Gallagher asked, "Tell me, Dr. Goetch, out of all the other cardiologists in Toledo, why did you happen to call David Barnett?"

"Dr. Tamayo has an arrangement with the emergency room. Since he's often out of town, and because he's a solo practitioner, he needs help from other cardiology groups to cover his practice during his absence. Dr. Barnett's group offered to serve as his on-call backup. I paged the physician on call for that group, Dr. David Barnett responded."

"And did Dr. Barnett come to the hospital?"

David felt anxious, silently embarrassed. His deep feeling of shame about his late arrival to the emergency room wasn't rational or justified but he couldn't make it go away. Michael Conti would have died regardless of the cardiologist's presence at the hospital. Even If David had been at the emergency room when Mr.Conti came through the door, it wouldn't have made any difference. Despite that, it was David's nature to be hard on himself. He'd been that way since childhood.

Goetch responded to Gallagher. "No. He didn't need to."

Gallagher nearly shouted. "He didn't need to! Please explain that."

"At the time of my initial call to Barnett, Mr. Conti's diagnosis was uncertain. There was no evidence of an acute heart attack and his chest pain was improving on the treatment I've already described--IV nitroglycerin and heparin."

"So, what did you tell Barnett?"

"Mr. Gallagher, this all took place over a year ago. I can't remember the details of our conversation verbatim but I'm sure I explained the situation, telling Dr. Barnett that Mr.Conti's condition was stable and that an acute infarction was yet to be ruled out. I do know that I told him I would call him stat if I wanted him to come in."

"And what did he say? Or, should I ask, what do you recall or believe you recall he said?"

Larry Burkhardt shot to his feet. "Objection, Your Honor. The question implies that the witness is lying." Judge Richardson agreed and told Gallagher to watch his step and rephrase the question.

The attorney continued. "Dr. Goetch, please tell us what Dr. Barnett said in response to your phone call."

Goetch was getting tired of what he considered to be incessant nagging by John Gallagher. His patience was withering. "I don't know exactly what I said, and if asked you to recall what you said to someone over a year ago, you wouldn't remember either. You're wearin' me out, sir."

Someone in the gallery shouted. "Yea, you're wearing on me, too."

Raucous laughter broke out in the courtroom. Richardson slammed his gavel down hard, three times and yelled, "Order in this court, now!" The gallery quickly settled. The Judge, likewise weary from Gallagher's prolonged questioning, tempered his reprimand to Steve Goetch, politely instructing him to direct all statements to the questions at hand. Goetch nodded in agreement. The Judge waived Gallagher on.

"Doctor, I sympathize with your fatigue. I'm getting exhausted myself. However, we're dealing with a serious matter, the death of a young man. This may take a while."

Goetch was silent. Staring at his adversary.

Gallagher proceeded. "Doctor, we'll drop that last question for the moment, if you'd like."

Steve Goetch wasn't going to delay this and leave David Barnett hanging and worrying about what could come up later. "No, I'd prefer to answer now."

"Very good."

"I recall that Dr. Barnett agreed with my diagnoses and said he would be available via his pager or cell phone if needed."

David vividly remembered how badly he felt after leaving his daughter's concert and findind a STAT pager message sent thirty minutes earlier.

Gallagher paused, contemplating his next question. "And, Dr. Goetch, can you recall what time it was when you first called David Barnett?"

"I've recently reviewed the Emergency room memo from that at evening. I called Dr. Barnett at six-fifty pm."

Gallagher pushed on. "Do you recall if the doctor told you where he was; how far he was from the hospital?"

The question startled David. He felt weak, worried and ashamed. What is Gallagher getting at? Burkhardt objected again. "Your Honor, why should Mr. Gallagher care where Dr. Barnett was? It's irrelevant."

John Gallagher quickly addressed the charge, "Your Honor, the importance of Dr. Barnett's whereabouts will become evident with later testimony." Frank Richardson overruled Burkhardt's objection and told Gallagher to proceed.

"Dr. Goetch, did Dr. Barnett tell you where he was? Did he say how long it would take to drive to the hospital if he were asked to come in?"

Steve Goetch was as exasperated as ever. "I don't remember. It's none of my business to ask physicians where they are. He told me he would be immediately available, and in my experience, he always has been."

"But you don't know where he was in Toledo, what he was doing or how long it would take him to get to hospital". And as you said earlier, 'Timing is of the utmost importance' in treating heart attacks."

"No, I didn't know his location and it didn't matter. Dr. Barnett is very attentive to his responsibilities. His whereabouts was none of my concern."

Burkhardt leaned over and asked David a question. "David, what's goin' on here?"

"I have no idea. I did arrive at the ER a bit late because I was at my daughter's school concert. But I don't see how that could be any big deal."

"Dr. Goetch, you previously said that Mr. Conti's condition was improving when you called Dr. Barnett. Tell me, did your patient's condition continue to improve?"

Goetch adamantly answered, "Obviously not."

"Tell us what happened, Doctor."

"I ordered what's referred to as 'serial EKG's', that's three electrocardiograms, fifteen minutes apart. In addition, blood work for cardiac enzymes to exclude a myocardial infarction was ordered to be run stat. As I've said, Mr. Conti had been improving, however, he quickly took a turn for the worse. The severity of his chest pain increased, and his second electrocardiogram looked suspicious for a myocardial infarction."

"Dr. Goetch what do you mean by 'suspicious'?" Did the EKG show a myocardial infarction or not?"

Steve's anger peaked. The attorney was pushing his buttons and he was sick of it. He, somewhat irresponsibly, decided to fire a volley at John Gallagher. "Mr. Gallagher, an electrocardiographic diagnosis of myocardial infarction is not always black and white. Of course, I shouldn't expect an attorney to know anything about electrocardiograms or much of anything else about medicine."

Barnett was shocked. His friend was digging a hole for both of them.

Judge Richardson jumped in. "Doctor, there's no place for personal commentary in my courtroom. Do you understand?"

Steve turned toward the bench, answering with a curt, "Yes, Sir."

Gallagher, very pleased by the doctor's outburst, moved right ahead.

"So, Dr. Goetch, what did you do, since your patient was, as you've said, 'getting worse'?"

"I increased his treatment with a higher dose of IV nitroglycerin, an increased dose of heparin and an additional dose of morphine. I also instructed the nurse to call Dr. Barnett."

"And did Dr. Barnett respond? Was he 'immediately available' as you've said he always was in your experience?"

Goetch paused and glanced toward his friend. David forced a smile. Gallagher repeated the question. "Dr. Goetch, did Dr. Barnett respond immediately?"

"No, he didn't. It took about thirty minutes to get in touch with him."

"I see. Did you finally surmise that Mr. Conti was in fact having a heart attack during this thirty minute delay?"

"Yes, I did. The third EKG was definitely abnormal and his chest pain was not responding to treatment."

"And?"

"And what?"

"Doctor, you must have assumed that I'd review your comments on Michael Conti's ER memo."

"Yes, I did."

"So, please tell me more about Mr. Conti's condition at the time of your second
call to Dr. Barnett."

Steve knew what Gallagher wanted. He reluctantly replied. "And, his blood pressure was falling."

Gallagher added, "And his pulse was increasing and he was pale, in a cold sweat. Is that correct."

Goetch gave a smart ass answer. "Yeah, If that's what I wrote."

Gallagher smiled and turned to the jury. "That's what he wrote." A few jurors laughed at the attorney's odd nature.

"Dr. Goetch, please bear with me on this. I realize I'm merely a lowly lawyer, ignorant of the field of medicine, as you've already mentioned. Therefore, I need your help with understanding this. Wouldn't the best treatment for Michael Conti, at the moment you've just described, have been the initiation of thrombolytic therapy? Which, in your own words was 'revolutionary'."

Goetch responded with a terse, "Yes!"

"But hospital policy at that time, prevented you from administering the thrombolytic treatment that was so desperately needed; isn't that true?"

Burkhardt could see that Goetch was sinking fast. He started groping at straws with objections. "Your Honor, Mr. Gallagher is not qualified to label the situation as 'desperate'!"

John Gallagher quickly jumped in. "Your Honor, the patient died. I think things were desperate."

Richardson overruled Barkhardt's objection and turned to the witness. "Please answer the question, Doctor."

Steve Goetch peered at David with an apologetic look. "Mr. Gallagher, I believe the answer is a 'qualified' yes."

"Dr. Goetch, it's either yes or no, isn't it?"

"No, it's not! I had the personal option of ignoring the hospital policy and proceeding with treatment."

"But you didn't do that, did you?"

"I instructed the nurse to have the hospital pharmacy prepare the dose of TPA, the thrombolytic medicine, and immediately deliver it to the emergency room. It was hung on Mr. Conti's IV line ready to go. I was just about to instruct the nurse to proceed with administration when Dr. Barnett called."

Gallagher sarcastically added, "So, the good Doctor finally got around to answering his stat page."

Richardson cleared his throat and said. "Mr. Gallagher, we can do without the sarcasm."

"Yes, Your Honor."

Steve was determined to help his friend. "Mr. Gallagher, I think the term 'finally' is misleading. It's not at all uncommon for it to take fifteen to twenty minutes for an on-call physician to answer his page. They're very busy people."

Gallagher quickly shot back, "We're not talking about 'most' doctors, here. I specifically asked about Dr. David Barnett's response to a stat page from you. A page to the cardiologist you had, a short time earlier, spoken with, to describe Mr. Michael Conti's potentially dire situation."

Goetch remained silent.

Gallagher paused to give the jury time absorb what he had just said. "Dr. Goetch, what did you do after conferring with Dr. Barnett?"

"I immediately proceeded with the TPA, the thrombolytic therapy. Dr. Barnett said he would be there ASAP. He was only ten minutes away."

"We've previously established that Mercy Hospital's policy for the use of TPA required the presence, and, I assume, permission from, a cardiologist. Is that correct?"

"Yes. At that time it was."

"Did the policy allow clearance to be given by a cardiologist over the phone?"

"We sometimes took orders over the phone after faxing a copy of an abnormal EKG to the cardiologist. If the diagnosis of acute MI was obvious on the EKG, the cardiologist would, at times, order TPA via the telephone. The reason was to expedite treatment and save critical time."

Barnett was disappointed with Steve. He wished he hadn't mentioned the fax. But he understood. Goetch was under fire.

"Did Dr. Barnett ask you to fax the electrocardiograms to him? On either of these calls?"

"He said there was no fax machine available. On my second call, he knew a fax would simply be an unnecessary delay since he wasn't far from the hospital."

"Where was he?"

Burkhardt jumped up with an objection. "Your Honor, we've already covered this ground many times. Dr. Goetch has explained that he didn't know where Dr. Barnett was and he didn't care."

Gallagher remained silent and looked towards the judge.

"Objection sustained. Mr. Gallagher let's get off that topic. Move on."

The attorney continued. "So did you in fact break policy by giving Michael Conti TPA, Dr. Goetch?"

"It was a judgment call on both our parts. It turned out to be the right call."

"I'm sure you did all of this in the best interest of your patient." Goetch was really sick of Gallagher's sarcasm. The attorney continued. "Dr. Goetch did you or did you not break hospital policy?"

Goetch shouted back, "It was a ridiculous, inappropriate policy and the hospital knew it. That's why they did away with it shortly thereafter. Nearly all of the other ER docs ignored that policy because it was in the best interest of the patient to do so. As I've previously enumerated, time is critical when treating a heart attack."

"But doctor, isn't it true that the ER policy on TPA was written because of the inherent risks of treating a patient with such a potent anticoagulant--a blood thinner? Are you sure you were acting in Michael Conti's best interest?"

Goetch felt the insult. "Yes, I'm sure! It's true that the risk of hemorrhage is real, but it's quite rare, especially in a young guy like Michael Conti. Most importantly, he didn't have a bleeding complication from the TPA. As I've said, we made the right call."

"Dr. Goetch, in some sense, Dr. Barnett's absence put both you and Mr. Conti in a precarious position, didn't it?"

Burkhardt objected. "Your Honor, Dr. Goetch has adequately answered these questions."

Gallagher responded, "Your Honor, Dr. Goetch had to break hospital policy because of Dr. Barnett's behavior. I think I have the right to pursue this further."

Frank Richardson squirmed in his chair to reposition the cushion behind his back. He looked uncomfortable as he addressed the attorney. "Mr. Gallagher, I believe the term 'behavior' is a poor choice. However, I will let you continue until the hospital policy issue is resolved. Objection over ruled."

Gallagher turned back to Goetch. "Dr. Barnett forced you to break policy, correct? You subjected your patient to potential harm by acting on an unconfirmed diagnosis in a patient who had not been examined by the appropriate specialist."

Burkhardt leaned over to speak with David. "I can't believe Gallagher is pushing so hard. This is crazy."

"Yea, it worries me. I don't understand what he's after."

All of this cross examination was going over Carlo Conti's head. He was barely paying attention. Laura felt sorry for Dr. Goetch. He had been very kind to her in the emergency room, and she didn't feel he had done anything wrong. If he had broken a rule, it was only to help Michael. She admired him for that.

Goetch responded to Gallagher's last query. "I've personally treated hundreds of patients with TPA, Mr. Gallagher. I have years of experience weighing the risk of TPA versus the benefits. In this case . . . ."

Gallagher interrupted. "Please, Doctor. I' m going to ask you to answer my question with a simple yes or no."

Burkhardt objected again. "Your Honor. Dr. Goetch has already explained the perplexity of the question. A yes or no answer is misleading."

Gallagher turned toward the judge and waited for his response. Judge Richardson's back pain was getting to him. He wanted to get this over with, leave the courthouse and go home to bed. He decided to overrule Burkhardt's objection. "A yes or no answer would help move things along, Doctor. Objection overruled. Please answer the question, Dr. Goetch."

"Steve Goetch looked toward David and hesitantly answered, "Yes.
Yes, we broke hospital policy?"

Gallagher stepped back from the witness stand and turned toward the jury. "Since Dr. Barnett was out of contact, location unknown, for a prolonged period of time,
Dr. Steven Goetch had no choice but to break strict hospital policy. In some respects, Dr. Barnett forced his friend to jeopardize his medical career."

Burkhardt blurted out with repeated objections. Gallagher turned back toward Goetch and raised his eyebrows, as if to ask, isn't that true?

Goetch felt trapped. He glanced back to David, gave a slight shrug of his shoulders and turned to face Gallagher. Frank Richardson, hoping to speed this along, overruled Burkhardt's objection and instructed Goetch to answer.

"Your statement is not true, Mr. Gallagher. Dr. Barnett did not force me to do anything. His location was of no concern, his delay of only twenty to thirty minutes was inconsequential and my career was definitely not jeopardized. As I said previously, I've broken that policy many times in the past. The Director of the Emergency Department was aware of that and never raised a question."

Gallagher paused to collect his thoughts. He felt that he was whipping a dead horse, and perceived the jury felt the same. He didn't want the questioning to give Goetch another opportunity to defend Barnett's performance. "I've only one last question for you, Dr. Goetch."

Goetch blurted out, "Thank God!" The jury erupted in laughter. The judge chuckled; even John Gallagher couldn't keep from smiling.

Gallagher spoke with a hint of humor still lingering within his voice. "I agree with you, Doctor. It's been a long session. If you had answered the last question with a simple yes or no, I'd be on my way."

"I did my best."

"Yes, you certainly did. I give you credit for that. Here's my last question. With regard to the treatment of an acute heart attack with TPA or a balloon angioplasty, isn't it true that the single most important factor affecting outcome is time. That is, isn't it true that it is of the utmost importance to give the thrombolytic treatment as soon as possible once a diagnosis of acute heart attack is made?"

This repetive line of questioning made Barnett anxious. His inner guilt surfaced again.
Goetch had been expecting more of the same. He had no way out and had to answer with the blunt truth. "Yes, Mr. Gallagher, that is correct."

"And, with regard to Michael Conti's treatment, Dr. Barnett's delay in calling back, likely had an adverse effect on your patient's outcome. Under the best of circumstances you would've wanted a cardiologist at your side, immediately. Correct?"

Goetch smiled, and broke the tension with a bit of humor. "That's your second question, Mr. Gallagher. You promised only one more. You're a fibber."

The jury roared with laughter. Richardson tried but couldn't hold it in. He thought, Calls the attorney a fibber. What a character.

Gallagher chuckled, finding the doctor's remarks quite humorous. It was obvious to all that the attorney wasn't upset with the Steve's sense of humor. "You're right, Doctor; I guess I did tell a fib. I apologize. I have just one or two or three more questions, I promise."

Goetch couldn't quit with the wise remarks. He loved entertaining his audience. "Well counselor, I think three more questions would be just fine. But not four!"

The judge intervened. "Doctor, it's time to get serious. Please answer the question."

Goetch had forgotten what the question was. "Could you please repeat the question?"

"The question is this. Is it or is it not true that Dr. Barnett's delay in calling you and his late arrival at the emergency room, caused a delay in the treatment of Michael Conti's acute heart attack, and that delay, may in fact have had an adverse effect on the patient's outcome?"

Burkhardt and Barnett were as mystified as ever by Gallagher's tenacity on this timing issue. Fifteen to thirty minutes, either way, was of no major concern in view of the final diagnosis showing severe, untreatable three vessel coronary disease. Gallagher's doggedness on this issue was an enigma.

Goetch carefully thought over his answer. "In certain cases that would be true. In this case, I think the timing is irrelevant."

Gallagher was ready to fire back with another question when Burkhardt stood. "Objection, Your Honor. Mr. Gallagher's pushing an issue that Dr. Goetch has repeatedly answered, numerous times."

Gallagher, turning to the Judge, noticed that Richardson seemed to be in pain. He grimaced and rubbed his lower back. Before Gallagher could speak, His Honor responded to the objection. "Objection sustained. Mr. Gallagher move on and finish up."

Gallagher turned back to Goetch. "I have no further questions, Your Honor." John Gallagher took his seat next to Carlo.

Richardson addressed Larry Burkhardt. "Mr. Burkhardt, I'm sure you have some questions for your client."

"Yes, Your Honor, I do." Burkhardt stood and approached the stand. "Dr. Goetch, in light of Mr. Gallagher's very exhaustive examination, I'll try to keep this short." Goetch smiled to show his relief. "Doctor, in your opinion, based on your many years of emergency room work, do you feel anything could have been done to save the life of Mr. Michael Conti?"

"No, I do not."

"Do you believe that your care for Mr. Conti was compromised at all by Dr. Barnett's performance or for any other reason?"

"No, I do not."

"Once again, in your experience, can you think of anything that could have been done differently to save a patient with such a massive heart attack and such severe coronary artery disease, as was demonstrated on Mr. Conti's coronary angiogram, his catheterization?"

"I know of no medical treatment or procedure which would have altered or improved Michael Conti's outcome. Unfortunately, I feel, just as Dr. Tamayo has previously stated, Mr. Conti's fate was sealed before he arrived at the emergency room."

Burkhardt finished his questioning. "And were there any consequences at all from your breaking the hospital policy on TPA?"

"Absolutely not."

"I have no further questions, Your Honor."

The Judge announced that court was adjourned until nine am the following day. A Sherriff's deputy escorted the jury members out, and the gallery quickly emptied. Judge Richardson sluggishly rose from his seat, using both arms to support himself. He stood, back bent, for a moment; forcing himself upright, he slowly walked to his chambers.

Carlo and John Gallagher were still seated, having a discussion about tomorrows events. Laura stood, said a brief goodbye to the attorney and her father-in-law, and walked toward the back of the courtroom.

David Barnett turned and intently watched her leave. He'd been slyly catching glimpse of her all day but his view was partially blocked by the Plaintiff's table, Carlo and the end of the gallery bench, which looked like a church pew. He hadn't seen her since her visit to his office, nearly six months ago. Now, to his delight, he could refresh his memory.

Barnett mentally collated her image: auburn hair cut just above her shoulders, five-foot- five in heels, one-twenty pounds, chocolate brown wool suit, three button, short wasted jacket, skirt, tastefully hemmed above the knee, soft yellow shade blouse, one button open at neckline, slender gold necklace. Her legs were beautiful, shear stockings, two tone brown and tan high heels. David Barnett was hopeful and happy. "Larry, I have to go. It's a bit urgent. Can we talk later--over the phone?"

Burkhardt sensed David's attraction to Laura; in spite of her even being a plaintiff, David didn't seem to care. "Sure, I'll call you." Larry smiled. "You better get out of here before she get's away on ya."

Barnett was surprised. "Burkhardt, you're either very observant or clairvoyant."

He laughed."Yea, sure. It's part of the job. Now get goin', Doctor."

Barnett practically ran out of the court house. Reaching the sidewalk, he quickly looked in both directions, up and down the street, just catching a glimpse of her as she rounded a corner. He jogged to the corner, stopped to catch his breath, and walked on, trying to look casual. There she was, just twenty feet or so ahead of him. He called out. "Mrs. Conti."

Laura's head turned with a start. "Oh. Hello, Doctor."

David was overwhelmed with anxiety. He felt like a junior high kid. His voice nearly cracked. "Hi...hello."

Laura calmly responded. "Can I help you?"

"No...I mean yes. I thought I'd walk you to your car...it's not safe, you know, sometimes, here, downtown." He walked ahead, stopping a few feet from her.

"That's very polite of you. But, I'm already here. This is my car." She pointed to a red Chrysler just a few feet away.

David's anxiety was gradually dissipating. He relaxed. "Yes, I tried to catch you when you left the courthouse. You were just to quick. You gotta away on me."

Laura laughed. "Well, looks like you caught me after all."