From: "ROBERT WEITZEL"
Date: Fri, 8 Nov 2002 23:26:36 -0700
To: "Friends and Colleagues"
Subject: 3rd and 4th days

Hello, all.

I'm sorry to have missed sending something out last night; I was exhausted, and so I'll try to encapsulate both days in this e-mail.

I don't want to sound "smug," and I do have some fear that the jury might do something crazy - it happened before when we thought we had won hands-down - but it really does seem that we are winning. The previous treating physicians have been testifying completely differently from the first trial. They have often gone out of their way to frustrate the state lawyers, who are trying to shore up their case theory, and have given us excellent fodder for attacking the claims made by the three state "experts" who will be testifying next week.

The witnesses from the families are really rather sad. Many of them filled with the hate that the state lawyers have inculcated since instigating this mess, and they come to the witness stand with obviously "coached" viewpoints, only to be completely surprised, confused and dismayed by the evidence as presented on cross-examination by my attorneys. Evidently the state has been consistently pulling the wool over their eyes; not even the one nurse/family member could have possibly looked at WeitzelCharts.com and seen the actual care as rendered. Thus they are bewildered and confused when confronted by evidence from the charts which directly contradicts their heavily influenced and re-worked memories of what transpired. The ability to present the chart evidence digitally has been invaluable in showing the true state of affairs in the winter of 95/96. It underscores my previous argument: that the state has victimized these people; I didn't.

One family member testified that I had said that her "mother was terminally ill, not expected to live." (Her mother was very ill; I wasn't the only doctor to have seen this. The consultant on the case testified to this just today). She testified yesterday that she asked me what the family could do, and that I replied, "We can give her morphine and hasten the inevitable." However, we had her sworn, handwritten statement from last summer, and when asked to read it, she read that I said: "We can give her morphine, and it might hasten the inevitable." (See accompanying article).

The jury seems to be getting it. Friends attending the trial tell me that often when the state lawyers make some particularly inane statement, or are unprepared, that jurors are seen to be rolling their eyes and exhibiting obvious disgust. I must try not to look over to the jury too much, but when I do, several jurors have caught my eye, nodding toward me with approval or raising their eyebrows in what I interpret as a look of commiseration and sympathy. The judge has been admonishing the state frequently to move along, asked several times about the relevance of testimony, and doesn't appear happy with their performance. The jurors can't help but see this. Most defense objections are sustained, most state objections are overruled.

This was particularly telling today, when state lawyer Charlene Barlow objected to the defense line of questioning re a physician's understanding of "suggested geriatric dosing guidelines." The physician had been queried about the fact that he'd started a patient on Buspar 10mg tid, when the Geriatric Dosing Handbook states that 5mg bid is the "maximum initial geriatric dose." The physician was in the process of explaining that all doses are individualized for the particular patient's circumstances; Barlow objected as to the relevance of the physician's understanding of geriatric dosing and the judge sharply overruled her, flatly stating that "this trial is all about such issues; nothing could be more relevant".

I do like the judge. He is no-nonsense, fair, and briskly moves the trial along. He's got guts, too.

Here is today's article from the Deseret News:

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http://deseretnews.com/dn/print/1,1442,440015109,00.html

Deseret News, Friday, November 08, 2002

Interpretation of comment at issue during Weitzel trial

By Linda Thomson
Deseret News staff writer

FARMINGTON — Subtle word changes that might affect the way statements are interpreted and testimony about how patients progressively deteriorated were presented to jurors Thursday in the third day of testimony involving psychiatrist Robert Weitzel.

Weitzel is on trial for two counts of second-degree felony manslaughter and three counts of misdemeanor negligent homicide in connection with the deaths of five elderly patients in late 1996 and early 1997. He is accused of killing them with morphine overdoses.

Karen Bringhurst, a registered nurse and the daughter of one of the alleged victims, Mary Crane, 72, testified that after her mother was admitted to the Davis Hospital and Medical Center's geropsychiatric unit, her mother began to get progressively sleepier and less communicative. At one point, the nursing staff told Bringhurst that her mother had either had a seizure or a stroke.

Bringhurst said Weitzel met with her and her husband on Jan. 7, 1996. "Dr. Weitzel said whatever had happened was irreversible and she wasn't expected to survive. He said, 'We can give her morphine and hasten the inevitable,' " Bringhurst said.

When questioned by prosecutor Mel Wilson, Bringhurst repeated that Weitzel used the words "hasten the inevitable."

However, defense attorney Walter Bugden asked Bringhurst to read a written statement about that particular meeting, one that she apparently had read publicly at an earlier court hearing that was not identified in court Thursday.

Bringhurst read: "I asked what could be done. Dr. Weitzel said we can give her morphine to keep her comfortable and it may hasten the inevitable. I said thank you."

Weitzel previously was tried for murder for the five deaths, but a jury in 2000 found him guilty of manslaughter and negligent homicide. A judge overturned the verdict upon learning that prosecutors had not disclosed an expert witness whose testimony could have influenced that trial's outcome. Prosecutors then filed new criminal charges.

Some families have filed medical malpractice lawsuits in civil court.

Bonnie Smith Weight, daughter of another of the alleged victims, Lydia Smith, 90, said her mother became more lethargic after being admitted to the unit, but also was more agitated, angry and didn't understand what was happening to her. Weight said she was distressed when Weitzel talked about how Smith would die in 24-to-48 hours while standing close to the patient who was at that time lying in bed and not moving.

Weight said when she tried to challenge Weitzel's decision to giver her mother more morphine, the doctor said he had another appointment and couldn't talk to her. Shortly afterward, a nurse came into the room with a syringe filled with morphine the nurse said she had been ordered to give. "I said, 'I refuse to let you give it to her,' but before I could get to the other side of the bed, she had flipped mother over and given the shot," Weight testified.

Weight said within 20-30 minutes, her mother was dead.

Defense attorney Tara Isaacson referred to medical records pointing to a "long list of medical problems," including a stroke four weeks before going into the Davis unit, losing 30 pounds in the previous year, congestive heart failure, hypertension and other physical ailments.

Especially noteworthy in this trial is the three-woman, seven-man jury, which is visibly attentive and takes notes even during rather tedious testimony.

The jury also is assertive to the point of making the unprecedented move of raising their hands to ask the judge for clarification of some testimony, to have glaring lights adjusted or to have an overhead projector moved so they can better see exhibits.

The trial is officially scheduled to run through Nov. 22, but attorneys say it could run longer.

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Important news! The UMA Board of Trustees did yesterday vote on and pass a resolution regarding end-of-life care, opiates, and professional responsibility.

Here it is:

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CARE AT THE END OF LIFE, OPIOID ANALGESICS AS APPLIED TO END OF LIFE CARE, AND COMMITMENT TO PROFESSIONAL RESPONSIBILITY

Care at the End of Life

1. Physicians are committed to relief of human suffering.

2. Physicians advocate for the very sick, especially the terminally ill.

3. Excellent end of life care is individualized in the context of the private doctor-patient relationship.

4. Excellent end of life care respects patient autonomy.

5. End of life care is optimized by communication between health care professionals and the patient and family.

Opioid Analgesics as Applied to End of Life Care

1. Knowledge of the use of opioids is essential to the clinical practice of pain and symptom management.

2. Pain antagonizes the respiratory depressant effect of opioid analgesics.

3. Patients can become tolerant to the respiratory depressant effect of opioids with repeated dosing.

4. Properly administered, opioid analgesics are not known to cause death in the setting of pain and symptom management of the terminally ill.

Commitment to Professional Responsibility

The Utah Medical Association recognizes that:

1. Regulatory agency influence and legal actions have been shown to inhibit the proper prescribing of opioids for pain and symptom management resulting in unnecessary human suffering.

2. Ongoing efforts to educate regulatory agencies, the legal profession and clinicians are needed.

3. Dialogue between the professionals, regulatory agencies and the legal profession is needed.

Therefore, the Utah Medical Association will explore mechanisms not only to protect the public from unwarranted interference by regulatory agencies and the legal profession but also to educate members of the association on appropriate use of opioid analgesics in end of life care.

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A reasonable statement, in my opinion. I don't know if it will prove useful or even be able to be introduced in the trial.

Well, thanks again to all of you. Please pass these comments on to people who might have interest, and tell everyone you can of www.WeitzelCharts.com . "You shall know the truth, and the truth will set me free."

Please keep in touch.

Yours,

Robert Weitzel MD

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