McKee V. Laurion – Dr. David McKee Deposed About Encounter With Laurion Family At St. Luke’s Hospital

Standard

The following text is continued from Exhibit AA-156 of David McKee, MD, V. Dennis K. Laurion.

State of Minnesota District Court

Sixth Judicial District

File # 69DU-CV-10-1706

David McKee, MD, Plaintiff, vs. Dennis K. Laurion, Defendant

Deposition of David C. McKee, MD, January 7, 2011

Carol Danielson Bille, RPR, Danielson Court Reporting, LLC The following is the deposition of David C. McKee, MD, taken before Carol Danielson Bille, RPR, Notary Public, pursuant to Notice of Taking Deposition, at the law offices of Hanft Fride, PA, 1000 U. S. Bank Place, 130 West Superior Street, Duluth, Minnesota, commencing at approximately 11:43 a.m., January 7, 2011.

Appearances

For the Plaintiff:

Marshall H. Tanick, Esq.

Mansfield, Tanick, and Cohen, P. A.

1700 U. S. Bank Plaza South

220 South Sixth Street

Minneapolis, Minnesota, 55402-4511

612-339-4295

For the Defendant:

John D. Kelly, Esq.

Nathan N. LaCoursiere, Esq.

Hanft Fride, PA,

1000 U. S. Bank Place,

130 West Superior Street,

Duluth, Minnesota, 55802

218-722-4766

Proceedings

 Mr. KELLY: You had never met Dennis Laurion or Kenneth Laurion or Lois Laurion or Bonnie Laurion prior to April 19 of 2010. Am I correct?

Dr. MCKEE: To the best of my knowledge, no.

Mr. KELLY: And when and how did you first learn that you were being asked to see Kenneth Laurion at St. Luk’es Hospital?

Dr. MCKEE: Well, I don’t remember this happening because it would have been a completely routine thing. I can tell you what – – what would have occurred and almost certainly did occur in this case. The attending physician, who, in this particular instance, was Craig Gilbertson, would have written an order in the chart to have a neurologist see Kenneth Laurion, and that order would have been taken off by the – – the secretary, the unit clerk in whatever part of the hospital; in this case, the intensive care unit. That person would have called my office and talked to one of the secretaries there, who would have told me about it or put a note on my desk.

Mr. KELLY: Do you know whether you had seen other patients at St. Luke’s on April 19 of 2010 before you visited Kenneth Laurion?

Dr. MCKEE: I can’t remember. I don’t know.

Mr. KELLY: Do you remember what time you went on duty that day?

Dr. MCKEE: Well, I’m on duty most of the time. There are only two neurologists that cover St. Luke’s, and one of us is on call at all times. Normally, call switches at 7:00 a.m., and – – and so I would have been responsible for anything coming through the emergency room or any in-patient work starting at 7:00 a.m. that day and extending till 7:00 a.m. the next day unless I was also on call the following day or, I guess, the preceding day. If you tell me – – and I don’t remember what day of the week it was that I saw Kenneth Laurion – – I can tell you how long I would have been on call already and when I would have come off call.

Mr. KELLY: So you don’t, as you sit here now, recall whether you had been on call or whether you were specifically asked by Dr. Gilbertson to see that patient?

Dr. MCKEE: No, and – – that raises a point. Sometimes the person on call isn’t the one who ends up seeing a patient, because if the referring physician specifically requests one of the two of us, then if that person is in town and available, then that person would – – would do the consultation, even if he wasn’t on call that day.

Mr. KELLY: Do you have any recollection, as you sit here this morning, of what information you were given concerning Kenneth Laurion before you went to see him?

Dr. MCKEE: No, I don’t. And normally what – – what I would have would be just a, you know, two – – or three-word presumptive diagnosis, something like hemorrhagic stroke, or stroke, and occasionally, maybe 20 or 30 percent of the time, if the referring physician either considers the situation especially urgent or if they think that the situation is confusing and that they’ve got some useful information that isn’t in the chart or not readily available, they’ll call and discuss the case rather than just send it through the secretarial channels, and then there would be some background that way. I don’t recall that having been the case here, and so normally I would have just a very brief one – – or two – – or three-word presumptive diagnosis. But I would have checked the electronic medical record before going in to see the patient, so I would have had, by the time I went into the room, a reasonable background. Probably would have, for example, already seen the CAT scan and pertinent laboratory tests.

Mr. KELLY: Do you remember anything about the specifics of any CAT scan or lab tests as they pertained to doctor – – or, excuse me, to Kenneth Laurion before you saw him?

Dr. MCKEE: I was aware that he had a hemorrhagic stroke that was acute and in the posterior portion of the brain. So, yes, I had that information.

Mr. KELLY: I suppose it goes without saying that such a stroke, any stroke, is a serious medical event?

Dr. MCKEE: Yes.

Mr. KELLY: Did you initially go find Kenneth Laurion in the ICU unit at St. Luke’s?

Dr. MCKEE: Yes.

Mr. KELLY: And you discovered that he was not there?

Dr. MCKEE: That’s right.

Mr. KELLY: And then how did you find out where he was? What’s the process?

Dr. MCKEE: Oh, it’s very simple. I – – you know, along with the brief presumptive diagnosis there would have been the room number that the patient was in. In this case, it was a room in the ICU. And then going there and not finding him, you know, then what you would do is check with the unit clerk there and ask if – – if the patient had been transferred or if he was just off having some kind of a study, presumably an imaging study somewhere else in the hospital. And from there, you would know where he was and where to go.

Mr. KELLY: And so off you went to find him?

Dr. MCKEE: (Nodding head.)

Mr. KELLY: And when you arrived at Kenneth Laurion’s room, do you recall what time it was? We’ve heard roughly 6:00 o’clock. Does that jibe with your recollection?

Dr. MCKEE: Well, I know it was in the evening, and, you know, I don’t think I could say anything more precise. That – – normally, that’s when I do hospital consultations, unless they’re especially urgent. And so 6:00 o’clock is probably about right.

Mr. KELLY: Were you wearing a white coat at that time?

Dr. MCKEE: Yes.

Mr. KELLY: And were you wearing a shirt and tie at the time?

Dr. MCKEE: I don’t know. Of course, I was wearing a shirt. I don’t always wear a tie. In fact, more days than not, I don’t wear a tie. I usually wear a dress shirt with a button-down collar, and then I usually don’t bother with a tie. If it’s an open collar, I wear one.

Mr. KELLY: So you may or may not have been wearing a tie?

Dr. MCKEE: Yeah. I definitely wasn’t wearing a stethoscope.

Mr. KELLY: All right. Did you carry anything with you when you went to see Kenneth Laurion? Did you have any instruments?

Dr. MCKEE: Oh, yeah. That’s the purpose of the white coat, really, the – – at least for me. Apart from it sort of denoting to patients and family that you’re a physician, it’s beneficial mostly for all the pockets that it has. And so, you know, my – – the pockets of my lab coat are always stuffed with reflex hammers and light sources and things of that nature.

Mr. KELLY: And needle? Something of that nature?

Dr. MCKEE: (Nodding head.) Mm-hmm.

Mr. KELLY: All right. And do you recall there being several people in Kenneth Laurion’s room when you arrived – –

Dr. MCKEE: Yes.

Mr. KELLY: – – to see him? And we have been told that Kenneth Laurion’s wife, Lois, was there, and that Dennis and Bonnie were there when you arrived. Do you have any reason to disagree with that?

Dr. MCKEE: No, I don’t have any reason to disagree with that. I can’t say that I can draw up a real precise mental picture of where everybody was, but I do remember that Dennis Laurion was sitting, as he said yesterday, at what we would call the 3:00 o’clock position, if the head of the bed was 12:00 o’clock.Mr.

Mr. KELLY: Had you finished?

Dr. MCKEE: Yes, I had.

Mr. KELLY: Good. And can you tell me what your recollection is of the length of the exam?

Dr. MCKEE: Well, I – – you know, again, I – – I can tell you how long it takes me to do this. I can’t tell you that I had a precise mental image of the encounter. But, you know, normally, to – – to evaluate somebody with a stroke who’s alert and able to provide a history – – as you can imagine, it takes longer if you can’t get a history easily from the patient or from family members. But that wasn’t the case here. If the patient is able to provide a history and / or their family members, it can help that way. You begin by introducing yourself and then taking the pertinent history and then doing the neurological exam, and the whole thing usually takes about twenty minutes.

Mr. KELLY: Is it your recollection, then, that you were in Kenneth Laurion’s room for twenty minutes?

Dr. MCKEE: Again, I can’t say that I can remember the – – all the sequence of events and how long they lasted. I remember a lot of what happened, but I – – yes, I think that’s a good estimate, you know.

Mr. KELLY: From portal to portal, from the time you entered till the time you left?

Dr. MCKEE: I think that’s – – yes, it’s probably right around twenty minutes.

Mr. KELLY: And in the course of time, it would be your custom, your practice, to introduce yourself, obtain a history, and go through a set of diagnostic tests?

Dr. MCKEE: (Nodding head.)

Mr. KELLY: Presumably you have some communication with the patient?

Dr. MCKEE: Yes.

Mr. KELLY: And then you leave?

Dr. MCKEE: Yes.

Mr. KELLY: While you were with Mr. Laurion, Doctor, did you take any notes?

Dr. MCKEE: Probably not. I usually don’t have a need to do that. I always dictate my report immediately after leaving, and I’m able to remember events well enough that that usually isn’t necessary.

Mr. KELLY: I take it you didn’t have his chart with you when you went into the room?

Dr. MCKEE: No, because the hospital switched to electronic charts some time ago. So, as I said a few minutes back, I would have looked over the pertinent – – you know, the most pertinent records and imaging studies before going in, so I had a background. But there wouldn’t have been a chart that I could have physically brought into the room.

Mr. KELLY: Did you go to the nurse’s desk immediately from Kenneth Laurion’s room?

Dr. MCKEE: Yes.

Mr. KELLY: To the nursing station?

Dr. MCKEE: Sure. Yes.

Mr. KELLY: And did you then immediately dictate your consultation notes?

Dr. MCKEE: Essentially, yes. I – – I might have written some orders in the chart before I started dictating my report, but I would have been doing those things essentially right after leaving.

Mr. KELLY: And when and how at that time did you prepare and dictate your consultation notes?

Dr. MCKEE: Well – –

Mr. KELLY: Is that in a room or with a mobile machine that you had, some sort of – –

Dr. MCKEE: No, no, no. At the nurse’s station you have multiple computer terminals, and next to each terminal there’s also a phone. Normally what I would do is – – you know, I would have acquired a lot of the information before going into the room. Now I’ve gone into the room and gotten additional history from the patient and family and done the physical exam, so leaving, I know more than coming in. At that point, I would, more often than not, go back to the computer to look up, you know, any – – anything additional that seemed important, based on the interaction I had in the room and then would have – – would have done the dictation through the phone system. And that’s also the time that I would have written any orders in the chart.

Mr. KELLY: Do you remember whether you had any orders with respect to Kenneth Laurion?

Dr. MCKEE: Not offhand. I — I almost always do. So I – – you know I probably wrote a few orders in the chart, but I can’t remember offhand that I did.

Mr. KELLY: When and how did you first learn that some complaint had been made about you in regard to the visit you had with Kenneth Laurion?

Dr. MCKEE: Well, the first time that I found out there was some kind of formal complaint was when I got a phone call from Gary Peterson on May 6th, who is – – Gary Peterson is the medical director at St. Luke’s Hospital. But I was aware of the – – at least one of the Internet postings several days before that.

Mr. KELLY: All right. And how was that brought to your attention?

Dr. MCKEE: It was brought to my attention by a patient, who is a long-term patient with a chronic neurologic problem, and she – – she’s a very energetic lady, and she – – as soon as I came in the room to see her in my clinic, she said something to the effect of, “Dr. McKee, you’re not going to believe what I saw on the Internet,” and then proceeded to describe one of Dennis Laurion’s postings and was very upset and thought that this was outrageous. And, in fact, on leaving, she, being very outgoing, made a point of telling the four or five people in the waiting room that they needed to go on line and find this and needed to rebut what she had read.

Mr. KELLY: Did she happen to tell you what Web site or what rating site – –

Dr. MCKEE: I’m sure she did – –

Mr. KELLY: – – she encountered this on?

Dr. MCKEE: – – but, you know, I can’t remember which Web site, because, as we all know now, there are several of them. I can’t remember which one she specifically mentioned.

Mr. KELLY: Did you go to look at the Web site that she had brought to your attention?

Dr. MCKEE: Well, not right away,but yeah, I did.

Mr. KELLY: Had you ever looked at that or any other Web site to see whether anybody had submitted a rating on you as a physician?

Dr. MCKEE: No, I never had. I was, up to that time, I think, vaguely aware that there were some Web sites of that sort. But, no, I had never looked at any of them.

Mr. KELLY: So this patient says, “I saw something on the Web site,: and at some point you went to look at what she brought your attention to?

Dr. MCKEE: Right. I don’t – – it was fairly soon after that. I don’t remember if it was, you know, perhaps that evening or the next day, but it was fairly soon after that.

Mr. KELLY: And then several days thereafter, if I understood you correctly, you received a call from Dr. Peterson?

Dr. MCKEE: Right.

Mr. KELLY: And as I understand the chronology, you first received a call from Dr. Peterson and then you were provided a copy of the document, the letter that Mr. Laurion sent to Dr. Peterson. Is that correct?

Dr. MCKEE: I should remember this, but I – – I think that’s correct. I’m – – we talked about this at length, and I think he all but read the whole letter to me on the phone.

Mr. KELLY: I see.

Dr. MCKEE: And – – and I can’t say if my knowledge of the letter came from what he said in the phone conversation or the phone conversation plus later reading the letter. But in one way or another, the contents of the letter were made available to me by – – by Dr. Peterson.

Mr. KELLY: Let’s mark these. (Whereupon Deposition Exhibitis 16, 17, and 18 were marked for identification.) Perfect. Thank you. All right, Doctor, I’m showing you what’s been marked as Exhibit Number 16, which I believe is a letter you wrote to Dr. Peterson on May 6th of 2010.

Dr. MCKEE: Yes, that’s right.

Mr. KELLY: Do you happen to remember how long after your conversation with Dr. Peterson you composed and sent this letter?

Dr. MCKEE: Very soon after. We – – we had our conversation of the phone, and it – – it essentially ended with Dr. Peterson telling me that – – something to the effect that he didn’t consider the complaint believable or reasonable, and that if I would just put it in letter form to him, the responses that I had given him over the phone, that he would consider the matter resolved.

Mr. KELLY: So he asked you for some document in response to the complaint he had received from Mr. Laurion?

Dr. MCKEE: Yes, he asked me to summarize what I had said in our phone conversation.

Mr. KELLY: All right. I’m showing you what’s been marked as Exhibit Number 17. This is a letter dated May 28 of 2010 to William Marczewski of the Minnesota Board of Medical Practice. Am I right?

Dr. MCKEE: Yes.

Mr. KELLY: And this is a letter that you composed and submitted?

Dr. MCKEE: Yes.

Mr. KELLY: Were you requested to submit this letter to the medical board?

Dr. MCKEE: Yes. I – – I was given a notice from them that a complaint had been filed and asked for my response.

Mr. KELLY: And presumably you intended this letter to constitute your response to Mr. Laurion’s – – Dennis Laurion’s complaint to the medical board?

Dr. MCKEE: Yes.

Mr. KELLY: And showing you finally what’s been marked as Exhibit Number 18, this letter dated June 24 of 2010, again to Mr. Marczewski, and I gather that this particular letter is in response to the submission that was made by Bonnie Laurion. Am I right?

Dr. MCKEE: Yes, the one that was signed by Bonnie Laurion.

Mr. KELLY: Now, Doctor, have you written any letters to the various agencies or offices that received a communication from Mr. Laurion concerning his appreciation of your encounter with Kenneth Laurion?

Dr. MCKEE: No, not that I can recall.

Mr. KELLY: In your letter to Dr. Peterson of May 6, in the first paragraph of your letter, you say, and this is in the middle of the paragraph, “When I entered the room, and this is Kenneth Laurion’s room, “I certainly wasn’t angry or annoyed, but did make the comment that I had looked for him in the intensive care unit and was glad to see that he had been transferred from there to a regular hospital bed, as the two possibilities when one leaves the ICU are that you are a patient” – – “are that you” – – I gather that there’s a word missing there – – “you are a patient who’s improved and doesn’t need the intensive care unit, or a patient who died.” And that would have been a comment you made in the room?

Dr. MCKEE: Well, that’s not a quotation – –

Mr. KELLY: But that’s what you wrote?

Dr. MCKEE: – – or anything to that effect. That’s what I wrote, yes.

Mr. KELLY: And so if that’s not a direct quote, words to that effect were uttered in Kenneth Laurions room?

Dr. MCKEE: That’s right.

Mr. KELLY: And then you say that “This was no glib or morose” – – and presumably another word is missing there.

Dr. MCKEE: I think it’s this letter – –

Mr. KELLY: “No glib or morose comment.”

Dr. MCKEE: I think it was meant to say, “This was not glib or morose.”

Mr. KELLY: All right. And you say that “Nobody in the room, the patient, his wife, or Dennis Laurion himself, expressed or showed any evident disconcert with that statement.” That was your recollection?

Dr. MCKEE: That’s right.

Mr. KELLY: When you prepared this letter to Dr. Peterson, were you relying on your memory?

Dr. MCKEE: Yes.

Mr. KELLY: That is, you hadn’t made any notes at the time of the encounter – –

Dr. MCKEE: That’s right.

Mr. KELLY: – – on which you based your recollection of what you had said when you entered the room?

Dr. MCKEE: Correct.

Mr. KELLY: And then directing your attention to the second paragraph, “As for the incident with the hospital gown, the lead-up to this was nothing like what Dennis Laurion stated. I asked the patient if he had been out of bed that day, and after hearing that the therapists had worked with him but had not gotten him out of bed, I asked him if he felt up to that and if he wanted to try to stand and walk a little bit.” So far, so good?

Dr. MCKEE: Yes.

Mr. KELLY: “He told me that he very much wanted to try to get out of bed, and I held my hands out so that he could grab them to pull himself up to a standing position.” And then you say, “I certainly did not jerk him out of bed or in any way rush him.” “It was when he was half-standing, half-sitting” – – here the picture I have is of somebody who’s got his fanny at the edge of the bed, and perhaps his feet on the floor?

Dr. MCKEE: No, it’s not quite that. The – – but luckily here’s an area in which Dennis Laurion and I agree, and we at least agree on the layout of the room and where people were. Before I started to help Kenneth Laurion up, he was lying supine. He was lying more or less on his back. And Dennis Laurion was – – if we think of him lying on his back, on his left side was Dennis Laurion. I would have been on his right side, which is also where the doorway to the room is. And so you should picture him as starting out lying on his bed – – on his back, slightly – – with the head of the bed slightly elevated, but still essentially lying back. Now I’ve got my hands on his forearms, and he, in turn, is holding my forearms like this (indicating). And so – – so he’s – – he’s being pulled up from this semi-reclined position to sitting and then, ultimately, to standing.

Mr. KELLY: All right. “I certainly did not jerk him” – – I’m going on. ” I certainly did not jerk him out of bed or in any rush him. It was when he was half-standing, half sitting that Dennis Laurion, sitting in a chair on the other side of the bed, made the observation that the patient’s hospital gown was only tied at the neck.” Had you noted that to be the case by that point?

Dr. MCKEE: No, when – – when – – when I – – again, you know, remembering that the hospital gown opens at the back, he’s lying on – – on his back, and you wouldn’t see whether it was closed or open. And as he’s now coming up, he and I are facing each other, so his back side is away from me.

Mr. KELLY: All right. “Dennis Laurion, sitting in a chair on the other side of the bed, made the observation that the patient’s hospital gown was only tied at the neck. By the way he said this, I thought that his concern was that the gown might fall off, but I could see the knot was well-tied and told him that I thought it would be fine.” So that, again, is your recollection or assessment of something that you said?

Dr. MCKEE: Yes.

Mr. KELLY: Would you agree, Doctor, that because these gowns are the way they are that people – – both the people who wear them and the people who may be in close proximity to them can sometimes have some modesty concerns that are legitimate?

Dr. MCKEE: Certainly.

Mr. KELLY: People don’t like having portions of their body that they consider to be private exposed. Correct? I mean, you know that from experience?

Dr. MCKEE: Sure. It varies from person to person. Some don’t seem to mind, but some – – some do.

Mr. KELLY: And family members very often don’t want to be caught in a circumstance where the family member is embarrassed and, by extension, they may be embarrassed themselves. Would you agree?

Dr. MCKEE: Yes.

Mr. KELLY: So you say, “It never crossed my mind that he was concerned about his father’s modesty,” but, in fact, that at least is a consideration in retrospect, that one must give consideration to?

Dr. MCKEE: In general, but not in this specific case, for the reason that I outline on the beginning of the next page.

Mr. KELLY: All right. Your assessment on the next page was that it would have been possible for Dennis Laurion to simply reach across the bed and tie the gown?

Dr. MCKEE: Exactly. You have to realize, these rooms are tiny. The – – you know, there’s not much more than the minimum amount of space that it would take to walk around the bed. That’s, you know, the kind of dimension we’re talking about. So if you’re on the side – – if you’re to the side of the bed, you’re within reach of the bed.

Mr. KELLY: Was the exam that you planned to do when you entered the room likely to involve Mr. Laurion, Kenneth Laurion, getting up and standing and walking to some extent?

Dr. MCKEE: It was certainly likely, as mentioned in the – – you know, as part of the letter that we’ve already covered, I asked him if he had been out of bed and if he felt up to getting out of bed and if he wanted to get out of bed, so once it had been established that we were going to do that, you know, at that point, yeah, it was, you know expected that he would be getting up and standing.

Mr.KELLY: Now, Doctor, would it typically be the case that you would conduct a neurological examination of the kind that you were planning to conduct on Kenneth Laurion in the presence of family members?

Dr. MCKEE: Yes. It’s – – you know, sometimes the family doesn’t want to stay, sometimes the patient doesn’t want the family to stay, but more often than not, both the patient and the family members prefer for them to stay.

Mr. KELLY: Did you ask Kenneth Laurion if he wanted his family members present while he was examined?

Dr. MCKEE: I don’t recall.

Mr. KELLY: Did you ask the family members whether they wanted to be present while Mr. Laurion was examined?

Dr. MCKEE: I don’t recall, but I probably wouldn’t have. You know, I – – it’s likely that I asked him, but since he was – – if he had been very confused or comatose or something like this, I probably would have asked the family – – that’s my – – that’s how I would typically handle that situation. And if I knew I was going to be doing something invasive that would be uncomfortable for them, I probably would ask them to leave. But in a situation where the patient’s awake and conversant, I would be leaving it up to the family – – or, I’m sorry, to the patient. In fact, very often family members will, when I’m starting an exam in a situation like this, ask me, “Is it okay if we stay,” and my response is always, again assuming the patient is alert, to ask the patient and say it’s entirely up to him or her.

Mr. KELLY: Do you recall whether any one of the Laurions who were in the room when you entered the room asked whether it was okay if they stayed?

Dr. MCKEE: I don’t recall.

Mr. KELLY: Is it the case that at some point Kenneth Laurion asked that the family members leave the room?

Dr. MCKEE: I don’t remember that.

Mr. KELLY: Do you remember whether Mr. – –

Dr. MCKEE: But I do remember that – – that at some point the family members left the room.

Mr. KELLY: Do you remember if Mr. Laurion at some point during the initial part of this encounter expressed some concern for his personal modesty?

Dr. MCKEE: Mr. – – no, I – – I don’t remember that. I mean, I don’t remember that as happening.

Mr. KELLY: All right. Why don’t we begin with your arrival at the room, then, and, if you would, walk me through what you recall happened from the time you entered the room until you left the room.

Dr. MCKEE: Well, these rooms are very small.

Mr. KELLY: Is this a – – excuse me, but – –

Dr. MCKEE: It’s a private – –

Mr. KELLY: – – one-person room?

Dr. MCKEE: Private room, right.

Mr. KELLY: Thank you.

Dr. MCKEE: Yeah. And I – – I mention that because I almost laughed yesterday when Dennis Laurion said that I strode in rapidly and appeared annoyed. Well, you can’t walk into these rooms rapidly. The first step would carry you smack into the side of the bed. And, you know, I always knock. Usually the door’s already open, and I always knock on the door frame.

Mr. KELLY: Do you recall doing that in this instance?

Dr. MCKEE: I know I did that. I always do that.

Mr. KELLY: Did you announce yourself?

Dr. MCKEE: I always do that. I always introduce myself. It’s – – it’s inevitably the very first thing that I say when I come into a patient’s room. The only exception would be if the patient’s comatose, I know they’re comatose, and there are no family members present.

Mr. KELLY: And, Doctor, over the course of time, I suppose you’ve come up with a custom, a habitual way of introducing yourself. How do you do that? When you enter a room, what do you say?

Dr. MCKEE: You’re – – you’re right. And again, let’s just work with the scenario where we’re not talking about a confused or comatose person and – – but normally I always knock on the door or the door frame. If the door is closed, I knock, wait to hear if there’s any kind of answer and stick my head in. But I always knock and come in and introduce myself. I say, you know, “Hello,” or “Good evening. I’m Dr. McKee. I’m the neurologist.” And usually at that point the patient responds with, you know, “Thanks for coming,” “Nice to meet you,” “Hello.” Something.

Mr. KELLY: Do you remember that occurring in – –

Dr. MCKEE: I don’t remember exactly – –

Mr. KELLY: – – particular instance?

Dr. MCKEE: – – what – – I’m sorry to interrupt. I don’t remember exactly what Kenneth Laurion said, but the sequence began like this.

Mr. KELLY: Do you remember any comments or any statements being made by any of the family members who were in the room in response to your introduction?

Dr. MCKEE: I don’t remember.

Mr. KELLY: What’s your next recollection of what happened?

Dr. MCKEE: Well, my next – – the next thing that happened was that I made a jocular comment meant to kind of relieve tension and – – to the effect of I had looked for him up in the intensive care unit and was glad to find that, when he wasn’t there, that he had been moved to a regular hospital bed, because you only go one of two ways when you leave the intensive care unit; you either have improved to the point where you’re someplace like this or you leave because you’ve died.

Mr. KELLY: All right. And what’s the next thing?

Dr. MCKEE: Well, after that, I would have started asking the patient about his symptoms, how he felt, and taking the history from him, and – – and – –

Mr. KELLY: If I may interrupt you just a second, Doctor?

Dr. MCKEE: Yes.

Mr. KELLY: Do you remember that as being next in the sequence, or are you telling me what customarily would have been the case?

Dr. MCKEE: Well, I think both.

Mr. KELLY: Go ahead.

Dr.MCKEE: You know this was, what, nine months ago now, but I – – I know that – – that following this little introduction that we got on with the business of the history and – – and his current symptoms and so forth, which would be the way things would pretty much always, you know, progress.

Mr. KELLY: Did you receive any information concerning his – – his history or concerning his immediate experience before he was admitted to the hospital from any of the family members?

Dr. MCKEE: That’s – – that’s what I was – – you know, at that point I’m getting history from him and – – and invariably I’m asking for supplementation from family members if the patient has trouble doing that. You know it’s – – it’s, in my mind, usually a good thing if there are family members there, because even if the patient is alert, sometimes they’re aware of – – of useful historical aspects that the patient either doesn’t know or doesn’t remember.

Mr. KELLY: Dennis Laurion testified that he made some remark about his father’s experience of vomiting prior to the time that you saw him. Do you recall that being said or not?

Dr. MCKEE: Yeah, Dennis Laurion mentioned that sort of after the fact, as sort of an addition to what he had said initially. But I don’t specifically remember him making those statements, no.

Mr. KELLY: Do you remember any of the family members providing you with any historical information pertaining to Kenneth Laurion while you were in his room?

Dr. MCKEE: Not specifically, no.

Mr. KELLY: Did you ask his wife anything in particular?

Dr. MCKEE: You know, I probably did, and it’s likely that – – that one or more family members interjected with – – with some historical information, because that’s generally the way an encounter like this takes place, but I can’t remember the – – the specifics.

Mr. KELLY: All right. The next thing that happened, then, in the sequence, as best you can recall, was what?

Dr. MCKEE: Well, the – – the next thing was, you know, after getting the pertinent history and establishing, as mentioned in the letter, that he had been somewhat active through the day, but hadn’t been out of bed, asking him if he wanted to try and get out of bed, and he answered that he – – he very definitely did, and so I put my hands out to help him. He grabbed both of my forearms, as I demonstrated before, and – – and this is where we have a huge disagreement. I can say unequivocally I did not jerk him out of bed or force him against his will out of bed. I can say that with absolute certainty because I have never, ever done that to any patient. But in any case, I recall very specifically that he was – – you know, he was pulling on my forearms, and I was pulling on his steadily and trying to get him up, and when he was sort of no longer, you know, supported – – his back was no longer supported by the bed and – – and now he’s pulling pretty hard on my forearms (indicating) and I’m bearing a fair bit of his weight, that – – that the comment was made to me by Dennis Laurion that his gown wasn’t tied. And as I said before, Kenneth Laurion and I were facing each other. I can see the front of the gown, but not the back and see the – – could see the knot, which presumably was on the side rather than on the back, and it appeared – – it appeared good to me and like the gown wasn’t in any risk of falling off. And so I said, “It looks like it’s okay.”

Mr. KELLY: And what happened next?

Dr. MCKEE: Well, then, you know, continued to try to get Mr. Laurion in a standing position, and he did stand. And it was around that time that one of the family members asked – – and I believe it was a woman, and I think probably Bonnie Laurion, and I can’t say for certain, asked Kenneth Laurion if he’d prefer that they leave, which is, as I said a minute ago, a very routine question for family members to make. And Mr. Laurion – – Kenneth Laurion said yes, and the family members left, and we continued with the exam from there.

Mr. KELLY: All right. Up to this time, up to the time that the Laurion family members leave the room, do you have any estimate of or appreciation of how long you had been in the room?

Dr. MCKEE: Probably in the ballpark of eight or ten minutes.

Mr. KELLY: And up to this point, what you have done is gotten a history – –

Dr. MCKEE: Mm-hmm.

Mr. KELLY: – – and had an opportunity to make some assessment of your patient based on his responses to your comments and questions?

Dr. MCKEE: Right.

Mr. KELLY: Had you done any tests up to that point?

Dr. MCKEE: There’s a – – there’s a pretty good chance – – though I can’t say for certain, but just, you know, thinking as to how I usually proceed in a situation like this, there’s a pretty good chance that I had already checked a few simple things while he was still lying down, some reflexes with a flashlight and some other simple things that wouldn’t require him to move. I can’t remember whether I did those maneuvers before or after the family left. But, otherwise, it’s – – it’s as you just said.

Mr. KELLY: So if I have the sequence of events down properly, what happens now is that the family troops out. Is the door closed behind them or do you close the door behind them?

Dr. MCKEE: you know, I don’t remember – –

Mr. KELLY: Would you typically – –

Dr. MCKEE: – – if they closed the door – –

Mr. KELLY: Sorry.

Dr. MCKEE: – – or if I closed the door, but normally the door would be closed at that point.

Mr. KELLY: It would be your practice to close the door – –

Dr. MCKEE: Yes.

Mr. KELLY: – – so there would be some confidentiality, privacy, with the patient?

Dr. MCKEE: Right.

Mr. KELLY: And then, as I understand it, you would have gone through the series of what was left of the series of diagnostic tests that you wanted to perform?

Dr. MCKEE: Yes, which at that point would have been most of it.

Mr. KELLY: All right. And if I recall properly, you said the whole sequence took roughly twenty minutes, and we’re seven minutes into the encounter now, so – –

Dr. MCKEE: I said eight to ten.

Mr. KELLY: Oh, I’m sorry.

Dr. MCKEE: Well, it’s probably hair-splitting, but, yeah, we’re probably eight to ten minutes in.

Mr. KELLY: Okay, And then how – –

Dr. MCKEE: And I probably – –

Mr. KELLY: Go ahead.

Dr. MCKEE: Sorry. I probable spent, you know, another ten minutes, maybe a little more, completing the exam and talking to Mr. Laurion.

Mr. KELLY: Now, of that time, how long was Mr. Laurion on his feet?

Dr. MCKEE: Oh, undoubtedly less than a minute. Maybe a lot less than a minute. What I would have wanted him to do after standing – – and now he would be standing at the side of the bed, facing the door, I would have just wanted him to take a very few steps, probably while I was still holding his hands or his forearms for support, to see what kind of balance he had. I wouldn’t have been trying to assess his endurance or anything of that nature.

Mr. KELLY: All right. So this would have been a relatively short phase of the exam?

Dr. MCKEE: Right. And then I would have – – you know, usually in a situation like this, and again knowing where his stroke was and how large it was, what I really wanted to know was whether or not he had something called truncal ataxia.

Mr. KELLY: Which is what?

Dr. MCKEE: It’s a – – it’s an abnormality of balance, which is really easy to assess. It’s basically whether or not there’s a decline in balance to the point where a person has to have their legs spread further apart than normal when standing or walking to maintain balance. You can tell almost instantly when somebody stands up whether they have this, aand if so, how severe it is. So, you know, we get them to their feet and then maybe ask them to take a step or two, and then – – and then that’s it. You would usually – – or I would pretty much invariably from that point be holding the patient’s hands or forearms and then ask them to back up so they could then just sit directly back on the side of the bed, which is the easiest position for finishing the rest of the exam.

Mr. KELLY: Do you remember, from the height of the bed in that room, whether Mr. Laurion would have been then returned to a seated position when you were done with this?

Dr. MCKEE: You’d always – – always.

Mr. KELLY: All right.

Dr. MCKEE: And the height of the bed is adjustable and, you know, what I do when I bring somebody out of bed like this, especially if they’re elderly or some reason to suspect that they’re going to have trouble with balance, is, if necessary, adjust the height of the bed so that their feet, once they’re over on the side of the bed, will be touching the floor without them having to hop down off the bed. It’s the easiest way to get them up.

Mr. KELLY: Do you remember doing – –

Dr. MCKEE: And then it’s the easiest way to get them back down again.

Mr. KELLY: Do you remember doing that with Kenneth Laurion?

Dr. MCKEE: I don’t remember if the bed needed adjustment. but it’s – – it’s something that I always do, because it’s the easiest and safest way to get them out, and, more importantly, it’s by far the easiest way to get them back into bed. That way, when they’re backing up to the bed, all I have to do is, once they’re back, if their legs are against the side of the bed, is just simply sit down and – – and then they’re right there where you need them and, no hopping up or, you know, anything of this nature.

Mr. KELLY: Do you remember if Kenneth Laurion, once returned to the bed, remained in the seated position until you left the room?

Dr. MCKEE: Well, he certainly remained in a seated position while I finished the exam, because the rest of the exam is hard to do in any other position. And – –

Mr. KELLY: Do you remember what you did for the rest of the exam, that is, after you got him back on the bed?

Dr. MCKEE: I know what I always do in that situation. you know, the whole – – there’s – – there’s a logical order to go in here just from a practical – –

Mr. KELLY: A protocol?

Dr. MCKEE: Just from a practical standpoint, because much of the exam can’t be easily done with somebody lying down. Some parts can’t be done at all with them lying down. Most parts of the exam are easiest to do with them sitting , so – – there are a few little bits that can be done either way equally well, and sometimes I’ll do that lying down; sometimes after they’re sitting. And that’s what I was referring to before, in saying that, well, before I had him stand, I might have checked his pupil reflexes with a flashlight or something like this. But I always check the – – the gait and standing ability relatively early because I want to then – – you know, after doing that, I’ll have them in a sitting position, where it’s easiest to finish the rest of the exam.

Mr. KELLY: Which would typically, customarily, be what?

Dr. MCKEE: Well, there are half a dozen maneuvers that relate to testing of cranial nerves, which are the nerves that come off the base of the brain, and those are the things that you can, at least in part, do either lying down or sitting up. So it’s checking some aspects of respiratory function, facial – – muscular symmetry, facial sensation, whether or not the soft palette moves symmetrically, whether or not the tongue moves symmetrically, whether eye movements are normal and conjugate. And then following that, testing strength of all four extremities; muscle tone of all four extremities; the reflexes, whether or not there’s any ataxia, that is, a tremulous-like movement of the hands and arms when they’re used for purposeful movements. It’s usually checked by asking a person, with his eyes closed, to bring his arms out, bring his index finger to his nose, back to the starting position (indicating), while marking the starting position with your own index finger, and then repeating that maneuver on the other side; checking sensation, at least in the hands, with the eyes closed; and then the plantar responses, which are reflexes in the feet that are normally checked in a sitting position, but with the knee extended. And that is – – that’s pretty much it. Those are the standard things. Then depending on whether or not the specific issues at hand dictate it, there might be some additional tests, the same kind of things, but some additional things that you don’t necessarily do on everybody.

Mr. KELLY: Would it be your custom and practice, Doctor, at the conclusion of this sequence of events constituting your examination to assist the patient in getting back into bed?

Dr. MCKEE: What I would almost always do at the end of that – – well, really always do, is, with the patient now sitting – – a lot of times they’re pretty relieved to be out of bed, and I always ask them, “Do you want to stay sitting up or do you want to lie down? Would you like me to,” you know, “help you get back into bed or would you rather just sit” – – “stay sitting?”

Mr. KELLY: Did you have that exchange with Kenneth Laurion?

Dr. MCKEE: I’m sure – –

Mr. KELLY: Do you remember?

Dr. MCKEE: I’m sure I did, because i always do that.

Mr. KELLY: Do you remember what his particular response was?

Dr. MCKEE: I don’t remember.

Mr. KELLY: Do you remember whether he was left in a seated or prone position?

Dr. MCKEE: I don’t remember.

Mr. KELLY: All right. Then when you left Kenneth Laurion, did you give him any instructions or did you provide him with any information concerning a follow-up?

Dr. MCKEE: By follow-up?

Mr. KELLY: I mean seeing him at some later date?

Dr. MCKEE: Well, what – – what I would have done after finishing the exam is, you know, tell him what I thought was going on and let him know what was coming up in the near term, if there were any, you know, important tests that he was going to be having and ask him if he had any questions. We wouldn’t have talked about follow-up, like, after discharge or anything like that at that point. That probably would have been – – well, unless I expected him to leave later that day or something, that would have been a little, you know, ahead of the game.

Mr. KELLY: Now, at this point we’ve reached the stage in the sequence where you have finished the exam and Mr. Laurion has been returned to and is on the bed in some configuration?

Dr. MCKEE: Yes.

Mr. KELLY: And the next thing, I suppose, was for you to leave the room?

Dr. MCKEE: Yes, of course.

Mr. KELLY: Now, ordinarily, Doctor, in a circumstance of this kind where you have the patient’s family members on the floor, would it be your practice to provide them with some information concerning your observations, your findings, or conclusions?

Dr. MCKEE: It’s – – that’s variable. It depends on a number of details. If – – if the patient, in my opinion, isn’t able to retain information well, and the most extreme case would be if they were in a coma. But, you know, if they were confused or anything of that nature, then yeah, always. If the patient – – if – – if I’ve already discussed what’s going on or conveyed, it seems like, the important information to the patient and he seems to grasp it well, then not necessarily, especially if the family is going to go in, you know, right away and realize that the patient’s perfectly able to relay what I’ve just said, then probably only unless – – only in the situation where a family member would ask something.

Mr. KELLY: Do you recall what your assessment or conclusion was in regard to Kenneth Laurion’s ability to, first, absorb and then relay the information you had provided to him during your examination of him?

Dr. MCKEE: My recollection is that he seemed to be doing well in terms his cognitive function.

Mr. KELLY: All right. So what did you do next, then?

Dr. MCKEE: I left the patient’s room and went to the nurses’ station to do the various tasks that we already discussed.

Mr. KELLY: Did you observe Lois Laurion when you left the room? That would have been Kenneth’s wife.

Dr. MCKEE: I don’t recall if I did or not. you know, now, since the time that this encounter happened, I’ve read some varying descriptions of that detail, and I – – I don’t remember whether or not I saw her immediately on leaving the room or not.

Mr. KELLY: Would it ordinarily the case, Doctor, that you would attempt to at least stop and provide some comment to the – – the spouse of the patient you’ve just seen?

Dr. MCKEE: Well, again, it’s variable. It – – it depends on whether or not I think the patient has understood it and has, you know, the information at hand and able to relate it. If I’ve just explained things to patient who seems to understand well and expect that the family will be going in shortly thereafter, I wouldn’t necessarily then repeat the entire conversation to a family member, even – – even a patient’s wife. It would, you know, be my feeling that the patient is going to be asked all these questions by the family and is able to relay the information himself. But certainly anytime that a family member asks any questions after I leave the room, I always take whatever time is needed to answer those questions, even if I’ve already just answered the identical question with the patient.

Mr. KELLY: Do you recall seeing Bonnie Laurion anywhere around the Kenneth Laurion room when you departed his room?

Dr. MCKEE: No, I don’t recall that.

Mr. KELLY: Do you recall – –

Dr. MCKEE: I recall her being in the room. She was one of the individuals in the room. But, no, I don’t remember if she was at hand when I left the room.

Mr. KELLY: Did – – did you look for her when you left the room? Did you look for Lois Laurion when you left the room?

Dr. MCKEE: I don’t recall making a specific, you know, search for family members after I left the room.

Mr. KELLY: And if I understood you correctly, you departed the room and went directly to the nursing station, where you would have dictated your consultation notes?

Dr. MCKEE: Written orders and prepared my report, yes.

Mr. KELLY: And that would have closed your encounter with Kenneth Laurion. Correct?

Dr. MCKEE: Yes.

Mr. KELLY: And that would have been the last time that you had any contact at all with Lois, Bonnie, or Dennis Laurion. Am I right?

Dr. MCKEE: Well, are you asking me with the conditional that that would be the normal routine?

KELLY: No, no I – –

Dr. MCKEE: – – and not be other things, or – – or what happened in this case?

Mr. KELLY: In fact, you never had another encounter with Lois Laurion – –

Dr. MCKEE: That’s – – that’s – –

Mr. KELLY: – – Kenneth Laurion’s wife?

Dr. MCKEE: Wife. That’s correct.

Mr. KELLY: And in fact, you never had another encounter with Bonnie Laurion? You never spoke to her again?

Dr. MCKEE: No, that’s correct.

Mr. KELLY: And you never spoke to Dennis Laurion again. Is that also correct?

Dr. MCKEE: Correct.

Mr. KELLY: You haven’t seen them, that is, Dennis Laurion and Bonnie Laurion, again until you encountered them here in this conference room in connection with these depositions. Am I right?

Dr. MCKEE: I believe so yes.


 

Defendant Dennis Laurion’s Web Posting

Defendant Dennis Laurion’s Patient Complaint

Plaintiff David McKee’s Reply To Patient Complaint

Plaintiff David McKee’s Cease And Desist Letter To Defendant Dennis Laurion

Defendant Dennis Laurion’s Complaint To Minnesota Board Of Medical Practice

Plaintiff David McKee’s Complaint To Sixth Judicial District Duluth Court

Plaintiff David McKee’s Response To Minnesota Board Of Medical Practice

Defendant Dennis Laurion’s Answer To Plaintiff David McKee’s Complaint

Defendant Dennis Laurion’s Motion For Summary Judgment

Defendant Dennis Laurion’s Deposition Extracts

Plaintiff David McKee’s Deposition Testimony About Circumstances Before Encounter With Laurion Family

Plaintiff David McKee’s Deposition Testimony About Encounter With Laurion Family

Plaintiff David McKee’s Deposition Testimony About Circumstances After Encounter With Laurion Family

Plaintiff David McKee’s Deposition Testimony In Response To Questions By Marshall Tanick

Affidavits By Defendant Dennis Laurion’s Parents

Defendant Dennis Laurion’s Supplemental Motion For Summary Judgment

Plaintiff David McKee’s Motion To Oppose Summary Judgment

Defendant Dennis Laurion’s Reply Memo In Support Of Motion For Summary Judgment

Sixth Judicial District Court’s Order On Motion For Summary Judgment

Plaintiff David McKee’s Appeal Of Order On Motion For Summary Judgment

Plaintiff David McKee’s Brief To Minnesota Court Of Appeals

Defendant Dennis Laurion’s Brief To Minnesota Court Of Appeals

Plaintiff David McKee’s Reply Brief To Minnesota Court Of Appeals

Minnesota Court Of Appeals Order To Strike Portion Of Plaintiff David McKee’s Reply Brief

Minnesota Court Of Appeals Announces Decision

Defendant Dennis Laurion’s Petition For Review By Minnesota Supreme Court

Plaintiff David McKee’s Opposition To Review By Minnesota Supreme Court

Defendant Dennis Laurion’s Brief To Minnesota Supreme Court

Plaintiff David McKee’s Brief To Minnesota Supreme Court

Defendant Dennis Laurion’s Reply Brief To Minnesota Supreme Court

Minnesota Supreme Court Decision On David McKee MD V. Dennis K. Laurion

David McKee MD v. Dennis Laurion 2010

David McKee MD v. Dennis Laurion 2011

David McKee MD v. Dennis Laurion 2012

David McKee MD v. Dennis Laurion 2013

 

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s