SOUTHERN DISTRICT OF CALIFORNIA. )CASE NO.: 12cv0432 ) DMS (PCL)

Transcription

1 UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF CALIFORNIA RUTH ANN HALL, as Administrator ) and Personal Representative of ) THE ESTATE OF MARSHA DAU; and ) RUTH ANN HALL, Individually, ) ) Plaintiff, ) ) vs. COUNTY OF IMPERIAL; et al., ) ) Defendants. ) ) )CASE NO.: 12cv0432 ) DMS (PCL) DEPOSITION OF: JOHN BAKER, M.D. TAKEN BY : ANGELA ZUGMAN, ESQUIRE Commencing : 2:15 P.M. Location : Blue Spruce Place Santa Clarita, California Day, Date : Tuesday, September 18, 2012 Reported by : NATALIE RODRIGUEZ, C.S.R. NO Pursuant to : Notice Original to : PETER BERTLING, ESQUIRE Pages 1-80 Job No

2 1 Q So that brings us to 2003? 2 A Exactly. 3 Q And then from there? 4 A Then I was -- deciding what I wanted to do to 5 further my career and I ran into a company that provides 6 medical and psychiatric care to a variety of California 7 county jails, CFMG, and then they invited me to come 8 start working and everything worked out very well. So 9 that expanded so I'm working in a variety of jails right 10 now. 11 Q CFMG in 2003 was that a company that was just 12 starting back in 2003, if you know? 13 A I don't know the exact history. I think 14 they've been around for 10 plus years by then, but I 15 don't know exactly. 16 Q So you've worked with CFMG since 2003? 17 A Correct. 18 Q Consistently? 19 A Yes. 20 Q Until the present time? 21 A Yes. 22 Q Are you an employee or independent contractor? 23 A Independent contractor. 24 Q How many jails do you currently work at through 25 CFMG? California Deposition Reporters Page: 10

3 1 A Eight. 2 Q Can you name those jails for me? 3 A Imperial, Ventura, Madera, Tulare, El Dorado, 4 Placer, Butte, Glen, and Yolo. 5 Q Do you have any other private practice that you 6 still pursue apart from your work with CFMG? 7 A No. 8 Q Your employment with CFMG that is as board 9 certified psychiatrist? 10 A Yes. 11 MR. BERTLING: I think that misstates his 12 testimony. I think he testified that he's an independent 13 contractor not an employee. 14 Q BY MS. ZUGMAN: Okay. Thank you. But your 15 title with CFMG is currently as a board certified 16 psychiatrist? 17 A That's the reason I work for them as a 18 psychiatrist and I am board certified, yes. 19 Q Do they have a title that they give you that's 20 different than what we just said? 21 A Not that I'm aware of. 22 Q As a board certified psychiatrist contracting 23 with CFMG what are your main duties? 24 A To provide psychiatric evaluation and/or 25 treatment to the inmates at various California county California Deposition Reporters Page: 11

4 1 jails where I work. 2 Q Approximately, how many inmate patients do you 3 have in your caseload currently? It doesn't need to be 4 an exact number. 5 MR. BERTLING: Just object that it's 6 irrelevant, but go ahead and answer the question to the 7 best of your ability. 8 THE WITNESS: I don't understand the question, 9 actually. 10 Q BY MS. ZUGMAN: Do you have a set number of 11 inmate patients that you are currently providing psych 12 treatment for at these jails? 13 A I guess I'm saying that because it's extremely 14 variable. It depends on the fluctuations of the jail 15 population and from week to week even. So it's hard to 16 say. I see so many people. Like from Imperial I spend 17 some time there and whoever I need to see that time than 18 I see them. 19 Q Would you have documentation that would help 20 you ascertain how many patients you were seeing back in 21 July 2011 approximately? 22 A I do not have that documentation. 23 Q Can you tell me approximately what the most 24 number of patients you saw or cared for in a given week? 25 MR. BERTLING: Let me just object that it's California Deposition Reporters Page: 12

5 1 irrelevant, but go ahead and answer the question. 2 THE WITNESS: Maybe 130 to 140 maximum. 3 Q BY MS. ZUGMAN: That's at all the jails in a 4 given week? 5 A Yes. 6 Q Do you have knowledge as to what types of 7 doctors work at these jails? For instance, you're a 8 psychiatrist. Are there other practices represented by 9 other doctors at these jails? 10 A Yes. 11 Q Can you tell me what they are? 12 MR. BERTLING: Let me just object. It's vague 13 and ambiguous as to which jail, but go ahead and answer 14 the question. 15 THE WITNESS: I can't tell you all of the exact 16 training of all the doctors. I mean, for example, there 17 are emergency room physicians. There are surgeons, but 18 again, I don't have their background. 19 Q BY MS. ZUGMAN: What about at the Imperial 20 County Jail, do you know of other doctors that service 21 the patients there? 22 A Dr. Singh. 23 Q Any other doctors besides Dr. Singh? 24 A As far as I know he's the current doctor. 25 Q Do you have an understanding of what his role California Deposition Reporters Page: 13

6 1 A These are previously scheduled. So I'm on a 2 regular weekly schedule. 3 Q Do you have a weekly schedule with ICJ as to 4 when you do telepsychiatry with the inmate patients 5 there? 6 A Yes. 7 Q What's that schedule? 8 MR. BERTLING: Let me just object that it's 9 vague and ambiguous. Are you talking about now or in 10 July of 2011 or if it's been the same, just let her know. 11 Q BY MS. ZUGMAN: If it's been the same -- let's 12 start with July A At that time it was Thursday morning and -- I 14 think it was Thursday morning and it's been consistent at 15 that time since then. 16 Q So Thursday mornings are your scheduled times 17 to do telepsychiatry for inmate patients at ICJ? 18 A Correct. 19 Q Is there a certain time slot? 20 A 7:00 a.m. 21 Q So Thursday mornings at 7:00 a.m. who schedules 22 the inmate patients to be seen by you by telepsychiatry? 23 A I schedule people for follow-ups if I feel it's 24 necessary. So that would be prescheduled. Or anybody 25 that is deemed by the medical staff there to need California Deposition Reporters Page: 16

7 1 psychiatric evaluation or there can be new inmates that 2 come in that are on medications and need to be evaluated 3 regarding those medications. 4 Q Do you have access to the inmate patient 5 medical files remotely when you do the telepsychiatry? 6 A I'm usually given some kind of an intake or 7 some of that information. I don't get the whole record. 8 Q Can you tell me what types of documentation you 9 would be given for purposes of doing telepsychiatry? 10 A Sometimes I get printouts of the medication. 11 Sometimes I get printouts of the intake form. Sometimes 12 I get notes from the nurse. Sometimes I get printouts of 13 the medication from -- let's say they called up a 14 pharmacy to find out what medications they're on. I get 15 a verbal comment from the nurse about what's going on. 16 Q Can you explain to me why the documentation 17 might vary from one telepsychiatry eval to another? 18 MR. BERTLING: Objection. Incomplete 19 hypothetical. Calls for speculation. But go ahead and 20 answer the question if you understand it. 21 THE WITNESS: Every patient is different or 22 every inmate is different. Every situation is different. 23 Q BY MS. ZUGMAN: Would you be the person to ask 24 for certain documentation such as the ones you just 25 listed, the printouts of the intake, pharmacy, nurse California Deposition Reporters Page: 17

8 1 notes? 2 A Yes, I can ask for that. 3 Q Does CFMG staff provide you with a set of 4 documents that are consistent for every telepsychiatry 5 meeting that you would do for an inmate? 6 A Every situation is different. It depends on 7 what that particular inmate or patient problem is and 8 depending on what that is I can get more or less 9 information depending on what I need. 10 Q Dr. Baker, I'm trying to get a sense for just 11 the general protocol. You have these telepsychiatry 12 evals on Thursday mornings. Is the first thing that 13 would happen would be a verbal report from a nurse? Just 14 chronology what happens? 15 A No. What happens, first of all, they fax me a 16 list of all the people I have to see that day plus any of 17 the documents that they feel are necessary for me to see. 18 Q Who is they? 19 A The nurse. And I review that with the nurse. 20 Q Review with the nurse? 21 A I just go through the list and what's happening 22 with this one, what's happening, what's happening just to 23 get a mental, you know, what am I doing here today. 24 Q Are you communicating with the nurse by phone? 25 A On the TV. And then she and the officer California Deposition Reporters Page: 18

9 1 Sometimes I will ask that. 2 Q Are you aware that she was currently at the 3 time of July 7, when she was incarcerated, taking meth? 4 A No. That doesn't mean she's taking meth in 5 jail. What I'm looking for is what was her pattern of 6 drug use prior to coming to jail. I'm not trying to 7 investigate whether they're sneaking meth in. 8 Q And continue. 9 A Then I said are you seeing any mental health or 10 behavior health, psychiatry outside the jail and she said 11 no. When I put down fibromyalgia history, I must have 12 asked are you seeing a doctor and she got the idea she 13 has fibromyalgia. Again, there may have been a little 14 more conversation in here but these are Q Do you recall? 16 A I don't remember. These are -- I write down 17 the things that are relevant. I don't write every word 18 down. Then I say do you have any psychological or 19 emotional problems today? And what I wrote is the issues 20 are physical problems. These are not her words, but 21 these are a paraphrase of her saying -- I don't remember 22 what she said, but I'm in pain or whatever she said. 23 Basically, she was indicating to me that she doesn't have 24 any psychiatric problems. 25 Q Okay. California Deposition Reporters Page: 44

10 1 A Then I'm putting down zero times three. That's 2 an abbreviation for orientation. That just means she 3 seems to be aware of where she was, the date, her age, 4 all that. These are, again, my observations. I saw no 5 thought disorder symptoms. That means I didn't see things 6 like hallucinations or paranoia or the idea were talking 7 behind her back. She was present here. I didn't see her 8 as somebody who was withdrawn in her own world type 9 thing. 10 Usually, as I said, I say are you happy or 11 depressed right this minute and this word neutral means 12 that she didn't document she was depressed or she didn't 13 document she was exceedingly happy. I don't remember 14 what she said. I put down affect. What am I seeing? 15 Affect is what -- what's emotional -- what's be shown on 16 emotions. What I'm putting down she was animated. She's 17 not withdrawn in herself. She's not hyperactive or her 18 emotions aren't flying all over the place. 19 She was animated. Her speech was clear. Her 20 eye contact was good, which means she seemed to be paying 21 attention and making contact with where I appeared on the 22 TV screen. The zero with the line over it means no and 23 SI means suicidal ideation and as I mentioned earlier I 24 asked that specific question virtually with everybody. 25 Zero with a line over it and HI means no homicidal California Deposition Reporters Page: 45

11 1 ideation because I'm really concerned, you know, having 2 somebody who wants to hurt themselves or thinking about 3 it or if I got somebody who has got the idea they may 4 want to hurt somebody else. This gives me a sense of do 5 I have to take action right now. 6 Q A danger? 7 A Exactly. So at that point I put down my -- 8 what looks like imp, which is my impression and I put 9 down fibromyalgia history. 10 Q Why was that significant for you to write that 11 down? 12 A Because that's what she had told me her problem 13 was and I didn't put anything psychiatric down because I 14 didn't see anything. So I didn't add anything else. She 15 had documented she had fibromyalgia. I had no way of 16 documenting or confirming that, so I put that was the 17 history she was giving. A little bit of a scroll on the 18 bottom it's actually the word plan. What am I planning 19 to do and I put down Dr. Singh is managing her care and 20 then there's my signature. 21 Q At the time you authored this note was it your 22 conclusion that she presented with no psych issues? 23 A Correct. 24 Q Did you speak with Dr. Singh, if you recall, 25 about her -- his managing her care? California Deposition Reporters Page: 46

12 1 A No. 2 Q Did you -- how did you get that information 3 that he was managing her care? 4 A Most likely from the nurse. 5 Q Do you recall speaking to Dr. Singh at all in 6 July 2011 regarding Ms. Dau? 7 A I don't recall speaking with him. 8 Q Let's go to your next set of notes for July 21, Same request, can you please read into the record 10 your notes so we have a clear understanding of what you 11 wrote at that time. 12 A It's the same documentation at the top of the 13 mental health note. Her name, date of birth. I just 14 copied the age. So it just keeps me in touch with who 15 she is. 16 Q Is there any significance for why you would 17 circle her age or even take note of her age? 18 A As I said in the initial evaluation I always 19 ask -- I know their date of birth. I'm asking how old 20 are they, which basically how is their brain working, are 21 they in touch with what's going on right now. I'm purely 22 guessing myself right now, but I probably did not ask 23 that the second time. I probably did that for my own I may have done it when I first got the record. I don't 25 remember. California Deposition Reporters Page: 47

13 1 Q Did you have any concerns as people get older 2 with respect to their brain working? 3 A Yep. 4 Q I'm trying to understand why you circled If there's any significance to that? 6 A That's just more of a habit than anything else. 7 Q Continue, please. 8 A So the date was the 21st of July, 2011 and 9 again the nurse -- the RN told me that this inmate had 10 attacked an officer and had been placed in a safety cell. 11 That's just a summary of -- gives me -- the nurse 12 couldn't give me more information. I don't remember all 13 the things she told me, but that summarized why was I 14 seeing this person again. 15 Q Do you recall this evaluation in July do you recall Marsha at that time? 17 A I do not recall this independently beside my 18 note. 19 Q You would have seen her on the feed -- the 20 video feed? 21 A I saw her in the room in telepsychiatry, yes. 22 Q But you don't have an independent recollection 23 of what you saw? 24 A I don't remember that particular event. 25 Q So after you read the first two notes into the California Deposition Reporters Page: 48

14 1 record can you continue from that point? 2 A I put down I am seen. So I'm sure I did see 3 her then. I actually probably -- I think I may have 4 asked her again what are you charged with because I put 5 down probation false check. Again, that's just trying -- 6 what I'm trying to, again, is to establish what are you 7 doing here? What's your understanding of what's going on 8 here? That's a paraphrase of whatever she said. I think 9 I repeated the idea from what kind of drugs or alcohol 10 you're using and she said -- this is with quotes, pain 11 killers and I don't think I finished that quote, but 12 since I put the quote in the beginning she used those 13 words. I'm purely guessing now, but I suspect the meth I 14 was just repeating what I had put down previously. I 15 doubt I would have asked again. I put on the left side 16 crt, but my guess at that point I did not ask that 17 question. I didn't put an answer to that. I put down 18 mental health. Diagnosis was fibromyalgia and panic. So 19 now she's putting down the panic. 20 Q Whose diagnosis? 21 A This is asking her. So I'm asking her. 22 Q Continue. 23 A So she said she is having panic feelings. 24 Again, I didn't quote it so that's probably a summary of 25 what she said. I put down Rx Valium. California Deposition Reporters Page: 49

15 1 Q Is that based on what she told you? 2 A What she told me, but also there is a note here 3 that on the 1st of July I had given her a Valium, twice a 4 day for three days. I suspect that was right after she 5 came into the jail. 6 Q You had given? 7 A It says telephone record from Dr. Baker. 8 Q Okay. I'm going to go over that in a second. 9 Okay. Continue. 10 A And then I said what's happening with you now? 11 What kind of psychological or emotional problems? I 12 don't remember exactly the questions. This is a 13 follow-up since I have already seen her once. Her quotes 14 were pain everywhere, end of quote. So those are her 15 words. Then I'm summarizing that she still seemed to be 16 oriented. She knew where she was. Her thoughts were 17 more scattered and usually what that means is she's not 18 staying on linear thoughts. She might go off on a 19 tangent here or somewhere else. That's usually what that 20 means. I usually -- I asked her are you hearing voices 21 and she denied that. She said she was depressed. Her 22 speech -- I can't say she said she was depressed. I 23 didn't quote that. My observation is that she was 24 depressed. 25 Q When you say depressed, is that her -- California Deposition Reporters Page: 50

16 1 A Depressed is like you're looking glum. You're 2 not looking like a happy person. 3 Q Would you also use that term if you're 4 observing someone that wasn't really animated, their body 5 movements were slowed down? 6 A Sure. 7 Q They seemed to have difficulty with their gait 8 or something along those lines? 9 A Not necessarily their gait. 10 MR. BERTLING: Lacks foundation that he's 11 observing their gait. 12 Q BY MS. ZUGMAN: But it's fair to say you 13 wouldn't -- you would make some observation about her 14 physical state? 15 A I'm really looking at what's more of her mental 16 status. What do I see as a psychiatrist. Her speech she 17 was somewhat breathless. She was talking very quickly. 18 I'm just guessing. 19 Q Would breathless -- you're a doctor. Did she 20 seem to have labored breathing? 21 A I don't think so. I think it was more 22 breathless. She was frustrated because the next word is 23 restless. Usually when I write restless, it means 24 they're sitting in the chair and they're not comfortable. 25 They're not sitting still. Her affect was labile, which California Deposition Reporters Page: 51

17 1 means -- again, I don't remember what specifically it 2 was, but at one point she might be getting overly 3 emotional. Like she might not want to communicate. So 4 she was not -- 5 Q Vacillating somehow? 6 A That's a good word. 7 Q Continue. 8 A I put down her eye contact was poor. She was 9 not -- she wasn't really connected where she had been 10 previously in the two week ago evaluation. 11 Q Okay. So she wasn't looking at you? 12 A Yeah. Again, I don't remember, but she wasn't 13 making contact in the same way. 14 Q Next notes. 15 A Then the same one. I asked her if she was 16 suicidal or homicidal and she said no. 17 Q Your next note. 18 A That's the imp for my impression. I put down 19 drug sequela psychosis. 20 Q What does that mean? 21 A That means when somebody is taking things like 22 methamphetamine, that alters the brain a great deal and 23 my impression at that point was that she was, number one, 24 psychotic and my impression was that this could very well 25 be after the drugs but the main thing was the psychosis. California Deposition Reporters Page: 52

18 1 Q But do you know if she was taking meth while 2 she was incarcerated? 3 A No. I wasn't thinking she was taking meth 4 while incarcerated. I was looking at the idea that 5 when -- depending on how many years she had been using 6 meth, which I don't know, but the effects of 7 methamphetamine can be relatively longer acting. Maybe 8 you wouldn't measure actual methamphetamine in the 9 system, but the actual effects on the brain can be 10 lingering and can include psychotic thinking. 11 Q You noted here on Rx Valium and we're going to 12 go to doctor's orders next regarding the order for 13 Valium. Would you have also documented in this note for 14 July 21, 2011 other medication she was prescribed by Dr. 15 Singh, for example? 16 A Again, when I put down the Valium, that may 17 have been what she said she was taking. I don't 18 necessarily think that means what we gave her in the 19 jail. 20 Q Would you have looked at other documentation to 21 see what other medication she was taking in the jail? 22 A At that point, no. 23 Q Why not? 24 A As I say, I was manly evaluating what was going 25 on with her at that point and what were the effects of California Deposition Reporters Page: 53

19 1 that. What was going on with her at that point. 2 Q As you sit here today do you have an opinion 3 one way or the other as to why she appeared to have drug 4 sequela psychosis as of July 21, 2011 when your 5 assessment of July 7, 2011 seemed to be that she had no 6 psych issues? 7 A Like I said before, I think that 8 methamphetamine can have long-term effects. On top of 9 that the fact that she was in jail, which was likely 10 related to drug abuse then whatever behavior she was 11 doing in conjunction with the drug abuse, I think that I 12 could have probably added other things like jail stress. 13 Again, my main issue there was she had attacked an 14 officer. She was in a safety cell and she was restless 15 and disconnected and psychotic. 16 Q Do you recall whether you had any -- whether 17 you had been consulted or asked to be given -- strike 18 that. Did you know she was in a safety cell apart from 19 what the nurse or CO told you? 20 A No. 21 Q So is it your impression drug sequela psychosis 22 is the supporting -- the finding that you've discussed 23 about her use of meth is that what's supporting that 24 impression? That diagnosis? 25 A I think that's the part that I put drug sequela California Deposition Reporters Page: 54

20 1 psychosis. 2 Q But drug sequela does not refer to any of the 3 other medication that she was taking in the jail that was 4 prescribed to her? 5 A I wasn't thinking that way. I was putting down 6 that I was very concerned that she was a person who used 7 a fair amount of meth and now she was psychotic. 8 Q I'm just trying to understand what drugs 9 sequela means. That means you're referring to the meth? 10 A I'm thinking one of the elements that could 11 lead to her psychosis right now could be meth, yes. 12 Because what I'm putting down is my impression at this 13 point. I'm not trying -- I've got to deal with this 14 difficult situation and I'm just putting together what's 15 happening in front of my eyes. This is my impression at 16 that point. 17 Q I just want to be clear. The drug sequela 18 doesn't refer to the drug medication she was taking in 19 jail? 20 A I did not write that down as that intention. 21 Q Can you go on to your plan? 22 A Plan was for Haldol 5 milligrams and Cogentin 23 one milligram this morning, which meant soon as we're 24 finished. 25 Q Why did you prescribe those medications at the California Deposition Reporters Page: 55

21 1 time? 2 A Because Haldol is an excellent medication for 3 people who are psychotic and agitated. 4 Q What does it do? Does it calm a person? 5 A Yes. In laymen's terms it has an aspect that's 6 sedating. It's an aspect which is calming. It has an 7 element which slows thinking down. So that instead of 8 having a lot of scattered thoughts you can become more 9 sequential with that and try to gather your thoughts. 10 Those are the general terms. 11 Q Are you aware if it also slows physical 12 movement in any way? 13 A As a sedating medication, yes. 14 Q What about Cogentin, what is that for? 15 A Cogentin is a medication that blocks some of 16 the more common side effects of Haldol. 17 Q Such as? 18 A These are under the general rubric of 19 extrapyramidal symptoms and they can include things like 20 akathisia. 21 Q What is akathisia? 22 A Akathisia is sort of a rippling movement inside 23 your muscles. It makes it feel like they're jittery. It 24 can cause dystonia, which means it can make the muscles 25 tighten up. For example, in your jaw or your neck. Or California Deposition Reporters Page: 56

22 1 it can cause what we call extrapyramidal side effects, 2 which are things such as -- extrapyramidal is like a 3 Parkinson's type movement. So you get the shakiness like 4 this or movements around the mouth and so on. 5 Q So those are the known side effects of Haldol 6 and Cogentin helps with that? 7 A Those are some of the side effects of Haldol 8 and Cogentin is intended to block those particular very 9 uncomfortable and preventable side effects. 10 Q Are there any side effects known with Cogentin? 11 A It can dry your mouth out, blur your vision. 12 Actually, it's pretty mild. 13 Q Is there any known risk of dehydration with 14 either Haldol and Cogentin that you're aware of? 15 A It's not necessarily dehydration, but it's a 16 dry mouth because it's artificially drying up some of the 17 saliva. 18 Q Were you aware that Marsha was being prescribed 19 and taking Ultram at the time that you did this 20 evaluation on July 21, 2011? 21 A I can't tell you that I can remember all the 22 medication that I was told. I did not document that, 23 but, you know, I don't recall what the nurse told me. 24 Q We went over this earlier, but the medication 25 administration record is not something you would be California Deposition Reporters Page: 57

23 1 typically given? 2 A Correct. 3 Q Do you have any reason to believe that you 4 would have noted her use of Naproxen at the time? 5 A Yeah, I didn't -- I don't recall that. I think 6 that I was aware as I put in my first note that Dr. Singh 7 was going to manage the pain issue. So I was pretty sure 8 that having observed other patients that he's taken care 9 of that he will give out medication appropriate for 10 people's pain issues. 11 Q Is it -- would Dr. Singh typically take into 12 consideration the medication she's currently on -- an 13 inmate's current medications and then whatever medication 14 you might prescribe to a patient and evaluate them? 15 MR. BERTLING: Objection. The question is 16 vague and ambiguous. Calls for speculation about his 17 part, but if you understand the question, you can answer. 18 THE WITNESS: All my interactions with Dr. 19 Singh tells me that he's a very capable doctor and he 20 keeps up on top of things pretty well. I don't know what 21 he specifically did, but I respect Dr. Singh's ability to 22 look at the whole situation. 23 Q BY MS. ZUGMAN: At the time you prescribed the 24 medications would you have considered any 25 contraindications of those medications with Ms. Dau's California Deposition Reporters Page: 58

24 1 other medications she was being prescribed in jail? 2 A Haldol does not have a lot of other 3 contraindications for medications. So I wasn't thinking 4 of any particular medication. There was no reason for me 5 to -- I just didn't think about anything else at that 6 point. 7 Q In your assessment on July 21, 2011 did you 8 eliminate the possibility of medications as being the 9 source of her psychosis at the time? 10 MR. BERTLING: What medications are you talking 11 about? The methamphetamines or the Naproxen, the 12 Tramadol and other medications? 13 Q BY MS. ZUGMAN: The other medication that she 14 was prescribed and taking in jail not the meth. 15 A I was not considering those specifically. 16 Q Are you familiar with Ultram? 17 A Yes. 18 Q Do you know what it's typically used for in 19 patients? 20 A Pain. 21 Q Are you aware of any of its side effects? 22 A I don't keep up with it very much. I don't 23 prescribe it myself. So I don't think about that very 24 often. 25 Q I want to show you one document just to see California Deposition Reporters Page: 59

25 1 if -- I'm going to give to you what's entitled consent 2 for medications Bate stamped 183. I just want to confirm 3 that's your signature? 4 A Yes. 5 (Plaintiff's Exhibit 22 was marked for 6 identification by the court reporter 7 and is attached hereto.) 8 Q And did you see Ms. Dau actually sign this 9 document or would that have been when she was in the 10 interview room -- let me strike that question. Did you 11 see Ms. Dau sign this form? 12 A I don't independently recall seeing her sign 13 that form. However, when I finish interviewing and we've 14 decided what medication, then the nurse usually has this 15 form there as it says the name of the medication were put 16 on here and the inmate is asked to sign that form, yes. 17 Q Do you recall explaining to Ms. Dau that she 18 would need to sign this in order to get the medication? 19 A I will tell them about the medication and 20 usually the nurse is the one that says you have to sign 21 the consent form. 22 Q Do you recall at the time if you had any 23 concerns that she may not have understood or had trouble 24 understanding what was happening with her being given 25 medication? California Deposition Reporters Page: 60

26 1 A I don't recall independently. I usually try to 2 explain things in relatively clear terms. 3 Q I only ask because you did diagnosis her with 4 drug sequela psychosis. 5 A I have to correct that. I didn't diagnosis 6 her. I put down that was my impression. 7 Q Sorry. I guess the question I had was did she 8 seem to have a grasp on what she was signing in terms of 9 consent? 10 A I don't have an independent recall of that, but 11 the way she answered some of these questions my guess it 12 was a little problematic that she was having a lot of 13 distress at that the point. 14 Q Do you recall at the time you gave her those 15 medications if you provided any follow-up instructions to 16 the nursing staff or anyone at the jail? 17 A I think there's another sheet that's got some 18 orders on here. 19 Q You mean the doctor's orders? Let's mark these 20 documents that are doctor's orders pages 173 through Do you have that? 22 MR. BERTLING: I have four pages 173 through Q BY MS. ZUGMAN: With respect to this document, 25 the doctor's order, I'd like to go through which entries California Deposition Reporters Page: 61

27 1 you wrote and verify which ones those are. So on the 2 first entry July 1, actually, let's go back. You 3 said that you would have provided follow-up instructions 4 to the staff at the jail regarding Ms. Dau after your 5 impression was made on July 21, 2011; is that correct? 6 A Uh-huh. 7 Q Where are those instructions? 8 A I wrote some orders. 9 Q Is that Bate stamp 176? 10 A Yes. 11 Q Can you go through what your instructions were 12 on this order? 13 A Yes. As my note says I was planning on giving 14 her Haldol that morning. I wrote on 21st of July 2011 at , number one was Haldol 5 milligrams, BID times one 16 day and number two says Cogentin one milligram, BID times 17 one day. The number three says then Haldol 5 milligrams 18 a half a pill twice a day, and number four and Cogentin 19 one milligram one-half po BID for 30 days. Number five 20 says psy sick call, which means psych sick call, which 21 means see me in one week. 22 Q What's BID stand for? 23 A Twice a day. 24 Q Why does that stand for twice a day? 25 A Some Latin thing probably. California Deposition Reporters Page: 62

28 1 Q And do you recognize that signature next to 2 yours? 3 A That's Madell Landrum. 4 Q Is that her signature there? 5 A That looks like her signature, yes. 6 Q The other writing is that all your writing? 7 A Yes. J. H. Baker, Jr., is my writing. 8 Q And what about any instructions as to 9 monitoring her behavior, is that something you would have 10 verbally told the staff? 11 A Actually, I didn't need to because she was in a 12 safety cell. So that's already part of the process. 13 Q If her behavior was in any way declining or 14 worsening, would the safety cell protocol be such that it 15 should bring that to your attention? 16 A Yes. 17 Q 23 is the doctors orders on July 21, 2011 and 18 then I just want to go through the other doctors orders 19 in sequence just to see which ones you authored and we'll 20 mark that Exhibit 24. Starting with July 1, Can 21 you read that into the record please? 22 (Plaintiff's Exhibits was marked 23 for identification by the court 24 reporter and is attached hereto.) 25 A I mean the only one that has to do with me is California Deposition Reporters Page: 63

29 1 dated July 1, 2011 at Q Okay. Can you read that into the record, 3 please? 4 A It says Valium 5 milligrams po BID times 3 days 5 then DC. 6 Q So the doctors orders are these typically 7 written by the doctors yourself or Dr. Singh? 8 A I can't recognize signatures, but on the one 9 that is relevant to me July 1, 2011 at 1500 at the bottom 10 it says TO, which means telephone order. TO is telephone 11 order. 12 Q Is there a signature by you that you see? 13 A No. What happens is it says telephone order, 14 Dr. Baker and then it says M. Landrum RN. What that 15 means is she called me up and indicated that there was a 16 problem with some agitation or whatever it was that I 17 don't recall right now and would I be willing to give 18 something to help this inmate calm down. 19 Q Is that the purpose of the doctors orders is to 20 jot or document which prescriptions have been authorized 21 by doctors? 22 A Correct. 23 Q Is there any other purpose for this doctors 24 orders sheet that you see that you can explain to me 25 other than authorizing medications? California Deposition Reporters Page: 64

30 1 A In this case all I see here are medications 2 except there's also a dental evaluation at some point on 3 one of these. 4 Q That's the only one that is relevant to you? 5 A There's also a -- I can't read all of it, but 6 it says psych MD eval. It says panic disorder. 7 Apparently, Dr. Singh wanted me to see her. 8 Q Where do you see that? 9 A Right there. 10 Q Okay. So July 5, And it says A That means psych MD eval - panic episode or 12 disorder. 13 Q So the doctor wanted you to see her? 14 A I can't tell you because I can't read too much 15 of the -- I don't know who wrote that. 16 Q Since I have you here do you know what place in 17 ophu means for shift observation? 18 A Could be outpatient housing unit. Pure guess. 19 Q As part of the evaluation July 21, 2011 would 20 you happen to provide these documents? 21 MR. BERTLING: These documents being the 22 doctors orders? 23 MS. ZUGMAN: The doctors orders. 24 THE WITNESS: No. 25 Q BY MS. ZUGMAN: As far as monitoring Marsha California Deposition Reporters Page: 65

31 1 after she was given the Haldol and Cogentin that's 2 something that the safety cell procedures would have 3 taken care of? 4 A Yes. 5 Q After July 21, 2011 do you recall following up 6 with anyone in the jail to see how Ms. Dau was doing? 7 A No. 8 Q Did you ever review surveillance tapes in the 9 safety cell for observation purposes? 10 A No. 11 Q I'm going to show you one note. It's from the 12 progress notes. It's Bate stamped 190. Can you just 13 take a minute and review that and let me know if you 14 remember reviewing that note at any point during July With respect to this progress note do you recall 16 seeing this note at any time? 17 A No. 18 Q With respect to the notation in here on July 19 17, 2011 it says inmate patient brought to ophu for 20 evaluation due to incontinence. Were you aware that Ms. 21 Dau had issues with incontinence in the cell at any time 22 prior to your evaluation on July 21, 2011? 23 A I don't recall. 24 Q But you don't recall -- is this a document you 25 would have been given prior to your evaluation on July California Deposition Reporters Page: 66

32 1 21, 2011? 2 A No. 3 Q That is Exhibit 25. The next one is Bate 4 stamped 191. It's also a progress note. Can you read 5 that. Take a moment or however long and -- it does have 6 an entry on July 21, (Plaintiff's Exhibit 25 was marked for 8 identification by the court reporter 9 and is attached hereto.) 10 A I've read it. 11 Q Do you recall seeing this progress note at any 12 time July 2011? 13 A No. 14 Q Would there be any reason for you to be given 15 this progress note at that time? 16 A No. 17 Q But it's stamped mental health at the bottom; 18 correct? 19 A Yes. 20 Q Would CFMG staff typically give you progress 21 notes marked mental health for purposes of your 22 evaluation of an inmate patient? 23 MR. BERTLING: Objection. Incomplete 24 hypothetical. 25 THE WITNESS: What they do, as I mentioned California Deposition Reporters Page: 67

33 1 before, the nurse will review with me verbally some of 2 the things that they've been observing. 3 Q BY MS. ZUGMAN: On July 22, 2011 there's an 4 entry and as part of the entry, I believe, it says laying 5 on floor tremulous. At any point after July 21, were you notified of any of the observations made here 7 regarding Ms. Dau being tremulous? 8 A No. 9 Q So that will be Exhibit (Plaintiff's Exhibit 26 was marked for 11 identification by the court reporter 12 and is attached hereto.) 13 A In that same note she said she was doing 14 better. 15 Q Can you take a look at this document Bate 16 stamped 209. It's entitled medical history Imperial 17 County Sheriff Department CFMG. I just want to know if 18 you recall ever seeing that document? 19 A No. 20 Q Would there be any reason for you to be given 21 this document as part of the evaluation of Ms. Dau? 22 A I usually don't get those. 23 Q Do you recall obtaining information that Ms. 24 Dau had Hepatitis C and possibly one functioning kidney? 25 A I do not recall getting that information. California Deposition Reporters Page: 68

34 1 can closely observe them because there's certain criteria 2 for regular observation in the safety cell. So we know 3 somebody is watching them at distinct intervals. The 4 custody officers have criteria for how many minutes in 5 between the time they have to go to the safety cell and 6 it's -- I think it's probably every 10 minutes. 10 or 15 7 minutes. 8 Q Do you know if as a psychiatrist for ICJ you 9 have to provide authority in some way before an inmate 10 goes to safety cell placement? 11 A No. 12 Q Do you get consulted for your opinion as to 13 whether an inmate should be placed into a safety cell? 14 MR. BERTLING: Objection. Incomplete 15 hypothetical. 16 THE WITNESS: Sometimes, yes. 17 Q BY MS. ZUGMAN: Do you recall if you were asked 18 for your input or opinion with respect to the placement 19 of Ms. Dau in the safety cell? 20 A Not that I'm aware of. 21 Q If you did provide your opinion as to whether 22 an inmate should be placed in a safety cell, would you 23 document that somewhere? 24 A It depends. If I'm -- when I'm seeing in 25 telepsychiatry, of course I'm documenting that. If I California Deposition Reporters Page: 71