Direct Exam: John Arnold

She is a registered nurse for Tri-Health and works in the ER at Bethesda-Arrow Springs Hospital.   She was the charting nurse in the ER the night Sarah died and has been an ER nurse since 1986.

They received a call from the life Squad that a patient with no heartbeat was being brought in and she got her trauma room "ready to go." There were 2 other nurses, a respiratory technician and a physician in the room with her and she was in charge of the charting.

When the life squad arrived, an EMT was doing CPR on Sarah and they switched her from the squad's stretcher to the ER stretcher. Sarah was not breathing and had no pulse, and that never changed. She started filling out a report for Sarah's medical chart.

Arnold put a report up on the screen and handed her a copy which she identified as the hospital report of the care they gave to Sarah that night. She said it's a narrative chart and she obtained background information on Sarah initially from the life squad and then Ryan.   Ryan said Sarah didn't have a medical history.   She asked him "what happened" and he replied that he found his wife in the tub "face up" so she documented that in the chart. She didn't notice any wetness on Sarah or Ryan.   She's familiar with pruning and didn't notice pruning on Sarah's body. She was there from the time Sarah was brought in until she was pronounced dead at 23:41.

They are taught, "Patients first, charting second" so she adds notes to a chart after the patient is stable or pronounced dead.   The chart was dated Aug. 12 and Costello said there were parts of the report where the time and date were incorrectly recorded and that was an oversight on her part. She

referred to Ryan as "Bryan" but said she did not record his name. The department that handled insurance would have done that.   She got his name from the records that were given to her.

Nothing further.

Cross Exam: Lindsey Gutierrez

Costello said she was assigned as the primary nurse for that trauma room that night. Bethesda-Arrow

Springs has electronic record keeping but a hard copy of the treatment and medicines given to a patient is filled out first so she can add more to the chart after the fact.   She agreed that accurate record keeping is important and she fills out everything that happens to a patient. She doesn't chart a standard of care but does chart any drugs that are given. The information is then entered into the computer but mistakes can be manually changed, if necessary.   She started the chart at 23:22 when Sarah arrived, but added that it might have been earlier.

Gutierrez put the chart on the overhead and pointed to the right-side column where her initials AC are next to the time and information she entered on the chart. The left side is the time the event actually occurred, she said. Gutierrez asked her about a line drawn through an entry and Costello said the date was incorrect in spots.   It said Aug. 12, but should have been Aug. 11. That was the only correction made, she said.   She said the dates are incorrect for all four medications given, but the times are correct. A notation on the chart said the coroner's investigator arrived at 11:50 p.m. but the date is incorrect.

In regards to Ryan's statement of finding Sarah face up in the tub, Guterriz asked Costello if she wrote it on the chart immediately. Costello replied that he gave the statement at 11:33 p.m. but admitted she charted it from memory, 9 minutes later. She said she did not take any notes when she talked to him. For the "Name of family contact" field,  she wrote Bryan.

When Sarah arrived they got a verbal summary from EMS workers about the treatment they had already done.

EMS treatment:  Airway- Ambu bag/mask;   Backboard;   IV fluid type-Normal Saline

She was not informed about the number of intubation attempts they tried and she didn't chart it.

Sometimes they (EMTs) tell and sometimes "we don't even ask" because it's not important information that ER workers need to know, she said. Anything EMTs tell her that she thinks is important to ER personnel would be entered in the chart, she said, but she admitted the drugs Sarah was given was also not charted.

Costello said, Dr. Marcus got a successful intubation in Sarah when she arrived.   She didn't know if he did the Sellick maneuver, but no one assisted him. The charting nurse contacts the coroner when someone dies and that would have been the responsibility of Lila Gibbs who was in charge of all the nurses on the shift that night. Costello said she wasn't present when Gibbs contacted him.

She agreed that one of her responsibilities that night was to "bag and mark the deceased". The coroner's investigator, Doyle Burke, asked for paper bags and she contacted housekeeping for bags to put on Sarah's hands. She said during chest compressions in the hospital, no one from EMS was in the room performing them.    Nothing further.

Re-Direct: John Arnold

She said, in spite of the other mistakes on the chart, she recollected that Ryan said he found Sarah face up.

Nothing further.