Todd Grey, MD
21 MR. WILSON: WE'D CALL DR. TODD GREY TO THE STAND AT
22 THIS TIME, YOUR HONOR.
23 THE COURT: DR. GREY, IF YOU'LL STEP UP PLEASE. IF
24 YOU'LL RAISE YOUR RIGHT HAND AND FACE THE CLERK.
25 TODD GREY,
1 BEING FIRST DULY SWORN, WAS EXAMINED
2 AND TESTIFIED AS FOLLOWS:
3 THE COURT: DOCTOR, IF YOU'LL STATE YOUR FULL NAME AND
4 SPELL YOUR LAST NAME FOR US PLEASE.
5 A. TODD CAMERON GREY, G-R-E-Y.
6 DIRECT EXAMINATION
7 BY MR. WILSON:
8 Q. GOOD AFTERNOON, DOCTOR. COULD YOU TELL US WHERE YOU ARE
9 CURRENTLY EMPLOYED?
10 A. I'M THE CHIEF MEDICAL EXAMINER FOR THE STATE OF UTAH.
11 Q. AND WHAT IS THE CHIEF MEDICAL EXAMINER?
12 A. A MEDICAL EXAMINER IS A PHYSICIAN WHO HAS BEEN TRAINED
13 IN PATHOLOGY AND HAS RECEIVED SUBSPECIALTY TRAINING IN
14 FORENSIC PATHOLOGY, WHICH IIS ESSENTIALLY THAT ASPECT OF
15 PATHOLOGY INVOLVED IN THE INVESTIGATION OF SUDDEN AND
16 UNEXPECTED DEATH.
17 Q. CAN YOU TELL US, SIR, HOW LONG YOU'VE OCCUPIED THAT
18 POSITION?
19 A. I'VE BEEN THE CHIEF MEDICAL EXAMINER SINCE 1988. I CAME
20 TO UTAH IN 1986 AS AN ASSISTANT MEDICAL EXAMINER.
21 Q. AS THE CHIEF MEDICAL EXAMINER, DO YOU SUPERVISE OTHER
22 INDIVIDUALS WITHIN YOUR OFFICE?
23 A. YES. I'M THE CHIEF ADMINISTRATIVE OFFICER FOR THE
24 MEDICAL EXAMINER'S OFFICE. I SUPERVISE THE WORK OF THREE
25 OTHER FORENSIC PATHOLOGISTS AS WELL AS INVESTIGATORS AND
1 OTHER MEMBERS OF THE M.E. STAFF.
2 Q. WOULD YOU BRIEFLY JUST GIVE US A LITTLE BIT OF
3 INFORMATION CONCERNING YOUR EDUCATIONAL BACKGROUND?
4 A. I RECEIVED AN UNDERGRADUATE DEGREE IN ANTHROPOLOGY FROM
5 YALE UNIVERSITY. MY MEDICAL DEGREE FROM DARTMOUTH MEDICAL
6 SCHOOL. I UNDERTOOK TRAINING IN ANATOMIC PATHOLOGY AT THE
7 UNIVERSITY OF CALIFORNIA IN SAN DIEGO. AND RECEIVED TRAINING
8 IN FORENSICS AT THE DADE COUNTY MEDICAL EXAMINER'S OFFICE IN
9 MIAMI, FLORIDA. I AM BOARD CERTIFIED IN ANATOMIC AND
10 FORENSIC PATHOLOGY.
11 Q. AND WHEN DID THOSE BOARD CERTIFICATIONS TAKE PLACE, SIR?
12 A. I WAS CERTIFIED IN 1986.
13 Q. OKAY. HOW MANY AUTOPSIES WOULD YOU SAY THAT OVER THE
14 COURSE OF YOUR TIME BOTH IN THE MEDICAL EXAMINER'S OFFICE AND
15 IN YOUR TRAINING HAVE YOU PERFORMED?
16 A. I THINK I'M UP AROUND ABOUT FIVE OR 6,000 NOW.
17 Q. OKAY. AND IN RESPECT TO -- DO YOU ALSO PLAY A PART IN
18 SUPERVISING THE OTHER AUTOPSIES THAT ARE PERFORMED IN THE
19 STATE?
20 A. YES. I WILL ALSO REVIEW THE WORK OF MY OTHER
21 PHYSICIANS, ESSENTIALLY OVER THE COURSE OF MY TENURE AS THE
22 CHIEF MEDICAL EXAMINER, THAT WOULD BE ON THE ORDER OF ABOUT
23 15,000 EXAMS.
24 Q. NOW, IS THERE A PROCEDURE THAT YOU FOLLOW IN CONDUCTING
25 YOUR AUTOPSIES?
1 A. YES, THERE IS.
2 Q. AND WHAT IS THAT, SIR?
3 A. AN AUTOPSY, THE STANDARD PERFORMANCE OF AN AUTOPSY
4 STARTS WITH A CAREFUL EXTERNAL EXAMINATION OF THE BODY,
5 LOOKING AT THE OUTSIDE TO SEE IF THERE'S ANY ABNORMALITIES.
6 THAT'LL BE FOLLOWED BY AN INTERNAL EXAMINATION WHERE WE WILL
7 LOOK AT ALL OF THE VARIOUS ORGANS WITH THE SAME VIEW TO
8 SEEING IF THERE'S ANYTHING WRONG.
9 Q. OKAY. AND IN RESPECT TO THAT PROCEDURE, DOES IT CHANGE
10 AT ALL RELATIVE TO THE WHETHER OR NOT YOU ARE VIEWING A BODY
11 THAT HAS BEEN INTERRED FOR A PERIOD OF TIME?
12 A. THE PROCESS WILL BE THE SAME. INTERMENT AND EMBALMING
13 AND OTHER KINDS OF THINGS THAT GO ALONG WITH A DELAY BETWEEN
14 THE TIME OF DEATH AND WHEN WE DO OUR EXAM MAY AFFECT THE --
15 OUR ABILITY TO SEE THINGS BECAUSE OF DETERIORATION IN THE
16 BODY.
17 Q. NOW, CALLING YOUR ATTENTION TO THE MATTER BEFORE THE
18 COURT, AS I UNDERSTAND IT, DOCTOR, YOU HAD OCCASION TO
19 PERFORM AUTOPSIES ON FOUR OF THE FIVE VICTIMS IN THIS MATTER?
20 A. YES.
21 Q. AND CAN YOU TELL US IN RESPECT TO THAT AUTOPSIES, WERE
22 THEY ALL CONDUCTED AT YOUR OFFICE IN SALT LAKE?
23 A. YES, THEY WERE.
24 Q. OKAY. NOW, I WANNA CALL YOUR ATTENTION TO A SPECIFIC
25 AUTOPSY. DO YOU HAVE A FILE RELATIVE -- OR RECOLLECTION
1 RELATIVE TO A INDIVIDUAL BY THE NAME OF ELLEN B. ANDERSON?
2 A. YES.
3 Q. AND YOU CONDUCTED AN AUTOPSY IN RESPECT ON ELLEN?
4 A. YES, WE DID.
5 Q. I SHOW WHAT'S BEEN MARKED AS STATE'S EXHIBIT 2-D AND ASK
6 IF YOU CAN IDENTIFY THAT PARTICULAR DOCUMENT FOR US IF YOU
7 WOULD PLEASE?
8 A. THIS IS A COPY OF THE AUTOPSY REPORT THAT I PREPARED IN
9 CONJUNCTION WITH THE EXAMINATION OF MS. ANDERSON.
10 Q. OKAY. AS I UNDERSTAND IT, YOU'RE STATUTORY REQUIRED TO
11 PREPARE THAT REPORT?
12 A. THAT'S PART OF MY DUTIES, YES.
13 Q. OKAY. IS THERE ANOTHER DUTY IN CONNECTION WITH
14 AUTOPSIES THAT YOU DO?
15 A. YES. I'M -- GENERALLY WHAT I'M SUPPOSED TO DO IS
16 MAINTAIN COMPLETE RECORDS OF ANY CASE THAT COMES UNDER MY
17 OFFICE'S JURISDICTION, INCLUDING INVESTIGATIVE INFORMATION,
18 AUTOPSY FINDINGS, TOXICOLOGIC FINDINGS, ESSENTIALLY ANYTHING
19 RELATED TO WHAT WE DO WHEN TRYING TO FIGURE OUT HOW SOMEBODY
20 DIED.
21 Q. AND SPECIFICALLY, DID YOU HAVE OCCASION RELATED TO THE
22 AUTOPSY OF ALLEN ANDERSON TO REVIEW ANY OTHER DOCUMENTS IN
23 CONNECTION WITH THAT PROCEEDING OR THAT AUTOPSY?
24 A. YES.
25 Q. CAN YOU TELL US WHAT THEY WERE?
1 A. WE WILL ALSO REVIEW INVESTIGATIVE INFORMATION AS PART OF
2 OUR -- THE PROCESS THAT WE GO THROUGH. THAT WOULD INCLUDE
3 THINGS LIKE MEDICAL RECORDS, WHICH I REVIEWED IN THIS CASE.
4 INVESTIGATIVE REPORTS, ANYTHING THAT GIVES US INSIGHT INTO
5 HOW THIS PERSON CAME TO THEIR DEATH.
6 Q. OKAY. AND DID YOU -- OTHER THAN MEDICAL RECORDS, DID
7 YOU HAVE ANY OTHER RECORDS THAT YOU RECALL THAT YOU EXAMINED
8 IN CONNECTION WITH THIS CASE?
9 A. THERE WERE, AS I SAID, INVESTIGATIVE RECORDS
10 PERFORMED -- PREPARED BY MY INVESTIGATIVE STAFF. THERE WAS
11 ALSO I BELIEVE A LETTER FROM DR. HARE CONCERNING THIS AND THE
12 OTHER CASES.
13 Q. OKAY. NOW, CALLING YOUR ATTENTION TO ELLEN ANDERSON,
14 CAN YOU TELL US WHEN THIS AUTOPSY WAS CONDUCTED?
15 A. THIS WAS DONE ON MAY 4TH OF 2000 STARTING AT 8:40 IN THE
16 MORNING.
17 Q. OKAY. AND CAN YOU TELL US WHO WAS PRESENT DURING THE
18 AUTOPSY?
19 A. IN ADDITION TO MYSELF AND MY ASSISTANT, THERE WAS
20 DETECTIVE JOE MORRISON AS WELL AS DR. ROBERT ROTHFEDER, AN
21 EXPERT HIRED BY THE DEFENSE.
22 Q. OKAY. CAN YOU TELL US, SIR, IN RESPECT TO THE BODY
23 ITSELF, HOW WAS IT BROUGHT TO YOU?
24 A. THE BODY WAS RECEIVED IN AN INTACT WOODEN CASKET. IT
25 HAD BEEN EXHUMED AND SO THE CASKET AND BODY WERE BROUGHT TO
1 MY OFFICE.
2 Q. OKAY. WERE THEY MAINTAINED AT YOUR OFFICE DURING THIS
3 TIME PERIOD?
4 A. YES.
5 Q. OKAY. NOW, I NEED YOU TO DESCRIBE FOR US, IF YOU WOULD,
6 HOW YOU WENT ABOUT THIS PARTICULAR AUTOPSY.
7 A. WHAT WE DID IS IN THIS CASE AS WE DO IN ALL CASES WAS WE
8 FIRST LOOK AT THE OUTSIDE OF THE BODY. IN THIS CASE WE NOTED
9 WHAT BURIAL GARMENTS THE DECEDENT WAS WEARING. THE BODY
10 WOULD BE THEN UNDRESSED AND WE WOULD LOOK AT THE EXTERNAL
11 SURFACES. THEN I DID A COMPLETE INTERNAL EXAMINATION LOOKING
12 AT ALL OF THE BODY ORGANS AS WELL AND A CRANIAL EXAM LOOKING
13 AT THE BRAIN.
14 Q. OKAY. NOW, DO YOU KNOW HOW LONG THE BODY HAD BEEN
15 INTERRED?
16 A. MY UNDERSTANDING WAS THAT THIS INDIVIDUAL DIED ON
17 DECEMBER 30TH OF 1995, AND SO WE'RE TALKING ON THE ORDER OF
18 FOUR AND A HALF YEARS.
19 Q. ALL RIGHT. CAN YOU CHARACTERIZE FOR US, IF YOU WOULD,
20 THE CONDITION OF THE EXTERNAL EXAMINATION AS FAR AS THE BODY
21 ITSELF, HOW IT APPEARED?
22 A. THE BODY WAS IN PRETTY GOOD SHAPE GIVEN THE POST MORTEM
23 PERIOD. THERE WAS FAIRLY EXTENSIVE MOLD GROWTH ON THE BODY,
24 AS WELL AS SOME DETERIORATION OF THE SKIN. BUT ON THE
25 SPECTRUM OF CHANGES THAT I SEE, THIS WAS A FAIRLY WELL
1 PRESERVED BODY.
2 Q. DID YOU MAKE ANY SPECIFIC FINDINGS RELATIVE TO YOUR
3 EXTERNAL EXAMINATION THAT WERE SIGNIFICANT IN YOUR MIND OR
4 SIGNIFICANT IN RESPECT TO YOUR REPORT?
5 A. IN TERMS OF ANY EXTERNAL FINDINGS FOR RELATING TO HOW
6 THIS PERSON DIED, NO. THE EXTERNAL FINDINGS WERE MORE
7 CONSISTENT WITH THE FACT THAT THE PERSON HAD BEEN EMBALMED
8 AND THEN INTERRED.
9 Q. OKAY. DOES THE ENBALMING PROCESS IN AND OF ITSELF
10 CREATE ANY PROBLEMS OR -- RELATIVE TO YOUR ABILITY TO EXAMINE
11 AN INDIVIDUAL FOR AUTOPSY?
12 A. IT DOES NOT CREATE PROBLEMS PER SE. EMBALMING IS THE
13 PROCESS WHICH IS UNDERGONE TO TRY TO PRESERVE TISSUES. SOME
14 OF THE THINGS THAT WILL HAPPEN, EMBALMING MAY INTRODUCE
15 ARTIFACTS. FOR EXAMPLE, ONE OF THE THINGS THAT MAY BE DONE
16 IS A LARGE NEEDLE MAY BE INSERTED THROUGH THE ABDOMINAL WALL
17 AND THE INTERNAL ORGANS WILL BE PERFORATED SO THAT THEY CAN
18 INFUSE PRESERVATIVES. THAT MAY LEAD TO HOLES AND DAMAGE IN
19 ORGANS WHICH WOULDN'T BE THERE IF EMBALMING HADN'T OCCURRED.
20 Q. OKAY. WHAT DID YOU NEXT PROCEED TO DO AFTER MAKING ANY
21 EXTERNAL EXAMINATION?
22 A. I DID THE INTERNAL EXAMINATION, ESSENTIALLY OPENING THE
23 CHEST AND ABDOMEN AND THEN EXAMINING EACH ORGAN FROM THE BODY
24 CAVITIES.
25 Q. OKAY. AND DO YOU PROCEED IN A PROGRESSION -- YOU SAY
1 YOU OPENED UP THE INTERNAL PART OF THE BODY. WAS THAT THE
2 ABDOMEN OR THE CHEST PLATE?
3 A. WHAT WE DO IS WE START WITH A LARGE INCISION THAT LOOKS
4 LIKE A Y. OVER THE CHEST AND ABDOMEN. WE REMOVE THE CHEST
5 PLATE AND THEN SEQUENTIALLY LOOK AT THE ORGANS. USUALLY WE
6 START THE HEART, PROCEED TO THE LUNGS, THE LIVER, SPLEEN,
7 KIDNEYS, INTESTINES, AND OTHER ORGANS.
8 Q. OKAY. CAN YOU TELL US WHAT -- THEN WHAT WAS YOUR NEXT
9 EXAMINATION CONDUCTED ON?
10 A. AFTER WE'VE DONE THAT PART OF THE EXAM, WE WILL THEN DO
11 AN EXAMINATION OF THE HEAD WHERE WE WILL MAKE A CUT OVER THE
12 BACK OF THE HEAD, FOLD BACK THE SCALP, LOOK AT THE SKULL, AND
13 THEN OPEN THE SKULL AND EXAMINE THE BRAIN.
14 Q. OKAY. AND THAT WAS DONE ON THIS OCCASION?
15 A. YES.
16 Q. AS TO THE OTHER PARTS OF THE BODY, ARE THERE OTHER AREAS
17 THAT YOU EXAMINE?
18 A. IF NECESSARY, WE MAY ALSO LOOK AT OTHER PARTS OF BODY IF
19 THERE'S EVIDENCE THAT THERE MAY BE INJURY OR OTHER PROCESSES
20 THAT NEED TO BE DOCUMENTED OR EXPLORED.
21 Q. AFTER HAVING -- DO YOU -- YOU DON'T RECALL WHETHER YOU
22 LOOKED AT OTHER PARTS IN CONNECTION --
23 A. IN THIS -- IN THIS CASE I DID. SPECIFICALLY, WHAT I
24 LOOKED AT WAS THE LEFT HIP REGION BECAUSE X-RAYS REVEALED
25 THAT THERE WAS A METAL PIN IN PLACE THERE. AND I WANTED TO
1 SEE IF THAT PIN WAS PROPERLY PLACED OR NOT. X-RAYS ALSO
2 REVEALED THAT THERE WAS AN ARTIFICIAL HIP ON THE RIGHT SIDE
3 THAT APPEARED INTACT, SO WE DID NOT ACTUALLY EXAMINE THAT
4 AREA.
5 Q. OKAY. THE BALANCE OF YOUR REPORT I THINK BASICALLY GOES
6 TO DIFFERENT FINDINGS AS THEY RELATED TO YOUR INTERNAL
7 EXAMINATION, DO THEY NOT?
8 A. YES.
9 Q. AND IN RESPECT TO THE -- TO ELLEN ANDERSON, SIR, DID
10 YOU -- DID YOU MAKE ANY -- OR DID YOU HAVE ANY SIGNIFICANT
11 FINDINGS RELATED TO THE CARDIOVASCULAR SYSTEM?
12 A. YES, I DID.
13 Q. AND WHAT WERE THEY?
14 A. I FOUND THAT MS. ANDERSON HAD A CONDITION CALLED
15 ARTERIOSCLEROTIC CARDIOVASCULAR DISEASE WHICH MEANS
16 ESSENTIALLY HARDENING OF THE ARTERIES. I FOUND THAT THE
17 ARTERIES THAT SUPPLY BLOOD TO HER HEART WERE HARDENED AND
18 WITH CALCIUM IN THEIR WALL, SO THEY'RE SOMEWHAT ROCK LIKE,
19 BUT DESPITE THAT CHANGE, THERE DID NOT SEEM TO BE VERY
20 SIGNIFICANT BLOCKAGE OF THE TUBE THAT THE BLOOD ACTUAL FLOWS
21 THROUGH. I ALSO FOUND THAT SHE HAD HARDENING OF THE MAIN
22 ARTERY OF HER BODY CALLED THE AORTA. THERE WAS EVIDENCE THAT
23 THAT HARDENING OF THE ARTERIES AT SOME POINT HAD CUT OFF SOME
24 BLOOD SUPPLY TO PART OF HER SPLEEN, SO SHE HAD A SMALL AREA
25 OF THE SPLEEN WHICH HAD INFARCTED OR DIED BECAUSE OF THE LACK
1 OF BLOOD SUPPLY. THIS WAS A VERY OLD FINDING, NOTHING ACUTE.
2 I ALSO SAW THAT SHE HAD EVIDENCE THAT HER KIDNEYS HAD SOME
3 DEGREE OF COMPROMISE OF BLOOD FLOW BECAUSE OF THE HARDENING
4 OF THE ARTERIES.
5 Q. DID YOU CHARACTERIZE THOSE -- THOSE FINDINGS IN TERMS OF
6 SEVERITY OF THE FINDING?
7 A. ALL OF THEM I CHARACTERIZED AS ESSENTIALLY MILD
8 FINDINGS.
9 Q. OKAY. IN REGARDS TO HER LUNGS, DID YOU MAKE ANY
10 FINDINGS IN RESPECT TO ELLEN ANDERSON?
11 A. YES, THERE WERE A NUMBER OF THINGS WRONG WITH
12 MS. ANDERSON'S LUNG. THE FIRST OF THESE WAS THAT I FOUND
13 EVIDENCE OF PNEUMONIA OR AN INFECTION INVOLVING HER LEFT
14 LUNG. THIS PROCESS WAS NOT SOMETHING THAT I COULD SEE WITH
15 MY NAKED EYE. IT WASN'T SO WIDESPREAD THAT YOU COULD LOOK AT
16 THE LUNG AND JUST SAY, WOW, THAT'S A PRETTY INFECTED LUNG.
17 IT WAS ONLY WHEN I LOOKED UNDER THE MICROSCOPE THAT I COULD
18 SEE THIS PROCESS GOING ON.
19 Q. AND HOW DID YOU CHARACTERIZE THIS PNEUMONIA?
20 A. I CHARACTERIZED IT AS AN ACUTE OR BASICALLY A FRESH OR
21 YOUNG PROCESS INVOLVING THE LEFT LUNG ONLY SEEN
22 MICROSCOPICALLY.
23 Q. OKAY.
24 A. I ALSO FOUND THAT SHE HAD EVIDENCE OF SCARRING IN HER
25 LUNG. THERE WERE TWO TYPES OF SCARS. ONE WAS AN AREA OF
1 SCARRING WHERE A BLOOD CLOT HAD TRAVELED PROBABLY FROM
2 ANOTHER PART OF THE BODY THROUGH THE HEART AND THEN GOTTEN
3 LODGED IN A BLOOD VESSEL TOWARDS THE OUTSIDE OF HER RIGHT
4 LUNG THAT CAUSED A SMALL AREA WHERE THE TISSUE HAD DIED
5 BECAUSE IT WASN'T GETTING ENOUGH BLOOD. I ALSO FOUND LOOKING
6 AT IT -- LOOKING AT HER LUNGS UNDER THE MICROSCOPE THAT SHE
7 HAD SOME ACTUAL SCARRING OF THE TISSUES THAT MAKE UP THE
8 STRUCTURE OF THE LUNG. AGAIN, THIS WAS SOMETHING WHICH
9 WASN'T SO SEVERE THAT I COULD SEE IT WITH MY NAKED EYE. I
10 COULD ONLY SEE IT UNDER THE MICROSCOPE.
11 Q. AND HOW DO YOU CHARACTERIZE THAT PARTICULAR CONDITION?
12 A. I AGAIN CHARACTERIZED THAT AS A FAIRLY MILD PROCESS.
13 Q. OKAY. AND IN REGARDS TO --
14 A. ONE OTHER THING IN THE LUNG.
15 Q. OH, EXCUSE ME.
16 A. SHE ALSO HAD EMPHYSEMA, WHICH IS A PROCESS WHERE THE
17 ACTUAL SUBSTANCE OF THE LUNG DETERIORATES AND SO THE AIR
18 SPACES IN YOUR LUNG BECOME BIGGER. EVEN THOUGH IT ISN'T
19 INTUITIVE, BIGGER AIR SPACES ARE BAD FOR YOU BECAUSE IT
20 DOESN'T HAVE AS MUCH SURFACE FOR BLOOD AND AIR TO INTERACT.
21 AND SO THAT WOULD AFFECT THE ABILITY OF THE BODY TO GET
22 OXYGEN INTO THE BLOOD.
23 Q. DID YOU THEN GO ON TO EXAMINE ANY BONE STRUCTURE AT THAT
24 TIME?
25 A. YES, I DID.
1 Q. CAN YOU TELL US WHAT YOUR FINDINGS WERE THERE?
2 A. MS. ANDERSON HAD DEGENERATIVE BONE DISEASE.
3 SPECIFICALLY, SHE HAD OSTEOPOROSIS, WHICH IS THE SOFTENING
4 AND LOSS OF SUBSTANCE IN BONE THAT IS A CONCOMITANT OF AGE AS
5 WELL AS UNFORTUNATELY SOMEWHAT RELATED TO AN INDIVIDUAL'S
6 SEX. FEMALES TEND TO HAVE THIS AS A PROBLEM MORE THAN MALES.
7 Q. OKAY. DID SHE HAVE ANY FRACTURES OR EVIDENCE OF ANY
8 KIND OF SURGERY?
9 A. SHE HAD NO ACUTE FRACTURES, NO BROKEN BONES THAT LOOKED
10 LIKE THEY WERE FRESH INJURIES IN A LIVING PATIENT. SHE HAD,
11 AS I SAID, EVIDENCE THAT SHE HAD HER RIGHT HIP REPLACED. AND
12 HAD HAD A METAL PIN PLACED IN HER LEFT HIP. I DID FIND ONE
13 FRACTURE OF A RIB WHICH WAS A POST MORTEM OR AFTER-DEATH
14 FRACTURE.
15 Q. OKAY. HOW DO YOU -- HOW DO YOU TELL THAT WAS
16 AFTER-DEATH FRACTURE?
17 A. YOU LOOK AT IT AND SEE FIRST OFF, IS THERE ANY EVIDENCE
18 OF BLEEDING ASSOCIATED WITH THIS BROKEN BONE. WHEN A BONE
19 BREAKS IN A LIVING PERSON, BLOOD IS GOING TO LEAK OUT OF THAT
20 AREA OF DAMAGE AND YOU'LL SEE HEMORRHAGE IN THE SURROUNDING
21 TISSUES. I DID NOT SEE THAT IN THIS FRACTURE. ANOTHER WAY
22 TO SEE IF IT IS A FRACTURE THAT OCCURRED DURING LIFE IS, IS
23 THERE ANY EVIDENCE THAT THE BODY HAS TRIED TO HEAL OR REACT
24 TO THIS AREA OF INJURY. AND AGAIN, I SAW NO EVIDENCE OF THAT
25 IN THIS FRACTURE.
1 Q. NOW, THE NEXT FINDING DEALS WITH THE HISTORY OF
2 DEMENTIA. WHY IS -- WHY IS THAT SIGNIFICANT? I TAKE IT YOU
3 HAD THE MEDICAL RECORDS AND YOU REFERENCED THE HISTORY OF
4 DEMENTIA.
5 A. YES.
6 Q. WAS THAT CORROBORATED BY ANY FINDINGS IN TERMS OF THE
7 AUTOPSY?
8 A. I FOUND EVIDENCE OF ATROPHY OR BASICALLY LOSS OF TISSUE
9 IN HER BRAIN. THAT COULD BE A CONCOMITANT OF THE CHANGES IN
10 HER BEHAVIOR AND MENTAL ABILITIES THAT WERE DOCUMENTED IN HER
11 MEDICAL RECORD.
12 Q. AND IN REGARDS TO THAT, HOW DID YOU CHARACTERIZE THAT
13 ATROPHY?
14 A. I CALLED THAT MODERATE TO SEVERE.
15 Q. OKAY. THE LAST FINDING, I THINK IT'S ITEM NUMBER 9 --
16 A. UH-HUH.
17 Q. -- COULD YOU TELL US WHAT THAT IS?
18 A. IN ADDITION TO THE OTHER THINGS THAT I'VE TALKED ABOUT,
19 THINGS -- I NOTED THAT THIS WAS A PERSON WHO HAD UNDERGONE A
20 GALL BLADDER REMOVAL SURGERY. SHE'D HAD HER APPENDIX OUT AND
21 HAD HAD HER UTERUS, FALLOPIAN TUBES, AND OVARIES REMOVED.
22 Q. OKAY. DOCTOR, IN RESPECT TO YOUR EXAMINATION, DID YOU
23 MAKE -- OR DID YOU TAKE ANY SAMPLES OR -- I GUESS SAMPLES
24 WOULD BE THE BEST WORD.
25 A. UH-HUH.
1 Q. OF ANY OF THE TISSUES OF THE BODY?
2 A. YES. AS PART OF THE EXAM, I COLLECTED VARIOUS MATERIALS
3 TO BE SUBMITTED FOR ANALYSIS FOR DRUGS OR POISONS.
4 Q. AND CAN YOU TELL US WHY YOU DID THAT IN THIS PARTICULAR
5 CASE?
6 A. BECAUSE THE QUESTION OF DRUG INTOXICATION AS A CAUSE OR
7 FACTOR IN THIS PERSON'S DEATH WAS ONE OF THE QUESTIONS THAT
8 WE WERE HOPING TO TRY TO ANSWER.
9 Q. OKAY. AND IN REGARDS TO THE SAMPLES, WAS THERE A
10 SCREENING TEST DONE?
11 A. YES.
12 Q. AND WHO IS -- WHO CONDUCTS THOSE SCREENING TESTS?
13 A. THE WAY IT WORKS IS WE WILL TAKE THE SAMPLES AND THEN
14 TURN THEM OVER TO THE STATE HEALTH DEPARTMENT LAB WHERE THEIR
15 FORENSIC TOXICOLOGY DIVISION WILL DO THE ACTUAL TESTING OR
16 PERFORMANCE OF THE TESTS TO DETERMINE WHAT'S IN THE SAMPLES.
17 Q. AND DID THEY RETURN THE TEST RESULTS TO YOU?
18 A. YES.
19 Q. AND DO YOU, SIR, INTERPRET THOSE TEST RESULTS?
20 A. YES.
21 Q. HAS THAT BEEN PART OF YOUR TRAINING AS A MEDICAL
22 EXAMINER?
23 A. YES.
24 Q. AND IN REGARDS TO THE SCREENING THAT WAS DONE RELATIVE
25 TO ELLEN ANDERSON, CAN YOU TELL US WHETHER OR NOT THERE WAS
1 ANY -- THERE WAS ANY -- WELL, CAN YOU TELL US WHAT THOSE
2 RESULTS WERE?
3 A. FOR THE SCREENING TESTS, THEY FOUND TRACE AMOUNTS OF A
4 ANTIDEPRESSENT MEDICATION CALLED AMITRIPTYLINE.
5 Q. OKAY. AND IN RESPECT TO MORPHINE, WAS THERE ANY TEST
6 CONDUCTED IN RESPECT TO THAT?
7 A. YES. WE DID HAVE THEM DO SPECIFIC TESTING LOOKING FOR
8 THE PRESENCE OF MORPHINE.
9 Q. OKAY. AND WAS THERE?
10 A. THEY COULD NOT DETECT ANY MORPHINE, NO.
11 Q. OKAY. DID THAT SURPRISE YOU?
12 A. NO.
13 Q. AND WHY IS THAT, SIR?
14 A. GIVEN THE FACT THAT THIS WAS A PERSON WHO HAD BEEN
15 EMBALMED AND THEN INTERRED FOR A PERIOD OF FOUR AND A HALF
16 YEARS, THE ABSENCE OF MORPHINE, EVEN WITH THE HISTORY OF IT
17 HAVING BEEN ADMINISTERED BEFORE THIS PERSON DIED, DID NOT
18 SURPRISE ME.
19 Q. OKAY. CAN YOU TELL US AS PART OF YOUR EXAMINATION, ARE
20 YOU REQUIRED OR DO YOU DETERMINE THE CAUSE OF DEATH?
21 A. YES. THAT'S PART OF MY STATUTORY DUTIES.
22 Q. OKAY. AND YOU ALSO WILL TRY TO DETERMINE MANNER OF
23 DEATH, IS THAT CORRECT?
24 A. THAT IS ALSO CORRECT, YES.
25 Q. WHAT TYPES OF CAUSES OF DEATH ARE THERE?
1 A. THERE ARE A MYRIAD OF DIFFERENT CAUSES OF DEATH.
2 Q. OKAY.
3 A. THERE ARE FIVE MANNERS OF DEATH.
4 THE COURT: MR. WILSON, IS THAT RELEVANT? LET'S JUST GO
5 TO WHAT WE'RE TALKING ABOUT HERE IF WE CAN.
6 MR. WILSON: I WILL, YOUR HONOR.
7 Q. (BY MR. WILSON) IN REGARDS TO THE MANNER OF DEATH, SIR,
8 YOU SAID THERE ARE FIVE OF THEM?
9 A. YES.
10 Q. AND WHAT ARE THOSE?
11 A. NATURAL, ACCIDENTAL, SUICIDE, HOMICIDE, AND
12 UNDETERMINED.
13 Q. OKAY. DID YOU MAKE A DETERMINATION ON THIS AUTOPSY AS
14 TO THE CAUSE OF DEATH?
15 A. YES, I DID.
16 Q. AND WHAT WAS THAT, SIR?
17 A. I CERTIFIED THAT THE CAUSE OF DEATH WAS UNDETERMINED.
18 BASICALLY MEANING THAT I COULD NOT DISTINGUISH BETWEEN A
19 NUMBER OF DIFFERENT POSSIBILITIES AS TO WHAT MAY HAVE KILLED
20 THIS INDIVIDUAL.
21 MR. BUGDEN: COULD YOU KEEP YOUR VOICE UP, DR. GREY?
22 THE WITNESS: CERTAINLY.
23 Q. (BY MR. WILSON) AND IN RESPECT TO THE --
24 MR. BUGDEN: YOU MIGHT WANNA MOVE TOWARDS THE MIKE. I'M
25 NOT SURE --
1 THE COURT: MR. BUGDEN, IF YOU JUST WANNA HANDLE YOUR
2 TABLE THERE, IF THERE'S A PROBLEM AS FAR AS HEARING, LET US
3 KNOW AND WE'LL TAKE CARE OF THAT.
4 MR. BUGDEN: OKAY. APOLOGIZE.
5 THE COURT: MAKE A DECENT RECORD. ALL RIGHT. LADIES
6 AND GENTLEMEN OF THE JURY, CAN YOU HEAR ALL RIGHT? OKAY.
7 LET'S GO.
8 Q. (BY MR. WILSON) I SHOW YOU NOW WHAT'S BEEN MARKED AS
9 STATE'S EXHIBIT 2-E AND ASK YOU IF YOU CAN IDENTIFY THAT
10 PARTICULAR EXHIBIT, IF WOULD YOU PLEASE.
11 A. YES.
12 Q. COULD YOU TELL US, SIR, RELATED TO THAT EXHIBIT, WHAT IS
13 IT?
14 A. IT'S A TWO-PAGE DOCUMENT. THE FIRST PAGE IS A COPY OF
15 THE ORIGINAL DEATH CERTIFICATE COMPLETED FOR MS. ANDERSON.
16 THE SECOND PAGE IS THE AMENDMENT OF THAT DOCUMENT THAT I
17 COMPLETED AND SIGNED.
18 Q. OKAY. AND IN RESPECT TO THE FIRST PAGE AS TO THE
19 ORIGINAL DEATH CERTIFICATE, WHAT DOES IT LIST AS THE CAUSE OF
20 DEATH?
21 A. THE CAUSE OF DEATH IS BROKEN DOWN INTO THREE PARTS. THE
22 FIRST PART IS CARDIAC ARREST. THE SECOND PART IS MYOCARDIAL
23 INFARCTION. AND THE FINAL AND -- OR THIRD PART IS SINUS
24 ARRHYTHMIA.
25 Q. WHO IS THIS SIGNED BY?
1 A. IT WAS SIGNED BY DR. ROBERT WEITZEL.
2 Q. OKAY. AND IN RESPECT TO YOUR FINDINGS, DID YOU LIST A
3 CAUSE OF DEATH?
4 A. ESSENTIALLY WHAT I DID WAS I CHANGED THE CAUSE OF DEATH
5 FROM A THREE-LINE STATEMENT TO A ONE-LINE STATEMENT READING
6 UNDETERMINED CAUSES.
7 Q. ALL RIGHT. OTHER THAN THE ACUTE NATURE OF THE
8 PNEUMONIA, WAS THERE ANY ACUTE FINDINGS THAT YOU HAD IN THIS
9 AUTOPSY?
10 A. NO.
11 Q. AND, SIR, CAN YOU -- CAN YOU TELL US WHETHER THERE'S ANY
12 SIGNIFICANCE TO THE FACT THAT YOU COULDN'T MAKE ANY ACUTE
13 FINDINGS?
14 A. I GUESS I'M NOT EXACTLY SURE WHAT YOUR QUESTION MEANS.
15 Q. WELL, LET ME REPHRASE THE QUESTION. YOU INDICATED THAT
16 THERE'S A NUMBER OF CAUSES OF DEATH. WOULD THE -- WELL, LET
17 ME REPHRASE IT. TAKING INTO ACCOUNT THE HISTORY OF THIS
18 PATIENT, AND THE INVESTIGATIVE REPORTS THAT YOU HAD RECEIVED,
19 CAN YOU EXCLUDE MORPHINE INTOXICATION AS A CAUSE OF DEATH?
20 A. NO, I CANNOT.
21 Q. OKAY. AND WHY IS THAT?
22 A. FOR THE A NUMBER OF REASONS. FIRST OFF, THE HISTORY
23 THAT WE HAD ON THIS INDIVIDUAL IS THAT SHE'S GIVEN MULTIPLE
24 DOSES OF MORPHINE RIGHT UP UNTIL THE TIME SHE DIES. THOSE
25 DOSES OF MORPHINE COULD HAVE CONTRIBUTED OR EVEN CAUSED DEATH
1 DIRECTLY. SECONDLY, I HAVE AN INDIVIDUAL WHO HAS A NUMBER OF
2 CHRONIC AGE-RELATED PROBLEMS, BUT NO SPECIFIC FINDING THAT I
3 COULD POINT TO THAT WOULD GIVE ME SOMETHING WHERE I CAN SAY,
4 A-HA, THIS CLEARLY IS SOMETHING THAT WOULD EXPLAIN WHY A
5 PERSON WOULD DIE SUDDENLY AND UNEXPECTLY. SHE HAS CONDITIONS
6 ALSO WHICH MAY BE EXACERBATED BY THE ADMINISTRATION OF
7 MORPHINE. SPECIFICALLY WHAT I'M REFERRING TO IS THE FACT
8 THAT SHE'S GOT LUNG DISEASE, BOTH AN INFECTION AS WELL AS
9 MORE CHRONIC CONDITIONS, AND MORPHINE AFFECTS THE BODY -- THE
10 ABILITY TO BREATHE, AND IF YOU HAVE LUNG DISEASE, THAT WOULD
11 BE A MORE SIGNIFICANT IMPACT THAN A PERSON WHO HAS HEALTHY
12 LUNGS.
13 Q. CAN I HAVE THE EXHIBIT BACK PLEASE? NEXT CALL YOUR
14 ATTENTION TO PATIENT JUDITH LARSEN. DID YOU CONDUCT AN
15 EXAMINATION IN RESPECT TO JUDITH LARSEN?
16 A. YES, I DID.
17 Q. AND I'M GOING TO SHOW YOU WHAT'S BEEN PREVIOUSLY MARKED
18 AS STATE'S EXHIBITS 3-C, AND ASK YOU IF YOU CAN IDENTIFY THAT
19 DOCUMENT FOR US, IF YOU WOULD PLEASE.
20 A. THIS IS A COPY OF THE AUTOPSY REPORT AND TOXICOLOGIC
21 FINDINGS RELATED TO MS. LARSEN.
22 Q. OKAY. CAN I SEE IT BACK PLEASE? WHEN WAS THAT
23 EXAMINATION CONDUCTED, SIR?
24 A. THAT EXAMINE WAS DONE ON JUNE 22ND OF 1999 COMMENCING AT
25 1 P.M.
1 Q. AND WHO WAS PRESENT AT THAT TIME?
2 A. AT THAT EXAMINATION, THERE WAS DETECTIVE JOE MORRISON
3 FROM LAYTON P.D. AND DAVE HARRIS FROM THE DAVIS COUNTY
4 SHERIFF'S OFFICE, IN ADDITION TO MYSELF AND MY ASSISTANT.
5 Q. AND DID YOU CONDUCT AN EXAMINATION SIMILAR TO THE
6 EXAMINATION YOU'D CONDUCTED IN RESPECT TO ELLEN ANDERSON?
7 A. YES.
8 Q. AND CAN WE -- WELL, THERE'S A COUPLE OF FINDINGS HERE
9 THAT -- IN THE INTERESTS OF TIME, I'M GONNA ASK YOU, DOCTOR,
10 DID YOU MAKE A DETERMINATION BASED UPON YOUR EXAMINATION AS
11 IT RELATED TO JUDITH LARSEN AS TO A MANNER -- OR EXCUSE ME, A
12 CAUSE OF DEATH?
13 A. YES, I DID.
14 Q. AND WHAT WAS THAT, SIR?
15 A. I CERTIFIED THAT MS. LARSEN DIES AS A RESULT OF DRUG
16 INTOXICATION WITH MORPHINE.
17 Q. OKAY. AND THE MANNER OF DEATH?
18 A. IN THIS CASE I CERTIFIED THE MANNER DEATH AS HOMICIDE.
19 Q. AND THAT WAS BASED UPON WHAT, SIR?
20 A. BASED UPON THE FACT THAT THIS INDIVIDUAL -- THE
21 INFORMATION I GOT CONCERNING THIS PERSON'S DEATH WAS THAT SHE
22 WAS INTENTIONALLY GIVEN MULTIPLE DOSES OF MORPHINE.
23 Q. OKAY. AND WAS THERE -- DID YOU IDENTIFY QUANTITIES OF
24 MORPHINE RELATIVE TO THAT INVESTIGATION?
25 A. DO YOU MEAN IN THE INDIVIDUAL OR --
1 Q. THAT THE INDIVIDUAL WAS GIVEN?
2 A. YES, I REVIEWED HER MEDICAL RECORDS AND SAW THAT SHE WAS
3 GIVEN MULTIPLE AND INCREASING AMOUNTS OF MORPHINE IN PERIOD
4 OF TIME PRIOR TO HER DEATH.
5 Q. DID YOU ALSO IN THE COURSE OF THIS EXAMINATION CONDUCT A
6 DRUG SCREEN?
7 A. YES.
8 Q. AND DID YOU RECEIVE THE RESULTS OF THAT SCREEN?
9 A. YES.
10 Q. AND CAN YOU TELL US WHAT THE RESULTS OF THE SCREEN WERE?
11 A. THE SCREENING INDICATED THAT THERE WERE OPIATES FOUND,
12 WHICH IS THE GENERAL CLASS OF DRUGS IN WHICH MORPHINE AND
13 OTHER NARCOTICS FALL.
14 Q. OKAY. AND IN RESPECT TO THE ACTUAL TESTS THEMSELVES,
15 WAS THERE ACTUAL MORPHINE IDENTIFIED IN THE -- IN THE
16 SUBSTANCES THAT YOU TESTED?
17 A. YES. IN ADDITION TO THE SCREENS, WE DID QUANTIFICATION
18 TESTS BASICALLY LOOKING TO SEE HOW MUCH MORPHINE WAS THERE.
19 WHAT WE FOUND WAS THAT MORPHINE WAS DETECTABLE AT A LEVEL OF
20 .09 MILLIGRAMS PER LITER IN THE LIVER. .28 MILLIGRAMS PER
21 LITER IN BILE. AND COULD NOT BE DETECTED AT A DETECTION
22 THRESHOLD IN THE BLOOD.
23 Q. OKAY. DID THOSE -- THOSE AMOUNTS --
24 A. OH, PARDON ME, I TAKE THAT BACK. IN THE BRAIN, NOT
25 BLOOD.
1 Q. DID THOSE AMOUNTS BEAR ANY SIGNIFICANCE RELATIVE TO YOUR
2 FINDINGS?
3 A. WELL, THAT'S A HARD QUESTION TO ANSWER, AND IF YOU'D
4 LIKE ME TO EXPLAIN, I'D BE HAPPY TO.
5 Q. I WOULD LIKE THAT, YES.
6 A. THE AMOUNTS MEAN CLEARLY THERE IS MORPHINE THERE. AND
7 IT IS IN AN AMOUNT MEASURABLE. WHAT DO THOSE AMOUNTS MEAN IN
8 RELATION TO WHAT HER LEVELS WERE AT HER ACTUAL TIME OF DEATH
9 IS A QUESTION WHICH I DON'T THINK ANYBODY CAN REALLY ANSWER.
10 WE HAVE THE SAME PROBLEM IN THIS CASE THAT WE HAD WITH THE
11 PREVIOUS. A BODY THAT HAS BEEN EMBALMED AND HAS THEN BEEN
12 BURIED IN THE GROUND FOR YEARS. THERE'S OBVIOUSLY GOING TO
13 BE DETERIORATION AND DEGREDATION OF ALL OF THE DIFFERENT
14 COMPOUNDS THAT MAY BE IN THIS INDIVIDUAL. SO THE FINDINGS
15 MEAN YES, THIS PERSON CLEARLY HAD MORPHINE THERE. HOW THAT
16 RELATES TO THE ACTUAL LEVEL AT THE TIME OF DEATH, I CANNOT
17 ANSWER. AND I'M NOT SURE ANYBODY COULD.
18 Q. DID YOU MAKE ANY OTHER FINDINGS OF AN ACUTE NATURE
19 RELATIVE TO YOUR EXAMINATION?
20 A. ACUTE NATURE, NO. I SAW A NUMBER OF CHRONIC
21 DEGENERATIVE TYPES OF CONDITIONS, BUT NO ACUTE PATHOLOGIC
22 FINDINGS.
23 Q. I WANT YOU TO TALK SPECIFICALLY ABOUT YOUR -- YOUR
24 EXAMINATION OF THE GASTROINTESTINE AREA, IF YOU WOULD PLEASE.
25 A. UH-HUH.
1 Q. CAN YOU TELL US WHAT YOU WERE LOOKING FOR IN MAKING THAT
2 EXAMINATION?
3 A. AS IN ANY PART OF MY EXAM, WHAT I'M LOOKING FOR IS TO
4 FIND ANY EVIDENCE OF DISEASE, INJURY, OR OTHER ABNORMALITY.
5 AND SO IN THIS CASE, THAT'S WHAT I WAS LOOKING FOR.
6 Q. OKAY. AND CAN YOU TELL US, DID THE HISTORY OF THE
7 PATIENT BEAR ANY SIGNIFICANCE IN TERMS OF WHY YOU EXAMINED
8 HER GASTROINTESTINAL AREA?
9 A. YES. IN THAT THERE WAS RECORDED IN THE MEDICAL RECORD
10 THAT THE HISTORY THAT THIS PERSON MAY HAVE VOMITED UP BLACK
11 COFFEE GROUND LIKE MATERIAL. THAT COULD BE INDICATIVE OF
12 GASTROINTESTINAL BLEEDING, HEMORRHAGE SOMEWHERE ALONG THE
13 GASTROINTESTINAL TRACT. SO CLEARLY, I WAS -- WANTED TO SEE
14 IF I COULD FIND ANY EVIDENCE OF PATHOLOGY THAT MIGHT
15 EXPLAIN --
16 THE COURT: YOU NEED TO SPEAK UP PLEASE.
17 THE WITNESS: OKAY.
18 THE COURT: MOVE CLOSER TO THE MICROPHONE IF YOU CAN.
19 Q. (BY MR. WILSON) DID YOU MAKE ANY FINDINGS OF ANY BLOOD
20 OR IDENTIFY ANY BLOOD IN THE STOMACH OR THE BOWEL?
21 A. NO. I SAW NO EVIDENCE OF BLOOD IN THE ESOPHAGUS,
22 STOMACH, OR BOWEL.
23 Q. DID YOU SEE ANY EVIDENCE RELATED TO ANY KIND OF -- GUESS
24 YOU'D CALL IT AN ULCER FOR LACK OF A BETTER WORD.
25 A. NO. I SAW NO ULCERS. THE ONLY ABNORMALITY I FOUND WAS
1 THAT SHE DID HAVE A HIATAL HERNIA, WHICH IS WHERE A SMALL
2 PORTION OF THE STOMACH PROTRUDES UPWARDS THROUGH THE
3 DIAPHRAM.
4 Q. OKAY. IN REGARDS TO – DID YOU EXAMINE HER BRAIN ON THIS
5 OCCASION?
6 A. YES.
7 Q. WERE THERE ANY SIGNIFICANT FINDINGS RELATED TO HER
8 BRAIN?
9 A. THERE WAS SOME DEGREE OF DETERIORATION IN BRAIN BECAUSE
10 OF THE POST MORTEM INTERVAL, BUT AGAIN, I COULD FIND NO
11 SPECIFIC PATHOLOGIC ABNORMALITIES. NO EVIDENCE OF BLEEDING
12 IN THE BRAIN, NO EVIDENCE OF TUMOR, NOTHING THAT I COULD
13 POINT TO AND SAY THIS IS A --
14 Q. OKAY.
15 A. -- DISEASE OR OTHER ABNORMALITY.
16 Q. I SHOW YOU WHAT'S BEEN MARKED AS STATE'S EXHIBIT 3-D AND
17 ASK YOU TO IDENTIFY THAT EXHIBIT IF YOU WOULD PLEASE?
18 A. UH-HUH. THIS IS A TWO-PAGE DOCUMENT. AGAIN, THE FIRST
19 PAGE IS THE ORIGINAL DEATH CERTIFICATE FILLED OUT BY
20 DR. WEITZEL. SECOND IS MY AMENDMENT OF THAT ORIGINAL
21 DOCUMENT.
22 Q. OKAY. AND CAN YOU TELL US -- I THINK YOU'VE ALREADY
23 TESTIFIED AS TO YOUR DETERMINATION OF CAUSE AND MANNER. WHAT
24 WAS THE -- WHAT WAS THE CAUSE OF DEATH LISTED BY DR. WEITZEL?
25 A. THIS WAS A TWO-PART CAUSE OF DEATH, THE FIRST LINE
1 READING CARDIAC ARREST, THE SECOND LINE READING RESPIRATORY
2 ARREST.
3 Q. OKAY. IN TERMS OF THE LINE DEALING WITH CARDIAC ARREST,
4 DID YOU MAKE ANY FINDINGS IN YOUR AUTOPSY AS IT RELATED TO
5 ANY CARIDAC ARREST?
6 A. YES.
7 Q. AND CAN YOU TELL US WHAT THOSE FINDINGS WERE?
8 A. WELL, IT'S -- CARDIAC ARREST BASICALLY MEANS THAT THE
9 HEART HAS STOPPED, AND MY EXAM CERTAINLY FOUND THAT THE
10 PERSON'S HEART HAD STOPPED.
11 Q. OH, OKAY. OBVIOUSLY, THE HEART STOPPED. IS THAT WHAT
12 YOU'RE TELLING ME?
13 A. YES.
14 Q. AND THE RESPIRATIONS HAVE STOPPED?
15 A. YES, THAT'S --
16 Q. THOSE ARE THE CAUSES --
17 A. -- ANOTHER FINDING THAT I DID CONFIRM.
18 Q. OKAY. I APPRECIATE THAT, DOCTOR. RELATIVE TO THE HEART
19 ITSELF, IF AN INDIVIDUAL HAD SUFFERED A HEART ATTACK, WOULD
20 THERE BE AN ABILITY TO ASCERTAIN A PATHOLOGICAL FINDING
21 RELATED TO THAT HEART ATTACK.
22 A. YES. THERE ARE A NUMBER OF THINGS THAT WE CAN SEE IN A
23 A HEART ATTACK. THAT'S VERY DIFFERENT FROM BEING -- SAYING
24 THAT THE HEART HAS STOPPED. I FOUND NO EVIDENCE OF A
25 MYOCARDIAL INFARCTION IN THIS CASE.
1 Q. OKAY. THANK YOU, DOCTOR. NOW LET'S TURN TO PATIENT
2 NUMBER 3 THAT YOU CONDUCTED THE EXAM ON, AND THAT WOULD BE --
3 EXCUSE ME. THAT WOULD BE LYDIA SMITH. DID YOU HAVE AN
4 OPPORTUNITY TO CONDUCT AN AUTOPSY RELATED TO LYDIA SMITH?
5 A. YES, I DID.
6 Q. AND CAN YOU TELL US WHEN THAT ONE OCCURRED?
7 A. THAT ONE WAS PERFORMED ON MAY 3RD OF 2000 STARTING AT
8 8:15.
9 Q. I SHOW YOU WHAT'S MARKED AS STATE'S EXHIBIT 5-C, AND ASK
10 YOU IF YOU CAN IDENTIFY THAT EXHIBIT?
11 A. YES.
12 Q. IS THAT YOUR AUTOPSY REPORT IN CONNECTION WITH LYDIA
13 SMITH?
14 A. MY AUTOPSY REPORT AND THE TOXICOLOGY REPORT, YES.
15 Q. OKAY. THANK YOU. NOW, YOU SAY YOU CONDUCTED THAT ON
16 0WHAT WAS THE DATE AGAIN, I'M SORRY?
17 A. MAY 3RD OF 2000.
18 Q. AND WHO WAS PRESENT AT THAT ONE?
19 A. IN ADDITION TO MYSELF AND MY ASSISTANT, DETECTIVE
20 MORRISON AND DR. ROTHFEDER WERE IN ATTENDANCE.
21 Q. OKAY. CAN YOU TELL US AS TO THE CONDITION OF THE BODY
22 ON THIS PARTICULAR INDIVIDUAL?
23 A. THIS --
24 THE COURT: IS THERE ANY REASON TO GO INTO THAT,
25 MR. WILSON?
1 MR. WILSON: OTHER THAN THAT IT -- I THINK IT -- MAYBE
2 HE CAN JUST GIVE US A BRIEF DESCRIPTION BECAUSE I THINK IT
3 RELATES TO HIS EXAMINATION.
4 THE COURT: I DON'T THINK IT DOES. GO TO HIS RESULTS
5 UNLESS THERE'S ANYTHING THAT'S RELEVANT.
6 Q. (BY MR. WILSON) DOCTOR, CAN YOU TELL US, DID YOU CONDUCT
7 AN EXAMINATION ON THAT DAY?
8 A. YES, I DID.
9 Q. AND IN THE SAME PROCESS THAT YOU CONDUCTED THE PREVIOUS
10 EXAMS?
11 A. YES, I -- YES, IT WAS.
12 Q. OKAY. WAS THERE ANY SIGNIFICANT FINDINGS RELATIVE TO
13 THE EXTERNAL EXAMINATION OF LYDIA SMITH?
14 A. THE DEGREE OF DETERIORATION IN THE BODY WAS GREATER THAN
15 WHAT I HAD SEEN IN THE OTHER TWO CASES THAT WE HAVE
16 DISCUSSED.
17 Q. DID THAT -- AS TO THE INTERNAL EXAM, DID THE DEGREE OF
18 DETERIORATION INHIBIT YOUR ABILITY TO MAKE SPECIFIC FINDINGS?
19 A. TO A DEGREE, YES.
20 Q. OKAY. CAN YOU TELL US AS TO A -- AFTER CONDUCTING THE
21 EXAMINATION, DID YOU DETERMINE A CAUSE OF DEATH?
22 A. YES.
23 Q. AND WHAT WAS YOUR FINDING AS TO CAUSE OF DEATH?
24 A. IN THIS CASE I CERTIFIED THAT THE CAUSE OF DEATH WAS
25 UNDETERMINED.
1 Q. OKAY. AND AS TO THE MANNER OF DEATH?
2 A. SAME THING, I CERTIFIED THIS AS UNDETERMINED.
3 Q. OKAY. AND IN RESPECT TO YOUR FINDINGS, WERE THERE ANY
4 SIGNIFICANT ACUTE FINDINGS RELATIVE TO YOUR EXAMINATION OF
5 LYDIA SMITH?
6 A. NO. I -- IN MY REPORT I INDICATED THAT THERE WERE NO
7 GROSS OR MICROSCOPIC ABNORMALITIES SUFFICIENT TO EXPLAIN
8 DEATH.
9 Q. OKAY. AGAIN, AS I'VE -- RELATIVE TO DRUG SCREENING, DID
10 YOU DO ANY DRUG SCREENING IN REGARDS TO THIS PARTICULAR
11 VICTIM?
12 A. YES.
13 Q. AND CAN YOU TELL US WHAT THE RESULTS WERE OF THE DRUG
14 SCREEN TESTS?
15 A. BOTH THE SCREENINGS AS WELL AS THE QUANTIFICATION TEST,
16 THE MORE SPECIFIC TESTS, FAILED TO REVEAL ANY DRUGS.
17 Q. OKAY. I FAILED TO ASK YOU AS TO THE LAST CASE RELATIVE
18 TO A DETERMINATION. WERE YOU ABLE TO EXCLUDE MORPHINE
19 INTOXICATION AS IT RELATED TO THE VICTIM JUDITH LARSEN -- NO,
20 EXCUSE ME, I WITHDRAW THAT YOUR HONOR.
21 IN REGARDS TO LYDIA SMITH, WERE YOU ABLE TO MAKE ANY
22 DETERMINATION RELATIVE TO THE EXCLUSION OF MORPHINE
23 INTOXICATION AS A CAUSE OF DEATH?
24 A. NO, I DID NOT EXCLUDE THAT.
25 Q. OKAY. AND WHY WAS THAT, SIR?
1 A. BECAUSE OF THE HISTORY IN THIS CASE.
2 Q. OKAY. THAT HISTORY BEING?
3 A. THE ADMINISTRATION OF MULTIPLE DOSES OF MORPHINE PRIOR
4 TO HER DEATH.
5 Q. I SHOW YOU WHAT'S BEEN MARKED AS STATE'S EXHIBITS 5-D
6 AND ASK YOU TO IDENTIFY THAT IF YOU WOULD PLEASE.
7 A. THIS IS AGAIN, A TWO-PAGE DOCUMENT. THE FIRST PAGE
8 BEING THE ORIGINAL DEATH CERTIFICATE COMPLETED ON LYDIA SMITH
9 BY DR. WEITZEL. THE SECOND BEING THE AMENDMENT OF THAT
10 DOCUMENT BY MYSELF.
11 Q. AND CAN YOU TELL US WHAT THE ORIGINAL DEATH CERTIFICATE
12 SAID AS AS TO CAUSE OF DEATH?
13 A. YES. THIS WAS A FOUR-PART DESCRIPTION OF THE CAUSE OF
14 DEATH, THE FIRST BEING CARDIAC ARREST, THE SECOND BEING
15 RESPIRATORY ARREST, THE THIRD BEING HYPOTENSION, AND THE
16 FOURTH BEING REFUSAL OF FLUIDS.
17 Q. OKAY. IS THERE ANYTHING FROM A PATHOLOGICAL STANDPOINT
18 THAT YOU COULD IDENTIFY RELATIVE TO THOSE FOUR CAUSES OF
19 DEATH?
20 A. NO.
21 Q. LET ME SEE, LET'S TURN NOW TO ENNIS ALLDREDGE, IF YOU
22 WILL. I SHOW YOU WHAT'S BEEN MARKED AS STATE'S EXHIBIT -- I
23 THINK IT'S 5 --
24 A. 6-C.
25 Q. 6-C, EXCUSE ME. CAN YOU TELL US WHAT THAT DOCUMENT IS?
1 A. THIS IS A COPY OF THE AUTOPSY REPORT AND TOXICOLOGICAL
2 REPORT RELATED TO MR. ALLDREDGE.
3 Q. AND CAN YOU TELL US, SIR, DID YOU CONDUCT AN AUTOPSY IN
4 REGARD TO MR. ALLDREDGE?
5 A. YES, I DID. THAT WAS PERFORMED ON JULY 21ST OF 1999,
6 COMMENCING AT 9:15.
7 Q. AND WHO WAS PRESENT ON THAT OCCASION?
8 A. DETECTIVE JOE MORRISON.
9 Q. OKAY. AND WERE YOU ABLE TO CONDUCT AN AUTOPSY?
10 A. YES.
11 Q. WAS THE -- WAS THE AUTOPSY CONDUCTED IN THE SAME MANNER
12 THAT YOU CONDUCTED THE PREVIOUS AUTOPSIES?
13 A. YES.
14 Q. DID YOU IN THE COURSE OF THAT PARTICULAR AUTOPSY MAKE
15 ANY FINDINGS RELATIVE TO A CAUSE OF DEATH?
16 A. AGAIN, IN THIS CASE AS IN THE OTHERS, I FOUND A NUMBER
17 OF CONDITIONS IN THE BODY RELATED TO THE HEART AND LUNGS THAT
18 MIGHT MIGHT EXPLAIN DEATH, BUT NOTHING WHICH ACUTELY I COLD
19 POINT TO AND SAY CLEARLY, THIS IS A CLEAR CAUSE OF DEATH.
20 Q. I WANT YOU TO FOCUS ON A COUPLE OF AREAS OF THE AUTOPSY
21 IN THAT REGARD. DO YOU YOU SEE ANY EVIDENCE OF PNEUMONIA?
22 A. YES.
23 Q. AND CAN YOU DESCRIBE THAT FOR US, IF COULD YOU PLEASE?
24 A. AGAIN, THIS WAS A PROCESS THAT I COULD NOT SEE WITH MY
25 NAKED EYE. I COULD ONLY DIAGNOSIS IT BY LOOKING UNDER THE
1 MICROSCOPE. WHAT I FOUND WERE ESSENTIALLY PATCHY AREAS WHERE
2 THERE WAS AN INFLAMMATORY OR INFECTIOUS PROCESS GOING ON IN
3 THE LUNGS.
4 Q. OKAY. NOW, YOU DO DESCRIBE IT AS FOCAL ACUTE
5 INFLAMMATORY INFILTRATES IN YOUR REPORT, IS THAT CORRECT?
6 A. YES.
7 Q. WHAT DOES A MEAN, FOCAL ACUTE?
8 A. PATCHY.
9 Q. OKAY. WERE THERE ANY OTHER SIGNIFICANT FINDINGS OF AN
10 ACUTE NATURE?
11 A. OF AN ACUTE NATURE, NO.
12 Q. OKAY. DID YOU HAVE OCCASION TO EXAMINE MR. ALLDREDGE'S
13 BRAIN?
14 A. YES, I DID.
15 Q. AND CAN YOU TELL US -- RELATIVE TO THE BRAIN, CAN YOU
16 DESCRIBE FOR US WHAT THAT EXAMINATION ENTAILED?
17 A. THE EXAMINATION ENTAILED THE PROCESS THAT I'VE TALKED
18 ABOUT PREVIOUSLY, WHICH IS WHERE WE REFLECT THE SCALP, LOOK
19 AT THE SKULL, OPEN THE SKULL, AND LOOK AT THE BRAIN.
20 Q. AND WAS THERE A -- WERE YOU ABLE TO -- WAS THE BRAIN
21 ABLE TO BE -- WELL, WHAT TYPE OF SHAPE WAS IT IN AT THE TIME
22 YOU EXAMINED IT?
23 A. THERE WAS CLEAR DETERIORATION OF THE BRAIN RELATED TO
24 THE LONG PERIOD OF INTERRMENT. THE BRAIN WAS SOFTER THAN
25 NORMAL. IT HAD ALMOST ESSENTIALLY MOLDED ITSELF MORE TOWARDS
1 THE BACK OF THE HEAD. SO THAT IT WAS NOT THE MOST OPTIMAL OF
2 EXAMINATIONS, BUT YOU COULD STILL SEE SOME OF STRUCTURES AND
3 YOU COULD SEE FEATURES IN THE BRAIN.
4 Q. NOW, YOU KNOW WHAT A STROKE IS?
5 A. YES, I DO.
6 Q. AND THERE ARE DIFFERENT TYPE OF STROKES?
7 A. YES, THERE ARE.
8 Q. CAN YOU TELL US WHAT KIND OF STROKES THERE ARE?
9 A. GENERALLY THERE ARE TWO CLASSES OF STROKES. ONE IS
10 WHERE A BLOOD VESSEL RUPTURES AND YOU BLEED INTO YOUR BRAIN.
11 THAT IS CALLED A HEMORRHAGIC STROKE. THE OTHER KIND OF
12 STROKE IS WHERE A BLOOD VESSEL IS BLOCKED UP FOR SOME REASON
13 AND YOU DON'T GET ENOUGH BLOOD TO A CERTAIN PART OF YOUR
14 BRAIN, AND THAT AREA OF THE BRAIN DIES.
15 Q. RELATIVE TO YOUR EXAMINATION OF ENNIS ALLDREDGE'S BRAIN,
16 WERE YOU ABLE TO DETERMINE WHETHER OR NOT HE HAD SUFFERED ANY
17 STROKE?
18 A. I SAW NO EVIDENCE OF ANY BLEEDING INTO THE BRAIN. I
19 COULD NOT SEE ANYTHING THAT LOOKED LIKE A HEMORRHAGIC STROKE.
20 A LACK OF BLOOD FLOW TYPE OF STROKE WOULD BE MUCH HARDER TO
21 SEE EVEN IN A FRESH BRAIN, AND I COULD NOT PROVE OR DISPROVE
22 WHETHER THAT WAS THERE.
23 Q. OKAY. BUT YOU DID RULE OUT ANY HEMORRHAGIC STROKE.
24 A. YES, I DID.
25 Q. OKAY. WERE YOU ABLE TO DETERMINE ANY -- DID YOU MAKE
1 ANY DRUG SCREENS?
2 A. YES.
3 Q. AND CAN YOU TELL US THE RESULTS OF THAT SCREEN?
4 A. THE SCREENING TEST REVEALED THE PRESENCE OF OPIATES IN A
5 SAMPLE OF BLOOD CLOT TAKEN FROM THE HEART.
6 Q. OKAY. AND WERE YOU ABLE TO CONDUCT ANY QUANTIFICATION
7 TESTS RELATIVE TO THE TISSUES THAT YOU HAD EXAMINED?
8 A. YES. QUANTIFICATION TESTS WERE PERFORMED ON THAT BLOOD
9 CLOT AS WELL AS BRAIN AND LIVER. ALL OF THOSE TESTS CAME
10 BACK ESSENTIALLYLY NEGATIVE, BELOW THEIR DETECTION THRESHOLD.
11 Q. AND AGAIN, WERE YOU ABLE TO RULE OUT DRUG INTOXICATION
12 OR MORPHINE INTOXICATION RELATIVE TO THIS PARTICULAR
13 INDIVIDUAL?
14 A. NO.
15 Q. AND MAY I HAVE THE EXHIBIT BACK? DOCTOR, CAN YOU TELL
16 US RELATIVE TO THESE PROCEEDINGS, DID YOU HAVE OCCASION TO
17 REVIEW THE REPORT OF THE DEFENDANT'S EXPERTS, TWO PARTICULAR
18 EXPERTS, MR. ROTH -- OR DR. ROTHFEDER AND DR. BADER CASSIN?
19 A. YES.
20 Q. RELATED TO THEIR STATEMENTS AS TO CAUSE OF DEATH, DO YOU
21 HAVE ANY OPINION AS TO WHETHER OR NOT YOU COULD RULE OUT THE
22 CAUSES OF DEATH THAT THEY ATTRIBUTE TO THESE INDIVIDUALS IN
23 THEIR REPORTS?
24 A. THAT'S A PRETTY BROAD QUESTION. SPECIFICALLY, MY
25 RECOLLECTION OF THEIR REPORTS ARE THAT THEY ATTRIBUTE THESE
1 PATIENTS' DEATH TO ESSENTIALLY THEIR CHRONIC CONDITIONS THAT
2 WE HAVE DISCUSSED. INSOFAR AS YES, THOSE CONDITIONS WERE
3 PRESENT, THEY ARE CORRECT. AND IF YOU TOOK THESE PATIENTS
4 SOLELY AS I SAW THEM AT AUTOPSY, THEIR CONCLUSIONS MIGHT BE
5 CORRECT. IT'S IN LOOKING AT THE CIRCUMSTANCES SURROUNDING
6 THE DEATH OF THESE PATIENTS THAT I THINK SOLELY ASCRIBING
7 DEATH TO THEIR CHRONIC CONDITIONS MAY BE INACCURATE.
8 Q. OKAY. IN REGARDS TO THE DISEASE OF CORONARY
9 ARTERIOSCLEROSIS, IS THAT SOMETHING THAT'S VERIFIABLE IN
10 TERMS OF YOUR PATHOLOGICAL EXAMINATION?
11 A. YES.
12 Q. AND DID YOU SEE THAT IN ELLEN ANDERSON?
13 A. YES.
14 Q. NOW, AGAIN, IN REGARDS TO THAT PARTICULAR FINDING, DO I
15 UNDERSTAND YOU TO SAY THAT THAT IS PRESENT, BUT IT CAN'T BE
16 RULED ONE WAY OR ANOTHER AS TO CAUSE OF DEATH?
17 A. IT IS PRESENT. IT IS FROM MY EXAMINATION, A CONDITION
18 WHICH WAS THERE CHRONICALLY, HAD BEEN THERE FOR A LONG PERIOD
19 OF TIME. I SAW NOTHING RELATED TO THAT THAT LOOKED LIKE IT
20 WAS AN ACUTE CHANGE OR DETERIORATION IN THAT CONDITION THAT
21 WOULD EXPLAIN DEATH.
22 MR. WILSON: OKAY. NO FURTHER QUESTIONS, YOUR HONOR.
23 THE COURT: THANK YOU, MR. WILSON. MS. ISAACSON --
24 MR. WILSON: OH, EXCUSE ME, YOUR HONOR. WE WOULD OFFER
25 IN AT THIS TIME STATE'S EXHIBITS -- LET'S SEE, 6-C, 6-D, 5-D,
1 5-C, 3-D, 3-C, 2-E, AND 2-D.
2 MS. ISAACSON: NO OBJECTION.
3 THE COURT: THAT WILL BE 6-C AND 6-D.
4 MR. WILSON: THAT'S CORRECT, YOUR HONOR.
5 THE COURT: THAT WILL BE 5-C AND 5-D.
6 MR. WILSON: THAT'S 5-D AND 5-C, YES.
7 THE COURT: THAT WOULD BE 3-C AND 3-D.
8 MR. WILSON: THAT'S CORRECT.
9 THE COURT: AND THAT WOULD BE 2-D AND 2-E.
10 MR. WILSON: THAT'S CORRECT.
11 THE COURT: THOSE WILL ALL BE RECEIVED. JUST PUT THEM
12 ON THE TABLE.
13 MR. WILSON: THANK YOU, JUDGE.
14 CROSS-EXAMINATION
15 BY MS. ISAACSON:
16 Q. GOOD AFTERNOON. MY NAME IS TARA ISAACSON. I'M ONE OF
17 THE ATTORNEYS THAT REPRESENTS DR. WEITZEL. YOU MENTIONED
18 THAT IN ADDITION TO THE PHYSICAL EXAM THAT YOU PERFORMED IN
19 THESE AUTOPSIES, YOU ALSO RELY ON INVESTIGATIVE REPORTS, IS
20 THAT RIGHT?
21 A. YES.
22 Q. AND AS I REVIEWED YOUR FILES, I NOTED THAT THERE WERE
23 NEWSPAPER CLIPPINGS ABOUT THIS CASE IN YOUR FILES. NOW, YOU
24 DON'T CONSIDER THOSE INVESTIGATIVE REPORTS FOR PURPOSES OF
25 MAKING FINDINGS IN THIS CASE, DO YOU?
1 A. NO. THEY'RE JUST DOCUMENTATION OF MATERIALS RELATED TO
2 THE FILE -- TO THE CASE.
3 Q. BUT YOU AGREE THAT IN YOUR FILES, IN A NUMBER OF THE
4 FILES, THERE ARE NEWSPAPER CLIPPINGS.
5 A. OH, IN ALL OF THEM I THINK WE HAVE CLIPPINGS.
6 Q. WITH REGARD TO THE DECOMPOSITION IN THIS CASE, AGAIN,
7 THE AUTOPSIES WERE PERFORMED THREE AND A HALF TO FOUR AND A
8 HALF YEARS AFTER DEATH. IS THAT RIGHT?
9 A. THAT IS CORRECT.
10 Q. AND ALL THE BODIES HAD BEEN EMBALMED?
11 A. THAT IS CORRECT.
12 Q. AND YOU WOULD AGREE THAT THIS POST MORTEM DETERIORATION
13 AFFECTS ALL THE TISSUES OF THE BODY?
14 A. YES.
15 Q. AND ALTERS THE APPEARANCE OF DISEASE AT THE TIME OF
16 DEATH?
17 A. TO A VARYING DEGREE, YES.
18 Q. AND THERE ARE PROCESSES THAT YOU SEE THAT ARE
19 IDENTIFIABLE WHEN SOMEONE DIES THAT MAY GO UNRECOGNIZED AFTER
20 THE BODY HAS DECOMPOSED.
21 A. AGAIN, VARYING CONDITIONS MAY BE OBSCURED TO SOME DEGREE
22 OR ANOTHER, DEPENDING ON HOW MUCH DETERIORATION THERE IS,
23 YES.
24 Q. WITH REGARD TO THE DIAGNOSIS OF DEMENTIA, ALL FOUR OF
25 THESE AUTOPSIES THAT YOU PERFORMED, YOU REVIEWED MEDICAL
1 RECORDS FOR EACH OF THE PATIENTS.
2 A. THAT IS CORRECT.
3 Q. AND YOU'RE AWARE THAT EACH OF THEM HAD DEMENTIA.
4 A. YES, BY HISTORY.
5 Q. AND DEMENTIA ALONE CAN BE A CAUSE OF DEATH.
6 A. YES.
7 Q. AND YOU IN FACT IN OTHER CASES HAVE INDICATED DEMENTIA
8 AS A SOLE CAUSE OF DEATH.
9 A. YES, I HAVE CERTIFIED INDIVIDUALS AS DYING AS A
10 CONSEQUENCE OF THE DETERIORATION IN THEIR BRAIN.
11 Q. AND IN FACT, DEMENTED INDIVIDUALS CAN ESSENTIALLY LAPSE
12 INTO A COMATOSE CONDITION AND DIE SOLELY BECAUSE OF THEIR
13 BRAIN CONDITION.
14 A. IN ADVANCED STAGES, YES.
15 Q. LET'S GO ON TO THE SPECIFIC PATIENTS. WITH REGARD TO
16 ELLEN ANDERSON, 91 -- SHE'S A 91-YEAR-OLD WOMAN WHO'S
17 DIAGNOSED WITH DEMENTIA, IS THAT CORRECT?
18 A. YES.
19 Q. AND WERE YOU AWARE FROM YOUR REVIEW OF THE MEDICAL
20 RECORDS THAT SHE -- IT WAS REPORTED SHE HAD LOST 30 POUNDS IN
21 THE LAST YEAR OF HER LIFE?
22 A. YES.
23 Q. WITH REGARD TO HER LUNGS AND THE CONDITION OF HER LUNGS,
24 SHE HAD A PREVIOUS BLOOD CLOT IN HER RIGHT LUNG?
25 A. THAT IS CORRECT.
1 Q. AND PART OF THE TISSUE HAD ACTUALLY DIED IN HER LUNG.
2 A. THAT IS CORRECT.
3 Q. SO TO START OUT WITH, HER LUNGS ARE NOT IN GREAT SHAPE.
4 A. I THINK THAT'S A FAIR CHARACTERIZATION, YES.
5 Q. AND YOU DETECT ACUTE PNEUMONIA IN THE LEFT LUNG.
6 A. THAT IS CORRECT.
7 Q. AND YOU CANNOT RULE OUT PNEUMONIA AS A CAUSE OF DEATH
8 FOR HER.
9 A. NO, I CANNOT.
10 Q. YOU ALSO FOUND IN THE LUNGS EMPHYSEMA?
11 A. THAT IS CORRECT.
12 Q. AND IN CONJUNCTION WITH THE OTHER FINDINGS, IT COULD
13 CONTRIBUTE TO HER DEATH.
14 A. CERTAINLY.
15 Q. WITH REGARD TO HER HEART, THERE WAS SCARRING IN THE
16 MUSCLE TISSUES?
17 A. MICROSCOPICALLY, NOT GROSSLY, BUT YES.
18 Q. AND THERE WAS SOME DEGREE OF COMPROMISE OF BLOOD FLOW TO
19 THE HEART.
20 A. THERE WAS MILD BLOCKAGE OF HER ARTERIES, YES.
21 Q. AND THIS OBSTRUCTION -- WELL, LET'S SEE, SHE HAD
22 HARDENING OF THE ARTERIES INVOLVING THE AORTA AS WELL. DO I
23 UNDERSTAND THAT RIGHT?
24 A. YES.
25 Q. AND THIS OBSTRUCTION HAD ACTUALLY CAUSED DEATH OF TISSUE
1 IN HER SPLEEN.
2 A. THE OLD AREA OF DEAD TISSUE IN THE SPLEEN WAS MOST
3 LIKELY RELATED TO THAT HARDENING OF THE ARTERY PROCESS, YES.
4 Q. AND YOU WOULD ALSO AGREE THAT CORONARY ARTERY DISEASE OR
5 HARDENING OF THE ARTERIES COULD HAVE CAUSED HER DEATH.
6 A. IT'S POSSIBLE.
7 Q. DO YOU RECALL TESTIFYING ON A PREVIOUS OCCASION,
8 DR. GREY?
9 A. VAGUELY, YES.
10 Q. DO YOU RECALL BEING ASKED THE QUESTION ABOUT WHETHER
11 CORONARY ARTERY DISEASE OR HARDENING OF THE ARTERIES COULD
12 HAVE CAUSED HER DEATH?
13 A. YES.
14 Q. DO YOU RECALL ANSWERING THAT AS TRUE?
15 A. MY RECOLLECTION IS THAT CORONARY ARTERY DISEASE CAN
16 CAUSE DEATH, AND MY ANSWER IS YES. IN THIS SPECIFIC CASE,
17 CAN IT -- COULD IT HAVE CAUSED HER DEATH, IT'S POSSIBLE.
18 Q. IT'S POSSIBLE. OKAY. SO YOU CAN'T RULE IS OUT AS A
19 CAUSE OF DEATH.
20 A. CAN I EXCLUDE IT COMPLETELY? NO.
21 Q. OKAY. AGAIN, WITH REGARD TO THE HEART, HEART ARRHYTHMIA
22 IS SOMETHING THAT CANNOT BE SEEN IN AN AUTOPSY.
23 A. NO.
24 Q. AND HEART ARRHYTHMIA CAN BE THE CAUSE OF SUDDEN DEATH.
25 A. YES.
1 Q. AND YOU CAN'T RULE OUT A HEART ARRHYTHMIA AS THE CAUSE
2 OF DEATH IN THE CASE OF ELLEN ANDERSON.
3 A. NO, I CANNOT.
4 Q. WITH REGARD TO DEMENTIA, YOU DID OBSERVE SIGNIFICANT
5 CEREBRAL ATROPHY WHEN YOU EXAMINED MS. ANDERSON'S BRAIN.
6 A. YES, I CHARACTERIZED IT AS MODERATE TO SEVERE.
7 Q. AND YOU CANNOT RULE OUT DEMENTIA AS A CONTRIBUTORY
8 FACTOR IN HER DEATH.
9 A. CERTAINLY NOT.
10 Q. WITH REGARD TO JUDITH LARSEN, YOU WERE AWARE OF COURSE
11 THAT SHE HAD A PRIOR HISTORY OF STROKES?
12 A. YES.
13 Q. SHE HAD A STROKE IN JANUARY OF '95.
14 A. THAT IS WHAT THE MEDICAL RECORD INDICATED, YES.
15 Q. STROKE IN AUGUST OF 1995.
16 A. YES.
17 Q. AND CERTAINLY HER HISTORY OF STROKES WOULD INDICATE
18 CEREBROVASCULAR DISEASE.
19 A. THAT OR OTHER REASONS FOR WHY SHE MAY HAVE OCCLUDED
20 VESSELS, YES.
21 Q. AND YOU CANNOT RULE OUT SOME SORT OF STROKE EVENT AS A
22 CONTRIBUTING FACTOR TO HER DEATH.
23 A. I CANNOT RULE IT OUT, NO.
24 Q. WITH REGARD TO THIS PATIENT, IT'S TRUE, DR. GREY, THAT
25 WITHOUT FLUIDS, YOU -- AN INDIVIDUAL WILL DIE. IF AN
1 INDIVIDUAL DOES NOT HAVE HYDRATION, THEY WILL DIE.
2 A. YES.
3 Q. AND IN THIS CASE, THERE WERE ISSUES ABOUT HER NOT TAKING
4 FLUIDS AT VARIOUS TIMES ON THE UNIT.
5 A. MY RECOLLECTION OF THE MEDICAL RECORD IS THAT THAT WAS
6 ONE OF THE ISSUES THAT WAS BEING DISCUSSED IN THE RECORD,
7 YES.
8 Q. AND WHEN YOU PERFORM AN AUTOPSY, YOU CAN'T TELL IF
9 SOMEONE DIED OF DEHYDRATION.
10 A. THAT'S NOT QUITE TRUE.
11 Q. WELL, LET'S -- LET'S SO I DON'T --
12 A. IF YOU WANT ME TO EXPLAIN, I'D BE HAPPY TO.
13 Q. WELL, LET'S JUST -- LET'S JUST SAY WITH REGARD TO JUDITH
14 LARSEN, CAN YOU RULE OUT LACK OF FLUIDS AS A CAUSE OF DEATH
15 FOR HER?
16 A. NO. IN THIS CASE I CANNOT EXCLUDE THAT.
17 Q. THE SAME THING WITH NOURISHMENT, IF SOMEONE DOES NOT
18 EAT, THEY'LL DIE.
19 A. EVENTUALLY, YES.
20 Q. AND OF COURSE AGAIN, YOU ARE AWARE SHE'D STOPPED EATING
21 AT SOME POINT IN THE HOSPITAL?
22 A. YES.
23 Q. AND YOU CAN'T RULE THAT OUT AS A CAUSE OF DEATH.
24 A. NO, NOT AS A FACTOR.
25 Q. LET'S TALK ABOUT THE GASTROINTESTINAL BLEED.
1 A. UH-HUH.
2 Q. THAT MEANS THAT THERE'S SOME AREA WITHIN ESSENTIALLY THE
3 GUT THAT IS BLEEDING.
4 A. YES.
5 Q. AND THERE ARE CIRCUMSTANCES WHERE THE BLEED IS REPAIRED
6 AND ESSENTIALLY THE BLOOD IS EXCRETED IN THE NORMAL EXCRETORY
7 PROCESSES IF THE BODY.
8 A. YES. THE PROCESS OF BLEEDING MAY STOP. THE BLOOD
9 THAT'S IN THE TUBES WILL BE EVACUATED. AND IF YOU COME ALONG
10 AND EXAMINED THE GUT AFTER THAT, YOU WILL NOT SEE ANYTHING.
11 Q. SO WITH REGARD TO MS. LARSEN, THE COMPLICATIONS OF A
12 GASTROINTESTINAL BLEED COULD STILL EXIST EVEN THOUGH THERE'S
13 NO EVIDENCE OF THE BLOOD NOW BEING IN THE BODY.
14 A. YOU'D HAVE TO BE MORE SPECIFIC ABOUT WHICH COMPLICATIONS
15 YOU MIGHT BE REFERRING TO.
16 Q. WELL, GENERALLY, JUST THE FACT THAT YOU DID NOT FIND
17 BLOOD, DOES NOT RULE OUT THE FACT THAT THERE COULD HAVE BEEN
18 GASTROINTESTINAL BLEEDING.
19 A. AT SOMETIME IN THE PAST, NO, I CANNOT EXCLUDE THAT.
20 Q. AND YOU DID NOT HAVE ANY BLOOD AVAILABLE TO ANALYZE
21 ANEMIA OR AN ANEMIC CONDITION AS CONTRIBUTING TO HER DEATH.
22 A. NO.
23 Q. SO ANEMIA CANNOT BE RULED OUT.
24 A. I CANNOT EXCLUDE IT, NO.
25 Q. AND AS WITH ELLEN ANDERSON -- WELL, LET ME BACK UP.
1 WITH REGARD TO JUDITH LARSEN, AN E.K.G. WAS RUN ON HER AND IT
2 WAS ABNORMAL.
3 A. I CAN'T REALLY COMMENT ON THAT BECAUSE I HAVEN'T SEEN --
4 I HAVE NOT SEEN THE E.K.G. AND I DON'T REMEMBER THE
5 INTERPRETATION.
6 Q. WELL, WE CAN GO BACK TO YOUR -- TO YOUR TESTIMONY, YOUR
7 PREVIOUSLY SWORN TESTIMONY IN WHICH YOU AGREED THAT AN E.K.G.
8 WAS RUN, IT WAS ABNORMAL. WOULD YOU LIKE TO LOOK AT THAT?
9 A. YEAH, I'D BE HAPPY TO.
10 Q. COUNSEL, I'M LOOKING AT PAGE 2009, LINES 1 THROUGH 5.
11 A. OKAY. I'VE READ IT.
12 Q. AND WOULD YOU AGREE THAT AT LEAST ON A PREVIOUS OCCASION
13 UNDER OATH, YOU INDICATED THAT AN E.K.G., ACCORDING TO YOUR
14 RECORD -- REVIEW OF THE RECORDS WAS RUN ON JUDITH LARSEN AND
15 WAS ABNORMAL?
16 A. YES.
17 Q. AND THAT GIVEN THAT FINDING, YOU CAN'T RULE OUT
18 ARRHYTHMIA AS A CAUSE OF DEATH?
19 A. NO, I CANNOT EXCLUDE THAT.
20 Q. YOU CAN KEEP THAT UP THERE IN CASE WE NEED TO GO BACK TO
21 IT. WITH REGARD TO LYDIA SMITH, AGAIN WITH HER, YOU CANNOT
22 RULE OUT DEHYDRATION AND LACK OF NOURISHMENT AS A CAUSE OF
23 DEATH.
24 A. A CAUSE OR A FACTOR IN THE DEATH? NO, I CANNOT.
25 Q. AGAIN, THIS -- THIS IS ANOTHER PATIENT WHO HAS A HISTORY
1 OF STROKES WITH AN INDICATION OF CEREBROVASCULAR DISEASE, IS
2 THAT CORRECT?
3 A. YES.
4 Q. AND WITH LYDIA SMITH, YOU CANNOT RULE OUT
5 CEREBROVASCULAR DISEASE AS CAUSING OR CONTRIBUTING TO HER
6 DEATH.
7 A. NO.
8 Q. IN EXAMINING HER CORONARY ARTERIES, YOU COULD ALSO SEE
9 THERE WAS CALCIFICATION IN ONE OF THOSE ARTERIES?
10 A. YES.
11 Q. BUT DECOMPOSITION WAS SO BAD THAT YOU REALLY COULDN'T
12 TELL HOW SEVERE.
13 A. THAT'S CORRECT, I COULDN'T REALLY ESTIMATE HOW BADLY
14 NARROWED THE VESSEL WAS BECAUSE OF THE DETERIORATION.
15 Q. AND YOU CAN'T RULE OUT CORONARY ARTERY DISEASE AS A
16 CAUSE OF LYDIA SMITH'S DEATH?
17 A. I CANNOT, NO.
18 Q. YOU CAN'T RULE OUT THAT SHE DIED OF CARDIAC ARRHYTHMIA.
19 A. NO.
20 Q. AND YOU CAN'T RULE OUT THAT SHE DIED FROM COMPLICATIONS
21 OF CONGESTIVE HEART FAILURE.
22 A. NO.
23 Q. OKAY. FINAL PATIENT, ENNIS ALLDREDGE. HAVE YOU GOT
24 YOUR FILE THERE?
25 A. UH-HUH.
1 Q. WITH REGARD TO THIS PATIENT, HE HAD FAIRLY SEVERE
2 HARDENING OF THE ARTERIES.
3 A. YES, HE DID.
4 Q. IN FACT, HE HAD UP TO 90 PERCENT BLOCKAGE OF MAIN
5 ARTERIES THAT SUPPLY BLOOD TO BOTH THE RIGHT AND LEFT SIDES
6 OF HIS HEART.
7 A. THAT IS CORRECT.
8 Q. CERTAINLY YOU CANNOT RULE OUT DEATH FROM CORONARY ARTERY
9 DISEASE IN HIS CASE.
10 A. NO, I CANNOT.
11 Q. YOU ALSO FOUND EVIDENCE THAT HE HAD SCARRING ON HIS
12 HEART.
13 A. CONSISTENT WITH AN OLD HEART ATTACK, YES.
14 Q. AND YOU CANNOT RULE OUT A HEART ARRHYTHMIA AS A CAUSE OF
15 DEATH IN THIS PATIENT EITHER.
16 A. NO.
17 Q. WITH REGARD TO STROKES, YOU WOULD AGREE THAT THERE ARE
18 TIMES WHEN A STROKE EVENT CAN BE FATAL.
19 A. OF COURSE.
20 Q. AND IN THIS CASE, A STROKE EVENT COULD HAVE CONTRIBUTED
21 TO ENNIS ALLDREDGE'S DEATH.
22 A. I CANNOT EXCLUDE IT, NO.
23 Q. AND AS WITH THE OTHER PATIENTS, THERE WAS A CONCERN WITH
24 THIS PATIENT BEING DEHYDRATED ACCORDING TO THE MEDICAL
25 RECORDS, ISN'T THAT RIGHT?
1 A. I BELIEVE SO, YES.
2 Q. AND AGAIN, THAT COULD CAUSE SOMEONE OF HIS AGE TO DIE.
3 A. OR MAY CONTRIBUTE TO DEATH, YES.
4 Q. AND YOU WOULD NOT FIND THIS IN YOUR AUTOPSY.
5 A. IN THIS EXAM, NO, I COULD NOT PROVE THAT.
6 Q. YOU ALSO FOUND FOCAL PNEUMONIA, AND THAT CAN BE A
7 CONTRIBUTING FACTOR.
8 A. CERTAINLY.
9 Q. SO COULD EMPHYSEMA.
10 A. CERTAINLY.
11 Q. AND AS WITH THE OTHER PATIENTS, DEMENTIA.
12 A. AGAIN, CORRECT.
13 MS. ISAACSON: NOTHING FURTHER.
14 THE COURT: REDIRECT, MR. WILSON.
15 REDIRECT EXAMINATION
16 BY MR. WILSON:
17 Q. ONE -- ONE QUESTION, DOCTOR. IS THERE A COMMON -- IN
18 YOUR REVIEW OF THE MEDICAL FILES AND YOUR AUTOPSIES WITH
19 THESE FOUR PATIENTS, IS THERE ONE COMMON DENOMINATOR BETWEEN
20 ALL FOUR PATIENTS?
21 A. ESSENTIALLY THAT THEY'VE ALL BEEN GIVEN MORPHINE IN THE
22 FACE OF LINGERING CHRONIC CONDITIONS.
23 MR. WILSON: THANK YOU, DOCTOR.
24 THE COURT: RECROSS.
25 MS. ISAACSON: NOTHING FURTHER.
1 THE COURT: YOU MAY STEP DOWN, DOCTOR.
2 THE WITNESS: THANK YOU.
3 THE COURT: MAY THIS WITNESS BE EXCUSED, MR. WILSON?
4 MR. WILSON: HE MAY, YOUR HONOR.
5 THE COURT: MS. ISAACSON.
6 MS. ISAACSON: YES.
7 THE COURT: JUST LEAVE THAT RIGHT THERE.
8 THE WITNESS: OKAY.
9 THE COURT: COUNSEL WILL GET THAT. THANK YOU FOR
10 COMING, DOCTOR.
11 THE WITNESS: THANK YOU VERY MUCH.
12 THE COURT: THANKS FOR YOUR TESTIMONY. YOU MAY BE
13 EXCUSED.