Maureen Frikke, MD
9 MAUREEN JANE FRIKKE,
10 BEING FIRST DULY SWORN, WAS EXAMINED AND TESTIFIED
11 AS FOLLOWS:
12 DIRECT EXAMINATION
13 BY MR. MAJOR:
14 Q. WOULD YOU STATE YOUR NAME AND SPELL YOUR LAST NAME FOR
15 THE RECORD?
16 A. MY NAME IS MAUREEN JANE FRIKKE, F-R-I-K-K-E.
17 Q. WHERE ARE YOU EMPLOYED, MS. -- OR DR. FRIKKE?
18 A. I'M EMPLOYED AT THE -- BY THE DEPARTMENT OF HEALTH AT
19 THE OFFICE OF THE MEDICAL EXAMINER.
20 Q. AND WHAT ARE YOUR DUTIES THERE?
21 A. I'M ASSISTANT MEDICAL EXAMINER, AND OUR DUTIES ARE TO
22 INVESTIGATE DEATHS THAT FALL INTO A NUMBER OF CIRCUMSTANCES
23 THAT ARE DEFINED BY THE MEDICAL EXAMINER'S ACT.
24 Q. AND DO YOU WORK WITH DR. GREY?
25 A. I DO.
2029
1 Q. AND HOW LONG HAVE YOU WORKED AT THE MEDICAL EXAMINER'S
2 OFFICE?
3 A. I'VE BEEN EMPLOYED THERE SINCE AUGUST 1ST OF 1991.
4 Q. AND WHAT TRAINING AND EXPERIENCE HAVE YOU HAD? COULD
5 YOU GO OVER THAT FOR US?
6 A. I HAVE A DOCTOR OF MEDICINE DEGREE. I COMPLETED
7 INTERNSHIP AND RESIDENCY IN PATHOLOGY. I COMPLETED A
8 ONE-YEAR FELLOWSHIP SPECIALIZING IN FORENSIC PATHOLOGY, AND
9 I HAVE WORKED SINCE 1991 FULL TIME AS A FORENSIC
10 PATHOLOGIST.
11 Q. OKAY. DURING THAT PERIOD OF TIME, DO YOU HAVE AN
12 ESTIMATE OF HOW MANY AUTOPSIES YOU'VE PERFORMED?
13 A. I DO BETWEEN THREE TO 400 AUTOPSIES PER YEAR.
14 Q. OKAY. AND DO YOU ASSIST IN OTHER AUTOPSIES?
15 A. OCCASIONALLY.
16 Q. OKAY. HOW MANY WOULD THAT BE? DO YOU KNOW?
17 A. OUR OFFICE HAS JURISDICTION -- WE INVESTIGATE
18 APPROXIMATELY ONE AND ONE HALF THOUSAND CASES PER YEAR, AND
19 I SEE MY SHARE OF THOSE, WHICH IS ONE-THIRD OF THOSE, AND I
20 SEE A FAIR NUMBER OF THE OTHERS THAT THE OTHER DOCTORS
21 PERFORM.
22 Q. AND YOU ALSO HAVE ATTENDED COURT AND TESTIFIED
23 CONCERNING YOUR FINDINGS?
24 A. I HAVE.
25 Q. AND HOW OFTEN WOULD YOU SAY YOU'VE DONE THAT?
2030
1 A. A COUPLE OF TIMES A MONTH.
2 Q. AND YOU HAVE BEEN QUALIFIED IN THE PAST AS BEING AN
3 EXPERT IN THIS AREA; IS THAT CORRECT?
4 A. I HAVE.
5 Q. THANK YOU. LET ME ASK YOU, DO YOU RECALL AN AUTOPSY
6 THAT YOU PERFORMED ON ONE MARY CRANE?
7 A. I DO.
8 Q. AND DO YOU HAVE YOUR NOTES AND REPORTS ON THAT?
9 A. I DO.
10 Q. AND WHEN DID YOU PERFORM THIS AUTOPSY?
11 A. IT WAS DONE ON JUNE 24, 1999.
12 Q. AND WHAT WERE THE CIRCUMSTANCES SURROUNDING THE BODY
13 ARRIVING AT YOUR FACILITY?
14 A. THE BODY WAS EXHUMED FROM THE GRAVEYARD, WAS TRANSPORTED
15 TO OUR OFFICE. AND THE FIRST TIME I SAW MARY CRANE WAS WHEN
16 I SAW HER COFFIN.
17 Q. AND WHO WAS PRESENT WHEN THE AUTOPSY WAS PERFORMED?
18 A. THE OFFICIAL OBSERVER AT THAT EXAMINATION WAS DETECTIVE
19 JOE MORRISON.
20 Q. AND JUST FOR THE RECORD LET ME ASK YOU THIS. DR. GREY'S
21 TESTIFIED SOMEWHAT TO THE PROCEDURES AND WHAT OCCURS AS FAR
22 AS THE AUTOPSY IS CONCERNED. DO YOU FOLLOW PRETTY MUCH THE
23 SAME PROCEDURES THAT HE -- HE DOES?
24 A. I DO.
25 Q. AS FAR AS THE ORDER AND WHAT YOU DO?
2031
1 A. YES.
2 Q. OKAY. SO WHAT WAS THE FIRST THING YOU DID AS FAR AS THE
3 AUTOPSY ON MS. CRANE?
4 A. WELL, THE FIRST PART WAS ACTUALLY OPENING THE CASKET,
5 EXAMINING HER AS SHE LAID THERE, AND THEN REMOVING HER,
6 DOCUMENTING HER EXTERNAL APPEARANCES, AND THEN UNDRESSING
7 HER.
8 Q. OKAY. AND WHAT DID YOU OBSERVE, IF ANYTHING, DURING
9 THAT PHASE?
10 A. SHE WAS FULLY CLOTHED IN THE BURIAL GARMENTS THAT SHE'D
11 BEEN PLACED IN. SHE HAD A LOT OF SIGNS OF HAVING BEEN
12 BURIED OR ENTOMBED AND THAT INCLUDED -- POSTMORTEM CHANGES
13 INCLUDED GROWTH OF MOLD ON HER BODY, SOME DETERIORATION OF
14 HER TISSUES, DETERIORATION OF MATERIALS THAT HAD BEEN PLACED
15 IN THE CASKET WITH HER.
16 Q. AND WHAT WAS THE NEXT THING YOU DID AFTER THE VISUAL
17 OBSERVATION?
18 A. WE REMOVED THE CLOTHING AND THE PERSONAL EFFECTS THAT
19 WERE WITH HER. WE ATTEMPTED TO REMOVE SOME OF THE FUNGAL
20 GROWTH FROM HER SURFACE OF HER BODY, AND THEN EXAMINED HER
21 AGAIN.
22 Q. WHAT, IF ANYTHING, DID YOU FIND, DOCTOR?
23 A. SHE WAS -- APPEARED TO HAVE BEEN A WELL-NOURISHED LADY.
24 SHE WAS ABOUT 4'11. SHE WEIGHED 130 POUNDS. SHE HAD A
25 SURGICAL SCAR ON -- ON THE FRONT OF HER ABDOMEN THAT WE
2032
1 COULD IDENTIFY. OTHER THAN THAT, HER EXTERNAL PHYSICAL
2 APPEARANCE WAS RATHER UNREMARKABLE.
3 Q. AND AFTER YOU DID THE EXTERNAL EXAMINATION, WHAT WAS THE
4 NEXT THING YOU DID?
5 A. THEN WE CONDUCTED THE INTERNAL EXAMINATION, WHICH IS
6 OPENING UP ALL OF THE BODY CAVITIES, REMOVING THE ORGANS AND
7 DISSECTING EACH OF THOSE ORGANS INDIVIDUALLY.
8 Q. AND DID YOU DO THAT BOTH MICROSCOPICALLY AND GROSSLY?
9 A. I DID. THERE WAS GROSS EXAMINATION WHICH IS OF THE
10 ORGANS THEMSELVES, AND THEN MICROSCOPIC EXAMINATION OF
11 SELECTED PORTIONS OF THOSE ORGANS.
12 Q. AND WHAT WAS THE -- THE FIRST ORGANS THAT YOU LOOKED AT
13 OR WHAT WAS THE PROCEDURE YOU FOLLOWED THERE?
14 A. THE SEQUENCE THAT I EXAMINED AFTER -- THAT I USE WHEN
15 THE BODY IS OPENED AND THE ORGANS ARE REMOVED IS THE
16 SEQUENCE IS I EXAMINE THE HEART, THEN I DO THE LUNGS -- THE
17 RIGHT AND THE LEFT LUNG. THEN I EXAMINE THE LIVER, THE
18 KIDNEYS, THE SPLEEN, AND THEN WHATEVER -- THE
19 GASTROINTESTINAL TRACT, WHICH IS THE ESOPHAGUS, THE STOMACH
20 PANCREAS, INTESTINES. WHATEVER GENITAL ORGANS MAY BE THERE
21 ARE EXAMINED. WE EXAMINE THE INTERNAL BODY CAVITIES AND
22 THEN THE BRAIN IS REMOVED AND EXAMINED.
23 Q. OKAY. BEFORE WE GET INTO THAT, LET ME GO BACK AND
24 PERHAPS REFER YOU TO PAGE 4 OF YOUR REPORT AND ASK YOU, WHEN
25 YOU DID THE EXAMINATION -- THE EXTERNAL EXAMINATION OF THE
2033
1 BODY, DID YOU FIND ANYTHING UNUSUAL ATTACHED TO THE BODY?
2 A. THE ONLY THING UNUSUAL ATTACHED TO HER BODY -- OTHER
3 THAN HER CLOTHING AND -- AND BURIAL GARMENTS -- WERE A
4 COUPLE OF ADHESIVE PATCHES THAT WERE ON HER BACK THAT WERE
5 LABELED DURAGESIC.
6 Q. AND DID IT INDICATE HOW MUCH THEY WERE, WHAT LEVELS THEY
7 WERE?
8 A. ONE OF THE PATCHES WAS LABELED AT 50 MICROGRAMS PER
9 HOUR, AND THE OTHER PATCH WAS LABELED AT 25 MICROGRAMS PER
10 HOUR.
11 Q. OKAY. WAS -- DO YOU KNOW WAS THAT -- THOSE PATCHES
12 TESTED?
13 A. THOSE TESTS -- THOSE PATCHES WERE SENT TO THE FORENSIC
14 TOXICOLOGY LAB AND THEY WERE IDENTIFIED AS CONTAINING A DRUG
15 CALLED FENTANYL.
16 Q. OKAY. SO NOW GETTING INTO THE INTERNAL PARTS OF THE
17 BODY, WHAT DID YOU DO AS FAR AS THAT EXAMINATION WAS
18 CONCERNED?
19 A. THE ORGANS WERE REMOVED. THEY WERE WEIGHED. THEIR
20 GROSS ANATOMY WAS EXAMINED. THEY WERE SECTIONED -- YOU
21 KNOW, CUT INTO SECTIONS AND PIECES WERE REMOVED AND SAVED
22 FOR MICROSCOPIC EXAMINATION.
23 Q. AND CAN YOU DESCRIBE WHAT YOU FOUND WHEN YOU EXAMINED
24 THOSE ORGANS?
25 A. THE ORGANS -- HER HEART WAS ENLARGED RELATIVE TO WHAT I
2034
1 WOULD EXPECT FOR HER AGE AND HER SEX. AND, IN FACT, THE
2 THICKNESS OF THE MUSCLE WALL OF THE HEART WAS DEFINITELY
3 ENLARGED.
4 HER LUNGS, ON GROSS EXAMINATION, APPEARED TO BE QUITE
5 UNREMARKABLE. IT WAS CLEAR THAT A PORTION OF HER STOMACH
6 HAD BEEN REMOVED IN THE PAST. IT WAS SMALLER THAN NORMAL
7 AND THERE WERE SURGICAL SCARS AND THINGS ON IT. HER LIVER
8 WAS UNREMARKABLE.
9 HER KIDNEYS HAD A LOT OF GRANULARITY TO THE SURFACE,
10 WHICH IS ABNORMAL. ONE OF THE KIDNEYS HAD ON ITS SURFACE A
11 SMALL FLUID-FILLED CYST WHICH IS NOT UNUSUAL. WE SEE THAT
12 FAIRLY REGULARLY IN PEOPLE.
13 HER GALLBLADDER HAD A SMALL AMOUNT OF FLUID IN IT WHICH
14 WAS STAINED GREEN. THE SPLEEN AND LYMPH NODES WERE
15 UNREMARKABLE. HER PANCREAS WAS NORMAL. THE ADRENAL GLANDS
16 WERE UNREMARKABLE. HER GENITAL ORGANS, INCLUDING THE
17 OVARIES, FALLOPIAN TUBES, UTERUS, CERVIX WERE UNREMARKABLE.
18 HER BRAIN WAS UNUSUALLY SMALL FOR BOTH HER GENDER AND
19 HER BODY SIZE. AND THERE WAS VERY CLEAR EVIDENCE THAT AT
20 SOME TIME IN THE REMOTE PAST SHE HAD HAD A STROKE.
21 Q. NOW, LET'S GO BACK A LITTLE BIT AND GET A LITTLE BIT
22 MORE DETAIL. FOR EXAMPLE, YOU INDICATE YOU DID THE
23 EXAMINATION OF HER HEART; IS THAT CORRECT?
24 A. CORRECT.
25 Q. AND BOTH GROSS -- LOOKING AT IT I GUESS WE CALL IT
2035
1 GROSSLY AND THEN MICROSCOPICALLY. AND, SPECIFICALLY, WHAT
2 IF ANYTHING DID YOU FIND CONCERNING HER HEART OR HER
3 ARTERIES?
4 A. SHE HAD VERY MINIMAL EVIDENCE OF A DISEASE WE CALLED
5 ATHEROSCLEROSIS, WHICH IS DEPOSITS OF FAT WITHIN THE WALL OF
6 THE ARTERIES. ONE OF HER ARTERIES HAD ONE FAT DEPOSIT THAT
7 RATHER -- THAT SIGNIFICANTLY REDUCED THE LUMINA OR THE SIZE
8 OF THAT ARTERY. ALL OF THE REST OF THE ARTERIES WERE CLEAR,
9 NO SIGNS OF SIGNIFICANT NARROWING.
10 THE MUSCLE OF THE LEFT VENTRICLE, WHICH IS THE PUMPING
11 CHAMBER OF THE HEART, WAS MUCH THICKER THAN I WOULD HAVE
12 EXPECTED FOR A WOMAN OF HER SIZE AND AGE. THIS IS TYPICALLY
13 INTERPRETED AS EVIDENCE OF HAVING HAD HIGH BLOOD PRESSURE IN
14 THE PAST WHERE THE HEART HAS TO WORK HARDER THAN NORMAL.
15 WHEN I EXAMINED THAT HEART MUSCLE MICROSCOPICALLY,
16 THERE WERE SCARS IN THE HEART WHICH WOULD INDICATE THAT IN
17 THE REMOTE PAST SHE HAD HAD INJURIES TO THE HEART, PROBABLY
18 WITH -- BECAUSE OF REDUCTION OF BLOOD FLOW OR OVERWORK
19 BECAUSE OF THE HIGH BLOOD PRESSURE THAT HAD RESULTED IN WHAT
20 WOULD BE CONSIDERED SMALL HEART ATTACKS. THESE WERE ALL
21 INJURIES THAT WERE WELL HEALED. THERE WAS NO EVIDENCE OF A
22 RECENT OR A NEW HEART ATTACK.
23 Q. OKAY. WAS THERE ANYTHING ON THIS EXAMINATION THAT WOULD
24 INDICATE THAT IT MIGHT HAVE BEEN THE CAUSE OF DEATH?
25 A. HEARTS THAT HAVE SCARRING IN THEM LIKE HERS HAD CAN FAIL
2036
1 TWO DIFFERENT WAYS. ONE OF THEM IS THAT THE HEART CAN
2 DEVELOP A VERY SUDDEN IRREGULARITY IN THE WAY THAT IT PUMPS
3 AND THOSE PEOPLE DIE VERY SUDDENLY. THEY WILL SEEM TO BE
4 PERFECTLY USUAL, THEIR USUAL STATE OF HEALTH. THEY MIGHT
5 EITHER JUST COLLAPSE SUDDENLY AS IF THEY WERE FAINTING, OR
6 THEY CAN COMMENT -- TYPICALLY THEY'LL COMMENT THEY'RE A
7 LITTLE TIRED, AND THOSE PEOPLE WILL LIE DOWN AND THEN BE
8 FOUND DEAD. THAT'S -- IN OUR EXPERIENCE THAT IS A VERY
9 COMMON METHOD OR WAY THAT A HEART SUCH AS HERS WOULD FAIL.
10 THE OTHER WAY THAT A HEART SUCH AS HERS WOULD FAIL
11 WOULD BE WHAT WE CALL CHRONIC CONGESTIVE HEART FAILURE, THAT
12 IT PROGRESSIVELY FAILS OVER A PERIOD OF WEEKS OR MONTHS OR
13 YEARS. THE PERSON WOULD TIRE MORE EASILY, WOULD SPEND MORE
14 TIME RESTING OR SLEEPING, WOULD DO LESS PHYSICAL ACTIVITY.
15 THEY WOULD HAVE MORE DIFFICULTY BREATHING. THEIR FEET WOULD
16 START TO SWELL BECAUSE THEY'D START PUTTING FLUID INTO THEIR
17 ANKLES AND LEGS. AND THAT IS A -- A -- A PROGRESSIVE SORT
18 OF FORM OF HEART FAILURE, AND THEN THEY WILL ONE DAY JUST
19 NOT BE ALIVE.
20 Q. OKAY. AND DID YOU FIND ANYTHING TO INDICATE THAT EITHER
21 ONE OF THOSE HAD OCCURRED ON THIS OCCASION?
22 A. BASED ON THE -- MY REVIEW OF HER MEDICAL RECORDS, I
23 DIDN'T SEE EVIDENCE THAT EITHER OF THOSE MECHANISMS OF HEART
24 FAILURE HAD HAPPENED WITH HER.
25 Q. DID YOU FIND ANYTHING IN THE EXAMINATION OF THE HEART
2037
1 THAT WOULD LEAD YOU TO BELIEVE IT MIGHT HAVE BEEN
2 LIFE-THREATENING?
3 A. POTENTIALLY SHE COULD HAVE DIED WITH AN ARRHYTHMIA.
4 Q. CAN'T RULE THAT OUT.
5 A. I CAN'T RULE THAT OUT.
6 Q. AND YOU'VE ALSO MENTIONED, I THINK, THAT YOU EXAMINED
7 HER LUNGS. DID YOU FIND ANYTHING SPECIFIC ABOUT HER LUNGS?
8 A. ON GROSS EXAMINATION HER LUNGS LOOKED VERY NORMAL, VERY
9 HEALTHY FOR -- EVEN FOR SOMEONE OF ANY AGE, HER LUNGS LOOKED
10 HEALTHY. WHEN I LOOKED AT THEM WITH THE MICROSCOPE, WHAT I
11 SAW IN THE LOWER PART OF THE RIGHT LUNG WAS A FOREIGN
12 MATERIAL AS IF SHE HAD PERHAPS CHOKED ON -- OR SWALLOWED
13 SOMETHING WRONG AND -- AND SOME MATERIALS GOT INTO HER LUNG.
14 ON THE LEFT LUNG THERE WAS SOME VERY SMALL MICROSCOPIC AREAS
15 WHERE THERE WAS WHAT WE CALL BRONCHITIS WHERE THERE WAS
16 PUSS, YOU KNOW, EVIDENCE OF ACTIVE INFLAMMATION IN THOSE
17 LUNGS. AND WITH -- WITH THAT INFLAMMATION THERE WAS ALSO
18 EVIDENCE THAT SOME FOREIGN MATERIALS HAD BEEN ASPIRATED.
19 Q. AND DID THAT HAVE ANY SIGNIFICANCE TO YOUR FINDINGS?
20 A. NO, THESE -- THESE FINDINGS ARE VERY MINOR. THEY WOULD
21 NOT CAUSE HER TO DIE.
22 Q. OKAY. AND DID YOU ALSO DO AN EXAMINATION OF HER HEAD
23 AREA, HER BRAIN?
24 A. I DID.
25 Q. AND WHAT DID YOU FIND THERE?
2038
1 A. HER BRAIN WAS MUCH SMALLER THAN I WOULD EXPECT FOR AN
2 ADULT, AND PERHAPS EVEN AN ADULT OF HER AGE. BRAINS DO GET
3 SMALLER WITH AGE AND HERS WAS SMALLER THAN I WOULD EXPECT
4 FOR HER AGE. AND I THINK PART OF THE REASON FOR THAT IS
5 THAT SHE'D HAD A STROKE A NUMBER OF YEARS PRIOR TO HER DEATH
6 AND THERE WAS AN AREA IN THE RIGHT SIDE OF HER BRAIN THAT
7 HAD BEEN DESTROYED BECAUSE OF THAT STROKE.
8 Q. DID YOU FIND ANYTHING -- ANY EVIDENCE OF A MORE RECENT
9 STROKE?
10 A. NO.
11 Q. AND ANYTHING ELSE THAT YOU OBSERVED ABOUT THAT
12 PARTICULAR BRAIN?
13 A. IT WAS AN UNUSUALLY SMALL BRAIN THAT SHOWED SIGNS OF
14 HAVING HAD A STROKE IN THE PAST.
15 Q. OKAY. ANYTHING ELSE THAT YOU OBSERVED?
16 A. SHE'D HAD -- THERE WAS EVIDENCE IN HER KIDNEYS THAT SHE
17 HAD HAD INFECTIONS OR IMFLAMMATORY PROCESSES IN HER KIDNEYS,
18 PROBABLY ON A CHRONIC BASIS.
19 Q. OKAY. HOW DID YOU DETECT THAT?
20 A. THAT'S BOTH ON LOOKING AT THE KIDNEY GROSSLY -- I TOLD
21 YOU THAT THE SURFACE OF THE KIDNEY WAS VERY GRANULAR. THAT
22 IS SCARRING OF THE KIDNEY. WHEN I LOOKED AT THAT UNDER THE
23 MICROSCOPE, THE AREA OF SCARRING WAS THE PART OF THE KIDNEY
24 THAT'S AFFECTED BY -- OH, A NUMBER OF THINGS. THE MOST
25 COMMON IS INFECTION. THERE ARE ALSO SOME SORTS OF
2039
1 MEDICATIONS THAT IF USED IN EXCESS CAN CAUSE SCARRING OF
2 THOSE PARTS OF THE KIDNEY.
3 Q. ARE YOU, AS PART OF YOUR PATHOLOGY AND AUTOPSY, ABLE TO
4 DETECT WHETHER A -- I WAS GOING TO SAY A BODY LIKE IN THIS
5 SITUATION HAS INFECTION INSIDE OF IT?
6 A. MANY TIMES WE CAN.
7 Q. AND HOW DO YOU DO THAT?
8 A. WELL, WE LOOK FOR SIGNS OF DISEASES THAT ARE CAUSED BY
9 INFECTIOUS ORGANISMS LIKE VIRUSES OR BACTERIA. I MEAN,
10 TYPICALLY THE INFECTIONS THAT WE -- THAT WE WOULD SEE WOULD
11 BE PNEUMONIA. INFECTIONS THAT CAUSE ACCUMULATIONS OF PUSS
12 IN ANY PART OF THE BODY, IT'S VERY EASY TO FIND THEM.
13 INFECTIONS THAT HAVEN'T GOTTEN TO -- HAVEN'T PROGRESSED TO
14 THE POINT OF CAUSING PUSS WILL CAUSE INFLAMMATION WHICH WE
15 SEE MICRO -- WITH THE MICROSCOPE WHERE THERE ARE PARTICULAR
16 KINDS OF CELLS THAT COME OUT OF THE BLOOD AND WILL
17 ACCUMULATE IN THE TISSUES WHERE THOSE BACTERIA ARE.
18 IF IT'S A VIRAL INFECTION, THE BODY MOUNTS A RESPONSE
19 TO THOSE VIRUSES THAT WE CAN SEE. A LOT OF TIMES INFECTIONS
20 WILL CAUSE SMALL HEMORRHAGES OR AREAS OF BLEEDING IN
21 DIFFERENT ORGANS AND WE SEE THAT MICROSCOPICALLY AND
22 SOMETIMES EVEN GROSSLY.
23 Q. NOW, YOU ALSO -- YOU UNDERSTAND THE TERM SEPTIC OR
24 SEPSIS?
25 A. I DO.
2040
1 Q. WHAT IS YOUR UNDERSTANDING OF THAT TERM?
2 A. SEPSIS AS I USE IT AND AS PATHOLOGISTS USE IT IS AN
3 INFECTION WHERE THE INFECTION STARTS IN THE BLOOD STREAM AND
4 THEN THE INFECTION CAN SPREAD FROM THE BLOOD STREAM INTO THE
5 INDIVIDUAL TISSUES IN THE BODY.
6 Q. OKAY. AND COULD THAT BECOME LIFE-THREATENING?
7 A. IT CAN BE.
8 Q. AND CAN THAT ALSO BE DETECTED ON A -- AT AN AUTOPSY IF
9 THE PATIENT REACHED THAT LEVEL?
10 A. MANY TIMES IT CAN BE, YES. Can be.
11 Q. OKAY. DID YOU CHECK WITH MARY CRANE TO DETERMINE IF SHE
12 HAD ANY INFECTION?
13 A. I SAW NO EVIDENCE ON HER AUTOPSY THAT SHE HAD INFECTION
14 THAT WAS ACTIVE AT THE TIME OF HER DEATH.
15 Q. OKAY. IF SHE HAD HAD AN INFECTION TO THE POINT THAT IT
16 BECAME LIFE-THREATENING, WOULD YOU ANTICIPATE BEING ABLE TO
17 FIND THAT?
18 A. I THINK MANY -- I HAVE IDENTIFIED IT MANY TIMES AT
19 AUTOPSIES, SO I KNOW THAT ON -- THERE ARE OCCASIONS WHEN I
20 CAN.
21 Q. OKAY. AND WOULD THAT HAVE BEEN AFFECTED BY THE
22 EMBALMING OR THE INTERMENT, DO YOU THINK?
23 A. IT WOULD HAVE MADE IT MORE DIFFICULT.
24 Q. BUT YOU -- YOU SAW NOTHING OF THAT SITUATION WITH MARY
25 CRANE?
2041
1 A. I DID NOT.
2 Q. OKAY. NOW, YOU'VE ALSO REVIEWED THE MEDICAL RECORDS, I
3 ASSUME. ARE YOU AWARE THAT THE RECORDS INDICATE THAT SHE
4 MAY HAVE HAD WHAT'S CALLED A FISTULA?
5 A. I AM.
6 Q. FISTULA? DID I SAY THAT RIGHT? AND WHAT IS THAT, AS
7 YOU UNDERSTAND IT?
8 A. A FISTULA IS AN UNNATURAL COMMUNICATION OR OPENING
9 BETWEEN TWO PARTS OF SOMETHING.
10 Q. OKAY. AND IN THIS CASE THE RECORDS WOULD REFLECT SHE
11 HAD IT BETWEEN HER -- I BELIEVE HER RECTUM AND HER VAGINA?
12 A. THAT'S CORRECT.
13 Q. DID YOU FIND THAT UPON AN AUTOPSY?
14 A. I DID NOT.
15 Q. AND WHY WOULD THAT BE?
16 A. FISTULAS IN THE HUMAN BODY CAN BE MOST EVIDENT WHEN
17 THERE IS PRESSURE ON ONE SIDE SO THAT A FLUID OR A -- OR A
18 TISSUE OR SOMETHING IS -- IS POKING THROUGH OR RUNNING
19 THROUGH THAT FISTULA. WHEN THE PRESSURE IS NOT THERE, THAT
20 FISTULA CAN BE A PINPOINT SMALL HOLE.
21 WHEN I EXAMINED MARY CRANE SHE HAD BEEN THOROUGHLY
22 EMBALMED, VERY THOROUGHLY EMBALMED. ALL OF HER TISSUES ARE
23 EXTREMELY STIFF AND HARD, ALMOST LEATHER LIKE. I DIDN'T SEE
24 A HOLE. IT -- IT JUST WASN'T VISIBLE GIVEN THE FLEXIBILITY
25 OF THE TISSUE THAT I HAD TO EXAMINE.
2042
1 Q. BUT YOU CAN'T RULE OUT THAT IT MIGHT HAVE BEEN THERE?
2 A. NO, I CAN'T SAY THAT IT WAS NOT.
3 Q. OKAY. AND DID YOU ALSO TAKE TISSUE SAMPLES AND SEND
4 THEM TO THE TOXICOLOGIST?
5 A. I DID.
6 Q. AND WHAT SAMPLES DID YOU SEND?
7 A. THE MATERIALS THAT WE SENT WERE A PORTION OF LIVER,
8 KIDNEY, THE FLUID THAT WAS IN THE CYST IN HER KIDNEY, THE
9 FLUID FROM HER GALLBLADDER, A PORTION OF SPLEEN, A PORTION
10 OF BRAIN, HEART, LUNG, SOME MATERIAL THAT WAS IN HER AORTA
11 WHICH LOOKED LIKE EMBALMED BLOOD, AND THEN THE TWO FENTANYL
12 PATCHES.
13 Q. AND OTHER THAN THE FENTANYL PATCHES, WAS ANY RESULTS
14 RETURNED FROM THOSE SAMPLES?
15 A. THE FENTANYL WAS IDENTIFIED IN THE PATCHES. THE
16 MATERIAL THAT WE TOOK FROM THE KIDNEY CYST DID TEST POSITIVE
17 FOR OPIATES, WHICH ARE THE NARCOTIC DRUGS. WE WEREN'T --
18 THE LAB REPORTED THAT THEY WERE NOT ABLE TO IDENTIFY
19 MORPHINE IN THE MATERIAL OUT OF THE AORTA, WHICH WAS THE
20 EMBALMED BLOOD; IN THE MATERIAL THAT WE ASPIRATED OUT OF THE
21 GALLBLADDER; AND THEY DID NOT IDENTIFY MORPHINE IN THE
22 BRAIN.
23 Q. OKAY. HAVE YOU DONE ANY STUDIES OR HAVE ANY INFORMATION
24 CONCERNING THE EFFECTS EMBALMING AND INTERMENT WOULD HAVE ON
25 THE DETECTION OF DRUGS IN THE BODY?
2043
1 A. IN GENERAL, EMBALMING MAKES IT MUCH LESS LIKELY THAT A
2 DRUG WILL BE IDENTIFIED. AND I HAVE NOT SEEN ANY STUDIES ON
3 THE EFFECT OF INTERMENT, YOU KNOW, A TIME STUDY.
4 Q. AND WHY WOULD EMBALMING HAVE AN EFFECT ON DETECTING THE
5 DRUGS?
6 A. FIRST OF ALL, EMBALMING IS DESIGNED TO REMOVE YOUR BLOOD
7 AND THE FLUIDS FROM YOUR BODY, AND THOSE ARE THE MATERIALS
8 THAT WE TYPICALLY TEST FOR DRUGS BECAUSE BLOOD IS -- IS THE
9 MEDIUM IN WHICH THE DRUGS ARE DELIVERED TO OUR TISSUES. AND
10 SO THE EMBALMING PROCESS, WHICH IS DESIGNED TO REMOVE THOSE
11 FLUIDS BY DEFINITION REMOVES THE MATERIALS THAT WE WOULD BE
12 MOST LIKELY -- IN WHICH WE WOULD BE MOST LIKELY ABLE TO
13 IDENTIFY THOSE DRUGS. In fact embalming fixes the opiates.
14 EMBALMING ALSO IS A PROCESS OF ADDING CHEMICALS TO OUR
15 BODY -- OR TO THE DECEDENT'S BODY SO THAT THE TISSUES OF THE
16 BODY ARE PRESERVED IN A LEATHER LIKE STATE. IT ACTUALLY
17 CHEMICALLY REACTS WITH THE MATERIALS IN OUR BODY SO THAT ALL
18 THOSE TISSUES ARE CHEMICALLY CROSS LINKED SO THAT WHEN THE
19 EMBALMING HAS BEEN ACCOMPLISHED, THE DRUGS ARE NO LONGER
20 PRESENT IN A -- IN A FORM THAT WE CAN EXTRACT. THEY ARE
21 CHEMICALLY BOUND TO THE TISSUES AND IT GREATLY REDUCES THE
22 POSSIBILITY THAT WE WOULD BE ABLE TO EXTRACT THOSE DRUGS AND
23 IDENTIFY THEM. Now that's true.
24 Q. THANK YOU. NOW, BASED ON THIS AUTOPSY THAT YOU
25 PERFORMED ON MS. CRANE, DID YOU FIND ANYTHING THAT WOULD
2044
1 INDICATE TO YOU THAT SHE WAS IN PAIN -- OR WOULD HAVE BEEN
2 IN PAIN, I SHOULD SAY?
3 MR. STIRBA: OBJECTION, YOUR HONOR. RELEVANCY.
4 THE COURT: OVERRULED.
5 A. THE DISEASE PROCESSES THAT I IDENTIFIED IN MARY CRANE
6 WOULD NOT CAUSE PAIN.
7 Q. (BY MR. MAJOR) OKAY. DID YOU FIND ANYTHING ON YOUR
8 AUTOPSY THAT WOULD INDICATE TO YOU MAY HAVE BEEN
9 LIFE-THREATENING AT THE TIME OF HER DEATH?
10 A. THE ONLY LIFE-THREATENING CONDITION SHE HAD WAS THE OLD
11 SCARRING IN HER HEART.
12 Q. LET ME SHOW YOU WHAT'S BEEN MARKED FOR IDENTIFICATION AS
13 PLAINTIFF'S EXHIBIT NUMBER 28 AND ASK YOU IF YOU CAN
14 IDENTIFY THAT?
15 A. I CAN.
16 Q. AND WHAT IS THAT?
17 A. THIS IS A DEATH CERTIFICATE FROM THE STATE OF UTAH THAT
18 IS FOR MARY ROSALIE CRANE, AND IT IS SIGNED BY
19 DR. R. WEITZEL.
20 Q. OKAY. AND ON THE SECOND PAGE, WOULD YOU IDENTIFY THAT?
21 A. THE SECOND PAGE IS AN AMENDMENT TO A STATE OF UTAH DEATH
22 CERTIFICATE, AND THIS AMENDMENT IS AN AMENDMENT THAT WOULD
23 HAVE BEEN PREPARED BY THE OFFICE OF THE MEDICAL EXAMINER.
24 IT IS FOR MARY CRANE AND IT IS SIGNED BY DR. TODD GREY.
25 Q. AND BASED ON THAT CERTIFICATE, WHAT WAS THE CAUSE OF
2045
1 DEATH LISTED BY DR. WEITZEL?
2 THE COURT: ARE YOU GOING TO OFFER THAT?
3 MR. MAJOR: YES, WE ARE, YOUR HONOR.
4 THE COURT: IS THERE ANY OBJECTION?
5 MR. STIRBA: NO OBJECTION, YOUR HONOR.
6 THE COURT: OKAY. IT'S RECEIVED.
7 A. DR. WEITZEL'S OPINION AS TO THE CAUSE OF DEATH WAS
8 CARDIAC ARREST DUE TO RESPIRATORY ARREST DUE TO SEIZURE DUE
9 TO C.V.A.
10 Q. (BY MR. MAJOR) OKAY. NOW, WE UNDERSTAND THE FIRST TWO
11 ARE JUST STOPPING BREATHING AND HAVING YOUR HEART STOP; IS
12 THAT CORRECT?
13 A. CORRECT.
14 Q. DID YOU FIND ANY EVIDENCE, BASED ON YOUR AUTOPSY, OF A
15 SEIZURE?
16 A. NO.
17 Q. DID YOU FIND ANY EVIDENCE, BASED ON YOUR AUTOPSY, OF A
18 C.V.A. OR A STROKE?
19 A. I CERTAIN -- I SAW EVIDENCE OF A STROKE THAT WAS YEARS
20 OLD. HE DESIGNATES THIS C.V.A. OR STROKE AS HAVING OCCURRED
21 BETWEEN -- 24 HOURS BEFORE DEATH, AND I SAW NO EVIDENCE OF A
22 STROKE THAT HAD HAPPENED WITHIN 24 HOURS OF DEATH.
23 Q. DID YOU MAKE A DETERMINATION AS TO THE MANNER OF DEATH
24 OF MARY CRANE?
25 A. WE -- THE OFFICE OF THE MEDICAL EXAMINER --
2046
1 Q. YEAH.
2 A. -- DID STATE ITS OPINION AS TO HER MANNER OF DEATH.
3 Q. AND WHAT WAS THAT MANNER?
4 A. THE MANNER IS CERTIFIED AS UNDETERMINED IF INJURED.
5 Q. AND WHAT DOES THAT MEAN?
6 A. THAT MEANS THAT THERE IS A POSSIBILITY THAT SHE WAS
7 INJURED. WE CAN'T SAY TO THE DEGREE OF CERTAINTY THAT WE
8 WOULD NEED TO SAY DEFINITELY THAT SHE WAS INJURED, BUT WE
9 THINK THERE'S A POSSIBILITY THAT SHE WAS INJURED.
10 Q. OKAY. WHAT TYPE OF INJURY ARE WE TALKING ABOUT?
11 A. IN HER CASE THE INJURY WOULD BE MORPHINE INTOXICATION.
12 Q. OKAY. SO WHEN I THINK OF INJURY I THINK OF LIKE A CAR
13 ACCIDENT. THAT'S NOT WHAT WE'RE TALKING ABOUT HERE?
14 A. NO.
15 Q. OKAY. AND WHAT WAS THE IMMEDIATE CAUSE OF DEATH?
16 A. THE CAUSE OF DEATH IS CERTIFIED AS UNDETERMINED.
17 Q. OKAY. AND WHY WAS THAT?
18 A. WE CAN'T SAY TO A DEGREE OF MEDICAL CERTAINTY AS TO WHAT
19 IT IS THAT CAUSED HER TO DIE.
20 Q. THANK YOU.
21 MR. MAJOR: ONE SECOND, YOUR HONOR.
22 (WHEREUPON, THERE'S AN OFF-THE-RECORD DISCUSSION.)
23 MR. MAJOR: NO FURTHER QUESTIONS, YOUR HONOR.
24 THE COURT: OKAY. MR. STIRBA?
25 MR. STIRBA: THANK YOU, YOUR HONOR.
2047
1 CROSS-EXAMINATION
2 BY MR. STIRBA:
3 Q. DR. FRIKKE, THE REASON WHY YOU CERTIFIED IT AS
4 UNDETERMINED IS BECAUSE THERE ARE OTHER POSSIBLE CAUSES OF
5 DEATH IN MS. CRANE'S CASE THAT YOU CAN'T RULE OUT; IS THAT
6 TRUE?
7 A. FOR A CAUSE OF DEATH UNDETERMINED?
8 Q. YES.
9 A. NO. WHAT UNDETERMINED MEANS -- SAYS IS THAT WE CAN'T
10 SAY TO A DEGREE OF MEDICAL CERTAINTY WHAT THE EXACT CAUSE OF
11 HER DEATH WAS.
12 Q. SURE. FOR EXAMPLE, YOU CAN'T TELL THIS JURY TO A
13 REASONABLE MEDICAL CERTAINTY THAT MS. CRANE DID NOT DIE FROM
14 AN ARRHYTHMIA, TRUE?
15 A. WELL, EVERYBODY HAS AN ARRHYTHMIA AS THEIR MECHANISM OF
16 DYING BECAUSE WHEN THE HEART STOPS, BY DEFINITION, THAT'S AN
17 ARRHYTHMIA.
18 Q. THE ARRHYTHMIA THAT YOU REFERRED TO ON DIRECT THAT
19 ESSENTIALLY IS AN ABNORMALITY, THAT'S WHAT I'M TALKING
20 ABOUT. CAN YOU TELL THIS JURY TO A REASONABLE MEDICAL
21 CERTAINTY THAT MS. CRANE DID NOT DIE FROM A HEART
22 ARRHYTHMIA?
23 A. NO, I CAN'T.
24 Q. AND IT'S TRUE, IS IT NOT, YOU ALSO CAN'T TELL THIS JURY
25 TO A REASONABLE MEDICAL CERTAINTY THAT MS. CRANE DID NOT DIE
2048
1 AS A RESULT OF CORONARY ARTERY DISEASE, THE FINDING THAT YOU
2 MADE?
3 A. I THINK TO MY MIND I SAW NO EVIDENCE THAT SHE HAD
4 LIFE-THREATENING CORONARY ARTERY DISEASE AND I WOULDN'T PUT
5 THAT HIGH ON MY LIST OF POSSIBLE CAUSES OF DEATH FOR HER.
6 Q. CERTAINLY A POSSIBLE CAUSE OF DEATH THOUGH, ISN'T IT, IN
7 YOUR MIND?
8 A. OH, IT'S POSSIBLE.
9 Q. AND ISN'T IT BECAUSE THERE ARE POSSIBILITIES LIKE HEART
10 DISEASE, POSSIBILITIES LIKE ARRHYTHMIA, POSSIBILITIES SUCH
11 AS DEMENTIA, WHICH YOU CAN'T CONCLUSIVELY RULE OUT, THAT'S
12 WHY THIS DEATH IS UNDETERMINED, TRUE?
13 A. THAT'S TRUE.
14 Q. NOW, YOU TESTIFIED ABOUT THE ASCERTAINMENT OF INFECTIONS
15 ON AUTOPSY, AND IT'S -- IT'S TRUE, IS IT NOT, THAT NORMALLY
16 IF YOU HAVE BLOOD AVAILABLE YOU CAN DO CERTAIN TESTS TO
17 DETERMINE WHETHER OR NOT THERE'S THE EXISTENCE OF INFECTION
18 OR AN INFECTIOUS DISEASE PROCESS IN THE BLOOD?
19 A. WE -- WE COULD TEST BLOOD, YES.
20 Q. AND -- AND, GENERALLY, ONE OF THE THINGS THAT YOU DO TO
21 DIAGNOSE AN INFECTION IS TO BASICALLY RUN A TEST ON THE
22 BLOOD TO LOOK AT THE -- FOR EXAMPLE, THE WHITE BLOOD CELL
23 COUNTS; ISN'T THAT TRUE?
24 A. NOT POSTMORTEM.
25 Q. IT'S TRUE, IS IT NOT, IN THIS CASE YOU HAD SOME BLOOD,
2049
1 CORRECT, FROM THE AORTA?
2 A. WHAT WE HAD WAS EMBALMED, CLOTTED BLOOD.
3 Q. AND TO THE EXTENT THAT YOU TESTED THAT, THAT WAS USED
4 AND TESTED TOXICOLOGICALLY, TRUE?
5 A. CORRECT.
6 Q. IN OTHER WORDS, YOU DIDN'T TEST IT TO SEE WHETHER OR NOT
7 THERE WAS BACTERIA IN THE BLOOD, DID YOU?
8 A. THAT KIND OF BLOOD IS TOTALLY UNSUITABLE --
9 Q. SO IT'S TRUE --
10 A. -- FOR TESTING FOR BACTERIA.
11 Q. OKAY. SO IT'S TRUE, IS IT NOT, THAT GIVEN WHAT WAS
12 PRESENTED TO YOU, YOU WERE NOT IN A POSITION TO PERFORM ANY
13 KIND OF TESTS TO DETERMINE WHETHER OR NOT THERE WAS BACTERIA
14 IN THE BLOOD, TRUE?
15 A. WE HAD NO TESTS AVAILABLE TO US TO TEST FOR BACTERIA.
16 Q. SO YOU CAN'T RULE OUT -- AS A RESULT OF THE FACT THAT
17 YOU DIDN'T HAVE THAT AVAILABLE TO YOU AND HAVE SUCH A
18 FINDING, YOU CAN'T RULE OUT THAT AT THE TIME OF MS. CRANE'S
19 DEATH THAT SHE WAS IN FACT SEPTIC, CAN YOU?
20 A. WHAT I CAN SAY IS THAT SHE HAD NO SIGNS IN THE TISSUES
21 OF HER BODY THAT WOULD SUGGEST SEPSIS BECAUSE IF YOU HAVE
22 BACTERIA IN YOUR BLOOD, YOUR BODY REACTS TO IT AND I SAW
23 NONE OF THOSE SIGNS OF HER BODY REACTING TO BACTERIA IN THE
24 BLOOD.
25 Q. NOW, YOU -- BUT YOU ONLY -- YOU ONLY MICROSCOPICALLY --
2050
1 YOU TESTED ONLY FOUR -- FOUR TISSUE SAMPLES, TRUE? THE
2 HEART --
3 A. I TESTED FOUR ORGANS.
4 Q. FOUR ORGANS. THE HEART, TRUE?
5 A. CORRECT.
6 Q. THE LUNGS, TRUE?
7 A. CORRECT.
8 Q. THE LIVER AND THE KIDNEY, CORRECT?
9 A. CORRECT.
10 Q. AND, IN FACT, IN THE KIDNEY YOU FOUND SOME EVIDENCE, DID
11 YOU NOT, OF SOME INFECTIOUS DISEASE PROCESS?
12 A. I SAW EVIDENCE OF SCARRING IN HER TISSUE -- IN HER -- IN
13 THE KIDNEYS OF HER TISSUE (SIC), AND AN OLD INFECTION IS ONE
14 OF THOSE CONDITIONS WHICH CAN CAUSE THAT SCARRING.
15 Q. AND IT'S TRUE, IS IT NOT, THAT AN INFECTIOUS DISEASE
16 PROCESS IS, IN FACT, A PROCESS? IN OTHER WORDS, IT BEGINS
17 AND THEN IT CAN PROGRESSIVELY BECOME MORE ACUTE; ISN'T THAT
18 TRUE?
19 A. IT CAN -- I WOULDN'T USE THE TERM ACUTE. ACUTE MEANS
20 THAT IT'S HAPPENING SUDDENLY OR RIGHT NOW.
21 Q. ALL RIGHT.
22 A. BUT INFECTIONS DO PROGRESS.
23 Q. SURE. AND YOU CAN HAVE A SITUATION, CAN YOU NOT, WHERE
24 SOMEONE HAS BACTERIA IN THE BLOOD WHICH IS ESSENTIALLY A
25 SEPTIC CONDITION? TRUE?
2051
1 A. YES, THAT CAN HAPPEN.
2 Q. WHICH HAS NOT DEVELOPED SUFFICIENTLY SYSTEMICALLY IN THE
3 BODY SUCH THAT YOU COULD MAKE A FINDING ON AN ORGAN ON
4 AUTOPSY; ISN'T THAT CORRECT?
5 A. THERE ARE TIMES WHEN DEATH CAN OCCUR SO RAPIDLY THAT THE
6 BODY DOES NOT REACT.
7 Q. WELL, THAT REALLY WASN'T MY QUESTION. MY QUESTION WAS,
8 YOU UNDERSTAND THAT THE PROCESS OF BECOMING SEPTIC; THAT IS,
9 SYSTEMICALLY INFECTED, TAKES A PERIOD OF TIME TO OCCUR,
10 TRUE?
11 A. THAT'S TRUE.
12 Q. AND IT'S ALSO TRUE THAT IN THE BEGINNING STAGES OF THAT,
13 YOU HAVE BACTERIA IN THE BLOOD, CORRECT?
14 A. THAT'S CORRECT.
15 Q. AND WHY IT BECOMES A SYSTEMIC PROBLEM IS BECAUSE ONCE
16 BACTERIA IS IN THE BLOOD, IN THE BLOOD STREAM, THEN
17 ESSENTIALLY IT CAN BE DISTRIBUTED TO ALL THE ORGANS IN THE
18 BODY, CORRECT?
19 A. THAT'S CORRECT.
20 Q. AND IT TAKES A PERIOD OF TIME, DOES IT NOT, FOR THE
21 BLOOD, ONCE SOMEONE IS SEPTIC, TO ESSENTIALLY MANIFEST
22 ITSELF IN THOSE ORGANS SUCH THAT YOU MIGHT BE ABLE TO THEN
23 HAVE A FINDING AT AN AUTOPSY; ISN'T THAT CORRECT?
24 A. THAT'S CORRECT.
25 Q. NOW, THE FISTULA YOU -- YOU TESTIFIED ABOUT, AND I GUESS
2052
1 BECAUSE OF THE NATURE OF THE EMBALMING PROCESS, IT WASN'T
2 SOMETHING CERTAINLY THAT YOU INDICATED IN YOUR REPORT YOU
3 FOUND.
4 A. I DID NOT FIND IT.
5 Q. AND -- AND IT'S TRUE, IS IT NOT, AS A FORENSIC
6 PATHOLOGIST, YOUR EXPERTISE IS -- IS NOT IN ESSENTIALLY
7 TREATING VAGINAL FISTULAS, CORRECT?
8 A. NO, I DON'T.
9 Q. IN FACT, YOU WOULD EXPECT A GYNECOLOGIST TO BE INVOLVED
10 IN THE CARE AND TREATMENT OF THAT KIND OF PROBLEM, WOULDN'T
11 YOU?
12 A. THAT'S ONE OF THE TYPES OF PHYSICIANS WHO COULD BE
13 INVOLVED.
14 Q. NOW, IT'S TRUE, IS IT NOT, THAT A VAGINAL FISTULA UNDER
15 CERTAIN CIRCUMSTANCES CAN, IN FACT, BE EXCEEDINGLY PAINFUL?
16 A. IF IT HAS JUST DEVELOPED. IF IT IS A RECENT, BRAND NEW
17 TEAR IT COULD BE PAINFUL. IF IT'S BEEN THERE FOR MONTHS,
18 WEEKS, YEARS, I WOULDN'T EXPECT THAT IT WOULD BE.
19 Q. SURE. BUT LET'S ASSUME THAT A FISTULA DEVELOPED, AS IS
20 INDICATED IN THE RECORDS WHICH YOU REVIEWED WITH MARY CRANE,
21 ON THE 1ST OF JANUARY OF 1996. WOULD YOU ASSUME -- EXPECT
22 THAT THERE WOULD BE SOME PAIN ATTENDANT WITH THAT
23 DEVELOPMENT ON THE 1ST OF JANUARY OF 1996?
24 A. THE RECORD THAT I REVIEWED SAID THAT IT WAS IDENTIFIED.
25 IT DOESN'T INDICATE THAT IT DEVELOPED THAT DAY. I DON'T
2053
1 KNOW -- THE -- THE RECORD I SAW SAYS THAT SHE WAS EXAMINED
2 AND A FISTULA WAS IDENTIFIED. IT -- I DON'T RECALL THAT
3 THERE WAS ANY INDICATION THAT IT WAS A RECENT -- AN ACUTE
4 TEAR.
5 Q. FAIR -- FAIR COMMENTARY. BUT GIVEN THE RECORDS THAT YOU
6 HAVE, I'M ASKING YOU TO ASSUME THAT IT IN FACT WAS --
7 OCCURRED ON THE 1ST OF JANUARY. ASSUME THAT. WOULD YOU
8 EXPECT THAT THAT EVENT ON THE 1ST OF JANUARY WOULD ENDEAVOR
9 AND OCCUR IN SOME PAINFUL WAY TO MARY CRANE?
10 A. IN A PERSON WHO HAS NORMAL PERCEPTION OF PAIN, YES, I
11 THINK IT WOULD BE PAINFUL.
12 Q. AND IS IT FAIR TO SAY IF IT'S NOT BEING TREATED -- IN
13 OTHER WORDS, BEING ATTENDED TO MEDICALLY BY SOME KIND OF
14 INTERVENTION --
15 MR. MAJOR: YOUR HONOR, I'M GOING TO OBJECT. I
16 THINK THIS GOES BEYOND HER EXPERTISE AND BEYOND DIRECT.
17 THE COURT: WELL, YOU BROUGHT UP THE PAIN.
18 OVERRULED.
19 Q. (BY MR. STIRBA) WOULD YOU SIMILARLY FEEL THAT AS OF
20 JANUARY 4TH AND 5TH THAT THAT CONDITION COULD INDEED BE
21 PAINFUL AT THAT TIME?
22 A. IT COULD BE.
23 Q. AND CERTAINLY WOULD YOU AGREE THAT IF A GYNECOLOGIST
24 BELIEVES THAT THE FISTULA IS OF SUCH MAGNITUDE THAT SURGICAL
25 INTERVENTION MAY BE REQUIRED, THAT IT IS LIKELY THAT THAT
2054
1 FISTULA WOULD BE IN FACT PAINFUL TO MS. CRANE?
2 MR. MAJOR: OBJECTION, YOUR HONOR. I THINK THAT
3 CALLS FOR SPECULATION. SHE'S ALREADY ANSWERED THE QUESTION.
4 THE COURT: OVERRULED.
5 A. I THINK A GYNECOLOGIST'S RECOMMENDATION THAT AT SOME
6 POINT THEY CONSIDER SURGICAL REPAIR OF THIS FISTULA IS A
7 REFLECTION OF HIS CONCERN FOR ONE, HYGIENE; AND TWO, RISK
8 FOR -- OR INCREASED RISK FOR URINARY TRACT INFECTIONS IN
9 THIS WOMAN.
10 Q. (BY MR. STIRBA) SURE. AND -- AND ALSO BACTERIAL
11 INFECTIONS IN THE BLOOD; ISN'T THAT RIGHT?
12 A. IF -- URINARY TRACT INFECTIONS CAN LEAD TO SEPTICEMIA,
13 YES.
14 Q. SURE. WHEN YOU SAY HYGIENE, THE CONCERN IS THE
15 TRANSMISSION OF BACTERIA --
16 A. NO, HYGIENE IS -- IS -- IS --
17 Q. I'M SORRY.
18 A. -- HAS MORE TO DO WITH BOWEL AND BLADDER COMPETENCE.
19 IF -- NORMALLY WE ARE COMPETENT OF OUR BOWEL BECAUSE WE HAVE
20 A MUSCLE SPHINCTER THAT CONTROLS WHEN WE EMPTY OUR BOWELS
21 AND WHEN WE DON'T. WHEN YOU HAVE A FISTULA SUCH AS SHE
22 REPORTEDLY HAD, THAT -- THAT'S A HOLE ABOVE THE LEVEL OF THE
23 SPHINCTER AND THAT SAYS THAT THEN FECAL MATERIAL CAN GET
24 INTO HER VAGINA, WHICH DOES NOT HAVE A SPHINCTER CONTROL.
25 SO THAT THEN SHE WOULD APPEAR TO BE INCOMPETENT OF HER
2055
1 BOWELS WHEN IN FACT HER ANAL SPHINCTER IS WORKING FINE, BUT
2 THE FECAL MATERIAL IS THEN LEAKING OUT HER VAGINA. AND
3 THAT'S A HYGIENE PROBLEM.
4 Q. FAIR TO SAY, FECAL MATERIA IS BACTERIA -- OR FECAL
5 MATERIAL IS BACTERIA FULL?
6 A. IT DOES HAVE BACTERIA IN IT, YES.
7 Q. NOW, IT'S TRUE -- YOU WERE ASKED ABOUT A SEIZURE. YOU
8 RECALL IN THE MEDICAL RECORDS THAT DR. DIENHART ON THE 7TH
9 OF JANUARY INDICATED POSSIBLE SEIZURE?
10 A. I DO.
11 Q. DO YOU RECALL THAT?
12 A. I DO RECALL THAT.
13 Q. AND IS IT FAIR TO SAY THAT A SEIZURE IS ESSENTIALLY A
14 CLINICAL DETERMINATION?
15 A. IT IS.
16 Q. AND IT'S NOT SOMETHING THAT YOU WERE GOING TO HAVE A
17 FINDING ON DURING AN AUTOPSY?
18 A. NOT USUALLY, NO.
19 Q. NOW, IN TERMS OF A STROKE, IF I LOOK AT WHAT
20 MICROSCOPICALLY YOU DID IN TERMS OF TISSUE, I SEE THAT
21 YOU -- YOU DID A MICROSCOPIC EXAMINATION OF THE HEART, THE
22 LUNGS, LIVER, AND KIDNEY; IS THAT RIGHT?
23 A. THAT'S CORRECT.
24 Q. YOU DID NOT DO A MICROSCOPIC EXAMINATION OF ANY BRAIN
25 TISSUE, TRUE?
2056
1 A. THAT'S CORRECT.
2 Q. AND IT'S TRUE, IS IT NOT, WITHOUT DOING SUCH A
3 MICROSCOPIC EXAMINATION OF THE BRAIN TISSUE, YOU CANNOT TELL
4 THIS JURY WHETHER OR NOT A SUBACUTE EVENT OCCURRED WITH
5 RESPECT TO MS. CRANE, CAN YOU?
6 A. I CAN. I CAN TELL THEM SHE DID NOT HAVE A STROKE. A
7 STROKE IS A HEMORRHAGE INTO YOUR BRAIN. WE SEE THOSE WITH
8 OUR EYES.
9 Q. OKAY.
10 A. YOU DON'T NEED A MICROSCOPE.
11 Q. OKAY. SO -- SO YOUR DEFINITION OF A STROKE THEN, AND
12 I -- I ACCEPT WHAT YOU'RE SAYING. YOUR DEFINITION IS AN
13 ACUTE, ESSENTIALLY, HEMORRHAGE IN THE BRAIN; IS THAT RIGHT?
14 A. THAT'S CORRECT.
15 Q. THERE ARE SUBACUTE EVENTS, ARE THERE NOT?
16 A. SUBACUTE MEANS THAT IT HAS HAPPENED A WHILE AGO.
17 Q. THERE ARE EVENTS THAT ARE ONLY DETECTABLE
18 MICROSCOPICALLY, TRUE?
19 A. THERE ARE PROCESSES THAT ARE IDENTIFIABLE
20 MICROSCOPICALLY.
21 Q. YEAH. CEREBROVASCULARLY IN THE BLOOD VESSELS OF BRAIN,
22 CORRECT?
23 A. CORRECT.
24 Q. AND THOSE CAN CALL -- THEY SOMETIMES CAN BE REFERRED TO
25 AS TRANSIENT -- TRANSIENT ISCHEMIC ATTACKS, CORRECT?
2057
1 A. TRANSIENT ISCHEMIC ATTACKS DON'T CAUSE ANATOMIC CHANGES
2 IN THE BRAIN.
3 Q. BUT IN ANY EVENT, WHAT YOU DID IS YOU DID A GROSS
4 EXAMINATION OF THE BRAIN AND ALL YOU'RE TELLING THIS JURY IS
5 YOU DIDN'T SEE A HEMORRHAGE, CORRECT?
6 A. I DID NOT SEE A HEMORRHAGE. I DID NOT ALSO -- ALSO DID
7 NOT SEE EVIDENCE OF AN ISCHEMIC INFARCT, WHICH IS A TOTALLY
8 DIFFERENT PROCESS WHERE THE BRAIN IS DEPRIVED OF BLOOD AND,
9 IN FACT, THE BRAIN DIES.
10 Q. WHICH YOU CAN SEE --
11 A. WE CAN SEE THOSE.
12 Q. -- ON GROSS EXAMINATION, TRUE?
13 A. WE CAN SEE THOSE ON GROSS EXAMINATION.
14 Q. BUT IT'S ALSO TRUE, IS IT NOT, THAT THERE ARE CERTAIN
15 VASCULAR -- CEREBROVASCULAR EVENTS, CALL THEM MINI STROKES,
16 WHICH YOU CAN ONLY DETECT MICROSCOPICALLY; ISN'T THAT
17 CORRECT?
18 A. NO, I DON'T THINK I WOULD AGREE WITH THAT.
19 Q. AND YOU TESTIFIED ABOUT THE DRUG TOXICOLOGY TESTING.
20 IT'S TRUE, IS IT NOT, THAT THE TISSUES THAT WERE SAMPLED
21 WERE BASICALLY THE AORTA BLOOD, AND THAT WAS TESTED FOR
22 MORPHINE, TRUE?
23 A. THAT'S CORRECT.
24 Q. NO MORPHINE WAS FOUND, CORRECT?
25 A. WELL, WHAT -- WHAT THEY REPORT IS THAT THE MORPHINE IS
2058
1 LESS THAN 0.05 MILLIGRAMS PER LITER. THAT IS THE LOWEST
2 CONCENTRATION AT WHICH THE LABORATORY FEELS THEY CAN BE
3 CERTAIN THAT THEY HAVE IDENTIFIED A DRUG.
4 Q. AND WHAT --
5 A. SO WHEN THEY REPORT IT AS LESS THAN THAT, IT MEANS THAT
6 EITHER THE DRUG IS NOT THERE OR IT IS IN A CONCENTRATION
7 THAT IS LESS THAN THAT AND THEY CANNOT CONFIDENTLY IDENTIFY
8 IT.
9 Q. IN OTHER WORDS, THE MACHINE HAS A CERTAIN LIMIT AND
10 BELOW WHICH IT CAN'T DETECT WHAT IT'S TRYING TO FIND.
11 A. WELL, THE INSTRUMENTATION -- THE METHODS OF EXTRACTION
12 AND THE INSTRUMENTATION, ALL OF THAT TOGETHER DEFINE THE
13 LOWEST LEVEL OF DETECTION.
14 Q. SO YOU'RE QUITE RIGHT IN TERMS OF THIS REPORT THAT IT
15 WAS REPORTED WITH RESPECT TO THE TISSUES THAT WERE SAMPLED,
16 THEY COULD NOT FIND ANY DETECTABLE AMOUNTS OF MORPHINE --
17 A. CORRECT.
18 Q. -- ISN'T THAT TRUE?
19 A. CORRECT.
20 MR. STIRBA: THAT'S ALL I HAVE, YOUR HONOR. THANK
21 YOU.
22 THE COURT: OKAY. MR. MAJOR, ANYTHING FURTHER?
23 MR. MAJOR: A COUPLE OF QUESTIONS.
24 REDIRECT EXAMINATION
25 BY MR. MAJOR:
2059
1 Q. IS A SEIZURE NECESSARILY LIFE-THREATENING?
2 A. NO.
3 Q. CAN IT BE LIFE-THREATENING?
4 A. IT CAN BE.
5 Q. IF IT DOES BECOME LIFE-THREATENING AND CAUSE THE DEATH,
6 IS THERE PATHOLOGICAL EVENTS THAT CAN BE SEEN OR OBSERVED?
7 A. NOT USUALLY.
8 Q. OKAY. DID YOU LOOK AT OTHER TISSUE SAMPLES OTHER THAN
9 THE ONES THAT YOU MENTIONED: THE BRAIN, THE LIVER?
10 A. THE GROSS EXAMINATION AND THE MICROSCOPICS ARE DESCRIBED
11 THERE. THAT'S WHAT I THINK -- THOSE ARE THE TISSUES THAT I
12 EXAMINED.
13 Q. THAT YOU LOOKED AT. THANK YOU.
14 MR. MAJOR: WE HAVE NO FURTHER QUESTIONS, YOUR
15 HONOR.
16 THE COURT: ANYTHING FURTHER?
17 MR. STIRBA: NO, YOUR HONOR. THANK YOU.
18 THE COURT: MAY THIS WITNESS BE EXCUSED?
19 MR. MAJOR: SHE MAY, YOUR HONOR.