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Breathing Machine Is Focus of Initial Testimony In Solvang ALS Murder Trial

Ventilator operation is detailed by first witness in trial of elderly mother Marjorie Good and caregiver Wanda Nelson in death of Heidi Good

Respiratory therapist Gordon Sawyer testified Friday about the ventilator used by ALS patient Heidi Good at the time of her death in 2013. Good’s mother and caregiver are accused of murdering her.
Respiratory therapist Gordon Sawyer testified Friday about the ventilator used by ALS patient Heidi Good at the time of her death in 2013. Good’s mother and caregiver are accused of murdering her. (Janene Scully / Noozhawk photo)

Breathing machines known as ventilators were the focus of opening testimony Friday in the trial of two women charged with conspiring to murder an ALS patient in Solvang more than two years ago.

Twenty-four jurors and eight alternates heard the first witness talk about ventilator operations in a Santa Maria courtroom during the first day of testimony in the trial of Marjorie Good, 89, and Wanda Nelson, 63.

The women are charged with killing Heidi Good, who died March 25, 2013, after a lengthy battle with amyotrophic lateral sclerosis, also known as ALS or Lou Gehrig’s disease.

After exceeding life expectations for a typical patient with the neurodegenerative disease, Heidi Good had a tracheostomy, and relied on a ventilator to breath and around-the-clock caretakers to handle her basic needs. 

Heidi died of asphyxia, which medical experts have blamed on her ventilator no longer providing those life-giving breaths.

Santa Barbara county prosecutors alleged that Good and Nelson conspired to murder Heidi by giving her heavy doses of sedative drugs that rendered her unconscious before the ventilator was disconnected.

Respiratory therapist Gordon Sawyer, a former employee of ventilator manufacturer CareFusion, reviewed the data that had been recorded by the machine that kept Heidi alive and ultimately led to her death.

Wanda Nelson is accused of conspiring to murder Heidi Good of Solvang in 2013. Click to view larger
Wanda Nelson is accused of conspiring to murder Heidi Good of Solvang in 2013. (Janene Scully / Noozhawk photo)

On March 25, 2013, the day Heidi passed away, the ventilator's "event trace," or black box, detailed several incidents involving the machine, including that the low-pressure alarm went off at 2:03 p.m. and was shut off 30 minutes later. (While those are the times on the ventilator's log, prosecutors said the clock was by five minutes fast.). 

"Usually, not always, it means that there's not enough ventilation going to the patient," Sawyer said. "If there's a leak in the circuit, some of the air's going to the patient and some of it's going out into the room."

"When that happens, the pressure that it took to deliver that gas gets lower, and that's the purpose of the low-pressure alarm — to let me know that something's wrong here, I'm not generating the airway pressure I should be, and I need to come look at it and see what it is," Sawyer said. 

Circuit is the industry term for the hoses and tubes involved in a ventilator's operations.

Sometimes the alarm may be set off inadvertently by patients who still have some ability to breathe on their own, Sawyer said. 

"Usually it's a leak, that's usually what it is," Sawyer said, adding that leaks can come from the tracheostomy tube.

The low-pressure alarm cleared 30 minutes after it went off, Sawyer said.

Alarms have both audible and visual notifications, with a high-pitched beeping sound signaling a concern.

"It just keeps going," Sawyer said, "as long as the condition's there. Once it's clear, then that would stop."

Marjorie Good faces murder charges in the death of her daughter, Heidi Good, in 2013. Click to view larger
Marjorie Good faces murder charges in the death of her daughter, Heidi Good, in 2013. (Janene Scully / Noozhawk photo)

Alarms can clear themselves in some unique circumstances, but typically they require some sort of intervention, he said.

"So tubes or leaks don't clear  themselves?" asked Senior Deputy District Attorney Cynthia Gresser.

"Not usually, no," Sawyer responded. 

The audible alarm can be silenced for 60 seconds, but would start blaring again unless the reset button is pushed.

"So if you wanted to continue silencing, how would you be able to do it?" Gresser asked.

"You'd have to stand there and push that button every 60 seconds," Sawyer said. 

Any of the tubes could cause a low-pressure alarm, because it's detected as a new opening in the ventilator's circuit, according to Sawyer. 

"It just depends on where the alarm is set in relation to what the airway pressure was," he said. 

The machine records a maximum of 455 events, tossing earlier items if the data is not downloaded before reaching that number, Sawyer said.

Earlier on March 25, 2013, the ventilator recorded other events, including a high-side disconnect and low-side disconnect .

Attorney Lori Pedego, who represents Nelson, asked about the possible reasons those events occurred.

"It has to be something with one of those lines," Sawyer said. "It could be a disconnect. It could be secretions got in the line. It could be water got in the line.

"It's something that's not letting that particular line read pressures and flows the way it's supposed to."

Patients on ventilators often need the line to be suctioned to avoid blockages, he said. 

Data recorded by the ventilator doesn't give detailed information about how a problem was resolved, Sawyer said. 

"All it's doing is documenting alarm conditions occurred and went away," Sawyer added. "That's all it's doing. What caused them or what someone did, I have no idea."

When he worked with patients in hospitals, alarms periodically went off, Sawyer said.

"Ventilators are capable of malfunction, correct?," asked attorney David Bixby, who represents Good.

"Yeah, any piece of equipment would be capable of that," Sawyer said.

He worked for CareFusion's customer advocacy department, which handled 5,000 complaints annually, he said.

Sawyer also testified that the alarm apparently had not sounded for the 16 minutes from the time the machine said the problem was cleared until the ventilator was shut off at 2:49 p.m., a key point since a deputy who arrived at the scene reportedly has claimed the ventilator alarm was sounding.

While CareFusion employees testified in the criminal case, the firm hired an attorney, who sat in the courtroom, to represent the workers.

"If Care Fusion has no ...  worry about liability, why is that attorney in the audience?" Bixby asked.

Sawyer said it's company policy to provide legal counsel for their employees anytime they are involved with attorneys.

Testimony in the case continues Tuesday morning in Judge Rogelio Flores' courtroom.

Noozhawk North County editor Janene Scully can be reached at .(JavaScript must be enabled to view this email address). Follow Noozhawk on Twitter: @noozhawk, @NoozhawkNews and @NoozhawkBiz. Connect with Noozhawk on Facebook.

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