1 1 IN THE UNITED STATES DISTRICT COURT 2 FOR THE DISTRICT OF WYOMING 3 ------------------------------------------------------- 4 THE ESTATES OF DEBORAH MARIE TOBIN 5 and ALYSSA ANN TOBIN, Deceased, by TIMOTHY JOHN TOBIN, Personal 6 Representative; and THE ESTATES OF DONALD JACK SCHELL and RITA CHARLOTTE 7 SCHELL, Deceased, by NEVA KAY HARDY, Personal Representative, 8 Plaintiffs, 9 vs. Civil No. 00-CV-025D 10 SMITHKLINE BEECHAM PHARMACEUTICALS, 11 Defendant. 12 ------------------------------------------------------- 13 DEPOSITION OF PATRICK H. BUCHANAN, M.D. 14 Taken in behalf of Defendant 9:12 a.m., Tuesday 15 February 13, 2001 16 17 PURSUANT TO NOTICE, the deposition of PATRICK 18 H. BUCHANAN, M.D. was taken in accordance with the 19 applicable Federal Rules of Civil Procedure at 500 S. 20 Gillette Avenue, Gillette, Wyoming, before Vonni R. 21 Bray, Registered Professional Reporter and Notary Public 19 1 Dr. Buchanan's Office Notes 3 3 1 P R O C E E D I N G S 2 (Deposition proceedings commenced 3 at 9:12 a.m., February 13, 2001.) 4 (Witness sworn.) 5 PATRICK H. BUCHANAN, M.D., 6 called for examination by the Defendant, being first 7 duly sworn, on his oath testified as follows: 8 DIRECT EXAMINATION 9 Q. (BY MS. WESTBY) Dr. Buchanan, please state 10 your full name and address for the record. 11 A. Patrick Henry Buchanan, xxxxxxxxxxxxxxxxxx 12 xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx. 13 Q. And what is your profession? 14 A. Psychiatrist. 15 Q. Are you currently practicing? 16 A. Yes. 17 Q. How long have you been in practice? 18 A. Little over 30 years. 19 Q. Dr. Buchanan, I am going to hand you what has 20 been marked for purposes of identification as Deposition 21 Exhibit 1. Can you please identify that document for 22 me? 23 A. Yes, this is a document that I faxed to you at 24 your request. 25 Q. And is that a complete and accurate copy of 4 1 your records relating to Donald Schell? 2 A. Yes, it is. 3 Q. And is that kept in the normal and ordinary 4 course of business? 5 A. Yes. 6 MR. FITZGERALD: I don't have any 7 Buchanan records. I was faxed -- unless -- is this the 8 ones at the top that say Don Schell referred by 9 Dr. Hemphill? 10 MS. WESTBY: Yes, those are the same 11 ones. Yeah, I believe we got these from you, Jim. 12 MR. FITZGERALD: I understand what 13 you're talking about now. These are Bates stamped 2621 14 on the first page, correct? 15 MS. WESTBY: No, these are Bates stamped 16 2588 through 2589-A. 17 MR. FITZGERALD: Do they begin with 18 January 16, 1990? 19 MS. WESTBY: No, they don't. They begin 20 with March 15, 1993. 21 MR. FITZGERALD: Okay, go ahead. 22 MS. WESTBY: And, Jim, we received these 23 records from you, but then we also subpoenaed them on 24 our own. 25 MR. FITZGERALD: Did you get any others 5 1 besides what we got? 2 MS. WESTBY: No, we have the same ones 3 you have. 4 MR. FITZGERALD: Okay. 5 Q. (BY MS. WESTBY) And, Dr. Buchanan, are you 6 responsible for maintaining your own records? 7 A. Yes, I am. 8 Q. Please, for purposes of making sure that we 9 understand what these records say, will you just read 10 these -- read your notes into the record starting with 11 the first page of handwritten notes that's identified 12 with March 15, 1993 at the top? 13 A. Well, his date of birth of 10-17-37. And I 14 have his address there. xxxxxxxxxxxxxxxxxxxxxxxx. Has 15 his phone number. And I have referred by Piedmont, 16 which was a psychological clinic at the time. 17 Q. And let me stop you there, Doctor. Do you 18 know who he was seeing or being treated by at Piedmont? 19 A. I do not. 20 Q. Okay, go ahead. 21 A. And I have his recent history; anxiety, 22 severe; and sleep difficulty, he had a mid-cycle and 23 terminal sleep disturbance for 2 weeks. 24 Q. And speak slowly. Whenever you read from a 25 document, you tend to talk faster. And the court 6 1 reporter has to take down every word you say. 2 A. His appetite was decreased. He'd lost 10 3 pounds over the -- it looks like -- I'm not sure how 4 long -- ten-pound weight loss is what I have. Probably 5 over the previous month is what I usually ask for. 6 He denied crying spells and had consistent 7 feelings of depression for the previous two weeks. He'd 8 been feeling helpless but denied any feelings of 9 hopelessness. And he denied any loss of enthusiasm of 10 life in general. He denied any -- he acknowledged some 11 loss of pleasure in the things he usually enjoyed. 12 He'd have some psychomotor agitation. He'd 13 had some decreased energy and had some feelings of 14 worthlessness. He also had a decreased ability to 15 concentrate. And at the time he denied any suicidal or 16 homicidal ideation or intent. 17 Q. Continue, please. 18 A. He denied any history of alcohol abuse. He 19 denied any history of drug abuse. He was taking no 20 medications at the time I saw him. He was allergic to 21 codeine. And under serious medical or surgical 22 illnesses, he had pterygium, p-t-e-r-g -- I don't know 23 how to spell that, pterygium. It's a little blip on 24 your eyelid. He essentially had a negative past 25 history. 7 1 And he denied any previous medical illnesses. 2 And he had past psychiatric history and seen a 3 physiatrist in 1989 and 1991. And I got his sheet 4 here. And on the back of it, he said I've had no real 5 moments of anxiety or depression. The first time was in 6 December of 1989, and the second was September or 7 October of 1991. 8 Q. Do you remember if he told you who he had 9 treated with during those bouts of depression? 10 A. I do not. And I have a social history. At 11 the time I saw him, he was married to his wife Rita who 12 was 50 at the time. And that was 8-14-1961 they were 13 married. And he had two children: Mike and Deb, who 14 were 26 and 30 respectively. And his family history, it 15 looks like to me his father was 84 at the time, and his 16 mother died at the age of 62 in 1969 from myocardial 17 infarction. 18 And I have I list of his family members. And 19 it looks like he had an older brother Leonard, who was 20 deceased. I can't read the next line. He had an older 21 sister and an older brother. And then there was -- oh, 22 it was him. And then he had a sister, Doris, who was 23 53. Eileen was 51. And Roger, his younger brother, was 24 47. 25 His religion was Catholic. He graduated from 8 1 high school in North Dakota. And post-high-school-age 2 work in the oil field. Military: In United States Army 3 1979 -- 1957 to 1959. 4 Q. And let me ask you while you're on the 5 military history. Did he mention any psychiatric 6 history that had occurred during the time he was in the 7 military? 8 A. I don't have it down. I don't recall that he 9 did. 10 Q. If he would have told you about that, do you 11 think that's something that you would have noted? 12 A. Well, yes, I would have. 13 MR. FITZGERALD: Pardon me. Can I ask 14 that the reporter read back the last two questions and 15 answers? 16 (Record read.) 17 Q. (BY MS. WESTBY) Okay, go ahead, Doctor. 18 A. Well, where was I? He said he did contract 19 work in the oil fields, and he denied any physical or 20 sexual abuse growing up. 21 And my mental status exam is next. I put he 22 was appropriately dressed. His speech was C&L, 23 conversational and logical. His attitude was 24 cooperative. His mood I thought was moderately 25 depressed. His affect was flat, which means not as much 9 1 expression. His associations were intact. He was 2 thinking logically. He denied any suicidal or homicidal 3 ideation or intent. He denied any hallucinations. He 4 had some depersonalization symptoms. His head was 5 occasionally floating off his shoulders. 6 Q. And let me stop you there. You described that 7 as a depersonalization symptom; is that correct? 8 A. Yes, ma'am. 9 Q. And can you elaborate on what you meant by 10 that? 11 A. I put the question in because it tells you how 12 much stress the person is under if they happen to have 13 these symptoms. It doesn't mean anything significant. 14 When your head feels like it's floating off your 15 shoulders, these people are usually trying to get away 16 from the stress they're enduring. 17 Q. Did that indicate to you anything in terms of 18 anxiety or psychosis? 19 A. Yes. He was under significant stress. 20 Q. Okay. 21 A. And then I have he denied any repetitive 22 thoughts or recurrent thoughts that come back day after 23 day. I did not think he was delusional. And he was 24 fully oriented at the time, place, person, situation. 25 His recent memory, his remote memory, his 10 1 recall, his IQ I thought were within normal limits. His 2 judgment and insight I thought was fair. 3 MR. FITZGERALD: Pardon me. Would you 4 repeat that last answer, please, Court Reporter? 5 (Record read.) 6 Q. (BY MS. WESTBY) Okay, Dr. Buchanan. Now, if 7 you will go to the other page of handwritten notes that 8 starts with March 15, 1993 at the top. And if you will 9 just read those notes into the record as well? 10 A. Well, at that time, I put my impression as 11 major depression recurrent. And I put treatment: 12 Patient previously on imipramine or lorazepam with good 13 results. 14 Q. Okay. Well, let me stop you really quickly. 15 When you're talking about major depression recurrent, 16 describe for me what that means to you. 17 A. Well, what that means is that you have these 18 constellation of symptoms that you've had for two 19 weeks: Either depressed mood or a lack of enjoyment of 20 life in general. And plus more of the symptoms, which 21 is he had those symptoms. You want me to enumerate the 22 symptoms. 23 Q. Yes, please. 24 A. Well, let's see what he had. He had -- he'd 25 had a loss of pleasure in life. He'd had some 11 1 psychomotor agitation. He had feelings of worthlessness 2 and decreased energy and difficulty concentrating. 3 Q. And you were talking about the medications he 4 was on and the fact that you put him back on imipramine; 5 did you also put him back on lorazepam? 6 A. Yes, I did. 7 Q. So go ahead and continue with your records if 8 you would. 9 A. I do not think patient is suicidal and had -- 10 I put I did not think he was suicidal. And I put down 11 when he was returning in August for his next 12 appointment. 13 Q. And continue on with the records. 14 A. Well, at that time I had a stamp. And I put 15 patient -- he came back on March 29. This patient's 16 mood was improving. Denied suicidal ideation. I 17 continued him on the medication and I gave him another 18 appointment in another month. 19 Q. And the next appointment is April 27 of 1993? 20 A. Yes. 21 Q. Please read -- 22 A. I put doing well. And I continued his 23 medication. And he was returned to see me WCFRA, which 24 is will call for return appointment within 8 weeks, 25 which he never did. 12 1 Q. Okay. So it's my understanding from your 2 records and notes and the things that you said here 3 today that you had documented agitation and severe 4 anxiety that were present before you put him on the 5 medication; is that correct? Or put him back -- 6 A. That's correct. 7 Q. You also have in here some description of his 8 work history. Did he mention anything to you about 9 problems at work, being off work because of his 10 depression? 11 A. I do not recall that. 12 Q. Is that something that would have been in 13 these records if he would have told you something like 14 that? 15 A. Yes -- 16 MR. FITZGERALD: Leading question. I 17 object. 18 Q. (BY MS. WESTBY) You can go ahead and answer. 19 A. I would have put it down most likely because 20 that would have been part of the stress that he was 21 enduring. 22 Q. Okay. Can you tell me how long this episode 23 of depression lasted? 24 MR. FITZGERALD: Lack of foundation. 25 A. I cannot do that. 13 1 Q. (BY MS. WESTBY) Do you have any indication 2 from your records how long it appeared that it had 3 lasted? 4 MR. FITZGERALD: Lack of foundation. 5 Q. (BY MS. WESTBY) And you can go ahead and 6 answer if you can. 7 A. Well, the presumption would be they continued 8 since his -- 1989 and 1991, when he had been treated 9 previously. 10 Q. But the last time that you saw him was on 11 April 27 of 1993; is that correct? 12 A. That is correct. 13 Q. And if I understood you correctly, then you 14 told him to call within 2 months, and he never did 15 that? 16 A. He never did. 17 Q. Okay. Where is Piedmont? Is that a clinic 18 here in town? 19 A. It was at the time. And it was down the 20 street, but it's gone now. 21 Q. Do you know what happened to the clinic? Did 22 they join some other facility, or did they just -- 23 A. To my recall, I believe they moved out of the 24 town and just left. 25 Q. Okay. Do you remember if Don Schell's wife 14 1 was present during any of the visits? 2 A. I don't recall. If she had been -- if I had 3 seen them together, I would have put that down. 4 Q. And you don't recall ever meeting her? 5 A. I do not. 6 Q. Do you have any independent recollection of 7 treating Don Schell? 8 A. I think I do vaguely, but not anything 9 concrete. 10 Q. Was there anything unusual or extraordinary 11 that sticks in your mind, sticks out in your mind that 12 makes you recall him specifically? 13 A. Not really. 14 Q. Okay. I think that's all the questions I have 15 for you. Mr. Fitzgerald may have some additional 16 questions for you. 17 CROSS-EXAMINATION 18 Q. (BY MR. FITZGERALD) Doctor, sometimes in 19 medicine there are terms like denied that have 20 particular meaning. Let me direct your attention to the 21 March 15, 1993 note. And as you reviewed that earlier 22 here, you said that Mr. Schell denied suicidal ideation 23 or intent. The question is: Denied has a particular 24 meaning in your field, does it not? 25 A. I assume. 15 1 Q. I mean, you didn't say, well, I think you got 2 suicidal ideation, and he denied it, right? 3 A. No. 4 Q. It's different than, you know, if you and I 5 were talking in a phone -- or in a conversation over a 6 cup of coffee, and you were describing something to me 7 that had nothing to do with medicine, you might use the 8 term denied to say you thought it, but he denied it, 9 right? 10 A. I don't believe that's correct. 11 Q. Yeah. So when you noted on March 15, 1993 12 that he denied suicidal ideation or intent, you didn't 13 have any feeling at that point that he had it, but he 14 was denying it, correct? 15 A. You mean -- are you asking if I was making an 16 interpretation of what he felt? 17 Q. No. What I'm talking about -- and I'm sorry, 18 it may not be so clear. When you say he denied suicidal 19 ideation or intent, you're not suggesting that he had 20 it, but he was denying it, are you? 21 A. No, sir, I'm not. Point blank I asked the 22 question, have you had thoughts about killing yourself 23 or anyone else? I always have and I always do. And 24 that's denied when they say no. 25 Q. Right, okay. So it's used as a term of art in 16 1 the field of medicine for the process you just 2 described, right? 3 A. I'm sorry, I missed what you said. Term of 4 art? 5 Q. Yeah, the word denied is used -- it has a 6 little different meaning in medical records and medical 7 field than it does in ordinary conversation, doesn't 8 it? 9 A. To my way of thinking, it means no. 10 Q. Okay. So you inquired about it, and he said 11 no. And were you satisfied with that answer? 12 A. Yes, sir, I was. 13 Q. All right. Later on you went in to some other 14 references in these records to, you know, denied 15 suicidal ideation. For example, on March 29, if we -- 16 March 29, 1993. I don't need to go through all those 17 same questions again, your answer would be the same 18 about that visit, too, and the meaning of that suicidal 19 ideation, correct? 20 A. No, sir. 21 Q. Okay. Are you going to be in the state of 22 Wyoming at the time of the trial of this case, which is 23 in April -- excuse me -- it's in May of 2001, coming up 24 starting on May 21st. Are you going to be in Wyoming 25 then? 17 1 A. Well, I hope so. 2 Q. You don't have any current plans to be out of 3 the country or out of the state of Wyoming, either one, 4 do you? 5 A. Well, I'm going to the American Psychiatric 6 Association meeting in New Orleans earlier. I believe 7 that's the 5th through the 10th. I should be back by 8 then. 9 Q. All right. So you'll be around at the time of 10 the trial? 11 A. Yes, sir. 12 Q. You don't have any particular plans for the 13 time frame of March 21, for the three weeks following 14 that, do you? Excuse me, May 21? 15 A. No, sir, not at this time. 16 Q. Okay. You were asked about having any 17 independent recollection, and I think we can appreciate 18 the fact this was some time ago, and you're relying on 19 your notes. Did I understand it right that you said you 20 didn't have any independent recollection of meeting with 21 Mr. Schell? 22 A. That's correct. I just have a vague 23 recollection of how the man may have looked. But I'm 24 not -- don't know that it's correct. 25 Q. Okay. In terms of meeting with his wife, Rita 18 1 Schell. You said you did not recall that. Are you 2 saying you recall definitely that she wasn't there, or 3 you don't recall one way or the other? 4 A. I don't recall. But I think I would have put 5 it on my note if she would have been with him. 6 Q. I also may have wrote down a reference on 7 March 15, 1993. If I have this right, you noted then 8 that you did not think that the patient is suicidal; is 9 that correct? 10 A. That is correct. 11 Q. That's something that you would look for in 12 any of your visits, correct? 13 A. Always. 14 Q. And if he were suicidal, you would note that 15 on any visit in which he was suicidal, correct? 16 A. Certainly. 17 Q. And the answer would be the same if he had -- 18 if he were homicidal in your view, correct? 19 A. Certainly. 20 Q. Okay. 21 MR. FITZGERALD: I need to go off the 22 record for just a minute to check my notes. I'll just 23 stay on the phone, and I'm going to put the phone down, 24 and I'll be right back as soon as I've went through my 25 notes here. 19 1 (Discussion held off the record.) 2 Q. (BY MR. FITZGERALD) Okay, I have some other 3 questions for you, Doctor. Am I correct that you have 4 essentially four -- I have exactly four pages of records 5 on this patient. 6 A. I believe it's three. 7 Q. Yes, you're right, I'm sorry. They begin 8 March 15, 1993, and the last entry is April 27, 1993, 9 correct? 10 A. That is correct. 11 Q. Could you point to the place in the record 12 where you used the word agitated or agitation? 13 A. Well, that was -- that's part of my routine 14 evaluation. It's up at the top there, where psychomotor 15 retardation or agitation, and I put yes for the 16 agitation. 17 Q. In terms of any notes that follow that, you do 18 not repeat the term agitation throughout any of the rest 19 of your records, do you? 20 A. I don't believe I do. 21 Q. Well, Doctor, if I have it right here, then 22 you must have seen Mr. Schell on March 15, March 29, and 23 April 27, 1993, correct? 24 A. Yes, sir. 25 Q. And is that all three of the visits? 20 1 A. Yes, sir. 2 Q. There are no other visits? 3 A. Not to my knowledge. 4 Q. Okay. Thank you, Doctor, I have no further 5 questions. 6 MS. WESTBY: I have one more question. 7 REDIRECT EXAMINATION 8 Q. (BY MS. WESTBY) You treated Don Schell with 9 imipramine and lorazepam; is that correct? 10 A. That is correct. 11 Q. And he told you that he had been -- he had 12 previously been treated with those two drugs; is that 13 correct? 14 A. With good results. 15 Q. With good results. And did he have -- what 16 kind of results did he have with this treatment of those 17 two drugs? 18 A. He responded to the medication when I saw 19 him. I don't know what the ultimate outcome was because 20 I didn't see him. 21 Q. You said he had responded? 22 A. Well, I put improved. And I would assume he 23 responded. And then doing well to me means he was calm, 24 his mood was improving. 25 Q. So by your records, does it appear that he had 21 1 good results on these drugs this time? 2 A. At that time when I was seeing him. 3 Q. Okay. And that is all the questions that I 4 have for you today. 5 MR. FITZGERALD: Thank you, Doctor.