SHERIDAN — If it wasn’t written down, it didn’t happen.

Delineation of whether nurses properly documented and cared for the actual needs of a patient were under scrutiny in day four of the civil trial filed by Neal Schuman against Sheridan Memorial Hospital for negligence and medical malpractice.

Five witnesses called by the defense testified: Sara Smith, a general surgeon who operated on Schuman for his Fournier’s gangrene; Michelle Rudolph, an expert reviewing charting and documentation completed by nursing staff for Schuman; JD Linn, a nurse overseeing care for Schuman in the intensive care unit; Brian Laman, Schuman’s orthopaedic surgeon; and Leah Bjord whose testimony was given via video recording from her deposition.

Proof of adequate care and documentation of that care dominated the testimonies of Linn and Bjord, who cared for Schuman between Aug. 4-6, 2015, in the intensive care unit. Linn transferred information to Bjord regarding a small black/yellow mass he had discovered while caring for Schuman on night shift. Counsel produced Linn’s charts and confirmed his observation.

In his testimony, Linn assured that the mass had no fluids oozing out of it and it was not red around the mass, a symptom that could indicate infection. Linn verbally relayed the message to Bjord in the nurse debriefing that routinely takes place during a shift change. Bjord completed her own assessment of Schuman and discovered a foul odor coming from the spots, which were located between the patient’s buttocks cheeks, while doing a check up. She ordered a shower and reevaluated the spots before sending him in the shower with another nurse.

Bjord testified to immediately going to tell the doctor, Derek Gilbert. Both Gilbert, the hospitalist overseeing Schuman’s care, and Smith both responded to the room and discussed a care plan that included surgery for Schuman. Smith testified to her experience with Fournier’s gangrene and that it cannot be resolved by using antibiotics, but instead is resolved through surgery to remove the dead tissue that is Fornier’s gangrene. Schuman’s attorney, Drake Hill, questioned Smith about the possible cause for the gangrene; implying it could’ve been due to fecal matter passing through a tear inside the rectum caused by improper administration of an enema.

Defense attorney Scott Ortiz attempted to show with the defense’s second expert witness, Rudolph, that nursing staff properly documented throughout Schuman’s stay. Hill then questioned Rudolph’s credibility in knowing anything that was not in written documents, indicating if nurses and doctors did not write things down — like complaints of pain and a swollen groin from Schuman and his family — they did not happen. Smith testified that Schuman’s chance of survival beyond surgery because of the Fournier’s gangrene was about 50 percent. In cross examination, Hill indicated testimony by Schuman of his pain level reaching a 10/10 due to a painful enema administration, and Smith responded that she was aware of that and said before being told that information, she had a difficult conversation with the family and said people often try to find things to blame when hearing traumatic news.

Day five of the trial will include a final set of witness testimonies followed by jury deliberations.

*Editor’s note: This article has been corrected to accurately reflect from where information regarding Schuman’s 10/10 pain came.