1 IN THE SUPERIOR COURT FOR THE STATE OF ALASKA

2 THIRD JUDICIAL DISTRICT AT ANCHORAGE

In The Matter of the )

4 Hospitalization )

)

5 )

of )

6 )

FAITH J. MYERS )

7 )

Case No. 3AN-03-277 P/S

DEPOSITION OF ROBERT HANOWELL, MD

16 Thursday, February 27, 2003

11:38 A.M.

23 Taken by Counsel for Respondent

24 Alaska Psychiatric Institute

2900 Providence Drive

25 Anchorage, Alaska

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 A-P-P-E-A-R-A-N-C-E-S

For Respondent:

James B. Gottstein, Esq.

4 LAW OFFICES OF JAMES B. GOTTSTEIN

406 G Street, Suite 206

5 Anchorage, Alaska 99501

907/274-7686

For Petitioner:

Jeffrey Killip, Esq.

9 ATTORNEY GENERAL'S OFFICE

1031 West Fourth Avenue, Suite 200

10 Anchorage, Alaska 99501

907/269-8484

Also Present:

Nicholas Kletti, MD

Court Reporter:

Jeanette Blalock

17 PACIFIC RIM REPORTING

711 M Street, Suite 4

18 Anchorage, Alaska 99501

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 I-N-D-E-X

EXAMINATION BY PAGE

Mr. Gottstein 4

Mr. Killip 45

Mr. Gottstein 50

EXHIBITS

1 1-page letter dated 2/27/03 7

2 Patient chart **

3 1-page cover of DSM-IV-TR 9

4 PDR report on Zyprexa (18 pages) 18

5 From Placebo to Panacea (58 pages) 31

6 Letter dated 2/26/03 (2 pages) 36

7 Curriculum vitae (2 pages) 50

8 Patient master chart **

** - Original retained by API. No copy provided to

19 reporter.

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 ANCHORAGE, ALASKA; THURSDAY, FEBRUARY 27, 2003

2 11:38 A.M.

3 -o0o-

4 ROBERT HANOWELL, MD,

5 deponent herein, being sworn on oath,

6 was examined and testified as follows:

7 EXAMINATION

8 BY MR. GOTTSTEIN:

9 Q Thank you, Dr. Hanowell. I understand this

10 is a diversion from your normal activities of the

11 day.

12 You were served with a subpoena duces tecum

13 to bring certain documents; is that correct?

14 A Yes, sir. And to the best of my ability, I

15 did so.

16 Q So No. 1 was the -- your curriculum vitae.

17 Did you bring that?

18 A I am having a copy of it made. I can

19 certainly ask that that be brought down. I didn't

20 have a copy in my office, and I asked Dr. Kletti's

21 administrative assistant to make a copy of that.

22 Q Okay. And then you were asked to bring the

23 medical chart. I assume that's there, right?

24 A Yes, sir. I was informed, however, by our

25 medical records director that I am not to release this

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 to you at this juncture. That was -- I received that

2 in a paged e-mail approximately an hour ago. But I do

3 have it here with me.

4 Q But you can -- would you be agreeable to

5 having a copy made, and given to the court reporter?

6 A I just wanted to clarify. Our medical

7 records director thought that she -- that perhaps a

8 copy had already been given to you a few days ago. Is

9 that accurate?

10 Q Yes.

11 A Okay. So you just wanted the additional

12 information that's been added since that time?

13 Q Well, I mean, I guess -- the thing is, is

14 that I need to have everything, okay? I don't know

15 what's been added since.

16 MR. KILLIP: You have got a release, right,

17 Jim?

18 MR. GOTTSTEIN: Yeah.

19 BY MR. GOTTSTEIN:

20 Q So the best thing is just to get what you

21 have now, and make a copy of it. And then we will

22 know that's what it is.

23 A I defer to my attorney.

24 MR. KILLIP: Yeah. At this point, I don't --

25 I mean, if you have got a release, and you're her

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 attorney representing her in this proceeding, I mean,

2 initially, I just don't see a problem with that.

3 But given the expedited nature of

4 everything -- I guess maybe it'll probably be brought

5 to my attention after this deposition. But I am not

6 aware of anything.

7 MR. GOTTSTEIN: I think that I am entitled to

8 it. I mean, it would take more time to figure out, I

9 think, what I don't have, than to just ask the office

10 to copy the whole thing again and give it to the court

11 reporter, trying to expedite things.

12 THE WITNESS: I defer to my attorneys.

13 DR. KLETTI: Jim, at what level would it be

14 reasonable, to every hour Xerox the chart for your

15 review? I mean, that's what --

16 MR. GOTTSTEIN: Well, it's been a couple of

17 days. If you want to compare, I would be happy if you

18 would agree to, as new entries are made, have copies

19 available, that would be great. Or if you want to

20 review what you sent last time and give me copies of

21 what --

22 DR. KLETTI: I think we have given you

23 updated progress notes from the last, and updated

24 treatment plans from the last, the medications orders,

25 if you'd like that, also.

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 MR. GOTTSTEIN: Yeah. Any changes, any

2 additions.

3 But what I'd really like to do is start with

4 what we have here, unless you have a record of what

5 you gave me two days ago.

6 DR. KLETTI: We don't have a copy of it, but

7 we have the original chart there.

8 MR. GOTTSTEIN: So you'll make a copy of the

9 whole thing?

10 We are taking a lot of time on this.

11 DR. KLETTI: It's your time.

12 BY MR. GOTTSTEIN:

13 Q And then No. 3 was your written report

14 regarding this matter?

15 A Yes, sir. I did draft a report. I wasn't

16 sure to whom I should address it. I addressed it to

17 Mr. Killip.

18 Q Could I see that, please?

19 MR. KILLIP: Sure. This is No. 3.

20 A I will acknowledge that it was done very

21 quickly, and it's perhaps not the best written letter

22 I have ever made -- ever written, but I did my best.

23 MR. GOTTSTEIN: Let's mark this as Exhibit A,

24 or whatever exhibit you want.

25 (Exhibit No. 1 marked.)

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 BY MR. GOTTSTEIN:

2 Q So we are going to have a copy of that.

3 MR. GOTTSTEIN: And let's make that

4 Exhibit 2.

5 BY MR. GOTTSTEIN:

6 Q How about No. 4?

7 A Yes. That would be the record -- the

8 hospital record, the medical record.

9 Q So you didn't rely on any medical,

10 psychiatric or other type of treatises, texts,

11 manuals, studies, or other materials or authorities

12 that you used at arriving at your opinion?

13 DR. KLETTI: He relied on his training.

14 MR. GOTTSTEIN: You are not -- you are not

15 being deposed here, so you really shouldn't be saying

16 anything.

17 A I didn't refer to any specific text.

18 However, I based it on the training that I have had

19 and the texts that I have read.

20 Q Do you have a list of those?

21 A I could certainly provide one verbally. I

22 don't have a written list. It would be difficult to

23 provide such a list.

24 Q Well, you were ordered to do that by the

25 court.

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 I am showing you a copy of the cover page of

2 the Diagnostic and Statistics Manual of Mental

3 Disorders, Fourth Edition, Text Revision, DSM-IV-TR.

4 Are you familiar with that?

5 A Yes, sir.

6 Q Would you consider that authoritative?

7 A Yes, sir.

8 I should also add something. I did refer to

9 the previous chart, as well, sir, the master file, so

10 to speak, which has a record of Ms. Myers' previous

11 hospitalizations.

12 Q That should have been brought.

13 A Indeed.

14 Q Could you provide a copy of that, and we'll

15 mark that as an exhibit.

16 (Exhibit No. 3 marked.)

17 A With my attorney's permission, and the

18 medical director's permission, I could certainly look

19 into that, and do my best to provide a copy of that,

20 if it's agreed upon by my medical director and by my

21 attorney.

22 MR. KILLIP: Yeah, Jim. My position is I

23 don't see a problem with that being -- I mean, it's

24 part of the record for treatment, so I would group

25 that in.

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 MR. GOTTSTEIN: I am entitled to know what

2 he's basing his opinions on.

3 BY MR. GOTTSTEIN:

4 Q So one of the things that's required is that

5 you give information to the respondent regarding

6 medications that you proposed. Did you bring a copy

7 of what you provided her with regard to that?

8 DR. KLETTI: Where is this?

9 A I'm sorry, sir?

10 Q It's part of the substance of all

11 communications to and from the respondent. But

12 basically, I can get to it later, and I am about to

13 get there. Well, actually, it's a little bit later.

14 Under AS 47.30.837(d)1-2, before you can seek

15 court-ordered medication, you have to have given the

16 patient all information that is material to the

17 patient's decision to give or withhold consent. Did

18 you do that?

19 DR. KLETTI: It can be verbally. It doesn't

20 have to be in writing.

21 A Yes, sir. It was done verbally. We did

22 discuss a number of different medications.

23 Ms. Myers has in the past taken Navane; she

24 has taken Zyprexa; she has taken Risperdal. I

25 attempted to find out which of these was most

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 agreeable, that she found most agreeable to her. And

2 basically, she indicated she didn't wish to take any

3 of those medications, that she wished to treat her --

4 Well, basically she doesn't believe that she has an

5 illness, but she feels that one can maintain good

6 mental health by good nutrition.

7 Q You should just answer the question.

8 A Sorry.

9 Q I am showing you a copy of a printout on

10 Zyprexa. You are seeking to medicate her with

11 Zyprexa; is that correct?

12 A I have offered her other medications, as

13 well.

14 Q What medication are you seeking the court to

15 order her to take?

16 A My preference would be Zyprexa, yes, sir,

17 because it has worked for her in the past, yes, sir.

18 Q Are you planning on requesting the court to

19 order any other medication?

20 A Generally, my understanding -- perhaps

21 mistaken, but my understanding is the court generally

22 provides an order that we can provide medications. It

23 doesn't usually specify which one.

24 Q Are you refusing to tell me what medications

25 you might ask the court to order?

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 MR. KILLIP: Jim, he's just trying to answer

2 your question.

3 BY MR. GOTTSTEIN:

4 Q So you don't know at this point? You are

5 expecting the court to order you to give her whatever

6 medications you might choose later?

7 A Sir, I did have some discussion with her this

8 morning in regards to some newer medications that she

9 hasn't tried. And perhaps those would be more

10 agreeable. She would be perhaps more agreeable to

11 take those.

12 She didn't wish to try any of those. But she

13 states that she didn't like the effects of Zyprexa.

14 And I attempted to determine specifically what side

15 effects she did have, and it wasn't at all clear,

16 based on our conversation. However --

17 Q I am trying to find out what -- I mean, I am

18 trying to find out what medications that you might be

19 requesting the court to order her to take.

20 A Well, Zyprexa would be one.

21 DR. KLETTI: Counsel --

22 MR. GOTTSTEIN: Could you -- Mr. Killip,

23 could you instruct Dr. Kletti to either not say

24 anything or to leave the room?

25 DR. KLETTI: Well, I think we have the

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 opportunity to stop and counsel around these questions

2 if -- you know, if I want to confer.

3 MR. GOTTSTEIN: I don't think so.

4 DR. KLETTI: We are on opposing sides here.

5 MR. GOTTSTEIN: Yeah, but this is my

6 deposition. You are not supposed to talk.

7 Could you please instruct your client to

8 either not say anything or to leave the room?

9 DR. KLETTI: He has the opportunity to confer

10 with counsel.

11 MR. GOTTSTEIN: You don't have the right to

12 speak now.

13 MR. KILLIP: Well, Jim, I mean --

14 MR. GOTTSTEIN: You are trying to testify in

15 his deposition.

16 DR. KLETTI: I am trying to object to stop,

17 so that we can --

18 MR. GOTTSTEIN: You don't have the right to

19 do that.

20 MR. KILLIP: Maybe what we should do is, if

21 it's okay with you, if Dr. Kletti could remain in the

22 room, and if the question comes up where Dr. Kletti

23 and Dr. Hanowell want to confer about a certain

24 question, then --

25 MR. GOTTSTEIN: No.

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 MR. KILLIP: -- that would be a fast way to

2 do it.

3 MR. GOTTSTEIN: We've got a limit set by the

4 court. We should just go through this. It has

5 already taken longer than it should.

6 I am perfectly happy to have him here, but

7 not participating. He is not permitted to do that.

8 DR. KLETTI: If you truly want answers to,

9 you know, these questions that you are asking, you

10 want to move to more germane areas.

11 MR. GOTTSTEIN: It is not your decision to

12 make.

13 DR. KLETTI: That's why I am asking for --

14 MR. GOTTSTEIN: I am requesting that you

15 instruct Dr. Kletti to leave the room, please.

16 MR. KILLIP: Well, I guess it's your -- If

17 that's what you want, I mean, then --

18 MR. GOTTSTEIN: I have asked repeatedly that

19 he just remain silent, and he is refusing to do it, so

20 I don't have any other alternative.

21 MR. KILLIP: I guess we would object. And

22 then if -- in an effort to try and reach a greater

23 area of common ground, I guess it's up to Dr. Kletti

24 about whether he wants to leave. And then if we have

25 a question for him, if Dr. Hanowell has a question, we

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 will try to track him down. And hopefully, that won't

2 delay the deposition too long.

3 MR. GOTTSTEIN: Fine.

4 MR. KILLIP: How do you feel about that?

5 DR. KLETTI: If I leave the room, I am going

6 to ask Mr. Killip to object to every question, and

7 come out and confer. I think that your line of

8 questioning is narrow-minded, biased, and you are

9 trying to get some kind of answer that suits the "when

10 did you stop beating your wife" kinds of questions.

11 MR. GOTTSTEIN: So earlier, we -- you know,

12 you mentioned -- when I talked about following the

13 law, you said that there's a spirit in the letter.

14 You know, can you explain a little bit more what you

15 mean by that?

16 MR. KILLIP: Jim, I am going to object to

17 that, because I mean, as you said, Dr. Kletti is not

18 being deposed.

19 MR. GOTTSTEIN: So he gets to talk when he

20 wants to, but not when I ask him a question?

21 MR. KILLIP: Well, the -- we've got four

22 educated professionals here, and we are acting -- we

23 are going down a road --

24 MR. GOTTSTEIN: I am just trying to find out

25 what medications he is going to ask the court to order

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 my client to take. That's a very basic question.

2 MR. KILLIP: I think he's already answered

3 it.

4 DR. KLETTI: Right.

5 BY MR. GOTTSTEIN:

6 Q Is it only Zyprexa?

7 DR. KLETTI: If you let me --

8 MR. GOTTSTEIN: That's all I was trying to

9 get.

10 BY MR. GOTTSTEIN:

11 Q Is it only Zyprexa?

12 DR. KLETTI: No. The treatment of

13 antipsychotic conditions is with antipsychotics.

14 MR. GOTTSTEIN: Please leave the room.

15 MR. KILLIP: Can we just move on.

16 Dr. Hanowell can you answer the question,

17 please?

18 A Sir, just to explain, basically, what I would

19 do, if Ms. Myers were court ordered to take

20 medications, I would meet with her again and say:

21 Look, these are the options that are available to you.

22 I have discussed them with her previously. Would you

23 prefer to go back on Zyprexa, or something different

24 that maybe you might find less objectionable?

25 So if I seem to --

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 Q What was the substance of the information

2 that you gave Ms. -- the respondent, regarding

3 information that is material to the patient's decision

4 to give her consent? You said you gave it verbally.

5 What was it?

6 A Yes, sir. I mentioned to her that she had

7 benefited -- this is my first discussion with her.

8 Excuse me, my second discussion with her.

9 My first discussion with her, she didn't wish

10 to continue the discussion beyond a very brief time.

11 My second discussion with her was on Monday.

12 And I mentioned to her that Zyprexa had helped her in

13 the past, and that it appeared to -- Going by memory

14 now. But it appeared to have been helpful to her, and

15 that when she left the hospital, she was doing well,

16 and would she be willing to resume that medication.

17 She indicated that she would not, that she

18 was opposed to medication, and that she felt the best

19 approach to deal with her issues -- although she

20 doesn't believe she has a mental illness, that the

21 best way for her to deal with her issues is maintain

22 good nutrition.

23 Q Okay. So I am going to give you a copy of

24 the printout. First off, you would agree, wouldn't

25 you, that the PDR is authoritative -- the Physician's

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 Desk Reference is authoritative with respect to

2 medications; is that correct?

3 A Yes, sir.

4 Q Could you look at that? It's a printout from

5 a CD version of the PDR. Does that look correct?

6 A Yes, sir.

7 MR. GOTTSTEIN: Could we mark that as

8 exhibit --

9 (Exhibit No. 4 marked.)

10 BY MR. GOTTSTEIN:

11 Q So specifically, then, did you warn her about

12 neuroleptic malignant syndrome?

13 A I did not.

14 Q Did you warn her about tardive dyskinesia?

15 A I did not, because the discussion didn't get

16 that far. She declined to take the medication before

17 I got to that point.

18 Q Did you advise her about somnolence?

19 A I believe she brought up the issue that she

20 had noticed some drowsiness on the medication.

21 Q And that wouldn't affect your desire to

22 forcibly medicate her with that?

23 A No. Because we -- as I mentioned, we have

24 discussed other medications, as well. And she has

25 indicated she is opposed to taking any psychiatric

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 medication.

2 Q Did you warn her that Zyprexa has a potential

3 to impair judgment, thinking or motor skills?

4 A Again, sir, we didn't discuss the side

5 effects in detail, because she declined to take any

6 medication.

7 Q So basically, you didn't give her any of

8 these indications -- any of the warnings, and didn't

9 give her any material about adverse effects; is that

10 correct?

11 A I certainly would have. Would she have

12 expressed an openness to taking medication, yes, sir,

13 I would have done that.

14 Q Did you discuss alternative treatments and

15 their risks, side effects and benefits?

16 A Actually, yes. I mean, we did talk about

17 alternative medications. Again, I didn't get to the

18 point where I could discuss -- have a reasonable

19 discussion of side effects with her, because she

20 declined to consider that possibility. She declined

21 to consider taking medication.

22 In terms of further alternative

23 interventions --

24 Q I'm sorry; could you repeat that again?

25 A Which part, sir?

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 Q The first part that you just said.

2 A Well, she -- I didn't get to the point of

3 discussing side effects with her, because she --

4 Q For alternative treatments, we are talking

5 about. You talked about alternative treatments.

6 A Are you referring to alternative medicine

7 treatments or --

8 Q Alternatives to medication.

9 A Alternatives to medication. We provide that.

10 We provide alternatives to medication to supplement --

11 not really alternatives, but we provide interventions

12 here at this hospital that supplement pharmacotherapy.

13 Q So you didn't really provide her with --

14 discuss alternative treatments to medication?

15 A I did -- I didn't discuss those interventions

16 with her at this hospital in detail. However, those

17 have been discussed with her by her nursing staff. I

18 have no question of that. We do provide unit --

19 provide groups and various activities and so on.

20 Q Is that an alternative to medication?

21 A In her situation, that would not be an

22 acceptable -- it would not be adequate treatment for

23 her illness.

24 I did talk with her about potentially trying

25 a low dose of an antipsychotic medication, in

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 conjunction with fish oil, since she's -- She was

2 unwilling to consider that.

3 Q Now, what was the basis for your deciding

4 that she was incapable of giving informed consent?

5 A Because she does not have insight into her

6 illness. She doesn't believe she has an illness. And

7 that is generally considered to be a fundamental tenet

8 of one's ability to give informed consent.

9 Q Is that the sole basis?

10 A No, sir.

11 Q What's the other?

12 A There are other considerations, as well,

13 including a person's recognition of the side effects

14 of the medication, a person's recognition of -- Well,

15 the benefits and risks, basically. Those are two of

16 the other tenets. And --

17 Q So what -- it seems to me that she recognizes

18 the benefits and side effects; isn't that true? She

19 has taken it before, hasn't she?

20 A Well, again, those are two of the tenets of

21 informed consent.

22 The third one being -- additional --

23 additional and crucial one being recognizing that she

24 has a condition that needs treatment.

25 Q So that -- so what I understand -- I am not

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 trying to put words in your mouth. I am just trying

2 to understand what the basis of your decision that she

3 lacked informed consent was.

4 So what I understand, from what you are

5 saying, is that the sole basis was that she lacked

6 insight into the need for it, or her mental illness?

7 A Yes, sir. You know, often, we have --

8 Q You didn't need to say more than yes, sir.

9 A Great.

10 Q Okay.

11 MR. KILLIP: Did you need to explain that?

12 If you do, then you can go ahead and explain.

13 THE WITNESS: That's okay.

14 BY MR. GOTTSTEIN:

15 Q Okay. You -- is this a copy of the petition

16 that you signed?

17 A Yes, sir, it is.

18 Q Let's just let the record reflect -- I don't

19 want to do it as an exhibit, because I didn't bring

20 one. But it's the petition.

21 And you added No. 3 after it was originally

22 filed, right?

23 A Yes, sir.

24 Q I'm sorry for interrupting you. I am just

25 kind of pressed for time. Go ahead.

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 A Thank you, sir.

2 Atypically -- actually, I don't recall ever

3 having done this before. But when I made out the

4 petition, I forgot to add the statement from the -- I

5 forgot to make reference -- I had checked both boxes:

6 Danger to self/others, and gravely disabled. But I

7 forgot to explain the reason I had checked the box of

8 danger to self or others, pertaining to danger to self

9 or others.

10 In this case, there was a concern about

11 danger to others, due to reports from the family that

12 Ms. Myers allegedly made threatening remarks to the

13 fellow -- excuse me, to her neighbors and to her

14 landlord.

15 Q Do you know the nature of those threats?

16 A In talking with the family -- in talking with

17 the family, there was mention made of a note that was

18 left on someone's car. They couldn't tell me the

19 exact content of the note, but that it was somewhat

20 threatening in its wording.

21 Q Did it threaten bodily harm?

22 A I think that was what they had indicated,

23 yes.

24 And in addition, one of the petitioners,

25 Ms. Meyers' daughter, indicated that when she had

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 interacted with Ms. Myers late last week, Ms. Myers

2 had been very belligerent, and she was frightened of

3 her. She also indicated the other tenants in the

4 building were frightened of her.

5 Q So based on that, are you predicting that if

6 she wasn't in here, that she would cause harm to these

7 people?

8 A Potentially, yes, sir.

9 Q What does potentially mean? What likelihood?

10 A It's difficult for me to put a percentage of

11 likelihood on it.

12 However, when I hear about people making

13 threatening remarks in the community, and when I hear

14 about patients' own children being frightened -- adult

15 children being frightened of them, that gives me cause

16 for concern.

17 Q Do you think that someone being frightened is

18 grounds for confinement here, under the relevant

19 commitment laws?

20 A It depends on the circumstances. In this

21 case, the fear was based on the daughter's belief that

22 she might be assaulted by the patient.

23 Q Does Ms. Myers have a -- Strike that.

24 Have you been trained in predicting future

25 violence?

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 A That's a difficult question to answer. We

2 are trained to act when we are aware of potential

3 violent situations, in terms of going through

4 proceedings like this one or medicating patients or

5 referring them to anger management programs.

6 Q No, no. But in terms of are you trained in

7 predicting who is going to be violent in the future?

8 Do you have training in that?

9 A Only to the extent that my psychiatric

10 residency addressed that issue. However --

11 Q How did it address that issue, specifically

12 predicting someone is going to be violent in the

13 future?

14 A We are not able to specifically predict.

15 Q Okay. Now, you marked "gravely disabled."

16 What does that mean? What standard do you use to

17 determine what gravely disabled means?

18 A Well, basically, that she is unable to

19 provide for her basic needs of food, clothing and

20 shelter.

21 Q Is that different than causing harm to

22 herself?

23 A Yes, sir.

24 Q How is that different?

25 A Danger to self usually implies suicidality or

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 other willful self-injurious behavior.

2 Q Does that mean serious harm?

3 A I'm sorry, sir; I don't understand the

4 question.

5 Q I will strike that.

6 So in other words, some -- you might mark

7 gravely disabled when you don't think a person is

8 likely to cause harm to himself or herself or others?

9 A Yes, sir.

10 Q Okay. Now, you say that you considered, but

11 had not found any, less-restrictive alternatives.

12 A Yes.

13 Q What less-restrictive alternatives did you

14 consider?

15 A Well, that's a difficult question to answer.

16 Because in this instance --

17 Q You signed an affidavit that says you did it,

18 so you ought to know the answer.

19 A Pharmacotherapy --

20 DR. KLETTI: Objection.

21 A -- is crucial --

22 MR. KILLIP: Jim, really, the sarcasm is not

23 helpful. This is an intelligent, seasoned

24 psychiatrist.

25 MR. GOTTSTEIN: I apologize, Dr. Hanowell.

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 MR. KILLIP: He is trying to be very helpful

2 and direct.

3 MR. GOTTSTEIN: I'm sorry. You're right.

4 You are absolutely right.

5 A I feel that pharmacotherapy is so crucial to

6 this patient -- to Ms. Myers' care, that there really

7 are no currently acceptable alternative --

8 alternatives to inpatient -- less restrictive

9 alternatives to inpatient hospitalization.

10 For example, if she were to go to the Crisis

11 Treatment Center, and not receive medication, her

12 illness would not be treated.

13 If she were to go to Providence on a

14 voluntary basis, her illness would not be treated.

15 If she were to be discharged home, without

16 patient follow-up, her illness would not be treated.

17 If she were to remain here on a voluntary

18 basis, and not take medications, her illness would not

19 be treated adequately.

20 Q Are you aware that there is controversy over

21 the efficacy of the drug treatment regime?

22 A I realize that some people have raised that

23 question, yes, sir.

24 Q Including prominent psychiatrists?

25 A Some -- well, I think "prominent" would need

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 to be defined. But certainly, yes. And certainly,

2 the medications we prescribe are not 100 percent

3 effective by any means; I will acknowledge that. And

4 I wish they were more efficacious than they are.

5 Q Now, is it your -- would it be your opinion

6 that the respondent should be on medication for the

7 rest of her life?

8 A That's a difficult question to answer. I --

9 I think it may be that she may need to be on

10 medication for the rest of her life, but I can't see

11 that far into the future.

12 There are some cases -- one very famous one

13 right now is John Nash. He -- his illness appeared to

14 go into remission after many, many, many years of

15 suffering.

16 So I certainly don't claim to have that kind

17 of foresight.

18 I do feel that currently, however, she is in

19 need of medication. And it, in my opinion, would be

20 of great benefit to her over the course of the next

21 several months to the next year or two.

22 Q Are you aware of studies that suggest that an

23 extremely small percentage of people should be

24 maintained on neuroleptics indefinitely?

25 A I know of clinicians who would recommend that

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 for some people -- for a number of patients. I am not

2 aware of specific articles I could quote regarding

3 that.

4 Q Would that be something that you would be

5 interested in finding out, in forming your opinion

6 about medications, what -- you know, what other

7 studies have shown about what other people should be

8 maintained on medication?

9 A I am always interested and always open to

10 hearing alternative views, absolutely.

11 Q Have you read any studies in that -- in that

12 line?

13 MR. KILLIP: I am going to object. You are

14 asking him questions about evidence that is not before

15 the court.

16 I mean, if you have got those studies, you

17 want to show them to Dr. Hanowell for him to look at,

18 I'm sure he'd be happy to do that.

19 I think he's answered your question.

20 MR. GOTTSTEIN: Actually, I have a bunch of

21 them, but I didn't bring them all here, because I

22 didn't figure we'd have time to go through them.

23 BY MR. GOTTSTEIN:

24 Q But the question is: Have you read any such

25 studies?

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 A Studies regarding the need for --

2 Q That suggest a very small percentage, if any,

3 patient should be maintained long term on

4 neuroleptics?

5 A Sir, I want to apologize. I misunderstood

6 your question. I'm sorry. I thought the question was

7 are you aware of studies that suggest that some

8 patients need to be on medications for the rest of

9 their life. I misunderstood your question. I am

10 sorry.

11 So what you actually asked was, was I aware

12 of studies that suggest that very few patients should

13 be maintained on medications for the rest of their

14 lives?

15 Q Yes.

16 A My apologies. I am not aware of any specific

17 studies that I have read that indicate that.

18 My apologies for misunderstanding your

19 question.

20 I haven't read any of those studies, but I

21 would be interested in reading them. I certainly have

22 heard a speaker recently that you are familiar with

23 who spoke at this hospital who addressed that issue.

24 I haven't read his book, though. I have to confess

25 that I haven't read that.

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 Q And that hasn't caused you to read any

2 studies that might support what he -- his research

3 shows; is that correct?

4 A Not at this point, sir, no. I haven't had a

5 chance to -- But if you wish to show me, I would be

6 very interested in reading them.

7 Q You know, actually, maybe I think I will. I

8 am going to show you --

9 A Thank you.

10 Q I assume you haven't read that.

11 A No, sir.

12 Q Let's mark this as Exhibit 5.

13 (Exhibit No. 5 marked.)

14 BY MR. GOTTSTEIN:

15 Q Now, do you -- you indicate on the petition

16 that -- as facts and specific behavior, that Ms. Myers

17 exhibits clear evidence of a psychotic process?

18 A Yes, sir.

19 Q Do you believe that justifies confinement?

20 A No, sir. No. There are many psychotic

21 patients who do fine in the community, despite the

22 fact that they're still exhibiting symptoms of their

23 illness.

24 Q Okay. So that alone is not sufficient to

25 support confinement, in your view?

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 A No, sir. No, sir.

2 Q Okay. So does that in itself -- is that

3 enough for -- in your opinion, that Ms. Myers is

4 mentally ill?

5 A That she exhibits evidence of a psychotic

6 process?

7 Q Yeah. Does that make her mentally ill?

8 A In Ms. Myers' case, I believe it does, based

9 on my review of her records and history, and having

10 worked with her in the past, a couple of years ago.

11 But in general, one has to be very careful

12 about making that determination. Where we are

13 actually very compulsive here about doing medical

14 workups on people who have just presented for the

15 first time with psychosis. So one has to be certain

16 that there's not a medical issue that one is missing.

17 Q Okay. So what causes mental illness?

18 A Regrettably, no one knows for sure.

19 Q Is it a chemical imbalance in the brain?

20 A There appears -- it certainly appears that

21 there are neurophysiologic changes in the brain of

22 many, if not most -- if not all individuals who suffer

23 from mental illnesses such as schizophrenia,

24 schizoaffective disorder, bipolar disorder.

25 I'm sorry that --

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 Q No, no. That's a good answer. What studies

2 are those? And the -- I'm sorry. I shouldn't

3 interrupt you.

4 A I couldn't quote the studies specifically. I

5 apologize. But there are certainly numerous theorists

6 who believe this to be true. There is a substantial

7 amount of research that's been done in this area.

8 Certainly, dopamine has been implicated as an

9 important neurotransmitter in the genesis of

10 psychosis.

11 Q But isn't it true there has never been any

12 proof that dopamine -- that any kind of dopamine

13 abnormality causes mental illness? Isn't it true that

14 that's never been proven?

15 MR. KILLIP: Objection, asked and answered.

16 He already said it hasn't been. There is no specific

17 answer for cause of mental illness. He can elaborate

18 on that.

19 MR. GOTTSTEIN: I am not sure that he did

20 actually answer that. And he seemed to change it a

21 little bit. That's why I'm asking.

22 A There's no proof -- no unequivocal proof that

23 that's the case. But it's felt strongly that it may

24 play a role. At least -- perhaps not in all

25 individuals afflicted with schizophrenia, but at least

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 in some.

2 Certainly, we do know that the medications

3 that are efficacious, for the most part, impact the

4 dopamine system. So it would be -- it's difficult

5 to -- I think it would be difficult to ever prove

6 beyond a shadow of a doubt that dopamine is the answer

7 to mental illness.

8 And I don't think anyone would try to prove

9 that, because it's quite clear to many of the

10 profession that -- for example, schizophrenia is

11 probably more a syndrome than an illness. In other

12 words, it could be a collection of illnesses rather

13 than just one illness, myriad causes.

14 Q So the neuroleptics don't correct any

15 chemical imbalance in the brain, do they?

16 A It's clear that -- it is clear that they are

17 efficacious. They do appear to --

18 Q That is not the question.

19 A I -- it's a difficult question to answer,

20 because I am not sure that anyone's -- we do know

21 that -- we do know what they do. How should I put

22 this?

23 It's -- there are many studies looking at

24 what they do; however, no one knows for sure exactly

25 why they work. No one knows for sure, okay? So I

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 guess it's difficult for me to answer that question.

2 I would probably argue that yes, there is

3 some. And obviously, they don't work in everybody.

4 But I would argue that for many people, there is some

5 chemical imbalance, if you will, that is brought back

6 into balance by use of antipsychotic medications, just

7 based on the fact that they do affect brain chemistry,

8 and they do for many people work.

9 Q Do you have any studies -- can you recite any

10 studies that support that opinion?

11 MR. KILLIP: I would object. Are you asking

12 whether he can cite them right now, or can he get you

13 cites to those studies?

14 MR. GOTTSTEIN: Right now.

15 A I couldn't recite them. Sorry.

16 Q Are you aware of any studies that support

17 that?

18 A Yes. Yes.

19 Q And -- but you don't know what they are right

20 now?

21 A I couldn't quote the researchers. I

22 apologize.

23 Q Can you provide that, say, by the end of the

24 day?

25 A I think I could, at least for some of the

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 medications. I think I have some files in my

2 office -- some papers in my office that I could bring.

3 Q Great. Is this the -- well, could you

4 identify this, please?

5 A Sorry, sir. This is a letter that I wrote to

6 Mr. Killip yesterday.

7 MR. GOTTSTEIN: Let's mark that.

8 (Exhibit No. 6 marked.)

9 MR. GOTTSTEIN: We go to 12:40, I think,

10 because we started ten minutes late?

11 MR. KILLIP: Yes.

12 BY MR. GOTTSTEIN:

13 Q Now, you stated that you've been involved in

14 more than 100 commitment cases over the years; is that

15 correct?

16 A Yes, sir.

17 Q How many are here?

18 A Presently, sir?

19 Q No. How many at API?

20 A Oh, all at API, sir.

21 Q How many forced medication hearings,

22 approximately?

23 A I would -- probably nearly the same number.

24 Q How many times have you -- Well, let me put

25 it this way. Have you ever sought an informed consent

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 order when the patient voluntarily accepted

2 medication?

3 A You mean a medication order from the court?

4 Q Yes. In other words, if you suggest

5 medication, have you ever decided, well, maybe the

6 person is not really competent to make that decision;

7 I should ask the court to confirm that? Have you ever

8 done that?

9 A There have been a few cases, I think, where I

10 may have done that. I couldn't quote them for you,

11 no.

12 Q Are you sure that you have?

13 A Let me think for a moment. I am fairly

14 certain I have done it on a couple of occasions.

15 Q Two occasions?

16 A I am not certain of the number. Sorry.

17 Q Less than five?

18 A Probably less than five, yes, sir.

19 Q What were the circumstances that made you do

20 that?

21 A I don't recall. I'm sorry; I just don't

22 remember the details. But I am fairly certain I have

23 done it on less than five occasions, sir.

24 Q So is it fair to say that in 90 -- at least

25 97 and a half -- I guess that's not a fair way to look

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 at it.

2 Is it fair to say that in virtually all

3 cases, if the person decides to accept the medication,

4 that that would be considered by you to be informed

5 consent?

6 A I think -- the way I was trained was that in

7 general -- This is how I was trained in residency, and

8 it appears to be the way -- the way -- well, anyway.

9 In residency, I was trained that if a

10 person -- a person is deemed competent by law until

11 proven otherwise in a court.

12 So in general, I kind of -- I rest on that --

13 that tenet, yes. I base my prescribing practices on

14 that tenet. If someone is psychotic, but is willing

15 to resume their medication, I see no reason to go

16 through the -- put the person through the stress of

17 going through a commitment hearing, when I feel like

18 I'm doing what they want me to do, anyway.

19 Q No, not a commitment hearing. It's just that

20 AS 47.30.836 says that you can't administer

21 psychotropic medication unless the patient has the

22 capacity to give informed consent.

23 So I'm just exploring, you know, how that

24 works in terms of when people consent. And it sounds

25 like you automatically -- not automatically, but

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 virtually automatically assume that if they agree to

2 it, then they are competent to do so; is that correct?

3 A And they would have had to, you know, engage

4 in some kind of a meaningful discussion with me about

5 it.

6 For example, if a person were catatonic and

7 said -- I wouldn't say to them: Do you have any

8 objections to my giving you medicine, and then when

9 they don't respond, I just prescribe it. I would

10 never do that. I would have to -- situations like

11 that would probably represent the five or less times

12 that I went to court.

13 Q Situations tantamount to being catatonic?

14 A Yeah.

15 Q Could you speak up, so she can hear?

16 A Yes. If I may elaborate further, I guess I'd

17 just say that suppose Mrs. -- just make up a name --

18 Mrs. Jones comes into the hospital, and she is hearing

19 voices, she is responding to internal stimuli, but

20 says to me: Dr. Hanowell, I really want to go back on

21 my medication X. It's really helpful to me. Can I

22 please take that?

23 And I talk to her about the medication, the

24 side effects, and we resume the medication.

25 Whether -- I guess I -- it -- I think that in a

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 situation like that, I am doing what the patient

2 wants, and I'm assuming that they appear to be making

3 an informed decision.

4 I might not perhaps go through an extremely

5 meticulous process of determining whether or not they

6 technically meet the criteria of -- I may ask them,

7 for example, do you -- in a situation like that, they

8 might not believe that they have schizophrenia or

9 whatever. They might believe they are demon possessed

10 or what have you.

11 But they feel the medication helps them; they

12 want to take it. And I think it would be unfair to

13 them to put them through the rigors of a commitment

14 process, for purposes of getting a medication order.

15 Q I am not suggesting that you should. I am

16 just wondering what it is -- you know, what the

17 process is. And I don't necessarily think that you

18 have to go through a forced medication proceeding to

19 follow that part of it, anyway. And I am all in favor

20 of that.

21 But if someone disagrees that -- about --

22 that has decided that they don't want to take the

23 medication, then what's the process?

24 A Well, then you have to go through a more

25 rigorous process of determining whether or not the

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 person meets the criteria, whether or not the person

2 is able to give informed consent.

3 Q What percentage of patients would you say

4 don't give consent -- voluntary consent?

5 A I don't know. I'm sorry. I can't quote you

6 a statistic. I just don't know what it is.

7 Q Okay. Let's say that you have 100 patients

8 that don't want to consent to the medication. How

9 many of those would you seek court-ordered medication

10 on?

11 A It would be difficult to say, because I would

12 have to look at each case individually.

13 Q I am talking about on average. I mean, if

14 there are 100 people that -- I mean, have you had 100

15 people since you have been here that have refused --

16 or have not voluntarily agreed to medication?

17 A Oh, including those that I have gone to court

18 on and such?

19 Q Yeah.

20 A Yes, sir.

21 Q What percentage of the people that you

22 don't -- that don't voluntarily agree to the

23 medication do you go to court on?

24 A Well, that's a difficult question to answer,

25 because on my -- by the time folks come to my unit,

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 it's usually felt that they are going to need a longer

2 period of time for treatment.

3 And usually -- so in other words, there is a

4 selection process. There are folks who come into the

5 Denali Unit, who may exhibit psychotic symptoms and

6 may refuse treatment, get discharged. By the time

7 they transfer to my unit, it is usually agreed upon by

8 the doctors or Denali that this person is going to be

9 disabled or presents a danger to themselves or others,

10 and therefore need treatment and need pharmacotherapy.

11 So I guess there is a bit of a selection

12 process.

13 Q So is your decision to seek court order based

14 on whether or not, in your opinion, the person needs

15 psycho -- the medications, is that -- that needs it,

16 that the person needs the medication?

17 A Well, sure. That certainly figures into the

18 equation, absolutely.

19 Q Sure. But what about the informed consent

20 part?

21 A Well, again, that has to be rigorously

22 assessed.

23 Q So --

24 A But actually, by the time they come to my

25 unit, often that already has been rigorously assessed.

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 And I reassess it when I meet with the patient.

2 Q So then what I am hearing from you -- again,

3 I don't want to put anything into your mouth. But

4 what I am hearing is that virtually all the patients

5 that come to your unit that don't want medication,

6 you'll seek court-ordered medication. But that group

7 has already been kind of selected into that -- into

8 that kind of a position; is that a fair

9 characterization?

10 A I wouldn't say all patients, no, sir. I

11 wouldn't say all patients, no.

12 Q So what percent would not be?

13 A It would be a low percentage, but I couldn't

14 give you the exact percentage.

15 Q Under 10 percent?

16 A Probably under 10 percent, yes, sir.

17 Q Under 5 percent?

18 A Probably under 5 percent, yes, sir.

19 Q You've agreed to provide the chart, and

20 you've agreed to provide the studies that suggest a

21 chemical imbalance, the CV.

22 The respondent hasn't been assaultive on the

23 unit, has she?

24 A No, sir.

25 Q I have known the respondent for some time, so

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 it wouldn't surprise me to hear that she would get

2 angry fairly quickly and raise her voice. Does that

3 happen?

4 A Yes, sir.

5 Q Was -- are you aware of any instance where

6 people on the unit were in fear that they would be

7 assaulted?

8 A No, sir. But she is in a controlled

9 environment -- excuse me -- a structured environment.

10 Q I mean, looking through the notes, it seems

11 to me that her -- her behavior on the unit, while not

12 maybe ideal, has not really been anything that would

13 be considered problematic; would that be a fair

14 characterization?

15 A She is in a structured environment. However,

16 she has not presented on the unit as an imminent

17 danger to herself or others on the unit.

18 Q Now, you put on the petition -- or somewhere

19 in there, I noticed that there are remarks about that

20 she hasn't bathed recently and has an odor; is that

21 correct?

22 A Yes, sir.

23 Q Is that -- in your view, does that support a

24 conclusion of someone being gravely disabled?

25 A I think it helps support that conclusion. I

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 don't think in and of itself, it's satisfactory

2 evidence. There needs to be more evidence than that.

3 MR. GOTTSTEIN: Well, I didn't want to leave

4 you any time for cross, but I guess I can. We're

5 about up, aren't we? So I'm through.

6 MR. KILLIP: Do you object to some questions?

7 MR. GOTTSTEIN: Well, for all the time we

8 have left. I have an appointment at 1, so we need

9 to -- I mean, I think we're at the hour now, but I

10 think we could go for ten minutes.

11 MR. KILLIP: I don't think I have too much.

12 EXAMINATION

13 BY MR. KILLIP:

14 Q Dr. Hanowell, was there anything that you

15 want to clarify, any questions? For example, the

16 question about the fish oil and alternatives to

17 treatment.

18 A Yeah. I just -- when I spoke with the

19 patient this morning, she indicated again her interest

20 in nutrition.

21 And I offered to her the possibility that we

22 could try perhaps a lower dose of Zyprexa, in

23 conjunction with Omega-3 fish oil. Omega-3 fatty acid

24 supplements have been shown to be -- very few, but

25 have been shown at times, in a small percentage of

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 patients, to be helpful in terms of addressing

2 psychosis.

3 Unfortunately, they're not -- I wish they

4 were more efficacious than they seem to be. But I was

5 willing to give that a try.

6 I offered the patient to get an opportunity

7 to work with me on a voluntary basis, and she

8 declined. In terms of participating in

9 pharmacotherapy at a lower dosage of Zyprexa or some

10 alternative antipsychotic medication, in conjunction

11 with Omega-3 fish oil. Again, she declined.

12 But I was attempting to respond to her

13 interest in nutritional interventions in addressing

14 her health. I don't think that she -- she would not

15 agree that she has a mental illness, but I think she

16 feels that she has an interest in nutrition in terms

17 of her health.

18 Q About approximately how many times have you

19 testified as an expert in psychiatry in connection

20 with cases like this?

21 A More than 100 times.

22 Q What is your -- what is your as-recommended

23 treatment plan for her?

24 A I would continue her on an inpatient basis

25 for the time being, with routine group activities.

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 She is concerned about nutrition, and

2 certainly, her nutritional concerns would be addressed

3 on our unit by our cafeteria. And part of her

4 treatment will of course -- would ideally involve

5 pharmacotherapy.

6 Q And what is your -- what is the present

7 diagnosis for her?

8 A Schizophrenia, paranoid type.

9 Q Based on the cases that you have handled over

10 the years and your expertise, where would -- what is

11 your best evaluation of where she fits, I guess, on

12 the severity of that diagnosis? I mean, how bad does

13 she need to be at API?

14 A I'd say she'd be at the far end of the

15 spectrum, in terms of severity. She would be

16 experiencing severe symptoms of her mental illness at

17 this juncture.

18 Q Okay. And as far as treatment options go,

19 could you describe the treatment options? Like, what

20 are the realistic treatment options for her at this

21 time?

22 A You mean in terms of the different

23 medications or in terms of --

24 Q Yeah. Placement, medications.

25 A I feel that the only -- regrettably, the only

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 realistic treatment option for her at this juncture,

2 to ensure that -- I feel that at this time, the only

3 realistic treatment option for her is treatment on

4 Susitna Unit, in the patient mental health unit,

5 with -- regrettably, with a court order for

6 medications on commitment status.

7 I would much prefer that she participate in

8 treatment on a voluntary basis, but that clearly isn't

9 possible at this juncture, and clearly isn't her

10 preference at this juncture.

11 Q Okay. And what is your best guess as to how

12 long she'll have to be at API?

13 A It's always a really difficult question to

14 answer.

15 Her previous hospitalization lasted somewhere

16 in the neighborhood of a month, I believe. I don't

17 have her old chart, but I think she was here more than

18 a month. So it unfortunately did take her a while to

19 get better.

20 Q Where do you see her going after API,

21 assuming that her condition improves and API feels

22 that it is appropriate for her to be released, or she

23 is released?

24 A There were -- although there was report from

25 the family that she was in danger of being evicted, it

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 doesn't appear that she has in fact been evicted at

2 this juncture. She probably could return to her home,

3 or perhaps have a period of transition through the

4 Crisis Treatment Center before returning home.

5 Q And could you describe API's efforts and

6 continued commitment to working with the family to try

7 and help Ms. Myers get out of API and succeed outside

8 of API?

9 A Yes. Family contact and family involvement

10 is always our preference.

11 I attempted to -- to facilitate that, I

12 attempted to get a release for information from

13 Ms. Myers, which she didn't wish to sign.

14 However, it has always been a preference to

15 have family involved in treatment planning and a

16 discharge plan. I find it not only -- well, I find it

17 useful, very useful.

18 Q Then concerning the studies that have been

19 referenced in your testimony, do you find it unusual

20 for somebody in your position to appear at a

21 deposition and not have a list of studies memorized,

22 to be able to just provide to somebody upon request

23 verbally on an immediate basis?

24 A I -- I'm sorry, sir. I apologize. Did you

25 say do I find it unusual or --

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 Q Yeah.

2 A Yes, it would be unusual to expect someone to

3 be able to recite a list of such studies, or at least

4 to expect me to. I would have difficulty doing that.

5 I could certainly find those studies in my

6 files and refer to them, but I don't have them

7 memorized.

8 Q Okay.

9 MR. KILLIP: That's all I've got.

10 RE-EXAMINATION

11 BY MR. GOTTSTEIN:

12 Q How many of these depositions have you

13 attended, a deposition like this?

14 A This is the first.

15 MR. GOTTSTEIN: That's it.

16 (Exhibit No. 7 marked.)

17 (Proceedings concluded at 12:47 P.M.)

18 (Signature waived.)

19 -o0o-

PACIFIC RIM REPORTING 907/272-4383

www.courtreportingalaska.com

1 CERTIFICATE

3 I, JEANETTE BLALOCK, Certified Shorthand

4 Reporter and Notary Public in and for the State of

5 Alaska, do hereby certify that the witness in the

6 foregoing proceedings was duly sworn; that the

7 proceedings were then taken before me at the time

8 and place herein set forth; that the testimony

9 and proceedings were reported stenographically by

10 me and later transcribed by computer transcription;

11 that the foregoing is a true record of the

12 testimony and proceedings taken at that time;

13 and that I am not a party to nor have I any

14 interest in the outcome of the action herein

15 contained.

16 IN WITNESS WHEREOF, I have hereunto set

17 my hand and affixed my seal this ________ day

18 of _______________________ 2003.

21 ______________________________

JEANETTE BLALOCK

22 My Commission Expires 6/25/03

PACIFIC RIM REPORTING 907/272-4383