Grace Schara trial - Bruce Goldberger expert testimony
Dr Bruce Goldberger is not a physician. He is a professional testifier in legal cases who often appears for the prosecution in State criminal cases, who charges $5000 per day, plus a non refundable initial fee of $2500.
He was called by the hospital defense to testify on behalf of the hospital. In his initial testimony he essentially testified that the amount of Morphine, Precedex and Atavan was not enough for an overdose.
The Schara’s lawyer pointed out that he reviewed less pages than the total medical records.
He read from Goldberger’s own writings: “An overdose would be a dose of a drug that would cause an ill effect, potentially a non-fatal or a fatal overdose.”
Schara lawyer: “How is this not an overdose according to your definition?”
Goldberger: “Because the professionals were there they adjusted the dose appropriately. Significant ill effect that would injure Grace or kill Grace.”
Schara lawyer: “Did you say a significant kill effect?”
Goldberger: “Significant effect.”
…..
Goldberger: “I don’t see this as life threatening.”
The Schara’s lawyer pointed out that on the 7th and the 8th Grace had been administered medication to raise her blood pressure after the overdose of Precedex on those days.
On being asked whether the Scharas should have been given the Precedex on the 13th given the overdoses on the 7th and 8th Goldberger declined to offer an opinion. Schara lawyer: “You’re not qualified to offer an opinion on standard of care?”
Goldberger: “I’m not.”
Schara lawyer: “If you don’t consider the events of October 7th and October 8th an oversedation, then why were they required to give Noraepinephrin?”
Goldberger: “I’m not a physician I cannot tell you that.”
Schara lawyer: “You could tell me that based on the impact of Noraepinephrin on these two medications, couldn’t you?”
Goldberger: “Raising the blood pressure?”
Schara lawyer: “Was it appropriate to increase the level of Precedex to 1.4 given the previous events of October 7th and 8th?” (Objection, overruled)
Goldberger: “In the context of my previous testimony when Grace was first started on the Precedex she was naive and intolerant, over the course of these days she became more tolerant to the Precedex so… it’s necessary to be given at a higher level…”
Schara lawyer: “Naive?… Based upon their physiological condition the ability of the drug to affect that person?… What you’re saying is that initially Grace was naive, so later she was able to tolerant so they had to increase it to that level?”
Goldberger: You need to increase the dose to get a clinical effect…. I’m not here to testify on her health status, but that’s also a consideration, whether it is needed.
Schara lawyer: “Specifically with respect to the Precedex it was increased to 1.4 you don’t have an opinion whether it’s appropriate to increase it to 1.4?”
Goldberger: I don’t have an opinion about the standard of practice. I’m not a standard of practice expert.
Schara lawyer: Do you know what RAS means?
Goldberger: No I don’t use it.
Schara lawyer: Would you agree with the following statement: Lorazapam and Morphine are both central nervous system depressants that could affect vital signs like heart rate blood pressure and respiratory rate, so when administered singly or in combination the health care provider should monitor the patient’s vital signs?
Goldberger: Yes.
…
Schara lawyer: Did you find that Grace Schara was in pain prior to the infusion of Precedex?
Goldberger: I don’t know. I don’t have an answer to that.
Schara lawyer: Confusion as to additive versus synergistic because I think there’s some confusion here. You would agree that it’s difficult to measure synergistic effect?
Goldberger: We can’t experiment and give various doses and see if it’s additive or synergistic. … we have to be careful about the loose use of the term synergism. It can be misleading. We don’t want to mislead the jury.
Schara lawyer: We don’t want to mislead the jury.
And everyone metabolises drugs in different ways.
Goldberger: Yes
Schara lawyer: … we have to rely on signs and symptoms of different patients so we can work if the drug has a synergistic or additive effect?
Goldberger: Yes
Schara lawyer: So Grace was unconscious after being given the massive dose of Precedex, so she didn’t have any pain or anxiety. Correct?
Goldberger: Correct.
Schara lawyer: If I could just have a minute judge. I’m very close to finish.
You would agree with me that none of these drugs are indicated for the treatment of Covid?
Goldberger: Directly, no, they’re not treating Covid
Schara lawyer: And you would agree with me that the risk of another oversedation event never went away after 10/8 correct?
Goldberger: Correct that’s why she’s in the ICU and being monitored.
Schara lawyer: On October 13th at around 6pm since you looked at the vital signs was it appropriate to continue Precedex at 1.4 when they couldn’t even locate a pulse.
Goldberger: “That’s best practices.”
Schara lawyer: “Best practices. Outside your area.
You’re not stating here that the side effects of drugs could be ignored. Correct?”
Goldberger: They should never be ignored. Even for potential.
Schara lawyer: And if there were listed exceptions to the typical administration of particular drugs whetehr those are found in the package insert or the PDR — did you say the PDR is no longer in existence? You used to have one on your desk.
Goldberger: I used to have one on my desk.
Schara lawyer: What if there was a second overdose would you then realise that the patietn is one of the exceptions listed in the package insert?
Goldberger: I don’t have an answer to that I’m not a phys-cian.
Schara lawyer: If your child had an adverse reaction to aspirin would you continue to give aspirin given that the risk of an adverse reaction is only 3%?
The Schara’s lawyer put up the charts of Grace’s last hours, and asked why Grace was still on Precedex given that she was unconscious and not suffering anxiety. He then noted the half-life of Precedex, which in Grace’s case would be on the higher end, that drug could be in her system up 20 hours?
There was an attempt to place an arterial line, which they couldn’t do because there was no blood pressure.
Goldberger: ….It’s helpful to have blood pressure.
…So why would they give morphine, six minutes after they realised she had no blood pressure?
Goldberger: You’ll have to ask the physician.
I haven’t had time to listen to the hospital lawyers’ redirect after the break at this point.
