Cross Examination of Anesthesiologist

Lawyer examining witnessThis 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
  • HYPOTHECIALLY, 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
  • Attorney Help Center: depositions, interrogatories, and other discovery to help put the case in position to win at trial

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