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HomeMy WebLinkAbout10-21-04 (2) 1 2 1 INDEX TO TESTIMONY 2 WITNESS DIRECT CROSS REDIRECT RECROSS 3 Joseph Brazel, M.D. 3,4 14 .... 4 5 6 7 8 9 10 11 INDEX TO EXHIBITS 12 NO. DESCRIPTION PAGE 13 (None.) 14 15 16 17 18 19 2O 21 22 23 24 25 JOSEPH F. BRAZEL, M.D, called as a witness, 2 being duly sworn, was examined and testified as follows: 3 4 DIRECT EXJ~MINATION (As to qualifications) 5 6 BY MR. FLOWER: 7 Q. Dr. Brazel, would you give your full name, 8 please? 9 A. Joseph F. Brazel, B-r-a-z-e-1. 10 (Interruption by phone.) 11 BY MR. FLOWER: 12 Q. Where are your offices located? 13 A. 220 Wilson Street, Carlisle, Pennsylvania. 14 Q. A_nd are you a physician licensed in the 15 Commonwealth of Pennsylvania? 16 A. Yes, sir. 17 Q. How long have you practiced medicine in 18 Carlisle? 19 A. 32 and a half years. 20 Q. Amd do you have any particular specialization? 21 A. Internal medicine. 22 Q. Are you board certified in internal medicine? 23 A. Yes, sir. 24 Q. Where did you graduate from medical school? 25 A. Temple University School of Medicine in 4 1 Philadelphia, Pennsylvania. 2 MR. FLOWER: Any cross-examinatien on 3 qualificatiens? 4 MR. THOMAS: No. DIRECT E~INATION 6 BY MR. FLOWER: 7 Q. Dr. Brazel, have you known Warren and Eleanor 8 Coolidge for a long time? 9 A. Yes, sir. 10 Q. Have they been long-term patients of yours? 11 A. Yes, sir. 12 Q. Do you have a sense as to how long Warren 13 Coolidge was a patient of yours? 14 A. I believe from the '70s, early to middle '70s. 15 Q. Did he continue as your patient until his death 16 in July of 20017 17 A. Yes, sir. 18 Q. And how about Ms. Coolidge, has she also been a 19 patient of yours since the '70s? 20 A. I believe the late '70s. The first record here 21 is 1980, but the chart may have been thinned out. I 22 believe it was the '70s also. 23 Q. And did she continue with you as her internal 24 physician until her death in Harch ef 2004? 25 A. Yes, sir. 5 1 Q. Are you aware that the Coolidges had three 2 children, Phil and Tom and Julia? 3 A. Yes, sir. 4 Q. Did Mrs. Coolidge ever talk to you about her relationship with her children? 6 A. Extensively at most of the office visits. She 7 had a very warm relationship with Thomas. Phillip lived, I 8 believe, in Boston and would occasionally visit and call 9 her mother, his mother, and I believe the relationship 10 there was a good one. 11 The relationship with Dr. Coolidge, Julia, was 12 from the time that I remember not good in Mrs. Coolidge's 13 viewpoint. There was a great deal of antagonism often 14 stated between the two, mother-daughter problems which were 15 never, I don't believe, ever solved. 16 Q. Was that a theme that you heard from her 17 frequently over the years? 18 A. Almost every visit. 19 Q. And can you be, can you recall any specific 20 comments she made about her relationship with her daughter? 21 A. She felt her daughter was attempting to control 22 her. She felt her daughter specifically had motives that 23 may have not been of the best intent. 24 Q. And this was -- 25 A. And it was long-standing. 1 Q. Long-standing as in from the '70s forward until 2 Nor death? 3 A. Yes, from the time the daughter married and left 4 this area after medical school. Julia is a, I believe, a 5 trained pathologist in Boston. 6 Q. Were you aware at some point that Mrs. Coolidge 7 appointed her son, Tom, as her Attorney In Fact? 8 A. Yes, sir. 9 Q. P~d did she ever make any remarks to you about 10 why she wanted to do that er hew he was performing these 11 tasks? 12 A. Tom -- she stated that Tom was performing the 13 task in a most admirable fashion, which he truly was. He 14 was a very caring son, cared greatly for his mother and 15 took care of her. 16 And basically because of his proximity to his 17 mother -- he lived, I believe, around the corner -- was 18 available to do so, in defense of the other children. And 19 they had a very warm relationship, and she trusted Tom with 20 all of her personal, medical and physical needs, and 21 financial. 22 Q. Now, we have a copy of medical records which you 23 supplied to us and which we supplied to Hr. Thomas. And 24 our review of the records suggests that from July of 2001 25 until her death in March of 2004 she may have seen you 7 1 approximately 30 times. Does that sound right, without 2 making you count them? 3 A. Right. ThatTs approximately true. 4 Q. During that time, was there ever a point at 5 which Hrs. Coolidge was not able to understand you or 6 respond to you appropriately? A. No. No, sir. She, with her age, her age 8 of -- excuse me a second. She had a gradual mental decline 9 to the point of having mild dementia in '03, but she was 10 able to understand, with the help of her son, her medical 11 needs. 12 And with the assistance of personnel and her 13 son, she was able to comply with her medical regimen, again 14 requiring assistance. But she was fully able to 15 understand. 16 Q. And this is the case up until her catastrophic 17 event? 18 A. Yes, sir. 19 Q. And when did that occur? 20 A. The catastrophic event occurred in March of '04. 21 It was March 12th. And she went back to the nursing home 22 March 16th, and Mrs. Coolidge expired on March 24th of 23 104 -- 24 Q. When you -- 25 A. -- as a result of a massive stroke. 8 1 Q. When you examined Hrs. Coolidge ena typical 2 occasion, would she have eno of her children with her? 3 A. Towards the ends ef her, the end of her life, I 4 would say the last year or two of her life, her sen 5 accompanied Nor en the vast majority of occasions and/or 6 her daughter-in-law, Beth Coolidge. 7 Q. New, when you say accompanied her, were they 8 present for the entire period of the examination? 9 A. Yes, sir. Well, for the majority. 10 ©. But were there times when the children who, 11 children or stepchild that accompanied 12 her -- daughter-in-law, I'm sorr}, that accompanied her, 13 left the room so that you were alone with Mrs. Coolidge? 14 A. At times during specific parts ef the 15 examination they would, yes, sir. 16 Q. Did she ever indicate that either Tom er Phil 17 were attempting to influence her with respect te whether 18 she should appoint somebody as Attorney In Fact? 19 A. No. 20 Q. Or with respect te what she did with her 21 property? 22 A. Ne. 23 Q. Or with respect to what she should put in her 24 will? 25 A. No. 9 1 Q. Did you ever see Tom or Phil or anyone else in 2 the family putting pressure on Mrs. Coolidge to do one 3 thing or another about her property? 4 A. No. The only thing I ever noticed with Thomas 5 was the excellent care and, he gave to his mother as a 6 caring son. Quite admirable. 7 Q. Now, Mrs. Coolidge did have a history of 8 depression, did she not? 9 A. Yes, sir, long-standing. 10 Q. Did she experience any change in her ability to 11 handle her depression after her husband's death in 20017 12 A. Yes, sir. 13 Q. Did you refer her to a psychiatrist around that 14 time? 15 A. We did not. We increased her treatment 16 intensity; and I forget the exact year after her husband 17 expired, that it was necessary that Mrs. Coolidge 18 eventually move to the personal care area of the Swaim 19 facility in Newville because at that time she was becoming 20 unable to physically care for herself, especially the large 21 home in which she and her husband resided was a very large 22 yard, many, many rooms and bathrooms, and it was becoming 23 beyond her physical capacity to take care of the home. And 24 she was lonely there, and living with ethers at the nursing 25 home actually was quite beneficial to her. 10 1 Q. Was there -- 2 A. Physically and emetionally. 3 Q. Was there a time that yeu referred her to 4 Dr. Craig Jurgensen? 5 A. Yes. I believe her son self-referred her there. 6 I den't believe that we referred her out. I think Tom 7 referred her there. And ~ ferget the exact year it was. 8 I'd have to find that here. 9 I~m sorry for the interruptions; that's the way 10 the phone system is. 11 Q. That's all right. 12 A. Dr. Jurgensen saw Hrs. Ceolidge April 30th ef 13 '03; and at that same time he agreed with the diagnosis 14 that she had dementia, and Ne discussed the course, 15 pregnesis of it with her son. And he felt that there weuld 16 be, with time, a gradual decline in her status, which is 17 the nature ef her, ef the disease. 18 Q. Did he -- 19 A. I don't believe he saw her after ~Nat. Let me 20 see. Ne, I den't believe. 21 Q. Did he say anything in his letter about whether 22 she understood what he was saying to her? 23 A. Let me see. 24 (Perusing document.) 25 He said she comprehends, however, quite well. I 11 1 would not exactly say quite well, but she comprehends at 2 that point. 3 Q. Did she make you aware of a court hearing in 4 November of 2003? 5 A. No, sir. 6 Q. Did she ever speak to you after moving to Green 7 Ridge Village about hew she felt about the level of care 8 and the quality ef care she was getting there? 9 A. She was very pleased with it, and -- she was 10 very pleased with it, as was the family, specifically the 11 sen and daughter-in-law. And it was obvious from her 12 physical condition that she was receiving excellent care. 13 And she seemed to be quite happy there, and she 14 was a personal favorite of many of the, apparently the 15 nursing staff because she actually blossomed in her 16 personality there with getting te be around people. 17 After Warren had passed away, she had spent a 18 great deal of time by herself, which wasn't good for her. 19 ©. Now, you don't knew exactly when her will was 20 executed, but I'll just mention that she executed a will, 21 which is being contested here, on December 8, 2003. 22 And I'm going to ask you to look at your records 23 and to address the appointment that you had before and 24 after that date. And I suggest to you that the one closest 25 to that date before signing the will was November 13, 2003. 12 Arid I'll ask yeu to review yeur notes fer that date and 2 tell us what happened er what your impressiens were at that 3 time. 4 A. In essence, in November, Mrs. Ceelidge 5 demenstrated a persistence of the mildly demented state, 6 that is, and it had net worsened by Januar} ef '04. 7 Q. Okay. On November 13, what were yeu examining 8 her for at that time? 9 A. She was having a check of -- she had a severe 10 allergy prehlem, her depressien. She had some problems 11 with skin lesions that were related to being at the heme 12 and that being semewhat inactive, and alse her mental 13 status, mild dementia, senile dementia of Alzheimer's type which she experienced a mild degree. 15 Q. Is there any specific mention in }eur notes 16 about the status of her depression? 17 A. She was doing quite well at that time and 18 smiling, and we considered her to be stable. 19 Q. I'm going to ask you now te turn the page and to 20 loek at yeur note of ~anuary 5, 2004. And would yeu tell 21 us what that visit was abeut? 22 A. At that time, the specific problem at that time 23 was the fact that she had a small decubitus ulcer en her 24 right hip, and she had alse had some lower intestinal 25 bleeding. 13 1 And we discussed it with the son and Eleanor, 2 and neither wished to have any further studies done in the 3 sense of endoscopic studies. And specifically they never 4 would want to have any surgery done because of her age and 5 the fact of her other associated problems. 6 And her mental status at that time was stable from what it had been in November. There had been no major 8 decline. At that time, she was in a wheelchair, and she 9 was unable to physically care for herself without the 10 assistance of others. 11 Q. Tom was appointed Power of Attorney in December 12 of 2002, and it was about a year later on December 8th of 13 2003 that she changed her will. 14 Can you just generally review for us, with those 15 two dates as sort of our lanch~arks, any changes of her 16 mental status that you observed during that time period? 17 A. Between Dece~er of '02 and '03? 18 Q. Yes. 19 A. Oh, there definitely during that period of time 20 was a decline in her mental status between '02 and 21 May -- correction, May of 703, when we placed her on 22 medicine called Aricept which is used for cognitive 23 dysfunction, dementia. And the current belief is to start 24 it early. 25 Dr. Jurgensen, in his consult, felt it wasn't 14 1 worth trying, as I don't believe he has great faith in the 2 value of these medicines. But in all honesty, they're the 3 only medicines we have for that problem, and I think they 4 did help Mrs. Coolidge to a degree. 5 Q. Did she have a change ef medication that you 6 recall during that period? 7 A. Other than the addition ef the Aricept, there 8 was no major change. 9 MR. FLOWER: Okay. Cress-e×amine. 10 CROSS-EXAMINATION 11 BY HR. THOMAS: 12 Q. Dr. Brazel, my name is Mark Thomas, and I 13 represent Julia Elizabeth Stoltz, the daughter. 14 A. I'm sorry. The last name, her last name? 15 Q. Stoltz. 16 A. I'm sorry. I didn't recognize the last name. 17 Q. If I understand you correctly, you have been the 18 treating physician for Eleanor Coolidge for quite some 19 time? 20 A. I believe dating into the '70s. And before 21 that, one of my other partners had her. He's since 22 retired. 23 Q. And you continued to treat her right up until 24 the time just immediately preceding her death? 25 A. Yes, sir. 15 1 Q. I note that in your records, if you take a look 2 at the June 10th, 2002 record. 3 A. (Perusing document.) 4 Yes, sir. 5 Q. In the middle of that first paragraph you 6 indicate, your notes indicate that she has had problems 7 with her memory; this has been an intermittent problem for 8 many months. 9 Could you explain those statements? 10 A. Actually that was Dr. Neiderer had seen her that 11 day, and he -- I don't believe he had ever seen her before. 12 But it was one of my associates had seen her that day. But 13 he so stated, right. 14 Q. Had you noticed over the times that you had been 15 treating her that she had experienced problems with her 16 memory as of June 2002? 17 A. To the best of my knowledge, sir, I did not 18 notice that until approximately, I believe, May of '03. 19 Q. Now, do you -- if I understood you correctly, 20 you did not refer Eleanor to Dr. Jurgensen? 21 A. I believe I did -- I don't believe I did. I 22 think her son self-referred. 23 Q. But Dr. Jurgensen wrote you a letter explaining 24 his findings? 25 A. Yes, sir. 16 1 Q. And in that letter he got history from one of 2 her children who would have attended that meeting with 3 Dr. Jurgensen? 4 A. I believe it was her son. 5 Q. And the history that he received had been that 6 she had been suffering from mental impairment for 7 approximately one year leading up to -- 8 A. That is so stated here, yes, sir. 9 Q. Is there anything in your records anywhere that 10 indicates that she had been suffering from mental 11 impairment as early as, say, April of 2002? 12 A. Not in my records. But Dr. Neiderer felt, one 13 of my associates felt when he saw her in '02 that she was 14 having problems with memory, out of keeping of what is 15 normal for a person of the age of 70. It was his opinion 16 in June of '02 that she was having problems with memory. 17 Q. And the -- there was a CT scan of her brain that 18 was ordered at some time. Do you recall when that was? 19 A. I~ll find it here, sir. 20 {Perusing document.) 21 That was done February 13th, '03. She had 22 fallen up at Green Ridge Village, and it was ordered, and 23 it showed atrophy of the brain. But we were looking to 24 make sure that she didn't have a cerebral hemorrhage from 25 the fall, that there was no bleeding. 17 1 And she had, at that time, mild diffuse cerebral 2 atrophy, which is a fancy word for basically shrinkage ef 3 the brain, which occurs sadly in all of us as we age. 4 Q. Are you the one who requested that? 5 A. I believe so. 6 Q. And do your records indicate the nature of the 7 fall that she had undergone and the nature -- 8 A. I'm sorry. I do net remes~er. I don't have a 9 record of it. And she fell at the nursing home, and I 10 believe they were concerned enough that the nursing staff 11 wanted her to have a CAT scan done because apparently she 12 did strike her head. 13 And she was sent down to, I believe either the 14 hospital or the emergency room, obviously the hospital, and 15 she had the x-ray done. It may have been done at one of 16 the outpatient units of the hospital. Let me see. 17 She later on had a CAT scan done when she had 18 her stroke in March of ~04, but it was negative because a 19 CAT scan always is negative in the acute phase of a stroke. 20 It was done at Walnut Bottom Radiology; it was an 21 outpatient procedure, just to be on the safe side. 22 It's very co~on for elderly people when they 23 fall in nursing homes to injure themselves and to bleed 24 into the brain from the fall, and it's a precautionary 25 measure to check the CAT scan. 18 1 Q. Okay. The three hospitalizations that Eleanor 2 underwent at Chambersburg Hospital, were any of those 3 hospitalizations as a result of your admitting her to the 4 hospital? 5 A. No. I do not work at Cha~ersburg Hospital; I 6 do not have privileges. She was cared for there by 7 Dr. Hagarty, who is a psychiatrist, and at that time, I 8 believe, was the only psychiatrist in the 9 Carlisle/Chambersburg area doing inpatient work. 10 Q. And you had referred her to Dr. Hagarty? 11 A. I'd have to go over the details, but I believe I 12 did. I believe previously I erroneously stated I did not, 13 but I believe we did. Yes, we did refer her to Dr. Hagarty 14 several years prior to her death. 15 Q. And what was your reason for referring her to 16 Dr. Hagarty? 17 A. Assistance with treatment of her depression 18 which was a long-standing problem. 19 Q. Yeah. I was going to ask you that. When you 20 say long-standing, how many years approximately are you 21 talking about? 22 A. Well over 30; probably closer to 40. 23 Q. Did she ever, Eleanor ever appear here to meet 24 with you with her daughter, Julia? 25 A. To the best of my knowledge, she did not. I 19 1 believe I have met her daughter once many years age wNen 2 she was a medical student, but I believe that's the only 3 time I ever met the daugNter. 4 MR. THOMAS: I have ne other questions. 5 MR. FLOWER: Ne redirect. 6 THE WITNESS: And I believe I also 7 erroneously -- before retirement, Eleanor was treated, 8 before the doctor's retirement, she was treated by a 9 psychiatrist in Harrisburg many years ago with medications 10 for depression. Pund to be honest with you, I can't 11 remember the name of the psychiatrist because that part of 12 the chart has been put in the files. 13 A_nd then when he retired, there was no one in 14 the area to treat Mrs. Coolidge. And we all, through the 15 years out of necessity, have had to become somewhat 16 psychiatric, a junior psychiatrist so to speak, because of 17 the unavailability of psychiatric care in the State of 18 Pennsylvania, in particular. 19 And we picked up her care then and followed her 20 for many years with the modern medications which are much 21 easier to use than the older drugs. 22 MR. FLOWER: Thank you, Dr. Brazel. I have no 23 further questions. We can go off the record. 24 (The deposition concluded at 4:30 p.m.) 25 2O COHMONWEALTH OF PENNSYLVANIA ) } ss. 2 COUNTY OF CUMBERLAND ) 3 4 I, A_MY R. FRITZ, R.P.R., a Ceurt 5 Reporter-Notary Public autherized te administer eaths and 6 take depesitiens in the trial ef causes, and having an 7 effice in Carlisle, Pennsylvania, de hereby certify that 8 the foregeing is the testimony of JOSEPH F. BRA~ZEL, M.D. 9 I further certify that befere the taking of 10 said depesition the witness was duly sworn; that the 11 questions and answers were taken down stenotype by the said 12 Reperter-Notary, approved and agreed re, and afterwards 13 reduced to cemputer printeut under the directien ef said 14 Reperter. 15 I further certify that the proceedings and 16 evidence are centained fully and accurately in the notes 17 taken by me en the within deposition, and that this copy is 18 a correct transcript of the same. 19 In testimony whereof, I have hereunte 20 inscribed my hand this 6th day of October, 2004. 21 NOTAR~ALSEAL Notary Public ~ 23 Amy R, Fritz, Notary Public City of Carlisle, Cumberland County 2 4 My commission expires February 9, 2006 25