united states district court southern district of … · 2020. 5. 27. · 24 a assessment means...

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, ) ) CASE NO: 12cv0432 DMS Plaintiff, ) (PCL) ) vs. ) ) COUNTY OF IMPERIAL; IMPERIAL ) COUNTY SHERIFF'S DEPARTMENT; ) SHERIFF RAYMOND LOERA; CALIFORNIA ) FORENSIC MEDICAL GROUP, INC.; JOHN) H. BAKER, JR., M.D.; ELISA S. ) PACHECO, R.N.; and DOES 1 - 30, ) inclusive, ) ) Defendants. ) __________________________________)

DEPOSITION OF: ELISA PACHECO TAKEN BY : ANGELA KIM ZUGMAN, ESQUIRE Commencing : 10:30 A.M. Location : 375 South 1st Street El Centro, California 92243 Day, Date : TUESDAY, SEPTEMBER 11, 2012 Reported by : Sonja A. Lane, CSR No. 13150 Pursuant to : Notice Original to : PETER BERTLING, ESQUIRE

Pages 1 - 247

Job No. 129597

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California Deposition Reporters Page: 39

1 Q Yes.

2 A Well, some patients will tell you, using foul

3 language, "Get the hell away from the door. I don't want

4 to talk to you. Leave me the hell alone." Some of the

5 ones will say, "No" or "Nah," or they just look at you

6 and they just won't come to the door. Some people just

7 say, "No, I'm fine right now. Leave me alone." Or

8 sometimes, "No, I don't need my blood pressure taken."

9 Or sometimes they tell you, "I don't have any medical

10 problems. I don't need it." It depends.

11 Q So for an inmate that's in a safety cell, are

12 they required to come to the cell door in order to get a

13 vital signs check, or does the cell door actually open

14 and a nurse goes inside to physically assess the inmate?

15 A Well, it depends on the patient's behavior.

16 When they're in the safety cell, there is something going

17 on with the patient. You don't just place people in

18 there just to place them there.

19 Q No, I know. That's what I'm trying to

20 understand is I want to understand how you do a vital

21 signs check on an inmate who's in a safety cell, general

22 protocol?

23 A Depends on their behavior.

24 Q So --

25 A Some people are cooperative. They come to the

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1 door, they show their arm. Some people, they just --

2 they're sitting in there and they drag themselves toward

3 the safety cell door. They don't want to get up, they

4 just show their arm. Some people, they just don't want

5 to talk to you, but they'll just go there and they'll

6 just sit there. The officer opens the door. And I don't

7 never go in there, I just kind of sit at -- I just go --

8 I walk just towards the entrance, or they make the

9 patient walk towards me. I'm never in there. We don't

10 go in there.

11 Q And if an inmate who's in the safety cell is

12 physically unable to get up to get a vital signs, then

13 what would you do in that situation?

14 A If they're unable to walk?

15 Q Unable to walk or get up from the sitting

16 position?

17 A Due to their --

18 Q Due to whatever reason?

19 A -- condition or if like they're disabled? What

20 do you mean?

21 Q If they are not able to physically get up to

22 get their vital signs checked, what's the protocol in

23 that situation?

24 A Well, I've never been through that situation.

25 Because if they're unable to walk or unable to move, I

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1 A Those are our standard procedures that we did

2 do without the doctor being there.

3 Q Okay. Is that placing an inmate in a safety

4 cell, for example?

5 A We place them in a safety cell, yes. And we

6 call the doctor and let them know what's going on when we

7 do some kind of entry in the doctor's order.

8 Q So in that situation when you placed Marsha in

9 the safety cell, it needed to be filled out in the

10 doctor's orders because the doctor okayed it or approved

11 it?

12 A That's our standard procedure. That's our

13 policy and procedures we have in jail, the county jail.

14 Q Standard policy and procedures to write down in

15 the doctor's orders that you placed an inmate in a safety

16 cell?

17 A Uh-huh.

18 Q That's why you wrote that note?

19 A Uh-huh.

20 MR. BERTLING: Instead of "uh-huh," can we get

21 a "yes"?

22 THE WITNESS: Yes. Sorry. Yes.

23 BY MS. ZUGMAN:

24 Q So it says here, "Placed in safety cell for

25 bizarre behavior and possible danger to others."

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1 Did you actually witness the bizarre behavior

2 that was being documented on July 20th, 2011?

3 A Yes.

4 Q Can you describe to me what that bizarre

5 behavior entailed?

6 A Can I look at my notes?

7 Q Yeah. I mean --

8 MR. BERTLING: Sure. What she wants to know is

9 did you see the bizarre behavior as opposed to being told

10 about it, the bizarre behavior?

11 MS. ZUGMAN: Exactly.

12 MR. BERTLING: Do you understand the

13 difference? Did you see her acting bizarrely or was it

14 just based on information --

15 THE WITNESS: No. She was -- I saw it.

16 MR. BERTLING: Go ahead. Go ahead and look at

17 your notes.

18 BY MS. ZUGMAN:

19 Q That's what we want to talk about and then I'll

20 let you make the call.

21 A She refused to take -- she refused my

22 assessment, first of all.

23 Q Is that the vital signs?

24 A Assessment means like I assess her. It's part

25 of the vital signs too. I ask her questions. She

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1 refused to answer questions.

2 MR. BERTLING: Just so the record is clear, she

3 is looking right now at a progress note dated July 20th,

4 2011 at 6:45.

5 BY MS. ZUGMAN:

6 Q Okay. Well, go ahead and mark that the next

7 exhibit in line, Exhibit 4, her progress notes for --

8 these are not Bates stamped; correct?

9 MR. BERTLING: Not these. The ones I have

10 given you should be.

11 (Plaintiff's Exhibit 4 was marked for

12 identification.)

13 BY MS. ZUGMAN

14 Q Okay. I will mark her progress notes, along

15 with doctor's orders, as the next exhibit in line, Number

16 4, but after she's had a chance to review the notes and

17 talk, answer the question.

18 So based on your notes, is that what you recall

19 the bizarre behavior being about?

20 A Yes.

21 MR. BERTLING: What she's talking -- when she's

22 talking about the bizarre behavior, is that what you

23 observed or is that the bizarre behavior that the staff

24 told you about?

25 THE WITNESS: Both.

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1 MR. BERTLING: Okay.

2 BY MS. ZUGMAN:

3 Q Okay. What specifically did the staff tell you

4 that was bizarre about her behavior --

5 I'm going to divide the question into two

6 things: What you observed and what the staff told you.

7 A Okay.

8 Q Right now I'm focusing on what the staff told

9 you.

10 A The staff called me --

11 Q Who?

12 A -- via radio, Officer C.O. Vargas --

13 Q Okay.

14 A -- said that they were going to take this

15 patient to medical for an evaluation.

16 Q Okay.

17 A Officer Vargas said that the patient was trying

18 kick her, and was talking to herself, and acting bizarre.

19 Q Okay.

20 A That's the best I can recall.

21 Q You didn't actually see Ms. Dau try to kick the

22 officer or talking to herself, this was just verbally

23 reported to you or written?

24 A The kicking and stuff I didn't see because she

25 was housed in her module back there where they house

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1 inmates and I was in the office.

2 Q Anything else that the staff reported to you

3 that indicated she was acting bizarre, other than that

4 comment by C.O. Vargas?

5 A Anything I recall that they said to me?

6 Q Uh-huh, even if it's not in the notes.

7 A That she was refusing to -- she was not

8 following verbal commands.

9 Q Okay.

10 A And she had aggressive behavior.

11 Q When you heard that she was not following

12 verbal commands, did you ask the staff if she was

13 refusing to voluntarily follow commands or if she was

14 unable to?

15 A No, I didn't ask her anything. When they took

16 her to medical is when I assess -- well, I was trying to

17 assess the patient.

18 Q Okay. So you got the information and then you

19 assessed Marsha Dau?

20 A Not on my own. She was there standing by.

21 Q Okay. So going back to the doctor's orders and

22 that entry. Did you read the earlier entries that were

23 written on the doctor's orders to see what was happening

24 with this patient, Ms. Dau?

25 A What happened in the past?

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1 regards to placing an inmate in safety cell, I think she

2 wanted to ask you about it. I know you said you look at

3 these every day because you give the medication. But her

4 question is more specific.

5 BY MS. ZUGMAN:

6 Q And let me back up. And I'm trying to speak

7 slowly for the court reporter, so I apologize if my

8 questions aren't out on the record fast enough.

9 But what I'm trying to get at is all the

10 documents you would look at prior to making the decision

11 to place an inmate in safety cell? Because my

12 understanding, per earlier testimony, is you would look

13 at some documents, medical history, things of that

14 nature, before making that decision; is that correct?

15 A I look at them, but -- I mean, when I place

16 somebody, I don't go based on what the medication they're

17 taking or if they're not taking medication. I go based

18 on their problem at that time that I assess them, when I

19 place them.

20 But yes, I look at the medication they're

21 taking. I look at their history, what has happened with

22 them. If I haven't seen them, I look at them. If I'm

23 not familiar with them, I look and see what have they

24 done in the past.

25 Q Okay. That's what I want to get at. For

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1 Marsha Dau specifically, what documents did you look at

2 to make the assessment that you were going to place her

3 in safety cell?

4 A No, I assess her. I don't look at documents

5 before. I don't go based on documents to place her

6 there. I look at her -- how she's acting, what they're

7 telling me, and based on what she talks to me about.

8 Q Okay. Is it more based on the circumstance?

9 A Yes, my assessment.

10 Q So do you take into consideration prior notes

11 or any other documentation that indicates medication

12 she's taking when you are going to place her in safety

13 cell? Let me rephrase the question.

14 A I don't understand.

15 Q My understanding is you decided to place Marsha

16 Dau in the safety cell because of bizarre behavior; is

17 that correct?

18 A Bizarre behavior.

19 Q Yes or no?

20 A Yes.

21 Q Did you at that time, July 20th, 2011, also

22 look at her other medical documentation, such as prior

23 notes from the doctors, Dr. Baker, medication

24 administration record, any other documents of that nature

25 to see what was going on with her, her medical history,

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1 before you placed her in safety cell?

2 In other words, was your decision strictly

3 based on her behavior at that -- on that day?

4 A Yes. But I had her file with me too.

5 Q Okay. Did you look at her file --

6 A Yes.

7 Q -- at that time?

8 A Yes. But I didn't make my decision based on

9 the file. I made my decision based on her behavior.

10 Q Okay. Did you look through her file to see if

11 she exhibited any bizarre behavior before July 20th,

12 2011, for example, other nurses' notes prior to July

13 20th, 2011 to see if she was acting bizarre previously?

14 A Uh-huh. I did. Yes.

15 Q Okay. Just to have a clear record, I'm showing

16 you a document that is one of the categories of documents

17 called medication administration record. I want to be

18 sure -- is this the type of document that you would use

19 to indicate the medications a patient is receiving?

20 A Receiving?

21 Q Uh-huh.

22 A Yes.

23 Q Is this a document that you would have to

24 update daily?

25 A Daily?

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1 I mean, that's what I believe for that time frame.

2 MR. BERTLING: Assuming that the doctor

3 actually ordered something.

4 BY MS. ZUGMAN:

5 Q Yes. Again, I'm just trying understand what

6 happened. And if she's know --

7 A Okay. She was seen by the doctor.

8 Q Based on the doctor's note?

9 A Based on what I seen and I read. But I wasn't

10 there, so I cannot specifically tell you. But she was --

11 based on my knowledge and what I'm reading, she was seen

12 by the doctor.

13 Q And July 1st -- I don't have a calendar in

14 front of me -- but do you believe Dr. Singh saw her in

15 person since he does go to the jail on Tuesdays and

16 Thursdays?

17 A We have to -- it's a requirement. We have --

18 when they're chronic care, they have to be seen by the

19 doctor.

20 Q Was Marsha chronic care?

21 A Based on what I'm reading, yes.

22 Q How --

23 A Her medical problems.

24 Q Okay. So what were her medical problems that

25 categorized her as chronic care?

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1 A If I look at the problem list and what her

2 complaints are, the fibromyalgia gives her a good -- a

3 good chronic care follow-up.

4 Q Okay. And you see on the left where it lists

5 some medication, "aboxim, Valium, premarin," do you see

6 that handwriting?

7 A Uh-huh.

8 Q Is that just indicating from your understanding

9 the medication she's currently on or medication she needs

10 to be prescribed?

11 MR. BERTLING: Calls for speculation.

12 But if you know.

13 THE WITNESS: I don't know.

14 BY MS. ZUGMAN:

15 Q You don't know. Okay.

16 Can you turn to the next page in the progress

17 notes. Sorry. I'm done with the doctor's orders, so

18 progress -- you got it.

19 Another request for medical services. It says,

20 "Date: July 16th, '11. Change pain meds. Allergic to

21 current meds." Do you see that note?

22 A Uh-huh.

23 Q Do you recall the situation that called for her

24 pain meds to be changed?

25 A No. She was seen -- what I read here, she was

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1 decision to place Ms. Dau in the safety cell, which was

2 July 20th, 2011. So the key date is July 20th, 2011.

3 Do you recall seeing this note prior to that

4 specific date?

5 A I seen the notes, but I don't do my placement

6 based on what I see in the notes. I probably glanced

7 through the chart to see what has happened with this lady

8 in the past. But I don't go, okay, this is what happened

9 that day. I do my own assessment as a nurse. I take

10 care of the problem when it's there.

11 Q Okay. And see that's a good point. So you

12 look through these notes and it's information for you --

13 A I glance at them.

14 Q -- to get a better understanding as to what's

15 going on with the inmate patient; is that correct?

16 A I don't use the notes to see what's going on

17 with the patient, no.

18 Q What do you use the notes for?

19 A I just glance and see how many people they have

20 seen and when was the last time she was in medical, why

21 she was in medical.

22 Q Why do you look at notes for those purposes?

23 A Just for me to see them. Me, as a nurse, just

24 to see the notes, to know a little more about the

25 patient. If she had the same problem before or it's a

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1 your notes; correct?

2 A Those are my notes, yes.

3 Q Because of the importance of that date and

4 significance of that date, can you please read the entire

5 note into the record?

6 A Okay. Do you want the date and time?

7 Q Yes.

8 A "July 23rd, 2011, at 8:55, during safety cell

9 rounds, C.O. Garcia and C.O. Worthington stand by for

10 assessment. Safety cell door was open. Inmate patient

11 was found lying on the floor supine position. Inmate

12 patient was awake, alert to person, not responding to

13 verbal commands. Zero distress noted. Pupils were

14 equal, reactive to movement 6 millimeters. Skin was warm

15 and dry to touch. Skin pale in color. Noted mucous

16 membranes dry to mouth, lips were" -- okay, I'm sorry.

17 "Mucous membranes were dry to mouth. Lips were dry

18 (chapped). Zero shortness of breath. Respiratory

19 pattern was regular - unlabored. No use of accessory

20 muscles noted. Inmate patient moving all extremities

21 purposively. While assessing skin turgor, the inmate

22 patient purposively pushed my hand away. Skin turgor was

23 poor. Capillary refill was less than three seconds.

24 Advised C.O. F. Garcia to inform the watch commander on

25 duty to 1198 safety cell 2. Corporal Murguia arrived to

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1 safety cell 2. Was advised that inmate patient needed to

2 be transferred to El Centro Regional Medical Center for

3 further evaluation. C.O. Worthington and C.O. Ramirez

4 assisted inmate patient with dressing and with

5 transferring to wheelchair. Noted inmate patient moving

6 all extremities while being secured with chains to

7 wheelchair. Inmate patient deported from Imperial County

8 Jail at 9:25. Stable condition." My signature, the date

9 and time.

10 Q Can you read that date underneath your

11 signature, what does it say?

12 A I see 9/25.

13 Q Do you know why it would say 9/25?

14 A No. I don't know why I would put 9/25.

15 Q So on the date column on the upper left column,

16 can you read the date and what you wrote underneath that

17 column just to take sure we have a complete record.

18 A Where?

19 Q Right here.

20 A 7/23/2011, 8:55.

21 Q And the number that you wrote, can you read

22 that and just tell us the significance of that?

23 A Blood pressure was 100 over 62. Pulse was 68.

24 Respirations were 16. 96 percent O2 sat.

25 Q And then you wrote another date, 7/23/2011,

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1 0900. Is that because the note took you longer to

2 write --

3 A Probably.

4 Q -- or is that a separate entry?

5 A It took me more than five minutes to write.

6 Q So as you sit here, you don't know why you

7 wrote down --

8 A I don't know why.

9 MR. BERTLING: Let her finish the question.

10 BY MS. ZUGMAN:

11 Q -- why you wrote down September 25th, 2011?

12 MR. BERTLING: If it is September 25th.

13 THE WITNESS: Or July. I don't know if it's

14 July or September. But to me, if I read on this copy, my

15 copy, I think it's a "9."

16 BY MS. ZUGMAN:

17 Q Okay. So we agree that the middle date is also

18 -- says "25" for whatever reason?

19 MR. BERTLING: What do you mean "the middle

20 date"?

21 MS. ZUGMAN: It says here either 7 or 9/25/11.


23 BY MS. ZUGMAN:

24 Q That's your handwriting. I just want to make

25 sure I'm not misreading that.

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1 A No, it is. Why I did it, I don't know.

2 Q Okay. So now that we have this note as

3 context, I want to ask you very specific questions about

4 that day and what happened.

5 A Okay.

6 Q Were you there with Correctional

7 Officer F. Garcia and C.O. Worthington, did the three of

8 you see Ms. Dau on the floor supine?

9 MR. BERTLING: Well, lacks foundation. Calls

10 for speculation.

11 But if you know what the other two people saw,

12 she's entitled to your recollection.

13 BY MS. ZUGMAN:

14 Q Okay. Let's do it easier. Did you see Ms. Dau

15 on the floor in a supine position on that date as

16 reflected on your notes?

17 A Yeah. You can only lie down or sit up.

18 Q Okay. And you said here, "She was awake, alert

19 to person, not responding to verbal commands." When you

20 say "awake," does that -- what does that mean?

21 A She was awake.

22 Q What does it mean to be alert to person?

23 A I call her, "Dau?" She looked at me, turned

24 away.

25 Q So she looked at you, that means alert to

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1 person?

2 A She knows who she is.

3 Q And "zero distress noted," what does that mean?

4 A Zero distress noted, that means I didn't notice

5 any kind of distress at that time.

6 Q "Pupils equal, reactive to movement." Did you

7 actually look at her pupils?

8 A Yes.

9 Q So did that require you to go inside the safety

10 cell where she was lying down?

11 A Well, we open the door to assess her.

12 Q Okay. So let's backtrack. On that date who

13 opened the door?

14 A C.O. Garcia.

15 Q Did you ask C.O. Garcia to open the door?

16 A We always open doors.

17 Q Okay.

18 MR. BERTLING: The question was: Did you ask

19 C.O. Garcia to open the door?

20 THE WITNESS: Yes.

21 BY MS. ZUGMAN:

22 Q Okay. Why did you ask C.O. Garcia to open the

23 door?

24 A So I could assess the patient and take vitals.

25 Q Did you try, before asking C.O. Garcia to open

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1 the door, to assess Ms. Dau and take her vitals by asking

2 her to come to the front of the door, or asking her to

3 get up and come to where you were standing?

4 A Yeah. We said, "Dau, can you please come to

5 the door? I need to check your vitals."

6 Q So you recall making that request?

7 A Uh-huh.

8 Q And how did she respond to that request,

9 Ms. Dau?

10 A She didn't respond.

11 Q Okay. And at that point did you make the

12 decision to tell C.O. Garcia to open the cell door?

13 A Yes.

14 Q Why?

15 A Because I needed to take vital signs.

16 Q Okay. Earlier, my understanding from your

17 testimony, is that sometimes they can refuse to get their

18 vitals checked.

19 A That's right.

20 Q And would you have interpreted that as Ms. Dau

21 refusing to get her vitals checked if she just looked at

22 you and looked away?

23 A Yes.

24 Q So why did you make the decision this time to

25 actually proactively take her vitals?

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1 A I noticed that she was a little pale and I

2 noticed she was -- it appeared to me she was dehydrated.

3 Q Okay. Why did she look dehydrated to you?

4 A Her lips were chapped.

5 Q Okay. That's -- was that the only indication

6 of dehydration?

7 A Her lips were dry, chapped and --

8 MR. BERTLING: Feel free to look at your notes.

9 BY MS. ZUGMAN:

10 Q They're right in front of you.

11 A Yeah.

12 Q Okay. So anything else?

13 A Skin was a little pale.

14 Q When you say "pale," can you describe maybe a

15 color or hue that may be --

16 A She was -- she was very light complected.

17 Q Okay. Can I show you a picture just to see if

18 she looked like this color or a different color from your

19 recollection.

20 So what I have I'll represent is the last photo

21 my client had of Ms. Dau before she was incarcerated July

22 2011. Was her skin color that color from the photo that

23 she's in or --

24 A What year is this picture?

25 Q It was 2011, three months prior to July

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1 approximately.

2 A She wasn't looking -- I could not recognize

3 this person.

4 Q So the person that -- again, I'm just talking

5 about skin color. We can -- is it your testimony that it

6 was the color you see in the photo?

7 A Not only that day. Ever since I have seen her

8 the first day that I kind of saw who she was, she didn't

9 look that color. She was always pale.

10 Q Always pale?

11 A When she came in, she was pale.

12 MS. ZUGMAN: Okay. We're going to attach this

13 as the next exhibit in line, 6.


15 identification.)

16 BY MS. ZUGMAN:

17 Q So she was pale. You noticed mucus membranes

18 dry to mouth and her lips were chapped. And zero

19 shortness of breath. How did you determine that?

20 A She was not having any kind of labored

21 breathing.

22 Q How did you make that determination? Did you

23 have to check her breathing by putting your ear next to

24 her --

25 A No. That's when you can't see that they're

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1 breathing, that's when you do that. But just by looking

2 at you, I know you're having unlabored breathing.

3 Q Okay.

4 A And you're not having any shortness of breath.

5 Q Okay. So that was just a visual observation

6 that you could assess that?

7 A Uh-huh.

8 Q What does it mean, "zero use of accessory

9 muscles"?

10 A That she wasn't using her accessory muscles,

11 other muscles that we use. When you're having some kind

12 of breathing problems, shortness of breath, you use other

13 accessory muscles. That's what they're called. You will

14 see your stomach retracting.

15 Q Okay. So you notice she was not using those

16 muscles?

17 A Uh-huh. That's when I opened the door and I

18 said, "You know what, let me see what's going on."

19 Q Okay. After you noticed she was not using the

20 accessory muscles, then you decided it's time to open the

21 cell door and see what's going on?

22 A No, no, no, no. As soon as she didn't come to

23 the door when I called her, she looked at me, she went

24 like this. I was like, you know what -- and I looked at

25 her mouth. I said, you know what, open the door, let me

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1 just get vitals. Even though she refused, I could have

2 just walked away. I said, no, I kind of noticed she was

3 dry. She wasn't dry the day before.

4 Q Okay.

5 A So kind of noticed her lips were dry. I notice

6 her skin was a little pale. She was always pale, but

7 that day I noticed she was a little more pale.

8 Q Okay.

9 A So I said, "Open the door. Let me check this

10 lady out."

11 Q Okay. That's when you started making the

12 assessment of zero distress noted?

13 A Uh-huh.

14 Q Okay.

15 A And I did put my hand on her chest so I could

16 check her respiration, which was 16.

17 Q Okay. And then you also noted that she was

18 moving all extremities purposively. What does that mean?

19 A I tried checking with skin turgor. That's the

20 only way that I can know, so I pinched her and she moved

21 her arm away.

22 Q What's the purpose of checking her skin turgor?

23 A Dehydration.

24 Q Dehydration.

25 A That's what I thought she was going through.

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1 Q And so when you checked the skin turgor, what

2 was the determination?

3 A She moved her arm away. And I didn't want her

4 to hit me in the face so I just -- I did this, she went

5 like this, so I left it at that.

6 Q So she pushed your hand away?

7 A Uh-huh.

8 Q "Skin turgor was poor," what does that mean?

9 A She stayed a little pinched. Like, I mean,

10 look at me, I'm well hydrated so I bounce back. She

11 stayed a little pinched. But I cannot assess her like I

12 wanted to because she moved her hand away from me.

13 Q And I know these questions are rudimentary, but

14 I'm not a nurse so I'm going to ask you everything

15 specific.

16 "Capillary refill less than three seconds,"

17 what does that mean?

18 A I could do this to you or anybody, whoever has

19 good circulation, your skin pops right back. When it

20 stays purplish or whitish, it doesn't bounce back.

21 MR. BERTLING: The record should reflect that

22 Ms. Pacheco was pinching her middle finger.

23 THE WITNESS: Uh-huh.

24 BY MS. ZUGMAN:

25 Q So the capillary refill was less than three

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1 seconds. Is that --

2 A Good.

3 Q -- a good thing?

4 A Her circulation was going.

5 Q Okay. And then "Advised C.O. F. Garcia to

6 inform the watch commander on duty." Do you recall what

7 that was at the time?

8 A Yes. That's the person in charge of the jail

9 that day. So it was Corporal Murguia. He was in charge.

10 Q Okay. Are you familiar with the Sergeant

11 Matus. I'm just asking if --

12 A Sergeant who?

13 Q Matus, does that name ring a bell to you? If

14 not, then I could have it wrong.

15 A If you spell it maybe, because I don't know.

16 Q Okay. We'll get to that later.

17 "Advised the watch commander on duty to 1198,"

18 what does that mean?

19 A To come here to safety cell. 1198 means come

20 and see me over here in safety cell. 1198 is come to our

21 location.

22 Q Is that kind of an emergency?

23 A No. Because when I have to just kind -- I want

24 him to go there, because if I'm going to send somebody

25 out or I'm going to make any other decision, I always

(;+,%,7�4


1 have to go through the chain of command. The C.O. -- the

2 Corporal Murguia was in charge.

3 Q Okay. And it says, "Advised that inmate needed

4 to be the transferred to ECMC" --

5 A ECRMC, that's the nearest hospital.

6 Q -- "ECRMC for further evaluation."

7 What did the watch commander -- do you recall

8 having a conversation with the watch commander, Corporal

9 Murguia, about this?

10 A Yes, he came over with me.

11 Q What did you tell him?

12 A I told him that this lady needed to go to El

13 Centro Regional Medical Center for evaluation. I mean, I

14 did mine. She needed to go for other evaluation from a

15 doctor.

16 Q Okay.

17 A I told him that she needed to go within the

18 next maybe 30, 40 minutes, approximately. I don't recall

19 if I told him 5 or 10. But I said "This lady needs to go

20 out. It's not an emergency. Do you have the proper

21 staff? Do you have the car available? Can you guys take

22 her?"

23 Q What did Corporal Murguia --

24 A Yes.

25 Q -- say to you?

(;+,%,7�4


1 A "Yes."

2 Q That was his only response?

3 A Yes.

4 Q Did he make any assessment of his own of

5 Ms. Dau and say anything to you at the time?

6 A No.

7 Q It says here that "C.O. Worthington and

8 C.O. Ramirez assisted the inmate patient with dressing

9 and with transferring."

10 What was her condition previous to having to be

11 dressed, was she without clothing?

12 A She had the -- when people are placed in safety

13 cell, they give them a Barney suit and a blanket.

14 Q Is a Barney suit like a jumpsuit?

15 A No. It's like a blanket that you can just put

16 like -- it's a blanket that you can wrap yourself around

17 with Velcro to hold on for covering. And the blanket is

18 another -- it's the same material, but it's a blanket.

19 So she wasn't --

20 Q So she wasn't wearing actual clothing?

21 A No. In the safety cell they don't wear

22 clothing because they -- they can't wear clothing because

23 they are there for their protection and observation and

24 maybe they could do a knot with their clothes. The

25 Barney suit and the Barney blankets, there's no way they

(;+,%,7�4


1 can tear them up or do anything.

2 Q Do you recall if Ms. Dau made any suicidal

3 attempts while she was at ICJ?

4 A I can only recall the date when I saw her.

5 MR. BERTLING: Well, did she make a suicidal

6 attempt that day?

7 THE WITNESS: When I take her there?

8 MR. BERTLING: Yes.

9 THE WITNESS: She refused to answer my

10 questions.


12 BY MS. ZUGMAN:

13 Q And so C.O. Worthington and C.O. Ramirez

14 assisted her with getting dressed. Were you there to see

15 them assist her --

16 A No.

17 Q -- or did you actually help them get her

18 dressed?

19 A I went back into the office to do the

20 paperwork, and they assisted her. They brought her the

21 clothes. I just know that they go and get the clothes.

22 The patient can't go and get the clothes. So by me

23 saying they assisted her, they brought the things and I'm

24 pretty sure they assisted her.

25 Q Do you recall having a conversation with

(;+,%,7�4


1 C.O. Worthington and C.O. Ramirez at that time regarding

2 Ms. Dau?

3 A No.

4 Q Did they say anything to you about Ms. Dau?

5 A That I can recall, no.

6 Q So you just made the command to --

7 A Corporal Murguia is the only one that me and

8 him speak because he's the watch commander. He makes all

9 the decisions. He tells me whether yes, no, or

10 something. If he doesn't -- if he doesn't have the

11 proper staff, he doesn't have the staff, he'll say, you

12 know what, no or yes. But he said yes. I left it as is.

13 I go, "Take her whenever you guys have a chance within

14 30" -- if I can recall, I told them "30, 40 minutes, she

15 needs to go out." But it was not an emergency that I

16 needed to tell him, you know what, do it right now.

17 Q Why did you not think it was an emergency?

18 A Because I just thought she was dehydrated.

19 That's what she appeared in the signs and symptoms. That

20 I saw and what I recalled, it was just she needed to be

21 hydrated.

22 Q Okay. So earlier you talked about the zero use

23 of accessory muscles; correct?

24 A Uh-huh.

25 Q Would that constitute a possible emergency that

(;+,%,7�4


1 she was not using those muscles?

2 A No. When she uses them, that means she's

3 having an emergency, she can't breathe. The airway is

4 not --

5 Q And did you ask her any questions that you

6 recall that's not written on this note?

7 A Well, I kept talking to her but she re- -- I

8 don't know if she refused or she was just not answering

9 my questions. She was not answering my questions.

10 Q Do you know at the time or do you know from

11 what you recall, whether or not she was able to answer

12 those questions, physically able to actually talk?

13 A Well, she talked.

14 Q What did she say?

15 A Well, she wasn't talking to me.

16 Q Okay. So she was talking but not talking to

17 you?

18 A She was just making sounds and she was just --

19 Q What kind of sounds?

20 A -- mumbling.

21 Q Okay. Let's back up. So during this entire

22 process where you were checking her in safety cell, was

23 she mumbling the entire time?

24 A Not the entire time.

25 Q At what point did she start mumbling? We've

(;+,%,7�4


1 got to pin this down. So you can break this down as much

2 as you want to in chronology, but I want to know when she

3 started mumbling?

4 A Since I -- since I -- since I got there.

5 Q Got where?

6 A To the safety cell at 9:00 in the morning, she

7 was making sounds and doing her -- you know, she was like

8 -- I don't know how I can explain exactly what she was

9 doing or saying.

10 Q I'm just trying to understand if she made

11 sounds.

12 A Yeah.

13 Q But none of these sounds were articulated words

14 as far as you know?

15 A I cannot recall. She was saying no or -- I

16 cannot recall.

17 Q So you don't know if she actually verbally said

18 anything that you can recognize as being words conveyed

19 to you?

20 A I don't recall.

21 Q But you do recall her making some sounds?

22 A Uh-huh.

23 Q Did the sounds seem like they were urgency that

24 she couldn't --

25 A No, no, no. I'm a nurse, I'm assessing her.

(;+,%,7�4


1 If I would know it was an emergency, I would call 911 and

2 get the lady going.

3 Q Okay. But you assessed that it's not an

4 emergency because of what you assessed in --

5 A My assessments were like not emergent. In the

6 past I tried talking to this lady and she would refuse to

7 talk to me or talk to the other nurses.

8 Q But that's why she was placed in -- is this why

9 -- because she was refusing to talk to you and other

10 nurses, my question to you, is that also why she was

11 recommended to see a psychiatrist?

12 A I don't know about the other nurses. About me,

13 she was acting bizarre that day that I saw her. I recall

14 she looked bizarre. She would look at me and just ignore

15 me and look the other away. She refused for me to take

16 vital signs. And based on what the other officers were

17 saying, she was bizarre. So I placed her there.

18 When I place somebody in safety cell, of course

19 they're going to be seen by the psychiatrist because

20 those are the major -- those are the main people that

21 knows what's going on more than I would know. I'm not a

22 psych nurse. But I do know she had a problem right

23 there, that's why I placed her there.

24 Q When you talked to Corporal Murguia, you said

25 it was a nonemergency?

(;+,%,7�4


1 A It was not an emergency, but she needed to go

2 out.

3 Q So in a nonemergency situation, what's the

4 protocol in terms of transporting an inmate to El Centro

5 Regional Medical Center?

6 A Rephrase it.

7 Q If it's a nonemergency situation when you want

8 to transport an inmate to ERNC, what is the protocol?

9 A You let the watch commander know or the

10 corporal, sometimes it's either the watch commander or

11 the corporal, and they are the bosses. You let them know

12 they need to go out.

13 Nonemergent does mean don't call 911 and don't

14 rush over there like right now. Because if they have an

15 emergency, it would be 911. When I say she needs to go

16 out, she needs to go out during the next half hour, an

17 hour, whatever. She just needs to be assessed by a

18 doctor.

19 Q Okay. So was there any other doctor available,

20 like for instance Dr. Singh's 24 hours availability, to

21 do some sort of assessment so that she didn't have to

22 wait to get to ECRMC?

23 A Well, it's not that she needed to go right then

24 and there. I would have to -- if I call my doctor, he

25 would just send her out.

(;+,%,7�4


1 Q Okay.

2 A It depends on what I see. If I say,

3 "Dr. Singh?"

4 "Send her 911."

5 He doesn't hesitate. If I call him, I'm

6 telling him what I see, he answers -- he's always on

7 call, so he always answers. Because it's not the first

8 time I ever have a problem.

9 Q Okay.

10 A I mean, we have a lot of patients there. We

11 see a lot.

12 Q Okay. I'm just focusing on your one patient.

13 A That was not -- to me, I thought it was not an

14 emergency. If it would have been, I don't even call the

15 doctor. I just tell the corporal, "911 like right now."

16 Q Okay. And when -- who told Worthington and

17 Ramirez to assist her in getting dressed, was that you?

18 A No, I don't give any orders to the C.O.s.

19 That's the watch commander or the corporal. I only tell

20 him, "This lady is going to go." Honestly, I don't talk

21 to the officers. I don't tell them -- I don't delegate

22 them because they're not under my supervision.

23 Q Who has the authority to have an inmate

24 transported to the hospital by ambulance?

25 A I don't understand your question.

(;+,%,7�4


1 Q When you told the officers that it was a

2 nonemergency --

3 MR. BERTLING: Well, I think she was talking to

4 Corporal about -- you're saying "officers." She said she

5 spoke with Corporal Murguia.

6 THE WITNESS: We always go to the watch

7 commander or corporal.

8 BY MS. ZUGMAN:

9 Q So my question is: Did Corporal Murguia have

10 the final say as to whether or not she gets transported

11 by ambulance or in a nonemergency manner?

12 A I don't understand. Because when we are the

13 nurses, we say, 911, by car, or doesn't go.

14 Q So you have the final say as to how she gets to

15 the hospital; is that correct?

16 A They can override me. I mean, if they think,

17 "No, they are not going to go," they don't go. But I

18 have never experienced that. I have never heard about

19 any other experience. We always say, "You know what,

20 call 911," and they're pretty good about listening to

21 you. Or take them to the hospital. If they don't have

22 -- you know what, we're short on staff, just call the

23 ambulance. Even though it's not an emergency, if they're

24 short on staff or they don't have the van available, they

25 go by ambulance or transfers.

(;+,%,7�4


1 Q So generally the protocol has been that they

2 would listen to your recommendation as to how an inmate

3 gets to the hospital?

4 A Uh-huh. And they could always say no.

5 Q Okay. In your experience, they've never

6 overruled you?

7 A Never. Never. No matter if the problem was

8 less than needed, or if it was an emergency,

9 nonemergency, or just for any other little complaint that

10 I said, "You know what, just take them to the hospital,"

11 they have never overrided me.

12 Q So earlier you testified that you thought she

13 may need to get to the hospital within 30 or 40 minutes.

14 A Approximately, I don't remember if I said 30 or

15 40 or 20. But it was nonemergent, that's the only word I

16 could use.

17 Q I understand. But why 30 to 40 minutes? Why

18 did that recommendation seem appropriate to you at the

19 time?

20 A Because I thought she was dehydrated. She

21 wasn't dying. Her vitals were good. She was breathing.

22 She was awake. She was not -- I didn't see anything that

23 I needed to say, "You know what, take her right now,"

24 because I would have called 911.

25 Q Okay. And after you -- after you saw

(;+,%,7�4


1 Worthington and Ramirez assist Marsha in getting

2 dressed --

3 A I didn't see that.

4 Q You didn't see that. Okay.

5 At what point did you walk away from the safety

6 cell to do the paperwork?

7 A When I told Officer Murguia, "She needs to go

8 for an evaluation. Do you have the staff? Can you get

9 ready? And do you guys have the van?" He said, "Yes."

10 Q And is that a van that's used for nonemergency

11 transport?

12 A For when they're -- it's a van that they

13 transfer people.

14 Q It's just a van that they use to transport

15 inmates?

16 A Uh-huh.

17 Q It doesn't matter to a hospital or just a

18 transportation van?

19 A Transportation van.

20 Q Do you know what's inside the van in terms of

21 equipment?

22 A I don't think it's equipped. It was a

23 wheelchair --

24 MR. BERTLING: Do you know?

25 THE WITNESS: No, I don't.

(;+,%,7�4


1 BY MS. ZUGMAN:

2 Q What do you know about the van, anything in

3 terms of what it looks like or what's inside it based on

4 your knowledge? Have you seen it?

5 A No, I haven't seen it.

6 Q Have you seen the outside of it?

7 A Yeah. It's at van.

8 Q Do you know if it's equipped with a wheelchair

9 ramp?

10 A That I know it is, yes.

11 Q Okay. And it says here, "Transferring to" --

12 Okay. At what point did you leave the safety

13 cell to do paperwork? Where was Ms. Dau at this point

14 when --

15 A In safety cell.

16 Q Was she still on the ground?

17 A I don't recall. I don't know if they sit her

18 up. I think they sit her up.

19 Q Okay. Do you recall if you saw the wheelchair

20 actually be brought to the safety cell before you left to

21 do the paperwork?


23 Q Okay.

24 A But there was a wheelchair there, but I don't

25 recall if I brought it before or after, I don't know. Or

(;+,%,7�4


1 who brought it, I don't recall.

2 Q But by the time you went to go do paperwork, it

3 looked like C.O. Worthington and Ramirez was kind of

4 handling the situation. Is that a fair assessment? They

5 took over the responsibility of getting her --

6 A Corporal Murguia is the one that I talked to.

7 That's the one that said, "You know what, take her." I

8 went back to the office. But I cannot recall exactly if

9 the wheelchair was taken before or who even -- who took

10 the wheelchair. If it was me, I do not recall.

11 Q Do you remember what state she was in when you

12 actually left the safety cell to tell Corporal Murguia?

13 Was she on the ground?

14 A She was stable. She was stable.

15 Q No. I'm just talking --

16 A She was lying down.

17 Q She was still lying down, supine position?

18 A She was lying down. You could only lie down

19 there or sit up.

20 Q In the safety cell?

21 A For most of the part, they're always laying

22 down.

23 Q How big is the safety cell, do you know?

24 A I mean -- approximately?

25 Q Yeah.

(;+,%,7�4


1 Q And this is exhibit next in line, 7.


3 identification.)

4 BY MS. ZUGMAN:

5 Q Before I get into that document, how long, if

6 you recall, approximately were you in the office filling

7 out this document and compiling the appropriate

8 documentation?

9 A Approximately five minutes.

10 Q About five minutes. So after the time it took

11 you to fill out the paperwork, you went back to see

12 Ms. Dau?

13 A Uh-huh.

14 Q And was she still in the safety cell at that

15 point?

16 A No. When I came back, if I can recall, she was

17 sitting in the wheelchair getting ready for the transfer.

18 Q And where in the -- where at ICJ was she

19 sitting in the wheelchair?

20 A Outside the safety cell in the hall.

21 Q In the hall. At that point did you do any more

22 assessments of her condition to see if she was still

23 stable?

24 A She was still stable.

25 Q What assessments did you perform to see if she

(;+,%,7�4


1 was still stable?

2 A No, I didn't do any more. Because I was there,

3 she was the same. I didn't see her -- I didn't see her

4 change in any kind of -- if I would have seen her go into

5 distress or her breathing kind of labored -- I didn't see

6 anything that I would say, "You know what, let's change

7 the status on it."

8 Q Who else was present with you?

9 A Corporal Murguia was there, that I recall. By

10 that time, if I can recall, Romero.

11 Q Romero?

12 A C.O. Romero was there.

13 Q What about C.O. Worthington, was she there too?

14 A Her, I don't recall if she was there at all

15 times or she left. I mean, they have to get prepared

16 too. And I don't know if she got prepared prior. I

17 wasn't paying attention. To me, it was like, you know

18 what, send her out. I was there with the patient.

19 MR. BERTLING: The question is: Do you recall

20 if Worthington was there?

21 THE WITNESS: No, I don't recall.

22 BY MS. ZUGMAN

23 Q But you do recall Officer Romero?

24 A Romero, yes.

25 Q And do you recall if you had any conversations

(;+,%,7�4


1 with Officer Romero about her?

2 A Me?

3 Q Yes.

4 A No. I never have any conversations with the

5 C.O.s because I don't display her personal history with

6 anybody.

7 Q Okay. But in terms of the transportation of

8 Ms. Dau to the hospital, did you have any conversations

9 with Officer Romero?

10 A Not that I can recall.

11 Q Do you recall any conversations with Mr. Romero

12 at that time that she was in the wheelchair waiting for

13 transportation?


15 Q Do you recall whether he said anything to the

16 effect of he was concerned about how she looked?

17 A No.

18 Q So at that point -- let's just kind of do

19 chronology from that point forward.

20 So she didn't change and she was the same,

21 that's your testimony; correct?

22 A Yes.

23 Q And that's based on your visual observation?

24 A My visual observation.

25 Q Were her eyes open?

(;+,%,7�4


1 A Yes.

2 Q Do you know if her -- again, her chest was

3 moving up and down?

4 A Yes. She was breathing.

5 Q Did you check her vitals as that point after

6 you came back?

7 A No.

8 Q Did you ask her any questions at that point?

9 A I kept talking to her and she would go like

10 this. Just turn away.

11 Q Did you think at any point that she may not be

12 able to respond to your questions, physically unable to

13 respond to your questions?

14 A No. Because she has done that in the past

15 before, same kind of behavior about turning away, not

16 wanting to talk to me. It was the same.

17 Q Okay. So at that point when you came back and

18 you made the determination that she was the same --

19 A Uh-huh.

20 Q -- she had her eyes open apparently. And then

21 what happened, did you watch the officers?

22 A Yeah. They tried to -- as best as I can

23 recall, they took her kind of fast. I didn't tell them

24 rush. I didn't tell them -- I just said 30, 40 minutes,

25 just take her out. She needs to go for evaluation.

(;+,%,7�4


1 She's going to go get hydrated and come back. We're

2 going to get her back.

3 Q Okay. That conversation, when did that happen?

4 A I told Murguia when we first got into the swing

5 -- when we first -- when I told 1198 to come to safety

6 cell, "You know what, take her for evaluation. I think

7 she's dehydrated. I don't know if she's been taking --

8 how much amount of water," you know, this and this and

9 that. "I don't know if she has any, but I think she

10 needs to be hydrated and she'll be back."

11 Q Okay. So then when you came back and she was

12 in the wheelchair, handcuffed waiting for transportation,

13 you didn't have any more conversations with anybody at

14 this point?

15 A No.

16 Q It just was a matter of waiting for the

17 transportation to happen; is that correct?

18 A Well, they had everything ready. They were

19 chaining her up and stuff like that. And I was right

20 there, and the van was right out in the sally port, which

21 is like from here like opening that door from -- it was

22 the hallway that just goes -- they wheel her there and

23 the van was there.

24 Q Okay. And how much time do you think expired

25 before they actually got her into the van? I'm trying to

(;+,%,7�4


1 understand --

2 MR. BERTLING: From what point in time?

3 BY MS. ZUGMAN:

4 Q From when you came back and saw her in the

5 wheelchair and you say that she was the same?

6 A About five minutes.

7 Q About five minutes, and they got her in the

8 van?

9 A Uh-huh.

10 Q And you don't recall any conversations

11 happening between you and Officer Romero or you and

12 Officer Worthington before the transportation took her?

13 A No.

14 Q I want to go over some of the -- did we already

15 go over the mental? I don't think so. I need to do

16 that.

17 We did progress notes, and there's specific

18 notes that says mental.

19 MR. BERTLING: Mental health notes that weren't

20 filled out by her.

21 THE WITNESS: Yeah, I don't understand them.

22 MR. BERTLING: She can ask you questions on

23 them.

24 BY MS. ZUGMAN:

25 Q I'm just going to ask you general questions.

(;+,%,7�4


1 A I have one, two, and three mental health notes.

2 Q And those will be the next -- well, I don't

3 know if I'm going to mark them as an exhibit. I just

4 want to see what she's knows about them.

5 But before we move on, did you call ahead to El

6 Centro Regional Medical Center to let them know that an

7 inmate was coming?

8 A No.

9 Q Why not?

10 A Because it was not an emergency. I always send

11 them out -- when they are not an emergency, I send them

12 out. And then after 20, 30 minutes of -- when they first

13 arrive I can't be calling them because they don't know

14 much. So first I wait -- when they're emergency, I do

15 let them know, "Hey, I'm going to send you this guy.

16 These are the vitals." I give them this.

17 But when it's not an emergency, I call like 30,

18 40 minutes after they arrive.

19 Q Okay. So in a nonemergency situation, you

20 don't call ahead to the hospital?

21 A It depends on the problem. Depends on the

22 problem. There's different kinds of nonemergent

23 problems.

24 Q Okay. So in Ms. Dau's case, you made the

25 assessment that you didn't need to call Dr. Singh, or any

(;+,%,7�4


1 of the doctors that was seeing her, to let them know that

2 you were referring her to El Centro Regional Medical

3 Center; is that correct?

4 A Did I what?

5 Q Did you call -- my understanding is that you

6 didn't make a call to a doctor, whether it be Dr. Singh

7 or Dr. Baker, letting them know you were going to refer

8 her over to El Centro Regional Medical Center; is that

9 correct?

10 A I called -- no, I did not call Dr. Baker and I

11 did not call Dr. Singh.

12 Q Okay. So my understanding is you notified the

13 watch commander --

14 A Yes.

15 Q -- that you made this recommendation?

16 But didn't call any of the doctors?

17 A No. Because in my assessment --

18 Q It's okay. I just want to make sure I get a

19 clear record.

20 A No, I did not call Dr. Baker or Dr. Singh.

21 Q This is just information. And if you talked to

22 people, I have to know who they were.

23 A No, I didn't.

24 Q Okay. So no calls were made to El Centro

25 Regional Medical Center about the fact that she was on

(;+,%,7�4


1 her way; is that correct? Are you aware of anyone else

2 that may have made a call, whether an officer --

3 A No. When I send a patient, I call as a nurse.

4 Q Okay. So they know that it's kind of your job

5 to call ahead, if that's what the situation involves?

6 A Uh-huh.

7 Q And do you recall when is the next point of

8 time you heard anything about Ms. Dau's condition after

9 you saw her get in the van or be taken away for

10 transportation?

11 A When did I what?

12 Q When is the next time you were notified or

13 heard anything about her condition after you saw her

14 transferred away?

15 A Corporal Murguia called me.

16 Q And at what time did he call you?

17 A I cannot recall the time. But he called me

18 shortly after she was received I guess.

19 Q Did you make any notes about the conversation

20 you had with him at that time?

21 A No, I did not.

22 Q Okay. Why not? Is that something you would

23 document in notes just as part of protocol, conversations

24 you had with the watch commander about an inmate?

25 A Yeah, that's the protocol, but I did not. I

(;+,%,7�4


1 did not. Corporal Murguia called me shortly after she

2 arrived.

3 Q Okay. But you don't recall documenting that

4 conversation?

5 A No, but I recall the conversation.

6 Q Okay. So what did he tell you?

7 A That the patient had -- the patient died.

8 Q Okay. Did he say anything else about how she

9 died?

10 A No. He said, "Pacheco, the lady you sent out,

11 she just died."

12 I told him "You're messing around. Don't mess

13 around because it's serious."

14 He said, "Yeah, she died."

15 I just told him, "I cannot believe she died.

16 You're playing around. Don't play like that."

17 He's said, "I telling you, she died."

18 I hang up the phone. I was in shock. I'm

19 like, "What happened?" That was not meant to happen and

20 I didn't think that was -- I never taught she was going

21 to die. I was in shock and I didn't want her to die.

22 Q All right. So you were in shock. So that

23 conversation happened, then what did you do?

24 A I called my program manager. I was just in

25 shock. I was like, what happened? She didn't look bad.

(;+,%,7�4


1 She was good as she could be. Like, it was not a

2 different Dau that I seen prior to her dying that day.

3 Q So the Dau you had seen, was that -- describe

4 -- what I'm understanding from earlier testimony is that

5 Ms. Dau refused to answer questions; is that correct?

6 A Yes.

7 Q That she kind of had this blank look?

8 A She looked at you and turned away.

9 Q Just you describing her, she looked at you and

10 looked away?

11 A Uh-huh.

12 Q So she was nonresponsive?

13 A No, not answer questions. Nonresponsive means

14 when they're just like there. Nonresponsive is when they

15 don't respond to anything, nothing. They don't look at

16 you, they don't move, that's nonresponsive.

17 Q Okay. And from your what you recall of

18 Ms. Dau, she was always in that state of being

19 nonresponsive --

20 A No, we're not going to put the word

21 "nonresponsive," because nonresponsive means they don't

22 respond to nothing.

23 Q Okay.

24 A She wasn't nonresponsive. I'm just saying she

25 just refused to answer questions. I could put that.

(;+,%,7�4


1 Nonresponsive means when somebody is just dead.

2 Q Okay.

3 A I cannot ever word that in my notes before and

4 after because that was never her case.

5 Q Okay. She refused to answer questions?

6 A Uh-huh.

7 Q And --

8 A Because I placed -- sorry. If I placed her on

9 the 20th, she saw Dr. Baker on the 21st. So when I was

10 reading the notes, she did talk to Dr. Baker. So

11 nonresponsive would be she didn't talk to me, didn't talk

12 to other nurses. I can read the notes. She did make

13 some notes. They made notes that at some point the

14 patient was talking.

15 Q So after your phone call with the watch

16 commander and you stated that you were in shock, you

17 talked to your program --

18 A I called my program manager, "Come into the

19 office. We just had a big, big, big problem."

20 Q And what did you say to the program manager at

21 that time?

22 A Exactly? Exactly I don't remember. The only

23 thing I can remember -- because I was in shock. And when

24 I was in shock -- it shocked me. I'm a nurse and this is

25 the first time this ever happened to me and I wasn't

(;+,%,7�4


1 expecting it. I just thought she was dehydrated.

2 So I called and I go, "Linda."

3 She goes, "Yes." It was a Saturday morning, so

4 she was not on call. We always call her. She's really

5 good about answering our phone calls.

6 I go, "Linda, you need to get over here."

7 She said, "Why?"

8 "Do you remember Marsha Dau?"

9 She goes, "No, I don't recall her name." But

10 she doesn't do -- she helps out a lot, but she doesn't go

11 do what we do.

12 Q She's not in the trenches like you guys are?

13 A Huh-uh. I said, "Well, you need to come over

14 here because she just died. You need to come over here."

15 That's all I told her.

16 She said, "Okay. I'll be right there." Hang

17 up the phone. That's it.

18 Q Was there any protocol procedure you had to

19 follow because it involved an inmate death?

20 What happened after -- so let me just -- a

21 chronology I think would be easier. So the program

22 manager came to --

23 A Yes.

24 Q -- ICJ?

25 A Uh-huh.

(;+,%,7�4


1 MR. BERTLING: Do me a favor, you're doing a

2 good job, but instead of "uh-huh," say "yes."

3 THE WITNESS: Sorry.

4 MR. BERTLING: It needs to be "yes."

5 THE WITNESS: Yes.

6 BY MS. ZUGMAN:

7 Q So where was she when you called her?

8 A I don't know. I didn't ask her. I just called

9 her. I dialed her cell phone, she answered maybe the

10 second ring. I told her, "Linda, get over here. We just

11 had a big problem and you need to get over here."

12 She said, "What happened?"

13 "Marsha Dau, do you remember her?"

14 She said, "No."

15 "She just died. She just died. I don't know

16 why she died. She should have not died."

17 Q Okay.

18 A That's all.

19 Q And then at some point did she --

20 A "I'll be there." She said, "I'll be there."

21 Q Okay. So at some point she met you at ICJ?

22 A She came right away. I don't know where she

23 was, but she came right away. I don't know how many

24 minutes.

25 Q Can you describe briefly, generally, the

(;+,%,7�4


1 conversation you had with her once she got to ICJ to meet

2 with you personally?

3 A The best I can recall -- I was in shock. This

4 is -- as I say, I'm still in shock today. It's not easy

5 to lose a patient.

6 So she got there and I just told her -- well, I

7 showed her. I went in and got the chart, this is the

8 lady that just died. She was in safety cell on the 20th.

9 She saw Dr. Singh I don't know how many days ago. She

10 had some problems. Not emergent problems. She didn't

11 have any kind of -- nothing, no problems where I could

12 say she was terminally ill. She died. She died.

13 I didn't think she was going to die. She had

14 vitals. She was breathing. They even transferred her

15 within a few minutes. And to me, I didn't call 911. I

16 didn't tell them to call 911 because she was fine. She

17 looked good.

18 Q We're going to have to go back a little bit in

19 time --

20 A Okay.

21 Q -- before we go forward with the investigation

22 and other things that's happened.

23 As you sit here today, while you worked at ICJ,

24 have you called 911 in certain situations?

25 A Multiple times.

(;+,%,7�4


1 Q Multiple times?

2 A Yes.

3 Q Can you give me at least three examples of

4 situations where you called 911?

5 A Head injuries, chest pain, assaults.

6 MR. BERTLING: What was the other one?

7 THE WITNESS: Assaults. People get assaulted.

8 They fight.

9 BY MS. ZUGMAN:

10 Q Have you ever --

11 A Overdose.

12 Q Okay. Talking about overdose. Meaning,

13 overdose in drugs that were illicit drugs or drugs that

14 were --

15 A I don't know. They don't tell you. Sometimes

16 they could be narcotics, controlled substances, drugs.

17 Q In that situation, was the inmate unresponsive

18 overdosed on drugs and then you call the ambulance?

19 A Level of consciousness, altered level of

20 consciousness.

21 MR. BERTLING: Is this before or after they're

22 incarcerated?

23 THE WITNESS: No, after. Before, no. No.

24 They will call me to the sally port. If I see something

25 like that, you know what, I'm not going to take -- what

(;+,%,7�4


1 ending on the --

2 MR. BERTLING: There were two separate places.

3 BY MS. ZUGMAN:

4 Q -- ending on the 23rd.

5 A No. She was placed on the 12th, and got

6 released. I cannot recall the date. I placed her on the

7 20th. She was not, from the 12th to the 23rd, in the

8 safety cell.

9 Q But the sobering/safety cell/restraints log

10 goes from July 12th, 2011 to July 23rd.

11 A No.

12 Q No? Those are not --

13 A The 20th is the new date that I placed her

14 there. This nurse placed her the 12th. She got

15 released. Then I placed her back in there. It's not a

16 continue --

17 Q So it's not a continuation. So we'll do it in

18 separate categories.

19 A Yes, I understand more like that.

20 Q All right. On the July 12th --

21 A Uh-huh.

22 Q Can you just explain to me the purpose of this

23 document, sobering/safety cell/restraints log, which will

24 be the next exhibit, and we're on Exhibit 9.

25 What is the purpose of this document?

(;+,%,7�4


1 A By looking at it?


3 identification.)

4 MR. BERTLING: No. What is the purpose of this

5 document? Why do you have this document?

6 THE WITNESS: Oh, because this document is when

7 you place someone in safety cell or the restraints chair.

8 BY MS. ZUGMAN:

9 Q Okay. And what things are documented in this

10 form? For example, let me read it.

11 The medical history of the patient is listed;

12 correct?

13 A Uh-huh.

14 Q And you have medical provider that would be

15 listed?

16 A Uh-huh.

17 Q In this situation it says "Dr. Singh"?

18 A Yes.

19 Q And then we have current medications?

20 A Uh-huh.

21 Q So in addition to the medication

22 administrations record, is this another form that you

23 would use to see what medications the inmate was taking?

24 A No. We just write on there to have them -- the

25 current medications. But we go based on the medical

(;+,%,7�4


1 chart profile.

2 Q Okay. Who reads this documentation?

3 MR. BERTLING: Lacks foundation. Calls for

4 speculation.

5 But go ahead and answer the question, if you

6 know.

7 THE WITNESS: Who reads this information?

8 BY MS. ZUGMAN:

9 Q What's the -- I mean, it says here

10 "Sobering/safety cell/restraints log." Do you know of

11 anyone at CFMG, besides the nurse, who reads this

12 documentation?

13 A The doctors.

14 Q The doctors read it. And anyone on the county

15 side, the guards?

16 A Oh, no. This is confidentiality. That's the

17 patient's --

18 Q This is patient's record. Okay. So this

19 really has nothing to do with --

20 A No.

21 Q That's the clarification I was seeking.

22 So doctors and nurses for CFMG, that's it?

23 A That's it.

24 Q Okay. List of medications. And it goes down

25 here to talk about their vitals; right?

(;+,%,7�4


1 What I do as a nurse, we don't keep them there. I don't

2 like to have people in safety cell. We place them there

3 for their safety.

4 Q All right. Did you ever have you -- did it

5 ever occur to you that you might want to talk to

6 Dr. Baker as to why she might be needing to be placed in

7 safety cell?

8 A She was going to be seen by the doctor the next

9 day.

10 Q Okay. So that's the 21st. Okay. Got it.

11 A So I placed her. I knew she was going to see

12 the psych doctor or the psych nurse the next day. So why

13 call the doctor for one day? She needed time to be

14 there, then I would have talked to her again. Maybe, you

15 know, sometimes they need time.

16 Q Then after Dr. Baker visited or somehow saw

17 Ms. Dau, because I don't know how he saw her --

18 A The next day.

19 Q -- the next day, but I'm not sure if it was in

20 person or over the phone.

21 A Teleconference.

22 Q Did you follow up with Dr. Baker to see what

23 his opinion was of Ms. Dau in terms of her mental state?

24 A No. Well, he has recommendations of what he

25 wants us to do, because there's always a psych nurse

(;+,%,7�4


1 Q That's all I'm trying to get at here. I'm

2 trying to understand the reasoning and whose reasoning it

3 is.

4 A Okay. With me, no, she wasn't aggressive. But

5 I was told she was aggressive, she was kicking officers,

6 the other nurse, she said she also got stabbed.

7 Q Okay. So "Inmate patient refused vital signs

8 check." Is that based on your observation and

9 interaction with her?

10 A No. I asked her, "Can I take your vitals?"

11 She went like this and she turned. That's the day I

12 placed her.

13 Q So if someone just looks at you and turns away,

14 is that --

15 A She said like --

16 Q I got to -- it's hard because I'm trying to

17 understand something.

18 If someone -- if you ask a patient or inmate,

19 "It's time to take your vitals," and they look at you and

20 turn away, is that considered a refusal, meaning that you

21 deem that a refusal so I don't take the vital signs?

22 A No. It depends on the situation.

23 Q This is important because I'm trying to

24 understand why sometimes we took vital signs or the nurse

25 took vital signs and why sometimes it says no because she

(;+,%,7�4


1 refused. So I'm trying to understand what was the

2 refusal that warranted her vital signs not getting

3 checked.

4 MR. BERTLING: I think the question has been

5 asked and answered.

6 But go ahead and answer it again. What made

7 you say that she refused to get her vital signs?

8 THE WITNESS: I asked her if I could take her

9 vital signs. She looked at me and turned away, kind of

10 went like this. That was like, "Don't touch me."

11 BY MS. ZUGMAN:

12 Q Okay. But that was enough of an indication of

13 her refusal --

14 A Yes.

15 Q -- that you did not take her vital signs; is

16 that correct?

17 A Yes.

18 Q Did she ever say, "No, I do not want my vital

19 signs checked"? Did she ever say that verbally?

20 A Like "No"?

21 Q Yes.

22 A I don't recall. I don't recall. She was

23 nonverbal if I put here she was nonverbal.

24 Q So earlier we talked about, you heard sounds

25 from her on the July 23rd incident date, mumbling, or

(;+,%,7�4


1 something like that. Do you remember that testimony?

2 Did she do any of the mumbling --

3 A Uh-huh.

4 Q -- at this point too, on this date, July 20th,

5 2011?

6 A I don't recall. I said "nonverbal." I didn't

7 put "mumbling."

8 Q That's what I'm trying to clarify. You said

9 "nonverbal," but does that also include that she was not

10 mumbling or making sounds?

11 A No, I don't recall.

12 Q Okay. So the next note that is -- well, it

13 goes on to say "refusal to answer questions."

14 Again, her refusal to answer questions, did

15 that mean she just didn't say anything?

16 A She looked at me and turned away.

17 Q Looked at you and turned away, but didn't say

18 anything?

19 A I'd say, "Dau?" She would look at me. And

20 then I'd ask her questions and she would turn.

21 Q Do you know at the time if your questions --

22 that she actually heard your questions or registered your

23 questions?

24 A I'm pretty sure because she looked at me and

25 turned away.

(;+,%,7�4


1 Q "Past suicide ideation, no." Does that mean no

2 past history of suicide attempts?

3 A Not with me.

4 Q No attempts here at ICJ?

5 A Yeah. I didn't -- I looked at the notes and I

6 didn't see anything.

7 Q Okay. And it says the medical doctor's name is

8 Dr. Singh; is that correct?

9 A Yes.

10 Q And he's the main doctor?

11 A He's the doctor that we call for any problems.

12 Q Is there any other doctor that you call for --

13 A Or Dr. Baker.

14 Q But what's your understanding of their

15 different roles, if you have one? Dr. Singh and

16 Dr. Baker, what's your understanding of their roles?

17 A One is a psychiatrist and one is an M.D.

18 Q Okay. Are there any other doctors?

19 A No.

20 Q And this is signed off by you?

21 A Yes.

22 Q The next one also dated -- really quickly

23 before I get into that, how often -- sorry. That's the

24 nursing assessment of psychiatric and suicidal inmate,

25 that's going to be the next exhibit in line, 10.

(;+,%,7�4


1 exhibit in line, Exhibit 11. It says on top "bizarre

2 behavior, safety cell"; correct?

3 A Yes.


5 identification.)

6 BY MS. ZUGMAN:

7 Q Again, that's your handwriting?

8 A Yes.

9 Q And is that based on your observation that she

10 was exhibiting bizarre behavior?

11 A Yes.

12 Q What exactly do you recall that was bizarre

13 about Ms. Dau's behavior at the time you wrote this?

14 A Bizarre behavior would be that she would not

15 answer my questions. She looked at me, turned away, and

16 she refused my assessment.

17 People, when they're sick and they want some

18 help, they talk to you. They let you assess them. They

19 let you know "I have a problem." I knew this lady could

20 talk. I knew this lady could walk. I knew everything

21 because I seen her.

22 Q Okay. So at some point you saw her. You knew

23 she could talk, you knew she could walk.

24 A Uh-huh. She came in the medical department

25 walking.

(;+,%,7�4


1 Q Okay. And that was earlier on?

2 A The same day. We're talking about the 20th.

3 Q The 20th?

4 A When I placed her.

5 Q Okay. So on that day you saw her come into the

6 medical unit walking and talking?

7 A She was fighting -- well, not the fighting.

8 But she was verbal with the officers that were bringing

9 her into the room where I was going to assess her.

10 Q Okay. Who was the officer that she was being

11 verbal with?

12 A C.O. Vargas.

13 Q Do you remember what she was saying to

14 C.O. Vargas?

15 A No. I didn't pay attention.

16 Q Okay. Do you know if she was in a verbal

17 argument with C.O. Vargas?

18 A Yes, a verbal argument. Why, I don't know. I

19 didn't ask. Because whatever happens with them, unless

20 they're injured, the patient is -- unless the patient is

21 injured or unless she injured one of the officers, "What

22 happened?" No. But they weren't happy.

23 Q Okay. So they were in some sort of a verbal

24 argument, but you don't remember what was being said?

25 A No, I don't remember.

(;+,%,7�4


1 This note goes exactly the same time. She looked at me

2 and she turned away. She went like this, like I was

3 going near them to see if they are going to let me. If

4 they don't want to let me, I cannot force them, and I do

5 not push them.

6 Q Okay. Then you wrote down "Placed in SC for

7 bizarre behavior." And that, what you described, was the

8 bizarre behavior; is that correct?

9 A Uh-huh. Yes.

10 Q Okay. So the "Refused VS and assessment,

11 refusal to answer questions," is the bizarre behavior

12 that warrants --

13 A Yes. And --

14 MR. BERTLING: Wait a second. Let her finish

15 asking the question.

16 BY MS. ZUGMAN:

17 Q Again, I'm trying to understand your notes.

18 A Okay.

19 Q The refusal to do VS, assessment and the

20 refusal to answer questions comprised the bizarre

21 behavior, in your opinion, that warranted her being

22 placed in safety cell; is that correct?

23 MR. BERTLING: Now, was that the only thing or

24 was there something else that you learned from Officer

25 Vargas?

(;+,%,7�4


1 THE WITNESS: Officer Vargas telling me that

2 she had -- that she was being aggressive/combative with

3 them. She tried kicking her. When the C.O. was telling

4 me in front of the patient, she never said, "No, that's

5 not true," or nothing. The patient was just looking at

6 her like they were mad. So I just said "possible

7 aggressive behavior." She wasn't aggressive to me

8 because I wasn't restraining her. I wasn't -- I was just

9 trying to do my nursing assessment. I was trying to help

10 her out.

11 BY MS. ZUGMAN:

12 Q Okay. So this is -- these notes, 7/20 6:45,

13 and it goes 7/20 9:35.

14 A That's me later on because I'm supposed to go

15 there every six -- I have my hours that I have to go. So

16 I placed her at 6:00. Then at 9:00 I'm scheduled to see

17 her again.

18 Q Every six hours?

19 A Every six hours.

20 Q But that's --

21 A No. My times are 9:00, 3:00, 9:00, and 3:00.

22 Q Got it.

23 A So my time was due at 9:00 in the morning. I

24 just placed her at 6:45, which I could have waited six

25 hours, but I always like to maintain my schedule like

(;+,%,7�4


1 every six hours like we're supposed to do. We have our

2 times, 9:00 and 3:00.

3 Q Okay. The next assessment, it's at 9:35. You

4 write down that she is "noncooperative."

5 A She was calm.

6 Q Okay. But I'm going in order because it says

7 "VS deferred, yes, per inmate, refusal."

8 Again, is it the same thing, you asked her to

9 get her vital signs checked, she looked at you, looked

10 away?

11 A She went like this.

12 Q For the record, Ms. Dau turned her head away

13 and kind of her body language, like her body turned to

14 the right.

15 A Yeah. She just went like this.

16 Q Okay. To the side.

17 A To the side, yes.

18 Q And where was she in the cell?

19 A She was sitting up against the wall.

20 Q Okay. So her looking away and kind of moving

21 her shoulders away was her indication to you that

22 she didn't --

23 A I don't want to talk to you.

24 Q So no vital signs were taken at that point?

25 A She refused.

(;+,%,7�4


1 Q Her breathing was regular. Is that just based

2 on visual observation in safety cell?

3 A Uh-huh.

4 Q Is there a window you can see in?

5 A Yes.

6 Q Okay. And you can see her skin color and

7 moisture from the location of where you're standing?

8 A Hold on. Okay. No, that day -- I always open

9 the door. I mean, I see them through the window to make

10 sure they are not going to hit me there. I don't want to

11 be hit. I don't want to be pushed.

12 Q Understood.

13 A So I see, and then they open the door. So I

14 remember I wrote it here, "She was calm." She wasn't

15 screaming. She was just calm.

16 Q Okay.

17 A "Noncooperative. States" -- she did talk to me

18 I guess. "I don't want to talk to anybody." She was

19 lying down. She was naked. I asked her to cover up and

20 she refused.

21 Q Okay. Refused means that she didn't cover

22 herself up or she said, "I'm not going to cover myself"?

23 Did she verbally refuse?

24 A She said, "I don't want to talk to anybody."

25 Lying down, supine, naked. And I asked her, "Cover up, I

(;+,%,7�4


1 need to see you."

2 Q And she just didn't do anything?

3 A I guess she didn't cover up. "She refused to

4 cover up." That means she didn't do it. Refused vital

5 signs and assessment. "Will continue to monitor, psych

6 next line." Psych was going to see her that next day

7 because obviously that was more bizarre than the first

8 time.

9 Q Okay. And so the next one, it's not your

10 writing. It's dated 7/20/2011, 1530, another nurse, RN

11 Houchin?

12 A Houchin.

13 Q Houchin. She writes down -- and you can see

14 her notes. Do you remember seeing these notes at some

15 point before you wrote your next note on 7/21/11?

16 A No. Because there were another -- no, I didn't

17 see this one.

18 Q Once you place someone in safety cell, like

19 Ms. Dau, do you read a continuation of the notes from

20 each nurse just to see what --

21 A We get a report every day we come in.

22 Q Is this part of the report you read?

23 A No, they tell me.

24 Q So it's a verbal report?

25 A It's a verbal report.

(;+,%,7�4


1 read it, I can tell you.

2 For me, I placed her on the 20th. I went back

3 three hours later, she was lying down. Then I went back

4 on the 21st. My notes I can tell you what I see.

5 BY MS. ZUGMAN:

6 Q Okay. Let's go to the 21st.

7 A She let me take vitals that day.

8 Q So will continue to monitor. Do you remember

9 what she did that made you think that it was okay to take

10 her vitals that day?

11 A The 21st? Why did she let me take vitals?

12 Q Yes. You testified --

13 A I cannot recall why she let me, but I know she

14 let me.

15 Q Okay. Do you remember, "Yeah, you can take my

16 vitals"? Did she do anything verbally to indicate that

17 you could take her vitals that day?

18 A I'm reading my notes.

19 Well, when I asked her "Dau, I need to take

20 your vitals," I guess she came to the door for me.

21 Q Okay.

22 A And I took her vitals.

23 Q It says her she was lying down supine.

24 A Uh-huh. When I first opened the door, she was

25 lying down supine. She refused to cover her body with a

(;+,%,7�4


1 blanket. So she came to the safety cell I guess naked.

2 I took her vitals. And I just said, "She's still not

3 clear," is what I thought. "Will continue to monitor,"

4 because obviously I'm telling her to cover up her body.

5 I mean, a normal person is not going to be exposing their

6 body to me or anybody that she doesn't know.

7 Q Cover her body with whatever blanket thing she

8 had?

9 A She had two blankets, and if she didn't cover

10 up --

11 MR. BERTLING: Were they two blankets or was it

12 one blanket and --

13 THE WITNESS: One Barney suit and one blanket.

14 They never have two blankets. Sorry.

15 And I just told her, "You're going to be seen

16 by the psych tomorrow morning."

17 BY MS. ZUGMAN:

18 Q Do you remember if she made any response to

19 that?

20 A No. She just listened to me.

21 Q And then the next entry is 7/21/2011. That is

22 not your handwriting. Is that --

23 A Sustaita.

24 Q -- Sustaita?

25 Do you remember seeing this entry prior to --

(;+,%,7�4


1 this was the medication that Ms. Dau was taking?

2 A The -- yes.

3 Q Where did you get this information?

4 A From the chart, from my medication profile.

5 Q Okay. And on the 22nd of 2011, 1435, you wrote

6 "Will continue to monitor." Is that because she -- wait.

7 "Will continue to monitor. She allowed me to do vital

8 signs."

9 A Uh-huh. Yes.

10 Q And you write down, "Sitting by food port."

11 A Yes.

12 Q Do you recall --

13 A Yes.

14 Q Do you recall what she looked like on that

15 specific date when she was sitting by the food port?

16 A Looked like as what?

17 Q Did she look like she was having any difficulty

18 moving her body?

19 A No. I said she was better than the other days.

20 Q So her behavior was cooperative that you

21 marked.

22 A Yes, because she let me take vitals. She was

23 mumbling things, I couldn't -- her voice, she was like --

24 she was not as strong as me. She wasn't like -- she was

25 mumbling words, I remember.

(;+,%,7�4


1 Q So earlier we talked about the fact that she

2 got in some sort of verbal argument with one of the

3 officers; correct?

4 A Uh-huh.

5 Q And at that time you heard her actually speak?

6 A Uh-huh.

7 Q So you knew she could speak; is that correct?

8 A Uh-huh.

9 Q So at this time, on 7/22/2011, you stated

10 earlier she was mumbling.

11 A Uh-huh.

12 Q Did you find it to be a concern that she was

13 mumbling at this point of your assessment on 7/22/2011?

14 A If mumbling words was concerning for me?

15 Q Yes.

16 A No.

17 Q Meaning she was having some sort of possible

18 reaction to her medication?

19 A No. You don't mumble. These new medications

20 that she was prescribed, Haldol and Cogentin together.

21 Doesn't mean everybody gets the same. No.

22 Q And you wrote in the comments, "Awake, alert,

23 calm, cooperative, but mumbling words. Not answering

24 questions."

25 A Yes.

(;+,%,7�4


1 Q Do you remember what questions again that you

2 were asking her?

3 A "How are you feeling?" The same questions I

4 always ask, "How are you feeling? What did the doctor

5 say to you yesterday?" That day I knew that the doctor

6 saw her.

7 Q Okay.

8 A "What did the doctor say to you?"

9 Q And does the medications record that we saw

10 earlier indicate -- would indicate if she took her

11 medications or not?

12 A Yes.

13 Q Okay. I'm just --

14 A I don't know. That day I cannot recall if I

15 seen them. I'll let you know. But right there in the

16 medication profile, we know when they refuse, when they

17 take, when they're out to court, or whatever the nature

18 was.

19 Q Okay. Well, here's medications. Can you

20 briefly look at it and maybe it will refresh your

21 recollection whether or not she took her medication.

22 A You want to know for that date, for that time?

23 Q Yes. After she saw Dr. Baker did she take her

24 medication that he prescribed to her?

25 MR. BERTLING: So are you asking about whether

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1 she took medication on the 21st, 22nd, or what?

2 THE WITNESS: She was seen by Dr. Baker on the

3 21st.

4 BY MS. ZUGMAN:

5 Q Anytime after she saw Dr. Baker, did she take

6 her medication?

7 A For me or for the other nurses?

8 Q I'm just saying --

9 A We were talking about my notes on the 22nd.

10 Q I know. But I want to know if that medications

11 record administration log, would that indicate it, so I

12 don't have to go back and forth.

13 A She took them.

14 Q And isn't that the purpose for --

15 MR. BERTLING: Well, what medications did she

16 take?

17 THE WITNESS: Haldol and Cogentin.

18 MR. BERTLING: Were there any others? Look at

19 the medication administration record. She wants to know

20 what medications she had taken on July 21st and up to the

21 point you had seen her on July 22nd.

22 THE WITNESS: All the medication she took on

23 that date?

24 MS. ZUGMAN: Yes.

25 MR. BERTLING: On July 21st and July 22nd, what

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1 BY MS. ZUGMAN:

2 Q Okay. And it could be that my choice of words

3 are --

4 A Interacting to me is like interacting like --

5 Q Okay. In any way physically touching her or

6 talking to her is what I mean by interacting?

7 A I don't recall.

8 Q You don't recall.

9 A They were there. I can tell you they were

10 there.

11 Q Okay.

12 A But I cannot recall -- I don't pay attention to

13 what the officers -- I mean, I just don't. I was doing

14 my thing.

15 Q Okay. All right. So when you noticed on July

16 23rd that Marsha wasn't doing well, or when you notice

17 that she needed to be checked on July 23rd, 2011, what

18 caught your attention?

19 A Her lips, they were chapped. They were dry.

20 She wasn't like that prior to the times I seen her.

21 Q Okay. I mean, chapped lips, is that something

22 that can be a --

23 A Dehydration.

24 Q -- warning, I guess.

25 A I thought something wasn't right that day.

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1 Q If she was dehydrated, do you start an IV?

2 A There at the jail?

3 Q Uh-huh.

4 A No, because I cannot make diagnosis. I thought

5 she was dehydrated, so I say, you know what, let's take

6 her to the hospital, they'll do labs, the doctor will

7 assess her. I'm just a nurse.

8 Q And because you thought she was dehydrated, did

9 you think that maybe either Dr. Singh -- maybe to check

10 with Dr. Singh to see if his diagnosis would be --

11 A No, because he would say, "Send her out.

12 You're the nurse. You're seeing a problem. If there's a

13 problem, send them out." We don't take any chances.

14 Q Okay. So in the situation where an inmate is

15 deemed to be dehydrated or in your opinion is dehydrated,

16 they get sent to El Centro Regional Medical Center, is

17 that what normally happens?

18 A I don't understand.

19 Q If you see --

20 A There's two hospitals in the valley.

21 Q If an inmate is dehydrated or you think an

22 inmate is dehydrated, is the protocol to send them to one

23 of the hospitals?

24 MR. BERTLING: Objection. Incomplete

25 hypothetical. Vague and ambiguous.

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1 But if you can answer the question the way it's

2 phrased.

3 THE WITNESS: I cannot understand.

4 BY MS. ZUGMAN:

5 Q You indicated in your notes that Ms. Dau needs

6 to be sent out to the hospital for further evaluation

7 regarding dehydration.

8 A What I thought, to rule out. I cannot make a

9 diagnosis. I thought she was dehydrated.

10 Q Okay. So if you think an inmate is dehydrated,

11 does that warrant the transportation of that inmate to an

12 outside hospital?

13 A No, because it seems to depend on the signs and

14 symptoms. I mean, there's other people that don't need,

15 there's other people that come in and they haven't eaten

16 for three days, but they have good skin turgor. Her

17 vitals were good, that's why I didn't think it was an

18 emergency.

19 It depends, if they're nauseous and they're

20 vomiting and have diarrhea. I mean, it depends on the

21 situation. Her situation, I just thought she was

22 dehydrated, but I wanted a doctor to see her. So if I

23 called my doctor, he'd say, "Send her out."

24 Q Okay. And you went -- I'm just making sure I

25 understand it.

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1 2011?

2 A Not that day, nor the prior times that I seen

3 her.

4 Q Do you recall any interactions with her public

5 defender James Johnson?

6 A I have nothing to do with -- I just would not

7 know, no. I don't even know if she has a public

8 defender. I don't know why she's there. We don't ask

9 those custody questions.

10 Q Okay. He was there. He just -- you answered

11 the question. Thank you.

12 Did the watch commander contact Officers

13 Worthington and Romero to do the transport of Ms. Dau?

14 A I don't recall. I don't know.

15 Q So you didn't contact any of the officers to

16 arrange the transportation; is that correct?

17 A I called Corporal Murguia to go to safety cell

18 because she needed to be transported within a few

19 minutes, not an emergency, but she needed --

20 After that, I don't know what he does. I don't

21 even ask. I don't question.

22 Q Okay. Are you aware of any other inmate deaths

23 at the ICJ within the past two years?

24 MR. BERTLING: Objection. Irrelevant.

25 But if you can answer the question, go ahead.

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1 THE WITNESS: I'm not aware.

2 BY MS. ZUGMAN:

3 Q You're not aware?

4 A I'm not aware. I only do my -- nobody has ever

5 died when with me. That's the only thing that I care.

6 That's the only thing I'm concerned about, what happens

7 when I'm there.

8 Q I'm going to show you the protocol document and

9 what I understand to be the -- I just want to confirm, on

10 page 145, where the subject says "Emergency Services," is

11 that your understanding of the protocol that governs when

12 you would make a call to the ambulance for a possible

13 medical emergency?

14 A If I'm familiar with this?

15 Q I'm just asking if that's the document that

16 governs protocol for when you would make a call to 911

17 for an emergency situation?

18 MR. BERTLING: Well, objection. Lacks

19 foundation that this is the only document such as this

20 that identifies under what circumstances you may call

21 911.

22 BY MS. ZUGMAN:

23 Q She identified the Imperial County Adult Policy

24 and Procedure Manual as being kind of the governing

25 manual for policy and procedures.

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