IN THE CIRCUIT COURT OF THE STATE OF OREGON
FOR THE COUNTY OF JACKSON
In the Matter of the Marriage of: )
)
SUSAN SAMORA COUTSOUKIS, )
)
Petitioner, )
)
and ) Case No. 94-3846-D-3
)
PHOTIUS COUTSOUKIS, )
)
Respondent. )
__________________________________)
PERPETUATION TESTIMONY OF
{BOn}BARBARA LYNN KOZOL{BOff}
BE IT REMEMBERED That the perpetuation testimony
of BARBARA LYNN KOZOL was taken as a witness on behalf of the Petitioner before Debra J. Dugan, a Certified Shorthand Reporter for Oregon, on September 4, 1997, beginning at the hour of 1:30 p.m. at the office of Cristina Sanz, 2 North Oakdale, Medford, Oregon.
{BOn}A P P E A R A N C E S{BOff}
FOR THE PETITIONER: CRISTINA SANZ
Attorney at Law
2 North Oakdale
Medford, OR 97501
FOR THE RESPONDENT: CHARTER & LORI
Attorneys at Law
BY: BETH LORI, ESQ.
220 North Oakdale
Medford, OR 97501
{BOn}C O N T E N T S{BOff}
{BOn}Examination by:{BOff} {BOn}Page:{BOff}
MS. SANZ 5, 110
MS. LORI 61, 117
{BOn}EXHIBIT INDEX{BOff}
{BOn}Exhibit No. {BOff}{BOn}Page{BOff}:
1 - Letter from Mr. Coutsoukis to Ms. Kozol 40
{BOn}S T I P U L A T I O N{BOff}
At said time and place the following stipulation was entered into between the attorneys present in behalf of the respective parties:
IT IS HEREBY STIPULATED that all irregularities as to notice of time and place and manner of taking said perpetuation testimony are hereby waived. Parties have stipulated to perpetuate testimony pursuant to ORCP Rule 39(i), and waive notice and objections to notice.
IT IS HEREBY STIPULATED that pursuant to Rule 39(i)(6), the perpetuation examination shall proceed as set forth in subsection D. All objections to any testimony or evidence shall be made at the time of the deposition and any objections not made at the deposition shall be deemed waived.
IT IS HEREBY STIPULATED that the reading and signing of said perpetuation testimony by the party and the filing thereof are hereby expressly waived.
---oOo---
{BOn}BARBARA LYNN KOZOL{BOff}
was thereupon called as a witness on behalf of the
Petitioner and, after having been first duly sworn, was examined and testified as follows:
MS. LORI: Before we proceed, what I want to do is a motion in limine, which is just to limit testimony about opinions to what the witnesses have personally observed in accordance with Rule 602 and Rule 701.
MS. SANZ: Well, I'm going to, you know, I don't know if you want the judge to hear this right off, but part of Ms. Kozol's responsibilities are overseeing, you know, medical records, information from staff; and she can form her opinions from all that information, not just from her own observations themselves.
MS. LORI: What I suggest we do is do an offer of proof; in other words, I state my objection, you make an offer of proof, and then it's preserved in the record and the judge can make a decision from there.
MS. SANZ: All right.
{BOn}DIRECT EXAMINATION{BOff}
BY MS. SANZ:
Q Okay. Ms. Kozol, please state your name, spell your last name for the record?
A It's Barbara Lynn Kozol, K-o-z-o-l.
Q And you are a resident of Jackson County?
A Yes, I am.
Q And for how long?
A Since 1970.
Q Okay. You are currently employed?
A Yes, I am.
Q And if you could state where you're employed and what you do?
A I'm the director of child development at Rogue Valley Medical Center, Asante.
Q Okay. What are your responsibilities?
A Uhm, I direct several different programs that serve children, usually either delayed, disabled, or high risk children.
Q And how many staff members do you supervise?
A Uhm, just under 100; possibly the hundredth got hired today.
Q And you are part of Rogue Valley Medical Center?
A Part of Rogue Valley Medical Center, correct. We provide a blended medical educational program.
Q What does that mean?
A We do get educational dollars to provide preschool type services, teachers, uhm, home family consultant people for identified handicapped children. And we also have physical therapy, occupational therapy, speech therapy, the more traditional medical services one thinks of for small children.
Q You just gave a summary of the kinds of services you provide in your center?
A That's most of them.
Q Most of them. Anything else?
A We have behavioral consultation for emotionally challenged children. I also have, we have a developmental assessment clinic for infants and preschoolers. I also have an employee child care for children of employees in the hospital, so --
Q And you have been director of that program for how long?
A The child -- there's more than one program in that. I've been director of all those children's programs since '82; some of them didn't start until a little bit after that, but --
Q Is that the first time you got involved with the Childrens' Development Center?
A Yeah, I created it; that makes it simple.
Q And you're physically located right now at Rogue Valley Medical Center?
A Actually, no.
Q You have different satellites?
A We have six different satellites, but we're at, this week, have moved our facilities in the hospital to 945 South Riverside.
Q You receive -- how do you receive referrals, you know, your patients? I don't know if you consider them patients or clients?
A Patients, usually, kids. Uhm, from a variety of sources; most of them come from doctors, SCF -- Services for Children and Families.
Q Who used to be called?
A CSD.
Q Children Services Division?
A Children Services Division, right.
Q Okay.
A Sometimes school districts; occasionally self referrals, which we screen to make sure they're appropriate. That's the great majority.
Q And your evaluation and services to the children, is that, you know, purely becomes an internal matter, or is that shared with other, you know, does it go automatically shared to the primary physician, or --
A We, yeah, we just, as a matter of philosophy, always look at the physician as a primary case manager. So anything we do with children, the reports go to the doctors, of what we're doing; and then we may consult with them beforehand, particularly if it's an involved case. Usually the typical child, the doctor will call and refer, they'll tell us about them, we'll do an eval on the child, we'll talk to the physician about what we'd like to do or what we plan on doing, and then we send them reports on a regular basis afterwards.
Q Okay. So doctors or the medical staff, specifically doctors are very involved with your planning and evaluation of how things are going?
A Uh-huh. If --
Q Is that a yes?
A That's a yes, I'm sorry. You can't put a nod on. Yes. Depending on the physician, a lot of times they're involved just by us giving them reports, and if it's a physician that tends to be someone that really wants to get in there and work, then we have more actual planning with them.
Q Okay. Can you tell us a little bit about your educational background?
A I have a Bachelor's degree in occupational therapy and a Master's degree in psychology.
Q And do you hold any licenses or --
A Just the national and state license for occupational therapy.
Q You have other experience other than your involvement with CDC?
A Right, when I first started as a therapist, I worked in Florida with, in child psychiatry. And then when I first moved here in the valley, I was what we refer to as a general practitioner, occupational therapist doing quite a lot of different types of therapy. And then I worked on the psychiatric unit, commonly called Two North, for eight years. Uhm, I had some psychiatric experience also in North Carolina as an intern in a state hospital.
Q How many years?
A Uhm, that was quite a while ago; that would have been a long time ago, '68, '69.
Q For two years? Or how many years did you hold that position?
A That was just as an intern, that was just four months.
Q When you said you worked in child psychiatry, how many years?
A That was a year and a half.
Q Year and a half. And as a general practitioner as a therapist, how many years?
A I moved here in '70 and we opened the psychiatric unit in spring of '72, so I would say two years. And then when we opened the psychiatric unit, I was 90 percent adult psychiatry and ten percent on the side working with children. I've never totally given children up at any particular time.
Q Now, how was Teddy Coutsoukis, who is the child of the parties, how was she referred to your center?
A Dr. Williams referred her to us.
Q And is that Dr. Diane Williams?
A Yes.
Q Is that the child's pediatrician?
A Yes, or was at that time.
Q And what were the concerns?
A That Teddy had some pretty significant developmental delay, and apraxia, which is trouble moving her body. Uhm, and Diane wanted her enrolled in our handicapped program for children.
Q And what service -- so when did you first evaluate Teddy?
A I, uhm, I didn't look at my dates for review before I first came. I remember meeting with the parents, it was in summer, so it must have been summer of '95.
Q Okay.
A And I'm not absolutely positive of that.
Q And what was the first, what did you have as your initial plan and goal for treatment for Teddy?
A We wanted, that, let's see, Teddy was not quite a year old then. The primary goal was to do a thorough ongoing evaluation, because she is a fairly complicated child in her disabilities; and to immediately get some physical therapy started, uhm, because movement was a big issue; and then provide family consultation, which is someone working with the parents and giving them ideas of what they can do at home to help the child function better.
Q At the time you first met Teddy and her parents, were Mr. and Mrs. Coutsoukis already separated?
A No. They had, uhm, the first meeting we had, they declared that they, you know, were having some troubles. But to my memory, they were together.
Q Okay. Anything remarkable that you remember from that first meeting with the parents?
A Photius was overbearing at that point, but also obviously concerned. I mean, both parents were obviously concerned about the child and both parents were distressed.
Q They had just learned, or they were dealing initially with some of these issues?
A Yeah, I think they appeared to be pretty stricken by the whole, just beginning to accept the severity of Teddy's problems. It's real typical of parents, initially to go okay, she's not all right, how fast will she be okay. And I think they were just beginning to really grasp that it wasn't something that was just going to get better overnight.
Q Okay. And what type of services, if you can go over the progression of services that you provided for Teddy?
A We started with the family consultation and physical therapy. As she got a little bigger, we have a parent toddler group that the parent and the child come in a small group with. So it's a beginning social experience for the child, and it's also an opportunity for parents to get ideas from other parents and sort of support each other. And then we have physical, occupational, and speech therapy available in that group.
Photius was originally coming because he had more time with the child, but he wasn't appropriate and we had to ask him to quit coming. We then provided just outpatient therapy, speech, occupational, physical therapy; for a while we had difficulty, uhm, with that and with Photius. And then we finally got her going in preschool, or we -- she, we offered her what's called the toddler school, and Photius didn't want her in it for the first year; but she did participate in that this last year.
Q What would you say her prognosis is now?
MS. LORI: Well, I'm going to object on the basis of, I guess lack of medical expertise.
BY MS. SANZ: (Continuing)
Q What was her last evaluation. What, had things progressed, or what is her current situation since when you last saw her?
A Well, of course, we haven't seen her now since April or so.
Q April of this year?
A Right. I did, uhm, a cognitive evaluation of her in the fall in getting ready for her annual yearly meeting. And she has, uhm, really varied abilities, even in her thinking skills, they're extremely varied. She is not an average retarded child. I mean, typically kids that are fairly clear cut retarded are kind of the same, their gross motor levels and their thinking levels and their fine motor levels are all roughly the same. And she's not like that at all. Uhm, even in the sub components of her thinking skills, they're very varied. So I think anybody, no matter how much medical expertise they had, or time they had with her right now could not give you a positive black and white answer. I think she has a lot of potential, but she has significant disabilities.
Q And what are those disabilities?
A Well, her biggest problem right now is she has a significant language disability; and some of her ability to think in that language process is affected. It's not just her ability to talk, it's her, apparently her ability to think language. She has excellent rote skills, she has excellent perceptual matching skills, but -- and her quality of movement in walking and her language, both abstract thinking language and spoken language, are significantly delayed, and are probably going to be that way for some time. She is, even if, quote unquote, the light bulb comes on in her cognitive language skills, she will always have motor problems.
Q Let's take her language skills, I'm not sure, is she -- is there an inability to speak clearly, or to understand language?
A Both.
Q Both?
A Both. She has a very limited vocabulary. She has signs, as well, a signing vocabulary as well as the spoken vocabulary. Her spoken -- I don't know what her spoken vocabulary is now, but it was limited to a few single words before that she couldn't consistently always use in a multitude of settings. Uhm, I don't know what to say past that.
Q How about in her quality of motor skills?
A The motor skill apraxia, she has like a tremor, jerkiness to her movement; you know, she's walking, uhm, she falls a lot. And that will improve, I mean, she'll get where she can move faster and get in and out of sitting and walking with more smoothness; but she is always going to have that kind of a jerkiness in her movement.
Q And you have shared this information with, I assume, Dr. Williams, correct?
A Uh-huh, oh, yes.
Q Have there been other medical or social experts or institutions that have asked you for similar, or this type of information?
A There's a facility in New York I have a request from, that I don't believe we've sent them that information yet. They want records to establish services for her there.
Q Okay. Now, in your dealings with Teddy, you, of course, have had interaction with both parents?
A Yes.
Q Have you had, yourself, had a lot of direct interaction with Mr. Coutsoukis?
A Yes.
Q Has he ever made comments to you concerning his opinions of women that you would consider sexist?
MS. LORI: Objection as to relevancy; it's more prejudicial than probative. Then if you want, we can discuss with the judge whether or not it comes in or stays out.
MS. SANZ: Okay. Do you want to call the judge now, or do you want to do it at the time of hearing?
MS. LORI: Let's do it at the time of hearing, because I think we'll be calling the judge a lot otherwise.
MS. SANZ: Right.
BY MS. SANZ: (Continuing)
Q Go ahead and answer the question.
A Okay. Yes, most definitely.
Q And what are those comments?
A That not just women in general, but particularly American women, uhm, you know, that we're, we don't raise our children right, that we don't care about the children, that we're more interested in, you know, money or success or whatever, than the children.
Q Does he use any kind of descriptive words or, you know, certain language to describe --
MS. LORI: And again, I'm going to object on relevancy. It's going to be ongoing in this situation.
THE WITNESS: Uhm, he, it's, it's cultural, probably, that he uses different words than one normally expects. You know, he has had several instances of when he has been angry at me and talking about spewing children out of my vagina to fail an American society. So it's not your traditional sexist comments; it's, uhm, I don't particularly appreciate having him discuss my vagina with the switchboard operator at work, etcetera.
BY MS. SANZ: (Continuing)
Q He also makes general comments?
A Uh-huh.
Q Not always those specifically concerning you, but general negative comments about American women?
A Right, American women, right. That's the reason he was asked not to come to the little parent toddler group because we have, of course, most of the parents that come with their toddlers are female; so they ended up in a situation where you would have Photius and five mothers and two or three female staff and all the children, you know, seven or eight children; and then he would proceed with what was wrong with American women and how they couldn't raise children right, and how the children were all turning out bad because of their inadequacies, etcetera. And of course there's all these poor mothers that were distressed. And we had asked him to refrain from that several times, and he didn't, so we just said, you're not welcome anymore, I'm sorry.
Q How is this relevant in terms of Teddy?
A Teddy is female, uhm, and he, he has, he does not respect -- and Teddy's American, too. I have never seen him really respect American women; he's always very belittling to us. And this is a female child who, in her, is going to grow up to be an American woman, and who is surely going to hear, and has already heard over and over and over and over again how worthless American women are. So for her self-esteem, it's going to be pretty devastating.
Q How would you say this affects your staff?
A Most of my staff were afraid of him. I mean, a lot of my meetings with, ongoing meetings with the staff regarding how we were handling him were people not wanting to treat Teddy because they were afraid of him, uhm, or they were burned out, they were just emotionally battered by him and asking to be removed from Teddy's care and somebody else taking it, and for me trying to find, one, people that were willing to work, and two, some security measures to give them some sense of confidence.
Q How would you say this would affect Mrs. Coutsoukis?
A What is this?
Q The --
A The sexist?
Q Yes.
MS. LORI: Objection as to speculation, unless she has personal knowledge of this.
BY MS. SANZ: (Continuing)
Q Do you have any -- has he made those types of comments -- well, do you have any basis to have an opinion as to how this affects Mrs. Coutsoukis, do you know?
A Mrs. Coutsoukis has not had specific conversations with me on her self-esteem. She has talked about, you know, being afraid that she didn't want him to find out, you know, she was doing this with the child or --
Q But specifically about --
A As far as treatment?
Q How about specifically about his attitudes or his berating of women?
A I'm still not exactly --
Q Does that, do you think, affect Mrs. Coutsoukis?
A Oh, I'm sure.
MS. LORI: Again, objection as to speculation.
BY MS. SANZ: (Continuing)
Q Do you have reason to know as to whether she is affected by these types of comments?
A She has, she has personally told me that, you know, one, I've seen her cry; uhm, two, she has talked to me about being afraid of him, yes. The specific concrete things like that, yes, she has done. As far as how she feels inside at any depth, she has not.
Q Has Mr. Coutsoukis ever insinuated or actually stated directly that he feels Teddy's medical situation is due to the separation he had with Mrs. Coutsoukis?
A Very clearly and in print, several different occasions, you know, he has said it's because she was in child care. And that's part of the reason that he is so against American women: They put their children in child care. And if he, if Teddy hadn't been abandoned in this child care situation, then yes, this would be a different situation.
Q In your experience and in your training, is it ever possible that separation from a parent can cause the kind of medical situation that Teddy has?
A Not -- I have seen children with significant problems from being separated from their parents; but they're very, very different from Teddy. Teddy is physically different; I mean, if you particularly look at some pictures when she was a year old, she has a kind of a, it was more obvious when she was younger, kind of a square-ish little pixie head that really isn't like either one of her parents. Uhm, she has actual structural, physical structural differences that are more like prenatal, fetal affect of some sort, or an unknown or unrecognized syndrome; it's not anything that neglect or emotional trauma could have caused. And dyspraxia, or apraxia, like we're talking about, the motor coordination problems are not something that emotional trauma would have caused, could have caused in any way, shape, or form.
Q So her actual physical medical situation could not have been caused by any separation that she had?
A Absolutely.
MS. LORI: Well, I'm going to object as to misstatement. I think she's indicating that at least the physical condition was not caused by emotional trauma.
MS. SANZ: Right. And that's what I want to make, that was my point.
MS. LORI: That's fine.
THE WITNESS: Right, the physical looks were not caused. The motor movement could not possibly have been caused. Uhm, her learnings, you know, if you take a child and they have the perfect well-bonded family and you removed that child from the parent, what you're going to get is a child who's depressed, a child who quits eating may lose weight, may have a lack of affect, may do some odd stereotypies, you know, banging their head against the wall, that kind of thing.
BY MS. SANZ: (Continuing)
Q Basically behavioral issues?
A Behavioral issues. And, you know, may get skinny because they're not eating, they're depressed; a lot like an adult in that situation. You don't get abnormal language development, uhm, abnormal ability to talk, abnormal motor planning, all of those things that are her primary big problems. Those don't come as a result of an emotional problem, it's a physical.
Q But is it --
A As in neurological physical.
Q But was it your understanding that Mr. Coutsoukis blames the separation and/or day care --
A Uh-huh.
Q On, uhm, and the reason for that, on -- that that had caused Teddy's physical situation?
A Uh-huh.
Q You're saying yes?
A I'm saying yes. I need to be clearer, sorry.
Q Now, you offered physical therapy to Teddy. And what were the goals you had for that?
A Initially that she could move about in preparation for walking; she was hypertonic, which is also a physical, neurophysical condition that -- and she still is hypertonic, that could not have been caused emotionally. Hypertonic means your muscles are kind of loose as a goose, real, real flexible. And she has always been significantly hypertonic; it goes with apraxia a lot. It means that she can't tighten her muscle up well enough to support a joint.
And when we first saw her, the hypertonia was really interfering with her ability to sit; you know, she would kind of be in a collapsed position, she didn't have enough muscle tone in her trunk to establish sitting. So we wanted to get good trunk tone established as sort of a prewalking on a strength building type of thing, with the eventual goal, of course, that she would walk.
Q Did you come across any problems in providing these services to Teddy?
A Quite a few. The first obstacle was that Photius didn't want us to touch the child. And it's really, really hard to treat a child if you can't touch them. And the, uhm, the initial therapist tried to accommodate that and show, well, okay, this is how, okay, you hold the child, this is how I want you to hold the child, this is how I want you to tip the child. We finally, we had to break down and put our hands on her because we just can't work, it's like asking a physician to treat you but not touch you. Then he didn't, he was --
Q This initial therapist was who?
A I'm trying to think who was, if there was one before David.
Q Shirley Steinson?
A Shirley Steinson is not a therapist. Uhm, I'm blocking on who we had before David. We had a female, we went to David Miller as a PT because we thought maybe Photius would be more comfortable with David.
Q If you don't remember, that's okay.
A And we've been through several for the reasons that I had mentioned earlier. We also wanted to put her on a variety of therapy equipment. It, at that time, and still does upset Photius that we wanted to use therapy balls. There's a very, very good therapeutic reason for needing the therapy balls, and that has always been a bone of contention.
Q What is a therapy ball?
A A therapy ball is a large rubber ball. Most of them are probably -- they come in different sizes, but the one you see most typically is about, oh, 30 inches across. And what you do is you set the child on top of the ball with your hands like at her waist supporting her, and you tend to tip the child one way or the other; and what you're doing is like if I take you and tip you over, your body is going to readjust in space to try to stay straight, to try to stay up. And that's an automatic reflex type of thing. And the therapist uses that, uhm, that built-in programed desire to try to stay upright, to build the muscles and to build the tone and to build the body's ability to respond to gravitational cues, if that makes sense.
Q And Mr. Coutsoukis requested that there not be the use of these balls?
A He absolutely did not want the balls.
Q Any particular reason?
A Because he -- you would have to ask, you know, it was, when we would try to explain why they were good, you know, it was always that he knew best and that's not what he wanted. I can't tell you exactly why because it would sort of get lost in the dialog.
Q All right. You kind of made a remark that you had several staff members work with Mr. Coutsoukis, I take it in the beginning it was Mr. Coutsoukis and Teddy, just the two of them who were handling, who were involved in the physical therapy?
A Or it could have been -- it would be Mr. Coutsoukis and Teddy, but it could be, uhm, Susan Samora and Teddy; but Susan would not allow the child on the balls either because Photius had forbid her to. So she was trying to respect his wishes at that point, too. So even when Photius wasn't around, we couldn't put her on the ball because that was what he had said.
Q In dealing, again, in physical therapy when I asked you initially whether you had problems specifically in your dealings with Mr. Coutsoukis?
A Oh, yeah; and then Susan following his instructions.
Q You had mentioned several staff members worked with Mr. Coutsoukis?
A At some, one point, all of our physical therapists did. Uhm, and --
Q And why was that?
A Because it was so emotionally draining to work with him, it would really burn them out. And with the females, we really did try to accommodate them. And because Susan worked all day, and I don't remember what Photius' schedule and things were, we would end up making physical therapy or speech therapy appointments at 5:00 or 5:30 so that we would end up in situations where there was nobody else around, uhm, except him and/or Susan if it was Susan, and Teddy and the therapist.
And to be berated by him regularly, and/or just to try to get, to say therapy is over now, the half hour is up and for him to keep talking and not drop situations, and you're in a place by yourself with the man, it was very uncomfortable.
Q About how many staff members ended up working with Mr. Coutsoukis?
A Well, we had, let's see, we've had the therapist before David. We've had four PT's I can think of -- I should have probably written all these down -- at least two or three OT's and two or three speech therapists.
Q Okay. Did he ever threaten any of your staff?
MS. LORI: Objection as to personal knowledge.
BY MS. SANZ: (Continuing)
Q Do you know whether Mr. Coutsoukis ever threatened a staff member of yours, was that ever raised, brought to your attention?
A The only time he physically threatened one was David. That is one thing I will say, you know, he never threatened one of the, physically threatened one of the females. He would talk --
Q Who is Dave?
A David Miller is the physical therapist, and he offered to take him out back and punch him out once.
MS. LORI: And again, I'm going to object. I assume you weren't there when this occurred and so it's hearsay upon which you're giving this information?
THE WITNESS: Correct.
MS. LORI: I object, and I move to strike on that.
BY MS. SANZ: (Continuing)
Q Let me make an offer of proof. Is it within your responsibility as director of CDC, would it be a routine matter to be made aware of this type of situation?
A Oh, sure.
Q Would it also be a routine matter for you to have to address the situation?
A Sure.
Q Did you end up having to make certain decisions on how to deal with the, you know, physical threat that he made on Mr. Miller?
A We did not deal with that one, because Mr. Miller felt that he had it under control, he simply refused the offer to go out back.
Q But you tried -- well, by that, I'm getting, you had to try to address that issue?
A Right. What we did in that was to make a decision that we would have no single therapist working, because we were working late. Uhm, David ended up -- I can't remember if Photius didn't want David or if David felt burnt out, too, at that point. We assigned another therapist. All my other therapists are female; and for security reasons, required that the female, that the therapist see him in twos. So we would schedule PT and OT, or OT and speech together so that we at least had a little comfort. But we did a lot of planning that way, okay, how can we handle this.
Q PT is physical therapy?
A Correct.
Q OT is?
A Occupational therapy.
Q Okay. Just for the record. Now, you said he never really physically threatened any of the female staff you had?
A Correct.
Q But were there problems specifically in terms of any anger issues that he --
A He was very angry.
MS. LORI: If I can interject here?
THE WITNESS: I've seen him, yes.
MS. LORI: If you have personal knowledge of this?
THE WITNESS: I have personal knowledge, yes.
MS. LORI: Okay.
BY MS. SANZ: (Continuing)
Q Go ahead.
A Yeah, I have been there, yes. Uhm, you know, he gets in your face; he would try to tell you he wants you to do -- and he has done this with me, you know, I don't want you using those balls, I want you, I want you to train her on stairs, I want you to do it this way. And if you, you know, try to tell him you're the therapist and you know what you're doing, he'll get in your face and he'll say he's the parent and he knows what's best. And he's done that with me and with all the therapist, and he won't let go of it.
Q When he says this, what is his personal, I mean, how do you describe his person?
A In your face big time.
Q Angry?
A Uh-huh.
Q Loud?
A Uh-huh.
Q Out of control? You're saying uh-huh, I assume it's yes?
A Yes. Yes, loud, uhm, I don't know that you can say out of control because he never really hit anybody. But in the pediatric unit, uhm, you could hear him all over the entire unit as well as the hallway that connects it to the rest of the hospital.
Q This is not a situation that happened once or twice?
A No, it was ongoing. We had, uhm, and it was at more than one site, also. We had, he was -- when we finally came to the point where we were saying we will use the ball, we really need to, and we will do it this way, he would get so upset with us, we had security standing by. And he would just be loud and belligerent, and we finally had to ban him from the hospital, uhm --
Q That's at the recommendation of the hospital?
A The hospital attorney.
Q What is his status in the hospital?
A He's persona non gratis. He's only to come to the hospital if he is in a medical emergency.
Q Do you have a lot of parents who fall into that category?
MS. LORI: Objection as to relevancy.
BY MS. SANZ: (Continuing)
Q Go ahead and answer.
A No, I've never done that before, ever.
Q Eventually, because --
A Can I continue on that a little bit?
Q Sure.
A I should say we probably have, at any given time, we always have five or six parents that we consider at risk to us, I mean, where there are really custody issues; and we deal with, at any given time, dozens and dozens and dozens of drug addicts or people that are using, so we're used to having people that are potentially dangerous. But I've never had to do a persona non gratis on somebody else, because it wasn't that ongoing, always happening type of problem that we had with Photius.
Q Do you feel -- eventually he was not involved, physically involved, you know, to be there with the therapy for Teddy, correct?
A Correct.
Q Because of the fact that the hospital had him as persona non gratis?
A Correct. And we actually saw him after that some at our Joy site.
Q Joy site?
A Our Joy Preschool site.
Q It's in a different location?
A It's in a different location. And then when we finally could square away that she could come to toddler school, we could provide the therapies during toddler school and there wasn't any, then we didn't need to see him other than the picking the child up.
Q Was there a time when he wasn't allowed to be in the therapy session at all, but tried to be present by looking through the window?
A Right.
Q Can you describe that?
A That was the last part of the time that he was, uhm, that we were providing therapy at the hospital. The pediatric pavilion at RVMC is totally glassed around on the outside; and we asked, we essentially insisted that he no longer be in the therapy sessions, and Susan backed us up. And then what he would do would be go to the glass window outside and yell directions at us through the glass about, don't put on her on that ball, etcetera.
Q How did that affect the therapy session?
A Disruptive; it's really hard and it was really hard on Teddy because she's got her dad yelling from outside, and she has at that point her mom who would be visibly upset, the therapist treating -- and going back to direct knowledge, I was never the therapist treating in those, but in a lot of that situation I was standing by with security outside, partly because I felt really responsible. This is, this is late in the evening, there's limited people here, I have asked my therapist to stay late to work with this person they're very uncomfortable with; so I ended up just being present to try to assure the best situation we could.
Q What did he actually want?
MS. LORI: Well, objection, I mean, unless she can read his mind, if that was your question.
BY MS. SANZ: (Continuing)
Q What did he actually voice to you as to what he wanted?
A Well, it varied at different times in Teddy's development; uhm, he has had particular things. He really, really wanted us to teach her to walk up and down stairs; he thought if we taught her to walk up and down stairs, that would make her a better walker. We were real resistant to that because she had very, very poor balance because of the motor problems that she had, and just even the idea of working on stairs with her was not therapeutic, and a danger to her.
Uhm, then the most recently, over the last winter, he, we had orthotics for her, he did not want the orthotics; he wanted to put shin guards on her, like little soccer shin guards that would lock her knees straight because that was going to help her walk. And that again is anti-therapeutic and dangerous because what she needed was to be able to flex her knees. And it's, it would be, if I, if I restricted your knees so that you couldn't bend them and then put you on a rolling ship at sea, you would fall pretty quick because you couldn't adjust your balance to the movement of the ship. Well, in a lot of ways, Teddy's body kind of moves like that; she's got a lot of kind of constant movement that she can't control very well, and she needs badly to develop the balance so that she can control the body better. And by locking your knees, you can't, you can't adjust your body on an ongoing basis. So it not only was exactly counter to what would be therapeutic for the child, it was dangerous.
And so we would, we would be in conflicts like that. So we would send her home in orthotics and he would take the orthotics off, put her in shin guards, send her back to school in the shin guards, we would take the shin guards off and put her back in. So it went back and forth.
Q So he's basically self treating the child?
A Right.
Q Do you feel you tried working with him?
A Oh, yes, I really, I really, you know, Photius loves his child and I have no doubt about that at all. And I think part of the reason that he, part of the reason that he took particular offense to me personally was just a response in the beginning when he was so upset and so much in pain about having this child in child care and everything. I spent a fair amount of time and some long conversations trying to reassure him that child care wasn't necessarily bad; that a lot of times it was harder on the parent than the child; that what you needed to do was to take the energy and assure that you had a good child care site and things to look for in a good provider and, you know, you had a responsibility to do that. And I was trying to be supportive and educate him and relieve his bad feelings some.
And that was the basis for his obsession with -- I put my kids in child care, and I don't normally say personal things, but I had said something that, you know, I had put my kids in child care and I know what it's like, it's very difficult, and what you need to do is, you know, just double check your situation and etcetera. And that one conversation was where all of the comments that later came about how I, you know, I was such a bad person because I had put my own kids in child care came from.
Q Now, you mentioned that you deal with a lot of parents who have, you know, a lot of things going on with them, either drug and alcohol issues or criminal activity; what do you think, how would you describe Photius in your dealings with him?
A I think it's not -- we do deal with a lot of addicts and things, but probably the one thing that all parents have in common that is particular to parents we work with is that we are dealing with parents in the very early stages of grief.
Q Grief because their child --
A Because their child is damaged. Most people who have an eight or ten or 12 year old child who's Down Syndrome or cerebral policy have had those years to adjust and accept their child with their disabilities. Those first couple, three, sometimes four years are a very painful time for the best, most well-adjusted family. They have to grieve for the child they thought they were going to have and lost, you know, the future football player or physician or lawyer or whatever they were going to be. You know, you have a dream of a child when you're pregnant with them, and you lose that. And then you have this child who's damaged in their place. And all of the pain and the ambivalence that goes with accepting that, we're used to seeing in all of our parents, whether it's a drug addict or whether it's a physician. And --
Q In Photius, though, you saw this in Photius and in Susan, also?
A Uh-huh.
Q Eventually in Photius, the anger that he was exhibiting never subsided?
A No. The anger, the anger grew, you know, it's, you know, I personally believe from my psychiatric experience that it, you know, he's displacing a lot of his frustration and pain into, and worry into anger, you know, at the American women. Just, you know, it's all their fault; if it wasn't for American women, my daughter would be all right. And he's locked there; he's not making any progress in a grieving process, and moving on to more adjustment and acceptance of Teddy for who she is.
Q You have never seen an improvement?
A Huh-uh. I've seen a worsening, a worsening that concerns me.
Q Do you think that he might be dangerous?
MS. LORI: Objection as to relevancy. And not only that, I don't know when the last time she saw Mr. Coutsoukis, but I would say her information could possibly be dated so her opinion would potentially be invalid.
BY MS. SANZ: (Continuing)
Q Well, let me give a little more background. In your -- you've been dealing with Mr. Coutsoukis and Teddy, the family, up until they moved to New York, correct?
A Uh-huh.
Q And so even though -- are you personally afraid of Mr. Coutsoukis?
MS. LORI: Objection as to relevancy.
BY MS. SANZ: (Continuing)
Q Go ahead and answer.
A Yes.
Q Why so?
A I think, uhm, I -- he's not diagnosed, I am not a physician to diagnose; he appears to me to be obsessive compulsive personality. He's putting a lot of denial in reality and it is mounting. He is a much more intensely unhappy person when I last saw him in April than he was when I first met him in early summer of '95. And when, historically when a person really obsesses on something, like he's obsessing on American women, you're displacing anxiety and displacing pain. But it doesn't heal it, doesn't make it go away. And so if you obsess more because the pain, you know, is greater, then eventually it cracks.
And I have great concerns that Photius could, quote unquote, crack, in the modern vernacular, I guess, and that he could be dangerous to himself and possibly to Teddy.
Q Possibly to Teddy, why so?
A Because if he so strongly believes that our society is awful and his poor child is suffering from our society, and he isn't making any progress in seeing any positive future, uhm, you always worry that there is one way out of that, you know, that he could just, he could take himself and Teddy. And if he doesn't flee to Greece, the other way out is a more violent one.
Q Has he ever talked about fleeing to Greece with Teddy?
A No.
Q How about himself?
A Fleeing?
Q Uh-huh, or leaving?
A No, he's never.
Q Are you afraid for yourself?
A Uhm, I was more so, of course, when he lived here; uhm, not so much as when he's in New York. Yeah, I, I don't think he's stable and I know that he is very unhappy with me, and I sort of am one of the representatives of those nasty professional American women that have screwed his life up so bad. So, you know, I don't sit up nights and worry about it; but I certainly am not comfortable with the man, and can see that he could be dangerous.
Q Now, he's written you a letter, several letters, I understand, one which I'll have marked as Exhibit 1.
(Document was marked for identification as Deposition Exhibit No. 1.)
BY MS. SANZ: (Continuing)
Q Can you please identify this letter?
A Okay. This is one of the early letters that he wrote me, or he -- almost all of them are faxed to me.
Q Is this the only letter that he has written you?
A No, I have a file of them. This was probably a little more polite than several of them. I also have a tape that the staff at one of the sites made when he was being particularly loud and aggressive on the phone.
MS. LORI: Do you still have that tape in your possession?
THE WITNESS: I do.
MS. LORI: Can you produce that to me before the hearing, Cristina?
MS. SANZ: I don't have it in my possession; I learned of it just today.
MS. LORI: Okay.
THE WITNESS: Yeah, see this was, this is, the fax date on this is March 30th of '95, so this was a fairly early one.
BY MS. SANZ: (Continuing)
Q What did you make of this letter? He talks about something about liability?
A Yeah, I think I would need to put my, uhm, it is my standard policy when a parent is unhappy, you know, especially, you know, Teddy was enrolled in our handicap program that is funded with educational dollars as well as medical insurance dollars, and so I have an obligation to a parent when they're unhappy to say, you know, if you don't agree with me, uhm, if you don't, uhm, you know, if I can't give you some satisfaction, then you need to know that I have a supervisor in the regional educational program and you can talk to them or you can file a grievance against me; you know, it's a parent's right, it's legal, you know, you can file a grievance against us and he would get involved. And then if you don't find satisfaction with him, you know, you could take that grievance to the department above that level.
I'm sure that that's what this is referring to, that I was trying to tell him if you're not happy, you know, there are channels that you can go through. And he responded with no intention of suing.
Q You mentioned that there are worse letters that were written by Mr. Coutsoukis to you?
A Uh-huh.
Q Do you remember what some of them said?
A Uhm, he, on several instances, refers to my vagina in different situations. He refers to how I have screwed up my children and how they don't have a chance because I put them in day care, you know. He doesn't even know how many children I have, of course. Just how awful I am, that I really don't have the concerns of the children, that my ambition blinds me to the real needs of the kids. It's, the same theme is here, only it's more offensive.
Q You also mentioned a tape that was made. Was that something that you had planned, you know, a tape of a telephone conversation?
A No. He, my kind of procedure is to say, you know, Photius, I don't want you to talk like that or I find that offensive or I need you to stop that. And then if he doesn't, I hang up on him. And at one -- I hung up on him at the hospital at one point, and he called the Joy site, Joy Preschool site and was demanding to talk to me, and he was very nasty. And I'm really not exactly sure if, if he called a couple of times and they found it so upsetting that they taped it when he called to give it to me.
Q So you did not tape this?
A I did not tape it. My staff was upset by it and thought I ought to know about it, and taped it to give to me. And so it had to be more than one call, because they wouldn't have automatically taped the first call. I don't have the exact -- the reason was they wanted me to know about it. And then he called the security, the switchboard at the hospital and was giving this poor switchboard operator this ranting about --
MS. LORI: Again, objection as to hearsay.
THE WITNESS: Okay.
BY MS. SANZ: (Continuing)
Q There were concerns --
A Yes.
Q -- you got notice later of concerns, security concerns?
A Yes. Security called me at home to tell me what happened with the switchboard and what did I want done about it.
Q By that time, he was persona non gratis at the hospital?
A That was -- I don't believe -- I believe that was the last straw, actually.
Q You have copies of these letters?
A Yes.
Q And you have a copy of this tape?
A Yes.
Q Would you make that available to myself for Ms. Lori?
A Yes, sure.
Q There was one concern, you also received a concern from probably Dr. Williams' staff or from a medical doctor's staff about a physical examination for Teddy; can you relate what that concern was?
A They had actually called my staff asking for some guidance, if there was a better way to work Mr. Coutsoukis; because he had brought Teddy in for an apparent vaginal infection and then he would not let them examine her.
Q Who is they, who called?
A One of the staff at the Medford Clinic had called our people wanting to know is there, is there something you do that will make Mr. -- is there a better way to approach Mr. Coutsoukis that he'll be more comfortable, because he was very inappropriate here, he wouldn't let us touch the child, we couldn't do the exam. And they were concerned. And I didn't have any good advice to offer them.
Q Now, what is your, what -- I'm going to ask you about Mrs. Coutsoukis. When you first met her, did you have concerns about her, about her appropriateness in dealing with Teddy?
A Oh, no. When I, I remember very clearly the first time I met her was when we sat down with she and Photius and I to describe what our program was and how we could meet their needs and sort of get the process going. And she seemed a sad woman at that time, but very appropriate.
Q Was she --
A Kind of quiet.
Q Did she understand everything and, you know, sort of knew exactly how -- I guess what I'm asking was she the perfect parent when you first met her?
A No. No. She's a pleasant lady and also very dedicated to her child. She didn't have a lot of knowledge about a lot of, you know, kind of basic, you know, child development things. What is, what is an appropriate time to be teaching a child colors, for instance, you know, she didn't have that kind of information.
Q Did Mr. Coutsoukis have that?
A No, most certainly not, and still doesn't.
MS. LORI: Objection, lack of personal knowledge on that.
THE WITNESS: That since April, correct, I can't say past April on that.
BY MS. SANZ: (Continuing)
Q Since April of 1997?
A Correct. You know, so she needed to learn a lot about how you talk to a child to enhance language; you know, you don't talk for a child, you wait and ask, you know, wait for the child to answer. You know, those kinds of child development tips or tricks. You know, she didn't have them naturally or, you know, any large experience. She did listen, she did learn, she asked lots of questions, and she seemed to follow through.
Q And in your dealings with her as time went, she was always appropriate?
A Uh-huh.
Q Yes?
A Yes. Yes. Like I said, not the perfect parent as far as knowing everything; but yes, she was always appropriate and nurturing.
Q You had concerns that sometimes you had to work with her to -- that she would be accommodating of the way Photius wanted physical therapy to go or not to go?
A Correct.
Q You found that to be the case?
A Right. If she, it amazed me because she was a professional woman and seemed so in charge in her business life type of thing, but she was very reluctant to do anything counter to Photius. And that was detrimental to the therapy in the beginning in that she didn't want to do things that Photius said no to, even though it was a step for her to stand up to him and say, no, I want, uhm, I want --
MS. LORI: Well, objection as to personal knowledge on that.
THE WITNESS: I've talked to her -- oh --
BY MS. SANZ: (Continuing)
Q Go ahead. Have you dealt with her directly?
A Yeah, we wanted Teddy to come to toddler school, and Photius wouldn't let her. And we had to, you know, kind of -- we approached Susan and encouraged Susan to kind of stand up for that because we thought that was really important that Teddy be around other children for language models; you know, children learn to talk better talking to other children. And so we sort of encouraged -- not sort of, we encouraged Susan to take a stand that she should be able to come to toddler school. And she did, eventually.
Q So she has sort of evolved over time?
A Yes. It was, when I said listen and learn earlier, like she originally said no, no, you can't put her on the ball, you know, that would upset -- and when we explained why, she would go away and think about it and come back and then ask more questions, and then be a little more comfortable with the ball. And so it was a process with her that it was beginning to make sense to her why we wanted to do things with Teddy this way or that way. Uhm, I think she learned a lot.
Q Was she very concerned about the opposition that her husband had and, you know, expressed that towards you, that she was sort of nervous about taking a stand for herself?
A Sure. Sure. Yes, and she has directly expressed that on more than one occasion.
Q You have had an opportunity --
A On multiple occasions.
Q Okay. You have had an opportunity to review Dr. Oas' report that he, I believe faxed a copy or sent you a copy?
A Uh-huh.
Q Yes?
A Yes, he did.
Q And that report is dated May 10, 1997, correct?
A Correct.
MS. SANZ: Counsel, are you going to be submitting that, or do you want --
MS. LORI: Yes, I'm having Dr. Oas, he's going to testify.
BY MS. SANZ: (Continuing)
Q Okay. Now, Dr. Oas never contacted you during the time he was doing this evaluation?
A No.
Q Did he contact any members of your staff?
A No. This came as a complete shock.
Q A complete shock that you received it, or complete shock as to what his findings were?
A Both. You know, we weren't expecting it, and were certainly surprised by the conclusions.
Q Okay. In one of the, in his, in his report, he, I would say he insinuates or maybe makes it that Mr. Photius -- Mr. Coutsoukis stated or implied that Teddy going to CDC was a way of trying to deny access to Photius, to the dad; and that was sort of something that the mother, Mrs. Coutsoukis, was trying to do, putting her child in CDC was a way to deny him access. Did you find that to be the case?
A No. That sort of infers, you know, that Teddy had, was at Child Development like a day care center. And we were only providing her with two days a week for a couple of hours, and then maybe an occasional, toddler school was two days a week for an hour and a half, and then she might have had a therapy time besides that. We weren't talking about great amounts of time that would be used for instead of his custodial time.
Q And, in fact, in your dealings with Mrs. Coutsoukis, did she ever have you try to deny information concerning Teddy to Mr. Coutsoukis?
A The program?
Q Did she ever tell you, don't give Mr. Coutsoukis any information about what's going on with Teddy?
A No, no, no.
Q I don't want him to --
A No. She was, uhm, she did once; it had nothing to do with our program. She had, she was very excited that she had set up a therapeutic horseback riding opportunity for Teddy and was just, she wanted to tell us because she knew that would please us because it is a very nice thing for children, but was very worried that Photius would find out and stop it. So she asked us please at that time, don't tell him, don't tell him I'm doing this with Teddy. That's the only time she ever said don't hold anything.
Q But in terms of your own --
A Our reports and everything, no, she never asked us to withhold anything. And we went to great effort to make sure that he had everything in writing that she had. And, I mean, that's just a philosophical. They're both custodial parents, they had those legal rights, and we tried to be very conscientious about that.
Q Did she act in any way to make you think or suspect her that she was trying to deny Mr. Coutsoukis access to this child, to their child?
A No.
Q Dr. Oas' report, I think later on on page four, makes a statement that "Mr. Coutsoukis sees Mrs. Samora's interactions with Teddy as expedient and parent centered rather than child centered." And I think goes on to say prior, before that, that she's less emotionally ever present with the child. Do you agree with that?
A Actually, I agree with that completely, but not necessarily in the same context. Photius is so overbearing emotionally that it's inappropriate, it's totally overwhelming to the child. Yes, Susan is less emotionally ever present, ever bearing; she's much more appropriate.
One of the concerns with Photius is this very, very strong force; and he also thinks for the child. Uhm, he, he'll tell you what she's feeling. And he'll tell you because, you know, he has this special relationship and this special language with Teddy; but in reality, what he's telling you a lot of times is not possible, it's not developmentally appropriate, and he's, he's thinking for her.
Q Would an example -- was there a concern he had about Teddy putting things in her mouth when she was at that age when she would, when I think young infants or toddlers would try to put something in their mouth?
A Uh-huh.
Q What was his reaction to that?
A Uhm, I can't remember, I'm afraid I can't remember the details to that as accurately as someone else may. I remember it didn't make sense. And when we tried to explain to him that mouthing behavior in young children is typical and it's an exploratory way, it wasn't acceptable. But I can't remember what -- he had, uhm, a whole rationale that just doesn't connect at all, but I can't think of what it is right off hand.
Another example that's more recent is that he would pick Teddy up at preschool and he would go out to put her in the car. And it would frequently take him 30 minutes to get out of the parking lot because he would go to strap her in and she would make some movement or some sound, and so he would have this long conversation with what it was that she really wanted, when she very frequently, I mean, you could watch and tell that she's just being a playful two-year-old operating, testing limits. And he's trying to have a fairly in depth conversation about what her needs were, and reading things back from her, when she's just being a two-year-old.
Q He also makes --
A Let me -- she was three, but she's acting more like developmentally a two-year-old.
Q Okay. Uhm, you made already some comments about day care and his opposition to that. He states that this is a reason for her failure to thrive. Do you see that at all as feasible in this case?
A No. No.
Q You know one of the care takers, one of the former care takers of Teddy, that was Donna Carillo; is that correct?
A Uh-huh.
Q Is that correct?
A Yes, it is.
Q And how do you know her?
A She had a child also that was a special needs child in our program, Caleb, who's a couple of years older than Teddy is.
Q And you met her and observed her?
A Yes.
Q What would you say -- I mean, is she an appropriate caretaker for Teddy?
A Sure, yeah. She was not a really bright lady; she wasn't the cutting edge of, you know, child development philosophy types of things; but she was a very appropriate, pleasant lady, very calm, sort of the salt of the earth type person that wouldn't be too rattled by anything and could take a child for where the child was and work with them there.
Q Do you think if Teddy entered day care in the future, would that be, would that be harmful to her? What's your opinion of that?
MS. LORI: Objection as to speculation; you're asking her to think about something that's going to occur in the future.
BY MS. SANZ: (Continuing)
Q Okay. Let me ask again. She has been in day care in the past; do you know whether that has been a harmful experience to her that has caused whatever medical and behavioral problems that she may experience now?
A There is no way that problems in day care would cause the problems that she has now. I can't speak that, you know, she hasn't been unhappy in a day care, you know, I wouldn't know that, but --
Q And her being around other children who are not impaired can be a positive, or is a positive --
A Very positive, yeah.
Q You actually encourage that?
A Right. And that's, in all of our three and four-year-old preschool sites, we have typically developing children with our handicapped children, specifically for that reason so that we have a model for the children. If we want children to develop good language, they will learn it a whole lot faster from another three and four-year-old than they will from a speech therapist saying, now say this. They're just much more motivated to be like their peers. And so we always look for somebody that's a little more capable for them to model after.
Q One of doctor --
A And they have fun.
Q One of Dr. Oas' recommendations on page six is that Teddy be co-parented with the least amount of interparental conflict. Do you think that's possible in this case from your experience in dealing with both parties?
A It never worked in the time that they were with us, uhm, because Mr. Coutsoukis has his way and his way is the way. And in all, whether it's listening to the therapist or whether it's what the, you know, child needs in feeding, it's his way; and if it's not his way, it's the wrong way. So there's no learning. There has to be give and take, and I have never observed give on his part.
Q On page seven, letter D, he also makes a recommendation that "Teddy develop skills to resolve conflict and calm herself and others when she is thrust into unbalanced environmental or relationship crisis;" what do you think of that recommendation?
A It's not developmentally appropriate. In the beginning, he said that he was going to look at Teddy's developmental needs, and assumptions regarding each parent's capacity; and he never really has addressed Teddy's developmental abilities or understanding. But even if Teddy was a typically developing three-year-old, it is not appropriate that three-year-olds, four-year-olds, even a five-year-old typically developing kid have conflict resolution skills. You start introducing those kind of concepts to late four, early five, in how to not fight with your friend over a candy bar, a very, very concrete kind of thing. Uhm, to be able to handle and balance conflict and stress, particularly in relationships with your parents, is way beyond an impaired three-year-old.
Q There's also a statement he makes in that same page seven that sort of values that if one parent is more available, that that might be the better custodial parent. Do you see -- what really makes the better custodial parent, in your opinion?
MS. LORI: Well, objection. I mean, that's going to open up a whole new subject to debate and I think we'll call the judge on that one; because how I raise my children may be completely different from how you raise your children, and my style may be perfect for my children and likewise yours, but they're completely opposite.
BY MS. SANZ: (Continuing)
Q Well, I'll make it specific to this case. Specific to this case, do you think Mr. Coutsoukis' availability of time with Teddy makes him, per se, a better parent for her?
A No. Mr. Coutsoukis, just like he doesn't listen and learn from adults, he really doesn't listen and learn well from his child. He reads his interpretation of what his child needs, just like when he deals with us, he tells us what needs to happen. He knows what needs to happen for Teddy without really understanding what Teddy's needs are. So Teddy's ability to grow up and tell this man she feels this way and needs this, is essentially non-existent because he knows what she needs. Does that make sense?
Q Yes. Dr. Oas also says that, uhm, describes Mr. Coutsoukis as "a one-dimensional personality and one that he highly values because he knows he has a daughter in crisis and he will not settle for anything less than the best care possible of her." Do you agree with that statement, or how do you respond to that?
A In the entire time that we worked with him, he did, he consistently across the board settled for less than the best care because we offered him the best care and got all sorts of proof that we certainly have the best care. You know, I have letters of recommendation from the State, we have a high quality program; and he consistently would not let us provide best care. So he will not settle for anything less than the best care possible for her is totally untrue; he has never accepted the best care possible for her from the multitudes of conventional people will tell you is the best care.
Q Because he's not open to options?
A Because he's not open to options, and he's not open to thinking about options. If he can't, if he can't change an opinion from constant input, and we all look at any situation and we have incoming information and we change our opinion; and other situations change and more incoming information comes, and we change our opinion. And his rigidity stops him from doing that. So, you know, I see him as an obsessive personality, uhm, that is rigid and certainly not one to be highly valued. Rigidity is not, by most people, considered a valuable parenting, uhm, component.
Q Characteristic?
A Characteristic.
Q Do you think David Oas knows Teddy?
MS. LORI: Well, objection; that's too speculative.
THE WITNESS: Yeah, this report does not say that. There's nothing, I can't say -- there's nothing in this report that says Teddy's abilities are -- and he says he couldn't test Teddy -- uhm, and there's nothing in here that indicates that he has an understanding of her cognitive or emotional abilities. There's actually very little in this report that says what Teddy is able to do.
BY MS. SANZ: (Continuing)
Q In your opinion, what do you see as, you know, if you were to advise the Court as to what you see Teddy's plan should be, what her needs, how she needs to be best cared for, what would that be?
MS. LORI: And just let me interject because I know where you're going to go with this, I'm going to object; I don't think she really has the expertise as does Dr. Oas to make essentially what you're asking her to do, is to make a custody evaluation.
MS. SANZ: I'm asking her to give a description of Teddy's needs, and I think that falls very much in line, whether it be medical or social, with the services that she has been receiving from the center. So go ahead and answer the question.
THE WITNESS: Ask it again, because I'm not --
MS. SANZ: Okay. Can you read that back, please?
(The court reporter then read back as requested.)
BY MS. SANZ: (Continuing)
Q In other words, what does she need?
A Yeah, she needs, uhm, she needs therapy.
Q Physical therapy?
A Physical therapy, occupational therapy, speech therapy, and an educational program that will continue to evaluate her potential, because we do not understand that yet clearly, like I was saying earlier, and will enhance that functional ability as much as possible. She needs, she needs to be getting as much learning opportunity now as possible so that she stands a chance to better fit in with her peers when she's five, six, seven.
Q Okay. And do you have an opinion as to which parent can provide those type, provide for Teddy in that way?
A Between the two, Susan for sure.
Q Why is that?
A Again, I think I sound probably a little like a broken record, because I don't see Photius modifying his thoughts or opinions or, at all; I don't see him learning anything about child development. Uhm, and he doesn't appear to be interested in learning about child development. Uhm, and his, his obsessive personality I still consider is a possibly dangerous situation.
Q How would you see Mr. Coutsoukis being involved in Teddy's life?
A I, I -- and I know Photius will probably have trouble believing this, but, you know, I know he loves this child greatly, and I really appreciate the love that he has for the child and the amount of pain that he has regarding this child. For his benefit, I think he should have right to see the child regularly; I think it would be, you know, sad for him not to be able to. But because he is so inappropriate so frequently, it should be a supervised situation, if I had the say.
Q Okay. Thank you.
{BOn}CROSS EXAMINATION{BOff}
BY MS. LORI:
Q Did you meet Mr. Coutsoukis first then in 1995?
A I'm trying to think if it was '95 or '94, you know, time flies when you're having -- but I've got records here I can look at if you don't know right away.
Q I don't know.
A Okay. I'm getting too old too fast. I don't think that goes on the record.
MS. SANZ: It's all on the record.
MS. LORI: Yeah, I want it on the record.
THE WITNESS: Let's see.
MS. LORI: And while you're looking for that --
MS. SANZ: Do you want to take a break first so she can just go through that quickly and I can go to the lady's room?
MS. LORI: Oh sure. Let me pick up.
(A recess was then taken.)
BY MS. LORI: (Continuing)
Q Back on record. Mrs. Kozol, were you able to find out when you first met Mr. Coutsoukis?
A It was the summer of '94. I believe the first formal meeting was August 23rd of '94; we may have had a shorter one before that.
Q Is it your recollection this it was Mr. Photius who first contacted CDC rather than Dr. Williams?
A No, Dr. Williams talked to me before Photius did, because Dr. Williams warned me about Photius.
Q Do you have any knowledge whether or not Mr. Coutsoukis could have contacted CDC without your knowledge to find out about the program in trying to enroll Teddy in it?
A Just to call in to ask questions? Sure, maybe, a lot of people can call to ask questions. And he may well have called me asking questions; I didn't take a referral from him, though, I took it from Dr. Williams.
Q Now, you're not a pediatric neurologist, correct?
A Correct.
Q And based on what you know of Teddy's conditions, there's no knowledge about how her condition developed, correct? No one can definitively say, yes, it was caused because of genetics; or yes, it was caused because of something that occurred at birth; or this reason or that?
MS. SANZ: Or do you know?
THE WITNESS: I am sure that a physician, a pediatric neurologist, any neurologist would tell you that it was, the great probability, that it was caused before birth. Without being able to identify a specific chromosome, they wouldn't be able to say 100 percent.
BY MS. LORI: (Continuing)
Q But you, yourself, are not a physician, correct?
A I'm not a physician. I have a lot -- occupational therapist in training has lot of neurological training; I've had multiple courses.
Q But you're not qualified to give a diagnosis about whether or not Teddy Coutsoukis' condition was genetically related, or caused at birth, or caused by some other reason; is that correct?
A I did not give a diagnosis. There is no diagnosis.
Q Correct. There's no diagnosis, and you would not be qualified to give such a diagnosis, correct?
A Correct. But that's not what I did. I feel, and I guess somebody could challenge it, I feel like I'm definitely qualified to be able to say that she has a lot of indicators that would indicate that the damage was done before birth, such as facial features, bone structure, motor delay.
Q Is one of Teddy's symptoms, for lack of a better word, somewhat related to epilepsy?
A She has -- no. Uhm, can you ask that more clearly?
Q Does she have seizures?
A Yes.
Q Are those seizures indicative of possibly being some epilepsy being involved with her condition?
A No, can --
Q Can you answer that question?
A Well, let me answer it, if I can make sense. It's more likely that she has, she has brain damage which causes, A, seizures; and B, motor imbalance; and C, cognitive problems. So the epilepsy is a result of a primary problem, not the primary problem. Just like the other factors; the epilepsy is one of the symptoms of the primary problem. Does that make sense?
Q Yes. As I understand what you're saying is brain damage occurred first and epilepsy followed as a result --
A As a result of the brain damage, yeah.
Q Are you aware of whether or not there's any research that neurological damage can result from infantile psychological trauma?
A Other than failure -- okay, again a little more probably complex answer. Neurological damage could result from poor nutrition, which could result from psychological problem. Like we were talking earlier, the child that is significantly depressed may not eat; and if they don't eat, then, you know, and that's a significant enough problem, you could have a neurological problem from that. But that's kind of a more far fetched one.
Q So is it your position -- well, so my question is, are you aware of there being any research on neurological damage being caused by trauma that occurs to an infant, and trauma being defined by some emotional event as opposed to a physical event? And I'm asking whether or not you know of any research on that?
A No. No. Uhm --
Q And what I'm pulling out is Parents magazine dated September 1997, and it's on page 54. And I realize this is not, you know, something; but are you aware of a study that was done examining the orphans in Romania, and a discussion of how the neurological --
A Oh, I'm very familiar with that.
Q And isn't that an indication that lack of contact with people resulted in their nerves not developing as well as they should?
A Yeah. The Romanian children are a classic effect. I did read a bunch of stuff, not that article particularly; in fact, maybe I did read that article if it's about a particular child ending up being adopted. Anyway, again, the children in Romania were taken; and where they have the neurological damage is they didn't have any stimulation. You know, they were put in a crib and they were left in the crib. If you, you either -- you got to stimulate it, you got to use it or lose it kind of thing. All of your brain cells, all of the brain cells you're ever going to have your entire life are formed by the time you're six months olds. And then after six months, it's all downhill; we've been losing brain cells forever. Those brain cells are conceived until six months; and then from six months to about three years they mature, they myelinate, they branch out and make thought ways and pathways, those kinds of thing. If you do not stimulate an organism, it doesn't build brain cells. It's not an emotional thing; again, it's a physiological thing.
Certainly emotional nurturing is a form of stimulation. But those children in Romania were totally ignored; they didn't have the loving cuddling, which is a form of stimulation. And that, to me, is different than like emotional pain because you're away from your parent. What a baby organism, a little person needs, is loving nurturing as a form of stimulation, just like bright colors and sounds are forms of stimulation. If you remove a child from a parent, that's not saying you're removing a child from stimulation. Uhm --
Q Are you assuming that if you remove the child from the parent, that where that child will end up will have a similar stimulating environment?
MS. SANZ: I'm going to object as to relevancy.
MS. LORI: Well, one thing that you brought up on cross-examination is what Ms. Kozol's, somewhat opinion of what had occurred with this child and her pointing to it as being some aspect that occurred at birth; and I think it's pretty clear that, as you pointed out on your direct before that, that Mr. Coutsoukis has a different opinion. And I'd like to explore that with Mrs. Kozol?
THE WITNESS: Yeah. Yeah, what a child needs to develop the brain is stimulation. When you're saying if you remove the child from the parent, there's no stimulation. It's not the removal from the parent that could cause neurological problem; it's the removal from stimulation, appropriate stimulation that could cause the damage. And the kids in Romania got nothing, they got no loving, they got no light, they didn't get fed regularly; and those kids are damaged permanently.
BY MS. LORI: (Continuing)
Q You have no personal knowledge when Teddy first went into day care, whether or not there was any sort of stimulation? That's a fair question, right?
A That is a fair question. And that's what I tried to coach and explain to Photius when I first met him, that that was important, that he had, that it was definitely an important thing for a parent to be responsible for picking out the right child care environment and making sure that it was the appropriate environment. And that all parents needed to take that seriously and not just drop the kid off someplace.
Q If I understand correctly, initially Mr. Coutsoukis attended the appointments that were set for Teddy; is that correct?
A We always invite parents. We really don't have an appointment just for the child, we usually have the appointment for the parent and the child, because it's a learning duet.
Q And until he was banned, he attended almost all of those appointments?
A He was very faithful.
Q Obviously he disagreed about how Teddy should be treated?
A Right.
Q He wanted to be fully participatory in the decisions about how she should be treated; is that correct?
A I would call it more than participatory. I mean, he was always -- we invite all parents to be participatory, not dictatorial.
Q And do you agree that when he was eventually banned from Rogue Valley in attending the therapy appointments, that that must have been extremely frustrating for him?
A Yes, I do.
Q And one of the points I think Dr. Oas is making is his desire to want to participate in the child's life. And you agree that that's what he wants to do, correct?
A I, I don't know that participate is the right word.
Q Okay. Do you agree with Dr. Oas' statement that "He demands that he have the right to guide and direct the network of care that Teddy will receive from others when he cannot be there or when it seems most appropriate to have assistance from professional personnel?" Do you want to see that statement?
A I'm a visual learner, easier.
Q Page six.
A Six, okay. Where on page six?
Q Mr. Coutsoukis will make his relationship with Teddy his top priority. And then the next sentence is he demands --
A He demands that he have the right to guide and direct is not, is understated. He does not guide; he tells. Uhm, and direct the network of care that Teddy will receive from others when he cannot be there or when it seems most appropriate to have assistance; uhm, we, we really value a parent's place, I mean, the parent is the most important place in that child's life. And we strongly want parents to be the primary, we respect them as the primary player. Uhm, but he did not guide. If he took the right to direct the network of care, he certainly did that; I mean, he was very demanding it will be this way.
Q So the answer to the question is he really wanted to participate in Teddy's care?
A For sure.
Q All right. And with Teddy, do you agree that having one-on-one attention is real important for her?
A And what kind of attention?
Q With one person, as opposed to putting her in a day care center where the ratio of staff to children might be one staff to 20 children?
A That's illegal, that doesn't exist.
Q Well, I'm just using that as an example.
A Uhm, I don't believe either one is the way. I think the child needs a balance in both: She should have one-on-one and she should have mixed social situations.
Q But you agree, don't you, that it's beneficial she have one-on-one exposure? I mean, that's important to her, too, right?
A Not if that's all she has.
Q Okay. That's not my question. I'm saying that it's important that she have one-on-one experience?
A For sure.
Q And do you agree that it's preferable that a small baby stay at home with one of the parents as opposed to being put in an institutional day care?
A I didn't know we had institutional day care.
Q The distinction I'm drawing, I suppose, is between family in home care as opposed to institutional care such as what might occur at the YMCA where they have more children, or at Blossom Hills where they have more children?
MS. SANZ: I'm going to object as to relevance.
THE WITNESS: Can I, well, can I make -- if you object, can I still make a statement? Because there are not --
MS. SANZ: What happens is when we object, the judge will rule on that.
THE WITNESS: Okay. In this state, uhm, in order to provide infant care, it has to be a one-to-four ratio; it can't be more than that legally. So when you say institutional day care, that has, uhm, you know, pictures of little kids lined up in Romania; and that's not legal. If the question is, is a child better off at home with a parent or in the legal one-to-four day care center for an infant, whether it's in somebody's home or Blossom Hills, I think it depends on the family.
There are instances where, I mean, if the parents are capable of being good parents, surely the child should be at home. But parents aren't born or trained in this state on how to be good parents. And sometimes that one-to-four child care provider who that's what she does for a living is care for children and she learns about what's appropriate for children, may be a better care provider than the parent who doesn't know what they're doing.
BY MS. LORI: (Continuing)
Q That's fair enough. You're aware that Mr. Coutsoukis wanted to take care of Teddy rather than put Teddy in day care?
A I think so, yes. I got to quit shaking my head, I'm sorry.
Q That's okay.
A Yes.
Q Were you aware that Mr. Coutsoukis had Teddy enrolled in a child care setting at Superior Athletic Club, were you ever aware of that?
A I believe so. I vaguely remember it. I can't, I don't have details to go with it, but it seems like I know that.
Q Could that have been, were you aware that that's possibly why he said don't put her in the toddler school?
A No, I don't have any knowledge of what the experience at Superior Courts was like.
Q But did you know that the reason he, as you said, objected initially to putting Teddy in toddler school was because he may have already enrolled her in the Superior Athletic Club; do you have any knowledge about that?
A No.
Q Now, I thought you also said that --
A Can I -- it's possible, and I'm not absolutely sure that that Superior Athletic Club wasn't open when we were first trying to get her in toddler school. It's a fairly recent, and maybe I'm wrong, the dates could be, but that's a fairly new building.
Q Are you referring to the Superior Athletic Club that's out there on Barnett?
A Yes.
Q Are you aware that there is a much older Superior Athletic Club, I believe located on Cardley Avenue near --
A Well, I know he was going to the one on Barnett; maybe he went to the old one before that, it's possible.
Q So is it my understanding that he initially objected to the toddler school; and then the next time around, Teddy went, he eventually agreed to let her go to toddler school; is that what happened?
A Right. It was about a year.
Q So then the next year, Teddy went with Mr. Coutsoukis' approval?
A I don't know how much Coutsoukis, or Photius approved. I know that Susan said, this year I will make sure that she goes. So the discussion between them, I'm not party to.
Q Okay. So you don't know whether or not, then, the next year he objected or approved; is that what you're saying?
A Well, I mean, whether he approved of the whole thing, I mean, she came, so --
Q And so my question is she came, but you don't know whether Mr. Coutsoukis said I approve or I continue to object?
A I see that in shades, I guess is why I'm sort of hesitating on how to answer it. Because I can't see him ever saying I approve, because he didn't approve of much of what we did. It was how strongly he objected. He obviously didn't object as strongly as he did the first year, or Susan was more adamant because she came.
Q Well, do you have any knowledge about what his reaction was the year that Teddy did go to toddler school?
A Well, he would come and pick her up, and he was frequently again still trying to tell us what to do or what happened, or, uhm, or how we weren't doing things right.
Q But did he tell you, I object to her going to toddler school?
A No.
Q As part of the evaluation that CDC -- and by using CDC, I'm referring to Child Development Center -- did they go to Mr. Coutsoukis' home and look at the home area?
A Uhm, I would have to go back and look at the record because it would have been Shirley Steinson. And when we first started serving them and they were still together, I'm sure she was at the home. When she quit going to the home, I would have to go back to the records to look.
Q Is your answer that, yes, the home site was looked at --
A Yes.
Q -- whether or not Mr and Mrs. Coutsoukis were living together or apart?
A Yes. Yeah, I do not know if we went to his home after they were separated or we only went to hers; I can't tell you that for sure. But I know in the beginning when they were together, we were going into the home.
Q In any of the reports that -- and it was Shirley Steinson, was that her name?
A Correct.
Q When she did these home evaluations, did any of them reflect a negative evaluation concerning Mr. Coutsoukis and his care for Teddy?
A I would have to go back and look specifically at all the records.
MS. SANZ: I would object. She is going to be based on speculation.
BY MS. LORI: (Continuing)
Q Then go ahead and look through your records so you don't speculate.
A Okay. You want to just take a break like you did before, for a while?
Q Yeah, let's just go off the record.
(Discussion off the record.)
THE WITNESS: The question was did she ever find anything wrong in Photius, or anything --
BY MS. LORI: (Continuing)
Q -- negative concerning his care for Teddy?
A Okay. Uhm, I'm not totally done with all of this, but I, I'm up past the separation. And most, when we chart on children, it's mostly what the child has done. But there is no instance of anything wrong with the home. There's nothing -- you're asking if we ever saw him do anything wrong, or if there's anything wrong with the home setting? I'm sorry to be obtuse.
Q If there was anything in those reports that show that he was doing something wrong with Teddy, something negative about his dealings with Teddy?
A I would not say anything negative. There are comments about his interpreting sounds to mean things, you know, that aren't necessarily developmentally correct. But there's nothing in the full text of something wrong, no. Maybe not the best choice, but nothing in a full negative sense. Is that clear enough?
I will go farther and say I know that none of us have ever seen him do anything that was deliberately hurtful to her in any way, shape, or form. It may be inappropriate and it may not match what was going on, but I've never seen him be, you know, deliberately hurtful to her. He's done inappropriate things, like he's called -- oh, calling Susan, you know, names in front of her that isn't the best choice at the moment, but wasn't meant to be harmful to the child.
Q He's very caring about Teddy; isn't that correct?
A Right. Right.
Q Do you agree that at least part of Mr. Coutsoukis' behavior stems from his concern about Teddy?
A Oh, no doubt.
Q And do you agree that a family breakup is an extremely stressful situation?
A Yes.
Q And do you agree that having a special needs child, and that's how I'm calling Teddy, I don't know if that's how you, in your profession --
A Special needs is actually more appropriate than handicapped these days.
Q And that that certainly is a stressful situation?
A That's what I was saying earlier, also, it's extremely stressful.
Q And the parents have to go through a process to learn to adapt to that unanticipated event?
A And we have a much higher rate of divorce among our parents than parents in the general population, because it is an extremely stressful situation to deal with -- to deal with adjusting to a special needs child is a heavy duty strain on a marriage.
Q Do you know whether or not the Coutsoukis' had moved from, say California to Oregon?
A Where they came from?
Q Yes.
A Uhm, I remember talking about where they came from in the beginning, I mean, they just had arrived; they hadn't been here that long. I can't tell you, I thought they came from back east.
Q Okay. But you had an impression that they had not lived here in Oregon for a long period of time?
A Correct.
Q And that they had just moved from a place out of the state, correct?
A They actually had been in Greece, I think, until not too far -- I think they were, you know, my memory, which could be faulty, was that they were in Greece; they, uhm, came back to the states, they were maybe briefly on the east coast, and then they landed here.
Q And you know that Mr. Coutsoukis was born and raised in Greece, correct?
A Correct.
Q And he's living in what, from his prospective, is a foreign country, meaning the United States of America?
A Correct.
Q And you recognize that that is a potential stressor, as well, living in a foreign country, correct?
A Sure.
MS. SANZ: Objection as to relevance.
BY MS. LORI: (Continuing)
Q With all those stressors -- the breakup of the family, the type of child that's involved here, the moving around, the living in a foreign country -- can you appreciate the amount of stress that Mr. Coutsoukis was undergoing?
A And actually I thought I tried to say that earlier when I was talking about my concern for his mental health. Yes, I think he's under an enormous amount of stress.
Q You're not saying that his behavior is a permanent feature of his character, correct?
A The level of his behavior at the moment; I would not see as a permanent feature. You know, we all have a tendency, you know, he could have a tendency to be an obsessive compulsive personality, but that not be extreme until he's under a lot of stress.
Q And if those stressors are removed from his life, then he would, most presumably, be someone who would not be so objectionable to you, correct? I mean, don't you think part of what was going on was he's trying to deal with all these things that are falling apart with his life; and the way he's trying to deal with it is, according to you, having disagreements about American women, and displacing, and all those other things?
A Yeah, his, his way of dealing with all those stressors is maladaptive, which creates more stressors, which makes the situation worse, so it is escalating. If you're removing -- how can you remove a special needs child as a stressor? I mean, that stress is there, it's not going to go away.
Q Is it possible for a parent to learn to adapt to a special needs child?
A Sure; the great majority of them do.
Q And once they adapt, the amount of stress that they may previously have been undergoing will be therefore minimized?
A Will be decreased, yeah.
Q So it's possible therefore that that stressor will lose its importance in a person's life, or lose the effect it was causing in that person's life, correct?
A If you handle it. I mean, that was the concern I was trying to express earlier, was I don't see any evidence of him working through that grief and working through those stresses; he's stuck in it.
Q Do you think that banning him from the sessions with his daughter and from Rogue Valley Medical Center, do you think that compounded his problem or helped his problem?
A Oh, I'm sure it compounded it. There is a limit to abuse to others, though.
Q And so do you think that if he's permitted to participate in his child's life, that that would ease the frustration he experiences by not being able to participate in it currently?
A No; because by participating in his child's life, he has to have control of everything around it, and that's not realistic. And as long as that conflict with realty exists, the stress isn't going to go away.
Q This may be a chicken in the egg question, but you don't know what Mr. Coutsoukis was like before you met him in 1994, correct?
A No. I have asked, because I was concerned about whether, when I, when I became somewhat more concerned for my personal safety, it was of importance to me if this man has always been like that or if he was escalating. And I asked his wife, who said that, no, he has not always been like that; he has always been an obsessive type of personality that was real detailed and really into making sure that things were done just right, but not to the degree that he's been in the last several years. And then over the last three that we have known him, we have seen a distinct escalation.
Q You also mention that going through this process is a process of grieving for a lost child. Now, isn't it true that parents in this situation will have a different way of managing their grief; isn't that true?
A Uh-huh.
Q And in your experience, some may become sad and cry, like Susan Coutsoukis did?
A Uh-huh.
Q And others like Mr. Coutsoukis will want to point the finger at you and you're an American woman; isn't that true?
A Yeah, displacing it, right.
Q And that's a way of dealing with the situation, correct?
A Correct. The difference in this situation is that the three years, it has not improved, it has worsened; and there doesn't seem to be a way to improve it because improving requires change, and Photius has been resistant to change. You have to take in new ideas and new information and move on; and he's not been able to do that.
Q The last contact you had with him was in April of 1997; is that correct?
A Uhm, I, yes, I have not had any contact with him since he moved back east.
Q So you --
A He could have made some changes in the last four months.
Q So you're basing your opinions and interpretation of Mr. Coutsoukis based on your dealings that you had with him between 1994 and 1997?
A Correct.
Q And your interpretations and opinions are based on someone who is living in a foreign country, going through a divorce, dealing with a stressful child, and doing some moves, including, as you understand it, from the east coast to here, and as you understand now, they've moved back to the east coast, correct? That's -- you're dealing with that kind of a person?
A Correct. Again, the stress is great, I would not argue that at all. The level of reaction is abnormal, even to the many stressors. And I know that's partly because his pain is so great; I don't contest that at all.
Q Do you think that perhaps his level of reaction was exacerbated by your decision to ban him from participation in his child's life?
A I'm sure it was. We gave him much opportunity before that, though, to make the change before we had to do that. We didn't just come out of the air and say, okay, you can't come anymore.
Q Right. And I want you to understand, Mrs. Kozol, I'm not accusing you of that.
A Yes, and I understand that. And I'm acknowledging that, yes, that -- actually I say yes, but I don't know because it was so stressful for him that we wouldn't do what he wanted us to do or that we wouldn't agree to what he wanted to; I mean, that was a stressor. At least when he didn't come, he wouldn't put up with that stress; so he's trading off one stress for another.
Q With regard to a parent, doesn't the parent have the ultimate say about what type of treatment his or her child should receive?
A The parent does have the ultimate say; uhm, but we had two parents, and we have always, that's what, in the beginning with the letter that, you know, when I was saying that he has -- every time a parent says, disagrees, and in all therapeutic good conscious we have to do it this way; if you don't like what we're doing, you certainly have a right to push it. You can go to the state, you can file a grievance against us, we will change. And I go out of my way to make sure people know what the phone number is, what the correct name is, etcetera. In this case, if both parents had been saying we don't want you to touch our child, you know, then the choice is we either can touch your child or you need to go find service someplace else. And that's always been an option.
Q And you understand from Mr. Coutsoukis' point of view, you adopted Susan's decision and not his?
A Correct.
Q And you understand that from his point of view, that that is not fair treatment?
A Because, because it's not his way? I, I don't, you know, if it's not his way, it's not fair, yeah.
Q If that's your interpretation of his reason for -- well, let me -- strike that. Is part of the reason why you preferred Susan Coutsoukis' decision making over Mr. Coutsoukis' decision making because you interpreted Mr. Coutsoukis to be so compelled to always have his way?
A What we were concerned about was that a child get appropriate care. Mr. Coutsoukis did not want to provide appropriate care. It would be -- and what you're saying, it would be like you going to the doctor and demanding that he treat you one way and him telling you, no, as a physician, he needs to treat you another; and you say, no, I want it this way. Then what you're asking me is if you don't get it, if the physician doesn't do what you want him to do, then he's not being fair? It doesn't kind of, it doesn't translate.
Q And one of the things you identified as being a bone of contention was regarding these therapy balls?
A Uh-huh.
Q Are you aware of the fact that both Mr. and Mrs. Coutsoukis had consulted with Dr. Skouteli, and I believe that's S-k-o-u --
A In Greece?
Q Yes.
A He said that happened. And we asked him for a report along that line and we never got it. Uhm, see, we have a physician prescription to provide therapy. And we talked to the physician at great length; and when he first became concerned about the balls, we made sure the physician knew what we were doing and was comfortable with it. He said he had this physician from Greece that had some sort of statement about how therapy should be done, but he never produced it. We never saw that report. When we asked for it, then it was in Greek and we didn't receive it.
Q Were you aware that Dr. Skouteli is a pediatric neurologist?
A No.
Q Did I understand you to just say that the report was in Greek?
A Well, when we asked for the report, he said that it was in Greek. And, you know, we said, you know, if we have not got something from this man that we can read, we can't look and evaluate his recommendations of what he's trying to tell us.
Q Are you aware that Dr. Skouteli is a woman?
A No, obviously. We have never received any communication from Dr. Skouteli, either through Photius or directly or in any other way.
Q Do you know whether or not Mr. Coutsoukis' objection to the therapy balls was based on information he had from Dr. Skouteli?
A I would have to venture that it was not, because he complained to them long before he mentioned Dr. Skouteli.
Q And I'm asking, though, if you ever had discussions with Photius in which he told you it was Dr. Skouteli's decision or recommendation that therapy balls not been used?
A He told me, yes, he told me that that recommendation had been made. But it, it counters all medical knowledge that I have ever been aware of. I mean, I can give you tons of information on why therapy balls are used, they're used in every physical therapy office in the United States. So the statement didn't make -- or anyone that works with children anyway -- the statement didn't make sense. And I couldn't get anything in writing to support it. And this was a physician who apparently saw the child in New York but puts a reports in Greek that nobody can read, and he couldn't produce for me. So I could not follow a recommendation that made no sense and that had no support.
Q Did you attempt to contact, yourself, Dr. Skouteli?
A I asked for the doctor's name, address, information, how to write him, and did not get it.
Q Did you ask Mrs. Coutsoukis to provide that same information?
A We were at an IFSP, I believe they were both at, when he made that mention; and I addressed both of them, that it would be very nice to have that information, we would be glad to see it, we would be -- particularly also because I have always been interested in what is the real cause of what's wrong with Teddy. And I was very interested in that report from that point of view, if that physician had any light to shed on what might be a possible diagnosis. I would like very much to have seen that report.
Q If, assuming hypothetically Dr. Skouteli said no therapy balls, would you have deferred to her opinion?
A No, because I had a physician telling me to do it, and that was the treating physician, the primary treating physician, and written a script and was backing the therapy balls. I would have been very -- if the person, if the physician had some reason, you know, that he had found, or she had found, uhm, oh, a cyst in the temporal lobe that was affecting the balance and there might have been some bizarre reason why it wouldn't have been good, I certainly would want to know about it. But if it's a tie in direction, I would go with the primary treating physician, who was Dr. Williams.
Q Do you know whether or not when Teddy did use the therapy balls, if she fell off and bruised herself?
A Well, you don't -- she's not on the therapy ball all by herself; she's got a therapist holding her. There was one point where she fell off, there was a question on whether she really bruised herself. You're only falling 18 inches, if you manage to fall off; and what you're doing is you're wiggling out of the therapist's hands, you know.
Q So the answer to the question is do you know whether or not --
A I do know that there was an incident.
Q Did Mr. Coutsoukis learn about that incident?
A He -- oh, yes.
Q And did that upset him?
A I mean, he's the one that told me. Uhm, I'm sure it did. The point -- it was not -- I know I keep hesitating and probably driving you nuts, but it was not an incident that really wasn't a reportable incident. It was an incident to Photius, but we did not mean in any way to try to hide it from him.
Q Another objectional thing was the use of his knee pads when you wanted --
A The orthotics.
Q -- the orthotics, correct?
A Correct.
Q And the objection that you had about the knee pads is that they would not permit --
A Knee flexion.
Q -- knee flexion. Were these soft pad knees, I mean, soft types of pads?
A He would strap -- when you strap them at the top and the bottom on a knee, you, they're soft but they don't allow the movement on a three-year old, a skinny three-year-old. You can then no longer bend your knees.
Q Did you observe that to be the case --
A Yes.
Q -- that Teddy could not bend her knees with those pads on?
MS. SANZ: You're shaking your head?
THE WITNESS: Yes, I'm sorry.
BY MS. LORI: (Continuing)
Q And do you know personally that it was Mr. Coutsoukis that had put those on as opposed to a care giver?
A I don't know who put them on her; they were put on. He gave us direction to put them on. He wanted everybody to put them on on a regular basis. Whether on any particular day it was him that put them on, or a care giver that put them on at his direction, I don't know. The idea was his.
Q Do you know whether or not his idea stemmed from his consultation with Dr. Skouteli?
A I've never seen that report, so how would I -- no, I don't have that knowledge at all. That would be most peculiar, again.
Q Was Mr. Coutsoukis' intention to help prevent Teddy from bruising herself when she fell?
A I'm sure his intentions were good. We tried to explain to him why they were not safe and counter to therapeutic gains, but he knew what was best, you know, according to him.
Q Did she fall and bruise herself when she was wearing the orthotics?
A She falls and bruises herself all the time. She doesn't have a good sense of balance; I'm sure it's, you know, it's gradually improving, but it's improving at a slow rate. She falls much more than the average child. She also does not have a good sense of proprioception, that's a sense of where your body is in space; and that contributes to some of her falling. It's like you don't know where your body is. We would put weighted vests on her, for instance, to help her have an increased sense of where her trunk was; and he did not like that at all, either.
Q And another bone of contention was, for example, Mr. Coutsoukis not wanting his daughter to be examined in the vaginal area, is that -- you got a phone call from, I assume, Medford Clinic about that incident?
A And all they asked was, you know, was there a way to work with this man better. So I don't know the specific details on what was wrong with her, that's not appropriate.
Q So you don't know whether or not Teddy was protesting, correct?
A No. I -- what they said was that, you know, he was protesting, he was very upset. I don't believe from the conversation that we got that they ever got a chance to touch her for her to protest.
Q And you don't know whether or not the type of examination would have caused Teddy's stress, correct? In other words, if they would have had to put an instrument in her vagina?
A I have no idea what they intended. All I know is that they were kind of at a loss on how to work with Mr. Coutsoukis.
Q Did they give you any explanation about why Mr. Coutsoukis objected?
A No. I mean, it wasn't -- I didn't feel that it was appropriate for me to ask questions about a situation that, you know, I wasn't involved in. It's a medical confidentiality thing; I wouldn't ask.
Q With the evaluations you have done of Teddy, have any of them included measuring her self-esteem?
A You -- there aren't tests that can measure a child's, a non verbal three-year-old's self-esteem; you can only do it by observation.
Q So the answer to my question is no, there have been no evaluations?
A Right, because they're not possible.
Q Have there been any observations made of her self-esteem?
A We do social evaluations and they have self-esteem type questions in them. So a child's social age, uhm, part of that is how you are aware of yourself and how you fit in society. And so there will be questions about does the child like to be the center of attention, and will the child protest, you know, when things are taken away. And those are measures of self, you know, a child with no self-esteem won't. Uhm, so that's, I think, the closest you can get. And yes, we did those kinds of tests regularly.
Q And did you do them of Teddy?
A Yes.
Q And was there any indication that she's suffering from low self-esteem?
A Not on a test. I mean, the being upset when her parents were fighting, you know, was a sadness that I think is typical of most kids when their parents are fighting. Uhm, not, that's, it's a complex question because there are social immaturities, uhm, like not, not really being aware of, or approaching your peers a lot, is that -- so that when you put her with other children, she seems happy enough, but she doesn't know how to play with other children. Is that because she's unsure of herself, or is that because she's really lacking some skills because of her complicated development; that's a real hard one to answer.
Q So isn't it fair to say, then, that you're speculating when you make a statement that what Mr. Coutsoukis says affects Teddy's self-esteem?
A What I said was that if she continued in that model as, you know, this is a man that says, you know, women are no good, American women are no good, and does not allow Teddy the opportunity to initiate activities, uhm, you know, he reads what's happening, he makes up his mind on what's happening, so she has no ability to explore -- I wish I could say this more eloquently -- uhm, if she has no, is not allowed the room to develop her own person and her own likes and dislikes, if she is told how she feels about things, then she can't come up with a normal self-esteem.
Q Are you assuming that Teddy would have the cognitive ability to develop her own identity of herself?
A Oh, yes.
Q So you don't know whether or not cognitively --
A She is cognitively impaired, but she has some very bright capabilities. It's more, it is a big concern to me that she is like a significantly learning disabled youngster more than a significantly retarded youngster. Like on the testing I did, she'll score out at a retarded level; but when you look at the sub scores, some of them are age level and some of the responses that parents, responses that she has learned are inappropriate on a test.
An example of, like when I was testing her and I would give her things to match, she would look at me and wait for me to tell her what to do. She didn't get the game of the matching things. All games are mom wants me to do, dad wants me to do something, I have to learn what they want me to do and then I'll do it. A self initiated matching kind of thing was totally foreign to her.
So she, you know, where we played another game and I played some, and she finally got it, and she could do everything on there at age level. Some other ones that she could do very remedially. So she has distinct inherent cognitive difficulty. She also has learned to do sort of a parrot rote response game that she's played to make her parents happy. And she's very limited in her ability to initiate learning because she's not been given appropriate opportunity by either parent, because Susan didn't really understand that either. And she has some difficulties.
Just, you ask me simple questions and I give you awful complicated answers, I'm sorry. But definitely she has the cognitive ability to have her own self-esteem and will, whether it's good or bad. You can be pretty significantly retarded and have self-esteem, whether it's good or bad.
Q In terms of what have been Mr. Coutsoukis' comments and indications about lacking respect for American women, you can't say whether she'll understand cognitively what that means?
A I would expect that she will, I don't --
Q But can you say today that she would, based on what you know of her, of her current situation?
A The question is will she understand his current opinion of American women? Eventually, you know, if she was a teenager now and he still had the same kinds of opinions of American women, would she understand that and be affected by it, is that what you're asking me?
Q No, I'm saying based on what you know now of Teddy, you can't -- you can strike that. You would, you can only speculate about whether, let's say for example when she's a teenager, if dad's comments about American women would affect her self-esteem?
A I would put salary on it. You can't give -- I'm not the lawyer; but to me, you can't give 100 percent black and white answer on something that's going to happen ten years down the road; nobody can. None of us are that brilliant, but I would sure put money on it.
Q Likewise you can't say because of Teddy and not knowing her full cognitive abilities, particularly since you're indicating she has problems interpreting language, right?
A Understanding it. Interpreting it is a little different word. Yeah, understanding it.
Q Understanding language that Mr. Coutsoukis' comments about American women, that she'll understand what that means and that she'll understand it's a criticism and it's a criticism that effects her? I mean, that takes a lot of cognitive ability to reach the point where she can conclude, hey, this is really an insult to me and it affects my self-esteem?
A If you figure that at three years old, her overall cognitive skills were roughly 15, 18-month-old level, that she's, you know, overall, overly simplified, she's working with half her IQ points. So when she's 14, she has the overall cognitive ability of a seven-year-old -- and that's way oversimplified -- and any seven-year-old can understand a slam like that.
Q But you don't know how far she'll develop, correct?
A Correct. There's no reason to think that she won't continue to develop. And in fact, we're quite hopeful that she's going to. I, while I'm relatively certain that she will never be a, quote unquote, normal child, she has the potential for being awfully close.
Q Now, I think a fourth area where you pointed out Mr. Coutsoukis had problems with the treatment Teddy was receiving was in relation to Mr. Miller, correct, where Mr. Coutsoukis allegedly threatened to punch out Mr. Miller?
A Wanted to take him out back and punch him out, duke it out.
Q Now, that information you received as hearsay, I assume, from Mr. Miller?
A Yeah. And that actually, when I was going back looking at the other records, was we, we did not have a PT that worked with her before David. We assigned David right off because we expected that Photius would be more comfortable with a man because those problems were evident from the beginning. David, you know, went, at that point said, you know, the man is not happy with me, I'm not able to work with him, you know, he's wanting, offering to punch me out, settle things; maybe we need to look at another therapist just because I don't think I'm effective. And that's when we traded off.
Q Do you have any knowledge how Teddy was responding to Mr. Miller's treatment, whether or not Teddy would cry and be hysterical, or whether she would laugh and want to be with Mr. Miller; do you have any knowledge about that?
A I can go and look specifically, you know, I have all the chart notes, again, here. Uhm, that was early on, so I do remember that there was very little handling by David because that was when, that was in the beginning when Mr. Coutsoukis didn't want us touching the child.
Q Do you know if the reason why Mr. Coutsoukis didn't want you folks touching the child is because Teddy might react hysterically if you did touch her?
A I have never seen Teddy react hysterically. She was upset, I mean, one, I have co-therapized with David on many occasions, I know what he works like, and I have been around Teddy when she was upset, cranky upset, tired, have a cold cranky kind of thing. I don't have any knowledge of her ever being hysterical at any time.
Q And likewise, do you have any knowledge about her being upset?
A Cranky cold upset, you know, typical two-year-old I'm tired, I don't feel good, I want to go home. And that's, we have several documentations of that, you know, Teddy had a bad day, had a cold, seemed tired, didn't want to play. We chart that.
Q So then my question is do you know if Mr. Coutsoukis' reason for why he didn't want you folks to handle Teddy was because Teddy might get upset?
A That wouldn't surprise me. But children get upset when you go to the doctor; that doesn't mean you quit taking them.
Q Do you know whether or not Mr. Coutsoukis asked that Mr. Miller not treat Teddy?
A I don't have a memory of that; it doesn't necessarily mean that it didn't happen. Again, we can check the notes if that's important. I do know that we agreed that another therapist might work better.
Q Meaning you and Mr. Coutsoukis agreed, or --
A David Miller and I agreed.
Q In the conversation you had with Mr. Miller, his information about Mr. Coutsoukis saying let's go back out, let's go out in the back and settle this, or something to that effect, Mr. Miller was describing that as being indicative of the relationship not working out, correct?
A Uh-huh.
Q Mr. Miller did not immediately call you up after Mr. Coutsoukis allegedly made those comments, correct?
A No, I think he called me the next day, let's meet, this isn't working, maybe we need to reassign.
Q You have no knowledge whether --
A And he wasn't afraid or over concerned or anything, at that time.
Q Okay. He also never called the police, correct?
A No. David is much bigger than Photius, and I don't think that David was seriously concerned. It was nothing to be fearful about, it was just an indication of inappropriateness in a relationship not working.
Q Now, with regard to Dr. Oas' report, you note in there that Mrs. Coutsoukis admits that she denies Mr. Coutsoukis access to Teddy; did you read that in the report? It's on page three at the bottom.
A Yeah, our statement was that we didn't bring her --
MS. SANZ: Wait. Before you begin, Counsel, what specifically are you relying on?
MS. LORI: She states her reason for denying Mr. Coutsoukis access to Teddy.
MS. SANZ: Well, I'm sorry, bottom of the page?
MS. LORI: Uh-huh. Last sentence.
THE WITNESS: Isn't that worded as now, I mean, that's the whole purpose of the custody thing is that now she is restricting access? I mean, that's, that's a present tense? Will thrive better -- "She states her reason for denying Mr. Coutsoukis access to Teddy is that Teddy will thrive better in a social milieu with a network of caretakers, educators and therapists."
MS. SANZ: I'm going to object, anyway, you know, Ms. Kozol was not present at that time, so she has no basis of knowledge of what transpired between Mrs. Coutsoukis and Dr. Oas.
MS. LORI: Well, Mrs. Kozol did indicate that she thought Susan was not denying access, and I think I'm entitled to --
THE WITNESS: I think what I was trying to say was that we had no knowledge of -- that we only had the child a few hours a week, and that you wouldn't have needed to deny access to Photius in order to provide our service. It's not an either or; so it wouldn't be, no, Photius you can't see this child because she needs to go to child development, like it's a day long program.
MS. LORI: Now, isn't it true that you really don't know what Teddy thinks, correct?
MS. SANZ: Objection as to relevance.
THE WITNESS: Well, and nobody knows what anybody else thinks.
BY MS. LORI: (Continuing)
Q And so for you to say what Mr. Coutsoukis says he thinks Teddy thinks, you can't necessarily say that Mr. Coutsoukis is wrong because you don't know what Teddy thinks, correct?
A Well, he'll make comments that, uhm -- and this may be something in court next week that you might want to use specific examples on -- I mean, he would make a comment on what she's thinking that is beyond her social, cognitive maturity to think.
Q Can you give a specific example?
A I wish I could remember the thing about why she was mouthing things before. Uhm, I've heard so -- the only clear example I personally have is watching him load her in the car and the whole routine as being inappropriate. I know that we have several instances that could be provided next week by other staff; I hate to quote them and not get it accurately.
Q And one of the things you indicated is that Mr. Coutsoukis settled for less than best care, correct, in your opinion?
A In my opinion, right.
Q But you don't know whether or not his idea of how Teddy should be treated came from Dr. Skouteli, correct?
A I have never in my life met a physician, a pediatric neurologist who has extensive child development background and knowledge, to give advice on those types of things. It's usually not a physician level type of thing.
Q You mean a pediatric neurologist would not give advice about whether or not Teddy should use a therapy ball?
A The only way I can conceive of them no using a therapy ball was if there was some bizarre important piece of information that they didn't get to us. But usually physicians, when it comes to whether or not a child should use an orthotic or use a therapy ball or be in a parent toddler group, those decisions are usually left to the therapist because physicians don't necessarily involve themselves at that level. They're physicians and they're not necessarily that tuned in to smaller child development type things; smaller details, I guess.
Q Is it fair to say that if Mr. Coutsoukis is consulting a pediatric neurologist and basing his decisions on those consultations, that --
A Why didn't he share them with us?
Q And then my question for you is perhaps, and I don't want to get into answering your questions, but wouldn't you agree that one major problem that occurred in this situation is there were problems communicating?
A I know we repeatedly, we repeatedly asked him for information from that physician. And if we've got a gentleman who is very, very single-minded and determined that things should be his way and he quotes a physician, and this physician is practicing in New York, but cannot give us a report in English?
Q Okay. Do you know --
A It just didn't seem like it stacked up well; it wasn't something I could trust.
Q Are you for certain that Mr. Coutsoukis told you Dr. Skouteli was practicing in New York?
A He took the child to New York to see this physician, and then couldn't provide us with a report.
Q Do you have any information whether Dr. Skouteli practices in the country of Greece, not New York, in the State of New York?
A She may well practice in Greece, but she saw this child in New York. And Greece may very well be the primary practice.
Q Is there any possibility that in any of the opinions you have given here today, that there's a possibility that somehow you might be in error?
A Oh, for sure. I don't know, I guess for sure is not a good legal response, but I have never, ever claimed to be perfect, never make a mistake; I should be so lucky, especially when it comes to exact dates or an instance like that. I think I have a fair amount of confidence in my medical opinions of her abilities, her future, her strengths, and my concerns about Photius. Sure, I can be wrong, anyone can be wrong; and I certainly can be wrong on details. But I tried; I read up.
Q I don't have any other questions. Photius, do you need to talk to me, or --
MR. COUTSOUKIS: Yes. Can we take a break?
MS. LORI: Sure. Can we go off record?
(A recess was then taken.)
BY MS. LORI: (Continuing)
Q Back on record. Mrs. Coutsoukis -- Kozol, do you have an estimate of how many hours you personally spent with Mr. Coutsoukis and Teddy together?
A Most of my time has been with Mr. Coutsoukis because I have not been a treating therapist to Teddy. I did some testing on Teddy. Most of the time that I have been with Photius and Teddy together, it's been in the background, like I was saying earlier when she would come in for therapy and I would hang around out the door, sort of eavesdrop, listening in to make sure that things were going okay. So not a lot. Uhm --
Q What about just you --
A Ten or 12, maybe.
Q Ten to 12 hours total?
A Uh-huh, I'm guessing.
Q Okay. That's over the '94 to '97 time period?
A Right.
Q What about total hours with just Mr. Coutsoukis personally?
MS. SANZ: Counsel, does that include all communication, or face to face?
MS. LORI: Face to face.
THE WITNESS: Most of our conversations have been on the phone at some length; or Mr. Coutsoukis is quite proficient with the fax machine, he sends me lots, or sent me lots of faxes.
BY MS. LORI: (Continuing)
Q So just on a face to face basis, how many hours would that have totaled?
A We did our IFSP's that I -- that's --
Q Was it less than the ten to 12 hours you spent with Mr. Coutsoukis and Teddy?
A No, I wouldn't think so. Because we've had, uhm, it's kind of hard because like the last IFSP meeting we had was four or five hours long, but it was by telephone again because, uhm, we had had to ban him from those, from the hospital and from the meetings. So face to face with him, it's probably maybe the same amount, maybe less. Actual conversations, though, would be many, many hours.
Q I don't have any other questions.
{BOn}REDIRECT EXAMINATION{BOff}
BY MS. SANZ:
Q How involved have you been, in the scope of your responsibilities, involved with this case of Teddy Coutsoukis?
A I'm sure hundreds of hours. Primarily, uhm, trying, in the beginning, really trying to make all the players happy, including the parents, to be able to meet his needs. We really thought originally that if we start out where who he is at and educate him and bring him along, uhm, things will go fine. So we didn't touch the child, and explained to him why we wanted to. Uhm, all of the therapists have been uncomfortable a lot of time, not just, you know, Shirley Steinson, all of the staff, the family consultants, etcetera, have been stuck, have really wrestled with how much does one personally put up with in order to serve a child. Because we're, our duty is to do the best service that we can for Teddy.
MS. LORI: Can I just object on non responsiveness.
BY MS. SANZ: (Continuing)
Q You answered it, you actually have spent an enormous amount of time assisting this family?
A Right, or the staff serving the family, attempting to serve the family.
Q IFSP meeting, what does that stand for?
A I'm sorry, Individual Family Service Plan. By law and by philosophy, every year we sit down as a team, as a group, the parent, the therapist, the family consultant, the teacher, whoever has been working with the child, and look at how the child has progressed over the last year, you know, what she's made gains in, and identify what is, what are appropriate goals for the coming year. That we want her to be, you know, an example would be Teddy will use two word combinations to indicate needs; that's a real appropriate goal for her. And then we would, we would just sit and talk and write all of those goals. We want her to be able to talk, we want her to be able to walk up and down stairs, you know, whatever.
And when we list all the goals that we want to work on, we being the entire time, then we go back and assign, okay, who is going to do, work on those goals, who's going to be responsible for them, how much service are we providing, etcetera. That happens once a year. And then every six months, we're required to legally to sit down and on paper go over those goals and progress.
Q And in you're dealings with the kind of service you provided for Teddy and her parents, was Dr. Williams made aware, and if so, how often would she be made aware of your evaluations?
A She received copies of everything, the IFSP, the therapist report in conjunction with this meeting. Before that meeting happened, we do evaluations so we can go into that Individual Family Service Plan with accurate information of progress. Those evaluations are sent to Diane -- Dr. Williams. And then the mid year, we do reports to her on how they're doing. And then I, you know, I would have conversations like when the balls were an issue with her to see if she had any problem with them and explained why we were using them, but --
Q Do you know whether Dr. Williams -- you don't actually know whether Dr. Williams was aware of Dr. Skouteli's involvement in depth or not?
A No, I don't.
Q What training have you received in terms of dealing with people who are under the stress, the grieving and the anger issues that tend to come up?
A There is a lot of general training. To me, it was, I always felt like it was an opportunity for me personally to use my psychiatry experience, because these parents are in a very difficult space, and to be able to use some good counseling technique to support them is valuable. But all of my staff have had training in working with parents in the grief process, uhm --
Q When you talked about the stress of the breakup of the family, moving from a new metropolitan, new city to another, and special needs of the child, would you say that Susan was also under a lot of stress?
A Sure.
Q Susan Coutsoukis, of the same kind as Mr. Coutsoukis?
A Sure. They were both under stress, and that was obvious to her, too. It was very painful for her to accept the extent, I mean, she would cry, she would get tearful, she would ask questions. To watch a parent get up the nerve to ask those hard questions about what do you think she'll be like when she's five or six, you can see it's a painful process for both of them.
Q You recognize, or you acknowledge that Mr. Coutsoukis deeply cares for Teddy, but still you recommend supervised visitation?
A Correct. With -- I would expect that if it was supervised, that there would be some responsibility of the supervisor to make sure that it maintained a positive environment.
Q Why do you feel that she needs, Teddy needs the extra protection that it be supervised?
A To ideally, you know, if it was supervised and if he got into sort of a ranting kind of thing like he does about being upset about one thing or the other, that that could be stopped or terminated. And it, you know, I have seen him be very tender and very caring with her; and, you know, if he's in that space, that's fine.
Q But you have also seen him be inappropriately angry when she's around?
A Yeah. And maybe its somebody else, but in front of her. And that could be restricted.
Q And the level of anger and what you called the level of behavior, is how you termed it when you were under cross examination, this level of anger and behavior, that this has been ongoing at least since 1994 when you dealt with him?
A In a distinctly escalating manner.
Q When you decided to, you know, when the hospital actually decided to have Mr. Coutsoukis persona non gratis, what were the factors that you were considering in terms of protection and what led to that?
MS. LORI: Well, objection. I mean, this is asked and answered; we've gone over this. This is improper rebuttal. I think the record speaks for itself on that.
MS. SANZ: I think you asked whether it was, you know, you went over that again on cross, and I want to make sure that we have it in context.
BY MS. SANZ: (Continuing)
Q Were you considering Teddy?
A That, we were definitely considering Teddy in that it took us so long to come to that decision.
Q Were you also considering staff members as well as other patients that you were serving?
A Correct. And other families.
Q When you reviewed Shirley Steinson's report of her going to the home, do you know whether you reviewed all the records, all her reports?
A No. As you can see, there's quite a thick file here. Uhm, I wouldn't -- you would have to give me the date. I have, I can say that I have never recollected her saying that he was doing anything deliberately harmful to her in any way, shape, or form; again, using poor judgment in some things. But I am sure if he had done something -- the only instance of deliberate possible harm ever mentioned was when he sat her in front of the car --
MS. LORI: Objection as to lack of personal knowledge.
BY MS. SANZ: (Continuing)
Q Do you know of an event that put Teddy in some danger, something to that effect?
A Correct, that he --
MS. LORI: And again, I'm going to object, not only on lack of personal knowledge, but also on relevancy.
BY MS. SANZ: (Continuing)
Q I think it's relevant. Go ahead and answer, briefly.
A Okay. He -- I had mentioned earlier that we had trouble when we had these sessions at the end of the day getting him to stop or to basically shut up. And one of the therapists could not shut him up, or stop him, and she simply said the session is over, and walked out. And he followed her out and was talking at her. And she was attempting to leave, and he sat Teddy down -- that was before Teddy could walk -- he sat Teddy down in front of her car to keep her from leaving.
Q And this was reported to you again?
A Yes.
Q Now, there was, one of my last questions is you feel that he intends to do the best thing for Teddy?
A Yes, I do, I believe that.
Q To participate in therapy, correct?
A I believe that.
Q But the outcome tends to be, the end result and how he behaves and how he deals with you or Teddy or the staff tends to be dictatorial?
A Correct.
Q Thank you.
{BOn}RECROSS EXAMINATION{BOff}
BY MS. LORI:
Q With regards to the parking lot incident, you didn't see it, correct?
A Correct.
Q And it was reported to you second or third hand, correct?
A By the therapist that was involved, in tears, who wanted not to work with this family anymore.
Q You have no evidence that Mr. Coutsoukis has been violent or angry or any way hostile to Teddy, correct?
A Correct. I've never said that he was hostile to Teddy, just that he was inappropriate toward her.
Q And likewise, he's never been angry towards Teddy, correct?
A Not to my knowledge.
Q With regard to the home study, if Mrs. Steinson had found something amiss, she would have brought it to your attention, correct?
A Yes. I actually started to say that earlier. I'm sure that if there's been something wrong, she would have said something.
Q I have no further questions.
MS. SANZ: No further questions.
(The deposition of Ms. Kozol was then concluded at 4:50 p.m.)
{BOn}CERTIFICATE{BOff}
STATE OF OREGON )
) ss.
County of Jackson )
I, Debra J. Dugan, a Registered Professional Reporter and Certified Shorthand Reporter for Oregon, do hereby certify that, pursuant to the stipulation of counsel for the respective parties hereinbefore set forth, BARBARA LYNN KOZOL personally appeared before me at the time and place mentioned in the caption herein; that at said time and place I reported in Stenotype all testimony adduced and other oral proceedings had in the foregoing manner; that thereafter my notes were reduced to typewriting under my direction, and that the foregoing transcript, pages 1 to 118, both inclusive, constitutes a full, true, and accurate record of all such testimony adduced and oral proceedings had, and of the whole thereof.
WITNESS MY HAND AND CSR STAMP at Medford, Oregon, this 10th day of September, 1997.
_____________________________
Debra J. Dugan, RPR, CSR
Certified Shorthand Reporter
CSR No. 90-0095