GEOFFERY MILLER, MD
1 (Proceedings recommenced at 9:04 a.m.,
2 May 15, 1997, with the court, counsel and defendant
4 COURT: Good morning. Are we ready to go?
5 Mr. Wadding?
6 MR. WADDING: Yes.
7 COURT: Mr. Correll?
8 MR. CORRELL: Yes, Your Honor.
9 COURT: Mr. Wadding?
10 MR. WADDING: Thank you. Call Dr. Miller to
11 the stand.
12 GEOFFREY MILLER, M.D.,
13 called as a witness on behalf of the state, being first
14 duly sworn by the court, was examined and testified as
16 COURT: Mr. Wadding?
17 MR. WADDING: Thank you, Your Honor.
18 DIRECT EXAMINATION
19 BY MR. WADDING:
20 Q. Would you state your full name and spell your
21 last name the record, please.
22 A. Geoffrey Miller. Actually the first name is
23 spelled G-E-O-F-F-R-E-Y. Miller is M-I-L-L-E-R.
24 Q. And your occupation, sir?
25 A. I'm an emergency physician.
1 Q. And how long have you been an emergency room
3 A. About two and a half years.
4 Q. And where are you employed?
5 A. Covenant Hospital.
6 Q. And could you describe your training and
7 education in achieving that position as an emergency room
9 A. I originally trained in family practice and
10 was in a rural practice in Anamosa, Iowa, but made a
11 career change, subsequently went back and took simple
12 continuing education courses and went on and became board
13 certified in emergency medicine and then obtained the job
14 at Covenant. At Anamosa I worked in emergency rooms most
15 of the 13 years I was there off and on.
16 Q. And where did you receive your education?
17 A. Oh, I was -- University of Iowa Med School.
18 The residency was in Cedar Rapids.
19 Q. And are you a licensed doctor in the state of
21 A. Yes.
22 Q. How long have you held your license in the
23 state of Iowa?
24 A. Since 1980.
25 Q. And could you briefly describe generally what
1 your duties are as an emergency room physician?
2 A. Well, we are at the hospital, and basically
3 at the emergency room just -- we take all-comers, so we
4 take major traumas all the way down to the common cold.
5 We are there to do initial assessments, initial
6 stabilization, make decisions about whether people should
7 be admitted or sent home or whether they need to be
8 transferred to a larger facility.
9 Q. Now, were you working in your position as an
10 emergency room physician on October 4th, 1996?
11 A. Yes.
12 Q. And did you receive and assess or treat an
13 individual by the name of Tamara Kleinheksel?
14 A. Yes, I did. But actually I think it was on
15 10-5 at 1 in the morning when I first met her.
16 Q. Okay. And do you recall -- can you describe
17 how you first met her then?
18 A. Tamara had been -- had been in a motor
19 vehicle accident and had originally gone to Sartori
20 Hospital who had contacted a neurologist, Dr. Choi, who
21 accepted her and was transferred to Covenant Hospital.
22 She was very briefly stabilized in Sartori. Dr. Choi
23 asked me to see her also to continue her stabilization
24 when she arrived at our hospital.
25 Q. And did you do that?
1 A. Yes.
2 Q. And could you describe what -- what you
3 observed, or what you observed of Ms. Kleinheksel's
5 A. Well, she was obviously seriously injured.
6 She had, in the motor vehicle accident, reported that she
7 was in the back seat unrestrained. When she arrived at
8 Sartori, she had been in a coma. They had done a CAT
9 scan. That was the reason they were transferring her.
10 The -- when en route to our facility, she started to have
11 seizures. She was having rhythmic deviation of her eyes,
12 I don't remember which side, but to one side. She was
13 completely in coma. She had a laceration to her chin.
14 And that was kind of the state that she arrived in.
15 Q. And what kind of an assessment did you make
16 of her condition then after she arrived?
17 A. Well, our first duty, as we worry about, we
18 worry about making sure that her airway is adequate, make
19 sure her breathing is adequate and then make sure her
20 circulation is adequate, and those were stable. So then
21 we move on to what we call secondary assessment, which is
22 basically a head-to-toe exam. And the main findings
23 were, you know, basically what I elicited, she had the
24 seizure going on with the eyes deviating. She had the
25 laceration to her chin. Her lungs, chest, abdomen, all
1 seemed to be fairly good on exam. The -- we then
2 proceeded to do several things to try and stabilize the
4 Q. When you said that you stabilized her
5 breathing, what are you -- what did you do to do that?
6 A. Well, we -- we did end up intubating, which
7 is passing a plastic tube down into her trachea and then
8 breathing for her, but that wasn't as much to stabilize
9 her breathing as it was to control her intracranial
10 pressure. One of the problems you have in a significant
11 head injury such as this where you do have definite
12 swelling is the intracranial pressure rises, and that
13 does further damage, so one of the -- in fact, the
14 fastest way we have of bringing that down is to
15 hyperventilate a patient, in other words, to increase
16 their breathing rate and lower their carbon dioxide.
17 When you have a deteriorating head injury, one of the
18 steps we take is to hyperventilate the patient.
19 Q. Is that how you would characterize Ms.
20 Kleinheksel, as a deteriorating head injury?
21 A. At that point she was.
22 Q. And did she stand a substantial risk of death
23 at the -- from the injuries that you observed?
24 A. I felt that she was at a substantial risk.
25 In fact, the Father stopped in and did last rites.
1 Q. And do you think that that risk was a -- that
2 risk was a result of the head injury that you described?
3 A. Yes.
4 Q. And were the injuries that you observed in
5 the emergency room consistent with injuries of a person
6 in an automobile accident?
7 A. It certainly is a reasonable explanation for
8 the injuries.
9 Q. And what further treatment or what further
10 action was taken with Ms. Kleinheksel?
11 A. Well, in addition to the intubation, as we
12 described, we also were attempting to control her
13 seizures. We gave her medication to stop the seizures,
14 initially some Ativan and Versed, subsequently gave her
15 Dilantin, another anti-seizure medication that we
16 commonly use in head injuries. Of course, when we had
17 her intubated, we continued to breathe for her because we
18 had medically paralyzed her at that point. We maintained
19 I.V. fluids. We -- typically in head injuries you don't
20 give full-blown I.V. fluids if they have adequate blood
21 pressure. We limit the amount of fluids we give them so
22 we do not increase the pressure inside the brain.
23 Q. And did you then -- was she admitted to
24 Covenant Hospital?
25 A. No, she was not. The decision, after Dr.
1 Choi, the neurologist, saw her, he also talked to Dr.
2 Chung, who is the neurosurgeon, and after discussion,
3 they felt that she would be better managed at the
4 University of Iowa Hospitals.
5 Q. And was she then transported?
6 (At 9:15 a.m., May 15, 1997, a recess was
7 taken, and Scott Halverson, Certified Shorthand Reporter,
8 reported the remaining non-jury trial proceedings held
9 May 15, 1997.)
1 THE COURT: You may remain seated. You are still
2 under oath and please give your full name to the reporter
3 THE WITNESS: Geoffrey Miller.
4 THE COURT: Mr. Wadding.
5 MR. WADDING: Thank you, your Honor.
6 GEOFFREY MILLER,
7 DIRECT EXAMINATION (cont'd.)
8 BY MR. WADDING:
9 Q. Dr. Miller, I believe that I was discussing with
10 you Miss Kleinheksel. What was the end result of your
11 contact with her at the at the emergency room at Covenant
12 Medical Center?
13 A. Yes, we had discussed the case with Dr. Choi,
14 C-H-O-I, a neurologist, and then he had discussed the case
15 with the Dr. Chung, and the decision was made to transfer
16 her to the University of Iowa to the neurosurgeons at Iowa
18 Q. And was that then done?
19 A. Yes.
20 Q. And did you have any further involvement with
21 Miss Kleinheksel?
22 A. No.
23 MR. WADDING: That's all the questions. I have thank
25 THE COURT: Mr. Correll.
1 MR. CORRELL: Thank you.
3 BY MR. CORRELL:
4 Q. Doctor, do you have your reports available to
6 A. I have my typewritten notes.
7 Q. Does that note -- or do you employed independent
8 recollection as to what time Miss Kleinheksel was received
9 at Covenant?
10 A. This note doesn't state so. I was reviewing the
11 medical record yesterday. I think she came in about 1:02.
12 Q. And is it your understanding that she had been at
13 Sartori Hospital prior to coming to Covenant?
14 A. Yes.
15 Q. Did you ever review the Covenant medical records
16 regarding her?
17 A. The Covenant medical records, yes.
18 Q. Excuse me, the Sartori records?
19 A. No.
20 Q. Would she have been -- do you have any
21 understanding of approximately how long she would have
22 been at Sartori Hospital?
23 A. No.
24 Q. In the year -- I guess the two and a half years
25 that you have been at Covenant in the emergency room would
1 you say that it is not uncommon for hospitals in this area
2 to refer people to the Covenant emergency room?
3 A. Not uncommon.
4 Q. And isn't that because Covenant emergency room
5 has a very good staff and very good machinery and all the
6 services that are needed to treat people in an emergency
7 care situation?
8 A. Being larger we have more equipment, yes.
9 Q. And you treat more people --
10 A. Yes.
11 Q. -- because of that, don't you?
12 A. Um-hum.
13 Q. And wouldn't it be fair to say that in the past
14 you have had, in fact, referrals from Sartori Hospital to
15 the Covenant emergency room?
16 A. Yes.
17 Q. And the fact that a person would be referred from
18 Sartori or a similar smaller type hospital to Covenant,
19 that would be basically indicative that the referring
20 hospital or physicians would be of the opinion that you
21 could offer services that they were unable to provide;
22 wouldn't that --
23 MR. WADDING: I'm going on object that to that, your
24 Honor. The question is actually testimony and it's not
25 relevant. It's not within the scope of the direct
1 examination and would -- and I think that's all the bases
2 I have.
3 THE COURT: The objection is overruled. You may
5 MR. CORRELL: Excuse me, I never did get to finish my
6 question. I don't know if the witness understood my
7 question or if it should be read back. I was going to ask
8 that you read it back.
9 THE COURT: If you hadn't finished, do you want to
10 finish your question or do you know whether you finished
11 your question?
12 MR. CORRELL: I know I didn't finish my question. I
13 was up to the last word. I'll leave it up to the Court or
14 the witness if I should rephrase it or have the reporter
15 read it back.
16 THE COURT: Why don't you just ask him again if you
17 weren't finished.
18 MR. CORRELL: Okay. Thank you, your Honor.
19 BY MR. CORRELL:
20 Q. Isn't it fair to say, based on your experience,
21 that when you have received transfers or referrals from
22 other hospitals in this area, including Sartori, that is
23 because they have a belief that you have services or
24 equipment that are unavailable to them?
25 A. Yes.
1 Q. There never was any indication that there was a
2 request to transfer Miss Farrell to your hospital; isn't
3 that a fair statement.
4 MR. WADDING: I'm going to object, your Honor. It's
5 outside the scope.
6 THE COURT: Overruled.
7 THE WITNESS: Could you repeat that again.
8 BY MR. CORRELL:
9 Q. You have no knowledge of any request from Sartori
10 or any physicians at Sartori to refer Juli Farrell to
11 Covenant Hospital. Am I not correct on that?
12 A. I don't have any knowledge of Juli Farrell.
13 Q. Would it be fair to say that from your experience
14 the people that are referred to Covenant from other
15 emergency rooms are generally more, or are considered to
16 be the more seriously injured people?
17 A. This is true.
18 Q. And isn't it fair to say, sir, that one of the
19 strengths of Covenant is you are trained and very aware of
20 when some other hospital can do something that even you
21 can't do?
22 A. You like to think that you are aware of which
23 hospital is better. I mean, such as the case that she
24 was transferred to the University of Iowa because we felt
25 that they could care for her better than we.
1 Q. That is the goal of medical services to get the
2 patient to a facility that is best able to meet the needs
3 of that patient; isn't that a fact, sir?
4 A. Yes.
5 Q. And Miss Kleinheksel was only at Sartori or at
6 Covenant for how long a period of time?
7 A. I think between about two or three hours.
8 Q. And within that period of time you were able to
9 determine that she would be better served -- in spite of
10 your valiant efforts she would be better served by being
11 transferred to another hospital; is that a fair statement,
13 A. That's what we felt, yes.
14 Q. And during that period of time you were in
15 consultation with at least two other specialists?
16 A. Yes.
17 Q. And she was then transferred to the University
18 Hospitals in the early morning hours of October 5, 1996,
19 is that not a fact?
20 A. Yes.
21 Q. And she was treated down there for a period of
22 time, is that a fair statement?
23 A. I actually don't know much beyond after she left
25 Q. Would you say that as you sit here today that you
1 are well pleased and well satisfied with the decision to
2 refer her from Covenant on down to University of Iowa
4 A. I think it was the right decision at the time.
5 Q. Okay. It was the right decision at the time and
6 it was the right decision as you sit here today, isn't it?
7 A. Yeah.
8 Q. And would you agree that she and her family are
9 fortunate that referral was made?
10 MR. WADDING: I'm going to object, your Honor. It's
11 an opinion that has no relevance to this incident. I
12 mean, the whole point of Mr. Miller's testimony is to
13 prove an injury. It's not whether we believe that they
14 had done the right thing or not. It's just not relevant.
15 THE COURT: Overruled.
16 THE WITNESS: Yes.
17 BY MR. CORRELL:
18 Q. And you have not followed her case since her
19 transfer to the University Hospitals, is that correct?
20 A. No, in fact, about the last direct feedback
21 was -- we often hear from the university a couple days
22 later how somebody is doing, and we did hear basically she
23 is still alive but I believe she was still in a coma at
24 that point. I understand that she has recovered some now
25 since then.
1 MR. CORRELL: Thank you, that's all I have.
2 MR. WADDING: Mr. Wadding.
3 THE COURT: Thank you.