1 1 UNITED STATES DISTRICT COURT 2 FOR THE DISTRICT OF WYOMING 3 4 5 THE ESTATES OF DEBORAH MARIE ) TOBIN, and ALYSSA ANN TOBIN, ) 6 Deceased by TIMOTHY JOHN TOBIN, ) Personal Representative; and THE ) 7 ESTATES OF DONALD JACK SCHELL, ) and RITA CHARLOTTE SCHELL, ) 8 Deceased, by NEVA KAY HARDY, ) Personal Representative, ) 9 ) Plaintiffs, ) 10 ) vs. ) CASE NO. 11 ) 00-CV-025D SMITHKLINE BEECHAM ) 12 PHARMACEUTICALS, ) ) 13 Defendant. ) _____________________________________) 14 15 16 17 DEPOSITION OF MARK V. SUHANY, M.D. 18 Taken on Tuesday, February 20, 2001 19 At 1:34 p.m. 20 At 2300 West Sahara Avenue, Suite 770 21 Las Vegas, Nevada 22 23 24 25 Reported by: Judith Payne Kelly, RMR, CCR #539 ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 2 1 APPEARANCES: 2 For the Plaintiffs: ANDY VICKERY, ESQ. Vickery & Waldner, LLP 3 2929 Allen Parkway, Suite 2410 Houston, Texas 77019 4 (Appearing telephonically.) 5 For the Defendant: MISHA E. WESTBY, ESQ. Hirst & Applegate, P.C. 6 1720 Carey Avenue, Suite 200 Cheyenne, Wyoming 82003-1083 7 8 9 10 11 12 13 I N D E X 14 Witness Page 15 MARK V. SUHANY, M.D. 16 EXAMINATION BY: 17 Ms. Westby 3,59 18 Mr. Vickery 41,61 19 20 21 E X H I B I T S 22 Number Description Page 23 (None) 24 25 ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 3 1 Thereupon, 2 MARK V. SUHANY, M.D. 3 was called as a witness by the Defendant, and having been 4 first duly sworn, testified as follows: 5 EXAMINATION 6 BY MS. WESTBY: 7 Q. All right. For the record, please state your 8 full name and address. 9 A. Mark V. Suhany, M.D. And you're talking about 10 my professional address? 11 Q. Yes, that would be fine. 12 A. Southern Nevada Adult Mental Health Services, 13 6161 West Charleston Boulevard, Las Vegas, Nevada. I 14 think the zip code is 89158, I think. 15 Q. Where is the phone number that it's easiest to 16 reach you from? 17 A. That would be the medical director's office. 18 That's (702) 486-6049. 19 Q. Dr. Suhany, have you ever had your deposition 20 taken before? 21 A. Yes. 22 Q. Okay. So you're aware, then, of the fact that 23 the court reporter has to take down everything we say, so 24 it's important if you let me finish my questions before 25 you answer, and I'll do the same for you. Please let me ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 4 1 know if you don't understand some of my questions. And 2 Mr. Vickery is here by telephone, so we'll have to make 3 sure that we speak clearly, and he'll let us know if he 4 has a problem hearing us. 5 Please give me a short synopsis of your 6 educational background. 7 A. I obtained my undergraduate degree at 8 Washington University in St. Louis in 1977. I graduated 9 from the University of Missouri Medical School in 1981. 10 I completed my residency in psychiatry at the University 11 of Texas Health Science Center in Dallas, Texas, in 1985. 12 Q. Okay. And then tell me where you have been 13 practicing since that time and basically what you've been 14 doing. 15 A. From 1985 to 1989, I was in private practice 16 in Dallas, Texas. From 1989 to 1991, I was in private 17 practice in Gillette, Wyoming. Then for about a year and 18 a half, I was doing temporary assignments. Then since 19 1992 -- no, sorry -- 1993, I've been in practice here in 20 Las Vegas, Nevada, associated with the Southern Nevada 21 Adult Mental Health Service, and also as an assistant 22 professor with the University of Nevada School of 23 Medicine, department of psychiatry. 24 Q. Do you have specific areas of expertise or 25 practice areas that you focus on? ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 5 1 A. I've been a general psychiatrist -- general 2 adult psychiatrist throughout my career, and that's what 3 I continue to do. Currently I treat a very severely ill 4 population in the hospital. When I've been in private 5 practice previously, I've treated adolescents as well as 6 adults, but still primarily focusing on adults. 7 Q. Okay. I have records that you sent to me, 8 approximately six pages of handwritten notes from January 9 16th of 1990 through December 18th of 1990. Is that 10 consistent with the records you have in your file? 11 A. Yes. And I have the originals here today, 12 and -- yes. 13 Q. Okay. I also have one letter dated 14 February 23rd, 1990, to a Mr. Vitrano. 15 A. Yes. That is also in my file. 16 Q. Okay. Are there any other documents in your 17 file that pertain to the treatment or care of Don Schell? 18 A. No, I don't find anything. 19 Q. Okay. Let's go ahead and start with the first 20 notation that I have, which is January 16th, 1990. Is 21 that the first note that you have? 22 A. Yes, it is. 23 Q. Okay. And is this the first time you saw Don 24 Schell? 25 A. Yes, it is. ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 6 1 Q. Do you know how this appointment was made? 2 A. I don't know for sure. The notation at the 3 top of the note, where it says REF Dr. Hemphill, would 4 refer to the patient being, quote, referred by 5 Dr. Hemphill, who was a general practitioner in town in 6 Gillette at the time. I would expect that Dr. Hemphill 7 suggested that Mr. Schell give my office a call. That's 8 the way that the bulk of my referrals were made. 9 Q. Okay. How familiar were you with 10 Dr. Hemphill? 11 A. Not extremely familiar. I mean, he was a 12 colleague in town, I would see him at the meetings, 13 occasionally at the hospitals. He would refer some 14 patients to me. 15 Q. Okay. And do you know or can you tell from 16 these records or do you have any independent recollection 17 if you ever talked to Dr. Hemphill about Don Schell? 18 A. I cannot tell from the record, and I have no 19 independent recollection as to whether I did or did not. 20 Q. Okay. Let's start with the notes from this 21 first visit. And if you will, please just read to me 22 what you've written. And in some places you have 23 shorthand or notations that you've made. Please just 24 tell me what those mean and read through your record. 25 A. Oh, okay. 52-year-old, married times 29 ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 7 1 years. Wife, Rita. Two children out of the home. 2 Patient works as a production foreman in the oil field 3 since '80. That means since 1980. Wife works, notation, 4 until 6 of '89 -- in other words, about six months before 5 this appointment -- working for a bank. And then I have 6 a section entitled problems, and there are a number of 7 different problem areas. The first one is job 8 difficulties, employee cutbacks. There's a notation, 33, 9 with an arrow to 3, which would appear to mean that at 10 Mr. Schell's job, there were 33 people working in 11 of 11 '89 and there are only 3 people working in January of 12 1990. That's at least what I'm -- would expect that that 13 notation would mean. 14 Q. Okay. 15 A. There's an arrow back to that that points to 16 the notation oil field sold, which I guess is the most 17 likely explanation for the job cutbacks, and patient 18 feels overwhelmed. No secretary -- that's s-e-c-y -- 19 et cetera. And then there's an arrow back to fears of 20 losing job. That's just really a description. 21 Second problem area, A, December of '89, EAP. 22 That stands for employee assistance program, which would 23 be a program out of Mr. Schell's work. An arrow to BH 24 and the notation, parenthesis, WRCC. What that means, 25 presumably, that the EAP referred the patient to a ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 8 1 counselor at the WRCC, which is the Wyoming Regional 2 Counseling Center, which was right there in Gillette, and 3 therapist BH, whom I'm sure I used to know what the 4 initials stand for and I'm not certain any longer, times 5 three, would mean that he saw the person three times, 6 which would be fairly ordinary in terms of an EAP. 7 Ordinarily someone gets a restricted number of visits. 8 And then there's a quotation, which I'm -- 9 would assume came from the patient, his interpretation. 10 The counselor said, quote, Put your head down and go to 11 work, unquote. 12 Then, B under 2, Dr. Hemphill, and then 13 there's medication listed. Desyrel, 150 milligrams, HS. 14 That means at bedtime. Plus Ativan, 1 milligram t.i.d. 15 That, of course, is shorthand for three times a day. 16 That refers to some medical treatment that Dr. Hemphill 17 was giving him, it looks like, at the time of this 18 initial evaluation. 19 Q. Okay. 20 A. Number 3, SX, that is shorthand for symptoms. 21 And these are listed as depression, anxious/agitated. 22 Slash would mean both or, you know, related theme. 23 Anxious/agitated thoughts. Quote: Will I be able to 24 perform job to their satisfaction, unquote. 25 A positive sign means the symptom is present, ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 9 1 so in that -- so that's crying spells are present. Arrow 2 going downward is a decrease. That's a decrease in 3 sleep. And X with a bar over it means except, and so the 4 notation decreased sleep, open parenthesis, X Ativan, 5 would mean not sleeping well unless he takes Ativan. SL 6 is slight. There's a slight decrease again. APPT is 7 shorthand for appetite. Then decreased interest, 8 decreased sexual potency. Decreased MEM is memory. 9 Slash CONC is concentration. And we have especially 10 work. Decrease in energy. And positive, or the presence 11 of, thoughts of death. 12 Q. Okay. And let me stop you there and ask you 13 what you mean by that last entry of positive thoughts of 14 death. 15 A. Well, I would mean that the patient admitted 16 that he was thinking about dying from time to time. 17 Q. Okay. And how does that relate to suicidal 18 ideation, if it does? 19 A. Well, it can. The way that I under -- have 20 understood this and the way that I ordinarily record 21 it -- and actually there's an example farther down the 22 page -- is that there's a kind of a progression, if you 23 will, from thinking about death to thinking about 24 suicide, which is a special kind of death, to actually 25 having formed some kind of intent to commit suicide, to ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 10 1 having some specific plan to commit suicide, to then 2 having the means to carry out the plan that's being 3 discussed. So on that kind of progression scale, this 4 would be the least severe of those kinds of symptoms. 5 Q. Okay. Okay. And then if you'll continue with 6 number 4. 7 A. Yes. 4A, last winter, arrow just is like a -- 8 he's going to describe it or a description. Stated 9 that -- A is his job is okay. B, concerns about DA, 10 would be daughter. Last year of college. C, a growth 11 removed. And L with a circle around it is left, so 12 growth removed from his left eye. And given Tylenol No. 13 3 for pain. Tylenol No. 3, medical compound, is Tylenol 14 with some codeine in it. Then RXN is a reaction, so it's 15 reaction to Tylenol No. 3. It's a question mark. In 16 other words, I wasn't certain. And then I have the 17 notation "depressive reaction" in parentheses. 18 Then he was RX -- that's prescribed -- so 19 prescribed Prozac and Ativan. Dr. H, I'm guessing that 20 means Dr. Hemphill. HA with a circle around it, with 21 headache. Then there's a quote, level mood. Also Dr. B 22 in 4 of '89. Dr. B, I would think, although I can't be 23 absolutely certain -- but I would think that Dr. B refers 24 to Dr. Bresnahan, who was another private psychiatrist in 25 Gillette at the time. And in fact, in 4 of '89, that ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 11 1 would have been before I myself came to Gillette. But he 2 was already there. 3 Q. Okay. 4 A. B, also had reaction to codeine several years 5 ago. So I -- I'm thinking that I'm on the right track 6 that he has some reaction to the codeine. And then 5 7 is -- ETOH is alcohol. It says nonsignificant. And then 8 it says almost none since last year. And drugs, with a 9 symbol behind it. That's a symbol for nothing, or null, 10 meaning no drugs. 11 Q. Okay. Let me ask you really quick -- 12 A. Sure. 13 Q. When you're talking about the reaction to 14 Tylenol 3 and then the depressive reaction, is that -- is 15 that your notes with regard to the Tylenol 3? 16 A. Yes, it is. 17 Q. Okay. Okay. And then if you'll continue. 18 A. MSE with a line under it is my shorthand for 19 mental status examination, which is a formal examination 20 of someone's thinking and mood and behavior. So it says 21 alert. Zero times three means oriented times three. 22 That means the person knows who he is, where he is, and 23 the date. APPR is appearance, slash, GRM. That's 24 grooming. That's okay, so that he presented in an 25 ordinary fashion in terms of his dress and hygiene. ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 12 1 Mood is described as depressed. Affect is 2 the -- that's a technical term having to do with how mood 3 is expressed. And I term that restricted. No thought 4 disorder or psychosis. SX is symptoms. And here again, 5 the notation positive ideas of death. Then S with a line 6 over it is without, so without suicidal ideation/intent, 7 further kind of amplifying what you had asked about the 8 progression before about thoughts of death and suicide. 9 And then MEM, memory, slash, CONC, 10 concentration, slightly decreased. I in this context is 11 insight. Slash J in this context is judgment, and that 12 was rated as okay. 13 Q. Okay. And then if you'll continue on to 14 impression, I'm assuming. 15 A. Yes, impression. Number 1, major depression. 16 That's the -- that would be my technical diagnosis. Said 17 by -- said at this time to be partially responsive to 18 MED. That would mean medication. That would be the 19 medication Dr. Hemphill has prescribed. And number 2, 20 the psychodynamic issue is lost. 21 Q. What would you have meant by that? Do you 22 know? 23 A. Well, by psychodynamic issue, I would mean 24 what kind of emotional stressor or problem is related to 25 and perhaps causing the clinical symptoms of depression. ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 13 1 And the loss, just looking at the notes, primarily having 2 to do with employment. 3 Q. Okay. 4 A. Plan, then, was I recommended to increase his 5 Desyrel, which is an antidepressant, starting from 200, 6 which is an increase from what Dr. Hemphill had him on, 7 up to possibly 250 milligrams a day. Increasing the 8 HS -- that's the bedtime dose of Ativan -- to 2 9 milligrams a day, if he's having trouble sleeping. And 10 that notation, the little symbol and therapy, 11 psychotherapy with me. And asked him to return the 12 following week. 13 Q. Okay. I'm assuming, then, from the notations 14 in the plan and from what you have up here in 2B, that 15 the medications that you talk about from Dr. Hemphill are 16 medications that he was currently taking at the time of 17 this visit. Is that correct? 18 A. That's what I assume from the record, yes. 19 Q. Okay. 20 A. And then lastly, since you asked me to explain 21 everything, right at the bottom, the MVS just indicates 22 that's the end of the visit. That's my initials to 23 myself telling me that's ended. 24 Q. Okay. Do you recall having met Rita Schell 25 during this first visit? And that would be Don's wife. ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 14 1 A. I do not. 2 Q. Okay. If she would have been present with 3 him, is that something that would have been noted in 4 these records? 5 A. If I had seen them together, I would expect 6 that to be noted, because I ordinarily would do that. 7 If, for example, she had accompanied him to the office 8 but had not accompanied him to the actual consultation, 9 then it would not be in the record. And if in fact she 10 had accompanied him to the office and I met her, I have 11 no recollection of that. 12 Q. Okay. All right. Let's proceed on to the 13 next note, which appears to be, from my records, January 14 23rd of 1990. Is that consistent with your records? 15 A. Yes. You want the note read again? 16 Q. Yes. 17 A. I see. Okay. Individual psychotherapy. 18 Actually feels worse. And then my question, "too 19 sedated," with increased Ativan and increased Desyrel. I 20 had discussed in detail feelings of loss associated with 21 job, explored how his expectations may be, quote, too 22 high, unquote. Seems quite interested in exploring 23 psychological issues. RE is regarding depression. 24 Medication plan as follows: Decrease Desyrel if 25 ineffective, will return to Prozac. And then I've ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 15 1 written him a prescription for Desyrel and Prozac and 2 asked him to see -- schedule an appointment next week, 3 following week. 4 Q. So you wrote him a prescription for both 5 Desyrel and Prozac; is that correct? 6 A. Yes, I did. And I guess, if you want me to 7 read it, I should have said prescription Desyrel, 150 8 milligrams, number 20. NR means no refill. 9 Prescription, Prozac, 20 milligrams, number 30, NR, no 10 refill. 11 Q. Were those two medications to be taken 12 together? 13 A. According to my note, I'd asked him to try 14 decreasing the Desyrel, because he had felt too sedated 15 when we had increased it the time -- the previous week. 16 If ineffective, will return to Prozac. So it appears to 17 me that if -- if the patient felt that it was not 18 working, that he could start -- he could restart Prozac. 19 He had taken Prozac previously, according to his -- 20 according to the initial consultation. 21 Q. Okay. If you'll proceed on to February 2nd, 22 1990. 23 A. Individual psychotherapy. Has switched back 24 to Prozac, times eight. DA in this context is days. No 25 relief. In fact, anxiety increased. That's the symbol. ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 16 1 The arrow going up is increased. Also C/O is for 2 complaint, so also complains of loss of appetite. Both 3 of these may be side effects of Prozac. Now off work, as 4 depression incapacitating. Obvious somatic anxiety 5 today. Plan is to continue Prozac trial. Increase 6 Ativan to 6 MG/DA -- is milligrams per day -- as 7 necessary. And then I have written him a prescription 8 for Ativan, 1 milligram, 50, no refill. Next 9 appointment, 2-9. 10 Q. Then it's my understanding that he would have 11 switched to Prozac at some point in between those two 12 visits. Is that correct? 13 A. In between 1-23 and 2-2, yes. In fact, it 14 says that he's switched eight days before 2-2, so that 15 must be very shortly after he left the other appointment. 16 Q. Okay. Was it -- was it your -- would it have 17 been your instructions to him to switch to the Prozac if 18 he were not getting the relief that he needed or the 19 effect from Desyrel? 20 A. It looks like that's what we both agreed at 21 the 1-23 visit. 22 Q. Okay. Did the switch from Desyrel to Prozac 23 have anything to do with his thoughts of death? 24 A. No. 25 Q. Okay. Okay. Let's go on to 2-9 of '90. ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 17 1 A. Okay. Individual psychotherapy. Trial of 2 increased Ativan, 6 milligrams per day, caused too much 3 sedation. 4 MR. VICKERY: Doctor, excuse me for 5 interrupting for a minute. But, Misha, did you-all 6 finish the 2-2 entry? I'm kind of going along with you 7 here. 8 THE WITNESS: Yes. Yes. Is there something 9 that . . . 10 MS. WESTBY: Yeah, I think we did, Andy. 11 MR. VICKERY: I apologize. Maybe I just 12 didn't get it, but it says obvious -- 13 THE WITNESS: Somatic anxiety today. 14 MR. VICKERY: Anxiety today? 15 THE WITNESS: Yes. 16 MR. VICKERY: Okay. 17 THE WITNESS: I can reread that if you would 18 like. 19 MR. VICKERY: What's the word before anxiety? 20 Obvious something, anxiety today. 21 THE WITNESS: Obvious somatic. That means of 22 the body. 23 MR. VICKERY: Got you. 24 THE WITNESS: Okay. 25 MR. VICKERY: Thank you. ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 18 1 THE WITNESS: Sure. Ready for 2-9? 2 Q. (BY MS. WESTBY) Yes. 3 A. 2-9-1990. Individual psychotherapy. Trial of 4 increased Ativan to 6 milligrams per day caused too much 5 sedation and memory loss. Anxiety relieved with 4 6 milligrams a day, with few side effects. Depression 7 improving somewhat. Agreed to continue Prozac trial. 8 Discussed loss of, quote, drive, unquote, related to 9 achieving, quote, top, unquote, of profession. Children 10 grown; financially stable. Will continue to explore 11 this. And schedule appointment 2-14. 12 Q. Okay. Now, you're -- in this entry, you talk 13 about the fact that the anxiety was relieved with the 14 4 milligrams of Ativan; is that correct? 15 A. Yes. 16 Q. Okay. So there's no notation or no indication 17 in this record that he has increased anxiety on this day, 18 correct? 19 A. Correct. In fact, the entry states that his 20 anxiety is relieved. 21 Q. Okay. And he is still taking Prozac at this 22 time, correct? 23 A. Yes. He would be taking Prozac and Ativan. 24 What this entry says is that Ativan, 6 milligrams a day, 25 was too much, but Ativan, 4 milligrams a day, seemed to ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 19 1 be working very nicely. 2 Q. Okay. And since you had mentioned in the 2-2 3 entry that the increased anxiety and de -- or decreased 4 appetite or loss of appetite were potentially side 5 effects of Prozac, and then we get down to 2-9 and the 6 anxiety is relieved, is that an indication that the 7 increased anxiety was not a side effect of Prozac? 8 A. No. The -- to my professional experience, the 9 connection between anxiety and depression is difficult to 10 sort out. There are many cases of depression in which 11 anxiety is a prominent feature, and the -- so that I 12 think in this -- in Mr. Schell's case, the anxiety being 13 so prominent, that's why I have recommended treating both 14 with an antianxiety medication as well as with an 15 antidepressant. 16 Q. Okay. But you would agree that he was 17 experiencing anxiety prior to the time he began taking 18 Prozac, correct? 19 A. Oh, yes. In fact, I believe he's having 20 anxiety even at the initial consultation. 21 Q. Okay. And then he just seems to be going 22 through cycles of increased or decreased anxiety during 23 his trial on Prozac or his treatment on Prozac. Would 24 you agree with that? 25 A. Yes. And actually that's common. ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 20 1 Q. Okay. Okay. And so what -- basically what 2 you're saying to me is that anxiety may just be a 3 function or a factor in his depression; is that a fair 4 statement? 5 A. Yes. The -- the anxiety symptoms may be from 6 a -- from an anxiety disorder that is separate from 7 depression. The anxiety symptoms may be part of the 8 symptoms of depression, and symptoms that look like 9 anxiety can be due to side effects of medication. So 10 that's what I would be trying to sort out with him. 11 Q. Okay. But you never made any specific finding 12 that these were side effects or that the increased 13 anxiety was a side effect of Prozac, correct? 14 A. In -- in -- to this point in the record, that 15 is correct. 16 Q. Okay. Okay. Let's go on to 2-14 of '90. 17 A. Okay. Individual psychotherapy. Overall 18 improved, although had increased anxiety during the 19 weekend. And then there's a notation, S/, which is 20 without identified precipitants. Continue to explore 21 loss of drive and loss of self-confidence. Discussed 22 possibility of returning to work part-time. Will 23 continue current treatment prescription for Ativan, 24 1 milligram, 75, number 75, no refill. And an 25 appointment for 2-23. ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 21 1 Q. Okay. Let's go on to February 23rd of 1990. 2 A. Okay. Individual psychotherapy. Continued 3 improved, although had increased anxiety yesterday 4 without apparent precipitant. Focus on fears surrounding 5 return to work. Emphasized progress he's made, and he 6 emphasized the importance of wife's support. Plan to 7 return to work 2-26. Will continue treatment and 8 schedule appointment in one to two weeks. 9 Prescription for Prozac, 20 milligrams, number 10 30, no refill; and prescription for Ativan, 1 milligram, 11 number 50, no refill. 12 Q. Okay. When he's expressing specific dates or 13 instances of increased anxiety, what does that mean to 14 you about the rest of the time, or what kind of anxiety 15 he's experiencing, if any, the rest of the time? 16 A. In general, a notation like "increased 17 anxiety" by me would indicate that there is some change 18 in his condition that he identified. And he identified 19 it as occurring the previous day. And then I would have 20 asked what may have triggered this, and apparently he 21 could not identify anything. 22 Q. Okay. Okay. Let's go on with 3-2 of '90. 23 A. Okay. Individual psychotherapy. Unable to 24 remain at work. Increased anxiety. This week has 25 developed trembling in hands, which seems unrelated to ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 22 1 anxiety. Question, side effect Prozac. However, 2 depression continues to improve. Will recommend 3 continued Prozac and Ativan and will supplement with 4 trial Inderal for tremor. 5 And then I have written a prescription for 6 Inderal, 20 milligrams, number 15, no refill. And 7 schedule an appointment the following week. 8 Q. Okay. You note in this entry a hand tremor. 9 Does that -- or, no -- trembling in the hands. 10 A. Right. 11 Q. Does that -- how do you -- how do you describe 12 these kinds of conditions? Could there possibly have 13 been other things going on? Is that going to be the most 14 serious symptoms? Tell me -- explain to me how you -- 15 how you describe these kind of things in your notes. 16 A. The phrase "developed" signals that this is 17 something new that either the patient is complaining 18 about or that I noticed myself in the consultation. 19 The -- ordinarily, although, of course, these are brief 20 notes, I would try to write down any change, any -- any 21 new symptom, any worsening symptom. So if -- if there 22 had been other new symptoms, I would likely have recorded 23 them. 24 Q. Okay. So then it would be your impression 25 from these notes that trembling in hands was the only new ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 23 1 symptom; is that correct? 2 A. That would be my impression. 3 Q. Okay. But you continued Prozac at this time? 4 A. Yes, even though I questioned to myself 5 whether or not the trembling in the hands might be a side 6 effect of the Prozac. 7 Q. Okay. And this occurred, it looks like, 8 approximately a month or a little bit longer after he had 9 initially started taking the Prozac; is that accurate? 10 A. Yes, about a month. 11 Q. And what is Inderal? 12 A. Inderal is a medication that in this context 13 can be helpful in controlling hand tremors. Inderal is 14 primarily used for the treatment of high blood pressure. 15 Q. Okay. Let's go on to the next notation, on 16 3-9 of '90. 17 A. Okay. Individual psychotherapy. Continued 18 tremors until Wednesday. P with a slash, that's post, 19 meaning after first dose of Inderal. However, dizziness 20 and tiredness secondary -- that's 2 with a little sort 21 of degree -- that's secondary -- secondary to Inderal. 22 And then I have a notation to myself -- it looks like a 23 parentheses with an exclamation point, which is like -- 24 which would be like a surprise to me. That's . . . 25 Discussed in detail advantages, disadvantages ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 24 1 of trial of new antidepressant; with incomplete 2 effectiveness and difficult side effects, have 3 recommended D/C, which is discontinue, Prozac and begin 4 trial of IMI. That's imipramine. And then I have 5 parentheses, depression mixed with anxiety, close 6 parentheses. Effects, side effects, explained. Patient 7 understands. 8 Plan, then, is to discontinue Prozac. Begin 9 imipramine, 50 milligrams, advancing to 75 milligrams at 10 bedtime. Prescription for imipramine, 25 milligrams, 11 number 25, no refill; to continue the Ativan and to 12 schedule an appointment on 3-15. And there's a box, Call 13 Dan Mainprize, it looks like, and telephone number, 3-23. 14 Q. Okay. So then this is the point in your 15 treatment of Don Schell when you discontinued Prozac, 16 correct? 17 A. Yes. 18 Q. Okay. And up until this point, the only motor 19 response that you had noticed was a hand tremor; is that 20 correct? 21 A. According to my notes, yes. 22 Q. Okay. And you would not describe this as 23 akathisia, would you? 24 MR. VICKERY: Objection. Leading. 25 Q. (BY MS. WESTBY) Would you describe this as ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 25 1 akathisia? 2 A. I would not. 3 Q. Okay. Let's go on to the next note, 3-15 of 4 1990. 5 A. Okay. Individual psychotherapy. Reports 6 significant improvement since Monday. Improved mood, 7 decreased anxiety, increased concentration, increased 8 appetite, even increased libido. HA -- that would be 9 headaches -- have gone and tremors markedly decreased. 10 Has also decreased Ativan to 4 milligrams a day. Again 11 discussing themes of loss, especially self-confidence. 12 Will continue IMI -- that's imipramine -- prescription, 13 25 milligrams, number 30, no refill. Prescription 14 Ativan, 1 milligram, number 60, no refill. May increase 15 imipramine to a hundred milligrams at bedtime if needed. 16 Next appointment, one week, 3-22. 17 Q. Okay. And before we get too far in these 18 records, I just wanted to ask you one other question 19 about the Prozac. 20 A. Yes. 21 Q. You describe in your notes of 3-9-90 22 incomplete effectiveness of Prozac, but would you agree 23 or wouldn't you agree that there was some improvement 24 with Prozac, or that it had some -- some value in the 25 treatment of Don Schell? ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 26 1 A. According to the notes, he had received some 2 benefit from Prozac, yes. 3 Q. Okay. Let's go on, then, to the notes of 4 3-20. 5 A. Okay. 3-20, this says a draft letter to 6 Mildred Ramsey, RN, OXY-USA, Medical Department, P.O. Box 7 300, Tulsa, Oklahoma 74102. This seems to me to be not a 8 session with Donald Schell but the draft of a letter that 9 I'm sending to this person. And this also talks about 10 Dan Mainprize. 11 Dan Mainprize with EAP contacted me Monday and 12 requested this letter. Donald Schell has been under my 13 care for treatment MDD -- that means major depressive 14 disorder -- since 1 of '90. Unable to work since 15 1-26-90. Originally had moderate positive response to 16 Prozac, but developed significant side effects, including 17 tremor, agitation, headache. Also depression did not 18 respond completely to Prozac. 19 Then little symbol would be like next 20 paragraph. 21 Accordingly, I recommended a trial of 22 imipramine early, 3 of '90. At last appointment, 3-15, 23 he demonstrated substantial positive response. Next 24 appointment is 3-22. If positive response continues, he 25 may be able to return to work week of 3-26. ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 27 1 And then another paragraph symbol. Thank you, 2 advance assist, kind of a standard closing thing. 3 I will contact DP, presumably Dan Mainprize, 4 after next week appointment with DS, Donald Schell. 5 Further assist, et cetera, kind of a closing. That was a 6 letter. 7 Q. Okay. The next note looks like 3-22 of '90. 8 A. Yes. Individual psychotherapy. Continues to 9 do well, underlined. No major symptoms, depression. 10 Decreased anxiety. Variable mood, rather than flat. 11 Actually has done paperwork at the office about two hours 12 a day for three days. And then a symbol of surprise. No 13 complaints side effects. Did increase imipramine to a 14 hundred milligrams. That is HH, recommended. Will 15 continue current treatment and plan half day of work next 16 week. 17 Prescription for imipramine, 50 milligrams, 18 number 30, two at bedtime, no refill. Next appointment, 19 3-29, it looks like. 20 Q. Then it looks like the note from 3-27 is 21 another letter. Is that correct? 22 A. Yes. It looks like it is. 23 Q. Okay. 24 A. Draft letter to Mildred Ramsey, RN. This 25 letter will update you on DS, Donald Schell's condition. ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 28 1 At last appointment, 3-22, he was responding well to new 2 medication. He will be able to RTW, return to work half 3 days begin 3-26. 4 Next paragraph. His next appointment is 3-29, 5 and we will review his readiness to RTW, return to work, 6 full-time. Next paragraph. Thank co-op. Continue -- or 7 contact further info, kind of a standard close again. 8 Q. Okay. And then 3-29? 9 A. Individual psychotherapy. RTW, return to 10 work, first two days quite good but in last two days has 11 had increased anxiety/depression/self-doubts. Explored 12 connections BTWN -- that's between -- quote, old job, 13 unquote, and these feelings. Also explored probable 14 relationship between these feelings and desire not to 15 make same, quote, trade-offs, unquote, as before. Plan 16 to continue half days next week. Next appointment one 17 week, 4-5. 18 Q. Okay. Do you know what -- can you be more 19 specific about your entry about "old job" and "same 20 feelings" and "trade-offs"? Do you have any more 21 information or remember anything more about that entry? 22 A. I don't remember anything other than what's 23 written. I don't. 24 Q. Okay. All right. Let's go to 4-5. 25 A. Individual psychotherapy. Continues to do ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 29 1 well. Work fine with seven-hour days and even one 2 11-hour day in the field. He knows he's, quote, thinking 3 clearly, unquote, now and wasn't able to before. One 4 noticeable change is certainly that he's less critical 5 and demanding of himself. Did have increased depressive 6 period on Sunday, perhaps connected with DA's -- that 7 would be daughter's -- visit/departure, and perhaps with 8 anxieties about work. 9 Overall quite improved and ready to RTW, 10 return to work, full-time next week. Will continue 11 current medication. Prescription for imipramine, 50 12 milligrams, number 60, two at bedtime, no refill. 13 Prescription Ativan, 1 milligram, number 100, t.i.d. to 14 q.i.d., three times a day to four times a day, no 15 refill. Next appointment two weeks, 4-19. 16 Q. Did it seem significant to you that this was 17 the first time he had noted a potential connection to his 18 depression with his daughter's visits or departures? 19 A. At the time it must have seemed significant, 20 since I wrote it down. And in this context, this would 21 be because the patient himself had noticed it or at least 22 we had connected it together. 23 Q. Okay. And that would have been related to 24 depression and anxiety; is that correct? 25 A. Yeah. The notation says did have increased ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 30 1 depressive period on Sunday, perhaps connected with 2 daughter's visit/departure, and perhaps with anxieties 3 about work. 4 Q. Okay. All right. Let's continue on to 4-9. 5 A. Okay. That also appears to be a letter, draft 6 letter to Mildred Ramsey, RN. This letter updates you 7 DS, Donald Schell, and confirmed phone 4-6. He continues 8 to respond well to current treatment. Half days at work 9 have been successful. He will be able to RTW, return to 10 work, full-time 4-9. He will continue F/U, follow-up 11 treatment, with me. 12 Paragraph. Thanks, cooperation. Contact 13 further info, et cetera. 14 Q. Okay. And then 4-19? 15 A. Yes. Individual psychotherapy. Reports first 16 week of work, quote, good. This week, quote, not very 17 good, unquote. He's noticed increased anxiety, increased 18 depression, decreased self-confidence, again centered at 19 work. No obvious precipitants outside of work. Continue 20 to discuss how hardest on himself, and made cognitive 21 plans to make changes. Will check serum IMI, serum 22 imipramine level, and continue current medications 23 pending results. Next appointment in two weeks, 5-3. 24 Q. Okay. So he's still showing cycles of 25 increased anxiety at this point; is that correct? ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 31 1 A. Yes, according to the notes. 2 Q. Okay. And he is on imipramine at this point; 3 is that correct? 4 A. Imipramine and Ativan, yes. 5 Q. Okay. Okay. Let's go to 4-23 of '90. 6 A. Okay. Phone call to patient. Serum IMI plus 7 DMI -- that is imipramine, and DMI is 8 desmethylimipramine. That's a metabolite of imipramine. 9 Equals 88 NG, which is nanograms, per ML. 10 Then I have the indication that that's low, 11 meaning that's below the therapeutic range, so advised to 12 increase imipramine to 150 milligrams at bedtime and keep 13 scheduled appointment. 14 Q. Okay. 5-3 of '90? 15 A. Individual psychotherapy. Reports significant 16 improvement with increased imipramine to 150 milligrams 17 at bedtime. Depression decreased, anxiety much 18 decreased. Self-confidence returning. Concentration 19 improved. Has noted positive changes both at work and 20 with family. Beginning to review episode of depression 21 and feels, quote, I can be a better person because of 22 this, unquote. Open parentheses, that is, more concerned 23 with others and not as, quote, harsh, unquote, close 24 parentheses. 25 No complaints of side effects. Will continue ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 32 1 imipramine at current dose and schedule appointment in 2 three weeks, 5-24. Prescription for imipramine, 50 3 milligrams, 100. Number -- number 100, three at 4 bedtime. No refill. And note that patient has 5 self-tapered Ativan to 2-1/2 to 2 milligrams a day. 6 Q. Okay. Let's go on to the next page. I have 7 the first notation as 5-24 of '90. 8 A. Yes. Individual psychotherapy. Reports he's 9 doing V -- that would be, in this context, very well. No 10 sustained depressive symptoms, no significant anxiety. 11 Increased self-confidence. Tried to taper below Ativan 12 2 milligrams a day, but anxiety increased too much. 13 Resumption of 2 milligrams a day resolved all symptoms. 14 Reviewed his increased comfort in handling work problems, 15 but also continue to support his ability to set limits 16 and not overextend himself. Will continue current 17 medication. Schedule appointment one month, 6-21. 18 Prescription, imipramine, 50 milligrams, 19 number 100, three at bedtime, no refill. And 20 prescription Ativan, 1 milligram, number 60, one twice a 21 day, no refill. 22 Q. Okay. 6-27-90? 23 A. Individual psychotherapy. Continues to do 24 very well without depressive symptoms, without 25 significant anxiety. Work going well. Received a ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 33 1 raise. He, his wife and daughter have all noticed 2 positive changes in personality. There's a colon, which 3 would mean, for example, less demanding, less critical, 4 less irritable, more willing to listen. He tried 5 decreasing Ativan to 1 milligram a day, but developed 6 increased anxiety. Discussed plans to taper more 7 gradually, for example, to 1-1/2 milligrams a day. Will 8 continue current medication. 9 Prescription imipramine, 50 milligrams, number 10 100, three at bedtime. That's a month's supply. No 11 refill. And prescription Ativan, 1 milligram, numbering 12 60, one twice a day. That's again a month's supply. No 13 refill. With an appointment the following month on 7-26. 14 Q. Okay. And then the notation from 7-26? 15 A. Individual psychotherapy. Continued stable 16 improvement. No symptoms of depression, no significant 17 anxiety. Work and family fine. Beginning to talk of 18 fears of relapse. Education given regarding signs and 19 treatment. Ativan decreased to 1 milligram a day, 20 occasionally 1-1/2 milligrams a day. Will continue 21 current treatment. 22 Prescription imipramine, 50 milligrams, number 23 100, three at bedtime, no refill, and next appointment 24 9-6. 25 Q. Since you increased the dosage to 150 ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 34 1 milligrams of imipramine, has -- has Don Schell been on 2 the same level since that point? 3 A. Yes. 4 Q. Okay. Okay. The next note is 9-13. 5 A. Individual psychotherapy. Doing very well. 6 No symptoms depression or significant anxiety. Feels 7 better than he has in two-plus years. Now feels better 8 than when he had last, quote, recovered, unquote, on 9 Prozac. Does have fears of relapse during approaching 10 winter. Plan to continue imipramine into early next 11 year. Ativan use decreased to five per week. And the -- 12 will continue current treatment prescription, imipramine, 13 50 milligrams, number 100, three at bedtime; prescription 14 Ativan, 1 milligram, number 25. Next appointment in six 15 weeks, at -- on 10-25. 16 Q. Do you have any independent recollection or 17 can you shed any light on Don Schell's previous treatment 18 with Prozac that you have noted here and other times in 19 the records? 20 A. I don't have any independent recollection. 21 The record showed that he had taken Prozac previously 22 when he had this, quote, depressive reaction after he was 23 taking Tylenol after a growth had been removed from his 24 eye. That was with the previous psychiatrist. And then, 25 of course, we had -- I mean, I -- Don Schell and I had ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 35 1 our own trial of Prozac with him for about four or five 2 weeks, and so that's what I would mean by, quote, 3 recovered. 4 Q. Okay. 5 A. And that would be -- in this context that 6 would be his perception; that is, that he feels better 7 than he had when he had last, quote, recovered on Prozac. 8 Q. Okay. Okay. The next entry is 10-25-90. 9 A. Yes. Individual psychotherapy. Continues to 10 do very well. Quote, I didn't think I could feel even 11 better, but I do, unquote. Now beginning to sort out 12 some of the precipitating events. And then I have a 13 bracket around, apparently, some of these precipitating 14 events: Brother-in-law died in 1987. Didn't grieve. 15 Quote, strong one, unquote, until 1988. R's, I'm 16 thinking in this context meaning his wife, Rita's 17 depression, '88 to '89, secondary to her mother's CA, in 18 this context presumably cancer; daughter's, quote, bad 19 Pap smears, unquote. And then there's a notation, now 20 resolved. And then that note continues to the following 21 page. 22 Also has renewed self-confidence at work. 23 Will be on vacation three weeks in the next two months. 24 Since doing well, will schedule an appointment in two 25 months, on 12-18. And then my prescription for ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 36 1 imipramine, 50 milligrams, number 100, one refill. That 2 is a month's supply and one refill. That's the end of 3 that note. 4 Q. Okay. And it looks like the final note is 5 2-18 of '90? 6 A. Actually, it's 12-18 of '90. 7 Q. 12-90. I'm sorry. 8 A. That's okay. Yes. Individual psychotherapy. 9 Continues in complete remission of depression. Has taken 10 no Ativan for -- that's times one month, and feels very 11 good about this. Facing possible major change at work, 12 including possible relocation, with confidence rather 13 than anxiety. Still plan to continue medication 14 throughout the winter. 15 Prescription imipramine, 50 milligrams, number 16 100, three at bedtime, one refill. Is to call for 17 appointment in about two months. 18 Q. Okay. So that would have been enough 19 imipramine for two months, correct? 20 A. Yes. That is a one-month supply of his 21 current dose of imipramine and one refill. 22 Q. Okay. And do you know if he ever called for 23 that appointment in two months? 24 A. I -- I don't know. There -- in my records 25 there's nothing to indicate one way or another, and I ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 37 1 don't have any independent recollection of that. 2 Q. Okay. And did you ever see Don Schell again 3 following the visit on 12-18 of '90? 4 A. According to my record, no. And I have no 5 independent recollection of anything different. 6 Q. Okay. According to the records -- or your 7 records, the only notations regarding ideas of death are 8 in the first note of 1-16-19 -- 1990. You never observed 9 any suicidal or homicidal ideation or behavior while Don 10 was being treated with Prozac; is that correct? 11 A. According to my notes, I would say that is 12 correct. 13 Q. Okay. 14 A. Since I didn't note it down as a positive 15 finding, which I would certainly expect to do if it had 16 been present. 17 Q. Okay. And was it your observation that work 18 was a significant stressor for Don Schell? 19 A. Clearly, all the way from the initial 20 consultation to his difficulties in returning to work. 21 Clearly in his own mind the depression and anxiety were 22 quite related to work and his ability to either be able 23 to work or not. 24 Q. Okay. So you would also agree that work was a 25 source of his anxiety? ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 38 1 A. According to my notes and the way I understand 2 them, yes. It seems that on more than one occasion, when 3 he was either returning to work or getting ready to 4 return to work, that some anxiety symptoms increased. 5 That was -- that was the connection that he made and 6 that, as he reported, I would write down. 7 Q. Okay. And was work a significant component of 8 his depression? 9 A. Well, I'm not sure what you mean by that. 10 Q. Well -- okay. Would you -- it appears to me 11 from the records that work is the most frequently 12 mentioned stressor or cause of his problems. Would you 13 agree with that? 14 A. I would say that it's the most frequently 15 mentioned stressor, yes. 16 Q. Okay. And do you believe that it was a 17 significant cause or led to his depression? 18 A. "Cause" is a difficult word for me in this 19 context. The -- a diagnosis that I made, major 20 depressive disorder, in my thinking then as well as my 21 current thinking, is a biological/biochemical illness. 22 So to say that a particular stressor, including a set of 23 stressors at work, is causative is not a link that I'm 24 prepared to make. 25 On the other hand, as I also indicated in my ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 39 1 first consultation note -- and I still look at these 2 issues this way -- the psychological issues or the 3 psychological impact is important besides the alteration 4 in the brain chemistry, and so I approached Mr. Schell 5 then from both perspectives of trying to manage the 6 biochemical abnormalities with medication and trying to 7 help him understand stressors and his response to them 8 through psychotherapy. 9 Q. Okay. Did you ever meet -- 10 MR. VICKERY: Let me interrupt you for a 11 minute. Are you about done with your exam or not? 12 MS. WESTBY: I have probably another 5 or 10 13 minutes. 14 MR. VICKERY: Can we just take about a 15 five-minute break? 16 MS. WESTBY: Even -- do you have -- do you 17 have a lot for Dr. Suhany? 18 MR. VICKERY: I don't have very much. 19 Maybe -- maybe 10 or 15 minutes. I just have had too 20 much lemonade. 21 MS. WESTBY: Oh, okay. Let's just hold on the 22 phone, then, and take a quick break. 23 MR. VICKERY: You want to hold on the phone? 24 Okay. I'll be right back. 25 (A recess was taken.) ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 40 1 Q. (BY MS. WESTBY) Do you recall -- I don't 2 remember hearing you mention it in any of the records, 3 but do you recall, after having gone through those 4 records, if you ever met Rita Schell or if she was ever 5 present at any of these visits? 6 A. According to my records, she would not have 7 been present at any of the visits, because they're all 8 labeled individual psychotherapy. Whether or not she may 9 have come to the office and I may have met her 10 incidentally, I have no independent recollection. 11 Q. Okay. Did you -- 12 A. If I had seen -- excuse me. If I had seen 13 them together, in terms of any kind of joint counseling 14 session, I would have recorded that information. 15 Q. Okay. Did you know the Schells socially at 16 all? 17 A. No, I didn't. 18 Q. Okay. And you never saw Don Schell outside of 19 the office? 20 A. Well, I -- I can't say with certainty. 21 Gillette, when I was there, is certainly a small 22 community, and I may have seen him in passing, but -- but 23 I don't know whether I did or not. 24 Q. Okay. Do you recall anything, independent of 25 the records from your visits with him, anything that ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 41 1 struck you as unusual, any particular concerns you had, 2 anything that may be of assistance to us? 3 A. No. 4 Q. Okay. And I think that we've already 5 discussed this, but I just want to make sure that it's 6 clear for the record. Would you describe what Don Schell 7 experienced on Prozac as akathisia? 8 A. According to the information that I have in my 9 record, I would not describe it as akathisia. 10 MS. WESTBY: Okay. I think that's all the 11 questions that I have for now. 12 MR. VICKERY: Okay. 13 EXAMINATION 14 BY MR. VICKERY: 15 Q. Doctor, this is Andy Vickery. Can you hear me 16 okay? 17 A. Yes, I -- 18 Q. Can you hear me? 19 A. Yes, sir, I can hear you fine. 20 Q. Why on earth would a guy leave Dallas, Texas, 21 and go to Gillette, Wyoming? 22 A. Well, that -- we're on the record, right? 23 Q. No, I'm just joking. I'm just joking. 24 They're both very nice places. 25 A. Well, actually Dallas was too big for us, we ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 42 1 thought, and Gillette turned out to be way too small. 2 Q. I hope you found the midpoint. 3 A. Well, I don't know -- I don't know if 4 Las Vegas is the midpoint, but it's suiting us just 5 nicely right now. 6 Q. It's a very nice town. I assume from the fact 7 that you now live and work in Las Vegas, that you will 8 not be available to testify in Cheyenne, Wyoming, in May 9 of this year in this trial. 10 A. I would prefer not. 11 Q. Okay. Well, if you're not available, then we 12 can use this deposition. I just had to make it clear on 13 the record that you did not plan on being there and would 14 prefer to not be there. 15 A. Yes, I would prefer that my deposition would 16 suffice for my physical presence. 17 Q. All right. Now, let me ask this, sir. You 18 are, of course, a trained psychiatrist, right? 19 A. Yes, I am. 20 Q. And when you have someone with a major 21 depressive disorder such as you diagnosed for Donald 22 Schell, are you always sensitive to the possibility that 23 that person would be thinking about harming themselves or 24 others? 25 A. Yes. ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 43 1 Q. Is that something that you look for, not only 2 at the initial intake session but periodically throughout 3 your treatment of that person? 4 A. Yes, typically. 5 Q. Did you ever see anything in Donald Schell 6 that would indicate that this patient was at risk for 7 harming himself or anyone else? 8 A. According to what I have detailed in my 9 records, no, with the exception of the mention at the 10 initial consultation that he had been thinking about 11 death, although not specifically about suicide. 12 Q. And if I understood what you were saying 13 there, looking back on the first page of your records, 14 there is a, in your shorthand way, a progression of 15 thoughts, beginning with thoughts of death being the most 16 mild and ending with an active suicide plan or attempt as 17 the most severe, correct? 18 A. Yes. Plan is the most serious. Plan and 19 means to carry out the plan. 20 Q. But when you say on the January 16th, 1990 21 visit, positive ideas about death, but without suicidal 22 ideation or other info, does that mean plan? 23 A. Actually, that's intent. 24 Q. Intent? 25 A. Yes. ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 44 1 Q. Does that mean that you affirmatively 2 questioned him at that time about that? 3 A. Yes, that would mean that. And that would be 4 my standard of practice. 5 Q. Dr. Suhany, I note in going through these 6 records that apparently you saw this man about 18 7 different times for individual psychotherapy throughout 8 1990. 9 A. I'll accept your count of that, yes. 10 Q. About how long would you see him each time? 11 A. Probably about an hour. Perhaps in some of 12 the later visits it was shorter than that, but certainly 13 the early visits would be about an hour. That was my 14 standard of private practice at the time in 1990. 15 Q. Tell us, if you would, just in your own words, 16 after spending 18 hours with this man, what adjectives 17 would you use to describe him? 18 MS. WESTBY: I'm going to object to the form 19 of the question. 20 Go ahead and answer if you can. 21 A. Do you mean when he first came to see me or do 22 you mean toward the end of what appeared to me to be a 23 successful treatment? 24 Q. (BY MR. VICKERY) Let's take them both. When 25 he first came to see you, how would you describe, ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 45 1 generally speaking, Donald Schell? 2 A. According to what my notes reflect, an 3 anxious, depressed, hardworking man. 4 Q. And did you believe that the anxiety and 5 depression related to the particular situation he was 6 facing at work then? 7 A. According to my notes and, you know, also just 8 trying to understand what I have written, that the 9 depression and anxiety would have been related to 10 concerns about his job, yes. 11 Q. Okay, sir. I didn't see anything in your 12 notes that -- let me ask you this from your memory. 13 Throughout the course of your treatment of this man for a 14 year, did you ever see any indication that he had 15 problems with his marriage or with his family? 16 A. I have no independent recollection of that 17 outside of the notes. The notes talk about at one point 18 that he values his wife's support. There are a couple of 19 notes about his daughter. And beyond that, I have no 20 other recollection, and there's nothing in the notes to 21 indicate that. 22 Q. I noticed that when we went through. And when 23 you write down something like "values his wife's 24 support," does that mean that he is getting that support 25 and appreciates it? ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 46 1 A. Well, let's see. Do you know which -- 2 Q. Yes, sir. I think I highlighted it for you. 3 A. All right. 4 Q. It's in the 2-23-90 visit. 5 A. Okay. Let's see. Actually, the actual words 6 are he emphasized the importance of wife's support. That 7 is -- the whole sentence says emphasized progress he's 8 made, and he emphasized importance of wife's support. 9 In that context, it appears to me that he 10 believes his wife is supportive and that that's been 11 important to him. 12 Q. Did you believe that he needed both the 13 medication as well as the individual psychotherapy? 14 A. Yes, I did. 15 Q. Can you just explain why, why it is in your 16 judgment that it's helpful for someone to have both of 17 these forms of therapy together? 18 A. Yes. My experience to that point in 1990 had 19 taught me that patients with clinical illness, like major 20 depression, need or will do better with a combination of 21 treatment. Not only the appropriate medication to 22 regulate whatever biochemical/biological abnormality may 23 be present, but also psychotherapy, both to identify 24 maladaptive ways of dealing with stressors, as well as 25 identify better coping skills, as well as a relationship ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 47 1 with a treating professional to understand the clinical 2 problem, and also as we talk about later on in the course 3 of Mr. Schell's treatment, understanding what needs to be 4 done to prevent or minimize relapse. 5 Q. Now, is that what -- what you in your 6 profession refer to as a therapeutic alliance? 7 A. Yes. 8 Q. And can you just sort of put that in 9 plain-speak for us. What is therapeutic alliance? 10 A. In plain-speak, a therapeutic alliance is a 11 working relationship between the patient and his doctor 12 in which both respect and trust each other. 13 Q. Did you believe you had a good therapeutic 14 alliance with Donald Schell? 15 A. Absent any evidence to the contrary in my 16 notes, yes. 17 Q. I didn't see any, but I just wanted your 18 testimony on it. Did this man want your help and did he 19 want to get better? 20 A. I believe he did, both in terms of that it 21 would appear that he himself contacted my office and that 22 he was quite faithful in working with me over a period of 23 almost a year. 24 Q. Was he a compliant patient? 25 A. According to the record, yes. ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 48 1 Q. And what do we mean by that? 2 A. What I would mean by that is that when I have 3 proposed a plan, he appears to have followed it; and what 4 I also mean by that is that he continued in treatment 5 with me. What I -- what I also mean by that is it would 6 appear from my record that he was using the medication 7 appropriately and not requesting extra or saying, I don't 8 need it, because I didn't take as much or anything like 9 that. That is, there seems to be no evidence like that 10 in the record, and the prescription amounts would appear 11 to be consistent with what would be needed from visit to 12 visit. 13 Q. Okay, sir. Now, let me ask you something. 14 You mentioned a Dr. B. that had apparently given him some 15 Prozac briefly in the spring of '89. 16 A. Yes. 17 Q. Would that have been Dr. Buchanan rather than 18 Dr. Bresnahan? 19 A. It could have been. I have no independent 20 recollection of that. Dr. Bresnahan is a psychiatrist 21 that I believe was in town at that time, but if you have 22 information that it was Dr. Buchanan, that -- I have no 23 way of knowing. 24 Q. Do you know Dr. Buchanan? 25 A. I don't recall. ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 49 1 Q. All right. Now, let's get specifically to the 2 medications, if we can. 3 A. Yes. 4 Q. At the time he first came to see you, he had 5 already been started by his GP on Desyrel and Ativan, 6 correct? 7 A. Yes, that is correct. 8 Q. Can you tell me what classification of drugs 9 Desyrel is in? 10 A. Yes. It's an antidepressant. 11 Q. What kind? 12 A. What kind? 13 Q. Is it a tricyclic? 14 A. Oh, no. It is -- at the time, in 1990, it was 15 in a class by itself. It was not a traditional tricyclic 16 antidepressant. It was not the new kid on the block, the 17 SSRI, Prozac, and it was not an even older type of 18 medication, a monoamine oxidase inhibitor, MOAI. So it 19 was in a class by itself. 20 Q. Okay. Did it have any effects, insofar as you 21 recollect, on the serotonin system? 22 A. Certainly. It was designed to enhance 23 serotonin, as most antidepressants are. 24 Q. But in a different way rather than blocking 25 the reuptake, right? ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 50 1 A. I'm not sure. 2 Q. All right. In any event, you continued him on 3 the Desyrel for a period of time, but then switched over 4 to Prozac, correct? 5 A. That is correct. 6 Q. Now, was Prozac, to use your words, the new 7 kid on the block in 1990? 8 A. I believe it was the -- I don't know if it was 9 the newest antidepressant in 1990, but it was certainly 10 one of the newer ones, and it was the first of what's now 11 recognized as the class of SSRIs, selective serotonin 12 reuptake inhibitors. 13 Q. Dr. Suhany, have you, since Paxil came out in 14 '92, had occasion to prescribe Paxil for patients? 15 A. Yes, I have. 16 Q. And I believe it's also an SSRI, right? 17 A. Yes, it is. 18 Q. How about Zoloft, which also came out in '92? 19 Have you had occasion since 1992 to prescribe that for 20 patients? 21 A. Yes, I have. 22 Q. And can you tell me whether or not Paxil is a 23 more potent inhibitor of the reuptake of serotonin than 24 Prozac? 25 MS. WESTBY: I'm going to object to ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 51 1 foundation. 2 MR. VICKERY: Okay. 3 MS. WESTBY: I'll just leave it at that. 4 Q. (BY MR. VICKERY) Can you tell me if you know, 5 sir? 6 A. I don't know. 7 Q. All right. Now, let's back up a minute. At 8 the time he first came to you, in addition to being on 9 the antidepressant Desyrel, he was also on Ativan, 10 right? 11 A. That is correct. 12 Q. Is that in a classification of drugs known as 13 benzodiazepines? 14 A. Yes, it is. 15 Q. Are they generally thought to be 16 anti-anxiolytic medication? 17 A. Yes, anxiolytic medications. 18 Q. That's a 10-penny word, too. Can you put that 19 one in plain-speak for us. What do they do for you? 20 A. Antianxiety. Depress anxiety. 21 Q. Do they also have a sedative or calming effect 22 on a person? 23 A. Yes. That would be another way of describing 24 its antianxiety effect. Sedative effect refers to the 25 fact that it helps people sleep at bedtime. ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 52 1 Q. Doctor, had you had occasion prior to Donald 2 Schell to prescribe Prozac for someone else? 3 A. I believe so, yes. 4 Q. Was it typical in your practice at that time, 5 when you were starting someone on Prozac, to give them 6 Ativan or some other benzodiazepine concomitantly? In 7 other words, the first period of time? 8 A. That would not have been my common practice in 9 1990, and it isn't my common practice now. 10 Q. Were you aware of the fact in the spring of 11 1990 that the maker of Prozac, Eli Lilly, had a warning 12 in the Federal Republic of Germany that recommended that 13 doctors give sedatives along with Prozac in the initial 14 period in order to reduce the risk of suicide? 15 A. No, I was not aware of that. 16 Q. All right. In any event, you start him on 17 Prozac -- let's see. When? You start him on the -- what 18 day? On the 23rd of January; is that correct? 19 A. Sometime between the 23rd of January and the 20 2nd of February. 21 Q. Okay. 22 A. It looks like much closer -- 23 Q. You gave a prescription for Desyrel and 24 Prozac, and he was to, what, taper down on the Desyrel, 25 and if that didn't work, then go to Prozac? ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 53 1 A. Yes. That was our plan as of 1-23. 2 Q. All right. Now, when you see him on 3 February 2nd, the next time after that, would you just 4 tell me there what are the two things that you think may 5 be side effects of Prozac, according to your entry. 6 A. Increased anxiety and loss of appetite. 7 Q. Okay, sir. When you write, under February 8 2nd, "increased" -- I'm sorry, "obvious somatic anxiety 9 today," is that an observation that you're making 10 objectively rather than reporting subjectively? 11 A. With the use of the word "obvious" and the use 12 of the word "today," I believe it's an observation that 13 I'm making rather than a self-report by the patient. 14 Q. Can you tell me what you would have seen or 15 heard typically from a patient like Mr. Schell to cause 16 you to make that entry, "obvious somatic anxiety today"? 17 A. The kinds of things -- and I can't be certain 18 that these were present in Mr. Schell, but the kinds of 19 things that I would -- that I would mean by that kind of 20 notation is really physical signs of anxiety, such as 21 trembling in hands, such as like tapping fingers 22 incessantly, you know, on a desk or something, frequent 23 or incessant, like, foot tapping or other jittery motions 24 of the body, possibly some difficulties with speech, like 25 rapid speech or, you know, a lot of sighing, something ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 54 1 that would appear to indicate problems with anxiety or 2 nervousness. 3 Q. All right. But in other words, something that 4 you could physically see; is that right? 5 A. My understanding of that notation would be 6 that it was something that I saw that day, yes. 7 Q. And would it be fair to say that 11 years 8 later, now, you don't recall specifically which one of 9 those outward symptoms you saw? 10 A. It's definitely fair to say that. I do not 11 have independent recollection. 12 Q. All right. Now, that is on February the 2nd, 13 and the -- a month later, on March the 2nd, you make 14 another entry about increased anxiety and also say, "This 15 week he has developed trembling on hands." What was -- 16 A. "In," I believe that is. 17 Q. What, the fact that he had developed trembling 18 of hands recently? 19 A. The significance would be, first of all, that 20 it was something new. Secondly, that either both he had 21 noticed it and complained about it or that I had noticed 22 it. 23 Q. Can you tell from your records which one that 24 was, whether this is something that he reported to you or 25 whether it was something you observed? ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 55 1 A. I cannot tell based on the entry. 2 Q. Can you tell us whether or not you believed 3 that that was a side effect of Prozac? 4 A. I questioned myself whether it was. 5 Q. And you gave him some medication that day to 6 help deal with that side effect, didn't you? 7 A. Yes, which makes me assume, although I will 8 caution you it is an assumption, that I myself saw a 9 tremor that -- or a trembling that day, since I had 10 recommended a specific treatment. 11 Q. The treatment that you gave was a category of 12 medicines known as beta-blockers, correct? 13 A. That is correct. 14 Q. And specifically a medicine called Inderal? 15 A. Yes. 16 Q. Can you just explain for us in plain terms 17 what a beta-blocker is. 18 A. Beta-blockers are used primarily for 19 difficulties in cardiovascular systems, particularly in 20 patients with high blood pressure, and it slows down 21 their heart rate and so makes their blood pressure 22 decrease. In this context, beta-blockers have been known 23 for a long time to decrease what are usually called 24 bodily or somatic symptoms of anxiety, particularly 25 tremors, butterflies in the stomach, difficulty with ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 56 1 speech. Some patients have been given Inderal for 2 so-called performance anxiety. 3 Q. Is propranolol a beta-blocker? 4 A. Propranolol is the generic form of Inderal. 5 Q. Have you -- 6 A. It's the same medication. 7 Q. Have you seen in the literature 8 recommendations that beta-blockers be used to treat 9 SSRI-induced movement disorders? 10 A. You mean did I have that information in 1990? 11 Q. Well, your point is well-taken. Did you have 12 that information in 1990? 13 A. I don't believe I did. 14 Q. Have you subsequently, in the years since 15 then, learned that that is a selective treatment for 16 SSRI-induced movement disorders? 17 MS. WESTBY: I'm going to -- real quick 18 before he answers, I'm going to object to the form of the 19 question as to lack of foundation. Go ahead. 20 A. I'm -- I'm aware of some of those kinds of 21 reports. 22 Q. (BY MR. VICKERY) All right. Now, Ms. Westby 23 asked you whether or not you would diagnose this 24 trembling that you noticed as akathisia. Have you ever 25 made a diagnosis in any patient of akathisia? ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 57 1 A. Yes, I have. 2 Q. Can you tell us what are the diagnostic 3 criteria for akathisia? 4 A. Yes. The primary feature of akathisia is an 5 inability to sit down or otherwise control gross motor 6 behavior. Along with that, patients themselves report 7 intense discomfort and inability to stop themselves from, 8 like, pacing around or from sitting down or -- or not 9 being able to sit down, actually. So it's both a 10 physical symptom as well as a discomfort that patients 11 feel. 12 Q. And are those diagnostic criteria taken from a 13 big old book you have in your office called the DSM-IV? 14 A. Well, I don't think that akathisia is 15 described in DSM-IV, since it's not a clinical syndrome, 16 but it's, rather, a side effect of medications. 17 Q. Actually, I think you'll find it under 18 neuroleptic-induced akathisia in the new version. But in 19 any event, is akathisia, by definition, something that is 20 drug-induced? 21 A. Yes. 22 Q. Were you, in early 1990, familiar with the 23 literature concerning Prozac and akathisia? 24 A. No. 25 Q. In February of '90, that's when you had him on ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 58 1 Prozac, right? 2 A. Yes. That's when we started. 3 Q. And in that very month an article came out in 4 a journal by Dr. Tisher and Dr. Cole about suicides, the 5 possible connection between Prozac and suicide. Did you 6 read that article then? 7 A. I don't know. 8 Q. Are you aware of that article now? 9 A. Not by the information that you've given me. 10 Q. Okay, sir. 11 MS. WESTBY: I'm going to object to the form 12 of the question, too. I know it's late, but I'm still 13 objecting to the form of your first question. 14 MR. VICKERY: Okay. Tell me what -- in what 15 way the form is defective and I'll try to cure it. 16 MS. WESTBY: In terms of the description of 17 the article, lacks foundation. I think it's improper 18 based on the fact it isn't the specific title of the 19 article. 20 MR. VICKERY: Ah, okay. 21 Q. (BY MR. VICKERY) Dr. Suhany, in your practice 22 in Gillette, would drug representatives periodically call 23 on you to tell you about their medications? 24 A. Not commonly in my private practice. 25 Q. Do you know whether or not anyone from ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 59 1 Eli Lilly had ever contacted you prior to February of 2 1990 to give you information or promotional literature 3 about Prozac? 4 A. I don't know for sure, but I would expect, 5 yes. 6 Q. Okay. Just stick with me. I'm going down my 7 list and making check marks, which is a good sign for all 8 of us here. 9 (Pause.) 10 MR. VICKERY: I believe that's all I have, 11 sir. Thank you very much. 12 THE WITNESS: Thank you, sir. 13 MS. WESTBY: I have one follow-up question. 14 FURTHER EXAMINATION 15 BY MS. WESTBY: 16 Q. You were talking with Mr. Vickery about the 17 entry on 2-2-90, "obvious somatic anxiety today." 18 A. Yes. 19 Q. The only actual description of a physical 20 symptom in any of your notes is the trembling in the 21 hands, is that correct, which occurs in your note on 3-2 22 of '90? 23 A. Yes, as near as I can tell and remember in 24 looking at these notes today. 25 Q. Okay. So when you were describing some of the ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 60 1 typical physical symptoms that generally represent 2 anxiety or physical or somatic anxiety, you don't know 3 specifically what you meant by that entry? Those were 4 just some general ideas of what may have been meant by 5 that entry; isn't that correct? 6 A. Yes, as I think I tried to say earlier. But 7 that is what I meant. 8 Q. Okay. 9 A. I can't be certain what exactly I observed on 10 2-2. I was listing categories of things that I might -- 11 might have observed that would lead me to make that 12 entry. 13 Q. Okay. But you don't have any specific entry 14 about any kind of physical symptom in 2-2, correct? 15 A. That is correct. 16 Q. And the only entry that appears anywhere in 17 the records is on 3-2, and that is trembling in hands; is 18 that correct? 19 A. 3-2, and then I think there's some mention of 20 the -- in the next appointment of 3-9, that the tremors 21 continued until after he took Inderal. 22 Q. Okay. 23 A. But then he couldn't take Inderal. 24 MS. WESTBY: Okay. Okay. That is all the 25 questions that I have for you. ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 61 1 THE WITNESS: Oh, just -- I was just looking, 2 just to be completely fair. On 3-15, there also is a 3 mention that the tremors have markedly decreased. That's 4 after the switch to imipramine. 5 Q. (BY MS. WESTBY) Okay. But still the only 6 physical symptom that's noted is trembling in hands, and 7 either the fact that it's there or that it's decreasing; 8 is that true? 9 A. That is true. 10 MS. WESTBY: Okay. All right. Thank you so 11 much for your deposition. 12 You have the right to read and sign your 13 deposition, and you can make any minor changes that you 14 need in terms of spelling, those kind of things. 15 MR. VICKERY: Hang on, Counsel. I need to 16 follow up on your question. 17 MS. WESTBY: Okay. 18 FURTHER EXAMINATION 19 BY MR. VICKERY: 20 Q. Doctor, on the entry on 2-2-90 -- 21 A. Yes. 22 Q. -- the list of symptoms that you ran down that 23 would cause you to write "obvious somatic anxiety 24 today" -- 25 A. Yes. ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 62 1 Q. -- first of all, they're all some kind of 2 outward manifested motor movement, correct? 3 A. I believe so, yes. 4 Q. And they include both foot tapping and 5 jitteriness, right? 6 A. I believe I mentioned that, yes. 7 MR. VICKERY: Thank you. That's all I have. 8 MS. WESTBY: Okay. So then you would like us 9 to send you your deposition; is that correct? 10 THE WITNESS: Yes, so that I can officially 11 review it and sign it so that it can be officially 12 entered into a court proceeding if necessary. 13 MS. WESTBY: That would be fine. And I think 14 what I'm going to do is have the court reporter send it 15 directly to you. Do you want it sent to that business 16 address that you gave us during your deposition? 17 THE WITNESS: Yes. That's the most 18 convenient. 19 MS. WESTBY: Thank you. That's all I have. 20 (Thereupon, the taking of 21 the deposition concluded at 22 3:08 p.m.) 23 * * * * * 24 25 ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 63 1 CERTIFICATE OF DEPONENT 2 PAGE LINE CHANGE REASON 3 _________________________________________________________ 4 _________________________________________________________ 5 _________________________________________________________ 6 _________________________________________________________ 7 _________________________________________________________ 8 _________________________________________________________ 9 _________________________________________________________ 10 _________________________________________________________ 11 _________________________________________________________ 12 _________________________________________________________ 13 _________________________________________________________ 14 15 I, MARK V. SUHANY, M.D., deponent herein, do hereby certify and declare the within and foregoing 16 transcription to be my deposition in said action; that I have read, corrected, and do hereby affix my 17 signature to said transcript. 18 ____________________________________ 19 MARK V. SUHANY, M.D., Deponent 20 COUNTY OF CLARK) SS: 21 STATE OF NEVADA) 22 Subscribed and sworn to before me this ______ day of ______________, 2001. 23 24 _________________________________ Notary Public 25 ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102 64 1 CERTIFICATE OF REPORTER 2 STATE OF NEVADA ) SS: 3 COUNTY OF CLARK ) 4 I, Judith Payne Kelly, a duly commissioned 5 Notary Public, Clark County, State of Nevada, do hereby 6 certify: That I reported the taking of the deposition of 7 the witness, MARK V. SUHANY, M.D., commencing on Tuesday, 8 February 20, 2001, at 1:34 p.m. 9 That prior to being examined, the witness was 10 duly sworn to testify to the truth. That I thereafter 11 transcribed my said shorthand notes into typewriting and 12 that the typewritten transcript of said deposition is a 13 complete, true and accurate transcription of said 14 shorthand notes. 15 I further certify that I am not a relative or 16 employee of an attorney or counsel of any of the 17 parties, nor a relative or employee of any attorney or 18 counsel involved with this action, nor a person 19 financially interested in the action. 20 IN WITNESS THEREOF, I have hereunto set my hand 21 in my office in the County of Clark, State of Nevada, 22 this _____ day of ___________, 2001. 23 24 __________________________________ Judith Payne Kelly, RMR, CCR #539 25 ASSOCIATED REPORTERS OF NEVADA 702-382-8778 2300 West Sahara Avenue, Suite 770 Las Vegas, Nevada 89102