1 1 STATE OF MINNESOTA DISTRICT COURT 2 COUNTY OF HENNEPIN FOURTH JUDICIAL DISTRICT 3 Court File No. 62 CO 06 11934 4 5 -------------------------------- 6 Mary Weiss, on her own behalf, 7 and as the next of kin and Trustee 8 of the estate of Dan Markingson, deceased, 9 10 Plaintiff, 11 12 vs. 13 14 Board of Regents for the University of 15 Minnesota; Dr. Stephen Olson; Dr. 16 Charles Schulz; Institutional Review Board 17 for the University of Minnesota; Astrazeneca 18 Pharmaceuticals LP, Astrazeneca LP and Zeneca, Inc., 19 20 Defendants. 21 ---------------------------------- 22 23 AUDIO VISUAL DEPOSITION OF 24 STEPHEN OLSON, M.D. 25 MAY 1, 2007 VERBATIM COURT REPORTING 763-493-4535 2 1 2 3 The following is the deposition of STEPHEN 4 OLSON, M.D.; Mari Skalicky, Court Reporter, Notary 5 Public, pursuant to Notice of Taking Deposition, at 6 701 Xenia Avenue South, Suite 600, Minneapolis, 7 Minnesota, commencing at approximately 9:00 a.m., 8 MAY 1, 2007. 9 ********* 10 11 A P P E A R A N C E S 12 13 For the Plaintiff: 14 15 R. Christopher Barden, PhD, JD 16 Ben Griffith, Esquire 17 Gale D. Pearson, Esquire 18 100 South Fifth Street 19 Suite 1025 20 Minneapolis, MN 55402 21 22 23 24 25 VERBATIM COURT REPORTING 763-493-4535 3 1 2 For the Defendants: 3 4 David Alsop, Esquire 5 Gislason & Hunter LLP 6 701 Xenia Avenue South, Suite 500 7 Minneapolis, MN 55416 8 9 Linda S. Svitak, Esquire 10 Feagre and Benson 11 2200 Wells Fargo Center 12 Minneapolis, MN 55402 13 14 Chuck Gross, Esquire 15 Geraghty, O'Louglin & Kenney 16 1400 Ecolab University Center 17 St. Paul, MN 55102 18 19 ALSO PRESENT: Mary Weiss 20 Ruth Flynn 21 22 23 24 25 VERBATIM COURT REPORTING 763-493-4535 4 1 2 I N D E X 3 4 Witness Examination by Page 5 6 STEPHEN OLSON, M.D. DR. BARDEN 4 7 Page Marked 8 Exhibit No. 1 Subpoena 14 Exhibit No. 2 Billing 17 9 Exhibit No. 3 Examiner's Statement 124 Exhibit No. 4 Report of Prepetition 126 10 Exhibit No. 5 Order to confine 131 Exhibit No. 6 Findings of Fact 134 11 Exhibit No. 7 Nov 20 2003 letter 139 Exhibit No. 8 Nov 24 2003 memo 147 12 Exhibit No. 9 Adult Consent form 147 Exhibit No. 10 Evaluation to sign 148 13 Exhibit No. 11 Washington Week 182 Exhibit No. 12 CCM Contacts 194 14 Exhibit No. 13 Dec 8 2003 letter 196 Exhibit No. 14 2004 safety alert 202 15 Exhibit No. 15 Seroquel insert 203 Exhibit No. 16 May 10 2004 letter 208 16 Exhibit No. 17 Informed consent process 219 Exhibit No. 18 Authorization and consent 224 17 Exhibit No. 19 WCST 64 230 Exhibit No. 20 Journal 234 18 Exhibit No. 21 Chart notes 234 Exhibit No. 22 Bell curve 245 19 Exhibit No. 23 Chart notes 245 Exhibit No. 24 Final report to court 248 20 Exhibit No. 25 Apr 27 2004 letter 250 Exhibit No. 26 Adverse Event Report 258 21 Exhibit No. 27 Coronor report 256 Exhibit No. 28 Statement of investigator 262 22 Exhibit No. 29 July 9 2004 letter 264 Exhibit No. 30 October 25, 2004 letter 267 23 Exhibit No. 31 AIMS 269 Exhibit No. 32 Autopsy pictures 273 24 Exhibit No. 33 pictures 274 Exhibit No. 34 Pictures 275 25 VERBATIM COURT REPORTING 763-493-4535 5 1 2 P R O C E E D I N G S 3 (Whereupon, the deposition of STEPHEN OLSON, 4 M.D. was commenced at approximately 9:00 a.m., as 5 follows): 6 7 ********** 8 9 EXAMINATION 10 11 12 DR. BARDEN: My name is Chris Barden. 13 That's B as in boy, A R D, as in dog, E N. And 14 I'm here for Mary Weiss. 15 MS. PEARSON: My name is Gale Pearson and 16 I'm here on behalf of plaintiff Mary Weiss. 17 MR. GRIFFITH: My name is Ben Griffith. 18 I'm here on behalf of plaintiff Mary Weiss. 19 MS. WEISS: And I am Mary Weiss the 20 plaintiff. 21 MR. GROSS: I am Chuck Gross on behalf 22 the Board of Regions for the University of 23 Minnesota. 24 MR. POGUST: Glenn Pogust Kaye Scholer 25 LLP, New York on behalf of Astrazeneca. VERBATIM COURT REPORTING 763-493-4535 6 1 MS. SVITAK: Linda Svitak, Faegre and 2 Benson. I'm also here on behalf of the 3 Astrazeneca. 4 MS. FLYNN: Ruth Flynn from the 5 University of Minnesota Physicians. 6 MR. ALSOP: David Alsop on behalf of 7 Dr. Olson. 8 9 (Witness sworn). 10 11 STEPHEN OLSON, M.D., 12 called as a witness, being first duly sworn, was 13 examined and testified as follows: 14 15 ********** 16 17 EXAMINATION 18 19 Q. (BY DR. BARDEN) Have you ever been deposed 20 before this morning? 21 A. Yes. 22 Q. And how many times? 23 A. I think twice. 24 Q. Can you name the cases and when and where that 25 took place? VERBATIM COURT REPORTING 763-493-4535 7 1 A. No. I acted as an expert witness in several 2 cases when I was a psychiatrist in Ohio and I 3 recall specifically on one occasion being 4 deposed. I believe I was deposed another time 5 but I don't remember the names of the cases or 6 the exact details. 7 Q. Do you remember the names of the lawyers or the 8 dates? 9 A. I don't. It would have been in the early '90s. 10 Q. And where in Ohio? 11 A. Columbus, Ohio. 12 Q. Have you ever been under oath in a trial before 13 or a hearing? 14 A. In a hearing. 15 Q. And -- 16 A. But not a trial. That was also in Columbus, 17 Ohio. 18 Q. Was that also in the early 1990's? 19 A. Yeah, probably, or mid-90's. 20 Q. Do you recall the name of the case or the 21 lawyers? 22 A. I recall the plaintiff was a former patient of 23 mine, but I don't recall the lawyers. In fact, 24 I'm not sure if that was a formal hearing or an 25 informal meeting at the courthouse, but I do VERBATIM COURT REPORTING 763-493-4535 8 1 recall it was at the courthouse. 2 Q. Have you ever been sued before? 3 A. Not to the point of going to trial. I had 4 actions brought against me but they never 5 proceeded to trial. 6 Q. When and where were those? 7 A. Again, when I was a faculty psychiatrist at the 8 Ohio State University Hospitals in Columbus. 9 Between -- I was there between 1985 and 2000. 10 So it would have been in Columbus, Ohio. 11 Q. How many actions were brought against you there 12 during that time period? 13 A. I think two or three, but they never went to -- 14 they never went to trial. They never, as I 15 recall, ever were any attorneys appointed for 16 me by the University. We were -- the 17 University was self insured, so one -- 18 Q. Yeah. I'm sorry. So these were malpractice 19 actions brought against you by clients of yours 20 or what? 21 A. Well, yeah, one or two certainly were. One, as 22 I recall, was a patient I did 23 electroconvulsives therapy and a patient 24 claimed that she suffered cognitive deficits as 25 a result of the ECT and hadn't been fully VERBATIM COURT REPORTING 763-493-4535 9 1 informed and there was preliminary documents to 2 that effect. And we provided the medical 3 records that showed that she had been informed 4 and she had been tested prior to the procedure 5 being performed and had cognitive problems at 6 that time, and then there was no further -- 7 there were no further -- didn't -- the case 8 didn't go forward. I think the attorney 9 advised her to drop it or something. 10 The other case where there was an actual 11 hearing was a patient who requested -- that she 12 took legal action to prevent me from publishing 13 a paper involving any information -- that she 14 was publishing an academic article about her 15 case. And there was a preliminary hearing and 16 I said I didn't have any intention of doing so 17 and that was dropped as well. There may have 18 been an attorney involved there. 19 Q. So as far as you know, these cases were both 20 dropped, none of them were settled? 21 A. That's correct. 22 Q. And, one, the ECT patient involved allegations 23 of improper informed consent, correct? 24 A. Oh, that was the -- yeah. 25 Q. And the second one involved allegations of VERBATIM COURT REPORTING 763-493-4535 10 1 improper authorization, correct, to release 2 information? 3 A. Well, I don't know what the claim was. She 4 wanted to prevent me from publishing a paper 5 that had no intention or had ever expressed any 6 interest in writing so -- 7 Q. Were those the only two previous actions 8 against you that have been filed in your 9 medical career? 10 A. I believe so. I think there was a -- the other 11 case, I don't know at what point it -- 12 Q. Excuse me. But when you say the other case, 13 you mean a third case? 14 A. A third case. A third case that I don't recall 15 what actual steps -- how far it got was a 16 suicide that occurred some 8 to 12 months after 17 I had had any involvement with the case. I 18 hospitalized the patient and discharged him 19 with recommendations for treatment and then had 20 no further involvement in the case and then he, 21 as I recall, failed to follow his 22 recommendations. And at 8 to 12 months later 23 committed suicide and his widow or next-of-kin 24 pursued some kind of preliminary lawsuit that I 25 failed to provide adequate care or follow-up VERBATIM COURT REPORTING 763-493-4535 11 1 but that, as I recall, never proceeded to any 2 sort of actual lawsuit. 3 Q. Do you remember the names of the plaintiffs or 4 any of the lawyers in any of those actions 5 against you? 6 A. No. 7 Q. Has anyone ever filed any licensing complaints 8 against you? 9 A. Yeah, the Minnesota Board of -- 10 MR. ALSOP: Wait a minute. If there is 11 anything about the Board that was not a 12 disciplinary action, you don't have to answer 13 that question. It's privileged. It's 14 confidential. If there has been any 15 revocation, any disciplinary action taken to 16 you by the Board, you can answer the question. 17 Anything else is privileged. 18 A. There were not. There were not. 19 Q. (BY DR. BARDEN) Let's go back to the 20 beginning. Since you've been deposed before, 21 you probably know these things, but let's just 22 run through them. It's very important that we 23 communicate clearly and that only one of us 24 speaks at a time. Fair enough? 25 A. Fair enough. VERBATIM COURT REPORTING 763-493-4535 12 1 Q. If you need to take a break, let me know and 2 we'll take a break but not during a question. 3 Fair enough? 4 A. Okay. 5 Q. Okay. Your lawyer may object from time to time 6 as he just did, and that's fine, and we want to 7 be careful to let him finish his objection 8 before you answer. Fair enough? 9 A. Yes. 10 Q. Now, there are some things I will not ask you 11 about. I will not ask you for any information 12 that you have received from your lawyers. 13 A. Yes. 14 Q. Does that make sense? 15 A. Yes. 16 Q. I'm not going to ask you for the names of any 17 of your clients other than Dan, who we're going 18 to be talking about quite a bit this morning. 19 A. Yes. 20 Q. I'm also not going to ask you for any 21 trademarked information. Does that sound fair? 22 A. Yes. 23 Q. What have you done to prepare for the 24 deposition this morning? 25 A. I've reviewed some of the medical records from VERBATIM COURT REPORTING 763-493-4535 13 1 the Fairview hospitalization and the source 2 documents from the CAFE trial where I was Dan's 3 psychiatrist. 4 Q. Have you done anything else? 5 A. I've met with Mr. Alsop. 6 Q. And that's it? 7 A. (Nods head in the affirmative). 8 MR. ALSOP: Is that a yes? 9 A. Yes. 10 Q. (BY DR. BARDEN) You haven't spoken to any 11 witnesses, any potential expert witnesses or 12 anything like that, correct? 13 A. No, I have not. 14 Q. Show you what's been marked as Exhibit 1. Have 15 you seen this document? 16 A. Yes, I believe so. 17 Q. And did you fully comply with it? 18 MR. ALSOP: I think that's vague as to 19 what do you mean by comply with it? 20 Q. (BY DR. BARDEN) Let's look specifically at 21 Exhibit A, which lists all the documents that 22 you were to bring to the deposition this 23 morning. If you'll -- there you go. Have you 24 seen this list before? 25 A. Is this Exhibit A here? VERBATIM COURT REPORTING 763-493-4535 14 1 Q. Yes. Were you aware that this was attached to 2 the subpoena and that you were required to 3 bring to the place, date and time specified 4 these documents? 5 A. Well, my understanding was that I didn't need 6 to bring any documents that were already in the 7 possession of all of the involved parties. I 8 don't have anything else that hasn't been 9 released and I was -- I did not understand this 10 to mean that I was required to bring either the 11 original records or any copies of information 12 that wasn't -- that's already been provided. 13 Q. Let's look at the front page of what's been 14 marked as Exhibit 1. If you look at the front 15 page. 16 A. Okay. 17 Q. Do you see the second X down where it says, you 18 are commanded to produce and permit inspection 19 and copying of the listed documents or objects 20 at the place, date and time specified below. 21 Did you see that? You either saw it or you did 22 not. 23 A. No, I didn't. Well, if I saw it, I didn't 24 understand that that meant that I was to bring 25 the actual documents, no. VERBATIM COURT REPORTING 763-493-4535 15 1 Q. Did you read that to mean something else or -- 2 MR. ALSOP: Well, Counsel, he is not the 3 custodian of any of these documents. They're 4 not in his possession. I've represented that 5 to counsel before. You can ask him that. The 6 records are not in our custody. He has no 7 records that are in his custody to bring with 8 him. They are part of the University of 9 Minnesota and the IRB. They are not his 10 records. He has no additional records beyond 11 that at all. For him to go to take IRB records 12 or University records, he can't do that so you 13 can ask him again but he has no -- I talked to 14 him before, and you can ask him again, he has 15 no additional documents or records responsive 16 to this request that are in his custody. 17 Q. (BY DR. BARDEN) So the records that we have 18 seen that have been given to us, the best of 19 your knowledge are complete and accurate, 20 right? 21 A. Yes. 22 Q. Thank you. 23 MR. ALSOP: I will add this, it's not in 24 his custody but one of the requests were for 25 billing records. And these are not in his VERBATIM COURT REPORTING 763-493-4535 16 1 custody but UMP and I have a copy of the 2 billing records. 3 DR. BARDEN: All right. Thank you. 4 MR. ALSOP: I'll make extra copies later 5 on. Why don't we mark that as Exhibit 2. 6 (Exhibit No. 2 was marked for 7 identification by the Court Reporter). 8 Q. (BY DR. BARDEN) Could you please identify that 9 for us, Doctor. 10 A. It appears to be a listing of the professional 11 fees billed to Dan Markingson during his 12 hospitalization, November of 2003. 13 Q. And there is no billings after December 14th, 14 2003, is that correct? 15 A. Yes. 16 Q. So you had no clinical visits with Dan after 17 December 14th, 2003? 18 A. All the visits after that date were in the -- 19 in my function as the investigator for the CAFE 20 study. So there were no bills for those 21 services because those services were provided 22 for by the sponsor in terms -- in the conduct 23 of the study. 24 Q. So you provided no clinical services or 25 treatment to Dan after December 14th, 2003, is VERBATIM COURT REPORTING 763-493-4535 17 1 that correct? 2 A. I provided clinical treatment in the research 3 protocol, which involved outpatient visits and 4 assessment of his condition, just as I would in 5 a clinic setting, but there were no bills. 6 Q. Who was Dan's, to the best of your knowledge, 7 who was Dan's personal psychiatrist from 8 December 14th, 2003, until the day he died in 9 May? 10 A. Myself. 11 Q. You were his personal, the only personal 12 psychiatrist? 13 A. That's correct. 14 Q. You did not transfer his personal care to 15 anyone during the time he was in your study? 16 A. No. 17 Q. Let's go back a little bit. I would like you 18 to tell me about your medical training. Where 19 did you go to high school? 20 A. White Bear Lake Senior High School. 21 Q. And where did you go to undergraduate? 22 A. Michigan State University. 23 Q. From what year to what year? 24 A. From 1972 to 1976. 25 Q. Do we have a resume for you? You didn't bring VERBATIM COURT REPORTING 763-493-4535 18 1 a resume? 2 MR. ALSOP: I don't have one right now, 3 no. 4 Q. (BY DR. BARDEN) Would you be able to send that 5 to us? 6 A. Sure. 7 Q. In the next few days. Thank you. That would 8 be very helpful. 9 MR. ALSOP: I think that's part of your 10 document request which we're going to respond 11 to. 12 Q. (BY DR. BARDEN) Okay. And where did you go to 13 medical school? 14 A. University of Minnesota from 1976 to 1980. 15 Q. Who was your adviser in medical school? 16 A. Michael Popkin. 17 Q. When did you decide to specialize in 18 psychiatry? 19 A. Probably arrived at that decision sometime in 20 my third year of medical school. 21 Q. Where did you serve your residencies? 22 A. University of Iowa Hospitals and Clinics. 23 Q. From when to when? 24 A. I was a resident from 1980 to 1984 and then I 25 did a year of fellowship in psychiatric VERBATIM COURT REPORTING 763-493-4535 19 1 genetics there for another year, so 1985. 2 Q. And who were your supervisors? 3 A. The residency director was Fritz Henn and/or 4 let's see, Bob Smith and Fritz Henn. Chairman 5 was George Winokur. My fellowhip advisor was 6 Ray Crow. There were a number of other 7 supervisors I had during my residency. 8 Q. So year by year starting with the end of 9 medical school, go through all the training 10 that you had and where it was. 11 A. From the end of medical school? 12 Q. Yes. 13 A. July 1971 through June -- I'm sorry, July, 14 1980, through June 1984 I was a psychiatry 15 resident in a general psychiatry program, four 16 year course of training at the University of 17 Iowa Hospitals. And for the following year 18 from July '84 to June of '85 I was a fellow 19 doing a postdoctoral felllowship in psychiatric 20 genetics. 21 Q. Who was -- 22 A. At the University of Iowa. 23 Q. Who was your supervisor for that fellowship? 24 A. Raymond Crow. 25 Q. What did you do after that? VERBATIM COURT REPORTING 763-493-4535 20 1 A. Then I went to the Ohio State University 2 College of Medicine and joined the faculty in 3 July of 1985 and stayed until December of 2000 4 when I came back to the faculty of the 5 University of Minnesota. 6 Q. Who was your supervisor at Ohio State? 7 A. Chairman through most of that time was Henry 8 Nasrallan and then he left in about '97 and the 9 chairman was Robert Bornstein and then Radu 10 Saveanu after that. 11 Q. Who has been the chairman at Minnesota since 12 you've been there? 13 A. Chuck Schulz. 14 Q. And he has been the chairman the entire time 15 you've been there? 16 A. Yes. 17 Q. During your medical training, have you had any 18 training in medical ethics? 19 A. Yes. 20 Q. And have you had any training specifically in 21 informed consent? 22 A. Yes. 23 Q. Have you had any training in obtaining informed 24 consent from psychotics? 25 A. Yes. VERBATIM COURT REPORTING 763-493-4535 21 1 Q. Have you had to have any continuing medical 2 education? 3 A. Yes. 4 Q. Do you have a copy of all of the continuing 5 medical -- the continuing medical education 6 classes you've taken in the last, say, decade? 7 A. No. 8 Q. How far back do your records go? 9 A. I'm not sure. I would say probably, you know, 10 probably three, four years. I usually -- I'm 11 required to certify that I've had 40 hours of 12 category one training and 200 hours of 13 continuing medical education training per, I 14 think, two year reporting period. I have to 15 certify that every time I renew my license, and 16 I'm not asked to provide specifics unless 17 they're requested by the Board. So I would 18 keep those records, but as an academic 19 psychiatrist, I attend scientific meetings, 20 grand rounds of various other meetings, prepare 21 lectures. And so I generally have no problem 22 in finding records of, at least enough to meet 23 those requirements. So, I mean, I may not 24 actually keep records of every educational 25 activity that I do that might be considered, VERBATIM COURT REPORTING 763-493-4535 22 1 you know, continuing education. 2 Q. Well, let me ask you this. As a licensed 3 physician in the State of Minnesota, which you 4 are, correct? 5 A. Yes. 6 Q. What is the Board rule for you with regard to 7 how long you're required to keep copies of your 8 continuing medical education files? 9 A. I don't know. 10 Q. You don't know? 11 A. I don't know. 12 Q. Have you had any continuing medical education 13 training in the last six years with regard to 14 medical ethics? 15 A. Yes. 16 Q. Have you had any with regard to obtaining 17 informed consent? 18 A. Yes. 19 Q. Have you had any training with regard to the 20 ethics of running a research study with human 21 subjects? 22 A. Yes. 23 Q. Have you ever treated any client with bipolar 24 disorder? 25 A. Many. VERBATIM COURT REPORTING 763-493-4535 23 1 Q. Have you treated people with Lithium? 2 A. Yes. 3 Q. And Depakot? 4 A. Yes. 5 Q. And Tegratol? 6 A. Yes. 7 Q. And ECT? 8 A. Yes. 9 Q. You didn't use any of those treatments with 10 Dan, though, correct? 11 A. No. 12 Q. Now, I would like to ask you about your history 13 of your relationship with Astrazeneca. When 14 did you first become a paid consultant or 15 worker of some kind for Astrazeneca? 16 MR. ALSOP: Well, I'll object as vague 17 but go ahead and answer. 18 MS. SVITAK: Same objection. 19 Q. (BY DR. BARDEN) I'm looking for any financial 20 relationship whatsoever you've had with 21 Astrazeneca, and I'm looking for the timeline 22 of that. 23 A. In the early '90s I was a co-investigator 24 with -- at the Ohio State University on a study 25 of Seroquel when it was in phase -- probably, VERBATIM COURT REPORTING 763-493-4535 24 1 three, two or three trials. In the sense that 2 I provided some of the care for patients who 3 were hospitalized on an acute psychosis 4 protocol. 5 Q. How much money did you receive from Astrazeneca 6 during that time period? 7 A. I don't know. We probably had maybe two or 8 three patients, and I wasn't the principal 9 investigator. The chairman of my department 10 was. I was the -- I was the inpatient 11 attending. 12 Q. Move to strike as non-responsive. Question 13 was, how much money did you receive from 14 Astrazeneca during that time period? 15 A. Nothing. 16 Q. What was the first date that you received money 17 from Astrazeneca, and how much money was that? 18 A. I don't -- I don't recall if back in the time 19 that I was at Ohio State University if I gave 20 any lectures on behalf of Astrazeneca, but the 21 time that I first recall would be when I first 22 arrived at Minnesota, Dr. Schulz was doing a 23 study of extended release Serequel and he asked 24 me to take over that study and I did. And we 25 didn't recruit anybody for the study so we -- I VERBATIM COURT REPORTING 763-493-4535 25 1 don't think we got paid anything for doing that 2 study. 3 Q. And that would have been what year? 4 A. That would have been in 2001. 5 Q. So 2001 you took over study, you couldn't 6 recruit any subjects so you were not paid any 7 money, is that correct? 8 A. That's correct. 9 Q. It's difficult to recruit subjects for a lot of 10 research projects; isn't that right? 11 A. Yes. 12 Q. In fact, it's very difficult, isn't it? 13 MR. ALSOP: Object as vague and 14 repetitive, but go ahead. 15 A. In some cases it could be. 16 Q. (BY DR. BARDEN) Let's move along now to the 17 next time you worked for Astrazeneca. What 18 year was that and how much were you paid? 19 A. To the best of my recollection, I may have gone 20 to one speaker's training or consultant meeting 21 for Astrazeneca sometime in the time 2001 to 22 2002 or three. I don't recall ever being asked 23 to give a talk on behalf of Astrazeneca, and I 24 only recall going to one meeting. I also may 25 have met somewhere in 2004 or five with some VERBATIM COURT REPORTING 763-493-4535 26 1 representatives from Astrazeneca to do a -- 2 what we call the preceptorship, be a training 3 pharmaceutical representatives and 4 understanding the nature of the treatment of 5 psychotic disorders and how to go about that. 6 I would have been paid probably $1,000 to 7 attend a consultant meeting and probably $500 8 or $750 to do a training, you know, in-house at 9 my office. That's the extent of my consulting 10 relationship with Astrazeneca. 11 Q. So prior to your research study that we're 12 going to discuss today in which Dan was 13 enrolled, how much money total had you received 14 from Astrazeneca? 15 A. $1,000 to the best of my knowledge. 16 Q. And did they send you 1099's for that or how 17 was that reported to the IRS? 18 A. Well, they would have sent me 1099's but in 19 some cases the -- I checked my tax records and 20 have no 1099's from Astrazeneca. Sometimes 21 these consulting meetings or I'm giving a 22 lecture is through an intermediary, and I can't 23 identify on the basis of the 1099s, you know, 24 who the actual pharmaceutical company that 25 sponsors the whatever activity it was so -- VERBATIM COURT REPORTING 763-493-4535 27 1 Q. When did you check your tax records and go back 2 and look to see how much you've been paid by 3 Astrazeneca? 4 A. Oh, probably a couple months ago. Whenever 5 there was a -- there were some -- 6 MR. ALSOP: Just asked when it was. 7 Couple months ago? 8 A. A month or two ago. 9 Q. (BY DR. BARDEN) Why did you do that a couple 10 months ago? 11 MR. ALSOP: That's privileged, 12 discussions with me. Don't answer the 13 question. If there is another reason beyond 14 that, you can answer the question. 15 Q. (BY DR. BARDEN) Yeah, as we've discussed I'm 16 never going to ask you about anything you've 17 discussed with your lawyers. Okay. So let's 18 talk specifically about this study. Okay. You 19 were paid some funding from Astrazeneca to do 20 this study, right? 21 A. (Nods head in the affirmative). 22 Q. The CAFE study is what it's called? 23 A. That's correct. 24 Q. So the CAFE study was a personally profitable 25 study for you, right? VERBATIM COURT REPORTING 763-493-4535 28 1 A. No. 2 Q. You didn't -- you weren't paid any money for 3 doing the CAFE study? 4 A. The University-sponsored projects 5 administration had a contract with Astrazeneca 6 to be paid a certain amount of money per 7 subject per visit as is typical with all 8 clinical trials. And that money went to the 9 University and how that money -- how that money 10 was allocated, you know, to the department, I 11 don't know all of the details, but I didn't 12 personally receive any money beyond my regular 13 salary. 14 Q. Okay. So the money, you didn't get a check 15 directly from Astrazeneca? 16 A. No, absolutely not. 17 Q. The money went to the University of Minnesota 18 from Astrazeneca for your work on the CAFE 19 study, correct? 20 A. Yes. 21 Q. And that money went into what kind of a fund? 22 Some medical schools have a pot of money that 23 is divided among the faculty. Some it goes 24 into some kind of travel fund, I mean, there is 25 all kinds of ways that it's done. How is it VERBATIM COURT REPORTING 763-493-4535 29 1 done at the University? 2 MR. ALSOP: Object on the basis of 3 foundation. If you know, go ahead. 4 A. Well, I don't know all of the details. It's 5 not my responsibility to divide up the money as 6 it comes. Some of it is indirect cost that 7 goes to the University-sponsored project 8 administration for overhead. Some of it is -- 9 some of the monies that come back are paid -- 10 are into a budget that I have some control over 11 that would allocate money for payment of 12 salaries of the staff as well as a percentage 13 that would go for -- to the department to help 14 cover my salary. We paid subjects. We paid 15 for their transportation. We paid rent for the 16 space that we used, so -- 17 Q. So some of your salary from the University of 18 Minnesota would be paid for with these funds, 19 correct? 20 A. Yes. 21 Q. You just don't know the percentage of your 22 salary that was paid for with these funds? 23 A. Not off the top of my head. That information 24 undoubtedly could be tracked back through the 25 budget of that particular account. VERBATIM COURT REPORTING 763-493-4535 30 1 Q. So part of your salary during these years was 2 paid by Astrazeneca, correct? 3 MS. SVITAK: Objection. 4 MR. ALSOP: I'll join. Misstatement of 5 his testimony. 6 Q. (BY DR. BARDEN) Part of the funding for your 7 salary came from Astrazeneca, correct? 8 A. Yes. 9 Q. And you're saying you don't know how much of 10 that? 11 A. I don't know exactly how much. 12 Q. Can you give me a ballpark figure? 13 A. I would say that no more than 10 percent of my 14 salary over that entire period of time would 15 have come from Astrazeneca. 16 Q. To the best of your knowledge, was Dr. Schulz 17 receiving any money from Astrazeneca? 18 MR. ALSOP: Object on the basis of 19 foundation. Go ahead. You can answer. 20 A. Dr. Schulz has -- also has research -- 21 Dr. Schulz also has research projects and may 22 have other arrangements with Astrazeneca that I 23 don't have any direct knowledge of. 24 Q. Have you never talked to Dr. Schulz about what 25 kind of work he does with and for Astrazeneca? VERBATIM COURT REPORTING 763-493-4535 31 1 A. I'm aware that he's a consultant to Astrazeneca 2 but I don't know anything about the specific 3 responsibilities that he has or his financial 4 arrangements with the company, no. 5 Q. As a consultant for Astrazeneca, is it your 6 understanding that he is paid money by 7 Astrazeneca? 8 MR. ALSOP: Object as speculative, 9 lacking foundation. 10 MS. SVITAK: And foundation. 11 MR. ALSOP: If you know, go ahead. 12 A. Yes, I would assume that he's paid money. 13 Q. Have you never discussed this with him? 14 A. No. 15 Q. You mentioned that some of the money went into 16 a pot that you had control over to pay 17 salaries, is that correct? 18 A. That went into a research account administered 19 by the University. 20 Q. Who paid the salary for Jean Kenney? Did she 21 work with you on this study? 22 A. Her salary was partly paid from the CAFE 23 account, yes. 24 Q. So you were in charge of some -- of paying some 25 of her salary, correct? VERBATIM COURT REPORTING 763-493-4535 32 1 A. Yes, she was also an employee of University of 2 Minnesota Physicians, that she was a licensed 3 clinical social worker and provided clinical 4 care in the outpatient clinic for which she 5 billed services directly to patients or their 6 insurance companies. 7 Q. Other than what you've disclosed on the record 8 so far, are there any other financial 9 relationships and ties and incentives between 10 Astrazeneca and you, Dr. Schulz and Jean 11 Kenney? 12 A. In regards to the CAFE study? 13 Q. In -- with regard to anything. 14 A. Well, I have others -- I have other studies. I 15 have a currently operating study called Clear 16 study, which is also sponsored by Astrazeneca 17 for which the same kind of arrangements are 18 made. Compensated for patient visits and 19 budget goes to the University and to an account 20 out of which we pay for the expenses of the 21 research. 22 Q. So this is another study where another 23 percentage of your salary would be paid by 24 Astrazeneca? 25 A. Yes. VERBATIM COURT REPORTING 763-493-4535 33 1 Q. How many other studies do you have with 2 Astrazeneca? 3 A. None currently. 4 Q. Is Jean Kenney working with you on the second 5 study? 6 A. No. Jean Kenney is no longer with the 7 University. She did work to a limited degree 8 on the Clear study when she was working with 9 me. 10 Q. When did she leave the University? 11 A. Some -- early 2005, May, April, May, couple 12 years ago. 13 Q. Do you know why she left or anything about why 14 she left? 15 A. To take a position with a private company. 16 Q. Do you know where that is? 17 A. CIGNA, I believe. 18 Q. Now, you mentioned that Astrazeneca would pay 19 you or the fund or whoever they were paying -- 20 A. The University account. 21 Q. The University account, yeah, let's call it 22 that, that they would pay per subject. Can you 23 explain how much they would pay per subject? 24 A. Well, this is standard kind of compensation for 25 clinical trials. Whether these are industry VERBATIM COURT REPORTING 763-493-4535 34 1 sponsored or NIMH funded studies that I've been 2 a part of, there is a budget at the beginning 3 of the study that spells out what's required at 4 each visit and what the payment to the 5 University will be for each visit, you know, I 6 can't tell you in detail what the payments were 7 per visit or the total, but usually these 8 studies would end up paying for -- a person 9 that completed the entire study, I think that 10 the CAFE study total payments were somewhere in 11 the range of $15,000. 12 Q. $15,000 per subject, right. Now, you were the 13 PI on this study, correct? 14 A. I was the local PI. 15 Q. Yeah. You were the local PI on the study, 16 correct? 17 A. Yes. 18 Q. As the PI you're responsible to know these 19 kinds of facts and figures, aren't you? 20 A. Yes. 21 MR. ALSOP: Object as argumentative but go 22 ahead, you can answer. 23 Q. (BY DR. BARDEN) You are responsible? 24 A. Yes. 25 Q. And you and I may be the only people in the VERBATIM COURT REPORTING 763-493-4535 35 1 room who have actually been a PI in a major 2 research study, so maybe you could explain for 3 the room what a PI does. 4 A. The principal investigator is the person who is 5 responsible for the conduct of the study, for 6 working with the sponsor and getting approval 7 from the IRB and informing the IRB of the 8 nature of the protocol, obtaining consent and 9 actually running the study. 10 Q. So you're legally and professionally 11 responsible for pretty much everything in that 12 study when you're the PI, is that right? 13 MR. ALSOP: Object as vague. Go ahead. 14 You can answer. 15 A. In general, yes. 16 Q. Especially for informing the IRB and the 17 patients or the subjects of risks and benefits, 18 isn't that right? 19 A. Yes. 20 Q. Did Dan complete the CAFE study and were you 21 paid the $15,000 for his -- 22 A. No. 23 Q. -- participation? Pardon? 24 A. No. 25 MR. ALSOP: Wait. First of all, it's a VERBATIM COURT REPORTING 763-493-4535 36 1 multiple question. 2 A. No and no. 3 MR. ALSOP: Okay. 4 Q. (BY DR. BARDEN) Do you have -- where are the 5 financial records kept of the study and what 6 Astrazeneca paid and for which subjects and 7 where are those records kept? 8 A. Some were at the University. I would think 9 many of them are on computer. 10 Q. But you've actually seen these documents, 11 correct? 12 A. Well, I've seen some of them. 13 Q. So when you're telling me you were paid $15,000 14 per subject, you've seen a document that 15 denotes that, as the PI you would have to have 16 seen that? 17 A. Yes, I've seen -- right, I've seen a grid of 18 the visits and what's to be expected and what's 19 paid per visit. I just don't recall the 20 precise numbers. 21 Q. Right. You signed a contract with Astrazeneca, 22 right? 23 A. Yes. 24 Q. And where are those contracts kept? 25 A. That would be with the University accounting VERBATIM COURT REPORTING 763-493-4535 37 1 division. I don't know whether they're 2 technically under the administration of the 3 department of psychiatry or sponsored project 4 administration. 5 Q. Was that a personal contract directly with you 6 at Astrazeneca or was it you and the University 7 and several others? 8 A. It's between Astrazeneca and Quintiles, the 9 research -- the company that would be the 10 intermediary, actually conducted and monitored 11 the research and the University. And as the 12 PI, I would sign off on that, but the 13 University-sponsored projects administration 14 would also be responsible for making those 15 negotiations. 16 Q. So to the best of your knowledge, how many 17 contracts are we talking about? First of all, 18 we have the one -- 19 A. One. 20 Q. Pardon? Just one contract, that was between 21 Astrazeneca and Quintiles and you? 22 MR. ALSOP: No. Not him, the University. 23 It's a misstatement of his testimony. Go 24 ahead. 25 A. Basically between Astrazeneca and the VERBATIM COURT REPORTING 763-493-4535 38 1 University. 2 Q. And you signed the contract as a faculty member 3 of the University or you signed? 4 A. Yeah, I signed it, right, as the. 5 Q. As the PI? 6 A. As the PI whether -- well, it wouldn't have 7 been -- wouldn't have been binding of the 8 University, were not also signed by someone 9 from the University. 10 Q. Now, you mentioned you were paid $15,000 per 11 subject. What was the schedule for that? Was 12 that front-loaded? 13 A. No. In fact, it was probably more, you know, 14 back-loaded to try to, you know, try to keep 15 people in the study. Generally it's really 16 not -- the study -- the visits are -- vary in 17 length from what, you know, visits might be 18 conducted in less than an hour to, for example, 19 initial screening or intermediate visits, 20 visits that required the cognitive assessment 21 would be several hours, you know, up to maybe 22 even nearly a full day of contact with multiple 23 research staff. So the payments would vary. 24 Q. So you're saying that the purpose of the study 25 was to try to see how long people stay on these VERBATIM COURT REPORTING 763-493-4535 39 1 medications, correct? 2 A. The primary outcome of the study -- 3 MS. SVITAK: Objection. 4 A. -- was the time to all cause discontinuation. 5 Q. So you're saying that the payments went up over 6 time? 7 A. No. The payments were based on the amount of 8 time involved with each visit. 9 Q. So you were paid by the hour for each visit? 10 A. No. We were paid by the procedure. 11 Q. I thought you said though that -- I asked if it 12 was front-loaded and you mentioned that it 13 might have been the opposite of front-loaded, 14 was that not correct? 15 A. Yeah. I said that. I don't know whether 16 that's the case or not. 17 Q. Okay. So there wasn't a large payment for 18 obtaining consent, for example, which some 19 studies have? 20 A. No. I believe the University would not allow 21 us to negotiate something like that. The 22 screening and baseline visits were longer, so 23 the payments were higher for those visits but 24 not disproportionately so. 25 Q. So at $15,000 per subject, when did you first VERBATIM COURT REPORTING 763-493-4535 40 1 start recruiting subjects for this study? 2 A. In 2002. 3 Q. And how many subjects did you recruit in 2002? 4 A. I can't -- I can't tell you exactly. 5 Q. Wasn't it one? 6 MR. ALSOP: Object as speculative, 7 lacking foundation. 8 A. I don't know exactly. 9 Q. As the PI of the study, are you testifying that 10 you cannot tell me at $15,000 per subject how 11 many subjects you recruited in the year 2002? 12 MR. ALSOP: That's argumentative, and 13 it's also repetitious. If you can recall, 14 that's fine. You can answer. 15 A. Well, no, I don't recall off the top of my 16 head. I can easily -- 17 MR. ALSOP: Okay. Doctor, you've answered 18 the question. If you recall you tell him. If 19 you don't, tell him. 20 A. I don't. 21 Q. (BY DR. BARDEN) Do you have any idea at all, 22 was it less than a hundred people? 23 A. Yes. 24 Q. Was it less than ten people? 25 A. Yes. VERBATIM COURT REPORTING 763-493-4535 41 1 Q. Was it less than five people? 2 A. I don't know. We began recruiting in 2002. We 3 recruited our first subject more than half-way 4 through the year so we recruited 13. Dan was 5 the 13th subject recruited in our involvement. 6 Q. But he was towards the end of 2003? 7 A. That's correct. 8 Q. We're just talking about 2002. 9 A. So -- 10 Q. So somewhere less than five? 11 A. That would be my guess, yes. If you say one, I 12 could, you know, I could check that out. 13 Q. How many did you recruit in the first six 14 months of 2003? 15 A. That I can't recall either. 16 Q. Do you have any idea at all out of the 13? 17 A. Out of the 13, how many were recruited in the 18 first half of 2003, no. 19 Q. No idea at all? 20 MR. ALSOP: It's repetitious. Asked and 21 answered. I don't want you to guess. 22 Q. How many other studies were you the PI of at 23 this time? 24 A. Well, one other study was the CATIE study which 25 was going on at the same time and -- probably VERBATIM COURT REPORTING 763-493-4535 42 1 not. There were several other studies that 2 started in late 2003 but not during the time 3 that -- not during the time that we were 4 recruiting for CAFE. 5 Q. What was the total number of subjects you had 6 in the CAFE study up through -- you stopped 7 recruiting in March of 2004, correct? 8 A. Yes. The study stopped recruiting in March 9 2004, 17. 10 Q. You had 17. Of those 17, how many came from 11 Unit 12? 12 A. Probably, I would estimate, five or six. 13 Q. When did you start recruiting from Unit 12? 14 A. Well, we were recruiting from -- we were 15 recruiting from the inpatient services from the 16 beginning. Unit 12 opened in April of 2003, 17 April or May, 2003, and I was an attending 18 psychiatrist there from that point on. So we 19 were recruiting from Station 12 as well as 20 other inpatient units and outpatient clinics, 21 student health center, our own clinic. We were 22 looking for appropriate patients in whatever 23 appropriate settings we had any contact with. 24 Q. Other than Dan, how many of your subjects had 25 been evaluated and found to lack the capacity VERBATIM COURT REPORTING 763-493-4535 43 1 to consent within a week of consenting to your 2 study? 3 MR. ALSOP: Object, calls for legal 4 conclusion. It's vague and argumentative. Go 5 ahead. You can answer. 6 A. Could you ask the question again? 7 Q. (BY DR. BARDEN) You were the court evaluator 8 for Dan, correct? 9 A. No. 10 Q. Did you not sign a form saying court evaluator 11 prior to the commitment hearing? 12 A. I filed a physicians statement, but I was not 13 the independent evaluator for the commitment 14 process. 15 Q. On, no, that was Dr. Jacobson, but you did file 16 a report telling the court that Dan lacked 17 capacity to consent, correct, that was on 18 December 14th, 2003, is that right? 19 A. No. 20 MR. ALSOP: Object as vague. Misstates 21 the evidence. Show it to him, that's fine. 22 Q. Did you ever -- 23 A. Re-ask the question. 24 Q. Did you ever write a medical opinion that Dan 25 lacked the capacity to consent? VERBATIM COURT REPORTING 763-493-4535 44 1 MR. ALSOP: Objection. 2 A. To consent to what? 3 Q. That he was incompetent. 4 A. I would have to look at that statement and see 5 what I -- what I exactly -- 6 Q. We're going to go through the records in 7 detail. I'm just asking your memory from your 8 memory at this point. 9 MR. ALSOP: Doctor, don't speculate and 10 guess. If you need to see the record, I don't 11 want you to guess. If you can answer it, 12 that's fine. 13 A. I filed a physicians examiners statement 14 within, I believe, two days -- two business 15 days of his admission, which would have been in 16 November of 2003, in which I stated the reasons 17 why we were pursuing a commitment and my 18 opinion at that time that he lacked capacity to 19 consent to antipsychotic medication. 20 Q. And that was November 14th; isn't that correct? 21 A. I don't know the exact date. 22 Q. Within a week on the 21st, you had him sign a 23 consent to enter your study; isn't that 24 correct? 25 A. That's correct. VERBATIM COURT REPORTING 763-493-4535 45 1 Q. How many subjects other than Dan had been 2 evaluated to lack the capacity to consent 3 within a week of signing into your study? 4 A. I don't know. 5 Q. Have you ever had a subject in any of your 6 studies other than Dan who were found -- 7 medically found to be incompetent to consent 8 within a week of signing a consent for your 9 study? 10 A. Well, I wouldn't characterize my opinion at the 11 time of the physicians statement as having him 12 having been found medically. That would imply 13 some legal decision. That was my opinion at 14 that particular time, that he lacked capacity 15 to consent but -- and I don't know if there 16 were any other subjects who may have fallen in 17 that circumstance, but I've treated many 18 patients for whom I made a statement similar to 19 that at the time of their admission to the 20 hospital and they were psychotic and refusing 21 treatment, who by the time several days or a 22 week had passed were either voluntarily signed 23 into the hospital, had a stay of commitment, 24 were consenting to treatment and proceeding in 25 that regards because a patient's ability to VERBATIM COURT REPORTING 763-493-4535 46 1 recognize their situation and make appropriate 2 decisions can change. 3 Q. Objection, move to strike as non-responsive. 4 Do you recall the question that I asked you? 5 A. Yes. You asked me if there were any persons 6 other than Dan who had been given -- who 7 were -- filed a statement saying that they were 8 lacked capacity who then consented to a 9 research study within a week. 10 Q. To your research study within a week. Other 11 than Dan, anyone? Not looking for a name. I'm 12 looking for a number. 13 A. I don't recall. 14 Q. Didn't Dr. Jacobson also find Dan to lack the 15 capacity to consent? 16 MR. ALSOP: Object, lacking in 17 foundation. 18 Q. Didn't the pre-screening team also find Dan to 19 lack the capacity to consent? Weren't they all 20 recommending that he be committed? 21 MR. ALSOP: Same objection. Now it's 22 multiple and vague. 23 Q. Didn't that all happen within a week of your 24 signing him into your study? 25 A. Repeat the question. VERBATIM COURT REPORTING 763-493-4535 47 1 Q. Didn't Dr. Jacobson, the court-appointed 2 evaluator, also find that Dan lacked the 3 capacity to consent to make medical decisions 4 for himself? 5 A. I don't recall what he specifically said in his 6 report. He supported the commitment. 7 Q. Didn't the team also -- screening team also 8 find Dan -- 9 A. From Dakota County, they also supported the 10 commitment. 11 Q. Wasn't all of that within a week, within a few 12 days, a few hours of your signing him into your 13 research study, isn't that right? 14 MR. ALSOP: Now, it's a multiple 15 question. Vague and ambiguous. Go ahead. 16 A. It was within a week. 17 Q. (BY DR. BARDEN) Now, the question again is, 18 have you ever heard of such a thing in a human 19 research study that someone is signed in to the 20 research study when they were found to lack 21 consent by three different professionals within 22 a matter of days? 23 MR. GROSS: Objection, argumentative. 24 MR. ALSOP: I'll join, it's argumentative 25 and it's also repititious. Go ahead. VERBATIM COURT REPORTING 763-493-4535 48 1 Q. (BY DR. BARDEN) Are you aware of subjects 2 being signed into studies at the University of 3 Minnesota under those circumstances other than 4 Dan? 5 A. Well, I wouldn't have any way of knowing what 6 patients are signed into other research 7 studies. I don't recall whether I had other 8 patients signed into research studies within a 9 week, but I don't find it inconsistent because 10 my opinion, he was able to. 11 MR. ALSOP: Well, Doctor, the only 12 question, Doctor, is, do you recall any other 13 patients similiar to this or not. If you do, 14 tell him. If you don't -- 15 A. I don't recall. 16 Q. Objection to move to strike all of the parts of 17 that answer that were non-responsive. 18 THE VIDEO OPERATOR: I need to take a 30 19 second break to change the tape. 20 DR. BARDEN: Okay. 21 (A brief recess was taken). 22 Q. (BY DR. BARDEN) We're back on the record. I 23 would like to go back to the incentives you 24 received from Astrazeneca to do the study. You 25 talked about there was funding of $15,000 per VERBATIM COURT REPORTING 763-493-4535 49 1 subject, right? 2 A. Yes. 3 Q. And some of this went directly to you 4 personally as part of your salary but you're 5 not sure how much, correct? 6 MR. ALSOP: That's a misstatement of his 7 testimony and it's also repetitious, but go 8 ahead. 9 A. It didn't go to me personally. It went to the 10 University and covered the cost of my salary as 11 well as other people conducting the study. 12 Q. Let me say it more precisely. Some of this 13 money went through the University and ended up 14 in your pocket, correct? 15 MS. SVITAK: Objection. 16 MR. ALSOP: It's repetitious but one more 17 time. Go ahead, Doctor, if you know, you can 18 answer. 19 A. Well, I guess I would say yes. 20 Q. And some of this money went through the 21 University and into the pockets of your 22 colleagues, like Jean Kenney, correct? 23 A. Yes. 24 Q. Now, being a PI on a study is professionally 25 advantageous in your business, isn't it? VERBATIM COURT REPORTING 763-493-4535 50 1 MR. ALSOP: Object as vague and 2 ambiguous. Go ahead, Doctor. You can answer. 3 A. Being involved in research is a part of my role 4 as a medical school faculty. Whether 5 involvement of any particular study is 6 advantageous or not depends on how the study 7 goes and what comes out of it, but it was part 8 of my -- it was part of my job. 9 Q. So clearly there are both professional and 10 financial incentives for you to do the study, 11 correct? 12 MR. ALSOP: It's argumentative and a 13 misstatement of his testimony, but go ahead, 14 Doctor. 15 A. Yes. 16 Q. There were personal and professional and 17 financial reasons why you wanted this study to 18 come out well, isn't that right? 19 MR. GROSS: Objection, vague as to 20 "well". 21 MR. ALSOP: I'll join. 22 MS. SVITAK: Join. 23 A. No. I had no vested interest in the outcome of 24 the study, but my job was to conduct it in a 25 scientific and ethical manner, and how the VERBATIM COURT REPORTING 763-493-4535 51 1 results come out is what it is. 2 Q. As a faculty member of the medical school, what 3 happens to you if you don't publish? 4 A. Well, depends on one's status, one's position 5 at the University. In a tenure track position 6 one would be expected to publish papers. I'm a 7 clinical scholar track, where my primary 8 function is to provide clinical care and 9 teaching and research is a less important than 10 for a tenure track faculty. 11 Q. But it is important, isn't it? 12 MR. ALSOP: It's a misstatement of his 13 testimony and argumentative but go ahead. 14 A. There are clinical scholars that don't do any 15 research. I'm one that does research. 16 Q. And clinical scholars who you do research have 17 more prestige than those that don't? 18 A. Not necessarily. 19 Q. At the University they are especially valued 20 because they bring in overhead money; isn't 21 that correct? 22 MR. ALSOP: Argumentative, lacking 23 foundation. Go ahead. 24 A. People can bring in money in different ways, 25 and some people generate clinical revenue and VERBATIM COURT REPORTING 763-493-4535 52 1 some people get research money and some people 2 get grants. 3 Q. Objection, move to strike as non-responsive. 4 Your study brought overhead money to the 5 University of Minnesota, correct? 6 A. Yes. 7 Q. As the PI, you're required to know that 8 percentage. What is the percentage of the 9 overhead? 10 A. At the time I believe it was 25 percent. 11 Q. What was the total funding that Astrazeneca 12 paid to do this study? 13 A. That, I don't know precisely. The study was 14 conducted over a several year period of time 15 but was probably over $150,000. 16 Q. So how much money would the University of 17 Minnesota receive in overhead? As the PI, can 18 you tell us that? 19 A. Oh, maybe -- if it was -- if that was the -- if 20 that was the total payments, it would be 21 roughly $30,000. 22 Q. And if the study doesn't come out right, what 23 happens to it, Doctor? 24 MR. ALSOP: Object as vague and 25 ambiguous. VERBATIM COURT REPORTING 763-493-4535 53 1 MS. SVITAK: Join in the objection. 2 Q. (BY DR. BARDEN) If the study doesn't come as 3 you're expecting or according to the hypothesis 4 of the study, what's the common outcome of 5 those kinds of study? 6 MR. ALSOP: Same objection, vague and 7 ambiguous. Also multiple. Go ahead. 8 MS. SVITAK: Vague and ambiguous. 9 A. Well, a number of things can happen. In this 10 study, the results are impress, so that's the 11 outcome of the CAFE study to my knowledge. 12 Q. And the results were what? 13 A. That there were no differences between all 14 three of the drugs that were studied. 15 Q. And that's exactly what Astrazeneca wanted you 16 to find, correct? 17 MR. ALSOP: Objection, lacking 18 foundation, argumentative. 19 MS. SVITAK: Objection. Same objections. 20 Q. (BY DR. BARDEN) Let me ask it a different way. 21 Astrazeneca had an enormous financial incentive 22 for you to find exactly what you found; isn't 23 that correct? 24 MS. SVITAK: Objection. Foundation. 25 MR. ALSOP: I'll join in foundation. Go VERBATIM COURT REPORTING 763-493-4535 54 1 ahead if you can answer it. 2 A. Well, no, I would have thought that Astrazeneca 3 would have had an incentive to find that 4 Seroquel was better than its competitors. That 5 was not found and -- 6 Q. But if it had found that it was worse, it could 7 have been quite damaging to the company, 8 correct? 9 MS. SVITAK: Objection as to the 10 foundation. 11 MR. ALSOP: I'll join. 12 A. If the results had to come out differently, it 13 may have been to the sponsor's advantage or it 14 may have been to their disadvantage, depending 15 on how the study was interpreted and how it was 16 seen in the medical community. 17 Q. As the PI in a Serequel study, how much money 18 does Astrazeneca make off Serequel in a given 19 year? 20 MS. SVITAK: Objection as to foundation. 21 MR. ALSOP: I'll join. There is no 22 foundation. If you know, Doctor. 23 Q. Do you have any ballpark idea on that? 24 A. I don't know how much money, how much profit 25 they make. I would think that the sales of VERBATIM COURT REPORTING 763-493-4535 55 1 Seroquel in the United States are certainly 2 over a billion dollars but not more than 3 or 4 3 billion. 4 Q. How about worldwide? 5 A. I have no idea. 6 MS. SVITAK: Same objection. 7 Q. (BY DR. BARDEN) As a PI, you had to sign a 8 Form 1572, correct? 9 A. Yes. 10 Q. Could you explain for the record what a Form 11 1572 is. 12 A. It's a document that is part of every research 13 protocol that lists the personnel that will be 14 involved in the study. And whenever there is a 15 change in those staff or co-investigators, the 16 1572 changes. The information is provided both 17 to the IRB and to the sponsor. 18 Q. What else does Form 1572 do? 19 A. Not sure. 20 Q. Did you sign a 1572 for this study? 21 A. Yes. 22 Q. How many 1572s did you sign? 23 A. I don't know. 24 Q. Would it have been more than one? 25 A. Yes. VERBATIM COURT REPORTING 763-493-4535 56 1 Q. As the PI on this study, do you have any idea 2 at all how many 1572 forms you signed? 3 MR. ALSOP: Object as repetitious. Asked 4 and answered, speculative now, but one more 5 time, you can answer if you know. 6 A. No, I don't know, but if I needed to know I 7 could go to the file and count them. 8 Q. Was it more than ten? 9 A. I don't know. 10 Q. Fewer than five? 11 MR. ALSOP: One more time. He doesn't 12 know. He's told you three times. 13 A. I don't know. 14 MR. ALSOP: And we're done with this 15 question. 16 Q. (BY DR. BARDEN) As the PI of the study, do you 17 think you had an obligation to have some idea 18 of how many 1572s you were signing? 19 MR. ALSOP: Now or back then? 20 A. No. 21 MR. ALSOP: It's vague. Go ahead. You 22 can answer. 23 Q. Pardon? 24 A. No. I have obligation that the 1572 that is 25 current is accurate, and when circumstances VERBATIM COURT REPORTING 763-493-4535 57 1 change with staff, then I would change the 2 1572, but how many times that happened over the 3 course of three years, no, I don't think I 4 need -- it's not a necessary number that I have 5 to keep in my head. 6 Q. Okay. Let me just back up for a minute. When 7 I asked you that question your lawyer made an 8 objection that was vague. That's a good 9 objection. He also said now or then. That's 10 coaching the witness and it's not appropriate, 11 so -- 12 MR. ALSOP: It's vague. 13 Q. So once again, you want to stop and let, you 14 may say vague, but you may not say now and 15 then. That's coaching the witness. And you 16 need to stop and let your lawyer make the 17 objection on the record so that we have a nice, 18 clear record. Does that make sense? 19 A. Yes. 20 Q. What was the latest date that you signed a 1572 21 to the best of your knowledge? 22 A. I don't know. 23 Q. Isn't it in fact the case that there is no 24 signed 1572 in any of the files for this 25 research study until after Dan died? VERBATIM COURT REPORTING 763-493-4535 58 1 MR. ALSOP: Object as lacking in 2 foundation and speculative. Go ahead. You can 3 answer. 4 A. I don't know. 5 Q. As a PI, what kind of serious ethical and legal 6 problems would there be for you and the 7 University of Minnesota if it was in fact the 8 case that there were no signed 1572s in the 9 file until after Dan died? 10 MR. ALSOP: Same objection, lacking in 11 foundation and speculative. Go ahead. 12 A. I don't know what the implications would be, 13 but I don't believe that that's true. 14 Q. You believe that you signed a 1572 and you've 15 seen that in the file of this research study? 16 A. I believe that I would have signed a 1572 17 because had I not, I most likely would not have 18 been allowed to start the study. 19 Q. If there was not a signed 1572 in the file, 20 what would be the explanation for that to the 21 best of your knowledge? 22 MR. ALSOP: Object. 23 A. I have no -- I have no explanation. 24 Q. (BY DR. BARDEN) You mentioned that you've had 25 training in medical ethics, is that right? VERBATIM COURT REPORTING 763-493-4535 59 1 A. Yes. 2 Q. Please explain for the record the concept of 3 therapeutic misconception. 4 A. I'm not familiar with that term. 5 Q. Have you read any articles on obtaining 6 informed consent? 7 A. Yes. 8 Q. And you're not familiar with the term 9 therapeutic misconception? 10 MR. ALSOP: It's repetitious. Asked and 11 answered now. 12 A. No. 13 Q. (BY DR. BARDEN) Have you had any training in 14 how to obtain informed consent from 15 schizophrenics? 16 A. Yes. 17 Q. And you've not heard of the phrase, the term 18 therapeutic misconception? 19 A. No. 20 Q. As a licensed health care provider in the State 21 of Minnesota who conducts research studies, 22 what is your understanding of the difference 23 between clinical treatment and a research study 24 as it pertains to the care of a patient? 25 A. What's the difference between clinical VERBATIM COURT REPORTING 763-493-4535 60 1 treatment and a research study? 2 Q. Yes. 3 A. In a research study, the treatment options are 4 constrained by the protocol. 5 Q. What does that mean for the care of the 6 patient? 7 A. That, for instance, in -- for someone in the 8 CAFE study, that their medication will be 9 randomly assigned to one of three drugs for the 10 duration of the time they were in the study. 11 And while in clinical care, the clinician is 12 free to make changes, you know, as is deemed 13 clinically indicated. 14 Q. What were limitations for Dan's care with him 15 being in your study versus being in a clinical 16 treatment relationship with a psychiatrist that 17 was not doing a research study? 18 MR. ALSOP: Objection as vague and 19 ambiguous and it's a multiple question but go 20 ahead. You can answer. 21 A. The only one would be that the medication would 22 be assigned by random choice rather than by 23 clinician decision. 24 Q. Was Dan permitted to take multiple 25 antipsychotics at once during your study? VERBATIM COURT REPORTING 763-493-4535 61 1 A. No. He was -- he would not have been permitted 2 to take any other antipsychotics other than the 3 study drug. 4 Q. But he would have been able to do that had he 5 been in normal clinical care, correct? 6 A. Yes. 7 Q. Did you forget that one, that difference? 8 MR. ALSOP: That's argumentative. You 9 don't have to answer that question. 10 Q. (BY DR. BARDEN) Are there other differences 11 that you might be forgetting between research 12 study and clinical care as it pertains to Dan's 13 treatment in this case? 14 MR. ALSOP: It's vague and multiple 15 question, ambiguous. Go ahead. 16 A. Well, there are certainly other differences. 17 The visits are planned to be on a schedule 18 rather than on the, you know, the clinician's 19 availability. There are lab tests that are 20 part of the protocol to be done at periodic 21 times. 22 Q. Anything else? 23 A. Well, the protocol requires other -- requires 24 assessments of depression and psychosis and 25 cognition that wouldn't be part of routine VERBATIM COURT REPORTING 763-493-4535 62 1 clinical practice. 2 Q. Would Dan have been able to receive treatment 3 for bipolar illness while he was in your study? 4 A. In my opinion, Dan didn't have bipolar illness. 5 Q. Objection, move to strike as non-responsive. 6 Would Dan have been able to receive treatment 7 for bipolar illness while he was in your study? 8 MR. ALSOP: Wait a minute. Now it 9 assumes facts not in evidence and it's 10 argumentative and vague, but go ahead and 11 answer. 12 A. Dan could have been treated with a mood 13 stabilizer drug while he was in the CAFE study. 14 Q. But he was not, was he? 15 A. He was not. 16 Q. Are you aware of any assessment devices for 17 informed consent with psychotics? 18 A. Yes. 19 Q. Did you use any of them with Dan? 20 A. Yes. 21 Q. Which one? 22 A. I don't know the name of it offhand, but there 23 is an examination that we perform which is not 24 required by the protocol at the end of the 25 initial consent meeting which he -- during VERBATIM COURT REPORTING 763-493-4535 63 1 which time he answered the questions about -- 2 Q. What did I ask you? Do you remember what I 3 asked you? 4 MR. ALSOP: He's answering your question. 5 Q. No, he's not. 6 A. Repeat the question again. 7 Q. Move to strike as nonresponsive. 8 A. Repeat the question. 9 Q. Did you use an assessment instrument for -- 10 A. Yes. 11 Q. That's a yes or no question, correct? 12 A. Yes. 13 Q. Can you give me the name, the formal name of 14 the assessment device that you used? 15 A. No. 16 Q. Can you give me a research citation that was 17 worth anything what you did? 18 MR. ALSOP: That's argumentative. 19 Q. (BY DR. BARDEN) That your procedure was worth 20 anything or has been documented to be a 21 reliable procedure? 22 A. No. No. 23 Q. Are you not aware that those assessment methods 24 and procedures were created to deal with the 25 problem of therapeutic misconception? VERBATIM COURT REPORTING 763-493-4535 64 1 MR. ALSOP: That's argumentative. He 2 doesn't know what that term means. He's told 3 you that three times and it's vague. 4 A. No. 5 MR. ALSOP: Go ahead. 6 Q. (BY DR. BARDEN) Who are the major leaders in 7 psychiatric medical ethics in the United 8 States? 9 MR. ALSOP: That's vague and ambiguous, 10 but go ahead. 11 A. I don't know. 12 Q. (BY DR. BARDEN) Do you have any idea at all? 13 MR. ALSOP: Speculative now. I don't 14 want you to guess. If you know, go ahead. 15 Q. (BY DR. BARDEN) Object. Let's stop for a 16 minute. Objection vague and speculative is all 17 right. I don't want you to guess is coaching 18 and instructing the witness. 19 MR. ALSOP: No, it's not. No, it's not. 20 MR. BARDEN: And it's not appropriate. 21 MR. ALSOP: I disagree with you. I think 22 it is. 23 Q. (BY DR. BARDEN) So can you give me the name of 24 any expert in medical ethics in the field of 25 psychiatry in the United States? VERBATIM COURT REPORTING 763-493-4535 65 1 MR. ALSOP: It's asked and answered. 2 It's repetitious. Speculative. 3 A. I can -- I can recall a few articles that I've 4 read, you know, within the past couple of 5 years. I could tell you where they were, you 6 know, where they were published, but I don't 7 recall the specific names of the authors. 8 Q. Do you recall the names of any authors, any 9 national expert in medical ethics? 10 A. No. 11 Q. Do you think that would be a good thing to know 12 when you're dealing with research on human 13 subjects that might involve the death of your 14 subjects? 15 MR. ALSOP: Object as vague and 16 ambiguous, irrelevant. Go ahead. 17 A. No, I don't think that whether I know the names 18 of the authors of specific journal articles is 19 important. 20 Q. Do you think knowing major issues like 21 therapeutic misconception would be important 22 for the protection of your patients and 23 subjects, Doctor? 24 MR. ALSOP: Same objections. 25 A. I don't know what exactly you're meaning by VERBATIM COURT REPORTING 763-493-4535 66 1 therapeutic misconception, but I believe that 2 I'm aware of the issues involved with obtaining 3 informed consent with psychiatric and psychotic 4 patients. And I believe that I followed the 5 guidelines and ethical procedures in obtaining 6 consent with this particular patient. 7 Q. Have you ever heard of the Nurenberg code? 8 A. Yes. 9 Q. Can you, for the record, can you give us your 10 understanding of the Nurenberg code? 11 A. Well, it's one of a series of historical 12 precedents on which ethical conduct of research 13 is based, and it has to do with the obtaining 14 the consent of people who are involved in 15 research. 16 Q. Anything else? 17 A. No. 18 Q. Where did the Nurenberg code come from, do you 19 know? 20 A. Well, I believe it came from the trials 21 following World War II, in which 22 experimentation on prisoners of the Germans 23 during World War II were evaluated. 24 Q. Right. It's designed to help prevent research 25 subjects from being exploited by researchers VERBATIM COURT REPORTING 763-493-4535 67 1 who have financial, professional and personal 2 incentives to exploit them, isn't that right? 3 MR. ALSOP: Object as vague and 4 ambiguous, argumentative. 5 A. That seems consistent with what I understand 6 about that, yes. 7 Q. Could you tell me what you understand about the 8 Belmont report? 9 A. I don't recall the specific -- I don't recall 10 what the Belmont report is specifically about. 11 I know it's one of -- another one of the 12 historical documents that bear on informed 13 consent and participation of people in clinical 14 trials. 15 Q. What does it say? 16 A. I don't recall. 17 Q. Where does the Belmont report come from? 18 A. I don't know. 19 Q. Do you feel that your training in medical 20 ethics has been competent and sufficient enough 21 to permit you to run a study involving human 22 beings, Doctor? 23 A. Yes. Absolutely. Absolutely. 24 Q. Can you tell me about the Helsinki agreement? 25 A. I believe that was a -- I believe that was a VERBATIM COURT REPORTING 763-493-4535 68 1 document arrived at by an international panel 2 and perhaps by the United Nations that spells 3 out many of the conditions for which patients 4 are -- the information that patients need to be 5 provided in order to give informed consent. 6 Q. Anything else? 7 A. No. 8 Q. You don't know anything else about the Helsinki 9 agreement? 10 MR. ALSOP: It's repetitious. Go ahead, 11 Doctor. 12 A. No. 13 Q. (BY DR. BARDEN) Have you heard of the 14 harmonization on good clinical practices 15 guidelines? 16 A. I certainly have heard of good clinical 17 practices guidelines and have received 18 training. What harmonization of good clinical 19 practice guidelines, I'm not sure what that 20 means or what that refers to? 21 Q. You don't know anything more about it than what 22 you've disclosed on the record so far? 23 MR. ALSOP: It's repetitious. 24 A. Not when you use the term harmonization of good 25 clinical practice, I'm not sure what that VERBATIM COURT REPORTING 763-493-4535 69 1 means. I know what good clinical practice 2 guidelines for clinical trials is. 3 Q. Have you ever, I'm sorry. Have you ever read 4 anything on the international conference on 5 harmonization of good clinical practice 6 guidelines? 7 A. Not that I recall. 8 Q. And, again, I ask you based on your last two 9 responses, do you think your training in 10 medical ethics is sufficient or competent 11 enough for you to run studies using human 12 subjects? 13 MR. GROSS: Objection. 14 MR. ALSOP: Objection. It's been asked 15 at least three times. One more time, then he's 16 not going to answer it again. 17 MS. SVITAK: Same objection. 18 MR. ALSOP: If you understand the 19 question, go ahead and answer it. 20 A. I believe I have a good understanding of the 21 principles of research ethics. Whether or not 22 I know which of those principles was first 23 identified at the Helsinki agreement or the 24 Nurenberg code or the harmonization of good 25 clinical practices, I don't think is important. VERBATIM COURT REPORTING 763-493-4535 70 1 Q. You never had a discussion with Dr. Schulz your 2 supervisor about any of these major 3 international foundational documents of human 4 subjects rights? 5 A. No. 6 Q. You never had a discussion with anyone at the 7 University of Minnesota IRB about any of these 8 international foundational documents on human 9 subjects rights? 10 A. Absolutely. We have -- 11 Q. If you don't even know what these documents 12 are, what they mean, how did you have a 13 discussion with people at the IRB about them? 14 MR. ALSOP: That's argumentative. 15 MR. GROSS: Objection. 16 A. Part of our -- part of our conduct of -- part 17 of my conduct of clinical research requires 18 training in research ethics and good clinical 19 practice. And so I have attended classes and 20 I've done training, periodic training which is 21 required by the University. Whether it's 22 through handouts or on-line training is the 23 more common method used recently. So I 24 recognize the -- the terms like Helsinki 25 agreement and Belmont. I don't know what VERBATIM COURT REPORTING 763-493-4535 71 1 the Belmont code, but I don't recall 2 specifically which aspects of recent ethics 3 apply to each of those terms. 4 Q. But your training at the University of 5 Minnesota was so defective that you didn't even 6 know the details of these basic international 7 foundational documents for human rights, isn't 8 that right? 9 MR. ALSOP: Doctor, you're not going to 10 answer that question. That's argumentative. 11 No, Doctor, do not answer that question. That 12 assumes it was defective. He's not going to 13 answer argumentative questions like that. Ask 14 the question. 15 Q. (BY DR. BARDEN) Your training at the 16 University of Minnesota did not include -- 17 MR. ALSOP: Wait. 18 Q. -- training on these basic foundational 19 documents, correct? 20 A. I don't believe that was defective. 21 MR. ALSOP: No. Answer the question. 22 Did you have training in those? 23 A. I had training, yes. 24 Q. To the extent of the knowledge that you've 25 disclosed on the record so far, correct? VERBATIM COURT REPORTING 763-493-4535 72 1 A. No, I think I have, as I said, knowledge of the 2 principles which I apply in my implementation 3 of obtaining informed consent, but my recall of 4 specific terms and historical documents is less 5 than, I guess, what you would like to see me 6 demonstrate. 7 Q. Your training with Dr. Schulz, your training 8 and supervision with Dr. Schulz, the University 9 of Minnesota and the IRB, nobody taught you the 10 term therapeutic misconception, isn't that 11 right? 12 A. I don't recall the term. It may have been part 13 of the training. I would guess that -- 14 MR. ALSOP: Well, Doctor, just answer the 15 question. The question was simply -- rephrase 16 it. Just listen to the question. 17 Q. (BY DR. BARDEN) You don't know that term, do 18 you? 19 MR. GROSS: Objection, argumentative. 20 A. You asked that before. No, I don't know the 21 term. If you would explain it to me. 22 MR. ALSOP: No. You've answered the 23 question. That's all you need. 24 Q. (BY DR. BARDEN) In your training at the 25 University of Minnesota, isn't it in fact the VERBATIM COURT REPORTING 763-493-4535 73 1 case that you are instructed that the clinical 2 physician for a patient should not be the 3 physician that gets them into their research 4 study? 5 MR. GROSS: Objection, vague. 6 Q. (BY DR. BARDEN) Weren't you instructed about 7 that? 8 A. No. But I'm well aware that there are ethical 9 issues. And as a clinician and investigator, I 10 have to keep those roles in mind in the exact 11 case that we're referring to. 12 Q. So you were Dan's clinical psychiatrist at the 13 time you signed him into your treatment study, 14 correct? 15 A. Yes. 16 MR. GROSS: Objection, asked and 17 answered. 18 Q. And the University of Minnesota training warns 19 you to not do that, isn't that right? 20 A. No. 21 Q. Did you do that with any of your other subjects 22 in the CAFE study? Were you their clinical 23 psychiatrist at the time you signed them into 24 your research study? 25 A. Yes. I'm the director of the schizophrenia VERBATIM COURT REPORTING 763-493-4535 74 1 program. I was both running inpatient team for 2 patients with acute psychosis and providing 3 care in the clinic, both by myself directly and 4 for residents because that is my area of 5 expertise. At the same time, I was asked to 6 perform the CAFE study because that's my area 7 of expertise. So the reason that people are -- 8 the reason that I was involved was because I 9 was considered to be an expert in this area and 10 so -- 11 Q. Objection, move to strike all portions of that 12 that are non-responsive. Doctor, how 13 many other -- 14 MS. SVITAK: Excuse me just a moment. I 15 would like to interpose an objection as well. 16 I'm asking that he be allowed to finish his 17 statement before you object to it and instruct 18 or object and ask that it be stricken from the 19 record. I would like to have him finish his 20 statement and not have you interrupt him. If 21 you will give him that courtesy. 22 DR. BARDEN: I think that's absolutely 23 fine, and we're going to go to the court and 24 ask for all of the time that he wastes at the 25 second day of his deposition. That's fine. VERBATIM COURT REPORTING 763-493-4535 75 1 MR. ALSOP: Next question. 2 Q. (BY DR. BARDEN) I'm looking for the number of 3 subjects in your CAFE study other than Dan who 4 you were, A, their clinical treater and, B, the 5 person who signed them in to your research 6 study. 7 A. I would guess that it would be somewhere around 8 a third of the subjects that we had. 9 Q. Now, I'm looking for the number of subjects who 10 were, A, you filed a document with the court, 11 seeking to get the patient committed or 12 threatened with commitment called a stay of 13 commitment, that, A, you did that, and, B, you 14 were their clinical treater and, C, you signed 15 them into your research study. How many 16 subjects other than Dan did you do that with? 17 MS. SVITAK: Objection, form. 18 MR. ALSOP: I'll join. It's repetitious 19 but go ahead, Doctor. 20 A. Yeah, I already answered that question. 21 Because I don't recall exactly how many 22 patients I signed the examiner's statement and 23 entered into the study, I would not have signed 24 the examiner's statement had I not been their 25 clinical treating psychiatrist. VERBATIM COURT REPORTING 763-493-4535 76 1 Q. Did anyone at the hospital or Dr. Schulz or the 2 IRB raise a concern that it appeared that you 3 were attempting to get people commited, obtain 4 legal control over them, and then coerce them 5 into joining your research study for which you 6 would be paid $15,000 per subject? 7 MR. ALSOP: That's a multiple question 8 MS. SVITAK: Objection, form. 9 MR. ALSOP: And vague and ambiguous. 10 Doctor, if you know, you can answer. 11 A. No one raised a concern and I disagree with -- 12 MR. ALSOP: You just answer the question. 13 That's the only question. 14 Q. (BY DR. BARDEN) No one raised a concern, 15 that's your answer, correct? 16 A. Yes. 17 Q. Did Dr. Schulz know that you were admitting 18 people to the study who were court ordered into 19 your care? 20 MR. ALSOP: That's a misstatement of the 21 evidence in this case and argumentative but go 22 ahead, Doctor. 23 A. Dr. Schulz saw the patient one day while he was 24 in the hospital, but I don't know at that point 25 whether he was aware. VERBATIM COURT REPORTING 763-493-4535 77 1 Q. Talking about Dan? 2 A. Was aware, yeah. 3 Q. Dr. Schulz saw Dan, but I'm asking you whether 4 Dr. Schulz was aware that Dan was court 5 ordered. 6 A. I don't know. 7 Q. To follow the recommendations of his treatment 8 team, and then you as the physician on his 9 treatment team got him into a research study. 10 Was Dr. Schulz aware of that or not? 11 MR. ALSOP: Same objections. Go ahead, 12 Doctor. 13 A. No. 14 Q. (BY DR. BARDEN) Was the IRB aware of that? 15 A. No. 16 Q. Did you not think it important to inform the 17 IRB of Dr. Schulz, that your research subject 18 was court-ordered into your care as a 19 physician? 20 MR. ALSOP: Same objections. Go ahead, 21 Doctor. 22 A. Repeat the question. 23 (Record read back.) 24 A. No. 25 Q. (BY DR. BARDEN) Was the court ever informed VERBATIM COURT REPORTING 763-493-4535 78 1 that Dan would be going into a research study? 2 MR. ALSOP: Object on the basis of 3 foundation. Go ahead, Doctor. 4 Q. (BY DR. BARDEN) Let me ask you this. Did you 5 ever inform the court that Dan was actually 6 going into a research study? 7 A. Not directly, although, the county case manager 8 who was responsible -- 9 Q. Objection, move to strike. Go ahead and finish 10 your answer and we'll ask for the time back the 11 next day. Go ahead. 12 MR. ALSOP: We're not coming back a next 13 day. 14 DR. BARDEN: Let me just make for the 15 record here. If the witness rambles on and if 16 we add up the time and at the end of the day 17 he's rambled on, obviously not answering my 18 question and he's wasted a half an hour of our 19 time, we will seek that time back, period. 20 MR. ALSOP: You can go ahead and seek it. 21 He's answered the question. 22 Q. (BY DR. BARDEN) So please, go ahead and answer 23 your -- give the answer that you think is 24 responsive to my question. 25 A. Would you ask it again? VERBATIM COURT REPORTING 763-493-4535 79 1 MR. ALSOP: Doctor, answer the question 2 the way you feel is most responsive. He's not 3 rambling, and he will answer the question as he 4 sees fit. 5 A. Will you ask the question again? 6 Q. Would you read that back. 7 (Record read back.) 8 A. I didn't inform the court directly but the 9 county case manager is required to make a 10 report to the court that the patient was 11 meeting the terms of the stay of commitment 12 that he seek appropriate care. And I had 13 discussions with Mr. Pettit numerous times that 14 the participation of the CAFE was one way that 15 he could receive appropriate care, although, 16 there were certainly other options had Dan 17 chosen not to participate in the study. 18 Q. Objection. Move to strike the entire response 19 after the first sentence. Did you follow-up 20 and make sure that the court was informed by 21 Mr. Pettit that Dan had not gone into treatment 22 but in fact had gone into a clinical research 23 study? 24 A. No. 25 Q. Other than Dan, were there any other subjects VERBATIM COURT REPORTING 763-493-4535 80 1 in your study who were court-ordered into 2 treatment, yet ended up in your research study? 3 MR. ALSOP: It's repetitious, but go 4 ahead. 5 A. I don't recall but there may have been. 6 Q. (BY DR. BARDEN) But no one, the IRB, Dr. 7 Schulz, the University, no one raised any 8 questions about that, correct? 9 MR. ALSOP: It's repetitious. Talk about 10 wasting time with multiple questions, that's 11 been asked and answered multiple times. Go 12 ahead one more time. 13 A. Repeat the question. 14 (Record read back.) 15 A. Not at the time and not after the conduct of 16 the study was investigated following Dan's 17 death. 18 Q. (BY DR. BARDEN) So let's take a look at the 19 various roles that you've played in Dan's 20 treatment. You were an examiner that filed a 21 document with the court recommending that he 22 lacked capacity to consent and should be 23 committed; isn't that correct? 24 A. Yes, as his treating psychiatrist. 25 Q. So, one, you were an examiner who provided VERBATIM COURT REPORTING 763-493-4535 81 1 information to the court, number two, you were 2 his treating psychiatrist, correct? 3 A. Yes. 4 Q. Number 3, you were the principal investigator 5 on the CAFE study; isn't that correct? 6 A. Yes. 7 Q. And Dan became a subject of that study; isn't 8 that correct? 9 A. Yes. 10 Q. And, four, you were the study physician on the 11 CAFE study who saw Dan as part of that research 12 project; isn't that correct? 13 A. Yes, as the principal investigator, I was the 14 primary psychiatrist seeing most of the 15 patients, not all, but most of the patients who 16 were in the CAFE study. 17 Q. Have you ever read any peer reviewed 18 psychiatric journal articles indicating that it 19 would be unethical for the treating 20 psychiatrist to also be the research study 21 psychiatrist as well as the PI, that those 22 roles are in fact in conflict? 23 A. I don't recall reading any articles that said 24 that would be not allowed, but I'm well aware 25 of the issues involved with obtaining informed VERBATIM COURT REPORTING 763-493-4535 82 1 consent where the potential exists to take 2 advantage of the therapeutic relationship in 3 order to coerce a patient into a study. 4 Q. So -- 5 A. That may be -- that may be -- that would be my 6 idea of what the term therapeutic misconception 7 you mentioned earlier may be but -- 8 Q. So with you being aware of these issues, did 9 you get an outside psychiatrist independent of 10 the financial conflicts of interests, that is 11 the payments from Astrazeneca, did you get an 12 outside psychiatrist to obtain informed consent 13 from Dan before putting him in your research 14 study? 15 MR. ALSOP: Object as misstatement of the 16 evidence, argumentative and vague but go ahead, 17 Doctor. 18 A. No. 19 MS. SVITAK: Same. 20 Q. (BY DR. BARDEN) Did you consider getting an 21 outside psychiatrist, that is, someone with no 22 financial incentives with Astrazeneca, to 23 obtain informed consent from Dan before putting 24 him into your study? 25 MR. ALSOP: Same objection as form. VERBATIM COURT REPORTING 763-493-4535 83 1 MS. SVITAK: Same objection. 2 A. No. 3 Q. (BY DR. BARDEN) Who were the two people that 4 obtained informed consent from Dan before he 5 entered your study? 6 A. Well, there may have been -- the primary person 7 was the study coordinator, Jean Kenney, myself 8 and the other coordinator Elizabeth Lemke 9 witnessed part of the informed consent document 10 procedure. 11 Q. Isn't it in fact the case on the informed 12 consent document, Jean Kenney is signed off as 13 the person who obtained consent and you signed 14 off as a witness to that? 15 A. Yes. 16 Q. And that both of you had financial ties to 17 Astrazeneca, and thus a conflict of interest to 18 Dan? 19 MR. ALSOP: Object, assumes facts not in 20 evidence, argumentative and form. Go ahead. 21 MS. SVITAK: Same objections. 22 MR. GROSS: Same objections. 23 A. Yes, that's true, but in the protocol, we have 24 to specify who can obtain informed consent and 25 it is the people who are involved in the study VERBATIM COURT REPORTING 763-493-4535 84 1 that know about the study who obtain the 2 informed consent. 3 Q. So the IRB raised no issue with the fact that 4 you were, A, the treating psychiatrist and had 5 a doctor-patient relationship with Dan, and 6 that, B, both you and Ms. Kenney had financial 7 links to Astrazeneca, the IRB raised no problem 8 or qualm whatsoever with the two of you 9 obtaining informed consent from a patient who 10 had been adjudicated incompetent within two 11 days? 12 A. The patient was not -- 13 MR. ALSOP: Wait a minute, Doctor. 14 Doctor, wait. It's repetitious. Object as to 15 assumes facts not in evidence. Go ahead. 16 MR. GROSS: Same objection, 17 argumentative. 18 MR. GROSS: Same objections. 19 A. The patient was not adjudicated incompetent. 20 The patient was agreed to a stay of commitment, 21 which then would imply that the court felt that 22 he was able to participate in the decisions 23 about his treatment and agree to those, hence, 24 the stay. 25 Q. Isn't it in fact the case that the court VERBATIM COURT REPORTING 763-493-4535 85 1 threatened Dan with incarceration or commitment 2 if he failed to comply with the treatment 3 recommendations of the team? 4 MR. ALSOP: Lacks foundation, but go 5 ahead. 6 A. No. The court didn't threaten him with that. 7 That's -- the stay of commitment is a voluntary 8 agreement that the patient arrives at with the 9 consent of the court and the treating 10 physicians with the contingency that the 11 commitment -- that the stay can be revoked if 12 the patient doesn't comply with the 13 recommendations. 14 Q. Are you aware of professional literature 15 indicating the stay of commitment is a threat 16 that hangs over the head of the patient? 17 MR. ALSOP: Objection as vague, but go 18 ahead. 19 MS. SVITAK: Objection. 20 A. Yes. 21 Q. So were there any other subjects other than Dan 22 where informed consent was obtained by Jeanie 23 Kenney. 24 A. Yes. 25 Q. How many? VERBATIM COURT REPORTING 763-493-4535 86 1 A. I don't know offhand. 2 Q. Are you aware of any ethical problems with 3 having a social worker obtain informed consent 4 in a human subjects research study where the 5 patient's health might be at risk? 6 A. No. I had delegated that responsibility, 7 informed the IRB that that would be our -- and 8 the sponsor, that that would be our procedure. 9 I personally was involved in the informed 10 consent process for every patient that 11 participated in the study. 12 Q. Were you aware of any training from the 13 University of Minnesota, indicating that they 14 consider it a problem for the treating -- for 15 someone who has financial links and ties to the 16 study to be the only ones obtaining informed 17 consent? Are you aware of any training from 18 the University of Minnesota in which they raise 19 that as an ethics problem? 20 MR. ALSOP: Repetitious, but go ahead. 21 A. No. In fact, as I said, we informed in the 22 application to the IRB who would be obtaining 23 consent, and it's almost always someone that's 24 paid by the sponsor. 25 Q. So they had no trouble with a social worker VERBATIM COURT REPORTING 763-493-4535 87 1 obtaining informed consent for this study? 2 MS. SVITAK: Object to foundation. 3 Q. (BY DR. BARDEN) The IRB signed off on that? 4 A. Yes. 5 Q. Now, let's get back to your multiple roles. 6 Have you ever heard of the term conflict of 7 interest? 8 A. Yes. 9 Q. As the principal investigator and the study 10 physician for the Astrazeneca funded study, 11 what if any conflicts of interest did you have 12 with Dan as you tried to obtain informed 13 consent for him? 14 MR. ALSOP: It's vague but go ahead. You 15 can answer. 16 A. Well, the conflict of interest would be that I 17 would induce him to participate in the study in 18 order to meet my obligation or commitment to 19 the sponsor and thereby benefit from that, when 20 in fact it was not in Dan's best interests or 21 appropriate for him to be a subject in the 22 study. 23 Q. Are you aware of any professional writing, 24 either research or other, indicating that that 25 kind of a conflict of interest is an ethics VERBATIM COURT REPORTING 763-493-4535 88 1 problem in medicine? 2 A. Yes. 3 MR. ALSOP: It's irrelevant, but go 4 ahead. 5 A. I would say that it's an ethics issue and, you 6 know, has the potential to be a problem if 7 people are enrolled in studies for which 8 they're not appropriate. 9 Q. Did you disclose this conflict of interest as a 10 conflict of interest to Dan in your informed 11 consent form? 12 MR. ALSOP: In the form? Just in the 13 form? 14 DR. BARDEN: That was the question. 15 MR. ALSOP: Okay. I want to understand. 16 A. In general, all the consent forms indicate that 17 the study physicians are being paid by the 18 sponsor. 19 Q. (BY DR. BARDEN) Objection, move to strike as 20 non-responsive. Is it your understanding that 21 that disclosed -- 22 A. Could you repeat the question? 23 Q. Yes. 24 A. I thought that was responsive. 25 Q. Did you disclose that you had these conflicts VERBATIM COURT REPORTING 763-493-4535 89 1 of interest with Dan? Is that disclosed, well, 2 let me ask you real simply. Does the term 3 conflict of interest appear in your consent 4 form? 5 A. No. 6 MR. ALSOP: Object as speculative. Go 7 ahead. 8 A. No. 9 Q. It doesn't, isn't that right? 10 MR. GROSS: Objection, argumentative. 11 Q. The term conflict of interest is not in your 12 consent form? 13 A. I don't believe it is. 14 Q. It's not. As Dan's -- well, let me ask you 15 this. What other treating psychiatrists did 16 Dan until the day he died other than you? 17 A. He was seen while in the hospital by other 18 faculty who were covering over the weekend or 19 the Thanksgiving holiday. 20 Q. After he left the hospital. I'm sorry. 21 A. After he left the hospital. There may have 22 been some times where -- may have been times 23 during the CAFE study where one of my 24 co-investigators, Dr. Vuchetich or Dr. Schulz 25 were consulted when I was unavailable, but I'm VERBATIM COURT REPORTING 763-493-4535 90 1 not aware of such instances so, absolutely, I 2 was his treating psychiatrist and had primary 3 responsibility for his care until his death. 4 Q. So he didn't see anyone as far as you know 5 other than you, Dr. Schulz and Dr -- what did 6 you say it? 7 A. Vuchetich. 8 Q. Vuchetich? 9 A. Right. 10 Q. Correct? 11 A. Correct. 12 Q. And you and Dr. Schulz and Dr. Vuchetich all 13 had a financial link to Astrazeneca, isn't that 14 right? 15 MS. SVITAK: Objection, foundation. 16 MR. GROSS: Vague. 17 A. Yes. The study was being paid for by 18 Astrazeneca. 19 Q. So during the time, from the time he left the 20 hospital until the time he died, to the best of 21 your knowledge, Dan saw no psychiatrist, he saw 22 no psychiatrist without the burden of the 23 financial conflict of interest from 24 Astrazeneca; isn't that correct? 25 MS. SVITAK: Objection, argumentative. VERBATIM COURT REPORTING 763-493-4535 91 1 MR. ALSOP: Objection to the form of the 2 question, argumentative. 3 MR. GROSS: Misstates the evidence. 4 A. Yes. 5 Q. (BY DR. BARDEN) And the answer is yes, 6 correct? 7 A. Yes. 8 Q. He saw no one else. He saw no one who was free 9 and independent of those financial links? 10 A. No. 11 MS. SVITAK: Objection to form and object 12 to argumentative. 13 MR. ALSOP: I'll join. 14 A. He saw no other psychiatrists but he saw a 15 number of experienced mental health 16 practitioners, both in the hospital and the day 17 treatment program and his outside 18 psychologists. 19 Q. Objection, move to strike as non-responsive 20 except for the yes. Did you obtain a family 21 history from Dan when you were treating him? 22 A. Yes. 23 Q. Strike that. Do you think you obtained a 24 competent family history from Dan when you were 25 treating him? VERBATIM COURT REPORTING 763-493-4535 92 1 A. Yes. 2 Q. What is Dan's family history of bipolar 3 disorder, if you know? 4 A. I don't recall offhand, if you would allow me 5 to look at the admission history, that 6 information would have been there. 7 Q. What if it wasn't? Would that have been an 8 error? 9 MR. ALSOP: Object to speculation. 10 A. I don't know what his family history is, so if 11 there is a clear family history and it's not 12 documented, then that may have been an 13 oversight. 14 Q. You did some training at Iowa, I believe you 15 said? 16 A. Yes. 17 Q. And was George Winokur involved? 18 A. Yes. 19 Q. And he knows a lot about the genetics of 20 bipolar disorder, doesn't he? 21 A. That's correct. 22 Q. Maybe as much as anyone in the world, huh? 23 A. He's deceased now but, yeah, at the time I 24 trained, sure. 25 Q. Right. And if someone had a number of close VERBATIM COURT REPORTING 763-493-4535 93 1 relatives with bipolar disorder, that would be 2 a very important diagnostic indicator, wouldn't 3 it? 4 A. It would be one factor to take into account, 5 but we considered at the time of his admission 6 to the hospital and throughout the assessment 7 procedure, absolutely considered whether he 8 might have been manic, but eventually decided 9 that that was not the most appropriate 10 diagnosis, that his symptoms and course of 11 illness were more consistent with paranoid 12 schizophrenia. 13 Q. But if a psychiatrist was treating a patient 14 who was psychotic and if that psychiatrist had 15 been trained by George Winokur and if they 16 failed to obtain family history information 17 that would strongly indicate many bipolar and 18 depressed relatives, if they in fact stuck with 19 a diagnosis of schizophrenia which would be 20 financially advantageous to that psychiatrist, 21 it might raise questions about the ethics of 22 that psychiatrist, isn't that right? 23 A. No. 24 MR. ALSOP: Multiple question. It's 25 argumentative and vague but you can answer. Go VERBATIM COURT REPORTING 763-493-4535 94 1 ahead. 2 MS. SVITAK: Same objection. Object to 3 form. 4 MR. ALSOP: Well, you've answered the 5 question, Doctor. 6 Q. (BY DR. BARDEN) When did you make the decision 7 that Dan was a schizophrenic? 8 A. It's not a -- there is not a single point in 9 time that I would say before that time I didn't 10 consider him having the schizophrenia and after 11 that time. I was certain about the diagnosis. 12 It's a process. Schizophrenia was considered 13 in the differential diagnosis from the very 14 beginning, and had I been required to arrive at 15 a diagnosis other than psychosis anna wess at 16 the -- based on the initial presenting history 17 it would have been paranoid schizophrenia, but 18 we often don't want to come down definitively 19 on any particular diagnosis, especially 20 schizophrenia, until we've considered all the 21 alternatives. 22 Q. But in this case, you as the treating physician 23 and the PI and the study physician had a 24 financial incentive to find Dan having 25 schizophrenia; isn't that correct? VERBATIM COURT REPORTING 763-493-4535 95 1 MR. ALSOP: That's argumentative, but go 2 ahead, Doctor. 3 A. No. 4 Q. (BY DR. BARDEN) If you found Dan to be a 5 schizophrenic and entered him in the study, the 6 study would be reimbursed $15,000 per subject; 7 isn't that correct? 8 MR. ALSOP: It's repetitious, 9 argumentative. Go ahead, Doctor. 10 A. No. 11 Q. Whereas, if you found Dan to be bipolar and he 12 couldn't enter your study, your study could 13 lose the $15,000 or you would have to work 14 harder to find another subject; isn't that 15 correct? 16 MR. ALSOP: Multiple and argumentative. 17 A. If I thought -- he could have entered the study 18 with a diagnosis of schizoaffective disorder, 19 which had I felt that his symptoms of mania met 20 criteria for mania, he would have been enrolled 21 under that diagnosis because clearly he had 22 delusional symptoms for many months in the 23 absence of a manic episode. And so he would 24 have been diagnosed schizoaffective and could 25 have qualified for the study on those grounds. VERBATIM COURT REPORTING 763-493-4535 96 1 Q. Objection, move to strike. Did I ask you about 2 schizoaffective or bipolar? 3 A. You said if he was -- if we diagnosed him as 4 bipolar. 5 Q. Bipolar, he could not enter your study, 6 correct? 7 A. But I evaluated -- 8 Q. Yes or no? 9 A. -- whether he had bipolar disorder and decided 10 that he did not. 11 Q. Right. But you had a financial incentive to 12 find that he did not, isn't that accurate? 13 MR. ALSOP: That's repititious and 14 argumentative. 15 Q. (BY DR. BARDEN) Did you, in your informed 16 consent form under alternative treatments, did 17 you discuss with Dan the alternative treatments 18 for bipolar disorder? For example, did you 19 discuss Depakot? 20 A. I discussed with Dan while he was in the 21 hospital the diagnosis and -- 22 Q. Objection, move to strike as non-responsive. 23 What did I ask you? 24 MR. ALSOP: Doctor, finish your answer 25 first. First finish your answer, Doctor. VERBATIM COURT REPORTING 763-493-4535 97 1 Q. (BY DR. BARDEN) Fine. We will ask for the 2 time back. 3 MR. ALSOP: You've told us that five 4 times, Doctor. Finish your answer. 5 A. While he was in the hospital, I had a 6 discussion with Dan about his diagnosis and 7 about whether he met criteria for mania or for 8 a primary psychotic illness and did discuss at 9 that point what the treatment differences would 10 be. 11 Q. What was the question I asked you? Do you 12 recall? 13 A. Did I discuss Depakot with him and the answer 14 is no. 15 Q. That's not that question I asked you. Doctor, 16 do you think it's important as a psychiatrist 17 to be able to remember what people say to you 18 in a conversation? 19 MR. ALSOP: Doctor, don't answer the 20 question. Doctor, just -- 21 Q. (BY DR. BARDEN) Is that a skill that's helpful 22 to you in your work? 23 MR. ALSOP: Doctor, don't answer the 24 question. Move on. 25 DR. BARDEN: There is no legal objection. VERBATIM COURT REPORTING 763-493-4535 98 1 MR. ALSOP: It's argumentative. It's 2 harrassing the witness. We're going to move 3 on. 4 Q. (BY DR. BARDEN) I'm going to ask the question 5 again, which is, in your informed consent form, 6 there is a section for alternative treatments, 7 correct? 8 A. Yes. 9 Q. And in your alternative treatments, you failed 10 in that form to mention any treatments for 11 bipolar disorder; isn't that correct? 12 MR. ALSOP: Argumentative, go ahead. 13 MR. GROSS: Same objection. 14 MS. SVITAK: Asked and answered multiple 15 times. 16 A. My interpretation of that discussion of 17 alternative treatments would be that the 18 discussion should be of appropriate alternative 19 treatments, and I would not consider discussion 20 of treatments for bipolar disorder to be 21 appropriate based on my assessment of Dan at 22 that time. 23 Q. Objection, move to strike the entire answer as 24 non-responsive. What did I ask you? 25 (A brief recess was taken). VERBATIM COURT REPORTING 763-493-4535 99 1 Q. (BY DR. BARDEN) We're back on the record. 2 Doctor, you're still under oath. Do you 3 understand that? 4 A. Yes. 5 Q. We talked about how you and Jean Kenney got Dan 6 into the study, right? 7 A. Yes. 8 Q. And we were talking about financial conflicts 9 of interest. Isn't it in fact true that you 10 got Dan into the study and that you had a 11 $15,000 financial incentive to get Dan into 12 your study? 13 A. No. 14 Q. Isn't it true that you kept Dan in the study 15 until his death? 16 A. No. 17 Q. You did not withdraw Dan from the study until 18 his death, correct? 19 A. That's correct. 20 Q. And that you had a $15,000 financial incentive 21 to keep Dan in the study until his death, 22 correct? 23 MR. ALSOP: Argumentative, asked and 24 answered at least three or four times. Answer 25 one more time, Doctor. VERBATIM COURT REPORTING 763-493-4535 100 1 A. No. The -- 2 MR. ALSOP: The answer is no, Doctor. 3 We're done. 4 Q. (BY DR. BARDEN) You filed documents with the 5 court, supporting Dan being ordered to obey his 6 treatment team, correct? 7 A. Repeat the question. 8 Q. You filed a document with the court, suggesting 9 that Dan should be ordered to obey his 10 treatment team, that he lacked capacity? 11 MR. ALSOP: That's a multiple question 12 now. Form. 13 A. Are you referring to the examiner's statement 14 of November 14th? 15 Q. Yes. 16 A. Yes. 17 Q. And you had a $15,000 financial incentive to 18 use the power of the court to coerce Dan into 19 being treated by you and then put him in your 20 study, correct? 21 MR. ALSOP: Repetitious. 22 MR. GROSS: Objection, argumentative. 23 MR. ALSOP: Go ahead, Doctor. 24 A. No. 25 Q. Dan never saw an outside psychiatrist, correct, VERBATIM COURT REPORTING 763-493-4535 101 1 that is, someone outside of the Astrazeneca 2 financial umbrella? 3 MS. SVITAK: Object to form, 4 argumentative. 5 MR. ALSOP: It's repetitious. We've 6 established this. Go ahead. 7 A. No. Dan did not see any -- 8 MR. ALSOP: Objection, vague. 9 A. No, Dan did not see any psychiatrists outside 10 the -- 11 Q. And you had a $15,000 financial incentive to 12 keep Dan away from such outside psychiatrists 13 who would be free from financial conflicts, 14 isn't that in fact the case? 15 MR. GROSS: Objection, argumentative. 16 A. No. 17 Q. (BY DR. BARDEN) Have you read any research or 18 writings on how financial conflict of interest 19 can cloud the judgment of medical, legal or 20 otherwise professionals? 21 A. Yes. 22 Q. Were you aware of the research and writings on 23 how much financial conflicts of interest can 24 cloud judgments during the time you treated 25 Dan? VERBATIM COURT REPORTING 763-493-4535 102 1 A. Yes. 2 Q. Have you ever heard of a phrase called -- term 3 called confirmatory bias? 4 A. No. 5 Q. Dr. Schulz or in your training with the 6 University of Minnesota or in your interactions 7 with the IRB, you've never had anyone instruct 8 you as to the meaning of the term confirmatory 9 bias, is that correct? 10 MR. ALSOP: Repetitious. Go ahead, 11 Doctor. 12 A. Yes, that's correct. 13 Q. (BY DR. BARDEN) Have you had any training at 14 all in research methodology? 15 A. Yes. 16 Q. Have you had any training at all in philosophy 17 of sciences? 18 A. Yes. 19 Q. Could you tell me about the work of Carl 20 Popper? 21 A. No. 22 Q. Never heard of Carl Popper? 23 A. No. 24 Q. In your training with Dr. Schulz, the 25 University of Minnesota or the IRB, no one has VERBATIM COURT REPORTING 763-493-4535 103 1 ever instructed you as to the work of Carl 2 Popper? 3 MR. GROSS: Objection, asked and answered. 4 A. I don't know whether I've learned about the 5 work of Carl Popper. I don't recognize the 6 name. 7 Q. You found that Dan did not suffer from bipolar 8 illness, correct? 9 A. Correct. 10 Q. You had a $15,000 financial incentive to find 11 that Dan did not suffer from bipolar illness, 12 correct? 13 A. No. 14 Q. You did not discover that Dan had multiple 15 relatives who suffered from bipolar -- from 16 bipolar illness, did you? 17 A. I was aware that there was some kind of family 18 history of bipolar illness, but I don't know 19 that I was aware of multiple relatives. 20 Q. You had a $15,000 financial incentive not to 21 diagnose Dan as having bipolar illness, isn't 22 that right? 23 A. No. 24 Q. Have you ever heard of the term boundary 25 violation? VERBATIM COURT REPORTING 763-493-4535 104 1 A. Yes. 2 Q. What is your understanding of the term boundary 3 violation as it's used in health care? 4 A. Refers to the blending of different roles, 5 whether it's a crossing over from the 6 physician-patient relationship to a personal 7 relationship, for example. 8 Q. Do you feel that you financially exploited a 9 vulnerable adult in this case in your treatment 10 of Dan? 11 A. No. 12 Q. Do you feel that you engaged in boundary 13 violations? 14 A. No. 15 Q. Do you feel that you engaged in undisclosed 16 conflicts of interest? 17 A. No. 18 Q. Did you have any medical ethicists at 19 University of Minnesota analyze your behavior? 20 A. No. 21 Q. And give you a -- pardon? 22 MR. ALSOP: Wait until the question is 23 asked. Take your time. 24 Q. (BY DR. BARDEN) Did you have a medical 25 ethicist at the University of Minnesota consult VERBATIM COURT REPORTING 763-493-4535 105 1 with you on whether your behavior violated 2 numerous and multiple serious ethics rules that 3 apply to health care professionals? 4 MR. ALSOP: Object as to form. It's 5 argumentative. Go ahead, Doctor. 6 A. No. 7 MS. SVITAK: Same objections. 8 Q. (BY DR. BARDEN) As someone who is trained in 9 medical ethics, Doctor, would you agree a 10 psychiatrist should not use or abuse mental 11 patients for their own financial benefit? 12 A. Yes. 13 Q. As someone trained in medical ethics, would you 14 agree a psychiatrist acting as someone who is 15 supplying evidence to a court should not 16 manipulate the legal system into forcing a 17 patient into the psychiatrist's research study 18 for the financial and professional benefit of 19 the psychiatrist? 20 MR. ALSOP: It's argumentative. It's a 21 multiple question, form, but go ahead, Doctor. 22 MS. SVITAK: Same objections. 23 A. Repeat the question. 24 Q. (BY DR. BARDEN) Would you agree that someone 25 trained in medical ethics, that a psychiatrist VERBATIM COURT REPORTING 763-493-4535 106 1 should not supply evidence to a court to 2 manipulate the legal system into forcing a 3 patient into the psychiatrist's care so they 4 can get them into their research study for the 5 financial and professional benefit of the 6 psychiatrist? 7 A. Yes. 8 Q. As someone trained in medical ethics, Doctor, 9 would you agree that a psychiatrist acting as 10 someone's personal physician should not 11 deliberately ignore and dismiss a dramatic and 12 dangerous deterioration in a patient in order 13 to keep that patient in the psychiatrist's 14 personally profitable research study? 15 MR. ALSOP: Objection as argumentative 16 and vague and ambiguous. 17 MS. SVITAK: Objection to form. 18 MR. ALSOP: Go ahead, Doctor. 19 A. Yes. 20 Q. (BY DR. BARDEN) When you supplied the evidence 21 to the court with regard to the commitment 22 proceedings of Dan, did you inform the court 23 that you were a PI on a drug study? 24 A. No. 25 Q. Did you inform the court deciding Dan's liberty VERBATIM COURT REPORTING 763-493-4535 107 1 that you were going to use Dan in your drug 2 research study? 3 MR. ALSOP: It's repetitious, asked and 4 answered but go ahead, Doctor. 5 A. No, but we had discussions with Dave Pettit 6 about whether participation in the CAFE study 7 would satisfy the court requirement that he 8 participate in treatment. 9 Q. When was Dave Pettit assigned to be Dan's case 10 manager, Dr. Olson? 11 A. I don't recall. 12 Q. Was it before or after you signed him into your 13 study? 14 MR. ALSOP: It's now speculative. Go 15 ahead, Doctor, if you know. 16 A. I don't know. 17 Q. (BY DR. BARDEN) Is it your testimony that you 18 received approval from Dan's case manager 19 before you signed Dan into your personally 20 profitable research study? 21 MR. ALSOP: Asked and answered, 22 repetitious, now speculative. If the answer is 23 any different, Doctor, go ahead. 24 A. Well, it may be the case that he signed the 25 consent form. There was a screening period of VERBATIM COURT REPORTING 763-493-4535 108 1 time during which at any point we could have 2 terminated his participation in the study had a 3 court or Mr. Pettit or Dan himself chosen not 4 to participate or felt that that was 5 inappropriate. 6 Q. Objection to move all non-responsive parts of 7 that answer. Did you inform the court which 8 was deciding if Dan's liberty would be taken, 9 that you would receive financial benefits from 10 Astrazeneca for putting Dan into your drug 11 study? 12 A. No. 13 Q. Did you inform the court deciding if Dan's 14 liberty would be taken, that you were also 15 going to act as the Astrazeneca's study 16 physician to evaluate Dan's progress despite an 17 obvious conflict of interest? 18 MR. ALSOP: Object as argumentative and 19 form. Go ahead, Doctor. 20 MS. SVITAK: Same objection. 21 A. No. 22 Q. (BY DR. BARDEN) Did you inform the court 23 deciding if Dan's liberty would be taken that 24 you were going to be Dan's personal physician, 25 and at the same time you were a paid consultant VERBATIM COURT REPORTING 763-493-4535 109 1 to Astrazeneca, the PI of Astrazeneca's 2 research study and also the study physician as 3 well? 4 MS. SVITAK: Object to form. 5 MR. ALSOP: Form, it's also repetitive 6 but go ahead, Doctor. 7 A. No. 8 Q. (BY DR. BARDEN) Did you inform the court 9 deciding if Dan's liberty would be taken that 10 you were going to change your opinion that Dan 11 lacked capacity, that you would find him 12 competent within a matter of days, so that you 13 could sign him into your personally profitable 14 drug study? 15 MR. ALSOP: It's argumentative as to 16 form, misstatement of the facts. Go ahead, 17 Doctor. 18 MS. SVITAK: Same objections. 19 A. Yes. By agreeing to a stay of commitment, we 20 were at that point recognizing Dan's ability to 21 consent to treatment of whatever type. 22 Q. Did you inform the court that you were going to 23 put Dan into your personally profitable drug 24 study? 25 MR. ALSOP: Repetitious and form. VERBATIM COURT REPORTING 763-493-4535 110 1 MS. SVITAK: Same objections. 2 MR. ALSOP: Go ahead, Doctor. 3 A. No. 4 Q. (BY DR. BARDEN) During the time you treated, 5 evaluated and studied Dan, did you ever inform 6 the University of Minnesota that you were 7 acting as, one, a source of evidence to the 8 court regarding Dan's commitment; two, his 9 personal physician; three, the study physician, 10 and; four, the PI on the Astrazeneca study? If 11 you did inform anyone, please tell me who and 12 when. 13 MR. ALSOP: Object as argumentative, 14 misstatement of the evidence and a multiple 15 question. Go ahead, Doctor. 16 A. The IRB was aware of my role as a clinical 17 psychiatrist and approved that as a source of 18 identifying patients that would be appropriate 19 for the study. 20 Q. Objection, move to strike as non-responsive. 21 Was there anyone else at the University of 22 Minnesota, was there anyone you informed that 23 you played all of those roles? And I'm 24 especially interested in anyone finding out 25 that you provided evidence to the court VERBATIM COURT REPORTING 763-493-4535 111 1 indicating that you believe Dan lacked capacity 2 and that he should be committed. 3 MR. ALSOP: Repetitious, argumentative, 4 vague. Go ahead, Doctor. 5 A. No, I didn't provide to the IRB the specific 6 details of the clinical care that I provided to 7 patients in my capacity as a clinician. 8 Q. (BY DR. BARDEN) Was the IRB aware, anyone at 9 the University of Minnesota aware that Dan was 10 under a threat of court order to obey your 11 treatment recommendations? 12 MR. ALSOP: Object on basis of 13 foundation. 14 MR. GROSS: Same objection. 15 A. Repeat the question. 16 Q. (BY DR. BARDEN) Was anyone at the IRB or at 17 the University of Minnesota aware that Dan was 18 under a court order to obey your treatment 19 recommendations? 20 MR. ALSOP: Same objections as to 21 foundation, Doctor, go ahead. 22 A. The IRB wasn't aware of any specifics regarding 23 any specific subject, no. 24 Q. Was Dr. Schulz at any time aware that you were 25 playing all of these roles, that is, providing VERBATIM COURT REPORTING 763-493-4535 112 1 evidence to the court to try to get Dan 2 committed or controlled by the legal system, 3 personal physician, study physician and PI, was 4 Dr. Schulz aware you played all those roles? 5 A. Yes. 6 Q. And Dr. Schulz had no questions about whether 7 this was misconduct? 8 A. If Dr. Schulz had any opinion that I was not 9 conducting a study properly, yes, he would have 10 objected, but I wasn't and he didn't. 11 Q. Dr. Schulz raised no qualms or issues with a 12 patient under court order to obey your 13 recommendations being signed in by you, giving 14 informed consent to your research study, Schulz 15 had no problem with that? 16 MR. ALSOP: Argumentative and vague. Go 17 ahead, Doctor. 18 A. No. 19 Q. (BY DR. BARDEN) So as someone trained in 20 medical ethics, could you see that perhaps 21 someone might be concerned about a psychiatrist 22 with financial incentives using the power of 23 the legal system to coerce a patient into a 24 study? 25 MR. ALSOP: Doctor, that's speculative, VERBATIM COURT REPORTING 763-493-4535 113 1 lacking in foundation. Go ahead, you can 2 answer. 3 MR. GROSS: Objection, argumentative. 4 A. Yes, I'm aware of those concerns, and I don't 5 believe that I abused my clinical relationship 6 with Dan. 7 Q. Wasn't your first hypothesis with Dan that he 8 suffered from bipolar illness? 9 A. I would have to consult my notes, but I believe 10 that my initial diagnosis was psychosis NOS, 11 Rule out schizophrenia bipolar disorder or 12 psychosis caused by a medical condition, which 13 was raised at the time of his admission as it 14 would be with any patient presenting with 15 psychoses. Those would be the primary medical 16 conditions. Those would be the primary -- it 17 would be the primary differential diagnosis, 18 drug-induced psychosis being included in part 19 of a medical cause. 20 Q. But Dan was admitted, he was clearly psychotic, 21 wasn't he? 22 A. Yes. 23 Q. He believed his mother was a lizard, correct? 24 A. Yes. 25 Q. He believed he was Angelina Jolie's brother, VERBATIM COURT REPORTING 763-493-4535 114 1 for example? 2 A. Yes. 3 Q. Clearly lacked capacity to give informed 4 consent at that point, didn't he? 5 MR. ALSOP: Objection, calls for legal 6 conclusion, but go ahead, Doctor. 7 A. The delusions themselves didn't indicate his 8 lack of capacity, but his failure to recognize 9 that he was suffering from a mental illness was 10 the basis for my statement that he lacked 11 capacity. 12 Q. There were multiple times during your research 13 study where it was clear Dan believed he had no 14 mental illness, isn't that right? 15 MR. ALSOP: Vague, go ahead. 16 A. No, I disagree. 17 Q. (BY DR. BARDEN) In fact, didn't you write that 18 Dan showed no insight into why he was brought 19 to the hospital? 20 MR. ALSOP: Objection, vague as to what 21 document you're referring to, speculative and 22 lacks foundation. Go ahead, Doctor, if you 23 know. 24 A. I believe initially that was the case. Insight 25 is not an all or none phenomena and Dan VERBATIM COURT REPORTING 763-493-4535 115 1 lacked -- at no point had complete insight and 2 awareness of his illness, but after the first 3 few days, he referenced that he did need help. 4 He acknowledged that his beliefs were odd. He 5 believed that they were due to sleep 6 deprivation but he expressed willingness to 7 continue with treatment. 8 Q. Now, he didn't believe he was mentally ill, he 9 thought he just had sleep deprivation, isn't 10 that right? 11 A. Well, he acknowledged that his beliefs were 12 odd. Whether he would -- he would consider 13 that a mental illness, I don't know. 14 Q. He also stated that he denied that he had 15 mental illness and he refused to take drugs or 16 get medical treatment, isn't that right? 17 A. That was the case at the time of admission, 18 yes, but shortly thereafter he began to take 19 medication. And then at that point following 20 that, he was willing and thought the medication 21 was helping. 22 Q. Is it your understanding that Dan started to 23 take medication voluntarily? 24 A. Yes. 25 Q. Even though he stated multiple times in the VERBATIM COURT REPORTING 763-493-4535 116 1 records that he was not interested in taking 2 any medications. Did anyone -- 3 MR. ALSOP: Wait, Doctor, there is no 4 question. He made a statement so just wait. 5 Q. (BY DR. BARDEN) Did anyone witness him 6 voluntarily agreeing to begin to take 7 medications? 8 MR. ALSOP: Object on the basis of 9 foundation. Go ahead, Doctor. 10 A. Yes. The nurse that -- the nurse that 11 administered the medication. 12 Q. Is it your understanding that that's in your 13 records? 14 A. It's in the records that he accepted and took 15 medication. 16 Q. Did you write him a prescription, even as he 17 told you he would not take it? 18 A. Yes, that's true. 19 Q. Do you find that coercive? 20 A. No. 21 Q. Do you find that disrespectful of a patient's 22 wishes? 23 A. No. 24 Q. Did you begin a legal process to find him a 25 substitute decision-maker? VERBATIM COURT REPORTING 763-493-4535 117 1 A. No. 2 Q. So he told you he would not take medication and 3 you just wrote him a prescription right there? 4 A. We had a discussion about the importance and 5 the value of medication, the side effects, the 6 alternatives. And I indicated that I would be 7 writing him a prescription and I hoped that he 8 would agree to take it. 9 Q. Is it your understanding that -- well, that Dan 10 took an MMPI II? 11 A. Yes. 12 Q. He did. So if there is not one in the records 13 that we've been sent, where do you think that 14 MMPI II would be? 15 A. If he took an MMPI, it would have been in 16 the -- it would have been as part of the 17 neuropsychological evaluation that Dr. Holker 18 performed while he was in the hospital. 19 Q. And that should be in his hospital chart, 20 though, correct? 21 A. Well, the report of -- the report of the entire 22 evaluation is in the hospital chart. The 23 actual test documents would likely be in 24 Dr. Holker's possession. She's a member of the 25 physical medicine and rehabilitation VERBATIM COURT REPORTING 763-493-4535 118 1 department, not the department of psychiatry. 2 She would be a consultant to me. 3 Q. Do you recall what Dan's MMPI II said? 4 A. No. 5 Q. Do you recall what diagnostic category he was 6 in? 7 A. No. 8 Q. We're going to start going into some documents 9 now. Maybe we should -- let's go off the 10 record just momentarily and talk about 11 scheduling. 12 (A lunch recess was taken). 13 Q. (BY DR. BARDEN) Back on the record. Doctor, I 14 had asked you earlier what you have done to 15 prepare for the deposition today, and you 16 mentioned you looked at some records. 17 A. Yes. 18 Q. Which records did you look at again? You 19 looked at Dan's CAFE study records? 20 A. Yes. I looked at some of those. 21 Q. Did you look at his clinical treatment records? 22 A. Yes. 23 Q. And where did you look at those? 24 A. Where was I? 25 Q. Yes. VERBATIM COURT REPORTING 763-493-4535 119 1 A. In my office and at home. Some of the records 2 I looked at on the CD-ROM that was prepared 3 where there are many scanned records. 4 Q. So since you had records in your office and at 5 your home, why did you violate the subpoena to 6 bring those records here today? 7 MR. ALSOP: He didn't. Those records I 8 gave him. The CD-ROM is from you, Counsel. 9 The records he looked at were records I sent to 10 him. 11 Q. (BY DR. BARDEN) The question is standing. The 12 records you looked at in your office, right? 13 A. (Nods head in the affirmative). 14 Q. And you had control of those records, correct? 15 A. Yes. 16 Q. And you're under a legal subpoena to bring them 17 here for us to inspect them, correct? You 18 filed no motion to quash the subpoena, correct? 19 MR. ALSOP: Don't answer. Just don't 20 answer those questions. Make a motion. Don't 21 answer the question. 22 DR. BARDEN: We will make a motion. 23 MR. ALSOP: Fine. 24 DR. BARDEN: Because I'm very concerned 25 about us not having records, about records not VERBATIM COURT REPORTING 763-493-4535 120 1 being produced, and I'm very concerned about 2 him violating a lawful subpoena, willfully 3 having control and access to records and 4 failing to bring them here. 5 MR. ALSOP: The records that we got from 6 you. 7 DR. BARDEN: And we will seek another day 8 to meet with him to go over the records which 9 was the purpose of us being here today. 10 Q. (BY DR. BARDEN) Did you look at any MMPI IIs 11 for Dan? 12 A. No. 13 Q. Have you seen any? 14 A. I know that the report was part of Dr. Holker's 15 report and I looked at some of that. I don't 16 think I specifically reviewed the MMPI results 17 or interpretation, you know, in the last week, 18 but I do not have the actual MMPI raw data. 19 Those are likely in the possession of 20 Dr. Holker's department. 21 Q. So which records do you have control over or 22 that are in your office, which ones, the CAFE 23 study records? 24 A. No. The CAFE study records are in the 25 possession of the University in the research VERBATIM COURT REPORTING 763-493-4535 121 1 clinic. The Fairview records are, whether it's 2 the inpatient records or the day hospital 3 records are in the possession of the hospital. 4 And any records I have in my office are copies 5 of that, which I have provided. The University 6 has provided, the hospital has provided 7 everything that we have, and I don't know what 8 additional records that you don't have that 9 you're seeking. 10 Q. I just want you to state clearly what records 11 you have in your office that you did not bring 12 here today. What are the records that you have 13 in your office? 14 A. Copies of the hospital notes and hospital chart 15 and copies of the CAFE records as well as 16 copies of some of the regulatory documents. 17 Q. And you did not bring those today, correct? 18 A. That's correct. 19 Q. Now, we talked earlier about Dan refusing 20 medication when he first came to the hospital, 21 correct? 22 A. Yes. 23 Q. I'm not asking you for your legal opinion, but 24 as a licensed health care provider in the State 25 of Minnesota who prescribes and uses VERBATIM COURT REPORTING 763-493-4535 122 1 neuroleptic medications, are you aware of the 2 legal requirements in this state before a 3 patient can be given neuroleptic medications? 4 A. Yes. 5 Q. And what are those legal requirements? 6 A. As I understand it, there is a written consent 7 to neuroleptic medication. 8 Q. Was it your understanding that Dan signed a 9 written concept to receive neuroleptic 10 medication? 11 A. No, I don't believe so. 12 Q. Would that be a violation of the statute then? 13 A. I don't know. 14 Q. Did anyone at the hospital mention that you 15 needed a signed, written consent in order to 16 give people neuroleptic medication? 17 A. No. 18 Q. Did Dan have any health care directive to the 19 best of your knowledge? 20 A. No. 21 Q. Did you ever seek to make a -- to have a 22 substitute decision-maker or guardian appointed 23 for Dan? 24 A. No. 25 Q. Did Dr. Schulz ever inform you that he was VERBATIM COURT REPORTING 763-493-4535 123 1 concerned about a statutory violation in the 2 treatment of Dan? 3 A. No. 4 Q. Did the IRB ever say they were concerned about 5 a statutory violation of the treatment for Dan? 6 A. No. 7 Q. Let's start looking at some records here. 8 Let's start with what we'll mark as Exhibit No. 9 3. 10 (Exhibit No. 3 was marked for 11 identification by the Court Reporter). 12 Q. (BY DR. BARDEN) Could you identify this for 13 the record, please? 14 A. This is the examiner's statement and support 15 for a petition of commitment. 16 Q. This had been marked as Exhibit No. 3. Is this 17 your writing? 18 A. Yes. 19 Q. Do you see where it says behavioral evidence to 20 support commitment, do you see that? 21 A. Yes. 22 Q. And the last two lines, it says -- that's all 23 right. The last line, it says, lacks insight 24 and is now guarded and evasive. Do you see 25 that? VERBATIM COURT REPORTING 763-493-4535 124 1 A. Yes. 2 Q. Was Dan like that for much of the study period 3 time all the way until his death? 4 A. As I stated before, insight is not an all or 5 none phenomenon. At this time he did not 6 believe that he had a mental illness and was 7 not willing to accept treatment. At later 8 points, he never gained complete insight as 9 most patients with schizophrenia don't, but he 10 had enough partial insight to participate in a 11 study to be aware of the treatment and to 12 willingly accept that treatment and take 13 medication. 14 Q. So at this point you thought he lacked insight 15 and was guarded and evasive, correct? 16 A. Yes. 17 Q. Now, down below, it says, if mental illness is 18 diagnosed, treatment with neuroleptic 19 medication is recommended. Do you see where -- 20 you checked that, didn't you? 21 A. Yes. 22 Q. Then it said the above-named person lacks the 23 capacity to make decisions regarding such 24 treatment. Did you check lacks? 25 A. Yes. VERBATIM COURT REPORTING 763-493-4535 125 1 Q. And then underneath the reason for this 2 opinion, if you could read that. 3 A. Does not believe he has mental illness, 4 attributes all symptoms to sleep deprivation 5 for a few days. 6 Q. So does not believe he has a mental illness, 7 that was a major reason why you felt he lacked 8 the capacity to make decisions regarding his 9 own treatment, correct? 10 A. Yes. 11 Q. Next, we look at the report of the pre-petition 12 screening team dated the 17th of November. 13 2003. 14 (Exhibit No. 4 was marked for 15 identification by the Court Reporter). 16 Q. (BY DR. BARDEN) These have always been marked 17 Bates number FH000108 through 110. For the 18 record, could you give us your understanding of 19 what the pre-petition screening team is and 20 does. 21 A. After the examiner's statement in support of a 22 petition is filed, the county of residence -- 23 in this case Dakota County -- court is 24 contacted and the team or an individual -- I 25 don't know how Dakota County works -- in VERBATIM COURT REPORTING 763-493-4535 126 1 Hennepin County an individual from the 2 pre-petition office comes to the hospital, 3 gathers information, some of which was prepared 4 by the hospital social worker and examines the 5 patient, then goes back to the office and 6 discusses the case with a team in the 7 pre-petition office to determine whether the 8 petition is supported. And if it is, then the 9 case goes on to a preliminary hearing. If the 10 petition is not supported, then the hospital 11 can appeal and go ahead and file the petition 12 with the court anyway. 13 Q. In your role as Dan's treating psychiatrist at 14 this time, you saw this report, correct? 15 A. Yes. 16 Q. Let's look at the first page here, FH 108, 17 what's been marked as Exhibit No. 4. Under 3, 18 the paragraph there discusses some of the 19 delusional ideas that Dan had, that his mother 20 is really his grandmother. Her boyfriend is 21 really his biological father and the actress 22 Angelina Jolie is really his sister. And that 23 many people in public were aware of him and 24 that a dossier regarding him had been 25 distributed through the public, that he VERBATIM COURT REPORTING 763-493-4535 127 1 believed his mother was a lizard and that he 2 had made threats to his mother's boyfriend 3 about slitting his mother's throat, correct? 4 These are the kinds of symptoms displayed by 5 Dan? 6 A. Yes. 7 Q. During this time frame, isn't that right? 8 A. Yes. 9 Q. Then down below, it says records indicate the 10 respondent showed no insight into why he was 11 brought to the hospital, correct? 12 A. Yes. 13 Q. That he was -- he had related to the nurse 14 about being chosen by a satanic cult and it 15 would be a privilege to do whatever they asked, 16 including kill people, correct? 17 A. Yes. 18 Q. Clearly very disturbed at this point, isn't 19 that right? 20 A. Yes. 21 Q. If we look at the next page under 22 administration of neuroleptic medications, do 23 you see where it says no advance directive or 24 substitute treatment authority is known to 25 exist for the respondent. Do you see that VERBATIM COURT REPORTING 763-493-4535 128 1 sentence? 2 A. Yes. 3 Q. These people obviously understood the statute, 4 didn't they? 5 MR. ALSOP: Object on the basis of 6 foundation as to what they understood. Go 7 ahead if you know. 8 A. I don't know what they understood. 9 Q. (BY DR. BARDEN) Do those terms mean anything 10 to you, advanced directive? 11 A. Yes. 12 Q. Substitute treatment authority? 13 A. Yes. 14 Q. Then it goes on to say, the respondent is 15 believed not to have the capacity to make 16 decisions regarding neuroleptic medications. 17 Do you see that? 18 A. Yes. 19 Q. And it says -- 20 A. However, a guardian in the State of Minnesota 21 cannot consent to neuroleptic medication and 22 still have to pursue a Jarvis ruling so -- 23 Q. Exactly. Treatment with neuroleptic medication 24 is being recommended. The respondent does not 25 consent to accept prescribed neuroleptic VERBATIM COURT REPORTING 763-493-4535 129 1 medication. Do you see that sentence in the 2 report? 3 A. Yes. 4 Q. Now, under interview with a proposed patient, 5 it says in the middle of the paragraph, he did 6 not believe he had a mental illness. Do you 7 see that? 8 A. Yes. 9 Q. Then in the next paragraph, it says, his 10 failure to acknowledge a mental illness as the 11 cause of these beliefs, do you see that? 12 A. Yes. 13 Q. And that would be consistent with your 14 examiner's statement, right? 15 A. Yes. 16 Q. Then down below 4A, it says rule out bipolar 17 affective disorder with psychosis. Do you see 18 that? 19 A. Yes. 20 Q. And under 4B, lacks insight and willingness, et 21 cetera, correct? Then on Page 3, do you see 22 where it says dated the 17th day of November, 23 2003? 24 A. Yes. 25 Q. Do you know Ken Geister? VERBATIM COURT REPORTING 763-493-4535 130 1 A. I believe I have met him. I don't know him 2 personally. 3 Q. So this was filed on November 17th, 2003, 4 right? 5 A. Right. 6 Q. Next document. 7 A. Based on the examination on November 14th. 8 Q. Correct. The next document is the order to 9 confine, transport for examination hearing and 10 appointment of attorney examiner and notice. 11 That's been marked as Exhibit No. 5, and it's 12 also marked with a Bates number DC00073. 13 As Dan's treating physician, did you see 14 this document? 15 A. Yes. 16 Q. Order to confine, transport for examination. A 17 civil commitment is a serious business, isn't 18 it, Doctor? 19 A. Yes. 20 Q. People can lose their liberty, isn't that 21 right? 22 A. Yes. 23 Q. They can be confined against their will, isn't 24 that right? 25 A. Yes. VERBATIM COURT REPORTING 763-493-4535 131 1 Q. They can be treated against their will, isn't 2 that right? 3 A. No. 4 Q. They can be transported against their will, 5 isn't that right? 6 A. Yes. 7 Q. Is it your understanding that once someone is 8 committed they can't be treated against their 9 will? 10 A. Unless an emergency exists. 11 Q. If someone is committed to the state hospital, 12 can they be treated against their will? 13 A. They can't be forcibly given antipsychotic 14 medication without a Jarvis order, without a 15 court order. 16 Q. And this process can take away peoples' 17 liberty; isn't that correct? 18 A. Yes. 19 Q. They can be transported against their will? 20 A. Yes. 21 Q. They can be arrested by the sheriff, et cetera; 22 isn't that correct? 23 A. I wouldn't call it that. 24 MR. ALSOP: Vague and ambiguous. 25 Q. (BY DR. BARDEN) So Dan was under very severe VERBATIM COURT REPORTING 763-493-4535 132 1 pressure from this court action, isn't that 2 true, this legal action that was moving 3 forward? 4 MR. ALSOP: Objection as vague and 5 ambiguous and argumentative. Go ahead. 6 A. I wouldn't characterize it as very severe 7 pressure. He was in the process of a 8 commitment. 9 Q. Do you think that people experience that as 10 being a stressful event, Doctor? 11 A. Certainly could. 12 Q. Do you think people would behave in certain 13 ways to escape being committed? 14 MR. ALSOP: Object as speculative. Go 15 ahead. 16 A. Would people -- 17 Q. (BY DR. BARDEN) Do you think people have an 18 incentive to try to escape being committed? 19 A. Yes. 20 Q. Do you think Dan had an incentive to try to 21 escape being committed? 22 A. I don't know. 23 Q. Let's look at the next document as the findings 24 of fact, conclusions of law and order of 25 November 20, 2003. VERBATIM COURT REPORTING 763-493-4535 133 1 (Exhibit No. 6 was marked for 2 identification by the Court Reporter). 3 Q. (BY DR. BARDEN) This has been marked as 4 Exhibit 6. As Dan's treating psychiatrist, you 5 saw this document, correct? 6 A. Yes. 7 Q. Were you actually present at the hearing? 8 A. No. 9 Q. We look on the first page, it says at the 10 bottom there, the respondent agrees to a stayed 11 commitment. Do you see that? 12 A. Yes. 13 Q. And it says under Paragraph 5 that the Dakota 14 County Social Services Department has developed 15 a plan for services to treat the respondent's 16 mental illness, right? 17 A. Yes. 18 Q. Now, in the findings of fact section which is 19 Pages one and first part of 2, do you see any 20 indication or can you find me any wording that 21 the court understood that Dan was going to be 22 entered into a research study? 23 A. No. 24 Q. Let's go ahead and look at conclusions of law 25 and the order, that the respondent Dan VERBATIM COURT REPORTING 763-493-4535 134 1 Markingson is mentally ill and in need of 2 treatment, that the respondent shall be 3 committed to the Anoka Metro Regional Treatment 4 Center. This commitment shall be stayed for a 5 period of six months under the following terms 6 and conditions. Have you ever been, Doctor, to 7 the Anoka Metro Regional Treatment Center? 8 A. Yes. 9 Q. Do you think most people look forward to being 10 committed there? 11 MR. ALSOP: Object as speculative, 12 irrelevant. Go ahead, Doctor. 13 A. No. 14 Q. (BY DR. BARDEN) Let me ask specifically, do 15 you think Dan looked forward to being 16 committed, that is, incarcerated at the Anoka 17 Metro Regional Treatment Center? 18 MR. ALSOP: Same objections. Go ahead. 19 A. No. 20 Q. (BY DR. BARDEN) The court says that the 21 commitment shall be stayed for a period of six 22 months under the following terms and 23 conditions: A, that the respondent remain 24 hospitalized and cooperate with the treatment 25 plan at Fairview University Medical Center VERBATIM COURT REPORTING 763-493-4535 135 1 until medically discharged and follow all of 2 the aftercare recommendations of the treatment 3 team. Do you see that? 4 A. Yes. 5 Q. Do you see any indication there that Dan is 6 going to end up in a research study? 7 A. No. 8 Q. Next, that the respondent enter, participate in 9 and satisfactorily complete the 10 inpatient-outpatient treatment program and the 11 aftercare recommendations as determined by a 12 social worker. Do you know who Dan's social 13 worker was? 14 A. I believe that would be David Pettit. 15 Q. David Pettit. And, again, do you know when 16 David Pettit was assigned to Dan? 17 A. No, I think typically the assignment of a 18 specific case manager would not occur until 19 there was a commitment or a stay because 20 sometimes if the commitment is dropped, then 21 the county doesn't appoint a social worker. 22 Q. Right. He was assigned on the 24th, correct? 23 Do you recall that? 24 A. I don't recall the date. 25 Q. And so Dan is being told by the court that if VERBATIM COURT REPORTING 763-493-4535 136 1 he doesn't follow the aftercare recommendations 2 and the treatment team and complete the 3 treatment program, that he is going to be 4 committed, isn't that right? 5 A. Yes. He could be committed. 6 Q. A stay of commitment is better described as a 7 threat of commitment; isn't that correct? 8 A. No. 9 MR. ALSOP: Object as argumentative. Go 10 ahead and anwer. 11 Q. (BY DR. BARDEN) Next, that the respondent 12 cooperate with the treatment plan and follow 13 the rules at any living facility as arranged by 14 his social worker. That the respondent consent 15 to admission or re-admission to a hospital or 16 other appropriate care facility. That the 17 respondent take drugs and medication as 18 prescribed. That the respondent see a 19 psychiatrist or therapist as recommended. So 20 this essentially orders Dan to do what you and 21 the treatment team told him to do, correct? 22 A. It orders him to follow a treatment plan, and 23 the plan that we developed happened to include 24 the CAFE study, although, he could have very 25 well chosen not to participate, and an VERBATIM COURT REPORTING 763-493-4535 137 1 alternative treatment plan with nearly 2 identical conditions would have been -- would 3 have been his treatment plan. 4 Q. So Dan was ordered to follow your treatment 5 plan, correct? 6 MR. ALSOP: That's a misstatement of the 7 evidence and his prior testimony. Go ahead, 8 Doctor. 9 Q. (BY DR. BARDEN) I just read you the court 10 order that says he was ordered to follow your 11 treatment plan, correct, your treatment team's 12 plan? 13 MR. ALSOP: The team plan. Again, it's 14 vague and ambiguous. 15 Q. (BY DR. BARDEN) Who was the physician on the 16 treatment team? 17 A. That was me. 18 Q. Yeah. And then -- 19 A. But I wouldn't characterize that the court 20 ordered him to participate in a research study. 21 Q. No. Oh, no, the court was deceived, wasn't it? 22 A. No. 23 Q. The court was deceived into thinking this was 24 an order for treatment, when in fact you 25 planned the very next day within 24 hours of VERBATIM COURT REPORTING 763-493-4535 138 1 this order to get Dan into your research study; 2 isn't that right? 3 A. No. 4 MR. GROSS: Objection, argumentative. 5 Q. (BY DR. BARDEN) Look at the last page in the 6 court order, Item 7. The respondent shall be 7 granted passes as approved by the respondent's 8 treating physician. That would be you, isn't 9 that right, Doctor? 10 A. Yes. 11 Q. You were the keeper of the gate? 12 MR. ALSOP: That's vague and ambiguous. 13 Q. For Dan by court order, you control his 14 freedom, isn't that right? 15 MR. ALSOP: Vague and ambiguous and 16 argumentative. Go ahead, Doctor. 17 A. Yes. 18 Q. (BY DR. BARDEN) Next, November 20th, 2003, 19 letter from Mary Weiss to Dr. Olson. This will 20 be marked as Exhibit No. 7. 21 (Exhibit No. 7 was marked for 22 identification by the Court Reporter). 23 Q. (BY DR. BARDEN) Looking at what's been marked 24 as Exhibit No. 7, as Dan's treating physician, 25 do you recall reading this letter? VERBATIM COURT REPORTING 763-493-4535 139 1 A. Yes. 2 Q. And look at the third paragraph down, it says, 3 quote, I find it unacceptable that he, meaning 4 Dan, could be released from Fairview Riverside 5 without a resolution. In fact, should he be 6 released without his acknowledgment of an 7 illness, he would be worse off than had he 8 never been an inpatient. He of course would 9 take no medication, for in his mind there is no 10 illness to medicate. His mind would 11 deteriorate to the point where he will act on 12 his evil thoughts. This will happen, 13 exclamation point. Is that what this says? 14 A. Yes. 15 Q. That's exactly what happened in this case, 16 isn't it? 17 MR. ALSOP: Object as argumentative, 18 vague and ambiguous. Go ahead, Doctor. 19 A. No. He did continue to take medication and he 20 did at a later point acknowledge some degree of 21 illness. And I disagree that he would be -- 22 that he was worse off after his hospital 23 treatment or in the CAFE study than he was 24 beforehand. 25 Q. Dan committed suicide, correct? VERBATIM COURT REPORTING 763-493-4535 140 1 A. Yes. 2 Q. And the autopsy report proved that he had no 3 medication in his blood stream at all at the 4 time he died, correct? 5 A. That's my understanding, although, I have not 6 seen any -- not seen the actual report and I 7 don't know the specifics of what assay was done 8 or sensitivity. 9 Q. And, in fact, the clinical treatment records 10 and the records of multiple sources document 11 that Dan almost certainly was not taking any 12 medication for weeks before he died, isn't that 13 in fact the case? 14 A. That is not the case. 15 Q. So isn't it in fact the case that Dan's mother 16 did correctly predict that his mind would 17 deteriorate to the point where he would act on 18 evil thoughts, that was an accurate prediction, 19 wasn't it? 20 A. Yes. 21 Q. You failed to call Dan's mom when she sent you 22 this letter, didn't you? You didn't talk to 23 her about this? 24 A. I don't recall. I don't recall the specifics 25 of my contact at this particular point. I know VERBATIM COURT REPORTING 763-493-4535 141 1 that I was certainly aware of this and we 2 discussed it with the team and it may be that 3 one of the other people on the treatment team 4 discussed it with her if I didn't. 5 Q. In fact, nobody did, isn't that right? 6 MR. ALSOP: Object on the basis of 7 foundation, speculative. If you know, Doctor, 8 go ahead. 9 A. I don't know. 10 Q. What kind of -- as someone who is doing 11 research involving human subjects, and as 12 someone trained by the University of Minnesota 13 and supervised by the IRB and Dr. Schulz, what 14 kind of authorization to use health care 15 information do you need from human subjects in 16 your research? 17 MR. GROSS: Objection, form. 18 MR. ALSOP: I'll join in that. 19 A. What kind of authorization do I need for what? 20 Q. (BY DR. BARDEN) To use health care records. 21 A. To use health care records? 22 Q. Yes. 23 MR. ALSOP: I'll object as vague and 24 ambiguous. 25 A. I don't understand if it's the hospital's VERBATIM COURT REPORTING 763-493-4535 142 1 health care records, then I'm involved in 2 writing and forming. I don't need anyone's 3 permission to document what's going on. If I 4 want to release that information to someone 5 else, I need the patient's permission. 6 Q. And someone conducting research with human 7 subjects and trained by the University of 8 Minnesota and supervised by the IRB and Dr. 9 Schulz, how many signatures and what kinds of 10 signatures do you need to get a study subject 11 enrolled? 12 MR. GROSS: Objection, form. 13 MR. ALSOP: It's vague and ambiguous 14 also. Go ahead. 15 A. I think the patient needs to sign the consent 16 form, the informed consent document, and 17 currently patients also sign a separate HIPA 18 document that contains language about protected 19 health information and how it will be used, but 20 I don't believe at the time that Dan entered 21 the CAFE study that a separate document was 22 required. I believe that that protected health 23 information was incorporated into the informed 24 consent document. 25 Q. Isn't it in fact the case that Dan was supposed VERBATIM COURT REPORTING 763-493-4535 143 1 to sign a HIPA authorization and he never was 2 asked to do so and never did so in your study? 3 MR. ALSOP: It's a multiple question, 4 vague and ambiguous. Go ahead, Doctor. 5 A. I'm not aware that there were any documentation 6 failures like that, no. 7 Q. (BY DR. BARDEN) Did anyone in your CAFE study 8 sign a HIPA authorization form? 9 A. I don't know. 10 Q. So you don't know if Dan was the only one who 11 did not sign a HIPA authorization? 12 A. I don't know. 13 Q. Do you know what the University rules are with 14 regard to conducting research when a subject 15 has not signed a HIPA authorization form? 16 A. No, I don't know what the consequences are or 17 the rules. 18 Q. Do you think that would be a good thing to know 19 before you do research with human subjects? 20 MR. ALSOP: Object as argumentative. 21 It's also irrelevant. Go ahead, Doctor. 22 A. Yes. I always try to follow the appropriate 23 documentation rules. And if at the time that 24 Dan entered the study we were required to have 25 his signature on a separate HIPA document and VERBATIM COURT REPORTING 763-493-4535 144 1 we failed to do so, I would have expected that 2 when the IRB and the FDA inspected the program, 3 I would have been informed of that. 4 Q. And it's your understanding that Dan never 5 during the entire time he was in your study, he 6 never did sign a HIPA document? 7 A. That's not my understanding. I don't know. I 8 don't recall offhand what he signed or not. 9 Q. Well, there is not in any of the documents 10 we've been disclosed, in fact, there is a blank 11 form. So if there was a blank form in the file 12 for a HIPA authorization that was never signed 13 by anybody, would that help you to understand 14 when you needed to do that? 15 MR. ALSOP: Object as speculative, 16 lacking foundation. 17 A. Could you repeat the question? 18 Q. If there was a blank HIPA form in the CAFE 19 documents that were disclosed to us with a 20 place for people to sign that was never signed, 21 would that help you understand when you needed 22 to get a HIPA signature? 23 A. Well, that would suggest that we in fact should 24 have had a -- he should have signed that, yes. 25 Q. Isn't that required by federal law and the VERBATIM COURT REPORTING 763-493-4535 145 1 University of Minnesota policy to have a study 2 specific HIPA form approved by the IRB and 3 signed by each subject? 4 MR. ALSOP: Object to foundation. Go 5 ahead, Doctor, if you know. Also multiple. 6 A. Yeah, I believe that's correct. 7 Q. (BY DR. BARDEN) Did you violate that rule in 8 the CAFE study? 9 A. I don't -- I don't have any -- I don't have any 10 personal knowledge that we violated that. 11 Again, if I had -- if that were the case, I 12 would be surprised that it hadn't been brought 13 to my attention before, and maybe it has and I 14 forgot about it. 15 Q. Under the IRB rules, how long must you keep 16 those signed authorizations? 17 A. A long time. I don't know specifically how 18 long. 19 Q. Do you have any idea at all other that a long 20 time? 21 A. Five years, ten years, something, 15 years. 22 Probably required by the FDA to hold the 23 records for longer than the IRB would require, 24 so it's 15 years for the FDA. 25 Q. The next document is the assignment of case VERBATIM COURT REPORTING 763-493-4535 146 1 manager dated -- why don't we stop now and 2 change tapes if you would like to. 3 (A brief recess was taken). 4 Q. (BY DR. BARDEN) Do you see where it says 5 mental health unit supervisors, Dakota County 6 Social Services? 7 A. Yes. 8 Q. Dated 11/24/03, assignment of mental health 9 case manager, the case of Dan Markingson has 10 been assigned to David Pettit. Do you see 11 that? 12 A. Yes. 13 Q. So David Pettit was not involved in your 14 getting Dan to sign your informed consent form 15 for your study, correct? 16 A. That's correct. 17 Q. Next document is the research consent form of 18 11/21/03. We will mark that as Exhibit No. 9. 19 (Exhibit No. 8-9 were marked for 20 identification by the Court Reporter). 21 Q. (BY DR. BARDEN) Could you identify that for 22 us, please? 23 A. This is the consent form for the CAFE study. 24 Q. If you look at the -- this is also Bates 25 numbered, by the way, PSY 000176 through PSY VERBATIM COURT REPORTING 763-493-4535 147 1 000185. If you go to page -- 2 MR. ALSOP: Counsel, just so I'm clear, I 3 think you've got two separate documents, 4 Exhibit 9 so we're clear on that. You got the 5 evaluation. I don't think that is the consent 6 form. 7 A. Yeah. 8 MR. ALSOP: It's a separate document, but 9 as long as the record is clear, that's fine. 10 Q. Okay. That's fine. We'll go ahead. 11 MR. ALSOP: So Exhibit 9 has both the 12 consent form and also a one-page document 13 entitled evaluation to sign consent form 14 000186. 15 Q. Why don't we make that Exhibit No. 10. 16 (Discussion off the record). 17 Q. (BY DR. BARDEN) If you look at the last page 18 of the consent form. This is PSY 000185, do 19 you see the signatures there? 20 A. Yes. 21 Q. Do you see the signature of Dan? 22 A. Yes. 23 Q. And that would be your signature? 24 A. Yes. 25 Q. You're signing as the witness, correct? VERBATIM COURT REPORTING 763-493-4535 148 1 A. Yes. 2 Q. And then Jean Kenney signed as the person 3 obtaining consent, isn't that right? 4 A. Yes. 5 Q. And Jean Kenney at that time was a social 6 worker, not a medical professional, isn't that 7 correct? 8 A. She's a licensed independent clinical social 9 worker who was the research study coordinator 10 for the CAFE study as well as an experienced -- 11 Q. Objection. 12 A. -- social worker but not a physician. 13 Q. She's not a physician, correct? Why did you 14 sign as a witness? Why did you not obtain 15 consent? Why did you have Kenney do it? 16 A. It's a collaborative process. I had to talk to 17 Dan on previous occasions about the CAFE study 18 and had informed him of many of the 19 characteristics and the requirements of the 20 study and talked to him after this session in 21 which Jean Kenney went through the document in 22 detail. And so I consider the consent a 23 process, not -- I wasn't simply present while 24 Jean discussed this with Dan. 25 Q. So this took place one day after the court VERBATIM COURT REPORTING 763-493-4535 149 1 order that we just looked at, correct? Look to 2 the court order dated November 20th, correct? 3 A. Yes. 4 Q. And the 21st would be one day after the 20th, 5 isn't that right? 6 A. Yes. 7 Q. And so both you and Jean Kenney, as we've 8 already discussed, have financial ties to 9 Astrazeneca, isn't that true? 10 MR. ALSOP: It's argumentative and 11 misstatement of his testimony and repetitious. 12 Go ahead. 13 MS. SVITAK: Same objection. 14 A. Astrazeneca funded the study, yes. 15 Q. (BY DR. BARDEN) And you and Kenney were paid 16 monies from that funding as it went through the 17 University system, correct? 18 A. Yes. 19 Q. And so no one -- there was no one present and 20 no one signed this form other than Dan who was 21 free of the obvious financial conflict of 22 interest of being paid monies by Astrazeneca, 23 isn't that correct? 24 DR. BARDEN: Object as argumentative, 25 misstatement of the testimony and repetitious. VERBATIM COURT REPORTING 763-493-4535 150 1 Go ahead, Doctor. 2 MS. SVITAK: Same objections. 3 A. No. As I recall, this meeting at which Dan and 4 Jeanie and I discussed his participation, there 5 was no one else present. However, the decision 6 to proceed with the CAFE study was one in which 7 the entire team participated, including Dave 8 Pettit, who was involved with the case during 9 this screening process that followed the 10 signing of the consent form. 11 Q. Objection, move to strike the entire response 12 as non-responsive after the word "present". 13 Doctor, are you arguing that David Pettit had 14 something to do with Dan signing your consent 15 form when he wasn't even assigned for three 16 more days? 17 A. No. What I said was that Dan's continued 18 participation in the CAFE study involved the 19 participation and approval of Dave Pettit, that 20 being in the CAFE study would meet the 21 requirements of an appropriate treatment plan. 22 Q. Did I ask you about his continuing 23 participation or am I asking you about his 24 informed consent? You obtained his informed 25 consent in a room alone with Dan and Ms. VERBATIM COURT REPORTING 763-493-4535 151 1 Kenney, correct? 2 A. Yes. 3 Q. One day after the court order, correct? 4 MR. GROSS: Objection, asked and 5 answered. 6 MR. ALSOP: Repetitious. Go ahead, 7 Doctor. 8 A. Yes. 9 Q. (BY DR. BARDEN) And you don't think there was 10 any coercion involved with the court ordering 11 him to do what you told him to do and then you 12 get him to sign your study form, you don't see 13 any coercion there at all, Dr. Olson? 14 MR. ALSOP: That's argumentative. Go 15 ahead, Doctor. 16 A. No, because the whole entire process, we made 17 it abundantly clear to Dan that he didn't have 18 to participate in the CAFE study, that there 19 were other options as well, and that this was 20 just one of the possible ways in which he could 21 be treated. 22 Q. And Dan was a psychotic, looking to get out of 23 the hospital in any way he could, isn't that 24 right? 25 MR. ALSOP: That's lacking in foundation, VERBATIM COURT REPORTING 763-493-4535 152 1 speculative and argumentative. 2 A. I suppose that he did want to get out of the 3 hospital, but that participating in the CAFE 4 study, if anything, may have delayed it since 5 there were procedures that were involved in the 6 study that might prolong his hospitalization. 7 Q. But if he didn't do what you wanted, he would 8 get committed to Anoka? 9 A. No. If he didn't participate in any 10 appropriate treatment plan, there could be 11 filed a motion to revoke the stay of 12 commitment, but the CAFE study was only one way 13 that he might get part of that treatment. 14 Q. Let me ask you this. Can you give me the name? 15 That is a question about a name. Can you give 16 me the name of any psychiatrist in the United 17 States that has ever signed one of his clinical 18 patients into his research treatment study the 19 day after there is a stay of commitment on that 20 patient? And I'm looking for a name. Anyone 21 who has ever done that in the United States 22 other than Dr. Stephen Olson? 23 MR. ALSOP: Object on the basis -- 24 Q. I'm looking for that name. 25 MR. ALSOP: Object on the basis of VERBATIM COURT REPORTING 763-493-4535 153 1 foundation and speculative. If you know, 2 Doctor. 3 A. No, I don't have a specific name, but I would 4 be surprised if it hadn't happened or that even 5 people were signed into studies who were 6 actually committed. 7 Q. Objection, move to strike as non-responsive 8 after the word "name". Let's go to the first 9 page of what's been marked as Exhibit No. 9. 10 Do you know the University of Minnesota rules 11 with regard to the informed consent form? 12 A. Yes. 13 Q. And what are they? 14 A. There are many rules regarding the consent 15 form. 16 Q. Let me ask you a few specifics. For example, 17 does it have to be printed on Minnesota 18 letterhead? 19 A. No. 20 Q. Really? Have you never heard of any rule, 21 stating that research studies at the University 22 of Minnesota, their consent form must be 23 printed on Minnesota letterhead? 24 MR. GROSS: Objection, argumentative. 25 MR. ALSOP: Asked and answered and VERBATIM COURT REPORTING 763-493-4535 154 1 argumentative. 2 Q. Are you aware of it or you're not? 3 MR. ALSOP: Same objections, asked and 4 answered. 5 A. I'm doing ten studies, and the consent form is 6 cleared by the IRB on every occasion, and none 7 of them are on the University of Minnesota 8 letterhead. 9 Q. Are you aware of any Web sites where the 10 University proclaims to the public that this is 11 a rule, that they require this? 12 A. No. 13 Q. Are you aware of any requirement that the 14 department must be listed on the informed 15 consent form? 16 A. No. 17 Q. Your department is not listed on your form, 18 isn't that right? 19 A. No. The words University of Minnesota 20 Department of Psychiatry are not on the consent 21 form. 22 Q. So it's not on letterhead and the department is 23 not named, correct? 24 A. It does say the research has been reviewed and 25 approved by the IRB at the University of VERBATIM COURT REPORTING 763-493-4535 155 1 Minnesota. 2 Q. Doesn't say your department, no letterhead, 3 correct? 4 A. That's correct. 5 Q. Now, on Page 1, it says, the investigator is 6 being paid by Astrazeneca to conduct this 7 study. Do you see where it says that? 8 A. Yes. Underlined. 9 Q. Do you see where it says that there are 10 financial incentives to keep you in the study 11 as long as possible? 12 MS. SVITAK: Objection, argumentative. 13 Q. Does it say that on the form or not? 14 A. No. No. 15 Q. But you said that yourself earlier this 16 morning, didn't you? 17 A. Yes. 18 Q. So Dan was not informed of that, was he, that 19 part of the conflict of interest? 20 MR. ALSOP: Object as argumentative. 21 Q. (BY DR. BARDEN) Is this the only information 22 you have in here about a financial conflict of 23 interest, that you're, quote, being paid, 24 unquote to, quote, conduct this study, unquote, 25 is that it? VERBATIM COURT REPORTING 763-493-4535 156 1 A. I would assume so. 2 Q. And you think that adequately discloses 3 financial conflict of interest where there is 4 more money involved for you the longer people 5 stay in your study? 6 MR. ALSOP: Argumentative, repetitious. 7 A. Yes. I think that this is adequate information 8 to provide to the subject. 9 Q. Do you think that adequately discloses that 10 Astrazeneca has a multi billion dollar interest 11 in finding that this drug is at least as good 12 as these others? 13 MS. SVITAK: Objection, form, 14 argumentative. 15 MR. ALSOP: Join. 16 MR. GROSS: Lack of foundation. 17 MS. SVITAK: Lack of foundation. 18 Q. (BY DR. BARDEN) Do you think this adequately 19 discloses that many national experts in ethics 20 find it unethical for a treating psychiatrist 21 to also be the study psychiatrist and also the 22 PI for an individual patient? 23 MR. ALSOP: Same objections. 24 A. I disagree with that conclusion. 25 Q. Now, at the bottom it says, you may refuse to VERBATIM COURT REPORTING 763-493-4535 157 1 participate or may withdraw your consent to 2 participate in any study at any time. Do you 3 see that? 4 A. Yes. And for any reason without jeopardizing 5 your future care at this institution or your 6 relationship with your doctor. You do not have 7 to participate in research in order to receive 8 treatment. 9 Q. That wasn't true, given the court order that 10 ordered Dan to do what you asked him to do, and 11 you asked him to go into your treatment study? 12 MR. ALSOP: Object as argumentative -- 13 wait -- and a misstatement of his statement. 14 Go ahead, Doctor. 15 A. No. That's -- it is absolutely true because if 16 he had refused to participate in the CAFE 17 study, he could have chosen to see me in the 18 outpatient clinic or he could have chosen to go 19 to a private practice clinic or mental health 20 center. 21 Q. And Dan, a patient who didn't even believe he 22 had a mental illness and has been court ordered 23 to do exactly what you tell him to do is 24 supposed to make that distinction, Doctor? 25 MR. ALSOP: Argumentative, irrelevant. VERBATIM COURT REPORTING 763-493-4535 158 1 Go ahead, Doctor. 2 MR. GROSS: Objection to form. 3 A. At the time that he signed this consent form, I 4 do believe that he had a -- I do believe that 5 he understood he had a mental illness and that 6 he was going to receive treatment for it. 7 Q. And you had a financial conflict of interest, 8 which is why the ethics rules of your 9 profession require that you get someone without 10 a financial conflict of interest to make that 11 assessment, isn't that right, Doctor? 12 MR. ALSOP: That's a misstatement of his 13 testimony. It's argumentative and it's 14 multiple. Go ahead, Doctor. 15 A. No. 16 Q. (BY DR. BARDEN) That says the purpose of the 17 study is to compare the effectiveness and side 18 effects of three antipsychotic medications for 19 the treatment of schizophrenia, 20 schizophreniform or schizoaffective disorder. 21 All of these medications are currently approved 22 by the FDA for use in the United States. Do 23 you see that? 24 A. Yes. 25 Q. Is that language deceptive and misleading? VERBATIM COURT REPORTING 763-493-4535 159 1 A. No. 2 Q. For example, at the time you did this study, 3 had the FDA approved those three drugs for 4 schizophrenia? 5 A. Yes. 6 Q. Had the FDA approved those three drugs for 7 schizophreniform? 8 A. No. There are no approved treatments for 9 schizophreniform disorder. 10 Q. So you don't find this language deceptive, 11 deliberately deceptive, in saying all of these 12 medications are currently approved by the FDA 13 but not for some of the illnesses studied, 14 where it say that, Doctor? 15 MR. ALSOP: Object. Is there a question? 16 Q. Don't you find that deliberately misleading to 17 subjects? 18 MR. ALSOP: It's repetitious and asked 19 and answered. Go ahead. 20 A. No. 21 MR. ALSOP: You've answered the question, 22 Doctor. 23 A. The majority of treatments, the majority of 24 disorders have no approved treatment, for 25 example, schizophreniform and for the most part VERBATIM COURT REPORTING 763-493-4535 160 1 schizoaffective disorder, yet we still have to 2 treat them and the standard of care in the 3 community is to use antipsychotic medication. 4 Q. So why don't you tell that to your research 5 subjects instead of misleading them into 6 thinking that the FDA has approved this drug 7 for all of these illnesses? 8 A. Well, for one thing, Dan had schizophrenia. 9 And that's what we had told him, so I didn't 10 feel the need to describe off-label treatment 11 of schizophreniform or schizoaffective disorder 12 because it wasn't relevant in his case. 13 Q. This is a form, isn't it? You don't print a 14 new informed consent form unique to every 15 individual, do you, Doctor? This is a form. 16 A. No. Yes. 17 Q. This form was approved by the IRB, the 18 University of Minnesota, correct? 19 A. Yes. 20 Q. Dr. Schulz saw this form, too, didn't he? 21 A. Yes. 22 Q. Astrazeneca saw this form, too, didn't it? 23 A. Yes. 24 MS. SVITAK: Foundation. 25 Q. And yet the FDA had not approved these drugs VERBATIM COURT REPORTING 763-493-4535 161 1 for schizophreniform and it had not approved 2 these drugs for schizoaffective, correct? 3 A. Yes. That's correct. 4 Q. And yet this clearly gives the impression, the 5 false, deceptive and misleading impression that 6 it's approved for all these illnesses, doesn't 7 it? 8 A. No. 9 MS. SVITAK: Object to form. 10 Q. I guess a jury will have to decide that. 11 MS. SVITAK: Objection to statements. Is 12 that a question? 13 Q. (BY DR. BARDEN) It says, if you are a -- I'm 14 going under number three, description of the 15 research study -- if you are an outpatient you 16 will come to the study doctor's office for 17 these visits. If you are hospitalized, the 18 study doctor will come to you for the study 19 visits. If necessary due to a change in your 20 condition we will schedule extra study visits 21 at no cost to you. Is that what it says? 22 A. Yes. 23 Q. Wasn't it in fact the case that most of his 24 visits he was seeing social workers and not 25 doctors? VERBATIM COURT REPORTING 763-493-4535 162 1 A. No. 2 Q. Did he see a doctor every time? Did a study 3 doctor come to him all the time? Was he going 4 to see a doctor at the office? Isn't this 5 misleading? Wasn't he in fact seeing social 6 workers more than doctors? 7 MR. GROSS: Objection. Multiple. 8 MR. ALSOP: Multiple questions. 9 Argumentative, vague and ambiguous. Go ahead, 10 Doctor. 11 A. No, he came to the -- he came to the research 12 clinic -- research clinic for his outpatient 13 visits. And when he was in the hospital, he 14 was seen by a physician every day, but that was 15 part of the research. That was part of the 16 clinical care provided because he was a 17 hospitalized patient. 18 Q. He was out of the hospital December 14th, 19 correct? 20 A. Before that. 21 Q. The 8th, December 8th, correct? 22 MR. ALSOP: The 8th. 23 Q. (BY DR. BARDEN) So from December 8th until he 24 died, how many visits did he have? 25 A. I believe eight or nine official study visits. VERBATIM COURT REPORTING 763-493-4535 163 1 Q. How many of those study visits did he see a 2 doctor? 3 A. I don't know specifically, but I would think 4 the majority of them. 5 Q. Does it indicate that he's going to be seen by 6 social workers for some -- or I think the 7 records will indicate maybe most of his visits, 8 any indication of that or is it misleading him 9 into thinking that he's going to get more care 10 from doctors than is true? 11 MR. ALSOP: It is now a multiple question 12 and it's also vague and ambiguous. Go ahead, 13 Doctor. 14 A. No, I don't think it was misleading. He was 15 provided care by a team and I saw him -- most 16 of the visits I supervised his care throughout 17 and I would have been available to see him at 18 short notice on any other time if there was an 19 indication of a crisis. So I believe that he 20 was provided with adequate care. 21 Q. How many times did you actually see him as a 22 physician during the time from December 8th 23 until Dan's death? 24 A. I don't know specifically. 25 Q. Do you have any idea at all, having reviewed VERBATIM COURT REPORTING 763-493-4535 164 1 the records in your office recently, do you 2 have any idea at all? 3 A. My guess is that I probably saw him half a 4 dozen times. 5 Q. You actually saw him less than once a month, 6 didn't you? 7 A. He had visits weekly for the first six weeks of 8 the study, then every other week and then 9 monthly visits, I think, by the time of his 10 death, the visits were monthly. 11 Q. During March and April when the records reflect 12 significant deterioration, how many times did 13 you see Dan then? 14 MR. GROSS: Objection. 15 MR. ALSOP: That is a misstatement of the 16 evidence in this case and it's argumentative. 17 Go ahead and answer. 18 Q. (BY DR. BARDEN) How often did you see him in 19 March and in April? 20 A. At that point the visits were monthly, but I 21 disagree that he had significant deterioration. 22 Q. Well, the proof of that is in the coroner's 23 report, isn't it, Doctor? 24 MR. ALSOP: You don't have to answer that 25 question, Doctor. VERBATIM COURT REPORTING 763-493-4535 165 1 Q. (BY DR. BARDEN) You saw him once in March and 2 once in April approximately during the last two 3 months of his life, correct? 4 A. Yes. 5 Q. Now, was this form read to Dan? Was the 6 informed consent form read to him? Was that 7 the method? 8 A. No. My recollection is that Dan was a college 9 graduate and a writer, so he was given a copy 10 to review prior to the meeting and it was read 11 over with him and he read along and asked 12 questions as he needed an explanation. 13 Q. Did Jean read it to him or did you? 14 A. I just said I don't think either of us read the 15 entire document to him. As I recall, he went 16 through it with Jeanie, outlining the important 17 points and reviewing any areas where he had 18 concerns. If he had questions, either Jean or 19 I answered them. 20 Q. Have you ever heard of the Western IRB? 21 A. Yes. 22 Q. What is the Western IRB rules about obtaining 23 informed consent with people with financial 24 conflicts of interest, if you know? 25 A. I don't know. VERBATIM COURT REPORTING 763-493-4535 166 1 Q. Isn't it in fact a requirement of the Western 2 IRB that a witness not affiliated with the 3 research be present in the room in such 4 circumstances? 5 MR. ALSOP: Doctor, it's lacking in 6 foundation and speculative. If you know, go 7 ahead. 8 A. My research is conducted under the supervision 9 of the University of Minnesota IRB, so I don't 10 know what the rules are for the Western IRB and 11 don't think they apply. 12 Q. Do you have any idea whether that is their 13 requirement? 14 A. No. 15 Q. Do you have any idea why they would make such a 16 requirement? 17 MR. ALSOP: Object as speculative, 18 lacking foundation, irrelevant. Go ahead, 19 Doctor. 20 A. Well, I suspect that they believe that prevents 21 any conflict of interest. 22 Q. Let me read you a study and see if you -- a 23 statement and see if you agree with it. When 24 the treating physician is an independent 25 individual, the treating physician can assess VERBATIM COURT REPORTING 763-493-4535 167 1 dispassionately his or her patient's competence 2 to sign informed consent because the treating 3 physician does not receive financial 4 compensation from a pharmaceutical company 5 sponsor for the subject study visits and is 6 also not subject to pressure by pharmaceutical 7 company to enroll a certain quota of subjects 8 within a certain period of time. Would you 9 agree with that statement? 10 MR. ALSOP: It's a multiple question, 11 vague and ambiguous and argumentative. Go 12 ahead, Doctor. 13 MS. SVITAK: Object to form. 14 A. No, I would disagree with that. 15 Q. (BY DR. BARDEN) Why would you disagree with 16 that, Doctor, that it's better to have a 17 treating physician who is an independent 18 individual, not subject to financial conflicts 19 and pressures to enroll subjects? 20 A. I'm sorry. I thought it was the required. 21 Q. No. I'm just -- as a general statement, isn't 22 that true, it's better to have an independent 23 physician who doesn't have conflicts of 24 interest to enroll, pressure to enroll 25 subjects, money to be made, $15,000 per VERBATIM COURT REPORTING 763-493-4535 168 1 subject? 2 MS. SVITAK: Object to form. 3 Q. Isn't it better care for a patient to have an 4 independent physician who is free of those 5 financial conflicts of interest? 6 MR. ALSOP: It's a multiple question. 7 Argumentative. Go ahead, Doctor. 8 A. No. Not necessarily. 9 Q. (BY DR. BARDEN) Let me read you from the 10 declaration of Helsinki. You said you've at 11 least heard of that, haven't you? 12 A. Yes. 13 Q. Isn't that an international bioethics 14 foundational document? 15 A. Yes. 16 Q. Article 10, quote, when obtaining informed 17 consent for research projects, the physician 18 should be particularly cautious if the subject 19 is in a dependent relationship to him or her -- 20 such as their patient -- or may consent under 21 duress -- such as being state commitment. In 22 that case the informed consent should be 23 obtained by a physician who is not engaged in 24 the investigation and who is completely 25 independent of this official relationship VERBATIM COURT REPORTING 763-493-4535 169 1 declaration of Helsinki Article 10. Would you 2 agree with that? 3 MR. ALSOP: I'll object to the form of 4 the question. It's argumentative. You've 5 added words beyond what's in that document. 6 Q. (BY DR. BARDEN) Just so the record is clear, 7 I'm going to read the Article 10. When 8 obtaining informed concept for the research 9 project, the physician should be particularly 10 cautious if the subject is in a dependent 11 relationship to him or her or may consent under 12 duress. In that case, the informed consent 13 should be obtained by a physician who is not 14 engaged in the investigation and who is 15 completely independent of this official 16 relationship, unquote. Do you agree with that, 17 Dr. Olson? 18 A. I agree that the clinician and the investigator 19 should be cautious. I don't agree that it's 20 necessary that the consent be obtained by 21 someone else. 22 Q. Let me ask you if you agree with this. By 23 contrast, Dr. Olson, who will simultaneously PI 24 the study, study physician for Dan, and 25 treating physician for Dan, having strong VERBATIM COURT REPORTING 763-493-4535 170 1 motivation both to enroll Dan into his study 2 and then not to draw Dan from the study. Since 3 Olson and his institution benefitted 4 financially from each successive study visit by 5 Dan and Olson and his institution maintain 6 their reputation with the study sponsor by 7 recruiting subjects, as many subjects as 8 possible, and by encouraging them to continue 9 participation in the study, end quote, do you 10 agree with that? 11 A. No. 12 MR. ALSOP: What's it from? Wait. Wait. 13 What's it from? What's the statement from 14 you're quoting from? 15 DR. BARDEN: I don't have to inform you. 16 MR. ALSOP: He doesn't have to answer the 17 question. 18 DR. BARDEN: I've asked his opinion about 19 a very clear statement about his conduct in 20 this case. 21 MR. ALSOP: You're quoting something. 22 You're not asking the question. You're quoting 23 something without telling us what it is. You 24 don't have to answer that question. 25 Q. (BY DR. BARDEN) So did you change your VERBATIM COURT REPORTING 763-493-4535 171 1 recruiting strategy after 2001 and 2002 when 2 you had so much trouble recruiting subjects? 3 MR. ALSOP: Object, assumes facts not in 4 evidence. Argumentative. 5 A. No. 6 Q. (BY DR. BARDEN) Do you remember you mentioned 7 the first study you did, you didn't recruit 8 enough subjects and it failed, correct? 9 A. That was a different kind of study all 10 together. 11 Q. But that's what you mentioned. You didn't 12 recruit enough and it failed, correct? 13 A. We didn't recruit any at the Minnesota site. 14 The study itself didn't fail. 15 Q. But you yourself didn't recruit enough to make 16 the study go, correct? That's what you told us 17 this morning. 18 A. I wasn't entirely responsible for that study. 19 That was initially Dr. Schulz's study and I 20 took it over and there were -- there are, you 21 know, many studies don't recruit, the single 22 biggest reason why research is difficult. 23 Q. Let's look at Page 6 of 10 of the consent form. 24 This is Bates stamp PSY 000181. Do you see 25 that, where he's talking about side effects of VERBATIM COURT REPORTING 763-493-4535 172 1 the drugs? 2 A. Yeah. 3 Q. Insomnia, inability to sit still, et cetera, et 4 cetera. 5 A. Yes. 6 Q. Could you show me anywhere on this form where 7 the risk of suicide is disclosed? I'm looking 8 for the word suicide in your adult consent. 9 A. It's not here. That would be covered under the 10 paragraph on Page 5, meaning the preceding this 11 section, is risk that your symptoms of your 12 illness will not respond to the study 13 medication, your condition may worsen if the 14 study drug is ineffective for you. 15 Q. The word suicide as a risk of the use of these 16 drugs is not disclosed anywhere on your 17 informed consent form, correct? 18 MR. ALSOP: Misstatement of his 19 testimony. 20 Q. (BY DR. BARDEN) The word suicide is not on the 21 form, correct? 22 A. Correct. 23 Q. Is the word suicide in the list of side effects 24 in the drug insert for Seroquel? 25 MR. ALSOP: Wait. Object as vague as to VERBATIM COURT REPORTING 763-493-4535 173 1 what we're talking but go ahead, you can 2 answer. 3 A. It is now. It was added in 2006. 4 Q. Was suicide a foreseeable outcome of the use of 5 these drugs in 2004? 6 MR. ALSOP: Object as speculative. Go 7 ahead. 8 MS. SVITAK: Same objection. 9 A. No. 10 Q. When did the Japanese require suicide to be 11 listed as a potential side effect for Seroquel? 12 MR. ALSOP: Object, it's irrelevant, 13 lacking in foundation and speculative. Go 14 ahead, Doctor. 15 MS. SVITAK: Same objection. 16 A. I don't actually know. 17 Q. Wasn't it several years before you enrolled Dan 18 in the study? 19 MR. ALSOP: Object on foundation and 20 speculative. He's already answered the 21 question. 22 Q. (BY DR. BARDEN) Is there some reason why the 23 Japanese deserve to be warned about suicide but 24 not Americans? 25 MR. ALSOP: You don't have to answer that VERBATIM COURT REPORTING 763-493-4535 174 1 question, Doctor. Don't answer that question. 2 MS. SVITAK: Object to form. 3 DR. BARDEN: Do you have a legal opinion 4 you're instructing him not to answer? 5 MR. ALSOP: Yes, I do. 6 DR. BARDEN: Are you having him take the 7 fifth amendment or what? You have to have a 8 legal rational. 9 MR. ALSOP: You're arguing with him. 10 DR. BARDEN: I asked him a question. 11 MR. ALSOP: No, you didn't. 12 A. I said, I don't know what the Japanese 13 requirements are. 14 Q. (BY DR. BARDEN) Are you aware of any medical 15 reason why the Japanese would need to be warned 16 of suicide months or years before Americans? 17 MR. ALSOP: Doctor, if you know. 18 A. No. 19 Q. How about diabetes as a risk for Seroquel? 20 MR. ALSOP: It's irrelevant. 21 Q. Is diabetes, is there an increased risk for 22 diabetes with Seroquel? 23 MS. SVITAK: Objection, irrelevant. 24 A. That's debatable. 25 Q. Did you receive a notice from Astrazeneca that VERBATIM COURT REPORTING 763-493-4535 175 1 that was in fact the case that you needed to 2 start getting consent that included warnings 3 for hyperglycemia and diabetes? 4 A. Yes. 5 Q. When did you receive that warning? 6 A. I don't recall specifically. Sometime during 7 the course of the CAFE study. I believe that 8 resulted in the revision of the consent form. 9 Q. And do you know if that was in fact also many 10 months after the Japanese were requiring 11 Astrazeneca warn the public about diabetes 12 there? 13 MS. SVITAK: Object, foundation. 14 MR. ALSOP: I'll join. 15 A. I know nothing about the timing of any warnings 16 to the Japanese medical community. 17 Q. (BY DR. BARDEN) How many months after 18 Astrazeneca informed you of the increased 19 dangers of diabetes, how many months did it 20 take you to inform the IRB? 21 A. I don't -- I don't know. 22 Q. You were informed in January of 2004, isn't 23 that right? 24 MR. ALSOP: Object to lack in foundation, 25 speculative. VERBATIM COURT REPORTING 763-493-4535 176 1 Q. (BY DR. BARDEN) You notified the IRB two days 2 after Dan died in May of 2004, correct? 3 MS. SVITAK: Object to form. 4 MR. ALSOP: Speculative, lacking 5 foundation. If you know the dates, go ahead. 6 A. Well, I don't know the dates. I'm sure that 7 informing the IRB about a risk of diabetes 8 didn't have anything to do with Dan's suicide. 9 Q. No one has to go with your ethical or unethical 10 practices, Doctor, right? 11 A. Is that a question? 12 Q. Yes. That's why I asked the question. Right. 13 Yeah. 14 A. No. 15 Q. Is there some reason why you waited until two 16 days after Dan died to inform the IRB of that 17 risk? 18 MR. GROSS: Objection, form. 19 MR. ALSOP: Form, also irrelevant. Go 20 ahead. 21 A. No. 22 Q. What is a dear doctor letter? 23 A. Generally, that refers to a letter from the FDA 24 that goes out to all physicians or all 25 physicians within a particular specialty VERBATIM COURT REPORTING 763-493-4535 177 1 alerting them to some safety concern about a 2 medication. 3 Q. And did you wait for months to inform the IRB 4 of the one that you received about Seroquel? 5 A. I don't recall. 6 Q. Let's look on Page 7 of 10, also PSY 000182. 7 Do you see where it says what if we learn about 8 new risks during the study. You will be given 9 any new information gained during the course of 10 the study that might affect your willingness to 11 continue your participation. Do you see that? 12 A. On Page 7? 13 Q. Right there. 14 A. Oh, yes. 15 Q. Okay. Do you see that? 16 A. Yes. 17 Q. But in fact, this new warning about diabetes, 18 was never given to Dan until -- he died, you 19 never gave it to him, isn't that right? 20 MR. ALSOP: Object as speculative, 21 lacking in foundation. 22 Q. (BY DR. BARDEN) So Dan never got to make the 23 decision as to whether it would affect his 24 willingness to continue his participation in 25 your study, did he? VERBATIM COURT REPORTING 763-493-4535 178 1 MR. ALSOP: Argumentative, irrelevant. 2 Go ahead, Doctor. 3 A. The consent form indicates a concern about high 4 blood sugar and high cholesterol, and we tried 5 for months to get Dan to go to a primary care 6 doctor to deal with his high cholesterol. And 7 he refused. So I doubt that a possibility of 8 diabetes would have played much of a role, but 9 we probably didn't inform him of that risk 10 specifically in writing. 11 Q. In fact, you never reconsented Dan at all, did 12 you? You got his consent, the day after the 13 court order and never got a reconsent; isn't 14 that correct? 15 MR. ALSOP: Vague and ambiguous as to 16 what you mean by that but go ahead, you can 17 answer. 18 A. We didn't have him sign another consent form 19 but there were numerous discussions about his 20 willingness to continue in the study and 21 specifically he was advised that he could drop 22 out of the study at any point. 23 Q. But one of those discussions included the risk 24 of diabetes, which you were notified of in 25 January of 2004, correct? VERBATIM COURT REPORTING 763-493-4535 179 1 A. I don't recall whether that was mentioned or 2 not. 3 Q. Let's look at Page 8 of 10 PSY 000183. Do you 4 see where it says alternative treatments? 5 A. Yes. 6 Q. Do you see that section? Do the words bipolar 7 illness appear in alternative treatments? 8 A. No. I think that's irrelevant. 9 Q. Does the term Depakot appear under alternative 10 treatments? 11 A. None of the alternative medications or 12 therapies are spelled out in this section. 13 Q. Does the term Tegretol appear in this section? 14 A. None of the specific medication alternatives 15 are specified in this section. 16 Q. Does the term ECT appear in this section? 17 A. No. 18 Q. Does the term using multiple antipsychotics at 19 the same time appear in this section? 20 A. No. 21 Q. Those are all gross violations of the standard 22 of care for informed consent, are they not, Dr. 23 Olson? 24 A. No. 25 Q. Does the word -- the term chemical dependency VERBATIM COURT REPORTING 763-493-4535 180 1 treatment appear in this section? 2 A. No. 3 Q. Was there a social worker who indicated in 4 Dan's hospital chart that he should have 5 chemical dependency treatment? 6 A. He underwent a chemical dependency evaluation, 7 yes, and I don't recall the specifics of their 8 conclusion. 9 Q. Did Dan continue to drink heavily while he 10 lived at the Theo house? 11 A. Not that I'm aware of. 12 Q. Did your study permit people to stay in the 13 study even if they drank heavily? 14 A. If we were aware that he was drinking heavily 15 in a way that would have invalidated the study 16 or jeopardized his stability or caused medical 17 problems, we certainly would have dropped him 18 out of the study but we weren't aware that 19 there was any such alcohol use. 20 Q. But your study specifically permits people to 21 even drink? 22 A. It did. 23 Q. Yeah. 24 A. It did allow that because this was a real world 25 study since half of the people with VERBATIM COURT REPORTING 763-493-4535 181 1 schizophrenia abuse drugs or alcohol. This 2 study is designed to be generalizeable to the 3 normal clinical situation, not be limited to 4 patients with narrowly defined illness. 5 Q. So your financial interest to keep Dan on this 6 study would not have been risked by him 7 drinking heavily while he was at the Theo 8 house, correct? 9 MS. SVITAK: Object to form. 10 MR. ALSOP: Object to form, assumes facts 11 not in evidence and argumentative. Go ahead, 12 Doctor. 13 A. His drinking didn't -- if he drank in 14 moderation, that would have been discouraged if 15 we -- if we were aware that he was abusing or 16 dependent on alcohol, we would have asked him 17 to seek chemical dependency treatment but those 18 in and of themselves wouldn't have disqualified 19 him from the study. 20 Q. In fact, let me go ahead and make this an 21 exhibit. This is Washington Week, news article 22 here, Minnesota Daily, University of Minnesota 23 researchers to study schizophrenia dated 24 January 27th, 2003, an interview with Elizabeth 25 Lemke. Do you know who she is? VERBATIM COURT REPORTING 763-493-4535 182 1 A. Yes. 2 Q. Is she the assistant coordinator of the CAFE 3 trial? 4 A. Yes. 5 Q. If she told the newspapers, for example, 6 participants can be taking other medications, 7 can have hypertension or diabetes, can go off 8 their medication or skip appointments, 9 potential participants will not be excluded 10 even if they are alcoholics or using street 11 drugs like you said. Is that true? 12 A. Yes. 13 Q. Why don't we take a five minute break. 14 (A brief recess was taken). 15 Q. (BY DR. BARDEN) Okay. Are we back on the 16 record. Once again, we're looking at 17 alternative treatment Section 6 of the consent 18 form for the study. Just so it's clear, in the 19 alternative treatment section, there is no 20 disclosure of the possibility of second 21 generation antipsychotics, correct? 22 A. No. Nor first generation antipsychotics. 23 Q. So second generation antipsychotics not 24 disclosed. First generation antipsychotics not 25 disclosed. Lithium is not disclosed, correct? VERBATIM COURT REPORTING 763-493-4535 183 1 It's just a yes or no. 2 A. No, it's not. 3 Q. Mood stabilizing anticonvulsions are not 4 disclosed, correct? 5 A. No. 6 Q. electroconvulsives therapy is not disclosed, 7 correct? 8 A. I already said no. 9 Q. Combinations of these various treatments are 10 also not disclosed, correct? 11 A. No. 12 Q. Now, there is other language in here. The next 13 sentence says, all of the medications we will 14 study are available to you through your study 15 doctor. Do you see that sentence? 16 A. Yes. 17 Q. That is deceptive and misleading because it 18 gives the study participant the idea of the 19 notion strongly implies that other doctors that 20 non-study doctors can't use these medications, 21 correct? 22 A. No. 23 Q. It's a very deceptively and improperly written 24 sentence, isn't it? 25 A. No. VERBATIM COURT REPORTING 763-493-4535 184 1 MR. ALSOP: It's repetitious, form, but 2 go ahead. 3 MS. SVITAK: Form. 4 Q. (BY DR. BARDEN) Does it say anywhere in here 5 that non-study doctors, that is doctors without 6 a financial conflict of interest could also 7 give you these medications? Does it say that 8 under alternative treatments? 9 A. No, but the discussion of alternative doctors 10 occurred before, during and after the consent 11 document was reviewed with Dan. 12 Q. The next sentence says, your study doctor will 13 discuss these alternatives with you. Do you 14 see that? 15 A. Yes. 16 Q. Yet none of that is documented in any of your 17 records, is it, Doctor, there is no 18 documentation of any discussion of any of these 19 alternatives we're going over with Dan at any 20 time, place, period; isn't that correct? 21 MR. ALSOP: Vague and ambiguous, multiple 22 question, lacks foundation. Go ahead, Doctor. 23 A. There is documentation that I had discussions 24 while Dan was in the hospital about the study. 25 And those discussions included the fact that he VERBATIM COURT REPORTING 763-493-4535 185 1 didn't have to participate, could have 2 treatment elsewhere, and he had those 3 discussions with the social worker in the 4 hospital, also with Jean Kenney and I would 5 assume with Dave Pettit as well. 6 Q. Let me make this clear. There are no -- there 7 is no, zero documentation in any of these files 8 that you discussed the alternative treatment of 9 second generation antipsychotics with Dan, 10 correct? 11 MR. ALSOP: Object as lacking in 12 foundation and speculative without the record 13 but go ahead, Doctor. 14 A. While in the hospital we were treating him with 15 risperidonhe, which is a second generation 16 antipsychotic and we had a discussion about 17 that. 18 Q. There is no documentation of any kind of other 19 second generation antipsychotics, there is no 20 discussion in your records of any kind that you 21 discussed that with Dan; isn't that correct? 22 MR. ALSOP: Same objections. 23 Q. (BY DR. BARDEN) I'm talking about documenting 24 these treatments by name, not the word 25 "discussion", which may mean nothing, but I'm VERBATIM COURT REPORTING 763-493-4535 186 1 talking about these actual, specific 2 alternative treatments documented in the 3 records. They're not there, isn't that right? 4 MR. ALSOP: That's vague and ambiguous, 5 multiple, argumentative. Go ahead, Doctor. 6 A. The consent form itself lists two other 7 antipsychotic treatments, and there is no 8 documentation of specific names of alternatives 9 as there generally isn't, unless there is a 10 specific alternative chosen in a case where, 11 for example, when considering Risperidone 12 versus Clozapine, we might document that we had 13 discussion about those two alternatives but 14 generally in a discussion in the progress notes 15 it wouldn't document that we talked about 16 alternative treatments which would include -- 17 Q. So in your clinical practice, you rarely 18 document specific alternative treatments, is 19 that what you're testifying? 20 A. I would rarely list all of the alternative 21 treatments available. 22 Q. Do you think just putting the word discussion 23 down is sufficient in your notes to indicate 24 that you've discussed alternative treatments 25 with a patient? You feel for your practice VERBATIM COURT REPORTING 763-493-4535 187 1 that that meets the standard of care, Dr. 2 Olson? 3 A. I think in many cases it does. In other cases 4 I would document more. 5 Q. But it's clear that you don't mention any of 6 these specific alternative treatments in any 7 records anywhere in this case with Dan, 8 correct? 9 MR. ALSOP: Object as repetitious, 10 lacking in foundation, speculative and 11 misstatement of the evidence. Go ahead, 12 Doctor. 13 A. I don't recall specifically having reviewed all 14 of those notes that it's not there. But I 15 wouldn't be surprised if there is not a 16 specific listing of all the medication 17 alternatives. 18 Q. Now, we had talked about the second sentence 19 again, all the medications we will study are 20 available to you through your study doctor. 21 And that was a concern because it indicated 22 that those meds would not be available through 23 non-study doctors. But let me ask you a 24 followup. 25 MR. ALSOP: Wait. Wait. That's a VERBATIM COURT REPORTING 763-493-4535 188 1 statement. 2 DR. BARDEN: I'm giving the background to 3 the next question. 4 MS. SVITAK: You're testifying. 5 MR. ALSOP: You made a statement about 6 something that was contrary to what he just 7 said as a preface to whatever question you are 8 now going to ask. 9 Q. (BY DR. BARDEN) The follow-up question is, the 10 sentence says, all of the medications we will 11 study are available to you through your study 12 doctor. The language implies that even if 13 patients decide not to participate in the 14 research, they're none the less going to 15 continue in treatment with the study doctor. 16 Do you understand why that's a problem, 17 Dr. Olson? 18 MR. ALSOP: Wait a minute. That's a 19 misstatement of that statement. It's 20 argumentative. But go ahead, Doctor. 21 A. No, I disagree that that's implied. 22 Q. (BY DR. BARDEN) It is in fact this language is 23 a direct violation of the University of 24 Minnesota's own Web based tutorial on informed 25 consent which states, quote, patients can say VERBATIM COURT REPORTING 763-493-4535 189 1 no to someone they do not expect to see in the 2 future, but it is very difficult for people to 3 say no when they rely on someone for ongoing 4 medical care. Isn't that right? That's a true 5 principle from the Web -- from the University's 6 Web site, isn't it? 7 MR. ALSOP: Well, object on the basis of 8 foundation. 9 Q. (BY DR. BARDEN) Do you want me to read that to 10 you again? 11 A. Yes. 12 Q. Quote, patients can say no to someone they do 13 not expect to see in the future, but it is very 14 difficult for people to say no when they rely 15 on someone for ongoing medical care. 16 MR. ALSOP: Wait. Wait. There is no 17 question. He just read a statement. 18 Q. (BY DR. BARDEN) That's a correct principle, 19 isn't it? 20 MR. ALSOP: It's vague and ambiguous, but 21 go ahead, Doctor. 22 A. I agree with the basic principles and issues 23 involved there, but there was no sense that Dan 24 had to rely on me for continued treatment. He 25 didn't have a relationship with me before the VERBATIM COURT REPORTING 763-493-4535 190 1 hospitalization. He, in fact, may have been 2 planning to go back to California or not, you 3 know, receive any treatment at all. 4 Q. Wait a minute. You've already testified that 5 you were his treating psychiatrist before you 6 had him sign the informed consent form, 7 correct, you had a clinical -- 8 A. For the previous nine days. 9 Q. Yes. And you were his first and only major 10 psychiatrist of his life, right, he didn't have 11 a lot of mental health care before he came into 12 the hospital, correct? 13 A. That's correct. 14 Q. So he had a very significant relationship with 15 you as his treating psychiatrist, correct? 16 MR. ALSOP: Object as vague and 17 ambiguous. Go ahead, Doctor, 18 A. Well, I would disagree that that meant that he 19 didn't understand that he could go see somebody 20 else. 21 Q. This statement on the University Web site is 22 exactly why you should never have taken someone 23 who was your clinical patient and gotten them 24 into your personally profitable research study, 25 isn't that right, Dr. Olson? VERBATIM COURT REPORTING 763-493-4535 191 1 MR. ALSOP: Object to the form. It's 2 argumentative and it's also repetitious. Go 3 ahead, Doctor. 4 A. No. I disagree with the characterization of 5 personally profitable. 6 Q. Where in the alternative treatment section does 7 it talk about concominant medications, that is 8 concominant antipsychotics as an alternative 9 treatment, do you see those words anywhere in 10 that section? 11 A. No. And I would disagree with the use of 12 multiple antipsychotics in most cases, 13 especially in someone with a first episode 14 psychosis because they are unproven and they 15 expose patient to unnecessary side effects. 16 Q. But it is an alternative treatment that you 17 failed to disclose in this form, correct? 18 A. Well, there are many alternative treatments 19 that are not in the form that are -- wouldn't 20 be appropriate. 21 Q. In fact, this alternative treatment is a clear 22 violation of 45 CFR Section 46.116a4, requiring 23 a disclosure of appropriate alternative 24 procedures or courses of treatment, if any, 25 that may be advantageous to the subject; isn't VERBATIM COURT REPORTING 763-493-4535 192 1 that correct? 2 MR. ALSOP: Object, calls for legal 3 conclusions, vague and ambiguous, lacking in 4 foundation. Go ahead, Doctor. 5 A. No. The consent is a process, and during that 6 process, alternative treatments were presented 7 to the patient. The form itself doesn't list 8 all of those medications, in my opinion, 9 doesn't mean that Dan wasn't aware that there 10 were alternatives. 11 Q. Was this language that we've been discussing, 12 was this approved by the Minnesota IRB? 13 A. Yes. 14 Q. Was it approved by Dr. Schulz? 15 A. Yes. 16 Q. Was it approved by Astrazeneca? 17 A. Yes. 18 Q. Did David Pettit work in conjunction with you 19 to make sure that Dan never saw any health care 20 provider with outside the financial conflict of 21 interest provided by Astrazeneca? 22 MS. SVITAK: Objection to form, 23 argumentative. 24 MR. ALSOP: I'll join. 25 A. Absolutely not. We tried to get Dan to go to a VERBATIM COURT REPORTING 763-493-4535 193 1 primary care doctor. We encouraged him to get 2 a second opinion because his mother was very 3 much in favor of that. So there was no effort 4 to keep him from seeing anybody else 5 whatsoever. 6 Q. He never expressed concern that Dan might see 7 an outside psychiatrist? 8 A. Did I ever express concern that Dan would 9 see -- 10 Q. David Pettit ever express concern about that? 11 A. I don't know what David Pettit expressed. I 12 wasn't aware of any concern. Possibly he was 13 concerned that Dan might seek an opinion from 14 someone who would feel that he didn't need 15 treatment and that he would attempt to go 16 outside of the stay of commitment. 17 Q. We'll offer this as Exhibit No. 12. The CCM 18 contacts report from social worker David 19 Pettit. Bates number is 0M000343. 20 (Exhibit No. 12 was marked for 21 identification by the Court Reporter). 22 Q. (BY DR. BARDEN) I'm going to have to look on 23 with you. Do you see the note of 12/3/2003? 24 A. Yes. 25 Q. So this would be very shortly after you had VERBATIM COURT REPORTING 763-493-4535 194 1 obtained the signature of Dan to enter your 2 study, right? 3 A. Yes. 4 Q. And do you see the comment here it says, his 5 mom and her man friend came to the interview 6 also. I am a little concerned about his mother 7 wanting him to see her man friend's 8 psychiatrist. Do you see that, Doctor? 9 A. Yes. 10 Q. That would be consistent with the theory that 11 at $15,000 per subject, it was very important 12 for the people around Dan at this particular 13 time to keep him in your study? 14 MR. ALSOP: Object, assumes facts not in 15 evidence, form, argumentative. Go ahead, 16 Doctor. 17 MS. SVITAK: Object to form. 18 A. There was no reason for Dave Pettit to have any 19 concern about whatever financial arrangements 20 were involved with the study, so, no. 21 Q. Let's look at the document of 12/8/03, the 22 discharge plan signed by Dan. 23 MR. ALSOP: This is still part of Exhibit 24 12? 25 Q. (BY DR. BARDEN) No. This will be Exhibit 13 VERBATIM COURT REPORTING 763-493-4535 195 1 and it's 000 165. 2 (Exhibit No. 13 was marked for 3 identification by the Court Reporter). 4 Q. (BY DR. BARDEN) Okay. Have you seen this 5 before, Doctor? 6 A. Yes. 7 Q. You're a member of the treatment team, correct? 8 A. Correct. 9 Q. It says, Dan, your discharge plan is based upon 10 your agreement with the Dakota County Court and 11 your FUMC treatment team that you will follow 12 through with the following discharge plan. You 13 have received papers from the court about your 14 stay of commitment. That's pretty threatening 15 language, isn't it, Dr. Olson, just reminding 16 Dan that if he doesn't follow these orders, he 17 could end up committed to Anoka; isn't that 18 right? 19 MR. ALSOP: Multiple question, form and 20 argumentative. Go ahead. 21 A. No, I disagree. That just says that he is 22 going to follow this particular discharge plan. 23 The stay of commitment says if he doesn't 24 follow any treatment plan, then his stay could 25 be revoked but doesn't require him to follow a VERBATIM COURT REPORTING 763-493-4535 196 1 specific plan. 2 Q. Well, we read the court order. It ordered him 3 to follow the plan of his treatment team and 4 that's what this is, correct, Dr. Olson? 5 A. I disagree. For example, it mentions here that 6 he should go to day treatment at the Eagan 7 Counseling Center. And in fact, he ended up at 8 day treatment at Fairview, so that was 9 considered an appropriate alternative and that 10 didn't result in any threat of commitment as if 11 he had chosen not to participate in the CAFE 12 study, whether at the time prior to this 13 document being filled out or later on, there 14 would have been an alternative, which then 15 would have been the requirement. 16 Q. Are you testifying that Dan didn't go to Eagan 17 Counseling Clinic? 18 A. No. Not for day treatment. He went to see a 19 psychologist there. 20 Q. Correct. 21 A. His day treatment was at Fairview. 22 Q. See where it says the following are 23 appointments and recommendations, remember the 24 court ordered him to follow the 25 recommendations. Number one, keep appointments VERBATIM COURT REPORTING 763-493-4535 197 1 with FUMC Clinics CAFE study. Your contact 2 person is Jean Kenney. Do you see that? 3 A. Yes. 4 Q. Do you see how some national experts might 5 interpret this order in conjunction with a 6 court order in conjunction with you being his 7 Dan's treating psychiatrist, the PI, and the 8 study physician as being one of the most 9 coercive and inappropriate examples of informed 10 consent in the United States? 11 MS. SVITAK: Object to form, 12 argumentative. 13 MR. ALSOP: I'll join. It's also lacking 14 in foundation what others may think, but go 15 ahead, Doctor. 16 A. No, I disagree. This -- whenever a person has 17 a stay of commitment, there is an agreement to 18 a treatment plan. When they leave the 19 hospital, the details of that treatment plan 20 are specified, and every patient should leave 21 with an idea of who they're supposed to see and 22 what that treatment plan consists of, but 23 they're not obligated to -- the court 24 commitment is not implemented just because they 25 choose to participate in one kind of treatment VERBATIM COURT REPORTING 763-493-4535 198 1 or another. 2 Again, an example that this also 3 specifies that he call Eagan Counseling Center 4 for intake for day treatment. He eventually 5 ended up getting day treatment at Fairview, and 6 he saw a counselor at Eagan Counseling Clinic. 7 That was a violation of these terms, but it was 8 within the scope of an appropriate treatment 9 plan and didn't result and never would have 10 resulted in a revocation of his stay of 11 commitment. 12 Q. So do you have patients other than Dan who are 13 ordered by a court to follow treatment plan 14 recommendations and the treatment plan 15 recommendations were for them to enroll in your 16 personally profitable research study? Do you 17 have any other patients other than Dan who had 18 this particular scenario? 19 A. I don't know if I have any other patients under 20 those circumstances, but I disagree that the 21 court was ordering them to participate in the 22 CAFE study. 23 Q. Then down at the bottom, you see the number one 24 treatment recommendation is the CAFE study, do 25 you see that? And then down at the bottom -- VERBATIM COURT REPORTING 763-493-4535 199 1 A. Yes. It's in the middle, yes. 2 Q. Pardon. It says number one CAFE study, right, 3 it's up in number one. Dan, your treatment 4 team wishes you a safe smooth return to the 5 community. Please know that it is important 6 that you follow this -- that would be the word 7 T H I S -- this aftercare plan which you agreed 8 to with your treatment team at FUMC and for 9 which you are being held accountable by the 10 court. Consequences for not following this -- 11 that's T H I S -- plan could result in court 12 commitment to the hospital. Now, given that 13 language and given the court order and given 14 that the number one recommendation is the CAFE 15 study, did anyone at the University of 16 Minnesota express concern that Dan had been 17 subject to improper coercion in enrolling in 18 your research study. And if so can you give me 19 the name of that person at the U? 20 A. No. No one expressed any concern. Dan -- 21 Q. Did Dr. Schulz express any concern? 22 MS. SVITAK: Could you let him finish his 23 answer, please. 24 DR. BARDEN: He did. 25 MS. SVITAK: He was mid-sentence. I VERBATIM COURT REPORTING 763-493-4535 200 1 would ask for some professional courtesy. 2 Q. Fine. We'll ask for the time back as noted. 3 Go ahead. 4 A. No one expressed any concern, Dr. Schulz, the 5 IRB, or anyone because anyone would realize 6 that the court was not ordering this and would 7 be aware that we had made that clear to Dan. I 8 would -- I would agree that this document 9 perhaps could have been more accurate by being 10 less specific and a statement may have been put 11 on here that said in effect that there may be 12 other alternatives which could be discussed 13 with your case manager and your treating doctor 14 that may also fulfill the court requirements. 15 So -- but this is probably a standard form that 16 we use at the time of discharge. And every 17 patient is given, as I said, specific doctors 18 and clinics and parameters that are part of 19 their treatment plan but they're not obligated 20 to follow that plan and only that plan, even 21 though this wording most likely occurs on other 22 documents. 23 Q. The word alternative treatments is not up here 24 on this claim, correct? 25 A. That's correct. VERBATIM COURT REPORTING 763-493-4535 201 1 Q. Okay. Let's go to the Dear Health Care 2 Provider, known as Dear Doctor Letter of 3 January of 2004. 4 (Exhibit No. 14 was marked for 5 identification by the Court Reporter). 6 Q. (BY DR. BARDEN) While we're getting ready to 7 do that, let me back up just a minute. You had 8 mentioned before that the risk of suicide, 9 suicide attempt was not on the Seroquel insert 10 until I believe you said 2006, is that correct? 11 A. That's my understanding, yes. 12 Q. And where did you get that information, who 13 informed you about that? 14 A. I don't recall. That was -- there has been a 15 very large controversy about the warnings 16 related to suicide for antidepressants and now 17 for those antipsychotics that have indications 18 for depression. So it may have been in the 19 Star Tribune or it may have been in an email or 20 Internet source or it may have been in a 21 journal. I don't specifically recall. 22 Q. As a researcher studying Seroquel, do you 23 receive information from Astrazeneca on the 24 nature of the drug and potential side effects 25 and risks? VERBATIM COURT REPORTING 763-493-4535 202 1 A. Yes. 2 Q. Do they keep you informed of the risks of the 3 drug? 4 A. Yes. 5 MS. SVITAK: Objection, vague. 6 Q. Do you think they do that in a competent 7 matter? 8 MS. SVITAK: Objection, vague. 9 MR. ALSOP: Lacking foundation but go 10 ahead, Doctor. 11 A. Yes. 12 Q. (BY DR. BARDEN) Were there significant risks 13 that they failed to inform you of in 2004? 14 MS. SVITAK: Objection, lack of 15 foundation. 16 MR. ALSOP: I'll join. 17 A. No, I don't believe so. 18 Q. (BY DR. BARDEN) We ask to make this an 19 exhibit. This is Exhibit 15. 20 (Exhibit No. 15 was marked for 21 identification by the Court Reporter). 22 Q. (BY DR. BARDEN) This is the Seroquel drug 23 insert for 2004. This is Exhibit 15. If you 24 look at what's marked as SER Page 7, at the 25 bottom where it says body as a whole, Page 7, VERBATIM COURT REPORTING 763-493-4535 203 1 do you see that? 2 A. Yes. 3 Q. And where it says frequent flu symptoms, 4 infrequent neck pain, pelvic pain, do you see 5 the words suicide attempt? 6 A. Yes. 7 Q. You were not aware of that as of 2004? 8 MR. ALSOP: Counsel, I'll object as vague 9 as to when in 2004. The document is dated July 10 of '04. Is that the date you're referencing? 11 DR. BARDEN: I don't know. We'll have to 12 investigate that, but I'm asking the questions. 13 MR. ALSOP: I'll object to as vague and 14 ambiguous. 15 Q. (BY DR. BARDEN) Dr. Olson, you mentioned that 16 this warning was not here until 2006, do you 17 recall that testimony? 18 A. Yes, I'm talking about a specific warning 19 relating to suicidal behavior or suicide 20 attempt. This is the so-called fine print of 21 the package insert, which includes any number 22 of events which occur in the course of 23 treatment. And as you noticed, the amount of 24 text in the package insert is probably several 25 times as much text as in the entire consent VERBATIM COURT REPORTING 763-493-4535 204 1 document. So it's customary for the consent 2 document to include the common side effects and 3 not to list every single behavioral or medical 4 event that may have occurred over the course of 5 many, many people taking the drug. 6 Q. What is the citing authority for that? 7 MR. ALSOP: Object as vague and 8 ambiguous. 9 Q. Can you cite for me any authority for your last 10 statement? 11 MR. ALSOP: Same objection. 12 A. You meaning summarize that it's customary for 13 the consent document to be a summary of common 14 side effects, that's my personal observation. 15 Q. Were you aware, were you not aware that it's an 16 infrequent side effect of Seroquel that the 17 patient attempts to kill themselves? Were you 18 aware of that as a warning in the insert in 19 2004? 20 A. No. I wasn't specifically aware of that. You 21 also noted right above that, it also lists 22 psychosis and delusions and manic reaction 23 which are listed as side effects but are also 24 clearly manifestation of the underlying 25 illness, which I believe suicide attempt would VERBATIM COURT REPORTING 763-493-4535 205 1 or could be. 2 Q. Move to strike all non-responsive portions and 3 to seek the time back. 4 Is this the kind of information you would 5 have liked, do you think would have been 6 helpful for you to know, that is, that suicide 7 attempts are an infrequent side effect of 8 taking Seroquel in 2004? 9 A. No. Because suicide is a frequent occurrence 10 in the course of schizophrenia, and I was well 11 aware of that, and the addition of an -- the 12 addition of a mention of suicide attempt as an 13 infrequent side effect wouldn't have influenced 14 my concern about suicide as a whole occurring 15 in any patient I'm treating for psychotic 16 illness. 17 Q. Just to make clear again, the word suicide does 18 not appear anywhere in your consent form you 19 had Dan sign for your study, correct? 20 A. Again, no. 21 Q. And the idea for informed consent is what's 22 important information for a reasonable person 23 to make that decision, not you, Dr. Olson, 24 correct? 25 MR. ALSOP: Object, that calls for a VERBATIM COURT REPORTING 763-493-4535 206 1 legal conclusion, but go ahead, Doctor. 2 MS. SVITAK: Same objection. 3 Q. (BY DR. BARDEN) I'm not asking you for a legal 4 opinion. I'm asking for what you know as a 5 licensed health care provider practicing in the 6 State of Minnesota as licensed by the State 7 Board. 8 MR. ALSOP: Same objection. 9 MS. SVITAK: Same objection. 10 A. And the question again? 11 Q. (BY DR. BARDEN) When you're filling out an 12 informed consent form, are you putting down 13 there the things that you, Dr. Olson, think 14 might be interesting to know or to discuss or 15 are you putting down things that a reasonable 16 person or a patient like Dan or both would want 17 to know in order to make a reasonable decision 18 as to whether to go into your study or not? 19 A. Obviously, it would be the person who is 20 signing the form. 21 Q. Let's look at Exhibit No. 14. Did you receive 22 a copy of this letter? 23 A. Yes. 24 Q. This is January 30th, 2004, correct? 25 A. Yes. VERBATIM COURT REPORTING 763-493-4535 207 1 Q. Then let's go to May 10, 2004 letter from 2 Dr. Olson to Ms. Patrice Webster, IRB, 3 University of Minnesota. 4 (Exhibit No. 16 was marked for 5 identification). 6 Q. (BY DR. BARDEN) Is that your signature there, 7 Doctor? 8 A. Yes, it is. 9 Q. Is this a letter you wrote on May 10, 2004 to 10 the IRB, correct? 11 A. Yes. 12 Q. Do you see where it says, the second sentence 13 says, recently, the FDA issued a new warning 14 about the risks of hyperglycemia and diabetes 15 in patients taking atypical antipsychotic 16 agents including CAFE study medications, 17 correct? 18 A. Yes. 19 Q. Do you think that was misleading and deceptive, 20 that in fact you received that in January and 21 instead you reported it to the IRB as, quote, 22 recently, unquote? 23 A. Well, we received the Dear Doctor Letter, 24 according to this letter, we were provided with 25 a revised consent form at the end of March, VERBATIM COURT REPORTING 763-493-4535 208 1 which most likely came from the sponsor. So 2 if, you know, it looks like there was a month 3 or six weeks that elapsed from that time until 4 we filed a -- this request to revise the 5 consent form. 6 Q. Move to strike as non-responsive. What did I 7 ask you? 8 A. Repeat the question. 9 Q. Do you know what I asked you? 10 A. No. 11 Q. You don't recall what I asked you? 12 A. I'm asking you to repeat the question, please. 13 I thought that was my right. 14 Q. Do you think your language was deceptive and 15 misleading in your letter to the IRB in telling 16 Ms. Webster that you had recently received this 17 FDA warning, when in fact it was in January of 18 2004? 19 A. No. 20 Q. Do you think that it is a coincidence that you 21 informed the IRB of this increased risk two 22 days after Dan died in your study? 23 A. I don't know whether it's coincidence or not. 24 Q. Were you in fact running around, trying to tie 25 down all the loose ends? VERBATIM COURT REPORTING 763-493-4535 209 1 MR. ALSOP: It's vague and ambiguous. 2 Q. (BY DR. BARDEN) And trying to button down the 3 hatches, trying to fix up as much of your study 4 as you could because you realized that you had 5 made serious mistakes in your research 6 protocols? 7 MR. ALSOP: Now a multiple question. 8 A. No. 9 MR. ALSOP: Argumentative. You've 10 answered. 11 Q. (BY DR. BARDEN) It says in here, diabetes was 12 not included as a risk on the consent form. By 13 that, you mean the consent form signed by Dan, 14 correct? 15 A. Yes. 16 Q. So in February you knew there was this risk but 17 you did not reconsent Dan; isn't that correct? 18 A. That's correct. 19 Q. And in March, you knew there was this -- 20 A. Let me finish. 21 MR. ALSOP: Go ahead, Doctor, finish your 22 answer. 23 A. Because we hadn't received specific wording. 24 We have to have every change in the consent 25 form, and the form itself has to be approved by VERBATIM COURT REPORTING 763-493-4535 210 1 the sponsor. So we didn't receive -- we didn't 2 receive that information apparently until after 3 March 24th. And in the meantime, we may or may 4 not have mentioned to Dan that this was a 5 change. I don't recall that we did. 6 Q. So you received the new consent form with this 7 new warning March 24th, 2004, correct? 8 A. I don't know that. This letter says that we 9 have sponsored approved wording in a new 10 version dated 3/24/04. It's likely that we 11 didn't receive it on the date that it was 12 approved by Astrazeneca so we probably received 13 it sometime after that. I don't know exactly 14 when. 15 Q. But you did not reconsent Dan with this new 16 form in April, did you? 17 A. No. That's correct. 18 Q. You did not reconsent Dan with this new form in 19 May, did you? 20 A. No. That's correct. 21 Q. So Dan died having never had this warning from 22 you; isn't that correct? 23 A. That's true. 24 Q. Isn't it in fact true that your signature 25 appears only twice throughout all of the VERBATIM COURT REPORTING 763-493-4535 211 1 research study documents from the time of Dan's 2 discharge from the hospital on December 8th, 3 2003 until the time of his death on May 8th, 4 2004? 5 A. No. 6 MR. ALSOP: Object as vague and ambiguous 7 but go ahead. You've answered. 8 A. No. 9 Q. (BY DR. BARDEN) How many times do you think 10 your signature appears through the study 11 documents during that time period? 12 MR. ALSOP: Object as speculative, 13 lacking in foundation. Go ahead, Doctor. 14 DR. BARDEN: Just clarify for the record 15 that the witness violated a lawful subpoena and 16 brought no records so that's why we're not 17 going through his records. 18 MR. ALSOP: He did not violate a lawful 19 subpoena. He didn't have any records in his 20 custody. 21 DR. BARDEN: He testified under oath that 22 he had records in his custody in his office 23 that he reviewed and he failed to bring them 24 here. 25 MR. ALSOP: Which I gave to him as a VERBATIM COURT REPORTING 763-493-4535 212 1 lawyer-attorney-client relationship which came 2 from you. 3 DR. BARDEN: That doesn't matter. 4 They're the records of this case. It doesn't 5 matter where they came from. 6 MR. ALSOP: Yes, it does matter. 7 DR. BARDEN: Well, we'll have to see 8 about that. 9 MR. ALSOP: We will have to see about 10 that, won't we? 11 Q. (BY DR. BARDEN) So, Doctor, would you like to 12 answer the question now? How many times do you 13 believe your signature appears throughout that 14 time period? 15 MR. ALSOP: Speculative, lacking 16 foundation. Doctor, you can answer. 17 A. There are some correspondence between the CAFE 18 site and Theo House that I signed during that 19 time, at least two and maybe three. 20 Q. I'm not talking about correspondence. I'm 21 talking about in the study documents, 22 indicating who is meeting with Dan, who is 23 evaluating him, who is checking him out. How 24 many times does your signature appear on those 25 documents? VERBATIM COURT REPORTING 763-493-4535 213 1 MR. ALSOP: Same objections. 2 Q. (BY DR. BARDEN) During that entire time. 3 A. I don't know exactly. 4 Q. Now, in the document consent form, which we've 5 marked as exhibit -- 6 A. Nine. 7 Q. -- you told Dan in this form that his condition 8 would be monitored closely by the study doctor, 9 isn't that true? 10 A. Yes. 11 Q. And, in fact, you only met with Dan by your own 12 testimony a handful of times during the entire 13 study and only twice during the last two months 14 of his life, correct? 15 A. I met with him in my estimation half a dozen 16 times between the time he left the hospital and 17 his death and, yes, twice in the prior month, 18 including the last visit that I had with him 19 was a -- included a long meeting with Jeanie 20 and Dave Pettit and Mrs. Weiss, in which we -- 21 in great detail discussed his condition and 22 arrived at what we thought was an appropriate 23 intervention. 24 Q. You filed another report to have him 25 recommitted, isn't that right? VERBATIM COURT REPORTING 763-493-4535 214 1 A. That's correct. 2 Q. Correct. Which would have made him under your 3 legal control for a full year, which was 4 exactly the time of your study and exactly the 5 time you had a financial incentive to keep 6 control of Dan, isn't that right? 7 MR. ALSOP: It's argumentative and as to 8 form. It's also multiple. Go ahead. 9 MS. SVITAK: Same. 10 A. It's just totally coincidental that the study 11 lasted for 12 months and the state law for a 12 stay of commitment lasts for six months. The 13 majority of patients' stay expires at the end 14 of six months and it's not renewed. We 15 extended it because it was one of the few 16 interventions that we could do to address the 17 concerns that Mrs. Weiss expressed, that as 18 soon as he was out of the study that he was 19 going to leave for California and stop taking 20 his medications. 21 Q. But it does fit the theory that you with your 22 $15,000 per subject financial incentive wanted 23 to gain legal control over Dan, enroll him in 24 your study, control him to maintain him in your 25 study and then recommit him to maintain him to VERBATIM COURT REPORTING 763-493-4535 215 1 the end of your study which would -- it 2 coincides perfectly with the financial 3 incentives Astrazeneca gave you to keep 4 patients in your study until the end; isn't 5 that correct? 6 A. No, it's not. 7 MR. ALSOP: It's argumentative. You've 8 answered. 9 MR. GROSS: Objection to form. 10 MS. SVITAK: Same objections. 11 A. No, it's not correct. We extended his 12 commitment purely on clinical grounds. He was 13 free to leave the study before and after that. 14 Q. And commonly in cases like this, the parents of 15 a patient like this will be made guardians, but 16 in this case, you couldn't let Mary Weiss be 17 the guardian because she would have taken him 18 out of your personally profitable study 19 immediately, isn't that right? 20 MR. ALSOP: Object as argumentative. 21 MS. SVITAK: Objection, argumentative. 22 MR. ALSOP: Multiple. Go ahead, Doctor. 23 A. It's very rare for parents to be made guardians 24 of a person who is mentally ill and not 25 cognitively impaired. And whether or not Mrs. VERBATIM COURT REPORTING 763-493-4535 216 1 Weiss was primarily trying to get guardianship 2 because of Dan's poor judgment about his 3 finances and guardianship of financial affairs 4 and guardianship of a person are two separate 5 issues. I didn't favor her being guardian and 6 neither did, as far as I'm aware, anybody else 7 who was working with Dan because we felt that 8 he should be responsible for making his own 9 decisions. 10 Q. Did the IRB -- was the IRB aware of how 11 infrequently you saw Dan during this time 12 period? 13 MR. GROSS: Objection, form. 14 MR. ALSOP: I'll join. Also lacking in 15 foundation. Go ahead. 16 A. No. The IRB isn't given the detailed records 17 and I object to the characterization of me 18 seeing him so infrequently. 19 Q. Was Dr. Schulz aware of how infrequently you 20 saw Dan during the last two months of his life? 21 MR. GROSS: Same objections. 22 MR. ALSOP: Same. 23 A. Dr. Schulz was aware of the schedule and aware 24 of my oversight of Dan's care and those of 25 other subjects in the CAFE study. VERBATIM COURT REPORTING 763-493-4535 217 1 Q. Did Mary Weiss attempt to get information 2 through to you about her son's deterioration? 3 MR. ALSOP: Object as vague and 4 ambiguous, also misstates the evidence. Go 5 ahead, Doctor. 6 A. Yes, I believe she talked to Jean Kenney on a 7 number of occasions and Jeanie relayed Mrs. 8 Weiss's concern. We had a meeting scheduled 9 with Mrs. Weiss in February that she called 10 that morning and cancelled, but I wasn't given 11 that information. And she didn't reschedule it 12 until April, but I was aware of her concerns 13 and we discussed them, both me with Jeanie as 14 well as in my evaluation of Dan and the 15 discussions with Dave Pettit and also the day 16 treatment program, which I attended to get 17 their observations of Dan as he was attending 18 the day treatment program. 19 Q. In keeping with our discussion about your 20 involvement in the study, did you delegate 21 baseline eligibility evaluations to Jean 22 Kenney? 23 A. I don't know if I formally put that in the 24 study documentation. I know that she filled 25 out the form but, you know, I was aware of the VERBATIM COURT REPORTING 763-493-4535 218 1 inclusion, exclusion criteria and certainly 2 agree with what she documented. 3 Q. Did you in fact sign off on some of her 4 eligibility evaluations weeks after it was 5 done? 6 A. Oh, I'm sorry. I thought you were going to 7 show me a document. 8 Q. Didn't you in fact sign off weeks after Jean 9 Kenney had done the baseline eligibility for 10 Dan? 11 A. It may be that I wasn't asked to sign that 12 document until sometime later. Often the study 13 monitor comes through a visit and decides that 14 certain documents within the clinical record 15 need to be signed by the PI, but I was well 16 aware of Dan's condition and was the one who 17 decided that he met those requirements. 18 Q. This will be Exhibit No. 17. 19 (Exhibit No. 17 was marked for 20 identification). 21 Q. (BY DR. BARDEN) This is from the University of 22 Minnesota Web site, informed consent overview 23 Module 2M. 24 Okay. I'm going to read you a statement 25 from the University of Minnesota Web site. VERBATIM COURT REPORTING 763-493-4535 219 1 Selecting participants. By the way, did you 2 ever go through this training module, 3 Dr. Olson, from the University of Minnesota? 4 A. I don't know specifically whether I did the 5 training on-line or attended a live conference, 6 but I'm familiar with this, the general 7 principles discussed here. We discussed these 8 earlier. 9 Q. It says at first, recruitment of participants 10 need to be done in a non-biased, non-power base 11 manner. It is important that none of the 12 participants ever feel they do not participate 13 in the study, they will be penalized. Do you 14 agree with that? 15 A. Yes. 16 Q. Do you agree that it was clear to Dan that if 17 he didn't follow the treatment recommendations 18 and enter the CAFE study he would be committed? 19 A. Absolutely not. 20 Q. Next section it says therapist client. 21 Therapist client relationships between the 22 investigator and participants. 23 A. My copy says doctor patient relationships so we 24 may be looking at different documents. 25 Q. Are we looking at different documents? VERBATIM COURT REPORTING 763-493-4535 220 1 (Discussion off the record). 2 Q. (BY DR. BARDEN) Doctor patient relationships 3 between the investigator and participants 4 should be avoided when possible to eliminate 5 any power based coercion. Patients can say no 6 to someone they do not expect to see in the 7 future but it is very difficult for people to 8 say no when they rely on someone for ongoing 9 medical care. Had you read that before you 10 signed Dan into your personally profitable 11 research study? 12 MR. GROSS: Objection, form. 13 MR. ALSOP: I'll join. 14 MS. SVITAK: Same objection. 15 MR. ALSOP: It's also repetitious. 16 A. I don't recall whether I specifically read 17 these words, but I'm aware of these principles 18 and I disagree with the characterization of the 19 study as personally profitable. 20 Q. Did you -- well, the record stands for itself. 21 Did you give Dan the informed consent form to 22 keep and to read and to discuss with family 23 members before signing him in to your treatment 24 study, I mean, your -- yeah. 25 A. I believe so. That's our usual practice. VERBATIM COURT REPORTING 763-493-4535 221 1 Q. And what did his mother say when Dan shared 2 that treatment and informed consent plan with 3 her, do you know? 4 A. I -- I don't recall all of the specifics of her 5 concern. I recall that she was -- she was 6 concerned about the study at the time and that 7 she had questions about switching medications 8 and, you know, what if the medication didn't 9 work. And as she expressed in her letter, she 10 didn't feel that he was even taking the 11 medication in the hospital. So we had, you 12 know, there were a number of discussions 13 between Mrs. Weiss and the treatment team in 14 the hospital, including with myself. 15 Q. Did you in fact refuse to talk to Mary Weiss on 16 multiple occasions? 17 A. No. 18 Q. Did you in fact when Mary Weiss was explaining 19 to you how her son was deteriorating in your 20 treatment program and she was fearful that he 21 would commit suicide, you ran away from her 22 saying, oh, I'm sorry, my BMW is being towed 23 now. Do you recall that conversation? 24 A. No. I don't own a BMW. I drive a Honda. 25 Q. Have you always driven a Honda? VERBATIM COURT REPORTING 763-493-4535 222 1 A. No. 2 Q. Have you ever driven a BMW? 3 A. No. 4 Q. Have you ever owned a BMW or leased a BMW? 5 A. No. 6 Q. Have you ever had your car towed and ran away 7 from Mary Weiss, wouldn't speak to her because 8 you said your car was being towed? 9 A. No. 10 Q. Have you ever -- 11 A. I don't recall that. 12 Q. Did you ever avoid speaking to Mary Weiss? 13 A. Not that I recall, no. 14 Q. Did you ever refuse to return her phone calls? 15 A. Not that I recall. I might have delegated that 16 responsibility on occasion to Jeanie who was 17 the study coordinator and a social worker. 18 It's the social workers who usually are the 19 intermediary between family and the physician. 20 Q. Did you receive detailed letters from Mary 21 Weiss which you did not respond to? 22 MR. ALSOP: Object as vague, lacking in 23 foundation. 24 A. I received a letter, the letter that we saw 25 earlier while Dan was still in the hospital. VERBATIM COURT REPORTING 763-493-4535 223 1 And there was a letter that she wrote to Dr. 2 Schulz in April, and I was aware of both of 3 those. 4 Q. But you never wrote back? 5 A. The first one he was in the hospital and we 6 addressed those concerns while he was in the 7 hospital. It wouldn't be usual to write a 8 letter to a parent while the patient was still 9 in the hospital and we could have face to face 10 discussions. The other letter was to Dr. 11 Schulz and he responded. 12 Q. To the best of your knowledge, Mary Weiss only 13 wrote you one letter? 14 A. To the best of my knowledge. 15 Q. Okay. I give you what's been marked as Exhibit 16 18. 17 (Exhibit No. 18 was marked for 18 identification by the Court Reporter). 19 Q. (BY DR. BARDEN) Have you ever seen one of 20 these before, Doctor? 21 A. Yes. Yes, this is a release of information 22 signed shortly after Dan was discharged from 23 the hospital, that we could release information 24 to Mrs. Weiss. 25 Q. Correct. So it's your testimony that you did VERBATIM COURT REPORTING 763-493-4535 224 1 not avoid talking to Mary Weiss? 2 MR. ALSOP: Object as repetitious, third 3 time asked. Go ahead. 4 A. Yes, it's my recollection that I did not avoid 5 talking to Mary Weiss. 6 Q. Let me ask you one quick question back about 7 the informed consent form for the study. And 8 that was Exhibit No. 9. Would you please show 9 me the part of the form that you believe meets 10 the HIPA requirements. You testified you 11 weren't sure whether you needed a separate HIPA 12 form during that year, and you felt that that 13 information had been in this form. Could you 14 please show me the part of the consent form 15 that you believe meets the HIPA authorization 16 requirements? 17 MR. ALSOP: Object as misstatement of his 18 prior testimony, but go ahead. 19 Q. If any. 20 A. Page 9, section marked confidentiality. 21 Q. That's it? 22 A. All study data will be kept confidential, so on 23 and so forth. My understanding in our more -- 24 in more recent studies where we have a separate 25 HIPA consent form, it states in the document -- VERBATIM COURT REPORTING 763-493-4535 225 1 in the main informed consent, in this section 2 about confidentiality, there is a reference to 3 a separate form. There is no reference here to 4 a separate HIPA form. But it may very well 5 have been that in fact there was a separate 6 HIPA form that it wasn't signed. It was an 7 oversight. But I don't know that for certain. 8 I would have to go back and check the 9 chronology of the regulatory documents. 10 Q. Well, if it isn't signed, it's more than an 11 oversight because University regulations won't 12 authorize you to study people who don't have a 13 HIPA form, correct? 14 MR. ALSOP: Object to the form. It's 15 argumentative. Go ahead. 16 Q. (BY DR. BARDEN) That means you may have 17 experienced on Dan without legal authorization. 18 A. Well, again, we were subject to an internal IRB 19 investigation, as well as an FDA inspection 20 that to my best of my knowledge did not 21 identify that as a protocol violation. 22 Q. In the section that you're discussing here, 23 Section 11 on confidentiality, there is no 24 statement that the patient or subject has a 25 right to refuse to sign this authorization, VERBATIM COURT REPORTING 763-493-4535 226 1 correct, that is, the authorization to release 2 records? 3 A. That's correct. 4 Q. And there is no statement in here that the 5 subject or patient has a right to revoke an 6 authorization; isn't that correct? 7 A. That's correct. 8 Q. Thank you. Now, what evidence did you have 9 other than deterioration noted by several 10 clinicians that Dan Markingson had stopped 11 taking his medication? 12 MR. GROSS: Objection, form. 13 MR. ALSOP: Join in the objection, 14 misstatement of the evidence. Also vague and 15 ambiguous. Go ahead, Doctor. 16 A. To the best of my knowledge, we thought Dan was 17 taking his medication and it was being 18 monitored after January and February by the 19 staff at Theo House. And in terms of the 20 deterioration, there was no evidence that came 21 to light either before his suicide or after 22 that he was suffering a psychotic 23 decompensation. The only deterioration that we 24 noted was some deterioration in his grooming 25 and other negative symptoms which are VERBATIM COURT REPORTING 763-493-4535 227 1 manifestations of schizophrenia that do tend to 2 increase over time, but they're not amenable to 3 treatment with antipsychotic medications, and 4 there was no indication that he had any return 5 of the behavior being influenced by his 6 delusional thinking. 7 Q. Have you ever read Dan's journals, Dr. Olson? 8 A. No. They weren't provided to me. 9 Q. How many paranoid schizophrenics have you 10 treated, Dr. Olson? 11 A. Likely hundreds. 12 Q. It's pretty common that they keep journals or 13 they write down their delusions at some point, 14 isn't it, especially if they have an English 15 degree from the University of Michigan? 16 MR. ALSOP: Objection, lack in 17 foundation, speculative. 18 MS. SVITAK: Objection. 19 A. Dan's the only paranoid schizophrenic that has 20 an English degree from the University of 21 Michigan that I've treated. 22 Q. What steps, if any, did you take to find out if 23 Dan kept a journal or other writings in which 24 he wrote down his delusional ideas? 25 A. I wasn't aware of a journal. He never VERBATIM COURT REPORTING 763-493-4535 228 1 volunteered that information. 2 Q. You never asked him? 3 A. Not that I recall. 4 Q. Would have been helpful, wouldn't it, to have 5 the actual writings day by day in Dan's diary 6 to see whether he was not taking his 7 medication, whether he was fooling the people 8 at Theo House, correct? 9 MR. ALSOP: Object as speculative as to 10 that. Go ahead. You can answer. 11 A. If in fact he wrote a journal and he said that 12 he was not taking his medication and he was 13 fooling the people at Theo, then had we had 14 that information, that certainly would have 15 been helpful. 16 Q. Are you denying that there is a number of 17 various kinds of clinical data in your research 18 study documenting that Dan began to deteriorate 19 dramatically in March and April of 2004? 20 A. I'm -- yes, I'm not aware that there are 21 substantial data -- you're implying from rating 22 scales that we're performing, no, I'm not aware 23 that there is evidence of substantial 24 deterioration. 25 Q. Okay. I'm informed we're changing a tape so VERBATIM COURT REPORTING 763-493-4535 229 1 let's take a brief break. 2 (A brief recess was taken). 3 Q. (BY DR. BARDEN) We're back on the record. All 4 right. I'll show you what the now been marked 5 as Exhibit No. 19. 6 (Exhibit No. 19 was marked for 7 identification by the Court Reporter). 8 Q. (BY DR. BARDEN) Okay. Doctor, would you 9 identify this? 10 A. This is the -- 11 Q. Wisconsin Card Sorting test, correct? 12 A. Well, this isn't the test. This is -- I was 13 just trying to identify how this related to the 14 Wisconsin Card Sort test. This is I believe a 15 printout from the CAFE neurocognitive testing. 16 Q. Right. And the last name, DRM, that's Dan 17 Markingson, correct? 18 A. That's correct. 19 Q. And the test date is 12/03, and wait a minute. 20 Which one are you looking at here? 21 A. It says 3/02/04. 22 Q. Yeah, 3/02/04, correct, that's March 2nd, 2004, 23 correct? Now, what I would like -- and he was 24 27 years, 3 months, correct, so this is the 25 form for Dan Markingson, correct? VERBATIM COURT REPORTING 763-493-4535 230 1 A. Yes. 2 Q. And the thing I'm drawing your attention to is 3 on medication, what does it say there, Doctor? 4 A. Oh, it says no. 5 Q. It says no. Now, given that this is a 6 psychotic patient who has thoughts of slitting 7 peoples throats and given the fact that you now 8 have information that he might not be on 9 medication, what steps if any did you take? 10 A. This is simply the -- the front page of the 11 report that was generated at that time, and 12 whoever -- I don't know who administered the 13 test at this particular time, but clearly 14 stating that he's not on medication is 15 incorrect and -- because he was -- he was as 16 far as anyone knew, certainly at the research 17 site, he was taking the medication as 18 prescribed. We were told that he was being 19 administered it, that he was being monitored. 20 He brought back pill bottles which we counted 21 and the appropriate number were, you know, not 22 in the bottle when he returned them at every 23 time. So whatever it says on this form is 24 wrong. 25 Q. With this information that he was not on VERBATIM COURT REPORTING 763-493-4535 231 1 medication, with a patient who was delusional, 2 psychotic and had talked about slitting 3 peoples's throats, did you at that point order 4 a blood test to ensure that Dan Markingson did 5 in fact have Seroquel in his blood stream or 6 not? 7 MR. GROSS: Objection, form, misstates 8 the evidence. 9 MR. ALSOP: I'll join. 10 MS. SVITAK: Same objection. 11 A. I had no information that he was not on 12 medication. This sheet is not something that 13 would have been reviewed by me. This was just 14 a piece of the cognitive testing that was 15 generated by the testing and obviously it would 16 have been wrong. 17 Now, in response to the question, did I 18 order a Seroquel level, the answer was no. I 19 don't monitor Seroquel levels because they're 20 very unreliable, and moreover, he was in a 21 blinded research study and we weren't aware 22 which of the three medications he was taking. 23 And for me to have ordered a therapeutic blood 24 level was not part of the protocol. 25 Q. How much would it have cost to do a blood VERBATIM COURT REPORTING 763-493-4535 232 1 level? 2 A. I don't know. I would guess $100. 3 Q. You signed the 1572 for the study, did you not, 4 Doctor? 5 A. Yes. 6 Q. That makes you responsible for the study, 7 correct? 8 A. Right. 9 Q. Are you stating under oath that you did not 10 even review the neuropsych testing, that is 11 someone in the neuropsych testing saying he's 12 not taking his medication, you didn't review 13 that, correct? 14 MR. ALSOP: It's argumentative, 15 misstatement of the evidence and form but go 16 ahead. 17 A. I don't recall -- 18 Q. (BY DR. BARDEN) That's a yes or no question by 19 the way. That's a yes or no question. Did you 20 review this or not? 21 A. I don't recall if I did or not. If I saw this, 22 I obviously missed that this is an obvious 23 error. 24 Q. Let's mark the next two sheets as Exhibit No. 25 20. VERBATIM COURT REPORTING 763-493-4535 233 1 (Exhibit No. 20 and 21 were marked for 2 identification by the Court Reporter). 3 Q. These are Dan's journals marked March 9 and 4 March 23rd of '04. These are in order in Dan's 5 journal, and they are in the order for March 6 '04, one is 3/09 but it says '05 but it's in 7 the order of '04. And then the next one is 8 03/23/04 these are Dan's journals. And I will 9 just read this to you, Doctor. You've been 10 given to observation on truth today, Dan. 11 MR. ALSOP: Which entry are we reading? 12 Q. 3/09/05. That's what it's marked 3/09/04. 13 You've been given observation on truth today, 14 Dan. If someone makes an assumption in asking 15 for a confirmation, such as you've seen Friday, 16 right? You may recast. The question by 17 saying, Have I seen Friday or more generously, 18 if you think the assumption might possibly be 19 all right to make concerning the average 20 person, like you've seen Star Wars, right. You 21 may answer the question, then say is it good 22 enough to assume that somebody's seen it. 23 Sounds like the writings of a psychotic, 24 doesn't it, Dr. Olson? 25 A. It could be. VERBATIM COURT REPORTING 763-493-4535 234 1 Q. That's a yes or no. Then the next page 2 3/23/04, world walking, you were at a farm 3 house and we're getting presents from dogs who 4 had presents fastened in plastic bags to their 5 snouts. And it goes on to say, in the gloaming 6 and breening, you were thinking of naming it 7 gloaming and greening or gloam-green. That was 8 someone brings a snowslide in summer or mid 9 summer. It has been left behind, et cetera. 10 Classic psychotic writing, isn't it, Dr. Olson? 11 A. Well, it certainly could be but this is an 12 English major, and I, you know, need to know 13 what his state of mind at the time, what was 14 his intention. If this is just stream of 15 consciousness writing, you know, it could be 16 Joyce. 17 Q. Any undergraduate psychology student reading 18 this would assume that this patient is 19 psychotic and being ineffectively, 20 incompetently untreated, isn't that correct? 21 MR. GROSS: Objection, argumentative, 22 MR. ALSOP: Multiple question. 23 Argumentative. Repetitious. Go ahead, Doctor. 24 MS. SVITAK: Objections. 25 Q. Next. VERBATIM COURT REPORTING 763-493-4535 235 1 A. It certainly is thought disordered and, yes, 2 the untrained observer would look at this and 3 say, this person is not well. Had I been aware 4 of this writing, then I might have thought 5 differently. I would have asked Dan what this 6 meant. 7 Q. So if an international expert in schizophrenia 8 says that this is a clear indication that Dan 9 was improperly or incompetently treated, you 10 would not agree with that? 11 MR. ALSOP: Object, assumes facts not in 12 evidence. It's vague and ambiguous and 13 argumentative. You can answer, Doctor. 14 Q. (BY DR. BARDEN) That's a yes or no. 15 A. Well, clearly his -- 16 Q. Our time is limited, so I'll ask yes or no 17 questions. 18 MR. ALSOP: If you can answer yes or no. 19 If you can't, Doctor, tell him. 20 A. I can't answer yes or no. 21 Q. The next exhibit we're going to go to is Bates 22 number PSY 000021 dated 3/25/04. 23 (Exhibit No. 21 was marked for 24 identification by the Court Reporter). 25 Q. (BY DR. BARDEN) Again, these are all from VERBATIM COURT REPORTING 763-493-4535 236 1 March '04. 2 (Exhibit No. 21 was marked for 3 identification by the Court Reporter). 4 Q. Okay. This is Exhibit No. 21. Doctor, do you 5 see this? Do you notice this as the clinical 6 record for Dan? 7 A. Yes. 8 Q. 3/25/04, he says he's leaving for California as 9 soon as court order expires. Do you see that? 10 A. Yes. 11 Q. But that would cost you money, wouldn't it? Be 12 much better to recommit him so you could 13 continue to draw funding from Astrazeneca until 14 the end of the study period, correct? 15 MR. ALSOP: Object as argumentative. 16 Misstatement of the evidence and as to form. 17 MS. SVITAK: Same objection. 18 MR. GROSS: Same objection. 19 Q. It says -- 20 A. I didn't want him to go to California because I 21 didn't think he was capable of living 22 independently. Had nothing to do with whether 23 he stayed in the study or not. 24 Q. You didn't think he was competent to make 25 treatment decisions then, right, that's why you VERBATIM COURT REPORTING 763-493-4535 237 1 wanted his commitment extended? 2 A. No. 3 Q. See, this is the fatal flaw in your plan, 4 Doctor, because by trying to get him his 5 extension of his commitment, you had to argue 6 that he was incapable of consenting to your 7 study, so he should have been reconsented at 8 that point, correct? 9 MR. ALSOP: It's argumentative, object as 10 to form. It's multiple in nature. Go ahead, 11 Doctor. 12 MS. SVITAK: Same objection. 13 A. No. His judgment about -- his judgment about 14 his future plans, his finances was quite 15 impaired and his willingness to continue in the 16 study didn't -- he didn't reflect any lack of 17 understanding of what staying in the CAFE study 18 meant in terms of his treatment. 19 Q. Oh, so, his judgment for his plans and his 20 finances and his travels and his future life 21 are completely incompetent, but his judgment to 22 stay in your personally profitable research 23 study is just fine, is that what you just 24 testified, Dr. Olson? 25 A. No, I disagree with your characterization. VERBATIM COURT REPORTING 763-493-4535 238 1 MR. ALSOP: It's argumentative. 2 Q. (BY DR. BARDEN) It says, he plans to take a 3 Greyhound bus until it runs out and then 4 hitchhike the rest of the way to California. 5 How many people have done that before, Doctor? 6 MR. ALSOP: Object as vague as to doing 7 what. Go ahead. 8 A. I don't know. 9 Q. (BY DR. BARDEN) I will withdraw the question. 10 It says he has no place to live, no one to stay 11 with, no money saved, not been making car 12 insurance payments, no question how this has 13 been maintained. Had you read that in March of 14 2004? 15 A. Yes. Jeanie -- 16 Q. That's a yes or no question. We're running out 17 of time, Doctor. We're going to try to end 18 here at 4:30. 19 MR. ALSOP: Doctor, if you can answer yes 20 or no, fine. If you can't -- 21 Q. I'm asking yes or no questions for a specific 22 reason. 23 MR. ALSOP: Well, if he says he can't 24 answer yes or no he's not going to. 25 Q. (BY DR. BARDEN) Question was, had you seen VERBATIM COURT REPORTING 763-493-4535 239 1 this in March of '04? If he can't answer that 2 yes or no, then we'll have a competency 3 hearing. Did you see this document in March of 4 '04? Yes or no? 5 A. Yes. 6 MR. ALSOP: Doctor, listen. 7 A. Yes, I saw it and I had a discussion with 8 Jeanie even before she wrote this note about 9 the -- what was going on and, consequently, our 10 intervention was that we were recommending an 11 extension of his stay of commitment as a way of 12 trying to keep him in the State of Minnesota, 13 and then while he was here, to try to move him 14 into independent living to see if he could 15 manage on his own. 16 Q. Objection, move to strike everything after the 17 word "yes" and ask for the time back. Doctor, 18 if you look down the middle of the note there, 19 it says he has cancelled several therapy 20 appointments and therapists reports, he is not 21 talking in sessions. Had you read that in 22 March of '04? 23 A. Yes. 24 Q. Next document is the Workbook Sheet No. 5. 25 Also dated March 31st, 2004. You don't have VERBATIM COURT REPORTING 763-493-4535 240 1 any copies of this? Okay. We only have one 2 copy. We'll make it an exhibit and we can see 3 it then. If you can just identify that for 4 everyone in the room, Doctor. 5 A. This is part of the psychoeducation materials 6 that was provided and taught to Dan by either 7 Jeanie or one of the other research staff 8 that's dated March 31st. It shows a 9 bell-shaped curve with a patient starting at 10 the prodrome, going through a point of recovery 11 and then down the other side, not taking 12 medications, getting worse, relapse symptoms, 13 relapse of symptoms. So it's the course of a 14 recovery with a relapse. 15 Q. And this is marked Exhibit what? 16 MR. ALSOP: She hasn't had had a chance 17 to mark it yet. 18 MS. SVITAK: Is there Bates numbers on 19 there? 20 Q. (BY DR. BARDEN) Let me look real quick. Bates 21 number CS 000776. All right. Now, Doctor, 22 this is in March 31st, 2004. Do you see that? 23 This is the same time period we're talking 24 about where the Wisconsin Card Sort says not 25 taking meds. We read from his journal and VERBATIM COURT REPORTING 763-493-4535 241 1 we've just read that he is not going to therapy 2 and he is not talking in therapy and he has 3 plans to go to California, correct? 4 MR. ALSOP: That's a misstatement of the 5 evidence. 6 Q. This is march of 'O4. 7 A. No. That's incorrect. We thought he was taking 8 his meds. That statement on the Wisconsin Card 9 Sort is an oversight by the psychometrist 10 filling in the screen, the face screen on the 11 test. I didn't have access to his journal. I 12 didn't even know he had a journal, and although 13 he was -- 14 Q. Let me ask you a quick question about this. 15 A. Let me finish my answer. 16 MR. ALSOP: Let him finish his answer. 17 A. You're alleging that I knew that he was 18 deteriorating and I'm telling you that we 19 didn't know that, that we thought he was taking 20 his medications, that he was in day treatment, 21 he was at the group home, and no one in either 22 of those places observed that he was becoming 23 more psychotic. 24 Q. Except that his mother kept telling you that he 25 was deteriorating rapidly and was going to VERBATIM COURT REPORTING 763-493-4535 242 1 commit suicide and nobody listened to her, 2 correct? 3 MR. ALSOP: That's argumentative. 4 Q. She said that repeatedly. 5 MR. ALSOP: Argumentative and vague. Go 6 ahead, Doctor. 7 A. She said that in a letter to Dr. Schulz. I 8 don't know that she said it repeatedly. 9 Q. It's in the clinical notes several times, isn't 10 it, Doctor? Jean Kenney wrote it down. What 11 has to happen before anyone pays attention, 12 does he have to kill himself, quote, Mary 13 Weiss, correct? 14 A. That's correct. 15 Q. Yes. Now, let me ask you a question about 16 that. This is in March of 2004, and on this 17 recovery curve, what has Dan checked? He's 18 checked full recovery with no symptoms and 19 functioning well in life. Do you see that? 20 A. (Nods head in the affirmative). 21 Q. This is exactly the point where he was at 22 December -- way back in November 14th when you 23 wrote he lacked capacity because he was 24 delusional and he had no insight, and he's 25 exactly where he is at that point in March of VERBATIM COURT REPORTING 763-493-4535 243 1 2004, and no one in your study is noticing it 2 because they have a financial interest not to 3 notice it, isn't that correct? 4 MR. ALSOP: Doctor, it's argumentative. 5 It's multiple, vague and as to form. You can 6 answer. 7 A. No. His condition was different in March and 8 April of 2004. He was living in a group home. 9 He was successfully completing a day treatment 10 program and was moving to -- after initially 11 planning to go to California after we had that 12 meeting, he agreed to work on independent 13 living and see how that went before he made any 14 decision to return. 15 Q. This is a yes or no question. During the time 16 you were treating Dan, did you see the Eagan 17 Counseling Clinic notes of March 29th, 2004 18 stating that he is showing slightly more 19 disorganization and thought and stream of 20 speech and risk to self low with plan. Did you 21 see a note indicating that Dan -- 22 A. Repeat that, the risk to self. 23 Q. With plan. 24 A. No, I did not see that nor was I informed that 25 he had told his counselor that he had a plan. VERBATIM COURT REPORTING 763-493-4535 244 1 Q. But you signed 1572 taking responsibility for 2 the subjects in your study, correct? 3 A. Right, but I'm not responsible for the 4 counselor in Eagan informing whether or not 5 that therapist informs anyone of those 6 findings. I wasn't aware of that. 7 Q. Next exhibit is 4/15/04, clinical note Bates 8 stamped PSY 000144. Do you have that 144? 9 Page 144. This will be marked as Exhibit No. 10 23. It's also Bates No. PSY 000022. 11 (Exhibit No. 22-23 were marked for 12 identification by the Court Reporter). 13 Q. (BY DR. BARDEN) This is a yes or no question. 14 Dr. Olson, as Dan's study psychiatrist, 15 treating psychiatrist and someone who signed 16 1572, during the time of April '04, had you 17 read this note which says, quote, Mary again 18 reiterating Dan's meds are not working. He is 19 totally out of control. He says things such 20 as, quote, are you asking me or telling me, 21 unquote. She also stated, quote, do we have to 22 wait until he kills himself or someone else 23 before anyone does anything, unquote. Had you 24 seen that? Yes or no? 25 A. Yes. VERBATIM COURT REPORTING 763-493-4535 245 1 Q. Next, exhibit -- let me ask you this as a yes 2 or no question. Had you seen any notes in the 3 occupational therapy records that in April of 4 2004 that said that over time client has become 5 more isolated. He seems to have no interest in 6 interacting with his peers. Personal 7 appearance, disheveled, isolated and withdrawn, 8 poor insight and self awareness. Plan to 9 become an actor in California continues. 10 Delusions seems fixed. Did you as the 11 psychiatrist for Dan and the person that signed 12 1572, had you seen that note in April of '04 or 13 not? 14 MR. ALSOP: Object, speculative and 15 lacking in foundation without seeing it. Go 16 ahead, Doctor, if you can recall. 17 A. Is that from occupational therapy at Fairview 18 day treatment program? 19 Q. Len Bennatti, have you ever heard of Len 20 Bennatti O.T.? 21 A. Well, I asked you whether it's from the 22 Fairview Day Treatment Records or not. 23 Q. Progress notes from FBS. 24 A. Fairview Behavioral Services? 25 Q. Yes. VERBATIM COURT REPORTING 763-493-4535 246 1 A. No. I hadn't seen that specific note but I -- 2 Q. It's just a yes or no question. 3 A. I regularly met with -- 4 MR. ALSOP: No. You can answer the 5 question. 6 Q. It's a yes or no question. 7 MR. ALSOP: Doctor, if you can't answer 8 yes or no, tell him. 9 Q. Fine. And I'll get the time back. 10 MR. ALSOP: You won't. Go ahead, Doctor. 11 Q. We're going to have to come back anyway for the 12 record, so go ahead. 13 MR. ALSOP: If you can answer yes or no, 14 do it. If you can't, tell him that. 15 A. No, I didn't see the specific note but I met 16 regularly with the day treatment staff and when 17 they discussed Dan's case, we all agreed that 18 he had poor insight, that he was showing some 19 worsening of negative symptoms, but that he 20 also was discharged from the day treatment 21 program the week of his suicide, which was an 22 indication that they felt that his progress had 23 been -- that he had successfully completed the 24 program. 25 Q. So yes or no, even though he was disheveled, VERBATIM COURT REPORTING 763-493-4535 247 1 isolated, withdrawn, had fixed delusions in 2 your mind at this time, he still was competent 3 to be a subject in your research study? 4 A. I disagree that his plan to become a actor was 5 a delusion. I think that was -- I think that 6 was a poor -- that was poor judgment on his 7 part, but I don't think that was a delusion on 8 the order of thinking his mother is a lizard. 9 Q. Let's make an exhibit out of the affidavit from 10 Jean Mitchell, the assistant Dakota County 11 Attorney. It's DC00066 and 0067. And also why 12 don't we add to that the final report to the 13 court from David Pettit and also Dr. Olson's 14 letter of April 27th, 2004, recommending an 15 extension of the stay of commitment. That's 16 one of them. So this was the second time, 17 Dr. Olson, you participated in a commitment 18 proceeding for Dan, correct? 19 A. Well, this isn't really a commitment 20 proceeding. This was a letter recommending 21 extension of his stay of commitment. 22 Q. Why don't we just go ahead and mark them. This 23 is Exhibit number what? 24. 24 (Exhibit No. 24 was marked for 25 identification by the Court Reporter). VERBATIM COURT REPORTING 763-493-4535 248 1 Q. (BY DR. BARDEN) This is the final report to 2 the court, stay of commitment for David Pettit, 3 correct? 4 A. Yes. 5 Q. And I'm just going to ask you a simple yes or 6 no question. Do you see in reading this final 7 report from David Pettit, do you see the word 8 research study? 9 A. No. 10 Q. For clinical -- do you see clinical research 11 study? 12 A. No. 13 Q. Do you see experiment? 14 A. No. 15 Q. Do you see research subject? 16 A. No. 17 Q. This is another example, isn't it, yes or no, 18 and no if you don't agree of a court of 19 Minnesota being deceived by the treatment team 20 for Dan into thinking he's receiving treatment 21 when actually he's in a research study? 22 MR. ALSOP: Objection to form. It's 23 argumentative and vague, but go ahead, Doctor. 24 Q. (BY DR. BARDEN) Yes or no, Doctor? 25 A. No. VERBATIM COURT REPORTING 763-493-4535 249 1 Q. Yes or no, Dan was discharged from day therapy 2 on doctors orders? 3 A. I believe that I was aware that he was moving 4 towards discharge, but I don't recall 5 specifically whether -- there was a phone 6 order. Usually that's how the day treatment 7 would handle that is that I would be aware of a 8 person's progress toward discharge, and then 9 sometime around the time that they actually 10 leave the program, I would get a phone call, 11 asking me to give a telephone order to 12 discharge the patient. And then I would sign 13 that order the next time I was in the 14 conference in the day treatment program. 15 Q. Move to strike everything after yes as not 16 responsive and ask for the time back. This is 17 Exhibit No. 25. 18 (Exhibit No. 25 was marked for 19 identification by the Court Reporter). 20 Q. (BY DR. BARDEN) We're looking at the letter 21 April 27, 2004 from Dr. Olson to David Pettit. 22 And you knew this would to go the court, 23 correct, Dr. Olson? 24 A. Yes. 25 Q. Yes. It says I am recommending extension of VERBATIM COURT REPORTING 763-493-4535 250 1 the stay of commitment for Dan Markingson. 2 He's been a patient of mine. Is that what that 3 says, patient of mine? 4 A. Yes. 5 Q. Does it say research subject of mine or does it 6 say patient of mine? 7 A. No. I already agreed with you, it says patient 8 of mine. 9 Q. But you've already taught us that after 10 December when Dan left the hospital, he was not 11 a patient of yours, you were the study doctor 12 only, correct? 13 MR. GROSS: Objection, misstates the 14 evidence. 15 MR. ALSOP: I'll join. That's also 16 argumentative. Go ahead. 17 A. No, I think he was my patient, and he was a 18 research subject in the study. 19 Q. So he was your clinical patient and he was a 20 research subject in your study, correct? 21 A. That's how I would characterize it, yes. 22 Q. Exactly what the University of Minnesota Web 23 site says you should not do, correct? 24 MR. GROSS: Objection. 25 MR. ALSOP: Objection, misstates the VERBATIM COURT REPORTING 763-493-4535 251 1 evidence. Argumentative. 2 Q. (BY DR. BARDEN) Yes or no? 3 A. No. 4 Q. All right. On this letter now what you know is 5 going to a court to the State of Minnesota, 6 find me the word research, please. 7 MR. ALSOP: It's repetitious. Go ahead, 8 Doctor. 9 A. There is nothing here that says research. 10 Q. Find me in this letter where you disclose to 11 the court that Dan was a research subject in 12 your personally profitable research study? 13 MR. ALSOP: Argumentative, form and 14 repetitious. 15 A. Those words don't appear there. 16 Q. Please show me in this letter where you inform 17 the court that you have financial conflicts of 18 interest with Dan. 19 MR. ALSOP: Same objections. 20 MS. SVITAK: Same objections. 21 A. Doesn't state that. I disagree with your 22 characterization. 23 Q. Please tell me where you inform the court in 24 this letter that Astrazeneca will pay you more 25 money if Dan stays longer in your treatment VERBATIM COURT REPORTING 763-493-4535 252 1 study, which is only possible if his extension 2 for commitment is granted by the court? 3 MR. ALSOP: Objection, form. 4 MS. SVITAK: Object, misstates the 5 evidence. 6 MR. ALSOP: Objection form. Misstates 7 the evidence and argumentative. 8 A. It doesn't say that, and I already testified 9 that his extension of commitment was based on 10 the clinical judgment, that that would allow 11 him a longer time to recover independent 12 functioning. Had nothing to do with the 13 participation in the study. 14 Q. Yes or no, Doctor, this letter is a deceitful 15 misrepresentation of your relationship with Dan 16 Markingson to a court of the State of 17 Minnesota? 18 MR. ALSOP: Argumentative, go ahead, 19 Doctor. 20 A. No. 21 Q. Next, the adverse event, serious adverse event 22 report. And this is Exhibit No. 26. 23 (Exhibit No. 26 was marked for 24 identification by the Court Reporter). 25 Q. (BY DR. BARDEN) It's three pages. It's Bates VERBATIM COURT REPORTING 763-493-4535 253 1 stamp numbers PSY 000143, PSY 000187. Looking 2 at the first page, did you work on this serious 3 adverse event report, Dr. Olson? 4 A. Yes. 5 Q. Now, I would like you to show me in this 6 serious adverse event report where you notify 7 Astrazeneca that Dan was court sentenced or 8 threatened to follow your treatment 9 recommendations? 10 MR. ALSOP: Object as a misstatement of 11 the evidence and multiple, argumentative. Go 12 ahead, Doctor. 13 Q. (BY DR. BARDEN) Let me ask you a simple yes or 14 no. 15 A. Let me answer the question. 16 Q. The question is withdrawn. 17 A. Let me answer the question. 18 MR. ALSOP: He's withdrawing it. 19 Q. Do you see the word court in this adverse event 20 report? 21 A. Yes. 22 Q. Where is it? 23 A. Dan was invested in his treatment plan, 24 cooperative with all treatments including the 25 provision of his court-ordered stay of VERBATIM COURT REPORTING 763-493-4535 254 1 commitment. 2 Q. Where does it say in here that you were wearing 3 the hats of court examiner, and PI and treating 4 psychiatrist and study psychiatrist? 5 A. At the bottom, it says investigator name 6 Stephen Olson. 7 Q. That's it? 8 A. And as would be typical for these kinds of 9 studies, the investigating -- the investigator 10 is treating the patient. 11 Q. That's common. But to be a treating 12 psychiatrist and the examiner for the court are 13 two very unusual roles, is that correct? Yes 14 or no? 15 MR. ALSOP: It's vague and ambiguous, 16 argumentative. 17 A. I was not -- I was not an examiner for the 18 court. The letter recommending an extension of 19 the stay of commitment is the kind of letter 20 that's written by the treating psychiatrist, 21 and extension of a stay doesn't require a 22 separate examination by an independent, 23 court-appointed psychiatrist. 24 Q. Where does it say in your serious adverse event 25 report that the patient's mother warned you VERBATIM COURT REPORTING 763-493-4535 255 1 repeatedly that the medication was not working? 2 Is that in there? Yes or no? 3 A. No. 4 Q. Where does it say in here that the subject's 5 mother warned you repeatedly that Dan was going 6 to kill himself or someone else if you didn't 7 change things? Is that in here? Yes or no? 8 A. No. 9 MR. ALSOP: Argumentative, form of the 10 question. Go ahead. 11 Q. (BY DR. BARDEN) Next document says duration of 12 therapy. Do you see where it says, started 05 13 December 2003, correct? That's on the next 14 page. That was the first date that he started 15 medication, correct? 16 A. Yes. 17 Q. This document -- this is the coroner's office 18 MRC 00003. Do you have that one or not? Okay. 19 With a different Bates number. No problem. 20 This is 0M 000189. 21 (Exhibit No. 27 was marked for 22 identification by the Court Reporter). 23 Q. (BY DR. BARDEN) Have you ever seen this 24 document before, Dr. Olson? 25 A. Yes. VERBATIM COURT REPORTING 763-493-4535 256 1 Q. And you notice under toxicology findings, it 2 says blood drugs screen, caffeine present only. 3 Do you see that? 4 A. Yes. 5 Q. Were you aware that Dan had no Seroquel in his 6 blood stream when he died? 7 MR. ALSOP: Object on the basis of 8 foundation and speculative. Go ahead. 9 Q. (BY DR. BARDEN) Do you have any evidence that 10 contradicts the conclusion that Dan had zero 11 Seroquel in his blood stream when he died? 12 MR. ALSOP: Same objections. 13 A. I was aware at the time that either I saw the 14 report or was informed of the findings that 15 there was no Seroquel detectable, but even to 16 date, I don't know the methodology, the 17 sensitivity of that result. And I was 18 certainly not aware at the time of his death or 19 beforehand that he -- or if he was not taking 20 medication. 21 Q. So then as far as you know, you have no 22 rational reason to disagree with the finding 23 that Dan's mother Mary Weiss was completely 24 accurate in stating that Dan did not think he 25 had a mental illness, that he would not take VERBATIM COURT REPORTING 763-493-4535 257 1 his medication, that he would deteriorate and 2 that he would kill himself, she was exactly 3 accurate on all of that, isn't that right? 4 MR. GROSS: Objection, form of the 5 question. 6 MS. SVITAK: Same objection. 7 MR. ALSOP: Objection, form of the 8 question. Argumentative. Multiple in nature 9 and misstates the evidence. Go ahead, Doctor. 10 A. I had assurances from the group home that they 11 were monitoring his taking the medication. So 12 I had no reason to think that he wasn't taking 13 the medication. The issue of whether he was -- 14 whether he was showing profound deterioration 15 in his function was not evidenced in the 16 standard ratings that we were doing. He didn't 17 report that he was more delusional. He didn't 18 appear to be more disorganized, and he didn't 19 appear to be depressed. He denied suicidal 20 thinking. 21 Q. And you're running a study with a financial 22 incentive to not find problems, isn't that 23 right, Doctor? 24 MR. ALSOP: Argumentative, repetitious. 25 MS. SVITAK: Same objections. VERBATIM COURT REPORTING 763-493-4535 258 1 MR. ALSOP: Go ahead, Doctor. 2 A. No, I'm running a study to determine the effect 3 of various medications and I had no idea what 4 medication he was taking. And my interest is 5 in the patient's well-being. And if I thought 6 he was suicidal or psychotic, we would have 7 taken action. 8 Q. But if your staff failed to detect Dan's gross 9 deterioration as noticed and reported 10 repeatedly by his mother, the responsibility 11 for that failure lies with you as the signer of 12 1572, isn't that right? 13 MR. ALSOP: Objection, calls for a legal 14 conclusion. It's multiple in nature and vague 15 and ambiguous. Go ahead, Doctor, if you know. 16 A. His deterioration was only characterized as 17 such by his mother and not by any other 18 professionals that were involved with his care 19 with whom we had discussions on whether or not 20 he was actually deteriorating. 21 Q. Except for the records I quoted to you that he 22 was disheveled, wore the same clothes every 23 day, was disorganized, cancelled his treatment 24 appointments, didn't talk to anybody, no 25 interest in meeting with people, et cetera, et VERBATIM COURT REPORTING 763-493-4535 259 1 cetera, correct, Doctor? 2 A. Those are -- those are evidence of negative 3 symptoms that -- for which antipsychotics are 4 not effective. Not evidence of a psychotic 5 relapse. 6 Q. So based on Dan's journal, evidence of gross 7 psychosis and based on the reports of his 8 mother who knew him best, and based on the 9 coroner's report, and based on Dan's death by 10 suicide, your study was listing Dan as a 11 treatment success, when in fact he was a 12 horrible treatment failure, isn't that right? 13 A. No. 14 MR. ALSOP: It's multiple in nature, 15 argumentative as to form. 16 A. No. 17 Q. Do you have any explanation for how your 18 cracker-jack study team could believe that Dan 19 was taking his meds all the time and yet the 20 coroner found no evidence of any Seroquel in 21 his blood stream at all? 22 MR. ALSOP: Doctor, you're not going to 23 answer that question. You can rephrase it, 24 Counsel, in an appropriate fashion. 25 Q. Do you have any -- VERBATIM COURT REPORTING 763-493-4535 260 1 MR. ALSOP: Wait. I'm making my 2 objection. If you want to rephrase that in an 3 appropriate fashion he'll answer the question. 4 Q. (BY DR. BARDEN) Do you have any reasonable 5 explanation for why your research team may have 6 failed to detect Dan's ceasing to take his 7 medication over the last eight weeks of his 8 life? 9 MR. ALSOP: Assumes facts not in 10 evidence. 11 A. I have no knowledge of why you might think that 12 he stopped taking his medication for eight 13 weeks. I think it's entirely plausible that he 14 may have stopped taking his medication for the 15 several days, perhaps two days, three days, 16 depending on the sensitivity of the assay that 17 was done at his death, he might not have taken 18 his medication for a few days, but there was no 19 indication of a change in his behavior that 20 would suggest that he hadn't been taking his 21 medication for several months. If that were 22 the case, I would expect that he would be 23 grossly psychotic as he was when he was on 24 admission, where it was apparent clearly that 25 he was acting on his delusions. And if he was VERBATIM COURT REPORTING 763-493-4535 261 1 delusional and writing in his notebook 2 delusional material, it wasn't evident in the 3 behavior that anyone who was living with him or 4 seeing him at a day treatment program or when 5 he came to his visits could detect. 6 Q. It's interesting, isn't it, because you just 7 did exactly what you did through the end of 8 Dan's life, which is to totally discount the 9 eye witness evidence of his own mother who had 10 spent more time with him than any of your 11 research people and told you he was totally out 12 of control, delusional, grossly psychotic, did 13 not believe he had an illness, thought he was 14 bulletproof and that he was going to kill 15 himself or other people, you discounted her 16 evidence at the cost of Dan's life, didn't you? 17 MR. ALSOP: Object as argumentative, 18 multiple nature, misstatement of the evidence. 19 Doctor, you can answer the question. 20 A. No. 21 MR. ALSOP: You've answered the question, 22 Doctor. 23 Q. (BY DR. BARDEN) Let me put this in the record 24 as Exhibit No. 28. It's an IRB Form 1572, IRB 25 0005 and 6. Do you have it? Great. VERBATIM COURT REPORTING 763-493-4535 262 1 (Exhibit No. 28 was marked for 2 identification by the Court Reporter). 3 Q. (BY DR. BARDEN) Doctor, is that your signature 4 there? 5 A. Yes, it is. 6 Q. What is the date for that signature? 7 A. July 9th, 2004. 8 Q. And why would you have signed a 1572 for this 9 study in July 9 of '04? 10 A. Probably because there was a change in study 11 personnel or an address change or the addition 12 of some new laboratory. I don't know 13 specifically. I would have to see what the 14 previous 1572 showed. 15 Q. Well, we have not received any signed previous 16 1572s, Doctor. So unless some records are 17 being withheld for us, we don't have one. Is 18 it your testimony that you have seen a signed 19 1572 from a date before July 9th, '04 or not? 20 A. I don't recall specifically seeing one, but it 21 would be very surprising to me if we had been 22 running this study for nearly two years with 23 monitors from the Quintiles checking our 24 documentation and the IRB monitoring our study 25 that we wouldn't have had a 1572 since that's VERBATIM COURT REPORTING 763-493-4535 263 1 usually -- or say customarily submitted at the 2 time of the IRB application. 3 Q. Well, it wouldn't be surprising, it would be 4 gross negligence and illegal, wouldn't it? 5 MR. ALSOP: It's argumentative. 6 Q. If you ran the study without signing a 1572, it 7 would be gross negligence, correct? 8 MR. ALSOP: It's argumentative. Calls 9 for a legal conclusion and it's irrelevant, but 10 go ahead. 11 A. I don't know what would be considered gross 12 negligence. 13 Q. We're at 29 Exhibit 29. That is a letter 14 written by Dr. Olson to Jo Zillhardt at the 15 Office of the Ombusdman. 16 (Exhibit No. 29 was marked for 17 identification). 18 Q. (BY DR. BARDEN) Is that your signature there, 19 Doctor? 20 A. Yes, it is. 21 Q. Okay. And in Section 2, it says unless a 22 subject is under a Jarvis order for forced 23 medication, which specifically prohibits the 24 forced treatment under an experimental 25 protocol, a commitment has no bearing on VERBATIM COURT REPORTING 763-493-4535 264 1 whether or not a subject would be deemed able 2 to provide informed consent. Did you write 3 that sentence? 4 A. Yes, I did. 5 Q. And that sentence is gross negligence, isn't 6 it, Doctor? 7 A. No, I believe that's correct. 8 Q. Did Dr. Olson know that you wrote this sentence 9 to the Ombudsman? I'm sorry. Dr. Schulz? 10 MR. ALSOP: Did who? 11 Q. Did Dr. Schulz know that you wrote this letter 12 to the Ombudsman? 13 A. I don't know. 14 Q. Did you have anyone at the University of 15 Minnesota evaluate this letter to see if it was 16 misleading and deceptive? 17 A. No. 18 Q. In this case, Mr. Markingson was on a stay of 19 commitment contingent on his cooperation with 20 recommended, appropriate treatment. Did you 21 write that sentence? 22 A. Yes, I wrote the entire letter. 23 Q. Since the treatment in the CAFE study is 24 consistent with standard treatment, and 25 approved, FDA approved antipsychotic, no VERBATIM COURT REPORTING 763-493-4535 265 1 restrictions on concurrent medications, et 2 cetera, and he was competent to provide 3 informed consent, he entered the study under 4 this stay. Did you write that sentence? 5 A. Yes. 6 Q. And you don't find, just yes or no, do you find 7 anything misleading and deceptive in this 8 letter at all? 9 A. No. 10 Q. But you're still not aware of the meaning of 11 the term therapeutic misconception, correct, 12 Doctor? 13 MR. ALSOP: Repetitious. 14 A. No. 15 Q. You do know that Dan was on Seroquel in the 16 study, correct? 17 A. Yes. That was reported -- well, was actually 18 reported by Mrs. Weiss to my study staff before 19 I learned of it months later from Astrazeneca. 20 Q. Now, from time to time, you have people 21 requesting information about joining your 22 clinical studies, correct? 23 A. Yes. 24 Q. And do you write them letters and notes with 25 information that will help them try to give VERBATIM COURT REPORTING 763-493-4535 266 1 informed consent as to whether to enter one of 2 your studies at the University of Minnesota? 3 MR. ALSOP: Object as vague and 4 ambiguous. Go ahead, Doctor. 5 A. I may. 6 Q. And this is Exhibit No. 30. 7 (Exhibit No. 30 was marked for 8 identification by the Court Reporter). 9 Q. (BY DR. BARDEN) Is that your signature, 10 Doctor? 11 A. Yes. 12 Q. This is dated October 25th, 2004, correct? 13 A. Yes. 14 Q. To whom it may concern, confirmation on adverse 15 events. This is to confirm that the University 16 of Minnesota Department of Psychiatry has had 17 no adverse events to report while conducting 18 clinical trials. Did you write that sentence? 19 A. No. 20 Q. You didn't? 21 A. No. This doesn't look like my signature 22 either. 23 Q. Really? 24 A. I don't recall making this -- I don't recall 25 the circumstances under which I would have VERBATIM COURT REPORTING 763-493-4535 267 1 written a letter like this. 2 Q. Are you denying that you wrote this letter? 3 A. I don't recall writing this letter. 4 Q. Are you denying that you wrote it or are you 5 just saying you don't remember writing it? 6 A. I don't remember writing it. 7 Q. Have you ever given false or deceptive or 8 manipulative information to research subjects 9 to get them into your studies? 10 A. No. 11 MR. ALSOP: Vague and ambiguous, 12 multiple. Go ahead and answer. 13 A. No. I would never have written this because 14 this says there have had no adverse events to 15 report. We have adverse events all the time. 16 That includes insomnia, restlessness, anything 17 that's a side effect or even a concurrent, ear 18 infection is an adverse event. So this doesn't 19 make any sense to me. I don't know why I would 20 have been asked to write such a letter. And it 21 doesn't look like my signature, so I can't 22 vouch for this validity. 23 Q. When you were doing the study, you frequently, 24 you would look over various tests and initial 25 them, is that right? VERBATIM COURT REPORTING 763-493-4535 268 1 A. I would look over various tests and initial 2 them? 3 Q. On various parts of the study data. 4 A. Yeah. Sure. 5 Q. It says rater initials, correct? 6 A. Yes. 7 Q. Did Jean Kenney ever forge your initials on any 8 of the rating scales? 9 MR. ALSOP: Object on the basis of 10 speculation. 11 MR. GROSS: Same objection, 12 argumentative. 13 A. I don't think so. I don't know how he would 14 know. 15 Q. Let's make these three, I've got 417, 731 and 16 77. And this is Exhibit No. 31. 17 (Exhibit No. 31 was marked for 18 identification by the Court Reporter). 19 Q. (BY DR. BARDEN) Look at the first one, there 20 CS 417. Do you see that, Doctor, the rater 21 initials are JMK, correct? 22 A. Yes. 23 Q. And that's the way Kenney did her initials, 24 isn't it, kind of block letters like that, 25 typically? VERBATIM COURT REPORTING 763-493-4535 269 1 A. I don't know. 2 Q. The next one is CS 731, and that looks like 3 your initials, correct? 4 A. Yes. 5 Q. And the next one is -- looks like your initials 6 written by Jean Kenney. Can you explain that? 7 MR. ALSOP: Objection, lacks in 8 foundation. 9 MR. GROSS: Same objection. 10 MR. ALSOP: Go ahead, Doctor. 11 Q. (BY DR. BARDEN) There are a number of these in 12 the record. I'm just showing you examples of 13 these. Is it your testimony that both of those 14 initials that have your initials were written 15 by you or Jean Kenney wrote the other one? 16 A. Well, I don't know -- 17 MR. ALSOP: Same objections. 18 A. -- who wrote it. It doesn't look like my 19 initials. I certainly can write like that. I 20 don't know that I did, and I don't have any 21 explanation. 22 Q. Was it a common practice for Jean Kenney to 23 sign off on things for you? 24 A. No. 25 Q. Are you denying that Jean Kenney falsely wrote VERBATIM COURT REPORTING 763-493-4535 270 1 in your initials on several of the rating forms 2 in your study? 3 MR. GROSS: Objection, lack of 4 foundation, argumentative. 5 MR. ALSOP: I'll join. 6 A. I don't believe that Jean Kenney would have 7 falsely wrote down my initials because she 8 would have had no reason to do so. Either I 9 was there and I did the exam and I should have 10 initialled it, or she would have given me the 11 sheet to initial if I left it off, or she did 12 the exam, which she was qualified to do, and 13 she would have initialled it herself. 14 Q. You have no other explanation for those 15 initials being the way they are, other than 16 what you've described on the record, is that 17 correct? 18 A. No, that's correct. 19 Q. Doctor, isn't it the case that the reason we 20 have the Nurenberg codes and the Helsinki and 21 the Belmont and the other international 22 foundational ethical guidelines is to prevent 23 patients from being abused; isn't that correct? 24 MR. ALSOP: It's a multiple question, 25 vague and ambiguous, lacking in foundation. VERBATIM COURT REPORTING 763-493-4535 271 1 Irrelevant. Go ahead, Doctor. 2 A. Yes. The reason why we have research protection 3 is to protect subjects. 4 Q. And isn't it in fact the case that when those 5 ethical foundational rules are violated, the 6 rights and safety of patients can be 7 threatened? 8 MR. ALSOP: Same objections. 9 A. Yes. 10 Q. (BY DR. BARDEN) And isn't it in fact the case 11 that when the fundamental ethical rules and 12 foundational principles of medical ethics are 13 violated, sometimes patients will actually lose 14 their lives due to those violations? 15 MR. ALSOP: Same objections. 16 MR. GROSS: Speculative. 17 A. Yes. There is that risk. 18 Q. Isn't that why we have those rules and 19 foundational guidelines to reduce the risk to 20 vulnerable patients? 21 A. Yes. 22 Q. How are the medications dispensed? Was Dan 23 actually given bottles of pills? 24 A. Yes. 25 Q. So he would be actually handed several bottles VERBATIM COURT REPORTING 763-493-4535 272 1 of pills, one or two in a baggie perhaps? 2 A. Yes. 3 Q. And it would be marked with his name. Where 4 would he take those pills, to the Theo house? 5 A. Yes, back to the Theo house. 6 Q. Then he was supposed to bring them back empty 7 when they were finished? 8 A. He would be -- my understanding was the Theo 9 House dispensed the medication, and prior to 10 his visit, they would give him the partially 11 used or empty bottles to return to us for us to 12 account for the study medication. 13 (Exhibit No. 32 was marked for 14 identification). 15 Q. (BY DR. BARDEN) Show you what is marked as 16 Exhibit No. 32, photograph from the coroner's 17 office. Could you identify that for us, 18 Doctor? 19 A. That's a CAFE study medication bottle. 20 Q. Would have been given to Dan to take to Theo 21 House, correct? 22 A. Yes. 23 Q. This is Exhibit 33. Once again, a coroner's -- 24 (Exhibit No. 33 was marked for 25 identification by the Court Reporter). VERBATIM COURT REPORTING 763-493-4535 273 1 Q. (BY DR. BARDEN) What's that, Doctor? 2 A. If that's the same bottle, that's the top of 3 the bottle, indicating that the foil seal 4 hasn't been broken. 5 Q. And no pills have been taken from that? 6 A. That's correct. 7 Q. Correct? Now, Doctor, we had talked about 8 these foundational ethical principles and rules 9 and Nurenberg codes. 10 A. Can I elaborate on this? 11 Q. Not right now. We'll have another time when we 12 look over documents, but we've talked about 13 these foundational ethical principles and how 14 they're designed to protect patients. Now, 15 it's true, isn't it, that Dan Markingson came 16 into your care as a grossly delusional 17 psychotic who had thoughts of killing people by 18 slitting their throat; isn't that correct? 19 A. Yes. 20 Q. And isn't that in fact exactly how he died? 21 A. Yes. 22 Q. I show you what's marked as Exhibit No. 34. 23 (Exhibit No. 34 was marked for 24 identification). 25 Q. (BY DR. BARDEN) And this will be our last VERBATIM COURT REPORTING 763-493-4535 274 1 exhibit for today. And this is the coroner's 2 photograph of Dan Markingson, one of them. And 3 I will make this Exhibit 34. 4 Have you ever seen that photograph 5 before, Dr. Olson? 6 A. No. 7 Q. Did anyone at the University of Minnesota, the 8 IRB, or Astrazeneca discuss with you the 9 dangers of ignoring the repeated warnings of a 10 patient's mother when the mother had more 11 contact with the patient than anyone else, the 12 mother stated that her son was grossly 13 psychotic, the medication was not working, and 14 he's going to kill himself or someone else if 15 you don't get him out of the study, did any of 16 those entities or people come and discuss with 17 you the dangers of proceeding on the course you 18 were on with Dan? 19 MR. ALSOP: Object as argumentative. 20 It's also irrelevant, but go ahead. 21 MS. SVITAK: Same objections. 22 A. No. 23 Q. (BY DR. BARDEN) Since Dan's death, have you 24 started listening more intently to alternative 25 sources of information, that is, from people VERBATIM COURT REPORTING 763-493-4535 275 1 outside of the financial conflict of interest 2 generated by a research study like yours? 3 MR. ALSOP: Objection as argumentative, 4 vague and ambiguous. And it's irrelevant as to 5 what changes he's made, but go ahead. 6 MS. SVITAK: Same objection. 7 A. Dan's death certainly brought to light the 8 possibility that people can appear to be in one 9 state and then do something that's unexpected 10 but -- and I've always listened to family 11 members and tried to get as much information 12 and put it together as I can in the care of my 13 patients. And I believe I did this in this 14 case and unfortunately, you know, I was wrong 15 and, you know, a tragedy did happen. And I'm 16 sorry about that, but I believe that I did -- I 17 provided him good care and that the research 18 project was appropriate for him and we 19 provided -- we communicated with everybody in 20 the course of his care in the study. 21 Q. Doesn't the record reflect that your last 22 answer did it again, you again discounted the 23 evidence, the very reliable, 24 greatest-number-of-hours-with-the-patient 25 evidence of Mary Weiss? She told you he was VERBATIM COURT REPORTING 763-493-4535 276 1 psychotic, she told you he was out of control, 2 she told you he would kill himself and you just 3 referred to this as, quote, unexpected, 4 unquote. You did it again, didn't you, 5 Dr. Olson? 6 A. No. 7 MR. ALSOP: There is no question. 8 DR. BARDEN: I have nothing further at 9 this time. We're going to have to reconvene at 10 a time when we can meet when we have the 11 records before us. I think we have a half an 12 hour left on our time that we can use for that 13 purpose. 14 MR. ALSOP: You can go off the record, 15 off the video record. 16 DR. BARDEN: Let's go off the video 17 record at this point 68. 18 MR. ALSOP: We talked to the videographer 19 and I want to make a record that we have had 20 approximately six hours, give or take, five 21 minutes of videotaped testimony. 22 DR. BARDEN: That's all I have. 23 24 25 VERBATIM COURT REPORTING 763-493-4535 277 1 C E R T I F I C A T E. 2 STATE OF MINNESOTA ) 3 } ss: 4 COUNTY OF HENNEPIN ) 5 6 I, MARI SKALICKY BRUNO, a notary public in and for the aforesaid county and state, do hereby 7 certify that the witness, DR. OLSON, was duly sworn by me prior to the taking of testimony as to the 8 truth of the matters attested to and contained therein, that the testimony of said witness was 9 taken by me in machine shorthand and was thereafter reduced to typewritten form by me or under my 10 direction and supervision, that the foregoing transcript is a true and accurate record of the 11 testimony given to the best of my understanding and ability. 12 I FURTHER CERTIFY that I am neither counsel 13 for, related to, nor employed by any of the parties to the action in which this proceeding was taken; 14 and, further, that I am not a relative or employee of any attorney or counsel employed by the parties 15 hereto, nor financially interested, or otherwise, in the outcome of this action; and that I have no 16 contract with the parties, attorneys, or persons with an interest in the action that affects or has a 17 substantial tendency to affect impartiality, that requires me to relinquish control of an original 18 deposition transcription or copies of the transcript attorney, or that requires me to provide any service 19 not made available to all parties to the action. 20 WITNESS MY HAND AND SEAL this 5th day of May, 2007. 21 _______________________________ 22 MARI SKALICKY BRUNO Notary Public 23 24 25 VERBATIM COURT REPORTING 763-493-4535 278 1 C E R T I F I C A T E I, the undersigned, DR. OLSON, do 2 hereby certify that I have read the foregoing deposition and that, to the best of my knowledge, 3 said deposition is true and accurate (with the exception of the following corrections listed 4 below): 5 6 PAGE/LINE CORRECTION AND REASON FOR CORRECTION 7 8 9 10 11 12 13 14 See attached sheet(s) for additional information: ___Yes___No 15 ______________________________ 16 STATE OF ___________) 17 ) ss.: COUNTY OF __________) 18 Subscribed and sworn to before me this 19 ______ day of ______________, 2005. 20 _______________________________ 21 Notary Public 22 My commission expires: ______________________. 23 PLEASE RETURN TO : Mari Bruno, Verbatim Court Reporting, 8906 Ashley Terrace, Minneapolis, MN 24 55443. 25 VERBATIM COURT REPORTING 763-493-4535 279 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 VERBATIM COURT REPORTING 763-493-4535 281 $1,000 26:6, 26:6, 52:15. 000186 147:14. 26:15, 26:15 $30,000 52:21, 000187 253:1. $100 232:2. 52:21. 000189 255:20. $15,000 34:11, $500 26:7. 0005 261:25. 34:11, 34:12, $750 26:8. 000776 240:21. 34:12, 35:21, '04 203:10, 233:4, 0067 247:11. 35:21, 36:13, 233:7, 239:1, 04 233:6. 36:13, 38:10, 239:4, 239:22, 05 255:12. 38:10, 39:25, 245:12, 262:9, 06 1:3. 39:25, 40:10, 262:19. 0M 255:20. 40:10, 48:25, '05 233:6. 0M000343 193:19. 48:25, 76:6, '85 19:18. 1 2:8, 4:8, 13:14, 76:6, 95:6, '97 20:8. 14:14, 41:17, 95:6, 95:13, 000 195:1. 42:10, 155:5, 95:13, 99:11, 000021 235:22. 168:16, 177:6. 99:11, 99:20, 000022. 244:10. 10 4:17, 4:23, 99:20, 100:17, 00003 255:18. 30:13, 126:16, 100:17, 101:11, 00014 253:1. 147:15, 169:1, 101:11, 103:10, 000144 244:8. 169:7, 171:23, 103:10, 103:20, 000176 146:25. 179:3. 103:20, 167:25, 00018 147:18. 100 2:18. 167:25, 194:11, 000181 171:24. 1025 2:19. 194:11, 214:22, 000182 177:6. 1099 26:16, 26:18, 214:22. 000183 179:3. 26:20. $150,000 52:15, 000185 147:1. 1099s 26:23. Page: 282 of 331 Concordance 14th 16:13, 16:17, 165 195:1. 11 4:18, 225:23. 16:25, 17:8, 17 4:9, 4:24, 110 125:17. 43:18, 44:20, 42:10, 218:18, 11934 1:3. 100:14, 130:7, 218:19. 12 4:19, 10:16, 162:18, 242:22. 17th 125:12, 10:22, 42:11, 15 4:22, 145:21, 129:22, 130:3. 42:13, 42:16, 145:24, 202:19, 18 4:25, 223:17. 42:19, 193:17, 202:20, 202:23. 18. 223:16. 193:20, 194:24, 157 55:8, 57:2, 182 4:18. 214:11. 244:16, 245:12, 19 4:26, 229:5, 12/0 229:19. 258:12, 261:24, 229:6. 124 4:10. 263:6. 194 4:19. 126 4:11. 1572 55:11, 55:16, 196 4:20. 13 4:20, 41:4, 55:18, 55:20, 1972 17:24. 41:16, 194:25, 56:2, 56:24, 1976 17:24, 18:14. 195:2. 57:20, 57:24, 1980 18:14, 18:24. 131 4:12. 58:14, 58:16, 1984 18:24. 134 4:13. 58:19, 232:3, 1985 8:9, 19:1, 139 4:14. 244:1, 262:8, 20:3. 13th 41:5. 262:14, 262:19, 1990 7:18. 14 4:8, 4:21, 262:25. 2 4:9, 16:5, 16:6, 201:4, 206:21. 1572s 55:22, 133:19, 263:21. 1400 3:16. 56:18, 58:8, 20 4:14, 4:27, 144 244:8, 244:9. 262:16. 232:25, 233:1. 147 4:15, 4:16. 16 4:23, 207:4. 200 16:14, 16:25, 148 4:17. 17:8, 21:12, 33:11, 41:18, 42:7, 42:16, 43:18, 44:16, 130:3, 138:18, 175:22, 176:2, 178:25, 181:24, 201:10, 203:16, 206:24, 210:7, 229:22, 242:16, 243:1, 247:14, 266:12. 2000 8:9, 20:3. 2001 25:4, 25:5, 25:21, 171:1. 2002 25:22, 40:2, 40:3, 40:11, 41:2, 41:8, 171:1. 2003 4:14, 4:15, 4:20, 16:12, 16:17, 41:6, 41:14, 42:2, 125:13, 211:3, 255:13. Page: 287 of 331 Concordance 22 4:29. 264 4:36. 2004 4:21, 4:23, 22-23 244:11. 267 4:37. 4:32, 4:36, 2200 3:11. 269 4:38. 4:37, 25:25, 224 4:25. 27 4:32, 4:34, 173:5, 201:3, 23 4:30, 244:10. 229:24, 255:21. 202:13, 202:23, 230 4:26. 273 4:39. 203:7, 203:9, 234 4:27, 4:28. 274 4:40. 204:19, 205:8, 23rd 233:4. 275 4:41. 208:18, 211:4, 24 4:15, 4:31, 27th 181:24, 228:19, 238:14, 137:25, 247:23, 247:14. 239:25, 240:22, 247:24. 28 4:35, 261:24, 243:8, 243:17, 245 4:29, 4:30. 262:1. 245:4, 262:7. 248 4:31. 29 4:36, 263:13, 2005. 278:27. 24th 135:22, 263:13, 263:16. 2006 173:3. 210:3, 210:7. 29th 243:17. 2007 2:8. 25 4:32, 4:37, 2M 218:23. 202 4:21. 52:10, 249:17, 2nd 229:22. 203 4:22. 249:18. 3 4:10, 55:2, 208 4:23. 250 4:32. 81:4, 123:9, 20th 138:18, 256 4:34. 123:10, 123:16, 149:2, 149:4. 258 4:33. 126:17, 129:21, 21 4:28, 233:1, 25th 266:12. 229:24, 272:16. 235:23, 236:2, 26 4:33, 252:22, 3/09 233:6. 236:4. 252:23. 30 4:37, 48:18, 219 4:24. 262 4:35. 266:6, 266:7. 21st 44:22, 149:4. 30th 206:24. 31 4:38, 268:16, 268:17. 31st 239:25, 240:8, 240:22. 32 4:39, 272:13. 33 4:40, 272:23, 272:24. 34 4:41, 273:22, 273:23, 274:3. 4 4:6, 4:11, 55:2, 125:14, 126:17. 40 21:11. 41 268:15. 417 268:20. 45 191:22. 46.116a4 191:22. 4:30 238:18, 238:18. 4A 129:16. 4B 129:20. 5 4:12, 130:11, 133:13, 172:10, 239:24. 500 3:6. 55102 3:17. Page: 292 of 331 Concordance 8th 162:21, 97:17, 264:1. 55402 2:20, 3:12. 162:21, 162:22, above 204:21. 55416 3:7. 162:23, 163:22, above-named 55443. 278:37. 211:2, 211:3. 124:22. 5th 277:38. 9 4:16, 4:36, absence 95:23. 6 4:13, 133:1, 147:4, 147:11, Absolutely 28:16, 133:4, 171:23, 153:9, 224:8, 67:23, 67:23, 182:17, 261:25. 224:20, 233:3, 70:10, 74:22, 60 2:6. 262:9. 90:1, 93:7, 62 1:3. 9. 146:18. 157:15, 192:25, 64 4:26. 90s 7:9, 23:23. 219:19. 68 276:17. 9:00 2:7, 2:7, abundantly 151:17. 7 4:14, 138:6, 5:4, 5:4. abuse 105:10, 138:20, 138:21, 9th 262:7, 262:19. 181:1. 138:24, 177:6, ___yes___no abused 113:5, 177:12, 202:24, 278:18. 270:23. 202:25. . abusing 181:15. 701 2:6, 3:6. . academic 9:14, 73 269:2. < A >. 21:18. 731 268:15. a.m. 2:7, 5:4. accept 124:7, 77 268:15. ability 45:25, 124:12, 128:25. 8 4:15, 4:20, 109:20, 277:21. accepted 116:14. 10:16, 10:22, able 18:4, 48:10, access 120:3, 179:3. 61:4, 62:2, 241:11. 8-9 146:19. 62:6, 84:22, according 53:3, 8906 278:36. 207:24. account 29:25, 31:18, 31:23, 32:19, 33:20, 33:21, 93:4, 272:12. accountable 199:9. accounting 36:25. accurate 15:19, 56:25, 96:12, 140:18, 200:9, 256:24, 257:3, 277:19, 278:5. acknowledge 129:10, 139:20. acknowledged 115:4, 115:11. acknowledgment 139:6. act 108:15, 139:11, 140:17. acted 7:1. acting 105:14, 106:9, 110:7, 260:25. action 9:12, Page: 297 of 331 Concordance 248:21, 249:9, 230:12, 230:19. 11:12, 11:15, 258:20, 265:17, administration 132:1, 132:2, 271:13, 271:23, 28:5, 29:8, 258:7, 277:25, 271:25. 37:2, 37:4, 277:29, 277:31, acute 24:3, 74:2. 37:13, 127:22. 277:36. add 15:23, 78:16, admission 44:15, actions 8:4, 8:11, 247:12. 45:19, 92:5, 8:19, 10:7, added 169:5, 93:5, 113:13, 11:4. 173:3. 115:17, 136:15, activity 21:25, addition 205:11, 260:24. 26:25. 205:12, 262:11. admitted 113:20. actor 245:9, additional 15:10, admitting 76:17. 247:4. 15:15, 121:8, Adult 4:16, 104:9, actress 126:21. 278:17. 172:8. actual 9:10, address 214:16, advance 127:23. 10:15, 11:2, 262:11. advanced 128:10. 14:25, 26:24, addressed 223:6. advantage 54:13, 117:23, 120:18, adequate 10:25, 82:2. 140:6, 186:1, 156:7, 163:20. advantageous 228:5. adequately 156:2, 49:25, 50:6, actually 21:24, 156:9, 156:18. 93:20, 191:25. 35:1, 35:9, adjudicated 84:10, Adverse 4:33, 36:10, 37:10, 84:19. 252:21, 252:21, 78:5, 133:7, administered 253:3, 253:6, 153:6, 163:21, 31:18, 116:11, 253:19, 254:24, 164:5, 173:16, 266:14, 266:17, 267:14, 267:15, 267:18. advised 9:9, 178:21. adviser 18:15. advisor 19:5. affairs 216:3. affect 177:10, 177:23, 277:32. affective 129:17. affects 277:31. affidavit 247:9. affiliated 166:2. affirmative 13:7, 27:21, 119:13, 242:20. aforesaid 277:11. aftercare 135:2, 135:11, 136:1, 199:7. agents 207:16. ago 27:4, 27:7, 27:8, 27:10, 33:12. Page: 302 of 331 Concordance alert 4:21. 179:9, 179:11, agree 84:23, alerting 177:1. 182:17, 182:19, 105:9, 105:14, allegations 9:22, 184:8, 184:9, 105:24, 106:9, 9:25. 185:8, 186:2, 117:8, 166:23, alleging 241:17. 186:10, 186:16, 167:9, 169:2, allocate 29:11. 186:18, 186:20, 169:16, 169:18, allocated 28:10. 186:24, 187:6, 169:19, 169:22, allow 39:20, 92:4, 191:6, 191:8, 170:10, 189:22, 180:24, 252:10. 191:16, 191:18, 200:8, 218:2, allowed 58:18, 191:21, 191:23, 219:14, 219:16, 74:16, 81:24. 192:6, 196:9, 235:10, 248:18. almost 86:23, 196:14, 200:23, agreed 84:20, 140:11. 274:24. 199:7, 243:12, alone 150:25. alternatives 246:17, 250:7. already 14:6, 94:21, 117:6, agreeing 109:19, 14:12, 75:20, 179:14, 184:13, 116:6. 149:8, 173:20, 184:19, 186:8, agreement 67:24, 183:8, 190:4, 186:13, 187:17, 68:9, 69:23, 250:7, 250:9, 192:10, 200:12. 70:25, 85:8, 252:8. although 78:7, 195:10, 197:17. alternative 96:16, 79:15, 136:24, agrees 133:10. 96:17, 98:6, 140:5, 241:12. AIMS 4:38. 98:9, 98:17, ambiguous 47:15, alcohol 180:19, 98:18, 137:1, 50:2, 52:25, 181:1, 181:16. 179:4, 179:7, 53:7, 53:8, alcoholics 182:10. 60:19, 61:15, 64:9, 65:16, 67:4, 76:9, 106:16, 131:24, 132:5, 137:14, 138:12, 138:15, 139:18, 141:24, 142:13, 143:4, 162:9, 163:12, 167:11, 178:15, 184:21, 186:4, 189:20, 190:17, 192:3, 203:14, 204:8, 209:1, 211:6, 217:4, 226:15, 235:12, 254:15, 258:15, 266:4, 267:11, 270:25, 275:4. amenable 227:2. amendment 174:7. Americans 173:24, 174:16. among 28:23. amount 28:6, 39:7, Page: 307 of 331 Concordance 78:17. apparent 260:24. 203:23. anticonvulsions apparently 210:2. analyze 104:19. 183:3. appeal 126:11. and/or 19:3. antidepressants appear 89:3, Angelina 113:25, 201:16. 179:7, 179:9, 126:22. antipsychotic 179:13, 179:16, anna 94:15. 44:19, 131:13, 179:19, 180:1, Anoka 134:3, 158:18, 160:3, 205:18, 212:24, 134:7, 134:16, 185:16, 186:7, 251:15, 257:18, 152:8, 195:17. 207:15, 227:3, 257:19, 275:8. answered 40:17, 264:25. appearance 245:7. 41:21, 56:4, antipsychotics appeared 76:2. 59:11, 63:1, 60:25, 61:2, appears 16:10, 65:1, 72:22, 179:18, 182:21, 210:25, 211:10, 73:17, 75:20, 182:22, 182:23, 212:13. 78:21, 80:11, 182:24, 185:9, application 86:22, 94:4, 98:14, 185:19, 191:8, 263:2. 99:24, 103:3, 191:12, 201:17, apply 71:3, 72:2, 107:4, 107:21, 259:3. 105:3, 166:11. 151:5, 153:25, anwer 136:10. appoint 135:21. 154:4, 159:19, anybody 24:25, appointed 8:15, 159:21, 165:19, 144:13, 193:4, 122:22. 173:20, 209:10, 216:6, 258:24. appointment 211:7, 215:8, anyway 126:12, 130:10. 261:21. 246:11. appointments answering 63:4, 182:8, 196:23, 196:25, 239:20, 258:24. appropriate 42:22, 42:23, 46:1, 57:10, 64:20, 79:12, 79:15, 87:21, 88:8, 93:9, 98:18, 98:21, 110:18, 136:16, 143:22, 150:21, 152:10, 191:20, 191:23, 196:9, 198:8, 213:22, 230:21, 259:24, 260:3, 264:20, 275:18. approval 35:6, 107:18, 150:19. approved 110:17, 138:7, 145:2, 154:25, 158:21, 159:3, 159:6, 159:8, 159:12, 159:24, 160:6, Page: 312 of 331 Concordance 194:12, 208:24, 63:9, 63:14, 160:17, 160:25, 249:9. 63:23, 93:6, 161:1, 161:6, arranged 136:13. 98:21, 158:11. 192:12, 192:14, arrangements assessments 61:24. 192:16, 209:25, 30:22, 31:4, assigned 60:9, 210:9, 210:12, 32:17, 194:19. 60:22, 107:9, 264:25, 264:25. arrested 131:21. 135:16, 135:22, approximately 2:7, arrive 94:14. 146:10, 150:15. 5:4, 165:2, arrived 18:19, assignment 135:17, 276:20. 24:22, 68:1, 145:25, 146:8. Apr 4:32. 213:22. assistant 182:2, April 33:11, arrives 85:8. 247:10. 42:16, 42:17, Article 9:14, assume 31:12, 164:11, 164:19, 168:16, 169:1, 156:1, 185:5, 165:2, 210:16, 169:7, 181:21. 233:22, 234:18. 217:12, 223:2, articles 59:5, Assumes 62:9, 228:19, 243:8, 65:3, 65:18, 71:12, 83:19, 245:3, 245:12, 81:18, 81:23. 84:15, 171:3, 247:14. Ashley 278:36. 181:10, 194:14, area 74:4, 74:6, aspects 71:2. 235:11, 260:9. 74:9. assay 140:7, assumption 233:14, areas 165:17. 260:16. 233:18. argue 237:5. assess 166:25. assurances 257:10. arguing 150:13, assessment 17:4, attached 14:1, 174:9. 38:20, 62:16, 278:17. around 75:7, attempt 193:15, 201:9, 203:5, 203:20, 204:25, 205:12, 217:1. attempting 76:3. attempts 204:17, 205:7. attend 21:19, 26:7. attended 70:19, 217:16, 219:5. attending 24:11, 42:17, 217:17. attention 145:13, 230:2, 242:11. attested 277:14. Attorney 9:8, 9:18, 130:10, 247:11, 277:27, 277:35. attorneys 8:15, 277:30. attributes 125:4. atypical 207:15. AUDIO 1:23. Page: 317 of 331 Concordance average 233:19. 223:4, 224:6, authority 127:24, avoid 222:12, 225:8, 229:3, 128:12, 204:6, 224:1, 224:4. 230:20, 239:17, 204:9. avoided 220:4. 242:22, 246:9, Authorization awareness 115:2, 246:11, 249:16, 4:25, 10:1, 245:8. 272:5, 272:6. 141:14, 141:19, away 101:12, back-loaded 38:14. 143:1, 143:8, 131:16, 221:21, back. 77:23, 79:7, 143:11, 143:15, 222:6. 80:14. 144:12, 224:15, . background 188:2. 225:17, 225:25, . baggie 272:1. 226:1, 226:6. < B >. bags 234:4. authorizations Back 11:19, 17:17, ballpark 30:12, 145:16. 20:4, 21:8, 54:23. authorize 225:12. 24:18, 27:1, BARDEN 2:15, 4:6, authors 65:7, 29:9, 29:24, 5:12, 64:20. 65:8, 65:18. 48:22, 48:23, base 219:10. Autopsy 4:39, 56:19, 57:6, Based 39:7, 66:13, 140:2. 78:10, 78:12, 69:8, 94:16, availability 78:19, 79:6, 98:21, 130:7, 61:19. 87:5, 97:2, 188:24, 195:9, available 163:17, 99:1, 118:13, 220:5, 252:9, 183:14, 186:21, 126:5, 182:15, 259:6, 259:7, 187:20, 187:22, 190:2, 200:2, 259:8, 259:9. 188:11, 277:36. 201:7, 205:3, baseline 39:22, Avenue 2:6, 3:6. 217:21, 218:9. basic 71:6, 71:18, 189:22. Basically 37:25. basis 26:23, 29:2, 30:18, 78:2, 111:12, 114:10, 116:8, 128:5, 141:6, 152:23, 152:25, 189:7, 256:7, 268:9. Bates 125:17, 130:12, 146:24, 171:24, 193:19, 235:21, 240:18, 240:20, 244:7, 244:10, 252:25, 255:19. Bear 17:20, 67:12. bearing 263:25. became 81:7. become 23:14, 245:4, 245:9, 247:4. becoming 241:22. beforehand 139:24, Page: 322 of 331 Concordance 115:5, 127:1, 87:20, 90:20, 256:19. 128:15. 122:19, 223:12, began 41:2, Bell 4:29. 223:14, 225:20, 115:18, 228:18. bell-shaped 240:9. 226:16, 259:8, begin 116:6, Belmont 67:8, 277:20, 278:4. 116:24. 67:10, 67:17, better 54:4, beginning 11:20, 70:25, 71:1, 136:6, 167:16, 34:2, 42:16, 270:21. 167:22, 168:3, 94:14. below 14:20, 236:12. behalf 1:6, 5:16, 124:17, 127:9, beyond 15:10, 5:18, 5:21, 129:16, 278:7. 27:13, 28:12, 5:25, 6:2, 6:6, Ben 2:16, 5:17. 169:5. 24:20, 25:23. benefit 87:19, bias 102:3, 102:9. behave 132:12. 105:11, 105:18, biggest 171:22. behavior 104:19, 106:5. billed 16:11, 105:1, 203:19, benefits 35:17, 32:5. 227:5, 260:19, 108:9. Billing 4:9, 261:3. benefitted 170:3. 15:25, 16:2. Behavioral 123:19, Bennatti 245:19, billings 16:13. 204:3, 245:24. 245:20. billion 55:2, behind 234:9. Benson 3:10, 6:2. 55:3, 156:10. beings 67:22. best 15:18, 17:6, bills 16:20, 17:5. beliefs 115:4, 25:19, 26:15, binding 38:7. 115:11, 129:11. 30:16, 37:16, bioethics 168:13. believed 113:23, 57:21, 58:21, biological 126:21. 113:25, 114:13, Bipolar 22:23, 62:3, 62:4, 62:7, 92:2, 92:20, 93:1, 93:17, 95:11, 96:2, 96:4, 96:5, 96:9, 96:18, 98:11, 98:20, 103:7, 103:11, 103:15, 103:16, 103:18, 103:21, 113:8, 113:11, 129:16, 179:6. bit 12:18, 17:17. blank 144:10, 144:11, 144:18. blending 104:4. blinded 231:21. block 268:24. blood 140:3, 178:4, 231:4, 231:5, 231:23, 231:25, 256:2, 256:6, 256:11, Page: 327 of 331 Concordance boyfriend 126:20, 230:20, 275:7. 259:21. 127:2. Bruno 277:10, BMW 221:22, break 12:1, 12:2, 277:42, 278:35. 221:24, 222:2, 48:19, 182:13, budget 29:10, 222:4, 222:4. 229:1. 29:25, 32:19, Board 1:14, 1:16, breening 234:6. 34:2. 5:22, 11:9, brief 48:21, bulletproof 11:11, 11:16, 98:25, 146:3, 261:14. 21:17, 22:6, 182:14, 229:1, burden 90:22. 206:7. 229:2. bus 238:3. Bob 19:4. bring 13:22, 14:3, business 44:14, body 202:25. 14:6, 14:10, 49:25, 130:17. Bornstein 20:9. 14:24, 15:7, button 209:2. bottle 230:22, 17:25, 51:20, . 272:19, 273:2, 51:24, 119:6, . 273:3. 119:16, 120:4, < C >. bottles 230:20, 121:11, 121:17, caffeine 256:2. 271:23, 271:25, 211:23, 272:6. California 190:2, 272:11. brings 234:8. 214:19, 236:8, bottom 133:10, broken 273:4. 236:20, 238:4, 156:25, 198:23, brother 113:25. 241:3, 243:11, 198:25, 202:25, brought 8:4, 8:11, 245:9. 254:5. 8:19, 52:4, call 26:2, 33:21, boundary 103:24, 114:18, 127:11, 131:23, 140:21, 104:2, 104:12. 145:12, 211:16, 198:3, 249:10. boy 5:13. called 6:12, 27:22, 32:15, 75:12, 102:2, 102:3, 217:9. Calls 43:3, 114:5, 192:2, 205:25, 222:14, 258:13, 263:8. cancelled 217:10, 239:19, 258:23. capable 236:21. capacity 42:25, 43:17, 43:25, 44:18, 45:2, 45:14, 46:8, 46:15, 46:19, 47:3, 80:22, 100:10, 109:11, 111:1, 111:7, 114:3, 114:8, 114:11, 124:23, 125:8, 128:15, 242:23. car 222:6, 222:8, 238:11. Page: 332 of 331 Concordance ceasing 260:6. 258:25, 259:1, Card 229:11, Center 3:11, 3:16, 265:2. 229:14, 240:24, 42:21, 134:4, CFR 191:22. 241:8. 134:7, 134:17, Chairman 19:4, career 10:9. 134:25, 157:20, 20:7, 20:9, careful 12:7. 196:7, 198:3. 20:11, 20:14, Carl 102:19, certain 28:6, 24:9. 102:22, 103:1, 94:11, 132:12, chance 240:16. 103:5. 167:7, 167:8, change 46:2, cases 6:24, 7:2, 218:14, 225:7. 48:19, 55:15, 7:5, 9:19, Certainly 8:21, 57:1, 57:1, 25:15, 26:19, 55:1, 61:16, 109:10, 146:2, 187:3, 187:3, 68:16, 79:16, 161:19, 170:25, 191:12, 215:14. 132:11, 140:11, 209:24, 210:5, category 21:12, 141:1, 180:17, 255:7, 260:19, 118:5. 218:1, 228:14, 262:10, 262:11. CATIE 41:24. 230:16, 234:11, changes 55:16, cause 39:4, 235:1, 256:18, 60:12, 275:5. 113:19, 129:11. 269:19, 275:7. changing 228:25. caused 113:12, CERTIFY 21:11, characteristics 180:16. 21:15, 277:12, 148:19. cautious 168:18, 277:23, 278:3. characterization 169:10, 169:19. cetera 129:21, 191:4, 216:17, CCM 4:19, 193:17. 131:21, 172:3, 220:18, 237:25, CD-ROM 119:2, 172:4, 234:9, 251:22. 119:8. characterize 45:10, 132:6, 137:19, 250:21. characterized 258:16. charge 31:24. Charles 1:16. Chart 4:28, 4:30, 117:19, 117:22, 121:14, 180:4. check 27:1, 28:14, 41:12, 124:24, 225:8. checked 26:19, 124:20, 242:17, 242:18. checking 212:23, 262:23. chemical 179:25, 180:5, 180:6, 181:17. choice 60:22. cholesterol 178:4, 178:6. choose 197:25. Page: 337 of 331 Concordance classes 21:6, 12:17. chosen 79:17, 70:19. Clinic 17:5, 32:4, 108:3, 127:14, Classic 234:10. 42:21, 74:3, 136:25, 157:17, Clear 32:15, 33:8, 121:1, 157:18, 157:18, 186:10, 57:18, 92:11, 157:19, 162:12, 196:11. 114:13, 147:2, 162:12, 196:17, Chris 5:12. 147:4, 147:9, 198:6, 243:17. Christopher 2:15. 151:17, 169:6, clinically 60:13. chronology 225:9. 170:19, 182:18, clinician 60:11, Chuck 3:14, 5:21, 185:6, 187:5, 60:23, 61:18, 20:13. 191:21, 200:7, 73:9, 111:7, CIGNA 33:17. 205:17, 219:16, 169:18. circumstance 235:8. clinicians 226:10. 45:17. cleared 154:6. Clinics 18:22, circumstances Clearly 11:23, 42:20, 197:1, 48:3, 56:25, 50:9, 95:21, 200:18. 166:4, 198:20, 113:20, 114:3, close 92:25. 266:25. 121:10, 127:18, closely 213:8. citation 63:16. 161:4, 204:24, clothes 258:22. cite 204:9. 230:13, 235:15, cloud 101:19, citing 204:6. 260:24. 101:24. civil 130:17. client 22:23, Clozapine 186:12. claim 10:3, 219:20, 219:21, CO 1:3. 200:24. 245:4. co-investigator claimed 8:24. clients 8:19, 23:23. clarify 211:14. co-investigators 55:15, 89:24. coaching 57:10, 57:15, 64:17. code 66:7, 66:10, 66:18, 69:24, 71:1. codes 270:20, 273:9. coerce 76:4, 82:3, 100:18, 112:23. coercion 151:10, 151:13, 199:17, 220:5. coercive 116:19, 197:9. cognition 61:25. cognitive 8:24, 9:5, 38:20, 231:14. cognitively 215:25. coincidence 208:20, 208:23. coincidental Page: 342 of 331 Concordance 112:2, 131:8, Compensated 32:18. 214:10. 131:11, 132:13, compensation coincides 215:2. 132:18, 132:21, 33:24, 167:4. collaborative 134:3, 134:10, competence 167:1. 148:16. 134:16, 136:4, competency 239:2. colleagues 49:22. 136:5, 139:25, competent 67:20, College 20:2, 152:8, 153:6, 69:10, 91:24, 165:8. 195:17, 219:18. 109:12, 202:6, Columbus 7:11, common 53:4, 236:24, 247:2, 7:16, 8:8, 8:10. 70:23, 204:2, 265:2. Combinations 204:13, 227:12, competitors 54:4. 183:9. 254:11, 269:22. complaints 11:7. comes 29:6, 50:7, commonly 215:14. complete 15:19, 126:2, 218:13. communicate 11:23. 35:20, 115:1, coming 78:12. communicated 124:8, 135:9, commanded 14:18. 275:19. 136:2. commenced 5:4. community 54:16, completed 34:9, commencing 2:7. 160:3, 175:16, 246:23. comment 194:4. 199:5. completely 168:24, commission 278:33. companies 32:6. 169:15, 237:21, commit 221:21, company 26:24, 256:23. 242:1. 31:4, 33:15, completing 243:9. commited 76:3. 37:9, 54:7, comply 13:17, committed 10:23, 167:4, 167:7. 13:19, 85:2, 46:20, 75:11, compare 158:17. 85:12. 80:23, 111:2, computer 36:9. concept 59:2, 122:9, 169:8. concern 76:2, 76:11, 76:14, 177:1, 178:3, 187:21, 193:6, 193:8, 193:10, 193:12, 194:19, 199:16, 199:20, 199:21, 200:4, 205:14, 217:8, 221:5, 266:14. concerned 112:21, 119:24, 120:1, 123:1, 123:4, 193:13, 194:6, 221:6. concerning 233:19. concerns 113:4, 165:18, 214:17, 217:12, 223:6. conclusion 43:4, 114:6, 156:24, 180:8, 206:1, 256:10, 258:14, Page: 347 of 331 Concordance conducting 49:11, 108:17, 149:21, 263:9. 112:9, 142:6, 155:19, 155:22, conclusions 143:14, 266:17. 156:3, 158:7, 132:24, 133:24, conducts 59:21. 158:10, 166:21, 192:3. conference 69:4, 184:6, 192:20, concominant 191:7, 219:5, 249:14. 275:1. 191:8. confidential conflicts 82:10, concurrent 265:1, 11:14, 224:22. 87:11, 88:25, 267:17. confidentiality 99:8, 101:13, condition 17:4, 224:20, 225:2, 101:23, 104:16, 113:12, 161:20, 225:23. 165:24, 167:18, 172:13, 213:7, confine 4:12, 167:23, 168:5, 213:21, 218:16, 130:9, 130:16. 251:17. 243:7. confined 130:23. conjunction conditions 68:3, confirm 266:15. 192:18, 197:5, 113:16, 134:6, confirmation 197:6. 134:23, 137:2. 233:15, 266:14. consciousness conduct 16:22, confirmatory 234:15. 35:5, 50:24, 102:3, 102:8. consented 46:8. 66:12, 70:16, conflict 81:22, consenting 43:1, 70:17, 80:15, 83:17, 87:6, 45:24, 237:6. 155:6, 155:24, 87:16, 87:25, Consequences 170:19. 88:9, 88:10, 143:16, 199:10. conducted 37:10, 89:3, 89:11, consequently 38:18, 52:14, 90:23, 101:18, 239:9. 166:8. consider 82:20, 86:14, 94:10, 98:19, 115:12, 148:22. considered 21:25, 74:9, 93:5, 93:7, 94:12, 94:20, 196:9, 263:11. considering 186:11. consistent 67:5, 93:11, 129:13, 194:10, 264:24. consists 197:22. constrained 60:4. consult 104:25, 113:9. consultant 23:14, 25:20, 26:7, 31:1, 31:5, 108:25, 118:2. consulted 89:25. consulting 26:9, 26:21. Page: 352 of 331 Concordance 36:21, 37:5, 264:19. contact 38:22, 37:20, 38:2, cooperative 42:23, 140:25, 277:30. 253:24. 197:1, 274:11. contracts 36:24, coordinator 83:7, contacted 125:24. 37:17. 83:8, 148:9, Contacts 4:19, contradicts 182:2, 222:17. 193:18. 256:10. Copies 14:11, contained 277:14. contrary 188:6. 16:4, 22:7, contains 142:18. contrast 169:23. 121:4, 121:14, contingency 85:10. control 29:10, 121:15, 121:16, contingent 264:19. 31:16, 76:4, 240:1, 277:34. continue 115:7, 119:14, 120:3, copy 16:1, 21:4, 139:19, 170:8, 120:21, 138:13, 165:9, 206:22, 177:11, 177:24, 214:3, 214:6, 219:23, 240:2. 178:20, 180:9, 214:23, 214:24, copying 14:19. 188:15, 236:13, 244:19, 261:12, coroner 164:22, 237:15. 276:1, 277:33. 255:17, 259:9, continued 150:17, controlled 112:2. 259:20, 272:16, 189:24. controversy 272:23, 274:1. continues 245:9. 201:15. Coronor 4:34. continuing 21:1, conversation CORRECTION 278:9, 21:4, 21:5, 97:18, 221:23. 278:9. 21:13, 22:1, cooperate 134:24, corrections 278:6. 22:8, 22:12, 136:12. correctly 140:16. 150:22. cooperation correspondence contract 28:5, 212:17, 212:20. cost 29:6, 49:10, 161:21, 231:25, 236:11, 261:16. Counsel 15:2, 15:5, 119:8, 147:2, 203:8, 259:24, 277:23, 277:27. Counseling 196:7, 196:17, 198:3, 198:6, 243:17. counselor 198:6, 243:25, 244:4. count 56:7. counted 230:20. COUNTY 1:2, 47:9, 78:7, 79:9, 125:22, 125:23, 125:25, 126:1, 133:14, 135:21, 146:5, 195:10, 247:10, 277:6, 277:11, 278:24. Couple 27:4, 27:7, 27:9, 33:11, Page: 357 of 331 Concordance crisis 163:19. D. 2:17. 65:4. criteria 95:20, Daily 181:22. course 19:16, 97:7, 218:1. Dakota 47:9, 57:3, 93:10, crossing 104:5. 125:23, 125:25, 139:8, 175:7, Crow 19:6, 19:24. 133:13, 146:5, 177:9, 203:22, CS 240:21, 268:20, 195:10, 247:10. 204:4, 205:10, 269:2. damaging 54:7. 240:13, 274:17, cult 127:14. dangerous 106:12. 275:20. current 56:25. dangers 175:19, courses 191:24. currently 32:15, 274:9, 274:17. court-appointed 33:3, 142:17, data 120:18, 47:1, 254:23. 158:21, 159:12. 224:22, 228:17, court-ordered curve 4:29, 240:9, 228:21, 268:3. 77:18, 80:1, 242:17. date 14:3, 14:20, 253:25. custodian 15:3. 16:18, 24:16, courtesy 74:21, custody 15:6, 44:21, 57:20, 200:1. 15:7, 15:16, 135:24, 203:10, courthouse 7:25, 15:24, 16:1, 210:11, 229:19, 8:1. 211:20, 211:22. 255:14, 256:16, cover 29:14. customarily 263:1. 262:6, 262:19. covered 49:10, customary 204:1, Dated 125:12, 172:9. 204:12. 129:22, 146:1, covering 89:18. . 146:8, 149:2, cracker-jack . 181:23, 203:9, 259:18. < D >. 210:10, 235:22, created 63:24. 239:25, 240:8, 266:12. dates 7:8, 176:5, 176:6. Dave 107:5, 107:9, 150:7, 150:19, 185:5, 194:18, 213:20, 217:15. David 3:4, 6:6, 135:14, 135:15, 135:16, 146:10, 146:13, 150:13, 192:18, 193:10, 193:11, 193:18, 247:13, 248:2, 248:7, 249:21. Day 17:8, 38:22, 74:25, 76:23, 78:11, 78:13, 78:16, 89:16, 91:16, 120:7, 121:2, 129:22, 137:25, 148:25, 149:4, 151:3, 152:19, 162:14, Page: 362 of 331 Concordance dealing 65:12. 162:21, 162:23, 178:12, 196:6, Dear 176:22, 163:22, 211:2, 196:8, 196:18, 201:1, 201:2, 242:22, 250:10, 196:21, 198:4, 207:23. 255:13. 198:5, 217:15, death 65:13, deceptive 158:25, 217:18, 228:5, 80:17, 90:3, 159:10, 159:11, 228:5, 241:20, 99:15, 99:18, 161:5, 183:17, 243:9, 245:18, 99:21, 124:3, 207:19, 208:14, 245:22, 246:16, 163:23, 164:10, 264:16, 265:7, 246:20, 249:1, 211:3, 213:17, 267:7. 249:6, 249:14, 256:18, 259:9, deceptively 258:23, 261:4, 260:17, 274:23, 183:23. 277:38, 278:27. 275:7. decide 18:17, days 18:7, 44:14, debatable 174:24. 161:10, 188:13. 44:15, 45:21, Dec 4:20. decided 93:8, 47:12, 47:22, decade 21:6. 96:9, 218:17. 84:11, 109:12, deceased 1:8, decides 218:13. 115:3, 125:5, 92:23. deciding 106:25, 150:16, 176:1, deceitful 252:14. 108:8, 108:13, 176:16, 190:8, deceived 137:21, 108:23, 109:9. 208:22, 260:15, 137:23, 248:19. decision 18:19, 260:15, 260:15, December 16:13, 45:13, 60:23, 260:18. 16:17, 16:25, 94:6, 150:5, DC00066 247:11. 17:8, 20:3, 177:23, 205:23, DC00073 130:12. 43:18, 162:18, 206:17, 243:14. deal 63:24, 178:6. decision-maker 116:25, 122:22. decisions 46:2, 47:3, 84:22, 124:23, 125:8, 128:16, 216:9, 236:25. declaration 168:10, 169:1. decompensation 226:23. deemed 60:12, 264:1. defective 71:5, 71:12, 71:20. Defendants 1:20, 3:2. deficits 8:24. defined 181:4. definitively 94:18. degree 33:7, 139:20, 227:15, 227:20. delayed 152:4. Page: 367 of 331 Concordance Depakot 23:3, 74:25, 118:15, delegate 217:20. 96:19, 97:13, 277:34, 278:4, delegated 86:6, 179:9. 278:5. 222:15. Department 24:9, depressed 93:18, deliberately 28:10, 29:13, 257:19. 106:11, 159:11, 37:3, 118:1, depression 61:24, 159:16. 118:1, 120:20, 201:18. delusion 247:5, 133:14, 154:14, deprivation 115:6, 247:7. 154:17, 154:20, 115:9, 125:4. delusional 95:22, 154:22, 155:2, describe 160:10. 126:19, 227:6, 266:16. described 136:6, 227:24, 231:1, dependency 179:25, 270:16. 242:24, 257:17, 180:5, 180:6, description 261:1, 261:2, 181:17. 161:14. 261:12, 273:16. dependent 168:19, deserve 173:23. Delusions 114:7, 169:10, 181:16. designed 66:24, 204:22, 227:13, depending 54:14, 181:2, 273:14. 245:10, 247:1, 260:16. despite 108:16. 260:25. depends 50:6, detail 34:6, 44:7, demonstrate 72:6. 51:4. 148:22, 213:21. denied 115:14, deposed 6:19, 7:4, detailed 216:16, 257:19. 7:4, 11:20. 222:20. denotes 36:15. Deposition 1:23, details 7:6, denying 228:16, 2:3, 2:5, 5:3, 28:11, 29:4, 267:2, 267:4, 12:24, 13:22, 71:6, 111:6, 269:25. 197:19. detect 258:8, 260:6, 261:5. detectable 256:15. deteriorate 139:11, 140:17, 228:18, 257:1. deteriorating 221:19, 241:18, 241:25, 258:20. deterioration 106:12, 164:12, 164:21, 217:2, 226:9, 226:20, 226:23, 226:24, 228:24, 257:14, 258:9, 258:16. determine 126:7, 258:2. determined 135:11. developed 133:14, 136:23. device 63:14. devices 62:16. diabetes 174:19, 174:21, 174:22, Page: 372 of 331 Concordance 256:11, 273:20. directly 28:15, 175:3, 175:11, difference 59:22, 32:5, 37:5, 175:19, 176:7, 59:25, 61:7. 49:3, 74:3, 177:17, 178:8, differences 53:13, 78:7, 79:8. 178:24, 182:7, 61:10, 61:16, director 19:3, 207:14, 209:11. 97:9. 73:25. diagnose 103:21. different 47:21, disadvantage diagnosed 95:24, 51:24, 53:20, 54:14. 96:3, 124:18. 104:4, 107:23, disagree 64:21, diagnosis 93:10, 171:9, 219:24, 76:11, 114:16, 93:19, 94:11, 219:25, 243:7, 139:21, 156:24, 94:13, 94:15, 255:19. 164:21, 167:14, 94:19, 95:18, differential 167:15, 188:21, 95:21, 96:21, 94:13, 113:17. 190:18, 191:4, 97:6, 113:10, differently 54:12, 191:11, 195:21, 113:17. 235:5. 196:5, 197:16, diagnostic 93:2, difficult 25:9, 198:20, 220:18, 118:5. 25:12, 171:22, 237:25, 247:4, diary 228:5. 189:2, 189:14, 251:21, 256:22. died 17:8, 57:25, 220:7. discharge 194:22, 58:9, 89:16, direct 30:23, 195:9, 195:12, 90:20, 140:4, 188:23. 195:22, 200:16, 140:12, 162:24, direction 277:18. 211:2, 249:4, 176:2, 176:16, directive 122:18, 249:8, 249:12. 177:18, 208:22, 127:23, 128:10. discharged 10:18, 210:21, 256:6, 135:1, 223:22, 246:20, 249:1. disciplinary 11:12, 11:15. disclose 88:9, 88:25, 191:17, 251:10. disclosed 32:7, 68:22, 71:25, 88:21, 89:1, 144:10, 144:19, 172:7, 172:16, 182:24, 182:25, 182:25, 183:4, 183:6, 183:10. discloses 156:2, 156:9, 156:19. disclosure 182:20, 191:23. discontinuation 39:4. discount 261:8. discounted 261:15, 275:22. discouraged Page: 377 of 331 Concordance 98:18, 98:19, 160:1, 160:11. 181:14. 117:4, 147:16, disordered 235:1. discover 103:14. 184:9, 184:18, disorders 26:5, discuss 26:12, 185:16, 185:20, 159:24. 96:17, 96:19, 185:25, 186:13, disorganization 97:8, 97:13, 186:14, 186:22, 243:19. 184:13, 206:14, 217:19, 220:1, disorganized 220:22, 274:8, 239:7. 257:18, 258:23. 274:16. discussions 27:12, dispassionately discussed 27:15, 79:13, 107:5, 167:1. 27:17, 31:13, 178:19, 178:23, dispensed 271:22, 96:20, 141:2, 184:23, 184:25, 272:9. 141:4, 148:24, 185:3, 217:15, displayed 127:4. 149:8, 150:4, 221:12, 223:10, disproportionately 185:8, 185:21, 258:19. 39:24. 186:24, 200:12, disheveled 245:7, disqualified 213:21, 217:13, 246:25, 258:22. 181:18. 219:7, 219:7, dismiss 106:11. disrespectful 246:17. disorder 22:24, 116:21. discusses 126:6, 92:3, 92:20, distinction 126:18. 93:1, 95:18, 157:24. discussing 192:11, 96:9, 96:18, distributed 225:22. 98:11, 98:20, 126:25. Discussion 70:1, 113:11, 129:17, DISTRICT 1:1, 1:2. 70:6, 70:13, 158:20, 159:9, disturbed 127:18. 97:6, 98:16, divide 29:5. divided 28:23. division 37:1. doctor-patient 84:5. doctors 161:25, 162:6, 163:10, 183:19, 183:20, 184:5, 184:5, 184:9, 187:23, 200:17, 249:2. documentation 143:5, 143:23, 184:18, 184:23, 185:7, 185:18, 186:8, 217:24, 262:24. documented 63:20, 92:12, 184:16, 186:2, 218:2. documenting 185:23, 228:18. documents 9:1, 13:2, 13:21, 14:4, 14:6, 14:19, 14:25, Page: 382 of 331 Concordance 28:25, 29:1, 181:13. 15:3, 15:15, 56:14, 61:20, draw 170:2, 36:10, 67:12, 70:20, 100:3, 236:13. 70:3, 70:8, 118:14, 140:7, drawing 230:2. 70:11, 71:7, 152:21, 218:5, drink 180:9, 71:19, 72:4, 218:9, 219:10, 180:21. 100:4, 117:23, 238:5, 260:17. drinking 180:14, 118:8, 121:16, dossier 126:24. 181:7, 181:13. 144:9, 144:19, doubt 178:7. drive 221:24. 147:3, 200:22, down 14:17, 94:18, driven 221:25, 211:1, 211:11, 124:17, 127:9, 222:2. 212:21, 212:25, 129:16, 139:2, DRM 229:16. 218:14, 219:24, 186:23, 198:23, drop 9:9, 178:21. 219:25, 225:9, 198:25, 206:12, dropped 9:17, 273:12. 206:15, 208:25, 9:20, 135:20, dog 5:13. 209:2, 227:13, 180:17. dogs 234:3. 227:24, 239:18, drug 61:3, 62:13, doing 9:16, 19:19, 240:11, 242:10, 106:23, 107:1, 24:22, 25:1, 270:7. 108:10, 109:14, 28:3, 60:17, dozen 164:4, 109:23, 156:11, 141:10, 154:5, 213:15. 160:6, 172:14, 238:6, 257:16, dramatic 106:11. 172:24, 201:24, 267:23. dramatically 202:3, 202:22, dollar 156:10. 228:19. 204:5. dollars 55:2. drank 180:13, drug-induced done 12:23, 13:4, 113:18. drugs 53:14, 60:9, 115:15, 136:17, 159:3, 159:6, 160:25, 161:2, 172:1, 172:16, 173:5, 181:1, 182:11, 256:2. due 115:5, 161:19, 271:14. duly 6:12, 277:12. duration 60:10, 255:11. duress 168:21, 169:12. During 8:12, 12:2, 16:11, 17:15, 19:7, 20:17, 24:6, 24:14, 30:1, 42:2, 42:3, 60:25, 62:25, 66:23, 89:23, 90:19, 101:24, 108:1, 110:4, 114:12, 127:7, 144:5, Page: 387 of 331 Concordance Ecolab 3:16. 14:21, 41:15, 150:8, 163:22, ECT 8:25, 9:22, 45:22, 87:24, 164:11, 165:2, 23:7, 179:16. 165:14, 165:18, 175:6, 177:8, education 21:2, 226:21, 240:6, 177:9, 184:10, 21:5, 21:13, 241:21, 256:13, 192:5, 211:11, 22:1, 22:8, 266:22, 270:8. 212:18, 213:2, 22:12. elaborate 273:10. 213:12, 213:13, educational 21:24. elapsed 208:3. 216:11, 216:20, effect 9:2, electroconvulsives 224:12, 243:15, 173:11, 200:11, 8:23, 183:6. 244:16. 204:16, 205:7, eligibility . 205:13, 258:2, 217:21, 218:4, . 267:17. 218:9. < E >. effective 259:4. eliminate 220:4. Eagan 196:6, effectiveness Elizabeth 83:8, 196:16, 198:3, 158:17. 181:24. 198:6, 243:16, effects 117:5, elsewhere 185:2. 244:4. 158:18, 171:25, email 201:19. ear 267:17. 172:23, 191:15, emergency 131:10. earlier 82:7, 201:24, 204:2, employed 277:24, 118:14, 121:19, 204:14, 204:23. 277:27. 155:15, 219:8, effort 193:3. employee 32:1, 222:25. eight 162:25, 277:26. early 7:9, 7:18, 260:7, 260:12. empty 272:6, 23:23, 33:11. Either 14:10, 272:11. easily 40:16. encouraged 193:1. encouraging 170:8. end 19:8, 19:11, 34:8, 41:6, 62:24, 78:16, 135:6, 170:9, 195:17, 207:25, 214:13, 215:1, 215:4, 236:14, 238:17, 261:7. ended 49:13, 80:2, 196:7, 198:5. ends 208:25. engaged 104:12, 104:15, 168:23, 169:14. English 227:14, 227:20, 234:12. enormous 53:21. enough 11:24, 11:25, 12:3, 12:8, 21:22, 67:20, 69:11, 124:10, 171:8, 171:12, 171:15, 233:22. Page: 392 of 331 Concordance 213:12, 264:22. et 129:20, 131:21, enroll 167:7, entirely 171:18, 172:3, 172:3, 167:19, 167:24, 260:13. 234:9, 258:25, 167:24, 170:1, entities 274:16. 258:25, 265:1. 198:15, 214:23. entitled 147:13. ethical 50:25, enrolled 26:13, entry 233:11. 58:5, 66:5, 88:7, 95:20, episode 95:23, 66:12, 73:8, 142:11, 173:17. 191:13. 86:2, 176:9, enrolling 199:17. error 92:8, 270:22, 271:5, ensure 231:4. 232:23. 271:11, 273:8, enter 44:23, escape 132:13, 273:13. 95:12, 96:5, 132:18, 132:21. ethicist 104:25. 135:8, 194:1, Especially 35:16, ethicists 104:18. 219:18, 266:1. 51:19, 94:19, ethics 20:18, entered 75:23, 110:24, 191:13, 22:14, 22:20, 83:5, 95:5, 227:14. 58:25, 64:7, 95:17, 133:22, Esquire 2:16, 64:24, 65:9, 142:20, 143:24, 2:17, 3:4, 3:9, 67:20, 69:10, 265:3. 3:14. 69:21, 70:18, entire 20:14, essentially 71:2, 86:19, 30:14, 34:9, 136:20. 87:25, 88:5, 79:18, 98:23, established 101:6. 93:21, 105:2, 117:21, 144:5, estate 1:8. 105:9, 105:13, 150:7, 150:11, estimate 42:12. 105:25, 106:8, 151:16, 165:15, estimation 213:15. 112:20, 156:19, 203:25, 213:2, 158:8, 271:12. evaluate 108:16, 264:15. evaluated 42:25, 45:2, 66:23, 96:7, 110:5. evaluating 212:23. Evaluation 4:17, 117:17, 117:22, 147:5, 147:13, 180:6, 217:14. evaluations 217:21, 218:4. evaluator 43:7, 43:10, 43:13, 47:2. evasive 123:24, 124:15. Event 4:33, 132:10, 204:4, 252:21, 252:21, 253:3, 253:6, 253:19, 254:24, 267:18. events 203:22, 266:15, 266:17, Page: 397 of 331 Concordance 252:5, 252:7, 273:20. 267:14, 267:15. 253:11, 256:9, exam 270:9, eventually 93:8, 257:9, 259:2, 270:12. 198:4. 259:4, 259:6, EXAMINATION 4:4, everybody 275:19. 259:20, 260:10, 5:9, 6:17, everyone 240:4. 261:9, 261:16, 62:23, 130:7, everything 35:11, 261:18, 275:23, 130:9, 130:16, 121:7, 239:16, 275:25. 254:22. 249:15. evidenced 257:15. examined 6:13. evidence 43:21, evident 261:2. Examiner 4:10, 62:9, 76:21, evil 139:12, 75:22, 75:24, 82:16, 83:20, 140:18. 80:20, 80:25, 84:15, 91:3, exact 7:6, 44:21, 100:13, 123:14, 105:15, 106:1, 73:10. 125:21, 129:14, 106:20, 110:7, Exactly 30:11, 130:10, 254:3, 110:14, 110:25, 40:4, 40:8, 254:12, 254:17. 112:1, 123:19, 44:5, 53:15, examiners 44:13. 137:7, 164:16, 53:22, 65:25, examines 126:4. 171:4, 181:11, 75:21, 128:23, example 38:18, 187:11, 194:15, 139:15, 157:23, 39:18, 96:18, 217:4, 226:8, 190:22, 210:13, 104:7, 114:1, 226:14, 226:20, 213:3, 214:4, 153:16, 159:2, 228:23, 231:8, 214:4, 242:21, 159:25, 182:5, 232:15, 235:12, 242:25, 250:22, 186:11, 196:5, 236:16, 241:5, 257:2, 261:7, 198:2, 248:17. 250:14, 251:1, examples 197:9, 269:12. Except 91:20, 241:24, 258:21. exception 278:6. exclamation 139:13. excluded 182:9. exclusion 218:1. Excuse 10:12, 74:14. exist 127:25. exists 82:1, 131:10. expect 189:1, 189:13, 220:6, 260:22. expected 36:18, 51:6, 144:1. expecting 53:3. expenses 32:20. experience 132:9. experienced 91:15, 148:10, 225:17. experiment 248:13. Page: 402 of 331 Concordance expose 191:15. face 223:9, 223:9, experimental express 193:8, 241:10. 263:24. 193:10, 199:16, facility 136:13, experimentation 199:21. 136:16. 66:22. expressed 10:5, factor 93:4. expert 7:1, 13:11, 115:6, 193:6, facts 34:19, 62:9, 64:24, 65:9, 193:11, 199:20, 83:19, 84:15, 74:9, 235:7. 200:4, 214:17, 109:16, 171:3, expertise 74:5, 221:9. 181:10, 194:14, 74:7. extended 24:23, 235:11, 260:9. experts 156:19, 214:15, 215:11, faculty 8:7, 20:2, 197:4. 237:1. 20:4, 28:23, expires 214:13, extension 237:5, 38:2, 50:4, 236:9, 278:33. 239:11, 247:15, 51:2, 51:10, explain 33:23, 247:21, 249:25, 89:18. 35:2, 55:10, 252:1, 252:9, Faegre 6:1. 59:2, 72:21, 254:18, 254:21. fail 171:14. 269:6. extent 26:9, failed 10:21, explaining 221:18. 71:24. 10:25, 85:2, explanation 58:20, extra 16:4, 93:16, 98:9, 58:23, 165:12, 161:20. 140:21, 144:1, 259:17, 260:5, eye 261:9. 171:8, 171:12, 269:21, 270:14. . 191:17, 202:13, exploit 67:2. . 211:23, 258:8, exploited 66:25, < F >. 260:6. 104:8. failing 120:4. failure 114:8, 129:10, 258:11, 259:12. failures 143:6. Fair 11:24, 11:25, 12:3, 12:8, 12:21. Fairview 13:1, 121:1, 134:25, 139:4, 196:8, 196:21, 198:5, 245:17, 245:22, 245:24. fallen 45:16. false 161:5, 267:7. falsely 269:25, 270:7. familiar 59:4, 59:8, 219:6. family 91:20, 91:24, 92:2, 92:10, 92:11, 93:16, 103:17, 220:22, 222:19, Page: 407 of 331 Concordance February 209:16, FH000108 125:17. 275:10. 217:9, 226:18. field 64:24. far 9:19, 10:15, federal 144:25. Fifth 2:18, 174:7. 21:8, 32:8, feel 67:19, 79:2, figure 30:12. 68:22, 71:25, 104:8, 104:12, figures 34:19. 90:4, 216:6, 104:15, 160:10, File 1:3, 43:15, 230:16, 256:21. 186:25, 193:14, 56:7, 58:9, Fargo 3:11. 219:12, 221:10. 58:15, 58:19, farm 234:2. fees 16:11. 126:11, 144:11. fashion 259:24, felllowship 19:19. filed 10:8, 11:7, 260:3. fellow 19:18. 43:12, 44:13, fastened 234:4. fellowhip 19:5. 46:7, 75:10, fatal 237:3. fellowship 18:25, 80:20, 100:4, father 126:21. 19:23. 100:8, 119:18, favor 193:3, felt 84:21, 95:19, 125:22, 130:3, 216:5. 108:4, 125:7, 152:11, 208:4, FBS 245:23. 216:7, 224:12, 213:24. FDA 144:2, 145:22, 246:22. files 22:8, 57:24, 145:24, 158:22, few 18:7, 47:11, 185:7. 159:3, 159:6, 47:12, 65:3, filled 196:13, 159:12, 160:6, 115:3, 125:5, 217:24. 160:25, 176:23, 153:16, 214:15, filling 206:11, 207:13, 208:17, 260:18. 241:10. 225:19, 264:25. Fewer 56:10. Final 4:31, Feagre 3:10. FH 126:16. 247:12, 248:1, fearful 221:20. 248:6. finances 216:3, 237:14, 237:20. financially 93:20, 104:8, 170:4, 277:28. Find 46:14, 46:18, 47:2, 47:8, 48:9, 53:16, 53:22, 54:3, 94:24, 95:14, 96:12, 103:10, 109:11, 116:19, 116:21, 116:24, 133:20, 139:3, 156:20, 159:10, 159:16, 227:22, 251:6, 251:10, 257:22, 265:6, 265:6. finding 21:22, 110:24, 156:11, 256:22. Findings 4:13, 132:23, 133:18, 244:6, 256:1, Page: 412 of 331 Concordance 96:25, 113:7, 136:1, 136:12, 256:14. 115:2, 121:20, 136:22, 137:4, Fine 12:6, 40:14, 126:16, 133:9, 137:10, 143:22, 43:21, 44:12, 133:19, 153:8, 195:11, 195:16, 74:23, 74:25, 164:7, 171:7, 195:22, 195:24, 97:1, 119:23, 182:22, 182:24, 195:25, 196:3, 147:9, 147:10, 190:9, 191:13, 196:24, 198:13, 200:2, 203:20, 223:5, 253:2, 199:6, 200:20, 237:23, 238:20, 255:14, 268:19. 219:17, 253:8. 246:9. fit 79:4, 214:21. follow-up 10:25, Finish 12:7, Five 25:25, 41:1, 79:19, 188:9. 74:16, 74:19, 41:10, 42:12, followed 66:4, 78:9, 96:24, 56:10, 97:3, 150:9. 96:25, 97:4, 145:21, 182:13, following 2:3, 199:22, 209:20, 276:20. 19:17, 66:21, 209:21, 241:15, fix 209:3. 80:16, 115:19, 241:16. fixed 245:10, 134:5, 134:22, finished 272:7. 247:1. 195:12, 196:22, firs 219:9. flaw 237:3. 199:10, 278:6. First 6:12, 23:14, flu 203:3. follows 5:5, 6:13. 24:16, 24:21, Flynn 3:20, 6:4, followup 187:24. 24:21, 35:25, 6:4. fooling 228:7, 37:17, 39:25, foil 273:3. 228:13. 41:3, 41:13, follow 10:21, forced 263:22, 41:18, 69:22, 77:7, 135:1, 263:24. 79:19, 96:25, forcibly 131:13. forcing 105:16, 106:2. foregoing 277:18, 278:3. foreseeable 173:4. forge 268:7. forget 61:7. forgetting 61:11. forgot 145:14. formal 7:24, 63:13. formally 217:23. former 7:22. forming 142:2. forms 56:2, 88:16, 270:1. forth 224:23. forward 9:8, 132:3, 134:9, 134:15. fou 81:10, 110:10. found 42:25, 45:6, 45:7, 45:12, 47:20, 53:22, 54:5, 54:6, Page: 417 of 331 Concordance 14:14, 230:10. 29:22. 95:4, 95:11, front-loaded future 157:5, 103:7, 259:20. 38:12, 39:12, 189:2, 189:13, foundational 70:3, 39:13. 220:7, 237:14, 70:8, 71:7, fulfill 200:14. 237:20. 71:18, 168:14, full 38:22, 214:3, . 270:22, 271:5, 242:18. . 271:12, 271:19, fully 8:25, 13:17. < G >. 273:8, 273:13. FUMC 195:11, gain 214:23. four 19:15, 21:10, 197:1, 199:8. gained 124:8, 99:24. function 16:19, 177:9. FOURTH 1:2. 51:8, 257:15. Gale 2:17, 5:15. frame 127:7. functioning gate 138:11. free 60:12, 91:8, 242:19, 252:12. gathers 126:3. 101:13, 149:21, fund 28:21, 28:24, gave 24:19, 119:8, 168:4, 215:13. 33:19. 177:19, 211:25, freedom 138:14. fundamental 215:3. frequent 203:3, 271:11. Geister 129:25. 205:9. funded 34:1, general 19:15, frequently 267:23. 87:10, 149:14. 35:15, 88:16, Friday 233:15, funding 27:19, 167:21, 219:6. 233:17. 30:6, 48:25, generalizeable friend 194:5, 52:11, 149:16, 181:2. 194:7. 236:13. Generally 21:21, Fritz 19:3, 19:4. funds 29:18, 38:15, 176:23, front 14:13, 186:9, 186:14. generate 51:25. generated 230:11, 231:15, 275:2. generation 182:21, 182:22, 182:23, 182:24, 185:9, 185:15, 185:19. generously 233:17. genetics 19:1, 19:20, 92:19. George 19:5, 92:17, 93:15. Geraghty 3:15. Germans 66:22. gets 73:3. getting 35:6, 82:20, 146:14, 175:2, 198:5, 201:6, 234:3, 240:12. Gislason 3:5. give 25:23, 30:12, 63:13, 63:16, 64:23, 66:9, 68:5, 74:21, Page: 422 of 331 Concordance gloam-green 234:7. 263:4, 263:7, 78:23, 104:21, gloaming 234:5, 263:11, 264:5. 114:3, 122:16, 234:7. grossly 260:23, 125:18, 152:14, gotten 190:23. 261:12, 273:16, 152:15, 184:7, graduate 165:9. 274:12. 199:18, 220:21, grand 21:20. grounds 95:25, 223:15, 249:11, grandmother 215:12. 265:25, 272:10, 126:20. group 241:21, 276:20. granted 138:7, 243:8, 257:10. given 15:18, 46:6, 252:2. guarded 123:24, 54:18, 122:3, grants 52:2. 124:15. 131:13, 157:9, Great 213:21, guardian 122:22, 165:9, 177:8, 261:25. 128:20, 215:17, 177:18, 199:12, greatest-number-of 216:5. 199:13, 199:13, -hours-with-the- guardians 215:15, 200:17, 216:16, patient 275:24. 215:23. 217:10, 230:5, greening 234:7. guardianship 230:7, 233:10, Greyhound 238:3. 216:1, 216:3, 233:13, 267:7, grid 36:17. 216:4. 270:10, 271:23, Griffith 2:16, guess 41:11, 272:20, 277:20. 5:17, 5:17. 41:21, 44:10, gives 161:4, grooming 226:24. 44:11, 49:19, 183:18. Gross 3:14, 5:21, 64:14, 64:17, giving 26:21, 5:21, 179:21, 72:5, 72:13, 112:13, 188:2. 258:8, 259:6, 75:7, 161:10, Glenn 5:24. 164:3, 232:2. guidelines 66:5, 68:15, 68:17, 68:19, 69:2, 69:6, 270:22, 271:19. . . < H >. half 41:18, 78:18, 164:3, 180:25, 213:15, 276:11. half-way 41:3. HAND 277:38. handed 271:25. handful 213:12. handle 249:7. handouts 70:22. hangs 85:16. happen 46:23, 53:9, 139:12, 242:11, 275:15. happened 57:2, 136:23, 139:15, 153:4. happens 51:3, Page: 427 of 331 Concordance heard 47:18, 68:8, 69:23, 52:23. 59:17, 66:7, 70:24, 168:10, harder 95:14. 68:13, 68:16, 169:1, 270:20. harmonization 87:6, 102:2, hence 84:23. 68:14, 68:18, 102:22, 103:24, Henn 19:3, 19:4. 68:24, 69:5, 153:20, 165:20, HENNEPIN 1:2, 69:24. 168:11, 245:19. 126:1, 277:6. harrassing 98:2. hearing 7:13, Henry 20:7. hatches 209:3. 7:14, 7:24, hereby 277:11, hats 254:3. 9:11, 9:15, 278:3. he'll 260:3. 43:11, 126:9, hereto 277:28. head 13:7, 27:21, 130:9, 133:7, herself 270:13. 29:23, 40:16, 239:3. High 17:19, 17:20, 57:5, 85:16, heavily 180:9, 178:3, 178:4, 119:13, 242:20. 180:13, 180:14, 178:6. Health 42:21, 181:7. higher 39:23. 59:20, 86:5, held 199:9. HIPA 142:17, 91:15, 104:3, help 29:13, 66:24, 143:1, 143:8, 105:3, 121:24, 115:3, 144:13, 143:11, 143:15, 122:18, 141:14, 144:21, 265:25. 143:25, 144:6, 141:20, 141:21, helpful 18:8, 144:12, 144:18, 142:1, 142:19, 97:21, 205:6, 144:22, 145:2, 142:22, 146:5, 228:4, 228:15. 224:10, 224:11, 146:8, 157:19, helping 115:21. 224:15, 224:25, 190:11, 192:19, Helsinki 67:24, 225:4, 225:6, 201:1, 206:5. 225:13. historical 66:11, 67:12, 72:4. history 23:12, 91:21, 91:24, 92:2, 92:5, 92:10, 92:11, 93:16, 94:16, 103:18. hitchhike 238:4. hold 145:22. holiday 89:19. Holker 117:17, 117:24, 120:14, 120:20. home 119:1, 119:5, 241:21, 243:8, 257:10. Honda 221:24, 221:25. hoped 117:7. horrible 259:12. hospitalization 13:1, 16:12, 152:6, 190:1. hospitalized Page: 432 of 331 Concordance hundreds 227:11. 125:15, 133:2, 10:18, 24:3, Hunter 3:5. 138:22, 146:20, 134:24, 161:17, hyperglycemia 193:21, 195:3, 162:17. 175:3, 207:14. 201:5, 202:21, Hospitals 8:8, hypertension 207:5, 218:20, 18:22, 19:17. 182:7. 223:18, 229:7, hour 38:18, 39:9, hypothesis 53:3, 233:2, 235:24, 78:18, 276:12. 113:7. 236:3, 244:12, hours 21:11, . 247:25, 249:19, 21:12, 38:21, . 252:24, 255:22, 47:12, 137:25, < I >. 262:2, 263:17, 276:20. idea 40:21, 41:16, 266:8, 268:18, House 180:10, 41:19, 54:23, 272:14, 272:25, 181:8, 212:18, 55:5, 56:1, 273:24. 226:19, 228:8, 56:17, 64:12, identified 69:23. 234:3, 272:4, 82:6, 145:19, identify 16:8, 272:5, 272:9, 163:25, 164:2, 26:23, 123:12, 272:21. 166:12, 166:15, 146:21, 225:21, human 22:20, 183:18, 197:21, 229:9, 229:13, 47:18, 65:12, 205:21, 258:3. 240:3, 272:17. 67:21, 69:11, ideas 126:19, identifying 70:3, 70:8, 227:24. 110:18. 71:7, 86:4, identical 137:2. ignore 106:11. 141:11, 141:15, identification ignoring 274:9. 142:6, 143:19. 16:7, 123:11, II 66:21, 66:23, hundred 40:22. 117:10, 117:14, 118:3. Iis 120:10. ill 115:8, 134:1, 215:24. illegal 263:4. illness 62:3, 62:4, 62:7, 93:11, 97:8, 103:8, 103:11, 103:16, 103:18, 103:21, 113:8, 114:9, 114:14, 115:2, 115:13, 115:15, 124:6, 124:17, 125:3, 125:6, 129:6, 129:10, 133:16, 139:7, 139:10, 139:21, 157:22, 158:5, 172:12, 179:7, 181:4, 204:25, 205:16, 256:25, 261:13. illnesses 159:13, Page: 437 of 331 Concordance 165:16, 194:11, 103:20, 132:18, 160:7, 161:6. 199:5, 205:22, 132:20, 214:5, immediately 219:11. 214:22, 257:22. 215:19. impress 53:10. incentives 32:9, impaired 215:25, impression 161:4, 48:23, 50:10, 237:15. 161:5. 67:2, 82:22, impartiality improper 9:23, 112:22, 155:10, 277:32. 10:1, 199:17. 215:3. implementation improperly 183:23, include 71:16, 72:2. 235:9. 136:23, 186:16, implemented in-house 26:8. 204:2. 197:24. inability 172:3. included 113:18, implications inappropriate 175:2, 178:23, 58:12. 108:5, 197:9. 184:25, 209:12, implied 188:21. Inc. 1:18. 213:19. implies 183:19, incapable 237:6. includes 203:21, 188:12. incarcerated 267:16. imply 45:12, 134:16. including 127:16, 84:21. incarceration 150:7, 207:16, implying 228:21. 85:1. 213:18, 221:14, importance 117:4. incentive 53:21, 253:24. important 11:22, 54:3, 94:24, inclusion 218:1. 51:9, 51:11, 96:11, 99:11, incompetent 44:3, 65:19, 65:21, 99:20, 100:17, 45:7, 84:10, 69:25, 77:16, 101:11, 103:10, 84:19, 237:21. 93:2, 97:16, incompetently 234:20, 235:9. inconsistent 48:9. incorporated 142:23. incorrect 230:15, 241:7. increase 227:2. increased 174:21, 175:18, 208:21. independent 43:13, 82:9, 91:9, 148:8, 166:24, 167:17, 167:22, 168:4, 168:25, 169:15, 239:14, 243:12, 252:11, 254:22. independently 236:22. indicate 88:16, 93:17, 114:7, 127:9, 163:5, 163:7, 186:23. indicated 60:13, Page: 442 of 331 Concordance ineffectively 142:23, 155:21, 117:6, 180:3, 234:19. 156:7, 177:9, 187:21. infection 267:18. 201:12, 201:23, indicates 178:3. influenced 205:13, 205:4, 205:22, indicating 81:18, 227:5. 210:2, 217:1, 85:15, 86:13, inform 77:16, 217:11, 223:21, 87:24, 111:1, 78:5, 79:8, 223:23, 224:13, 212:22, 243:21, 106:22, 106:25, 228:1, 228:14, 273:3. 108:7, 108:13, 230:8, 230:25, indication 133:20, 108:22, 109:8, 231:11, 265:21, 135:5, 163:8, 109:22, 110:5, 265:25, 267:8, 163:19, 227:4, 110:11, 122:25, 274:25, 275:11, 235:8, 246:22, 170:15, 175:20, 278:17. 260:19. 176:16, 177:3, informing 35:7, indications 178:9, 202:13, 35:16, 176:7, 201:17. 251:16, 251:23. 244:4. indicator 93:2. informal 7:25. informs 244:5. indirect 29:6. information 9:13, infrequent 203:4, individual 125:24, 10:2, 12:11, 204:16, 205:7, 126:1, 156:22, 12:21, 14:11, 205:13. 160:15, 166:25, 29:23, 55:16, infrequently 167:18. 68:4, 81:1, 216:11, 216:18, induce 87:17. 92:6, 93:16, 216:19. industry 33:25. 126:3, 141:15, initial 38:19, ineffective 142:4, 142:19, 62:25, 94:16, 172:14. 113:10, 267:24, 268:1, 270:11. initialled 270:10, 270:13. initially 114:24, 171:19, 243:10. initials 268:5, 268:7, 268:21, 268:23, 269:3, 269:5, 269:14, 269:14, 269:19, 270:1, 270:7, 270:15. inpatient 24:10, 42:15, 42:20, 74:1, 121:2, 139:8. inpatient-outpatie nt 135:10. insert 4:22, 172:24, 201:9, 202:23, 203:21, 203:24, 204:18. Insight 114:18, 114:24, 115:1, Page: 447 of 331 Concordance instrument 63:9. 167:24, 168:5, 123:23, 124:4, insurance 32:6, 181:5, 184:6, 124:8, 124:10, 238:12. 192:21, 243:2, 124:14, 127:10, insured 8:17. 245:5, 251:18, 129:20, 242:24, intake 198:4. 258:4, 258:25, 245:8, 246:18. intention 9:16, 275:1, 277:31. Insomnia 172:3, 10:5, 234:14. interested 110:24, 267:16. intently 274:24. 116:1, 277:28. inspect 119:17. interacting 245:6. interesting inspected 144:2. interactions 206:14, 261:6. inspection 14:18, 102:6. interests 82:10, 225:19. interest 10:6, 87:20. instance 60:7. 50:23, 83:17, intermediary instances 90:1. 87:7, 87:11, 26:22, 37:10, instead 160:5, 87:16, 87:25, 222:19. 207:21. 88:9, 88:10, intermediate institution 157:5, 89:1, 89:3, 38:19. 170:3, 170:5. 89:11, 90:23, internal 225:18. Institutional 99:9, 101:18, international 1:16. 101:23, 104:16, 68:1, 69:4, instruct 74:17, 108:17, 149:22, 70:3, 70:8, 102:7. 155:19, 155:23, 71:6, 168:13, instructed 73:1, 156:3, 156:10, 235:7, 270:21. 73:6, 103:1. 158:7, 158:10, Internet 201:20. instructing 64:18, 165:24, 166:21, interpose 74:15. 174:4. interpret 197:5. interpretation 98:16, 120:17. interpreted 54:15. interrupt 74:20. intervention 213:23, 239:10. interventions 214:16. interview 129:4, 181:24, 194:5. invalidated 180:15. invested 253:23. investigate 203:12. investigated 80:16. investigating 254:9. investigation 168:24, 169:14, 225:19. investigator 4:35, 16:19, 24:9, 35:4, 73:9, Page: 452 of 331 Concordance 19:22, 92:14. . 81:4, 81:13, Irrelevant 65:16, . 87:9, 155:5, 88:3, 134:12, < J >. 169:18, 219:22, 143:21, 157:25, Jacobson 43:15, 220:3, 254:5, 166:18, 173:12, 46:14, 47:1. 254:9. 174:20, 174:23, January 175:22, involve 65:13. 176:19, 178:1, 178:25, 181:24, involved 9:18, 179:8, 263:9, 201:3, 206:24, 9:22, 9:25, 271:1, 274:20, 207:20, 208:17, 14:7, 17:3, 275:4. 226:18. 39:8, 50:3, IRS 26:17. Japanese 173:10, 55:14, 66:2, isolated 245:5, 173:23, 174:12, 66:14, 74:8, 245:7, 247:1. 174:15, 175:10, 81:25, 83:25, issue 84:3, 88:5, 175:16. 86:9, 92:17, 257:13. Jarvis 128:22, 142:1, 146:13, issued 207:13. 131:14, 263:22. 150:8, 150:18, issues 65:20, JD 2:15. 151:10, 152:5, 66:2, 73:9, Jean 31:20, 32:10, 156:4, 189:23, 81:25, 82:8, 33:4, 33:6, 194:20, 258:18. 112:11, 189:22, 49:22, 83:7, involvement 10:17, 216:5. 83:12, 99:5, 10:20, 41:5, Item 138:6. 148:2, 148:5, 50:5, 217:20. itself 171:14, 148:21, 148:24, involving 9:13, 186:6, 192:7, 149:7, 165:13, 67:21, 141:11. 209:25, 220:20. 165:18, 185:4, Iowa 18:22, 19:17, 197:2, 217:6, 217:21, 218:8, 242:10, 247:10, 268:7, 269:6, 269:15, 269:22, 269:25, 270:6. Jeanie 85:22, 150:4, 165:16, 213:19, 217:7, 217:13, 222:16, 238:15, 239:8, 240:7. jeopardized 180:16. jeopardizing 157:4. JMK 268:21. Jo 263:14. job 50:8, 50:24. Join 30:4, 47:24, 50:21, 50:22, 53:1, 53:25, 54:11, 54:21, 75:18, 91:13, 141:18, 156:15, Page: 457 of 331 Concordance 252:10. Ken 129:25. 175:14, 192:24, judgments 101:24. Kenney 3:15, 197:13, 202:16, JUDICIAL 1:2. 31:20, 32:11, 216:14, 220:13, July 4:36, 20:3, 33:4, 33:6, 226:13, 231:9, 203:9, 262:7, 49:22, 83:7, 250:15, 270:5. 262:9, 262:19. 83:12, 84:6, joined 20:2. June 19:13, 19:18. 85:23, 99:5, joining 76:5, jury 161:10. 148:2, 148:5, 265:21. . 148:15, 148:21, Jolie 113:25, . 149:7, 149:15, 126:22. < K >. 151:1, 185:4, Journal 4:27, Kaye 5:24. 197:2, 217:6, 65:18, 81:18, keep 21:18, 21:24, 217:22, 218:9, 201:21, 227:23, 22:7, 38:14, 242:10, 268:7, 227:25, 228:11, 57:5, 73:10, 268:23, 269:6, 233:5, 240:25, 99:21, 101:12, 269:15, 269:22, 241:11, 241:12, 106:13, 145:15, 269:25, 270:6. 259:6. 155:10, 181:5, kept 36:5, 36:7, journals 227:7, 193:4, 194:13, 36:24, 99:14, 227:12, 233:3, 196:25, 202:2, 224:22, 227:23, 233:8. 214:5, 215:3, 241:24. Joyce 234:16. 220:22, 227:12, kill 127:16, judgment 101:19, 239:12. 204:17, 242:12, 216:2, 237:13, keeper 138:11. 255:6, 257:2, 237:13, 237:19, keeping 217:19. 261:14, 274:14, 237:21, 247:6, 276:2. killing 273:17. kills 244:22. kin 1:7. kind 10:24, 23:15, 28:21, 28:24, 30:25, 32:17, 33:24, 58:5, 87:25, 103:17, 141:10, 141:14, 141:19, 171:9, 185:18, 185:20, 197:25, 205:4, 254:19, 268:24. kinds 28:25, 34:19, 53:5, 127:4, 142:9, 228:17, 254:8. knowing 48:5, 65:20. knowledge 15:19, 17:6, 26:15, 30:16, 30:23, 37:16, 53:11, 57:21, 58:21, 71:24, 72:1, Page: 462 of 331 Concordance 111:1, 114:3, 158:25, 159:10, 90:21, 122:19, 114:10, 115:1, 183:12, 188:12, 145:10, 223:12, 124:14, 125:7, 188:22, 192:11, 223:14, 225:20, 242:23. 195:15, 199:13, 226:16, 260:11, Lacking 31:9, 208:14. 278:4. 40:7, 46:16, large 39:17, known 127:24, 51:22, 53:17, 201:15. 201:2. 58:1, 58:10, last 21:6, 22:13, knows 92:19. 113:1, 144:16, 69:8, 120:17, . 151:25, 166:5, 123:22, 123:23, . 166:18, 173:13, 138:5, 147:17, < L >. 176:4, 177:21, 165:2, 204:9, lab 61:19. 185:11, 187:10, 213:13, 213:18, laboratory 262:12. 192:3, 197:13, 216:20, 229:16, Lack 42:25, 45:2, 202:9, 211:13, 260:7, 273:25, 46:14, 46:19, 212:15, 216:14, 275:21. 47:20, 114:8, 222:22, 245:15, lasted 214:11. 156:16, 156:17, 270:25. lasts 214:12. 175:24, 202:14, Lacks 85:4, late 42:2. 227:16, 237:16, 114:22, 123:23, later 10:22, 16:4, 270:3. 124:22, 124:24, 124:7, 139:20, lacked 43:16, 129:20, 184:22, 196:13, 218:12, 43:25, 44:18, 269:7. 265:19. 45:14, 46:8, Lake 17:20. latest 57:20. 47:2, 80:22, language 142:18, law 132:24, 100:10, 109:11, 133:24, 144:25, 214:11. lawful 120:2, 211:15, 211:18. lawsuit 10:24, 11:2. lawyer 12:5, 57:7, 57:16. lawyer-attorney-cl ient 212:1. lawyers 7:7, 7:21, 7:23, 11:4, 12:12, 27:17. leaders 64:6. learn 177:7. learned 103:4, 265:19. leased 222:4. least 21:22, 69:15, 99:24, 156:11, 168:11, 212:19. leave 33:10, 197:18, 197:20, 214:19, 215:13, Page: 467 of 331 Concordance legally 35:10. 247:20, 249:20, 249:10. Lemke 83:8, 251:4, 251:10, leaving 236:8. 181:25. 251:16, 251:24, lecture 26:22. Len 245:19, 252:14, 254:18, lectures 21:21, 245:19. 254:19, 263:13, 24:20. length 38:17. 264:11, 264:15, left 20:8, 33:13, less 38:18, 40:22, 264:22, 265:8, 33:14, 89:20, 40:24, 41:1, 267:1, 267:2, 89:21, 90:19, 41:10, 51:9, 267:3, 267:20. 213:16, 234:9, 72:4, 164:5, letterhead 153:18, 250:10, 270:11, 188:14, 200:10. 153:23, 154:8, 276:12. Letter 4:14, 4:20, 154:22, 155:2. legal 9:12, 43:3, 4:23, 4:32, letters 222:20, 45:13, 58:5, 4:36, 4:37, 265:24, 268:24. 76:4, 97:25, 138:19, 138:25, level 231:18, 101:19, 105:16, 140:22, 176:22, 231:24, 232:1. 106:2, 112:2, 176:23, 201:2, levels 231:19. 112:23, 114:5, 206:22, 207:1, liberty 106:25, 116:24, 119:16, 207:9, 207:23, 108:8, 108:14, 121:23, 122:2, 207:24, 208:15, 108:23, 109:9, 122:5, 132:2, 210:8, 221:9, 130:20, 131:17. 174:3, 174:8, 222:24, 222:24, license 21:15. 192:2, 206:1, 223:1, 223:8, licensed 22:2, 206:3, 214:3, 223:10, 223:13, 32:2, 59:20, 214:23, 225:17, 242:7, 247:14, 121:24, 148:8, 258:13, 263:9. 206:5, 206:6. licensing 11:7. lies 258:11. life 165:3, 190:10, 213:14, 216:20, 237:20, 242:19, 260:8, 261:8, 261:16. light 226:21, 275:7. Likely 58:17, 117:23, 120:19, 200:21, 208:1, 210:10, 227:11. limitations 60:14. limited 33:7, 181:3, 235:16. Linda 3:9, 6:1. line 123:23. lines 123:22. link 90:13. links 84:7, 86:15, 91:9. list 13:24, 172:23, 186:20, 192:7, 204:3. Page: 472 of 331 Concordance 243:8, 243:13, 138:5, 139:2, listed 14:19, 261:3. 146:24, 147:17, 154:14, 154:17, lizard 113:23, 149:1, 171:23, 173:11, 204:23, 127:1, 247:8. 177:6, 179:3, 278:6. LLP 3:5, 5:25. 193:22, 194:21, listen 72:16, local 34:14, 202:24, 206:21, 239:6. 34:15. 235:2, 239:18, listened 242:1, long 22:7, 38:25, 240:20, 266:21, 275:10. 145:15, 145:17, 267:21, 267:24, listening 274:24. 145:18, 145:19, 268:1, 268:19, listing 16:10, 147:9, 155:11, 269:18, 273:12. 187:16, 259:10. 213:19. looked 118:16, lists 13:21, longer 33:6, 118:19, 118:20, 55:13, 186:6, 39:22, 145:23, 119:2, 119:9, 204:21. 156:4, 251:25, 119:12, 120:15, literature 85:14. 252:11. 134:15, 149:1. Lithium 23:1, Look 13:20, 14:13, Looking 23:19, 182:25. 14:14, 27:2, 23:21, 42:22, little 17:17, 44:4, 80:18, 46:11, 46:12, 194:6. 92:5, 118:18, 75:2, 75:9, live 219:5, 118:21, 118:23, 123:7, 138:23, 238:10. 120:10, 125:11, 151:22, 152:20, lived 180:10. 126:16, 127:21, 152:24, 172:7, lives 271:14. 132:23, 133:9, 182:16, 219:24, living 136:13, 133:24, 134:9, 219:25, 229:20, 236:21, 239:14, 249:20, 253:1. looks 208:2, 269:2, 269:5. loose 208:25. lose 95:13, 130:20, 271:13. lot 25:9, 92:19, 190:11. low 243:20. LP 1:18, 1:18. lunch 118:12. . . < M >. machine 277:16. main 225:1. maintain 170:5, 214:24, 214:25. maintained 238:13. major 35:1, 64:6, 65:20, 70:2, 125:7, 190:9, 234:12. majority 159:23, 159:23, 163:4, 214:13. Page: 477 of 331 Concordance 209:19, 210:3, 138:19, 215:16, malpractice 8:18. 210:7, 228:19, 217:1, 221:15, man 194:5, 194:7. 229:22, 233:3, 221:18, 222:7, manage 239:15. 233:4, 233:5, 222:12, 222:20, manager 78:7, 238:13, 239:1, 223:12, 224:1, 79:9, 107:10, 239:3, 239:22, 224:5, 242:12, 107:18, 135:18, 239:25, 240:8, 244:17, 256:23, 146:1, 146:9, 240:22, 241:6, 275:25. 200:13. 242:16, 242:25, material 261:2. mania 95:19, 243:7, 243:17. materials 240:5. 95:20, 97:7. Mari 2:4, 277:10, matter 47:22, manic 93:8, 95:23, 277:42, 278:35. 109:12, 202:7, 204:22. mark 16:5, 123:8, 212:3, 212:5, manifestation 146:18, 232:24, 212:6. 204:24. 240:17, 247:22. matters 277:14. manifestations Markingson 1:8, mean 10:13, 13:19, 227:1. 16:11, 134:1, 14:10, 15:1, manipulate 105:16, 146:9, 226:10, 21:23, 28:24, 106:2. 229:17, 229:25, 60:5, 70:12, manipulative 231:4, 250:1, 128:9, 178:16, 267:8. 252:16, 264:18, 185:25, 192:9, manner 50:25, 273:15, 274:2. 209:13, 220:24. 219:11. Mary 1:6, 3:19, meaning 65:25, March 42:7, 5:14, 5:16, 102:8, 139:3, 164:11, 164:19, 5:18, 5:19, 172:10, 204:12, 165:1, 207:25, 265:10. means 64:2, 68:20, 69:1, 225:16. meant 14:24, 190:18, 235:6, 237:18. meantime 210:3. medically 45:7, 45:12, 135:1. medicate 139:10. medications 39:1, 116:2, 116:7, 122:1, 122:3, 127:22, 128:16, 158:18, 158:21, 159:12, 179:11, 182:6, 183:13, 183:20, 184:7, 187:19, 188:10, 191:7, 192:8, 207:16, 214:20, 221:7, 227:3, 231:22, 240:12, 241:20, 258:3, 265:1, 271:22. Medicine 20:2, Page: 482 of 331 Concordance 105:10, 114:9, 130:1, 213:11, 88:1, 117:25. 114:14, 115:13, 213:15, 218:17, meds 187:22, 115:15, 124:6, 246:3, 246:15. 240:25, 241:8, 124:17, 125:3, method 70:23, 244:18, 259:19. 125:6, 129:6, 165:7. meet 21:22, 87:18, 129:10, 133:16, methodology 120:8, 150:20, 146:5, 146:8, 102:14, 256:16. 276:10. 157:19, 157:22, methods 63:23. meeting 7:25, 158:5, 190:11, Metro 134:3, 25:20, 25:24, 256:25. 134:7, 134:17. 26:7, 62:25, mentally 115:8, Michael 18:16. 79:11, 150:3, 134:1, 215:24. Michigan 17:22, 165:10, 212:22, mention 98:10, 227:15, 227:21. 213:19, 217:8, 122:14, 187:5, mid 234:8. 243:12, 258:25. 205:12. mid-90 7:19. meetings 21:19, mentioned 31:15, mid-sentence 21:20, 26:21. 33:18, 38:10, 199:25. meets 187:1, 39:12, 58:24, middle 129:5, 224:9, 224:15. 82:7, 118:16, 199:1, 239:18. member 38:2, 51:2, 171:6, 171:11, mind 73:10, 139:9, 117:24, 195:7. 179:1, 201:8, 139:10, 140:16, members 220:23, 203:15, 210:4. 234:13, 247:2. 275:11. mentions 196:5. mine 7:23, 250:2, memo 4:15. met 13:5, 25:25, 250:3, 250:5, memory 44:7, 44:8. 95:19, 97:7, 250:6, 250:8. mental 91:15, Minneapolis 2:6, 2:20, 3:7, 3:12, 278:36. minute 11:10, 57:6, 62:8, 64:16, 84:13, 182:13, 188:18, 190:4, 201:7, 229:19. minutes 276:21. misconception 59:3, 59:9, 59:18, 63:25, 65:21, 66:1, 72:10, 82:6, 265:11. misconduct 112:7. misleading 158:25, 159:16, 160:5, 161:5, 162:5, 163:8, 163:14, 183:17, 207:19, 208:15, 264:16, 265:7. misrepresentation Page: 487 of 331 Concordance 120:16, 120:18. 52:16, 54:17, 252:15. MN 2:20, 3:7, 54:24, 156:4, missed 232:22. 3:12, 3:17, 167:25, 236:11, Misstatement 30:4, 278:36. 238:11, 251:25. 37:23, 49:6, moderation 181:14. monies 29:9, 50:13, 51:12, Module 218:23, 149:16, 149:22. 76:20, 82:15, 219:2. monitor 218:13, 109:16, 110:14, mom 140:21, 194:5. 231:19. 137:6, 149:11, moment 74:14. monitored 37:10, 149:25, 157:13, momentarily 213:8, 226:18, 158:12, 164:15, 118:10. 230:19. 172:18, 187:11, money 24:5, 24:13, monitoring 257:11, 188:19, 224:17, 24:16, 24:17, 262:24. 226:14, 232:15, 25:7, 26:13, monitors 262:23. 236:16, 241:4, 28:2, 28:6, month 27:8, 164:5, 253:10, 261:18. 28:8, 28:9, 208:2, 213:17. Misstates 43:20, 28:9, 28:12, monthly 164:9, 91:3, 217:4, 28:14, 28:17, 164:10, 164:20. 231:7, 250:13, 28:21, 28:22, months 10:16, 250:25, 252:4, 29:5, 29:11, 10:22, 27:4, 252:6, 257:9. 30:17, 31:6, 27:7, 27:10, mistakes 209:5. 31:12, 31:15, 41:14, 95:22, Mitchell 247:10. 49:13, 49:20, 134:5, 134:22, MMPI 117:10, 51:20, 51:24, 165:3, 174:16, 117:14, 117:15, 52:1, 52:4, 175:10, 175:17, 118:3, 120:10, 175:19, 177:3, 178:5, 213:13, 214:11, 214:12, 214:14, 216:20, 229:24, 260:21, 265:19. Mood 62:12, 183:3. morning 6:20, 12:18, 12:24, 13:23, 155:16, 171:17, 217:10. mother 113:23, 126:19, 127:1, 127:2, 127:3, 140:15, 193:2, 194:6, 221:1, 241:24, 247:8, 254:25, 255:5, 256:23, 258:10, 258:17, 259:8, 261:9, 274:10, 274:10, 274:12. motion 119:18, 119:20, 119:22, 152:11. Page: 492 of 331 Concordance . 156:19, 197:4. motivation 170:1. . Nations 68:2. Move 24:12, 25:16, < N >. nature 26:4, 35:8, 46:3, 48:16, N. 5:13. 201:24, 237:10, 52:3, 62:5, name 5:12, 5:15, 257:8, 258:14, 63:7, 74:11, 5:17, 6:24, 259:14, 261:18. 78:9, 79:18, 7:20, 46:11, nearly 38:22, 88:19, 91:19, 62:22, 63:13, 137:1, 262:22. 96:1, 96:22, 63:13, 64:23, necessarily 51:18, 97:24, 98:2, 103:6, 152:14, 168:8. 98:23, 108:6, 152:15, 152:16, necessary 57:4, 110:20, 150:11, 152:20, 152:24, 161:19, 169:20. 153:7, 205:2, 153:3, 153:8, neck 203:4. 208:6, 239:13, 185:24, 199:19, need 12:1, 14:5, 239:16, 249:15. 229:16, 254:5, 44:10, 48:18, moving 132:2, 272:3. 57:4, 57:16, 243:10, 249:3. named 154:23. 68:4, 72:23, MRC 255:18. names 7:5, 7:7, 115:3, 134:1, Ms. 5:15, 5:19, 11:3, 12:16, 141:15, 141:19, 6:1, 6:4, 23:18, 65:7, 65:8, 142:2, 142:5, 84:6, 150:25, 65:17, 186:8. 142:10, 160:10, 207:2, 208:16. naming 234:6. 174:15, 193:14, multi 156:10. narrowly 181:4. 218:15, 219:10, Myself 17:10, Nasrallan 20:8. 234:12. 74:3, 83:7, national 65:9, needed 56:6, 221:14. 122:15, 144:14, 144:21, 165:12, 175:1, 224:11. needs 142:15. negative 226:25, 246:19, 259:2. negligence 263:4, 263:7, 263:12, 264:5. negotiate 39:21. negotiations 37:15. neither 216:6, 277:23. neurocognitive 229:15. neuroleptic 122:1, 122:3, 122:7, 122:9, 122:16, 124:18, 127:22, 128:16, 128:21, 128:23, 128:25. neuropsych 232:10, 232:11. neuropsychological Page: 497 of 331 Concordance 255:11, 255:13, 114:25, 124:5, 117:17. 269:2, 269:5. 154:6, 179:11, New 5:25, 160:14, next-of-kin 10:23. 179:14, 184:16, 177:8, 177:9, nice 57:17. 188:14, 219:11. 177:17, 207:13, NIMH 34:1. nonresponsive 210:6, 210:7, Nine 162:25, 63:7. 210:9, 210:15, 190:8, 213:6. Nor 182:22, 210:18, 262:12. nobody 72:9, 243:24, 277:24, news 181:21. 141:5, 242:1. 277:28. newspapers 182:5. Nods 13:7, 27:21, normal 61:5, Next 1:7, 18:7, 119:13, 242:20. 181:3. 25:17, 75:1, non-biased 219:10. NOS 113:10. 78:11, 78:12, non-power 219:10. Notary 2:4, 125:11, 127:21, non-responsive 277:10, 277:43, 129:9, 130:6, 24:12, 46:3, 278:31. 130:8, 132:23, 48:17, 52:3, note 193:23, 135:8, 136:11, 62:5, 74:12, 239:8, 239:18, 137:25, 138:18, 88:20, 91:19, 243:21, 244:7, 145:25, 146:17, 96:22, 98:24, 244:17, 245:12, 183:12, 184:12, 108:6, 110:20, 246:1, 246:15. 188:3, 219:20, 150:12, 153:7, notebook 261:1. 232:24, 233:7, 205:2, 208:6. noted 200:2, 234:1, 234:25, non-study 183:20, 204:21, 226:9, 235:21, 239:24, 184:5, 187:23. 226:24. 244:7, 245:1, None 9:20, 33:3, notes 4:28, 4:30, 249:13, 252:21, 113:9, 121:14, 186:14, 186:23, 187:14, 242:9, 243:17, 245:2, 245:23, 265:24. Nothing 24:15, 175:15, 185:25, 236:22, 251:9, 252:12, 276:8. Notice 2:5, 130:10, 163:18, 174:25, 236:5, 243:3, 256:1. noticed 203:23, 258:9. noticing 243:1. notified 176:1, 178:24. notify 253:6. notion 183:19. Nov 4:14, 4:15. November 16:12, 44:16, 44:20, 100:14, 125:12, 130:3, 130:7, Page: 502 of 331 Concordance 273:9. 216:21, 234:24, 138:18, 149:2, nurse 116:10, 251:19, 251:20, 242:22. 116:10, 127:13. 256:12, 257:25, Number 19:6, 42:5, . 269:17, 271:8, 46:12, 53:9, . 271:15, 274:21. 57:4, 75:2, < O >. objects 14:19. 75:9, 81:1, O'louglin 3:15. obligated 197:23, 81:4, 91:15, o. 245:20. 200:19. 92:25, 125:17, O4 241:6. obligation 56:17, 130:12, 161:14, oath 7:12, 99:2, 56:24, 87:18. 193:19, 196:25, 211:21, 232:9. observation 198:23, 199:2, obey 100:5, 100:9, 204:14, 233:10, 199:3, 199:14, 111:10, 111:18, 233:13. 203:21, 217:7, 112:12. observations 221:12, 228:16, objected 112:10. 217:17. 230:21, 235:22, Objections 53:19, observed 241:22. 240:21, 247:23, 65:24, 77:11, observer 235:2. 255:19, 269:11. 77:20, 83:21, obtain 59:14, numbered 146:25. 83:22, 84:18, 76:3, 82:12, numbers 36:20, 105:7, 105:22, 82:23, 83:24, 240:18, 253:1. 109:18, 110:1, 84:1, 86:3, numerous 79:13, 111:20, 134:18, 87:12, 91:20, 105:2, 178:19. 150:2, 154:3, 93:16, 148:14. Nurenberg 66:7, 156:23, 185:22, obtained 83:4, 66:10, 66:18, 213:1, 215:10, 83:13, 85:22, 69:24, 270:20, 91:23, 150:24, 168:23, 169:13, 169:20, 194:1. obtaining 20:23, 22:16, 35:8, 39:18, 59:5, 66:2, 66:5, 66:13, 72:3, 81:25, 84:9, 86:16, 86:22, 87:1, 148:3, 165:22, 168:16, 169:8. obvious 108:17, 149:21, 232:22. Obviously 78:17, 128:3, 206:19, 231:15, 232:22. occasion 7:3, 154:6, 222:16. occasions 148:17, 217:7, 221:16. occupational 245:3, 245:17. occur 135:18, Page: 507 of 331 Concordance 168:25, 169:15. 151:13, 152:22, 203:22. Often 94:18, 169:17, 169:23, occurred 10:16, 164:18, 218:12. 170:3, 170:5, 184:10, 204:4. Ohio 7:2, 7:10, 179:23, 187:2, occurrence 205:9. 7:11, 7:17, 8:8, 188:17, 190:25, occurring 205:14. 8:10, 20:1, 195:15, 196:4, occurs 200:21. 20:6, 23:24, 203:15, 205:23, October 4:37, 24:19. 206:13, 207:2, 266:12. Okay 12:4, 12:5, 219:3, 227:7, odd 115:4, 115:12. 14:16, 18:12, 227:10, 233:24, off-label 160:10. 27:17, 27:18, 234:10, 237:24, offer 193:17. 28:14, 36:3, 244:14, 247:13, offhand 62:22, 39:17, 40:17, 247:17, 249:21, 86:1, 92:4, 48:20, 57:6, 249:23, 253:3, 144:8. 88:15, 147:10, 254:6, 255:24, Office 26:9, 177:15, 182:15, 263:14, 264:8, 119:1, 119:4, 195:4, 201:1, 274:5, 276:5. 119:12, 120:22, 218:24, 223:15, Ombudsman 264:9, 121:4, 121:11, 228:25, 229:8, 264:12. 121:13, 126:2, 236:4, 240:1, Ombusdman 263:15. 126:5, 126:7, 255:18, 263:21. on-line 70:22, 161:16, 162:4, Olson 1:15, 1:24, 219:5. 164:1, 211:22, 2:4, 4:6, 5:3, Once 57:13, 60:25, 255:17, 263:15, 6:7, 6:11, 131:7, 164:5, 272:17. 107:10, 138:19, 165:1, 165:2, official 162:25, 182:16, 272:23. one-page 147:12. ones 86:16, 120:22. ongoing 189:3, 189:15, 220:8. opened 42:16. operating 32:15. OPERATOR 48:18. opinion 43:24, 44:18, 45:10, 45:13, 48:10, 62:4, 109:10, 112:8, 121:23, 125:2, 170:18, 174:3, 192:8, 193:2, 193:13, 206:4. opposite 39:13. options 60:3, 79:16, 151:19. Order 4:12, 68:5, 82:3, 87:18, 106:12, 111:10, 111:18, 112:12, 122:15, 130:8, Page: 512 of 331 Concordance orders 136:20, 275:1. 130:16, 131:14, 136:22, 195:16, overhead 29:8, 131:15, 132:24, 249:2. 51:20, 52:4, 133:25, 137:10, original 14:11, 52:9, 52:17. 137:24, 138:1, 277:33. oversight 92:13, 138:6, 138:13, others 32:14, 216:24, 225:7, 149:1, 149:2, 37:7, 156:12, 225:11, 241:9. 151:3, 157:7, 197:14. overview 218:22. 157:9, 178:13, otherwise 101:20, own 1:6, 42:21, 196:2, 197:5, 277:28. 105:11, 125:9, 197:6, 199:13, outcome 39:2, 188:24, 213:11, 206:17, 231:3, 50:23, 53:4, 216:8, 221:24, 231:18, 233:4, 53:11, 173:4, 239:15, 261:9. 233:5, 233:7, 277:29. owned 222:4. 236:9, 247:8, outlining 165:16. . 249:6, 249:11, outpatient 17:3, . 249:13, 263:22. 32:4, 42:20, < P >. ordered 76:18, 157:18, 161:15, package 203:21, 77:5, 100:5, 162:12. 203:24. 100:9, 137:4, outside 82:9, Page 4:4, 4:7, 137:10, 137:20, 82:12, 82:21, 14:13, 14:15, 157:10, 157:22, 91:17, 100:25, 126:16, 127:21, 196:2, 196:24, 101:1, 101:9, 129:21, 133:9, 198:13, 231:23. 101:12, 192:20, 138:5, 147:1, ordering 151:10, 193:7, 193:16, 147:17, 153:9, 198:21, 200:6. 155:5, 171:23, 172:10, 177:6, 177:12, 179:3, 202:24, 202:25, 224:20, 230:10, 234:1, 244:9, 253:2, 255:14. PAGE/LINE 278:9. Pages 133:19, 252:25. paid 23:14, 25:1, 25:6, 25:18, 26:6, 27:2, 27:19, 28:2, 28:6, 29:9, 29:14, 29:14, 29:15, 29:18, 29:22, 30:2, 31:6, 31:12, 31:20, 31:22, 32:23, 35:21, 36:6, 36:13, 36:19, 38:10, 39:9, 39:10, 52:12, 76:6, Page: 517 of 331 Concordance 34:2, 49:4, 84:22, 87:17, 86:24, 88:17, 50:3, 50:7, 107:8, 108:4, 90:17, 108:25, 50:8, 55:12, 124:10, 135:8, 149:15, 149:22, 61:20, 61:25, 136:25, 137:20, 155:6, 155:23. 70:16, 70:16, 151:18, 152:9, pain 203:4, 203:4. 70:16, 72:12, 157:1, 157:2, panel 68:1. 81:11, 83:9, 157:7, 157:16, paper 9:13, 10:4. 113:18, 117:16, 185:1, 188:13, papers 51:6, 120:14, 133:19, 196:11, 197:25, 195:13. 152:13, 155:19, 198:21, 219:12. Paragraph 126:18, 159:25, 162:15, participated 129:5, 129:9, 162:15, 194:23, 86:11, 150:7, 133:13, 139:2, 200:18, 224:9, 247:17. 172:10. 224:14, 231:24, participating parameters 200:18. 240:5, 247:7. 152:3. paranoid 93:11, partial 124:10. participation 94:17, 227:9, partially 272:10. 35:23, 67:13, 227:19. participant 79:14, 107:6, Pardon 35:23, 183:18. 108:2, 150:4, 37:20, 56:23, participants 150:18, 150:19, 104:21, 199:2. 182:6, 182:9, 150:23, 170:9, parent 223:8. 219:1, 219:9, 177:11, 177:24, parents 215:14, 219:12, 219:22, 252:13. 215:23. 220:3. particular 29:25, Part 15:8, 18:9, participate 79:17, 45:14, 50:5, 30:1, 30:6, 66:6, 94:19, 140:25, 176:25, 194:12, 195:22, 198:18, 230:13. particularly 168:18, 169:9. parties 14:7, 277:24, 277:27, 277:30, 277:36. partly 31:22. parts 48:16, 108:6, 268:3. passed 45:22. passes 138:7. past 65:4. Patients 24:2, 24:8, 32:5, 35:17, 42:22, 45:18, 48:6, 48:8, 48:13, 65:22, 66:4, 68:3, 68:4, 74:2, 75:22, 81:15, 81:15, 105:11, 110:18, Page: 522 of 331 Concordance pays 242:11. 74:6. 111:7, 124:9, Pearson 2:17, performed 9:5, 142:17, 152:18, 5:15, 5:15. 117:18. 181:4, 188:13, peer 81:17. performing 228:22. 188:25, 189:12, peers 245:6. perhaps 68:2, 198:12, 198:17, pelvic 203:4. 112:20, 200:9, 198:19, 207:15, penalized 219:13. 260:15, 272:1. 214:13, 215:4, peoples 131:16, period 8:12, 220:5, 270:23, 230:7, 231:3. 21:14, 24:6, 271:6, 271:13, per 21:13, 28:6, 24:14, 30:14, 271:20, 273:14, 28:7, 33:22, 52:14, 78:19, 275:13. 33:23, 34:7, 107:25, 124:2, Patrice 207:2. 34:12, 36:14, 134:5, 134:21, Paul 3:17. 36:19, 38:10, 167:8, 184:20, pay 31:16, 32:20, 39:25, 40:10, 211:11, 212:14, 33:18, 33:22, 48:25, 76:6, 216:12, 236:14, 33:23, 251:24. 95:6, 167:25, 240:23. paying 31:24, 194:11, 214:22. periodic 61:20, 33:19, 34:8. percent 30:13, 70:20. payment 29:11, 52:10. permission 142:3, 34:4, 39:17. percentage 29:12, 142:5. payments 34:6, 29:21, 32:23, permit 14:18, 34:10, 38:23, 52:8, 52:8. 67:21, 180:12. 39:5, 39:7, perfectly 215:2. permits 180:20. 39:23, 52:20, perform 62:23, permitted 60:24, 82:11, 238:12. 61:1. person 34:8, 35:4, 75:5, 83:6, 83:13, 124:22, 148:2, 197:2, 197:16, 199:19, 205:22, 206:16, 206:19, 215:24, 216:4, 233:20, 235:3, 245:11, 249:8. Personal 17:7, 17:11, 17:11, 17:14, 37:5, 50:16, 67:1, 104:6, 106:10, 108:24, 110:9, 112:3, 145:10, 204:14, 245:6. personally 27:24, 28:12, 49:4, 49:9, 86:9, 106:14, 107:19, 109:13, 109:23, 130:2, 190:24, 191:5, 198:16, Page: 527 of 331 Concordance pharmaceutical 112:3, 112:3, 215:18, 220:10, 26:3, 26:24, 130:13, 137:15, 220:19, 237:22, 167:4, 167:6. 138:8, 138:24, 251:12. Pharmaceuticals 148:12, 148:13, personnel 55:13, 1:18. 162:14, 163:22, 262:11. phase 23:25. 166:24, 166:25, persons 46:5, Phd 2:15. 167:3, 167:17, 277:30. phenomena 114:25. 167:23, 168:4, pertains 59:24, phenomenon 124:5. 168:17, 168:23, 61:12. philosophy 102:16. 169:9, 169:13, petition 123:15, phone 222:14, 169:24, 169:25, 125:22, 126:8, 249:5, 249:10. 197:8, 222:19. 126:10, 126:11. photograph 272:16, physician-patient Pettit 79:13, 274:2, 274:4. 104:6. 79:21, 107:5, phrase 59:17, Physicians 6:5, 107:9, 108:3, 102:2. 32:2, 43:12, 135:14, 135:15, physical 117:25. 44:13, 45:11, 135:16, 146:10, physician 22:3, 85:10, 88:17, 146:13, 150:8, 73:2, 73:3, 176:24, 176:25. 150:13, 150:19, 77:8, 77:19, PI 34:13, 34:14, 185:5, 192:18, 81:10, 87:10, 34:15, 34:18, 193:10, 193:11, 94:22, 94:23, 35:1, 35:3, 193:19, 194:18, 106:10, 108:16, 35:12, 36:15, 213:20, 217:15, 108:24, 109:2, 37:12, 38:5, 247:13, 248:2, 110:9, 110:9, 38:6, 40:9, 248:7, 249:21. 41:22, 49:24, 52:7, 52:17, 54:17, 55:7, 56:1, 56:16, 58:5, 81:21, 94:23, 106:23, 109:1, 110:10, 112:3, 156:22, 169:23, 197:7, 218:15, 254:3. Pictures 4:39, 4:40, 4:41. piece 231:14. pill 230:20. pills 271:23, 272:1, 272:4, 273:5. place 6:25, 14:3, 14:20, 144:20, 148:25, 184:20, 238:10. places 241:22. Plaintiff 1:10, 2:13, 5:16, 5:18, 5:20, Page: 532 of 331 Concordance 243:11. 42:18, 44:8, 7:22. plans 237:14, 76:24, 94:8, plaintiffs 11:3. 237:19, 238:2, 97:9, 108:1, Plan 133:15, 241:3. 109:20, 115:1, 134:25, 136:12, plastic 234:4. 115:19, 124:14, 136:22, 136:23, plausible 260:13. 139:11, 139:13, 137:1, 137:3, played 80:19, 139:20, 140:17, 137:5, 137:11, 110:23, 112:4, 140:25, 164:20, 137:12, 137:13, 178:8. 178:22, 231:3, 150:21, 152:10, playing 111:25. 240:10, 242:21, 194:22, 195:9, PLEASE 16:8, 59:2, 242:25, 276:17. 195:12, 195:22, 78:22, 110:11, points 124:8, 195:24, 196:1, 123:13, 146:22, 165:17. 196:3, 197:18, 199:5, 199:23, policy 145:1. 197:19, 197:22, 208:12, 224:8, poor 216:2, 245:8, 198:9, 198:13, 224:14, 251:6, 246:18, 247:6, 198:14, 199:7, 251:16, 251:23, 247:6. 199:11, 200:19, 278:35. Popkin 18:16. 200:20, 200:20, pocket 49:14. Popper 102:20, 221:2, 237:3, pockets 49:21. 102:22, 103:2, 243:20, 243:23, Pogust 5:24, 5:24. 103:5. 243:25, 245:8, poin 114:4, portions 74:11, 247:4, 253:23. 127:18, 227:13, 205:2. planned 61:17, 237:8. position 33:15, 137:25. point 8:3, 10:11, 51:4, 51:5. planning 190:2, possession 14:7, 15:4, 117:24, 120:19, 120:25, 121:3. possibility 178:7, 182:20, 275:8. possible 151:20, 155:11, 170:8, 220:4, 252:1. Possibly 193:12, 233:18. postdoctoral 19:19. pot 28:22, 31:16. potential 13:11, 82:1, 88:6, 173:11, 182:9, 201:24. power 100:18, 112:22, 220:5. practice 62:1, 68:19, 68:25, 69:1, 69:5, 70:19, 157:19, 186:17, 186:25, Page: 537 of 331 Concordance prepare 12:23, prestige 51:17. 220:25, 269:22. 21:20, 118:15. pretty 35:11, practices 68:14, prepared 119:2, 195:14, 227:12. 68:17, 69:25, 126:3. prevent 9:12, 176:10. Prepetition 4:11. 10:4, 66:24, practicing 206:5. prescribed 128:25, 270:22. practitioners 136:18, 230:18. prevents 166:20. 91:16. prescribes 121:25. previous 10:7, pre-petition prescription 148:17, 190:8, 125:11, 125:19, 116:16, 117:3, 262:14, 262:15. 126:2, 126:7. 117:7. primarily 216:1. pre-screening PRESENT 3:19, primary 39:2, 46:18. 133:7, 148:23, 51:7, 81:14, precedents 66:12. 149:19, 150:5, 83:6, 90:2, preceding 172:10. 150:12, 166:3, 97:8, 113:15, preceptorship 256:2. 113:16, 113:17, 26:2. presented 192:6. 178:5, 193:1. precise 36:20. presenting 94:16, principal 24:8, precisely 49:12, 113:14. 35:4, 81:4, 52:13. presents 234:3, 81:13, 87:9. predict 140:16. 234:4. principle 189:5, prediction 140:18. pressure 132:1, 189:18. preface 188:7. 132:7, 167:6, principles 69:21, preliminary 9:1, 167:24. 69:22, 72:2, 9:15, 10:24, pressures 167:19. 189:22, 219:7, 126:9. 220:17, 271:12, 273:8, 273:13. print 160:13, 203:20. printed 153:17, 153:23. printout 229:15. prior 9:4, 26:11, 43:11, 137:7, 165:10, 196:12, 213:17, 224:18, 272:9, 277:13. prisoners 66:22. private 33:15, 157:19. privilege 127:15. privileged 11:13, 11:17, 27:11. Probably 7:19, 11:21, 18:19, 21:9, 21:10, 23:25, 24:7, 26:6, 26:7, 27:4, 38:13, 41:25, 42:12, Page: 542 of 331 Concordance 274:17, 277:25. 105:3, 258:18. 52:15, 145:22, proceedings profit 54:24. 164:3, 178:9, 106:22. profitable 27:24, 200:15, 203:24, process 4:24, 106:14, 107:20, 210:12, 262:10. 43:14, 86:10, 109:13, 109:23, problem 21:21, 94:12, 116:24, 190:24, 191:5, 63:25, 84:7, 131:16, 132:7, 198:16, 215:18, 86:14, 86:19, 148:16, 148:23, 220:10, 220:19, 88:1, 88:6, 150:9, 151:16, 237:22, 251:12. 112:15, 188:16, 192:5, 192:6. profound 257:14. 255:19. proclaims 154:10. program 19:15, problems 9:5, prodrome 240:10. 74:1, 91:17, 58:6, 86:2, produce 14:18. 135:10, 136:3, 180:17, 257:22. produced 120:1. 144:2, 217:16, procedure 9:4, profession 158:9. 217:18, 221:20, 39:10, 63:19, professional 243:10, 245:18, 63:21, 83:10, 16:10, 50:9, 246:21, 246:24, 86:8, 93:7. 50:16, 67:1, 249:10, 249:14, procedures 63:24, 85:14, 87:23, 261:4. 66:5, 152:5, 105:18, 106:5, Progress 108:16, 191:24. 148:6, 200:1. 186:14, 245:23, proceed 150:6. professionally 246:22, 249:8. proceeded 8:5, 35:10, 49:24. prohibits 263:23. 11:1. professionals project 29:7, proceeding 45:24, 47:21, 101:20, 37:3, 81:12, 247:18, 247:20, 169:9, 275:18. projects 25:10, 28:4, 30:21, 37:13, 168:17. prolong 152:6. proof 164:22. properly 112:9. proposed 129:4. protect 271:3, 273:14. protected 142:18, 142:22. protection 65:22, 271:2. protocol 17:3, 24:4, 35:8, 55:13, 60:4, 61:20, 61:23, 62:24, 83:23, 225:21, 231:24, 263:25. protocols 209:6. proved 140:2. provide 10:25, 21:16, 51:8, 111:5, 156:8, Page: 547 of 331 Concordance 244:8, 244:10, 94:15, 113:10, 264:2, 265:2, 253:1, 253:1. 113:12, 113:18, 277:35. psychiatric 18:25, 129:17, 191:14, provided 9:2, 19:19, 64:7, 204:22, 259:7. 14:12, 16:21, 66:3, 81:18. psychotic 26:5, 16:24, 17:2, psychiatrists 45:20, 66:3, 24:2, 32:3, 89:15, 91:14, 93:14, 97:8, 55:16, 68:5, 101:9, 101:12. 113:20, 151:22, 80:25, 110:25, Psychiatry 18:18, 205:15, 226:22, 111:6, 121:5, 19:14, 19:15, 230:6, 231:2, 121:6, 121:6, 37:3, 64:25, 233:23, 234:10, 162:16, 163:15, 118:1, 154:20, 234:19, 241:23, 163:20, 192:21, 266:16. 258:6, 259:4, 207:24, 227:8, psychoeducation 260:23, 261:12, 240:6, 275:17, 240:5. 273:17, 274:13, 275:19. psychologist 276:1. Provider 59:20, 196:19. psychotics 20:24, 121:24, 192:20, psychologists 62:17. 201:2, 206:5. 91:18. Public 2:5, providing 74:2, psychology 234:17. 126:23, 126:25, 111:25. psychometrist 154:10, 175:11, provision 253:25. 241:9. 277:10, 277:43, PSY 146:25, psychoses 113:15. 278:31. 146:25, 147:18, psychosis 24:3, publish 51:3, 171:24, 177:6, 61:24, 74:2, 51:6. 179:3, 235:22, published 65:6. publishing 9:12, 9:14, 10:4. purely 215:12. purpose 38:24, 120:9, 158:16, 276:13. pursuant 2:5. pursue 128:22. pursued 10:24. pursuing 44:17. put 100:19, 109:23, 200:10, 217:23, 261:23, 275:12. putting 82:13, 82:23, 108:10, 186:22, 206:12, 206:15. . . < Q >. qualified 95:25, 270:12. qualm 84:8. qualms 112:11. Page: 552 of 331 Concordance 170:21, 170:22. 268:20. quash 119:18. . rather 60:22, questions 63:1, . 61:18. 71:13, 80:8, < R >. rating 228:21, 80:10, 93:21, R. 2:15. 268:8, 270:1. 112:6, 119:20, Radu 20:9. ratings 257:16. 162:8, 165:12, raise 76:2, 86:18, rational 174:8, 165:18, 203:12, 93:21. 256:22. 221:7, 235:17, raised 76:11, raw 120:18. 238:21. 76:14, 80:7, Ray 19:6. quick 224:6, 84:3, 84:7, Raymond 19:24. 240:20, 241:14. 112:11, 113:13. re-admission Quintiles 37:8, rambled 78:17. 136:15. 37:21, 262:23. rambles 78:15. Re-ask 43:23. quite 12:18, 54:7, rambling 79:3. reaction 204:22. 237:14. ran 221:21, 222:6, read 15:1, 59:5, quota 167:7. 263:6. 65:4, 69:3, Quote 139:3, random 60:22. 77:23, 79:6, 155:23, 155:24, randomly 60:9. 79:7, 80:14, 168:16, 170:9, range 34:11. 81:17, 101:17, 188:25, 189:12, rapidly 241:25. 125:2, 137:9, 207:21, 242:12, rare 215:23. 165:5, 165:6, 244:17, 244:20, rarely 186:17, 165:10, 165:11, 244:21, 276:3. 186:20. 165:13, 165:14, quoted 258:21. rater 268:5, 166:22, 168:9, quoting 170:14, 169:7, 189:9, 189:17, 196:2, 218:24, 220:9, 220:16, 220:22, 227:7, 233:9, 238:13, 239:21, 240:25, 241:1, 244:17, 278:3. reading 81:23, 138:25, 233:11, 234:17, 248:6. ready 201:6. real 89:2, 180:24, 240:20. realize 200:5. realized 209:4. Really 38:15, 126:20, 126:21, 126:22, 153:20, 247:19, 266:23. REASON 27:13, 74:7, 74:8, 125:1, 125:7, 157:4, 171:22, 173:22, 174:15, Page: 557 of 331 Concordance 107:18, 177:4, recommendation 176:15, 194:18, 195:13, 207:20, 198:24, 199:14. 238:22, 256:22, 207:23, 208:16, recommendations 257:12, 270:8, 209:23, 210:6, 10:19, 10:22, 270:19, 271:2, 210:12, 222:24, 77:7, 85:3, 278:9. 262:15. 85:13, 111:11, reasonable 205:22, receiving 30:17, 111:19, 112:13, 206:15, 206:17, 248:20. 135:2, 135:11, 260:4. recent 71:2, 136:1, 196:23, reasons 44:16, 224:24. 196:25, 198:14, 50:17. recently 70:23, 198:15, 219:17, recast 233:16. 164:1, 207:13, 253:9. receive 24:5, 207:22, 208:16. recommended 24:13, 28:12, recess 48:21, 124:19, 128:24, 52:17, 62:2, 98:25, 118:12, 136:19, 264:20. 62:6, 79:15, 146:3, 182:14, recommending 108:9, 122:9, 229:2. 46:20, 80:21, 157:7, 158:6, recognize 46:1, 239:10, 247:14, 167:3, 174:25, 70:24, 103:5, 247:20, 249:25, 175:5, 190:3, 114:8. 254:18. 201:23, 206:21, recognizing recommit 214:25, 210:1, 210:2, 109:20. 236:12. 210:11, 222:20. recollection recommitted received 12:12, 25:19, 165:8, 213:25. 24:16, 26:13, 224:4. reconsent 178:13, 48:24, 68:17, 209:17, 210:15, 210:18. reconsented 178:11, 237:7. reconvene 276:9. Record 32:7, 44:10, 48:22, 55:10, 57:17, 57:18, 59:2, 66:9, 68:22, 71:25, 74:19, 77:23, 78:15, 79:7, 80:14, 99:1, 118:10, 118:13, 123:13, 125:18, 147:9, 147:16, 169:6, 182:16, 185:12, 211:14, 218:14, 220:1, 220:20, 229:3, 236:6, 246:12, 261:23, 269:12, 270:16, 275:21, 276:14, 276:15, 276:17, Page: 562 of 331 Concordance 225:3. 125:8, 126:24, 276:19, 277:19. referenced 115:3. 128:16, 153:14. recover 252:11. referencing regards 32:12, recovery 240:10, 203:10. 45:25. 240:14, 242:17, referred 276:3. Regents 1:14. 242:18. referring 73:11, Regional 134:3, recruit 24:25, 100:13, 114:21. 134:7, 134:17. 25:6, 25:9, Refers 68:20, Regions 5:22. 40:3, 41:13, 104:4, 176:23. regular 28:12. 171:7, 171:12, reflect 164:11, regularly 246:3, 171:13, 171:15, 237:16, 275:21. 246:16. 171:21. refuse 156:25, regulations recruited 40:11, 221:15, 222:14, 225:11. 41:3, 41:4, 225:25. regulatory 121:16, 41:5, 41:17. refused 115:15, 225:9. recruiting 40:1, 157:16, 178:7. rehabilitation 41:2, 42:4, refusing 45:20, 117:25. 42:7, 42:8, 121:19. reimbursed 95:6. 42:13, 42:14, regard 22:6, reiterating 42:15, 42:19, 22:13, 22:16, 244:18. 170:7, 171:1, 22:19, 32:13, relapse 240:12, 171:2. 106:21, 143:14, 240:13, 240:14, recruitment 219:9. 153:11. 259:5. reduce 271:19. regarding 110:8, related 127:13, reduced 277:17. 111:22, 124:23, 201:16, 229:13, reference 225:2, 277:24. relating 203:19. relationship 23:13, 23:20, 26:10, 60:16, 82:2, 84:5, 104:6, 104:7, 113:5, 157:6, 168:19, 168:25, 169:11, 169:16, 189:25, 190:14, 212:1, 252:15. relationships 32:9, 219:21, 219:23, 220:2. relative 277:26. relatives 93:1, 93:18, 103:15, 103:19. relayed 217:7. release 10:1, 24:23, 142:4, 223:21, 223:23, 226:1. released 14:9, 139:4, 139:6. Page: 567 of 331 Concordance repeatedly 242:4, 259:23, 260:2. relevant 160:12. 242:8, 255:1, repititious 47:25, reliable 63:21, 255:5, 258:10. 96:13. 275:23. Repetitious 40:13, Report 4:11, 4:31, relinquish 277:33. 41:20, 49:7, 4:33, 4:34, rely 189:3, 49:16, 56:3, 43:16, 47:6, 189:14, 189:24, 59:10, 65:2, 67:8, 67:10, 220:8. 68:10, 68:23, 67:17, 79:10, remain 134:23. 75:18, 80:3, 117:21, 117:21, remember 7:5, 7:7, 80:9, 84:14, 120:14, 120:15, 11:3, 63:2, 86:20, 95:8, 125:11, 126:14, 97:17, 171:6, 100:21, 101:5, 129:2, 140:2, 196:23, 267:5, 102:10, 107:3, 140:6, 164:23, 267:6. 107:22, 109:25, 193:18, 213:24, reminding 195:15. 111:3, 149:11, 230:11, 247:12, renew 21:15. 149:25, 151:6, 248:1, 248:7, renewed 214:14. 156:6, 159:18, 252:22, 253:3, rent 29:15. 184:1, 187:9, 253:6, 253:20, Repeat 46:25, 191:2, 220:15, 254:25, 256:14, 63:6, 63:8, 224:2, 234:23, 257:17, 259:9, 77:22, 80:13, 251:7, 251:14, 266:17, 267:15. 88:22, 100:7, 257:24, 265:13. reported 26:17, 105:23, 111:15, repetitive 25:14, 207:21, 258:9, 144:17, 208:8, 109:5. 265:17, 265:18. 208:12, 243:22. rephrase 72:15, Reporter 2:4, repeated 274:9. 16:7, 123:11, 125:15, 133:2, 138:22, 146:20, 193:21, 195:3, 201:5, 202:21, 223:18, 229:7, 233:2, 235:24, 236:3, 244:12, 247:25, 249:19, 252:24, 255:22, 262:2, 266:8, 268:18, 272:25. Reporting 21:14, 278:36. reports 239:20, 259:7. representatives 26:1, 26:3. represented 15:4. reputation 170:6. request 15:16, 18:10, 208:4. requested 9:11, 21:17. requesting 265:21. Page: 572 of 331 Concordance 61:23, 70:17, 136:14, 136:17, requests 15:24. 277:33, 277:35. 136:18, 138:6, require 145:23, requiring 175:10, 138:7. 154:11, 158:9, 191:22. response 79:18, 173:10, 195:25, reschedule 217:11. 150:11, 231:17. 254:21. researcher 201:22. responses 69:9. required 14:2, researchers 66:25, responsibilities 14:10, 21:11, 181:23. 31:3. 22:7, 34:3, residence 125:22. responsibility 38:20, 52:7, residencies 18:21. 29:5, 86:6, 62:24, 70:21, residency 19:3, 90:3, 222:16, 79:9, 94:14, 19:7. 244:1, 258:10. 142:22, 143:24, resident 18:24, responsible 34:18, 144:25, 145:22, 19:15. 34:23, 35:5, 167:20. residents 74:4. 35:11, 37:14, requirement 107:7, resolution 139:5. 78:8, 171:18, 154:13, 166:1, respond 18:10, 216:8, 232:6, 166:13, 166:16, 172:12, 222:21. 244:3. 196:15. responded 223:11. responsive 15:15, requirements respondent 127:10, 78:24, 79:2, 21:23, 122:2, 127:25, 128:14, 88:24, 249:16. 122:5, 148:19, 128:24, 133:10, rest 238:4. 150:21, 174:13, 133:15, 133:25, restlessness 200:14, 218:17, 134:2, 134:23, 267:16. 224:10, 224:16. 135:8, 136:11, restrictions requires 61:23, 265:1. result 8:25, 196:10, 198:9, 199:11, 256:17. resulted 175:8, 198:10. results 51:1, 53:10, 53:12, 54:12, 120:16. resume 17:25, 18:1. RETURN 199:4, 222:14, 227:4, 243:14, 272:11, 278:35. returned 230:22. revenue 51:25. Review 1:16, 165:10, 232:10, 232:12, 232:20. reviewed 12:25, 81:17, 120:16, 154:24, 163:25, 184:11, 187:13, 211:23, 231:13. reviewing 165:17. Page: 577 of 331 Concordance Risperidone 145:15, 153:10, revise 208:4. 186:11. 153:14, 158:8, revised 207:25. risperidonhe 165:22, 166:10, revision 175:8. 185:15. 271:5, 271:11, revocation 11:15, Riverside 139:4. 271:18, 273:8. 198:10. Robert 20:9. ruling 128:22. revoke 152:11, role 50:3, 110:16, run 11:22, 67:21, 226:5. 126:13, 178:8. 69:11. revoked 85:11, roles 73:10, running 22:20, 195:25. 80:19, 81:22, 35:9, 74:1, rights 70:4, 70:9, 87:5, 104:4, 208:24, 238:16, 71:7, 271:6. 110:23, 111:25, 257:21, 258:2, risk 86:5, 172:7, 112:4, 254:13. 262:22. 172:11, 172:15, room 35:1, 35:3, runs 238:3. 174:19, 174:21, 150:25, 166:3, Ruth 3:20, 6:4. 176:7, 176:17, 240:4. . 178:9, 178:23, roughly 52:21. . 201:8, 208:21, rounds 21:20. < S >. 209:12, 209:16, routine 61:25. S. 3:9. 243:20, 243:22, Rule 22:6, 113:11, safe 199:4. 271:17, 271:19. 129:16, 145:7, safety 4:21, risked 181:6. 153:20, 154:11. 177:1, 271:6. risks 35:17, rules 105:2, salaries 29:12, 177:8, 201:25, 136:13, 143:13, 31:17. 202:2, 202:12, 143:17, 143:23, salary 28:13, 207:14. 29:14, 29:17, 29:22, 30:1, 30:7, 30:14, 31:20, 31:22, 31:25, 32:23, 49:4, 49:10. sales 54:25. satanic 127:14. satisfactorily 135:9. satisfy 107:7. Saveanu 20:10. saved 238:11. saw 14:21, 14:23, 76:23, 77:3, 81:11, 90:21, 90:21, 91:8, 91:8, 91:14, 91:14, 100:25, 126:14, 133:5, 160:20, 160:22, 163:15, 164:3, 164:5, 165:1, 192:19, 198:6, 216:11, 216:20, Page: 582 of 331 Concordance 94:12, 94:17, schools 28:22. 222:24, 232:21, 94:20, 94:25, Schulz 1:16, 239:7, 256:13. 113:11, 124:9, 20:13, 24:22, saying 30:9, 158:19, 159:4, 30:16, 30:20, 38:24, 39:5, 160:8, 181:1, 30:21, 30:24, 43:10, 46:7, 181:23, 205:10, 32:10, 70:1, 159:11, 221:22, 227:1, 235:7. 72:7, 72:8, 232:11, 233:17, schizophrenic 76:1, 76:17, 267:5. 94:7, 95:5, 76:23, 77:3, scales 228:22, 227:19. 77:4, 77:10, 268:8. schizophrenics 77:17, 80:7, scanned 119:3. 59:15, 227:9. 89:24, 90:5, scenario 198:18. schizophreniform 90:12, 102:5, schedule 38:11, 158:20, 159:7, 102:24, 111:24, 61:17, 161:20, 159:9, 159:25, 112:4, 112:6, 216:23. 160:11, 161:1. 112:8, 112:11, scheduled 217:8. scholar 51:7. 112:14, 122:25, scheduling 118:11. scholars 51:14, 141:13, 142:9, schizoaffective 51:16. 160:20, 171:19, 95:18, 95:24, Scholer 5:24. 192:14, 199:21, 96:2, 158:20, School 17:19, 200:4, 216:19, 160:1, 160:11, 17:20, 18:13, 216:23, 223:2, 161:2. 18:15, 18:20, 223:11, 242:7, Schizophrenia 19:9, 19:11, 264:9, 264:11. 73:25, 93:12, 50:4, 51:2. sciences 102:17. 93:19, 94:10, scientific 21:19, 50:25. scope 198:8. screen 241:10, 241:10, 256:2. screening 38:19, 39:22, 47:7, 107:25, 125:12, 125:19, 150:9. SEAL 273:3, 277:38. second 9:25, 14:17, 33:4, 48:19, 74:25, 182:20, 182:23, 185:9, 185:15, 185:19, 187:18, 193:2, 207:12, 247:16. Section 98:6, 133:18, 172:11, 179:6, 179:12, 179:13, 179:15, 179:16, 179:19, 180:1, 182:17, Page: 587 of 331 Concordance 140:6, 162:14, 183:13, 183:15, 182:19, 191:6, 163:5, 195:4, 183:24, 184:12, 191:10, 191:22, 223:19, 233:15, 187:18, 188:10, 219:20, 224:20, 233:17, 233:20, 207:12, 264:3, 225:1, 225:22, 233:22, 238:25, 264:5, 264:8, 225:23, 263:21. 244:24, 245:2, 264:21, 265:4, seeing 81:14, 245:12, 246:1, 266:18. 161:24, 162:5, 255:23, 262:18, sentenced 253:7. 193:4, 216:18, 274:4. separate 142:17, 245:15, 261:4, sees 79:4. 142:21, 143:25, 262:20. Selecting 219:1. 147:3, 147:8, seek 78:19, 78:20, self 8:17, 243:20, 216:4, 224:11, 79:12, 120:7, 243:22, 245:8. 224:24, 225:3, 122:21, 181:17, send 18:4, 26:16. 225:4, 225:5, 193:13, 205:3. Senior 17:20. 254:22. seeking 75:11, sense 12:14, 24:1, SER 202:24. 121:9. 57:18, 189:23, Serequel 24:23, seems 67:5, 245:5, 267:19. 54:17, 54:18. 245:10. sensitivity 140:8, series 66:11. seen 13:15, 13:24, 256:17, 260:16. serious 58:5, 15:18, 36:10, sent 26:18, 105:2, 130:17, 36:12, 36:14, 117:13, 119:9, 209:5, 252:21, 36:16, 36:17, 140:21. 253:2, 253:6, 36:17, 54:16, sentence 79:19, 254:24. 58:15, 89:17, 128:1, 129:1, Seroquel 4:22, 120:13, 140:6, 23:25, 54:4, 55:1, 172:24, 173:11, 174:19, 174:22, 177:4, 201:9, 201:22, 202:22, 204:16, 205:8, 231:5, 231:18, 231:19, 256:5, 256:11, 256:15, 259:20, 265:15. serve 18:21. service 277:35. Services 16:21, 16:21, 16:24, 32:5, 42:15, 133:14, 133:15, 146:6, 245:24. session 148:20. sessions 239:21. setting 17:5. settings 42:23. settled 9:20. several 7:1, 37:7, 38:21, 42:1, Page: 592 of 331 Concordance 253:5, 272:15, 147:13, 148:14, 45:21, 52:14, 273:22. 151:12, 167:2, 173:17, 203:24, showed 9:3, 178:18, 190:6, 226:9, 239:19, 114:18, 127:10, 205:19, 218:3, 242:9, 260:15, 262:14. 218:8, 218:11, 260:21, 270:1, showing 243:18, 225:25, 249:12, 271:25. 246:18, 257:14, 269:23. severe 131:25, 269:12. signature 143:25, 132:6. shows 240:8. 144:22, 147:21, shall 134:2, side 117:5, 147:23, 194:1, 134:4, 134:21, 158:17, 171:25, 207:6, 210:24, 138:6. 172:23, 173:11, 211:10, 212:13, shared 221:1. 191:15, 201:24, 212:24, 262:3, Sheet 231:12, 204:2, 204:14, 262:6, 263:18, 239:24, 270:11. 204:16, 204:23, 266:9, 266:21, sheet(s 278:17. 205:7, 205:13, 267:21. sheets 232:24. 240:11, 267:17. signatures 142:9, sheriff 131:21. sign 4:17, 37:12, 142:10, 147:19. short 163:18. 43:10, 44:22, signer 258:11. shorthand 277:16. 55:7, 55:20, significant shortly 115:18, 55:22, 109:13, 164:12, 164:21, 193:25, 223:22. 142:15, 142:17, 190:14, 202:12. Show 13:14, 43:21, 143:1, 143:8, signing 45:3, 172:6, 218:7, 143:11, 144:6, 45:8, 46:24, 224:8, 224:14, 144:20, 146:14, 47:12, 56:18, 229:4, 251:16, 147:25, 150:10, 150:14, 206:20, 220:23, 263:6. similar 45:18. similiar 48:13. simple 248:5, 253:13. simply 72:15, 89:2, 148:23, 230:10. simultaneously 169:23. single 94:8, 171:21, 204:3. sister 126:22. sit 172:3. site 171:13, 189:6, 190:21, 212:18, 218:22, 218:25, 230:17, 250:23. sites 154:9. situation 46:1, 181:3. six 22:13, 41:13, Page: 597 of 331 Concordance 148:12, 161:24, 234:8, 244:15, 42:12, 134:5, 162:5, 163:6, 244:22, 255:6, 134:21, 164:7, 180:3, 185:3, 274:14. 208:3, 214:12, 193:18, 222:17, Sometime 18:19, 214:14, 276:20. 222:18. 25:21, 175:6, SKALICKY 2:4, somebody 190:19, 210:13, 218:12, 277:10, 277:42. 233:22. 249:9. skill 97:21. someone 38:8, Sometimes 26:20, skip 182:8. 47:19, 60:7, 135:20, 271:13. sleep 115:5, 82:21, 86:15, somewhere 25:25, 115:9, 125:4. 86:23, 92:25, 34:10, 41:10, slightly 243:18. 101:1, 105:8, 75:7. slitting 127:3, 105:13, 105:14, son 217:2, 221:19, 230:6, 231:2, 105:24, 106:8, 274:12. 273:18. 106:10, 112:19, soon 214:18, Smith 19:4. 112:21, 131:7, 236:9. smooth 199:4. 131:11, 141:10, sorry 8:18, 19:13, snouts 234:5. 141:12, 142:4, 69:3, 89:20, snowslide 234:8. 142:6, 158:9, 167:20, 218:6, so-called 203:20. 169:21, 189:1, 221:22, 264:9, Social 32:3, 86:3, 189:3, 189:12, 275:16. 86:25, 126:4, 189:15, 190:22, Sort 11:2, 229:14, 133:14, 135:12, 191:13, 193:14, 240:24, 241:9. 135:12, 135:21, 220:6, 220:8, Sorting 229:11. 136:14, 146:6, 232:11, 233:14, sound 12:21. 148:5, 148:8, Sounds 233:23. source 13:1, 110:7, 110:17, 201:20. sources 140:10, 274:25. South 2:6, 2:18, 3:6. space 29:16. speaker 25:20. speaking 222:12. speaks 11:24. specialize 18:17. specialty 176:25. specific 31:2, 65:7, 65:18, 67:9, 72:4, 111:5, 111:23, 135:18, 145:2, 153:3, 179:14, 186:1, 186:8, 186:10, 186:18, 187:6, 187:16, 196:1, 200:10, 200:17, 203:18, 209:23, 238:21, Page: 602 of 331 Concordance 268:10. sponsor 16:22, 246:1, 246:15. Speculative 31:8, 35:6, 54:13, specifically 7:3, 40:6, 56:4, 55:17, 86:8, 13:20, 20:20, 58:2, 58:11, 86:24, 87:19, 27:18, 47:5, 64:13, 64:16, 88:18, 167:5, 67:10, 71:2, 65:2, 89:6, 170:6, 208:1, 120:16, 134:14, 107:14, 107:22, 210:1. 145:17, 163:3, 112:25, 114:21, sponsored 32:16, 163:24, 175:6, 132:14, 134:11, 34:1, 37:3, 178:10, 178:21, 141:7, 144:15, 210:9. 180:20, 187:13, 152:1, 153:1, sponsors 26:25. 201:21, 204:20, 166:6, 166:17, ss 277:5, 278:23. 219:4, 220:16, 173:6, 173:13, St. 3:17. 249:5, 262:13, 173:20, 175:25, stability 180:16. 262:20, 263:23. 176:4, 177:20, stabilizer 62:13. specifics 21:16, 185:12, 187:10, stabilizing 183:3. 111:22, 140:7, 211:12, 212:15, staff 29:12, 140:24, 153:16, 227:17, 228:9, 38:23, 55:15, 180:7, 221:4. 245:14, 256:8, 57:1, 226:19, specified 14:3, 271:16. 240:7, 246:16, 14:20, 179:15, speech 243:20. 258:8, 265:18. 197:20. spelled 179:12. stamp 171:24, specifies 198:3. spells 34:3, 68:2. 253:1. specify 83:24. spent 261:10. stamped 244:8. speculate 44:9. spoken 13:10. standard 33:24, speculation 92:9, 160:2, 179:21, 187:1, 200:15, 257:16, 264:24. standing 119:11. stands 220:20. Star 201:19, 233:20. start 40:1, 42:13, 58:18, 118:8, 123:7, 123:8, 175:2. started 42:2, 115:22, 255:12, 255:14, 274:24. starting 19:8, 240:9. STATE 1:1, 8:8, 17:22, 20:1, 20:6, 22:3, 23:24, 24:19, 59:20, 121:10, 121:24, 122:2, 128:20, 131:11, 168:21, 206:6, 206:6, 214:11, Page: 607 of 331 Concordance 218:24, 225:24, 193:16, 195:14, 234:13, 239:12, 226:4, 241:8. 195:23, 195:24, 251:5, 251:21, statements 161:11. 197:17, 198:10, 252:16, 275:9, States 55:1, 64:8, 214:12, 214:13, 277:3, 277:11, 64:25, 152:17, 237:22, 238:10, 278:22. 152:21, 158:22, 239:11, 247:15, stated 44:16, 188:25, 197:10, 247:21, 248:2, 115:14, 115:25, 224:25. 250:1, 253:25, 124:4, 244:21, stating 153:21, 254:19, 254:21, 274:12. 230:14, 232:9, 264:18, 265:4. Statement 4:10, 243:18, 256:24. stayed 20:3, 4:35, 43:12, Station 42:19. 133:10, 134:4, 44:4, 44:13, status 51:4. 134:21, 236:23. 45:11, 45:18, statute 122:12, staying 237:17. 46:7, 74:17, 128:3. stays 251:25. 74:20, 75:22, statutory 123:1, Stephen 1:15, 75:24, 100:13, 123:5. 1:24, 2:3, 4:6, 114:10, 116:4, stay 38:25, 45:23, 5:3, 6:11, 123:14, 125:21, 75:12, 79:11, 152:22, 254:6. 129:14, 157:13, 84:20, 84:24, steps 10:15, 166:23, 167:9, 85:7, 85:11, 227:22, 230:9. 167:21, 170:13, 85:15, 109:19, stop 57:13, 57:16, 170:19, 188:1, 135:19, 136:6, 64:15, 146:1, 188:5, 188:19, 152:11, 152:19, 214:19. 189:17, 190:21, 156:5, 180:12, stopped 42:6, 200:10, 204:10, 42:8, 226:10, 260:12, 260:14. strategy 171:1. stream 140:3, 231:5, 234:14, 243:19, 256:6, 256:11, 259:21. Street 2:18, 182:10. stressful 132:10. stricken 74:18. Strike 24:12, 46:3, 48:16, 52:3, 62:5, 63:7, 74:11, 78:9, 79:18, 88:19, 91:19, 91:23, 96:1, 96:22, 98:23, 110:20, 150:11, 153:7, 205:2, 208:6, 239:16, 249:15. strong 169:25. strongly 93:17, Page: 612 of 331 Concordance 49:1, 76:6, 65:14, 65:23, 183:19. 77:17, 81:7, 66:25, 69:12, stuck 93:18. 87:21, 95:6, 70:4, 70:9, student 42:21, 95:14, 111:23, 73:21, 75:3, 234:17. 142:10, 143:14, 75:8, 75:9, studied 53:14, 145:3, 156:8, 75:16, 79:25, 110:5, 159:13. 167:5, 167:6, 85:21, 86:4, studies 32:14, 167:18, 168:1, 141:11, 141:15, 33:1, 34:1, 168:18, 169:10, 142:7, 143:19, 34:8, 39:19, 191:25, 194:11, 159:17, 160:5, 41:22, 42:1, 199:17, 214:22, 167:7, 167:19, 45:6, 48:2, 225:18, 225:24, 167:25, 170:7, 48:7, 48:8, 226:5, 247:3, 170:7, 171:2, 59:21, 69:11, 248:15, 250:5, 171:8, 216:25, 88:7, 153:5, 250:18, 250:20, 244:2, 267:8, 153:21, 154:5, 251:11, 255:4, 271:3. 171:21, 224:24, 263:22, 264:1. submitted 263:1. 254:9, 265:22, subjects 22:21, Subpoena 4:8, 266:2, 267:9. 25:6, 25:9, 14:2, 119:5, studying 201:22. 29:14, 35:17, 119:16, 119:18, subject 28:7, 36:6, 40:1, 120:2, 211:15, 33:22, 33:23, 40:3, 40:11, 211:19. 34:12, 36:14, 42:5, 42:24, Subscribed 278:26. 38:11, 39:25, 45:1, 45:16, substantial 40:10, 41:3, 48:1, 65:13, 228:21, 228:23, 41:5, 45:5, 277:32. Substitute 116:25, 122:22, 127:24, 128:12. success 259:11. successfully 243:9, 246:23. successive 170:4. sued 8:2. suffer 103:7, 103:11. suffered 8:24, 103:15, 113:8. suffering 114:9, 226:22. sufficient 67:20, 69:10, 186:23. sugar 178:4. suggest 144:23, 260:20. suggesting 100:8. suicidal 203:19, 257:19, 258:6. suicide 10:16, 10:23, 139:25, 172:7, 172:8, Page: 617 of 331 Concordance 19:7, 146:5. 95:19, 95:22, 172:15, 172:20, supplied 106:20. 125:4, 127:4, 172:23, 173:4, supply 106:1. 172:11, 203:3, 173:10, 173:23, supplying 105:15. 226:25, 240:12, 174:16, 176:8, support 123:14, 240:13, 242:18, 201:8, 201:9, 123:20, 125:21. 246:19, 259:3. 201:16, 203:5, supported 47:6, system 105:16, 203:19, 204:25, 47:9, 126:8, 106:2, 112:2, 205:6, 205:9, 126:10. 112:23, 149:17. 205:12, 205:14, supporting 100:5. . 205:17, 221:21, suppose 152:2. . 226:21, 242:1, supposed 142:25, < T >. 246:21, 259:10. 157:24, 197:21, talked 15:13, Suite 2:6, 2:19, 272:6. 30:24, 48:25, 3:6. surprised 145:12, 99:5, 121:19, summarize 204:12. 153:4, 187:15. 148:20, 186:15, summary 204:13. surprising 262:21, 187:18, 217:6, summer 234:8, 263:3. 231:2, 273:7, 234:9. suspect 166:20. 273:12, 276:18. supervised 141:13, SVITAK 3:9, 6:1, tape 48:19, 142:8, 163:16. 6:1, 23:18. 228:25. supervision 72:8, switching 221:7. tapes 146:2. 166:8, 277:18. sworn 6:9, 6:12, taught 72:9, supervisor 19:23, 277:12, 278:26. 240:6, 250:9. 20:6, 70:2. symptoms 93:10, tax 26:19, 27:1. supervisors 19:2, teaching 51:9. team 46:18, 47:7, 47:7, 74:1, 77:8, 77:9, 85:3, 100:6, 100:10, 125:12, 125:19, 125:24, 126:6, 135:3, 136:2, 136:21, 137:11, 137:13, 137:16, 141:2, 141:3, 150:7, 163:15, 195:7, 195:11, 196:3, 199:4, 199:8, 221:13, 248:19, 259:18, 260:5. technically 37:2. Tegratol 23:5. Tegretol 179:13. telephone 249:11. ten 40:24, 56:8, 145:21, 154:5. tend 227:1. tendency 277:32. tenure 51:5, Page: 622 of 331 Concordance 241:11. text 203:24, 51:10. tested 9:4. 203:25. term 59:4, 59:8, testified 6:13, Thanksgiving 59:17, 64:2, 190:4, 211:21, 89:19. 68:24, 72:10, 224:10, 237:24, themselves 114:7, 72:12, 72:17, 252:8. 181:18, 204:17. 72:21, 82:6, testifying 40:9, Theo 180:10, 87:6, 89:2, 186:19, 188:4, 181:7, 212:18, 89:11, 102:2, 196:16. 226:19, 228:8, 102:8, 103:24, testimony 30:5, 228:13, 272:4, 104:2, 179:9, 37:23, 49:7, 272:5, 272:8, 179:13, 179:16, 50:13, 51:13, 272:20. 179:18, 179:25, 107:17, 137:7, theory 194:10, 265:11. 149:11, 149:25, 214:21. terminated 108:2. 158:13, 172:19, therapeutic 59:3, terms 16:22, 203:17, 213:12, 59:9, 59:18, 70:24, 71:3, 223:25, 224:18, 63:25, 65:21, 72:4, 79:11, 262:18, 269:13, 66:1, 72:10, 128:9, 134:5, 276:21, 277:13, 82:2, 82:6, 134:22, 198:7, 277:15, 277:20. 231:23, 265:11. 226:19, 237:18. testing 229:15, therapies 179:12. Terrace 278:36. 231:14, 231:15, Therapist 136:19, test 117:23, 232:10, 232:11. 219:20, 219:21, 229:11, 229:12, tests 61:19, 244:5. 229:14, 229:19, 267:24, 268:1. therapists 239:20. 230:13, 231:4, therapy 8:23, 183:6, 239:19, 241:1, 241:2, 245:3, 245:17, 249:1, 255:12. thereafter 115:18, 277:16. thereby 87:19. therein 277:15. thinking 137:23, 160:6, 163:9, 227:6, 234:6, 247:8, 248:20, 257:20. third 10:13, 10:14, 10:14, 18:20, 75:8, 139:2, 224:2. though 23:10, 39:11, 115:25, 117:20, 200:21, 246:25. thoughts 139:12, 140:18, 230:6, 273:17. Page: 627 of 331 Concordance throats 230:7, 52:11, 52:20. thre 8:13, 21:10, 231:3. totally 214:10, 24:1, 110:9, throughout 93:6, 244:19, 261:8, 161:14, 268:15. 163:16, 210:25, 261:11. threat 85:15, 212:13. toward 249:8. 111:10, 136:7, tie 208:24. towards 41:6, 196:10. ties 32:9, 83:16, 249:4. threaten 85:6. 86:15, 149:8. towed 221:22, threatened 75:12, timeline 23:21. 222:6, 222:8. 85:1, 253:8, timing 175:15. toxicology 256:1. 271:7. today 26:12, track 51:5, 51:7, threatening 118:15, 119:6, 51:10. 195:14. 120:9, 121:12, tracked 29:24. threats 127:2. 121:17, 233:10, trademarked 12:21. three 24:1, 24:8, 233:13, 274:1. tragedy 275:15. 25:22, 47:21, together 171:10, trained 92:24, 53:14, 56:12, 275:12. 93:15, 105:8, 57:3, 60:9, took 6:25, 9:12, 105:13, 105:25, 64:3, 69:15, 25:5, 116:14, 106:8, 112:19, 99:24, 150:15, 117:10, 117:15, 141:12, 142:7. 158:18, 159:3, 148:25, 171:20. training 17:18, 159:6, 212:19, top 29:23, 40:15, 19:9, 19:16, 231:22, 252:25, 273:2. 20:17, 20:18, 260:15. total 26:13, 34:7, 20:20, 20:23, throat 127:3, 34:10, 42:5, 21:12, 21:13, 273:18. 22:13, 22:19, 25:20, 26:2, 26:8, 58:25, 59:13, 67:19, 68:18, 69:9, 70:18, 70:20, 70:20, 70:22, 71:4, 71:15, 71:18, 71:22, 71:23, 72:7, 72:7, 72:13, 72:24, 73:18, 86:12, 86:17, 92:14, 102:5, 102:13, 102:16, 102:24, 219:2, 219:5. transcript 277:19, 277:34. transcription 277:34. transfer 17:14. transport 130:9, 130:16. transportation Page: 632 of 331 Concordance 133:4, 138:8, 253:24. 29:15. 138:24, 156:20, trial 7:12, 7:16, transported 131:4, 166:24, 166:25, 8:3, 8:5, 8:14, 131:19. 167:2, 167:17, 13:2, 182:3. travel 28:24. 169:25, 185:14, trials 24:1, 28:8, travels 237:20. 190:5, 190:15, 33:25, 66:20, treat 133:15, 197:7, 200:13, 67:14, 69:2, 160:2. 205:15, 243:16, 266:18. treated 22:23, 244:15, 254:3, Tribune 201:19. 23:1, 45:17, 254:10, 254:11, tried 87:12, 62:12, 100:19, 254:20. 178:4, 192:25, 101:24, 110:4, treatments 23:9, 275:11. 131:1, 131:8, 96:16, 96:17, trouble 86:25, 131:12, 151:21, 98:6, 98:9, 171:2. 227:10, 227:21, 98:10, 98:17, true 58:13, 83:23, 235:9. 98:19, 98:20, 99:9, 99:14, treater 75:4, 159:8, 159:23, 116:18, 132:2, 75:14. 179:4, 179:7, 149:9, 157:9, treating 75:25, 179:10, 183:9, 157:15, 163:10, 80:24, 81:2, 184:8, 185:24, 167:22, 182:11, 81:19, 84:4, 186:2, 186:7, 189:4, 210:23, 85:9, 86:14, 186:16, 186:18, 210:24, 213:9, 89:15, 90:2, 186:21, 186:24, 273:15, 277:19, 91:21, 91:25, 187:6, 191:18, 278:5. 93:13, 94:22, 192:6, 200:23, Trustee 1:7. 126:13, 130:13, truth 233:10, 233:13, 277:14. try 38:14, 38:14, 38:25, 112:1, 132:18, 132:20, 143:22, 238:17, 239:13, 265:25. trying 208:24, 209:2, 209:3, 216:1, 229:13, 237:4, 239:12. tutorial 188:24. tw 81:1, 110:8. twice 6:23, 210:25, 213:13, 213:17. two 8:13, 8:21, 10:7, 21:14, 24:1, 24:7, 27:8, 44:14, 44:14, 69:8, 83:3, 84:8, 84:10, 123:22, 147:3, 165:2, 176:1, 176:15, Page: 637 of 331 Concordance underneath 125:1. undisclosed 186:6, 186:13, undersigned 278:2. 104:15. 208:21, 212:19, understand 14:9, undoubtedly 29:24. 213:13, 216:4, 14:24, 67:5, unethical 81:19, 216:20, 232:24, 67:7, 69:18, 156:20, 176:9. 254:13, 260:15, 88:15, 99:3, unexpected 275:9, 262:22, 272:1. 122:6, 141:25, 276:3. type 109:21. 144:13, 144:21, unfortunately typewritten 188:16, 190:19. 275:14. 277:17. understanding unique 160:14. typical 28:7, 14:5, 26:4, Unit 42:11, 42:13, 254:8. 31:6, 59:22, 42:16, 146:5. typically 135:17, 66:10, 69:20, United 55:1, 64:7, 268:25. 88:20, 104:2, 64:25, 68:2, . 115:22, 116:12, 152:16, 152:21, . 117:9, 122:8, 158:22, 197:10. < U >. 125:18, 131:7, units 42:20. umbrella 101:2. 140:5, 144:4, University-sponsor UMP 16:1. 144:7, 201:11, ed 28:4, 29:7, unacceptable 224:23, 237:17, 37:13. 139:3. 272:8, 277:20. Unless 21:16, unavailable 89:25. understood 128:3, 131:10, 186:9, undergraduate 128:6, 128:8, 262:16, 263:21. 17:21, 234:17. 133:21, 158:5. unnecessary Underlined 155:8. underwent 180:6. 191:15. underlying 204:24. unproven 191:14. unquote 155:24, 155:24, 169:16, 207:22, 244:21, 244:23, 276:4. unreliable 231:20. until 17:8, 20:3, 57:25, 58:9, 89:16, 90:3, 90:20, 94:20, 99:15, 99:17, 99:21, 104:22, 124:3, 135:1, 135:18, 162:23, 163:23, 176:15, 177:18, 201:10, 203:16, 208:3, 210:2, 211:3, 215:4, 217:12, 218:12, 236:13, 238:3, 244:22. untrained 235:2. untreated 234:20. unusual 254:13. uses 121:25. using 69:11, Page: 642 of 331 Concordance videotaped 276:21. 39:22, 39:23, 112:22, 179:18, violate 119:5, 61:17, 161:17, 182:10. 145:7, 211:18. 161:19, 161:20, usual 220:25, violated 105:1, 161:24, 162:13, 223:7. 145:10, 211:15, 162:24, 162:25, . 271:5, 271:13. 163:1, 163:7, . violating 120:2. 163:16, 164:7, < V >. violation 103:25, 164:9, 164:10, validity 267:22. 104:3, 122:12, 164:20, 167:5, value 117:5. 123:1, 123:5, 261:5. valued 51:19. 188:23, 191:22, VISUAL 1:23. various 21:20, 198:7, 225:21. voluntarily 45:22, 80:19, 183:9, violations 104:13, 115:23, 116:6. 228:17, 258:3, 179:21, 271:14. voluntary 85:7. 267:24, 268:1, visit 28:7, 34:4, volunteered 228:1. 268:3. 34:5, 34:7, vouch 267:22. vary 38:16, 38:23. 36:19, 39:8, vs 1:12. Verbatim 278:35. 39:9, 170:4, Vuchetich 89:24, version 210:10. 213:18, 218:13, 90:7, 90:8, versus 60:15, 272:10. 90:12. 186:12. visits 16:16, vulnerable 104:9, vested 50:23. 16:18, 17:3, 271:20. VIDEO 48:18, 32:18, 36:18, . 276:15, 276:16. 38:16, 38:17, . videographer 38:19, 38:20, < W >. 276:18. Wait 11:10, 35:25, 62:8, 71:17, 84:13, 84:14, 104:22, 116:3, 116:4, 157:13, 170:12, 170:12, 172:25, 177:3, 187:25, 187:25, 188:18, 189:16, 189:16, 190:4, 229:19, 244:22, 260:1. waited 176:15. walking 234:2. wanted 10:4, 50:17, 53:15, 152:7, 214:22, 237:1. wanting 194:7. War 66:21, 66:23. warn 175:11. warned 173:23, 174:15, 254:25, 255:5. warning 175:5, Page: 647 of 331 Concordance 44:22, 45:3, 224:5, 242:13, 177:17, 203:16, 45:8, 45:22, 256:23, 265:18, 203:18, 204:18, 46:9, 46:10, 275:25. 207:13, 208:17, 46:23, 47:11, well-being 258:5. 210:7, 210:21. 47:16, 48:9, Wells 3:11. warnings 175:2, 120:17, 164:8, wess 94:15. 175:15, 201:15, 181:21, 246:21. Western 165:20, 274:9. weekend 89:18. 165:22, 166:1, warns 73:18. weekly 164:7. 166:10. Wars 233:20. weeks 140:12, whatever 26:25, Washington 4:18, 164:7, 208:3, 42:22, 109:21, 181:21. 218:4, 218:8, 127:15, 188:7, wasted 78:18. 260:7, 260:13. 194:19, 230:23. wastes 74:24. Weiss 1:6, 3:19, whatsoever 23:20, wasting 80:10. 5:14, 5:16, 84:8, 193:5. ways 28:25, 51:24, 5:18, 5:19, Whenever 27:4, 132:13, 151:20. 5:19, 138:19, 55:14, 197:16. WCST 4:26. 213:20, 214:17, Whereas 95:11. wearing 254:2. 215:16, 216:1, Whereupon 5:3. Web 154:9, 188:24, 217:1, 217:8, Whether 33:25, 189:5, 189:6, 217:9, 221:13, 37:1, 38:6, 190:21, 218:22, 221:15, 221:18, 39:15, 48:7, 218:25, 250:22. 222:7, 222:12, 50:4, 65:17, Webster 207:2, 222:21, 223:12, 69:21, 70:21, 208:16. 223:24, 224:1, 76:25, 77:3, Week 4:18, 43:1, 93:7, 96:9, 97:7, 103:4, 104:5, 105:1, 107:6, 112:6, 115:12, 121:1, 126:7, 166:12, 177:23, 179:1, 196:12, 206:18, 208:23, 215:25, 219:4, 220:16, 224:11, 228:6, 228:7, 236:22, 244:4, 245:21, 249:5, 257:13, 257:14, 258:19, 264:1, 266:1. White 17:20. whoever 33:19, 230:12. whole 151:16, 202:25, 205:14. whom 45:18, 258:19, 266:14. widow 10:23. willfully 120:2. Page: 652 of 331 Concordance 46:23, 47:11, witnesses 13:11, willing 115:20, 47:11, 47:16, 13:11. 124:7. 47:21, 48:8, word 150:12, willingly 124:12. 65:4, 84:10, 153:8, 172:8, willingness 115:6, 109:12, 137:25, 172:15, 172:20, 129:20, 177:10, 167:8, 176:25, 172:23, 179:25, 177:24, 178:20, 198:8, 218:14. 185:24, 186:22, 237:15. without 90:22, 199:6, 200:23, Winokur 19:5, 131:14, 131:14, 205:17, 239:17, 92:17, 93:15. 139:5, 139:6, 248:7, 251:6, Wisconsin 229:11, 157:4, 158:9, 253:19. 229:14, 240:24, 170:23, 184:5, wording 133:20, 241:8. 185:12, 225:17, 200:21, 209:23, wishes 116:22, 245:15, 263:6. 210:9. 199:4. WITNESS 4:4, 6:9, words 154:19, withdraw 99:17, 6:12, 7:1, 169:5, 179:6, 157:1, 238:9. 57:10, 57:15, 191:9, 203:5, withdrawing 64:18, 78:15, 220:17, 251:15. 253:18. 83:14, 98:2, wore 258:22. withdrawn 245:7, 116:5, 147:25, work 28:18, 30:25, 247:1, 253:16. 148:14, 166:2, 31:21, 33:7, withheld 262:17. 211:15, 261:9, 95:13, 97:22, Within 43:1, 277:12, 277:15, 102:19, 103:1, 44:14, 44:22, 277:38. 103:5, 192:18, 45:3, 45:8, witnessed 83:9. 221:9, 243:12, 46:9, 46:10, 253:2. Workbook 239:24. worked 25:17. worker 23:15, 32:3, 86:3, 86:25, 126:4, 135:12, 135:13, 135:21, 136:14, 148:6, 148:9, 148:12, 180:3, 185:3, 193:18, 222:17. workers 161:24, 162:6, 163:6, 222:18. working 33:4, 33:8, 35:6, 216:7, 244:18, 255:1, 274:13. works 125:25. World 66:21, 66:23, 92:22, 180:24, 234:2. worldwide 55:4. worse 54:6, 139:7, 139:22, 240:12. Page: 657 of 331 Concordance 263:14, 267:1, 25:3, 25:18, worsen 172:13. 267:13, 269:6, 40:11, 41:4, worsening 246:19. 269:14. 52:14, 54:19, worth 63:17, wrote 117:3, 214:3, 224:12. 63:19. 207:9, 223:1, years 21:10, write 43:24, 223:4, 223:13, 22:13, 30:1, 114:17, 116:16, 227:24, 228:11, 33:12, 57:3, 223:7, 227:13, 239:8, 242:10, 65:5, 145:21, 264:2, 264:21, 242:23, 264:8, 145:21, 145:21, 265:4, 265:24, 264:11, 264:22, 145:24, 173:17, 266:18, 267:20, 267:2, 267:4, 174:16, 229:24, 269:19. 269:15, 269:18, 262:22. writer 165:9. 269:25, 270:7. York 5:25. writing 10:6, . yourself 155:15, 87:23, 117:7, . 171:15. 123:17, 142:2, < X >. . 178:10, 234:10, Xenia 2:6, 3:6. . 234:15, 235:4, . < Z >. 261:1, 267:3, . Zeneca 1:18. 267:5, 267:6. < Y >. zero 185:7, writings 101:18, year 17:23, 17:23, 256:10. 101:22, 227:23, 18:20, 18:25, Zillhardt 263:14. 228:5, 233:23. 19:1, 19:8, . written 122:6, 19:8, 19:16, . 122:9, 122:15, 19:17, 21:14, < Dates >. 183:23, 254:20, 03/23/04 233:8. 11/21/03 146:18. 11/24/0 146:8. 12/3/2003 193:23. 12/8/0 194:21. 3/02/0 229:22. 3/02/04 229:21. 3/09/04 233:12. 3/09/05 233:12. 3/23/0 234:2. 3/24/04 210:10. 3/25/0 236:8. 3/25/04 235:22. 4/15/0 244:7. april '04 244:16, 244:16. april 27, 2004 249:21, 249:21, 249:21. july '84 19:18, 19:18. july 1971 19:13, 19:13. july, 1980 19:13, 19:14. june 1984 19:14, Page: 662 of 331 Concordance 19:14. march '04 236:1, 236:1. march 2004, 17 42:8, 42:9, 42:9. may 1, 2007 1:25, 1:25, 1:25. may 10, 2004 207:1, 207:1, 207:1, 207:9, 207:9, 207:9. may, 2003 42:17, 42:17. may, 2007. 277:38, 277:39. november 20, 2003 132:25, 132:25, 132:25. november, 2003 129:22, 129:23. Page: 664 of 331