BY MR. WEINBERG:
Q Now we were in the process and the midst of talking about thrombotic conditions and emboli --
Q so let me go back to that for a moment -- and we had discussed your finding, as indicated in the autopsy report, of a thrombus behind the left knee in the popliteal vein, correct?
Q You need to say "yes." A Yes.
And also your finding of an embolism in the pulmonary artery in the lung; is that right?
Q Which lung was that? The left lung; correct?
A I'm getting paranoid about looking at which report. Yes.
Q When you say "multifocal", what's that mean in English?
A Okay. In English, that means it's in several different spots, okay?
If it were -- that's in distinction to -- to a word "diffuse", which means it's everywhere all over the place.
For instance, if you had -- oh, say, if you were painting this room and you had a bunch of little kids painting it and they had a whole bunch of splotches here, there, everywhere, the paint would be multifocal.
If you had a professional painter paint it, by the time he got through, the painting would be diffuse. It would be ubiquitous; it would be everywhere; it's all-encompassing.
"Multifocal" means you find it in several different spotty areas.
Q And, in this case, the thrombus -- I mean, the embolus that you have found in the left lung, was that in a position to have killed Lisa McPherson; caused her death?
A That is -- that's possible. I don't know that I would -- I could say that it did.
I do recall and it is in the report that it's partially occlusive and what that means is that blood can get around it, okay?
Now the lung, just like other organs, lives, if you will, on blood, see, so it can get around it, so the question is a little hard to answer not knowing her previous state --
Q What --
A As to whether this would have been the cause of death or not.
Q Did you find anything else during the autopsy that you believed could be the cause of death as opposed to this well-established what you call thrombus or embolus which is multifocal in the left lung?
A As a function of circumstances, that could be a cause. The other thing that could be a cause could be predominantly dehydration, as a possible cause; however, to be dogmatic of one versus the other, to me, is a little difficult.
Q Now --
A In other words, that could be a red herring. See what I mean? Q The dehydration.
A The dehydration could be a red herring.
Dehydration I think is -- again, you have to appreciate, I don't run the lab, see, so -- but if you were to ask me a question in a vacuum, it might be easier to answer with regard to dehydration.
Q What do you mean by that?
A Do you understand what I'm saying?
Q No, I'm in a vacuum right now, because I don't understand what you mean by that.
A If we separate -- if we separate Lisa McPherson -- okay? -- from the question you just asked about dehydration -- okay? -- then I might be able to relate to your question with regard to dehydration.
A Because I don't have the circumstances.
Q So I mean, if you had -- if you had information, for example, that Lisa McPherson was drinking protein shakes and water and stuff like that, is that the kind of circumstances you're looking for?
A No, I'm looking for you just to possibly -- well, I think dehydration was significant. I don't know that I can be unequivocal relative to it versus a thromboembolism as an immediate cause of death.
Q All right. When you originally drafted the front page --
Q -- you had not included dehydration, but you had indicated a hand-written note, Rule out malnutrition "slash" dehydration.
A That's correct.
Q Did you ever conclude that process; ruling it out?
A I got various vitreous studies amongst others, okay?
A I -- and I say "amongst others"; in other words, we did a variety of different studies.
Q In addition to the vitreous studies, what studies did you do that would have anything to do with malnutrition or dehydration?
A At one point, there was a question of meningitis raised and I did a cisternal tap, and that's a big word for saying like getting spinal fluid, and I submitted this for serological studies, which, again, is a big word for looking for antibodies to particular organisms, and these came back negative, okay?
A Now I felt that, based upon those studies and my gross and microscopic examination of the brain, that there was no meningitis.
I mean, you asked about other studies; that's an example of other studies.
Q Right, but you had referred -- I thought we were talking about dehydration and you said that you did this vitreous study and then you said "other studies". Were there any other studies that had to do with dehydration?
A The vitreous are the predominant ones, and I must say I don't have -- I don't have any independent recollection of why urine was listed on the --
Q That was done a year later.
A Oh, okay.
Q The urine was done after you left. A Oh, okay.
Q I'll show you the results, but, see --
A Oh, all right.
Q -- this is an amended page four, so the page four that existed at the time the report was released in October, was the one that says "original page four" that has no urine on it.
A I gotcha, okay.
Q Which leads me to a question. Why didn't you do a urine analysis?
A The -- I feel -- well -- and I think that the literature backs it up -that it's vitreous that you use to look for dehydration.
I mean, the problem -- and you can run into a variety of problems in urine and part of the problem is you don't know when that urine got there. You don't know how long it was there.
Urine comes from the kidneys and the function of kidneys is largely to concentrate, which is a big word for saying it sucks stuff out and puts it
in much greater amounts, so that it's very easy to over-interpret urine and it is not as easy to over-interpret vitreous.
Q Now do you do vitreous exams every time you do an autopsy -- do you take vitreous fluid every time you do an autopsy?
Q So that's --
A I direct it to be taken.
Q So that the fact that you took vitreous fluid in this autopsy was because that was your routine in ever autopsy.
Q Okay. Do you have it analyzed in every autopsy?
Q And when you have it analyzed, where do you send it? Is there a particular place you send it?
A The chief at this office chose a particular lab and -Q This is Wuesthoff --
A This is Wuesthoff -- yeah, Wuesthoff.
Q -- Memorial Hospital?
Q Who took the vitreous fluid samples?
A I have no independent recollection in this particular case, though, ordinarily, this is taken -- I think I mentioned when we first started this -- this is one of the things that ordinarily is done by the autopsy assistant under my direction.
Q During the autopsy?
Q Do you actually have to remove the eyeballs from the eye?
A Oh, no, no, no. What you do, you take a needle and you stick it in the side of the eye and you suck out the fluid with a syringe. See what I mean?
Q Right. You don't use a "vacutainer" or do you use a "vacutainer"?
A I don't -- you know, I don't personally use one and I don't -- no, no.
I would have a concern about too much pressure relative to the lining of the eyeball.
What you want is the fluid; not to suck up the retina, see. I mean, that's the stuff that's the lining around the outside. You don't want to get a bunch of tissue.
Q You don't want to contaminate.
A That's right.
Q Do you have any specific recollection, independent recollection, of who did the taking of the vitreous in the Lisa McPherson --
Q -- autopsy?
Q Do you have any recollection as to actually how it was taken? In other words, taken with a syringe or a "vacutainer" or do you have a specific recollection of that?
A No, I don't.
Q Do you have a specific recollection as to whether it was done gently as opposed to with some force?
A Well, you don't attempt to do it other than gently. I mean --
Q Do you --
A -- you know.
Q Do I understand you to say that, typically, you do not do the actual taking of the fluid?
A That's right.
Q Okay. have you ever done it?
A Oh, yes.
Q Do you take it from one eye or both eyes? A I take it from both eyes.
Q And is the fluid maintained in one container or two separate containers, do you know?
A No. Ordinarily, it will come out, at least the way I do it, I'll take the fluid and there may be minuscule changes of one versus the other, but, ordinarily, I'll get the material from one and then I'll go get it from the other.
Q Separate containers.
A In the -- essentially in the same syringe.
Q Oh, in the same syringe. I'm sorry.
How was her fluid stored at the medical examiner's office? A Ordinarily, what we'll do is cool that.
To get the specifics, I don't have an independent recollection, but there -- and, again, I can't speak to what their -- to what a procedure manual would have or would not have relative to your questions.
Q How quickly is the fluid sent to the lab after it's taken?
A That's a function of the time of day and the time of delivery -- I'm sorry -- the time of pick-up and I believe they would pick it up in the afternoon.
Q Does it -- is it typically sent to the lab shortly after -- for examination, shortly after it's taken? I mean whether it's a few hours or a day, but within the immediate time frame of the sample being taken?
A Yeah, we try and have standardized care of the specimens, be it vitreous or whatever else in terms of -- in terms of like say toxicology or what have you in a standard manner.
As for your question on "typically", I think that -- I don't know that I can really answer that question. I think perhaps the director of the lab would.
Q Does it make any difference in the final results, the validity of the final results, whether the sample has been sent immediately to the lab or a period of time, weeks or months has passed?
A Oh, weeks or months, yes.
Q And what's the difference that it makes?
A Well, certain values can fall off and certain values can be altered and we'd probably have to go to a textbook with regard to the numerical variation of whatever it was. I don't know that I can answer it in greater detail.
Q So it is you -- as a medical examiner, you want the vitreous fluids to be analyzed by the lab as quickly as possible after they were taken.
A As soon as reasonably possible, yes.
Q And -- all right. Let me show you what's been marked as Exhibit Four. Now the first page of that, I think, is the meningitis thing that you --
Q Lab results; right?
Q And the second page, I believe, is the vitreous results --
And if you look at the second page, you will see that -- you will see the various results with regard to the vitreous fluid on Lisa McPherson; is that right?
Q Now can you see when that test was actually run? A Run date, 12/01/96.
Q 12/1. what are you looking at?
A I'm sorry. 02 -- I'm sorry - 02/01/96.
Q February 1st, 1996?
A Yeah, right. Run date -- or run time 12:43.
Q Now can you look at all the other writing on that and do you understand what it means?
Q Can you explain it to us? Before you get to the results. I'm talking about above the line.
A Oh, above the line.
Okay. I think the best way to answer this is that I can relate back to my experience when I was in a lab -- in a hospital lab myself, and I will -but I believe what I say to be correct.
Okay, it's got the name of the lab at the top. It says Wuesthoff Memorial NPR lab -- and I'm not sure what "NPR" stands for. It says "live". I'm not sure what "live" means. It says page one, as indeed the previous page, which is interesting.
It, beneath that, has got the patient's -- oh, probably an accession number; it's got the patient's name; it's got the account number. Some places will commingle accounts with accession numbers; apparently, this place doesn't.
It's got the location and my guess would be that this refers in terms of this medical examiner's office, District Six.
A Okay, it's got the unit number, I guess, although I can't be sure what "U" stands for. ST-68348. It's got the Social Security number, I'm assuming; there's none listed. It's got her age and sex; it's got the status.
Q What's that mean, "reg"?
A I would guess regular refrigeration, but I mean that's something else you'll have to get.
It's got another reg --
Q Or is that -- "REC"; is that "received", you think? A It could be?
A If it is, it's a misprint, because it's a "G."
A You see that?
Q Right. But that says 1/30/96; is that what it says? A Yes, it does.
Q Okay. And then it's got the results under that.
A That's right.
Q All right. Do you know why it took until February 1st, 1996, to do the analysis of the vitreous?
Q Okay. Now did you actually receive these results? I mean, you viewed these results while you were in the medical examiner's office?
Q Okay. And this was part of you notation on Exhibit Two, which is, Rule out malnutrition "slash" dehydration "hyphen" vitreous --
Q -- right?
So this is the vitreous and these are the results; is that right?
A If you're going to do a quality control flow, I'm telling you this is what the report says. I'm not telling you that this is -- I mean, I don't know what transpires. It is -- you know, it's possible for things to happen. I don't know.
This represents -- I don't know that this represents this particular -- I don't know how anybody would for sure.
Q What you're saying -- I think what you're saying is that you don't know whether the sample might have been in some way degraded or contaminated or whatever; is that correct?
A Well, that and/or --
Q Confused with somebody else's sample.
A That's possible, yes.
Q When you got these results, you questioned some of them because of their high values, did you not?
Q And did you discuss that with Dr. Wood?
Q And did you tell her that you had never seen values this high?
A I told her that with regard to the urea nitrogen, i hadn't recalled seeing a value that was that elevated. I try to avoid words like "never" and "always" if I can.
A So I think my inclination -- and, here again, it's not an independent recollection, but I'm not sure that I'm going to say "never" or "always",
you know? I think that can get you in trouble.
Q Okay. You don't recall having seen readings that high before; is that right?
A I don't recall on the urea nitrogen, no.
Q And they were so high that you questioned whether they were valid, did
?Q And you told that to Dr. Wood; is that right?
Q What did she say, if you recall?
A I don't recall. I mean, I was the one -- it was my case, so I asked to
have it checked again.
I believe I asked to have it -- I believe I asked to have it checked again.
Q All right, but did you have any way to check things like whether the
sample was originally contaminated or not? You had no way of checking that,
at that point in time, did you?
Q I mean, the fact that the lab got these results, it wouldn't surprise
you, if they ran it again, they'd get the same results.
Q Right. If the sample was contaminated the first time, the results would
be invalid the second time, as well; right?
A That's right.
Q Okay. Well, did Dr. Wood seem concerned about your concerns as to the validity of the test?
A Yeah, I think she was concerned.
Q All right. Did you all discuss any other ideas that you all would have
to scientifically verify whether there was, you know, severe dehydration?
A I think I gave you my best opinion of the urine, okay? Vitreous, really,
is your best bet and to be candid with you, I'm not sure that I know other ways, at that point, absent what we have along with the urine, but at the
same time de-emphasizing the urine relative to the vitreous.
Q Did you do any research once you got these results as to whether -particularly, on the urea nitrogen -- as to whether anybody else had ever
found readings that high?
A We had a situation in which, for a variety of reasons, it was -- there was no -- well, it was difficult, and I had a bunch of other cases and I knew information I did not have -- I think we've been through this before and so --
Q I just asked you a simple question. Did you do any research?
Q Okay. the results were such that you were not prepared to draw any diagnostic conclusion from the vitreous results; is that right?
A By itself?
Q No, you were not; is that correct?
A That's correct.
Q Did you have any discussion with Dr. Wood as to why there had been a two-month delay or almost a two-month delay in the submission of the vitreous results to the lab --
MR. DANDAR: Object to the form.
BY MR. WEINBERG:
Q -- I mean, the vitreous fluids to the lab? MR. DANDAR: Object to the form.
Q Do you understand the question?
A Yeah. I don't recall them, but I was concerned myself.
Q At the time, you were concerned.
Q Do you recall some discussion with anybody in the medical examiner's office as to what happened; why they had not been sent?
MR. DANDAR: Object to the form --
MR. WEINBERG: What's wrong with the form?
MR. DANDAR: -- assumes facts not in evidence.
You're showing him a lab report that's a recheck, a retesting, rather than showing him the original one.
MR. WEINBERG: I'm showing him what the medical examiner's office was ordered by the court to give us, Ken, and this is what they gave us.
BY MR. WEINBERG:
Q Now, did you -- if I understand your testimony, you recall, back when you were in the office, being concerned that there had been a delay between the samples being taken and the samples being tested; is that right?
A No, I was concerned about the level of the sample -- my concern was the level of the sample of the urea nitrogen in particular.
Q I understand.
Q And as a result of that concern, you were -- you were trying to figure out what may have gone wrong; is that right?
A I just did not see -- well -- that was a very high value.
Q Okay. I thought I heard you say that there was some discussion in the office about there being a holdup between the samples being taken during the autopsy and being sent to the lab.
A I don't believe I said that.
A I mean, I don't believe I said that. Q Okay.
MS. CARLUCCI: Are you at a breaking point to get the food in here?
MR. WEINBERG: YEAH.
MS. CARLUCCI: Let's go off for a minute and get our food.
(WHEREUPON the proceedings were in recess from 1:35 p.m. to 1:57 p.m.)
go back to part three -- return to Lisa page -- go to part five