Cross Examination of Anesthesiologist

This is a sample outline of a cross-examination of an anesthesiologist in a medical malpractice case that result in a $10 million verdict in Baltimore City.

Background and Bias

• YOU ARE NOT AN EMPLOYEE OF UMMS HOSPITAL
• YOU WERE HIRED BY UMMS HOSPITAL TO COME TO COURT AND GIVE OPINIONS
• YOU ARE BEING PAID BY THE HOSPITAL TO TESTIFY
• YOU HAVE DONE PROFESSIONAL WORK BEFORE
• AND YOU BILL FOR THAT TIME
• THAT IS HOW MEDICAL MALPRACTICES GO RIGHT
• EXPERTS GET PAID BY THE SIDE THAT IS CALLING THEM
• THIS CASE ISN’T UNUSUAL
• YOU USUALLY TESTIFY FOR THE HOSPITAL OR DOCTOR BEING SUED
• YOU HAVE TESTIFIED IN OTHER STATES
• ARE YOU IN CHARGE OF MAKING POLICIES AND GUIDELINES AT YOUR HOSPITAL

Blood Draws

• IT IS IMPORTANT FOR A DOCTOR TO KNOW WHAT HIS PATIENTS LABS SAY
• IT IS IMPORTANT SO THE DOCTOR CAN PROPERLY TREAT THE PATIENT
• LABS CAN SHOW HOW MUCH POTASSIUM IS IN THE PATIENTS SYTEM
• TOO MUCH POTASSIUM IS A BAD THING FOR THE HEART
• DR. BURKS TESTIFIED HE USUALLY GOT LABS ON HIS PATIENTS IN THE AM
• HE DIDN’T REALIZE THAT HE DIDN’T HAVE MR. ALLENS’ LABS ON THE AM OF MARCH 18TH
• HE DIDN’T KNOW HE HAD HIGH POTTASIUM LEVELS UNTIL HIS CARDIAC ALARM WENT OFF
• MR. ALLEN HAD HEMODIALYSIS FOR 4 DAYS AND TOOK OFF THE 17TH,
• YOU THINK DR. BURKS WOULD HAVE EXPECTED HIS P TO GO UP RIGHT
• THE ALARM GOING OFF IS WHAT MADE HIM REALIZE HE HAD NO LABS
• THE NEPHROLOGIST CAME THROUGH AT 11:30 TO CHECK ON MR. ALLEN

Treatment of Hyperkelimia

• YOU TREAT HYPERKELIMIA IN YOUR PRACTICE
• YOU HAVE ORDER SETS AT YOUR HOSPITAL
• YOU DON’T KNOW WHAT YOUR ORDER SET IS FOR YOUR HOSPITAL
• YOU WERE ASKED ABOUT THAT IN JUNE THIS YEAR AT YOUR DEPO
• YOU NEVER LOOKED AT YOUR ORDER SET BETWEEN JUNE AND TODAY
• YOU HAVEN’T TREATED A PATIENT WITH HYPERKELIMIA SINCE JUNE

Three Phases

• FIRST THING YOU DO IS GIVE CALCIUM TO STABILIZE THE HEART
• THAT IS A REALLY IMPORTANT MEDICINE TO GIVE RIGHT
• CRITICAL THAT IT BE GIVEN SO THE PATIENT DOES NOT GO INTO CARDIAC ARREST
• YOU WANT TO MAKE SURE YOU GIVE THE CALCIUM ASAP D23
• WORKS VERY QUICKLY, 5 MINUTES D25
• THERE IS NO EVIDENCE IN THE CHART THAT THE MR. ALLEN WAS EVER GIVEN THE CALCIUM OTHER THAN DOCTOR BURKS SAYING IN HIS DEPOSITION THAT HE DID GIVE IT
• NO RECORDS OF IT IN THE BILLS
• NO RECORDS OF IT LEAVING THE PHARMACY
• NO RECORDS OF IT LEAVING THE CRASH CART

Shifting Agents

• SHIFTING AGENTS, THEY WORK VERY QUICKLY TOO RIGHT? D25
• THESE MEDICATIONS BUY YOU TIME AND KEEP THE HEART UNDER CONTROL
• THE HOSPITAL DID GIVE MR. ALLEN THE SHIFTING AGENTS
• AFTER THOSE SHIFTING AGENTS WERE GIVEN, THE IRREGULAR HEARTBEAT WENT BACK TO NORMAL
• THE LIFE THREATENING PROBLEM WAS UNDER CONTROL FOR THE TIME BEING D31
• NEXT THING TO DO WAS TO GET THE POTTASSIUM UNDER CONTROL

Kayekelate

• THAT DOES NOT START TO WORK FOR A COUPLE OF HOURS D24
• HEMODIALYSIS WORKS THE MINUTE YOU HOOK SOMEONE UP D27
• IF DIAYISIS WAS STARTED BEFORE MR. ALLEN DRANK THE K THERE WOULD NOT BE ANY NEED TO GIVE THE KAYEKELATE
• CC NOTE AT PAGE NOTES THAT HEMODIALYSIS WAS “EN ROUTE” AS OF 1:45
• YOU HAVE NOT WORKED AT UMMS
• YOU DO NOT KNOW HOW MANY HEMODIALYSIS MACHINES THEY HAVE
• HOW QUICKLY THEY ARRIVE ON AVERAGE
• YOU ARE AWARE OF THE LITERTURE THAT SAYS DON’T GIVE KAYEXALATE WHEN HEMODIALYSIS IS READILY AVAILABLE
• MR. ALLEN HAD HEMODIALYSIS ON 13,14,15,16 THE WEEK BEFORE
• NOTHING IN THE CHART TO SAY ANYONE HAD A HARD TIME GETTING THE HEMODIALYSIS MACHINE TO HIM
• NO REFERENCE OF ANY DELAY
• NO SHORTAGE OF CARTS AVAILABLE, NOTHING LIKE THAT
• YOU DO NOT GIVE K UNLESS THERE IS A LIFE THREATENING EMERGENCY D 36
• SINCE THE FDA WARNINGS CAME OUT, YOU ONLY GIVE KAYEKELATE IN A LIFE THREATENING EMERGENCY D79
• YOU ARE AWARE THAT THE K WAS NOT ORDERED ON A STAT BASIS, OR EMERGENCY BASIS
• THE K WAS ORDERED ON A ROUTINE BASIS
• HE WASN’T GIVING HIM THE K FOR THE HEART ISSUES HE HAD ALREADY DONE THE OTHER THINGS FOR THAT D89

Cause of Death

• YOUR OPINION ON WHETHER K CAUSES TISSUE DEATH IN THE COLON IS YOU DON’T KNOW ONE WAY OR ANOTHER
• YOU ARE AWARE THAT UMMS HAD GUIDELINES FOR THE TREATENT OF HYPERKELEMIA
• THEY DID RESEARCH TO COME UP WITH THOSE GL
• DID A LITERATURE SEARCH
• CONSULTED THE EXPERTS IN DIFFERENT DEPARTMENTS
• THE HOSPITALS GL SAY KAYEXALATE HAS MAJOR COMPLICATIONS
• THE MAJOR COMPLICATIONS ARE ISCHEMIC COLITIS AND BP
• MR. ALLEN HAD KAYEKELATE
• MR. ALLEN HAD BOWEL PERFERATION
• MR. ALLEN HAD IC
• MR. ALLEN’S DEATH CERTIFICATE SAYS ISCHEMIC COLITIS
• A DOCTOR FROM THE HOSPITAL WROTE THE DC
• YOU ARE NOT SAYING K DOES NOT CAUSE ISCHEMIC COLITIS
• YOU JUST ARE SAYING EITHER WAY
• YOU DON’T REALLY KNOW WHAT EXACTLY CAUSED MR. ALLENS DEATH
• THINK ALL THE OTHER MEDICAL PROBLEMS ARE WHY HE DIED
• YOU AGREE HE WAS AT HIGHER RISK OF IC BECAUSE OF THESE OTHER MEDICAL PROBLEMS
• YOU AGREE DR. BURKS SHOULD HAVE BEEN AWARE OF HIM BEING AT HIGHER RISK OF DEVELOPING OTHER PROBLEMS

Ischemic Colitis

• A SYMPTOMS OF IC IS BLOODY STOOLS
• ANOTHER SYMPTOM IS ABDMONIAL PAIN
• MR. ALLEN DID NOT HAVE BLOODY STOOLS BEFORE THE HOSPITAL GAVE HIM KAYEKELATE
• AGREE NO ONE DX HIM WITH ISCHEMIC COLITIS OR ISCHEMIC BOWEL BEFORE THE KAYEKELATE WAS GIVEN
• YOU THINK HE HAD ISCHEMIC COLITIS BEFORE THE 18TH
• YOU CANNOT SAY WHEN HE GOT IC BEFORE THE 18TH
• NO SYMPTOMS OF IC BEFORE THE 18TH
• NO BLOODY STOOLS
• NO ABD PAIN
• THOSE TWO THINGS ARE SYMPTOMS TS OF ISCHEMIC COLITIS. THEY ONLY HAPPEN IN MR. ALLEN AFTER THE KAYEKELATE IS GIVEN TO HIM
• YOU SAY HE WAS CRITICALLY ILL ON MARCH 10TH
• HE DID NOT HAVE A CRITICAL CARE DOCTOR
• HE WAS NOT IN ICU
• HOSPITAL DIDN’T HAVE A FAMILY MEEING ABOUT END OF LIFE CARE
• NO PALITAVE CARE WAS DISCUSSED IN THE CHART

Hypotension

• YOU DO NOT KNOW WHEN HE HAD HYPOTENSION
• YOU DO NOT KNOW HOW MANY TIMES HE WAS HYPOTENSIVE D111-2
• YOU DO NOT KNOW FOR HOW LONG HE HAD HYPOTENSION D110
• YOU DO NOT KNOW HOW LONG HYPOTENSION NEEDS TO LAST TO CAUSE IC D57
• YOU DO NOT BELIEVE THAT LOW BLOOD FLOW TO THE COLON THROUGH THE ARTERIES CAUSED THE ISCHEMIC COLITIS D62
• THERE IS NO EVIDENCE FOR THAT RIGHT D60
• YOU DON’T DISAGREE WITH DR. GOLDSTEIN WHO SAID THE SMALL BOWEL WOULD BE MORE AFFECTED BY LOW FLOW THAN THE COLON D62
• THE SURGEON WHO REMOVED THE COLON DID NOT REMOVE THE SMALL BOWEL
• THAT TELLS YOU THAT THE SURGEON DIDN’T THINK THE SMALL BOWEL WAS DYING RIGHT

Summary of Opinions

• YOU CANNOT SAY ONE WAY OR THE OTHER IF KAYEKELATE CAUSED ISCHEMIC COLITIS
• YOU DO NOT THINK LOW BLOOD FLOW CAUSED THE ISCHEMIC COLITIS
• YOU CANNOT SAY FOR SURE WHAT DID CAUSE THE ISCHEMIC COLITIS
• YOU CANNOT SAY THE ISCHEMIC COLITIS WAS CAUSED BY THE RHABDO
• YOU CANNOT SAY THE IC WAS CAUSED BY THE KIDNEY PROBLEMS
• YOU AGREE THAT MR. ALLEN DID NOT HAVE ANY SYMPTOMS OF ISCHEMIC COLITIS BEFORE THEY GAVE THE KAYEKELATE
• BUT IF HE DID HAVE SYMTOMS OF ISCHEMIC COLITIS THEY SHOULD NOT GIVE KAYEKELATE
• YOU CANNOT TELL US WHEN THE ISCHEMIC COLITIS STARTED OCCURRING
• HYPOTHEC
  IALLY, DR. BURKS ASSUMES HEMODIALYSIS IS EN ROUTE
• HE DOES NOT GIVE THE KAYEKELATE AND HEMODIALYSIS STARTS IN ABOUT 1 HALF
• THAT WOULD BE OK D77

More Help for Plaintiffs’ Lawyers

• Sample Trial Materials: get more example direct and cross-examination of witnesses, sample opening and closing statements and really everything you need to know to get a medical malpractice or auto tortready for trial
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