BY MR. WEINBERG:
Q Were these phone calls from Dr. Wood and Mr. Bedore somewhat intimidating to you? Do you understand what I mean by that?
A Not really, no. I mean, I don't know why they -- why would they be intimidating to me?
Q Well, I'm asking you the question. I don't know.
A Well, I don't know, either. You don't know, I don't know, you know.
Q Did they suggest that they were concerned that you wouldn't agree with what she had signed out -- off on the report? Was that the suggestion?
A I didn't care what --
Q No, I'm not telling you what you cared. Was the suggestion that somehow they were concerned that you might not agree with their final conclusions?
A They never enunciated anything with regard to my agreeing or not agreeing with regard to it, and if I disagreed, I would have disagreed.
A And it -- but I mean, I didn't really care, see. I wasn't a party, you know. I had nothing to do with it.
Q Now this fax came in on December 23rd?
Q That would have been at or about the time that these calls took place?
A The calls may have taken place later than that.
A They may have.
Q In this first document that appears in this stack of documents, which is medical examiner Report of Autopsy, there are certain -- there is certain handwriting on here --
Q -- and underlines. Did you put that on there?
A Asking about a hundred percent of these?
Q Well, no. I mean, your recollection is -- I'm sure it didn't come in with that on it, because those look like those were applied after the fax got there.
A Yeah, actually -- okay. Referring now to page one -- I guess that's the only page -- I'm sorry -- and the -- page six, that's my handwriting.
Q Okay. Can you read your handwriting for me?
A It's perfect handwriting. Of course, I can read it.
Q What about up in the corner up there?
A Okay. I've got down, Pronounced December 5th, '95, at 9:51 p.m. Q That's when she would have died then.
A Yeah, when she was pronounced.
Q Okay. Now what's this here?
A "Dehydrated" with the word underlined.
Q Okay. Anything else?
A Well --
Q And then there's -- did you say there was some other writing or not?
A Yeah, I think on the last page there was --
Q What's that say?
MR. DANDAR: What page are we on?
THE WITNESS: We're on page six.
MS. CARLUCCI: If you look at the fax numbers way up in the top corner --
MR. WEINBERG: Why don't you look at this. This may be a better copy. What's that say?
MS. CARLUCCI: They're all identical.
THE WITNESS: Oh, okay. What my handwriting says here is, "Wrong by my history." Okay, "HX" is an abbreviation for "history."
"Question" -- that means I have a question in my mind, see? -- Dr. -- or "question" Anderson, M.D. and the thing that's blocked out there should be "licensed in Florida, now in Colorado, anesthesiologist." And, you know, I don't --
MS. CARLUCCI: That was the question.
THE WITNESS: Okay.
BY MR. WEINBERG:
Q What does that mean? Where did that come from?
A I don't know where. At that point in time, there was something that made me question whether this was the proper last name.
Q Oh, I see. okay. A See?
Q All right.
A And -- okay.
Q All right. Now this case history, which is at the back of this first exhibit, Defendant's Exhibit Three, it says, "Case history, Lisa McPherson", with your writing on it. You prepared that case history?
A I prepared the case history. Well, I prepared it from the invest notes; from the investigator's notes.
Q Okay, and do you know when you prepared it, approximately?
Q Okay. These were from the investigator of the medical examiner's office.
A That's right.
Q Okay, now, at the bottom of the -- toward the bottom of the page, it says, "Apparently, there was some problem in communication between our office and Officer Perez. The deceased had been associated with the scientologists."
Q Okay, now -- period.
My question is, what is the significance -- why does that get into a case history? In other words, that somebody is a scientologist as opposed to being a Southern Baptist or --
A All I do -- what -- okay. The policy of that -- of this particular office, is that the pathologist shall dictate -- okay? -- his own case history, okay?
Now, I was an associate pathologist -- okay? --
A -- and I didn't do that in Dallas and I don't do that here, okay?
A This is an abstract of information that was present and was put into the invest notes by the investigators.
A And do what I do is, I go through and I take the information that's there and I put down the information that's there in the particular thing.
Q I understand.
Now what -- do you know what the significance, if any, was of the fact that Lisa McPherson had been a scientologist to the investigators and/or the medical examiner back in December of 1995 when she died?
A Not -- no, I don't.
A But it was of -- you know, I mean, somebody put it down, otherwise, I wouldn't have written it.
Q That's what I'm asking. Do you know why somebody -- I mean, did anybody explain to you why that was significant enough to be written down?
Q Okay. Now -- now the last sentence says -- last two sentences -"Because of the passing of several hospitals, and independent investigation is being set up by the Clearwater Police Department", and then it lists two detectives; and then it says, There may have been a history of a religious rite, which is quotes, associated with the scientologists concerning a purification involving vitamins and minerals, although this information -- it says "at this" is questionable. "At this time", it probably means, is questionable.
A That's a typo or something.
Q Right. What is that all about; a religious rite? Where did that come from?
A Again, the invest notes.
Q Same answer, then. It came -- it's not something that you produced.
A Oh, no.
Q Did you have any conversations about -- with anyone about this whole religious rite thing?
Q Is this your -- is this your comment, "at this time questionable", or is that from the invest notes, as well?
A That's from the invest notes.
Q Okay. Now --
A You know, I mean. I'm trying to think about the way I write things and the way I do things and so on.
If there's some degree of the question expressed, then -- or some degree of uncertainty expressed -- the I will go ahead and put it in there.
Q Okay. Now this case history says, There was, quote, no evidence of injury or trauma, period, end quote. The deceased had, quote, petechiae P-E-T-E-C-H-I-A-E -- end quote, all over her.
Q Is that correct, that there was no injury of -- no evidence of injury or trauma and that she had petechiae all over her?
MR. DANDAR: Object to the form as to time.
MS. CARLUCCI: Go ahead, if you can answer.
BY MR. WEINBERG:
Q I assume this is written with regard to a woman that you saw for the first time when you were doing an autopsy of her; right?
A Oh, yeah. Q Okay.
Q All right.
A I don't recall having seen petechiae, and in terms of evidence -- you know, I've got evidence of injury already in there, you know, as for evidence of injury, at certain times, certain things can be put under different areas.
Like, say, you know, is crusting on the nose evidence of injury? I don't know if it is or not, but it might be put, say, there as opposed to a general external exam.
A See what I mean?
But as I recall, I had something down there about some bruises on the legs and stuff like that.
Q Okay. Is this you -- these are your sentences?
Q It is you --
A That's my taking -- that's -- because I was told to; because the whole office has to do that.
Q No, I understand, but you didn't put in here "no evidence of injury or trauma" because somebody told you that there was no evidence of injury or trauma. You put that in there because that was your observation at the time?
A No. No. No. Just the opposite. The "invest" have got their information. Part of the reason -- okay.
MS. CARLUCCI: Wait. Is there a question?
THE WITNESS: Okay.
MR. WEINBERG: I guess he was explaining something that I didn't really understand.
Q So all you're doing is abstracting what is in the -A That's right.
Q -- investigator's notes.
A That's right.
Q All right. Okay. We'll go to your Protocol in a few minutes and we'll talk about that -- those bruises that you noted.
MR. DANDAR: Can we get a definition of petechiae? I mean, do you mind?
MR. WEINBERG: We could.
THE WITNESS: okay. Petechiae are essentially punctate small areas of hemorrhage and they can be associated with a variety of different things, and I could go through a differential for you of the things that they're associated with, but sure as shootin' I'd leave something out, and so -but there can be a variety of different things that they can be associated with.
BY MR. WEINBERG:
Q But it is a -- it's bruising-like -A Much smaller.
Q -- imaging? Much smaller.
A It's punctate, like, say, the point of your pen there, see; that's a petechiae.
Q Would it be red, usually? Kind of reddish? A Oh, yeah.
Q It could be associated with an infection? A Can be.
Q Some trauma? Can it be associated with trauma?
A It's possible, but, usually, you have larger bruises that you'll call -- and the big medical word is "ecchymosis" or things like that.
A Contusions, stuff like that.
Q Okay, now, the -- the -- what is also apparently was faxed to you on that day, on December -- well, was all this stuff in here, which are -Certificate of Death; that was also faxed to you by Dr. Wood's office --
Q -- on December 23rd?
That was a certificate that you had not done; is that right? A Certainly is correct.
Q And then they also faxed you an investigative follow-up; is that correct?
A That is the first page of the invest notes.
MS. CARLUCCI: Was that faxed to you as part of the package? THE WITNESS: Yes. Yes.
BY MR. WEINBERG:
Q Do you know why they faxed you the first page of the investigative follow-up?
Q Do you know why they faxed any of this stuff to you?
A See, I can't put myself in her head. I don't know why she did that. You know, you'd have to ask her that.
Q Is this what you used to dictate your summary; the first page?
A Well, in a given case, you would use all pages that were available. In some cases, there might be more; there might be less. There might be a greater number of entries. If -- you know, it could go on for five, six, pages.
Q Who is DLC?
A That's Cary. And Cary is the --
Q That's his last name?
A Yeah, and he's the -- he's the -- Scot Cary. he's the chief investigator.
Q All right, so it appears that Scot Cary, even though his initials are DLC --
A I'm sorry. Let me -- I was incorrect about that.
DLC is the individual who put these in -- put these notes in and I may be incorrect with regard to -- because his first name was Scot. I may be incorrect as to who that particular individual is.
Q This is somebody in the office, though.
A Oh, yes.
Q Okay. And -- and -- and what this -- and this first entry, which is -I won't go over them all -- but the first entry is December 5th of '95, has notations like "decedent has petechiae all over her" and there is no injury "slash" trauma; that's where you would have gotten that for your case?
A Yes, this is where I would have gotten it and this was as a result of, as it says here, "Telephone call" -- from whoever.
Q Would have been a nurse at the hospital.
Q Okay. Now it appears that they also faxed you copies of some newspaper articles that ran in the Tampa/St. Pete area regarding the death; is that right?
Q Now there's some writing on this; is this your writing on this article?
Q Can you read what that says?
MR. DANDAR: What article are we on? MR. WEINBERG: It's the second article. MS. CARLUCCI: Page ten at the top.
MR. WEINBERG: Right there.
MR. DANDAR: Okay.
THE WITNESS: Oh, yes. Okay.
Okay. I have up here, and it crossed my mind, apparently, in reading this or the previous page -- I think there might have been a -- because it looks like this is a two-part article -- may have been.
A question to myself apparently alluding to someone named Andrew as a scientology spokesman. DOA and NPR Hospital -- dead on arrival -- and then the question to myself, "What about DOA at Morton Plant?"
BY MR. WEINBERG:
Q Okay. What did you mean by that?
A Morton Plant is physically closer that is NPR and what I didn't know and what I was asking her -- one of the other reasons that I didn't -you know, now, in retrospect, I think it's -- well, at any rate, I just -- I couldn't understand going to that particular hospital.
Q Right, but you had to have those questions back when you were in the office having done the autopsy; right? This didn't just occur to you a year later.
Q Okay. You agree with what I just said.
Q Okay. And had those discussions been had with Dr. Davis or Mr. Bedore before you had left the office?
A You mean Dr. Wood?
Q I'm not doing too well.
MS. CARLUCCI: This is Dr. Davis. BY MR. WEINBERG:
Q Had those discussions been had with Dr. Wood or Mr. Bedore while you were still in the office as to what hospital they --
A I really don't recall. It may well have. I just don't recall.
Q Okay. Amongst the records that were sent to you is -- by fax last December, is a December 16th, 1996, letter from Dr. Minkoff to the medical examiner --
Q -- which I take it you had not seen until it was faxed to you.
A That's right.
Q Now what this letter says is that "When I got a copy of the autopsy report, there was a crucial fact that was omitted from your findings. At the time, I thought the issue was settled, so I did not contact you."
Then it goes on and it says "If you recall, two days after Lisa's death, we discussed the case."
Did you have a discussion with Dr. Minkoff after Lisa's death?
A I don't recall, myself, a personal discussion with him, and, ordinarily, if I personally have a call, I would put that, myself, in the invest if I have something that relates to that, okay? It may be that he talked with the medical examiner's office, okay?
The other thing, too, that you didn't -- I mean, no one has ever written me a letter saying, Dear Medical Examiner, okay? I've got a name. When I --
Q No, but you were gone. This was a letter written in December of '96 to the medical examiner, okay? In other words, this is six months after you've left.
MS. CARLUCCI: Answer whatever question he poses.
THE WITNESS: All right.
BY MR. WEINBERG:
Q What the letter says is that -- it suggests that a couple of days after the death in 1995 --
Q -- that the doctor talked to someone in the medical examiner's office with regard to a finding, he said, from a blood culture of Staph aureus. Do you have any recollection of that?
A He may have. I don't know.
Q Okay. And then it describes that history and it sends a copy of the blood culture.
Q Do you have any recollections of receiving information from New Port Richey Hospital that their lab had done a blood culture and found positive for Staph aureus on Lisa McPherson?
A There was -- yeah, there was discussion of blood being recovered from the blood -- I'm sorry -- Staph aureus being recovered from the blood of Lisa McPherson.
Q And did you --
A -- with the office. I don't recall exactly who.
Q Did you do anything with that with regard to the autopsy?
A This came and the first I saw of this was December 16th or December whatever the date is.
Q Right. Right.
What I'm asking you, you said that you recall that there was some discussion in the office back when you were in the office about a positive blood culture.
A No, this is after the fact of the autopsy.
Q Right, but within a few days of the autopsy -- right? -- or a week?
A Oh, I don't recall. You know, to be honest with you, I don't. I really don't.
Q Since things were still pending, do you recall --
A Could have been months, as far as I know.
Q By the time you left, it was still pending; everything was still pending; right?
Q Did you do anything while you were still there with the information concerning the Staph aureus and if not, why not?
A Well, no, I didn't do anything with it and the reason I didn't was, is I think -- I think I mentioned this before -- there are findings and circumstances and there were -- I had a lack of circumstances and I don't -- I usually won't go over a case forty or eleven times if I can go over it once and I knew I couldn't sign the case out absent the circumstances which I did not have, at that point in time.
The data was not going to be lost from the file. Information was not going to be lost from the file. There'd be nothing that you could really do, at that point in time, relative to that situation. I mean --
A You -- okay.
Q No, I -- and then you don't know why, once you left when the autopsy reported was finalized, why Dr. Wood did not make references to the blood culture that had been received from, from Dr. Minkoff? You don't have any way of knowing.
A No, I haven't talked to her.
Q When you did your autopsy, did you make any sort of examination for evidence of an infection?
A In a living individual -- well, if you see internally certain things, you might be suspicious of an infection, but I didn't see any evidence of, say -- I guess, again, about petechiae. I didn't see internally any petechiae. I didn't see anything that particularly would have turned me on to that.
Q Okay. The last documents in this package are your correspondence with Mr. Bedore and Dr. Reeves' correspondence with Mr. Bedore about this FedEx thing that we've already talked about.
Q Plus a copy of the judge's public records opinion -A Yeah.
Q -- in the public records case.
All right. Now we've talked about the manner of death, and if you look at the autopsy report in front of you --
Q -- or the Report of Autopsy, we've talked about the manner and how you had not reached a final conclusion, because you were waiting for information as to the manner, but what about the immediate cause of death; had you reached a conclusion as to the immediate cause of death by the time you left?
A Not absent circumstances, and -- I mean, the circumstances are all important, in my mind, in this case -- okay? -- and I think that it is -as a function of circumstances, you could look at more than one manner of death and I didn't have the circumstances.
Q Okay. Without belaboring it, because I'm really -- I don't understand.
A You don't understand what?
Q I don't -- let me explain.
I really don't quite understand what the circumstances were that you're looking for that you need in order to reach the conclusion as to the manner and cause of death.
Q Give me some examples.
MS. CARLUCCI: You've already done this. MR. WEINBERG: Well, I don't know. I -BY MR. WEINBERG:
Q Can you give me an example or two examples?
A I think the question is relatively innocuous.
Q Okay, go ahead.
A Okay. Any time a patient is in a facility -- okay -Q Like a hospital.
A -- a hospital, an ACLF, a nursing home -- what have you -- records are obtained, they're kept and so on.
Okay. Those were not forthcoming, number one; number two, to the best of my recollection, there still was -- okay -- number two, there was not an explanation of the distance to different hospitals; number three, there was not a hospital record, such as -- okay? -- that I had seen from New Port Richey where she was pronounced.
If someone comes to an emergency room, they come into an emergency room, and if they're dead on arrival, they have a standard sheet that goes like this, that or the other thing. If that's present, it's not present in my records, okay?
In other words, you'll have the name of the hospital at the top. You'll have, you know, the date and time of admission; the examination by the physician; nurse's observations; standard things such as vital signs, we call them; blood pressure, pulse, respirations -- those types of things and so on.
Q Anything else?
A Those are the main things, but --
Q Did anything prevent your office from getting the New Port Richey Columbia Hospital records?
A Okay. I was doing a number of cases and I believe I requested them to request the records, to the best of my recollection.
Q For example, because remember this investigative follow-up that we looked -- that we looked at in this file that you turned over today, talks about your investigator had a conversation with Barb, the nurse, from Columbia, saying, ER reporting the apparent natural death of this female. The decedent was taken to the ER from Clearwater. They talk about resuscitative measures which failed, indicating that they had worked on her. She was intubated, and it goes on.
I mean, obviously, there was some work that happened and, in fact, we've now seen a hospital record that Columbia --
MS CARLUCCI: There's no question.
BY MR. WEINBERG:
Q My question is, at some point before you left, didn't your office have the hospital records from New Port Richey?
A I don't recall having seen them.
Q Was any request made -- you said there was no record from any hospital, but I guess what you're talking about is wherever she'd been before.
A That's right.
Q Was any request made for records from where she had been before by you?
A By me, no.
Q Do you know if anybody requested records?
A I believe that the -- and again, I can't swear on this, but I mean there's the medical examiner's aspect and then there's the, quote, investigative aspect by the investigative wing, who happened to be the police, and I believe -- I believe that the police requested it, but I hadn't seen it.
Q Did they show you copies of investigative interviews that the Clearwater police did in December of 1995?
A Not that I recall.
Q Do you recall --
A I don't recall. I really don't. I mean -- okay.
Q Do you recall any -- I'm not suggesting they did, okay? I'm just asking if they did.
Q Do you recall any conversations with the police officers while you were still there as to what their investigation was showing, if anything?
A No, I just recall we didn't have -- we didn't have information that I felt I needed.
Q Well, would you need information from a hospital to make the determination that the immediate cause of death was from a pulmonary -from a large pulmonary embolism, which is located in the autopsy?
A What you get is that you get date and time and action, doctor's orders, et cetera, et cetera, et ceter, to various degrees.
In other words, in a nursing home or an ACLF or someplace where you're taking care of people, you're going to have documentation of what transpires, okay?
A Now you're going to probably have a greater degree of nurse's notes, say, in a nursing home and a much lesser degree of physician involvement as compared to, say, a hospital in which an operation is done or, say, if a patient's in ICU or something like that, and that's what I'm talking about, is -- and that -- and, yes, that can certainly affect how you would call a manner of death.
Q Well, I'm putting manner aside now. I'm asking you about the immediate cause of death, which is what -- which I take it, as opposed to manner, is what actually killed somebody; right?
Q And in this case, Dr. Wood, when she signed this out, said that the immediate cause of death is a pulmonary embolism. She had more technical terms, but it's a pulmonary embolism; right?
Q You don't disagree with that conclusion, do you?
A I neither agree nor disagree, because I'm not privy to the information.
Q Okay. You located a large pulmonary embolism in your Protocol; is that right?
A I located an embolism.
Q Okay. Well, if you'll refer to the lung section, whatever section it is.
A The Respiratory System.
Q Yeah, the Respiratory System, you note a well-established thrombus, which is mutlifocal.
MS. CARLUCCI: Again, these are not established that these are his notes. It has not been established.
BY MR. WEINBERG:
Q Do you recall that that's what you located?
A I recall that there was a -- it was there, yeah.
Q And even though you refer to it as a thrombus, basically, is there a difference between a thrombus and an embolus?
Q Was this really an embolus that had located here from somewhere else?
A It was -- based upon examination of the remainder of the body, there was a thrombus -- okay? -- in the left popliteal vein, and given those circumstances, then this is consistent with an embolus arising from that area.
Q Now an embolus is essentially something -- a thrombus that moves?
A Breaks off.
Q Breaks off?
Now a pulmonary embolism --
Q -- it can cause sudden death?
A It can.
Q Okay. The pulmonary embolism which you found in your autopsy here was large enough to have cause a death; is that correct?
A It could. It could. It's -- you're getting away from cause and manner into mechanisms and mechanisms are things that, you know, you can get a professor of medicine to talk about, but it can.
Q Pulmonary embolisms are life-threatening?
A They may be.
Q All right. Pulmonary embolisms can occur in hospitals and often do, don't they?
A Yes. Yes.
Q Pulmonary embolisms can be fatal to people in hospitals, can't they?
Q Pulmonary embolisms result from a thrombotic condition somewhere else in the body, typically; right?
A Embolism, yes.
Q A thrombotic condition is what, Doctor?
Q It's a clot that's in a particular area attached to a particular portion of the vascular system; typically, veins. You can have what they call a mural thrombus of the heart, which could be the right side of the heart. You can have it in the extremities. You can have it, say, in the pelvis, and so on.
Q Thrombus -- thrombotic conditions sometimes result from trauma; is that right?
A They can, yes.
Q In other words, I get hit in some extremity or I break a bone, that could lead to a thrombotic condition; is that correct?
A It could.
Q Okay. And once you have a developed thrombus, you are at risk of it embolising.
A It's possible.
Q Okay. Thrombuses (sic) are not easily detected, are they?
A No, that's too broad a statement. It's a function of the locale, size, et cetera, in some cases.
Q And the patient.
A And the patient, yes.
Q So that if a patient were a person that was intelligent and alert, not drugged, you know, not medicated in a hospital, he may be -- he or she may be able to feel a sensation that would lead a doctor to examine whether or not there's a thrombotic condition --
Q -- is that right?
Q But if a patient were psychotic, mentally disturbed, you may not have that kind of cooperation from a patient what would allow a doctor or someone to identify a thrombotic condition?
MS. CARLUCCI: We're getting a little far afield from his area of expertise, so I want to alert you to maintain your opinions to your area of expertis, Doctor.
BY MR. WEINBERG:
Q Is that correct?
A Psychotic people would be psychotic.
Q What I'm saying is, a person -- part of the way in which to identify a thrombus is to get cooperation from the patient, right?
A You always have a combination of a history and a physical.
Okay. The history is what the patient tells you, which may or may not be true.
If the person is psychotic, by definition he's crazy, okay? If he's crazy, what he says, who knows what it means, okay? That does not preclude the physician doing an examination which may or may not show a thrombus.
Q You found a thrombus or remains of a thrombus behind the left knee -is that correct? --
Q -- of Lisa McPherson.
Q There's no way you could tell -- is there? -- that the embolus that ended up in the pulmonary artery actually came from the thrombus that you found behind the left knee.
Q Okay. But you suspected that it had from you -- from the fact that you didn't find any other evidence of a thrombus; is that right?
A That's correct.
Q Okay. You don't -- you couldn't determine from your examination or an autopsy what actually caused the thrombus; is that right?
A No. In an individual case, there are a number of variables that come in and as to saying in a particular patient, no, you can't be specific.
Q Okay. The -- you did locate various bruises and contusions and mehatomas as noted in the report of -- in the Protocol; is that right?
Q And, in fact, if you refer to the Protocol in the autopsy report, you will see in the area of Extremities, at the bottom of the page, that you note, "Old, blue-green/brown areas of discoloration consistent with old hematomas are present on the medial aspect of the left thigh over a greatest area measuring two and a half inches and to an extent, over areas a half and inch and three quarters of an inch."
Q Do you see that?
What's that mean in English?
A Okay. First of all, it must be said that the aging of hematomas is a matter of difference of opinion amongst different forensic pathologists.
There are some people that, with good reason, may say that you cannot age one for sure. Others will say, Well, if it's greenish brown and if you've got some purple and yellow spreading, it's going to be old, and there's reason for that, too; that's hemosiderin that's spreading.
To me, these looked, quote, old,unquote, as opposed to recent, in which case it would be red/purple, the margins would be sharper and I wouldn't see yellow spreading from the sides.
Q Now when you say "old", are you referring to a couple of weeks; is that what you're referring to?
A That can vary with the age of the patient, but ordinarily, say with a patient this age, that could be, say, seven to ten days.
Q Or more?
A Or more, yeah.
Q Okay. Now -- and then you described various other contusions, some of which, in light of the color, you would have concluded were more recent that the older ones; is that right?
A They may have been.
THE WITNESS: Excuse me, I have to use the john again.
(Whereupon the proceedings were in recess from 12:57 p.m. until 1:08 p.m.)
go back to part two -- return to Lisa page -- go to part four