Direct Exam: John Arnold

Dr. Marcus graduated from UC Medical School and is employed as an ER physician at Bethesda Arrowsprings Hospital. He has been licensed for 34 years and is board certified in family practice and emergency medicine.

He was on duty in the ER on the night of Aug. 12, 2008, and received a call that a patient was en route in cardiac arrest and not breathing. EMTs were doing CPR and had attempted to intubate without success.

The patient arrived and he received summary information of her treatment so far. An EMT was doing chest compressions and another EMT was bagging her at that time.   She was "blueish-gray" and there was no pulse or respiration. She was immediately placed on a heart monitor and he successfully intubated her in 30 seconds or less. He said he does about 2 intubations a week.  

"I could see the vocal cords, but the patient had to be suctioned. There was a little bit of mucus and vomit in the mouth, he said. He said she also had an IV in her left jugular so he gave her epinephrine and compressions continued.   They also tried an external pacemaker with electrical pads that were attached to the chest, but there was no response from Sarah. She was pronounced dead at 11:41 p.m.,--about 19 minutes after she arrived.   He knew EMS workers had been working on her for a half hour or more but she was not responding to anything.   He dictated his report of the incident and then it was transcribed. After it was reviewed it was electronically signed. In the final diagnosis field, he wrote:   Cause of death; "cardiac arrest".   Heart stopped "we don't know why," he said.

Dr. Marcus talked to Ryan, and Ryan told him Sarah had a tendency to fall asleep in the tub and he found her floating face down and pulled her out.   Dr. Marcus recorded that in the report.   "It was what I was told," he said but he agreed that he knew the nurse had written something different in her report.   Nothing further.

Cross Exam: Lindsey Gutierrez

Dr. Marcus said when a patient is being transported , the ER is advised that someone is on the way. Someone has to report the times and that person would be the primary nurse, Lila Gibbs. Amy Costello is also a primary nurse/charting nurse.

Marcus reviewed the medical chart and said that one time was marked as 11:30 instead of 11:22 but he said every watch is different.  He thought Sarah had arrived at 11:22 but it might have been 11:30. The intubation is recorded at 11:31 but he said it was probably sooner than that because it was done within 90 seconds of her arrival.   If EMTs have given drugs to the patient, they tell the ER when they give their summary of treatment on arrival, but he doesn't recall if they told him she was given epinephrine. It was his understanding that they had done 1-2 intubation attempts. He didn't recall if an EMS worker was in the trauma room giving chest compressions to Sarah.

He didn't recall if she had defibrillator pads on, but they would not have been compatible with the hospital's.  ER staff take off defibrillator pads placed by medics and use their own. He said it "probably" would be charted in the record if there were pads.

Marcus said he's seen drowning victims before and pulmonary edema (pink, frothy fluid) is typical. He didn't have any real difficulty in the intubation of Sarah but about 12 ounces of frothy fluid was suctioned from her nostrils.   It was the first time he had seen that much frothy fluid in a drowning patient.

Marcus said when he talked to Ryan he seemed very upset. He dictated his report Aug. 12th at about 7:00 a.m., then Michelle Myers typed it up later in the day.

He didn't see any obvious signs of trauma on the front of Sarah but he was more "concerned" with saving her. There were no obvious marks on her back either. He knew the coroner's investigator was there, but didn't know if he arrived before or after she was pronounced dead. Nothing further.

Re-Direct: John Arnold

Marcus said it's not uncommon for medics to continue with chest compressions until ER staff can take over.

He said he's treated patients with signs of trauma and that trauma marks sometimes don't show up until later. It's also possible that no trauma signs are visible on a dead patient because there's no circulation. He admitted he was not using a "critical eye" looking at her for trauma. Nothing further.