1 1 NO. 90-CI-06033 JEFFERSON CIRCUIT COURT DIVISION ONE 2 3 4 JOYCE FENTRESS, et al PLAINTIFFS 5 6 VS TRANSCRIPT_OF_THE_PROCEEDINGS __________ __ ___ ___________ 7 8 9 SHEA COMMUNICATIONS, et al DEFENDANTS 10 11 * * * 12 13 14 WEDNESDAY, OCTOBER 19, 1994 15 VOLUME XVIII 16 17 * * * 18 19 20 21 _____________________________________________________________ REPORTER: JULIA K. McBRIDE 22 Coulter, Shay, McBride & Rice 1221 Starks Building 23 455 South Fourth Avenue Louisville, Kentucky 40202 24 (502) 582-1627 FAX: (502) 587-6299 25 2 1 2 I_N_D_E_X _ _ _ _ _ 3 4 WITNESS: DOCTOR_PETER_BREGGIN - Continued _______ ______ _____ _______ 5 Examination by Mr. Smith................................. 7 6 Examination by Mr. Freeman...............................109 7 Further Examination by Mr. Smith.........................190 8 9 Reporter's Certificate...................................204. 10 * * * 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 3 1 2 A_P_P_E_A_R_A_N_C_E_S _ _ _ _ _ _ _ _ _ _ _ 3 4 FOR THE PLAINTIFFS: 5 PAUL L. SMITH Suite 745 6 Campbell Center II 8150 North Central Expressway 7 Dallas, Texas 75206 8 NANCY ZETTLER 1405 West Norwell Lane 9 Schaumburg, Illinois 60193 10 IRVIN D. FOLEY Rubin, Hays & Foley 11 300 South, First Trust Centre Louisville, Kentucky 40202 12 13 FOR THE DEFENDANT: 14 EDWARD H. STOPHER Boehl, Stopher & Graves 15 2300 Providian Center Louisville, Kentucky 40202 16 JOE C. FREEMAN, JR. 17 LAWRENCE J. MYERS Freeman & Hawkins 18 4000 One Peachtree Center 303 Peachtree Street, N.E. 19 Atlanta, Georgia 30308 20 * * * 21 22 23 24 25 4 1 The Transcript of the Proceedings, taken before 2 The Honorable John Potter in the Multipurpose Courtroom, Old 3 Jail Office Building, Louisville, Kentucky, commencing on 4 Wednesday, October 19, 1994, at approximately 9:08 A.M., said 5 proceedings occurred as follows: 6 7 * * * 8 9 (BENCH DISCUSSION) 10 MS. ZETTLER: Judge, I know you'll be proud of 11 me, I did Max Talbott's deposition last night and whiddled it 12 down from 600 pages to about 40, so if we can do those at 13 lunch. 14 JUDGE POTTER: That's fine. 15 (BENCH DISCUSSION CONCLUDED) 16 SHERIFF CECIL: All rise. The jury is now 17 entering. Court is now in session. You may be seated. 18 JUDGE POTTER: Please be seated. Ladies and 19 gentlemen of the jury, did anybody have any difficulty with my 20 admonition over the evening? Whose turn is it? Ms. Ryan, did 21 you have any problems with the admonition? 22 JUROR RYAN: No, sir. 23 JUDGE POTTER: Let me mention two things. One, 24 I was watching television last night about a trial, and one of 25 the news things was talking about the O. J. Simpson trial. 5 1 And apparently there's been a book published and the judge -- 2 the commentator said something about the judge was concerned 3 that giving the jury the admonition or the potential jurors 4 the admonition not to read the book might not be effective or 5 they even used the term "probably wouldn't work" or something 6 like that. 7 You know, there's nothing wrong with you-all 8 watching about O. J. Simpson, but I did want to emphasize that 9 if you-all saw a program like that, I would consider an 10 admonition not to read a book to work. You might hear people 11 on TV say, "Well, in California or wherever that if a judge 12 tells a jury not to read a book, you know, that's not going to 13 work," and from that you might get the idea that what I tell 14 you every day about reading things or letting people talk to 15 you about it is some kind of show or I'm not serious about it. 16 I mean, when I heard them say that on TV, I thought it would 17 be the easiest thing in the world; I simply explain to the 18 jury if I find out anybody is reading the book, you'll end up 19 in jail, and it would work. So I just want to emphasize, the 20 reason I say these things every day is because they're 21 important. 22 There are some things, I don't know whether it's 23 the Pledge of Allegiance to the flag or whatever it happens to 24 be that you say all the time and you don't really think you 25 mean it. This is for real. I mean what I say. Okay? And 6 1 it's important. It has real consequences for you as an 2 individual as well as the system, so it's something you have 3 to be conscious of. 4 Let me tell you about the exhibits. When we 5 tried to find a place to store those boxes where they're 6 securely locked up, we found out we've kind of run into 7 problems. It's hard in this building to find a closet or a 8 space that is totally secure where we don't have to stack them 9 all on top of each other or make it very difficult to get to. 10 There were some cleaning spaces but they would be difficult to 11 make secure, and unless anybody sees a problem with this, I've 12 talked with the attorneys and they feel that that one box will 13 probably allow you-all to get through the rest of the trial. 14 And what my plans would be is to leave your boxes in the jury 15 room and you'll have your name on them. And I can 99.9 16 percent assure you that nobody is ever going to look in that 17 box, because the cleaning people don't, they'll be instructed 18 that's locked at night. But it won't have the same level 19 of -- the folders you have go to the closet; the only person 20 that has a key to it is my sheriff. They go in at night and 21 they come out in the morning. 22 So what I'm going to suggest, if you-all think 23 it's workable or if anybody has any problem with it, that 24 things you haven't written on or things like that, put them in 25 the box; it stays in the jury room. Anything you want to have 7 1 extra secure -- and, by all means, I'm going to collect your 2 tablets like it's been done, and that will go in the closet at 3 night. Does anybody think that will make you feel 4 uncomfortable? And you can bring it all out with you today. 5 If somebody feels particularly sensitive, you can put it all 6 on the cart. And I'm assuming each of you has about six 7 inches' worth of stuff that you haven't written anything on. 8 I think it's 99 percent certain that, you know, if anybody 9 ever looked at it, it would be another jury that rummaged in 10 the wrong box trying to find their own stuff. So we'll do 11 that. The boxes will stay in the jury room, but the cart will 12 be locked up every night, but the notes will go on the cart 13 and anything else you want will go on the cart. 14 Doctor, I'll remind you you're still under oath. 15 Mr. Smith. 16 MR. SMITH: Thank you, Your Honor. 17 18 EXAMINATION ___________ 19 20 BY_MR._SMITH: (Continued) __ ___ _____ 21 Q. Doctor Breggin, we have spent a great deal of 22 time talking about Prozac and your findings and your research 23 in connection with the dangers and risks presented by Prozac 24 to individuals in the clinical trials and to individuals 25 generally in the postmarketing experience. I'd like to focus 8 1 with you this morning, Doctor Breggin, on Joseph Wesbecker, 2 the individual who went into Standard Gravure and committed 3 this act on September 14th, 1989. Have you, Doctor Breggin, 4 reviewed facts in connection with Mr. Wesbecker himself? 5 A. Yes, sir; I have. 6 Q. And would you explain to the jury what facts you 7 reviewed, what toxicology you reviewed to make yourself 8 familiar with Mr. Wesbecker? 9 A. Well, I reviewed every record that was 10 available, every health record, his hospitalizations, his 11 psychiatric treatments. I reviewed the coroner's inquest 12 which had a lot of testimony in it that was relevant. Doctor 13 Coleman gave a number of depositions, and since he was the 14 person there evaluating the situation, I thought that was 15 important, so I looked over all his depositions and compared 16 them to his notes in his record. I read a variety of 17 depositions surrounding the issue; in particular, I was 18 interested in the family, the people who saw him most 19 recently, which was his former wife, his son James, and his 20 friend James. So I looked over the -- as much of the stuff 21 surrounding the actual events as I could. 22 Q. When you talk about his friend James, are you 23 talking about Mr. Jim Lucas? 24 A. Yeah. Jim Lucas. 25 Q. And did you review Mr. Lucas's wife's 9 1 deposition, also? 2 A. Yes. I also looked at his wife's deposition and 3 her diary because we have really two contemporaneous 4 documents; we have her diary and we have the doctor's notes. 5 Q. There has been a number of depositions taken, 6 Doctor Breggin, of co-workers, of people who knew 7 Mr. Wesbecker at work, saw him in varying amounts of time. 8 Have you reviewed those depositions or summaries of those 9 depositions, also? 10 A. Yes. Not in as great detail because most of 11 those are not right around the event and they're after the 12 event has occurred, and people's viewpoints change after a 13 tragedy occurs. People see things or reinterpret things very 14 commonly in line with the tragedy. So I was really concerned 15 about what happened at the time, what did people see at the 16 time. 17 Q. Okay. Did you consider any record any more 18 important than any other record or did you begin with anything 19 in particular that you were looking for, Doctor Breggin? 20 A. Well, my main focus in the beginning was on 21 Doctor Coleman's record because he had seen this man for two 22 years. He's the trained observer. He's the person -- the 23 only person in the picture who has familiarity with the 24 medication, knows how to evaluate the individual, can make an 25 estimate of the condition of the person, whether it's 10 1 deteriorating or improving. He's the only person we have who 2 is in a position to do that during the two-year period leading 3 up to the tragic events. 4 Q. Did you consider Doctor Coleman's notes 5 conclusive in connection with Mr. Wesbecker's medical 6 condition? 7 A. Well, I considered them to be the primary 8 document but, obviously, other people are getting other 9 sources of information. So I felt that the input from the 10 family and friend was also important, but I think the medical 11 record is among the most important things. 12 Q. All right. Let's begin, then, with Doctor 13 Coleman's records. Well, maybe before we begin with Doctor 14 Coleman's records, Doctor Breggin, can you give the jury a 15 basic outline of the mental health care and treatment that 16 Mr. Wesbecker had received up to the time he began with Doctor 17 Coleman? That might be a little more logical way to get into 18 this. 19 A. Well, he had a long history beginning really 20 significantly in 1980, of having psychiatric problems and 21 seeking help for them. I mean, I think that's one of the 22 really important things. And each time, there were events in 23 his life that played a role in his having difficulties. In 24 fact, his first two hospitalizations, 1980, 1984, were around 25 events with his wives, his first wife and his second wife. 11 1 And, like many people, when he went through separation and 2 divorce, it was probably the most traumatic experience of his 3 life, and he became depressed, he became anxious. At times he 4 became agitated, was described as being agitated during these 5 very severe, severe upheavals in his life. 6 Then in 1987, he had a third hospitalization, 7 and at that time the stress was more focused on work. And 8 again he showed the response that he had had in the past. 9 Over time -- finally, he ends up seeing Doctor Coleman for the 10 final two years and during much of this time he is taking 11 psychiatric medication; he is apparently taking it 12 responsibly; he seems to basically follow the Doctor's 13 directions. The pill counts that we have made -- that I've 14 made in terms of how many pills in his bottle at the time of 15 his death indicate that he was then, too, taking the 16 medication as directed. 17 Going all the way back into his childhood, we 18 know that he had a tough childhood. He didn't have an 19 unusually difficult one. I think the most startling things 20 were the loss of his father very early, about Year One; the 21 fact that his mother was overburdened; that his grandmother 22 helped a great deal to raise him; that for a time -- short -- 23 relatively short period of time he was actually in an 24 orphanage and going home to be with his grandmother. But 25 there isn't a history in his childhood of a lot of violence 12 1 directed at him. 2 It's not like somebody as we see in studies of 3 violence, in my own experience as a doctor, as a clinician, 4 somebody who has been trained to be violent. Very often 5 people who go ahead and commit terrible crimes when they grow 6 up, you can go back and you see that they're in an environment 7 where the people around them are violent. They're in an 8 environment in which the other young people are violent. 9 Often there's an older person who was very devoted to getting 10 even and standing up for themselves and not putting up with 11 anything, who trains the youngster and beats the youngster or 12 beats the youngster's mother in front of them. We don't have 13 that kind of history, but we do have a tough history. We have 14 a tough one. 15 Q. Well, would this tough childhood in your 16 judgment, as you characterize it, would that be any more 17 unusual than hundreds or thousands or maybe millions of people 18 experience in life? 19 A. I don't think very different, certainly not as 20 bad and as difficult as many I see routinely in my own work 21 with patients. I've spent a lot of time looking at the issues 22 of the origins of violence because that's a lot of what I 23 teach at the university is conflict resolution and origins of 24 violence. And what we know of people who become very violent 25 when they grow up, they have much more isolated lives than 13 1 this man. There's debate about how isolated he may have been 2 at one time or another, but this is not a man who couldn't 3 relate to women, doesn't have anybody at all in his life, has 4 always been unmarried, who's been rejected time and time 5 again, who can't relate to children, if he even has any, who 6 lives in a kind of a private fantasy world and then breaks 7 out, breaks out and assaults somebody. This is not a man who 8 lived in that kind of utter desolation. He had relationships. 9 In fact, his problems, like for so many of us, 10 develop when his relationships temporarily break up, and he 11 quickly gets another. He goes from his first marriage ending 12 to married again. When that marriage ended, he has the 13 remarkable wherewithal to maintain the relationship with his 14 wife. He maintains the relationship with both of his 15 ex-wives. At the time of this tragedy, he in fact has a 16 relationship with both of his sons, although for a time he was 17 estranged from one of his sons, hardly an unusual phenomena in 18 America. 19 So looking at the whole span of his life, you 20 see some ups and downs and you see some difficulties and you 21 see some serious mental problems at times. This is not the 22 caricature of your typical person who suddenly commits the 23 crime and you go back and you look at his life and almost 24 always, complete isolation. I mean, you don't go back and 25 find wives and kids talking about him like a responsible 14 1 person. You don't go back and find a relatively violent-free 2 life. 3 Now, he did obviously struggle with violent 4 impulses; about that, there can be no doubt. Around each of 5 his -- actually around his second divorce he was very, very 6 angry and he said the kinds of things that people do say 7 during periods of stress, but I think they were very serious 8 things. He talked about wanting to, you know, injure people, 9 wanting to hurt the ex-husband whom he thought was harassing 10 him, wanting to hurt one of the kids on one occasion. So he 11 talked at times. We have five or six incidents, maybe less, 12 where he talked about being very angry and wanting to hurt 13 people. And during one of the hospitalizations, the '87 one, 14 there is concern -- there is concern about his feelings toward 15 one of his supervisors, and the hospital sets as a goal to 16 help him overcome these very violent impulses that he seems to 17 be feeling from the hospital's viewpoint at that point. And 18 it's at that time that he does go to his place of work, 19 apparently, according to Jim Lucas, with a gun in a bag. And 20 I don't know how much testimony you've heard about this, but 21 apparently this was strangely not so uncommon there that this 22 happened. 23 So we do have a man who at times is struggling 24 with his impulses. We know that he had two suicide attempts, 25 at least that we know of, that seem to be corroborated. At 15 1 one point he mentions that he's had lots, at least that's put 2 in a record. I want to comment on that. I mean, I have seen 3 many records where with no documentation at all somebody 4 writes down, "Patient says he had 12 to 15 suicide attempts," 5 and you look and there's nothing in the record, and you ask 6 the patient and the patient says, "I don't know what that 7 doctor was thinking about." This happens time and time again 8 in my practice, my consultation work. You get one very 9 wild-sounding phenomena and then it turns out, in this case, 10 everybody interviewed didn't know anything about it. Most 11 people didn't know about the two that seemed to have occurred, 12 but nobody knows about five, six, seven, eight, nine, ten. So 13 I wouldn't honestly take too seriously his one statement 14 allegedly that a doctor wrote in. 15 Remember, when a doctor writes a chart there's 16 no attorney to guide him, there's no attorney to protest; the 17 patient doesn't see what goes in it; there aren't all these 18 checks and balances that some very tired doctor who's maybe 19 thinking of something else or who is mishearing a statement 20 writes something down. So we don't have corroboration on that 21 particular remark, but certainly he was self-injurious and on 22 two occasions that we know of was self-injurious. 23 During the time that he's seeing Doctor Coleman, 24 he seems to be doing better and better. He -- in the 25 beginning of seeing Doctor Coleman, he's preoccupied with his 16 1 anger at work. 2 Q. Let's get to Doctor Coleman specifically -- 3 I've got his record -- in a minute, but -- 4 A. Let me think if there's anything else just about 5 the general history. I think I'm kind of giving you the sense 6 of what I think was going on. 7 Q. What were the differing psychiatric diagnoses 8 that had been made up to the time that Mr. Wesbecker came to 9 Doctor Coleman in 1987? 10 A. Well, he had been -- he went through the process 11 that people often go through when they're ending up with 12 several hospitalizations or experiences with psychiatrists. 13 It starts out I think where he's called depressed or something 14 less than that, dysthymia, which is like neurotic depression. 15 It's kind of an odd diagnosis, but it's intended to mean 16 something less than major depression. And then he also shows 17 at times that he can get very hyper and his mind seems to kind 18 of race a little bit and he's tense, and that's thought to be, 19 well, there's a manic component, a -- although we don't see a 20 real full-blown mania there's a manic component, so he gets 21 the diagnosis manic depressive, and that's what he comes to 22 Doctor Coleman with. 23 Then he sees Doctor Coleman for a while, and on 24 a couple occasions he sees some things that seem to Doctor 25 Coleman to kind of go beyond reality. He's suspicious that 17 1 Doctor Coleman is tape-recording him, but he seems to respond 2 to the reassurance. He may have some either visual problems 3 from the drugs or some kind of mental uncertainty about what 4 he's seeing. It's not an outright hallucination; he doesn't 5 see little, green men, but there's a visual or equilibrium 6 disturbance. Doctor Coleman is not sure what to make out of 7 this, so he takes a breath and he calls it schizoaffective 8 disorder. And that might take -- should I give a little 9 description maybe of what that means? 10 Q. Okay. 11 A. Affective refers to an emotional problem, so 12 depression is an affective disorder. Affect is emotion. 13 Manic depression is an affective disorder. Schizo refers to 14 the possibility of a schizophrenic tendency, which is looked 15 at as a thinking disorder. You have thoughts that are deluded 16 or irrationalizing, or also perceptions, you see or hear 17 things that aren't there. So when he became suspicious and 18 had some visual experiences, the doctor changed the diagnosis 19 to schizoaffective; however, this is not unusual, by the way, 20 I mean, the diagnosed categories in psychiatry are not like 21 the ones in medicine. They sort of shift and they're hard to 22 pin down. This is not an unusual phenomena. 23 I think most important is that, throughout, 24 Doctor Coleman and everyone else who saw him thought that he 25 got depressed. Being depressed was the big component of his 18 1 difficulties. And then he would go from being depressed to 2 getting sort of an agitated depression or a suspicious 3 depression, but that depressive problem was what came back and 4 that would have a lot to do with when he'd have losses in his 5 family life that he would get into a worse condition. 6 In retrospect, I think that Doctor Coleman's 7 diagnoses are fine. I probably would have stayed with manic 8 depressive; maybe Doctor Coleman might even with further 9 thought, because there isn't a lot of evidence that he has any 10 trouble with reality till the last session, then there's a 11 dramatic change in the last session. 12 Q. All right. Do you have Doctor Coleman's record 13 in front of you, Doctor Breggin, which is marked as 14 Plaintiffs' Exhibit 160? 15 A. Yeah. I have an unmarked Coleman's record. 16 MR. SMITH: All right. We would offer 17 Plaintiffs' Exhibit 160, Your Honor, Doctor Coleman's records. 18 MR. FREEMAN: No objection, Your Honor. 19 JUDGE POTTER: Be admitted. 20 SHERIFF CECIL: (Hands document to jurors). 21 Q. Now, let's generally identify the order in which 22 these go, and let me give you a marked copy so we make sure 23 we've got a copy stapled in the same order. You're looking at 24 a copy stapled in the same order that that exhibit with the 25 jury is. I have at the top of the first page that's marked 19 1 Plaintiffs' Exhibit 160, a notation of 6-26-89; is that right? 2 A. Yeah. Right. I turned them around so it's more 3 like I keep records, so we're -- yeah. 4 Q. All right. Why don't we go back. It looks like 5 this is in descending or ascending order, one of the two. Why 6 don't we go back to the first record of office visit of Doctor 7 Coleman back in 1987, and that would be probably on the third 8 from the back page, that visit marked 7-8-87. 9 A. Yeah. That's where I start. 10 Q. All right. And it has Joseph Wesbecker and then 11 it has notation, it says, "Forty-five-year-old self-referred." 12 It appears to me, then, that Doctor Coleman was seeing Mr. 13 Wesbecker as a result of Mr. Wesbecker going to him; is that 14 right? 15 A. Yes. 16 Q. Does that have any significance to you, Doctor 17 Breggin? 18 A. Well, it indicates that he is seeking help as he 19 has always done. He sees himself as having a mental problem 20 and he sees himself as needing help, and that's throughout the 21 record. 22 Q. We've heard the term denial used in our social 23 context in a lot of instances in a lot of ways here within the 24 last few years. Would you say that Mr. Wesbecker was in 25 denial of his mental illness? 20 1 A. No. Throughout, he has a surprising degree of 2 acknowledgment that he has emotional problems. This is two 3 years before the tragedy, and a couple days before the tragedy 4 he's explaining to his son that he has mental difficulties and 5 he's concerned that his son has inherited them, and so, 6 throughout, he's taking seriously that he's got a problem. 7 Q. Is that a good predictor or a poor predictor 8 that a patient might get better, the fact that the patient 9 acknowledges that they have a mental illness? 10 A. It's a very good predictor. It's hard to help 11 somebody who doesn't want any help. In fact, there's many 12 questions about that in the profession, obviously. I mean, if 13 the person doesn't want help, it's very hard to help them; if 14 they do want help, if they see they have a problem, you can 15 develop a relationship and you can offer help to that 16 individual. 17 Q. "The patient states he is bipolar and needs a 18 psychiatrist to follow his medications. Patient presently is 19 on Lithobid, 300 milligrams, 2 in the morning and 2 at night. 20 He states that his last blood level was 1.0 about one month 21 ago." Is any of that of any significance to you, Doctor 22 Breggin? 23 A. Well, again, it's a surprisingly responsible 24 patient. He comes in with all the necessary information. He 25 has his chemistries and he knows what he needs and he's 21 1 looking for it. So he's behaving very responsibly. 2 Q. "He states that he has been bipolar for ten 3 years and on lithium less than one year. He was seeing Doctor 4 Schramm but did not want to be in group and left him." 5 A. Yes, sir. 6 Q. Is that of any significance to you? 7 A. He's making an independent decision. I think 8 he's right about group. I mean, this is a man who is 9 comfortable, I think, with one person at a time and he's not 10 going to probably do very well in a group. Of course, he has 11 a lot of anxieties and tensions at work; on the other hand, 12 perhaps if he could have stayed in a group it might have 13 helped him deal with that issue, but it's really 14 understandable that he would prefer to be one on one with 15 somebody. 16 Q. All right. Next says, "Patient presents primary 17 stress as job and employers, quote, jerking him around, end 18 quote. Feels medication decreases his concentration and 19 ability to think and wants to be moved off his present job but 20 states his employer refuses." Correct? 21 A. Yes, sir. 22 Q. Is that of any significance to you? 23 A. Well, it repeats a theme that's been going on, 24 especially in his last hospitalization, that he really feels 25 injured at work. He feels taken advantage of at work, and his 22 1 thought that his medication decreases his concentration and 2 ability to think is consistent with his taking 1200 milligrams 3 of lithium. Many people find an interference with their 4 thinking processes, not enough to prevent them from 5 functioning, but many people report that memory or quickness 6 is -- or concentration isn't so good. So he's reporting 7 something that makes a great deal of sense, and I think the 8 Doctor will in fact try to lower his lithium. 9 Q. Anything about the past history that's recorded 10 there that is of any significance to you? 11 A. Well, again, he is very accurate about his 12 representations. His memory is intact. He's responsible. 13 He's not holding back anything at all from Doctor Coleman; 14 he's giving him a thumbnail of what he's been through as a 15 patient and the difficulties he's had, so the Doctor is not 16 going to be mistaken. He even tells him. I don't know if we 17 got to the sentence where he tells him that he's seen other 18 doctors and gives the names. So he's giving a very accurate 19 history as it's abbreviated here. 20 Q. The next notation there concerns his medical 21 history. Now, it says Lithobid; is that lithium? 22 A. Yes. That's lithium. Just consider it lithium 23 for all practical purposes. 24 Q. All right. And that dosage there, is that an 25 acceptable dosage of lithium for some patients or is there 23 1 such a thing as an acceptable range of dosage of lithium? 2 A. Well, the only way to tell whether the dosage 3 range of lithium is correct is through the blood level. This 4 is not an unusual dose, though. But the acceptance is within 5 the blood levels rather than the dose because people respond 6 differently to different doses and, to some extent, at 7 different times to different doses. 8 Q. The next medication is Tofranil, 200 milligrams 9 at night. What is Tofranil? 10 A. Tofranil is a very old, long-tried 11 antidepressant, and it could be given at night both for its 12 hypnotic value, it will tend to help one sleep, or for its 13 antidepressant effect. 14 Q. Is it a specific serotonin reuptake inhibitor or 15 is it a tricyclic or an MAOI? 16 A. It's a tricyclic, one of the safer groups of 17 drugs. It does affect serotonin but it's not -- it's not its 18 main impact. 19 Q. Next we have a social history, and anything 20 about that that's significant to you? 21 A. It just corroborates that he is readily able to 22 give an accurate history, and I think that's the main point 23 about it; that he says he's been divorced; that he explains 24 what he's been through, at least in enough detail for the 25 Doctor to get it in a relatively short period of time. 24 1 Q. Next is MSE, Mental Status Exam. What is a 2 mental status exam, Doctor Breggin? 3 A. Mental status exam covers many different things. 4 It's basically the doctor saying I've looked him over 5 mentally; this is my general impression of his mental 6 functioning. And it can go from that to a very formal exam, 7 which he probably didn't do under these conditions. 8 There's a more formal mental status exam where 9 you make sure you're examining the emotionality of the 10 patient, the communication flow of the patient, whether the 11 person understands where he is and what time it is and whether 12 he's oriented. You do a thorough evaluation. But in actual 13 practice, there's quite a variety in what a doctor will feel 14 is necessary at any given moment. These notations are very 15 typical of a doctor's record. He notices that the patient is 16 casually dressed. If he had seen something like that he was 17 disheveled, he would have mentioned it. And he notices that 18 there's a certain hyperness. He's quite talkative, he's 19 irritable, he's anxious, he's pacing; he doesn't call it 20 agitation. It probably falls short of that in the Doctor's 21 mind. And then he specifically says no -- 22 MR. FREEMAN: That's objectionable as to what's 23 in the Doctor's mind. 24 JUDGE POTTER: Mr. Smith, I think your Witness 25 needs to deal with what the record says. 25 1 Go ahead, Doctor. 2 Q. All right. 3 A. He then goes on and says, "No flight of ideas." 4 Q. What does that mean, no flight of ideas? 5 A. That this is not a manic person. Flight of 6 ideas is one of the signs that we use to say that the mind is 7 really spinning, that ideas are really flying, the flight of 8 ideas, that that's not happening. And he also says, "No 9 psychotic symptoms," by which he surely means no 10 hallucinations or delusions or break with reality. And then 11 he has, "No suicidal or homicidal ideation," indicating he 12 actually asked him when he writes that down. 13 Q. Okay. His impression then is bipolar disorder? 14 A. Yes. That's identical to manic depressive 15 disorder. 16 Q. Okay. It says the plan was to continue the 17 present medications and obtain the records from Doctors 18 Schramm, Moore, Senler and OLOP, which I'm sure means Our Lady 19 of Peace; correct? 20 A. Yes, sir. 21 Q. Anything inappropriate or unusual about what 22 Doctor Coleman has diagnosed, what his plan is or what his 23 future mode of care seems to be? 24 A. No. The fact he's continuing medication is 25 quite common. A new patient presents in a situation, you want 26 1 to get to know them before you make any changes, but it also 2 suggests that he doesn't see any emergency, that the patient 3 is not deteriorating or otherwise he would have reconsidered 4 the treatment. So he's going to continue with the treatment; 5 he's being very responsible, he's going to order all the 6 appropriate medical records. 7 Q. All right. The findings there, then, of 8 irritability, anxiousness and pacing appear related to his 9 disorder at that time; is that right, Doctor? 10 A. Yes. 11 Q. And his job situation. You say his primary 12 stress at that time was his job; is that right? 13 A. It seems to be, in 1987, yes. 14 Q. All right. Let's go to the next time that 15 Mr. Wesbecker saw Doctor Coleman. It looks like we have a 16 brief note of 7-29-87 up on the top of the page before that; 17 is that right? 18 A. Yes, sir. 19 Q. All right. It says, "Patient states mood more 20 even since back on meds. Thinks a lot better at work. No 21 side effects of meds." Correct? 22 A. Yes, sir. 23 Q. Any comment about that, Doctor Breggin? 24 A. The patient's gotten a new doctor. He's got his 25 medications ordered again and it is doing well. 27 1 Q. Does the fact that he has a new doctor have any 2 significance in your experience in making people feel better 3 that are suffering from disorder such as doctor -- as Mr. 4 Wesbecker? 5 A. Yes. Depression in particular, you know, is 6 related to hopelessness, to a sense of despair, and meeting a 7 new doctor, liking him can be very helpful. And even his 8 difficulties at work, the suspiciousness he has, the feelings 9 of being abused, just having an ally -- he has a new ally now, 10 somebody who's going to seem like maybe trusting. So he may 11 have liked him very early, and all of that could have a 12 remarkably good influence on an individual. 13 Q. The next notation looks like four months later 14 in November of 1987; is that right? 15 A. Yes. Uh-huh. 16 Q. Or actually three and a half months. And Doctor 17 Coleman had told him to return in three months; is that right? 18 A. Yes. 19 Q. Is there anything significant about the fact 20 that Doctor Coleman was willing to allow three months to 21 elapse before he intended to see him? 22 A. Well, I understand that in Doctor Coleman's 23 opinion he was very stable. 24 MR. FREEMAN: Your Honor, we would object to 25 Coleman's opinion. 28 1 JUDGE POTTER: Mr. Smith, I think your Witness 2 needs to stick with what the record says and not express what 3 Doctor Coleman's opinions are unless they're set out in his 4 record. 5 Q. Let me ask it this way, then. Generally, if you 6 see a psychiatrist who has been seeing a patient once every 7 month and then moves him to see him the next time in three 8 months, is that from a medical standpoint indicative of a 9 judgment on the part of the psychiatrist concerning the 10 patient's condition? 11 MR. FREEMAN: It's the same question. 12 JUDGE POTTER: No. It's a different question. 13 Objection overruled. 14 A. It almost always is, yes. 15 Q. Of what is it indicative of? 16 A. Well, if he were worried about him -- if a 17 doctor -- if a doctor were worried about his patient, he 18 wouldn't want him to go three months, because a lot can happen 19 in three months. You'd want to see him sooner first to check 20 his medications, see if he had the right amounts; second, to 21 give him some emotional support. While he's not doing intense 22 psychotherapy, just seeing the doctor is emotional support; 23 he'd want to keep an eye on him. It's fairly straightforward. 24 Q. All right. Then what is the patient's condition 25 on November 11th, 1987? 29 1 A. It says, "Mood has been stable, one episode of 2 anger at work. Has been put in less stressful job situation." 3 And then he goes on to talk about that he's having some side 4 effects from the drugs, tiredness, decreased sexual 5 performance, increased weight. And he puts in parentheses, 6 "side effects of Tofranil versus increased depression but mood 7 seems okay." So he's balancing in his mind. 8 MR. FREEMAN: We don't know what the doctor is 9 balancing in his mind. 10 JUDGE POTTER: Objection sustained. 11 A. Excuse me. Excuse me. 12 Q. Well, does Doctor Coleman there note a 13 determination of whether or not these symptoms that he's 14 seeing are side effects of the medication or have symptoms of 15 the underlying disease? 16 A. Yes. 17 Q. All right. And what was his plan? 18 A. Well, he says "but mood seems okay," rather than 19 it's depression, and so he decreases the Tofranil to 100 20 milligrams every night as an attempt to handle the side 21 effects. 22 Q. When is the next notation concerning treatment 23 rendered by Doctor Coleman? 24 A. Two months later. 25 Q. Okay. And what was the notation at that time? 30 1 A. "Complained of continued level of depression 2 (tiredness, decreased sleep, decrease of sexual appetite). He 3 attributes some of this to medication, wants to try and get, 4 quote, partial disability, end quote. Advised him I need to 5 talk with his attorney about his case to see if this is an 6 alternative for him." 7 Q. What's your judgment, in your opinion, Doctor 8 Breggin, as to Mr. Wesbecker's condition at that time? 9 A. He seems to be still depressed. Whether it's a 10 little more depressed is not made too clear in the record. It 11 says "continued level of depression" and he has mentioned some 12 of these problems earlier, so he's struggling with some degree 13 of depression, and he talks about wanting to get a disability. 14 And the Doctor is willing to be active and actually get in 15 touch with the attorney, talk to the attorney. 16 Q. When did he next see Doctor Coleman? 17 A. He saw him toward the end -- well, no, toward 18 the end of the month. It looks to me like it's probably a 19 telephone call, although that's not marked as such, on January 20 24th, '88, "Talked with attorney Sandy Berman. Talked about 21 feasibility of workers' comp claim." It would be unusual if 22 he went out of his way and met him personally. Perhaps he 23 did. Perhaps he did. It isn't marked telephone call. 24 Q. But it certainly doesn't indicate it was an 25 office visit and treatment rendered to Mr. Wesbecker on 31 1 January 24th, 1988, does it? 2 A. I can't tell from that. 3 Q. All right. When is -- 4 A. Well, now -- oh. Oh. Maybe he's saying -- no, 5 I think he's saying he talked with Attorney Sandy Berman, but 6 maybe he's saying the patient did. Maybe it is the patient. 7 It's unclear to me. I had had an assumption; now I look at it 8 again, it's unclear. 9 Q. April 6, 1988, appears to be the next time that 10 Doctor Coleman saw Mr. Wesbecker. What was his condition at 11 that time? 12 A. "Patient continues to feel somewhat depressed, 13 lack of energy, trouble sleeping, lack of interest." 14 Q. Anything about that unusual? 15 A. No, other than he just seems to maintain a kind 16 of a low level of feeling depressed. 17 Q. And, again, it's about how long at least since 18 he had last seen Doctor Coleman? 19 A. Well, since sometime in January, so that's three 20 months. 21 Q. All right. And then when did he next see him? 22 A. Again in three months. At this time the Doctor 23 takes lithium level, a CBC and SMA 18, which is just a blood 24 screen, typical blood screen, various or routine blood test. 25 Does a thyroid profile, a TSH, a thyroid stimulating hormone, 32 1 and a U/A and laboratory -- and he puts in parentheses, 2 laboratory tests. 3 Q. What was his condition on June 9th, 1988? 4 A. "Continues to feel depressed even with decrease 5 of antidepressant. Continued side effects. States mood has 6 really not been good times three years. Irritability at work 7 and home, sleeps poorly, continues to focus on work problems." 8 Q. Okay. What does that tell you as a 9 psychiatrist, Doctor Breggin, about Mr. Wesbecker's condition 10 at that time? 11 A. It sounds like it's a combination of this is how 12 it always is and maybe it's a little worse or maybe he's 13 wishing he could do more about it. It's nothing drastic at 14 this point. 15 Q. The plan there says, "Discontinue Tofranil. 16 Start Prozac 20 milligrams every day. Lithium level. Patient 17 prefers to try to keep working if possible but may have to put 18 on medical leave." Correct? 19 A. Yes. That would indicate even more than the 20 note above that he's feeling more stressed than he has been 21 because he's getting nearer to wanting medical leave. 22 Q. All right. And this is the first time in Mr. 23 Wesbecker's history that he's ever received Prozac, is it not? 24 A. Yes, sir. 25 Q. That's June 9th, 1988, that the notation is made 33 1 that he's to start the Prozac; correct? 2 A. Yes, sir. 3 Q. What occurred next in connection with 4 Mr. Wesbecker's treatment? 5 A. There's a phone call on June 20th, 1988, and it 6 says, "Patient's lithium level 1.5. I called patient. He was 7 unsure whether he took A.M. (morning) lithium that day. Will 8 decrease dose to 900 milligrams per day and recheck in two 9 weeks." 10 Q. Is the lithium level of 1.5 normal or abnormal? 11 A. That is an abnormal level. 12 Q. All right. How abnormal is it? 13 A. With a person who is on a maintenance dose, the 14 general recommendation is to stay below 1, 1 or below; .8 is 15 considered a nice level. Anything between 1 and 1.5 is 16 getting in the more dangerous range and 1.5 is generally 17 considered too high. The only time you might see a level like 18 that would be in a mental hospital, a person who is being 19 carefully monitored and is very out of control and effort is 20 being made to control seriously disturbed behavior. It is not 21 what you would ever maintain anybody on in a private practice 22 setting. 23 Q. You said -- the notation there says, "He was 24 unsure whether he took A.M. (morning) lithium that day," 25 which is the day he was checked, I assume? 34 1 A. Right. 2 Q. What's the significance of that, Doctor Breggin? 3 A. You're supposed to not take your morning dose 4 when you get your blood levels so that there's a constancy 5 that lab can relate to, that doctor can relate to, that here 6 it is, it's 12 hours -- roughly 12 hours later, that's when 7 we're getting our blood level and that's what we're going to 8 compare each time, and it's a time in which the blood level 9 should be fairly stable. But if he took his morning dose, it 10 could have given him a somewhat higher level, if he took it by 11 mistake when he got his lab test and he couldn't remember. 12 Q. The next notation is 6-29-88. It says, "Off 13 Prozac for the last several days because of complained of 14 fatigue. Has improved since off Prozac. Still feels 15 depressed and willing to try to alleviate this." And then 16 there's a plan there that indicates that Prozac will not be 17 continued? 18 A. Yes. 19 Q. Do you have an explanation as to why Mr. 20 Wesbecker would have discontinued his Prozac, why he would 21 have discontinued it as a result of these complaints of 22 fatigue, Doctor Breggin? 23 A. Yes. It's a confusing situation because Prozac 24 can elevate the lithium level. So what very possibly happened 25 is that with the taking of Prozac the lithium level is now 35 1 beyond that which the doctor considers safe, and the doctor -- 2 the doctor then says we'll cut back on the lithium. Now, the 3 patient is feeling fatigued. That could be very, very easily. 4 In fact, I would expect him to be fatigued, worn-out feeling 5 at the 1.5 level. He's not used to that. That's not what he 6 gets. And so he's probably feeling fatigued because Prozac 7 has elevated his lithium level. 8 Q. All right. 9 A. There could be other reasons, but that would be 10 the most probable. Then what happens is that doctor says 11 lower your lithium level. The patient thinks to himself, "I 12 think it's my Prozac." He stops his Prozac; he feels less 13 fatigued. The patient says, "It's due to my Prozac," but he's 14 had his lithium level lowered. There would be no way to say 15 which it is, but we can say that 1.5 is enough to make anybody 16 fatigued. So I say, medical probability, it's the lithium 17 level that was making him fatigued. 18 Q. Obviously, Doctor Breggin, the question that 19 arises here is that if Prozac caused Mr. Wesbecker to commit 20 these acts on September 14th, 1989, why didn't it cause him to 21 do it in June of 1988 when he took it? 22 A. Well, there are many, many different possible 23 reasons. One, he's not on it as long. He was on for 16 24 tablets. The bottle -- I checked, the bottle was identified 25 as having 16 tablets. When I subtracted how many were there 36 1 from what was supposed to be there, he had taken 16 days; 2 that's considerably less than he took the other time. 3 Secondly, he has a high level of lithium which is making him 4 fatigued and certainly suppressing his responsiveness. 5 Lithium is an anti-agitation medication. As we 6 saw yesterday in my testimony, there are people who have 7 gotten very violent on Prozac while on lithium, but the 8 lithium would tend to suppress that response. And he's on a 9 high level of lithium at this point, higher than he's supposed 10 to be. So the situation is very complicated and is by no 11 means just a replica of what happens later on. 12 In addition, people do respond differently. I 13 mean, we have an example here with the lithium. All of a 14 sudden he's got a higher lithium level, maybe from the Prozac, 15 maybe he was drinking less and got dehydrated. 16 Q. You mean drinking less fluids, not necessarily 17 alcohol? 18 A. Less fluids. Not alcohol at all, no. Drinking 19 less fluids. So we see here the variability of the human 20 system in response to a medication. It could have just been 21 the variability; it could have been the presence of the 22 lithium; it could have been the shorter time. And as Doctor 23 Beasley's report, when he is talking about -- he was the Lilly 24 doctor who looked at agitation and found that 38 percent of 25 the patients on Prozac are agitated. 37 1 MR. FREEMAN: That report has been ruled out 2 several times. 3 A. I didn't know that. I apologize. 4 JUDGE POTTER: Mr. Smith was supposed to tell 5 you. 6 Q. I'm sorry. 7 A. So I can't comment on that document? 8 Q. Yes. Don't comment on that document. 9 A. Anyway, you can have a mixed situation from 10 Prozac where you're agitated and fatigued or you can get 11 fatigue from Prozac. That's very clear in the documents that 12 I showed you on the board, that you can get a variety of 13 responses to Prozac. But in this unique situation, it's 14 shorter, he's on this lithium, he's got the high lithium 15 level. There's no reason to think that it's in any way 16 identical to the next time. 17 Q. Well, could it be possible, Doctor Breggin, that 18 it's significant that Mr. Wesbecker is potentially having some 19 reaction to the Prozac? 20 A. Yes. There is no doubt that if a patient has a 21 serious negative reaction to a medication there's a 22 possibility that he will again, but not necessarily the same 23 one. And, in fact, it has been noted that people who have a 24 fatigue response to Prozac can be at risk for behavioral 25 abnormalities later on. 38 1 Q. All right. It says that in the 6-29 notation 2 that Doctor Coleman was going to start Pamelor, 25 milligrams, 3 every day for 5 days, then 50 milligrams. What is Pamelor? 4 A. Pamelor is another tricyclic antidepressant. It 5 may have less sedating effects than the one he took earlier. 6 The Doctor may be hoping that there will be less of a fatigue 7 or sedation response than before. And he's starting it in an 8 appropriate manner, gradually, because he's been trained that 9 that's what you do with a drug like that as far as experience. 10 Q. The notation appears 7-21-88, which was a phone 11 call, indicating that the meds were helping somewhat but wants 12 to increase, and that the Pamelor was increased to 75 13 milligrams a day. Anything significant about that notation, 14 Doctor Breggin? 15 A. No, just that Doctor Coleman is trying to stay 16 on -- I'm sorry. This is the treatment you'd do as a doctor 17 if you were trying to stay on top of things. It's well within 18 normal medical practice with doses. 19 Q. Okay. The next notation is 8-8-88. Phone call. 20 "Increased illusionary incidents (floor and ceiling moving). 21 Increased on his own to 4 lithium a day and 5 Pamelor with no 22 benefit. Work performance has deteriorated." Correct? 23 A. Yes, sir. 24 Q. What's the significance of these notations, 25 Doctor Breggin? 39 1 A. Well, he's having some problems, clearly. Now, 2 increased illusionary incidents, that is not a delusion. An 3 illusion is like a misperception. It's not an irrational, 4 bizarre, breaking-with-reality phenomena; that would be called 5 a delusion rather than an illusion, and it's floor and ceiling 6 moving. That is not typical of a mental disorder of a 7 psychiatric origin, say, rather than drug induced. This 8 sounds like he's having balance or visual problems, probably 9 due to the medication increase, and he has mistakenly given 10 himself even more medicine thinking that's what's going to 11 help. That would be my retrospective analysis of that; that 12 is, floor and ceiling moving is very different from "my walls 13 are wired and the FBI is listening to me" or a kind of 14 delusionary experience. 15 Q. Is it normal for a patient to report illusions 16 if a patient is suffering from bipolar disorder? 17 A. I don't think it's particularly related to that. 18 I think it's quite often that people have responses like this 19 to medication. 20 Q. All right. It says the plan there is obtain 21 medical leave of absence as of 8-7-88, to try and stabilize 22 his condition. He was going to decrease lithium and decrease 23 Pamelor. 24 A. The Doctor writes, "Work performance has 25 deteriorated," and I think that's obviously key here. And the 40 1 Doctor responds to that by obtaining medical leave and 2 decreases lithium and Pamelor, probably as I do, thinking that 3 that's what's making the floor and ceiling move. 4 Q. All right. On 8-10-88, it says that, "The 5 patient called Monday. Increased pressure at work and 6 increased depressive feelings. Poor sleep. Interpersonal 7 relationships at work poor. Continues to have illusions." It 8 looks like Mr. Wesbecker is having some problems at this time. 9 A. Yes. He's definitely having some problems. It 10 appears to be probably a combination of work and medication, 11 and the Doctor indeed continues to decrease the Pamelor 12 because all of the floor-and-ceiling stuff started with the 13 Pamelor and now the Doctor is removing the Pamelor, so he's 14 right on top of that situation. He's raising the lithium 15 because he doesn't think the lithium -- well, I can't say -- 16 you would raise the lithium if you didn't think the lithium 17 was causing the floor-and-ceiling movement, and I wouldn't 18 think it would. It's more typical of an antidepressant. And 19 he is not worried -- he says return in a month. He doesn't 20 say return in a week. 21 Q. So if in a normal psychiatric patient Doctor 22 Coleman were abnormally concerned or the psychiatrist were 23 abnormally concerned, would it be usual to ask the patient to 24 return in a month as opposed to a shorter time? 25 A. It would be unusual. 41 1 Q. Unusual? 2 A. It would be unusual to wait a month if you were 3 very concerned. 4 Q. All right. Then it appears the next notation is 5 a phone call to Herbert Segal, patient's attorney, 6 re: disability; correct? 7 A. Yeah. 8 Q. And is it your understanding that Mr. Wesbecker 9 was placed on either sick leave or disability sometime in 10 August 1988? 11 A. Yes. On August 10th it says, "Patient placed on 12 disability because of mental state." I'm not sure. I think 13 he may have been put on sick leave and then formally on 14 disability later, but he's no longer working. 15 Q. There's a notation on 10-8, that maybe is 16 miss -- maybe it's a continuation. Maybe he saw him and 17 talked to him on 8-10-88, because there's "10" notations on 18 both pages; is that correct? 19 A. Oh, I see that. Yeah. Uh-huh. 20 Q. It says, "Still complains of concentration and 21 memory problems and mood down. Patient placed on disability 22 because of mental state. Continues to have visual illusions. 23 Stabilize Lithobid, two morning, two night. Pamelor, 50 24 milligrams. At this time patient seems more schizoaffective 25 rather than bipolar with strong affective component." 42 1 A. Yes. At this point he has decided that with the 2 patient still having these visual illusions that it's probably 3 not the antidepressant, which is what I originally thought, he 4 originally thought, as you go through the record. Now he's 5 beginning to think that it's a psychiatric problem. 6 MR. FREEMAN: Wait a minute. He's talking about 7 what he thinks. 8 JUDGE POTTER: Sustain the objection. Doctor 9 Breggin needs to stay out of Doctor Coleman's head. 10 Q. Your opinions need to be based on what a 11 psychiatrist would do and these interpretations as a 12 psychiatrist as opposed to getting into Doctor Coleman's head. 13 A. I don't mean to persist in that. It's a matter 14 of putting myself in his place in the record. 15 Q. All right. Don't do that. 16 All right, go back now. It looks like Mr. 17 Wesbecker has been under the care of Doctor Coleman for a 18 year. Count the times that Mr. Wesbecker has complained of 19 anger or agitation or irritability. 20 A. Well, we have irritability, anxious and pacing 21 the first visit. He's never again described in that manner, 22 just that first visit. And then on June 9th, it says, 23 "Irritable at work and home," but that's a different concept 24 than of that pacing kind of irritability that's described. It 25 sounds more like aggravated or annoyed. I mean, really it's 43 1 the first visit. 2 Q. All right. Now go to the September 7th, 1988 3 notation. It says, "Feels slightly better but memory still a 4 problem. Focused on anger at work. Also asked if I had 5 hypnotized him last session because of memory lapse during 6 session." The patient on that notation -- 7 A. Well, it's a confusing situation. Remember, I 8 mentioned to you yesterday that lithium can cause memory 9 problems. The Doctor has raised the lithium level in an 10 appropriate manner for medical practice to try to control the 11 patients upset, but the patient is also complaining of memory 12 problems, but now it gets more complicated. He, the patient, 13 wonders if the memory problem is related to the Doctor having 14 hypnotized him. I think I mistakenly earlier said when I 15 meant hypnotized said something else. 16 But, at any rate, now it begins to look more 17 like suspiciousness, more like it's a psychiatric kind of a 18 problem rather than a mental problem from the lithium. So 19 this would be confirming the diagnosis of schizoaffective 20 disorder. It's a hard situation to diagnose. We do know that 21 he's having psychiatric problems, he's depressed. He may have 22 a tendency toward the schizoaffective. 23 Q. Do you see any notation there about any intent 24 by the patient, Mr. Wesbecker, to murder or do any physical 25 violence to anyone? 44 1 A. No. It's important that he is discussing work. 2 He says he's focused on anger at work. It's important also to 3 relay that in the past he has told doctors that he has had 4 violent feelings and needed help with them. He did that in 5 the hospital. So I think that it's important that he is able 6 to do that. He has done that on that occasion and he's not 7 doing it now. He's discussing work but not making any threats 8 or feeling any impulse out of control. 9 Q. All right. The next notation is October 5th, 10 1988, where it states that Mr. Wesbecker "feels worse, 11 increased depression and visual illusions. Decreased sleep 12 and stays at home most of the time." What does that tell you 13 about Mr. Wesbecker's mental condition? 14 A. He's doing worse and the Doctor decided to 15 change antidepressants. 16 Q. All right. It says, "Switch to -- I'm sure 17 that's a typo -- to Desyrel, 100 milligrams at night and 18 increase to 200 milligrams at night." What is Desyrel? 19 A. Desyrel is yet another antidepressant. This 20 time, a unique class of antidepressant that doesn't affect 21 neurotransmitters in such a clear and straightforward fashion 22 as some others, and it produces a very serious side effect, 23 priapism, which is an erection of the male organ that won't go 24 down, and it can be very serious, even requiring surgery. And 25 I think it's important that the Doctor is being -- again, he's 45 1 responsible; he specifically warns the patient. I've seen it 2 happen where doctors don't warn patients, but this is the most 3 serious side effect of that drug. It's rare but it's very 4 serious, and so he warns him about it. 5 Q. Let me ask you this, Doctor Breggin. And we 6 lawyers are not supposed to ask our witnesses questions that 7 we don't know the -- or have a general idea what the answer 8 is, but let me ask you this because I don't know. Is priapism 9 with Desyrel more frequent as a side effect than anxiety, 10 agitation and nervousness is with Prozac? 11 A. Oh, it's much less frequent, much, much, much 12 less frequent. 13 Q. But he's being warned of the side effects of 14 Desyrel; is that correct? 15 A. Yes. 16 Q. On October 19th, 1988, the next notation says 17 there's a phone call. "Some dryness of eyes and muscle 18 cramps, but he feels this may be tension. Plan, increase 19 Desyrel to 300 milligrams." Anything significant about that 20 phone call to the patient? 21 A. Again, there's an issue of what is side effects 22 and what's a psychiatric problem, and he's trying to adjust 23 the medication as best he can. 24 Q. Another phone call on the 31st. It says, "Not 25 at home." Does it look like maybe Doctor Coleman is checking 46 1 himself as opposed to the patient phoning in? 2 A. Yes. Yeah. 3 Q. The next notation is 11-2-88. That's 4 additionally a phone call. "Dizziness and problems with 5 Desyrel. Plan, patient has appointment tomorrow. Stop meds 6 (Desyrel) for tonight." It's unclear as to whether or not 7 that phone call -- who initiated that phone call, isn't it? 8 A. Right. 9 Q. Anything significant about that notation? 10 A. Well, again, the doctor and the patient are 11 communicating and the doctor is involved appropriately. 12 Q. The next notation is 11-3, the next day. "The 13 patient states that he took ampicillin that his wife had and 14 had a bad reaction. Felt Trazodone was helping him feel less 15 depressed prior to this without side effects." Now, is 16 Trazodone and Desyrel the same thing? 17 A. Yes. 18 Q. Was Trazodone increased at that time? 19 A. Yes. 20 Q. Didn't keep his appointment on the 1st -- on 21 December 1st, but saw him on December the 12th; is that right? 22 A. Yes. 23 Q. What was the notation then? 24 A. "Patient feels mood slightly better. Now taking 25 500 milligrams of Desyrel every night. Sleep has improved 47 1 somewhat. Still on Lithobid 2 every morning and 2 at night. 2 Continue present meds. Return to clinic 1 month." 3 Q. Go back to the page in your packet that is a 4 list of -- a medications list. Do you see that? It's a 5 separate page? 6 A. I have it. 7 Q. On Exhibit 160, it would be the last two pages. 8 I see notations of Halcion and Restoril there. What are those 9 medications? 10 A. They're sleeping medications. 11 Q. All right. And does it appear that 12 Mr. Wesbecker was generally on hypnotics, sleeping medications 13 through most of this time that he was being treated by Doctor 14 Coleman? 15 A. Yes. 16 Q. The next notation is January 9th, 1989. 17 JUDGE POTTER: I tell you what, Mr. Smith. 18 You've come to the end of a year and we're going to have to 19 take a break in the morning and this might be a good time to 20 do it. 21 MR. SMITH: Be fine. 22 JUDGE POTTER: Ladies and gentlemen, I'm going 23 to remind you again, do not permit anybody to communicate with 24 you about this case; do not discuss it among yourselves, and 25 do not form or express opinions about it. We'll stand in 48 1 recess for 15 minutes. 2 (JURORS EXCUSED; BENCH DISCUSSION) 3 JUDGE POTTER: I'm assuming this is some 4 typed-up thing of his original notes? 5 MR. SMITH: Yes. What happened was -- and we'll 6 get this when we get Doctor Coleman -- Doctor Coleman made 7 handwritten notations and then more lengthy handwritten 8 notations and then had them typed up. 9 JUDGE POTTER: You might explain that to the 10 jury that you-all have agreed that Doctor Coleman -- because 11 it's obvious that something is going on. You don't write out 12 DNKA (Did not keep appointment). You might just explain that 13 to them when you start. 14 MR. SMITH: That was actually typed by Doctor 15 Coleman's office. 16 JUDGE POTTER: Just explain to them what it is; 17 that there are things in there that don't make sense, you 18 know, in his office notes. 19 (BENCH DISCUSSION CONCLUDED; RECESS) 20 SHERIFF CECIL: The jury is now entering. All 21 jurors are present. Court is back in session. 22 JUDGE POTTER: Please be seated. 23 Doctor, I'll remind you you're still under oath. 24 Mr. Smith. 25 Q. Doctor Breggin, is it your understanding that 49 1 these notes that are in front of you are notes that have been 2 typed up by Doctor Coleman's office based on handwritten 3 notations that he's made -- that he made at the time? And if 4 there are some explanations, like on December 1st, 1988, we 5 see the word DNKA and then, paren, did not keep appointment, 6 close parens. That's probably something that the typist wrote 7 in to give an explanation as to what those initials mean; is 8 that right? 9 A. Yes. Thank you. 10 Q. Where were we, on November 3rd, 1988? Sound 11 reasonable? 12 A. Yeah. Uh-huh. 13 Q. It says, "Patient states he took ampicillin that 14 wife had and had a bad reaction. Felt Trazodone was helping 15 him feel less depressed prior to this without side effects. 16 Resumed Desyrel 300 milligrams at night." We've discussed 17 that, have we not? 18 A. I think so. 19 Q. December 1st, he didn't keep his appointment. 20 On December 12th, his mood was better. He was taking 500 21 milligrams of Desyrel at night and his sleep had improved; 22 correct? 23 A. Yes, sir. 24 Q. His mood was better on the 12th of December. 25 Then on January 9th says, "His mood was better but still some 50 1 nights having trouble sleeping. Less symptoms of floor 2 moving. Quite animated and talkative about problems with 3 lawsuit. Plan, try 600 milligrams Desyrel every day." Does 4 this finding of less symptoms of floor moving have any 5 significance to you, Doctor Breggin? 6 A. It sounds as if he's feeling better and that 7 that symptom is being reduced, that he's generally doing 8 better now that he's not working. 9 Q. It says also, though, that he's quite animated 10 and talkative about problems with lawsuit. What's your 11 understanding or do you have any knowledge in connection with 12 what that was? 13 A. I've been told it was an EEOC complaint, a 14 complaint about job discrimination based on his mental 15 illness. 16 Q. All right. We've had testimony concerning that. 17 And your understanding is that's what he was animated about? 18 A. Yeah. And it indicates he's feeling like maybe 19 he can get something done here. He's involved in having some 20 resolution of his problems with work. 21 Q. In your practice have you seen that that's 22 important in connection with individuals who have depression 23 and mood disorders of this nature, that if they can get 24 something done or resolved that that causes an improvement in 25 their symptoms? 51 1 A. Oh, very much so. I'm frequently saying to my 2 patients you need a project, and this is a project. It 3 matters to him. It's perhaps a part of his getting better. 4 He has this project but he's also no longer at work. 5 Q. On February 6, 1989, he came in. It says, 6 "Patient feels increase of Desyrel to 600 milligrams has not 7 helped any. Increase in visual illusion, although he 8 attributes this with argument with son. Continues to complain 9 of memory difficulty and loss of train of thought." What's 10 your impression of that notation, Doctor Breggin? 11 A. The fact that the visual illusions are 12 continuing and that he himself thinks they have something to 13 do with stress and conflict suggest they are psychiatric. 14 Continues to complain of concentration and memory difficulties 15 and loss of train of thought could be either his psychiatric 16 problem, the depression can do that to you, or it could be 17 lithium that can cause that. It could be both. This is 18 common in either case. I suspect, though, -- usually patients 19 on lithium don't make such a definitive statement like this; 20 it's usually a little more vague, the memory problems with 21 lithium, so I suspect it's probably a mood problem. 22 Q. The next is a phone call, says, "Patient saw 23 report on Halcion on TV and wants to switch. Will switch to 24 Restoril 15 milligrams at night as needed." And I believe the 25 medication chart will show that the Restoril came on board at 52 1 that time. 2 A. Yes, sir. 3 Q. Was it appropriate to switch to Restoril at that 4 time? 5 A. Yes. Restoril is a much safer -- much, much 6 safer drug than Halcion and very appropriate to switch to it. 7 Q. Again, is the Halcion and the Restoril being 8 given for sleep as opposed to anxiety? 9 A. Yes. It's definitely being given for sleep. 10 Halcion, for example, has an extremely short half-life; it's 11 mostly gone by the morning. Restoril has a little bit longer 12 half-life of nine hours, but its effects are largely gone by 13 the morning and, as I mentioned I think earlier, it's been 14 marketed strictly as a sleeping pill. If you look into 15 textbooks they're likely to have it in a separate chapter 16 under sleeping medications, not under anxiolytic or 17 anti-anxiety medications. And most patients taking this drug 18 do not feel an effect from it when they get up in the morning; 19 that's the whole purpose of its being a sleeping medication, 20 so you can get up in the morning and drive to work and not be 21 in danger of being under the influence of the drug. 22 Q. I don't see any agitation or anxiety or anger 23 mentioned on the January 9th, 1989, notation nor do I see any 24 on the February 6, 1989, notation. Do you see any, Doctor 25 Breggin? 53 1 A. No. There's no mention of any symptoms like 2 that. 3 Q. On March 27th, 1989, he comes in reporting that 4 the, "Patient feels discontinue of Halcion has helped a lot, 5 feeling much better with improved mood, more active, less 6 upset by things. Tapered lithium to b.i.d., two a day, with 7 no reported ill effects. Patient would like to see how he 8 would do off of lithium. Talked about potential risks of 9 increased mood disturbance and patient willing to risk this." 10 Generally what does this say about Mr. Wesbecker's condition 11 in March of '89? 12 A. At this point when the Halcion has stopped, he 13 no longer talks about the room moving and about illusions, as 14 far as I can tell. And that makes me now wonder, as I'm going 15 through in his shoes, whether it was the Halcion. And Halcion 16 can cause a lot of mental problems. He feels better off of 17 the Halcion. 18 The tapering of the lithium, a doctor would do 19 that when he's feeling safer about his patient; this patient's 20 mood is stabilized. And he mentions to the patient that this 21 could mean that there will be more problems because we've 22 lowered your lithium, so be on the lookout for that, and he 23 instructs the patient to give a call if tapering this lithium 24 is proving a problem, if reducing the lithium is proving to be 25 a problem. 54 1 Q. And to return in two months? 2 A. That again indicates -- a doctor would not 3 likely do that if he thought his patient was in any trouble, 4 so things are looking better. 5 Q. And two months later he did see him on May 31st, 6 1989, with a notation, "Feeling more depressed. Decreased 7 sleep, decreased motivation and energy. More irritable. 8 Relates some of this to in-law problems and problems with 9 son." Correct? 10 A. Yes. 11 Q. Is this unusual to see some changes in mood with 12 individuals with this type of illness? 13 A. No. This man really seems to have a kind of 14 baseline feeling depressed. 15 Q. All right. 16 A. That he is often just not feeling good. 17 Q. And his lithium level is checked and he's 18 getting more Desyrel, apparently? 19 A. Yes. 20 Q. The next notation is June 26th, 1989. There 21 Doctor Coleman notes, "Patient's mood seems to have improved 22 but feeling drugged and lethargic. Still complains of memory 23 problems. Explained dilemma of need for medication to balance 24 mood versus side effects. Can try to decrease meds slightly. 25 Decrease Lithobid to two every morning and one at night. 55 1 Decrease Desyrel, Trazodone, to 500 milligrams at night." 2 Correct? 3 A. Yes. And then return to clinic in one month. 4 And it says last lithium level, one. 5 Q. Everything seem appropriate? 6 A. Yes. And he is still struggling with that 7 question of what is the drug effect versus what -- at least 8 the record indicates issues continuing of what's the drug 9 effect and what's the mood problem and he's trying to figure 10 that out. 11 Q. It looks like he missed his appointment on 12 August 3rd, 1989, but on August the 10th, 1989, reports the 13 following: "Patient relates change of meds no specific 14 benefit. Still has morning lethargy, trouble initiating sleep 15 and trouble with memory. Talked about whether to accept 16 present level or try something different. Talked about 17 possibility of benefits of Prozac and patient agreeable to 18 this. Most risk-free method seems to be to start this and 19 then gradually taper Trazodone. Plan, start Prozac 20 20 milligrams per day." Correct? 21 A. Yes. 22 Q. Now, is there any mention here about anger, 23 agitation or irritability with Mr. Wesbecker? 24 A. No. I mean, it's been quite some time since 25 there's been any mention of anger over work. It's been 56 1 months. 2 Q. No mention in June, is there? 3 A. No. 4 Q. There's a mention in May of some irritability 5 but there's no mention of anger, is there? 6 A. No. 7 Q. In March there was no mention of irritation, 8 anger or hostility, was there? 9 A. No. 10 Q. There was no mention of hostility in February 11 of '89, however, it's clear he had an argument with his son; 12 correct? 13 A. Yes, sir. 14 Q. There's no mention of anger, hostility, or 15 irritation on June 9th, 1989, is there? 16 A. No. 17 Q. Back in December of 1988, is there any mention 18 of hostility, irritation or anger? 19 A. No. 20 Q. Is there any mention of hostility, agitation or 21 anger in November of 1988? 22 A. No. None on the phone calls, either. 23 Q. Is there any mention back in October of 1988 of 24 anger, irritation or hostility? 25 A. No. 57 1 Q. The word anger is mentioned a year earlier in 2 the September 7th, 1988 notation, is it not? 3 A. That's right. 4 Q. But there it says "focused on anger at work," 5 does it not? 6 A. Yes. 7 Q. Now, read the September 11th, 1989 notation. 8 A. September 11th, 1989, "Patient seems to have 9 deteriorated. Tangential thought. Weeping in session. 10 Increased level of agitation and anger. Question from Prozac. 11 Patient states he now, quote, remembers, end quote, sexual 12 abuse by co-workers and has called, quote, sex crimes 13 division, end quote, of police. Because of deterioration I 14 have encouraged patient to go into the hospital for 15 stabilization but he refused. Plan, discontinue Prozac, which 16 may be cause. Return to clinic, two weeks." 17 Q. What's your opinion, Doctor Breggin, about the 18 change in this man's condition since he began the Prozac? 19 A. It's an abrupt change. It takes place in less 20 than a month. It is a typical agitation reaction. It is 21 exactly what I documented for I guess more than a day as one 22 of the effects of Prozac, in fact, as the primary side-effect 23 constellation of Prozac starting with the animal research 24 through the very first Phase 1 and Phase 2 studies and right 25 on up. He also at this point would seem to be suffering from 58 1 a delusion, and Prozac can in the process of this 2 overstimulation produce psychosis; that's been recorded again 3 and again and is acknowledged in the labeling by the FDA. 4 He seems to be having a typical Prozac reaction. 5 We learned later that there was no report to the sex crimes 6 division and that there almost surely was never an incident of 7 sexual abuse by co-workers and definitely, in retrospect, this 8 becomes a delusion. Those are some of my general comments on 9 that. 10 Q. Is this, Doctor Breggin, a classic case of what 11 you've been describing for the last day and a half to us? 12 A. Oh, yes. It's as if I were reading from all 13 that other material I read to you earlier of the cases and the 14 reports and the evaluations. It just fits right smack in the 15 middle of it. 16 Q. All right. When you saw this notation in Doctor 17 Coleman's records when you first received Doctor Coleman's 18 records, did this cause alarm or concern for you, sir? 19 A. Well, it immediately implicated Prozac in the 20 events that followed three days later on the 14th. 21 Q. Do you have any -- 22 A. I went further than that. I mean, I didn't just 23 simply make the decision based on that but... 24 Q. But was it significant to you that Doctor 25 Coleman's records in fact demonstrated the same thing that you 59 1 had seen in your research in connection with this drug? 2 A. Well, it indicated, among other things, that he 3 was a good observer, clinically, we've seen. He's attentive, 4 he's paying a lot of attention to his patient and he makes 5 these observations based on that two years of clinical 6 experience that he's seen him; he bases it on a knowledge of 7 Prozac. He's used Prozac. He perfectly describes the 8 agitation syndrome, and he attributes it, saying "which may be 9 the cause." He certainly wouldn't have stopped the medication 10 if he thought it wasn't most probably the cause. 11 Q. Doctor Coleman's deposition has been taken in 12 this case and we expect that he will testify in this case, but 13 have you had the opportunity to read Doctor Coleman's 14 deposition to get details concerning these particular 15 notations, Doctor Breggin? 16 A. Yes, I have. 17 MR. FREEMAN: Your Honor, may we approach? 18 (BENCH DISCUSSION) 19 MR. FREEMAN: First of all, it's been 20 represented that Doctor Coleman himself is going to be here to 21 testify and you know your previous rulings about depositions. 22 Secondly of all, we object to any summary or conclusions from 23 the depositions of what he said without the specific language 24 being read, because to have him interpret like he's been 25 trying to do what's in Doctor Coleman's mind or interpret what 60 1 he's saying is totally inappropriate. Since the witness is 2 going to be here, we object to the references to it. 3 MR. SMITH: He's an expert and he's entitled to 4 testify concerning what his opinion is in connection with the 5 causation. 6 JUDGE POTTER: I think he can testify as to, you 7 know, what Doctor Coleman said, but he better be slam accurate 8 when he paraphrases or... 9 (BENCH DISCUSSION CONCLUDED) 10 Q. In reviewing Doctor Coleman's deposition, it's 11 important to be 100-percent accurate. Do you have any 12 accurate quotations concerning what Doctor Coleman testified 13 concerning this last office visit? 14 A. Yes, sir; I do. Just happened to have my note 15 cards again. 16 Q. All right. What did Doctor Coleman -- what did 17 you find in Doctor Coleman's deposition that was significant 18 to you in understanding more completely these office 19 notations? 20 A. Actually, I looked at several depositions and 21 also his testimony. 22 Q. All right. What we're going to need is 23 quotations, if you have that, sir. 24 A. Sure. In the deposition of September 9th, '93, 25 in response to how he was on this visit compared to other 61 1 visits, quote, more anxious, end quote. Quote -- 2 MR. FREEMAN: What page was that on, please? 3 A. What I have here is Page 36 and following, 36 4 and following. 5 JUDGE POTTER: Mr. Freeman, if you want him to 6 wait while you check, you can have him wait; otherwise, 7 Doctor, just be very careful you've got it right. 8 A. Okay. Quote, his emotions seem to be up and 9 down a lot. 10 MR. FREEMAN: What page reference is that, 11 please? 12 A. This is 36 and following. That's all I have 13 here. 14 MR. FREEMAN: We don't know what that means, 15 Judge. 16 A. It means the next few pages. 17 JUDGE POTTER: You want him to wait while you 18 confirm it, Mr. Smith, or not? 19 Q. Beg your pardon? 20 JUDGE POTTER: I'm sorry. Mr. Freeman, 21 Mr. Myers, do you want him to read his quotes and wait while 22 you find them or do you want to find them on the break? 23 MR. FREEMAN: We'll wait till the break. 24 Q. Do you have the deposition with you? 25 A. We probably do. I'll be happy to find it. 62 1 JUDGE POTTER: They'll check him on the break, 2 Mr. Smith. 3 Q. All right. Did you at least get further details 4 to confirm that what you had seen of this Prozac profile, what 5 you read here in these office notations were indeed the 6 observations of Doctor Coleman? 7 A. Yes. I have more quotes, some with exact page 8 numbers. 9 Q. Okay. If you'd give exact page numbers then. 10 Your Honor, is it appropriate for him to quote 11 exact page numbers at this time? 12 JUDGE POTTER: That's fine. That's fine. 13 A. In explaining that his sleep was worse than 14 ever, he said, quote, hardly any sleep last month. That's the 15 depo of April 16th, Page 134. Again he said, quote, 16 significantly more sleep problem, end quote. That's from the 17 inquest, Page 76. Then back to the deposition, quote, he 18 wasn't his normal self at the first -- 19 MR. FREEMAN: Which deposition? 20 A. The one I started to quote from, the 9-9-93. 21 Q. Have you got a page number for that next quote? 22 A. I have a page number for the very next quote 23 after it, and that means to me it's in the area. 24 Q. Okay. Unless you can give them a specific page 25 number for a specific quote, Doctor Breggin, right now just 63 1 give the quote if you've got an exact page number. 2 A. Okay. I have another quote, certainly at the 3 last session he was agitated, and my note says 72 ahead, so it 4 could be on 72 or the next page. 5 JUDGE POTTER: Mr. Smith, maybe you 6 misunderstood my ruling. He can go ahead and read his quotes 7 and they'll check them on the break, and then if there's 8 something wrong they'll catch him on cross-examination. I may 9 not have made myself clear. 10 A. May I go back? 11 Q. Yeah. Go back and give us the exact quotes that 12 you wrote down. I assume you read through Doctor Coleman's 13 deposition and made notes? 14 A. Yes. Right. 15 Q. All right. 16 A. Well, we're going back to the September 9th, 17 1993 depo, and just to kind of get context, what I have is 18 that from the moment the patient came in, according to the 19 doctor, he was, quote, more anxious, end quote; his emotions 20 seemed to be up and down a lot. Sobbed. His voice was 21 louder, end quotes. Quote, get angry real quickly, end quote, 22 and then calm down. Quote, fairly labile, end quote. 23 Q. What's labile mean? 24 A. Emotionally up and down. Emotions not level. 25 And then I gave you the quotes, hardly any sleep last month. 64 1 That was on the depo of 4-16, Page 134. Significantly more 2 sleep problem, Inquest 76. And the sleep problem is very 3 important in terms of violence and agitation. 4 Then continuing now with the depo of 9-9-93, 5 quote, he wasn't his normal self at the first of the session. 6 Quote, he didn't look very calm, and then, quote, certainly at 7 the last session he was agitated, end quote. And that's where 8 it says 72 or ahead. He calls it deterioration. He describes 9 him as quote nervous, end quote. Quote, shaky or pacing more, 10 end quote. Then a lengthy quote, and it looks to me like Page 11 36, although it's written in pencil so that could be off. 12 MR. FREEMAN: Which deposition? 13 A. It would be the -- these are the basic notes are 14 from the 9-9-93 depo, and what I have here, quote, I knew that 15 Prozac in some people could cause nervousness, could cause 16 agitation, could cause sleep problems, plus I had started him 17 on it three or four weeks before; whereas, he had previously 18 been in and now he's deteriorated, period. When you start a 19 new medication and something different happens, you tend to 20 support that it's the medication that is causing -- and then I 21 can't read my next word -- within that period of time. 22 Causing it -- causing it within that period of time. So 23 that's what made me question, one, the constellation of 24 symptoms that I was observing and, two, that we had just 25 started it three or four weeks before, end quote. And then 65 1 I've got a 36 circled, which would suggest I went back to put 2 a page number in later. 3 Q. All right. 4 A. I have more. But only with quotes? 5 Q. Yeah. Only with quotes right now. 6 A. Quote, only two sessions that I remember him 7 pacing about and being agitated. He's referring to the very 8 first session and the very last. 9 MR. FREEMAN: What's the page number? 10 A. Seventy-two. Fairly agitated, it's a quote, 11 Page 90. Quote, in none of his suicide attempts had he 12 attempted to harm anybody else, to my knowledge, Page 73. 13 More notes here but without quotes. Quote, his primary 14 problem was a mood problem, end quote, Page 78. That's what I 15 have with the quotations. 16 Q. All right. Did generally your reading of Doctor 17 Coleman's deposition confirm that this constellation was 18 occurring as was written in Doctor Coleman's office notes? 19 A. Well, yes. Well, he's more specific in the 20 depositions. I mean, it comes out that this is clearly the 21 most agitated he's ever seen him. It's worse than the first 22 session. The sleep problem is worse than it's ever been; he's 23 pacing and so on. So the description of him, you know -- and 24 he suggests hospitalization, which is very key. It's the 25 first and only time he suggests hospitalization. 66 1 Q. You say that's the first and only time he ever 2 suggested hospitalization? 3 A. Yes. Uh-huh. I'm just kind of glancing at some 4 of my notes that weren't in quotes. But the overall 5 impression is of a definitive change. He's in a way the 6 doctor's never seen him before. It's more serious and 7 deteriorated in a way he's never seen him before. 8 Q. Does deterioration have any specific meaning 9 when written by a psychiatrist or is it just an ordinary, like 10 we all say, deterioration? 11 A. It's like we all say, but when a physician uses 12 that word it has a lot of punch. I mean, it's consistent with 13 something serious. It's a serious word to use. And he's 14 making absolutely clear this is basically new. He's seen a 15 little bit of it the first time he came in but this is new and 16 he was very, very concerned. He also said -- made an 17 appointment for two weeks. 18 Q. Is that significant? He had gone up to three 19 months without seeing him on previous occasions. 20 A. And he actually -- I recall from one of the 21 depositions he actually wanted it for one week and he wanted 22 him to come in with his ex-wife, and that is a whole break 23 with his practice previously. He's never said that before, 24 that I know of, that I know of. And she can't come in the 25 next week so he makes it for two weeks simply because she 67 1 can't come in right away, and he has not responded in that 2 fashion at any other time. 3 Q. You mean Doctor Coleman has not suggested that? 4 A. Has not; right. 5 Q. And he felt that the situation was perhaps less 6 serious just because it was caused by Prozac because he hoped 7 it would get -- 8 MR. FREEMAN: This is "he felt" again, Your 9 Honor. 10 DOCTOR BREGGIN: He said. 11 JUDGE POTTER: Why don't you stay out of Doctor 12 Coleman's head unless it's written down somewhere. 13 Q. Did you read testimony that would indicate 14 Doctor Coleman's reasoning for this way -- 15 MR. FREEMAN: Doctor Coleman it's been 16 represented is going to be here on behalf of the plaintiff. 17 A. I really mean said when I say felt, and I 18 apologize again for that. He said that he had hoped that the 19 patient would get better because he was stopping the Prozac. 20 So not only does he think Prozac is the cause, he thinks that 21 stopping the Prozac is going to help. So that's one of the 22 reasons why he felt a little secure even though the patient 23 did not want to go into the hospital. 24 Q. Okay. Did I interrupt you? Did you have 25 another thought? 68 1 A. Well, about the hospital, which is all part of 2 this package, he says that he didn't want to force him to go 3 into the hospital in part because he thought that would in 4 effect break rapport, it might make him feel distrustful of 5 him. And also I think he said he didn't meet the standard 6 for -- that he could tell -- for hospitalization. 7 Q. You mean involuntary hospitalization? 8 A. For involuntary hospitalization. But he did do 9 something that was significant and important, which was to 10 make a visit soon, to stop the Prozac and to get a family 11 member in. 12 Q. Okay. Tell us then, Doctor Breggin, how if 13 Doctor Coleman stopped the Prozac on September 11th, 1989, the 14 Prozac could cause conduct by Mr. Wesbecker on September 14th, 15 1989. 16 A. Well, there are two things to take into 17 consideration there. You remember I've talked to you about 18 these short half-lives of drugs? Lithium's half-life is a 19 day; Restoril is nine hours. The half-life of Prozac, 20 fluoxetine, and its metabolite, the medication that then 21 becomes in the system norfluoxetine, which is also active, 22 lasts half-life seven to nine days and, in addition, there has 23 been other literature that it may be longer, but that's long 24 enough for our case here, for our situation. So we can expect 25 him to be carrying a significant and therapeutic or 69 1 untherapeutic dose within his system of Prozac three days 2 later, even longer than that. 3 The other thing is that remember I talked about 4 the compensatory mechanisms and how the receptor for Prozac 5 die back or disappear, depending on your concept, when the -- 6 when the drug is present, that the receptors get flooded so 7 they go down in number. Now, if that happens and you've now 8 reduced your dose of Prozac a little, I mean, it's starting to 9 go down, the dose is going down but those receptors haven't 10 turned around yet; they haven't regenerated yet, if they're 11 ever going to regenerate. We have no studies on whether these 12 receptors regenerate. Lilly has done no studies on whether 13 these receptors ever, ever come back. 14 So we have a situation the blood level's going 15 down, the receptors are used to a higher blood level. 16 Theoretically, at least, we could be producing exactly the 17 situation that Lilly says causes violence and causes 18 impulsivity, which is a relatively sluggish system with the 19 Prozac diminishing in the blood and the receptor still 20 subsensitive, still diminished in number. That's a theory. 21 It conforms with what I have seen, which is, on stopping 22 Prozac, people sometimes get much worse in the first few days 23 afterward. But we don't need that explanation. I would class 24 that as one of the possibilities. The clear thing is he's got 25 a Prozac agitation during those days. 70 1 Q. All right. And do we also have blood work taken 2 at autopsy of Mr. Wesbecker that showed therapeutic levels, if 3 there is such a thing, of Prozac on board at the time? 4 A. Yes, we do. It's very clear that the 5 combination of fluoxetine and norfluoxetine which, remember, 6 is its long-acting metabolite, is 1,000 -- over 1,000 7 nanograms. 8 Q. All right. I don't think the jury has that 9 exhibit in front of them, so let's see if we can get it in 10 front of them. Is this the blood autopsy toxicology reports 11 that you reviewed -- 12 A. Yes. 13 Q. -- and that you're talking about, Doctor 14 Breggin? 15 A. Yes, sir. This is it. 16 MR. SMITH: We would offer Exhibit 161. 17 JUDGE POTTER: Be admitted. 18 Q. Wait until they've got that so they can follow 19 along with you. 20 SHERIFF CECIL: (Hands document to jurors). 21 MR. SMITH: May I approach the bench, Your 22 Honor? 23 JUDGE POTTER: Uh-huh. 24 (BENCH DISCUSSION) 25 MR. SMITH: We've got the jury's attention now 71 1 that we have the school kids out there. I just looked. 2 (BENCH DISCUSSION CONCLUDED) 3 Q. All right. If you'll look at -- where are you 4 reading from on 161, where you have the report of Prozac, 5 Doctor Breggin? 6 A. It's about five lines down, and you see they 7 have given the blood level. 8 Q. Is that on the SmithKline-Beecham Science 9 Laboratories? 10 A. Yeah. SmithKline-Beecham Science Laboratories. 11 And if you go down, it says fluoxetine, Prozac, then it gives 12 you the concentration in the blood of the fluoxetine, 328; 13 then it gives you the concentration of the norfluoxetine, 764, 14 and it adds them together for us for a level of 1,092. Now, 15 on the other side is therapeutic range. That is this 16 laboratory's estimate of what an effective dose level is. And 17 the dose -- effective dose level that they suggest is 300 to 18 1,150. That would indicate that by this laboratory's standard 19 for their testing of fluoxetine and norfluoxetine, he is 20 actually at the high end of the therapeutic range, so he's 21 more than certainly under the influence of Prozac. He's 22 clearly, definitively, unequivocally under the influence of 23 Prozac on that third day at a rather intense level. 24 Q. And could he still have been under the influence 25 of Prozac on September 14th if he did indeed follow Doctor 72 1 Coleman's instructions and discontinue Prozac on September 2 11th? 3 A. Well, definitely, and I think that he did. I 4 again went and looked at the pill count as reported, and 5 according to my simple mathematical calculations, he took one 6 pill as directed every day until he was told to stop, and this 7 is entirely consistent with that. 8 Q. All right. Now, to be clear on what we're 9 looking at, D