you refined this

10 technique?

11 A. Well, mainly by very close observation of

12 patients, serial observations of patient.

13 Q. Serial observation of patients?

14 A. Observing patients for long periods of time

15 both in the office as well as months and years down the

16 road.

17 Eventually, there have been new medications

18 that have also come out. This technique has allowed us

19 to identify these medicines easily and to use them with

20 patient --

21 Q. Now, what is the -- what does the term

22 Kenombra mean with regard to blood flow to the brain?

23 A. Kenombra is an old concept, a scientific

24 concept that was first seen in wound healing, but it's

25 been seen -- as technology's gotten more sophisticated,






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1 it's been seen in every organ. It's the body's common

2 response to injury of any form. That response is that

3 you get different areas of brain tissue or heart tissue

4 or skin tissue, have different degrees of injury. The

5 areas farthest away from the site of the injury are the

6 least damaged. Sometimes they are not even damaged at

7 all, but they are thrown into a hibernating stage.

8 Areas closest to the site of the injury or at

9 the site of the area may be dead. And seeing everything

10 from hibernating tissues or even normal tissue -- you

11 know, normal tissue by definition is normal tissue

12 outside of the area damage. Everything from hibernating

13 tissue to undamaged tissue, a tissue which, for some

14 reason, cannot carry out its normal functions; either

15 there is not enough blood flow into the area for it to

16 have the energy to carry out its normal function or

17 there's been some other injured area of problem, lack of

18 glucose or sugar or protein, whatever. So its

19 undamaged cells, not active cells, not functioning

20 active cells carrying out what they are designed to do

21 all the way into the deeper areas where you actually

22 have deadened areas.

23 Q. Now, has your technique or method of treating

24 patients resulted in any insight on your part in any

25 number?

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






114

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.






115

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

45

1 physical therapists?

2 A. Yes.

3 Q. Do they also involve speech therapy?

4 A. Yes, they do. We have therapy and other level

5 of activities, but I'm just not aware of the details of

6 their program.

7 Q. Now, you became Terry's attending physician in

8 April of '98, correct?

9 A. That's correct.

10 Q. I want to direct your attention to bate number

11 Page 98 in Exhibit 12. It's further back, next to the

12 last page. The number 98 is within the middle of the

13 page. You got it?

14 A. Yes, I have it.

15 Q. Very good. The last entry is dated 4/20/98.

16 A. Yes.

17 Q. Is that your handwriting?

18 A. Yes, it is.

19 Q. I can almost read all of it, but would you

20 read it aloud?

21 A. Yes. "Chart review patient's condition.

22 Discussed with nursing staff and staff nurses.

23 Concerned about contractures of upper extremities and

24 elbows. Right worse than left, antecubital areas.

25 Yeast infection. No areas of cutaneous breakdown. No






46

1 respiratory symptoms. Patient stable. Lungs remain

2 clear. Cardiac examination regular; no murmur.

3 Neurologically unchanged. Impression: Anoxic

4 encephalopathy with residual persistent vegetative

5 state, contractures. Continue nursing home care.

6 Lotrimin cream to antecubital space to prevent yeast

7 infection. Husband declined physical therapy evaluation

8 for treatment of contractures."

9 Q. Have her contractures worsened since April 28,

10 1998, in your opinion?

11 A. I don't believe so.

12 Q. You don't believe so?

13 A. No.

14 Q. She was as contracted in April of 1998 as she

15 is today?

16 A. I believe so.

17 Q. Now, do you know why Mr. Schiavo was not

18 interested in physical therapy for his wife?

19 A. I didn't say that he declined. He declined

20 evaluation by the therapist. And his reason was that

21 she had had multiple evaluations and it seemed not to be

22 appropriate to call on someone else to make the same

23 evaluation.

24 Q. Well, it would be somebody right there on the

25 staff, wouldn't it?






47

1 A. Yes.

2 Q. So she gets no physical therapy?

3 A. Yes.

4 Q. And she has never had physical therapy while

5 under your care?

6 A. Yes. Treatment of the contractures is

7 something which is done as part of bedside nursing. And

8 we ask, you know, if there was anything more that could

9 be done. We asked the professionals who are on staff to

10 evaluate what work needs to be done, as Michael pointed

11 out to me at a particular point in time.

12 Q. So you deferred to his recount of his wife's

13 medical history?

14 A. Yes, I did.

15 Q. And you didn't search out a previous

16 evaluation?

17 A. I don't recall exactly what I did in April of

18 1998. Perhaps, he pointed out to me an evaluation

19 review and I was satisfied. I do remember discussing

20 with him, among other things that come up in the

21 records, but, then we have a limited amount information.

22 Q. And, well, aren't contractures normally

23 treated with physical therapy?

24 A. To a certain extent physical therapy can help,

25 yes.






48

1 Q. And, in fact, isn't physical therapy ordered

2 in order to prevent contractures or to prevent their

3 worsening?

4 A. Well, a physical therapist can help to a

5 certain point in which they provide a daily program for

6 the caregivers to maintain a level of flexibility.

7 Q. Do you work closely with Mr. Schiavo in taking

8 care of Terry?

9 A. Yes, I do.

10 Q. Are you in telephone contact with him?

11 A. Yes, I am.

12 Q. About how frequently?

13 A. If I notice that there are problems, I will

14 call him. But, certainly, if I notice anything that the

15 nurses raise or one of the nurse practitioners, I would

16 be in contact with Michael.

17 Q. So can you estimate how frequently that would

18 be that you would call?

19 A. I would say several times a year.

20 Q. Do you know when the last time you spoke?

21 A. Yes. I think the last time I spoke with him

22 was at the time of the examination in April. He

23 happened to be at the facility at that time.

24 Q. And Terry, in order to get the tube replaced,

25 you had to speak to him?






49

1 A. That's correct.

2 Q. Did she miss any feedings, do you know?

3 A. She gets fed 12 hours a day, so I don't think

4 that -- I couldn't tell you the exact time I had. There

5 was -- couldn't tell you. There was another physician

6 taking care of her.

7 Q. Who was that other physician? I thought you

8 were the main physician.

9 A. No. I do not -- I limit my practice to the

10 long-term care scope. Even though I have privileges at

11 the hospital, I prefer to have hospital specialists

12 attending in her care.

13 Q. So it's the staff physician or the attending

14 physician?

15 A. Yes. The physician on staff; that is correct.

16 Q. Do you know who it was?

17 A. Yes. Dr. Koletis.

18 Q. Do you know how to spell his last name for the

19 court reporter?

20 A. Yes. It's K-O-L-E-T-I-S. I don't think

21 it's Z.

22 Q. You did a good job.

23 Now, are contractures permanent, by the way?

24 A. They can be, yes.

25 Q. Are her contractures permanent?






50

1 A. Yes. As far as I know, yes.

2 Q. Now, when you accepted Terry as a patient, do

3 you remember who you accepted her from?

4 A. Yes, Dr. Mulroy.

5 Q. Dr. Mulroy?

6 A. Yes.

7 Q. And why did her care get transferred to you,

8 if you know?

9 A. I was told that Dr. Mulroy was concerned about

10 the conflict within the family and felt that -- he felt

11 better if he turned her care over to another physician.

12 Q. Did you speak with Dr. Mulroy before you took

13 over her care?

14 A. I believe I did, but I don't recall that

15 conversation.

16 Q. Did he give you his impression of her

17 condition?

18 A. Yes. He did forward the medical records to

19 me.

20 Q. Where do you maintain patient medical records,

21 by the way?

22 A. In the facility where the resident resides.

23 Q. Okay. So her medical records are all at

24 Hospice, as far as you know?

25 A. Yes, or Palm Gardens.






51

1 Q. But Dr. Mulroy's records of his treatment of

2 Terry came with her to Hospice; is that right?

3 A. I'm not sure if Dr. Mulroy's records have been

4 copied to Hospice. I couldn't tell you. They were at

5 Palm Gardens.

6 Q. Why did she get moved from Palm Gardens to

7 Hospice? You moved her, right?

8 A. Yes. That definitely wasn't my decision. I

9 feel there is a reason to move her from one medical

10 facility to another. It was just a decision that was

11 made by Michael.

12 Q. Mr. Schiavo?

13 A. Yes.

14 Q. And you conceded to that, once again?

15 A. Yes.

16 Q. Did you have reservations about putting her in

17 Hospice?

18 A. No, not in Hospice.

19 Q. Aren't patients admitted to Hospice Woodside

20 expected to die within six months?

21 MR. FELOS: Your Honor, I believe that

22 question calls for a legal conclusion by the

23 witness. I would object.

24 THE COURT: Overruled.

25 BY MS. ANDERSON:






52

1 Q. What's the answer to that question, Doctor?

2 A. I estimate that at Hospice -- Terry is the

3 resident who has been here the longest. They said they

4 have had no other resident that are in Hospice Woodside

5 a for longer period.

6 Q. Are the patients generally expected to die

7 within six months of their admittance? Isn't that a

8 Hospice policy?

9 A. No, it's not a Hospice policy. It's just a

10 guideline that is used to determine the prognosis for

11 Hospice.

12 Q. It's kind of a rule of thumb?

13 A. Yes.

14 Q. Now, do you remember when you first began

15 treating her?

16 A. In 1998?

17 Q. Yes.

18 A. Yes.

19 Q. What did you do at the time she came under

20 your care as far as clinical examination?

21 A. The examination was similar to the examination

22 that I made recently. It was a physical examination.

23 She was a new patient, so it took a longer period of

24 time to go through the records, talk to Michael and the

25 nursing staff.






53

1 Q. Now, what was her blood pressure at?

2 A. I do not take blood pressures myself. I rely

3 on blood pressure from the nursing staff. We

4 anticipated your question and I got that information

5 the. Systolic blood pressure range from 115 to 120.

6 Q. And diastolic?

7 A. Diastolic pressure -- you know, I forgot what

8 it was. It was in the low range. I think it was 70

9 plus or minus five.

10 Q. And what was the normal range?

11 A. I guess that would be considered within the

12 normal range.

13 Q. And these blood pressures are current as of

14 yesterday?

15 A. The blood pressures are current as of prior to

16 the beginning of the week.

17 Q. The beginning of the week?

18 A. Yes.

19 Q. Thank you for checking on that, Doctor.

20 Now, before the dialysis that was done in the

21 spring, the one that showed the colonization --

22 A. Yes.

23 Q. -- when was the timing for that that you

24 ordered the urinalysis?

25 A. In -- I don't have an answer on time, so I






54

1 have to read the records because I don't know exactly

2 when it was.

3 Q. If she is susceptible to urinary tract

4 infections, do you routinely order a urinalysis be done

5 on her?

6 A. No. We would not routinely do a urinalysis.

7 We would look for changes in condition, nursing

8 observations, foul odor to the urine, a fever, an

9 increased moaning. We would look for reasons to

10 investigate further. It might be something else besides

11 a urinary tract infection.

12 Q. Now, you've done two urinalyses this year on

13 Terry, correct?

14 A. Yes.

15 Q. And both of them were abnormal, also correct?

16 A. Yes.

17 Q. The first showed bacterial colonization, and

18 you ordered antibiotic therapy for her?

19 A. Yes.

20 Q. And then -- and that was in April?

21 A. Uh-huh.

22 Q. In September, she had a full-blown infection,

23 correct?

24 A. Well, I'm not sure of the term "full-blown,"

25 there was a urinary tract infection.






55

1 Q. I think you said it was significant.

2 A. Number of white cells, a number of significant

3 as opposed to insignificant, which would lead you in a

4 different direction.

5 Q. Well, I understand you are distinguishing it

6 from a colonization.

7 A. Okay.

8 Q. In the sense that she had progressed to an

9 infection as opposed to the colonization that she had

10 exhibited earlier?

11 A. Right.

12 Q. Okay. So two urinalyses, two abnormal

13 readings. Both times she got MRIs, right?

14 A. Yes.

15 Q. Is there any reason you didn't do a follow-up

16 urinalysis after April to make sure you killed off the

17 bacteria?

18 A. Yes. It's generally not recommended.

19 Q. How would you know that the antibiotic that

20 was given to her in April was ineffective and in fact

21 she has had an infection this whole time?

22 A. Along with the urine culture, you could order

23 an antibiotic study and that study tells you

24 specifically whether the antibiotic that you ordered is

25 bactericide, which kills the bacteria. Generally, these






56

1 antibiotics are in very high concentrations in the

2 urine.

3 Q. So you're confident that you killed off this

4 bacteria in April?

5 A. Yes, based upon that information. And I think

6 that you will find when you talk to experts that in

7 urinary tract infections, they would not recommend a

8 follow-up urine culture.

9 Q. When did you -- when did her most recent

10 urinary tract infection start?

11 A. I don't know if I could answer that question

12 to tell you what date that was. But the nurses did note

13 that there was some increase

moaning, they were

14 concerned to be problems. So when you have changes like

15 this, it would be appropriate to check urine.

16 Q. Now, this urinalysis, this most recent one

17 that detected the infection, was pursuant to court

18 order, right?

19 A. Yes, it was pursuant to court order.

20 Q. All right. As far as her annual physical, do

21 you order a urinalysis usually?

22 A. Yes, we would perform a urinalysis. Not

23 necessarily for infection, but to look for other

24 problems or metabolic problems.

25 Q. Albumin is related to liver function, isn't






57

1 it, or kidney function?

2 A. Yes. Her albumin reading was abnormal.

3 Q. What would that abnormal reading indicate to

4 you?

5 A. The abnormal albumin?

6 Q. Yes.

7 A. Well, first off, it would be malnutrition, and

8 there was no evidence of malnutrition. And my thought

9 was that since it was borderline and had been borderline

10 in the past, that this was indicative of someone with

11 very low muscle mass, that she has. She has not moved,

12 so her muscles are all shriveled. They are essentially

13 scar tissue.

14 Q. Her muscles are scar tissue.

15 A. Well, they have atrophied.

16 Q. They have atrophied, haven't they?

17 A. Yes, they have.

18 Q. Would physical therapy help that?

19 A. If you continue to move the muscles.

20 Q. Would she --

21 A. If there's no innervation to the nervous

22 system through the muscles, it won't help.

23 Q. Did she get range of motion therapy?

24 A. She should have range of motion therapy. And

25 not having read the observation, I'm assuming it's been






58

1 done.

2 Q. What would range of motion therapy consist of?

3 Can you describe it for the court?

4 A. Well, I could describe it briefly. Physical

5 therapy consists of -- first, you very slowly move the

6 hands, wrist, shoulders to the point where it might

7 cause some discomfort and then relax it. And that's the

8 range of motion they're able to perform on Terry.

9 Q. Because of her contractures?

10 A. That's correct.

11 Q. You're not sure they are doing that though?

12 A. Yeah, they are.

13 Q. You do know that for sure?

14 A. Not how often and what extent. I would have

15 to review the records and the nurses' notes.

16 Q. How is it that you are sure she is receiving

17 range of motion therapy?

18 A. Because when I examined her, there would be

19 findings that would suggest, you know -- if you're not

20 moving them, as you might find in someone that is not

21 eating properly, that would be an indications that

22 suggesting that the care was taken in the proper matter,

23 that they were not moving the limbs in certain areas.

24 In Terry, you do not see that.

25 Q. Now, is it safe to say that the lab work Terry






59

1 has had done this year pursuant to court order is an

2 unusual amount of work in terms of your care of her?

3 A. There were tests which I wouldn't normally

4 order unless there was some suspicion. And, yes, I did

5 those tests in addition to routine care.

6 Q. So this year she has received more blood work,

7 urinalysis, and so forth, than in any other year under

8 your care?

9 A. I could tell you there were some additional

10 tests that were performed.

11 Q. Additional?

12 A. Yes. You know, the court order was, you know,

13 consistent with the time that I had. The interesting

14 thing was that I had just seen her and George called me

15 and told me that these are the tests we needed, and I

16 had no real problem ordering these extra tests because

17 it was just part of the examination. There was some

18 additional blood tests, endocrine tests, you know, which

19 I would not have requested.

20 Q. So twice a year you order blood work to be

21 done on her?

22 A. Yes.

23 Q. You do?

24 A. Yes.

25 Q. And twice a year you do a urinalysis?






60

1 A. I have been doing the urinalyses when there

2 are symptoms. So the urinalysis may be done more often

3 than twice a year.

4 Q. Is she anemic right now?

5 A. No, she is not.

6 Q. What's her hemoglobin reading on that test?

7 A. In the Exhibit 2, the blood count is not

8 recorded.

9 Q. Was the hemoglobin count not part of that?

10 A. It's not on the exhibit, so I could not give

11 you the exact number. The test was done but not

12 recorded in the exhibit. This shows that the report

13 says the test was completed. But flipping through, I

14 don't have the report, so I could not tell you exactly

15 her hemoglobin. But, I was told it was normal.

16 Q. So the report simply says that they did the

17 test?

18 A. The test. And I receive reports over the

19 phone, as I haven't been in this facility since. The

20 records are kept in the facility, so I received a report

21 over the phone. And the nurse told me that the white

22 count of the hemoglobin were within the normal range and

23 there was one very slight abnormality, which was of no

24 concern.

25 Q. And that's the albumin?






61

1 A. Yeah. That would be the albumin.

2 Q. Isn't her vitamin B-12 deficiency slightly

3 off, also, in that same report?

4 A. The vitamin B-12 is 1,515. It should be

5 somewhere under 200.

6 Q. Reference range is normal, 4.0, to, looks

7 like, 22 nanograms per milliliter.

8 A. It says in the -- okay. You may not be

9 familiar with this report, but on the top, the third

10 line laboratory it says "vitamin B-12 level." And if

11 you read across it says 1,515-H, H being high. If you

12 go a little further, it references "reference range 211

13 to 911."

14 Now, if you look down to the bottom of the

15 page, they explain it further. The normal range to

16 intermittent range is 106 and a deficient range of less

17 than 159. So she is ten times what someone would be if

18 they were deficient. The folic acid, also, is high. As

19 I mentioned earlier, I concluded the borderline albumin

20 was not consistent with a deficiency stated.

21 Q. I can't quite make out the readings under

22 vitamin B-12.

23 A. FHS is folate. And then, under that, FHS,

24 vitamin B-12, and then folic.

25 Q. And you order these tests twice a year?






62

1 A. I order these tests --

2 MR. FELOS: Objection, Your Honor. That's

3 been asked and answered.

4 MS. ANDERSON: Not as to these specifics

5 tests.

6 THE COURT: She's just following up on the

7 tests.

8 THE WITNESS: I order all of the tests twice a

9 year.

10 BY MS. ANDERSON:

11 Q. Not all of them?

12 A. Not all of them, no.

13 Q. Now, she also had an unusual number of imaging

14 tests done, has she not?

15 A. Yes. I would say that there were certainly a

16 number of tests done in the years that I have been

17 treating her.

18 Q. Have you ever ordered a CT scan be done on

19 Terry other than pursuant to the court order?

20 A. No.

21 Q. Did you review a CT scan when she first came

22 under your care?

23 A. A CT scan of the brain.

24 Q. Of the brain. Okay.

25 A. I did not review the actual films, but I was






63

1 given a report from Dr. Mulroy at the time, her prior

2 treating physician.

3 Q. Have you ever reviewed her film?

4 A. No, I have not.

5 Q. Did you look at the film from the CT scan that

6 was done recently?

7 A. No, I have not.

8 Q. She also had a spec scan done. You are aware

9 of that, right?

10 A. Yes.

11 Q. Did you schedule that?

12 A. No, I did not.

13 Q. You left that to Mr. Felos or Mr. Schiavo?

14 A. Yes. I was not involved with the scheduling

15 of those tests or the ordering of those tests, and the

16 copy of those reports would go to Mr. Felos.

17 Q. You were out of the loop on that?

18 A. That's correct.

19 Q. Do you consider yourself particularly

20 qualified to read a CT scan?

21 A. Absolutely not.

22 Q. When Terry initially came under your care,

23 what was her diagnosis?

24 A. Chronic persistent vegetative state.

25 Q. And did you accept that diagnosis?






64

1 A. Yes, I did.

2 Q. Tell me what you did, if anything, to confirm

3 the diagnosis in your own mind to your own professional

4 standards?

5 A. I read the reports of the other physicians,

6 Dr. Barnhill, who I have a lot of faith in him, and my

7 own examination. And the findings were such that I felt

8 she met those criteria.

9 Q. And what did you consider those criteria to

10 be?

11 A. Her brain studies and brain wave tests showed

12 that she has a brain which is predominantly replaced by

13 spinal fluid.

14 Q. Whose report says that?

15 A. That's the report of the scan that I saw.

16 Q. The written report?

17 A. Yes.

18 Q. So you relied on that and relied on

19 Dr. Barnhill's report?

20 A. Yes.

21 Q. What else did you do?

22 A. I performed an examination.

23 Q. Tell me your findings from that examination.

24 A. I found that Terry had no appreciation of her

25 environment or purposeful movement.






65

1 Q. How did you determine that?

2 A. By examination.

3 Q. What did you do specifically?

4 A. Well, I used my voice to see if I could get a

5 response. I used my hand to put over her eyes to see if

6 there was a response to vision or visual threats. These

7 were some of the things that I did to determine if there

8 was a response. I also discussed with the caregivers

9 who work with her day in, day out -- as you know, my

10 time with her short -- and no one felt they were able to

11 have any response from her as far as an appreciation of

12 her environment.

13 Q. What else did you do?

14 A. Also we want to look for metabolic or other

15 conditions that may influence the neurologic stats,

16 depress the neurologic stats. The blood studies that

17 were done might suggest there were other conditions,

18 like her drugs, for instance, that would depress her

19 neurologic condition.

20 Q. So you read labs reports on her?

21 A. Yes.

22 Q. Did you check her reflexes?

23 A. Yes, I did.

24 Q. And were her reflexes in tact?

25 A. She had some spinal cord reflexes, brain stem






66

1 reflexes.

2 Q. Have you ever observed Terry in presence of

3 her mother?

4 A. No, I have not.

5 Q. How much time did you spend with Terry to

6 initially satisfy yourself that she was in a persistent

7 vegetative state?

8 A. The first time I was there I was probably

9 there for an hour.

10 Q. One hour?

11 A. Yes.

12 Q. And part of that time was spent reviewing

13 reports?

14 A. Right. I have to tell you that sometimes I do

15 make my notes -- I have private rooms, so I can make my

16 notes and sit there and observe her, review some records

17 and observe her again. So I can have more and more

18 contact.

19 Q. Did that occur on that occasion? The very

20 first time you were in the presence of Terry Schiavo

21 when you first examined her, did you sit with her for

22 one hour and observe her?

23 A. That's correct. That's why, as I mentioned to

24 you, to satisfy myself that, you know, her condition was

25 what everyone said it was.






67

1 Q. Well, what Dr. Barnhill said it was.

2 A. Well, I don't think there was anyone else who

3 disputes Dr. Barnhill.

4 Q. And Mr. Schiavo told you that his wife was in

5 a vegetative state?

6 A. I don't think he actually came out and used

7 those words to describe his wife's condition.

8 Q. How was it that it came out that you, as

9 opposed to all of the other physicians in Pinellas

10 County, were chosen to be her attending physician?

11 A. Maybe you can ask Mr. Schiavo. He is the one

12 who selected me.

13 Q. Did he come to you because of Dr. Barnhill's

14 recommendation? You said that Dr. Barnhill consults in

15 some of your cases.

16 A. Yes. I don't think that that was the case.

17 But, again, you know, I don't know what criteria he used

18 to select me.

19 Q. Okay. So in addition to using your voice and

20 putting your hands over her eyes and checking her

21 reflexes and reading reports, what else did you do to

22 satisfy yourself that she was in a persistent vegetative

23 state?

24 A. I felt that I was satisfied from that point.

25 I examined reports, discussed with the staff, reviewed






68

1 the records. I felt that she was in a persistent

2 vegetative state. She has not changed during the four

3 years I have taken care of her.

4 Q. And that's based on your quarterly visit with

5 her and observation?

6 A. That's correct. I just mentioned the last

7 time that I testified, I consented to the same thing.

8 So someone who had spent a lot of time going through all

9 of her extensive box of records in detail. I found in

10 one of the notes somewhere where a recreational

11 therapist pointed out to me the only thing in the record

12 that would suggest that she could appreciate her

13 environment.

14 Q. So in your mind, the appreciation of the

15 environment would be the key factor in determining

16 whether she was in PVS.

17 A. I think that's part of the criteria.

18 Q. What else?

19 A. I'm just talking about what the caretakers

20 know, and that was my point. So I just want to point

21 out that I had asked many people. But someone who

22 actually spent a lot of time on your side with respect

23 to this, that's the only information they were able to

24 bring to me and say, look, we will you read this.

25 Q. And that's, of course, assuming that the






69

1 medical chart is totally complete, right?

2 A. From your side, this is the only thing that

3 was brought to me to say, look, here's somebody who has

4 a different opinion.

5 Q. Now, have you ever tried to evoke a smile from

6 Terry?

7 A. I treat her, you know, as I would any other

8 patient, you know. I speak to her when I'm there as

9 another person. And I -- you know, when you're

10 examining someone you say, "I'm going to turn you to the

11 side, listen to your heart." So I would treat her like

12 any patient; not as someone who would not be able to

13 respond. In all of my visits, I have not appreciated

14 any response.

15 Q. Has it always just been you and Terry and,

16 perhaps, a nurse in the room?

17 A. Yes, sir, that's correct. Michael has been

18 there a couple times.

19 Q. Michael has been there?

20 A. Yes.

21 Q. But you have never observed her in the

22 presence of her parents?

23 A. No, I have not.

24 Q. You have never seen her in the presence of her

25 brother or sister, either, right?






70

1 A. No, I have not.

2 Q. The last time you saw her, did she appear to

3 be in any imminent danger of dying; was she in crisis?

4 A. No.

5 Q. You say that her condition is basically the

6 same?

7 A. Yes.

8 Q. Not deteriorating?

9 A. No.

10 Q. And that's since April of '98?

11 A. Yes; that's correct.

12 Q. Is her saliva suctioned on a regular basis?

13 A. I don't think that's been a problem.

14 Q. When you are with her --

15 A. I haven't seen a suction machine. They

16 haven't brought that to my attention that saliva was a

17 problem.

18 Q. So when you have been with her and observed

19 her, she has been swallowing her saliva?

20 A. You could assume that she was swallowing her

21 saliva. Saliva is made from stimulation or food or

22 objects in the mouth. Nothing goes in her mouth, so her

23 saliva production is probably less than a normal

24 person's. So in reference to the amounts of saliva she

25 would make is different in reference to a person in a






71

1 different situation.

2 Q. But regardless of whatever it is, she is

3 swallowing?

4 A. Yes.

5 Q. What is that name of the swallowing test that

6 is done?

7 A. The video swallowing.

8 Q. Right. Has that ever been done on her?

9 A. I don't have that information for you.

10 Q. You have not ordered it, anyway?

11 A. That's correct.

12 Q. Now, assuming somebody has the time, could she

13 be fed by mouth?

14 A. Well, the nurses are very concerned even with

15 oral care because of aspirations.

16 Q. Now, speaking to oral care. A dentist

17 examined her this year, right?

18 A. Yes.

19 Q. When was that?

20 A. That was maybe in April. It was around the

21 same time as my examination.

22 Q. Was that pursuant to court order?

23 A. I don't know if it was court ordered or a

24 suggestion was made.

25 Q. Was it related to this litigation, these






72

1 proceedings?

2 A. Perhaps. You know, all I know is that

3 George Felos asked me if she had a dental examination

4 recently, and I said I will check it out.

5 Q. Now, was the dental examination in April of

6 2002 the first dental exam she had received since you

7 have been her attending physician?

8 A. Probably not. I don't know what the

9 regulations cite. We're not governed by the same state

10 regulations as a nursing home. But in a nursing home, a

11 dental examination is required. So Terry would have had

12 such examination unless there was a refusal to have an

13 exam done.

14 Q. She would have had an annual dental exam if

15 she would have been in a nursing home, right?

16 A. Yes.

17 Q. And you are saying you are not sure if that

18 same statement applies to Hospice?

19 A. Right.

20 Q. So you are not sure if that applies?

21 A. Right. But I didn't go back into the record

22 to Palm Gardens to see if she had one. I guess,

23 obviously -- I noted what the findings were from the

24 dentist and those findings were not of concern. So what

25 it showed last year or the year before were not of






73

1 concern.

2 Q. Well, you are assuming it wasn't done last

3 year or the year before?

4 A. I'm not assuming anything at all. I'm saying

5 if she was at Palm Gardens, unless there was a refusal

6 to have an examination, it should have been done.

7 Q. Were you present during the dental exam?

8 A. No, I was not.

9 Q. Did the dentist recommend a deep cleaning?

10 A. I don't recall reviewing his report. If you

11 have it.

12 Q. Do you know if her teeth were cleaned this

13 year?

14 A. Her teeth were not cleaned this year as far as

15 I know.

16 Q. They were not cleaned by a dental hygienist as

17 a part of normal routine care?

18 A. Right.

19 Q. I'm talking about a dental hygienist. So you

20 know that her teeth were not cleaned; is that what you

21 are saying?

22 A. They were not cleaned by a dental hygienist.

23 Q. I don't know if I have that copy with me right

24 now.

25 MS. ANDERSON: Judge, I'm perceiving some






74

1 restlessness. Would you like to take a break,

2 court reporter?

3 THE COURT: I was going to go to 11:30, which

4 would be two hours. But we can break now if you

5 would like. How much additional time do you

6 anticipate spending with this witness?

7 MS. ANDERSON: Several more hours. Probably

8 two, three more hours. Two hours.

9 THE COURT: Okay. Let's take ten minutes now

10 and, obviously, we will break for lunch.

11 Now, Dr. Gambone, I'm going to have to

12 instruct that you during this break you are still

13 on the witness stand, figuratively speaking.

14 Please, don't talk to anybody except for, perhaps,

15 a bailiff or other court personnel, if you have

16 questions of where to go and so forth. Okay. We

17 will stand in recess for ten minutes.

18 BY MS. ANDERSON:

19 Q. Dr. Gambone, has Terry moved in a Gerry chair.

20 Does she sit in a Gerry chair instead of her wheelchair?

21 A. She sits in a specialized chair. I don't use

22 the term "Gerry" chair.

23 Q. What is a Gerry chair?

24 A. A Gerry chair is a particular brand of chair

25 which has a table at the waist level.






75

1 Q. Is it mobile?

2 A. Yes, a Gerry chair has wheels on it.

3 Q. Have you ordered that Terry not be taken

4 outside for fresh air?

5 A. If there is an order on the chart from me, I

6 don't recall such an order.

7 Q. There is no medical reason she can't go

8 outside?

9 A. That's correct.

10 Q. Do you know if she's been taken outside for

11 fresh air during the entire time you have been her

12 attending physician?

13 A. I do not know that.

14 Q. Would it surprise you if Terry laughed at a

15 funny story?

16 A. Yes.

17 Q. That would be something new for you?

18 A. Yes.

19 Q. Would that be inconsistent with your

20 diagnosis?

21 A. Yes.

22 Q. Would you be surprised if Terry smiled and

23 vocalized and turned her head toward her mother's voice

24 and face?

25 A. Yes.






76

1 Q. Would that be inconsistent with your

2 diagnosis?

3 A. Yes, if it was a response and not just a

4 random act.

5 Q. Right. Assuming that she heard her mother's

6 voice and smiled and turned her head and began

7 vocalizing.

8 A. Yes.

9 Q. That's something you have never observed?

10 A. No, I have not.

11 Q. Would it surprise you if she, say, raised her

12 leg on command?

13 A. Yes.

14 Q. Have you ever given her a command to raise her

15 leg?

16 A. I have, during my examination, said move to

17 the side, but there is no appreciation of a comment or

18 cooperation.

19 Q. Would it surprise you if she laughed in

20 response to piano music?

21 A. Yes, it would surprise me.

22 Q. And that would that be inconsistent with her

23 diagnosis?

24 A. Yes.

25 Q. Would it surprise you if she visually tracked






77

1 an object, a moving object, in front of her face?

2 A. Yes, it would.

3 Q. That's because you are not able to evoke that

4 response from her?

5 A. That's correct.

6 Q. What did you move in front of her face? What

7 object was it?

8 A. Terry would generally look to the right. Most

9 of her eye movements, looking and twitching to the

10 right. So on the right side I think there is something

11 that you said or did cause her to look to the right. If

12 you do it on the left, you're not going to get that same

13 response.

14 MS. ANDERSON: Move to strike. That answer as

15 not responsive, Your Honor.

16 BY MS. ANDERSON:

17 Q. My question, Doctor, was what object did you

18 use to get her to visually track?

19 A. I was talking about moving your body from one

20 side of the room to the other side of the room or to use

21 your hand.

22 Q. Has Terry ever turned her head toward you,

23 toward your presence during your ten-minute examinations

24 of her?

25 A. Not at me.






78

1 Q. Would it surprise you if she did?

2 A. Yes, it would.

3 Q. Now, does Terry require special nursing care?

4 A. Yes. I would say so.

5 Q. And have you given any instructions in that

6 regard?

7 A. Yes, she has instructions for her care.

8 Q. Have you given it?

9 A. Yes. It's called "orders." Physician's

10 orders of her care.

11 Q. What is the nature of her special nursing

12 requirements?

13 A. She has a feeding tube.

14 Q. And that requires special nursing care?

15 A. I suppose that someone could be trained to

16 give those feedings. A lay person could be trained in

17 the medical requirements of a feeding.

18 Q. A lay person could be trained to give what

19 feedings, the tube feedings?

20 A. Yes.

21 Q. Would a lay person be trained to spoon-feed

22 her?

23 A. That's not something that I would recommend.

24 Q. What presently is the state of Terry's

25 gynecological health?






79

1 A. It appears that she has regular menstrual

2 periods. Her last lab showed that the FSH was in the

3 range of normal for someone her age.

4 Q. What is that, the estrogen level?

5 A. Yes.

6 Q. What does the last pap smear show?

7 A. Last pap sheer was done prior to my evaluation

8 of her. Michael told me that in 1996, that she had her

9 last examination and that examination was normal.

10 Q. So she hasn't had a pap smear since 1996?

11 A. That's correct, in six years.

12 Q. What did her last mammogram show?

13 A. I don't know.

14 Q. Do you know if she ever had a mammogram?

15 A. Allow me to look at my report.

16 Q. Absolutely.

17 A. It may be indicated on there. My report

18 indicates that she's never had a mammogram.

19 Q. Does she have kidney stones?

20 A. Excuse me?

21 Q. Does she have kidney stones?

22 A. My report shows there is no history of kidney

23 stones.

24 Q. Have you checked for them?

25 A. Blood in the urine would be an indicator of






80

1 kidney stones. You would not routinely do the test for

2 kidney stones unless someone came down with symptoms or

3 blood in the urine.

4 Q. And you found no blood in the urine on this

5 last test?

6 A. I do not have the report of the urinalysis

7 with me, but there are occasions that blood is found in

8 the urine in small amounts, microscopic amounts,

9 associated with the catheterization process, that is a

10 tube in the bladder to collect the urine. That could be

11 also related to infection.

12 Q. Has she had her gallbladder removed?

13 A. According to my records, the gallbladder was

14 removed in 1994.

15 Q. Are their after-effects of the gallbladder

16 removal that you can detect?

17 A. Not that I'm aware of. She has had multiple

18 blood studies on liver function.

19 Q. Is that the albumin, this test?

20 A. Yes. The albumin is not necessarily, you

21 know, an indicator of liver problems.

22 Q. It's relating to liver function?

23 A. It could be related to many things in the

24 body.

25 Q. I think earlier you said it was related to






81

1 liver function.

2 A. I said that albumin is made by the liver. But

3 if you were to look for a test of liver function,

4 abnormality of albumin would be down on the list of

5 tests that you would look at to diagnosis a problem.

6 Q. So albumin is related to what other bodily

7 condition?

8 A. Malnutrition.

9 Q. Malnutrition. That's what you said. No other

10 thing?

11 A. No, there are other conditions that albumin

12 can relate to.

13 Q. What other conditions?

14 A. Overhydration. If someone were to drink

15 excessive amounts of water, that could affect the count.

16 It's a delusional effect, so to speak.

17 Q. What else, what other condition might explain

18 lower albumin?

19 A. If the body was making immunologic proteins

20 instead of -- there was a diversion of metabolism to

21 make inflammatory proteins, hemoglobins, that would take

22 away from the synthesis, that is the building of the

23 albumin. So in that case you would find the total

24 protein would be higher because there are total proteins

25 that the albumin would be lower in proportion.






82

1 Q. Do you believe that either of those conditions

2 would account for the lower albumin?

3 A. No, I don't.

4 Q. How acute is Terry's hearing?

5 A. I don't know.

6 Q. Do you know how acute her eyesight is?

7 A. She has no reaction to visual threat that I

8 could detect. What I'm doing is taking your hand and

9 putting it over someone's eyes, their reaction would be

10 to blink in response to that.

11 Q. Which eye did you cover, by the way?

12 A. I checked both eyes.

13 Q. I realize that you don't take the blood

14 pressure. But have you observed the nurse taking her

15 blood pressure?

16 A. No, I have not.

17 Q. Do you know, given the state of her

18 contractures, how they do it?

19 A. Yes. The nurse takes her blood pressure in

20 the leg because of the contractures.

21 Q. They put the cuff on the calf?

22 A. Yes.

23 Q. Is there any indication that Terry cannot have

24 a bowel movement?

25 A. Not that I'm aware of.






83

1 Q. To what extent have you relied on Mr. Schiavo

2 for her medical history?

3 A. I think that he has been a part of the medical

4 history. And the history that I obtained and the

5 information that I have given you here are pieces of

6 information that might assist me, along with the medical

7 records.

8 Q. So to the extent that you have information

9 that's not in the medical records, it comes from

10 Mr. Schiavo, pretty much?

11 A. Yes. I think the information outside the

12 medical record comes from Mr. Schiavo, yes.

13 Q. Have you ever interviewed the parents?

14 A. No, I have not.

15 Q. Have you ever met them at all?

16 A. Just to shake hands at one prior hearing, yes.

17 Q. Okay. Do you think Terry feels pain?

18 A. I think the word "feel" -- there is a reflex

19 action at the brain stem level which shows a response to

20 pain. But I don't think the "word" feel is the right

21 word.

22 Q. So she reacts to pain?

23 A. Yes, a physiologic brain stem reaction.

24 Similar to if you were to touch your finger to a hot

25 stove, you would pull your hand away before you realized






84

1 that you were burnt.

2 Q. So it would be sort of instantaneous. It's a

3 reflex?

4 A. It's a reflex, yes.

5 Q. If she appears to be in pain, then, for longer

6 than a second or two, would it be more accurate to say

7 that she is feeling pain?

8 A. I would not use the word "feel" for someone

9 without recognizable cognition. I don't think that's

10 the proper term.

11 Q. Do you order pain medication for Terry?

12 A. Yes, I do.

13 Q. Why, if she doesn't feel?

14 A. The nurses state that she moans from time to

15 time and this seems to be associated with her menstrual

16 period. They asked me to prescribe medication for her

17 menstrual period pain.

18 Q. To relieve pain?

19 A. Yes.

20 Q. But it's not for their benefit, is it?

21 A. It's to their benefit and for Terry's benefit.

22 Q. How is it for the nurses' benefit to medicate

23 Terry for pain; so they don't have to listen to her

24 moan?

25 A. I think that's a good answer.






85

1 Q. Now, that little summary that you used that

2 the brain will protect her hand from being burned on a

3 hot stove by causing you to jerk it away before it even

4 registers --

5 A. Yes.

6 Q. -- that it's hot.

7 A. Right.

8 Q. So that would indicate a very instantaneous

9 pain reaction pain reflex, right?

10 A. Yes. I think we are talking about many

11 reflexes that occur. In light of the reflexes, I just

12 described one of those reflexes to give you an idea of

13 something in your own world how you can relate to a

14 spinal reflex or some reflex that's lower than your

15 actual willful movement. That's all my remark was.

16 Q. It's not a precise analogy, is what you're

17 saying?

18 A. No, it's not a precise analogy. And I think

19 we have many other experts who we know in this area that

20 maybe could delve into that further.

21 Q. So if it were proven to your satisfaction that

22 she has a cognizant awareness of her environment, you

23 would be more comfortable saying Terry feels pain?

24 A. Yes.

25 Q. Have you ever witnessed her moaning, appearing






86

1 to moan in pain?

2 A. No, I have not.

3 Q. Has she ever made any sounds in your presence?

4 A. I do not recall her making any sounds.

5 Q. Would you say that Terry has lived longer than

6 might otherwise be expected given her condition?

7 A. No.

8 Q. Do you have patients who live longer?

9 A. No.

10 Q. Can you reconcile those two answers for me?

11 A. Yes.

12 Q. Would you do it?

13 A. Yes. I guess she is otherwise a physically

14 healthy woman who receives very good care. And it

15 wouldn't surprise me that she has been medically stable

16 up until this period of time.

17 Q. So barring removal of the feeding tube, she

18 could be expected to be to live on, right?

19 A. Yes.

20 Q. Have you ever had a patient just give up the

21 will to live and die?

22 A. Yes.

23 Q. Do you think if Terry had given up her will to

24 live, she would be dead right now?

25 MR. FELOS: Your Honor, I want to object.






87

1 That's supposing that she does have an expressive

2 will, which is what we are here to determine.

3 MS. ANDERSON: He can express his opinion on

4 it.

5 THE COURT: I will allow him to answer the

6 question.

7 THE WITNESS: Could you repeat the question,

8 please?

9 BY MS. ANDERSON:

10 Q. Sure. If Terry had lost her will to live, do

11 you think she would be dead now?

12 A. I don't know.

13 Q. You're not sure?

14 A. I really didn't know her as the person she

15 once was.

16 Q. Well, the will to live is a documented medical

17 phenomenon, is not it?

18 A. A living will, did you say?

19 Q. The will to live, desire to survive.

20 A. Yes, it is.

21 Q. You have probably encountered it a fair amount

22 in your practice, have you not?

23 A. Yes, I have.

24 Q. When patients give up the will to live, what

25 do they do? How can you tell it's their position?





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___________________________________________________
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Terri Schiavo Trial Transcript October 11-22, 2002

pages 1-87
IN THE CIRCUIT COURT OF THE
SIXTH JUDICIAL CIRCUIT IN AND FOR
PINELLAS COUNTY, FLORIDA
PROBATE DIVISION


IN RE: THE GUARDIANSHIP OF File No.90-2908-
GD-003
THERESA MARIE SCHIAVO,
Incapacitated. APPEAL
___________________________________// VOLUME I

MICHAEL SCHIAVO, as Guardian of the
person of THERESA MARIE SCHIAVO,

Petitioner/Appellee,

vs.

ROBERT SCHINDLER and MARY SCHINDLER,

Respondents/Appellants.
________________________________________________//


BEFORE: The Honorable GEORGE W. GREER

PLACE: Pinellas County Courthouse
315 Court Street North
Clearwater, Florida

DATE: October 11, 2002

TIME: All day

REPORTED BY: TONYA H. MAGEE, RPR
Court Reporter and Notary
Public
Sixth Judicial Circuit

___________________________________________

HEARING
___________________________________________

Pages 1 - 143

ROBERT A. DEMPSTER & ASSOCIATES
OFFICIAL COURT REPORTERS
P.O. BOX 35
CLEARWATER, FLORIDA 34618-0035
(727) 443-0992






A P P E A R A N C E S:



GEORGE J. FELOS, ESQUIRE
595 Main Street
Dunedin, Florida 34698

Attorney for the Petitioner/Appellee.





PATRICIA FIELDS ANDERSON, ESQUIRE
447 Third Avenue North, Suite 405
St. Petersburg, Florida 33701

Attorney for the Respondents/Appellants.







3
1 P R O C E E D I N G S

2 THE COURT: Morning everyone.

3 MS. ANDERSON: Morning, Your Honor.

4 THE COURT: We're here in the matter of

5 Teresa Marie Schiavo, 90-2908GD. We are here at

6 the direction of the Second District Court of

7 Appeals in its opinion handed down October 17,

8 2001.

9 Is the guardian ready to proceed?

10 MR. FELOS: Yes, we are, Your Honor. And

11 before the proceedings this morning, we had

12 scheduled on the Court's calendar a motion to

13 quash.

14 THE COURT: I understand that. Is Mr. and

15 Mrs. Schindler ready to proceed?

16 MS. ANDERSON: Indeed they are.

17 THE COURT: Mr. Felos, you filed a Motion to

18 Quash Subpoena of Mr. Schiavo?

19 MR. FELOS: Yes, Your Honor.

20 THE COURT: You faxed over a copy of that.

21 Here you are.

22 MR. FELOS: If it please the Court, both the

23 mandates of the Second District Court of Appeals

24 and this Court's case -- specifically this Court's

25 Case Management Order of February 25, 2002 and






4

1 Conference Order issued October 1 as a result of

2 our prehearing conference in August, all

3 contemplate and direct that the appointed have a

4 hearing limited in scope, in scope of witnesses to

5 the five doctors, two selected by each side and one

6 select by the Court, in lieu of the parties's

7 agreement. Which -- the court did have a

8 prehearing conference at the discretion of

9 Dr. Gambone to testify today.

10 Your Honor, this is not a retrial. It's a

11 rehearing on specific issues. This motion really

12 not only deals with Mr. Schiavo's testimony as

13 requested by the respondents, but I'm also informed

14 this morning that there are other witnesses,

15 specifically patients of Dr. Hammesfahr and another

16 physician which the respondents intend on calling.

17 It's our position that this hearing is limited

18 to five physicians and Dr. Gambone's testimony

19 today. The Second District, in its mandate, said

20 the Motion for Relief from Judgment alleges

21 evidence of a new treatment that could dramatically

22 improve Mrs. Schiavo's condition and allow her to

23 have cognitive function to the level of speech.

24 And they cited an affidavit of Dr. Webber and went

25 on to state "the Schindlers will need to support






5

1 similar evidence at the hearing to support their

2 claim for relief from the judgment." The Second

3 District said specifically "to control the scope of

4 the hearing, we're going to have the testimony of

5 these five selected doctors."

6 Your Honor, we've had this -- we've had these

7 proceedings back on remand for approximately a year

8 now from our -- from the first case management

9 order and the Court has scheduled a day of

10 testimony for each of the doctors. The Court

11 specifically ordered that at the conclusion of the

12 doctor's testimony we are going to have final

13 argument. It was not the intent of this Court, nor

14 is it the mandate of the Second District Court of

15 Appeal that this turn into an extended -- or more

16 extended proceeding.

17 If we are going to have additional witnesses,

18 Your Honor, I can call patients of Dr. Hammesfahr

19 who says this treatment is no good. I can call

20 witnesses -- I can call the Hospice staff who have

21 taken care of Terry the last two years. But that's

22 beyond the scope of this hearing.

23 And the Second District also said that after

24 you hear -- after the evidentiary hearing on the

25 question of is there new treatment that can help






6

1 her, after that evidentiary hearing is settled, the

2 Court has a number of options; it could affirm its

3 prior decision or it may then set a new trial. If

4 the Court finds this initial question is proved by

5 the respondents so the Court concludes there is

6 treatment available, then the Court might set it

7 for a new trial.

8 So I'd think it's extremely late in the game

9 here to say that -- it's against the rules set by

10 this Court and the Second District to say now we're

11 going to open this up open in this proceeding and

12 call all of the witnesses we would like. I don't

13 think that is what was intent of the order. So we

14 would ask that not only that the subpoena directed

15 to the petitioner be quashed, but the Court

16 reaffirm that the witnesses be limited to those

17 mentioned by the Court.

18 THE COURT: Thank you, Mr. Felos.

19 Ms. Anderson.

20 MS. ANDERSON: Morning, Your Honor, I have put

21 an exhibit book, it has copies of the exhibits and

22 exhibit lists for your convenience.

23 THE COURT: I did not move it there for any

24 other reason that just gave it away from blind

25 sight.






7

1 MS. ANDERSON: Your Honor, the Second District

2 is interested in her current medical condition. I

3 have a few questions for Mr. Schiavo related to

4 her current medical condition. That's all that I

5 want to show.

6 He has testified that he is responsible for

7 making all of her care decisions. And nowhere in

8 the Second District's opinion does it say you can't

9 call other witnesses that relate to these issues

10 they want to know about. They specifically say

11 one, two, three, four. That's all.

12 I'm not going into the whole rigmarole about

13 this marriage. I just have some questions that

14 relate to this number one issue, the current

15 medical condition. Also, Judge --

16 THE COURT: What can he add to what

17 Dr. Gambone would say?

18 MS. ANDERSON: He makes medical decisions for

19 her. He communicates with Hospice. My guess is

20 that Dr. Gambone is not aware of that. That would

21 help explain her condition. It would flush out the

22 picture of what her current medical condition is,

23 how we got to where we are.

24 THE COURT: Well, the reason the Court added

25 Dr. Gambone was for the very purpose of






8

1 establishing the current medical condition. I do

2 not want to get into a bunch of lay testimony and I

3 am not going to about her condition. The mandate

4 of the Second District speaks of taking the

5 testimony of the five doctors and limited

6 discovery. Limited hearing, that's their word, to

7 assess these things. And I think the doctors can

8 certainly tell me what her current medical

9 condition is.

10 Your doctors -- not your doctors. The doctors

11 you have selected, I know, have examined her. I

12 don't know for sure if the others have. And

13 Dr. Gambone has examined her. I think that's the

14 relevant testimony regarding her current medical

15 condition.

16 MS. ANDERSON: He has, Your Honor. And I'm

17 telling you. I will make a proffer, if you want.

18 But I am telling you that there is only some

19 information that Michael Schiavo knows about her

20 current medical condition. Don't prejudge this

21 issue, Judge. I am not going off the reservations

22 with my questions today.

23 THE COURT: But he has no more of that kind of

24 evidence than every nurse or every caseworker

25 that's ever seen her. If I open the door there,






9

1 the door is wide open for everybody that's ever

2 been in her hospital or Hospice room.

3 MS. ANDERSON: He is in charge of her medical

4 condition.

5 THE COURT: I am well aware of that.

6 MS. ANDERSON: There is nobody else who can

7 say that, not even Dr. Gambone. I am raising that

8 Dr. Gambone will prove that Mr. Schiavo controls

9 her medical condition. Now, there is going to be a

10 big gapping hole in this record if we don't have

11 his testimony.

12 THE COURT: The issue the Second District has

13 framed for this Court to consider is this, quote,

14 "new treatment" set forth in the affidavits. I am

15 going to reserve ruling on this motion.

16 If something develops after the testimony of

17 Dr. Gambone and after the testimony of your

18 physicians, I'll reconsider whether or not to let

19 Mr. Schiavo testify. But my previous position

20 based upon prior ruling is that I am going to hear

21 from six medical experts and I am going to hear

22 some excellent closing arguments. And I am going

23 to decide, based upon all of that, what the Second

24 District Court of Appeal left for me to decide.

25 So I'm going to take your motion, Mr. Felos,






10

1 under advisement, but I am not going to let

2 Mr. Schiavo testify until I have heard from the

3 first three medical doctors, anyway, just to see if

4 there is some efficacy to your statement that there

5 is a gapping hole.

6 MS. ANDERSON: Until the first three

7 physicians have testified; is that what you said?

8 THE COURT: Yes, ma'am.

9 MS. ANDERSON: So it would not be until next

10 week, is what you're saying?

11 THE COURT: Right.

12 MS. ANDERSON: Judge, can you point me to a

13 previous order? You said nobody other than these

14 three physicians can testify.

15 THE COURT: No. I don't recall an order like

16 that. We certainly discussed this. I said one

17 doctor per day. That's been set up. And we will

18 go until the doctor finishes and then we will

19 adjourn.

20 MS. ANDERSON: I don't that recall being put

21 into an order or that we ever even discussed that.

22 THE COURT: I will tell when you we

23 specifically discussed that is when Mr. Felos

24 wanted me to limit your examination of

25 Dr. Hammesfahr because he thought it might run






11

1 over.

2 MS. ANDERSON: Judge, I'm sorry. We haven't

3 discussed initial limiting this hearing only to

4 physicians. We talked about timing.

5 THE COURT: Well, I can't point you to book

6 and page, but I am satisfied it was discussed. If

7 push comes to shove, I guess we can transcribe

8 every hearing we have had in the last year and take

9 a look at it. But clearly, this hearing was set

10 forth to have one witness per day, i.e., a

11 physician.

12 We spoke about having your two physicians

13 testify first, then we turn to the other three.

14 Now, that, clearly to me, anyway -- if it was

15 unclear to you, I apologize you. But clearly, to

16 me it tells me you have two witnesses and three

17 other witnesses.

18 MS. ANDERSON: Actually, when you spoke to me,

19 you told me that my case in chief is today -- or is

20 Monday and Tuesday?

21 THE COURT: Yes, ma'am.

22 MS. ANDERSON: And that I can use that time to

23 best advance my client's cause as I see fit, which

24 includes the testimony of Dr. Hammesfahr and

25 Maxfield. I did not read anything that you have






12

1 ever said in this case or written to limit the

2 witnesses.

3 THE COURT: Well, I just don't see -- I don't

4 see how lay people can talk to me about this new

5 treatment. That is the medical issue and I need

6 medical experts to tell me about this, quote, new

7 treatment, closed quote. That's why we're here.

8 That's why the Second District directed that we be

9 here.

10 MS. ANDERSON: I thought it was about her

11 current medical condition and that's what I want

12 the testimony today to go to, but I understand your

13 ruling.

14 THE COURT: Well, I want to hear from not less

15 than three doctors who will tell me about her

16 current medical condition. And I can't imagine how

17 a lay person is going to add to that body of

18 knowledge.

19 Mr. Felos.

20 MR. FELOS: Your Honor, I thought the Court

21 already made a ruling. And if we are going to have

22 a debate here, then I want to participate, as well.

23 I think the appellate court was abundantly clear

24 about this type of proceeding. "The trial court

25 shall exercise its own judgment and discretion






13

1 concerning the resolution of any such motion." I

2 think the Court has made it abundantly clear in its

3 discussions with counsel in the comment that we

4 were having a hearing, and I don't think there is

5 any knowledge that's what the parties intended.

6 THE COURT: Well, I ruled on your motion and

7 we are just going to sit on it for a few days to

8 see if something develops, in fairness to

9 Ms. Anderson's clients, that we need to modify

10 that. But my understanding of why we are here and

11 how we're going to get the evidence before the

12 Court is that it will be done with six doctors

13 only, but I can change my mind, certainly, if

14 something develops.

15 MS. ANDERSON: Judge, will you continue

16 Mr. Schiavo's subpoena that I served on him

17 contingent upon your ultimate disposition of the

18 Motion to Quash.

19 THE COURT: I have taken the Motion to Quash

20 under advisement, so I haven't ruled on the Motion

21 to Quash. So if you have good service, you have

22 good service.

23 MS. ANDERSON: Very good. Thank you.

24 THE COURT: All right. Does either side

25 desire an opening statement?






14

1 MS. ANDERSON: Yes, I do, Your Honor.

2 THE COURT: Okay. Briefly.

3 MS. ANDERSON: Briefly. Would you like me to

4 proceed first?

5 THE COURT: Yes, please. I think we agreed

6 that it was your burden, so you would go first.

7 MS. ANDERSON: Judge, last month or the month

8 before, during a hearing, you told me that

9 Terry Schiavo wanted to die and that's what this

10 was about. But, in fact, I disagree with you. If

11 Terry wanted to die, she would already been be

12 dead. Common sense tells you that. She's 13 years

13 out.

14 The Second District has remanded the case

15 twice. The reason they remanded it is that they

16 have great concerns that her life is about to be

17 ended under circumstances that are not permitted by

18 Florida law. In the case of Christian versus

19 McGiever, the Florida Supreme Court has rejected

20 the position that is advanced now by Mr. Schiavo.

21 They rejected the position of suicide in a case

22 where the patient was fully competent and wanted to

23 choose the date of his death at some point in the

24 future because he was in too much pain and would

25 not want to live.






15

1 The court, after McGiever and Brownley came

2 down on the sideline and said, "We cannot permit

3 the physician-assisted suicide any more than we can

4 permit suicide." So Terry's wishes, if they reject

5 a competent person's wishes in the case of an

6 express desire to die, if that's not an overriding

7 consideration, then it cannot be in the case where

8 she have no advanced record. You have to focus on

9 what is her medical condition because the statute

10 has certain safeguards built in.

11 In order to end her life under these

12 circumstances, 765.305 says, "She must be in a

13 persistent vegetative state or terminal or an end

14 stage." You must have had the determination before

15 you even consider the issue of her wishes. So

16 that's why the Second District sent it back;

17 otherwise, people would say kill me please or I am

18 going to commit suicide. It runs against public

19 policy in Florida.

20 The overriding issue is not what Terry wants.

21 The preliminary issue, the first issue is does

22 Terry meet the statutory condition precedent to

23 even get to the point where you can look at that.

24 And that's where we are, that's why we're focusing

25 on these medical issues.






16

1 Terry has the right to reject the feeding tube

2 and that's why the Second District sent it back.

3 If she can regain sufficient cognitive ability to

4 tell us what she wants, then that comes into play.

5 But, only after we determine what her medical

6 condition is.

7 You have also said in the first, very first

8 hearing back in January after the remand of this

9 case, first or second, that we were not one to

10 relitigate the issue of PVS. You're quite right.

11 We are not going to talk about what condition she

12 was in in January of 2000 when you first heard

13 evidence. We are litigating what her current

14 medical condition is. That was then. This is
now.

15 So, Judge, that's why the Second District

16 has spoken. That's why they listed this as the

17 number one thing that they want to know about:

18 What is her current medical condition. We are not

19 relitigating her condition from two years ago. If

20 you look at Page 647 of the opinion where they list

21 their four items they're going to focus on, you'll

22 see that the number one item is what is her current

23 medical condition.

24 Now, during the course of this hearing you are

25 going to see and hear some remarkable evidence that






17

1 you have never been exposed to before. And I hope

2 that you can bring an open mind to it and an open

3 mind to this question of what is her current

4 medical condition, is there new treatment

5 available, will it work for her within any sort of

6 reasonable degree of medical probability. You

7 didn't hear before what you are going to hear in

8 this hearing, and that's why we're focusing on what

9 her current medical condition is.

10 I know that I can expect that you will

11 approach this with a fair and impartial mind

12 because, after all, this is a life or death case.

13 Feelings run high about this case. This case

14 represents a profound debate about the rights of

15 handicapped people in America.

16 I hope, Judge, that you can listen to this new

17 evidence. I hope that you can set aside any

18 preconceived notions that stem from the prior trial

19 two and a half years ago because we're here to

20 focus on today and tomorrow, not yesterday.

21 Thank you, Judge.

22 THE COURT: Thank you.

23 Mr. Felos, do you wish an opening statement?

24 MR. FELOS: Yes, Your Honor.

25 Your Honor, the case we had and the trial we






18

1 had in January of 2000 was a case of life and death

2 which was affirmed through the appellate court

3 system and which judgment still stands. What we

4 are here this week to do is to dispel the lingering

5 doubt that the Second DCA expressed in its opinion.

6 In Schiavo III, even they said, in their words,

7 they expressed scepticism over the claims raised by

8 the Respondents' physicians.

9 This is not a case to change the law in

10 Florida or profound debate on the law in Florida.

11 The law in Florida is settled. It was settled in

12 the Brownley case in 1990 that says that "competent

13 Floridians, as a part of their liberty, interest,

14 and control of their own body, has the right to

15 refuse unwanted medical treatment. And if they

16 have the treatment, they have the right to

17 discontinue it and that it's irrespective of their

18 medical condition or their prognosis or their type

19 of treatment."

20 If somebody can't communicate that decision

21 for themselves, then a close family member, friend,

22 or guardian may make the decision based upon clear

23 and convincing evidence. And this Court has

24 already found clear and convincing evidence. It's

25 been upheld on appeal, so that's not an issue in






19

1 this proceeding.

2 This is obviously not the case of statutory or

3 legal authority to remove life support. That's

4 been settled. The Second District has found that

5 Terry Schiavo was in terminal condition pursuant to

6 Florida statute. This proceeding is about whether

7 the fantastic claims of the parents' physician, to

8 which the Second District has already expressed

9 scepticism, have merit. And that's a burden which

10 the respondents will have to prove in this case and

11 they will be unable to meet.

12 Just briefly on the evidence, Your Honor.

13 One, obviously, would be the testimony of five

14 expert physicians in this case. Credibility -- and

15 just -- this is not a hearing of numbers, but the

16 evidence will show the physicians selected by the

17 guardian and the independent physicians selected by

18 the court all conclude that Terry Schiavo is in a

19 persistent vegetative state and there is no

20 treatment that can help her recover. But it's not

21 just a matter of a quantity, it's quality of

22 evidence that I think is even more persuasive
here.

23 Who are these physicians that are going to be

24 testifying before the court? The physicians are

25 part of the -- the physicians on the part of the






20

1 husband are affiliated with major universities.

2 Dr. Cranford, a professor of neurology at the

3 University of Minnesota. Dr. Greer, the former

4 head of the Department of Neurology up at Shans

5 Hospital for over 20 years. Well respected, well

6 offered physicians, as is Dr. Bambakids. The

7 physicians select by the parents don't even have

8 hospital privileges, let alone affiliations with

9 universities of this type.

10 Another piece of evidence, Your Honor, would

11 be medical testing, new medical testing ordered by

12 this Court. A new CT scan, which confirms what

13 this Court already concluded two years ago, there

14 is a small lump of brain cells still remaining in

15 the cerebral hemispheres, two EEGs with no evidence

16 of cerebral activity, flat, a spec scan that

17 shows -- severely abnormal spec scan that shows

18 reduced levels of activity in the brain, which you

19 would expect.

20 Also, we are going to see in this hearing, I

21 gather, approximately four hours of videotapes from

22 examinations of Terry Schiavo. And that, Your

23 Honor, I think deserves special mention. We

24 contend that those videotapes will show a patient

25 that you would expect to see in a persistent






21

1 vegetative state. Those tapes will show a patient

2 that at moments and occasions has reflex actions to

3 painful stimuli, that has a primitive auditory and

4 visual reflex but shows no cognitive ability.

5 I think it's extremely important to note --

6 and I make these comments in a broader sense

7 because the appellate court certainly said, "these

8 open proceedings are essential to the issue of

9 public understanding of this process", and the

10 public should have access to these videos and with

11 that comes responsibilities.

12 There are certain physical movements that

13 Terry Schiavo has. She opens her eyes. She closes

14 her eyes. She blinks her eyes. Now, these tapes

15 will show numerous attempts to have her do those,

16 "open your eyes, Terry. Close your eyes, Terry.

17 Blink your eyes, Terry." Now, there may be on

18 these four hours of videotape -- sooner or later a

19 command is going to correspond with a random

20 action, so there may be a time when someone says,

21 "Terry, blink your eyes," and her eyes blink. And

22 if the media broadcasts that ten second segment out

23 of context --

24 MS. ANDERSON: Your Honor, Mr. Felos has

25 strayed into closing argument, actually.






22

1 MR. FELOS: Your Honor, I am almost concluded.

2 THE COURT: Okay. Thank you.

3 MR. FELOS: So in viewing -- as the court

4 views these tapes and the public views these tapes

5 as they are, Your Honor, it's important when you

6 see something, to also take into account what you

7 are not seeing at that moment. I think that this

8 court, as you peruse these videotapes very

9 carefully and hears testimony, will be convinced at

10 the end of this hearing that Terry Schiavo is in a

11 vegetative state and also that these treatments

12 will not possibly help her.

13 THE COURT: Thank you. With respect to the

14 later point Mr. Felos mentioned, the only

15 constraint this Court has placed upon the media is

16 that the filming of those videos may only be

17 utilized in the ordinary dispensing of the news.

18 The Court is certainly not going to tell the news

19 or media what portions of those tapes they should

20 or should not use. They are the pros at it and

21 they will do what they think they need to do.

22 Okay. Are we ready for Dr. Gambone?

23 MR. FELOS: Yes, Your Honor. At the Court's

24 instruction, I call Dr. Gambone.

25 THE COURT: Thank you. Solemnly swear this

23

1 testimony you are going to give in this cause will

2 be the truth, the whole truth, and nothing but the

3 truth so help you God?

4 THE WITNESS: Yes, I do.

5 THE COURT: Thank you, Doctor. Have a seat,

6 please. Doctor, if you need water, just ask the

7 bailiff. It's available right here.

8 DIRECT EXAMINATION

9 BY MR. FELOS:

10 Q. Morning, Dr. Gambone.

11 A. Good morning.

12 Q. Could you state your name and profession for

13 the record?

14 A. Victor Gambone. I am a physician practicing

15 in the state of Florida. My specialty is internal

16 medicine and geriatric medicine.

17 Q. Doctor, are you board certified in any of

18 those fields?

19 A. Yes. I am board certified in internal

20 medicine and geriatric medicine.

21 Q. And how long have you been licensed to

22 practice medicine in Florida?

23 A. Since 1976.

24 Q. And, sir, you are the primary treating

25 physician for Teresa Schiavo?






24

1 A. Yes, I am.

2 Q. Approximately how long have you acted in that

3 capacity?

4 A. Since 1978.

5 Q. Dr. Gambone --

6 THE COURT: What year did you say?

7 THE WITNESS: Excuse me. 1998.

8 THE COURT: Thank you.

9 BY MR. FELOS:

10 Q. Dr. Gambone, you were ordered by the court to

11 perform a comprehensive medical evaluation of

12 Teresa Schiavo earlier this year. Did you perform such

13 a medical evaluation?

14 A. Yes, I did.

15 Q. And approximately when did you do that?

16 A. That was in April.

17 Q. Of 2002?

18 A. Yes.

19 Q. I would like to show you what's been marked as

20 Petitioner's Exhibit 1 for identification at this time

21 and ask you if you can identify it?

22 A. Yes. It's a copy of the examination that I

23 made on April the 9th of this year.

24 Q. And in conjunction with that examination, did

25 you order any tests to be performed?






25

1 A. Yes, I did. I ordered tests.

2 Q. What type of tests are those?

3 A. These tests were blood tests of the blood

4 chemistries, the hematologic evaluation, blood counts,

5 and also tests of the urine.

6 Q. Now, Dr. Gambone, pursuant to the court's

7 order of, I believe, a week or so ago, did you order any

8 further blood work?

9 A. Yes. Recently, I did repeat additional blood

10 tests.

11 Q. Were there any added tests on your most recent

12 blood work that were not done the first time?

13 A. Yes. At the court's request, they included

14 some tests of the hormone functions.

15 Q. That would be in connection with the blood

16 screen?

17 A. That's correct.

18 Q. Dr. Gambone, I would like to show you

19 Petitioner's Exhibit 2, which has been marked for

20 identification purposes. And, please, tell me if you

21 recognize that.

22 A. Yes. These are the blood tests which were

23 performed on October the 3rd on Terry Schiavo.

24 Q. Okay. Dr. Gambone, first, can you describe to

25 the court, please, the procedure that you followed in






26

1 conducting your medical examination back in October --

2 excuse me, back in April of this year.

3 A. Yes. The examination consisted of a review of

4 the medical record since my prior examination, a

5 discussion with the nursing staff and review of their

6 notes on Terry's condition, and a physical examination.

7 Q. And, please, describe your physical

8 examination of Terry.

9 A. The physical examination was performed,

10 including examination of the skin, body ordinances,

11 organs, the heart and lungs. It's the usual examination

12 that one would do.

13 Q. Okay. All right. And on the basis of the --

14 well, let's move to the blood tests, as well, that were

15 taken back in April. Was there anything unusual or out

16 of the ordinary in the blood work performed back in

17 April?

18 A. No, there was nothing abnormal.

19 Q. And how about in the urine screen?

20 A. Yes. There were some bacteria in the urine

21 specimen.

22 Q. Okay. And what did that indicate to you,

23 Doctor?

24 A. Terry has had a history of urinary tract

25 infections. And this is something which one might






27

1 expect with someone in her condition, not able to care

2 for herself and move bowels and urinate in the normal

3 manner. She is more susceptible to such infections than

4 the normal person. The bacteria come from fecal

5 material, which they can spread into the bladder. And

6 that's how this occurs.

7 Q. Now, you mentioned that there was bacteria

8 found in her urine. Were you able to conclude whether

9 she had a urinary tract infection?

10 A. Yes. Because of bacteria on the skin, which

11 can get into the bladder, we often find someone in this

12 condition will have bacteria in the bladder. If the

13 bacteria invades the bladder tissue, it would cause

14 infection.

15 Q. So you could have bacteria in the urine

16 without an infection; is that correct?

17 A. That's correct. We use the term

18 "colonization" to describe that condition as opposed to

19 infection.

20 Q. How do you tell the difference between a

21 colonization or an infection in a patient?

22 A. In general, white cells or puss cells, if I

23 might use that vernacular, are cells that are found in

24 the urine specimens in large numbers in nursing home

25 patients.






28

1 Q. And are white cells something that would show

2 up on a blood screening?

3 A. The test of the urine, I'm speaking of the

4 blood cells in the urine, we find numerous white cells.

5 Q. Was there an elevated white blood cell count

6 in Terry's urine?

7 A. In examination in April, there was not an

8 elevated count. But more recently, she did have an

9 infection that we treated.

10 Q. I want to say, first of all, to the April

11 examination, based upon the -- did you form an opinion

12 as to whether or not Terry had an infection or

13 colonization back in April?

14 A. My opinion was that she had a colonization at

15 that time.

16 Q. By the way, you mentioned that Terry, in the

17 past, has had urinary tract infections. Have they been

18 associated with elevated white blood cell counts?

19 A. Elevated white blood cell counts. You know, I

20 would have to review the record to come to that

21 conclusion.

22 Q. Okay. What, if anything, did do you in

23 response to your conclusion that she had a colonization?

24 A. I went ahead and treated her with a short

25 course of mild antibiotic to eradicate the bacteria from






29

1 the urine.

2 Q. Now, Dr. Gambone, as a result of your

3 examination in April of this year, did you find that

4 Terry's physical condition had appreciably changed since

5 1998 when you started treating her?

6 A. No. There was no absolutely no change in her

7 condition in my examination.

8 Q. Now, in the -- as a result of your April

9 examination and the testing that you did, did you find

10 any evidence of heart problems with Terry?

11 A. No, I did not.

12 Q. Did you -- other than the colonization of

13 urine, did you find any other neurological problems?

14 A. No, I did not.

15 Q. Any sinus problems?

16 A. No.

17 Q. Any problems with her ears?

18 A. There was a buildup of wax in the ear.

19 Q. Was that an extraordinary buildup of the ear

20 wax?

21 A. No. Something that would you expect to

22 find --

23 Q. You have to speak up a little bit.

24 A. Yes. That would be an everyday finding upon

25 examining.


30

1 Q. Did you -- I gather you listened to her lungs.

2 A. Yes, I did.

3 Q. Did you use a stethoscope?

4 A. Yes.

5 Q. Did you notice any pulmonary abnormalities?

6 A. No, I did not.

7 Q. Now, did you notice -- as a result of your

8 examination and testing, were there any problems you

9 noticed with Terry's liver, liver function?

10 A. No. There were no abnormalities there.

11 Q. With her kidneys?

12 A. No.

13 Q. With her bladder?

14 A. No.

15 Q. Other than the colonization you were talking

16 about.

17 A. That's correct.

18 Q. Now, in your -- I would like to bring you to

19 the blood testing that was recently done.

20 First, let's take the specific question about

21 the endocrine blood screening. What hormones did you

22 request be tested?

23 A. The testing included tests of the pituitary

24 hormone. The pituitary gland is a natural gland in the

25 brain. This mic is bad.


31

1 THE COURT: It's better than it used to be.

2 Court administration has done a great job with this

3 PA system.

4 THE WITNESS: I did a thyroid blood test, the

5 pituitary gland. I checked the thyroid stimulated

6 hormone, and also the volatile stimulated hormone,

7 which is the hormone important in illiciting

8 production of estrogen by the ovaries. It's an

9 important test of her normal menstrual function.

10 BY MR. FELOS:

11 Q. Any other hormones?

12 A. Yes. I tested the cortisol, this is a hormone

13 made by the adrenal gland, and also aldosterone, a

14 hormone made by the adrenal glands which is important in

15 the regulation of blood cells.

16 Q. Did you find -- what were the results,

17 Dr. Gambone, of the blood screening for these hormones?

18 A. All of these tests were within the normal

19 range.

20 Q. Okay. Regarding the balance of the testing,

21 of the recent blood testing, did you find anything out

22 of the ordinary?

23 A. No, I didn't.

24 Q. Now, I did notice in the -- they have columns

25 in the blood tests for normal, abnormal. And there's






32

1 two, albumin and total protein, that appear in the

2 abnormal category. First of all, could you tell me what

3 those are and what those measure?

4 A. Yes. It's a measure of the protein found in

5 the blood. The protein in the blood would come from

6 albumin, from proteins that transport various chemicals

7 and hormones throughout body and also through the immune

8 system. Her total proteins were borderline low.

9 Q. And what significance, if any, did you give

10 that finding?

11 A. I didn't investigate it any further.

12 Q. Why not?

13 A. Because my feeling was that with her lack of

14 muscle mass, that she would not have as much protein in

15 the blood as someone who was --

16 Q. I believe -- excuse me?

17 A. The other concern when there is low protein is

18 their malnutrition situation. And her body weight has

19 been very stable and she has been receiving a formula

20 which has very high nutrition. We also checked other

21 vitamins, B12, Folic Acid. Those levels were extremely

22 high suggesting that it was not a situation of lack of

23 nutrition.

24 Q. You used the word "borderline." How close

25 were the blood protein results to the lower end of the






33

1 normal range?

2 A. The normal is 3.0 and her test was 2.9. And

3 the other test was 6.0 and she was a 5.8.

4 Q. What's the high range for those tests?

5 A. 5.0 on the albumin and 8.0 on the total

6 protein. And the results of the high protein could

7 indicate a chronic inflammatory state or a chronic

8 infection, so she was on the other end of the results.

9 Q. All right. Dr. Gambone, when is the -- let me

10 backtrack. You mentioned something about a subsequent

11 urinary tract infection that Terry had since April; is

12 that correct?

13 A. That's correct.

14 Q. When did that occur?

15 A. Within the past two weeks.

16 Q. And how was that addressed?

17 A. That was treated with an antibiotic. In this

18 case, a urinalysis revealed a large number of white

19 cells along with significant bacteria. So it was clear

20 there was infection.

21 Q. Okay. When is the last time you saw

22 Mrs. Schiavo, Dr. Gambone?

23 A. September 26 of this year.

24 Q. And what was the reason for that?

25 A. A routine visit. I had her on my schedule to






34

1 visit. I would like to see her every three to four

2 months.

3 Q. And did you notice any appreciable changes in

4 her physical condition as compared to your examination

5 in April?

6 A. No, I didn't see any.

7 Q. Since your examination in April, has Terry

8 been in the hospital?

9 A. Yes, she was in the hospital.

10 Q. What was she in the hospital for?

11 A. Her gastrostomy tube malfunctioned. The bulb,

12 which is an inflatable bulb that holds the tube in place

13 in the stomach, had ruptured, so the tube came out.

14 Q. I see. And she was hospitalized to repair

15 that?

16 A. Yes. Usually you can replace it at bedside,

17 but the nurses had some difficulty and we felt it would

18 be best to have her in the hospital setting.

19 Q. Is the tube becoming dislodged an uncommon

20 event when someone is tube fed?

21 A. Tube problems are wonderful to manage that we

22 have to deal with, so this could be a common occurrence.

23 MR. FELOS: I have no other questions, Your

24 Honor.

25 THE COURT: Thank you. Cross-examination?






35

1 MS. ANDERSON: Give me a moment, Your Honor.

2 THE COURT: Certainly.

3 CROSS-EXAMINATION

4 BY MS. ANDERSON:

5 Q. Dr. Gambone, I could not quite hear you when

6 you said you were board certified in internal medicine

7 and something else?

8 A. Geriatric medicine.

9 Q. And you said you see Terry about every four

10 months or so?

11 A. Yes.

12 Q. About how long do you spend when you see her?

13 A. Twenty minutes.

14 Q. What do you do in those 20-minute exams?

15 A. Review the medical record, discuss any ongoing

16 problems with the staff, including Hospice in this case,

17 and do a physical examination.

18 Q. You take her vital signs?

19 A. I have the nurses take vital signs. I do not

20 do it myself.

21 Q. You say that you spend 20 minutes with her.

22 Do you spend 20 minutes in her room examining her?

23 A. No, I wouldn't say 20 minutes examining her.

24 Q. You confer with the nurses and review her

25 prognosis?






36

1 A. That is correct.

2 Q. How much of the 20 minutes is actually spent

3 with your spending time with Terry in her room?

4 A. I would say half of that. Maybe ten minutes.

5 Q. Ten minutes?

6 A. Uh-huh.

7 Q. And you did that about every four months?

8 A. That's correct.

9 Q. Dr. Gambone, does -- you began being her

10 attending physician when she was still in the nursing

11 home, correct?

12 A. Yes.

13 Q. So you oversaw her movement to Hospice?

14 A. Yes.

15 Q. Now, does both the nursing home where she was

16 and Hospice keep medical records in the ordinary course

17 of business?

18 A. Yes, they do.

19 Q. Is it those records that you review when you

20 make the rounds?

21 A. Yes, they're the records that I review.

22 Q. Well, would you recognize those records if you

23 saw them?

24 A. Yes, I would.

25 Q. All right. Very good.






37

1 MS. ANDERSON: May I approach, Your Honor?

2 THE COURT: Yes, you can.

3 BY MS. ANDERSON:

4 Q. Dr. Gambone, I have handed you Composite

5 Exhibit 12 for identification and ask you to flip

6 through those briefly and tell me if you can recognize

7 those documents.

8 A. Yes. They are copies of records from

9 Terry Schiavo.

10 Q. And some of those records contain notations

11 that you, yourself, have signed, correct?

12 A. Yes, they do.

13 MS. ANDERSON: Your Honor, I would move

14 Respondents' Exhibit 12 into evidence at this time.

15 THE COURT: Any objection?

16 MR. FELOS: Your Honor, I just want to make

17 sure. If we're going to be introducing medical

18 records - we don't have a record custodian - that

19 there would be no objection to my introducing a

20 portion of medical records at a later time.

21 MS. ANDERSON: Well, Your Honor, that's why I

22 ask the foundation questions of Dr. Gambone. He

23 recognizes them and knows that they're business

24 records. That falls under the business record

25 exception of the hearsay rule.






38

1 MR. FELOS: Your Honor, he is not the records

2 custodian.

3 THE COURT: Is there any question as to the

4 legitimacy of these records, Mr. Felos?

5 MR. FELOS: Well, Your Honor, also, there are

6 hearsay matters in the records. I don't have an

7 objection to the introduction of a portion of the

8 medical records if we are afforded the same

9 opportunity.

10 MS. ANDERSON: Well, you see, I have taken the

11 opportunity to have Dr. Gambone answer the

12 foundation questions that are necessary to

13 establish a hearsay exception. Mr. Felos has not

14 done that in this case. I haven't seen what

15 medical records he wants to introduce. I'm not

16 saying I will stipulate to them. I don't think

17 it's an issue to be addressed in my case in chief.

18 I would like to ask my witness a question about

19 these medical records. We are taking care of a

20 housekeeping matters in the middle of the

21 examination of my witness.

22 THE COURT: This is not your witness, is it?

23 MR. FELOS: This is not your case in chief.

24 THE COURT: I'm going to allow them to come

25 in. They have been identified and they can be






39

1 identified by Mr. Felos.

2 MS. ANDERSON: You will allow Exhibit 12 to

3 come in, correct? You are accepting Exhibit 12

4 into evidence.

5 THE COURT: That's what I thought I said.

6 MS. ANDERSON: Very good.

7 THE COURT: Now, these are coming in on cross.

8 Is there technically -- is there an objection to

9 having them come in out of order, Mr. Felos?

10 MS. ANDERSON: Well, Judge. I can move them

11 into evidence. If you would like to withhold and

12 treat them as merely marked for identification, I

13 can move them in on Monday and it may be actually

14 more proper.

15 THE COURT: Well, I'm just trying to find out

16 if there is a problem. Is there problem with the

17 exhibits coming in, Mr. Felos?

18 MR. FELOS: No, Your Honor.

19 THE COURT: All right. They will be so

20 received as Exhibit Number 12. How are they

21 designated?

22 MS. ANDERSON: Respondents.

23 THE COURT: Respondents' Exhibit 12. That's

24 how they would be received.

25 MS. ANDERSON: Thank you, Your Honor.






40

1 (Whereupon, the documents referred to were

2 received in evidence as Respondents' Exhibit 12.)

3 BY MS. ANDERSON:

4 Q. Dr. Gambone, if you go through these records,

5 you will see that on each page there's what we call a

6 "bate stamp" number.

7 A. Yes. Yes, I see that.

8 Q. I may have some questions for you and refer

9 you to specific pages, and I will refer you to by

10 number. I also want to ask you, Dr. Gambone, your

11 opinion on some matters. And can we understand when you

12 express an opinion that's it's within a reasonable

13 degree of medical certainty?

14 A. Yes.

15 Q. Now, are you medical director at Hospice where

16 Terry is?

17 A. No, I am not.

18 Q. Do you have other patients at Hospice?

19 A. Not at this time.

20 Q. Have you had in the past?

21 A. Yes, I have.

22 Q. Are you a medical director at nursing homes in

23 the area?

24 A. Yes, I am.

25 Q. How many?






41

1 A. Five.

2 Q. Are you also responsible for the care of the

3 patients there?

4 A. I have patients under my care in those nursing

5 homes, yes.

6 Q. For which you are the attending physician?

7 A. That's correct.

8 Q. What is your patient load, all total, of

9 patients in the nursing home?

10 A. Two hundred and eighty two.

11 Q. Plus Terry at Hospice, are you including her?

12 A. Yes, I am including her.

13 Q. And you get around to see each one of them

14 about every four months or so?

15 A. Different patients have different levels of

16 medical needs and I would treat my schedule accordingly.

17 Q. And sometimes, as in Terry's case, people in

18 Hospice have called you about some question or another,

19 haven't they?

20 A. Yes.

21 Q. Have you given any special standing

22 instructions to Hospice nurses about how they are to

23 record their chart notes?

24 A. No, I have not.

25 Q. Do you know if Mr. Schiavo has?






42

1 A. No, I am not aware of any instructions for

2 Hospice notes.

3 Q. Have you ever attended a meeting at which this

4 topic was addressed?

5 A. No, I have not.

6 Q. Would it be unusual for only two nurses, for

7 example, to make entries on her Hospice chart?

8 A. I don't think I would be able to answer that

9 question.

10 Q. Whether or not it would be unusual?

11 A. Yes, I couldn't answer that question.

12 Q. When you go to see Terry and review the chart,

13 have you noticed that it seems to be the same two nurses

14 over and over again making chart entries?

15 A. If you brought it to my attention. You may be

16 correct.

17 Q. Are there nurses with whom you consult at

18 Hospice on a routine basis about Terry?

19 A. When I arrive, I ask for the nurse that is

20 caring for Terry and that's the nurse that I communicate

21 with. I'm sorry. I don't know their names, so I don't

22 remember who they were.

23 Q. So it may be a different person depending on

24 what time of day you arrive or shift you arrive?

25 A. And I have seen Terry during regular business






43

1 hours, so it would be the day nurse.

2 Q. The day nurse?

3 A. Yes.

4 Q. Incidentally, do you maintain an office

5 practice in addition to your nursing home practice?

6 A. I no longer have an office practice. I sold

7 my office practice in 1995.

8 Q. So a typical day for you consists of going to

9 nursing homes?

10 A. Yes. I am also employed as a medical director

11 with United Health Group, and that's 20 hours a week.

12 Q. Twenty hours a week?

13 A. Yes.

14 Q. In what facility are you assigned?

15 A. It's an administrative position. It's not a

16 facility.

17 Q. I see. So you have an administrative office

18 somewhere?

19 A. Yes, I do, in Tampa.

20 Q. In Tampa?

21 A. Yes.

22 Q. Give me the address.

23 A. 9009 Corporate Lake Drive, Suite 200, Tampa,

24 33614.

25 Q. And what's entailed in that position?






44

1 A. In that position, I work with nurse

2 practitioners in a demonstration project for the

3 center's Medicare and Medicaid services.

4 Q. So it, too, focuses on geriatric care?

5 A. Yes, long-term care.

6 Q. Now, is Terry your youngest patient?

7 A. No.

8 Q. Is she one of your youngest?

9 A. Yes, she is.

10 Q. Now, what kind of therapy have you ordered for

11 Terry, if any?

12 A. I don't believe that I have order any therapy

13 in the period of time that I have been taking care of

14 her.

15 Q. Have you ever suggested that she be evaluated

16 for therapy and have Mr. Schiavo overrule you?

17 A. No. There are periodic evaluations done in

18 the nursing home and at Hospice, and those evaluations

19 show she would not benefit. At least at Palm Gardens,

20 we could periodically evaluate Terry.

21 Q. Does Hospice have licensed therapists on the

22 staff?

23 A. They do, and I am not exactly sure of their

24 level of activity.

25 Q. Do you know whether a -- are we talking


Continued in PART 2




--
___________________________________________________
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Terri Schiavo Trial Transcript October 11, 2002

pages 172-250

172

1 A. Well, yes. You know, when we first started

2 dealing with this therapy, it was really an

3 anti-migraine medication. But we started having

4 patients, psychologists call us up and say within a

5 month of treatments, "what are you doing? These people

6 are getting better on the psychological tests."

7 We had a large amount of people return to work

8 in 90 days. We actually wrote a paper about that.

9 These were folks on Social Security disability between

10 one and ten years or so who returned to work within 90

11 days of starting vasodilators.

12 But not all -- they weren't necessarily

13 normal. They were returning to work off of Social

14 Security, but not normal for the most part. What that

15 means is that there is still injury, although, there is

16 also return of function, too.

17 Q. And they were not normal in the sense that

18 they had to continue with these medications?

19 A. No, they weren't normal in that they weren't

20 always normal. They were not back to their preinjury

21 baseline. They were -- you know, you don't always have

22 a psychological test or a physical exam on a patient

23 before an injury. But you can figure out pretty much

24 what they were on the basis of standardized school test

25 scores and as well as other standardized things we all






173

1 go through everyday. So you get an idea of what these

2 folks did to return to that level. But they did return

3 well enough where they were able to go back and hold

4 jobs.

5 So what that means is that there is a number

6 in those patients, a number where there is still injury

7 but also a reversible area where improvement can be

8 obtained.

9 Q. Did your findings lead you to believe that the

10 reversible area was larger than was previously

11 suspected?

12 A. Well, it was suspected there was no reversible

13 area. What was remarkable about this was several

14 things. I was at the Medical College of Virginia when a

15 lot of the early work on vasodilators was done and

16 successful. It was thought prior to this that there was

17 medication that would expand and increase blood flow to

18 the brain, that the blood brain barrier was insolvable

19 problem. First, we found it was solvable.

20 Q. Has any one you before used vasodilators

21 specifically for the treatment of brain injury?

22 A. Yes. Vasodilators have been tried

23 repetitively or the last 50 years for the treatment of

24 brain injury as well as the treatment of stroke.

25 Q. Had they been given by mouth?






174

1 A. They had been given by mouth as well as by

2 cream and as well as intravenous techniques.

3 Q. And traditionally, the blood brain barrier had

4 caused them to fail?

5 A. I think that the failures were for a variety

6 of reasons. I think one reason is the blood brain

7 barrier resistent to some medications. Others, I think

8 they gave the wrong dose. The monitoring tools out

9 there were not sufficient to follow the therapy.

10 The third reason that they failed is that some

11 of the medications that we use did not exist.

12 Q. So it's a combination of improvements in

13 medication and the technology?

14 A. Right. And the fourth is the double blind

15 study problem.

16 Q. What do you mean by that?

17 A. Well, in medicine in the United States,

18 historically, medical communication and medical

19 treatment came about from observing patients, seeing if

20 it worked, and then trying to reproduce it or to do more

21 of the same and observe the results and customize the

22 therapy.

23 Back about 20 years ago, the FDA, in order to

24 identify whether a new drug should be released, had to

25 develop a standardized testing mechanism. And that






175

1 standardized testing mechanism to determine whether a

2 new drug should be released was the double blind study

3 where you give one population of people one set of

4 medications. Everybody in that population gets the

5 identical dose. You give a second group of people a

6 different placebo, usually a placebo.

7 Q. And what was significant for your work about

8 the requirement of identical doses?

9 A. Well, it's extremely dangerous. When they try

10 to do the double blind studies with vasodilators, they

11 found that vasodilators caused strokes in many
patients.

12 You know, we never treat patients in clinical

13 practice as a double blind patient. We don't give them

14 all of the same dose that was first done in the original

15 papers. The dose we give for anything, whether it is an

16 infection or heart attack, depends on what that patient

17 needs and what side effects they get. If you don't

18 customize a dose to the patient, you could cause strokes

19 with medication. The reason you cause strokes is you

20 drop the blood pressure. It could decrease the blood

21 pressure.

22 Q. Now, what is the relationship between blood

23 pressure and blood flow inside the brain?

24 A. There is a -- essentially, blood flow is

25 determined by several different things in the brain. It






176

1 used to be thought that blood flow to the brain was

2 entirely dependent upon blood pressure. So, therefore,

3 it used to be thought that patients who had a blockage

4 in artery, you would allow their blood pressure to rise

5 to whatever level it wanted to. The idea being that you

6 had partial blockage in the blood vessels like a pipe.

7 You increase the blood pressure in one end, you force

8 more blood through that blocked area to the tissues

9 downstream in the brain. That's what the old theory

10 was.

11 In our work, that wasn't true. Our work's has

12 been reproduced by now quite a few major studies around

13 the world. What these studies show is blood flow to the

14 brain is more complicated. It's dependent upon blood

15 flow to the area of blockage, yes. But it's also

16 dependent upon the area of blockage. You can make that

17 area go away or get less as you get more blood to the

18 brain.

19 Q. And thus vasodilation?

20 A. And thus vasodilation.

21 And, third, it's depend -- the third is

22 dependent upon blood vessel downstream from the

23 blockage. If that blood vessel -- what happens in a

24 normal person is that that blood vessel in response to

25 blockage should dilate, make a partial vacuum, and suck






177

1 blood into the brain tissue. That does happen a little

2 bit, but these are not normal people. Those arteries

3 become injured and they lose the ability to autoregulate

4 or to function normally. They don't expand the way they

5 should and thus they don't pull enough blood to

6 compensate for the blockage.

7 Q. So your vasodilation therapy, in a sense, is a

8 substitute for autoregulation?

9 A. Right. Just like it is in the heart. You

10 know, the heart attack patient comes through the office

11 or the emergency room. They have a partial blockage.

12 And the medications given do not raise blood pressure,

13 the medication given vasodilate. They dilate small

14 blood vessels in the area damaged as well as the blocked

15 area themselves directly.

16 Q. Now, Dr. Hammesfahr, have you reviewed the

17 medical literature on these topics that you have touched

18 upon here this morning?

19 A. I have reviewed quite a bit of literature

20 about this, yes.

21 MS. ANDERSON: Your Honor, I have some

22 exhibits on medical literature that I would like to

23 approach the witness with and have him discuss. I

24 want him to read them into the record.

25 THE COURT: That's fine.






178

1 MR. FELOS: Your Honor, I'm going to interpose

2 my objection at this time. It is improper on

3 direct examination of an expert witness to rely on

4 authoritative text. And to that, I'm citing

5 Liberatore versus Hoffman, which is a 2002 Fourth

6 District case.

7 In that case, the court reversed the trial

8 court saying it abused its discretion in allowing

9 defendants to use bulletins published by the

10 American College of Obstetricians and Gynecologists

11 to bolster the testimony of their expert witness.

12 You will note on page -- I guess page eight of

13 this printout, "Experts cannot, on direct

14 examination, bolster their testimony by testifying

15 that a treatise agrees with their opinion.

16 Authoritative publications can only be used during

17 the cross-examination of an expert and not to

18 bolster the credibility of an expert."

19 And that's exactly what respondents' counsel

20 is trying to do here, bolster the credibility and

21 opinion of her expert on outside sources and it's

22 not proper on direct examination.

23 MS. ANDERSON: I offer that the abstract is

24 not bolstering evidence. But you will recall the

25 Second District wanted to know the state of






179

1 scientific literature. And these various abstracts

2 and articles go to that very point. He has simply

3 said that he has viewed the literature and it's out

4 there.

5 As I say, I am not offering him enough time to

6 go into it through substantive evidence. But

7 certainly the Second DCA wants to know what the

8 state of the scientific literature is, and it will

9 be very helpful to this court to know what the

10 state of scientific literature is in these areas of

11 stroke and the use of vasodilators for brain

12 injuries.

13 MR. FELOS: Your Honor, the Second District

14 also wants the court to follow rules of evidence

15 and follow the law. And in the -- we can parse

16 words about bolster and evidence and substantive,

17 but the word in this case is "use." They reversed

18 the trial court for allowing the defendants to use

19 the bulletins.

20 Authoritative publication can only be used

21 during cross-examination. And what opposing

22 counsel is doing is attempting to use these

23 bulletins to bolster the -- bulletins, articles,

24 treatises, whatever they are, to bolster the

25 opinion and credibility of an expert. It's not






180

1 proper on direct examination.

2 THE COURT: My guess is the trial judge in

3 this case, again, Mr. Felos, would not have a

4 lengthy opinion of the appellate court upon him or

5 her on how they are to proceed. I am required to

6 assess the new medical treatment and their

7 acceptance in the relevant scientific community.

8 So I'm not sure how I assess Dr. Hammesfahr's

9 treatment in the relevant scientific community

10 unless I hear from the relevant scientific

11 community. And quite candidly, documents take a

12 whole lot less time than a live witnesses.

13 We've restricted ourselves to the six

14 physicians. I think it would do me a disservice

15 not to have all of what the relevant scientific

16 community uses.

17 MR. FELOS: Well, Your Honor, so I gather the

18 Court is denying my objection?

19 THE COURT: That's where I'm headed,

20 Mr. Felos. I just -- in the abstract, you're

21 absolutely correct in that the doctor is not going

22 to be able to get on the stand and say this patient

23 of mine has whiplash and, therefore, he is --

24 that's just start from scratch lawsuit as opposed

25 to this particular litigation, which giving this






181

1 court, anyway, a guidebook of what I'm supposed to

2 do. Other than getting copies of these documents,

3 I don't know how I can assess the acceptance in the

4 relevant scientific community.

5 MR. FELOS: Well, that would be done, Your

6 Honor, through the witness's testimony. Not

7 through use of a -- not through use of external

8 publications, documents, and treatises.

9 MS. ANDERSON: You know --

10 MR. FELOS: And if I may, Your Honor, on this

11 topic. The proper procedure would be here, when

12 our witness testifies, opposing counsel, if she can

13 show that the witness admits that these treatises

14 are authoritative or she can independently

15 establish that to the Court, then you can cite from

16 those treatises on the cross-examination of those

17 witnesses.

18 That's what authoritative treatises are used

19 for in purposes of cross-examination. And if

20 they're found to be authoritative, she can use them

21 in cross-examination and bring them before the

22 court in that way, but they are not to be used on

23 direct examination of her own witness.

24 MS. ANDERSON: You know, Mr. Felos did not

25 object when I asked Dr. Hammesfahr if the medical






182

1 literature had progressed since 1994. In fact, he

2 did testify there has been quite a bit of research

3 on the use of drugs, specifically vasodilators as

4 it relates to vasospasm, cerebral and otherwise.

5 But in any event, Judge, the Second DCA has

6 sort of created a -- coupled together two aspects

7 of the Frye hearing which normally precedes an

8 evidentiary hearing. So that's why we're stuck.

9 We've got to provide them and provide you with the

10 literature base, and at the same time, provide

11 substantive opinion evidence about the ultimate

12 fact question.

13 So while I certainly agree, as you say, in the

14 abstract, it wouldn't ordinarily -- treatises are

15 used strictly for cross-examination. Here,

16 Dr. Hammesfahr has to be able to say what his

17 understanding of the current literature is.

18 THE COURT: Frye test, I'm not addressing that

19 on this subject in this case at this time.

20 Let me do this: Let me try and fashion

21 something and see if we can satisfy the Second

22 District as well as the Fourth District.

23 I'm going to allow this in. But unless some

24 other physician testifies these are good

25 authorities, I will allow Mr. Felos' motion to






183

1 strike. Now he is the only one that says these are

2 good, then I'll hear, again, his motion to

3 supplement here.

4 MS. ANDERSON: The motion about Mr. Schiavo?

5 THE COURT: This motion. So let's do that.

6 And we might want to reserve ruling on this. I'm

7 going to let it in but I will consider a motion to

8 strike, unless you can tie it up. Fair enough?

9 MS. ANDERSON: Perfect.

10 MR. FELOS: Your Honor, just to clarify this.

11 When you say "let it in," you don't mean to say

12 that these documents are accepted into evidence,

13 but that counsel can approach the witness and

14 discuss them.

15 THE COURT: If he identifies them, I'll let

16 them in subject to your motion at the end of your

17 case. They haven't been tied up to another witness

18 to start.

19 MS. ANDERSON: Well, why don't I ask

20 Dr. Hammesfahr if the Lancet, for example, is

21 considered an authoritative source? Because that's

22 the preliminary question.

23 THE COURT: Sure.

24 MR. FELOS: Your Honor, I guess -- and forgive

25 me because I don't quite understand. If these are






184

1 deemed to be authoritative, at least preliminarily,

2 and the witness is questioned about them, do I

3 understand the Court's ruling that these documents

4 can be used during the testimony of the witness as

5 they would on cross-examination under the normal

6 rule. But under the normal rule, even if they're

7 used for purposes of cross-examination, they're not

8 accepted as exhibits in evidence.

9 So that was my question: Is the Court

10 allowing their use in terms of questioning the

11 witness about them or is the Court accepting these

12 documents into evidence? If the Court is going

13 that further step, I formally object to the

14 introduction of these exhibits as evidence.

15 MS. ANDERSON: You know, the judges and the

16 law clerks who will be mightily relieved not to

17 have to do this research. I can stand here at this

18 podium and ask Dr. Hammesfahr to read the citations

19 into the record, if that would satisfy Mr. Felos.

20 But it seems awfully sudden, particularly when the

21 appellate court has specifically asked about the

22 acceptance in the relevant scientific community.

23 MR. FELOS: I'm not talking about the citation

24 but having the substantive articles introduced into

25 evidence.






185

1 THE COURT: Well, Mr. Felos, if they're not in

2 evidence, why would you need a reservation on a

3 motion to strike?

4 MR. FELOS: Well, because there's two parts

5 here. One is accepting them into evidence. The

6 other is their use in any fashion even though

7 they're not accepted into evidence.

8 MS. ANDERSON: Again, he has -- you know, we

9 are all sort of operating under this quasi

10 half-Camel-half-elephant-type of hearing where we

11 have to address Frye issues, but also we have to

12 illicit opinions and fact testimony.

13 THE COURT: Well --

14 MS. ANDERSON: So I think your ruling is

15 appropriate, Judge, under the circumstances.

16 THE COURT: Well, I'm not sure how Frye

17 applies because Frye is a rule of evidence. So I

18 think the Second District has said that

19 Professor Erhardt's book controls unless the

20 opinion of the Second District says it doesn't in a

21 specific hearing. And in this hearing, for the

22 purpose only of the court assessing several things,

23 one of which is acceptance of this new treatment in

24 the relevant scientific community.

25 Quite candidly, Mr. Felos, you're talking






186

1 about not wanting to get this witness to make a

2 proffer. If we do it your way, it may be eight

3 o'clock in the morning. So I'm not certain what

4 you really want the Court to do.

5 MR. FELOS: Well, Your Honor, what I would

6 want the Court to do is, number one, not use them

7 at all on direct examination and wait until

8 cross-examination of my witness. But since the

9 Court is allowing they can be used, show the

10 witness a little of the articles, mark that for

11 identification, and ask him are these articles --

12 do you consider authoritative. And if he says yes,

13 then counsel can question the witness about the

14 articles without the documents being introduced

15 into evidence.

16 THE COURT: Well, Mr. Felos, unless a

17 document, a pertinent portion of it's read into the

18 record, how in the world am I or the three other

19 judges in Tampa going to know what it says? Gee,

20 this is authoritative. I agree. All of us four

21 doctors agree this is authoritative. So I

22 enumerate this and scratch my head and say, what do

23 they say, who sent them, who wrote this book.

24 MS. ANDERSON: You know, Judge --

25 THE COURT: It's an impossible burden on the






187

1 court.

2 MR. FELOS: That would be developed through

3 the examination of the witnesses.

4 THE COURT: Would you rather the witness

5 testify ad nauseam as to what's contained in all

6 these articles or do you simply prefer to let these

7 articles in, if they're not tied up and he is the

8 only witness who can authenticate them? We will

9 hear you again only at this time on the motion to

10 strike.

11 I think I agree, if he is the only physician I

12 hear from that says that this particular article is

13 newsworthy from a medical prospective, then it is,

14 obviously. But I think we're better served from

15 judicial economy, if nothing else, just having the

16 burden of this in evidence. If they are tied up,

17 they stay in evidence. And if they are not tied

18 up, I will hear you.

19 MS. ANDERSON: May I approach the witness,

20 Your Honor?

21 BY MS. ANDERSON:

22 Q. Dr. Hammesfahr, I have handed you a number of

23 premarked exhibits for identification: Exhibit 24,

24 Exhibit 29, Exhibit 28, Exhibit 30, Exhibit 32, Exhibit

25 33, Exhibit 34, 35, 40, 41, 42, 44, 45, 46, 47, 50, 54,






188

1 58, 64, 72, 74, 75, and 76.

2 Do you have those before you?

3 A. Yes, I do.

4 Q. Is this a combination of abstracts, articles,

5 and articles themselves on medical topics?

6 A. Yes, it is.

7 Q. And do these articles appear in publications

8 that are considered authoritative in the medical

9 research world?

10 A. Yes, they are.

11 Q. Can you briefly name those publications?

12 A. Lancet, Stroke. Current Controls and Trials

13 in Cardiovascular Medicine. Medical Review, Liege,

14 L-I-E-G-E. Anesthetist. Cardiovascular Drug Therapy.

15 CNS Drugs.

16 Q. What does CNS stand for?

17 A. Central Nervous System.

18 Current Opinions of Cardiology. Medical

19 Science Monitor. Circulation. The British Medical

20 Journal. Journal of Hypertension. The Journal of

21 Cardiovascular Oncology. The Journal of Human

22 Hypertension.

23 Q. Dr. Hammesfahr, have there been any changes in

24 the last year or so as a result of research findings in

25 the treatment of stroke?






189

1 A. Yes. There have been dramatic changes in

2 prospectives on stroke in the last two and a half, three

3 years, yes.

4 Q. Can you explain to the court what those

5 changes are?

6 A. The changes essentially are that stroke is not

7 just an embolic phenomenon where a clot goes to the

8 brain and blocks off oxygen. But rather a stroke itself

9 and -- and all medical treatment, most medical treatment

10 prior to two-and-a-half years ago was based on this

11 concept that we were trying to stop embolisms to the

12 brain, and a few cases of hypertension.

13 But rather it's been determined and found that

14 we can treat the blood vessels in the brain, themselves

15 directly, both to prevent stroke as well as treating

16 stroke itself. So what has happened in the last two and

17 a half years or so is that the medications we identified

18 seven years ago, eight years ago, have now been

19 identified with widespread use in randomized studies of

20 sometimes thousands of patients that it should be used

21 in the treatment of stroke or prevention of stroke.

22 Q. So this group in '94, this group of patients

23 that you described earlier is now the subject of

24 research?

25 A. Right. What has been found is that these






190

1 types of medications do in fact work on the blood

2 vessels of the brain. They also find that certain

3 medications work better than other medications in the

4 brain, but they work regardless of the blood brain

5 barrier and that you could have dramatic improvements in

6 a patient's problem from these medications. For

7 instance, the reduction in stroke risk by 30 to

8 40 percent by those who are expected to have strokes.

9 Q. Is it that finding, that research finding that

10 dramatically changed stroke treatment in the last few

11 years?

12 A. Yes, it has. It used to be thought that --

13 now the recommendations are specific medications be used

14 in those patients for strokes and high risk of strokes.

15 Those medications are medicines that we advocate and

16 use, ACE inhibitors, nitrates, and so on. Second, that

17 these medicines' effect is not due to the blood pressure

18 effect but rather the effect on the brain's blood

19 vessels themselves.

20 So just as in cardiology, we use these

21 medicines to treat heart attacks for the vasodilators

22 quality. And the issue of the blood pressure is not an

23 issue other than how you customize the dose. This is

24 the same. We found that these medicines have a benefit,

25 and it's not due to blood pressure but due to the direct






191

1 effect on the blood vessels of the brain just like we

2 use on the blood vessels of the heart.

3 Also, interesting, to make a similar comment.

4 It also works in the blood vessels of the kidneys.

5 Q. What does research in cardiology have to do

6 with your field?

7 A. Well, most of these -- many of these articles

8 were actually done primarily by cardiologists and

9 circulatory experts with neurologists as a relatively

10 minor part of the team but a present part of the team.

11 Others of these articles are done specifically by stroke

12 specialist teams, headed by stroke specialist teams. So

13 being it's identified across the board now by people who

14 do vascular diseases, whether it's brain or other types.

15 Q. What is a stroke team in a hospital?

16 A. Well, a stroke team hospital specialists are

17 involved in the treatment of stroke.

18 Q. So it would consist of neurologists,

19 radiologists, interns?

20 A. Yes.

21 Q. Who else?

22 A. Emergency room physicians, and frequently

23 intensive care unit nurses and doctors, also.

24 Q. So it's a cross-disciplinary approach to a

25 particular stroke?






192

1 A. Very much, yes.

2 Q. Now, what does the term "perfusion" mean?

3 A. Perfusion means blood clot.

4 Q. So if the perfusion in the brain has been

5 damaged or reduced, it simply means that the blood flow

6 itself -- can blood flow be lowered if the pressure

7 remains strong?

8 A. I'm sorry?

9 Q. Can perfusion be lowered -- will we rarely see

10 lowered perfusion if the blood pressure is normal?

11 A. Yes. You can lower perfusion of brain tissue

12 if you lower blood pressure. Now, blood pressure is in

13 a range so that if you have a normal-low blood pressure

14 and you have a low blood pressure, you lower it using

15 the wrong medicine, you can lower the perfusion.

16 That was the problem with the early studies is

17 that they used the wrong medicine that resulted in a

18 lower blood pressure with a lower perfusion. Whereas,

19 these studies talked about lowering blood pressure into

20 a normal range or sometimes even in a low-normal range

21 and yet maintaining perfusion.

22 So if you use the right medicines, you have an

23 effect in the brain itself. If you use the right

24 medicine, but the wrong dose, you can lower perfusion.

25 You have to customize it.






193

1 Q. And how are you able to customize it?

2 A. Well, we customize it through repetitive

3 physical examinations as well as the monitoring that's

4 done, an ultrasound and electronic monitoring. So we

5 are using a method of customizing these outpatient's

6 medicine similar to what somebody in an emergency room

7 or intensive care unit setting would do. They use the

8 same technique of repetitive monitoring of the testing

9 and repetitive physical exam and blood pressure

10 monitoring.

11 Other ways that they have monitored here is

12 things like blood flow studies. There are different

13 ways of monitoring.

14 Q. Is Transcranial Doppler ultrasound an accepted

15 monitoring device?

16 A. Yes. Transcranial Doppler monitoring, you'd

17 go to Medline, there would be thousands of records.

18 Medline is the National Library of Medicine essentially

19 archived in many print journals, many medical journals

20 there. If you go in there and type in the words

21 "Transcranial Doppler monitoring," you will get a large

22 number of published papers that deal with the monitoring

23 of blood gas which are in blood vessels and guide to

24 therapy by the use of Transcranial Doppler.

25 Q. Now, what is titration?






194

1 A. Titration is the customizing of the dose --

2 titration of medicine is the customizing of the dose of

3 medicine to -- against some variable. That variable can

4 be blood pressure or could be chest pain, heart attack,

5 or could be neurological function. It's the customizing

6 of the dose of medication, both at one time as well as

7 over time, over months or years.

8 So your physician can treat blood pressure in

9 the office and he treats it -- changes the dose of blood

10 pressure every six months or a year is titrating the

11 medicine against blood pressure and against the

12 patient's physical response.

13 In the emergency room you titrate medication

14 against a patient's chest pain and having a heart attack

15 and their cardio function.

16 Q. Now, Dr. Hammesfahr, have you ever published

17 your observations and findings about vasospasm and

18 Transcranial Doppler, the use of Transcranial Doppler

19 and vasodilators?

20 A. Yes, I have.

21 MS. ANDERSON: May I approach the witness,

22 Your Honor?

23 THE COURT: Yes, ma'am.

24 BY MS. ANDERSON:

25 Q. Dr. Hammesfahr, I have given you Respondent's






195

1 Exhibit 17, premarked for identification, and ask you if

2 you recognize that document?

3 A. Yes, I do.

4 Q. What is it?

5 A. That's an article that was published in 1995

6 that deals with cerebral vasospasm. Is that the

7 question?

8 Q. Yes.

9 In brief, what is the subject matter -- what

10 is encompassed within the subject matter of this

11 article?

12 A. Briefly, what we identified in the paper and

13 discussed was that cerebral vasospasm is common to many

14 different disorders that it wasn't suspected in

15 previously or had very limited suspicions of it, and

16 that there is a medical approach to having reproduced a

17 consistent improvement in patients that suffer from

18 vasospasm. In that improvement, you use vasodilators to

19 monitor, Transcranial ultrasound, and physical

20 examinations.

21 Q. Now, did you find that your treatment protocol

22 was affected in a variety of neurological deficits?

23 A. Yes. This was a great surprise at that point

24 because vasospasm was only theoretically suspected in

25 some of these disorders and not suspected in other






196

1 disorders.

2 Q. What were some of the disorders?

3 A. Well, it was known to exist in stroke and

4 cerebral palsy, hypoxic encephalopathy, and anoxic

5 encephalopathy. But in those areas, it was primarily

6 known to exist through pathology and autopsy studies

7 done on patients and also on injured graphic studies

8 done on patients. It wasn't known that you could treat

9 a patient.

10 Where I came from the medical college of

11 Virginia, a great deal of the effort of the department

12 was spent on publishing and working on research treating

13 patients that had a subarachnoid type of stroke.

14 Q. What is a subarachnoid hemorrhage?

15 A. A subarachnoid hemorrhage is a condition where

16 a blood vessel breaks and causes the blood pressure to

17 affect the blood pressure to the brain, throughout the

18 brain, causes the pressure to affect the brain itself

19 and causes blood to spill which is causes a toxic injury

20 to the blood vessel.

21 Similar to what you get in anoxic

22 encephalopathy in some cases, because you have the

23 injury to the blood vessel which causes constriction of

24 the blood vessel. So there are several different

25 methods that would develop constriction or vasospasm of






197

1 the blood vessels and subarachnoid hemorrhage common to

2 stroke and common to anoxic and hypoxic encephalopathies

3 and common to cerebral palsy.

4 Q. So subarachnoid refers to what?

5 A. It refers to the location of blood vessel that

6 has ruptured in the brain. It's underneath the

7 arachnoid, which is a thin covering of the brain.

8 MS. ANDERSON: May I approach the witness,

9 Your Honor?

10 THE COURT: Yes, ma'am.

11 BY MS. ANDERSON:

12 Q. Dr. Hammesfahr, I have handed you what I have

13 premarked as Respondent's Exhibit 15 and ask you if you

14 recognize that?

15 A. Yes, I do.

16 Q. And how do you recognize that?

17 A. Well, this is a copy of my patent, which I

18 applied for, I think, in 1996 or 1997. Somewhere in

19 that time frame. It deals with the treatment through

20 titration of vascular injuries to the brain. Vascular

21 injuries to the brain include injuries which injure the

22 control mechanism that controls blood flow to the brain

23 thus causing vascular injury.

24 Q. This patent is on the technique that we talked

25 about this morning; is that correct?






198

1 A. Yes, it is.

2 Q. When was it issued?

3 A. It was issued --

4 Q. Hint: Top right-hand corner.

5 A. July 10, 2001.

6 Q. Now, why did you patent this?

7 A. I patented it for several reasons. For the

8 standpoint of medicine, it clearly identifies the state

9 of a prior art to have a patent issued. A patent is

10 issued for something new and novel and by definition,

11 not intuitively obvious to other practitioners in the

12 field. By having a patent, you are clearly identifying

13 the state of the prior art prior to these observations,

14 these discoveries.

15 Q. Now, can anybody just apply to the U.S.

16 government and get a patent for a medical procedure?

17 A. Well, anybody can apply. But what happens

18 after the application is that the patent goes to review

19 by patent officers.

20 MR. FELOS: Your Honor, I object. Lack of

21 foundation. I believe this witness has been

22 established as a medical person. He hasn't been

23 established as an expert in patent and the patent

24 process.

25 MS. ANDERSON: Well, I can ask him that






199

1 foundation question.

2 THE COURT: Just for my edification. Isn't a

3 patent just simply something that hasn't been

4 patented before?

5 BY MS. ANDERSON:

6 Q. Dr. Hammesfahr, can you answer that? It has

7 to be new, correct?

8 A. It has to be new.

9 Q. Does it also have to be anything else?

10 A. Well, it has to work. It has to be new. It

11 has to be --

12 MR. FELOS: Excuse me, Your Honor. I renew my

13 prior objection. I don't believe the witness is

14 qualified to testify as to what he recalls.

15 THE COURT: I don't know if he is either.

16 BY MS. ANDERSON:

17 Q. Well, do you know what review your patent

18 application underwent?

19 A. I know a great deal about what this patent

20 went through.

21 Q. How do you know that?

22 A. Because we go through communications with my

23 attorneys and the patent office directly and as well as

24 their reviews of what was published.

25 Q. By "them," you mean who, the patent office?






200

1 A. The patent office. The patent office in the

2 process of the patent will send back initial reviews and

3 hearings and ask for additional information.

4 Q. So this is ongoing dialog with the patent

5 office and you don't know until the end whenever you

6 satisfied that?

7 A. Correct.

8 Q. Is that right?

9 A. Right.

10 MS. ANDERSON: Does that answer your question?

11 THE COURT: My basic question is: To what

12 extent does a patent have to accomplish something?

13 MS. ANDERSON: He said it has to work.

14 THE COURT: Well, I don't know what the word

15 work means. There are lots of things that are

16 patented and ongoing.

17 MS. ANDERSON: And in terms of --

18 THE COURT: I'm not sure why you brought that

19 up.

20 BY MS. ANDERSON:

21 Q. In terms of treatment protocol, medical

22 treatment protocol, when you say it has to work, what do

23 you mean by that?

24 MR. FELOS: Your Honor, again, I renew my

25 objection. This witness is not qualified to






201

1 testify as to what standard of review for granting

2 patents is.

3 MS. ANDERSON: He knows as a patent applicant

4 what the government asked him to provide.

5 THE COURT: What the government told him to

6 provide?

7 MS. ANDERSON: What the government told him to

8 provide, yes.

9 THE COURT: Or what his lawyer told him?

10 BY MS. ANDERSON:

11 Q. Well, you were a part of this process, were

12 you not, Dr. Hammesfahr?

13 A. Yes, I was.

14 Q. And it lasted how many years?

15 A. It lasted about four to five years.

16 Q. Periodically, the patent office make inquiries

17 for additional information?

18 A. Yes, they did.

19 Q. Did they raise questions periodically?

20 A. Yes, they did.

21 Q. Were the people raising questions

22 medically-framed?

23 A. The people raising the questions relied on

24 information from background, medically trained --

25 MR. FELOS: Your Honor, I object. He is






202

1 testifying as to the state of mind of another

2 person.

3 MS. ANDERSON: No. No, he is not. There is

4 nowhere in that testimony about the state of mind.

5 He simply said that --

6 BY MS. ANDERSON:

7 Q. Are doctors involved in the patent review

8 process?

9 A. Doctors are involved in the part of the patent

10 review process that is one level behind the hearing

11 officers. So, yes.

12 MR. FELOS: Your Honor, I move to strike all

13 of that testimony on the basis that it's hearsay.

14 It's apparently what a patent examiner told him

15 that somebody in the review process was doing.

16 THE COURT: Well, this doctor will be

17 testifying as to medical matters, and a patent is

18 not a medical matter.

19 MS. ANDERSON: Well, Mr. Felos is the one who

20 had identified this angle, that the patent was an

21 issue.

22 THE COURT: He has done that.

23 MS. ANDERSON: Correct.

24 THE COURT: To have him testify as to all of

25 the steps that were done by others in order to






203

1 arrive at that is -- I'm not sure he is qualified

2 to do that.

3 MS. ANDERSON: Judge, that's fine. I did not

4 ask him those questions. It was Mr. Felos who is

5 making the objection.

6 MR. FELOS: Well, to the question. The man

7 identified the document as a patent, so he

8 identified a document that hasn't been sought to be

9 introduced into evidence. And the whole question

10 of what the procedure of applying for the patent is

11 and what he was told by the patent office and his

12 impressions of the patent law is hearsay and it's

13 also irrelevant.

14 THE COURT: He can't testify to what others

15 have done or what the standard involvement in

16 obtaining a patent would be unless you can qualify

17 him as an expert.

18 BY MS. ANDERSON:

19 Q. Dr. Hammesfahr, what is your patent number?

20 A. 6258032.

21 Q. The question that provoked that colloque was

22 why you got it patented. You said it has to be new and

23 it has to work, right?

24 A. Correct.

25 Q. Was it your intention to have stake and






204

1 ownership claim and demand royalties if another

2 physician used your treatment protocol?

3 A. That was not my intention; although, that is

4 legally what I can do.

5 Q. You have not exercised those rights?

6 A. I have not.

7 Q. Thank you.

8 What is the "Therapeutic Window Concept" that

9 is referred to in the patent?

10 MR. FELOS: Your Honor, I object. The patent

11 is not in evidence. He cannot refer to it from the

12 witness stand.

13 MS. ANDERSON: It has been identified, Judge.

14 I'll move it into evidence.

15 MR. FELOS: The fact that he has identified a

16 document does not mean that he can read from it

17 because it's not in evidence.

18 MS. ANDERSON: I'm not asking him to read from

19 it. I'm asking him to explain a term that is used

20 in the patent "therapeutic window." I am entitled

21 to ask a question about that term and that

22 document.

23 And by the way, Judge, I move into evidence at

24 this time all previously identified exhibits that

25 this witness has handled, including Exhibit Number






205

1 15 which is the patent. I'm asking him what the

2 term "therapeutic window" means.

3 MR. FELOS: Your Honor, I object to

4 introduction of the patent on, number one, lack of

5 communication, and number two, it's hearsay.

6 THE COURT: Well, every document is hearsay,

7 Mr. Felos.

8 MR. FELOS: What other document is hearsay?

9 THE COURT: Every single document is hearsay

10 unless it's introduced into court.

11 MR. FELOS: Your Honor, frankly, I'm not --

12 MS. ANDERSON: Let me get my Exhibit 15.

13 THE COURT: Now, the first bulk of documents,

14 you've already objected to those and I've overruled

15 the objection. So I will receive those and the

16 court reporter will have those numbers in the

17 record.

18 MS. ANDERSON: And also Exhibit 17, Your

19 Honor, I move to introduce into evidence at this

20 time, his document.

21 THE COURT: His paper?

22 MS. ANDERSON: His paper.

23 MR. FELOS: I object on the same basis as my

24 previous objection as to medical articles and also

25 as to hearsay.






206

1 THE COURT: Well, his article is hearsay? He

2 authored it. It's hearsay?

3 MR. FELOS: It's an -- it is a statement of

4 the declarant, but it was a statement not made

5 under oath, which was the definition of hearsay,

6 Your Honor.

7 MS. ANDERSON: What? That is not the

8 definition of hearsay.

9 THE COURT: What does hearsay have to do with

10 under oath, Mr. Felos? That's a new one on me.

11 MR. FELOS: Your Honor, hearsay --

12 MS. ANDERSON: Is an out-of-court statement

13 offered to prove the truth of the matter asserted

14 therein.

15 THE COURT: There's an exception for prior

16 testimony which is under oath.

17 MR. FELOS: "Hearsay is a statement made other

18 than one made by the declarant while testifying in

19 trial or hearing offered into evidence to prove the

20 truth of the matter asserted."



To be continued in next email

--
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> ----- Original Message -----
> From: "Lisa Ruby" <Commissioned@...>
> To: forthelifeofterrischiavo@yahoogroups.com
> Subject: [forthelifeofterrischiavo] Washington, DC, Scientology and Terri
Schiavo
> Date: Mon, 22 May 2006 01:02:14 -0500
>
>   From the alt.religion.scientology Google news group:
>
> steelerfreak wrote:
> > Why did RLH not begin in St. Pete?  Americas number one beach (Ft.
> > Desoto) and number Five)?  Per doctors ratings on beaches he must have
> > onto been onto something.  That's history.
>
> > I don't know why he (RH) id not lock into downtown St. Petes  D.T., but
> > look a it's for it's worth...I respect his decision on d.t. Clearwater.
>
> > Let's clear Florida.....I'm with the rest of ya on the rest!!!!   I'lll
> > join ya in St. Pete.   Going to be a tought town though.   It's just
> > not Clearwater.  I'm good and out of here!!!!!!
>
> The Founding Church of Scientology was established in Washington, D.C.
> This makes perfect sense because Scientology secretly carries out the
> orders of key government officials.
>
> A good example of this was the Terri Schiavo case. Unless, as some
> contend, the fact that the Clearwater, Florida precedent-setting case
> was marked for Scientology from top to bottom is a bizarre coincidence.
>
>
http://libertytothecaptives.net/scientology_and_terri_schindler_schiavo_death_co\
nnection.html


According to the Church of Scientology of Washington website, man is
only as valuable as he can serve others. Scientology's philosophy
relegated Terri Schiavo (and millions of others) to the category of
worthless.

"We believe that man is only as valuable as he can serve others, and it
is in this spirit that we are here for our parishioners who come to
receive Scientology services, as well as for the community. We want to
share our church and look forward to participating in civic and
community events and activities together."

Quoted from: http://www.scientology-washingtondc.org/

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From the alt.religion.scientology Google news group:

steelerfreak wrote:
> Why did RLH not begin in St. Pete?  Americas number one beach (Ft.
> Desoto) and number Five)?  Per doctors ratings on beaches he must have
> onto been onto something.  That's history.

> I don't know why he (RH) id not lock into downtown St. Petes  D.T., but
> look a it's for it's worth...I respect his decision on d.t. Clearwater.

> Let's clear Florida.....I'm with the rest of ya on the rest!!!!   I'lll
> join ya in St. Pete.   Going to be a tought town though.   It's just
> not Clearwater.  I'm good and out of here!!!!!!

The Founding Church of Scientology was established in Washington, D.C.
This makes perfect sense because Scientology secretly carries out the
orders of key government officials.

A good example of this was the Terri Schiavo case. Unless, as some
contend, the fact that the Clearwater, Florida precedent-setting case
was marked for Scientology from top to bottom is a bizarre coincidence.

http://libertytothecaptives.net/scientology_and_terri_schindler_schiavo_death_co\
nnection.html






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Subject: Schiavo's kin join Poutre debate

http://www.boston.com/news/local/massachusetts/articles/2006/04/25/schiavos_kin_
join_poutre_debate/?rss_id=Boston+Globe+--+City/Region+News
<http://www.boston.com/news/globe/>
The Boston Globe


Schiavo's kin join Poutre debate


Urge tighter rules in end-of-life cases

By Scott Helman, Globe Staff  |  April 25, 2006

The family of Terri Schiavo, the brain-damaged
Florida woman at the heart of a divisive
right-to-die case that ended with her death last
year, is urging Governor Mitt Romney to tighten
regulations of end-of-life cases in Massachusetts.
Article Tools

Schiavo's family, which runs the Terri Schindler
Schiavo Foundation Center for Health Care Ethics
Inc., is alarmed that doctors misread the medical
condition of 12-year-old Haleigh Poutre, a
Westfield girl who authorities say was beaten
into a coma by her adoptive parents. State
authorities, believing she was in a permanent
vegetative state, were close to removing
Haleigh's life support before her condition began improving earlier this year.

The foundation made a number of recommendations
in a letter to Romney last week, including that
Massachusetts open end-of-life proceedings to the
public, increase the standard of evidence
required to remove life support in certain
instances, and establish judicial panels to hear such cases.

''Haleigh's shocking story demonstrates that much
more needs to be done to protect the sick and
disabled from harm, including harm imposed by
courts," the letter reads. ''The common sense
reforms outlined herein will help to provide the
most vulnerable among us with better protection
in the legal system. The Foundation respectfully
requests that the Commonwealth immediately
address the law to provide Haleigh Poutre and
other children like her with greater protections."

Schiavo's case became a flashpoint for
conservatives, who rallied behind bids by her
parents and siblings to fight her husband's
effort to remove her feeding tube. Romney's
actions in Haleigh's case could be watched
closely if he decides to seek the Republican presidential nomination in 2008.

''We are happy to review the letter," Romney
spokesman Eric Fehrnstrom said in an e-mail.

An independent panel appointed by Romney
recommended a series of changes last month on how
the state handles such cases, including that DSS
more closely scrutinize requests to withdraw life
support. Romney accepted the recommendations.

Schiavo's brother, Bobby Schindler, said in an
interview yesterday that this was the first time
the foundation has gotten involved in another
case to this extent. ''Basically we saw how the
case was being handled, and we're very concerned
with some of the things that were happening in
her case," said Schindler, who plans to speak
about the issue in Agawam next month. ''This kind
of goes at what we've been saying: Doctors are
oftentimes wrong with these diagnoses that they
are making, and it becomes a death sentence for these people."

Baystate Medical Center in Springfield, the
hospital whose doctors concluded Haleigh was in
an irreversible coma, has defended its work and
said that the ultimate decision about her fate
fell with the state Department of Social
Services, which has had custody of the girl.
Haleigh has been recovering at Franciscan Hospital for Children in Brighton.

Schiavo's father, Bob Schindler Sr., said in an
interview that there are similar cases elsewhere
in the country, and the foundation's goal is
''essentially to guard against this rush to judgment."

''It's almost a ticket to the gas chamber," he
said of a doctor's diagnosis that someone is in a permanent vegetative state.

Schiavo suffered brain damage in 1990 after her
heart stopped from a chemical imbalance, possibly
caused by an eating disorder. She was on life
support for 15 years before dying in March 2005
at age 41, 13 days after her feeding tube was removed.

Schiavo did not designate in writing anyone to
make decisions for her. Her parents fought a
legal battle with her husband, Michael, who said
it would have been her wish to remove the feeding tube.

Scott Helman can be reached at <mailto:shelman@...>shelman@....
[]

© Copyright 2006 Globe Newspaper Company.


Cheryl Eckstein
Founder President Compassionate Healthcare Network (CHN)
CHN is a not for profit organization, formed 1990.
CHN - 11563 Bailey Cres., Surrey, B.C.
   V3V 2V4 Canada
Phone - 604 582 3844
Visit us at www.chninternational.com
NEW BOOK Available NOW.... The book, Our
Fight4Terri by Cheryl Ford, RN & Jan Craddock,
MD. Discounted for Fight4Terri supporters at:
<http://www.fight4terri.com/>www.Fight4Terri.com
or, can be ordered directly from publisher at:
<http://www.trafford.com/4dcgi/dosearch>Trafford
Publishing: Our <http://www.trafford.com/4dcgi/dosearch>Fight4Terri

QUOTES " Health care is concerned with life and
should never have anything to do with hastening
or causing death. . . . "Each person is special,
unique and unrepeatable. . . Excision of the
heart or liver from a living human being causes
death.  Therefore, it is immoral to remove an
unpaired vital organ before death.  Moreover, it
is currently not possible to successfully
transplant an unpaired vital organ after
death.  To satisfy a desire for transplantable
organs, an ingenious method was devised to get
around these realities: certain living comatose
patients were simply defined as "brain dead." . .
. We have been forced to accept brain-related
criteria for death so that organ transplant teams
can obtain vital organs in good physiological
condition because an unpaired vital organ taken
from a true corpse is not suitable for
transplantation. " - LIFE, LIFE SUPPORT and DEATH
Principles,Guidelines, Policies and Procedures
for Making Decisions to Protect and Preserve
Life, (Second Revised Edition) by Paul A. Byrne
M.D., FAAP, et al., American Life League Inc.
------- End of forwarded message -------

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Terri Schiavo's Parents Radio Guests


Gianni Hayes' rare, live interview with the Schindlers will be broadcasted
worldwide on Wednesday, April 26th, from 8:00-10:00pm, EST, on AVR-American
Voice Radio. Click on the link to listen online:
http://radio.theamericanvoice.com
Then click on a server link on the right-hand side of the page.


Robert and Mary Schindler, the parents of Terri Schiavo, will be interviewed on
a radio show hosted by Salisbury author and former professor, Gianni (Nan)
Hayes, Ph.D.  The Schindlers' appearance marks the one year anniversary of the
death of their daughter whose feeding tube was removed by the order of her
husband, Michael Schiavo, resulting in 13 days of starvation.  Schiavo had
called the police when he could not revive his wife lying injured on the floor. 
For fifteen years, Mrs. Schiavo remained in a semi-comatose state which prompted
the international landmark case of Terri's parents fighting to keep her alive,
and her husband-who had since  re-married and had three children-ordering the
removal of her feeding tube, Terri's sole nutrition.  Hayes' rare, live
interview with the Schindlers will be broadcasted worldwide on Wednesday, April
26th, from 8:00-10:00pm, EST, on AVR-American Voice Radio.  If listeners cannot
get the show on their FM dials, they may also access it through
www.theamericanvoice.com, or by podcast, or through a phone bridge by calling
712-580-1100, and putting in the code #97524.  A chatroom at the web address is
also set up for listeners, as well as a toll free call in number,
1-800-433-1429.





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EXCLUSIVE - Schiavo Attorney Felos Perpetuated His Wish, Not Terri's

http://www.northcountrygazette.org/articles/040306FelosWish.html



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addendum:

Anne DePrato is now back in her room in the Courtenay Nursing Home. She is not
being fed by mouth (she has been weakened by dehydration) and she has ONLY an
IV. She needs to be fed via some means. SOON.

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Anne DePrato and Courtenay Springs Nursing Home

Updates

Update:  Update: Anne DaPrato was transported to Cape Canaveral Hospital between
11:30 a.m. and 12 noon and attended by Dr. Bobs in the emergency room. Dr. Bobs
inserted an IV with no difficulty and checked her medical records. He did not do
any tests and she was not admitted. In spite of the fact that Anne endured
almost a week of dehydration (she had an IV for one day last week and has been
given no sustenance by mouth), Dr. Bobs said that her vitals were strong and
that she was doing remarkably well considering what she has gone through.

The emergency room doctor's diagnosis of Anne DaPrato's condition was in stark
contrast to the Hospice nurses' dire assessment of her condition. In response to
John DePrato's request to have his mother's IV reinserted last week, the
Courtenay Springs medical personnel claimed that it was impossible to insert an
IV in Anne's vein. The Hospice nurses remarked to John's niece, who as present
as Anne was being loaded into the ambulance, that Anne DePrato's condition was
so bad "she won't make it to the hospital." This was not the case. She had an
uneventful trip to the hospital and an IV was inserted into her vein without any
fuss or difficulty.


Why is Hospice involved anyway? Hospice is called in when a patient is
terminally ill. They are not legally allowed to render a patient terminal via
dehydration or any other means.

original report:
http://libertytothecaptives.net/anne.html

The nurses kept using phrases like dying process, etc. for a patient who was
being MADE to die. Yes. In Florida--in violation of the Florida statutes.

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I forgot to ask. Please pass this on to your lists and get this information out
ASAP. This woman is not terminal and her whole family (except for two people)
are mortified that this is going on.

Lisa


> ----- Original Message -----
> From: "Lisa Ruby" <Commissioned@...>
> To: forthelifeofterrischiavo@yahoogroups.com
> Subject: [forthelifeofterrischiavo] Anne DaPrato is being dehydrated to death
in Courtney Springs Nurisng Home on Merritt Island, Florida
> Date: Sun, 09 Apr 2006 03:35:22 -0500
>
>   Anne DaPrato is Currently Being Dehydrated to Death in Courntey Springs
> Nursing Home on Merritt Island, Florida
>
> Florida
>
> Anne DaPrato, an 89-year-old woman who is in the care of the Courtney
> Springs Nursing Home of Merritt Island, Florida, has been denied food and
> water for three consecutive days.
>
> Anne DaPrato is being denied normal care in violation of her Living Will
> on the order of her daughter, Carol Gilliar, who holds the power of
> attorney. Carol Gilliar's order to deny her mother food and water
> violates her mother's Living Will and therefore, is without legal
> authority.
>
> Anne has never been on a feeding tube and she is not terminally ill.
> According to her son, John DaPrato, Anne has recently been diagnosed with
> hydrocephalus and possibly has had a mild stroke which has been
> exacerbated by possible ongoing dehydration. (She has been hand fed for
> some time.) She has already demonstrated her hearty constitution because
> after she was forcibly dehydrated for days—John intervened and demanded
> that the IV be reinserted—she recovered and began producing urine in only
> two hours. The hospice workers' woeful prediction that her organs had
> shut down proved to be inaccurate. John DaPrato remarked that the hospice
> workers and his sister seemed to be dejected after learning about the
> healthy functioning of his mother's organs.
>
> Three days ago, Carol Gilliar, against the wishes of eight members of her
> family, ordered the removal of her mother's IV again. Even though Anne
> DaPrato has had no fluids of any kind for three days, she is fighting for
> her life and to her son's knowledge, her vitals are stable. She is being
> dehydrated-—in violation of her expressed wishes stated in her Living
> Will—by the order of her daughter, whose decision regarding her mother
> might be affected by the philosophy of the hospice workers. She currently
> has no discoloration of her nails, but her skin is warm due to her
> dehydration. She communicates by raising her eyebrows, smiling and
> gesturing. She is responsive only about three hours per day probably due
> to the forced dehydration. She needs and is legally entitled to, not only
> the proper medical attention, but NORMAL CARE.
>
> On Friday, April 7th, John called 911 and the paramedics arrived with the
> intention of transporting her to the emergency room for hydration and a
> proper diagnosis. The director of nurses, Dawn Johnson, as well as John's
> sister, Carol Guillar, signed papers to prohibit her transport for
> treatment for dehydration, which was previously diagnosed by a nurse by
> the name of Carolyn. John DaPrato said:
>
> "They made excuses for this behavior by saying the 'end is near' That is
> not true. My mother will live longer with water. Who does she [Dr.
> Maurice] think she is fooling? In my judgment, this relates to assisted
> suicide."
>
> Carol Gilliar has NO LEGAL AUTHORITY to deny her mother normal care, and
> Courtney Springs Nursing Home has no authority to make a non-terminal
> patient terminal by denying NORMAL care.
>
> Carol Gilliar holds the power of attorney which includes the duty of
> making sure that Anne DaPrato's Living Will instructions are honored.
> Anne DaPrato's Living Will is simple and straightforward: "Do not
> resuscitate." Providing NORMAL CARE to sustain life has nothing to do
> with resuscitation.
>
> If you can help, contact John DaPrato immediately at:
> sillverstream@...
>
> April 9, 2006
>
>
>
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>


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Anne DaPrato is Currently Being Dehydrated to Death in Courntey Springs Nursing
Home on Merritt Island, Florida

Florida

Anne DaPrato, an 89-year-old woman who is in the care of the Courtney Springs
Nursing Home of Merritt Island, Florida, has been denied food and water for
three consecutive days.

Anne DaPrato is being denied normal care in violation of her Living Will on the
order of her daughter, Carol Gilliar, who holds the power of attorney. Carol
Gilliar's order to deny her mother food and water violates her mother's Living
Will and therefore, is without legal authority.

Anne has never been on a feeding tube and she is not terminally ill. According
to her son, John DaPrato, Anne has recently been diagnosed with hydrocephalus
and possibly has had a mild stroke which has been exacerbated by possible
ongoing dehydration. (She has been hand fed for some time.) She has already
demonstrated her hearty constitution because after she was forcibly dehydrated
for days—John intervened and demanded that the IV be reinserted—she recovered
and began producing urine in only two hours. The hospice workers' woeful
prediction that her organs had shut down proved to be inaccurate. John DaPrato
remarked that the hospice workers and his sister seemed to be dejected after
learning about the healthy functioning of his mother's organs.

Three days ago, Carol Gilliar, against the wishes of eight members of her
family, ordered the removal of her mother's IV again. Even though Anne DaPrato
has had no fluids of any kind for three days, she is fighting for her life and
to her son's knowledge, her vitals are stable. She is being dehydrated-—in
violation of her expressed wishes stated in her Living Will—by the order of her
daughter, whose decision regarding her mother might be affected by the
philosophy of the hospice workers. She currently has no discoloration of her
nails, but her skin is warm due to her dehydration. She communicates by raising
her eyebrows, smiling and gesturing. She is responsive only about three hours
per day probably due to the forced dehydration. She needs and is legally
entitled to, not only the proper medical attention, but NORMAL CARE.

On Friday, April 7th, John called 911 and the paramedics arrived with the
intention of transporting her to the emergency room for hydration and a proper
diagnosis. The director of nurses, Dawn Johnson, as well as John's sister, Carol
Guillar, signed papers to prohibit her transport for treatment for dehydration,
which was previously diagnosed by a nurse by the name of Carolyn. John DaPrato
said:

     "They made excuses for this behavior by saying the 'end is near' That is not
true. My mother will live longer with water. Who does she [Dr. Maurice] think
she is fooling? In my judgment, this relates to assisted suicide."

Carol Gilliar has NO LEGAL AUTHORITY to deny her mother normal care, and
Courtney Springs Nursing Home has no authority to make a non-terminal patient
terminal by denying NORMAL care.

Carol Gilliar holds the power of attorney which includes the duty of making sure
that Anne DaPrato's Living Will instructions are honored. Anne DaPrato's Living
Will is simple and straightforward: "Do not resuscitate." Providing NORMAL CARE
to sustain life has nothing to do with resuscitation.

If you can help, contact John DaPrato immediately at: sillverstream@...

April 9, 2006



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