t1 Ree'O

rr 11
I [ cE D
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... MAR
M AR 22fiA 1988 NITED
lQSRNITED STATES DISTRICT COURT
STATES DISTRICT COURT
- FOR
tOR T THE EASTERN DISTRICT~~CH lGAN
2 SOUTHERN
SOUTHERN D I:VISI
VIS
DIV\SI Y
JOHN P. HEHMAN, Clerk ~ \ "
^, \ ,\CjCO~
C\t / ~
UNITED
UNITED STATES OF
STATES

-vs-
•vs-
OF AMERICA,
AMERICA,

Plaintiff,
Plaintiff ,

\®
~~\)

~\~~.
y..r,,_y..,*,~~'
o{$^ *'
^&£b ■ #1
. .

\\:) No. 82 a 8 .'X.::JII"l~..4-'

...

NELLIE BELL
NELLIE BELL KASSIM,
KASSIM, et al.
et al.
Defendants.
Defendants.
9
---- --------1
-/

10
11 Proceedings
Proceedings had
had and testimony
testimony taken

12 in the
the above-entitled
above-entitled matter,
matter, before
before the HONORABLE
the HONORABLE

13 ANNA DIGGS
ANNA DIGGS TAYLOR,
TAYLOR, U. S. District
U. S. District Judge, at 211 U.S.
Judge, at U.S.
14 Courthouse and Federal
Courthouse and Federal Building,
Building, Detroit,
Detroit, Michigan,
Michigan,

15 on
on Thursday,
Thursday, October
October 28,
28, 1982.
1982.

16
APPEARANCES:
APPEARANCES:
17

"~ 11' .IELLEN DENNIS, AUSA

DENNIS, AUSA

"=',~
ELLEN

~ t 1> ~
18 and JAMES MCCARTHY, AUSA
and JAHES .MCCARTHY, AUSA
t 1»)' Appearing on behalf of Government
Government.
19 ' Appearing on behalf of

20 'T\,\ , V KENNETH
KENNETH ROBINSON,
ROBINSON,

21 ., On behalf
On behalf of Defendant
Defendant Krebs.
Krebs.

22

23 ELIZABETH
ELIZABETH E,
E. MONTGOMERY, RPR, CSR
MONTGOMERY, RPR,
Official Court
Official Court Reporter
Reporter
24 (313)
(313) 961-5965
961-5965
25

1&>
 190
190

11 AA Yea.
Yes.
22 MS. DENNISs
MS. DENNIS: That's all,
That's all, your
your Honor.
Honor.

33 MR. ROBINSONs
MR, ROBINSON: Could the
Could the doctor
doctor come
come

44 down and
down and I'll
Itll call
call —-- dould we finish
dauid we finish Dr.
Dr. Heimlick
Heimlick

55 today?
today?
66 THE COURT:
THE COURT: We
We have
have a
a Judges'
Judges' meeting at
meeting at

77 4:30.
4:30.
88 DDR.
R. HHEN
E N RRY Y HH EElM
IM LIe K ,,
L I C K
99 was thereupon
thereupon called
called as a witness herein,
herein, and after
after

10
10 havin9 been
having been first
first duly
duly sworn
sworn to
to tell
tell the
the truth,
truth, the
the
11
11 whole truth,
whole truth, and
and nothing
nothing but
but the
the truth,
truth, was
was examined
examined

12
12 and testified
and testified as
as follows:
follows:
13
13 DIRECT EXAMINATION
DIRECT EXAMINATION
14
14 BY MR.
BY MR. ROBINSON
ROBINSON
15
15 Q0 Would you
Mould you please
please tell us your
tell us your name
name and
and age
age and
and
16
16 profession.
profession.
17
17 AA 11m Dr.
I'm Henry Beiralick.
Dr. Henry Heimlick. II am
am 62.
62. II am
am aa Thorasic
Thorasic
18
18 surgeon. That's
surgeon. That's aa chest
chest Burgeon, aa scientist,
surgeon, SCientist, aa
19
19 writer and
writer lecturer.
and lecturer.
20 Doctor, II have
have just
just been
been advised
advised that
that the
the Court
Court is
is
20 QQ Doctor,
21
21 going to
going to have
have to
to break at 4J3Q
break at 4:30 today.
today. DoDo you
you have
have --
-
22
22 can you
can you be
be here
here in
in the morning or
the morning or would
would it
it be
be
23 better for
for you
you to
to come
come back
back tomorrow
tomorrow afternoon?
afternoon?
23 better
24
24 A
A Well, I
Well, I could stay over
could stay over until the morning.
until the morning.
25
25
Q
Q We appreciate
We it.
appreciate it.
 I
191 \
191

1 A
A It
It would
would be
be difficult
difficult in
in the afternoon.
the afternoon.
2 Q
Q Doctor,
Doctor, would
would you
you please
please tell
tell us
us your
your educational
educational
3 background?
background?
4 A
A 1 attended
I attended Cornell
Cornell University
University where I got
where I got my
my B.
B. A.
A.
5 degree.
degree. Then Cornell
Then Cornell Medical
Medical College
College in
in New
New York
6 City for
City for my
my M.
M, D.
D. degree.
degree. Did graduate
Did graduate work
work at
7 Columbia University Medical
Columbia University Medical College
College in
in New
New York
York
8 City and graduated
City and graduated from
from med
med school
school in
in 1943.
1943. I
9 I then
I then went to the
went to the United
United States
States Navy
Navy as
as J_i
I
I
10 I'm sorry
sorry II took
took a nine
nine month internship at
month internship at Boston
Boston
11 City Hospital, and
City Hospital, and then
then went
went into
into the
the United
United states
States

12 Navy
Navy during
during world War II,
world War II. I volunteered
volunteered for
for extra
extra
13 hazardous
hazardous duty
duty in
in the
the Navy,
Navy, and
and I ended
ended up
up in
in a
a
14 guerilla Army in
guerilla Army in northwest
northwest China
China behind
behind Japanese
Japanese
15 lines
lines in inner
inner Mongolia.
Mongolia.
16 0
Q Did you
Did you practice
practice medicine
medicine then
then behind
behind the
the lines?
lines?
17 A
A Yes, II did.
Yes, did. I practiced
I practiced in
in aa mud
mud hut
hut or
or wherever
wherever
1B we'd
we'd have
have to
to be.
19 Q
Q And following
And following the
the end
end of
of the
the war
war and your return
and your return to
20 the States, what
the States, what did you do
did you do next
next in
in your
your
21 profession?
profession?
22 A
A What, when
What, when II came
came back
back to
to the
the States,
States, II then
then sought
sought
23 additional training in
additional training in surgery,
surgery. I took neuro
took a neuro
24 surgery residency at
surgery residency at the
the Veteran's
Veteran's Administration
Administration
25 Hospital
Hospital in New
New York.
York. I went
went from
from there
there to
to Mt.
Mt. I

I
-------------------~
 192
192

1 Sinai hospital
Sinai hospital in
in New
New York,
York, and
and took
took a
a general
general
2 surgical residency.
surgical residency, II then
then continued
continued at
at Bellevue
Bellevue
3 Hospital as aa general
Hospital as general surgical
su£gical residency
residency also in
also in
4 New York;
York; and then
then took
took a chest
chest surgery
surgery residency,
residency,
5 Thorasic Hospital
Thorasic Hospital at
at Traybough
Traybough (ph.) Hospital and
(ph.) Hospital and
6 General
General Hospital, New York
Hospital, all in Mew York City.
City.
7 Q
Q And
And when
when did
did you
you finish
finish all
all of those
those surgery
surgery
8 schools?
schools?
9 A
A I finished
finished the surgical
Burgical training
training in 1950.
1950.
10 Q
Q How,
NOW, on
on the
the coropletion
completion of the
the surgery
surgery training,
training, did
did
11 there come
there come a time
time that
that you
you did any clinical
clinical type
type
12 work as a physician?
work physician?
13 A Yes,
Yes, I —
-- at that
that time,
time, frosa
from 1950
1950 on I have
have always
always
14 both practiced
both practiced medicine
medicine and surgery
surgery and had aa
15 teaching
teaching position
position or several
several teaching
teaching positions
positions in
in
16 universities
universities or major
major hospitals.
hospitals. I —
-- from
from 1950,
1950,
17 while
while I was
was still
still in New
New York
York City,
City, I had an
an
18 attending
attending position
position at Ht.
Nt. Sinai
Sinai hospital
hospital at
at
19 Kontaburn
Montaburn (ph.) Hospital,
Hospital, Southside,
Southside, Philadelphia,
Philadelphia,
20 Albert
Albert Einstein
Einstein Medical
Me~ical College
College and New
New York
21 Medical
Medical College
College in New
New York
York City.
City.
22 At
At the same
same time should say,
time I should say, being
being the
the
23 young
young surgeon
Burgeon and just
just —
-- 1
I worked
worked —
-- in order
order to
to
24 work
work as a doctor
doctor in Saks
Sake 34 street,
street, a department
department
25 store
store in New
New York
York City
City and
and also
also I worked
worked for aa

1__ _j
 193
193

1 health center
health center called
called the
the Hot©!
Hotel Health
Health Center.
Center. That
That
2 was for members
was members of the union of the
the union the hotels for
hotels for
3 several years,
several years, which wa$ doing
wbich I was doin9 teaching
teaching and
4 graduately building up my practice.
graduately building practice.
5 I also
I also continued
continued with
with research
research during
during
6 that time,
that time, and
and in the
the early
early 1950's
1950's did
did develop
develop an
an
7 operation for replacement
operation replacement of the
the esophagus.
esophagus. The
The
8 esophagus is the
esophagus the tube
tube that
that carries
carries your
your food
food from
9 your throat
your throat down
down to your
your stomach.
stomach. Either brought
Either brought
10 birth defect©
by birth
by defects by people swallowing
by people swallowing or children
children
11 particularly caustic
particularly caustic substance, drain cleaners,
substance, drain cleaners, lye
lye

12 and so forth which

80 forth which block
block the
the esophagus
esophagus and these
these
13 people are unable
people unable to swallow
swallow food
food and they're
they're fed
fed
14 through a
through a rubber
rubber tube
tube inserted
inserted into
into their
their stomach.
stomach.
15 And at that time I had the concept
that time concept of
of
16 making a new esophagus
making esophagus using a part
part of the
the patients
patients
17 own stomach
own stomach and
and develop
develop that
that operation
operation with
with aa
18 surgical research
surgical research laboratory*
laboratory. And that
And that was
was one
one of
of
19 my first
first scientific
scientific pieces
pieces of work.
work. And that
that
20 operation is
operation is now
now —
-- is
is a
a standard
standard procedure
procedure in
in many
many
21 of the surgical
surgical ethics.
ethics.
22 Q You created
created a standard
standard for medicine?
medicine?
23 A Oh yes.
yes.
24 As a matter
matter of fact beyond that, at that
beyond that, that
25 time there
time there was
was no
no such field as
such field as esophagus
esophagus surgery
surgery

---------- J
 194

or an interest in the esophagus as the organ.

Q When you say you worked for a couple of years in
1950 at the Hotel Center, did you have occasion to
examine patient's complaining of low back problems?
k Yes, I had patients complaining of all sorts of
problems and with the hotel worker they were very
common because you had people lifting heavy bags
and equipment and so forth.
Q Did you have occasion to prescribe any medication
with narcotics any time for back pain?
h Schedule II medication, we usually prescribed for
back pain were aspirin or a combination of aspirin
and Codeine*
Q Codeine is what is known as a controlled substance
these days?
A Yes, Codeine is a Morphine derivative.
Q Could you tell us just generally about the type of
physical examination you gave in 1950 at the Hotel
Health Center for back patient's who had an
examination by you?
h Well, at that clinic we had a pretty good turnover
of patient's and some would come in for a thorough
examination and go through a whole routine or would
be sent to a hospital for treatment. But we also
had the everyday visits to the clinic. And in that
 195
195

1 instance I
instance I would
would examine
examine the
the patient
patient within
within the
the
2 time that
time that was
was available
available and
and prescribe
prescribe accordingly.
accordingly.
3 0Q And
And when
when you
you examined
examined patients
patients back
back in
in 1950
1950 for
4 lower back
lower back problems,
problems, did
did you
you use
use x-rays
x-rays to
to examine
examine
5 for back
for back problems?
problems?
6 A
A NO, I think
No, think if we
we took
took an
an x-ray
x-ray every
every time
time aa
7 patient came
patient with a back
came with problem we'd be taking
back problem taking
8 them forever.
them forever. It was known
known then that
that x-ray,
x-ray, except
except
9 for very
for very specific
specific types
types of back
back problems
problems are
are really
really
10 not very
not very helpful,
helpful. The person
The person is arthritic
arthritic or has
has
11 strained his
strained back and is examined
his back examined and
and found
found out
out
12 there's reason
there's reason to believe
believe it's
it's a chronic
chronic complaint
complaint
13 where he's
where be's been
been working
working and seen
seen many
many times
times by
by
14 doctors.
doctors. YOU would
You would treat
treat the
the complaint.
complaint. We were
We were
15 treating patient's
treating patient's who
who needed
needed treatment
treatment at that
that
16 time and
tirae and had
had to go
go back
back to
to work
work or to whatever
whatever they
they
17 were doing.
were doing_
18 Q
0 Doctor,
Doctori I'm
I'm going
going to
to skip
skip ahead
ahead aa little
little bit
bit to
to the
the
19 70's and
70'© and then
then I'm dropping
dropping back
back into
into sow©
some of the
the
20 tbings you
things you have
have done
done since
since the
the 50'e
SO's when
when you
you
21 developed the
developed the surgery
surgery on
on the
the throat,
throat.
22 I'm going
going to
to show
show you
you exhibit
exhibit 37,
37, II
23 think.
think. My numbering
numbering system
system is
is becoming
becoming —
-- if II
24 give this
give this a duplicate
duplicate number,
number, nay
may I change
change it
it
25 later?
later?

-------- ------------------.-------------------------~
 196
196

1 THE COURTJ
THE COURTs Yes.
Yes.
2 QQ Mr. Robinson):
(By Mr,
(By Robinson): Doctor I*m
Doctor I'm going
goiog to
to show
show you
you
3 38.
33, This appears
This appears to
to be
be aa Heiralick
Heimlick Maneuver.
Maneuver. Are
Are
4 you familiar
you familiar with
with this?
this?
5 AA Yes indeed.
Yes indeed.
6 QQ What is
What is the
the Heimlick
Heimlick Maneuver and who is
Maneuver and is the
the
7 creature who
creature who created
created it?
it?
8 AA Well, it
Well, it was my developaient.
was my development. The Heimlick
The Heimlick Maneuver
Maneuver
9 is the
is the means for saving
means for saving the 11fe of
the life of aa patient who
patient who
10 is choking,
is choking, usually
usually on
on food,
food, choking
choking to
to death?
death;
11 although in
although in the
the case
case of
of children,
children, young
young children
children
12 will put
will put objects
objects in
in their
their mouth
mouth or
or aa small
small piece
piece of
of
13 material
material and
and can
can choke
choke to
to death On that.
death on that. And
And II
14 became
became aware
aware in
in the
the early
early 70*
70'ss that
that the
the children
children
15 who
who did
did that
that on
on food
food was
was the
the leading
leading cause
cause of
of
16 accidental
accidental death.
death. And therefore
therefore looked
looked into
into what
what
17 was
was being
being done
done and found
found that
that the things
things were
were
18 taught
taught weren't
weren't correct,
correct, and did some
some research
research and
and
19 realized,
realized, along
along with
with the background
background I had in chest
chest
20 surgery,
surgery, that
that there
there would
would be enough
enough air in the
the
21 lungs
lun96 so that
that if you
you could push
push upward
upward on the
the
22 diaphragm
diaphragm to comprese
compress that
that air you could
could cause
cause
23 enough
enough air and that
that would
would carry
carry the object
object out
out of
of
24 the
the throat
throat and
and out
out of
of the
the air
air way,
way.
25 And after
And after doing
dOing substansial
substansial research
research on
on

..
_.J
 197
197

1 that, published
that, published it
it in
in a
a medical
medical journal
journal and
and began
began
2 saving lives.
saving lives. And
And therefore
therefore became
became well
well known
known —
3 it was
it was named
named Heimlick
Heimliek Maneuver
Maneuver in
in the
the American
American
4 Medical Journal
Medical Journal in
in 1975.
1975.
5 Q
0 Doctor
Doctor Heimllak,
Heimlick, here
here again
again in
in reference
reference to your
to your
6 scientific isethod
scientific method which
wbich you have
have developed
developed called
called
7 Heimlick Maneuver,
the Heimllck Maneuver, was
was a standard
standard again
again created
created
a reviving choking
for reviving choking or drowning
drowning victims
victims since
since 1975
1975
9 your experience?
by your experience?
10 A That's
That's correct,
correct.
11 Q So Doctor,
So Doctor, at
at least
least in those
those two
two instances,
instances, is
is it
it

12 fair
fair to say in your lifetime
lifetime as a physician
physician back
back to
to
13 1943,
1943, at least
least on two
two instances
instances you
you assisted
assisted the
the
14 medical
medical profession
profession at one point
point to give
give credit
credit in
in
15 creating
creating a new
new standard
standard of medical
medical therapy
therapy and
and
16 assistance
assistance to patients?
patients?
17 A Yes,
Yes. I'd like
like to say in regard
regard to esophagus,
esophagus, that
that
18 prior
prior to that
that time
time there
there was
was not
not a particular
particular
19 interest
interest in
iri the esophagus.
esophagus. And
And since
since it has
has become
become
20 a specialized field
• specialized field as
as aa result
result of
of showing
showing that
that it
it

21 was
was an organ
organ that
that should
should be treated
treated specifically
specifically
22 and
and so there
there are
are now
now standards
standards for
for treatment
treatment of the
23 disease
disease of the
the esophagus
esophagus as
as a result.
result.
24 Q Can you
Can you tell
tell us
us whether
whether you
you bad
had occasion
occasion to
to become
become
25 a fellow
fellow in
in any
any phySicians'
physicians' association
association or
 198
198

1 diplomate in
dlploiaate in any
any of
of the
the boards?
boards?
2 A
A Yes.
Yes. After
After I finished my
I finished ray training! became
training I became
3 licensed in
licensed in the
the State
State of
of New
New York
York and
and subsequently
subsequently
4 another state,
another state, practiced
practiced medicine
medicine in
in surgery.
surgery. II
5 passed the
passed the examination
examination and
and became
became aa diplomate of
diplomate of
6 the American Board
the American Board of
of Surgery
Surgery and on the
and on the Board
Board of
of
7 Thoraxic Surgery, Chest
Thoraxia Surgery, Chest Surgery,
Surgery.
8 I am
am aa fellow
fellow of
of the
the American
American College
College of
of
9 Surgeons since that
Surgeons since that time*
time. A
A fellow
fellow of
of the
the American
American
10 College of Chest
College of Chest Physicians,
Physicians. I
I also
also have
have honorary
honorary
11 teaching
teaching positions
positions that
that have
have developed
developed since
since that

12 time.
time. Professor of
Professor of surgery
surgery at
at the
the University
University of
of
13 Laplata.
Laplata ..
14 Q
Q Laplata, Maryland?
Laplata, Maryland?
15 A
A Laplata, Maryland.
Laplata, Maryland,
16 0
Q In
In reference
reference to
to teaching
teaching positions,
positions, did
did you
you once
once
17 have a teaching
have a teaching pOSition
position at
at the
the medical school
medical school
18 named Xavier?
named Xavier?
19 A
A At present,
At present, until
until the
the past
past five
fiv® years,
years, I'm aa
20 professor of advanced
professor of advanced clincal
clincal sciences
sCiences at
at Xavier
Xavier
21 University in Cincinnati
University in Cincinnati and
and Director
Director of
of the
22 Helralick
Heimlick Institute
Institute at
at Xaview
XAview University
University in
23 Cincinnati,
Cincinnati. And
And prior to that
prior to that I
I —-
-- after
after leaving
leaving
24 K@w York II became,
New York became, Director
Director of
of surgery
Surgery at
at the
25 Jewish
Jewish Hospital
Hospital in
in Cincinnati
Cincinnati and
and have
have an
 199
199

1 appointment as
appointment as Associate
Associate Clinical
Clinical Professor
Professor at the
at the

2 University of
University of Cincinnati]
Cincinnati] Medical
Medical College,
College, which
which II

3 still possess,
still possess, of
of surgery.
surgery.
4 QQ Doctor,
Doctor, to summarize
summarize before
before I go into
into other
other areas,
areas,
5 is it fair to say you have
is have experience
experience as aa
6 physician
physician in the residency
residency obviously,
obviously, is that
that
7 correct?
correct?
8 A Yes.
Yes. actually formed
I actually formed the residency
residency which
which had
had
9 been
been slipping
slipping at the Jewish
Jewish Hospital
Hospital in Cincinnati
Cincinnati
10 and brought
brought it
it to the point
point where
where it was
was again
again
11 recognized
recognized and established
established residency
reSidency and trained
trained
12 residents
residents at the time
time I was
was lecturing
lecturing at the other
other
13 institutions,
institutions.
14 Q The
The residency
residency follows
follows the
the medical
medical school
school degree,
degree, is
is
15 that
that correct?
correct?
16 A Yes,
Yes. Actually
Actually you
you go from
from medical
medical school.
school. You
17 then take
then take an internship
internship and if you want
want specialized
specialized
18 or advanced
advanced training,
training, you
you take
take a residency
residency which
which
19 can
can last,
last, depending
depending on the field,
field, from
from three
three to
to
20 five years*
years.
21 Q Can aa doctor
Can doctor become
become aa licensed
licensed physician
physician after
after
22 finishing
finishing medical
medical school without going
school without going through
through the
23 residency?
residency?
24 A Tee,
Yes, he
be can
can be
be licensed
lioensed in most
most states.
states. It varies
varies
25 by state.
state. But
But in states
states yes,
yes, a one
one year
year internship
internship

I
I
--------------~
 200
200

1 is required
is required at
at which
which time
time and
and during
during the
the course
course

2 that you can take

that you take license
license examinations,
examinations, but
but you get
you get
3 your license, in
your licenser in most states, on
most states, on completion
completion of
of an

4, internship.
internship. The residency
The residency is
is additional.
additional.
5 Q
Q In
In your
your experience
experience doctor,
doctor, as
a© aa physician
physician and as a
and as
6 Professor
Professor at
at the
the medical
medical schools
schools and
and the
the creator
creator of
of

7 the residency program

the residency program at
at the
the Jewish
Jewish Hospital
Hospital in
in

8 CinCinnati, what is
Cincinnati, what is the
the purpose,
purpose, frora
from your
your
9 experience, of
experience, of a
a residency
residency program?
program?
10 A
A Well,
Well, the
the residency
residency program
program is
is to,
to, for
for aa doctor
doctor who
who

11 is interested in
is interested expanding his
in expanding his knowledge
knowledge and
and
12 experience to get
enperience to get training
training under
under the
the direction
direction of
of
13 experienced
experienced teachers
teachers and
and phYSicians
physicians or surgeons.
or surgeons.
14 Ae matter of
a matter
As a of fact,
fact, at the present
at the time
present time
15 there exists a
there exists residency in
a residency in family
family practice
practice so that
so that
16 it is not
it is not whatever
whatever area
area you're
you're going
going into
into but it's
but it's
17 advanced training that
advanced training entitles a
that entitle© a roan
man to
to take
take a
a
18 residency.
residency.
19 Q
Q Have
Have you,
you, in
in your
your experience
experience of 39 years,
of 39 years, since
since you
you
20 finished medical school
finished medical school in that what
1943, that
in 1943, what you
you

21 l•• rned you

learned you learned
learned and
and apply
apply certain
certain standards
standards and
22 tests
tests in your residency
in your residency in a raedical
in a medical school
school
23 environment
environment that are not what
that are what necessarily what you
necessarily what you
24 do in
do a clinical
in a clinical university
university environment,
environment, such as
such
25 when you
when you were
were working
working down
down there
there at
at the
the Hotel?
Hotel?

--_j
 201
201

1 hA Botel Center.
Hotel Center~
2 QQ Hotel Center.
Hotel Center. Is there
Is there aa difference
difference in
in what
what you
you do
do
3 in
in using
using your
your skills
skills and
and learning
learning in
in aa residency
residency
4 and
and training
training to
to apply
apply the
the skills
skills and
and judgment
judgment at
at
5 the place
the place such
such as
as the
the Hotel
Hotel Health
Health Center?
Center?
6 hA Well, I'd
Well, I'd like
like to
to answer
answer that
that more
more broadly,
broadly, if
if II
7 can.
can. Tbat was
That was just
just one
one type
type of
of practice.
practice. But
But
8 obviously you
obviously you learn
learn what
what you do in
you do in the
the residency
residency
9 and
and you
you utilize
utilize it
it to
to the
the best
best of
of your
your ability
ability in
in
10 your
your residency
residency training.
training. Because it is
Because it is aa major
major
11 hospital, only
hospital, only major
major hospital's
hospital's are
are accredited
accredited for
for
12 certain
certain types
types of
of residency
residency training
training or
or medical
medical
13 school
school or
or medical
medical college
college or
or medical
medical centers,
centers.
14 You start
You start of
of by learning as
by learning as much
much as
as you
you
15 can.
can. You're
You're rather
rather free
free in
in ordering
ordering tests
tests and
and

16 seeing
seeing how
how they come
come out
out and as
as part
part of your
your
17 training,
training, the
the medical
medical school
achool has
bas the
the facility
facility and
and
18 the finances
finances for that.
that.
19 Well, then
Well, then when
when you
you get
get out,
out, there
there are
are
20 different types
different types of practices.
practices. Some people
Some people will
will
21 remain
remain in a medical
medical school
school atmosphere
atmosphere and
and will
will
22 continue
continue that way seeking
that way seeking out
out only
only very
very coraplicated
complicated
23 cases that
cases that carry
carry their
their interest
interest and
and are
are discussed
discussed
24 at conferences,
conferences.
25 But there
But there are
are other
other aspects.
aspects. guess
I guess
 202
202

1 the farthest
the farthest atat Boston
Boston City
City hospital.
hospital. When II got
When got
2 t.hereII had
there had to
to use
use ray Inind,
my mind, my hands
my bands and
and my
my mind
mind

3 and whatever experience

and whatever experience 1I had
bad accumulated.
accumulated. And
And
4 that was
that was in
in aaroud
mud hut
hut or
or wherever
wherever you
you happened
happened to
to
5 be.
be. The same,
The same, II guess
guess for
for any
any military
military surgeon.
surgeon.
6 He has to
He has to do
do what
what happens
happens on
on the
the field.
field. HeHe can't
can't
7 wait to
wait to do
do all
all of
of the
the things
things that
that he
he would
would do
do in
in aa
B teaching hospital.
teaching hospital. Then there are
Then there are the
the different
different
9 shades between
shades between that.
that. You may
You may have
have aa doctor
doctor in
in his
his
10 private office
private office and
and he
he is
is seeing
seeing more
more patients
patients
11 generally than
generally than one seeS in
one sees residency at
in aa residency at aa time,
time,
12 at least
at least for
for him
him as
as an
an individual.
individual.
13 Now, if
Now, if he
he is
is practicing
practicing very average
very average
14 medicine, where
medicine, where he
he can
can take an hour
take an hour with one
with one
15 patient and
patient and doing
doing aa lot
lot of
of tests
tests and
and so
so forth,
forth,
16 that's another
that's another type
type of
of medicine
medicine that's
that's practiced.
practiced.
17 You
You mentioned the
mentioned the Hotel
Hotel Center.
Center. In that
In that
I

18 type of
of center
center you have got 4
have got 4 or or 66 patients
Or 55 or patients
type you i
19 every hour
every and you
hour and you are not
are not there
there as their
aa their whole
whole
20 physiCian entity.
physician entity. You are there
You are there to see is
to see there
is there
I
21 anything in
anything in this
this patient
patient that
that requires
requires emergency
emergency I
22 treatment.
treatment. If you
If you determine
determine there
there is,
is, you
you send
send \
23 that patient
that patient to
to an
an emergency
emergency hospital,
hospital, emergency
emergency I
24 departments in a
departments in a hospital
hospital or if they
or if they need
need \
25 hospitalization
hospitalization for surgery
for surgery you
you might
might send
send them for I
them for
I
I
I
I
1

I
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 203
203

1 that.
that. But the majority
But the majority of
of your
your patients certainly
patients certainly
2 in the
in the health center are
health center are coming
coining in
in for that which
for that which
3 is bothering
is bothering them
them at the moment,
at the moment. And you
And you have
have to
4 treat them with
treat them with that
that in mind.
in mind. In fact,
In you want
fact, you want to
5 help your
help your patient
patient and
and you
you want to —
want to -- at
at the
the same
same
6 time you
time try not
you try not to
to miss
miss anything,
anything, but
but you
you do
do have
have
7 to carry
to carry them over.
them over. You
You can't
can't just
just send
send them
them out
8 and say
and go to
say go to another
another hospital
hospital for
for this
this minor
minor
9 complaint*
complaint.
10 Q And in
And in your
your doing
doing that,
that, as
as long
long ago
ago as
as 1950
1950 when
when
11 you saw
you saw the
the patient
patient with
with pain
pain in
in the
the lower
lower back
back
12 complaint that
complaint that you
you diagnosed,
diagnosed, you
you testified,
testified, I
I
13 believe,
believe, that
that you
you would
would prescribe
prescribe a form of
a form of aspirin
aspirin
14 with Codeine, a narcotic
with Codeine, narcotic 32
32 years
years ago?
ago?
15 A
A If II determine
If determine while
while going
going over
over them
them and
and checking
checking
16 them, that II felt
them, that felt that
that was
was the
the thing
thing that
that could
could
17 tide them
tide them over
OYer and
and get
get them over their
them over their illness
illness or
or
18 maintain
maintain them as a
them as a result
result of
of their
their pain.
pain.
19 o
Q From your
From your experience,
experience, is
is the
the dialogue
dialogue between
between
20 patient and
patient and physician
pbysician important in that
important in that
21 examination.
e~amination. What
What is discussed?
is discussed?
22 hA Yes, very
Yes, very definitely.
definitely. You ask
You ask aa patient
patient certain
certain
23 leading questions.
leading questions. First you
First you bear
hear that
that what
what the
24 patient
patient has
has to
to say,
say, then
then you
you ask
ask questions
questions that
that can
can
25 lead
lead you to a
you to a diagnosis.
diagnosis. Then
Then you
you have
have to
to call
call on i
I

~---------------- J
 204
204

1 your
your judgment.
judgment. You
You also
also examine
examine the
the patient.
patient. You
You
2 examine
examine the
the patient.
patient. If it's
If it's a
a back
back pain,
pain, and from
and from
3 that you then
that you call into
then call play your
into play judgment from
your judgment from the
the
4 thing you
thing have learned
you have learned in
in your
your training
training and
and in your
in your
5 experience, and
experience, and deal
deal with it accordingly.
with it accordingly.
6 I Q
Q Doctor have
Doctor have you
you had
had occasion
occasion in
in the
the past
past 15
15 years
years
7 or so to
or so to lecture the residents
lecture the residents in
in various
various hospitals
hospitals
8 or to lecture
or lecture phYSicians in society,
physicians in society, such
such as the
the

9 American Medical
American Association and
Medical Association be aa speaker
and be speaker
10 commenting on what
commenting on what you have done
you have done as
as a physician?
a physiCian?
11 A I have
I have lectured
lectured and
and continue
continue to
to lecture.
lecture. I
I have
have
12 always lectured at
always lectured at different
different medical
medical clinics
clinics and
13 hospitals.
hospitals. As
As a matter
matter of fact, II was
of fact, was thinking
thinking of
14 being here
being in Detroit
here in Detroit from
from Cincinnati,
Cincinnati, I
I lectured
lectured
15 some
some years
years ago
ago at
at the
the Grace
Grace Hospital
Hospital and
and another
another
16 hospital -—
hospital -- I
I don't
don't recall
recall which one it
which one was --
it was — on
17 two
two different occasions and
different occasions and have
have attended
attended medical
medical

18 meetings
meetings here
here as
as well.
well.
19 Q
Q Have you
Have you had
had occasion
occasion to
to testify
testify in
in litigations
litigations and
and
20 court cases before
court cases as an
before as an expert?
expert?
21 A Yes, II have.
Yes, have ..
22 Q
Q Testify as
Testify as aa physician
physician as
as an
an expert
expert in
in the
the field
field of
23 medicine?
medicine?
24 A
A Yes.
Yes.
25 Q Now, doctor,
Now, doctor, can
can you
you tell
tell us
us some
some of
of the
the --
— we
we have
have

...
_ .._j
 205
205

1 to do
to do these
these things
things in
in court
court neatly
neatly —-- things
things but
but
2 have you
have you had
bad occasion
occasion to have various
to have various awards
awards
3 presented to
presented you from
to you from presidents
presidents on
on down
down for your
for your
4 accomplishments?
accomplishments?
5 AA have had,
II have had, yes.
yes.
6 QQ Could you
Could you just
just list
list aa few?
few?
7 AA II had
had several
several commendations
commendations when
when II was
was in
in the
the Navy.
Navy.

e II received
received honorary
honorary degrees
degrees in
in the
the last
last few
few years
yeats
9 ffrom Delphi (ph„)
rojii Delphi (ph.) University
University in
in New
New York,
York, Doctor
Doctor of
of
10 Science, Doctor
Science, Doctor of
of Science
Science from
from Willmington
Willmlngton College
College
11 in Ohio,
in Ohio, and
and II have
have always
always been
been interested
interested in
in the
the
12 lecturing in
lecturing in teaching
teaching both
both the
the public,
pUblic, as
as well
well as
as
13 medical students
medical students and
and residents
residents in
in the
the medical
medical
14 profession.
profession. And II did
And did develop
develop aa film.
film. On My
On My
15 Operation which,
Operation whicb, in
in the
the 1960's,
1960's, won
won aa bronze
bronze
16 medallion at
medallion at the
the International
International Film
Pilm Festival.
Festival. And
And
17 that's something
that's something which
which II still
still am
am very
very pleased
pleased
18 about, though
about, though it's
it's not
not a
a medical
medical award.
award.
19 II am
am very
very much
much interested
interested now
now in
20 teaching medicine
teaching medicine to
to the
the public
public and
and have
have appeared
appeared
21 on television
television quite
quite a
• few
few tiroes
times to do that
that on the
the
22 Today Show,
Today Show, Good
Good Morning
Morning America,
America, Johnny
Johnny Carson,
Carson,
23 -- it's
and so — it's light,
light, but
but I feel
feel that
that it's
it's
24 important that
important that the
the public
public understand
understand medicine.
medicine. And
And
25 keeping with
in keeping witb this
this I developed
developed a program,
program, a one
one
 206

1 minute cartoon
minute cartoon shown
shown on
on television, Doctor
television, Doctor
2 Heimlicb's emergency
Ifeiralich's lessons for
emergency lessons for people.
people. It teachs
It teachs
3 children medicine,
children and I
medicine, and I was
was pleased
pleased it won aa
it won
4. national Emmy
national Emmy award
award after
after it
it was on 6 months
was on months
5 starting 12
starting 12 years
years ago.
ago.
6 Q Now, doctor
Now, doctor as a physician
as a physician and
and teacher
teacher have you had
have you had
7 the —
the -- during
during your
your career
career as
as physician
phYSiCian and teacher,
and teacher,
a witness what
to witness what is taught in
is taught in residency
residency programs
programs at
9 various universities
various universities and what is taught
what ie taught in
in the
the
10 medical school,
medical school, the medical schools
the medical sChools and
and what
what
11 physicians put
physicians into practice
put into practice when they're out
when they*re there
out there
12 the real
in the real world?
world?
13 A Yes, I
Yes, I have been fortunate
have been fortunate in
in seeing the various
seeing the various
14 aspects of
aspects of medical
medical practice.
practice. It's been
It's interesting
been interesting
15 to do
to do so.
so. I have
I have operated
operated at
at different
different hospital's,
hospital's,
16 at Boston
at Boston Children's
Children's Hospital
Hospital for
for example,
example, and
and II
17 would stay
would a few
stay a few days
days to
to follow
follow the
the patients
patients and
18 lecture to
lecture the residents?
to the residents, answer
anSWer students
students at
at the
the
19 same time.
eatae time. I lectured
I this year
lectured this year at
at the
the --
— for
20 example the
example the American
American Osteopathic
Osteopathie Association which
Association which
21 is the
is the largest
largest group,
group, really
really percentage
percentage wise
wise of
22 general family
general doctors,
family doctors. that I
So that
So I have
have gotten
gotten and
23 had contact
had contact really
really with
with all
all different
different levels
levels of
24 medical practices
medical practices and
and the
the scientific aspects as
scientific aspects
25 well.
well,
 207
207

1 QQ Doctor, approximately
Doctori approximately how
how many
many journals
journals have
have you
you
2 published articles
published for in
articles for in your
your career
career for
for purposes
purposes
3 of discussing
of discussing various
various raedical
medical views
views that
that have been
have been
4 published?
published?
5 hA sure I have
11m sure
I'm have published
published more
more than
than one
one hundred
hundred
6 medical scientific
medical scientific papers
papers and medical
medioal journals
journals and
and
7 1 have
I have also
also published
published aa book
book for
for surgeons, Post
surgeons, Post
8 Operative Thoraxic
Operative 'rhoraxic surgery
surgery some
some years
years ago.
ago. More
More
9 recently I published
recently published a book
book for the public
public called
called
10 Dr. Beimlick'E
Dr. Heimlick's Horae
Home Guide
Guide to Emergency
Emergency Hedical
Medical
11 Situations, which again
Situations, again is to teach medicine
medicine to the
the

12 public.
public. And I have
And have done
done other
other types
types of popular
popular
13 writing and
writing and interviews
interviews as well.
well. interests have
My Interests have
14 extended beyond
extended beyond the
the medical
medical surgical,
surgical.
15 Q Can you
Can you tell
tell us
us whether
whether you
you put
put in
in a
a practice
practice to
16 writing, lecturing
writing, lecturing and
and teaching
teaching the
the practice
practice of
of
17 medicine, it's the
medicine, the therae
theme that
that there
there is a place for
place for
18 treatment in that
treatment that you
you treat
treat the
the immediate
immediate problem
problem
19 the patient
the patient brings
brings to you*
you. That's one
That's one of the
the
20 standards that
standards that you
you have
have lectured
lectured on,
on, if a person
person
21 comes to complain
comes complain of pain,
pain, you
you deal
deal with
with that
that
22 problem then
problem then and
and there?
there?
23 hA One thing
One thing I have
have been
been trying
trying to
to do,
do, I never
never feel
feel
24 the public
the public has
bas to
to know
know more
more about
about raedicine.
medicine. The
The
25 doctor has
doctor has the
the background
background and
and knows
knows about
about it, but II i
it, but

~------------------------------. J
 208
208

1 feel the
feel the public
pUblic should
should know
know better
better every
every day
day
2 medicine answers
medicine answers and
and television
television programs.
programs. Ir don't
don't

3 know if it
know if it comes
comes in
in this
this area,
area, it's
it's about
about 88 states
states
4 whicb originates
which originates in
in Cincinnati,
CinCinnati. And once
and once aa month
month II
5 go to
go to that
that for
for just
just that
that purpose
purpose to
to say
say so
sorauch
much on
on
6 television, that
television, tbat is
is this
this gigantic
gigantic machine
machine that
that
7 costs five
costs five hundred
hundred million
million dollars
dollars or
or whatever,
whatever, and
and
8 very complicated
very complicated and
and what
what is
is now,
now, II feel
feel that it is
that it is
9 important to
important to get
get down
down to
to the
the basics,
basics, to
to what
what hurts,
hurts,
10 wbere does
where does it
it hurt,
hurt, how
how do
do you
you treat
treat it,
it, both
both to
to
11 yourself and
yourself and what
what the
the doctor
doctor should
should know.
know.
12 gQ Doctor, what
Doctor, what you
you know
know of
of university
university atmosphere
atmosphere of
of
13 the medical
the medical school
school or
or residency
residency program
program would
would you
you
14 describe —
describe -- what
what is
is the
the term,
term, a
a full
full work
work up
up for
for
15 the patient
the patient in
in that
that hospital
hospital atmosphere
atmosphere generally
generally
16 entail?
entail?
17 hA Well, in
Well, in a
a full
full work,
work, your
your talking
talking about
about a
a medical
medical
18 school major
school major hospital
hospital type
type of
of thing
thin9 in
in a
a teaching
teaching
19 proqtam?
program?
20 Q
Q Yes.
Yes*
21 hA Of course
Of course in
in the
the teaching
teaching program
program it's
it's much
much more
more
22 extensive than
extensive than the
the doctor
doctor who
who is
is practicing
practicing in
in the
the
23 hospital.
hospital. The doctor
The doctor practicing
practicing in
in the
the hospital
hospital
24 will hopefully
will hopefully stick
stick to
to those
those —
-- that
that are
are apparent
apparent
25 to the
to the patient
patient at
at that moment.
that moment. But in
But in a
a teaching
teaching

I
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 209
209

1 program a
program a resident
resident or
or medical
medical student
stud~nt has
has to
to learn
learn
2 out right,
out right, of
of things
things to
to do whether they
do whether they are
are
3 essential at
essential at that
that point
pOint or
or not,
not. He has
He has to
to know
know to
to
4 do something
do something so that
tbat he says
says that
that he
he doesn't
doesn't get
get aa
5 positive result
positive result in a
a large
large number
number of
of cases
cases and
and
6 might not
might not do it again
again in the
the future.
future. So a full
full
1 work up includes
work includes all
all types
types and varieties
varieties of blood
blood
8 tests, x-rays
tests, x-rays as well
well as the
the history
history and
and the
the
9 examination
examination of the
the patients,
patients.
10 MR,
MR. ROBIHSONs
ROBINSON: May I ask
ask one
one more
more
11 question, your
question, your Honor?
Honor?
12 THE COURT:
COURT: Weil,
Hell, go ahead,
ahead.
13 Q (By
(By Mr.
Mr. Robinson)
Robinson) Doctor,
Doctor, have
have you
you ever
ever heard
heard of
of a
a
14 drug or medication
drug medication called
called Pyribena&mine?
Pyribenzamine?
15 A Yes.
Yes,
16 Q And
And have
have you
you ever
ever heard
heard of
of a
a pain
pain relief medication
relief medication
17 called
called Talwin?
T&lwin?
18 A Talwin, of course,
Talwin, course.
19 Q Yes.
Yes. Could
Could you
you tell
tell Hie whether
me whether in
in your
your 39
39 years
years as
20 a physician
physician all
all these
these things
things you
you have
have ever
ever
21 discussed,
discussed, you
you have
have ever
ever heard
heard don't
don't prescribed
prescribed
22 PB£,
PBZ, is
is what
what I'm going
going to
to call
call it and
and Talwin
Talwin
23 because
because it may
may be
be addictive
addictive to
to addicts
addicts on
on the
24 street.
25 Have
Have you
you ever
ever heard
heard that
that in
in the
the

!
I
!
._------_j
 210
210

1 residency programs or
residency programs or lectures
lectures you
you participated
participated in
2 across
across the
the world in 39
world in 39 years
years of
of medicine?
medicine?
3 A
A No,
No, I have not.
have not,
4 Q Did you
Did you know,
know, that
that -- did you
— did you know,
know, until met you
until II met you
5 and diScussed your
and discussed your testimony
testimony last
last night
night that there
that there
6 is a journal,
is journal, or
or journal
journal articles
articles written
written in
7 September
September of 1980,
1980, which
which someone
someone may
©ay show you
show you
8 later, that
later, that suggests
suggests that if an
that if an addict gets Talwin
addict gets Talwin
9 and paz and
and PBZ takes the
and takes the capsules
capsules and
and breaks
breaks them
them down
down
10 and
and melts
melts them
them and
and heats
heats them
them and
and injects
injects them
thera into
11 their body, they
their body, they can
can get
get a
a Heroin
Heroin high.
high. Did you
Did you
12 know
know that before it
that before was discussed
it was discussed with
with you
you last
last
13 night?
night?
14 A
A Ho, II bave
NO, not.
have not.
15 Q Have
Have you
you ever
ever heard that it
heard that it had
had been
been aa standard of
standard of
16 medicine that a
medicine that a physician should not
physician should not prescribe
prescribe
17 those two medicines
those two medicines at
at the
the same
same time'?
time?
18 A No,
No, II never
never heard
heard that.
that. In fact, I
In fact, I might
might say
say II
19 think they
they have commonly been
have commonly been prescribed
prescribed at
at the
the
20 same time because
same time because the
the complaint
complaint that
that cross
cross one or
one or
21 the other frequently
the other frequently requires
requires both,
both.
22 Q Doctor,
Doctor, are
are you
you familiar
familiar with
with the
the reputation
reputation of
of the
the
23 University
University of
of Michigan
Michigan Medical school?
Medical school?
24 A
A Yes,
Yes, it's
it's one
one of
of the
the world leaders.
world leaders.
25 Q And
And are
are you
you familiar
familiar with
with Ryan
Ryan Krebs
Krebs over
over there
there on
 211
211

1 the wall?
the wall?
2 AA Yes, II certainly
Yes, certainly am.
am.
3 0Q How many
How many years
years have
have you
you been
been knowing
knowing Ryan
Ryan Krebs?
Krebs?
4 AA little over
AA little over ten
ten years,
years.
5 QQ And this
And this is
1s your
your son,
son, right
right here?
here?
6 AA my son,
That's ray
that's yes.
son, yes.
7 QQ You have
You have been knowing him
been knowing him about
about 29
29 years?
years?
8 AA Yes, just
Yes, just about.
about.
9 QQ And can
can you
you tell
tell us whether
whether your
your son
son and
and Ryan
Ryan Krebs
Krebs
10 went to
went to college
college together?
together?
11 AA Yes, they
Yes, they certainly
certainly did,
did.
12 QQ And you
And you had
had an
an opportunity,
opportunity, since
since those
those days,
days, to
to
13 get to
get to know
know Ryan
Ryan Krebs?
Krebs?
14 AA II certainly
certainly did.
did.
15 QQ Have you
Have you had
had an opportunity,
opportunity, over
over the
the past
past ten
ten
16 years, to meet
years, meet with
with and get
get to know
know Ryan
Ryan Krebs
Krebs and
and
17 form an opinion
form opinion as to his
hie honesty
honesty and Integrity?
integrity?
18 A most certainly
I most certainly have.
have.
19 Q
0 What
What is
is your
your opinion?
opinion?
20 A Ryan, he's
As to Ryan, be's an —*
-- in his
his integrity,
integrity, he's
hels aa
21 marvelous young
marvelous young man,
man. would say
I would say he's
hefs like
like my son.
son.
22 Se'e absolutely
He's absolutely honest,
honest, and
and I just
just can't
can't conceive
conceive
23 him straying.
of hira straying_ know him
I know him very
very well
well because
because of
of
24 my son's
my sonts close
close friends,
friends, he
he was
was interested
interested in
in
2S medicine*
medicine, and
and I therefore,
therefore, took
took a particular
particular

-__
J
 212
212

1 interest in
interest in him,
him.
2 Qo Can you
Can you tell
tell us
us when
when your
your sons
sona birthdate
birthdate is,
is, by the
by the

3 way?
way?
4 hA Pardon.
Pardon.
5 Qo What day
What day of
of the
the year
year was
was your
your son born?
SOD born?

6 hA 11.
December 11.
December
7 QQ Do you
Do you recall
recall December
December 11,
11, 1981,
1981, almost
almost aa year
year ago,
ago,
8 whether Ryan
whether Ryan Krebs
Krebs came
came down
down to
to see
see you
you and
and your
your
9 son in
son in Cincinnati,
Cincinnati, on
on the
the birthday
birthday weekend?
weekend?
10 hA YYes.
es.
11 QQ Was there
was there aa tennis
tennis tournament?
tournament?
12 AA Yes, it
Yes, it was
was the
the Davis
Davis Cup
Cup Tournament
Tournament at
at the
the
13 coliseum.
coliseum.
14 QQ Did you
Did you attend
attend any
any of
of the
the —
15 hA (Interposing) Yes,
(Interposing) Yes, 1I did.
did.
16 QQ Can you
can you tell
tell us
us whether
whether your
your son
son and
and Ryan
Ryan Krebs
Krebs
17 attended?
attended?
18 AA Yes.
Yes.
19 QQ They were
They were both
both there?
there?
20 hA YYes.
es.
21 Q
Q That would
That would be
be Saturday Or Sunday?
Saturday or Sunday?
22 hA II was
was there
there one
one day
day and
and I
I honestly
honestly cannot
cannot recall,
recall,
23 but I
but I think
think it
it was
was mostly
mostly Saturday.
Saturday. aut II know
But know
24 that Ryan
that Ryan was
was with
with Phillip
Phillip for those
those three
three days,
days,
25 from Phillip
from Phillip telling
telling roe
me that.
tbat.
I
I

II
I

------_j
 213
213

1 Q
Q Now,
Now, doctor
doctor Heimlick,You
Heimlick you referred
referred to
to the
the Hcimlick
Heimlick
2 Institute which
Institute which was
was a part
part of the Xavier Medical
Xavier Medical
3 School, is that correct?
School, correct?
4 A
A Xavier
Xavler University,
University, not medical school.
medical school.
5 Q
Q What
What is
is the
the purpose
purpose of the
the Heimlick
Heimlick Institute?
Institute?
6 A
A Well,
Well, my
my work has
has been
been broadened
broadened involving
involving many
7 things of an innovative
things innovative nature.
nature. A proscriptive.
A prescriptive.

8 You —
You -- we spoke
spoke of the Heimlick
Heimlick Maneuver
Maneuver
9 which has
which has become
become more public than
more public than other things
things such
10 esophagus operation,
as the esophagus operation.
11 I also
I also had
had the
the opportunity,
opportunity, in
in the mid
the raid
12 60's, or in the early
60's, early 60*s
60's to develop
develop what
what is known
13 to the medical
medical profession
profession as the
the Heimliok Chest
Heimlick Chest
14 Drainage valve
Drainage valve and that severe
severe small
small gadget,
gadget, really
15 little plastic
just a little plastic valve
valve which,
which, when
when I was
was in
16 charge in a — I had one guerilla American soldier
11 just 12 Americans.
just Americans. And there were a £ew hundred
18 Chinese guerillas.
Chinese guerillas. I had one man shot in the chest
19 and he was
was the one man
man I felt I
1 had lost that
20 perhaps something
perhaps something could be done
done about it because
about it because
21 there was
there was no way to treat
treat a wound
wound of the chest at
22 that time.
time. And the Helmlick
Heiialick Chest
Chest Drainage
Drainage valve
23 came about
casae about after I had
bad finished
finished my
my chest
chest surgical
surgical
24 training and was
training was practicing
practicing and teaching.
teaching. It was aa
25 means of introducing
means introducing the tube through
through the bullet
 214
214

1 hole with
hole with a
a valve
valve on
on it
it which
which enabled
enabled a
a person
person to
2 survive.
survive. That
That was
was credited
credited with saving hundreds
with saving hundreds of
of
3 lives of
lives of Vietnam
Vietnam and has since
and bas since that
that time.
time.
4 I mentioned this
I mentioned this to
to show
show different
different work
work
5 I have
have been
been involved in. I'm
involved in. I'm working
working now and II say
now and say
6 the Heimlick
the Heimlick institute
Institute for
for improving
improving the
the domestic
domestic
7 economy through world
economy through world peace.
peace. So the
So the Heimlick
Heimlick
8 Institute can
Institute defined as
can be defined a© an institution
inatitution that
that
9 tries to prevent
tries to prevent medical, sociological and
medical, SOCiological and
10 international
international tragedies, and
tragedies, and act
act in
in aa humanitarian
humanitarian
11 way_
way.
12 Q I'll ask
I'll two questions
ask two questions and then I'll
and then I'll be
be done
done with
with
13 the
the area,
area.
14 First doctor,
First based on
doctor, based on your
your knowledge
knowledge of
15 Ryan Krebs
Ryan Krebs and your
your opinion
opinion of
of him
him and
and knowledge
knowledge of

16 the medical school

the medical school and
and the
the undergraduate
undergraduate school,
school,
17 his internship
his internship in
in Michigan, residency program
Michigan, residency program he
18 was in, and
was in, and your
your opinion
opinion that
that you have given
you have given about
about
19 his integrity, did
his integrity, did there
there corae
come a tiro®
time in
in December
December
20 following that weekend
following that weekend of
of your
your Bon's
son's birthday,
birthday, that
that
21 weekend, that you
weekend, that you made
made a
a decision
decision to
to offer
offer Ryan
Ryan
22 Krebs
Krebs a job
job with
with the
the Heimlick Institute?
Heimlick Institute?
23 A Yes.
Yes. I
I would
would like
like to
to say
say I
I met
met Ryan
Ryan Krebs
Krebs as
as II
24 said
said over
over a
a —
-- a
a little
little over
over ten
ten years
years ago.
ago. I
I used
used
25 to
to see him when
see him when I
I would
would visit
visit Phillip
Phillip at
at the
the
 215
215

1 college and we
college and we talked.
talked.
2 I was impressed
I was impressed with
with his
his intelligence
intelligence
3 and hia
and his decency.
decency. And
And I
I followed
followed his
his career.
career. He
4 got into an
got into excellent medical
an excellent school, which
medical school, which means
means
5 he had
he had both a good
both a good background
bacKgrOund and good marks.
and good marks. He
6 went to school
went to school at the University
at the University of
of Texas
Texas in
7 Dallas, and
Dallas, and that 9ave me
that gave another inkling
me another inkling to
to support
support

8 my judgment
my judgment as to his
as to his qualifications.
qualifications. Then I
Then I did

9 find, as II was
find, as was following
following him,
him, that
that he
he had
had his
his
10 internship at
internship at the
the University
university of
of Michigan
Michigan Medical
Medical
11 Center which
Center which is
is truly one of
truly one of the
the very
very best.
best. You
12 don't get
don't get in
in there unless you
there unless you are
are a
a special
special type of
type of

13 person*
person.
14 I
I was
was impressed
impressed with
with ~is
his dedication
dedication to
to
15 people and
people to medicine
and to medicine because
because he
he was
was willing
willing to
16 take the
take extra years,
the extra years, to
to take
take a
a residency
residency in
17 internal roedicine
internal medicine and
and to
to advance
advance his
his knowledge
knowledge and
and
18 experience and guidance.
experience and guidance. And II was
And was impressed
impressed with
with
19 the fact
the fact that
that he
he had
had been
been accepted
accepted into that
into that
20 program
program and
and been
been able to advance
able to advance right
right through it
through it
21 at
at the University of
the University of Michigan.
Michigan.
22 After he
After was viSiting
he was in Cincinnati
visiting in Cincinnati on
23 that weekend
that weekend in
in December,
December, II spoke
spoke to my son
to ray son or
24 asked him
asked him to
to get
get in
in touch
touch with
with Ryan
Ryan and
and asked Or.
asked Dr.
25 Krebs to come
Krebs to and head
come and head the
the direction
direction of the --
of the — to
to
 216
216

1 act as
act as Associate
Associate Director,
Director, and
and head
head the direction
the direction
2 and the
and the runnin9
running of the research
of the research and
and medical work at
medical work

3 the at
the the Heiitlick
at the Heimlick Institute.
Institute. was informed
I was informed that --
4 Phil informed
Phil informed me
me that
that he
he had
had already
already had
had been
been
5 offered a
offered a position
position at
at the
the Scripts
Scripts Clinic
Clinic in Loyola,
in Loyola,
6 California, wbich
California, which is
is one
one of the
the finest
finest in
in the
7 country.
country. And I suspected
And suspected that
that probably
probably that
that is
8 where he
where he would choose to
would choose to go.
90. But I wasn't
But wasn't sure.
sure.
9 But I
But would say
I would say that
that he
he would be be
would be be welcome
welcome to
to work
10 at the
at the Heimlick
Heimlick Institute
Institute at
at any
any time
time he
he should
should so
11 desire.
desire.
12 Q Doctor, would
Doctor, the credibility
would the credibility of
of your
your institute
institute and I

13 the need
the need for
for credibility
credibility for
for carrying
carrying on
on your work,
your work,
14 notwithstanding
notwithstanding these charges
these charges he
he is
is welcome
welcome there
there
15 be gets
if he gets through
through this
this mess?
mess?
16 A is most
He is most welcome, yes.
welcome, yes. I think
think he'd
he'd be great
be a great
17 asset. *
asset
18 Ryan is
Ryan is a
a dedicated
dedicated young
young man,
man, and
and II
19 just can't
just can't accept any of
accept any of the thingB charged
the things against
charged against
20 bim.
him. He's not
He's not that
that kind.
kind. And I came
And aame here froo
here frora
21 CinCinnati, to
Cincinnati, to make that known,
make that known, and
and I
I might
might say
22 now, that
now, that II have
have to be here
to be here for
for an
an ejctra
extra day.
day. II
23 came yesterday.
came yesterday. I would
I would certainly
certainly do
do so
so if
if need
need
24 be.
be,
25 COURT:
THE COURT? The Court
Court is
is in
in recess.
recess. Do
 217
217

11 not diaeuss
not discuss our
our case
case or
or read
read any
any articles,
articles, if there !
if there
!
22 should be any, or listen to any program or
should be any, or liaten to any program or !
33 broadcast if there should be any concerning our
broadcast if there should b® any concerning our
44 case.
case• !
55 (Adjournment.)
(Adjournment.)
66
77
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J C r : F. HEHMAN, Cierk
UNITED STATES
UNITED
. I^t^jp-THE
STATES DISTRICT
THF-EASTERV
EASTERN
DISTRICT COURT
DrDISTRICT
STERN DISTRICT
SOUTHERE DIVISION
COURT
or OF KICHLGAK
STRIC,]' OF
SOUTHERN DIVISIOF

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UNITED STATES OF
UNITED STATES OP AMERICA?
l,CiERI Clfi ~ ••'ft?
~ f.
Plaintiff \
- >.

-VE- *IVK\ C-^Cfi^5imina 1 Action

•VE-
6 \A£\A^- ' Ko. 8 2-80242
l
NELLIE
lJELLIE BELL
BELL KASSIK, et.«ad^,?. ' _^-
7
Defendant.
Defendant.
8 ______________
. y1
9
Proceedings
Proceedings had
had and
and testiir.ony
testimony take-
take~
10
in the
the above-entitled
above-entitled matter,
matter, before
before the HONORABLE
the HONORAELE
11
., ,..
ANNA
ANNA DIGGS TAYLOR, U. S. District
DIGGS TAYLOR, District Judge,
Judge, at
at 211
211 U.S.
r.E .
.L-l

~ ..,
Courthouse
Courthouse and
and Federal
Federal Building,
Building, Detroit,
Detroit, Nichigar.,
Lichis:c.f ..
J__J

cn Friday,
on Friday, October
October 29,
29, 1982.
1982.
,,
..l-4.

APPEARANCES:
APPEARA.NCES ~
1 t::
..,L _,- ELLEN DENNIS and CAKEE I cCh~~E'
ELLEN DENNIS and JM'.EE NcCARTHV- :-V:
16 On behalf of t he Governn.E:',t.
On behalf of the Government.
~ "7
.!. f KENNETH ROBINSON, ESQ .
KERNETE ROBINSON, ESQ.
On behalf of
IE,
On behalf of Defendant Krets.
Defendant Krecs.
1°
_' -~j ** - • JAMES HOWARTE,
JAMES EOWARTE, ESO.
ESO.

20 On behalf
On behalf of
of Defendant
Defendant Levine.
LEvi~e.

21 *"?- j\ / DAVID
DAVID WRIGHT,
WRIGHT, ESQ.
ESQ.
n On
On behalf
behalf of
of Defendant
Defendant Danner.
Danner.
22
,....
-l:5
-~ t i
RICHARD J. AMBER,
RICHARD AKBER, JR.,
JR., ESQ.
ESO.

24 On
On behalf of Defendant
behalf of DefenClant Curry.
Curry.
-T
25 (Cont inuec .
(Contint.:EC

• i~
~<.
 I. Appearances (Continued)s
1 EDWARE l7I
EDWi\Hr UISENOK,
SHNOK r

3 On
On behalf
behalf of
of Defendant
Defendant Ricks.
Ricks.
4 WILLIAK WOODARD,
WILLIAM WOODARD, ESQ.
ESQ.
~ On behalf of
On behalf of Defendant Hicks.
Defendant Hicks.
EC DONALD FERRIS,
DONALD FERRIS, ESQ.
ESQ.
7 On behalf
On behalf of
of Defendant
Defendant Zellner.
Zellner.
8
8 ! DENNIS SNYDER,
DENNIS SEYDER, ESQ.
ESQ.
9
9 On
On behalf
behalf of
of Defendant
Defendant Fields.
Fields.
10 SANFORD ROSENTHAL,
SANFORD ROSENTHAL, ESQ.
ESQ.

11
11 On
On behalf of Defendant
behalf of Defendant Iczkovit:
Iczkovitz.

12 RICHARD ROTH,
RICHARD ROTH, ESQ.
ESQ.

13
13 On behalf
On behalf of Defendant
Defendant Scotch
Scotch

14
14 Castle Pharmacy
Castle Pharm&cy

}6
16
,I
17-
..\.

IE
16
19

20

21
21
j
22
22 ELIZABETH
ELIZABETH E.
E. MONTGOMERY,
MONTGOMERY, RPR,
RPR, CSR
CSR
IOfficial
Official Court
Court Reporter
Reporter
23
23 !(313)
(313) 961-5965
961-5965
24
24

--
 -;- f- t-\ Tn ^'
1 I; i.' b ii
~'.
L

3 ITUESSES: PAGE

"- PENRY HEIMLICE

RENRY BEH1LICK
t::
Direct Exaiaination
Direct EXBDination by Mr.
by Mr. Robinson
Robinson

6 Cross Examination
Cross Examination by Mr.
by Mr. McCarthy
McCarthy 17

7 Cross Examination
Cross Examination Mr. Kowarth
by Mr.
by Howarth 58

8 ReDirect Examination
ReDirect Examination by Mr.
by Mr. Robinson
Robinson

9 Recross Examination
Recross Examination Mr. McCarthy
by Mr.
by McCarthy 66

10 ReDirect
ReDirect Examination
Examination by
by Mr.
Mr. Robinson
Robinson 66
~, c~
1. .1. ALLAN LAUFMAN
ALLAN LI:tUFHAN v I

12- Direct Examination

Examination by Mr.
Mr. Robinson
Robinson ("7
Direct by
13 Examination
Cross Examination
Cross by Mr.
by McCarthy
Mr. McCarthy ~ 2 C

14 ReDirect Examination
ReDirect Examination by Mr.
by Robinson
Iiir. Robinson

15 GEROCr: KILLER
GEROGE HILLEr:

16 Direct Examination
Direct Examination Mr. Robinson
by Kr.
by Robinson

17 Voir Dire
Voir Dire Examination
Examination Mr. McCarthy
by Mr. McCarthy lS:'

IB Direct Examination
Direct Examination (Continuned)
(Continuned) by
by
19 hr.
Kr. Rob Ln acri
Robinson 16(,

20 Cross Examination
Cross Examination Mr. McCarthy
by Kr. McCarthy
191=
21
22

23

24

25

•
 --- ----------------------------------. --- _-------_- ----

Detroit,
Detroit, Michigan
Michigan 48226
43226
Friday, October 29,
Friday, Cctober 29, 1982
1982
3
3 (9 9:00
{ : 0 a.m.)
C a.m.)
4
4
5 TEE
THE COURT:
COURT: Good
Good morning,
morning, ladies
ladies and
anc

6
6 gentlemen.
gentlemen.

7
7 You are
You are still
still under
under oath,
oath, Doctor.
Doctor.

8
8 D RR.. H E N H
HEN R Y
Y E EE II r·tM L
H L II C
C K
9
9 having been
having been previously
previously sworn to
sworn to tell
tell the
the truth,
truth, the
the

10 whole truth,
whole truth, and
and nothing but the
nothing but the truth,
truth, was
was examined.
exarnine6

11
11 and
and testified
testified as
as follows:
follows:

12
12 DIRECT
DIRECT EXAKINATIOK
EXAMINATION CONTINUED
CONTINUED

13 EY
BY MR. ROBINSON:
MR. ROBINSON:
, '\-,.
14 Q
Q Dr. Eeimlick,
Dr. Beimlick, other than
other than, your
your experiences,
experiences, Wulcn
which
15,
15 you outlined
you outlined in detail
detail yesterday,
yesterday, do
do you
you still
still have
havE

16 hospital
hospital privileges
privileges and
and a
a practice
practice along
along with
with all
all

17 of
of these other things
these other things ycu do?
yeu do?

18 A
']& Yes,
Yes, I
I do.
do.

19 ; And tell
And us, please,
please, what
what some
some of
of those
those functions
functions
Q
Q tell us,

20
20 in that practice
in that practice are
are that
that you
you presently
presently have
have

21
21 regarding
regarding patients?
patients?

:A Well, I'm practicing

Well, practicing primarily
primarily in consultation
consultation fcr
fer

23
23 various
various conditions.
conditions. But
But also,
also, particularly
particularly in
24
24 regard
regard to
to treating
treating patients
patients with
with a new
new method
method 1
~

25 developed
developed for
for providing
providing oxygen
oxygen to
to people
people with
with

-----------------
 chronic
chronic lung
lunc disease
disease or
or heart diseasE.
heart disease. An~ ~atle~:
Any patient
that needs
that needs oxygen
oxygen formerly
formerly has been
has been tied
tied down
tow~ tc a
to a

tank or
tank machine
or machine through a
through a tube
tube going
going into their
into their
nose which delivers
nose which delivers the oxygen.
the oxygen.

Through
Through studies
studies done
done ever
ever aa perio6
period of
6 years
years in
in our
our research
research laboratories,
laboratories, II was able tc
was able to

7 show that
show if you
that if you give the oxygen
give the oxygen through
through a very
a very

8 tiny, tiny
tiny, tiny little
little plastic
plastic tube,
tube, a plastic
a plastic tube
tube put
~~t

9 in the
in the windpipe,
windpipe, the trachea
the trachea under
under here,
here, just
just the
the

10 lowest part
lowest part of
of the
the neck,
neck, that
that you
you save
save so
so much
much
11 oxygen and
oxygen and you
you save,
save, you
you use
use four
four times less oxyge~
times less oxygen
than
than if
if you
you give
give it
it through
through the
the nose,
nose, becauLE
because i~
13 you 91ve
you the oxygen
give the oxygen through
through the nose,
the the r e s a
nose i there'sj v e':
( vay

14 ~round the
arcund the nose
nOSE and
and mouth
mouth and
and the
the patient
patient has
nSf tc
tc

15 suck the
suck oxygen down
the oxygen down into
into the
the lungs.
lungs.

16 We found
We found in
in our studies,
our studies, original
original
17 studies
studies and it
and it has been proven
has been proven in
in the
the patients
patientE ~ha~
that
18 treated over the
treated over the last,
last, little
little more
more than
than two
two and
and a&
19 quarter
quarter years with this
years with this method,
method, that a --
that a they save
-- they saVE

20 so
so much
much oxygen by having
oxygen by having it
it delivered,
delivered this way
this way --
21 this
this procedure
procedure which
which takes
takes about five minutes
about five minutes
22 actually, that a
actually, that a small
small tank,
tank, a
a six
six pound
poun~ tank
tank that
tha:

23 can be
can be carried
carried like a
like a camera
camera case
case will
will last
last the
the

24 patient a
patient whole day,
a whole day, at least say
at least say 6 to
to 12 hours,
hours,

25 depending
depending on
on how
how much
much they
they use.
use. So that these
So that these
 (

pa t i e n t e who
patients who were
were fo r nie r Ly tied
forraerly t. i e d down to the
down to the Le a sh
leash
r-.
4, or to
or to the
the tank,
tank, are
are now
now free to move
free to move about
about and livE
and iiv
3 within the
within the framework
framework of
of aa fairly normal life.
fairly normal life. ThE. ,.
The
4 can travel
can travel and
and work,
work, some
some of
of them,
them, and
and enjoy
enjoy
r;.
.J themselves •
themselves.
6 am now
So, I am now seeing
seeing patients
patients primarily
primarily
7 for this
for this purpose
purpose and
and I'm providing
providing this
this care
care both
both
8 in a hospital
in hospital in Cincinnati
in Cincinnati and also,
and also, I a
received a
I received

0 grant from
.;I
grant from aa foundation,
foundation, aa foundation that is
foundation that is

10 particularly
particularly interested
interested in the
in the people of West
people of West
11 Virginia,
Virginia, and I received
and I received a grant
a grant to
to provide
provide this
this tto
12 the people
the people of
of West
West Virginia
Virginia who have
who have black
black lung
lung
., ..,
j_~ disease,
disease, a
a great many of
great many of them,
them, as
as well
well as
as their
their
14 families
families who
who may have emphysema
may have- emphysema or other
or other chronic
chronic
15 lung disease
lung disease or heart
or heart disease.
disease. So I
So I have
have been
been
16 traveling
traveling once a
once month to
a month West Virginia
to West Virginia to provide
to provide
17 this for
this these people.
for these people.
18 Q Doctor,
Doctor, is it
is it fair
fair to
to say
Bay that
that in
in your
your 38
38 years as
years as
19 a physician
a physician all
all of
of the
the things you have
things you have described
described
20 you have
you have become
become familiar
familiar with the
with the standards
standards of
21 practiCing
practicing medicine the universities,
at the
medicine- at universities, in
22 residencies
residencies and hospitals
and hospitals and in
and in clinical
clinical
23 situations
situations as well
as well as having listed
as having listed at
at least
least three
three
24 innovative
innovative standards
standards that you
that have come
you have come up
up with
with
25 yourself?
yourself?
 L Tnat"s correct.
2 MR. ROBINSON:
MR. ROBINSON: Your
Your Eonor,
Honor, I
1 offEr tte
offer the
doctor as
doctor as an
an expert
expert at
at this time, in the
this time, the fiele
field of
4 medicine.
medicine.
MR. McCARTHY:
MR. Me CARTEY: No
Mo objection,
objection, your
your Honor.
Honor.
6 THE COURT:
THE COURT: He is.
is.
7 Q
Q (By Mr.
Mr. Robinson):
Robinson): Doctor, are
Doctor, are you
you familiar
familiar with
with
8 the Physicians
the Physicians Desk Reference,
Desk Reference, the PDR?
the PDR? You are
You are
9 familiar with that?
familiar with that?
10 A
A Oh, yes.
Oh, yes.

11 Q
Q Can you
Can you tell
tell us
us whether
whether or
or not,
not, in
in your
your opinion
opinion as
as
12 a physician
a physician with
with reasonable
reasonable medical
medical certaint~r
certainty, it
it

1'<. is authoritative or
is authoritative or not
not to
to physicians
physicians both in
both tt~
in the
14 practice
practice of medicine,
medicine, in hospitals
in hosfitals and residenclEE
ana residencies
15 and universities?
and universities?
16 A It is
It is both
both authoritative
authoritative and
and widely
widely used.
used. Probably
Prob2.tly

17 one
one of
of the
the most
most widely
widely used
used sources
sources of medication.
of medication.

18 Q
Q Doctor, assume
Doctor, assume that
that you're
you're aa physician
physician and
and that
that you
you
19 are prescribing
are prescribing a medication
medication which
which is
is listed
listed in the
the

20 PBR and that

PDR and that you
you want
want to
to see
see what
what the
the warnings,
warnings,

21 contraindications
contraindications and
and indications
indications are
are for
for that
that

22 medication
medication and you refer
and you refer to
to the
the PDR,
PDR, would
would it be

23 reasonable
reasonable to
to expect
expect a physician
physician to
to rely
rely upon what
upon what

24 is
is said that PDR,
said in that PDR, to
to use
use in
in his
his judgment
judgment in

25 prescribinc
prescribing that medication?
that medication?

-----------------
 r
t

1 K would say
I would say so,
so, yes.
yes.

G Do
Do you
you feel
feel that
that --
-- say
say there
there were
were two
two me6icaticDE
medications
3 such as
such as PBZ
PEZ and
and Talwin
Talwin in the
the Physicians
Physicians Desk
Desk
4, Reference
Reference and the
and the physician was unaware
physician was unaware that
that if
if you
yo~

put the
put two together
the two together and
and you're
you're an
an addict
addict and
and you
yo~

6 do what
do what II was
was telling
telling you yesterday, you
you yesterday, can put
you can put

7 them together, melt

them together, melt them
them down,
down, inject
inject it
it and
and get
get

8 what is called
what is called a Heroin
Heroin high,
high, would
would you
you expect
expect --
9 if the
the PDR
PDR doesn't tell a physician
doesnlt tell physician that
that that
that
10 combination
combination is possible,
possible, would
would you
you expect
expect the
11 physician
physician to
to know
know that
that in his judgment?
his judgment?
12 A I'm sorry.
sorry. It went
It on aa while.
went on while.
,..,
.L ..5 Q I'E --
I'ffi -- II do that.
do that.
14 In other
other words,
words, you
you have
have got
got a PDR that
th~:
15 refers to Talwin
refers to Talwin and
and a FDR
PDR that
that refers
refers to
to PBZ.
PEZ.

16 A
A Yes.
Yes.
17 G
Q And that if
And that if you
you read
read the
the two
two in
in the
the PDR
PDR and
and you
ycu are
are
1B talking
talking about
about tablet
tablet form
form of each
each of the
the

19 medications
medications and
and there's no reference,
there's no reference, and there's
and there's

20 no reference in the
no reference the FDR
PDR from
from the
the drug manufacturer
drug ~anufacturer

21 who
who made
made those
those two drugs, or
two drugs, or no
no editorials
editorials abou- it
about it

22 from
from the
the drug companies in the
drug companies the PDR
PDR indicating
indicating that
that

23 you
you shouldn't
shouldn't mix
mix the two at
the two at any
any time
time as
as aa
24 prescription
prescription to the
to the patient,
patient, at
at the
the same
same time,
time,
25 would
would you
you expect
expect the
the physician
physician to go
to go out
out and
and do
do any
e nv I •. ,
 kino of biological
kino of biological or research
or re se a rch work
wo rk before
b e rc rc he
IlE: .i ac
had
prescribed
prescribed PEE and
FBZ and Talwin,
Talwin, or would
woule you
you expect
E~pect hir.
~lr

to rely on
to rely on what
what the
the PDR
PDF, shows
shows the contraindications
the contraindicaticns

4 and
and indications
indications are?
are?
A I think
I think that
that he
he would
would rely
rely both
both on
on what
what the
the FDR
PDR
6 shows and
shows and his
his knowledge.
knowledge.
7 Q
Q On his
On his knowledge?
knowledge?
(3 A
A Yes.
Yes.
9 Q II believe you
believe you testified
testified yesterday
yesterday that
that your
your
10 knowledge
knowledge is all of
is all of the
the things
things you
you have
have done
done in
_1 ....
1 your life,
your until you
life, until you talked
calked to
to me
me about
about this
this case
case
12 you were
you unaware that
were unaware that there
there ca~
can be
be harmful
harmful affcct~
affectt
13 to an addict
to an addict if
if he
he uses
uses FBZ
PEE ana
and Talwin
Talwin together.
togctter.

You didn't know

You didn't know that
that until
until II discussed.
discusseC

it w ith y
it with you?
ou?

16 A I didn't
I didn't know
know that.
that. I still
I still don't
don't know
know that
that you
you
17 said there could
8ai6 there could be
be harmful
harmful affects.
affects. I'm not surE
not sure
18 of that.
of that.
19 Q Doctor, you
Doctor, you testified
testified yesterday
yesterday about
about in
in 1950
1950
20 working
working in the
in the --
-- a hotel
hotel ~-
-- I can't remember
can't remember
that "-~
that.
A It's called
It's called the
the Hotel
Hotel Health
Health Center
Center and
and it
it was
was the
thE

hotel union
hotel union employees
employees clinic.
clinic.

24 Q All right,
All right, keeping
keeping that
that in
in mind,
mind, let
let me
me give
give you
you aa
hypothetical.
hypothetical.
--------,----"-------- -_"

"-""~"--~--~-"--~--.-~-----_---------

.1 Assume that
Assume a patient
thaL a patient comes to
CODeE to a
a clinic
C~lnl(

"
,(. in 1S81 in a city,
1981 in city, Detroit
Detroit for example,
for example, and
and they
they
-::;
complain
complain of
of a lower back
a lower back problem.
problem. And
And they
they co~e
come in
1~

4 and they
and they see a physician,
see a physician, they
they complain
complain of the
the back
back

5 problem,
problem, the physician has
the physician has the
the blood pressure
blood pressure

6 taken, height,
taken, weight, pulse,
height, weight, pulse, listens
listens to
to whether
whether
7 there's problem in the
there's a problem the lungs,
lungs, has
has the
the patient
patient sit
sit

8 on
on a
a table
table or
or lean
lean over
over a
a table
table and
and do certain
do certain

9 exercises,
exercises, examines the
examines the small
small part of the
part of the back
back

10 where
where the
the complaint
complaint is and
anc feels
feels for
for tenderness
tenderness or
11 muscular
muscular problems and
problems that phYSician
and that physician diagnoses
diagnoses on
12 that visit,
that which takes
visit, which takes from le to
from 1C to 15 minutes
minutes in a
i~ a

13 clinic atmosphere, that

clinic atmosphere, that there is aa back
there is back probler
pro bier, or
or
14 muscular
muscular problem with
problem with the
the back
back and
and prescribes
prescribes
15 Talwin.
Tal \,1 in.

16 Can you
Can you tell
tell us whether or
us whether or not
not your
your

17 examination
examination in 1950,
1950, where
where people
people were complaininc
were complainin~

18 about
about some
some of
of these
these things
thingE were
were any
any different
different than
than

19 that I just
that I just gave
gave you
you in
in the hypothetical?
the hypothetical?

20 I>.. If
If you're
you're talking
talking about
about my
my clinic
clinic and
and I
I worked
worke6 in
in

21 the
the 50's,
50's, the
the hotel
hotel clinic
clinic where
where it
it was
was a single
a sin~le

22 visit walk-in situation,

visit walk-in Situation, then
then that
that was
was the
the type
type of
of

23 treatment
treatment that certainly is
that certainly is usual
usual and
and very
very common
common

24 also in doctors'
also in doctors' offices.
offices.

25 Q And
And have
have you
you talked, or heard
talked, or heard talk in your
talk in your time
time at
at
 .l._

the University
the University during
during the years w
the years h i Le a ccc
while tcr
doctor, any
c.r;~·
1

2 different
different standard
standard in
in that
that kind
kind of
of environment
environment in
l~

dealing with
dealing a patient
with a patient who
who complains that
complains of that
4 problem, who has
problem, who has limited
limited resources
resources and
and who
who has
has

5 pa i n.
pain.
6 Did
Did you treat him
you treat and diagnose
him and diagnose him
hiffi that
that

7 way?
way?
8 l\. I'm not aware
11m not aware of
of any
any such
such discussion.
discussion.
l
9 Q Again your
Again your diagnosis
diagnosis in the 1950 s
the 1950's when
when there waE
there was
10 pain that
pain that you
you felt
felt was
was sufficient
sufficient to
to require
require aa
11 narcotic.
narcotic. believe you
I believe
I you testified
testified you prescribec
you prescribed
12 Aspirin with
Aspirin with Codeine,
Codeine, which
which was
was a controllec
controllec
13 substance,
substance, is
is that right?
that right?
14 Aspirin itlsss equivalent
Aspirin or it equivalent or Aspirin
or Aspirin and
anG Codeine.
Co6eine.
15 All right.
All right. Well,
Well, I'll
I'll give
give you
you the
the other
other
16 hypothetical.
hypothetical.
17 Assume that
Assume that the
the doctor
doctor sits
sits behind
behind aa
18 desk and
desk and a patient
patient comes
comes in
in complaining of a back
complaining of back

19 problem and
problem and the doctor doesn't
the doctor doesn't get
get out
out of
of his
his

20 chair, asks
chair, asks the
the patient
patient what
what he
he wants,
wants, the patient
the patient

21 tells him
tells him and
and the
the doctor
doctor writes
writes out
out a prescripticn
prescription
22 for Talwin.
for Talwin.
23 That would
That would breach
breach the
the standard
standard of
of care,
care,

24 wo u Ldn t it?
wouldn't tit?

I would
would say
say if
if that's
that's the
the first
first time
time the
the doctor
doctor has
has
 1 seen the
seen the patient,
patient, yeE.
yes. If it's
If it's patient who
a patient who has
haE

been coming back

been coming back and
and he
he knows
knows the
the patient and has
patient and has
been treating
been treating the ailment, then
the ailment, it is
then it is conceivable.
conceivable.

Q
Q And of
And of course
course under
under the
the circumstances
circumstances such
such as
as that,
that,
r;
you'd have
you'd have to
to listen
listen to
to what
what the
the patient
patient says
says and
an6
6 what the
what the doctor
doctor says
says and
and then
then believe
believe which
which ever
ever
7 person you
person you wish
wish to
to believe
believe before
before you
you can decide
can decide

8 what
what really happened.
really happened.

Would that be
Would that be a fair statement?
fair statement?

10 A You mean
You mean --
11
........ 0
Q (Interposing) In
(Interposing) In other
other words,
words, the
the patient
patient comes
comes in
in
12 and says
and says the -- pretend
the -- pretend the
the patient
patient who says that
who says that
13 is an
is an FBI
FBI agent and he
agent and. he says
says that
that doctor
doctor se
sc and
and EG
EO

did that,
did and the
that, and the doctor says that
doctor says that is
is not
not true,
true, II
did something
did something else.
else. You are
You not here
are not here to
to give
give an

16 opinion
opinion on who you
on who you believe
believe are you?
are yeu?

17 A No,
Ko, 11m not.
I'm not.
18 G
Q But
But when
when you
you testified
testified earlier
earlier on
on Dr.
Dr. Krebs
Krebs
19 character
character you listed it
you listed it as
as pretty high as
pretty high as I recall?
recall?
20 A Yes, if
Yes, if the
the doctor
doctor were
were Dr.
Dr. Krebs,
Krebs, II would
would accept
accept
his
his word.
wo rd ,
22 Q
Q Now, Doctor,
Now, Doctor, II believe
believe there
there was
was aa time
time in
in the
the past
past
23 where
where you
you were
were called down to
called down to a
e pharmacy
pharmacy or to
24 someone
someone or someone in
or someone in your
your office
office allegedly
allegedly had
had

25 forqed a prescription
forged a prescription in
in your
your name,
name, or
or someone
someone had
had
 1 presented a prescription
presentee: a prescription with
with your
your namE
name C~ it to
on it to aE
2 pharmacist
pharmacist that you
that you had
had to
to sign
sign it,
it, is that
that true~
true?
situation
The situation
The was that I
was that r was called by
was called by a
a phar~aciEt
pharmacist
in Cincinnati
in Cincinnati who said
who that he
said that had just
he had just filled out
filled out
5 a prescription
prescription for
for two
two people
people for
for Diluadid,
Biluacid, which
which
6 is a Morphine
is Morphine type
type narcotic
narcotic drug,
drug, and
and that
that is my
is my
7 signature
signature and
and my number, my
ffiy number, my drug regulation
drug regulation number
number
8 was on
was the prescription.
on the prescription. It was written
It was written on
on a
a
9 hospital
hospital prescription
prescription blank
blank and
and the
the patient's
patient's name
name
10 was, or supposedly
was, or supposedly the patient's
the patient's name had
name had been
been put
put
, 1 on it
.L_
on it and the pharmacist
and the pharmacist said that when
said that when these
theEe
12 people came in
people came in they
they called my office
called my office and this V~f
and this \>cc-
it happened
"■- it happened after
after five p.m. and
five p.m. a usually nc
usually nc or.t
e,LS

III is in
18 in my
my office
office after
after five r.m., or
five p.m., if it
or if it were
were
15 after
after five
five p.m.
p.m. whenever,
whenever, and
and that
that somebody
somebody in ~~
in my
16 offiCE said this
office said this is
is a patient
patient of Dr. Keimlick
of Dr. Heimlick and he
and
17 did write
did write the
the prescription
prescription and gave
and gave her
her name
name and it
and it
18 was not
was -- it
not -- was the
it was the name
name of
of someone who hadn't
someone who hadn't

19 worked for me
worked for me for
for a year and the
year and the druggist
druggist had filleo
had filled
20 the prescription
the prescription and it
and it was
was obviously
obviously a forged
forged
21 prescription
prescription because
because I had
had not
not written
written it,
it, and th~
and the
22 druggist informed me
druggist informed me that
that he
he was going to
was going to turn it
turn it
in.
24 Q Doctor, from your
Doctor, from your experience
experience as a physician
as physician dealins
dealing
with mediCine,
with medicine, obviously,
obviously, oan you tell
can you tell us
us whether
whether
 or not
or not there's
there'E been literature and
been literature and things ycu have
things ycc have

been familiar
been familiar with
with in
in the
the universities
universities and journals
an6 journEls
and medical
and medical schools
schools that
that indicates
indicates in
in the practice
the practicE
of medicine the
of medicine the private
private practice
practice of
of medicine,
medicine,
5 : particularly there
particularly there is
is what
what is
is called
called extensiVE
extensive
6
6 ' tests being
tests being done
done to
to the
the detriment
detriment of
of the
the patient's
patient's
7
7 financial
financial posture?
posture?

8 \h There's
There's been
been a lot
lot of
of information
information coming
corning out
out in
in the
the
Q medical
medical literature
literature to that regard,
to that regard, not
not only
only to
to the
the

10
10 patient's
patient's detriment
detriment but to the
but to the detriment
detriment of
of the
the

11 third
third party
party payee, such as
payee, such as insurance
insurance companies.
companies.
12 There have been
There have been medical
medical studies
studies that
that show
show there
there are
arE
excess
exceEE examinations
examinations being
being done,
done.

14
14 C Can you
Can you tell
tell us
us whether
whether or
or not
not there
there has
has been
been sSCGe
or.;e
15 suggestion
suggestion in some
in some of
of that
that information
information that
that has
has

16 been
been discussed,
discussed, that
that one
one of
of the
the reasons
reasons is
is the
the

17 physicians'
physicians' fear of
fear of malpractice
malpractice so
so they
they create
create aa

18 paper
paper trail
trail to
to suggest
suggest they
they did everything
did everything

19
19 conceivable
conceivable in treating the
in treating patient?
the patient?

20 <h Yes, that is

Yes, that is one
one of
of the
the reasons
reasons and
and I
I think
think some
some
21
21 doctors have good
doctors have good reason
reason to
to do
do that.
that.

c /. ; There has
There has been
been so
so much
much increase
increase in
in
23 \ malpractice in
malpractice in the
the last
last period
period of
of years,
years,
24
24 malpractice
malpractice suits, f and
suits and such
such large
large awards
awards being
being
25 given, that
given, that doctors
doctors in order
order to protect
to protect themselvEE
themselves
 from that
from standpoint,
that standpoints, rather than
rather than as pa[~ c:
2E par- tt~
cf the
patient's
patient's treatment ,,;illfrequently
treatment will cr ce r mar.y
frequently order rcC.r.:·

tests that
tests that are
are beyond
beyond the need
the need c£
ci the
the patient.
P~ti0~L.

Q Without
Without reference to any
reference to any specific
specific drug
crue or
or
5 medication
medication or narcotic
or narcotic the FDR,
in the
in PDF, wo u Lc, you
would e av
YOC say

6 with reasonable
with reasonable medical
medical certainty
certainty that if a dru~
that i~ iE
drug is
7 listed in the
listed PDR as
the FDR as one
one that
that can
can be
be prescribed
prescribed li~
r.
this country
this country by a
a physician,
physician, that
that it
it has
has to
to have
have aa
9 legitimate
legitimate medical purpose?
medical purpose?
10 A I would
I would say
say that
that is
is true.
true.
11 Q And most
And most of
of what
what you
you do
do these
these days,
days, as
as I understa~d
understand
12 it,
it, is try to
is try to develop
develop new methods
new methods to
to further :if
further ric
c eu se of
cause of medicine
medicine and to
and to educate
educate the
t h e public
public or.
CL \ \.-'::iz
;~iCC:

14 medici~e
medicine should be
should be doing,
doing, is that a fair
is that fair statement.,
st~temELC(

through lectures
through lectures and
and research?
research?
16 lim educatins
I'm educating in
in treatment of patients
treatment of patients in general,
scneral,

17 yes.
18 MR. ROBINSON:
KR. ROBINSON: all I have,
That is all
That havE, your
your

19 Honor.
Honor. Thank you.
Thank you.

20 THE COURT:
THE COURT: Doctor.
Doctor.
21 THE WITNESS:
WITNESS: Yes, Honor.
Yes, your Honor.
THE COURT:
THE COURT: patient of apparent
A patient lo~
apparent low
23 economic
economic -- a Black
— Black inner city patient
inner city patient who
who comes
comes to

24 a clinic
clinic which
which bears
bears the
the title
title Medical
Medical Clinic
Clinic and
and
25 is required
is required to
to pay
pav $30
$30 in cash
cash in advance
advance and
and tells
tells
 --- ---~-----------------

~ ,
1 the doctor
the doctor about
about his
his pain;
pain; does
does your
your prOreSS1Cr:
profession
2 recognise
recognize a lesser
lesser standard
standard of
of care to save
care to save the
tte

3 third party
third party payment
payment as
as possibly
possibly --
-- is
is the
the

4 determination
determination made in your
made in your profession
profession that
that this
this is
~~

5
5 not
not the
the time
time to
to make
make the
the tests
tests or
or --
--
6
6 THE HITNESS:
WITNESS: (Interposing) II would
(Interposing) would ha;e
r et e

77 to think
to that the
think that the reason
reason that
that anyone
anyone was
was not
not
8
8 properly
properly tested was
tested was because the}7 were
because they were an inner city
an inner
Black
Black patient.
patient.

10 In fact, in
In fact, in my
ray office
office today
today the manager
the manager
11
11 of my office
of my office is
is --
--
THE COURT:
THE COURT: I just
I just want
want an
an answer to
answer tc
that Question
that --
question --
14
14 THE
THE WITNESS:
WITNESSj I'{
I'd just
just like
like to
to --
--
15
15 'llllE COUET';
THE COURT: (In t e rpo sin 9 ) —
(Interposing) -- is
is the
the sane

16 standard
standard of care applied?
of care applied?
17
17 THE WITNESS:
TEE WITNESS: Unfortunately
Unfortunately in many
in many
18
18 instances it is
instances it is not
not applied,
applied, and
and I'm
I'm aware
aware of thiE
of this
19
19 because --
because --
20
20 THE
TEE COURT:
COURT: And
And does your profession
does your profession
21
21 recognize two standards
recognize two of care,
standards of care, or
or more
more than
than two
twc

22
22 standards
standards of
of care
care for
for patients
patients on
on their
their presumed
presumed
23 ability to pay,
ability to pay, or
or their
their presumed
presumed attachment to the
attachment to thE

24 third party patient?

third party patient?
25 THE WITNESS:
WITNESS: I know
know I
I do
do not
not recognize
recocnize
 twa standards
two standards of care
of care because
becausE it is en
it is C~ aLlllt~ tc
ability
2 pay.
pay. And I'm
lHld I'm sure that
sure that there
there a
art doctors \;;,0
re doctors who doco
3 an6 doctors
and who don't.
doctors who don't.

I have
have been
been in
in some
some very
very excellent
excellent
5 clinics and I have
clinics and have seen
seen some
some even
even in hospitals
hospitals that
tha~
6 are
are not
not as
as good.
good. They
They vary.
vary.

7 THE COURT:
COUR.'l': Thank
Thank you,
you, that
that is
is all.

8 THE WITNESS:
WITNESS: I might,
If I might, your
your Eoncr,
Eonor,
just to
just add that
to add that in my
my office
office the
the manager
manager in my
my
10 office
office is
is a man
man who
who happens
happens to
to be
be Black
Black who
who waE
was the
the
11 assistant.
assistant.
12 'lIRE COURT:
TEE COURT: I thought that's
i thought thatfs what
what yct
YCl

l~.
..:
were goin0
were going to
to tell me .
tell me.
14 THE viI TNE S S :
'r'FIE FITNESS: Is n. not saying it for that
15 purpose,
purpose, but was the
but was the Assistant
Assistant Commissioner
Commissioner of
16 Health in
Health the City
in the City of Cincinnati
Cincinnati and Assistant
and Assistant EEa~
Head
17 of the-
of CETA project
the CETA project before
before it
it closed
closed and was very
and was VEry

18 much aware
much aware of
of what
what happened
happened in the
the inner
inner city.
city.

19 CROSS EXAMINATION
CROSS EXAMINATION

20 MR. MCCARTHY:
BY MR. MCCARTHY:
21 Doctor, when
Doctor, when you worked in the
you worked the hotel
hotel clinic
clinic In the
in the
22 '50'Sf would it
150's, would be fair
it be fair to say that
to say that most
most of the
tte

23 patients
patients that you
that saw come
you saw come in were
were walk-in
walk-in patien~5
patients
24 with
with an immediate problem
an immediate problera that
that you
you treat
treat so
so that
that
they
they could
could go
go back
back to
to work
work or
or better,
better, to
to see
SEe their
their
 ~----~~-.-.-~---.--.--.~------~----~---

1 regular doctor?
regular doctor?

2 IA
A Most were
Most were that
that time,
time, yes.
yes.

3 CQ And
And on
on sorae
some occasions,
occasions, while
while you
you were
were working
workinq in
in

4 that
that particular
particular facility
facility you
you would
would refer
refer persons
persons tc
tc

surgeons
surgeons or
or other
other specialists
specialists during
during the
the course
course of
of

6 your
your practice?
practice?

7 A Yes, I
Yes, I would.
WOUld.

8 Q During the
During the time
time you
you were
were in that
that facility
facility in
in
9 treating persons
treating persons for
for lower
lower back
back problems,
problems, would ycu
would you

10 say that
say that you
you treated
treated all
all of
of those
those patients
patients alike
alike in
in

11 terms of
terms of your
your diagnosis
diagnosis and treatment?
and treatment?

12 A No, I
No, I don't
don't think
think so.
so. II would
would say
say necessarily
necessarily no
no
13 two patients
two patients should be
should be treated
treated alike.
alike.

14 0 Would it
Would it b~
be fair
fair to
tc say
say that
that there
there are
are many
many
15 different
different causes of
causes of lov?er
lower back
back pain
pain and
and many
many

16 different
different types of
types of low
low back
back pain?
pain?
...,
.l. I A
A Yes, there
Yes, there are.
are •

18 Q
Q Could you
Could you describe
describe some of
some of those
those for
for us,
us, please?
please?
19 A
A Well, there
Well, there are
are the
the lower
lower back
back pain
pain due
due to
to injury
injury

20 or strain,
or strain, lifting,
lifting, bending over.
bending over. There are
There are those
those

21 due to chronic conditions, such as arthritis; there

due to chronic conditions, such as arthritis; there
are some due to kidney disease and other general
are some due to kidney disease and other general
23 diseases.
diseases.
24 Q Now, what type -- what different types of treatment
Q Mow, what type -- what different types of treatment
25 would you use for those different types of
would you use for those different types of
 problems,
problems, at least during
at least durins that
that time?
time?
2 A
k 1 can
I can only speak of
only speak of that
that time
time by
by the
the way.
way.
3 C 1 understand.
1 understand. II don't
don't mean
mean to
to ask
ask you
you about
about
4 different
different times?
times?
A
h What
What sort
sort of
of --
-- would
would you
you repeat
repeat the
the question.
question.
6 Q Yes.
Yes.
7 During the
During the '50's
ISO'S while
while you were workins
you were working
8 in that facility
in that and would
facility and would see
see persons
persons with
with back
back
9 problems,
problems, lower back problems
lower back problems with
with the
the different
different
10 causes that
causes that you
you have
have already
already described
described for us,
for us, what
what

11 different
different types of treatment
types treatment would
would you use for
you use for
12 those
those individuals?
individuals?
h
A Well,
Well, it
if it
it were
were aa patient
patient where
where II suspected
suspected there
there
14 were kidney problems
were kidney problems and
and thet
that person's
person's kidneys ha6
kidneys had
15 not
not been
been worked
worked up,
up, I
1 would
would then recommend
then recommend them for
therr, for

16 fUrther work up
further work up from
from that
that standpoint.
standpoint. For example,
For example,

17 if it were
if it were an
an obvious
obvious acute
acute injury
injury and my
and my
18 questioning
questioning and
and examination
examination brought
brought that
that out
out II
19 would
would then treat them
then treat them accordingly
accordingly with medication.
with medication.
20 Q Now,
Kow, let's
let's talk
talk about
about the
the person
person who
who would
would come
come in
21 with
with an
an acute
acute injury
injury to
to your
your facility
facility back in the
back in the

22 '50's
'5C's and
and say
say they
they had
had strained
strained their
their back
back and they
and they
23 were in pain
were in pain from
from lifting
lifting something
something heavy in
heavy in the
the

24 store
store that
that day,
day, and you would
and you would have
have made
made an
an

25 examination and determined

examination and determined that it
that was a mUScle
it was muscle

----------------_--_------- --------------
- .,
..t strain and
strain
T ••
and treated
treated them
.,
them with
with 7-s.spirin
Aspiri~ or with
with
2C

"
L .,Spi r In and
Aspirin a n o Codeine.
Codeine. No",,; , let's
Mow, let's say that
that the
the sane
Earne
3 person ce.Ee
person came back
back two
two weeks
weeks later
later with
with the
the same
samE
4 complaint
complaint and said
and said it
it wasn't
wasn't any
any better.
better. What
What
h
'" would you
would have done
you have that situation?
done in that situation?
6 r.
r: Again, it
Again, it would
would depend
depend on
on my
my questioning
questioning of the
of the

7 patient.
patient. Had
Had they
they strained
strained themselves
themselves a little
little
8 more?
more? Was it diminishing
Was diminishing somewhat,
somewhat, was
was it
9 increasing,
increasing, were
were there
there any
any other
other signs
signs that
that II
10 didn't know about.
didn't know about. It would
It would depend
depend on those
on those
11 findings.
findings.
12 Q What
What would you do
would you do in
in a
a situation
situation where the
where the perSG~
person
,-,
.... .:) came in two weeks
came weeks to
to four
four weeks
weeks later,
later, said
sai6 thai
~h~L

14 they hadn't
hadn1t reinjured their bach
back but it i;
wasn't
it wasn ~ny
they reinjured their but : any
15 better
better than
than on
on the
the first
first visit
visit and
and that
that Asriri~
Aspirin
16 with Codeine
with Codeine was
was very helpful and
very helpful and could
could they have
they have
17 it asain?
it again?
18 A I
I would
would say
say if
if there
there were
were aa patient
patient who
who had a
had a
19 sufficiently
sufficiently serious
serious injury
injury and that if
and that if I were, if
I were, if

20 I expected
I expected that
that injury
injury to
to persist,
persist, then
then II would
would
21 treat them
treat them again
again with medication.
with raedication. If it
If it had
had been
beer, a
6

22 very minor
very minor injury.
injury. I would
I would have
have expected
expected it.
it. If
If I-
23 would expect
would expect that
that it should have
it should have cleared
cleared up
up I might
might
24 then do
then do further
further examinations
examinations or tests.
or tests.
25 Q What type
What type of
of further
further examination
examination and
and testings
testings would
would
•
....
1 you
you havE:
have done?
done?
'}
c: A I would
would examine
examine the
the back
back probably.
probably. II would
would
3 particularly
particularly ask
ask some questions.
some qUEstions. If it waE
it was
4 something where 1
something v/here suspected
I suspected it could
could be
be more
more
5 serious than just
serious than just the
the injury,
injury, I
I might
might get
get an x-ray.
an x-ray.
6 Q What if that
What that same person came
same person came with
with the
the same
same
7 complaints
complaints once a month
once a month for
for six
six months
months and
and each
each
8 time the complaint
time the complaint didn't change
didn't change at
at all.
all. It was
It was

9 the same, hadn't

the same, hadn't gotten
gotten any
any better,
better, hadn't
hadn't gotten
gotten
10 any worse
any worse and
and they
they liked
liked the
the Aspirin
Aspirin and Codeine
and Codeine
11 and
and could they have
could they have it
it again?
again?
12 A Well
Well you
you know,
know, in a
a clinic
clinic setting
setting of
of that type,
that type,
, '{
J.. .... frequently
frequently you
you don't
don't cee
SEE -- of the
-- of the type
type I was
was in,
in,

14 you don't see

you don't the same
see the same patient
patient time
time after
after time.
time.
15 You might see
You might see a patient
patient and
ana they
they might
might see
see sometod~
somebody
16 else in the
else in the interim
interim and
and you
you go
go by what you
by what you see
see at

17 the moment.
the moment. And just
And just as
as the
the patient
patient coming
coming into
into aa
18 doctors' office wasn't
doctors' office wasn!t treatment
treatment for a specific
for specific
19 problem
problem and
and you
you suspect there is
suspect there is nothing
nothing
20 additionally serious about
additionally serious about that
that problem,
problem, within
within
21 limits you just
limits you just continue
continue giving the treatment.
giving the treatment. II
22 think there's an
think there's an extent
extent at
at which
which you
you would
would stop
stop or
23 a point
point at
at which
which you
you would
would re-evaluate
re-evaluate your
your
24 findings, but of
findings, but of the
the vast
vast majority
majority of people
people
25 treated in doctors'
treated in doctorsl offices,
offices, not
not only
only are
are there
there no
 ,
.... physical
physical findings,
findings, 6espite all
despite all of the
the tests
tEE~f a very
VEr~

vast majority
vast majority and
and I'm sure
sure equally
equally so
sc in clinics
i~ C~l~lCE

3 that
that are
are --
-- things
things that are related
that are related tc
te

psychoneurotic
psychoneurotic problems
problems and
and pains
pains resulting
resulting from
frorr

5 that and
that stress aE
and stress as much
much as
as any
anything
thins physical.
physical.

6 In that
In that case, if you
case, if feel you
you feel haVE that
ycu have that

7 type of a patient
type patient then
then you would continue
you would continue the
the
8 treatment
treatment on an
on an on-going
on-going basis
basis when
when you
you saw
saw that
that

9 patient again.
patient again. You
You would
would know
know that from your
that from your

10 discussions
discussions that
that there
there is nothing that
is nothing that you
you can
can

11 treat in any
treat any other
other manner.
manner. If you suspect there
you suspect there
12 is, cf
is, of course, then you
course, then you might
might want
want to
to --
--
In a clinic
clinic type
type situation
situation as yev have
as you have descri~e{
describee
14 where a patient
where patient dOEsn1
doesn't
t necessarily
necessarily BeE
set the dector,
the dcctci,
15 the same
the same doctor
doctor on
on each
each visit,
visit, would
would it be fair
it be tC
fair tc
16 say that
say that the
the files that were
files that were kept, the charts
kept, the t hat
charts that
17 are kept
are kept for
for that
that patient
patient in
in that particular
that particular clinic
clinic
18 are fairly
are fairly important?
important?
19 I think
think charts
charts should
should be
be kept
kept as
as well
well as
as possible,
possible,
20 yes.
yes.
21 And what
And what sort
sort of information
infornation should be
should be in aa

22 patient's
patient's chart
chart in
in a situation
situation where
where the same
the same
23 doctor won't see
doctor won't see the
the same patient every
same patient every time?
time?

24 The complaints,
The complaints, the
the findings
findings and
and the
the medication.
medication.
25 Q Why is that
Why is that important?
important?
 1 So that
So that the
the next
next doctor
doctor will
will knov;
knC1,7 w h a c the
what: t he

2 treatment was.
treatment waE.

Q When you
When you were
were treating
treating patients
patients in
in the
the '50's
'50'e for
fer
4 back problems,
back problems, would
would you
you be
be able
able to
to say
say whether
whether you
veu
5 treatea as many as
as many as 90
90 to or:: percent
to 95 of patients
patientE
treated percent of
J _,-

6 with those
with those complaints
complaints in the
in the saiae
same fashion,
fashion, with
with the
the

7 same
same diagnosis
diagnosis and
and treatment?
treatment?
8 II really
really can't
canlt say
say at
at this
this date,
date, but
but r
my back
ay back
problemE -- well
problems well my aching back.
my aching back. During World
During Horla War
liar

10 II when
II when you
you wanted
wanted to
to get
get out
out of
of doing
doing something
somethin9
11 -- II suppose
suppose it's
it's still
still that
that way,
way, you
you had
had an
an
12 aching back.
aching back. It's the
It's the most
most vague
vague type
type of
of ccos~~~i~ti
o-v.r. lair.t,
the
t. h E most d iff i c uI t thing
reo S t difficult t h i n 9 tc
t c pin any t h ins down
pin anything c; 0 vi r. or,
0L I

s
14 and it
it's £ one
one of
of the
the common
common things
things that
that people ,. ~-
people will t-·,
...;,.
'

15 complain
complain about
about when
when there
there are
are no
nc physical
physical findings.
tin6ingE.
IG It is just
just something
something that
that -- when
when you
you can
can put
put your
your
17 finger
finger on something
something is very
very rare.
rarc. There
There are
are
18 specific
specific back
back findings,
findings, a fracture that a
fracture -- that b re a k
a break

19 of the
the bone,
bone, or as I say
say arthritis
arthritis or something,
something,

20 but
but it really
really is something
something that
that drives
drives most
most of your
your

21 first
first line
line of defense
defense doctors
doctors crazy.
crazy. Many
Hany patients
patients

22 come
come in and
and have
have back
back pain
pain and
and you
you cannot
cannot pin
pin it
it

23 down.
down. It
It may
may be
be due
due to
to overweight.
overweight. It may
may be
be due
Que

24 to
to stress
stress but
but not
not very
very frequently
frequently can
can you
you say
say this
this
back
back pain
pain is
is due
due to
to such
such a
a such
such a
a situation.
situation. And
And
 ~~------_- -_--~-------------~--- ~-----_---- - -_- ----------

many
many people
people are
are even
even operated their backs
operated on for their backs

for a specific problem

specific p when
r o b l e m and w the problem
h e n the problem ExistE.
exists.

It one of the
is one the vague
vague areas
areas to say,
say, a heart
heart

attack.
a 11 a c K .

5 Q Would
W o u l d it be fair
fair to say
say that
that complaints
c o m p l a i n t s of backacte
backache

6 are frequently
are frequently used as
used as excuses
excuses to get
get out
out of work
work

7 in auto
auto plants?
plants?

8 A I donlt
I don't know
know about
about in auto
auto plants, but it
p l a n t s , but it is
is

frequently
frequently used to get
used out of w
get out work,
o r k , yes.
yes. I wo uIQ
would

10 say the reason

reason is because
because it's so
it's sc d
difficult
i f f i c u l t to pin
pin

11 it down.
down.

12 Q Would
W o u l d it also
also be fair
fair to say
say that
that most
most persons
p e r s o n s who
who

13 have back
have back pain
pain recover pretty much
recover pretty much on their
their own
own

with the passage

with passage of time
time and
and rest?
rest?
15 P. That is
That is hard
hard to
to say.
say. You say
You say most,
most, and
and I don't
don't
16 know Exactly
know what that
exactly what that means.
means. There are
There are people
people who
who

17 go on
co on for
for years
years and
and years
years with
with their
their back
back pain
pain and
and

18 I would
would say
say if
if II were
were open
open that
that would
would be
be aa guess.
guess.
19 I don't
don't have
have any
any figures
figures on
on this.
this. II would
would say
say that
that
20 ifiost commonly
most commonly people
people with
with back
back pain
pain it just
it just

21 continues
continues on and
on and on
on for
for years.
years. And it
An~ it doesn't
doesn't gc
co

22 away.
away. rI think
think the
the acute
acute back
back pain
pain of someone
someone who
who

23 has played a game

has played game of tennis or
of tennis lifted a barrel
or lifted barrel or
24 something
something might go
might go away.
away.
25 Q Would you
Would you recommend
recommend the
the use
use of
of the
the constant
constant use
use of

----------------------
 ~-~~--------------~--~-----------------~----~-~----~------------

- r

1 Talwin for
Talwin for chronic
chronic back
back pain?
pain?
2 I think
think it
it is
ie aa very
very common
common medication
medication for
for that
that
purpose.
purpose. I don't --
I don't -- as
as 1 say I
I say ~ have
have never
never treate6
treated
back pain
back pain with Talwin because
with Talwin because I don't treat
I don't treat that
that
5 type of
type of situation
situation anymore,
anymore, but
but II know
know that
that it
it is
6 one of
one of the
the common
common medications
medications used by doctors
used by doctors
7 throughout
throughout the
the country
country for
for the
the treatment
treatment of
of back
back

8 pain.
pain.

Q Yesterday
Yesterday I
I believe
believe Mr.
Mr. Robinson
Robinson referred
referred to
to an
an
10 article
article to you in
to you in the
the journal
journal of
of American
American Medical
Medical

11 Association
Association dated
dated September
September 12,
12, 1980 entitled
entitled T'
T'ss
12 and Blues.
and Blues. Do you
Do recall reviewing
you recall reviewing that
that article
article
yesterday?
ye s t e r c ay ?

14 1. I didn't
didn't review
review that
that article.
article.
Q Well, would you
Well, would you accept
accept the
the Journal
Journal of
of American
American
16 Medicine
Medicine as an
as an authoritative
authoritative source?
source?
17 Generally
Generally the American
the American Medical Association.
Medical Association.

18 Yes?
Yes?
19 Yes.
Yes.
20 Q Would
Would you agree with
you agree with the following statement
the following statement that
that

21 soon after
soon after the
the introduction
introduction of
of Pentazocine,
Pentazocine, Talwir.
Talwin

22 in
in 1967,
1967, as
as a narcotic
narcotic to
to the
the analgesics
analgesics without
withou~

23 known abuse potential

known abuse potential it
it became
became apparent
apparent that
that the
th~

24 drug
drug was
was being
being abused
abused and
and that
that it
it was addictive?
was addictive?
Would
Would you agree or
you agree or disagree
disagree with
with that
that

-- - ~- --- ~----~---------
 1 statement?
statement t
2 1:.
A I
I would
would like
like to
to see
see the
the statement
statement and
and what
what went
went
with it, if
with it, if I may.
I may.

4 Q
Q All
All right.
right. II will
will hand
hand you
you a
a copy
copy of
of the
the two-page
two-page
5 article entitled TIs
article entitled and Blues
T's and Blues from
from the
the Journal
Journal of
of

6 the
the American Medical Association,
American Medical Association, September 12,
September 12,
7 1980 Volume 244
1S80 Volume 244 number
number 11
11 page
page 1224
1224 and
and 1225.
1225.

8 A
A I'd like
I'd to comment
like to comment on that.
on that. Could you
Could you repeat the
repeat the
question.
question.
10 Q
Q Do
Do you
you see
see the
the statement.
statement. II believe
believe itfs
it's in
in the
the
11 first
first paragraph
paragraph and
and underlined,
underlined, that
that talks
talks about
about
12 the
the year
year 1967
1967 when Talwin was
when Talwin was introduced?
introduced?
13 A The
The statement
statement you
you reat.
read. Shall
Shall I1 read
read it
it aaain?
again?
14 G Please?
Please?
15 You
A
A You read
read that
that soon
soon aiter
after the
the introduction of
introduction of
16 pentazocine, which ie
pentazocine, which iE Talwin,
Talwin, N196P
N196P as
as a
a non
non

17 narcotic analgesic
narcotic analgesic without
without known
known abuse
abuse potential it
potential it
18 became
became apparent that the
apparent that the drug
drug was
was being
being abused
abused and
an~

19 that it
that it was
was addictive.
addictive.

20 I
I believe
believe that
that is
is all
all you
you read.
read. II mig-f.
might t

21 say
say that
that without
without reading
reading through
through the
the entire
entire
article,
article, II hesitate
hesitate to
to comment
comment on all of
on all of it,
it, but
but: I

23 will comment on
will comment on that
that and
and II also
also think
think we
we ought to
ought tc
24 understand that when
understand that when we
we have
have an
an article
article in the
in the
25 Journal
Journal of
of the American Medical
the American Medical Association
Association that
that
 .,
~
1 simply means
simply means that
that the
the doctor
doctor is
is writin~
writing for
tor t~E
the
r-.
2
L Journal and
Journal anc expressing
expressing his
his opinion
opinion ant
anc findingE
findings &nc
and
3'" that the
that the Journal
Journal of
of the
the American
American Medical
Medical
4
4 Association, if
Association, if you
you will
will look
look in
in the
the front
front portion,
portion,
5
t:'
..., states that
states that it
it is
is net
not responsible.
responsible. The I::'DEricar
The American.
6
6 Medical
Medical Association,
Association, nor
nor the
the Journal
Journal of
of the
the
7
7 American Medical
American Medical Association
Association are
are responsible
responsible for
for
8
8 the writings
the writings therein.
therein. They are
They are simply
simply reportinq
reporting
sS someone elses
someone elses work.
work. Is that
Is that understood?
understood?
10 Q Weil,
Well, if it wasn't
if it wasn't before,
before, it is
it is now.
now. Thank you.
Thank you.

11 A
A Okay.
Okay. Then you
Then you said
said soon
soon after
after the
the introduction
introduction cf
of
~ ,.,
12
..L~ pentszocine in
pentazocine in 1967
1967 as
as a
a non-narcotic
non-narcotic analgesic
anals€sic
13 without
without known
known abuse
abuse potential
potential it
it became
became apparc~~
apparent
14 that thE
that the druq
drug waE
was being abused and
beina abused and it
it was
was addiotlvE
addictive
,
15 I:
..J.. ...i and this thing
and this thing refers
refers to another
another article
article publishet
published
16 in
in the
the New
New York
York State
State Medical
Medical Journal
Journal in
in 1971.
1971. -
17
17 think
think it
it goes on to
goes on to say
say abuse
abuse was
was limited to the
limited to the

18
1£3 medical
medical coirimunity and
community and patients
patients and street
and street abuse
abuse was
was

19 unpopular
unpopular until
until recently.
recently.

20 This may
This may have
have been
been due, in part,
due, in part, to i +- ~
to its c '-

21 mild
mild narcotic antagonistic
narcotic antagonistic ano that
and that would
would be

22 unplesant
unplesant on regular Heroin
on regular Heroin users because
users because the drug
the arus

23 Talwin actually
Talwin actually acts against
acts against Heroin
Heroin and
and the
the affects
affects
24
24 of
of Heroin,
Heroin, for
for example.
example. So that
So that I think
think that
that that
that

25 clarifies
clarifies it
it a little
little further
further that
that the
the abuse was
abuse was
 1 limited to
limited to the
the medical
medical community.
community. That means that
That means that

2 the doctors
the doctors were
were perhaps
perhaps prescribing
prescribing and it
it and it

3 began having
began having reports
reports of psychiatric
psychiatric disturbances
disturbances
4 associated
associated with pentazocine
with pentazocine use and
use and abuse
abuse inclucinS
inducing
5 disphoria
disphoria depression,
depression, confusion
confusion ana hallucination~
and hallucinations
6 either while
either under the
while under the influence the drug
influence of the drug or

7 during withdrawal.
during withdrawal.
8 Now, II should
Now, should really
really read the whole
read the whole
9 thing but
thing but I don't know.
don't know.
10 Q Please do.
Please do.
11 A Shall I?
Shall I?
12 Q Please do.
Please do.
13 Doctor, bave
Doctor? "nave you
you hat
hac, a chance now to
chance now
14 review T's
review Tis and
and Blues
Blues article
article in its
its entirety?
entirety?
15 A
A I
I have.
have.
16 Q
C II would
would ask
ask you
you for
for aa moment
moment to
tc turn
turn to
to the
the secon{
second
17 page of
page that article
of that and look
article and look to
to the
the middle
middle
18 paragraph,
paragraph, I believe
believe there's
there's several
several sentences
sentences
19 underlined
underlined in red.
in red. lid like
I'd like you
you to
to read
read that
that part
part

20 that's underlined
that's in red
underlined in red outlaud
outloud and
and tell
tell us
21 whether you
whether you agree
agree or
or disagree
disagree with
with the
the statement
statement
22 made there?
made there?
23 A
A It says
It much of
says much of pentazocine
pentazocine and
and trimanomine
trimanomine is
24 obtained
obtained through legal
through legal prescriptions.
prescriptions. Prescribins
Prescribing
25 physicians
physicians should
should be
be aware
aware of
of the
the abuse
abuse of thesE
of these

------------- -
 two drugs
two drugs particularly
particularly since pentazocine
since pentazocine tablet
in tablet
Iorm is
form often considered
is often considered of
of low
lev? abuse
abuse potential.
potential.

Umh, II donlt
Umh, don't know that there's
know that anything
there's anythin~

4 to
to agree
agree or
or disagree
disagree with.
with. I
I think
think he's
he's stating
stating aa

5 fact
fact of his
his opinion.
opinion.
6 Q Is there
Is anything else
there anything else that
that you
you have
have read
read in
in that
that

7 article in either
article in either of
of the
the two
two pages
pages that you woul~
that you would
8 like to
like to comment
comment on
on that r haven't
that I asked you
haven't asked about
you about
or that
or that you
you haven't
haven't already
already explained?
explained?
10 Well I
Weil I think
think that
that I'd
lid like tc comment
like to on the
comment on the thrust
thrust
11 of the
of the article.
article.
12 What this
What this author
author is 86ying, he is
saying, he
a d ViE i r.c doc
advising tor E tthat
doctors his T
hat tthis a l\; ::.
Taiwin r iis
s as :Efairly
a i r1y
14 p ro sc r i be c drug.
commonly proscribed
commonly dru~. It!£ not a drug, it's a
15 rae d i c a t i on ,
medication. And
And that
that the
the reason for writing
reason for writing the
the

16 article apparently,
article apparently, make the
to make
is to the physicians
physicians aware
aware
17 that these
that these two
two drugs
drugs are
are being
being used
used by
by some
SOIDe

18 narcotic
narcotic -- by
-- some drug
by some drug users,
users, narcotic
narcotic addiction
addiction
19 to mix
to mix the
the tablets
tablets together
together and
and inject
inject them into
them into
20 their veins,
their veins, which
which is
is not the way
not the way the
the d~ug
drug is
21 supposed
supposed to be
to be used.
used. It's suppose to
It's suppose to be
be taken
taken as
as a&

22 tablet by
tablet by mouth
mouth as
as an
an Aspirin
Aspirin tablet.
tablet. And real
And really
li­
23 the primary
the primary point
point as
as II can
can see
see of
of this
this article
article is
24 he is
he is saying
saying at
at this
this time
time is
is becoming
becoming a common
common
abuse of the
abuse of the drug
drug that
that narcotics
narcotics addicts are
addicts are
 3C
2C

.i. obtaining
obtaining this drug
this drug which
which is
is supposed
supposed -- the
-- the two
two

drugs which are

6rugs which are supposed
supposed to
to be
be taken
taken by
by mouth,
mouth, and
and
3 mixing them
mixing them and
and injecting
injecting them
them into the
into the
4 bloodstream.
bloodstream. And as
And as a result
result those
those physicians
physicians vwhc
?he-
5 take care of
take care narcotics
of narcotics addicts should
addicts should be
be aware
aware that
that
6 complications can arise
complications can arise from this misuse
from this misuse of
of these
these

7 two drugs.
two drugs. Such
Such as
as ulcers
ulcers en
on the
the skin
skin and
and
8 complications
complications in the
the lungs
lungs from
from the material
the material
getting
getting into
into the lung.
the lung. And he
And he is
is advising
advising the
the
10 physicians
physicians that
that if
if ycu
you are
are taking
taking care
care of narcotics
narcotics
11 addicts and they
addicts and have these
they have complications, they
these complications, they may
may
very
very well
well be
be misusing
misusing these
these two
two drugs.
drugs.
13 He also speaks
He also of the
speaks of the treatment.
treatment. If
If you
'lGL~_

14 find
fin6 a person
person who lias been
who has been taking
taking the
the drugs
drugs in the
the
15 vein this way,
vein this way, he
he says that pentazocine
says that pentaZOCine addiction
addiction --
16 that's Talwin addiction
that's Talwin addiction is
is associated
associated with mild
with a mile

17 narcotic
narcotic like
like withdrawal
withdrawal symptom.
symptom. That means
That means
18 consisting
consisting of
of restlessness,
restlessness, insomnia,
insomnia, irritability
irritability
and so forth.
and so forth. In other words,
In other words, he
he is
is saying
saying it
it is
20 not a narcotic,
not a narcotic, but when
but when you
you withdraw
withdraw the
the drug
drug

21 after it's been

after it's been taken
taken in
in the
the vein
vein there
there are
are mild
mil{

22 symptoms
symptoms that are
that are similar
similar to
to those
those of
of the
the minimal
minimal
symptoms of narcotics
symptoms of narcotics addiction.
addiction. And he
And he goes
goes on
on tc
tc

24 say that in
say that in the
the treatment
treatment of
of such
such addiction
addiction to
to this
ttis
drug being taken
drug being taken in
in the
the vein,
vein, hospitalization
hospitalization is
is
 .i usually
usually unnecessary;
unnecessary; and
and he
he alec
also goes
goes on
on to
to say
say for

many patients
many ~atients where
where the
the drug
drug is
is being
being withdrawn
with6rawn no
supportive medication
supportive medication is
is required.
required. I
I think
think th,,-tls
that's
what he's
what hels trying to
trying to point
point out.
out.

Q Would, you
Would you say
say that
that he's
he's also
also trying
trying to
to point
point out
out to
tc

6
6 physicians
physicians in general,
in general, that
that they
they should be aware
should be aware of
7
7 or be
or suspicious if one
be suspicious one patient
patient is
is consistently
consistently
8
8 getting
getting Talwin
Talwin and
and Pyr ibenzaraine?
Pyribenzamine?
9
9 :A
A -- you
I -- you mean
mean if
if this
this doctor
doctor should be suspicious
should be suspicious
10 if
if he prescribes
he prescribes it.
it.
11
11 Q
|Q Given the fact
Given the fact that
that that
that article
article talks about the
talks about the
12 high abuse potential
high abuse potential of the
of the two.
two.

13
13 L Repeat
Repeat your question.
your question.
14 c lim
I'K not sure that
not sure that II can
can repeat it.
repeat it.
15 Do
Do you
you believe that it's
believe that itls a fair
fair -- would
16 it
it be
be aa fair
fair statement
statement that
that that
that article
article is also,
is also,
17 in addition
in addition to warning
to warning doctors
doctors that
that they
they should
should be

18 suspicious
suspicious of addiction
of addiction type persons
type persons who
who Kay
may be

19 abusing Talwin
abusing and Pyribenzamine,
Talwin and Pyribenzamine, that
that physiciane
physicians
20
20 | in general
in general should
should be
be very
very aware of or
aware of or concerned
concerned
21 about the
about the fact,
fact, or
or concerned
concerned about the
about the situation
situation in
22
££ which they
which may be
they may be over
over a long
long period
period of
of time,
time,
i
23
23 , prescribing
prescribing for certain of
for certain of their
their regular
regular patients,
patients,
24
24 addiction or not,
addiction or not, Talwin and Pyribenzamine?
Talwin and Pyribenzamine?
0C A
A No, you
No, use the
you use the word
word suspicious, the doctor
suspicious, the doctor should
should
 1 be suspicious.
be suspicious. 1
I don't
don't see
see that anywhere
that anywhere here.
hEr~.

2 What he's saying

What he's saying is that
that if a
a perso~
person
3 does choose
does to mix
choose to mix these two tablets
these two and injectS
tablets and injects i:
i~

4 into the
into the veins
veins and
and you
you see
see such
such a patient
patient and
an6 ycu
ycc

5 are
are treating such aa patient,
treating such patient, you
you should
should be
be awarE
aware
6 that they
that they can
can have
have lung
lung complications that shou:d
complications that shoulc
7 be treated
be treated and
and ulcers
ulcers on
on the skin that
the skin that should
shou16 be

8 treated;
treated: and that if
and that if you
you want
want to
to cure
cure that
that p2tlen:
patient
9 of the
the addiction
addiction that
that you
you can
can withdraw
withdraw the
the drug
6ru~

10 without
without giving any
giving any other medication or
other medication

11 hospitalization
hospitalization and
and the
the withdrawal
withdrawal symptoms are
symptoms are not
12 severe enough
severe enough to
to warrant
warrant necessarily
necessarily
13 hospitalization
hospitalization or treatment.
or treatment. In fact they
In fact they go en
C~

14 to say
to say that
that there's
thereis a -- it is
-- it is controversial
controversial as
as tc
15 whether Methadone
whether should be
Methadone should be used
used in
in the
the case of a
case of a

16 person addicted
person addicted to
to injectiona
injectiona with
with the other twe
the other twc

17 drugs.
drugs. And
And he
he points
pointE out that the
out that the reason
reason there iE
there is
18 a controversy,
controversy, Methadone
Methadone is
is used
used for
for withdrawal,
withdrawal, tc
19 help an
help an addict
addict get
get over
over withdrawal
withdrawal of Heroin
of Heroin
20 because Heroin
because Heroin is
is so
so much
much more
more severe
severe a drug
drug than
than

21 hethadone.
Methadone. But here he
But here he is
is pointing
pointing out
out that
that
22 Methadone
Methadone is
is a
a much
much more
more severe
severe drug
drug than the
than the
23 medications
medications that we
that we are
are talking
talking about
about given
given
24 intravenously
intravenously and therefore
and therefore would be
it would be unwise
unwise to

give the Methadone,

give the Methadone, in order
order to
to try
try to
to cure
cure the
the
 1 person.
person. And think he
lino II think is pointing
he is pOlDtlng out that this
out that this

2 can be
can be done
done and
and that
that doctors
doctors should
should not
not abuse
abuse the
the
3 prescription
prescription of
of thesE
these two drugs.
two drugs.
4, Will you
Kill that --
you say that -- let's
let's say you
you saw
saw a patient's
patient's
5 chart where
chart one doctor
where one doctor prescribed
prescribed Talwin
Talwin and
and

6 Pyribenzamine
Pyribenzamine approximately
approximately once
once a
a month
month for
for 78
78

7 months
months for the same
for the same person.
person. Would
Would you
you be
8 suspicious
suspicious at
at that
that point,
point, having
having read
read that
that article,
article,
9 that
that perhaps
perhaps there
there was an abuse
was an abuse problem
problem going
going on
on
10 with that patient?
with that patient?
11 MR. ROBINSON:
ME. ROBINSON: For
For the
the record
record I object.
object.
12 There's no evidence
There's evidence in this
this case, hypotheticaliy
case, hypothetically

13 that the doctor

that the doctor hae
had -- the
the do
doctor this ccase
c t o r in this a se had
iJc:c

14 read
read that
that article.
article. In
In fact he aenied
fact he denied it.
it. So I=
So
think
think that
that should be clear
should be clear to the
the Court
Court and
and jury
jury

16 that that hypothetical

that that hypothetical should
should net
net apply
apply to
to Dr.
Dr.

17 Krebs.
Krebs.
18 THE COURT:
THE COURT: Well
Well did
did the hypothetical
the hypothetical

19 say reading the

say reading the article
article --
--

20 MR. ROBINSON:
MR. ROBINSON: Assuming Dr.
Assuming Dr. KlebE
Krebs had
had

read that article.

read that article. Doctor Krebs had
Doctor Krebs had not
not read
read that
that

22 article.
article.
23 Q Hr. McCarthy):
(By Mr. McCarthy): Let me
Let me try
try one
one more
more time,
time,

24 Doctor.
Doctor. you saw
If you saw a patient's
patient's chart
chart that
that the
the same
sa~e

25 patient had received

patient had received from
from the
the same
same doctor
doctor for
for a
2
 -s
.l. perio6 of
period of let's say siK
let's say six months,
months, once
once a month,
month, L
h

prescription
prescription for 50 Taiwin
for Talwin and
and a prescription
prescription for
Pyribenzamine,
Py ribenEarr.ine, should
should that
that doctor
doctor be
be suspicious
suspicious of
of
4 possible
possible abuse that patient.
abuse by that patient. Would any
Would any bells
bells go

5 off
off or
or lights
lights go
go off
off in
in a doctor's head or
doctor's head or should
should
6 they?
they?
7 A What do you
What do you mean
mean by abuse by
by abuse by that
that patient?
patient?
8 Q That perhaps those
That perhaps those controlled
controlled substances
substances are not
are not
being used for
being used for the
the purpose
purpose that
that they
they were
were
10 prescribed.
prescribed.
11 I
I think
think if
if the
the doctor
aoctor was
was prescribing
prescribing it
it because
because of
of
the symptoms of
the symptoms of the
the patient,
patient, I
I would
would have
have to know
to know
what
what symptoms that patient
symptoms that patient had.
had. In other
In other wardE it
words if
14 r f ec t Ly well
you're telling me a perfectly patient conies
"Jell patient comes in
in

15 and
and has
has no
no complaints
complaints and the doctor
and the is prescribing
doctor is prescribing
16 the
the two
two medications,
medications, that
that is
is one
one thing.
thing. But it
But it
17 would
would depend.
depend. Now for
Mow for example,
example, there are
there are

18 conditions
conditions --
-- in fact
fact in
in Cincinnati
Cincinnati a very
a very
prominent
prominent and
and fine doctor was
fine doctor was brought
brought up
up on
on chargES
charges
20 of using
of using large doses, huge
large doses, huge doses,
doses, tremendous
tremendous doses
doses:
21 of Demeroi,
Demelol, which is
which is a narcotic,
narcotic, an addicting
an addicting
22 substance, to treat
substance, to treat a man who
a man who happened to be
happened to be a very
a very
23 well known
well known radio
radio announcer who is
announcer who is now
now in
in another
another
24 city
city and
and the charges were
the charges were dropped when it
dropped when it was
was shown
ShOWf;

25 that there are

that there are certain
certain conditions
conditions where huge
where huge doses
doses
 ,":1 r:

1 Demerol are
of Demerol are required.
required. The only
The only thine
thing that
that will
wil~

relieve a patient's
relieve patient's pain and
pain and certain
certain patients
patientE
3 decompose
decompose the Demeroi
the Demerol because
because of the
the physical
physical

condition.
condition. And so
kne so there's
there's no
no way
way tc
to say
say that
that

5 because a patient
because patient has
has prescribed
prescribed for him
for him certain
certai~

E medication,
medication, that the
that the doctor
doctor should
should think
think it is
is

7 being abused.
being abusea. I think he thought
think if he was being
thought it was beir-g
8 abused,
abused, he would
would not
not have
have prescribed
prescribed the
the
9 medication.
medication.
10 Q Doctor, you
Doctor, you talked
talked yesterday
yesterday about how
about how rauch
much you
you

11 enjoyed teaching
enjoyed teaching and
and making
making the
the public
public aware
aware of
of

12 medicine
medicine general.
in general.
13 That is a fair
That fair statement?
statement?

14 k Yes.
Y€E.

15 Q Have you
Have you done
done any
any teaching
teaching in the
in the area
area of drug
Gru~

16 abuse?
abuse?
17 k have not.
No, I have
No, not. think it would
But I think
But would be a good
gaoe

18 subject.
subject.
19 Q
0 Let
Let us
ue know
know what
what show
show it's
it's going
going to be on.
to be on. We'll
We'll
20 all watch.
all watch.
21 Assume that
Assume that the
the patient
patient comes to aa
com~s to

22 doctor, complains
doctor, complains chronic back
of chronic back pain
pain that
that they
they

23 have had
have had for
for a
a two
two to
to three
three year
year period,
period, resulting
resultin~

24 from a fall
from a fall from
from a
a horse
horse which
which caused
caused something
something

known as aa fused
known as fused spine.
spine. And also
And also assume
assume that
that that
that
 ,
..1. patient said
patient said to you that
to you that her
her doctor,
doctorf her
her own
own doctor
doctor
was treating her
was treating her with
with heat, rest antiinflamatory
heat, rest antiinflamatory
3 drugs?
drugs, perhaps
perhaps some
some muscle
muscle relaxants
relaxants and wouldn't
and wouldn't

4 give
give her
her anything
anything stronger.
stronger. Would
Would it
it be
be a standar~
standard
E::. of practice
practice to
to prescribe
prescribe for that
for that patient Percodan
patient Percoda~
-'
6 without
without at
at least
least first
first contactinc
contacting that patient's
that patient's

7 own
own doctor and finding
doctor and finding out
out what
what that doctor had
that doctor had
done
Gone and
and reviewing
reviewing that
that doctor's
doctor's file?
file?
9 A I think
think it
it depends
depends on
on the
the circumstances
ci reumstances of
of
10 treatment.
treatment. hs I mentioned
As mentioned yesterday
yesterday there are
there are
11 different
different circumstances
circumstances in
in which
which you
you can
can treat
treat a
patient.
pa t i e n t , If you're
you're in a private
private office
office and
and a
patient comes in you
patient comes know, and
you know, an6 gives
gives you permission
you permission

14 to call that
to call that other
other 6cctor.
doctor, &nc
and of
of course
course you
you cannot
cannot
15 obtain
cb c a i r, medical
medical information
Ln without
n w
f o rn.at i.o the patient's
i t h o ut; the patient's

16 permission.
pe r m i s s i on •

17 Q «ould it be
Would it be fair
fair to
to say
say that
that the
the doctor
doctor should
should ask
ask

18 for an opportunitl
for an opportunity to
to review
review the
the case
case with
with the
the

19 patient's
patient's earlier physiCian?
earlier physician?
20 It
It depends on --
depends on --
21 Is that your
Is that standard?
your standard?
22 Well, it depends
Well, it on that
depends on doctor's evaluation
that doctorls evaluation of
of the
the

23 patient.
patient. If the
the doctor
doctor assumes
assumes and
and believes
believes that
that

24 that
that patient
patient is describing
describing something
something that
that is
is the
the

25 truth
truth and
and the
the symptoms
symptoms are
are such
such and
and the
the patient
patient has
haE

~~~ -~-~--~.. ------ - ~-.-~-----~--. ~~-~~~.------~----

..--~~- ~~
----~~-------
 been treate~ in
oeen treated in that
that way,
way, I
I think
think in
in general
general ycu
you

have to
have to assume the patient
assume the patient coming to you
cODing to you is telling
is tell inc.
3 you the truth
you the truth an6
and is
is coming to you
coming to you for
for treatment
treatment
and
and if
if you were tc
you were to take
take every
every patient
patient that
that coraes
comes
through
through and
and say
say II wonder
wonder if
if hiE
his patient
patient is
is lying to
lying tc
6 me and should
rue and should I
I treat
treat this
this patient
patient or
or should I call
should I cal:

7 some
some of
of the
the other
other people
people or
or other
other doctors
doctors you just
you just
8 wouldn't be
WOUldn't be able
able to
to treat
treat anybody.
anybody. So
So if
if yol..:
you ggive
ive

me a hypothetical
rae a situation
hypothetical situation I can't
I andwer it.
can't andwer it.

10 Q So you
ycu canlt
can't say
say whether
whether --
— at
at least
least as
as II have
have

11 given
given you
you the
the hypothetical
hypothetical so far that
so far that meets
meets or
does not meet
does not any standard
meet any standard and I
and I would
would say
say the.
th~_ i;
,-

13 the
the doctor
doctor who
who is
is doing
doing the
the treatsent
treatment believes vr:~
believes vr.;:
14 u told
you tole. me
live ar.o
u t the
about the patient. a n c feels
patient and t h e t the
feels that tL(

15 patient has been

patient has been under
under another
another doctor
doctor'sEs treatrnE~~
treatment
16 haE
has induced fused spine,
& fused
induced a spine, has
has pain, ae a
p2in, as a result
result of
of

17 the
the injury
injury and
and has
has not
not been
been helped by the
helped by other
the other
18 doctor, then the
doctor, then the doctor
doctor who
who is
is doing
doing to
to preeent
present
19 treatment must use
treatment must use his
his judgment or her
judgment or judgment
her judgment anc
and
20 decide how
decide how tc
to treat
treat that
that patient?
patient?
21 Shall 1
Shall I relieve the symptoms
relieve the symptoms giving sornethins
by giving
by something
the other
the other doctor
doctor has
has given
given or
or should I just
should I just say
say ric
I'm
23 not
not about to treat
about to treat you
you until you know,
until ~- you know, come
come back
back

24 and I'll treat

and I'll treat to
to get
get follow
follow up
up examination,
examination, that
that
25 ~ere done elsewhere.
were done elsewhere. It just depends
It just depends on
on the
the
 ------ ~~-~~~-~-----~--------~ ---_ --- ----_

1 circumstances.
ci rcumstances.
2 Q
Q Doctor,
Doctorf can
can you
you tell
tell us
us what
what Percodan
Percodan is?
is?
3 K not an authority
I'm not authority any means
by any
by means on
on this
this type
type cf
of

4 medication.
medication. does relieve
It does relieve pain.
pain.
5 Q Are you
Are you aware
aware at
at all
all of
of the
the addict
addict potential
potential or
6 anything like that?
anything like that?
7 A I would
I would have
have to look it
to look it up in the
up in PDR or
the PDR or its
its

8 equivalent.
equivalent.
Q
Q Let's try
Let's try aa different
different hypothetical
hypothetical for
for aa moment?
moment?
10 If a patient
patient came
came in
in in
in 1980
1980 said
said that
that
11 he had
he had lower back pain
lower back off and
pain off and on since 1973
on since 1973 as
aE a
a
1: result strain from
result of a strain frorr lifting
lifting something
something heavy
heavy in
i~

an automobile plant
an automobil€ plant an{
and the
the patient
patient now
now being lr
being in
14 his mic 20*5,
his mid said that
20 s, sai6
1
that he
he was
was getting Talwin frcr.
getting Talwin frc[
15 his regular doctor
his regular doctor for
for that
that pain,
pain, but
but that
that he

16 wanted
wanted more
more and
and his
his regular
regular doctor
doctor wouldn't
wouldn't give
give

17 him anymore than

him anymore than he
he was
was already
already giving
giving him, would
him, wou16

18 it
it meet
meet the
the standard
standare of
of practice
practice in
in the
the field
field of
of

19 medicine
medicine to prescribe
to prescribe Talwin
Talwin for
for that patient
that patient

20 without first talking

without first talking to
to the
the regular doctor?
regular doctor?

21 A It depends
It depends on
on whether
whether it
it is
is your
your intent
intent to
22 thoroughly
thoroughly work up
work this patient.
up this patient.

23 Q Is this
Is this patient
patient coming
coming to
tc you
you as
as aa family
family physician
physicia
24 or coming
or to you,
coming to you, in a major
major hospital
hospital setting.
setting. are
ar
25 going
going to follow this
to follow this patient
patient and
and treats
treats all
all of his
his
 - (

1 illnesses
illnesses or
or are
are you
you treating
treating that
that patient
patient for
for his
his
2 present complaints?
present complaints?
3 \k Now, that
Now, that would
would have to be
have to be decided.
decided. It would
It would
4 depend on
depend on that
that situation.
situation.
5
5 Q
:Q How do you
How do you know
know that.
that. dc you
Eov; de
How you know
know which
which of
of
66 those two
those two situations
situations it
it is
is when
when aa patient
patient comes
comes in?
in?
7
7 |A
A Well, II think
Well, think it
it depends
depends on
on where
where you
you are
are treating
treating
i
8
8 the patient.
the patient. The patient
The patient comes
cones into
into aa doctor'S
doctor's
D office.
office. He
He assumes
assumes that
that that
that doctor
doctor is going
going to

10 follow him perhaps

follow him for the
perhaps for the rest
rest of his
his life
life and
and the
the

11 doctor assumes that

doctor assumes ae well
that as well in the
the usual private
usual private
12 practice.
practice.
13 If you're
you're in a
c hospital or medical
hospital medical
14 school
school setting
setting you
you havE a clinic.
have & clinic. And
And I have
have
15 worked
worked in many
many clinics
clinics of this
this type.
type. Then
Then you
you also
also
16 assume that
assume that the
the patients
patients will
will come
come in there
there you
you are
are

17 going
going to
to treat
treat them, you yourself,
them, you yourself, are
are going
going to
to

18 treat
treat them.
them. and in
And in most
most clinics
clinics of
of that
that type
type now
now

19 ! you will
you will find
find they
they have the patient
h ev e the patient referred
referred back
back

20
20 \ to
to the
the same
same doctor
rioctor each
each time,
time, if
if possible.
possible. You're
You're
21
21 going to
going to have
have a continuity
continuity of treatment.
treatment.

22 | you're in a situation
If you're situation such
such as
as II
23
23 described
described in the
the clinic
clinic I was
was in at
at the
the Hotel Union
Hotel Union

24 I in New
New York,
York, then
then you
you are seeing the
are seeing patient for
the patient for

25 that
that thing and that
thing and that is
is what
what you
you are
are treating
treating at
 -_ ,

that moment
that moment and
and you
you have
h&ve to
to relieve
relieve that
that patient
patien~

2 and you
and you might
might follow
follow him
him on
on and
and off
off for
for a& few
few
times.
times. But you
But you are
are not
not solely
solely his
his total
total physician.
physici~~.
4 C So b a s i ca L'ly you
So basically you can't
can't say
say whether
whether that
that --
-- the
the
5 conditions
conditions that II described
that described in
in that
that hypothetical
hypothetical
6 rae e t s the
meets t h e standard
standard of medical practice.
of medical practice.
7 A So far
So far back
back --
--
8 QQ (Interposing)
(Interposing) I'll try
I'll try it
it again.
again.
c right.
1111 right.
~.
A All
10 Q If aa patient
If patient comes
comes to
to you,
you, say
say aa patient
patient in
in his
his mid
rid
11 20's that
20's that he
he had
had sprained
sprained his
his back
back back
back in
in 1573
1973 and
ant
12 was coming to
was coining to you in 1980
you in strained his
1980,r strained his back
back ii:_
:. 2.:
e.r
auto plant
auto plant in
in his
his home
home town
town which
which is
is 60
60 miles
mile~ awey
c~e-

14 from your
from clinic
your clinic, and also
and
1 also he
he was
was treated
treated by a
15 doctor in
doctor in his
his home
home town
town and
and was
waE receiving
receiving Taiwir.
Talwi~ or.
or

16 aa reqular
regular basis
basis from
from that
that doctor
doctor but
but he wanted
wanted ncre
nore
, -
.1. I Talwin.
Talwin. He wasn't
He wasn't getting
getting enough
enough from
from his
his own
own
18 doctor to
doctor to relieve
relieve the
the pain
pain and
and wanted
wanted more
more from
fro~

19 you.
you. Would
Would it
it meet
meet the
the standard
standard of
of medical
medical

20 practice
practice to
to prescribe
prescribe Talwin
Talwin for
for that
that patient
patient
21 without
without at least
least first
first contacting
contacting that
that patient's
patient'E
regular
regular doctor?
doctor?
23 A would depend
It would depend on whether
whether believed
I believed
I that patient
that patient
24 and what
and what he was
was telling
telling me
me and
and whether
whether then felt
I then felt
25 that my
that my diagnosis
diagnosis was equivalent
was equivalent the other
to the other
 L

1 doctor and
doctor and whether
whether the
the pain
pain that
that was
was described waE
described was
2 in fact
fact so
so severe
severe that
that his
his dosage
dosage should
should be
3 increased.
increased, not an
I'm not an expert
expert on
on Talwin, but it
Talwin, but it it
is

4 an analgesic.
an analgesic. It
It is
is a non-narcotic.
non-narcotic. It
It is a
a

relatively
relatively mild
mild drug
drug or medication
medication I should
should say,
say,
6 and if I were
and giving back
were giving back in the
the '50's Aspirin and
'50's Aspirin and
7 Codeine under
Codeine under those
those circumstances
circumstances and another
and another
8 doctor had
doctor had given
given it and I felt
it and felt this
this patient
patient really
really
is in discomfort
is discomfort and must be
and must be tided
tided over
over now
now I would
would
10 say go
say go home
home until
until I can
can get
get your
your records
records and
and
11 suffer.
suffer. I'd say this is
say this is what
what I think
think you
you should
should be
12 treated
treated with.
with.
13 Q
Q If
If the
the person
person in
in that
that circuDstance
circumstance where
where they
they were
were
14 in what
what you
you believed
believed tc
to be
bE legitimate
legitimate immediate
immediate
15 discomfort
discomfort would you
would you consider
consider any
any alternative
alternative
16 therapies
therapies or
or prescriptions
prescriptions other
other than
than Talwin?
Talwin?
17 A
A I
I said --
said --
18 Q
Q (Interposing)
(Interposing) before
before that
that person
person could
could get
get back
back tc
19 their regular
their regular physician?
physician?
A I
I certainly
certainly would
would consider
consider everything
everything II knew
knew of
of in
21 the medication.
the medication.
22 Q Specifically
Specifically with
with respect
respect to
to back
back problems
problems what
what
23 else would
else would you
you consider
consider in addition
addition to
to or in lieu
lieu
24 of Talwin?
of Talwin?
25 A
A Well
Well again,
again, 11m
I'm not
not an
an expert
expert on
on back
back problems
problems
 1 today.
today. Talwin was
Taiwin was not
not in
in existence
existence when I
when ~ was
W&E

treating this type

treating this type of
of problem.
problem. But
But I
~ -- if I were
3 I might
might be
be aware
aware of
of other
other things
things, that
that coulf
could be
be as
as
4 good or
good or not as good,
not as good, you
you know,
know, or
or alternatives
alternative~ as aa
as
5 possibility.
possibility. But I
But would still
I would still use
use the
the Judgments.
Judgments.
6 it were
If it were Talwin
Taiwin was
was a good
good drug
drug or
or medication
medication for
7 this particular
this particular patient that
patient that is what I
is what would
I would

8 prescr ibe.
prescribe.
9 Q HaVE you
Have you ever prescribed
ever prescribed Talwin for
Taiwin for a back
back pain?
pain?
10 I don't want
I don't want to
to say
say yes
yes or
or no.
no. II do have
do have patients
patients
11 in the
the hospital
hospital for
for other
other causes,
causes, and
and it
it is
12 conceivable
conceivable that they
that they would
would have back pain,
have back pain, and
anc
13 generally
generally now we
now we have
have residents
residents the hospi~al
in the hospital
14 where I
where work and
I work and I
I know
know that
that they
they would
would surely
surely
15 prescribe
prescribe Talwin
Taiwin for
for back
back pain
pain if one
one of these
of these
16 patients
patients had it and
had and I may
may have
have in the course
in the course of

17 events; but
events; really don't
but I really recall a specific
don't recall specific
18 incident.
incident.
19 Q Would it be
Would be within
within the standard of
the standard of practice
practice in the
in the

20 field of
field of medicine
medicine to prescribe
to prescribe for a
for n patient
patient such
such

21 controlled
controlled drugs
drugs as Talwin, Ambenyl,
as Taiwin, Ambenyl, Tussionex,
Tussionex,
22 Emperin No.4
Eroperin Ro.4 without
without performing
performing anymore
anymore examinatior.
examination
23 on the
on the patient
patient other
other than
than the
the patients
patients being
being
24 weighed,
weighed, having their height
having their height taken
taken and
and their
their blooe
blood
pressure
pressure taken?
taken?

,------ ,-,----------
 t. I
1 would
would say
say if
if that
that were
were all
all you
you had,
had, if
if tha~
that werE
were
the only information
the only information the answer is
the answer is no
no I would no:
would no:
3 prescribe.
prescribe. had asked
If I had asked certain
certain questions
questionE that
that
4 lee me to
le6 me to feel
feel that
that s
e medication
medication was
was indicated,
indicated,
r.
..J then would order
then I would order it.
it .

6 Mow doctorf at
Now doctor, at this
this tine
time I'd like
like to
to hand
hand you
you
..,
I Government
Government Exhibit 20,
Exhibit 20 r --— DW-20,
DVJ-20, DW-21, DK-25,
m'/-21, Dt\'-25,

8 DW-22,
DH - 2 2, BW-23,
Dv~- 23, DW-2 4, Dlim
mq - 24
1 DWD, 225
1 and II'd
5 and ask you
d ask
I you ttc
o
9 take a moment
take & moment and
and look
look these
these different
different six
six over,
over,
10 then I'll ask
then I'll ask you
you a few
few questions
questions about them.
about them.
11 Doctor,
Doctor, now
now referring
referring to
to each
each of these
of these
, r

.1 L exhibits by the
exhibits by the Le
letters and numbers
t t e rs and numbers on
on the
the yyellow
e Ll ov
1 .,
sticker,
sticker, can you tell
can you tell us
us what's
what1s ~-

14 t. Kell, t h e t contain
that
';-Jel2., prescription blanks
co n t a i r, rrEscription blanks witt
with certfci
ce r t a a r.

medications
medications on the~,
on then., and
and a signature.
signature.
16 c. Referring
Referring to the
to the different
different envelopes
envelopes with
with the
the

17 different
different prescription
prescription blanks in them,
blanks them, can
can you
you

18 relate tc UE
relate to us the
the nu~ber
number on
on the
the yellow
yellow sticker
sticker with
with
19 the
the prescription
prescription that's
that's written
written on
on the blanks
the blanks

20 inside
inside as well as
as well as the
the name
name on
on the
the bottom
bottom of
of the
the

21 prescription
prescription pad?
pa6?

22 A You want
You want me to read
me to read what
what is
is written
written on
on the
the

23 prescription
prescription blank
blank after give you
after I give you the
the number,
number, is
iE

24 that correct?
that correct?
25 Q Please?
Please?
 1
1 A D\'\1-20,
DW-20, Py Py rriibensemine,
be nz era i n e , 50 i Lr i o rarr.e Eo.
50 mmilligrams , rc
Ko. i1, , by
PC, by
2 mouth.
mouth. KW6H,
KW6E, that's
that's every
every six
six hours.
hours. Freludin,
Preludin, 3(:
30
3
3 tablets.
tablets. Tussionex one
Tussionex one teaspoon
teaspoon --
-- this
this is
is D~-21.
DV/-21.
4
4 us s ion €: x, 0one
TTussionex, net teaspoon,
e a s po 0 n , Kv'18 0 U r 5,
KW8 hhours, 1u0 in I 8
preludin,
pre 8

5 ounces.
ounces. These
These are
are all
all signed
signed with
with the
the name
narae Ryan
Ryan
66 Krebs.
Krebs.
77 DW-22
DW-22 Fercodan,
Fercodan, No.
Ko. 11 PO
PO 66 hours
hours
88 preludin is if
preludin is if necessary.
necessary. No.
Mo. 50,
50, Ryan
Ryan Krebs.
Krebs.
9
9 DH-23
DW-23 Ambenyl,
Ambenyl, XX --
— EXP.
EXP. 1'10.
Mo. 1
1
10
1G teaspoon,
teaspoon, KW 8 hours
KW hours are
are preluoin.
preludin. 8 ounces, Ryan
8 ounces, Eyar,

11 :Krebs.
Krebs.
, .-, DW-24,
12
..\.£., Descxyn,
Descxyn, I'm sorry
sorry.. DW-24, Desoxy~
Desoxyn J~It
13 r"ruill
i 11 iigraiv.,
9 ra L ,onone
e PO, by rnmouth,
PC, by 0 u t tit KV. C,c::;
EF day, teaeach
y, iit cL cday.
(;' .

14 La,
ho. 30 tablets.
tablets. Dr. Ryan Krebs. DW-25 Talwin 5C
15 ra i L'li q rame ,
railiigran.s, No.
Ho. 1
1 PO,
PO, Kt'J 6E p
KI'7 6E re Lu d i n one
preludin one by
by rno ut n
nouth
16
16 every
every 6 hours
hours every
every night,
night, 50
50 tablets,
tablets, Ryan
Ryan KrebE
Krebs
17
17 11
1i •. [j.
L' .

16
18 cC Now doctor
Now doctor do
do you
you recognize
recognize the signatures
the signatures on
on thOSE
those
19 prescription
prescription blanks at
blanks at all?
all?
20 A
A Do I recognize
recognize them.
them.
1 "i
Q
Q Yes, sir?
Yes, sir?

22 ! A How do
How you mean.
do you mean.

iQQ Does it look

Does look familiar
familiar to you?
to you?

24
24 i:A A Oh, no.
Oh, no.

25 Q
;Q Now, assume
Now, assume for
for this
this hypothetical,
hypothetical, that
that all
all of
 those
those prescription
prescription blanks
blanks --
-- well
well let
let me ask you
me ask yoc
,..,
L. another questions first.
another questions first. Are
Are there
there any
any patients'
patients'
3 names or addresses
names addresses on
on any
any of these prescription
these prescription
4 blanks?
blanks?

A
A No there
NO there aren't.
aren't.
6 o
Q Assume for
Assume for this
this hypothetical
hypothetical that
that all
all of
of these
these
'"
7 prescription
prescription pads
pads made
made out
out as
as to drug and
to drug signed in
and signed 1~

8 the name of a doctor

the name doctor are
are found
found in a doctors office
doctors office
in a clinic
clinic when
when the
the doctor
doctor is
is not
not there.
there. Would
Would
10 such preparation of
such a preparation of prescription
prescription blanks
blanks in that
that

11 nature
nature be within the
be within the standard
standard of
of practice
practice in the
the
field
field of medicine?
of medicine?
A It certainly
certainly would in a clinic.
would in clinic. As
As a matter
matter of

fact in some
fact some hospital
hospital clinics
clinics I have
have worked
worked in they
they

15 have
have a stamp.
stamp. It's
It's just
just stamped
stamped on
on there.
there. And for
An6

16 drugs,
drugs, medication
medication that
that you
you commonly
commonly use.
use. It's
It's just
JUSt

17 such
such a great
great turnover
turnover of these
these drugs
drugs that
that they
they are
are

18 stamped
stamped in this
this way.
way. In
In fact
fact they
they are
are also ordered
also orderet

19 as to how
as to how treatment
treatment should
should --
— what
what treatment
treatment shou16
should
20 be
be given
given and
and these
these are
are frequently
frequently printed
printed out
out and
and
stamped
stamped and
and then you just
then you just have to check
have to check them
them and
and

22 sign
Sign the
the appropriate
appropriate ones.
ones.

23 Q Now in
Now in the
the clinics
clinics you
you have
have talked
talked about
about where
where
24 those particular
those particular prescriptions
prescriptions that, DW-20
that, DW-20 through
through
25 DW-25, those type
DW-25, those type of
of prescription
prescription blanks
blanks filled
filled out
out
 in those
in those clinics
clinics for
for those
those particular
particular controlle~
controlled
2 substances?
substances?
A II really
really couldn't
couldn't tell
tell you
you because
because 1~ haven't
haven't been
been

4 in
in aa clinic
clinic since
since some
some of
of these
these substances
sUbstances have-
have

5 come
come into
into being.
being.

C When was
When was the
the last
last time
time that
that you
you were
were in
in a
a clinic
clinic
7 setting?
setting?
8 A II would
would say
say certainly
certainly well
well --
-- let's
let's say,
say, II was
was in
in

9 charge obviously
charge obviously as
as Director
Director of
of Surgery
Surgery in
in the
the
10 Jewish
Jewish Hospital
Hospital in
in Cincinnati
Cincinnati which
which ended
ended in
in 1977
1977
11 or it
or it was
was '77.
f77. Umh I
Umh I was
was occasionally
occasionally in such
in suct

12
,. .
clinics.
C.l.lnlCS.

13- Q Can you

Can you name
name for us the types
UE the types of drugs
c ruc s that
that wouic
\i01.1c

14 have
haVE been
been on
on prescription
prescription pads
pads filled
filled out
out in
in
15 advance at that
advance that time?
time?

16 A Very frequently
Very frequently non-narcotic
non-narcotic pain remedies,
pain remedies, cough
cou~t

17 remedies,.
remedies,.
18 Q Non-controlled?
Non-controlled?
19 A Things where
Things where there
there was
was a constant
constant turnover
turnover of
of

20 patients who
patients who had
had certain
certain very,
very, very
very common
common

21 complaints.
complaints.
22 Q Can you
Can you give
give us
us any
any examples?
examples?
23 A Aspirin surely
Aspirin surely and
and we
we used
used to
to use
use very
very frequently
frequently
24 in the
in the days
days gone
gone by,
by, elixer
elixer of terpin
terpin hydrate,
hydrate, and
ana

25 Codeine, was
Codeine, was a common
common remedy
remedy for
for a cough.
cough. T'
It
...'C
 1 depended on
depended on the
the clinics.
clinics. If you
If you were
were in
in aa clinxc
clinic

that was
that was Urinary,
Urinary, Urology
Urology CIinic
Clinic,f then
then some
so~e of
of the
the

3 antibiotics
antibiotics that frequently
that frequently were
were given
given for
for Urinary
Urinar~
4 infections
infections if you
if had aa clinic
you had with aa large
clinic with large
turnover you
turnover you would
would have
have those
those available.
available.
Now the
Now the ones
ones that
that you
you talked
talked about
about as
as having
having beer,
been
7' in the
in the settings
settings you
you have
have seen
seen or
or the
the drugs
drugs were
were any
any

8 of those
of those controlled
controlled substances?
substances?
They would
They would have
have to
to be
be or
or they
they wouldn't
wouldn't need
need aa
10 prescription.
prescr iption.
11 Q Well do
Well do you
you know
know what
what I
I mean
mean by the terra
by the term controlled
controllet
substance?
substance?
Well define
Well define it, if you
it, if you will.
Wl~~.

14 Controlled
Controlled substanCGE
substances substances
~re substances
are that by
that by lav
la~
15 fit into
fit into one
one of
of five
five schedules,
schedules, controlled
controlled
16 substance
substance schedules;
schedules; one being
one being things
things like
like Heroin,
Heroi~,

17 going down
going down to Schedule
Schedule V
V something
something like
like Ambenyl,
Ambenyl,

18 the higher
the higher the
the —
-- the
the lower
lower the
the schedule
schedule number
number the
the

19 higher the
higher the abuse
abuse potential.
potential. The lower
The lower the
the medical
medical
?
20 value, basically
value, basically that would
that would be about
about it? '.L.
11.. •

21 A They are
They are prescribed
prescribed medications.
medications.
22 Q Well?
Well?
23 MR. ROBINSON:
MR. ROBINSON: Your Honor,
Your Honor, I object
object to
tc

24 controlled
controlled substance
substance questions
questions I have
-- I have no
no problem
proble~

25 with the
with the doctor
doctor being
being asked
asked about
about specific
specific
 " r
'-:: '.._

I medicationE.
medications.
2 TEE COURT:
'l"EE COURT: I sustain
I sustain the objection.
the objection. He
Ee

3 doesn't
doesn't know what
know what is
is a
a controlled
controlled substance.
substance.
MR. McCARTHY:
MR. MCCARTHY: Thank you,
Thank you, your
your Honor.
Bonor.

5 Q (By Hr.
(By Mr. f'lcCarthy):
McCarthy): The prescribed
The re s c r Lp t i o r.
prescribed pprescription
6 pads that
pads that we
we talked about things
talked about things like
like Aspirin,
Aspirin,

7 would
would those
those also
also be
be signed
signed in advance by
in advance the doctor
by the doctor
8 or
or would
would they
they just
just have
have the
the medicine
medicine written
written on
on the
the
9 pad
pad in advance?
in advance?
10 A
A Hell very
Well very frequently
frequently they
they would
would be
be Signed
signed and
and given
given
11 out as
out as the patient left,
the patient by aa nurse
left, by nurse for
for example.
example.
Q I'm
I'm not sure
not sure II un
understand your answer.
c e r s t a n d your answer. Would
F01Jlc': the-
tLt:

13 w r it e Aspirin
doctor write
doctor Aspirin on
o n f, let's
let s say one hundred
[ioY one
I hun c re c. ; ac,£
; c,c.;:

14 and
and sign
sign his
hiE name
name to
to their, and leave
theE enc leave the
the patient:
patient
15 area
area blank
blank and
and leave
leave that
that pad
paG with
with the
the nurse
nurse and
anc

16 then
then as
as the
the doctor
doctor would
would see
see a patient
patient and
and send
sene:

17 that
that patient
patient home, stop
home, stop at
at the
the nurse
nurse and she'll
and she'll

18 give you the

give you the prescription?
prescription?
19 A
A Have the
Have the nurse
nurse write
write the
the name
name on
on the
the prescription,
prescription,
20 yes.
yes.
21 Q That
That would
would be
be aa standard
standard practice?
practice?
22 A
A I would
I would say
say so.
so.
23 THE COURT:
COURT: So the
the nurse
nurse would keep
would keep
24 something
something equilalent
equilalent to DW-20
to DW-20 through
through 0\-'1-25,the
DW-25, the
nurse would have
nurse would have those
those in
in blanks.
blanks.
 1 THE WITKESS:
TEE WITNESf: I think
think in a busy C~l~:C
a busy clinic
or in a busy
or in doctor's office.
busy doctor's office.

TRE
THE COURT:
COURT: Row does
How does she
she know
know tc
to vr.or
~~c~ tc
:c

4 give
give it?

TEE
THE WITNESS;
WITNESS: Well,
Well, the
the doctor writes
doctor writes
6 orders
orders for
for the
the patient
patient and
and only
only that
that patient gets
patient gets
7 it.
it. It's basically
It's basically a simple
simple time-saving
time-saving mechanisc.
mechanism.
8 And
&nd basically you have,
basically you have, I believe as
I believe as we
we brought
brought out
out
in the last
in the last few
few minutes,
minutes, no
no specific
specific knowledge
knowledge
10 about there being
about there being anything
anything different
different about
about
11 controlled substances
controlled, substances or
or about the specific
about the specific dru~:
drugs
12 that are listed
that are listed in
in Government
Government's
I E Exhibit
Exhibit m7-20
DW-20
throuah DW-25.
through DE-2.5. }
I really
really have
have nc ExpertisE
no expertise on
on this
drug pa r t Lc u La r Ly , though.
drug particularly, t h ou ch ,

1 r,
..._..; Q I would
would now
now hand
hand you
you what
what has
has been
been marked
marked as
as
16 Government
Government Exhibit
Exhibit DW-8.
D¥-B. Ana
And it
it consists
consists of
of s2
17 package of files.
package of files. wcul~ like
I would
I like you
you to
to take
take a
a

18 moment
moment tc flip
flip through
through the files and
the files and after
after you de
you cc
19 so I'll ask
so I'll ask you
you a few
few questions
questions about them?
about them?
20 Yes, the files
Yes, the files contained
cont~ined within Government
within Government Exhibit
Exhibit
DW-8 I have.
DW-8 have.
22 Q Could you describe
Could you describe for
for us
us briefly
briefly what
what you have
you have
23 seen
seen in that
that exhibit?
exhibit?
24 These
These are
are apparently patient history
apparently patient history files
files that thE
that the
25 patient would fill
patient would fill out.
out.
 1 Q Is there any
Is there any medical
medical type iinformation
type nf o rma t i o n co i r.
n t s i r.ec ir.
contained
those files
those files that
that you
you were
were able
able to see?
to see?
3 There is an
There iE an evaluation
evaluation --
-- the right portion
the right portion of
of the

sheet there
sheet there are
are some notes?
some notes?

Can you tell

Can you tell us
us what
what those
those notes
notes are?
are?
6 They are
They are aa description
description of
of some
some physical
physical findings
findings
7 and complaints.
and complaints.
8 Q Is there
Is any indication
there any indication on those
on pages of
those pages of aa
9 prescription
prescription for controlled
for controlled or
or for
for medication
medication --
10 let me try
let me try that
that one
one more
more time.
time.
11 Any indication
Any indication on
on those pages of
those pages any
of any
medications
medications as
as well
well as
as the brief description
the brief description ECfL
ton
of 2a medical
of medical problem.
problem.
14 t: I o n ' t kknow.
I cdon't n cw ,

Any indications
Any indications of
of medications?
medications?
16 There are
There are some
some abbreviations
abbreviations that I
that I donlt
don't
17 understand.
understand. This is
This is a habit
habit in
in medical
medical circles
circles tc
18 abbreviate.
abbreviate. So, I can't
Bo, can't be
be sure
sure of
of that.
that. I don't.:
I don't
19 see any
see any I recognize.
I recognize.
20 Q Can you
Can tell us
you tell us what
what type
type of -- what
of -- what are
are the
the

21 initials on
initials on there
there that
that say
say you
you don't
don't understand,
understand,
22 but can
but can you
you tell
tell us
us what
what initials
initials they are?
they are?
23 A Well on
Well on this
this one
one I —
-- in
in this
this particular
particular one
one I can
can

24 recognize
recognize overweight
overweight and
and insomnia
insomnia and
and then
then there
there is
25 a P75
P7 5 over 30. II assume
over 30. assume it's
it's the
the pulse,
pulse, but
but I'm
I'm
 not sure.
not cure. I don't
don't know
know what
what the
the over
over 30
3 0 is
is
Preludin 75 milligr
Preludin milligrams,
a TAG , dispense
dispense 30.
30.
NR.
MR. ROBINSO!~:
ROEIKSOK: I
I object.
object. The doctor
The dcctor ht£
~~[

Et~ted a
stated a lack
lack of expertise
of expertise on controlled
on controlled substEnce~
substances
and those
and files contain
those files contain controlled
controlled substances.
substances. He
Ee

6 lack of
has a lack
has of knowledgE
knowledge of
of Dr. Krebs' writing.
Dr. Krebs' writing. Ke
7 doesn't identify
doesn't identify his
his writing.
writing. He has no
He has no evidence
evidence
that Dr.
that Dr. Krebs
Krebs prepared
prepared those files and
those files and there's
there's nc
nc
predicate
predicate to ask
to ask that
that type
type of question.
of question.
10 COURT:
THE COURT: No comment
Ko comment has
has been
been
requested
requested yet
yet and he is
and he still building
is still building an
an
12 assumption
assumption and asked if he
and asked he knows
knows it.
it .
., -. MR. EOEIKEG1':
ROBINSON: My objection sail .
..L.5 MR. Ky objection is
is he
he sail.
hE c;
he 0 e s nIt
doesn't kn
know b o L~t the
a vi [:_
about the ccontrolled
o n t r 0 11 e d substances.
sub s tan ce s .
He
Be doesn't
doesn't know
know about
about the writing,
the writing/ he doesn't
he doesn't knc~
know
16 about pa t i e n t e , and
the patients,
about the ane' he do e sn I t know
he doesn't know about
about the
t he

17 files.
files. He's
He's not here
not here as
as an expert to
an expert to testify on
testify on
18 something
something --
-- no
no evidencE
evidence other
other than
than an FBI
an FBI
19 handwriting
handwriting and object that
and I object that you
you are
are asking
asking an
an

20 inappropriate
inappropriate opinion.
opinion.

21 THE COURT:
THE COURT: Overruled.
Overruled. He has
He has been
been
asked to
asked to comment
comment substantially
substantially on prescriptions
on prescriptions
23 which we
which we know are controlled
know are controlled substances.
substances.
24 Q 11r. l:lcCa
(By Mr.
(By r thy) :
McCarthy): In that
In particular
that particular file you
file you
25 said it had
said had the
the indication
indication of insomnia
of insomnia and
and
 overweight
overweight and the
and the P,
Pr 75-30.
75-30. Dc you
Do you see
see any
any nan.e
naDE

v?ritten
written on that page
on that page at all?
at all?
3 hI There's aa name
There's name that
that looks
looks like
like it
it could
could be
be Krebf
Erebs
and above
and above it it's
it's a KWVA,30.
KWVA,30.
rC
)._ Assume that
Assume that means
means Quaalude?
Quaalude?
6 A What?
7 Q
Q Quaalude, dispense
Quaalude, dispense 30.
30.

8 Now is
Row is there any patient's
there any patient's name on that
name on that

9
9 page, doctor?
page, aoctor?

10 A Yes.

11 Q
iC What is the
What is the patient name?
patient name?
12 i& Ella Taylor.
Ella Tc.ylor.

13 Q Why
Why don't
donlt you
you go
go to
to the
the next
next one?
one7

14 thereisss another
Anc there another narne
name there
therE it
it says, likes
likes like
15 Larry Murphy
Larry or something
Murphy or something like
like that.
that.

16 Q Are those names

Are those names actually.
actually. the name
Is the name Larry
Larry Taylor
Taylor

17 written
written on
on the
the patient
patient history
history or is that
or is that a

18 separate piece of
separate piece of paper?
paper?
19 ;A Ella Taylor
Ella is on
Taylor is on the
the patient's
patient's history
history and Larry
and Larry

20
20 Murphy and
Murphy and another
another one
one en
on Ella
Ella Taylor
Tayler is
is on
on a
a

21 separate piece of
separate piece paper and
of paper there's an
and there's an abbreviation
abbreviation
22 on the
on the Larry
Larry Murphy.
Murphy. don't understand.
I don't understand.
9^ Q What abbreviation
What abbreviation is that?
is that?
/* -^
;G
24
24 |A A PTAB..
PTAB
25 Q
!0 Is there
Is there on the patient
on the patient history
history sheet,
sheet, is
is there
there any
any
 -------------------------------~---- ---~--------~-~~-------

1 patient
patient history
history indicated?
indicated?
,..,
.G ! 11 No, there isn't.
No, there isn't. ot,
Ch f yes
yes there
there is just
just in the ~otE
note
.)
3 b e Low •
below.
~ Q
iQ For the
For the overweight
overweight insomnia?
insomnia?

5 :
-.
1A Yes.
Yes.

6 Q Why don't
Why you open
don't you open one
one of the
the next
next files, Doctor.
files, Doctor.

7
7 Can you
Can you describe
describe for
for us what
what you
you see
see in that file?
that file?

8
8 A Again
Again in that file we have
that file have history
history sheets,
sheets, three
three

9
9 history
history sheets,
sheets, the
the patient's
patient's name and address.
name and addresE.

10 Letters
Letters on
on the
the top
top and
and some writing on
some writing on the
the bottoir..
botto~.

11 Q Can
Can you tell us what
you tell what the
the letters
letters on
on the
the top are?
top are?

12 THE COURT:
TEE COURT; Well,
Well, let's start with the
start with

13 name.
name. Are all
Are all three
three history
history sheets for the
sheets for the same
sane
14 perGon.
person.
15 THE WITNESS:
WITNESS: Well
Well it's
it's three
three history
history

16 sheets for
sheets for the
the sairie
same person,
person, one
one name.
name.

17 THE COURT:
TEE COURT: What the name?
What is the name?

18 THE WITNESS:
WITNESS: Yes,
Yes, they are.
they are.
19
19 THE COURT::
THE COURT:: All right.
All right. What is
What is the
the

20 name.
name.
21 THE
THE WITNESS:
WITNESS: Joe
Joe Brown.
Brown.
22 THE
THE COURT:
COURT: All right.
All right.
23 Q (By Mr. McCarthy):
(By Mr. McCarthy): Are
Are there
there any
any initials
initials at
at the
the
24
24 bottom?
bottom?
25 A Yes, there are.
Yes, there are.

-------------~-----
 1 Q Can
Can you
you tell
tell us
us what
what they
they are?
are?
A It's
Itl;:: difficult
difficult to
to ma ke out.
wake out. LikeE
Likes Li ke CECIT
like t n er
flECEV: then
3 you aare.
you re. I --
I -- it's
it's like
like URI, it's!s not
URI, it not clear b'· -
clear bu- l.. ~

that I would
that I would understand
understand at upper
aE upper respiratory
respiratory
infection. I
~ don't
don't know
know whether
whether the
the first letter
first letter
6 is K
is and TCPE
Nand TCPE and T5 or
or 50.
50. think it's
I think it's a E, 88
a E,

7 ounces and
ounces there's aa signature
and there's signature on
on it.
it.
8 Q Okay.
Okay. Why
VJhy don't you
don't you go
go to
to the
the next
next file.
file. r.e re
Is tther
Is

a patient
a patient name
name in
in that
that file?
file?
10 A Yes,
Yes, there
there is.
is.
11 Q
Q What is
What is the
the name
name in
in that
that file?
file?
12 A George:
George Johnson.
Johnson.
13 0
Q Any initials
Any initials at
at the
the bottom?
bottom?
14 A There are
There are both a T,
both a Tf aa E on
on the
the top
top ana
and agaln
again it
15 looks like
looks like MSCBE
MSCBB I see
see the
the five.
five. Looks
Looks like
like das'..
6aE ..

16 50.
50. URI.
URI. And there's
And there's a
a E something.
something. I ---- v.'e::"::",
T well,

.L i maybe that's 68 ounCES

maybe that's ounces and
and there's
there's a signature.
signature .

18 C
Q All right.
1.11 right. In the
In the remaining
remaining files
files that
that we
v;e havE~':
haver,' :
1S talked about yet
talked about that are
yet that are in
in Exhibit
Exhibit DW-8,
DW-8, did you
yc:

20 find any files

find any files in
in there
there that
that did not have
did not have patier.^
patie~~

21 names
names written
written on
on the
the history
history form at the
form at the top?
top?

A I'd have
lId have to
to go
go through
through again.
again. I don't
I don't recall.
recall.

0
Q Would you
Would you do
do that,
that, please?
please?
24 A Sure.
Sure. Four do
Four do have
have the
the name
name written
written on
on top.
top.

25 Q
Q Of the
Of the four
four that
that don't
don't have
have names
names at
at the
the tC~1
top, arE
ere
 55
55

there any initials

therE..any initials at
at the
the bottom?
bottom?
2 h Yes.
Yes.

3 G tJhat are
What are the
the initials,
initials, please?
please?
4 h
I. On this one
On this one it's MS something
it's MS something likes
likes like
like BP
BP
5 overweight
overweight The 50,
The 50, 50P75-30.
50P75-30.
6 Q Is there
Is there aa name
name signed
signed on
on it?
it?
7 h There's
There's aa name
name signed
signed on
on it
it and
and II would
would not
not know
know
8 the name
the name if I didn't
didn't know
know who
who we
we were
were talking about
talking about

9 but it
but it could
could be
be Krebs.
Krebs.
10 Q II understand.
understand.

11 A Eut it's
But it's --
-- itls
it's not
not written
written so
so that
that it
it can
can be
read.
read.

C How
Kow about
about the
the others
others that
that you
you said
said don't
don't have
have a~
14 patient's
patient's narae
name on
on them.
them. Did.
Did they
they also
also have
have

15 initials at
initials at the
the bottom
bottom and
and a narae
name that
that looks
looks like-
like-

16 it could
could be Krebs?
be Krebs?

17 A Yes.
Yes.
18 Q With
With respect
respect to
to those
those four
four files,
files, where
where it
it appears
appears
19 that medication
that medication is indicated
is indicated on
on patient's
patient's charts
charts
20 appears that
appears there is
that there is a signature
signature of
of a doctor
doctor it

21 appears
appears to
to be
be a patient
patient history
history sheet
sheet without even
without even
22 a patient
patient name
narae or
or history
history on
on there,
there, would
would you
you say
say
that that, those
that that, those four files are
four files within the
are within the

24 standards
standards for
for medical
medical care
care in the profession?
the profession?

25 hA -- please
I -- please explain,
explain, because
because I donlt
don't know
know what
what
 1
1 these
these files
files indicate.
indicate.
i

Well,
2 Q
\C Well, that
that they
they are
are found
found in
in aa doctor's
doctor's office?
office?
3 A Yes.
3 >A Yes.
4 Q Just
4 \Q Just as
as they
they are
are already
already made
made out?
out?
5
5 A
A Yes.
Yes.
6 Q In
6 Q In aa clinic?
clinic?
7 A Yes.
7 A Yes.
a8 Q
Q And
And they
they are
are found
found in
in the
the form
form that
that they
they presently
presently
99 | exist?
exist?
10
10 JAA Yes.
Yes.
11
11 |QQ IsS that
I that the
the type
type of
of thing,
thing, putting
putting a
a diagnosis
diagnosis en
en aa
12
12 piece of
piece of paper
paper words
words like overweight,
like overweight, low back
low back

13
13 pain, writing
pain, writing the
the name
name of
of a
a doctor without there
doctor without therE

14
14 being
being anything
anything else
else on
on the
the history
history sheet
sheet within ~hE
within -che
15
15 bounds of
bounds standard medical
of standard medical practice?
practice?
16
16 |A If a
If doctor did
a doctor did that
that then
then it
it would
would not
not be
be in
in the
the
17 bounds of
bounds of standard medical practice.
standard medical practice.

18
18 Q
|Q Now yesterday
Now I believe
yesterday I believe you
you said that you
said that you had
had known
known
19 | Dr. Krebs
Krebs --
—
20 \h (Interposing)
(Interposing) I
I said
said by
by the
the way
way I
I noticed
noticed one of
one of
21
21 | the charts
the charts here
here had
had or
or more
more had
had one
one of
of these
these had
had a
a
i
22
22 ; name on
name on the
the file
file folder.
folder.
23
23 JQ We assume that
We assume that all
all of
of the
the rest
rest of
of them
them had patients
had patients
i
24
24 j named on them?
named on them?
25
25 |A N O , the
No, the name on the
name on the file
file folder
folder is
is not
not the
the same
same as
as

-----------_.
 1 the
the patient
patient name.
name. There
There are
are se
so many.
many. I
I don't kr.cv
don't knew
2 whether
whether that
that indicates
indicates that
that these
these file folders,
file folders,
3 that
that these files were
these files were in
in folders
fo16ers that
that had
had patients
patients
4 names but I
names but I will
will say ! will
say I will agree
agree with
with you
you that if
that if

this is all
this is all there
there was
was and
and a
a doctor would write
doctor would do~~
write down
6 a diagnosis
a diagnosis and
and treatment
treatment it
it would
would not
not be
be within
within
7 the
the standard.
standard.
8 Q Now
Now just
just so
so we
we have
have the
the record
record straight,
straight, can
can you
you
9 tell us the
tell us the name that is
name that is on
on the
the file,
file, that
that you
you just
10 mentioned, as well
mentioned, as well as
as the
the patient
patient name that is
name that is

11 different
different from that that
from that that is
is inside
inside the
the file?
file?
12 A There's
There's aa Janet
Janet McFarland
McFarland on
on the
the outside
outside of
of this.
this.
13 Q That
That is
is on
on the
the manila
manila folder.
folder. On
On the manila fclcer
the manila felder
14 and
and there's a Barbara
there's a Scott on
Barbara Scott on the
the sheet
sheet inside?
inside?
15 There
There are also 1
are also I might
might note
note tabs
tabs that
that

16 were placed on
were placed on all
all of
of these
these charts
charts that
that are
are no
no

17 longer there, that

longer there, that have
have been
been apparently
apparently removed.
removed.
18 Q
Q Now
Now II believe
believe you
you testified
testified yesterday,
yesterday, Doctor,
Doctor, that
that
19 you
you had
had known
known Dr.
Dr. Krebs for ten
Krebs for ten or
or so
so years?
years?
20 A
A Ye s, indeed.
Yes, indeed.
21 Q
Q And
And you
you had
had gotten
gotten to
to know
know him
him very
very well
well not
not only
only
22 as your son's
as your friend but
son's friend but really
really as
as your
your own
own friend
friend
23 as well.
as well. Also his medical
Also his medical career?
career?
24 Q And
And you
you held
held him
him in
in such
such esteem
esteem that
that you
you offered
offered
25 him
him a
a position
position in
in Cincinnati
Cincinnati at
at your
your institute, is
institute, is
 re

1 that right?
that right?
2 jA That's right.
That's right.

3 iQ During the period

During the period of
of time
time from
from 1981
1981 until
until late,
late, or

4 ! 1980 until
1980 until late
late 1981
1981 or
or early
early 1982
1982 did
did you
you ever
ever
5
5 | visit Dr.
visit Dr. Krebs
Krebs at
at any
any of
of the
the three
three clinics
clinics that
that he
he
6
6 worked in the
worked in the City
City of
of Detroit?
Detroit?
7
7 A
A No, II did
No, did not.
not.
8
8 Q Did you
Did you visit
visit any
any of
of those
those three
three clinics
clinics known
known as
as
9
9 ' RNA or
RNA or 77 Mile
Mile or
or Jefferson
Jefferson Medical
Medical Clinic
Clinic at
at any
any
10
10 time either
time before, during
either before, during or after the
or after the time
time that
that

11
11 Dr. Krebs was
Dr. Krebs was working
working there?
there?
12
12 jA No,
No, II did
did not.
not.

13 McCARTHY:
MR. MCCARTHY:
MR. Your Honor,
Your I have
Honor, I have nc
14 additional
additional questions
questions at the present
at the present time,
time, thank
thank

15 you.
you.

16 MR. HOWARTH:
KR. HOWARTH: Your Honor,
Your Honor, I'll probably
I'll probably

17 i be
be brief
brief if
if II can
can ask
ask questions
questions from
from here.
here.
18 THE
THE COURT:
COURT: Certainly.
Certainly.
19 CROSS
CROSS EXAMINATION
EXAMINATION
20
20 IBY
BY MR.
MR. HOWARTH:
HOWARTE:
21
21 Q
Q Dr.
Dr. Heirnlick,
Heimlick, is
is it
it possible
possible that
that you
you have
have another
another
22
22 son who
son who is
is in the
the pharmacy business?
pharmacy business?
23 A Not that
Not that II know
know of.
of.
24
24 Q II was
was afraid
afraid you
you were
were going
going to
to say
say that.
that. No
No
25 further questions.
further questions.
 1
1 : r~R•
MR. WRIGH'I':
WRIGHT: No questions.
No questions.
2
2 ! MR. r""l.MBERG:
HR. AKBERG: No questions.
No questions.
3
3 KR. FERRIS:
NR. FERRIS: No questions.
No questions.
4
4 i r.m.
MR. ROBINSON:
ROBINSON: II have
have one.
one.
5 REDIRECT EXAMINATION
REDIRECT EXAMINATION
6 BY I,!JR.
IBY MR. ROB
R O INSON
B I N S O N: :

7
7 |Q
Q Dr. Heimlick
Dr. Heimlick the
the Court
Court asked
asked you
you questions
questions before
before
i

8
8 ; that
that relate
relate to
to whether
whether or
or not
not -- II got
got the
the
9 | impression
impression from
from the
the questions
questions that
that whether
whether or
or not
not
10 j there's a different
there's a different standard
standard of
of care
care that
that you
you

11 ; recognize
recognize in
in the
the medical
medical profession
profession for
for poor
poor Elack
Elack

12 people in the
people in the city;
city; and
and I got the impression
got the that
impression that
13 you \
you were trying to
-7ere trying Explain
to explain an answer
an answer about
about the
the

14 differences
differences in
in medic&l
medical treatment
treatment in
in the
the University
University
15 atmosphere and residency
atmosphere and residency atmosphere
atmosphere and
and hospital
hospital
16 and
and some
some private
private practices
practices and
and clinics
clinics in
in the inner
the inner
17 city or with
city or with poor
poor people.
people. Would you
Would you tell
tell us
us what
what
18 you meant by
you meant by your
your answer?
answer?
19 A That
That there
there are
are differences between
differences between them.
them. There are
There are
20
20 -- well first
— well first of
of all
all let's
let's talk
talk about
about different
different
21 types of clinics.
types of clinics. I don't know
I don't know that
that you
you can break
can break
it down into
it down into inner city necessarily
inner city or Black
necessarily or Black or
or

23
23 white.
white.
24 Most clinics
Most clinics I know
I know of
of are
are mixed
mixed or if
or if

25 they are
they are in
in a
a certain
certain area they might
area they might have
have the
the race
race
 ,
oJ. or nationality.
or nationality. you want
If you want to
to speak
speak about
abcut inner
in~e:

city clinics, there

city clinics, there are
are --
-- as
as there
there is
is in
in n.e d i c i ne
medicine
3 general,
in general, all levels.
all levels. There are
There are inner citv
inner city
4 clinics with some
clinics with some of
of the
the most dedicated doctors
most dedicated doctors in
5 the
the world.
world. The fact that
The fact that they
they will
will give
give up
~~
6 lucrative
lucrative practices to
practices work there
to work there indicates
indicates the
the

7 dedication
dedication of some
of some of
of the
the young
young men
men I have
have seen
seen in
8 such clinics.
such clinics. So I'm really
So really speaking
speaking about
about the
the
9 different
different level of
level of treatment
treatment or
or different
different type
type of
10 treatment
treatment depending
depending on
on the
the site and atmosphere
site and atmosphere of
11 the
the place
place itself.
itself.
12 There is a medical
There is medical school treatment
school treatment

13 which I described
which described yesterday
yesterday which
which is
is very extensive
very extenEi~E

14 and
and complete
complete for
for teaching
teaching purposesj as
purposes; as excessive
excessivE as
-~
15 far
far as
as the
the individual
individual patient goes.
patient goes. But for
But for

16 teaching
teaching there
there are
are hospital
hospital clinics
clinics where
where they
they have
have

17 certain types of
certain types of hospital
hospital clinics
clinics and
and where
where perhaps
perhaps
18 one or more
one or more of a group
of a group of
of doctors
doctors are interested in
are interested

19 certain
certain types
types of
of disease
disease and
and concentrate
concentrate on
on that
that in

20 the
the clinics
clinics and
and do
do extensive
extensive studies
studies on certain
on certain

21 diseases
diseases they are
they are particularly
particularly involved with,
inVOlved with,

22 significantly.
Significantly. There are
There are clinics
clinics that
that are
are walk-in
walk-in
23 type
type clinics
clinics where
where that
that patient
patient comes
comes into
into the
the
24 clinic and says
clinic and says II have
have a pain or I have
pain or have this
this
25 problem,
problem, help me.
help me. And the
And the type
type of
of treatment
treatment varies
vsries
 ---~"------'

C-,

with that
with that situation.
situation. And there
And there are
are good
good doctors
doctors

and there
and there are
are bad
bad doctors.
doctors. II don't
den't know
know what
what else
elSE
3 can say.
II can say.
4 MR. ROBINSON:
MR. ROBINSON: That is
That is all.
all. II have
have

nething additionally.
nothing additionally. Thank you,
Thank you, doctor.
doctor.
6 COURT:
THE COURT:
THE Is it
Is it presumed
presumed in
in an
an inner
inner
7 city clinic
city clinic when
when aa patient
patient comes
comes and
and is
is required
required to
to

8 pay $30.00
pay $30.00 in
in advance
advance to
to see
see aa physician
physician about
about
9 pain, is
pain, it presumed
is it presumed that
that this
this is
is aa one
one time
time
10 walk-in obligation;
walk-in obligation; that the
that the doctor
doctor has
has to
to tide
tide hi
hi~
rr.
11 over to
over to go
go for
for other
other care
care elsewhere,
elsewhere, or
or that
that there
there
12 are
are not
not other
other resources
resources to
to follow
follow up
up or
or test
test

13 whatever
whatever the
the patient's
patient's problem
problem is?
is? That
That is,
is, is
is aa

J.4 patient
patient who
who walks
walks in
in and
snC pays
pays $30.00
$30.00 in
in advance
advance and
anG

15 complains
complains of
of pain
pain to
to aa doctor,
doctor, is
is he
he able
able to
to expect
expect

16 medical
medical care
care or
or simply
simply a
a medication
medication and
and to
to use
use his
his

17 wits
wits and
and find
find true
true care
care elsewhere.
elsewhere. Must
Must he
he find
find an
an

18 individual doctor's
individual doctor's name
name posted
posted or
or a
a hospital?
hospital?

19 THE WITNESS:
THE WITNESS: That's a
That's very difficult
a very difficult --

20 THE
THE COURT:
COURT: (Interposing)
(Interposing) are the
are the

21 standard of the profession

standard profession such that
such that only
only certain
certain

22 care is given
care given in a clinic,
clinic, and
and is
is it presumed,
presumed, he
he

23 too poor
is too poor to see
see through
through his
his care?
care?
24 WITNESS:
THE WITNESS: The word
The word clinic
clinic I think
think is
is

25 a little
little ambiguous,
ambiauous, because
because we
we did
did refer
refer to
to aa
 62

1 medical
medical school clinic
school clinic or
or to
to and
and outpatient
outpatient cli~ic
clinic
2 ana sc
and se forth.
forth. It
It varies
varies so,
so, but
but If 1
I can talk just:
can talk jus~

3 to the point,
to thE point, perhaps of medical
perhaps of medical care
care and
and not
not use
use

4 the word clinic

the word clinic which
which is too
too broad.
broad.
5 It varies
It varies extensively
extensively and
and varies
varies with
with
6 the doctor
the doctor who
who is
is doing
doing the
the treatment
treatment and the
and the type
type

7 of clinic.
of clinic. I
I know
know private
private doctors
doctors who,
who, when vou
when you
8 call for an
call for an appointment
appointment in their office, the
their office, the nurse
nurse
9 tells them
tells them that we want
that we want you
you to
to know
know that
that the
the

10 initial visit
initial visit is
is $150.00
$150.00 to
to $200.00
$200.00 which will
which will

11 include all
include all of your blood
of your blood tests,
tests, urinalysis,
urinalysis, chest
chest
12 x-rays, etcetera,
x-rays, etcetera, etcetera
etcetera without
without knowing what
knowing i~
wh&t is

wrong with
wrong with the
the patient.
patient. And if the
hnd. the patient
patient ca~'~
can't
14 put up
put then they'll
up then they'll say I'm
say I'm sorry-
sorry you
you will haVE tc
will have tc

15 go elsewhere.
go elsewhere.

16 There are
There are clinics
clinics such
such as
as the
the Mayo
Mayo
17 Clinic where, when
Clinic where, when you
you travel
travel out
out there
there you
you go
go to
18 spend days
spend days of
of examination
examination and
and usually
usually you travel
you travel

19 out there with

out there with the
the doctors
doctors there
there already
already having
having
20 received
received extensive records
extensive records from
from your
your cwn
own doctor
doctor
21 because you
because you are
are going there for
going there for a complicated
complicated
22 situation
situation that your
that your own
own doctors
doctors cannot treat.
cannot treat. And
And
23 then there
then there are
are clinics
clinics and
and doctors offices where
doctors offices where
24 there is
there is no
no alarming
alarming number
number of
of patients,
patients, where
where
25 perhaps
perhaps the
the amount paid is
amount paid is not
not enough
enough to allow for
to allow
 -----~-----------------~--~------------- -- - -----------

1 a whole
whole hour
hour or two with
or two with the
the patient.
patient. And
And they
they
2 provide
provide a service as well
service as well to
to people
people who
who have
have to ~et
to get
back to
back to work,
work, who
who have everyday complaints,
have everyday complaints, and are
and are
4 to be treated.
to be treated.
I think perhaps
I think perhaps the
the best
best explanation
explanation is
is
6 if you took away
you took away anyone
anyone of
of these
these things
things what
what wcule
wculc
7 you have?
you have? And there
And there we
we would
woulo all like to
all like to have
have Mayc
Eave
8 Clinics all over the
Clinics allover the country
country because
because it's
it's a
a

9 marvelous
marvelous institution.
institution. For
For reasons
reasons that
that may
may be
10 governmental,
governmental, employment problems,
employment problems, overwhelming
overwhelming
11 numbers of people
numbers of people in
in a certain
certain area,
area, the medical
the medical
12 standards
standards around
around the
the country
country cannot
cannot be,
be, or
or has
has not
not

13 been,
been, I
I wish it were,
wish it were, Mayo
Mayo Clinic
Clinic standards.
standards. So
14 you
you are either going
are either going to say every
to say every patient
patient has
has to

15 have
have that, and therefore
that, and therefore these
these many
many millions
millions of
16 people
people cannot get any
cannot get any treatment
treatment or
or you
you have
have to
17 divide
divide them
them with
with what
what help
help you
you can
can to
to support
support then
the~
18 and carry them
and carry them over
over their
their immediate
immediate illness.
illness.

19 Does that answer

Does that answer your
your questions,
questions, your
your

20 Honor?
Honor?
21 THE COURT:
THE COURT: No.
Nc.

Is
Is there
there an
an obligation
obligation by
by the profession
the profession

23 to see
to see a patient
patient through treatment of
through treatment of whatever
whatever type
type

24 that patient may

that patient may be
be able
able to
to afford
afford or
or aa third
third party
party

25 provider.
provider. The
The standard
standard of
of care
care does
does not provide
not provide
 64

1 that:.
thst —

2 THE WITNESS:
WITNESS: (Interposing)
(I n t e r po sing) I would
I would say
":l
oJ if
if you recognize a treatment
you recognize treatment that should
that should warrant
warrant
4 extensive
extensive work-up if you
work-up you will,
willr or
or what
what have
have you,
you,

5 that
that there should be
there should be places
places in every area
in every area where
where
6 patients
patients could be
could be referred
referred for
for that
that type
type of

7 treatment.
treatment.

8 Q
Q Mr. Robinson):
(By Mr. Robinson)? Doctor, is
Doctor, is it
it fair
fair to
to say
say that
that
9 based
based on
on the
the Court's
Court's question
question that
that any
any such
such

10 standard
standard to refer a patient
to refer patient depends
depends on
on the
the

11 physician's
physician's at
at the
the clinic,
clinic, judgment
judgment tc determine
to determine

12 whether
whether that is
that is indicated?
indicated?
13 Lr;,.
;;
That
Th~,t is correct.
correct.

14 Q
(: Finally, Doctor
Finally, Doctor --
--
15 P.
A (Interposing)
(Interposing) I think
think what
what is
is also
also important,
important, is
16 that you
that you have to rely
have to rely on
on the
the physician's
physician's judgment.
judgment.

17 Q
Q Doctor, from
Doctor, from your
your experience
experience --
— let's take
let's take this
this
18 case
case of
of Dr.
Dr. Krebs
Krebs where,
where, according
according to
to Dr. Krebs'1
Dr. Krebs

19 own testiraony,
own testimony, he
he saw
saw at
at least
least in
in the
the hundreds
hundreds of
20 patients
patients not
not necessarily
necessarily thousands,
thousands, but
but in
in the
the
'; 1
.:... .... hundreds
hundreds over
over a 15 month period
15 month and to
period and to our
our

22 knowledge
knowledge in all
all of these
these cases
cases not
not one
one patient who
patient who

23 saw him
saw complained of
him complained malpractice.
of malpractice. Are you
Are you aware
aware
24 of the
of potential
the potential and ability
and ability the patient
of the patient to

25 complain
complain that their
that their needs
needs were
were not
not tended
tended to
to wittin
within
 t. :

the requirements
the requirements of the
of the stanaarc';.
standarG. Don't tney
Don't they have
have

2. the right
the right to
to sue
sue doctors
doctors and
and clinics?
clinics?

They surely
They surely can
can and
and they
they surely
surely do.
do.

4 Q And does
And does that
that appear
appear to
to you
you that
that based
based upon
upon your
your

5 experience
experience with hundreds
with hundreds of
of patients
patients visiting
visiting Dr.
Dr.

6 Krebs that
Krebs that not
not one
one has
has filed
filed aa complaint
complaint of
of

7 malpractice
malpractice indicates he
indicates he was
was within
within the
the standard
standard of
of

8 care, at
care, at least
least for
for those
those patients
patients in
in their
their

9 judgment.
judgment.
10 II would
would say
say it
it certainly
certainly is --
is -- apparently
apparently within
within
11 the standards.
the standards. II also
also say
say in
in line
line with
with what
what I
I said
sai~

12 to the
to the Judge,
Judge, if
if Dr.
Dr. Krebs
Krebs were
were not
not there
there to
to treat
tre&~

13 these people,
these people, who
who would
would be
be there?
there? Now it's
Now it's my
my

14 understanding
understanding he told
he tol~ r
DE that he
r.e that he had
had answered
answered an
an

15 add in
add in the
the newspaper
newspaper and a
and a doctor
doctor was
was needed
needed in
in

16 this area
this area and
and he
he felt,
felt aa doctor
doctor was
was needed
needed in
in that
that

17 area.
area. Now he
Now he had
had the
the choice.
choice. He had
Ee had the
the choice
choice of
of

18 opening a
opening a practice,
practice, which is
which is for
for doctors
doctors a
a very
very

19 lucrative
lucrative thing to
thing to do.
do. I have
I have had
had a
a practice.
practice. II
20 have never
have never put
put that
that before
before the
the other
other things
things I
I had
had

21 to do,
to do, I
I wanted
wanted to
to do.
do. The scientific
The scientific work as
work as

22 well, and
well, and all
all of
of that
that that
that you
you do
do either
either in
in your
your

23 practice.
practice. So he
So he had
had the
the choice.
choice. Shall I
Shall I go
go down
down

24 to this
to this clinic
clinic or
or go
go into
into practice
practice and build
and build up
up a
2

25 practice?
practice? And he
And he made
made his
his choice
choice and if he
and if he hadn't
hadn't
 66

madE that
mace that choice
choice I
I don't
don't know
know what
what would
would you
you say
say
,..
L: these people
these people would
would have
have had,
had, the
the thousand
thousand or so
se he

3 trec:teo?
treated?
4 MR. ROBINSON:
MR, ROBINSON: Thank you,
Thank you, doctor,
doctor, ~ have
I have

5 no
no iaore
more questions.
questions.

6 RECROSS
EECROSS EXAMINATION
EXAMINATION
7 BY MR. MCCARTHY:
8 Q Doctor,
Doctor, are you telling
are you telling us
us that the standard
that the standard of
9 care for
care for practice
practice in the
in the field
field of
of medicine
medicine is up to
is to

10 the judgment
the judgment of the
the individual
individual physician?
physician?
11 A No.
No.

12 Q Is there?
Is there?
13 "P.
A I'm
I * m saying
saying the
the treatment
treatment ofof the
the patient
patient isisupuptcto
14 the judgment
the judgment of the
of the individual
individual physician
physician w ho should
who s.t.c u i c

15 stay within the

stay within the standard
standar6 practice
practice of medicine.
of medicine.

16 Q
Q Did —
Did -- when
when Dr.
Dr. Krebs
Krebs told
told you
you about
about his
his answerinq
answering
17 an ad
an ad in
in the
the newspaper
newspaper that a
that a doctor
doctor was
was needed
needed at
at

18 the clinic,
the clinic, did
did he
he also
also tell
tell you
you that
that he
he had
had

19 indicated
indicated that the
that the pay
pay would
would be
be $100.00
$100.00 per
per hour?
hour?

20 A No,
No, I didn't
didn't know
know that.
that.

21 MR. MCCARTHY:
MR. McCARTHY: No further
No further questions,
questions,

22 your Honor.
your Honor. Thank you.
Thank you.

23 REDIRECT EXAMINATION
REDIRECT EXAMINATION

24 BY MR.
BY MR. ROBINSON:
ROBINSON:

25 QQ Did you
Did you know,
know, that
that Dr.
Dr. Krebs
Krebs testified
testified he was
he was paid
paio
 r.~

$25.00 an
$25.00 an hour?
hour?
1 didn't know
I 6i6n't know that
that either;
either; though
though that
that would
would be
be
generally
generally --
4 MR. ROBINSON:
MR. ROBINSON: That
That is
is all.
all. Thank
Thank you.
you.

5 I'
I n.m so
I r ry we
sorry we kept
kept you
you so
so long.
long.
6 I'm going
going to
to call
call Dr.
Dr. Laufman
Laufman now,
now, your
your

7 Honor.
Honor. Was that
Was that our
our break
break for
for the
the morning?
morning? I'd
I'~

8 just soon go
just soon go on.
on.
o
.J A LLAN
A A N L A U P K A N
Lll.UFf!;AN

10 was thereupon called

was thereupon as a witness
called as witness herein,
0 herein, and
and after
after

11 having been first

having been first duly
duly sworn
sworn to
to tell
tell the
the truth,
truth, the
the
whole truth,
whole truth, and
and nothing
nothing but
but the
the truth,
truth, was examined
was examined

and testified as
and testified as follows:
follows:
14 THE COURT:
THE COUR~: You are a
Yeu are a lawyer.
lawyer.

15 THE WITNESS:
THE WITNESS: Yes, ma'am.
Yes, ma'am.
16 MR. ROBINSON:
MR. ROBINSON: And a doctor
And a doctor
17 DIRECT EXAMINATION
DIRECT EXAMINATION

18 MR. ROBINSON:
JEY MR. ROBINSON:
19 Q Tell
Tell us your name
us your name and
anti educational
educational background?
background?

20 My
My name
name is
is Alan
Alan Kerry
Kerry Laufman.
Laufman. I grew
grew up
up in Texas,
Texas,

21 went to the
went to the University
University of Pennsylvania
Pennsylvania in
22 Philadelphia.
Philadelphia. I then
then attended
attended Harvard
Harvard Law School
Law Schoel

23 and earned a law

and earned law degree
degree and during that
and during that period
period II

24 became
became a resident
resident in the
the field
field of legal medicine
of legal medicine

25 and
and went on to
went on earn a M.D.
to earn at the
M.D. at the medical school
medical school
 F 1 C I, I

7 I, ELIKftRTTIT E. n o n T C O M F H V t Oliicul

Ccutt
Co reporter,
u r t, l.c in ana
[tel, ~~ anc for
icr Unitec States
the Unitec Gtetec District
District
Court, in the Eastern District ot Kichioan, Southern
10 Division,
Uivi::..ion, do hereby
(10 he re certify
certify h a t, I
tthat T report.Cu
r(~ stenocrtrhi-
c&Iiv the foreccinq proceedinct at the time ana ijii.ee
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