THESE TRANSCRIPTS ARE POSTED HERE FOR PRIVATE USE ONLY. THEY ARE NOT INTENDED FOR RESALE OR FOR USE FOR ANY COMMERCIAL PURPOSES. VIOLATIONS COULD RESULT IN COURT TV'S INABILITY TO POST SUCH COMPREHENSIVE TRANSCRIPTS
LOS ANGELES, CALIFORNIA; FRIDAY, JULY 14, 1995
9:20 A.M.
DEPARTMENT NO. 103 HON. LANCE A. ITO, JUDGE
APPEARANCES:
(APPEARANCES AS HERETOFORE NOTED.)
(JANET M. MOXHAM, CSR NO. 4855, OFFICIAL REPORTER.) (CHRISTINE M. OLSON, CSR NO. 2378, OFFICIAL REPORTER.)
(THE FOLLOWING PROCEEDINGS WERE
HELD IN OPEN COURT, OUT OF THE
PRESENCE OF THE JURY:)
THE COURT: ALL RIGHT. BACK ON THE RECORD IN THE SIMPSON MATTER.
MR. SIMPSON IS AGAIN PRESENT BEFORE THE COURT WITH HIS COUNSEL, MR. SHAPIRO, MR. COCHRAN, MR. DOUGLAS, MR. BAILEY.
THE PEOPLE ARE REPRESENTED BY MISS CLARK, MR. DARDEN AND MR. KELBERG.
MR. KELBERG: THEY DRAGGED ME DOWN HERE, YOUR HONOR. WHAT CAN I SAY?
MS. CLARK: WE INVITED HIM.
THE COURT: ALL RIGHT. KEEP IT SHORT.
ALL RIGHT.
COUNSEL, MR. COCHRAN, YOU HAD SOME ADDITIONAL COMMENT YOU WANTED TO MAKE TO PROTECT YOUR RECORD?
MR. COCHRAN: YES, I DO, YOUR HONOR.
GOOD MORNING, YOUR HONOR.
THE COURT: GOOD MORNING, COUNSEL.
MR. COCHRAN: THANK YOU, YOUR HONOR.
YOUR HONOR, THERE -- THERE IS TWO THINGS.
FIRST OF ALL, THE COURT WILL RECALL, I BELIEVE DURING THE TESTIMONY OF WITNESS MR. VALERIE YESTERDAY, HE INDICATED THAT IN A CONVERSATION WITH DETECTIVE KILCOYNE OF THE LAPD HE SAID THE STATEMENT WAS TAPE-RECORDED BECAUSE HE COULD HEAR THE BEEP, BEEP, BEEP IN THE BACKGROUND.
WE NEVER HAVE RECEIVED A TAPE-RECORDED STATEMENT.
AND THE COURT WILL RECALL, IN OUR SPIRIT OF COOPERATION, I DID WALK OVER TO THE PROSECUTORS AT THAT MOMENT. I DID NOT JUMP UP BEFORE THE JURY AND SAY ANYTHING, AND I JUST TALKED ABOUT IT.
AND NOW I WANT TO PUT ON THE RECORD WHAT THE WITNESS SAID AND I NEED SOME OFFICIAL RESPONSE REGARDING WHETHER OR NOT THERE IS A TAPE-RECORDED STATEMENT FROM DETECTIVE KILCOYNE REGARDING THE WITNESS STEVE VALERIE BECAUSE WE HAVE NEVER RECEIVED SUCH A STATEMENT.
THAT'S THE FIRST ISSUE FOR TODAY, YOUR HONOR.
THE COURT: ALL RIGHT.
SECOND ISSUE?
MR. COCHRAN: THE SECOND ISSUES DEALS WITH THE FACT THAT -- JUST A POINT OF CLARIFICATION.
THE COURT WILL RECALL THAT DURING MY CROSS -- DURING MY SHORT CROSS-EXAMINATION OF DETECTIVE LANGE AT ONE POINT I ELICITED --
THE COURT: NOT SHORT. IT WAS SUCCINCT AND TO THE POINT.
MR. COCHRAN: THANK YOU, YOUR HONOR.
SO STIPULATED.
BUT WITH REGARD TO THAT --
MS. CLARK: I WON'T JOIN IN THAT ONE.
MR. COCHRAN: SHE WON'T STIPULATE TO THAT.
BUT AT ANY RATE, YOUR HONOR, IN ALL SERIOUSNESS, WITH REGARD TO DETECTIVE LANGE, THE SUBJECT MATTER CAME UP OF WHETHER OR NOT FAYE RESNICK RESIDED, STARTING I THINK WITH FRIDAY, JUNE 3RD, AT NICOLE BROWN SIMPSON'S CONDOMINIUM.
AND THERE WAS SOME -- WE WERE CUT OFF AT SOME POINT OR WHATEVER, AND BASED UPON THE COURT'S RULING YESTERDAY I THINK IT WOULD BE UNFAIR TO THE DEFENDANT WERE I NOT TO EITHER HAVE A STIPULATION, WHICH I HOPE TO WORK OUT WITH MR. DARDEN, THAT BETWEEN THE DATES OF THE 3RD AND CERTAINLY THE DATE OF THE INTERVENTION ON THE 8TH FAYE RESNICK DID IN FACT RESIDE AT THAT LOCATION.
AND I AM PERFECTLY WILLING TO STIPULATE THAT AFTER THE 9TH SHE WENT INTO INTERVENTION AND WENT INTO EXODUS AND ON THE DATE OF THE MURDERS WAS IN FACT IN EXODUS AND APPARENTLY FOR LIKE A TWO-WEEK PERIOD OF TIME, AND I THINK WE CAN WORK THAT OUT.
THE COURT: MR. DARDEN, GOOD MORNING.
MR. DARDEN: WE DON'T PLAN TO STIPULATE THAT MISS RESNICK WAS IN DRUG REHAB ON THE 9TH, BUT --
MR. COCHRAN: WHAT DO YOU WANT TO CALL IT? EXODUS?
MR. DARDEN: WE WILL CERTAINLY ATTEMPT TO WORK OUT A STIPULATION.
MR. COCHRAN: OH, WELL, I'M NOT TYING TO BE FUNNY. YES, I FORGOT. SO IF WE GET INTO DRUGS, THAT SHE WAS AWAY OR WHATEVER WE WANT TO CALL IT. I JUST WANT A STIPULATION.
MR. DARDEN: I WAS TALKING.
THE COURT: LIVING ELSEWHERE?
NO, THAT IS CORRECT. I MEAN, THE ISSUE DID COME UP AS TO THE DATES THAT FAYE RESNICK WAS RESIDING AT 875 SOUTH BUNDY AND WE AGREED WAS A PERIOD OF TIME APPROXIMATELY A WEEK BEFORE THIS INCIDENT AND THAT DID COME UP IN THE CROSS-EXAMINATION OF DETECTIVE LANGE.
MR. DARDEN: WELL, APPARENTLY THE COURT CONSIDERS THAT RELEVANT, AND IF I CAN JUST HAVE THE WEEKEND, I WILL WRITE OUT A STIPULATION AND WE CAN RESOLVE THIS MONDAY MORNING.
MR. COCHRAN: ALL RIGHT.
THERE IS A FOURTH ISSUE BEFORE I GET TO THE LAST ONE, YOUR HONOR.
(DISCUSSION HELD OFF THE RECORD
BETWEEN DEPUTY DISTRICT ATTORNEY
AND DEFENSE COUNSEL.)
MR. COCHRAN: YOUR HONOR, THE OTHER THING IS -- AND SO THERE IS NO CONFUSION REGARDING THIS, LAST WEEK I INDICATED TO THE COURT THAT THE DEFENSE WOULD LIKE TO -- ONE MEMBER OF THE DEFENSE WOULD LIKE TO, ALONG WITH THE PROSECUTION, SPEAK TO THE MINOR SYDNEY SIMPSON.
SO THE RECORD IS ABUNDANTLY CLEAR, THE LAST THING IN THE WORLD WE WANT TO DO IS TO CALL SYDNEY SIMPSON TO THE STAND. MR. SIMPSON DOESN'T WANT IT AND NEITHER DO WE.
BUT WE WOULD HAVE -- WE THINK WE HAVE AN OBLIGATION TO TRY AND TALK TO HER, AND I JUST TALKED TO MISS CLARK ABOUT IT WHO HAS SHE INDICATED SHE WILL DO WHAT SHE CAN TO TRY AND SET UP A MEETING THROUGH THE BROWN FAMILY.
IF SHE AND I OR WHOM SHE DESIGNATES OR I DESIGNATE TO DO, WE WILL TRY TO HAVE A STIPULATION, AS WE DID WITH JUDITHA BROWN, HOPEFULLY NEXT WEEK.
THAT IS THE OTHER THING.
THE FINAL THING, YOUR HONOR, WITH REGARD TO YOUR HONOR'S RULING YESTERDAY REGARDING THE FAYE RESNICK DRUG DEALERS ISSUE, IF I MIGHT, WE WANTED TO INDICATE, AND I'M NOT SURE I INDICATED SPECIFICALLY, THAT THE COURT'S RULING, IT SEEMS TO US, VIOLATES MR. SIMPSON'S RIGHT TO PRESENT A DEFENSE AND TO DUE PROCESS OF LAW UNDER BOTH THE STATE AND FEDERAL CONSTITUTIONS.
AND I WANTED THE COURT TO HAVE THAT IN MIND WITH REGARD TO YOUR RULING AS TO OUR PRECLUSION FROM DOING -- PRESENTING A DEFENSE IN THAT REGARD BY YOUR RULING, BECAUSE BASICALLY WE ARE PRECLUDED FROM DOING IT AT THIS POINT BECAUSE OF OUR ABSENCE OF THE SHOWING OF MOTIVE, AS YOU HAVE INDICATED, AMONG OTHER THINGS.
THE COURT: AMONG OTHER THINGS.
MR. COCHRAN: ALL RIGHT.
THE COURT: ALL RIGHT.
I THINK THE COURT WAS COGNIZANT OF THAT ISSUE, AS WAS THE CALIFORNIA SUPREME COURT JUSTICE MOSK, WHEN HE CONTEMPLATED THE ISSUES IN THE HALL CASE.
AND THAT WAS AN ISSUE THAT WAS -- THAT I THINK EVERY JUDGE THINGS ABOUT IN MAKING THOSE RULINGS, BUT EVERY TIME YOU MAKE A 352 RULING YOU TAKE INTO CONSIDERATION THE SAME ISSUES.
MR. COCHRAN: ALL RIGHT.
YOUR HONOR -- AND I UNDERSTAND ON THE ISSUE REGARDING MENZIONE, BASED UPON WHAT THE COURT HAS INDICATED TO US, BASED UPON A FURTHER FOUNDATION THE COURT CERTAINLY IS GOING TO RECONSIDER THAT RULING.
THE COURT: I TOLD YOU AT THAT TIME YOU WERE CLOSE AND I THINK I GAVE YOU GUIDANCE.
MR. COCHRAN: WE TOOK THAT TO HEART, YES, YOUR HONOR, YOU DID.
(DISCUSSION HELD OFF THE RECORD
BETWEEN THE DEPUTY DISTRICT
ATTORNEYS.)
THE COURT: ALL RIGHT. ARE WE READY TO CALL THE NEXT WITNESS?
MR. KELBERG: YOUR HONOR, THERE IS A MOTION WITH RESPECT TO THE NEXT WITNESS, IF IT IS DR. HUIZENGA.
MR. SHAPIRO: YES, IT IS.
MR. KELBERG: YOUR HONOR --
THE COURT: MR. KELBERG.
MR. KELBERG: I WAS PROVIDED RECORDS THROUGH OTHER LAWYERS IN OUR OFFICE, AS WELL AS DR. HUIZENGA'S REPORT, AND AS WELL AS DR. MALTZ', AND I COULDN'T HELP BUT NOTICE FROM THE REPORT OF DR. HUIZENGA DATED JUNE 15, 1994 -- AND I HAVE A CLEAN COPY WHICH I CAN GIVE THE COURT TO LOOK AT FOR THE PURPOSES OF THIS MOTION, IF THE COURT WISHES.
THE COURT: WELL, PROCEED.
MR. KELBERG: THE FIRST PAGE IS BASICALLY BLANK WITH RESPECT TO ANY SUMMARY OF WHAT ACUTE PROBLEM
NO. 1 IS AND THE FIRST HALF OF PAGE 2 IS ALSO BLANK, WHICH I ASSUME IS A CONTINUATION OF WHATEVER IS DISCUSSED ON PAGE 1.
AND MY UNDERSTANDING WOULD BE THAT THE COURT PROBABLY IN AN IN CAMERA PROCEEDING RULED THAT A 5TH AMENDMENT PRIVILEGE STILL WAS APPLICABLE WITH RESPECT TO THE CONTENTS OF THAT INFORMATION RELYING UPON THE CASES OF WOODS, RODRIGUEZ AND SO FORTH THAT HAVE INDICATED THAT EVEN UNDER THE RULES OF RECIPROCAL DISCOVERY THAT THERE CAN BE APPLICABLE PRIVILEGES BECAUSE THE PRIVILEGES ARE PRESERVED THROUGH THE STATUTES THEMSELVES DEALING WITH RECIPROCAL DISCOVERY.
HOWEVER, IF DR. HUIZENGA IS CALLED TO THE WITNESS STAND, THEN I SUBMIT TO THE COURT THAT ANY 5TH AMENDMENT PRIVILEGE IS WAIVED.
AND THE CASE LAW I THINK IS QUITE CLEAR STARTING WITH THE LYONS CASE, 13 CAL.3D 500, WHICH DEALS WITH MORE WORK PRODUCT THAN ATTORNEY/CLIENT PRIVILEGE, AND ONTO OTHER CASES, I THINK RICH IS ONE OF THE CASES, 45 CAL.3D, AND A SERIES OF SIMILAR CASES.
THERE IS NO COMPULSION FROM THE PROSECUTION, BECAUSE IT IS THE DEFENSE THAT IS CALLING THEIR WITNESS.
ONCE THAT WITNESS IS CALLED, YOUR HONOR, HIS REPORT IN ITS ENTIRETY IS FAIR GAME. WHETHER THEY WANT TO GO INTO THE CONTENTS OF THAT AREA OR NOT, WE STILL HAVE THE RIGHT TO SEE THE ENTIRE REPORT.
AND I SUBMIT TO THE COURT THAT BEFORE THIS WITNESS IS CALLED, IF HE IS IN FACT GOING TO BE CALLED, I ASK THIS COURT TO RELEASE TO THE PROSECUTION PAGES 1 AND A HALF, PAGE 1 AND THE FIRST HALF OF PAGE 2, SO THAT I CAN REVIEW THAT INFORMATION AND HAVE IT AVAILABLE TO USE IN CROSS-EXAMINATION, IF APPROPRIATE.
THAT IS THE FIRST ASPECT OF MY MOTION.
THE SECOND ASPECT DEALS WITH THE POSSIBILITY -- AGAIN I DON'T KNOW WHAT THE DIRECT WILL ACTUALLY BE, BUT THE POSSIBILITY THAT DR. HUIZENGA WILL BE ASKED ANY STATEMENT MADE BY THE DEFENDANT REGARDING HOW HE GOT INJURIES THAT ARE OBSERVED ON HIS PRIMARILY LEFT HAND.
AND I ANTICIPATE, IF IT IS IN ACCORDANCE WITH DR. HUIZENGA'S REPORT, THAT IT WOULD BE ALLEGED BY MR. --
MR. SHAPIRO: YOUR HONOR, EXCUSE ME FOR INTERRUPTING.
I'VE ALREADY TOLD MR. KELBERG WE ARE NOT GOING TO DO THAT.
MR. KELBERG: WELL, AGAIN, YOUR HONOR, WHETHER THEY WANT TO DO IT, I HAVE BEEN TOLD BY MR. SHAPIRO THEY ARE GOING TO GO INTO THE NATURE OF THE INJURIES, AND APPARENTLY DR. HUIZENGA IS GOING TO OFFER OPINIONS REGARDING THE SOURCE OR SOURCES FOR THESE INJURIES, INCLUDING THE POSSIBILITY THAT GLASS IS A SOURCE FOR AT LEAST ONE OF THE CUTS THAT IS IDENTIFIED IN THIS JUNE 15TH EXAMINATION BY DR. HUIZENGA, POSSIBLY A JUNE 17TH EXAMINATION AS WELL.
MY CONCERN IS IF THERE IS GOING TO BE TESTIMONY ELICITED IN ANY WAY REGARDING THAT MR. SIMPSON IS THE ONE WHO TOLD DR. HUIZENGA THAT HE CUT HIS HAND ON GLASS, AND IF DR. HUIZENGA RELIED ON THAT IN ANY WAY IN FORMING HIS OPINION OR CONSIDERED IT -- AND QUITE FRANKLY, YOUR HONOR, DOCTORS WILL HAVE TO ADMIT THAT THEY RELY TO A LARGE DEGREE AND CONSIDER TO A LARGE DEGREE THE HISTORY GIVEN TO THEM BY THE PATIENT IN FORMING OPINIONS -- THEN MY CONCERN IS THAT IT IS INADMISSIBLE HEARSAY AND THE JURY SHOULD NOT HEAR THE CONTENT OF IT.
BUT IF THE COURT SHOULD RULE IT COMES IN UNDER 801.B AS MATTERS REASONABLY RELIED UPON BY EXPERTS IN THE FIELD, THEN I WOULD SUBMIT TO THE COURT THAT PATIENTS WHO GO TO DOCTORS IN NON-LITIGATION POSSIBILITY SETTINGS, THEY DO -- HAVE INDICIA OF TRUSTWORTHINESS IN THEIR HISTORIES.
A SITUATION OF DR. HUIZENGA SEEING MR. SIMPSON AT THE REQUEST OF MR. SHAPIRO DOESN'T QUITE HAVE THAT SAME TRUSTWORTHINESS ELEMENT THAT ONE MIGHT ATTACH TO THE HISTORY AS GIVEN. IT IS SELF-SERVING MOTIVATION FOR MR. SIMPSON TO EXPLAIN THESE INJURIES CERTAINLY MAY BE EVIDENT ON JUNE 15TH.
BUT SETTING ALL THAT ASIDE, IF THE COURT FEELS, FOR WHATEVER REASON, THAT THE CONTENT IS DISCLOSEABLE TO THE JURY, I WOULD ASK FOR A LIMITING INSTRUCTION THAT THAT INFORMATION MAY ONLY BE CONSIDERED AS A BASIS FOR THE EXPERT OPINION AND IS NOT TO BE CONSIDERED BY THE JURY FOR THE TRUTH OF THE MATTER ASSERTED.
THE COURT: MR. DOUGLAS.
MR. DOUGLAS: YOUR HONOR, AS TO THE FIRST ISSUE, AS THE COURT WILL RECALL, THERE WAS AN OCCASION IN MARCH THIS YEAR WHERE I PRESENTED TO THE COURT THE FULL UNREDACTED VERSION OF DR. HUIZENGA'S REPORT.
THERE WAS A PORTION THAT WAS CONCERNING CERTAIN IMPRESSIONS OF DR. HUIZENGA WHICH WAS OUTSIDE OF HIS PARTICULAR SPECIALTY THAT I ASSURED THE COURT WE DID NOT INTEND TO ELICIT FROM HIM DURING THE COURSE OF HIS EXAMINATION AND THEREFORE WE FELT IT WAS NOT DISCOVERABLE.
THE COURT AGREED. I SHARED WITH THE COURT THE REDACTED VERSION THAT I INTENDED TO TURN OVER THAT THE COURT APPROVED.
AS TO THE SECOND PORTION OF THE OBJECTION, IT IS MY UNDERSTANDING THAT MR. SHAPIRO DOES NOT INTEND TO GO INTO ANY STATEMENTS THAT MAY HAVE OCCURRED BETWEEN MR. SIMPSON AND DR. HUIZENGA.
I HAVE NO OBJECTION, HOWEVER, TO THE LIMITING INSTRUCTION AS PROPOSED.
THE COURT: ALL RIGHT.
COUNSEL, THE COURT DID REVIEW THE REPORT IN ITS ENTIRETY PREVIOUSLY IN A HEARING AUTHORIZED UNDER 1054.7 OF THE PENAL CODE AND THE COURT'S RULING AT THAT TIME WAS THAT THAT PART OF THE STATEMENT WAS NOT DISCOVERABLE.
THAT RULING STANDS.
AS TO THE ISSUE REGARDING STATEMENTS BY MR. SIMPSON, THE REPRESENTATION IS, IS THAT NO STATEMENTS WILL BE ELICITED. THE COURT ACCEPTS THAT REPRESENTATION AND WILL PROCEED WITH THE WITNESS.
ALL RIGHT. ONE OTHER ISSUE.
MISS CLARK, ARE YOU GOING TO LOOK INTO THE VALERIE/KILCOYNE TAPE ISSUE?
MS. CLARK: YOUR HONOR, THERE IS NO TAPE.
THE COURT: ALL RIGHT.
MS. CLARK: THERE IS NO TAPE AND I APPRECIATE MR. COCHRAN'S DEFT HANDLING OF THE MATTER.
THERE ARE POLICE TELEPHONES THAT HAVE A BEEPING ON THEM AND HE MAY HAVE CALLED IN ON THAT LINE, AND THERE IS NO TAPE OF MR. VALERIE AT ALL, AND I DID INFORM MR. COCHRAN OF THAT YESTERDAY WHEN THAT ISSUE CAME UP.
THE COURT: ALL RIGHT. SO THE RECORD IS CLEAR.
THANK YOU.
LET'S HAVE THE NEXT WITNESS AND ALSO HAVE THE JURY FIRST.
(BRIEF PAUSE.)
(THE FOLLOWING PROCEEDINGS WERE
HELD IN OPEN COURT, IN THE
PRESENCE OF THE JURY:)
THE COURT: ALL RIGHT. THANK YOU, LADIES AND GENTLEMEN.
PLEASE BE SEATED.
ALL RIGHT.
LET THE RECORD REFLECT THAT WE HAVE BEEN REJOINED BY ALL THE MEMBERS OF OUR JURY PANEL.
GOOD MORNING, LADIES AND GENTLEMEN.
THE JURY: GOOD MORNING.
THE COURT: GLAD TO SEE YOU ALL HERE BRIGHT AND SHINY. EVERYBODY HAPPY?
OKAY.
ALL RIGHT. MR. SHAPIRO, YOU MAY CALL THE NEXT WITNESS.
MR. SHAPIRO: THANK YOU VERY MUCH.
GOOD MORNING, YOUR HONOR.
GOOD MORNING, LADIES AND GENTLEMEN.
THE JURY: GOOD MORNING.
MR. SHAPIRO: WITH THE COURT'S PERMISSION, WE WOULD LIKE TO CALL DR. ROBERT HUIZENGA.
ROBERT HUIZENGA,
CALLED AS A WITNESS BY THE DEFENDANT, WAS SWORN AND TESTIFIED AS FOLLOWS:
THE CLERK: PLEASE RAISE YOUR RIGHT HAND.
YOU DO SOLEMNLY SWEAR THAT THE TESTIMONY YOU MAY GIVE IN THE CAUSE NOW PENDING BEFORE THIS COURT, SHALL BE THE TRUTH, THE WHOLE TRUTH AND NOTHING BUT THE TRUTH, SO HELP YOU GOD.
THE WITNESS: I DO.
THE CLERK: PLEASE HAVE A SEAT ON THE WITNESS STAND AND STATE AND SPELL YOUR FIRST AND LAST NAMES FOR THE RECORD.
THE WITNESS: MY NAME IS ROBERT HUIZENGA. THAT IS SPELLED H-U-I-Z-E-N-G-A.
THE CLERK: THANK YOU.
MR. SHAPIRO: MAY I PROCEED, YOUR HONOR?
THE COURT: PLEASE.
MR. SHAPIRO: THANK YOU.
DIRECT EXAMINATION
BY MR. SHAPIRO:
Q GOOD MORNING, DR. HUIZENGA.
A GOOD MORNING.
Q HOW ARE YOU TODAY?
A GOOD.
Q YOU ARE A PHYSICIAN AND SURGEON LICENSED TO PRACTICE IN THE STATE OF CALIFORNIA?
A YES, I AM.
Q AND FOR HOW LONG HAVE YOU BEEN SO LICENSED?
A I GOT MY MEDICAL DEGREE IN 1978, SO LET'S SEE, THIS IS HIGHER MATH, BUT I THINK THAT IS SOMETHING LIKE 17 YEARS.
Q AND DO YOU PRACTICE IN SOUTHERN CALIFORNIA?
A YES, I DO.
Q WHERE IS YOUR OFFICE?
A I HAVE A PRIVATE PRACTICE IN BEVERLY HILLS, CALIFORNIA.
Q AND WHAT TYPE OF PRACTICE DO YOU HAVE?
A I PRACTICE INTERNAL MEDICINE.
Q WOULD YOU KINDLY TELL THE JURY -- WELL -- FIRST, MAY I MARK AS AN EXHIBIT DR. HUIZENGA'S CURRICULUM VITAE, YOUR HONOR?
THE COURT: YES. THAT WILL BE DEFENSE
EXHIBIT -- WHERE IS MR. DOUGLAS?
MR. SHAPIRO: WE WILL GET THAT NUMBER WHEN HE RETURNS.
(DEFT'S 1248 FOR ID = DR. HUIZENGA'S CV)
MR. SHAPIRO: MAY I APPROACH THE WITNESS?
THE COURT: YOU MAY.
Q BY MR. SHAPIRO: IS THIS A COPY THAT YOU PROVIDED FOR MYSELF AND TO MR. KELBERG OF YOUR CURRICULUM VITAE?
A YES, IT IS.
Q WOULD YOU BRIEFLY SUMMARIZE FOR THE JURY YOUR EDUCATION BEGINNING WITH YOUR GRADUATION FROM HIGH SCHOOL.
A I GRADUATED FROM PENFIELD HIGH SCHOOL. I WAS VALEDICTORIAN. I WENT TO COLLEGE AT THE UNIVERSITY OF MICHIGAN. I GRADUATED THERE IN ZOOLOGY WITH HIGHEST DISTINCTION AND WAS AN ALL AMERICAN WRESTLER.
I WENT TO HARVARD MEDICAL SCHOOL IN BOSTON, MASS.
MR. COCHRAN: I'M HAVING TROUBLE HEARING THE WITNESS, YOUR HONOR.
THE COURT: YES. DOCTOR, WOULD YOU PULL THE MICROPHONE CLOSER TO YOU.
Q BY MR. SHAPIRO: MAY I MAKE A SUGGESTION?
A SURE.
Q SLOW DOWN JUST A LITTLE BIT.
A WENT TO COLLEGE AT THE UNIVERSITY OF MICHIGAN. GRADUATED IN 1974, ZOOLOGY, WITH THE HIGHEST DISTINCTION.
1974 TO 1978 I ATTENDED HARVARD MEDICAL SCHOOL AND GRADUATED THERE WITH A MAJOR IN IMMUNOLOGY.
I DID MY CLINICAL TRAINING IN INTERNAL MEDICINE AT CEDARS-SINAI MEDICAL CENTER. I WAS CHIEF RESIDENT THERE FOLLOWING THAT INTERNSHIP AND RESIDENCY FROM 1982 TO 1983.
AND SINCE 1982 I HAVE BEEN ASSISTANT CLINICAL PROFESSOR OF MEDICINE AT THE UNIVERSITY OF CALIFORNIA, LOS ANGELES, AND RECENTLY CHANGED TO ASSOCIATE PROFESSOR OF CLINICAL MEDICINE.
AND THAT I THINK IS MY EDUCATION IN MEDICINE.
Q AS PART OF YOUR PRACTICE DO YOU ROUTINELY TESTIFY IN COURT?
A NO, I DON'T.
Q HAVE YOU EVER TESTIFIED IN COURT BEFORE ON A MEDICAL ISSUE?
A NO, I HAVE NEVER TESTIFIED BEFORE IN COURT ON ANY ISSUE.
Q THIS IS A NEW EXPERIENCE FOR YOU?
A TOTALLY NEW.
Q WE WOULD LIKE YOU TO RELAX. ARE YOU A LITTLE NERVOUS?
A THAT IS POSSIBLY A TRUE STATEMENT.
Q OKAY.
DID YOU SEE MR. O.J. SIMPSON AS A PATIENT?
A YES, I DID.
Q AND WHEN DID YOU SEE MR. O.J. SIMPSON FIRST AS A PATIENT?
A I SAW HIM FIRST NOON AT JUNE 15, 1994.
Q AND WAS THAT AT SOMEONE'S SUGGESTION OTHER THAN MR. SIMPSON'S?
A YES, IT WAS.
Q WHOSE SUGGESTION WAS THAT AT?
A IT WAS AT YOUR SUGGESTION.
Q AND DID WE HAVE A PREVIOUS RELATIONSHIP?
A YES, WE DID. YOU ARE A LONG-TIME PATIENT OF A PARTNER OF MY PRACTICE AND I HAVE SEEN YOU ON A MEDICAL BASIS WHEN HE HAS BEEN ON A LEAVE OF ABSENCE AND ON VACATION.
Q THAT IS DR. ROBERT KOBLIN?
A DR. ROBERT KOBLIN, CORRECT.
Q YOU HAVE SEEN ME ON A PROFESSIONAL BASIS?
A THAT IS CORRECT.
Q WOULD YOU DESCRIBE US AS SOCIAL FRIENDS?
A WE HAVE SEEN EACH OTHER AT SEVERAL OUTINGS, BUT I WOULD SAY IT IS MORE PROFESSIONAL THAN SOCIAL.
Q WOULD YOU TELL THE LADIES AND GENTLEMEN OF THE JURY WHAT TYPE OF EXAMINATION YOU CONDUCTED OF O.J. SIMPSON ON THE 15TH, WEDNESDAY.
A WELL, WHEN HE CAME I DID A VERY THOROUGH HISTORY. SUBSEQUENTLY, A PHYSICAL EXAMINATION. WE DID VARIOUS URINE, BLOOD AND X-RAY EVALUATIONS. THEN OF COURSE SUBSEQUENTLY WE COLLATED A LOT OF HIS PREVIOUS MEDICAL RECORDS AND X-RAY REPORTS AND X-RAYS AND REVIEWED THOSE.
Q HAVE YOU BROUGHT ALL THOSE RECORDS WITH YOU?
A I HAVE BROUGHT ALL MY MEDICAL RECORDS WITH ME, CORRECT.
Q AND WOULD IT HELP TO REFRESH YOUR MEMORY, AS WE GO THROUGH YOUR TESTIMONY, TO REFER TO THOSE RECORDS?
A YES, IT WOULD.
Q WHEN YOU REFER TO THOSE RECORDS WOULD YOU BE KIND ENOUGH JUST TO TELL THE LADIES AND GENTLEMEN OF THE JURY THAT YOU ARE REFRESHING YOUR MEMORY OR REFERRING TO YOUR MEDICAL RECORDS.
A SURE. OKAY, GREAT.
Q HAVE YOU REVIEWED THOSE PRIOR TO COMING HERE?
A YES, I HAVE, LAST NIGHT.
MR. SHAPIRO: AND WE HAVE PROVIDED COPIES TO MR. KELBERG OF THE COMPLETE FILE; IS THAT CORRECT, MR. KELBERG?
MR. KELBERG: WITH THE EXCEPTION AS PREVIOUSLY NOTED.
Q BY MR. SHAPIRO: WOULD YOU DESCRIBE -- YOU TOOK A HISTORY OF MR. SIMPSON?
A THAT'S CORRECT.
Q DID YOU DISCOVER DURING THE COURSE OF THAT HISTORY ANY PREEXISTING MEDICAL CONDITIONS OR INJURIES?
A YES, I DID.
Q WOULD YOU RELATE THOSE TO THE LADIES AND GENTLEMEN OF THE JURY.
A WELL, INITIALLY, AND PROBABLY THE MOST TROUBLING TO ME AS AN INTERNIST, HE GAVE AN APPROXIMATELY ONE-MONTH HISTORY OF DRENCHING NIGHT SWEATS SO SEVERE THAT HE WOULD HAVE TO GET OUT OF BED, TOWEL HIMSELF OFF AND GO BACK AND SLEEP IN THE DRY PORTION OF THE BED.
MR. KELBERG: YOUR HONOR, EXCUSE ME. I HATE TO INTERRUPT THE DOCTOR.
I WOULD ASK THE COURT TO GIVE A LIMITING STATEMENT ABOUT ANY STATEMENT MADE BY THE DEFENDANT TO DR. HUIZENGA.
THE COURT: MR. SHAPIRO, ANY COMMENT?
MR. SHAPIRO: NO, YOUR HONOR. I HAVE NO OBJECTION TO THAT.
THE COURT: ALL RIGHT.
LADIES AND GENTLEMEN, THE STATEMENTS MADE BY THE DEFENDANT TO THE DOCTOR ARE FOR THE PURPOSE OF GIVING YOU A BASIS TO EVALUATE AN OPINION THAT THE DOCTOR WILL FORM ON THE BASIS OF WHAT THE DEFENDANT TOLD HIM, AND IT IS NOT TO BE ASSUMED TO BE TRUE AND IT IS FOR YOUR PURPOSES IN EVALUATING THE DOCTOR'S TESTIMONY, ONLY FOR THAT LIMITING PURPOSE.
MR. SHAPIRO.
MR. KELBERG: THANK YOU, YOUR HONOR.
MR. SHAPIRO: THANK YOU, YOUR HONOR.
THE COURT: MR. SHAPIRO.
Q BY MR. SHAPIRO: YOU MAY CONTINUE, DOCTOR.
A SO THE DRENCHING NIGHT SWEATS ARE A SIGN IN MEDICINE OCCASIONALLY OF A SIGNIFICANT DISEASE.
AND IN ASSOCIATION WITH THAT HE GAVE ME A VERY STRONG PERSONAL FAMILY HISTORY OF CANCER, AND IN FACT HE HIMSELF HAD HAD CARCINOID CANCER OF THE RECTUM, A CANCER THAT CAN BE QUITE BENIGN OR CAN HAVE MORE SINISTER IMPLICATIONS.
CORRELATING THOSE SYMPTOMS WITH HIS PHYSICAL EXAM, HE HAD AN ENLARGED LYMPH NODE IN HIS RIGHT AXILLA, WHICH IS UNDER THE RIGHT ARMPIT, IN ADDITION TO CLUBBING OF HIS FINGERNAILS, WHICH IS SOMETHING THAT CAN BE AN INHERITED CONDITION OR IT CAN BE ALSO CONSISTENT WITH A LUNG PROCESS, AND THOSE THINGS WERE NOTED AND WORRISOME FOR ANYTHING FROM AN INFECTION TO A CANCER TO SOME OTHER SORT OF AUTOIMMUNE PROCESS.
Q AND DID YOU DO FOLLOW-UP EXAMINATIONS IN THAT AREA?
A YES, WE DID.
BASICALLY SUBSEQUENT TO THAT INITIAL OBSERVATION I SAW HIM AGAIN TWO DAYS LATER AND WE DID FURTHER BLOOD TESTS, FURTHER SKIN TESTING, AND FURTHER DIGGING OF HIS PAST HISTORIES TRYING TO GET AT THAT PARTICULAR ISSUE AND THE EXACT ETIOLOGY OF THAT SIGNIFICANT ENLARGED LYMPH NODE UNDER HIS RIGHT ARMPIT.
Q DID YOU MAKE ANY RECOMMENDATIONS AS A RESULT OF YOUR INITIAL EXAMINATION AND SUBSEQUENT FOLLOW-UP EXAMINATION?
A YES, I DID.
Q WHAT WAS THAT RECOMMENDATION?
A THE RECOMMENDATION WAS THAT WE BIOPSY THAT LYMPH NODE.
Q WHAT IS A BIOPSY AND WAS ONE DONE?
A A BIOPSY IS A PROCEDURE WHERE SURGICALLY YOU GO THROUGH THE SKIN, REMOVE THE LYMPH NODE AND EVALUATE IT PATHOLOGICALLY UNDER THE MICROSCOPE TO TRY TO GET MORE INFORMATION AS TO THE EXACT CAUSE.
Q AND DID YOU FOLLOW THAT PROCEDURE?
A YES, WE DID.
Q AND WERE YOU PRESENT WHEN THE BIOPSY WAS PERFORMED?
A YES, I WAS PRESENT.
Q AND WHAT WAS THE RESULT OF THAT BIOPSY?
A THE RESULT OF THE BIOPSY WAS REVEALING ABNORMALLY ENLARGED LYMPH NODES, A COLLECTION OF LYMPH NODES, AND THE PATHOLOGY WAS CONSISTENT WITH A BENIGN REACTIVE LYMPHOID HYPERPLASIA WHICH MAY BE ASSOCIATED WITH A NUMBER OF DISEASES.
BUT WE RULED OUT A WHOLE HOST OF POTENTIAL CAUSES, EVERYTHING FROM AIDS TO EPSTEIN-BARR VIRUS, CYTOMEGALO VIRUS,
TOXOPLASMOSIS -- THERE WAS A CAT AT THE HOME -- AND A WHOLE HOST OF CANCEROUS CAUSES.
SPECIFICALLY WE WERE VERY WORRIED ABOUT HODGKIN'S DISEASE AND WE FELT THAT LYMPH NODE WAS CONSISTENT WITH RHEUMATOID ARTHRITIS.
THE COURT: DO YOU WANT TO SPELL SOME OF THOSE FOR THE COURT REPORTER.
MR. SHAPIRO: I'M SORRY, YOUR HONOR?
THE COURT: DO YOU WANT TO SPELL SOME OF THOSE FOR THE COURT REPORTER.
MR. SHAPIRO: YES. WOULD YOU KINDLY HELP OUR REPORTER HERE AND SPELL SOME OF THOSE MEDICAL TERMS AND SPELL THEM SLOWLY, PLEASE.
THE WITNESS: I THINK MY SPELLING IS PROBABLY AS WEAK AND ANYBODY ELSE.
MR. SHAPIRO: CAN WE REVIEW THAT LATER, YOUR HONOR, IN THE INTEREST OF TIME THAT THE DOCTOR WILL GET TOGETHER WITH THE REPORTER?
THE COURT: ALL RIGHT.
Q BY MR. SHAPIRO: DID YOU DISCOVER, THROUGH YOUR HISTORY AND SUBSEQUENT EXAMINATION, ANY OTHER SURGERIES THAT MR. SIMPSON HAD HAD PRIOR TO HIM COMING TO SEE YOU?
A YES, I DID.
Q WOULD YOU DESCRIBE THOSE TO THE LADIES AND GENTLEMEN OF THE JURY AND TRY TO TAKE THEM ONE AT A TIME, IF WE CAN.
A OKAY.
IN MY INITIAL HISTORY WITH MR. SIMPSON HE KIND OF PRESENTED WITH THAT WHOLE ARRAY OF THE TYPICAL POST-NFL INJURY SYNDROMES.
HE HAD, OF COURSE, A NUMBER OF HEAD CONCUSSIONS WHEN HE WAS PLAYING WITH THE BUFFALO TEAM. HE HAD A LEFT RETINAL TEAR AND THEN HE HAD THIS WHOLE HOST OF SIGNIFICANT ORTHOPEDIC COMPLAINTS.
SPECIFICALLY, HE HAD INITIALLY A SURGERY ON HIS LEFT WRIST ALL THE WAY BACK TO 1965 WHICH SIGNIFICANTLY LIMITED THE MOTION IN HIS LEFT WRIST AND CAUSED HIM CONTINUING PAIN.
HE COMPLAINED OF SOME FINGER PROBLEMS. HE HAD MULTIPLE FRACTURES, WHICH IS PRETTY COMMON IN FOOTBALL, AND HAD VISIBLY ENLARGED KNUCKLES WHICH ALSO CAN BE ASSOCIATED WITH EITHER FRACTURES OR OSTEOARTHRITIS OR OTHER RHEUMATOLOGIC ARTHRITIC CONDITIONS.
HE HAD A SIGNIFICANT KNEE COMPLAINTS. HE HAD HAD A HISTORY OF FIVE TO SIX KNEE ARTHROSCOPIES IN THE PAST WHICH IS WHERE THEY PUT A LITTLE TUBE INTO THE KNEE CAPSULE AND INJECT IT WITH DYE SO THAT THEY CAN LOOK AROUND AT THE VARIOUS COMPONENTS INSIDE THE KNEE TO SEE IF ANYTHING IS TORN OR NEEDS SURGICAL REPAIRS.
AND HE HAD SUBSEQUENTLY ON HIS LEFT KNEE HAD FOUR SURGERIES. HIS INITIAL SURGERY WAS IN 1977 AND THAT IS WHEN THEY HAD TAKEN OUT HIS LATERAL MENISCUS, SO LEFT KNEE LATERAL COMPONENT. THE MENISCUS IS A SPONGE-LIKE PIECE OF BODILY TISSUE THAT HELPS CUSHION THIS FEMUR AS IT LOADS ON THE TIBIA AND FIBULA BELOW.
HE SUBSEQUENTLY, IN 1978, HAD A, QUOTE-UNQUOTE, CLEAN-OUT WHERE THEY SAW SIX FOREIGN BODIES WHICH USUALLY ARE CALCIFIC MASSES IN THERE. THEY TOOK OUT SCAR TISSUE AND THEY ALSO TOOK OUT SOMETHING CALLED THE BAKERS CYST WHICH CAN BE A SEQUELAE OF CONTINUING TRAUMA TO THE KNEE AND MAY ALSO BE SUSPICIOUS OF OTHER THINGS, INCLUDING RHEUMATOID ARTHRITIS.
HIS THIRD LEFT KNEE SURGERY WAS IN 1986, AGAIN CLEANING OUT DEBRIS, SCAR TISSUE AND BITS AND FRAGMENT OF THE KNEE THAT KIND OF KEEPS BREAKING OFF.
THE COURT: ALL RIGHT. DOCTOR, I'M SORRY.
IF YOU COULD, COULD YOU JUST SLOW DOWN JUST A LITTLE BECAUSE --
THE WITNESS: SURE.
THE COURT: -- IT IS TECHNICAL STUFF. SOME OF US NEED TO UNDERSTAND ALL THE TECHNICAL THINGS THAT ARE GOING ON, BUT TAKE YOUR TIME.
TAKE A DEEP BREATH AND SLOW DOWN.
THE WITNESS: OKAY.
THE COURT: WE NEED TO UNDERSTAND WHAT YOU ARE TELLING US.
THE WITNESS: OKAY.
UMM, THE FOURTH LEFT KNEE SURGERY WAS IN 1991, DONE HERE AT THE JOE KERLIN CLINIC, AND THERE THEY REMOVED THE MEDIAL MENISCUS, SO BASICALLY THERE IS NO SPONGE LAYER, NO CUSHION THERE.
HE ALSO AT THAT TIME WAS OBSERVED TO HAVE ESSENTIALLY HUGE HOLES IN HIS ARTICULAR CARTILAGE. YOU HAVE THIS KIND OF CUSHIONING DEVICE IN THE MIDDLE OF THE KNEE AND THEN YOU HAVE AN ARTICULAR CARTILAGE. IT IS THE TEFLON COATING ON TOP OF THE JOINTS TO ALLOW SMOOTH FRICTIONLESS MOTION OF BONES AS THEY MOVE AGAINST EACH OTHER.
AND GIVEN THE MULTIPLE TRAUMA THAT HE HAD TAKEN, IN ADDITION TO POSSIBLE OTHER RHEUMATOLOGIC DISEASES THAT WE WILL GET TO LATER, BIG BITS ON ALL THREE COMPARTMENTS OF THE KNEE -- THERE IS THREE COMPARTMENTS:
THERE IS THE LATERAL SIDE OF THE KNEE, THE MEDIAL SIDE AND THERE IS WHAT IS CALLED THE ANTERIOR SIDE RIGHT BEHIND YOUR KNEECAP.
AND IN ALL THREE THOSE HE HAS DENUDED AREA OF ARTICULAR CARTILAGE SO THAT THE BONE WAS SHOWING THROUGH THERE.
Q BY MR. SHAPIRO: LET ME JUST STOP YOU ON THE KNEE.
A SURE.
Q LET ME JUST SEE IF WE CAN PUT THIS IN PERSPECTIVE.
THE FIRST THING YOU TOLD THE JURY WAS THAT HE HAD A TYPICAL POST-NFL SYNDROME.
BREAK THAT DOWN AND EXPLAIN WHAT YOU ARE TRYING TO CONVEY TO THE JURY.
A WELL, IN THE NATIONAL FOOTBALL LEAGUE, SOMETHING LIKE SEVENTY POSSIBLY EIGHTY PERCENT OF NFL FOOTBALL PLAYERS -- EVEN THOUGH HE HAD SOMEWHAT OF A LONGER CAREER THAN IS AVERAGE IN THE NATIONAL FOOTBALL LEAGUE -- THE AVERAGE IN THE NATIONAL FOOTBALL LEAGUE IS PROBABLY MORE IN THE TWO- TO THREE-YEAR SPAN.
BASICALLY EVEN WITH THAT SHORT OF AN AVERAGE PLAYING CAREER, SOMETHING LIKE SEVENTY TO EIGHTY PERCENT OF NFL PLAYERS SUFFER FROM A PERMANENT PHYSICAL DISABILITY, FOOTBALL PLAYING RELATED, THAT AFFECTS THEM FOR THE REMAINDER OF THEIR LIVES, IN ADDITION TO A WHOLE HOST OF OTHER THINGS PARTICULAR TO PLAYING IN THE NATIONAL FOOTBALL LEAGUE; AFFECTS OF DRUGS. HE RECEIVED MULTIPLE CORTISONE INJECTIONS, WHICH IS -- CERTAINLY WAS DONE IN THE PAST, I THINK ALL WOULD AGREE, FAR TOO FREELY AND MAY HAVE CERTAIN SEQUELAE DOWNSTREAM.
AND ALSO WAS BASICALLY EXPOSED TO MULTIPLE TRAUMA. YOU KNOW, WHAT ARE THE EFFECTS OF GETTING YOUR HEAD, YOUR KIDNEYS, YOUR LIVER BANGED REPEATEDLY AGAINST THE TURF? AND THEN YOU GO THROUGH ALL THESE OTHER DIFFICULT THINGS AFTER YOUR PLAYING CAREER, YOU KNOW, WHEN YOU GO FROM ONE LIFE TO ANOTHER, AND YOU KNOW, THE NFL TEAMS REALLY HAVEN'T PREPARED MOST OF THE GUYS FOR DOING ANYTHING.
HE WAS VERY LUCKY THAT HE WAS VERY TALENTED AND HAD OTHER AVENUES, BUT THOSE ARE THE THINGS THAT I SAY OF THE TYPICAL NFL SYNDROME.
Q AND WHAT IS YOUR EXPERIENCE IN DEALING WITH ATHLETES IN A PROFESSIONAL CAPACITY?
A I WAS THE TEAM PHYSICIAN FOR THE LOS ANGELES RAIDERS FROM 1983 UNTIL 1990.
Q FOR THE WHAT WAS THE LOS ANGELES RAIDERS?
A WHAT WAS THE LOS ANGELES RAIDERS.
Q SO YOU HAVE AN EXPERTISE IN THE FIELD OF SPORTS AND SPORTS INJURIES AS WELL AS INTERNAL MEDICINE?
A CERTAINLY THE NON-ORTHOPEDIC PORTION OF SPORTS MEDICINE I FEEL I'M QUITE QUALIFIED TO DISCUSS.
Q ALL RIGHT.
LET'S FOCUS OUR ATTENTION ON THE KNEE THAT YOU HAVE DESCRIBED.
CAN YOU TELL THE LADIES AND GENTLEMEN OF THE JURY IN LAY TERMS THAT YOU WOULD DISCUSS WITH A PERSON WHO DOES NOT HAVE A MEDICAL BACKGROUND, WHAT THE CONDITION OF HIS KNEE WAS WHEN YOU EXAMINED HIM?
A WELL, WHEN I FIRST SAW HIM IN THE OFFICE, WHICH AS I SAID WAS NOON, WE SQUEEZED HIM IN DURING THE LUNCH HOUR, HE BASICALLY WAS VISIBLY LIMPING AS HE CAME DOWN THE HALL. YOU KNOW, THAT IS THE FIRST THING THAT STRIKES ME. AND HE REALLY WAS NOT WALKING PROPERLY.
UMM, ON EXAMINATION OF THAT KNEE -- AND WE HAVEN'T EVEN GOT TO HIS RIGHT KNEE WHICH WAS FAR LESS SEVERELY INVOLVED, JUST HAD A MENISCAL TEAR.
WHEN YOU MOVE THE KNEE THERE IS FOUR DIFFERENT LIGAMENTS THAT HOLD IT IN PLACE AND THERE WAS SOME LAXITY THERE MAINLY BECAUSE YOU ARE MISSING THE MENISCUS AND YOU ARE POSSIBLY MISSING ARTICULAR CARTILAGE SO IT IS A LOOSER KNEE.
AND WHEN YOU MOVE THE KNEE, THE KNEE SHOULD GO THROUGH A CERTAIN RANGE OF MOTION. WHEN I EXTEND MY KNEE YOU CAN SEE IT IS STRAIGHT, IT IS 180 DEGREES. WHEN I FLEX IT, THERE IS A DIFFERENT RANGE THAT EVERYONE CAN FLEX THAT KNEE, BUT TYPICALLY IT GOES BACK TO 135 DEGREES, 140 WHATEVER.
HE WAS ABLE TO EXTEND HIS KNEE, BUT REALLY COULD ONLY FLEX IT TO A POINT WHERE HE WAS LIMITED BY 25 TO 30 DEGREES, APPROXIMATELY.
THAT INDICATES DAMAGE THERE.
WHEN YOU MOVE THE KNEE AND PUT YOUR HAND OVER DIFFERENT PARTS OF THE KNEE, YOU CAN HEAR KCCHHH-KCCHHH, KCCHHH-KCCHHH, AND BASICALLY THAT IS, YOU KNOW, SURFACES RUBBING, ABRADING EACH OTHER THAT PROBABLY SHOULDN'T BE DOING THAT IN A PERFECT WORLD.
Q NOW, YOU INDICATED THAT -- WOULD YOU DESCRIBE THE DEGREE OF DAMAGE TO THAT KNEE.
A HIS KNEE -- THERE ARE KNEES THAT ARE MORE SEVERELY DAMAGED, BUT ACCORDING TO THE ORTHOPEDIST HE WAS SEEING HE WAS ESSENTIALLY --
MR. KELBERG: OBJECTION, YOUR HONOR. MOVE TO STRIKE AS HEARSAY.
THE COURT: SUSTAINED AT THIS POINT.
Q BY MR. SHAPIRO: WHAT IS YOUR OPINION AS TO --
A MY OPINION WAS --
Q LET ME ASK THE QUESTION.
WHAT IS YOUR OPINION AS TO THE CONDITION OF HIS KNEE BASED ON YOUR EXAMINATION AND THE MEDICAL HISTORIES THAT YOU REVIEWED?
A HE HAD SEVERE WEAR AND TEAR ARTHRITIS OF THE LEFT KNEE AND WAS A STRONG CANDIDATE IN THE RELATIVELY NEAR FUTURE FOR A TOTAL KNEE REPLACEMENT.
Q WHAT DOES THAT CONSIST OF?
A A TOTAL KNEE REPLACEMENT CONSISTS OF BASICALLY TAKING A SAW AND SAWING OFF THE DISTAL PORTION OF THE FEMUR AND INSERTING AN ARTIFICIAL KNEE AND INSERTING THAT DOWN INTO THE TIBIA AND BACK UP IN THE FEMUR SO THAT WHEN THE POINT COMES WHERE THE PAIN IS TOO MUCH AND YOUR QUALITY OF LIFE IS INTERFERED WITH -- HE WAS OBVIOUSLY NOT ABLE TO DO A NUMBER OF THINGS -- THEN IT IS TIME TO MOVE ON TO AN ARTIFICIAL KNEE.
Q IN YOUR OPINION HOW WOULD THAT AFFECT HIS MOBILITY ON THE DAY YOU SAW HIM?
A ON THE DAY I SAW HIM HE HAD SIGNIFICANTLY LIMITED MOBILITY BECAUSE OF THE KNEE AND ACTUALLY ANOTHER ANKLE PROBLEM THAT WE HAVEN'T DISCUSSED, AND I THINK WOULD BE SIGNIFICANTLY LIMITED IN TERMS OF FAST WALKING, CERTAINLY IN TERMS OF SLOW JOGGING, IT WOULD BE VERY DIFFICULT, IF NOT IMPOSSIBLE, THAT DAY.
Q WHAT ABOUT A WEEK PRIOR TO THIS?
A I HAVE NO KNOWLEDGE OF WHAT HIS CONDITION WAS LIKE A WEEK PRIOR TO THAT.
Q DO YOU THINK THERE WOULD BE ANY SIGNIFICANT CHANGE TWO DAYS PRIOR TO THAT?
A OCCASIONALLY WITH ACTIVITY YOU CAN WORSEN WEAR AND TEAR ARTHRITIS, OSTEOARTHRITIS, AND SO THAT CAN BE A VARIABLE.
HE ALSO -- AND WE HAVEN'T TALKED ABOUT
IT -- THERE WERE OTHER RHEUMATOLOGIC CONDITIONS THAT MAY HAVE A WAXING AND WANING AND FLUCTUATING CAUSE, BUT WITHOUT QUESTION THIS IS SOMEONE THAT WAS NOT ABLE TO JOG OR MOVE QUICKLY ON THE BASIS OF HIS LEFT KNEE.
Q LET'S GO TO THE RIGHT KNEE. WHAT WAS THE CONDITION OF THE RIGHT KNEE?
A THE RIGHT KNEE HAD ONLY A SUBTLE LIMITATION IN FULL FLEXION. HE WAS PROBABLY ONLY DOWN 10 OR SO DEGREES, AND HE HAD A MUCH MILDER FORM OF CREPITATION AND IN FACT HE HAD NEVER HAD A KNEE SURGERY ON THAT KNEE, ALTHOUGH WE KNOW FROM STUDIES DONE IN 1992 THAT HE DOES HAVE A MENISCAL TEAR ON THE MEDIAL SIDE.
Q WHAT DOES THAT MEAN?
A WELL, AGAIN, THE MENISCUS IS THIS KIND OF RUBBERY HORSESHOE-SHAPED MATERIAL THAT IS IN BETWEEN THE SMOOTH SURFACE OF THE TIBIA AND THE FIBULA BELOW AND THE SMOOTH ARTICULAR SURFACE THAT IS LINING THE TOP OF THE FEMUR AND ACTING AS A CUSHIONING OR AN UNLOADING MECHANISM.
Q DID YOU DO ANY FURTHER EXAMINATION BELOW THE KNEE?
A YES, I DID.
Q WHAT TYPE OF EXAMINATION DID YOU DO?
A I EVALUATED HIS ANKLES.
Q AND DID YOU HAVE ANY PRIOR HISTORY FROM MEDICAL RECORDS ABOUT HIS ANKLES?
A YES, I DID. HE HAD HAD MULTIPLE RIGHT ANKLE INJURIES IN PROFESSIONAL FOOTBALL, AND ON MY EXAMINATION, WHEN YOU DO A CERTAIN TEST, YOU GRAB THE ANKLE AND YOU TRY TO STABILIZE THE DISTAL PORTION OF HIS SHIN AND THEN YOU PULL IT BACK AND FORTH.
THAT -- THERE REALLY SHOULDN'T BE MUCH GIVE THERE BECAUSE YOU HAVE A NUMBER OF QUITE FIRM LIGAMENTS THERE.
AND HE HAD SIGNIFICANT LAXITY THERE AND HE ALSO HAD SIGNIFICANT PAIN. THE LATERAL MALLEOLUS, IS THIS BUMP ON THE OUTSIDE PART OF YOUR ANKLE AND ANTERIOR AND A LITTLE BIT INFERIOR TO THAT HE HAD SIGNIFICANT POINT TENDERNESS AND THAT WAS MY OPINION OF WHY HE WAS LIMPING WAS BECAUSE OF THE PAIN ON THAT ANKLE AND THE -- THE PROBLEMS THAT WE DISCUSSED ON HIS LEFT KNEE.
Q WHAT DOES THE TERM "LAXITY" MEAN TO ORDINARY PEOPLE?
A LAXITY JUST IS LOOSENESS, YOU KNOW. YOU SHOULD HAVE, YOU KNOW, WITH THE LIGAMENTS -- A LIGAMENT IS SOMETHING THAT HOOKS A BONE TO A BONE. TENDON IS SOMETHING THAT HOOKS THE MUSCLE TO A BONE.
WHEN THE LIGAMENTS ARE ALL WORKING PROPERLY, YOU SHOULDN'T BE ABLE TO MAKE TWO BONES JUMP AND MOVE A SIGNIFICANT DISTANCE OVER EACH OTHER.
Q WERE THERE ANY OTHER OBSERVATIONS YOU MADE OF HIS LOWER EXTREMITIES BELOW THE WAIST?
A UMM, NO, THERE WERE NOT.
Q NOW, LET'S GO ABOVE THE WAIST.
DID YOU DO ANY EXAMINATION BETWEEN -- LET'S TALK ABOUT THE WRIST.
A HIS --
Q WAIT. LET ME JUST FINISH THE QUESTION.
YOU TOLD THE JURY THAT THERE WAS SOME INJURY TO THE RIGHT WRIST?
A THE LEFT WRIST.
Q THE LEFT WRIST. WOULD YOU EXPLAIN THAT INJURY.
A HE SUSTAINED AN INJURY, THE EXACT NATURE OF WHICH I'M NOT EXACTLY CLEAR, IN 1965, BUT NEEDED SURGERY OF THIS AREA.
WHEN I DID AN EXAM, USUALLY THE WRIST SHOULD COME UP SOMETHING LIKE NINETY DEGREES AND IT SHOULD KIND OF FLAP DOWN ALSO AT ABOUT NINETY DEGREES, SO YOU ESTIMATE THESE THINGS IN THE OFFICE.
AND HIS LEFT WRIST REALLY WAS ONLY ABLE TO COME UP ABOUT THIRTY OR FORTY DEGREES. THIS IS NOT AN EXACT SCIENCE, BUT YOU KNOW, YOU KIND OF ESTIMATE 45 DEGREES, AND HE DID NOT SEEM TO BREAK THAT PLANE.
AND WHEN YOU FORCIBLY TRIED TO MOVE IT UP, YOU KNOW, THERE WAS NO GIVE AND PAIN.
Q WAS THERE ANY OTHER INJURIES THAT YOU OBSERVED IN THE ARM AREAS?
A HE HAD DAMAGE TO HIS ELBOWS SUCH THAT WHEN HE WOULD TRY TO FULLY EXTEND -- AGAIN, THE ELBOW SHOULD EXTEND 180 DEGREES, TO BE PERFECTLY STRAIGHT, AND HE HAD WHAT WE CALL A FLEXION CONTRACTURE. IT WAS CONTRACTED SOMEWHAT FLEXED, SO HE REALLY MISSED THE LAST SEVERAL DEGREES, 10 OR 15 DEGREES OF STRAIGHTENING OUT THE ELBOW SUCH THAT THIS WOULD BE ABOUT THE BEST HE COULD DO WHEN YOU SAID STRAIGHTEN OUT YOUR ARMS.
Q ANY OTHER OBSERVATIONS OF THE UPPER TORSO?
A UMM, HE HAD MULTIPLE SCARS, KELOIDS OVER PARTS OF HIS UPPER BODY AND THE BACK, AND OF COURSE THE FINGERS AND THE ELBOWS AND FOREARMS AND HANDS.
HE WAS SOMEWHAT BOWLEGGED, YOU KNOW, IN ADDITION TO THE LIMP WE DESCRIBED, AND I THINK THOSE WERE THE -- IN ADDITION TO THE FINGER THINGS THAT WE TALKED ABOUT, THE LARGE -- ENLARGEMENTS, THOSE WERE THE MAJOR FINDINGS.
Q DID YOU DO ANY RANGE OF MOTION STUDIES?
A YES, I DID.
Q WHAT ARE RANGE OF MOTION STUDIES?
A RANGE OF MOTION IS TAKING A PARTICULAR JOINT AND MOVING IT IN EVERY DIRECTION THAT IS HUMANLY POSSIBLE AND COMPARING THAT WITH A NORMAL POPULATION AND SEEING WHERE YOUR PATIENT FALLS.
Q AND WOULD YOU DESCRIBE TO THE LADIES AND GENTLEMEN OF THE JURY WHAT YOUR FINDINGS WERE REGARDING THOSE RANGE OF MOTION STUDIES.
A RANGE OF MOTION STUDIES REVEALED LIMITATION IN TERMS OF ELBOW EXTENSION, LIMITATION IN TERMS OF LEFT WRIST DORSIFLEXION, IN TERMS OF LEFT KNEE FLEXION, MORE SO THAN RIGHT KNEE FLEXION, AND THOSE WERE THE MAJOR RANGE OF MOTION ABNORMALITIES.
Q DID YOU -- YOU TESTIFIED THAT YOU DID SOME BLOOD TESTS?
A THAT IS CORRECT.
Q AND DID YOU -- DID YOU COME UP WITH ANY SIGNIFICANT FINDINGS THAT WERE MEDICALLY IMPORTANT TO YOU REGARDING MR. SIMPSON'S CONDITION?
A HE HAD A VERY MODESTLY ELEVATED SEDIMENTATION RATE.
Q WHAT DOES THAT MEAN?
A A SEDIMENTATION RATE IS A NONSPECIFIC TEST FOR INFLAMMATION, INFECTION, CANCER, SOMETHING OF THAT NATURE.
Q REGARDING INFLAMMATION, DID YOU NOTICE ANY INFLAMMATION IN YOUR VISUAL EXAMINATION OF MR. SIMPSON?
A HE HAD WHAT APPEARED TO BE MODEST INFLAMMATION IN THE RIGHT LATERAL MALLEOLAR AREA AND ALSO IN THE LEFT KNEE AND IT WAS DIFFICULT TO TELL WHETHER IT WAS A FRANK EFFUSION, WATER IN THE KNEE, OR JUST A LITTLE BIT OF BONY GROWTH AFTER ALL THIS TRAUMA.
Q DID YOU NOTICE ANY INFLAMMATION IN THE HAND AREA?
A YES, I DID.
Q WOULD YOU DESCRIBE THAT TO THE LADIES AND GENTLEMEN OF THE JURY.
A HE HAD MULTIPLE AREAS THAT WERE ENLARGED, THESE BONY ENLARGEMENTS ON HIS JOINTS.
BASICALLY -- AND HERE I WILL REFER TO MY ORIGINAL SCRIBBLINGS.
WHEN I SAW HIM ORIGINALLY I JUST KIND OF GOT OUT A PEN AND WENT AROUND HIS HAND AND THIS WAS HIS RIGHT HAND, AND BASICALLY THIS JOINT, RIGHT HERE, (INDICATING), WAS ENLARGED, THIS WAS ENLARGED, THIS WAS ENLARGED, THIS, THIS, THIS, THIS BONY KIND OF ENLARGEMENTS THAT COULD HAVE BEEN FROM A DEGENERATIVE JOINT DISEASE OR OLD FRACTURES OR TRAUMA OR GETTING IT STEPPED ON TOO MANY TIMES.
Q WHICH HAND WERE YOU REFERRING TO?
A THIS IS THE RIGHT HAND.
MR. KELBERG: YOUR HONOR, I HATE TO INTERRUPT.
AGAIN WE HAVE NOT BEEN PROVIDED WITH THAT ROUGH DRAFT THAT THE DOCTOR IS REVIEWING.
COULD I HAVE AN OPPORTUNITY JUST TO TAKE A QUICK LOOK AT IT?
MR. SHAPIRO: MAY WE GET A COPY OF THAT I'M SORRY THAT THAT WASN'T PROVIDED.
MR. KELBERG: THANK YOU, DOCTOR.
(BRIEF PAUSE.)
MR. KELBERG: PERHAPS WE CAN GO TO A DIFFERENT AREA.
THE COURT: WELL, IT WILL TAKE US 20 SECONDS.
MR. KELBERG: I'M SORRY.
THE COURT: I HAVE MY OWN PHOTOCOPY MACHINE.
(BRIEF PAUSE.)
THE COURT: ALSO, DOCTOR, WOULD YOU LET THE ATTORNEY FINISH ASKING THE QUESTION BEFORE YOU START TO ANSWER.
THE WITNESS: OKAY.
THE COURT: THANK YOU.
(BRIEF PAUSE.)
(DISCUSSION HELD OFF THE RECORD
BETWEEN DEPUTY DISTRICT ATTORNEY
AND DEFENSE COUNSEL.)
THE COURT: ALL RIGHT. MR. SHAPIRO.
Q BY MR. SHAPIRO: WOULD YOU DESCRIBE SLOWLY TO THE JURY YOUR FINDINGS ON MR. SIMPSON'S RIGHT HAND.
A HIS RIGHT-HAND HAD MULTIPLE JOINT ENLARGEMENTS. BASICALLY BONY OVERGROWTHS LOCATED ON THE PROXIMAL JOINT OF HIS THUMB, THIS PROXIMAL PHALANGEAL JOINT ON HIS RIGHT INDEX FINGER, THE PROXIMAL JOINT ON HIS THIRD RIGHT FINGER, BOTH THE DISTAL INTERPHALANGEAL JOINT AND THE PROXIMAL INTERPHALANGEAL JOINT ON HIS FOURTH RING FINGER, AND AGAIN DISTAL INTERPHALANGEAL JOINT AND PROXIMAL INTERPHALANGEAL JOINT SWELLING AND HYPERTROPHY ON THE FIFTH RIGHT FINGER.
Q HOW ABOUT THE LEFT HAND. WOULD YOU GO THROUGH THE SAME DEMONSTRATION.
A YES, I DID. HERE IS THE LEFT HAND AND AGAIN ENLARGEMENT OF THIS JOINT RIGHT HERE, THE PROXIMAL THUMB FINGER JOINT, THE THIRD PIP PROXIMAL INTERPHALANGEAL JOINT AND THE FOURTH BOTH THE PROXIMAL AND THE DISTAL INTERPHALANGEAL JOINT AND AGAIN ON THE FIFTH FINGER JUST THE PROXIMAL INTERPHALANGEAL JOINT.
Q AND WHAT DID YOU OBSERVE OF THOSE JOINTS?
A THOSE JOINTS WERE SWOLLEN WITH BONY OVERGROWTHS SIGNIFYING SOME TYPE OF TRAUMA OR OLD FRACTURES OR INFLAMMATORY OR OSTEOARTHRITIC DISEASE.
Q ALL RIGHT.
WOULD YOU BRIEFLY TELL THE JURY ABOUT ARTHRITIS.
A WELL, ARTHRITIS, THAT IS -- THAT IS OBVIOUSLY A VERY LARGE TOPIC, BUT ARTHRITIS MEANS, YOU KNOW, THERE IS SOMETHING WRONG WITH THE JOINTS AND YOU ARE GETTING PAIN FROM THE JOINTS.
THERE ARE TWO BROAD CATEGORIES THAT I BELIEVE MR. SIMPSON SUFFERS FROM. ONE IS, YOU KNOW, WHAT'S CALLED COMMONLY WEAR AND TEAR ARTHRITIS OR OSTEOARTHRITIS.
THAT IS A DISEASE THAT CAN BE CAUSED BY MANY, MANY THINGS. ENDOCRINE PROBLEMS, GENETIC CONGENITAL THINGS, BUT I BELIEVE IN HIS INSTANCE THE OSTEOARTHRITIS CAUSED FROM REPETITIVE TRAUMA AND POSSIBLY FRACTURES TO VARIOUS JOINTS.
UMM, THE OSTEOARTHRITIS MEANS THAN THE SMOOTH ARTICULAR CARTILAGE IS DAMAGED. ARTICULAR CARTILAGE, AS I ALLUDED TO BEFORE, REALLY HAS SEVERAL FUNCTIONS. ONE IS SO THAT YOU HAVE THAT SMOOTH BALL BEARING JOINT WITH THAT TEFLON SURFACE AND THE OTHER FUNCTION IS IF YOU HAVE A WEIGHT-BEARING JOINT, IT ACTUALLY HAPPENS TO UNLOAD SO THAT, YOU KNOW, THE BONES WON'T TAKE ALL THE PRESSURE IN A CERTAIN WAY AND POSSIBLY FRACTURE MORE EASILY.
SO THAT IS WHAT OSTEOARTHRITIS IS. IT IS DAMAGE TO THAT SMOOTH GLISTENY SURFACE BY REPETITIVE TRAUMA OR FRACTURES.
THE OTHER TYPE OF ARTHRITIS IS -- THAT -- THAT MR. SIMPSON HAS THAT WE HAVEN'T --
Q WOULD YOU TALK ABOUT THE -- ANOTHER --
A RHEUMATOID.
Q -- ANOTHER TYPE OF ARTHRITIS?
A ANOTHER TYPE OF ARTHRITIS IS RHEUMATOID ARTHRITIS WHICH IS A VERY DIFFICULT DISEASE TO UNDERSTAND. IT IS A DISEASE OF UNKNOWN ORIGIN, IT HAS A FLUCTUATING COURSE, AND IT IS A DISEASE THAT HAS TOTAL BODY SYMPTOM. YOU CAN FEEL TIRED, FATIGUED, YOU CAN HAVE NIGHT SWEATS, YOU CAN HAVE LYMPH NODES, YOU CAN -- YOUR SPLEEN BECOMES ENLARGED.
BUT ESSENTIALLY IT HAS A LIST THINGS THAT IT DOES TO THE JOINTS.
THERE IS THIS CAPSULE AROUND JOINTS CALLED THE SYNOVIUM. IT IS A CAPSULE THAT ENCASES IT AND THAT LAYER SOMEHOW FOR SOME REASON THICKENS, INFLAMES, YOUR BODY JUST DECIDES I'M GOING TO -- I'M GOING TO ATTACK MY OWN JOINT.
YOU KNOW, IT IS A LOOSE ASSOCIATION. YOU COULD SAY SOMEONE THAT GOT A KIDNEY TRANSPLANT AND THE BODY REJECTS IT. THE BODY ALMOST IS TRYING TO REJECT A CERTAIN PORTION OF YOUR OWN JOINT.
AND IN THAT INSTANCE THERE ARE A LIST OF THINGS THAT HAPPEN.
YOU KNOW, YOU GET STIFF IN THE MORNING. YOU TEND TO HAVE MULTIPLE JOINTS INVOLVED, ESPECIALLY HANDS AND WRIST. YOU TEND TO HAVE A SYMMETRICAL INVOLVEMENT ON BOTH SIDES OF THE BODY. YOU TEND TO HAVE THE DISEASE -- SOMETHING UNDER THE SKIN AS WELL CALLED NODULES. YOU TEND TO HAVE CHARACTERISTIC CHANGES ON X-RAY WITH EROSIONS INTO THE BONE. YOU HAVE CHARACTERISTIC PATHOLOGIC CHANGES WHEN YOU EXAMINE AFFECTED TISSUE UNDER THE MICROSCOPE.
AND YOU KNOW, THOSE ARE THE MAIN CLINICAL FINDINGS IN RHEUMATOID ARTHRITIS.
AND AGAIN, SOMETIMES THERE IS EVEN A THEORY A LOT OF TRAUMA CAN PRECIPITATE RHEUMATOID ARTHRITIS. IT IS NOT AN ABSOLUTELY POPULAR THEORY, BUT IT'S -- IT HAS BEEN MENTIONED, AND ON THE OTHER HAND, RHEUMATOID AND OSTEOARTHRITIS CAN KIND OF WORK TOGETHER, AS IT WERE, AND SOMETIMES COEXIST AND INTENSIFY.
Q HOW DO THESE CONDITIONS IN YOUR OPINION, AFFECT MR. SIMPSON IN HIS MOBILITY?
A WELL, I --
MR. DARDEN: OBJECTION, YOUR HONOR, AS TO THE TIME FRAME.
THE COURT: REPHRASE THE QUESTION.
Q BY MR. SHAPIRO: WHEN YOU SAW HIM ON THE 15TH DID YOU HAVE ANY OPINION AS TO HOW THESE CONDITIONS WOULD AFFECT HIS MOBILITY?
A WELL, HE WAS VISIBLY LIMPING TO MY EYE, AND MY INITIAL IMPRESSION WAS THAT IT WAS MAINLY THE OSTEOARTHRITIS OR THE WEAR AND TEAR DISEASE.
I WASN'T FULLY APPRAISED OF SOME OF THE BACKGROUND. I HADN'T GOT ALL HIS OLD RECORDS.
BUT I THINK THAT REALLY HE IS LIMITED, SPECIFICALLY LOWER EXTREMITIES, BY HIS ARTHRITIS, AND HE CERTAINLY WAS LIMITED TO A WAY ON THE 15TH OF JUNE WHERE HE WOULD HAVE A VERY DIFFICULT TIME MOVING QUICKLY IN HIS LOWER EXTREMITIES.
Q THIS IS NOT A CONDITION, IN YOUR OPINION, THAT CAME ON WITHIN TWO DAYS, IS IT?
A NO, I DON'T BELIEVE THAT IS -- I THINK THAT THESE ARE LONG-LIVED SYMPTOMS. THERE CAN BE SOME FLUCTUATION, AS I SAID, BASED ON OVERUSE, BASED ON CERTAIN OTHER VARIABLE, INCLUDING THE USE OF MEDICATIONS, BUT GENERALLY SPEAKING, AT THE LEVEL OF OSTEOARTHRITIS HE HAS IT BECOMES A PERSISTENT DAILY THING AND NOT LIKE EARLY ARTHRITIS WHERE YOU HAVE SOME, YOU KNOW, TOTALLY SYMPTOM FREE DAYS. HE WAS NOT OF THAT.
Q WAS THERE ANY MEDICATION THAT MR. SIMPSON WAS TAKING, TO YOUR KNOWLEDGE, FOR THESE CONDITIONS?
A YES.
Q WHAT MEDICATIONS?
A HE WOULD TAKE AS NEEDED IBUPROFEN.
Q WHICH IS?
A 800 MILLIGRAMS WHICH IS A NON-STEROIDAL ANTI-INFLAMMATORY. IT IS KNOCK-OFF OF ASPIRIN ESSENTIALLY.
HE WAS NOT TAKING A HUGE DOSE OF THIS. HE WAS NOT TAKING ENOUGH THAT MOST RHEUMATOLOGISTS WOULD THINK THAT THAT WAS A TREATING LEVEL OF DRUG TO REALLY AMELIORATE RHEUMATOID ARTHRITIS BUT BASICALLY JUST TO OCCASIONALLY KNOCK DOWN SYMPTOMS.
AND IN ARREARS WE FOUND OUT -- I FOUND OUT BECAUSE THERE WAS MY FIRST VISIT WITH HIM THAT HE HAD ALSO BEEN PUT ON SULFASALAZINE WHICH IS A DISEASE MODIFYING DRUG FOR RHEUMATOID ARTHRITIS, BUT THAT IN FACT HE HAD STOPPED TAKING THAT ABOUT A MONTH PRIOR TO MY SEEING HIM.
Q DO YOU KNOW -- DID YOU MAKE A RECOMMENDATION AS TO WHETHER HE SHOULD RE -- BEGIN THE COURSE OF SULFASALAZINE?
A YES. ONCE I GOT TO KNOW HIM AND COLLATED ALL HIS PAST RECORDS AND RE-SAW HIM ON SUBSEQUENT VISITS, INCLUDING IN THE JAIL, AND DETERMINED THAT AT LEAST A PORTION OF HIS PROBLEM WAS A FLARE OF RHEUMATOID ARTHRITIS, WE DID MAKE THAT RECOMMENDATION.
Q AND WAS THAT FOLLOWED, TO THE BEST OF YOUR KNOWLEDGE?
A YES, IT WAS.
Q DID YOU DO A VISUAL EXAMINATION HEAD TO TOE OF MR. SIMPSON?
A ABSOLUTELY.
Q AND IN THAT VISUAL EXAMINATION WOULD YOU TELL THE LADIES AND GENTLEMEN OF THE JURY, STARTING WITH THE HEAD, WHAT YOU OBSERVED.
AND WOULD IT HELP YOU IF I SHOWED YOU SOME PHOTOGRAPHS?
A SURE. I CAN TALK ABOUT EACH PHOTO INDIVIDUALLY OR JUST GO THROUGH BODY PARTS, WHATEVER YOU --
Q WERE PHOTOGRAPHS TAKEN IN YOUR OFFICE ON THE 15TH?
A YES, THEY WERE.
Q AND WERE PHOTOGRAPHS TAKEN ON YOUR SECOND VISIT WITH HIM ON THE 17TH?
A YES, THEY WERE.
MR. SHAPIRO: I HAVE SHOWN MR. KELBERG A SERIES OF PHOTOGRAPHS.
WITH THE COURT'S PERMISSION I WOULD LIKE TO PLACE THEM QUICKLY ON THE ELMO.
THE COURT: YES.
MR. SHAPIRO: THANK YOU VERY MUCH, YOUR HONOR.
THE COURT: AND FOR THE RECORD, DR. HUIZENGA'S CV WILL BE 1248, SO WE'LL START WITH 1249.
THE COURT: DO YOU WANT TO MARK THESE COLLECTIVELY AS ONE EXHIBIT?
MR. SHAPIRO: YES. YOUR HONOR. I THINK THAT WILL BE EASIEST.
THE COURT: DEFENSE 1249 AND THESE ARE ALL FROM THE EXAMINATION OF JUNE 15TH?
MR. SHAPIRO: YES, YOUR HONOR.
THE COURT: ALL RIGHT.
THEY WILL BE MARKED THEN AS DEFENSE 1249, JUNE 15TH PHYSICAL EXAM PHOTOS.
(DEFT'S 1249 FOR ID = PHOTOGRAPHS)
Q BY MR. SHAPIRO: IS THAT THE WAY MR. SIMPSON APPEARED ON THE 15TH IN YOUR OFFICE?
A YES, IT IS.
Q AND WHAT WERE YOU LOOKING FOR WHEN YOU EXAMINED THIS AREA OF HIS BODY?
A WELL, INITIALLY I WAS LOOKING OVER EVERY PART OF HIS HEAD, INCLUDING HIS SCALP, FOR ANY EVIDENCE OF HEMATOMAS, WHICH IS A -- AFTER YOU GET SOME DIRECT TRAUMA, A LITTLE BLEEDING UNDER THE SKIN, THINK BUMP, YOU KNOW, YOU KNOW IT AS A GOOSE EGG.
WE WERE LOOKING VERY CAREFULLY FOR SCRATCH MARKS. I WAS LOOKING FOR ANY AREA OF A CHIPPED TOOTH AND RAN MY FINGERS AROUND ALL OF HIS TEETH IN HIS MOUTH.
WE WERE LOOKING FOR ANY EVIDENCE THAT ANYTHING HAD KIND OF PULLED ON HIS EARS AND LOOKED VERY CAREFULLY BEHIND HIS EARS AND EXAMINED HIS SKIN.
IN ADDITION, I DID A VERY CAREFUL PHYSICAL EXAM OF HIS NOSE. I DO THAT ROUTINELY, LOOKING FOR ANY EVIDENCE OF THE USE OF COCAINE AND HIS NASAL PASSAGES WERE ENTIRELY NORMAL.
LOOKED VERY CAREFULLY ON HIS NECK FOR ANY EVIDENCE OF PULLING OR TUGGING OR ANY BRUISE. BASICALLY A BRUISE IS SOME EVIDENCE OF DIRECT CONTUSION WITHOUT LACERATION, AND SAW NONE.
THERE WAS NO PURPURA WHICH IS A BLACK AND BLUE TYPE OF MARK IF YOU BREAK A BLOOD VESSEL UNDER THE SKIN.
THERE WAS NO EVIDENCE OF CHANGE IN SKIN COLOR OTHER THAN SOME THESE OF THESE OLD DARKLY PIGMENTED EVIDENCES OF OLD ABRASIONS AND THE MULTIPLE CUTS YOU GET AS A FOOTBALL PLAYER.
Q LET ME SHOW YOU A PROFILE PHOTOGRAPH.
THE COURT: LEFT PROFILE.
Q BY MR. SHAPIRO: DID YOU MAKE ANY -- DID YOU FIND ANYTHING OF SIGNIFICANCE IN THE EXAMINATION OF THE LEFT PROFILE OF MR. SIMPSON?
A NO, I FOUND NO FINDINGS OF SIGNIFICANCE.
Q SPECIFICALLY DID YOU FIND ANY EVIDENCE OF BRUISING, SCRATCHES, CUTS OR ABRASIONS?
A NO, I DID NOT.
Q WOULD THAT BE THE SAME FOR YOUR OBSERVATIONS OF THE FRONT VIEW?
A YES, IT IS.
Q WOULD YOU DESCRIBE YOUR FINDINGS REGARDING THE PROFILE OF THE RIGHT SIDE OF THE FACE.
THE COURT: THIS APPEARS TO BE RIGHT NECK AND JAW AREA.
MR. SHAPIRO: YES.
THE WITNESS: THE RIGHT SIDE OF THE FACE WAS LIKEWISE COMPLETELY CLEAR. THE RIGHT NECK AND JAW AREA ALSO SHOWED NO EVIDENCE OF ANY ACUTE RECENT ONSET TRAUMA; SCRAPES, SCRATCHES, BRUISING.
Q WOULD YOU AGREE THAT AS OF THE 15TH IN THE ENTIRE AREA ABOVE THE NECK OF MR. SIMPSON THERE WAS NO EVIDENCE OF ANY PHYSICAL CONTACT?
A THAT IS CORRECT.
Q BY SOMEONE ELSE?
A THAT IS CORRECT.
Q DID YOU OBSERVE THE TORSO AREA OF MR. SIMPSON?
A YES, I DID.
Q AND IS THIS THE WAY HE APPEARED WHEN YOU CONDUCTED YOUR VISUAL EXAMINATION ON THE 15TH?
A YES, IT IS.
Q WOULD YOU DESCRIBE YOUR FINDINGS TO THE LADIES AND GENTLEMEN OF THE JURY, PLEASE, REGARDING THE FRONT TORSO AREA OF MR. SIMPSON.
A THE FRONT TORSO AREA ON THE 15TH REVEALED NO EVIDENCE OF ANY BRUISES, SCRAPES OR SCRATCHES OF ANY SORT.
THERE WERE OLD SCARS AND I BELIEVE ON THE UPPER RIGHT HE HAD A LITTLE KELOIDING DARK AREA ON HIS UPPER CHEST, BUT NO, NO ACUTE INJURIES.
Q WAS THERE ANY EVIDENCE OF ANY RECENT INJURIES WHATSOEVER TO THE FRONT TORSO OF MR. SIMPSON?
A NO, THERE WAS NOT.
Q MAY I DIRECT YOUR ATTENTION TO THE BACK OF MR. SIMPSON.
IS THIS THE WAY HE APPEARED ON THE 15TH?
A YES, IT WAS.
Q WOULD YOU RELATE YOUR FINDINGS ON YOUR VISUAL EXAMINATION TO THE JURY.
A WELL, HERE WE LOOKED VERY CAREFULLY FOR UNDER THE ARMPIT, WHETHER, YOU KNOW, SOMEONE HAD GRABBED IN THE TRICEPS AREA OR OBVIOUSLY VERY CAREFULLY ON THE ELBOWS AS WELL AND UP ON THE SHOULDERS.
AND I SAW NO EVIDENCE OF ANY TRAUMA OR ANY DIRECT BRUISES OR INJURIES OR DISCOLORATION OF HIS SKIN OTHER THAN PREVIOUS SCARS FROM LONG, LONG TIME AGO.
(DISCUSSION HELD OFF THE RECORD
BETWEEN DEFENSE COUNSEL.)
MR. SHAPIRO: I HAVE A PHOTO NOW OF THE ARM AND SHOULDER AREA OF MR. SIMPSON.
THE COURT: APPEARS TO BE THE RIGHT ARM.
MR. SHAPIRO: THANK YOU, YOUR HONOR.
Q WOULD YOU DESCRIBE THAT.
A UMM, HIS RIGHT UPPER EXTREMITY, HIS SHOULDER, BICEPS, TRICEPS AREA, AS WELL AS THE ELBOW, DID NOT SHOW ANY AREAS OF BRUISES OR ANY CUTS OF A RECENT NATURE.
Q NO EVIDENCE OF ANY RECENT CONTACT?
A NO, THERE WAS NOT.
Q ON -- I CAN'T SEEM TO FIND THE LEFT ARM AT THIS POINT. WE ARE UNSURE WE WILL GET A PHOTOGRAPH OF IT.
BUT WOULD YOU DESCRIBE YOUR FINDINGS OF THE LEFT ARM IN THE SAME AREA TO THE JURY.
A THE LEFT UPPER EXTREMITY, SHOULDER, BICEPS, TRICEPS, ELBOW REGION, DID NOT REVEAL ANY EVIDENCE OF ANY TRAUMA.
THE COURT: ALL RIGHT.
DOCTOR, SO YOU DON'T STRAIN YOUR NECK LOOKING UP AT THE MONITOR, WHERE YOU HAVE YOUR NOTES THERE --
THE WITNESS: OH.
THE COURT: -- THERE IS --
THE WITNESS: THAT WOULD BE TOO EASY, WOULDN'T IT?
THE COURT: YES, IT WOULD.
Q BY MR. SHAPIRO: WE NOW PROGRESS TO THE LEG AREA AND THE KNEE AREA.
WOULD YOU DESCRIBE YOUR FINDINGS AND WHAT THIS DEPICTS.
A I'M GOING TO REFER TO MY PHYSICAL EXAM HERE BECAUSE HE HAD A LARGE KELOID AREA FROM A DISTANT PROCEDURE.
THE COURT: MR. SHAPIRO, DO YOU WANT TO HAVE THE DOCTOR DEFINE "KELOID" AREA.
MR. SHAPIRO: YES.
THE WITNESS: HE HAD A MODERATELY KELOID --
Q BY MR. SHAPIRO: WOULD YOU KINDLY EXPLAIN WHAT A KELOID AREA IS TO THE JURY, PLEASE.
A A KELOID IS AN OVERAGGRESSIVE SCARRING.
BASICALLY TISSUE UNDERGOES A LOT OF DIFFERENT STAGES OF HEALING, AND IN CERTAIN SITUATIONS UNDER CERTAIN CONDITIONS, INCLUDING GENETIC AND THERE ARE CERTAIN RACIAL PROCLIVITIES, SOME PEOPLE ACTUALLY FORM TOO MUCH OF A SCAR.
THE SCAR ACTUALLY CAN HAVE THREE-DIMENSIONAL COMPONENTS THAT OBVIOUSLY PLASTIC SURGEONS, IF THEY ARE DOING A PROCEDURE -- IN THIS CASE IT WAS A BIOPSY -- DON'T WANT THAT OVERGROWTH OF SCAR TISSUE, BUT IN THAT UPPER THIGH AREA, AND IT WAS THE LEFT INNER MID-THIGH, HE HAD KELOIDING BIOPSY SCAR AND THAT WAS ALSO AN OLD -- AN OLD INJURY.
HE ALSO HAD A SMALL SKIN TAG WHICH IS A NORMAL EPIDERMAL EXTRAVASATION OF SKIN IN THAT LEFT UPPER THIGH. THAT ALSO WAS A NORMAL NON-WORRISOME FINDING.
Q LET ME SHOW YOU THE RIGHT UPPER THIGH AREA.
WOULD YOU DESCRIBE YOUR FINDINGS REGARDING MR. SIMPSON'S CONDITION ON THE 15TH.
A ON THE 15TH THERE WAS NO EVIDENCE OF ANY TRAUMA OR BRUISING OR ANY EVIDENCE OF RECENT TRAUMA.
Q LET ME SHOW YOU SOME PHOTOGRAPHS THAT I BELIEVE WERE TAKEN ON THE 17TH.
DO YOU RECOGNIZE THOSE PHOTOGRAPHS?
A YES, I DO.
Q AND WERE THEY INDEED TAKEN ON THE 17TH?
A YES, THEY WERE.
Q AND WOULD YOU DESCRIBE THE CONDITIONS THAT WE SEE IN THOSE PHOTOGRAPHS, PLEASE.
A UMM, HE HAS THE OBVIOUS MULTIPLE BIOP -- EXCUSE ME -- SURGICAL INCISIONS ON THE LEFT KNEE. YOU CAN SEE THE RAILROAD TRACKS.
ON THE 15TH HE HAD NO EVIDENCE OF ANY TRAUMA. ON THE 17TH, ON THE RIGHT KNEE -- I WOULD HAVE TO LOOK AT THE PICTURES -- THERE WAS AN EVER SO SMALL LITTLE DOT OF A SCRAPE THAT I HAD SPECIFICALLY LOOKED AT AND PHOTOGRAPHED ON THE 15TH AND HAD NOT APPRECIATED.
Q I WILL SHOW YOU ADDITIONAL PHOTOGRAPHS. WE WILL SEE IF THERE IS ANYTHING ELSE -- WERE THESE ALSO PHOTOGRAPHS ON THE 15TH -- ON THE 17TH?
A THESE ARE TAKEN ON THE 17TH.
Q WOULD YOU DESCRIBE THOSE FINDINGS.
A AGAIN, IT IS DIFFICULT TO SEE, BUT MY PREVIOUS COMMENTS WOULD HOLD ON THE 17TH, AND AGAIN I WOULD HAVE TO SEE THE EXACT PICTURE, BUT THERE WAS A VERY SMALL DOT WHERE IT JUST LOOKED LIKE VERY TINY CIRCULAR ABRASION, PROBABLY ONLY ONE OR TWO MILLIMETERS, BASICALLY LIKE EVEN AN INFECTED HAIR THAT YOU WOULD PICK OR SOME SORT OF JUST LOCAL DOT THAT WAS A SCAB OVER THAT KNEE.
AND OTHER THAN THAT, THERE WAS NO EVIDENCE OF ANY TRAUMA AND THAT WAS JUST SEEN, AS I SAID, ON THE 17TH AND NOT ON THE 15TH.
Q ON THE 17TH DID YOU ALSO EXAMINE THE MOUTH AREA OF MR. SIMPSON?
A REXAMINED ON THE MOUTH ON THE 17TH AND LIKEWISE FOUND IN CHIPPING OF ANY TEETH OR ANY SHARP EDGES THAT APPEARED TO BE OF RECENT ORIGIN IN HIS TEETH.
Q AND DID YOU REEXAMINE THE HEAD OF MR. SIMPSON ON THE 17TH?
A YES, I DID.
Q AND WHAT WERE YOUR FINDINGS IN THAT?
A THERE WAS NO EVIDENCE OF TRAUMA OF ANY SORT.
Q DID YOU TAKE BLOOD OF MR. SIMPSON ON BOTH THE 15TH AND THE 17TH?
A YES, WE DID.
Q DO YOU RECALL WHAT HIS REACTION WAS WHEN BLOOD WAS TAKEN FROM HIM?
A IT HURT. UMM --
Q ARE THESE PEOPLE FROM YOUR OFFICE THAT ARE IN THE PHOTOGRAPH?
A YES, THEY ARE. THAT IS MY NURSE,
LINDA KITA, AND WE HAD A SPECIAL LAB TECHNICIAN FROM CEDARS HOSPITAL THAT ACCOMPANIED US AS WELL TO MAKE SURE THAT ALL THE TESTS WERE DONE VERY PROPERLY FOR THE TYPES OF TESTS WE WERE LOOKING FOR.
Q LET'S NOW GO TO YOUR OBSERVATIONS OF THE HAND AREA OF MR. SIMPSON ON THE 15TH IN MORE DETAIL.
A UH-HUH.
Q DID YOU EXAMINE THE RIGHT HAND FOR ANY CUTS OR ABRASIONS?
A YES, I DID.
Q AND LET ME SHOW YOU A PHOTOGRAPH.
THESE -- PHOTOGRAPHS WERE TAKEN ON BOTH THE 15TH AND 17TH OF THIS AREA?
A (NO AUDIBLE RESPONSE.)
Q DO YOU KNOW IF PHOTOGRAPHS WERE TAKEN?
A YES, THEY WERE.
Q LET ME SHOW YOU A PHOTOGRAPH.
I THINK THIS WAS -- DO YOU KNOW WHEN THIS PHOTOGRAPH WAS TAKEN?
A THAT IS THE LEFT HAND AND THAT WAS TAKEN ON THE 17TH.
Q OKAY.
LET'S GO WITH THE LEFT HAND SINCE WE HAVE IT UP THERE.
WAS THAT THE WAY -- WELL, DESCRIBE WHAT YOU SEE IN THE PHOTOGRAPH.
A WELL, THERE IS A JAGGED LACERATION THAT EXTENDS FROM THE DISTAL INTERPHALANGEAL JOINT OF THE FOURTH LEFT FINGER AND IT COMES IN ALMOST A SNAKE-LIKE FASHION AND JUST IT -- IT SLICES COMING DOWN IN THIS WAY, (INDICATING), AND THEN IT ALMOST SEEMS TO CHANGE IN THE PLANE AND THEN IT IS A DEEPER CUT.
ON THE TOP, SOME OF THE VERY SUPERFICIAL -- IF YOU JUST GO THROUGH THE OUTER LAYER OF THE SKIN, THE EPIDERMIS, YOU WON'T BLEED BECAUSE THERE IS NO BLOOD VESSELS IN THAT OUTER LAYER OF THE SKIN AND YOU HAVE TO GO DEEPER TO GET INTO THE DERMIS AND THEN THIS IS VARIOUS LAYERS OF THE DERMIS.
AND IN THE INFERIOR PORTION WHERE IT EXTENDS TO JUST ABOVE THE PROXIMAL INTERPHALANGEAL JOINT IS WHERE IT BECAME A LITTLE BIT DEEPER BUT STILL IT WAS QUITE WHAT WE WOULD CALL A VERY SUPERFICIAL WOUND.
AND ESSENTIALLY THE PART THAT WAS A LITTLE BIT DEEPER WAS A HALF OF A CENTIMETER IN LENGTH AND IT DIDN'T APPEAR EXACTLY STRAIGHT.
Q HOW LONG IS HALF A CENTIMETER IN INCHES?
A ONE INCH EQUALS 2.2 CENTIMETERS.
Q SO HOW MUCH WOULD THAT BE?
A YOU ARE GOING TO MAKE ME DO MATH AGAIN.
Q APPROXIMATELY. APPROXIMATE AMOUNT?
A BASICALLY A HALF A CENTIMETER IS A QUARTER OF AN INCH.
Q THANK YOU.
DID YOU OBSERVE THIS INJURY ON MR. SIMPSON ON THE 15TH, AS WELL AS THE 17TH?
A YES, I DID.
Q WOULD YOU DESCRIBE THAT TO THE JURY.
A OKAY. OKAY.
ON HIS THIRD FINGER HE HAD A LESION THAT HAD THE APPEARANCE OF A FISHHOOK AND BASICALLY FROM THE TOP IT CAME DOWN AND KIND OF FISHED IN A DIRECTION TOWARD HIS FOURTH INDEX FINGER. AND YOU CAN SEE IT CROSSED THIS JOINT LINE AND IT APPEARED TO HAVE AN ANGULATION OR A BEVELING TO IT SUCH THAT IT WAS AN INJURY FROM THIS TYPE OF DIRECTION, (INDICATING), AND IT WAS -- FISHHOOK WHEN IT WAS MEASURED WAS ABOUT A CENTIMETER AND A HALF OR A LITTLE BIT UNDER, YOU KNOW, THREE QUARTERS OF AN INCH PLUS OR MINUS.
UMM, HE HAD A SECOND LACERATION ON THAT THIRD FINGER THAT YOU CAN ALSO SEE IN THE PICTURE THERE, WHICH WAS --
Q WOULD YOU POINT THAT OUT TO THE JURY.
A DO I HAVE A -- A MARKER?
MR. SHAPIRO: WE WILL GET A LASER FOR YOU IN A SECOND.
THE WITNESS: IT IS DIFFICULT TO SEE BUT --
Q BY MR. SHAPIRO: JUST DESCRIBE IT TO THE JURY.
A YOU CAN SEE THE INFERIOR PORTION -- ACTUALLY I CAN POINT IT OUT RIGHT HERE.
FROM THIS AREA -- NOW, I CAN'T POINT IT OUT.
THE COURT: ALL RIGHT, DOCTOR.
WHY DON'T YOU STEP DOWN BEHIND THE PROJECTOR THERE. I THINK YOU MIGHT GET A CLEARER VIEW.
MR. SHAPIRO: WE HAVE A LASER POINTER HERE.
THE WITNESS: OKAY.
THE COURT: WATCH WHERE YOU POINT THAT THING.
THE WITNESS: OKAY.
THIS WAS THE LESION THAT WE JUST DESCRIBED. THERE WAS APPROXIMATELY A -- ONE CENTIMETER -- LACERATION THAT WAS JUST PROXIMAL TO HIS DISTAL INTERPHALANGEAL JOINT RIGHT HERE ON THE LEFT THIRD FINGER, (INDICATING), AND IT HAD A ANGULATED OR BEVELED APPROACH THAT SEEMED TO COME MORE FROM THIS DIRECTION, (INDICATING), AND IT ALSO HAD SOME AMOUNT OF A SHAGGY BORDER TO IT.
IT WASN'T EXACTLY CLEAN. AND IT BASICALLY EXTENDED RIGHT IN THAT DIRECTION THERE, (INDICATING).
Q BY MR. SHAPIRO: THANK YOU.
YOU MAY RESUME THE WITNESS STAND, PLEASE.
A (WITNESS COMPLIES.)
Q DO YOU HAVE ANY OPINION AS TO -- LET'S LEAVE THAT UP FOR A SECOND -- AS TO HOW THE INJURY ABOVE THE KNUCKLE WAS CAUSED?
A I BELIEVE IT WAS BY SOME SORT OF A SHARP OBJECT.
Q DO YOU HAVE ANY OPINION AS TO HOW THE SECOND INJURY DEPICTED ON THAT PHOTOGRAPH WAS CAUSED?
A I ALSO BELIEVE THAT WAS BY SOME SORT OF SHARP OBJECT.
Q AND REGARDING THE TWO OTHER INJURIES THAT YOU DESCRIBED IN THE EARLIER PHOTOGRAPHS ON THE SIDE OF THE FINGER, DO YOU HAVE ANY OPINION AS TO HOW THEY WERE CAUSED?
A I BELIEVE WERE ALSO CAUSED BY A SHARP OBJECT.
Q WHEN YOU SAY A SHARP OBJECT, WHAT ARE YOU REFERRING TO?
A ANYTHING WITH A SHARP EDGE, SHARP METAL, GLASS, UMM, ANYTHING WITH NOT A BLUNT SURFACE.
Q NOT A KNIFE?
A A KNIFE IS A POSSIBILITY, BUT TO ME THE EDGES LOOKED A LITTLE BIT RAGGED, BUT THAT WAS A POSSIBILITY, BUT IT SEEMED TO ME TO BE MORE CONSISTENT WITH GLASS, BUT CERTAINLY A SHARP OBJECT CAN DO THAT.
Q IS THAT REFERRING TO THE FISHHOOK INJURY ABOVE THE KNEE -- ABOVE THE KNUCKLE NOW.
LET'S TALK ABOUT THE ONE ABOVE THE KNUCKLE.
WHAT IS YOUR BEST OPINION AS TO HOW THAT INJURY WAS CAUSED AND WHAT IS YOUR REASONING FOR THAT?
A IT WAS CAUSED BY A SHARP OBJECT. UMM, I LOOKED VERY CAREFULLY TO SEE IF IT WAS A TOOTH MARK, BECAUSE OBVIOUSLY THAT IS ONE OF THE MORE COMMON THINGS TO HAPPEN RIGHT OVER A KNUCKLE, BUT THOSE TEND TO HAVE VERY JAGGED SERRATED -- PUNCTURE LIKE -- APPEARANCE AND I DIDN'T SEE THAT.
AND OBVIOUSLY THOSE NEED PROMPT ANTIBIOTICS, SO I DIDN'T BELIEVE IT WAS THAT.
I ALSO LOOKED TO SEE IF IT COULD BE A SCRATCH, BUT A SCRATCH WILL NEVER GIVE, YOU KNOW, A ANGULATED CUT OF THAT NATURE.
AND SO BASICALLY CONCLUDED IT WAS A SHARP OBJECT.
AND THAT WAS PROBABLY THE SMOOTHER OF THE CUTS THAT I OBSERVED.
Q AND WITHIN THE RANGE OF SHARP OBJECTS THAT YOU HAVE DESCRIBED THAT COULD BE POTENTIAL CAUSES FOR THAT, WHAT IS YOUR BEST OPINION AS TO WHAT CAUSED THAT PARTICULAR INJURY?
MR. KELBERG: OBJECTION. OBJECTION, CALLS FOR SPECULATION AND LACK OF EXPERTISE.
THE COURT: FOUNDATION.
Q BY MR. SHAPIRO: HAVE YOU WORKED IN EMERGENCY ROOMS?
A YES, I HAVE.
Q AND WOULD YOU DESCRIBE TO THE LADIES AND GENTLEMEN OF THE JURY AND TO HIS HONOR WHAT YOUR EXPERTISE IS IN EMERGENCY ROOMS.
A WELL, FROM APPROXIMATELY JUNE OF 1979 TO 1984, I PROBABLY WORKED AND MOONLIGHTED IN NINE OR TEN DIFFERENT EMERGENCY ROOMS PROBABLY AT AN AVERAGE OF TWICE A WEEK, WHICH WOULD BE TWO TWELVE-HOUR SHIFTS, SOMETHING LIKE 24 HOURS A WEEK FOR, YOU KNOW, FOR A PERIOD OF FIVE PLUS YEARS.
Q AND HAVE YOU TREATED FOR INJURIES OR CUTS THAT ARE SIMILAR TO THE ONE DEPICTED IN THIS PHOTOGRAPH?
A YES, I HAVE.
Q HAVE YOU SEEN EVIDENCE OF INJURIES CAUSED BY A KNIFE?
A YES, I HAVE.
Q AND HAVE YOU SEEN EVIDENCE OF INJURIES CAUSED BY GLASS?
A YES, I HAVE.
Q ARE THERE DIFFERENCES BETWEEN THE TWO?
A THERE CAN BE. TYPICALLY GLASS MAY HAVE MORE OF A JAGGED AREA, BUT OCCASIONALLY GLASS LOOKS JUST LIKE A KNIFE. A GLASS CUT APPEARS VERY SIMILAR TO A KNIFE CUT.
Q IN THIS WOUND, DO YOU HAVE AN OPINION AS TO WHAT IS MORE REASONABLE AS THE CAUSE FOR THAT INJURY?
A THIS WOUND, AS I SAID, WAS ONE OF THE -- APPEARED TO BE SLIGHTLY CLEANER THAN THE OTHERS, BUT I THINK FOR THE CONSTELLATION OF ALL THE WOUNDS IT SEEMED MORE LIKELY THAT GLASS WAS THE CAUSE.
Q YOU CAN'T BE POSITIVE OF THAT?
A I CAN'T BE POSITIVE.
Q BUT THAT IS YOUR BEST PROFESSIONAL OPINION?
A YES, IT IS.
MR. SHAPIRO: THANK YOU.
WOULD THIS BE AN APPROPRIATE TIME TO TAKE A BREAK?
THE COURT: YES.
ALL RIGHT.
LADIES AND GENTLEMEN OF THE JURY, WE ARE GOING TO TAKE OUR MID-MORNING RECESS FOR FIFTEEN MINUTES AT THIS TIME.
REMEMBER ALL MY ADMONITIONS TO YOU.
DOCTOR, YOU CAN STEP DOWN. YOU ARE ORDERED TO COME BACK IN FIFTEEN MINUTES.
ALL RIGHT. WE WILL BE IN RECESS FOR FIFTEEN.
(RECESS.)
(THE FOLLOWING PROCEEDINGS WERE
HELD IN OPEN COURT, OUT OF THE
PRESENCE OF THE JURY:)
THE COURT: ALL RIGHT.
BACK ON THE RECORD IN THE SIMPSON MATTER.
ALL PARTIES ARE AGAIN PRESENT.
AND, DOCTOR, IF YOU WOULD, WOULD YOU CONSCIOUSLY TRY TO SLOW DOWN A LITTLE. AND WHEN WE HIT SOME MORE OF THESE MEDICAL TERMS, WE MAY NEED SOME SPELLINGS ON THESE.
ALL RIGHT.
LET'S HAVE THE JURORS, PLEASE.
MR. SHAPIRO: YOU'RE GOING TO HAVE TO BRING YOUR DICTIONARY.
THE WITNESS: YEAH. MY STEDMAN'S MEDICAL DICTIONARY.
MR. COCHRAN: MAY I INQUIRE? WE HAVE SOME OTHER WITNESSES. I WANTED TO MAKE SURE WE HAVE WITNESSES OUT IN THE HALLWAY.
THE COURT: NO WAY. SEND THEM HOME.
MR. SHAPIRO: 16 TO ONE RULE.
MR. COCHRAN: YOU WILL BE WHAT; MORE THAN 15, 20 MINUTES?
MR. KELBERG: PROBABLY SLIGHTLY MORE THAN THAT.
MR. COCHRAN: I WOULD LIKE THEM TO COME BACK MONDAY MORNING.
THE COURT: SEND THEM HOME. BUT WE ARE NOT GOING TO GET TO THEM THIS MORNING.
MR. KELBERG: ON THE PHOTOGRAPHS, ARE WE MARKING THEM SEQUENTIALLY? WE ONLY STARTED WITH THE FIRST PHOTOGRAPH. WE GOT A NUMBER I BELIEVE 1249.
THE COURT: 1249 IS AS A GROUP.
MR. KELBERG: AS A GROUP?
THE COURT: I MEAN, IT'S APPARENT TO ME WHAT EACH ONE IS.
MR. KELBERG: THAT'S TRUE. JUST IN TALKING TO THE WITNESS, IT'S EASIER FOR ME FOR THE RECORD IF IT WAS AN INDIVIDUAL DESIGNATION.
THE COURT: WE'LL GO THROUGH AND DO A THROUGH.
MR. KELBERG: I THINK THAT MIGHT BE HELPFUL.
(THE FOLLOWING PROCEEDINGS WERE
HELD IN OPEN COURT, IN THE
PRESENCE OF THE JURY:)
THE COURT: ALL RIGHT.
THANK YOU, LADIES AND GENTLEMEN. PLEASE BE SEATED.
ALL RIGHT.
THE RECORD SHOULD REFLECT WE'VE BEEN REJOINED BY ALL THE MEMBERS OF OUR JURY PANEL. DR. ROBERT HUIZENGA IS ON THE WITNESS STAND UNDERGOING DIRECT EXAMINATION BY MR. SHAPIRO.
AND, MR. SHAPIRO, YOU MAY CONTINUE WITH YOUR DIRECT EXAMINATION.
MR. SHAPIRO: THANK YOU VERY MUCH, YOUR HONOR.
MAY WE PUT ON THE ELMO TWO ADDITIONAL PHOTOGRAPHS OF THE PALMS OF MR. SIMPSON'S HANDS, PLEASE?
THE COURT: RIGHT AND LEFT.
MR. SHAPIRO: YES.
Q BY MR. SHAPIRO: DO YOU RECALL THOSE PHOTOGRAPHS BEING TAKEN?
A YES, I DO.
Q AND DID YOU NOTICE ANY INJURIES ON THE PALM VIEW OF EITHER HAND OF MR. SIMPSON?
A YES, I DID.
Q WHAT DID YOU NOTICE?
A ON HIS RIGHT PALM, THE DISTAL TUFT OF HIS FOURTH FINGER, THERE WAS A VERY SMALL, VERY FINE, MINUSCULE FOUR TO FIVE MILLIMETER PAPER CUT APPEARING LACERATION.
Q MILLIMETER IS HOW MUCH?
A UH, ONE SONOMETER, AGAIN, WE WERE SAYING WAS HALF AN INCH. SO, YOU KNOW, THREE MILLIMETERS WOULD BE A THIRD OF A HALF OF AN INCH. A SIXTH OF AN INCH.
Q WOULD YOU POINT OUT WITH THE LASER TO THE LADIES AND GENTLEMEN OF THE JURY WHERE THIS WAS?
A YOU KNOW, I CAN BARELY SEE IT, BUT IF YOU SEE RIGHT THERE, THERE'S A VERY FINE -- REALLY WAS A -- EXACTLY HORIZONTAL, AS I SAID, PAPER CUT LIKE LESION RIGHT IN THIS -- IT'S THE THUMB SIDE OF THE DISTAL FOURTH FINGER, AND THIS IS KIND OF THE TUFT (INDICATING).
Q THANK YOU.
NOW, IN GOING THROUGH YOUR EXAMINATION OF MR. SIMPSON, DO YOU HAVE AN OPINION AS TO WHETHER OR NOT HE COULD HOLD A KNIFE?
A I THINK HE CERTAINLY COULD HOLD A KNIFE.
Q DO YOU HAVE ANY FEELING AS TO WHETHER OR NOT HE COULD CARRY GOLF CLUBS?
A I THINK HE COULD PICK UP GOLF CLUBS, SURE.
Q DOES HE HAVE STRENGTH?
A HE HAS DEFINITE STRENGTH.
Q LET ME PUT THESE TWO PHOTOGRAPHS BACK ON, THE FRONT AND BACK TORSO OF MR. SIMPSON.
AND THIS APPEARS TO ME AS A LAYPERSON TO BE A MAN IN PRETTY GOOD SHAPE. WOULD THAT BE YOUR EVALUATION?
A WELL, TO LOOK AT HIM, YOU KNOW, HE REALLY HAS THE PHYSIQUE CERTAINLY, WHEN I SAW HIM, OF TARZAN. I MEAN, HE'S EXTREMELY WELL MUSCULAR. HE HAS BY VISION AND ALSO BY, YOU KNOW, FEELING, YOU CAN FEEL A LEVEL AT THE WAIST AND THE THIGH, YOUR FLANK, YOUR TRICEPS THERE. YOU CAN ESTIMATE A MAN'S AND A WOMAN'S BODY FAT, AND HE HAS A VERY, VERY LOW BODY FAT AND HE REALLY DOES APPEAR TO BE TARZAN.
CURIOUSLY, SOME PEOPLE HAVE THESE PHENOMENAL BUILDS AND REALLY AREN'T IN ALL THAT GREAT AEROBIC SHAPE, AND I THINK THAT BASED ON MY HISTORY, HE HADN'T REALLY BEEN DOING MUCH EXERCISE IF ANY. AND THERE ARE SOME VERY LUCKY PEOPLE THAT LOOKS CAN BE DECEIVING, AND CERTAINLY IN HIS CASE, ALTHOUGH HE LOOKED LIKE TARZAN, YOU KNOW, HE WAS WALKING MORE LIKE TARZAN'S GRANDFATHER.
Q WHAT ABOUT HIS MOBILITY ON THE 15TH? DO YOU HAVE AN OPINION AS TO HIS ABILITY FOR LATERAL MOVEMENT?
A I THINK HIS ABILITY FOR LATERAL MOVEMENT WOULD DEFINITELY BE DIMINISHED BASED ON HIS LEFT KNEE AND RIGHT ANGLE PROBLEM THE DAY I SAW HIM ON THE 15TH.
Q AND WOULD YOU EXPECT THAT HE WAS IN RELATIVELY THE SAME CONDITION ON THE 12TH?
A I WOULDN'T HAVE ANY REASON TO DOUBT THAT.
Q NOW, ARE THERE CERTAIN TYPES OF ACTIVITIES SOMEBODY WITH THE CONDITIONS THAT MR. SIMPSON SUFFERS FROM BE CAPABLE OF DOING?
A YES, THERE ARE.
Q WHAT TYPE OF ACTIVITIES WOULD YOU OPINE THAT HE IS CAPABLE OF DOING?
A WELL, RELATIVELY SEDENTARY THINGS SINCE HIS CARDIO VASCULAR SHAPE WASN'T REALLY THAT GOOD THAT REALLY DON'T NEED, YOU KNOW, QUICK MOVEMENT ON THAT KNEE AND OF COURSE OVER THE PERIOD OF THAT TIME HIS ANKLE WHICH WAS BOTHERING HIM AT THAT TIME.
Q NOW, YOU HAVE BEEN AROUND ATHLETES?
A YES, I HAVE.
Q AS A PHYSICIAN?
A YES, I HAVE.
Q AND YOU'VE ALSO TOLD US YOU'RE AN ATHLETE YOURSELF?
A YES, I WAS.
Q AND THAT YOU'VE PLAYED SPORTS?
A YES, I DID.
Q WHAT SPORTS ON THE 15H DO YOU BELIEVE THAT MR. SIMPSON WOULD BE CAPABLE OF ENGAGING IN?
MR. KELBERG: OBJECTION. IRRELEVANT.
THE COURT: OVERRULED.
YOU CAN ANSWER THE QUESTION.
Q BY MR. SHAPIRO: WHAT SPORTS DO YOU BELIEVE MR. SIMPSON WOULD BE CAPABLE OF --
A HE WOULD BE ABLE TO PLAY A SPORT WHERE HE WAS -- ESSENTIALLY DIDN'T HAVE TO MOVE MUCH OR CERTAINLY VERY QUICKLY, SOMETHING THAT HE COULD STAND. HE WOULD BE ABLE TO SHOOT FREE THROWS FOR INSTANCE. HE WOULD BE ABLE TO PLAY GOLF. HE WOULD BE ABLE TO ARM WRESTLE IF IT WASN'T THE SIDE INVOLVING POSSIBLY THE INJURED WRIST. HE WOULD BE ABLE TO PLAY BILLIARDS.
Q WHAT ACTIVITIES WOULD HE BE EXCLUDED FROM?
A HE WOULD BE EXCLUDED FROM ANY SORT OF RUNNING SPORTS SUCH AS LEGITIMATE FULL-COURT BASKETBALL, ANY TYPE OF DAY AFTER DAY RUNNING, JOGGING EXERCISES OR SPORTS WHERE HE WOULD HAVE TO LEGITIMATELY RUN. EVEN SOMETHING LIKE BASEBALL, HE WOULD HAVE TO ESSENTIALLY LOPE OR WALK ALTHOUGH HE PROBABLY WOULD BE ABLE TO STAND AT THE PLATE AND SWING AT A BALL.
THE COURT: ALL RIGHT.
WHY DON'T YOU PULL THE MICROPHONE JUST A LITTLE BIT CLOSER, DOCTOR.
Q BY MR. SHAPIRO: FOR A RECREATIONAL GOLFER, DO YOU HAVE AN OPINION AS TO WHAT SHAPE SOMEBODY WOULD HAVE TO BE IN TO PLAY GOLF ON A RECREATIONAL LEVEL, NOT A PROFESSIONAL LEVEL?
A WELL, RECREATIONAL GOLF IS QUITE A SEDENTARY ACTIVITY. IF YOU TAKE SOMEONE WHO IS LET'S SAY SWINGING 90 OR A HUNDRED TIMES A GAME AND THEY'RE TAKING A FEW PRACTICE SWINGS, THEY STAND AROUND A LITTLE BIT AND THEY GET RIGHT BACK TO THE GOLF CART.
MR. SIMPSON GAVE ME THE HISTORY THAT HE HAD TO RIDE A GOLF CART. HE COULD NOT WALK A GOLF COURSE. AND EVEN AT GOLF COURSES, PRESTIGIOUS GOLF COURSES WHERE IT WAS PREVENTED, PROHIBITED, HE WOULD GET SPECIAL MEDICAL CLEARANCE TO HAVE A GOLF CART.
GIVEN THOSE PERIMETERS, IF YOU TAKE GOLF CART, STAND BRIEFLY, SWING, GET BACK IN THE GOLF CART, THAT ACTIVITY FOR A TWO- OR THREE-HOUR GOLF GAME IS ROUGHLY COMPARABLE TO, YOU KNOW, SITTING AND PLAYING THE FLUTE AT HOME FOR THOSE SEVERAL HOURS OR SITTING AT HOME AND PAINTING A PORTRAIT. THOSE AEROBIC ENERGY LEVELS ARE ROUGHLY COMPARABLE.
Q IS THERE ANY TYPE OF PHYSICAL -- WELL, STRIKE THAT.
YOU DID PRESENT A DIAGRAM TO US REGARDING ONE OF THE HANDS OF MR. SIMPSON. DID YOU DO A DIAGRAM OF BOTH HANDS?
A YES. I COPIED AROUND BOTH HANDS ON THIS INITIAL PHYSICAL PIECE OF PAPER.
Q AND DID YOU GET A FORM FROM SOME TYPE OF REFERENCE BOOK FOR YOUR DIAGRAM?
A AFTER I DID THE INITIAL HISTORY AND PHYSICAL, BASICALLY I TOOK NOTES ONLY VERY BRIEFLY ON THIS PIECE OF PAPER AND IMMEDIATELY DICTATED MY WHOLE HISTORY AND PHYSICAL. SUBSEQUENTLY, I TOOK THIS KIND OF ROUGH COPY AND XEROXED OFF A COUPLE OF HANDS FROM AN ANATOMY BOOK AND WAS GOING TO TRY TO PRESENT SOMETHING A LITTLE BIT NEATER.
AND IT TURNED OUT BOTH WERE RIGHT HANDS. AND ON THE LEFT, THE WAY THAT I COPIED IT DIDN'T COME OUT SINCE THEY WERE BOTH RIGHT HANDS. BUT I HAD ALREADY SENT YOU THE HISTORY AND PHYSICAL ON THAT PICTURE. SO I KEPT THOSE IN THE CHARTS, BUT I HAVEN'T REALLY REFERRED TO THEM OR USED THOSE PICTURES.
Q YOU POINTED OUT THAT MISTAKE TO ME EARLIER THIS MORNING?
A RIGHT.
Q IS THERE ANYTHING THAT YOU -- IS THERE ANY -- STRIKE THAT.
BASED ON YOUR EXAMINATION OF MR. SIMPSON ON THE 15TH, DID YOU SEE ANY EVIDENCE OTHER THAN THE CUTS YOU'VE DESCRIBED ON THE LEFT HAND OF ANY RECENT INJURY THAT WAS VISIBLE TO MR. SIMPSON?
A WELL, THEY HAD THE ONE CUT ON THE RIGHT HAND AS WELL.
Q YES. OTHER THAN THOSE CUTS.
A OTHER THAN THOSE ON THE 15TH, THERE WAS NO OTHER EVIDENCE OF ANY TRAUMA EXCEPT FOR SEVERAL VERY SMALL LITTLE ALSO PUNCTATE ABRASIONS THAT WERE ALSO ON THE BACK OF HIS LEFT PALM. BUT THEY WERE -- APPEARED TO BE BASICALLY ZIGZAG AREAS OF MAYBE SEVERAL SONOMETERS, WHICH WERE VERY SUPERFICIAL, IRRITATION SCRAPES OF SOME SORT.
Q DO YOU HAVE AN OPINION AS TO WHETHER OR NOT ON JUNE THE 12TH OF 1994, MR. SIMPSON HAD ANY INJURIES THAT YOU WERE NOT ABLE TO SEE ON JUNE THE 15TH?
MR. KELBERG: OBJECTION, YOUR HONOR. CALLS FOR SPECULATION.
THE COURT: OVERRULED.
THE WITNESS: COULD YOU REPEAT THE QUESTION?
Q BY MR. SHAPIRO: DID YOU OBSERVE -- DO YOU HAVE AN OPINION AS TO WHETHER OR NOT ON JUNE THE 12TH, 1994, MR. SIMPSON HAD ANY INJURIES THAT YOU WERE NOT ABLE TO OBSERVE ON JUNE THE 15TH?
A CERTAINLY CUTS OR ANYTHING THAT WOULD HAVE OCCURRED THEN, WE WOULD HAVE SEEN THEN AND ANY ORTHOPEDIC INJURIES WE WOULD HAVE SEEN. AND SO MY SUSPICION WOULD BE THAT WE WOULD SEE ALL THE INJURIES.
MR. SHAPIRO: THANK YOU.
NOTHING FURTHER.
THE COURT: MR. KELBERG.
MR. KELBERG: THANK YOU, YOUR HONOR.
GOOD MORNING, LADIES AND GENTLEMEN.
THE JURY: GOOD MORNING.
CROSS-EXAMINATION
BY MR. KELBERG:
Q AND GOOD MORNING, DOCTOR.
A GOOD MORNING.
Q DOCTOR, YOUR SPECIALTY IS INTERNAL MEDICINE; IS THAT CORRECT?
A THAT IS CORRECT.
Q YOU DID A RESIDENCY OF THREE YEARS IN INTERNAL MEDICINE?
A THAT IS CORRECT.
Q AND YOU'RE BOARD CERTIFIED IN INTERNAL MEDICINE; IS THAT CORRECT?
A THAT IS CORRECT.
Q NOW, THERE IS A SUBSPECIALTY OF INTERNAL MEDICINE CALLED RHEUMATOLOGY; IS THERE NOT?
A YES, THERE IS.
Q DID YOU EVER DO ANY POST-RESIDENCY TRAINING IN RHEUMATOLOGY?
A NO, I DID NOT.
Q BUT IN YOUR TRAINING AS AN INTERNAL MEDICINE RESIDENT, WERE YOU EXPOSED TO HOW YOU EVALUATE PEOPLE FOR THE POSSIBLE PRESENCE OF RHEUMATOID ARTHRITIS?
A YES, I WAS.
Q YOU HAVE NEVER UNDERTAKEN A RESIDENCY TRAINING IN ORTHOPEDIC SURGERY, HAVE YOU?
A NO, I HAVE NOT.
Q OR ORTHOPEDICS, WHETHER OR NOT YOU'RE GOING TO DO SURGERY OR NOT, CORRECT?
A THAT IS CORRECT.
Q AND THE EXAMINATION YOU DID ON THE 15TH OF JUNE, YOU SAY YOU HAVE NO NOTES OF THAT; IS THAT CORRECT?
A I HAVE NO NOTES OF THAT, NO.
Q BUT YOU DID IN FACT PREPARE A TYPEWRITTEN REPORT; IS THAT CORRECT?
A THAT IS CORRECT.
Q AND THAT REPORT WAS TO INCLUDE THE MOST IMPORTANT SIGNIFICANT FINDINGS YOU HAD MADE IN THE COURSE OF YOUR EXAMINATION OF MR. SIMPSON; IS THAT CORRECT?
A THAT IS CORRECT.
Q DOCTOR, WHERE IN YOUR REPORT DID YOU LIST ANYTHING RELATED TO MR. SIMPSON WALKING -- I HATE TO USE YOUR TERMINOLOGY -- LIKE TARZAN'S GRANDFATHER OR HAVING ANY KIND OF IRREGULAR GAIT, G-A-I-T?
A UH, THAT IS NOT IN THE REPORT. THAT WAS SUBSEQUENTLY ADDED --
Q EXCUSE ME, DOCTOR.
MR. KELBERG: I MOVE TO STRIKE EVERYTHING AFTER "NOT IN THE REPORT."
THE COURT: YES.
PROCEED.
Q BY MR. KELBERG: AND, DOCTOR, THAT TO YOU WAS A VERY SIGNIFICANT FINDING; WAS IT NOT?
A IT WAS A VERY SIGNIFICANT FINDING.
Q AND YOU DICTATED THIS REPORT RIGHT AFTER THE EXAMINATION; IS THAT CORRECT?
A I WOULD SAY 20 -- WITHIN 24 HOURS.
Q WELL, DOCTOR, CAN YOU NARROW THE TIME FRAME DOWN AT ALL WITHIN 24 HOURS? WAS IT THE SAME DAY?
A UMM, I CAN'T -- I CAN'T SAY. IT WAS DEFINITELY WITHIN 24 HOURS.
Q NOW, YOU SAID YOU SQUEEZED MR. SIMPSON IN DURING THE LUNCH HOUR. IN FACT, THIS EXAMINATION WAS APPROXIMATELY TWO HOURS IN LENGTH; WAS IT NOT?
A THAT IS EXACTLY CORRECT.
Q AND, DOCTOR, THIS EXAMINATION WAS ARRANGED BY MR. SHAPIRO AS THE LAWYER FOR MR. SIMPSON; IS THAT CORRECT?
A THAT IS CORRECT.
Q AND, DOCTOR, IS IT NORMALLY THE CASE AS A PHYSICIAN THAT A PATIENT HISTORY IS VERY IMPORTANT TO A DOCTOR IN EVALUATING THE CONDITION OF THE PATIENT?
A PATIENT'S HISTORY IS CRUCIAL.
Q AND, DOCTOR, WOULD YOU AGREE THAT UNDER NORMAL CIRCUMSTANCES, A DOCTOR ACCEPTS AS TRUE THE HISTORY THAT IS GIVEN TO HIM BY THE PATIENT BECAUSE OF THE BELIEF THAT THE PATIENT HAS AN INCENTIVE TO BE HONEST AND CANDID WITH THE PHYSICIAN IN ORDER THAT THE PHYSICIAN CAN ACCURATELY IDENTIFY ANY PROBLEM AND SUBSEQUENTLY TREAT IT?
A IN MOST CASES, THAT'S TRUE.
IT TURNS OUT I HAVE A SPECIALTY IN TRYING TO BE DETECTIVE BECAUSE WHEN I WAS TEAM PHYSICIAN FOR THE LOS ANGELES RAIDERS AND IN THAT FUNCTION OF EVALUATING ALL-AMERICAN PROSPECTS COMING INTO THE INDIANAPOLIS COMBINE FOR A POTENTIAL DRAFTING POSITION, WE WERE ROUTINELY LIED TO BECAUSE OBVIOUSLY THEY VIEWED THE DOCTOR AS THE ENEMY AND ROUTINELY MISREPRESENTED THEIR CASE AND SAID, "NO, I HAVE NO ORTHOPEDIC PROBLEMS, NO, I HAVE NO MEDICAL PROBLEMS," AND IT WAS OUR DUTY, AND THIS IS SOMETHING THAT I'VE WRITTEN ABOUT, TO TRY TO BE A MEDICAL DETECTIVE AND UNDERSTAND THAT THEY WERE NOT IN A POSITION TO NECESSARILY BE TRUTHFUL. AND THAT WAS THE FIRST TIME I WAS EXPOSED TO A TIME WHERE I WOULD BE SEEING A PATIENT AND THEY WOULD NOT NECESSARILY BE WANTING TO COOPERATE WITH ME.
Q DOCTOR, IN THAT SITUATION, THESE WERE PEOPLE WHO WERE TRYING TO GET JOBS IN THE NFL, JOBS THAT THEY BELIEVED WOULD BE VERY HIGH-PAYING CAREERS FOR THEM; IS THAT CORRECT?
A THAT IS CORRECT.
Q AND SO THEY HAD A MOTIVE TO LIE; IS THAT CORRECT?
A THAT IS CORRECT.
Q DID YOU CONSIDER THE POSSIBILITY IN EVALUATING MR. SIMPSON ON JUNE 15TH THAT HE HAD A MOTIVE TO LIE REGARDING HIS SYMPTOMS?
A YES, I DID.
Q AND, DOCTOR, YOU HAVE NO INDEPENDENT BASIS ON WHICH TO EVALUATE WHETHER OR NOT MR. SIMPSON WAS TRUTHFUL WITH YOU, FULLY CANDID OR WHETHER IN FACT HE WAS PULLING HIS PUNCHES WITH YOU, CAN YOU?
A MY REPORT IS BASED ON THE HISTORY THAT I OBTAINED FROM HIM AND MY OBSERVATIONS ARE THE OBSERVATIONS THAT I MADE OF HIM. HE MAY SAY WHATEVER HE WANTS, BUT THE PHYSICAL EXAM IN CERTAIN ASPECTS IS DIFFICULT TO QUOTE, UNQUOTE, LIE ABOUT. THAT'S AN ABSOLUTE FINDING.
Q WELL, DOCTOR, MY QUESTION THOUGH TO YOU WAS, DO YOU HAVE ANY INDEPENDENT BASIS ON WHICH YOU COULD EVALUATE THE TRUTHFULNESS OF MR. SIMPSON ON THE 15TH OF JUNE WITH RESPECT TO ANY HISTORY HE GAVE YOU REGARDING ANY ASPECT OF YOUR EXAMINATION?
A WELL, CERTAIN ASPECTS CERTAINLY WERE CORROBORATED WHEN WE DID GET HIS OLD RECORDS. EVEN A TWO-HOUR EXAM IS VERY BRIEF WHEN YOU'RE DISCUSSING THE NUMBER OF PROBLEMS WE DISCUSSED AND THE DEPTH.
AND CERTAINLY WHEN YOU GO OVER THE PRIORITIZATION THAT I WAS FACED WITH THAT DAY AND THE FACT THAT I HAD, YOU KNOW, FOUR OTHER PEOPLE WAITING TO SEE ME IN THE EXTRA HOUR THAT WE HAD PUSHED BACK FROM LUNCH, OBVIOUSLY THERE ARE SOME CONSTRAINTS IN WHICH YOU CAN HUMANLY DO. HOWEVER, ALL YOU CAN DO IS TAKE THE HISTORY, TRY TO CORROBORATE IT WITH OLD RECORDS AND SEE THE TRUTHFULNESS OF THE STATEMENTS THAT WERE MADE, AND THE AREAS WHERE THERE IS NO INDEPENDENT CORROBORATION, MAKE YOUR BEST JUDGMENT; AND THAT'S WHAT I TRIED TO DO.
Q DOCTOR, ON THE 17TH OF JUNE, YOU WERE PRESENT AGAIN WITH THE DEFENDANT; WERE YOU NOT?
A YES, I WAS.
Q THAT WAS AT MR. KARDASHIAN'S HOME?
A YES, IT WAS.
Q AND IN FACT, WHERE --
MR. SHAPIRO: YOUR HONOR, MAY WE APPROACH? I DON'T THINK HE WAS HERE FOR OUR DISCUSSIONS.
THE COURT: NO. YEAH.
WITH THE COURT REPORTER, PLEASE.
(THE FOLLOWING PROCEEDINGS WERE HELD AT THE BENCH:)
THE COURT: ALL RIGHT.
WE'RE OVER AT THE SIDEBAR.
MR. SHAPIRO.
MR. SHAPIRO: YES.
WE HAD DISCUSSIONS -- UNFORTUNATELY MR. KELBERG WASN'T THERE. APPARENTLY HE HAS NOT BEEN NOTIFIED THAT WE'RE NOT GOING TO GET INTO ANY DEMEANOR OR ANY OF THE ACTIVITIES SURROUNDING THE 17TH, AND I DELIBERATELY DID NOT BRING UP WHERE THE EXAMINATION TOOK PLACE, WHO WAS PRESENT. THAT'S WHY I SHOWED THE PHOTOGRAPH OF THE TWO NURSES.
MR. KELBERG: YOUR HONOR, AGAIN, I AM NOT GOING TO GO INTO DEMEANOR OR ANYTHING EXCEPT I AM GOING TO GO INTO WHETHER OR NOT HE FELT HE HADN'T HAD ADEQUATE TIME TO CONDUCT THE EXAMINATION ON THE 15TH. HE CONDUCTED A FURTHER EXAMINATION ON THE 17TH.
AND I DON'T UNDERSTAND WHY THE LOCATION HAS ANY BEARING. I'M NOT GOING TO GO INTO WHO WAS THERE, WHO ELSE WAS THERE. BUT CERTAINLY AS TO THE PHOTOGRAPH SHOWN, MR. SIMPSON GRIMACING WHERE BLOOD IS TAKEN, WHETHER HE MAY HAVE HAD A MOTIVATION TO FAKE THAT FOR LACK OF A BETTER TERM.
MR. SHAPIRO: I HAVE NO PROBLEM WITH ANY OF THAT. BUT I THINK WHEN YOU GET INTO MR. KARDASHIAN'S HOME, YOU'RE TREADING ON DANGEROUS TERRITORY WHICH OPENS UP AN AREA MISS CLARK AND I AGREED SHOULD NOT BE OPENED UP.
THE COURT: ALL RIGHT.
LET'S JUST GO INTO LENGTH. LOCATION IS NOT RELEVANT.
(THE FOLLOWING PROCEEDINGS WERE
HELD IN OPEN COURT:)
THE COURT: ALL RIGHT.
THANK YOU VERY MUCH, COUNSEL.
MR. KELBERG: THANK YOU.
Q BY MR. KELBERG: NOW, DOCTOR, ON THE 17TH, IF YOU FELT THAT YOU HAD BEEN UNABLE TO ADEQUATELY EXAMINE MR. SIMPSON ON THE 15TH, YOU HAD AN OPPORTUNITY TO CONDUCT ANY ADDITIONAL EXAMINATIONS YOU REQUIRED; ISN'T THAT CORRECT?
A THAT IS CORRECT.
Q WHAT ADDITIONAL PHYSICAL EXAMINATION OF MR. SIMPSON DID YOU CONDUCT ON THE 17TH?
A ON THE 17TH, BASICALLY THERE WAS A REEVALUATION OF HIS MENTAL STATUS. ON THE --
Q THAT'S NOT A PHYSICAL EXAMINATION. THAT'S A MENTAL STATUS EXAMINATION; IS THAT CORRECT?
A PART OF THE NEUROLOGIC EVALUATION.
Q WERE YOU CONDUCTING THE NEUROLOGICAL EVALUATION?
A YES, I WAS. THAT'S PART OF THE PHYSICAL.
Q AND, DOCTOR, DO YOU HAVE ANY SPECIALIZED TRAINING IN PSYCHOLOGY, PSYCHIATRY OR NEUROLOGY?
A BEING A GENERAL INTERNIST, I GUESS IS -- YOU KNOW, CONSIDERING 50 PERCENT OF THE PATIENTS ARE NON-CONCRETE MEDICAL DIAGNOSIS CASES, THAT WOULD BE I GUESS THE EXTENT OF IT.
Q FAIR TO SAY AS AN INTERNIST, YOU'RE SUPPOSED TO BE A JACK OF ALL TRADES, BUT NOT NECESSARILY AN EXPERT IN ANY PARTICULAR SUBSPECIALTY OF MEDICINE?
A THAT'S CORRECT.
Q ALL RIGHT.
WHAT OTHER PHYSICAL EXAMINATION IF ANY DID YOU CONDUCT ON THE 17TH?
A ON THE 17TH -- MAY I REFER TO MY NOTES?
Q SURE.
(BRIEF PAUSE.)
MS. CLARK: YOUR HONOR, WITH THE COURT'S PERMISSION, MAY WE REMOVE THE BOARD?
MR. KELBERG: I DON'T THINK WE'RE GOING TO BE USING THAT EXHIBIT WITH THIS WITNESS, YOUR HONOR.
THE COURT: ALL RIGHT.
BE CAREFUL, MISS CLARK.
THE WITNESS: DON'T PULL A MUSCLE.
BASICALLY WHAT I DID WAS, NO. 1, TO REASSESS THE PATIENT'S MENTAL STATUS; NO. 2, TO, MOST IMPORTANTLY, FROM THE INTERNAL MEDICINE STANDPOINT, TAKE ANOTHER SWING AT THIS VERY PERPLEXING CONSTELLATION OF FINDINGS WITH THE DRENCHING NIGHT SWEATS, THE FAMILY HISTORY AND PERSONAL HISTORY OF CANCER, THE CARCINOID CANCER, WHICH WAS ASSUMED TO BE BENIGN INITIALLY, AND THE MODEST ELEVATION IN THE SEDIMENTATION RATE AND HIS FINGER CLUBBING.
ALSO, WE RETHOUGHT ABOUT VARIOUS ASPECTS THERE. OBVIOUSLY CONSIDERING THE MAGNITUDE OF THE CASE AND I WAS THE ONLY ONE FEELING HIS LYMPH NODES ORIGINALLY, I REPEATED THAT EXAM AND LOOKED AT ALL THE LYMPH NODE AREAS VERY CLOSELY.
Q BY MR. KELBERG: YOU DIDN'T FIND ANY ENLARGED LYMPH NODE UNDER THE LEFT ARMPIT, DID YOU, AT THAT TIME?
A I DID NOT.
Q YOU HAD PREVIOUSLY IDENTIFIED AN ENLARGED LYMPH NODE UNDER THE RIGHT ARMPIT; IS THAT RIGHT?
A THAT IS CORRECT.
Q AND I'LL TOUCH BASE WITH YOU ON THIS A LITTLE BIT FURTHER.
BY THE WAY, ARE THOSE SOME NOTES YOU HAVE?
A YES, THEY ARE.
MR. KELBERG: COULD I APPROACH, YOUR HONOR?
THE COURT: YES.
Q BY MR. KELBERG: I THINK I HAVE THOSE.
A OKAY.
Q WHAT ELSE IF ANYTHING, DOCTOR?
A WELL, THE OTHER ISSUES THAT I WAS -- ATTEMPTED TO DO THAT DAY WAS, WE WERE DOING A VERY SOPHISTICATED EVALUATION OF HIS BLEEDING FUNCTION AND BASICALLY WENT THROUGH ANOTHER HISTORY PERTINENT TO WHETHER HE HAD ANY TENDENCY TO BLEED EXCESSIVELY OR TO CLOT EXCESSIVELY, ANY PROBLEM OF THAT NATURE.
I ALSO WANTED TO LOOK VERY CAREFULLY WHETHER, GIVEN MY FEARS OF CANCER AT THAT TIME, THERE WAS ANY BRAIN CONDITION THAT WOULD BE PERTINENT AND WENT THROUGH A NEUROLOGIC EXAMINATION AT THAT TIME. I ALSO OF COURSE, GIVEN THE CONSTRAINTS AND MY SUSPICION ALSO OF INFECTION BEING HIGH, WANTED TO REPEAT A TEMPERATURE.
AND THE SKIN TESTS WERE ALSO FELT TO BE IMPORTANT BASED ON HIS INITIAL CONSTELLATION OF COMPLAINTS AND SKIN TESTS, BOTH COCCI, TUBERCULOSIS AND MUMPS SKIN TEST AS A CONTROL REPLACE, AND, AGAIN, WE THEN WERE ABLE TO SEND OFF A WHOLE LITANY OF ESOTERIC SEROLOGY TESTS AND COAGULATION TESTS AT THAT TIME. AND THOSE WERE THE MAJOR THRUSTS OF MY REEVALUATION AT THAT TIME. IT WAS MAINLY TO DO LABORATORY VERY FRANKLY, BUT --
Q AND THE BOTTOM LINE, DOCTOR, IS, YOU DID NO FURTHER ORTHOPEDIC EVALUATION OF MR. SIMPSON ON THE 17TH; ISN'T THAT CORRECT?
A NO. THAT WOULD BE INCORRECT.
Q THE EVALUATION OF THE HAND INJURIES?
A BASICALLY WATCHING HIM WALK IS AN EVALUATION OF HIS ORTHOPEDIC CONDITION.
Q DID YOU MAKE SOME NOTE OF HOW HE WALKED IN YOUR PROGRESS NOTES?
A I BELIEVE -- THAT IS NOT -- I DON'T HAVE AN ORTHOPEDIC EVALUATION IN THE NOTES THERE.
Q AND, DOCTOR, AGAIN, THOSE NOTES WERE TO HIGHLIGHT WHAT YOU THOUGHT TO BE THE MOST SIGNIFICANT FINDINGS, CORRECT?
A GIVEN THE WHOLE SCENARIO TO DO, CORRECT, WHAT I THOUGHT WAS THE MOST SIGNIFICANT FINDINGS AND THAT -- IN THE CONSTRAINTS OF TIME THAT I PUT DOWN AND DICTATED IMMEDIATELY THERE, YES.
Q WELL, AGAIN, DID YOU FEEL CONSTRAINTS OF TIME THAT PRECLUDED YOU FROM DOING AN ORTHOPEDIC EXAMINATION THAT YOU FELT YOU WERE PRECLUDED FROM DOING ON JUNE 15TH BECAUSE OF THE PRESS OF OTHER BUSINESS?
MR. SHAPIRO: YOUR HONOR --
MR. KELBERG: NO. I'M TALKING ABOUT THE PRESS OF OTHER BUSINESS ON THE 15TH.
MR. SHAPIRO: MAY WE APPROACH?
ON THE 15TH.
THE WITNESS: THE ORTHOPEDIC EVALUATION WAS EXTREMELY COMPLETE ON THE 15TH. YOU ARE CORRECT THAT THE DESCRIPTION OF THE GAIT WAS OMITTED, AND THAT'S A CORRECT OBSERVATION ON YOUR PART.
Q BY MR. KELBERG: YOU SAID YOUR ORTHOPEDIC EXAM ON THE 15TH WAS COMPLETE; IS THAT CORRECT?
A THAT'S CORRECT.
Q THOROUGH?
A YES.
Q AND IN FACT, AS AN INTERNIST, YOU ARE TRAINED HOW TO CONDUCT A HAND EXAMINATION TO ASSESS THE DISTINCTION BETWEEN OSTEOARTHRITIS AND RHEUMATOID ARTHRITIS; ISN'T THAT CORRECT?
A NO, THAT IS NOT CORRECT. THAT WOULD BE QUITE A SPECIALIZED OR VERY DIFFICULT DIFFERENTIATION.
Q DOCTOR, HAVE YOU EVER HAD TRAINING AND EXPERIENCE IN IDENTIFYING OSTEOARTHRITIS BASED UPON THE HARD NATURE, THE BONY NATURE OF THE SENSATION WHEN YOU FEEL AROUND THE JOINT SUCH AS THE PROXIMAL INTERPHALANGEAL JOINT OF ONE OF THE FINGERS?
A I THINK THE CREPITATION, THE NOISE AND THE CREAKING THAT YOU FEEL WHEN YOU MOVE JOINTS CAN BE VERY DIFFICULT TO DIFFERENTIATE ON THAT BASIS ALONE RHEUMATOID FROM OSTEOARTHRITIS.
Q THAT WAS NOT MY QUESTION, DOCTOR.
MY QUESTION IS THAT WHEN YOU FEEL THE AREA OF THE JOINT, IT FEELS, IN OSTEOARTHRITIS, HARD BONY LIKE, WHICH IS DIFFERENT THAN IT FEELS IF IT'S RHEUMATOID ARTHRITIS.
EVER HAD ANY TRAINING IN THAT, DOCTOR?
A WELL, I THINK THAT THERE ARE DIFFERENT PHASES OF OSTEOARTHRITIS. THERE ARE EARLY PHASE WHERE IT CAN BE QUITE --
MR. KELBERG: EXCUSE ME. I MOVE TO STRIKE AS NONRESPONSIVE. THE QUESTION IS ASKING IF HE'S HAD TRAINING TO IDENTIFY OSTEO --
THE COURT: SUSTAINED.
Q BY MR. KELBERG: DOCTOR, MY QUESTION -- AND PLEASE LISTEN TO THE QUESTION CAREFULLY.
A OKAY.
Q IN YOUR TRAINING, HAVE YOU BEEN TAUGHT FOR IDENTIFYING OSTEOARTHRITIS, THAT WHEN YOU FEEL AROUND THE JOINT, YOU EXPECT TO FIND A HARDENING TYPE OF FEELING, A BONY TYPE OF FEELING?
A YES.
Q AND HAVE YOU ALSO BEEN TAUGHT -- RHEUMATOID ARTHRITIS IS AN INFLAMMATORY DISEASE; IS IT NOT?
A YES, IT IS.
Q WERE YOU TAUGHT THAT WHEN YOU FEEL AROUND THAT SAME JOINT FROM RHEUMATOID ARTHRITIS, IT WOULD FEEL SOFT IN NATURE?
A "BOGGY" IS THE WORD THAT WE TYPICALLY USE.
Q WELL, IF A RHEUMATOLOGIST USED "SOFT," WOULD YOU ACCEPT THAT?
A YES, I WOULD.
Q AND, DOCTOR, SO YOU'VE HAD SOME EXPERIENCE, HAVEN'T YOU, IN EXAMINING THE JOINTS TO DISTINGUISH THE SENSATION OF HARDNESS VERSUS SOFTNESS?
A YES, I HAVE.
Q NOW, DOCTOR, DID MR. SIMPSON EVER COMPLAIN TO YOU ON THE 15TH THAT HE SUFFERED FROM RHEUMATOID ARTHRITIS?
A HE DID NOT TELL ME ON THE 15TH THAT HE WAS SUFFERING FROM RHEUMATOID ARTHRITIS.
Q AND IN FACT, IN YOUR REPORT, YOU MAKE MENTION OF A DR. MALTZ, M-A-L-T-Z, AND YOU LIST HIM AS A RHEUMATOLOGIST; IS THAT CORRECT?
A THAT IS CORRECT.
Q SO AT THAT TIME, DID YOU EXPECT OR BELIEVE THAT MR. SIMPSON HAD AT LEAST BEEN SEEN BY SOMEBODY SPECIALIZING IN RHEUMATOID ARTHRITIS?
A I KNEW HE HAD BEEN SEEN BY SOMEONE SPECIALLING IN RHEUMATOID ARTHRITIS, I KNEW HE HAD A FAMILY HISTORY OF RHEUMATOID ARTHRITIS. HE WAS VAGUE ON EXACTLY WHETHER HE HAD RHEUMATOID ARTHRITIS OR IT WAS A QUESTIONABLE DISEASE.
HE WAS EXHIBITING MANY OF THE CLINICAL FEATURES OF RHEUMATOID ARTHRITIS, ALTHOUGH THE FEATURES WHICH INCLUDE SYMMETRICAL ARTHRITIS, GREATER THAN THREE JOINT AREAS, THE HAND AND WRIST INVOLVEMENT AS WELL AS CERTAIN OTHER CLINICAL FINDINGS IN RHEUMATOID ARTHRITIS CAN BE RELATIVELY DIFFICULT AND THERE CAN BE OVERLAP WITH OSTEOARTHRITIS.
SO VERY FRANKLY, THERE WAS SOME CONFUSION ON THE 15TH ABOUT EXACTLY WHAT TYPES OF ARTHRITIS THERE WERE. AND I THINK IN ARREARS, IT TURNED OUT THAT HE IS A -- QUITE A STRONG DENIER OF THE RHEUMATOID ARTHRITIS, AND THAT'S PART OF THE PROBLEM AND WHY HE WENT OFF HIS RHEUMATOID ARTHRITIS --
HE NEVER REALLY ACCEPTED THAT HE HAD RHEUMATOID ARTHRITIS AND HE CERTAINLY WAS NOT ADMITTING IT TO ME ON THAT EXAM, ALTHOUGH I KIND OF FIGURED IT OUT BASED ON THE DOCTORS HE WENT TO AND SOME OF THE THINGS THAT HE HAD BEEN THROUGH AND THE MEDICATIONS THAT HE HAD BEEN EXPOSED TO. BUT THAT WAS DEFINITELY NOT CLEAR ON THE 15TH.
Q DOCTOR, IS IT YOUR TESTIMONY YOU SPECIFICALLY ASKED MR. SIMPSON ON JUNE 15TH, "DO YOU SUFFER FROM RHEUMATOID ARTHRITIS"?
A I DID NOT ASK HIM THAT.
Q AND WHERE IN YOUR REPORT IF ANYWHERE IS THERE ANY ASPECT IN WHICH YOU'VE DESCRIBED HIS EQUIVOCATION REGARDING POSSIBLE RHEUMATOID ARTHRITIS AS YOU'VE JUST TESTIFIED?
A THERE ARE NUMEROUS AREAS WHERE I DIDN'T DICTATE IT IN. WE TALKED STRAIGHT THROUGH AND -- I DON'T HAVE TWO HOURS OF DICTATED NOTES IN THAT, NO. THAT'S A COLLATION, AND SOME OF THE IMPORTANT THINGS, AS YOU'VE POINTED OUT, MAY HAVE BEEN OMITTED AND THAT'S -- AND THAT WOULD BE, YOU KNOW, AN ERROR AND ALLS I CAN DO IS SAY WHAT HAPPENED.
Q NOW, DOCTOR, IN DOING A CAREFUL HAND EXAMINATION, DID YOU TRY AND EVALUATE WHETHER THERE WAS A BONY HARD SENSATION AROUND THE HAND JOINTS VERSUS A SOFT SENSATION?
A YES, I DID.
Q AND WHERE IF AT ALL DID YOU RECORD YOUR FINDINGS REGARDING THOSE OBSERVATIONS?
A WELL, I'D HAVE TO LOOK. IF I DIDN'T, I DIDN'T.
Q OKAY.
IF YOU WOULD PLEASE LOOK.
(BRIEF PAUSE.)
THE WITNESS: THAT'S NOT LISTED.
AGAIN, I DID EVERY SINGLE ORTHOPEDIC AREA, EVERY SINGLE NEUROLOGIC AREA AND DIDN'T MENTION SOME OF THE THINGS, AND CERTAINLY IN HIS CASE, THEY WERE MORE CONSISTENT WITH OSTEOARTHRITIS BECAUSE THEY WERE QUITE FIRM AND BONY.
Q BY MR. KELBERG: DOCTOR, IN FACT, LET ME -- I'M GOING TO MARK YOUR REPORT, IF I COULD, YOUR HONOR, AS --
MR. KELBERG: I'M SORRY. I DO NOT KNOW WHAT THE LAST PEOPLE'S EXHIBIT --
THE COURT: 507.
MR. KELBERG: SO THIS BECOMES 508 OR --
THE COURT: 507.
(PEO'S 507 FOR ID = REPORT)
MR. KELBERG: MAY IT BE MARKED, YOUR HONOR -- IT HAS PAGE NUMBERS OR CHRONOLOGICAL NUMBERS FROM ONE OF THOSE CONTINUOUS COUNTERS THAT STARTS ON 433 AND ENDS WITH 440 -- COLLECTIVELY THEN AS 507?
THE COURT: 507.
MR. KELBERG: AND IF I COULD ASK MR. FAIRTLOUGH TO HELP ME OUT, PUTTING ON PAGE 5 OF THIS REPORT.
COULD WE -- I'M SORRY, MR. FAIRTLOUGH -- RAISE IT SO WE CAN GET THE BOTTOM PART OF THE DOCUMENT?
THE COURT: ALL RIGHT.
DOCTOR, DO YOU HAVE THE ORIGINAL IN FRONT OF YOU?
THE WITNESS: YES, I DO.
MR. KELBERG: PAGE 5, DOCTOR.
THE COURT: EASIER TO READ.
MR. KELBERG: AND IN FACT, MR. FAIRTLOUGH, THE ONLY ONE I'M INTERESTED IN IS THE LAST ONE THERE, "ORTHO."
Q BY MR. KELBERG: DOCTOR, THAT IS THE COMPLETE SUMMARY OF YOUR ORTHOPEDIC EXAMINATION ON JUNE 15TH, 1994 OF MR. SIMPSON; IS IT NOT?
A YES, IT IS.
Q NOW, DOCTOR, IF YOU'RE CONCERNED ABOUT RHEUMATOID ARTHRITIS, THERE'S SOMETHING CALLED A GRIP TEST THAT CAN BE DONE, ISN'T THERE?
A YES, THERE IS.
Q AND THAT'S A VERY SIMPLE TEST TO DO; IS THERE NOT -- IS IT NOT?
A IT REQUIRES SOME SPECIALIZED THINGS BECAUSE TYPICALLY YOU DO IT WITH A BULB WITH A GAUGE, AND WE DON'T HAVE THAT AT OUR OFFICE.
Q WELL, DOCTOR, CAN'T IT BE DONE IN FACT USING A BLOOD PRESSURE DEVICE? YOU DO HAVE A BLOOD PRESSURE DEVICE, YOU KNOW, THOSE CUFF THINGS THAT YOU PUMP UP AND THEN YOU HAVE A COLUMN, A SPHYGMOMANOMETER I THINK IS THE FANCY NAME FOR IT, RIGHT?
A WE DO HAVE THAT.
Q AND IN FACT, IF YOU WANTED TO DO A GRIP TEST, ALL YOU HAVE TO DO IS ROLL THE CUFF UP, HAVE MR. SIMPSON PUT IT IN HIS HAND, PUMP IT UP TO ABOUT 20 MILLIMETERS OF MERCURY AND THEN HAVE HIM SQUEEZE AND WATCH ON THE COLUMN TO SEE HOW HIGH HE CAN GET THE LITTLE MERCURY THING TO GO, RIGHT?
A I THINK A MUCH BETTER AND SIMPLER TEST IS JUST TO DO A GRIP TEST RIGHT ON TWO FINGERS, AND THAT WAS DONE.
Q WELL, DOCTOR, EXCUSE ME. THAT'S NOT THE QUESTION I ASKED. YOU COULD HAVE DONE THIS TEST; COULD YOU NOT?
A I COULD HAVE DONE THAT TEST, BUT THAT'S NOT A TYPICAL THING TO DO AND WOULD BE TOTALLY INAPPROPRIATE FOR THIS EXAM.
Q IF A RHEUMATOLOGIST SAID IT'S A VERY TYPICAL TEST TO DO AND GIVES YOU SOME OBJECTIVE STANDARD BECAUSE YOU CAN MEASURE IT AGAINST THE COLUMN LEVEL OF MERCURY, WOULD YOU HAVE ANY BASIS TO DISAGREE WITH THAT, SIR?
MR. SHAPIRO: OBJECTION. CALLS FOR HEARSAY.
THE COURT: OVERRULED.
Q BY MR. KELBERG: YOU MAY ANSWER THE QUESTION.
A YEAH, I WOULD SAY THAT THAT'S TOTALLY INAPPROPRIATE BECAUSE BASICALLY, HERE'S A PATIENT THAT CAME TO MY OFFICE FOR AN EVALUATION OF HIS MENTAL STATE AND TO TRY TO SEE IF THERE ARE ANY EXTENUATING CIRCUMSTANCES IN HIS CURRENT SITUATION.
THE RHEUMATOLOGIC EVALUATION, THE ORTHOPEDIC EVALUATION IS A TOTAL THROW AWAY. THIS IS SOMETHING THAT I WAS NOT ASKED TO DO, HAD NO PERTINENCE AS FAR AS I WAS CONCERNED THAT DAY.
I WAS PARTICULARLY INTERESTED IN, A, HIS MENTAL STATUS, WHICH WAS WHY I WAS CALLED TO SEE HIM. NO. 2, I WAS VERY INTERESTED ABOUT TRAUMA, AND I LOOKED VERY CAREFULLY FOR ANY EVIDENCE OF ACUTE PROBLEMS OR ANY DAMAGE THAT HE SUSTAINED.
THE ENTIRE ORTHOPEDIC EXAM FOR -- IF -- IF -- I THINK WHAT WE NEED TO DO IS REVIEW A TYPICAL ONE- OR TWO-HOUR EVALUATION IN THE COMMUNITY AT LARGE, THE UNITED STATES. I THINK THAT THAT'S -- THAT'S QUITE AN ADEQUATE EVALUATION.
THE RHEUMATOLOGIC EVALUATION WHEN THERE WAS STILL SOME QUESTIONS -- AT THIS POINT IN TIME, I HAD NO OLD RECORDS, I HAD NO INDICATION THAT HE HAD RHEUMATOID ARTHRITIS. I THINK TO DO A GRIP TEST WITH A SPHYGMOMANOMETER WOULD HAVE BEEN WHOLLY INAPPROPRIATELY ESPECIALLY SINCE HIS GRIP WAS TESTED BECAUSE I DID THAT IN THE THOROUGH NEUROLOGIC EXAM WHEN WE TEST HIS MEDIAN NERVE.
YOU DO BASICALLY A WRIST DORSI FLEXION STRENGTH, YOU DO A GRIP AND YOU DO THE FINGERS APART AND THAT TESTS THE THREE DIFFERENT NERVES COMING DOWN THE ARM. AND SO I THINK IT WOULD BE QUITE REPETITIVE AND I DON'T REALLY SEE WHY YOU WOULD GAIN ANY INFORMATION.
I'M NOT SURE WHY YOU WOULD BE GOING IN THAT DIRECTION IN A PERSON WHERE IT DIDN'T APPEAR TO BE AN APPROPRIATE THING TO DO IN THE FIRST TWO DAYS OF THIS PARTICULAR MAN'S EVALUATION, AND THAT DIDN'T SEEM TO BE IN HIS -- YOU KNOW, IT DIDN'T SEEM TO BE SOMETHING THAT WAS TIME EFFICACIOUS OR COST EFFICACIOUS OR APPROPRIATE AT THAT TIME GIVEN, YOU KNOW, THE SITUATION.
Q COST --
THE COURT: HOLD ON. LET HIM TAKE A BREATH. LET THE COURT REPORTER CATCH UP.
ALL RIGHT.
DOCTOR, WOULD YOU PLEASE SLOW DOWN.
Q BY MR. KELBERG: COST EFFICACIOUS, DOCTOR?
A ONE OF THOSE BUZZ WORDS THAT YOU HEAR EVERY DAY IN MEDICINE NOWADAYS.
Q IN FACT, DIDN'T YOU SEND MR. SHAPIRO -- INDICATING YOU WERE GOING TO BILL ALL OF THIS THROUGH MR. SIMPSON'S INSURANCE?
A YES, I DID.
Q SO IS IT YOUR STATEMENT, DOCTOR, THAT YOU DID NOT DO A COMPLETE AND THOROUGH ORTHOPEDIC EXAM, THAT WHAT YOU DID WAS A THROW-AWAY EXAM?
A I DID A COMPLETE AND THOROUGH ORTHOPEDIC EXAM.
TYPICALLY WHAT YOU DO IS, WHEN YOU GET AN ABNORMALITY, THEN YOU GO FURTHER ON IT. IN OTHER WORDS, IF I HAD DONE A GRIP TEST HERE, WHICH IS BASICALLY ASKING YOU TO SQUEEZE AS HARD AS YOU CAN, IF THAT GRIP TEST IS ABNORMAL AND YOU ARE FOLLOWING THEM AS A RHEUMATOLOGIST ON AN ONGOING BASIS, THEN TO DO THAT TEST IS PERFECTLY APPROPRIATE WHEN YOU HAVE A SITUATION LIKE THIS AND INDIVIDUAL WHO IS IN THE STATE HE WAS IN, WHO IS HAVING TROUBLE STAYING AWAKE BECAUSE OF SLEEP DEPRIVATION.
TO BE GOING THROUGH ESOTERIC TESTS THAT ARE REALLY NOT OF ANY IMMEDIATE VALUE I THINK WOULD BE ABSOLUTELY INAPPROPRIATE. SO I ABSOLUTELY HAVE TO DISAGREE WITH YOU.
Q DOCTOR, WHERE IS IT RECORDED THE GRIP STRENGTH TEST RESULT IN YOUR REPORT OF JUNE 15TH?
A WELL, THERE ARE NUMEROUS THINGS THAT ARE NORMAL THAT AREN'T REPORTED. AS I SAID, TWO HOURS OF OUR INTERREACTION ARE CERTAINLY NOT RECORDED HERE.
Q SO YOUR OPINION WAS, FROM THE GRIP TEST, THAT MR. SIMPSON, WHATEVER THE FINDINGS WITH RESPECT TO THE ENLARGED AREA OF THE JOINTS, HE HAD NORMAL GRIP STRENGTH IN YOUR JUDGMENT, CORRECT, DOCTOR?
A THAT IS CORRECT.
Q AND THERE WAS NOTHING OF URGENCY -- I MEAN, YOU TOLD US ON DIRECT EXAMINATION ABOUT, HE'S GOING TO BE A CANDIDATE FOR A KNEE REPLACEMENT I THINK WAS WHAT YOU SAID; IS THAT CORRECT?
A THAT'S CORRECT, DOWN THE LINE.
Q DOWN THE LINE, THERE WAS NO EVIDENCE THAT YOU FELT APPARENT AT THAT TIME THAT MR. SIMPSON NEEDED A KNEE REPLACEMENT, RIGHT, ON JUNE 15TH?
A ON JUNE 15TH, I THINK THERE WAS BECAUSE HE HAD SIGNIFICANT CREPITATION, HE HAD SIGNIFICANT PAIN AND HE HAD, BY HISTORY, SIGNIFICANT LIMITATIONS THAT WERE AFFECTING THE QUALITY OF LIFE. AND KNOWING THE NATURAL HISTORY, AGAIN, BASED ON SOME INFORMATION THAT WAS GIVEN TO ME LATER IN TERMS OF REVIEW OF X-RAYS AND FURTHER HISTORY, ON FURTHER INFORMATION, THAT OPINION WAS BASED, NOT SOLELY ON WHAT I FOUND HISTORY AND PHYSICAL WISE ON THE 15TH.
Q WELL, DOCTOR, WHAT MY QUESTION WAS THOUGH -- AND, PLEASE, AGAIN, IF YOU WOULD LISTEN CAREFULLY TO THE QUESTION. MY QUESTION WAS, ON THE 15TH, DID YOU THINK HE NEEDED A KNEE REPLACEMENT?
A ON THE 15TH, I THOUGHT THAT HE WAS IN TROUBLE WITH HIS KNEE AND HIS ANKLE, AND MY PLAN WAS, BASED ON THE FACT THAT I DIDN'T REALLY HAVE A TREMENDOUS HIGH SUSPICION ABOUT THE RHEUMATOID ARTHRITIS, WAS THAT HE NEEDED AN ORTHOPEDIC REEVALUATION.
AND THAT WAS ONE OF MY INITIAL POINTS; IS THAT WHEN THIS WHOLE THING WAS CLEARED UP, HE NEEDED SOME HELP WITH HIS KNEE AND HIS ANKLE SO THAT HE WOULD BE ABLE TO PLAY GOLF AND NOT BE IN THE PAIN EVERY MORNING THAT HE WAS IN.
MR. KELBERG: YOUR HONOR, I MUST MOVE TO STRIKE AS NONRESPONSIVE. MY QUESTION ASKED HIM DID HE NEED --
THE COURT: I UNDERSTAND. JUST ASK THE QUESTION AGAIN.
Q BY MR. KELBERG: DOCTOR, PLEASE LISTEN.
MY QUESTION WAS, ON JUNE 15TH, DID MR. SIMPSON IN YOUR OPINION NEED A KNEE REPLACEMENT?
A HE DID NOT NEED A KNEE REPLACEMENT ON THE 15TH.
Q AND IN FACT, YOU MADE NO EFFORT TO HAVE HIM SEEN BY AN ORTHOPEDIST AFTER JUNE 15TH, BETWEEN THE JUNE 15TH AND JUNE 17TH EXAMINATIONS; IS THAT CORRECT?
A THE ORTHOPEDIC PROBLEMS WERE CHRONIC AND SOMETHING THAT WOULD BOTHER HIM OVER A MANY YEAR PERIOD AND WERE NOT OF AN ACUTE NATURE, CERTAINLY NOT AS ACUTE AS HIS OTHER PRESSING PROBLEMS.
Q AND IN FACT, YOUR OPINION WAS THAT HE HAD NO EVIDENCE OF AN ACUTE ARTHRITIC PROBLEM, THAT IS A FLARE-UP OF ANY ARTHRITIC CONDITION, WHETHER IT BE OSTEOARTHRITIS OR RHEUMATOID ARTHRITIS ON JUNE 15TH, 1994; IS THAT CORRECT, DOCTOR?
A THAT IS NOT CORRECT.
Q WELL THEN, DOCTOR, WHAT EVIDENCE DID YOU HAVE THAT HE HAD AN ACUTE FLARE-UP OF EITHER THE OSTEO OR THE RHEUMATOID?
A SOME OF WHICH CAME BY IN TERMS OF ARREARS. BUT HE HAD A VERY PAINFUL KNEE, HE HAD A VERY PAINFUL ANKLE, AND THOSE CONDITIONS SUBSEQUENTLY RESPONDED TO TREATMENT.
ALSO, WHEN WE FOUND OUT THAT THE DRENCHING NIGHT SWEATS AND SOME OF HIS OTHER SYSTEMIC SYMPTOMS RESPONDED TO RHEUMATOID ARTHRITIS TREATMENT, SOME OF THIS IS DEDUCED IN ARREARS. BUT WHEN HE CAME TO ME, HE WAS -- HE HAD JOINT PAIN AND IT WAS UNCLEAR WHAT THE EXACT IDEOLOGY WAS.
I MADE THE ASSUMPTION ORIGINALLY BASED ON HIS HISTORY AND MY PHYSICAL EXAM THAT THEY WERE PREDOMINANTLY ORTHOPEDIC PROBLEMS BASED ON HIS PREVIOUS WEAR AND TEAR INJURIES. I THINK THAT BASED ON FURTHER WORK-UP OF HIS DRENCHING NIGHT SWEATS AND ENLARGED LYMPH NODE, WHICH I BELIEVE INDICATED RHEUMATOID ARTHRITIS IN THE END, AND THE FACT THAT I FOUND OUT LATER HE HAD UNBEKNOWNST TO ME STOPPED HIS RHEUMATOID ARTHRITIS MEDICATION APPROXIMATELY A MONTH AGO, THAT SOME OF HIS PROBLEMS WHICH THEN SUBSEQUENTLY CLEARED SIGNIFICANTLY WERE DUE TO RHEUMATOID ARTHRITIS.
BUT IT WAS VERY DIFFICULT FOR ME GIVEN THE CONSTRAINTS AT THAT TIME AND THE FACT THAT I DIDN'T GET A FULL HISTORY AND THEREFORE COULDN'T DO SOME OF THE SPECIALIZED TESTING YOU'RE INDICATING IT WOULD HAVE BEEN NICE TO DO, THAT I WASN'T ABLE TO DEDUCE THAT RIGHT ON THE 15TH.
Q YOUR HONOR, I'VE ASKED MR. FAIRTLOUGH NOW TO PUT UP PAGE 6, DOCTOR, OF YOUR REPORT, AT LEAST THE COPY I'VE BEEN PROVIDED, AND IT LISTS, AT LEAST ON THE COPY I HAVE, VARIOUS WHAT ARE UNDER ASSESSMENT PLAN --
A UH-HUH.
Q -- 15 VARIOUS ITEMS; IS THAT CORRECT?
A 16 ITEMS. CORRECT.
Q WELL, THIS ONE SHOWS ITEMS 2 THROUGH 16.
A OKAY.
Q IT DOES NOT KNOW ITEM 1.
A REMEMBERING THAT ITEM 1 TOOK 40 PERCENT OF --
THE COURT: HOLD ON. HOLD ON. NONE -- THERE'S NOT A QUESTION PENDING.
Q BY MR. KELBERG: THIS DOCUMENT SHOWS -- THIS IS THE DOCUMENT I'VE BEEN PROVIDED. IT SHOWS ITEMS 2 THROUGH 16, RIGHT, DOCTOR?
A YES, IT DOES.
Q NOW, DOCTOR, IN ESSENCE, IS THIS YOUR EFFORT TO SUMMARIZE IN ORDER OF SIGNIFICANCE YOUR FINDINGS?
A NO.
Q IS IT AN EFFORT TO IDENTIFY ANY ABNORMALITY OF YOUR FINDINGS?
A IT'S A REVIEW -- IT'S A REVIEW PROCESS WHERE I TRY TO LUMP DIFFERENT SYMPTOMS INTO BROAD CATEGORIES SO THAT I COULD RETHINK HIS VARIOUS PROBLEMS, BUT NOT NECESSARILY ON A DIRECT PRIORITIZATION, ALTHOUGH TYPICALLY NO. 1 IS YOUR MAIN PROBLEM.
Q NOW, DOCTOR -- AND WHATEVER NO. 1 MAY BE, IT WASN'T ACUTE RHEUMATOID ARTHRITIS, RIGHT?
A THAT IS CORRECT.
Q IT WASN'T ACUTE OSTEOARTHRITIS, WAS IT?
A THAT IS CORRECT.
Q IT WASN'T ANYTHING ORTHOPEDIC?
A THAT IS CORRECT.
Q IT WASN'T ANYTHING THAT DEALT WITH HIS PHYSICAL CAPABILITY TO MURDER TWO HUMAN BEINGS ON JUNE 12TH, 1994, WAS IT?
MR. SHAPIRO: OBJECTION. ARGUMENTATIVE.
THE COURT: SUSTAINED.
REPHRASE THE QUESTION.
Q BY MR. KELBERG: DOCTOR, WAS ITEM NO. 1 ANYTHING TO DO WITH MR. SIMPSON'S PHYSICAL ABILITY TO MURDER TWO HUMAN BEINGS ON JUNE 12TH, 1994?
MR. SHAPIRO: OBJECTION TO THAT.
THE COURT: SUSTAINED.
REPHRASE THE QUESTION.
Q BY MR. KELBERG: DOCTOR, WAS THERE ANY FINDING MADE BY YOU IN -- COVERED IN WHATEVER ITEM NO. 1 IS WHICH DEALT WITH ANY PHYSICAL LIMITATION OF MR. SIMPSON'S WHICH IN YOUR OPINION WOULD HAVE PREVENTED HIM FROM MURDERING TWO HUMAN BEINGS USING A SINGLE-EDGED KNIFE ON JUNE 12TH OF 1994?
MR. SHAPIRO: OBJECTION. OBJECTION.
THE COURT: OVERRULED.
Q BY MR. KELBERG: YOU MAY ANSWER THE QUESTION, DOCTOR.
A NO, THERE WAS NOT.
Q AND THERE IS NO ENTRY HERE ON THE 2 THROUGH 16 THAT ARE LISTED FOR AN ACUTE PHASE OF ANY KIND OF ARTHRITIS, RIGHT?
A THAT'S INCORRECT.
Q WHERE, DOCTOR, IS THERE A REFERENCE TO AN ACUTE EPISODE OF ARTHRITIS?
A WELL, THE RIGHT ANGLE INSTABILITY IN THE -- IS OF UNKNOWN DURATION. YOU KNOW, I WROTE BASICALLY "RIGHT ANKLE INSTABILITY WITH CHRONIC PAIN," BUT I THOUGHT THAT THAT COULD BE AN ACUTE PROBLEM. AND OF COURSE, THE LEFT KNEE WAS VERY BOTHERSOME. I HAD NO IDEA WHETHER THAT WAS ACUTE, BETTER OR WORSE. I JUST KNEW IT LOOKED BAD AT THAT POINT.
Q DOCTOR, THE TERMS "ACUTE" AND "CHRONIC" ARE MEDICAL TERMS THAT HAVE SIGNIFICANCE, DON'T THEY?
A YES, THEY DO.
Q DID YOU USE THE WORD "ACUTE" TO DESCRIBE ANY OF THOSE FINDINGS?
A I DID NOT USE THE WORD "ACUTE," NO.
Q AND IN FACT, YOU SPECIFICALLY USED THE WORD "CHRONIC" TO DESCRIBE THE RIGHT ANGLE INSTABILITY, MEANING IT'S BEEN OF LONG-STANDING DURATION?
A THAT WAS WHAT I WROTE, RIGHT.
Q NOW, DOCTOR, YOU HAD SOME LABORATORY TESTS DONE, DID YOU NOT --
A YES.
Q -- FROM A SAMPLE DRAWN ON JUNE 15TH?
A YES, I DID.
Q AND YOU HAD SOME MORE LAB WORK DONE ON A SAMPLE DRAWN ON JUNE 17TH. THAT'S THE ONE IN THE PHOTOGRAPH WHERE MR. SIMPSON APPEARS TO BE GRIMACING IN REACTION TO THE NEEDLE EXTRACTING THE BLOOD; IS THAT CORRECT?
A THAT'S CORRECT.
Q INCIDENTALLY, YOU HAVE NO IDEA ON THE 17TH WHETHER MR. SIMPSON WAS PUTTING ON AN ACT OF THE PAIN RELATIONSHIP TO HAVING THE NEEDLE INJECTION OR THE NEEDLE INSERTED TO WITHDRAW THE BLOOD OR IN FACT HE REALLY WAS REACTING TO PAIN FROM THAT PROCEDURE, RIGHT? YOU HAVE NO WAY OF KNOWING?
A NO, I HAVE NO WAY OF KNOWING.
Q BUT YOU DO KNOW HE WAS SEEING YOU AT THE REQUEST OF HIS ATTORNEY AGAIN; ISN'T THAT CORRECT?
A I WAS ASKED TO MAKE A HOUSE CALL TO FURTHER EVALUATE A VARIETY OF MEDICAL PROBLEMS.
Q MY QUESTION WAS, YOU DID KNOW ON THE 17TH THAT YOU WERE SEEING HIM AGAIN AT THE REQUEST OF HIS ATTORNEY?
A YES.
Q THIS WAS NOT A SITUATION OF A PATIENT CALLING YOU UP AND SAYING, "I'D LIKE TO COME IN AND BE EVALUATED," RIGHT?
A THAT'S CORRECT.
Q NOW, DOCTOR, LET'S START WITH THE LABORATORY TESTS.
IF ONE WERE LOOKING FOR EVIDENCE OF ACUTE RHEUMATOID ARTHRITIS --
MR. KELBERG: AND, YOUR HONOR, I HAVE ANOTHER DOCUMENT TO BE MARKED. IT'S GOT OUR PAGE NUMBER 446.
MAY THIS BE THEN I GUESS IT'S 508?
THE COURT: 508.
(PEO'S 508 FOR ID = DOCUMENT)
MR. KELBERG: AND BECAUSE I THINK IT MIGHT GO FASTER, I'M GOING TO HOLD ON TO IT AND DO THE MARKING AND THEN ASK MR. FAIRTLOUGH TO PUT IT UP ON THE --
THE COURT: ALL RIGHT.
MR. KELBERG: AND MAY I APPROACH TO SHOW THE DOCUMENT?
THE COURT: YOU MAY.
MR. SHAPIRO, DO YOU HAVE THIS ITEM?
MR. SHAPIRO: YES.
Q BY MR. KELBERG: ALL RIGHT.
DOCTOR, THERE IS A LAB TEST DONE FOR SOMETHING CALLED CRP. THAT'S ONE OF THE TESTS, RIGHT?
A UH-HUH.
Q THAT'S A YES?
A YES, IT IS.
Q AND CRP IS A PROTEIN THAT'S GENERATED FROM THE LIVER; IS IT NOT?
A YES, IT IS.
Q AND IT CAN BE GENERATED IN RESPONSE TO INFLAMMATION IN THE BODY; IS THAT CORRECT?
A YES, IT CAN.
Q WHAT WAS THE RESULT ON THAT TEST?
A THAT RESULT WAS NEGATIVE.
Q AND IN FACT, IF SOMEBODY HAD -- AND WHEN I USE THE TERM "ACUTE," I'M TALKING ABOUT AN ONSET, NOT A CHRONIC PROBLEM, BUT ONE WHERE YOU'VE GOT AN ONSET OF NEW SYMPTOMS OR RENEWED PAIN, THAT KIND OF THING. YOU UNDERSTAND HOW I'M USING THE TERM?
A SURE.
Q IF ONE HAD AN ACUTE ONSET OF RHEUMATOID ARTHRITIS EPISODE, ONE WOULD EXPECT TO SEE A POSITIVE CRP VERY QUICKLY, WOULDN'T YOU?
A TYPICALLY IT SHOULD BE ELEVATED.
Q WITHIN 12 TO 24 HOURS, RIGHT? IS THAT CORRECT?
A THAT'S CORRECT.
Q AND IT WOULD THEN COME DOWN ONLY AFTER THE EPISODE, THE ACUTE EPISODE HAD PASSED; IS THAT CORRECT?
A THAT'S CORRECT.
Q NOW, THERE IS SOMETHING ELSE CALLED AN RA QUANT TEST, RIGHT?
A RIGHT.
Q AND THAT IS ANOTHER ASPECT OF LOOKING FOR A FINDING ASSOCIATED WITH RHEUMATOID ARTHRITIS, RIGHT?
A THAT IS CORRECT.
Q AND WOULD IT BE ACCURATE TO SAY THAT THE RA TEST IS A SLOWER TEST TO SHOW THE PRESENCE OF AN ACUTE EPISODE OF RHEUMATOID ARTHRITIS THAN THE CRP TEST?
A I THINK THAT WOULD BE FAIR.
Q ARE YOU SPECULATING OR DO YOU ACTUALLY HAVE SOME UNDERSTANDING OF THIS AREA?
A THE EXACT TIME COURSE I WOULDN'T CLAIM TO BE AN EXPERT ON.
Q I'M ASKING MR. FAIRTLOUGH NOW TO PUT THIS EXHIBIT 4 -- I'M SORRY -- 508 UP, AND I'VE OUTLINED IN BLUE THE TWO AREAS WE'VE BEEN TALKING ABOUT.
NOW, THE FIRST AREA -- AND MR. FAIRTLOUGH'S GOT IT THERE -- THAT'S WHAT WE WERE TALKING ABOUT, THIS CRP, THIS LIVER-GENERATED PROTEIN, RIGHT?
A CORRECT.
Q AND IF WE MOVE TO THE RIGHT WHERE IT SAYS "NEG," THAT'S THE TEST RESULT, CORRECT?
A THAT'S CORRECT.
Q IF WE MOVE TO THE NEXT FULL WORD, "NEGATIVE," AND GO UP A BIT, THERE'S SOME PREPRINTED INFORMATION REFERENCE RANGE; IS THAT CORRECT?
A THAT'S CORRECT.
Q AND THAT IS TO GIVE THE DOCTOR SOME INDICATION OF WHAT YOU WOULD EXPECT IN A HEALTHY PATIENT, RIGHT?
A THAT IS CORRECT.
Q AND SO IN THIS PARTICULAR TEST FOR CRP QUANT, IT'S NEGATIVE, WHICH IS EXACTLY WHAT YOU WOULD EXPECT IN THE HEALTHY PATIENT, RIGHT?
A THAT IS CORRECT.
Q NOW, IF WE DROP DOWN TO THE NEXT OUTLINED AREA, RA QUANT, YOU SEE THAT?
A YES, I DO.
Q AND THE RESULT, DOCTOR, THAT'S A LITTLE MATHEMATICAL SYMBOL MEANING LESS THAN 17.3, WHATEVER UNITS ARE BEING USED, RIGHT?
A THAT'S CORRECT.
Q AND THE REFERENCE RANGE FOR A NORMAL PERSON WOULD BE ANY RESULT WHICH WAS LESS THAN 20.0, CORRECT?
A THAT'S CORRECT.
Q SO, AGAIN, A NORMAL RESULT FOR MR. SIMPSON; ISN'T THAT CORRECT?
A THAT'S CORRECT.
Q AND AGAIN, THIS WOULD SUGGEST THAT MR. SIMPSON DID NOT HAVE AN ACTIVE EPISODE OF RHEUMATOID ARTHRITIS, CORRECT?
A IT WOULD BE ON THAT SIDE.
Q AND, DOCTOR, THEN YOU TALKED ABOUT SOMETHING CALLED A SEDIMENTATION RATE TEST, RIGHT?
A THAT'S CORRECT.
Q AND THAT WAS DONE ON THE 17TH; IS THAT CORRECT?
A NO. THAT WAS DONE ON THE 15TH.
Q I'M SORRY. THE TEST RESULTS WE'RE LOOKING AT -- ARE YOU SURE ABOUT THAT?
A THERE WAS ONE DONE ON THE 15TH AND THE 17TH.
Q ALL RIGHT.
IF WE COULD --
MR. KELBERG: MR. FAIRTLOUGH, YOU SEE WHERE IT SAYS "DATE COLLECTED"? THERE WE GO.
Q BY MR. KELBERG: THAT'S TO REFERENCE WHEN THE BLOOD SAMPLE WAS DRAWN, RIGHT? IS THAT CORRECT, DOCTOR?
A THAT'S CORRECT.
Q SO THIS TEST, SERIES OF TESTS IS FROM A BLOOD SAMPLE OF MR. SIMPSON'S DRAWN ON JUNE 15TH?
A THAT'S CORRECT.
Q BY THE WAY, DID MR. SIMPSON GRIMACE WHEN BLOOD WAS DRAWN ON THE 15TH?
A I WASN'T IN THE ROOM WHEN HE HAD HIS BLOOD DRAWN. SO I CAN'T ANSWER THAT.
Q ALL RIGHT.
NOW, ON THIS DOCUMENT, IS THERE ANY REFERENCE TO A SEDIMENTATION RATE TEST?
A NO, THERE IS NOT ON THIS DOCUMENT.
Q DOCTOR, WOULD YOU PULL OUT WHATEVER RESULT YOU HAVE OF A SEDIMENTATION RATE TEST DONE FROM A SAMPLE DRAWN ON THE 15TH?
A OKAY.
(BRIEF PAUSE.)
THE WITNESS: I KNOW IT'S IN HERE. HERE IT IS.
MR. KELBERG: MAY I APPROACH, YOUR HONOR?
THE COURT: YES, YOU MAY.
Q BY MR. KELBERG: AND, DOCTOR, LET ME GET THE PAGE NUMBER THEN SO THAT I'LL HAVE A REFERENCE ON THAT.
THIS IS ON PAGE I THINK 450 FOR COUNSEL'S INFORMATION.
DOCTOR, THIS FORM.
MR. KELBERG: AND, YOUR HONOR, MAY THIS BE MARKED AS 509, PLEASE?
THE COURT: YES.
PEOPLE'S 509.
(PEO'S 509 FOR ID = DOCUMENT)
MR. KELBERG: AND, MR. FAIRTLOUGH, YOU'RE GOING TO HAVE TO MOVE IT DOWN.
Q BY MR. KELBERG: DOCTOR, THAT SHOWS A SEDIMENTATION RATE OF 24; IS THAT CORRECT?
A THAT'S CORRECT.
Q THAT'S HANDWRITTEN; IS THAT CORRECT?
A THAT'S CORRECT.
Q WHAT'S THE SOURCE FOR THAT?
A OUR LAB IN OUR OFFICE.
Q I'M SORRY?
A OUR LAB IN OUR OFFICE.
Q SO THAT WAS A TEST THAT WAS DONE IN YOUR OFFICE?
A THAT'S CORRECT.
Q THE OTHER TEST RESULTS WERE SENT OUT?
A THE OTHER TEST RESULTS WERE SENT OUT. IN OTHER WORDS, WE DID AN INITIAL CBC. YOU CAN SEE THAT THAT'S PART OF IT. SO THAT'S HIS COMPLETE BLOOD COUNT BECAUSE WE WANTED TO KNOW INSTANTLY WHAT HIS WHITE BLOOD COUNT WAS.
Q DONE IN YOUR OFFICE?
A DONE IN OUR OFFICE INCLUDING A SEDIMENTATION RATE.
Q THAT HAS A COMPUTER GENERATED PRINTOUT; DOES IT NOT?
A YES, IT DOES.
Q WHY IS THERE NOT A SIMILAR FORMALIZED PRINTOUT OF THE SEDIMENTATION RATE?
A BECAUSE AT THAT TIME, WE DIDN'T HAVE THE COMPUTER SOFTWARE TO PRINT IT ALL OUT.
Q NOW, YOU HAD A SECOND SEDIMENTATION RATE TEST RUN ON A SAMPLE FROM THE 17TH; IS THAT CORRECT?
A THAT'S CORRECT.
Q AND WHAT WAS THE RESULT ON THAT?
A THE RESULT ON THAT WAS 17.
Q AND THAT IS MARGINALLY ELEVATED; IS THAT CORRECT?
A I WOULD SAY THEY'RE BOTH MARGINALLY ELEVATED.
Q NOT OF GREAT SIGNIFICANCE TO YOU, IS IT?
A I WOULD SAY MILD ELEVATION, PROBABLY A SHOULDER SHRUG. YOU DON'T KNOW WHICH WAY TO INTERPRET IT, BUT CERTAINLY NOT SKY HIGH.
Q ARE YOU FAMILIAR WITH THE TERM "PATHONOMIC"?
A YES.
Q WHAT DOES THAT TERM MEAN?
A WELL, PATHONOMIC WOULD MEAN SOMETHING WHERE YOU SEE A RESULT, AND YOU'RE -- IT'S COMPELLING EVIDENCE TOWARD A CERTAIN DIAGNOSIS.
Q WOULD IT BE ACCURATE TO SAY JUST GIVEN WHAT YOU TESTIFIED, THAT A SEDIMENTATION RATE OF 17 OR 24 WOULD NOT BE CONSIDERED PATHONOMIC FOR AN ACUTE EPISODE OF RHEUMATOID ARTHRITIS?
A NO, IT WOULD NOT.
Q IS THAT AN ACCURATE STATEMENT THAT I JUST MADE?
A AGAIN, RHEUMATOID ARTHRITIS IS VERY DIFFICULT BECAUSE IT'S NOT A LAB TEST DISEASE. RHEUMATOID ARTHRITIS IS A CLINICAL DISEASE AND THE DIAGNOSIS ITSELF IS BASED ON SEVEN CLINICAL CRITERIA, ONLY ONE OF WHICH IS REALLY A LAB TEST AND ONE OF WHICH IS AN X-RAY.
SO USUALLY RHEUMATOLOGISTS IN COUNTERDISTINCTION TO MANY OTHER MEDICAL SUBSPECIALTIES DON'T RELY THAT HEAVILY ON LAB TESTS ALTHOUGH THEY CERTAINLY HAVE A ROLE. AND AS FAR AS I'M CONCERNED, WHEN I SAW THAT RESULT INSTANTLY, THAT'S PART OF THE REASON WHY I DIDN'T PURSUE RHEUMATOID ARTHRITIS INITIALLY, BECAUSE I WAS LED AWAY FROM IT BY THESE INITIAL TWO RESULTS -- THREE RESULTS THAT YOU'VE POINTED OUT.
AND THAT'S WHY I WAS GOING THE OSTEOARTHRITIS ROUTE INITIALLY IN MY MIND, NOT THE RHEUMATOID ARTHRITIS ROUTE AS A CAUSE OF ALL OR A PREPONDERANCE OF HIS ORTHOPEDIC JOINT COMPLAINTS.
Q NOW, AS YOU TESTIFIED, I BELIEVE YOU SAID IN ARREARS SEVERAL TIMES. YOU GOT INFORMATION AFTER JUNE 17TH OF PRIOR MEDICAL CARE MR. SIMPSON HAD RECEIVED; IS THAT CORRECT?
A THAT'S CORRECT.
Q AND ONE ASPECT OF THAT INFORMATION WAS FROM DR. MALTZ?
A THAT'S CORRECT.
Q THE PERSON WHO HOLDS HIMSELF OUT AS A RHEUMATOLOGIST?
A THAT'S CORRECT.
MR. SHAPIRO: OBJECT TO THAT CHARACTERIZATION.
THE COURT: SUSTAINED.
REPHRASE THE QUESTION.
Q BY MR. KELBERG: DOCTOR, DO YOU KNOW WHETHER DR. MALTZ IS BOARD CERTIFIED IN RHEUMATOLOGY?
A I HAVE NOT REVIEWED HIS EXACT CREDENTIALS.
Q DO YOU KNOW WHETHER HE'S BOARD CERTIFIED IN INTERNAL MEDICINE?
A I HAVE NOT REVIEWED HIS EXACT CREDENTIALS.
Q DID YOU EVER GET DR. MALTZ' RECORDS?
A YES, I DID.
Q WHEN DID YOU GET THOSE RECORDS?
A PROBABLY SEVERAL MONTHS AGO.
Q AND IN FACT, YOU SPOKE TO DR. MALTZ FOR THE FIRST TIME, DID YOU NOT, ON JUNE 27TH OF 1994?
A THAT'S CORRECT.
Q SO WAS IT ACCURATE TO SAY THAT YOU FELT NOTHING FROM YOUR EVALUATIONS OF THE 15TH OR 17TH DICTATED AN IMMEDIATE CONSULTATION WITH DR. MALTZ?
A CORRECT.
Q AND IN GETTING THE RECORDS FROM DR. MALTZ, DID YOU FIND THAT IN 1992, WHEN MR. SIMPSON HAD COMPLAINTS THAT HAD HIM GO TO DR. MALTZ, THAT DR. MALTZ HAD A SEDIMENTATION RATE TEST RUN? DID YOU FIND THAT TO BE THE CASE?
A I'M NOT THAT FAMILIAR WITH HIS RECORDS. SO IF YOU COULD TELL ME WHAT IT WAS, I'D BELIEVE YOU.
MR. KELBERG: YOUR HONOR, I HAVE ANOTHER DOCUMENT. MAY THIS BE MARKED AS PEOPLE'S I GUESS 5 --
THE COURT: 10. 510.
(PEO'S 510 FOR ID = DOCUMENT)
MR. KELBERG: IT'S PAGE 686.
THE COURT: DO YOU HAVE THE ORIGINAL SO THE DOCTOR CAN SEE IT?
THE WITNESS: I BUY THAT.
THE COURT: YOU CAN READ THAT?
THE WITNESS: SURE.
MR. KELBERG: WELL, IF THE DOCTOR -- I'M NOT SURE THE DOCTOR HAS AN ORIGINAL. I THINK HE HAS A COPY AND WE GOT A COPY SOMEHOW.
UNFORTUNATELY, THE DATE, I'M NOT SURE IF THAT'S JUNE 27TH, 1992. PROBABLY NOT. I'M NOT SURE WHAT MONTH IT IS. BUT WHATEVER IT IS, IF -- MR. FAIRTLOUGH, JUST LEAVE IT RIGHT THERE.
Q BY MR. KELBERG: DO YOU SEE WHERE IT SAYS, LOOKS LIKE ESR 34?
A YES, I DO.
Q IS THAT A SEDIMENTATION RATE TEST RESULT?
A YES. ERYTHROCYTE SEDIMENTATION RATE, 34 MILLIMETERS PER HOUR.
Q AND IS IT ACCURATE TO SAY FROM YOUR UNDERSTANDING OF RHEUMATOLOGY, DOCTOR, THAT A PATIENT TENDS TO HAVE A PATTERN; THAT WHEN THERE ARE ACUTE EPISODES OF AN ONSET OF THE INFLAMMATION CAUSING SYMPTOMS OF DISCOMFORT AND SO FORTH, THAT A PATTERN CONTINUES SUCH THAT YOU WOULD SEE A SIMILAR SEDIMENTATION RATE RESULT IN EARLIER AND LATER EPISODES?
A I'M NOT REALLY AWARE OF ANY RESEARCH THAT SHOWS, YOU KNOW, A SIMILAR SEDIMENTATION RATE WITH EACH FLARE. SO I REALLY CAN'T COMMENT ON THAT. I HAVE NO KNOWLEDGE THAT THAT IS IN FACT FACTUAL.
Q YOU HOLD -- YOU DO NOT HOLD YOURSELF OUT TO BE AN EXPERT IN RHEUMATOLOGY?
A NO, I DO NOT.
Q ALL RIGHT.
WOULD YOU DESCRIBE A 34 AS SOMETHING OF GREATER SIGNIFICANCE TO YOU IF YOU HAD THAT RESULT THAN THE 24 AND THE 17?
A HONESTLY, I REGARDED EVERYTHING IN MY OWN MIND UP IN THAT RANGE AS MODESTLY, MILDLY ELEVATED. SO NO, I WOULDN'T SAY THERE'S MUCH OF A DIFFERENCE BETWEEN 24 AND 34 VERY FRANKLY.
Q NOW, INCIDENTALLY, I THINK YOU MENTIONED THAT FROM YOUR UNDERSTANDING OF RHEUMATOLOGY, THAT IT TENDS TO BE A BILATERAL, A SYMMETRICAL KIND OF DISEASE, A FANCY WAY OF SAYING IF YOU SEE SOMETHING ON THE LEFT MIDDLE FINGER, YOU SHOULD EXPECT TO SEE SOMETHING ON THE RIGHT MIDDLE FINGER, THAT KIND OF THING, CORRECT?
A I AGREE. AND THAT IN FACT IS ONE OF THE SEVEN DIAGNOSTIC CRITERIA FOR RHEUMATOID ARTHRITIS.
Q WHEN YOU EXAMINED IN THE ORTHOPEDIC EXAMINATION OF JUNE 13TH, DID YOU SEE SUCH SYMMETRY BETWEEN THE LEFT AND RIGHT HANDS OF MR. SIMPSON?
A THERE WASN'T -- NO. THERE WASN'T STRIKING SIMILARITY BECAUSE THE LEFT WRIST WAS SO MUCH MORE -- WAS SEVERELY INVOLVED AND THE RIGHT WRIST SEEMED RELATIVELY NORMAL.
Q AND DID YOU -- YOU SAID THE GRIP TEST -- YOU DID A GRIP TEST ON BOTH HANDS?
A YES, I DID.
Q AND IN YOUR OPINION, THEY WERE BOTH NORMAL; IS THAT RIGHT?
A RIGHT. THAT'S LISTED UNDER THE MOTOR IN THE NEUROLOGIC EXAM.
Q DOCTOR, WOULD YOU SHOW US -- AND PERHAPS YOU NEED ME TO BE THE PATIENT -- HOW THE GRIP TEST YOU DID WAS CONDUCTED?
MAY I, YOUR HONOR?
LET'S START WITH THE RIGHT HAND.
A OKAY.
BASICALLY, I'LL SAY TAKE MY TWO -- ACTUALLY I DO IT WITH BOTH BECAUSE I WANT TO COMPARE SIMULTANEOUSLY.
Q OKAY.
A SO I'LL JUST SAY --
Q LIKE THIS?
A -- SQUEEZE AS HARD AS YOU CAN. AND THEN I'LL SOMETIMES FIGHT TO TRY TO GET OUT, AND THAT BASICALLY ASSESSES YOUR GRIP (DEMONSTRATING).
Q NOW, IS THERE ANY WAY AT THAT TIME THAT YOU CAN TRULY ASSESS THE LEVEL OF COOPERATION OF THE PATIENT?
A NO, THERE'S NOT.
Q IF YOU WOULD RETAKE THE STAND.
A (THE WITNESS COMPLIES.)
Q AND, DOCTOR --
A ALTHOUGH IF THE PATIENT DOESN'T COOPERATE OR IS WEAK, THEN YOU REFER THEM FOR FURTHER TESTS INCLUDING ENG -- ENG AND WHATNOT, AND YOU MAY BETTER ASSESS THAT, BUT --
Q DOCTOR, IS IT IMPORTANT IN EVALUATING PATIENTS TO PROVIDE SOME RECORD THAT IS OF SOME OBJECTIVE NATURE SO THAT DOCTORS WHO MAY SEE THE PATIENT DOWN THE LINE IN TIME AND WHO MAY NOT HAVE BEEN PRESENT FOR THE EARLIER EXAM CAN EVALUATE ANY CHANGES BETWEEN YOUR EXAM AND LATER EXAMS?
A THAT'S CERTAINLY HELPFUL IF YOU HAVE THAT DOCUMENTATION ABILITY, SURE.
Q AND WITHOUT SOME OBJECTIVE STANDARD FOR EVALUATING THE GRIP TEST YOU DID, HOW WOULD A DOCTOR BE ABLE TO ASSESS WHETHER OR NOT THERE'S A CHANGE DOWN THE ROAD GIVEN YOUR SUBJECTIVE EVALUATION THAT HIS GRIP TEST RESULT WAS NORMAL?
A WELL, IF HIS GRIP WAS WEAK OR ONE SIDE WAS WEAKER THAN THE OTHER, THEN YOU WOULD HAVE TO ASSUME THAT THERE WAS A CHANGE THAT NEEDED EVALUATING.
Q BUT WEAKNESS IS A SUBJECTIVE EVALUATION. THERE ARE TESTS THAT QUANTIFY THE GRIP STRENGTH, CORRECT?
A YES. THAT'S TRUE. BUT IF YOU HAVE A FIRM STRONG GRIP STRENGTH AND IT'S EQUAL ON BOTH SIDES, TYPICALLY THERE'S NO NEED TO FURTHER GO INTO IT.
IN OTHER WORDS, YOU CAN KEEP DOING TESTS. YOU CAN SAY I'M HEALTHY AND YOU CAN DO AN EKG AND A STRESS TEST AND A STRESS THALLIUM AND THEN YOU CAN -- YOU KNOW, ARE YOU GOING TO DO AN ANGIOGRAM ON EVERYONE. HOW FAR DO YOU PUSH ON SOMEONE WHERE YOUR INITIAL TESTS ARE REVEALING GENERAL NORMALCY.
Q AND THAT'S WHY YOU DIDN'T HAVE ANY FURTHER ORTHOPEDIC TESTS ORDERED FROM THE JUNE 15TH EXAMINATION, RIGHT?
A FOR THE GRIP, THAT'S CORRECT.
Q OR FOR ANYTHING ELSE?
A NO. THERE IS A PLAN.
PUT -- PROBA -- PUT APPROPRIATELY OR NOT, TO HAVE HIM SEE AN ORTHOPEDIST IN THE FUTURE FOR HIS ANKLE AND KNEE PROBLEMS WHICH I DIDN'T THINK WERE COMMISERATE WITH A GOOD QUALITY OF LIFE AND WITH THE ABILITY TO PLAY GOLF IN A PAIN FREE STATE. SO THERE WAS A PLAN, BUT CERTAINLY THAT WAS NOT SOMETHING THAT NEEDED TO BE DONE OVER A VERY BRIEF PERIOD OF TIME.
Q A NUMBER OF AREAS I WANT TO TALK ABOUT, BUT I HAVE JUST A FEW MINUTES TO TALK BEFORE WE BREAK FOR THE DAY APPARENTLY.
YOU TALKED ABOUT OBSERVING WHAT YOU THOUGHT TO BE SOMEWHAT RAGGED EDGES IN AT LEAST ONE IF NOT MORE OF THE CUTS ON MR. SIMPSON'S HAND; IS THAT CORRECT?
A THAT'S CORRECT.
Q DOCTOR, WHEN A PERSON SUSTAINS AN INJURY LIKE THAT, HOWEVER IT WAS CAUSED --
A UH-HUH.
Q -- IS THERE AN IMMUNOLOGICAL REACTION THAT RELEASES SOMETHING CALLED PHAGOCYTES, P-H-A-G-O-C-Y-T-E-S, INTO THE INJURED AREA?
A ACTUALLY INITIALLY, IN THE FIRST 24 HOURS, IT'S INFLAMMATORY CELLS. SO IT'S MORE NEUTROPHILS WOULD COME IN WITHIN THE FIRST 24 HOURS.
SO PHAGOCYTES IS A LATER STAGE, AND THAT -- ACTUALLY MONOCYTES IS A BETTER NAME FOR THAT CELL, AND THAT TYPICALLY WON'T ARRIVE AT THE SIGHT OF THE INJURY UNTIL MORE LIKE THE SECOND TO THE FIFTH DAY.
Q ALL RIGHT.
AND YOU WERE SEEING MR. SIMPSON ON THE 15TH OF JUNE; IS THAT CORRECT?
A THAT'S CORRECT.
Q AND ASSUMING THAT THESE INJURIES WERE SUSTAINED IN THE EVENING OF JUNE 12TH, THAT WOULD NOW MEAN THE EXAMINATION IS TAKING PLACE ALMOST THREE DAYS LATER, TWO AND A HALF TO CLOSING IN ON THREE DAYS LATER, RIGHT?
A THAT'S CORRECT.
MR. SHAPIRO: OBJECTION. MAY WE APPROACH THE BENCH, YOUR HONOR?
THE COURT: I THINK YOU SHOULD PHRASE THAT AS A HYPOTHETICAL QUESTION.
MR. KELBERG: OKAY. SURE.
Q BY MR. KELBERG: ASSUMING, DOCTOR, THAT THESE INJURIES WERE SUSTAINED, SOME OR ALL, ON JUNE 12TH AROUND 10:15 IN THE EVENING AND YOUR EXAMINATION IS TAKING PLACE BETWEEN NOON AND 2:00 O'CLOCK IN THE AFTERNOON ON JUNE 15TH, WE'VE GOT MORE THAN TWO AND A HALF DAYS THAT HAVE PASSED, CORRECT?
A CORRECT.
Q AND IF -- WE'LL USE YOUR TERM "MONOCYTES."
THE MONOCYTES YOU WOULD EXPECT COULD HAVE BEEN ALREADY WORKING ON THE INJURED AREA, RIGHT?
A ASSUMING THAT HYPOTHETICAL INFORMATION, YES.
Q AND, DOCTOR, IN FACT, DON'T SUCH CELLS IN ESSENCE EAT UP THE DAMAGED AREA BEFORE THE BODY STARTS TO LAY DOWN NEW CELLS?
A THAT'S CORRECT.
Q AND BY EATING UP THE DAMAGED AREA, IT CREATES A RAGGED APPEARANCE; DOES IT NOT?
A IT CREATES ERYTHEMA, REDNESS AROUND THE RIM. THE RAGGED EDGE THAT I WAS REFERRING TO SPECIFICALLY ON THE LEFT FOURTH INDEX FINGER WAS THE SLIGHT SNAKE LIKE APPEARANCE, THE IN AND OUT COMPONENTS RATHER THAN JUST A NICE SMOOTH SLIT LIKE YOU MIGHT EXPECT WITH MORE LIKE A SURGICAL KNIFE OR SOME OTHER, YOU KNOW, INSTRUMENT OF THAT NATURE.
Q MY QUESTION THOUGH, DOCTOR, WAS, WILL SUCH MONOCYTES, PHAGOCYTES IF YOU WANT TO USE MY TERM, LEAVE EVIDENCE OF A RAGGED APPEARANCE TO THE AREA OF THE INJURED TISSUE WHERE THEY HAVE BEGUN TO WORK?
A RIGHT WHERE THE POINT OF THE INCISION IS, I DON'T BELIEVE SO.
WHAT HAPPENS IS, ESPECIALLY THE WOUND OVER THE THIRD WAS WIDENED BECAUSE THAT WAS DIFFERENT THAN THE OTHER ONES BECAUSE IT WAS RIGHT AT A JOINT LINE. AND SO WHAT HAPPENS IS, THERE'S THIS KIND OF THIS FIBRINOUS EXUDATE THAT -- THAT -- THIS -- YOU KNOW, IT'S A SCAB BASICALLY THAT -- THAT -- YOU KNOW, THE YELLOW STUFF THAT COMES OUT AFTER CUTS SECRETES IN THERE. AND THAT WOUND -- THEN THE ONE HERE WAS SUBSTANTIALLY MORE OPEN THAN HIS OTHER WOUNDS (INDICATING).
YOUR QUESTION -- AND I UNDERSTAND IT -- IS, WHEN YOU LOOK AT THE EDGE, CAN YOU TELL IF IT'S A SERRATED OR AN UNDULATING LINE OR A STRAIGHT SLICE AND IS THAT AFFECTED BY THE SEVERAL DAYS OF THIS BATTLE GOING ON, FIRST WITH THE INFLAMMATORY, THEN THE MONOCYTE PHASE BEFORE THE COLLAGEN AND THE SCARRING STATE SETS IN.
AND CERTAINLY, WITH RELATIVE HYDRATION AND DEHYDRATION, YOU COULD GET EDGES THAT MIGHT POTENTIALLY CONFUSE YOU. I'D HAVE TO SAY THAT THAT'S PROBABLY TRUE.
Q AND, DOCTOR, YOU SAID IN RESPONSE TO MR. SHAPIRO'S QUESTION THAT A KNIFE COULD GIVE THE APPEARANCE OF A CUT THAT YOU BELIEVE WAS DUE TO GLASS; IS THAT CORRECT?
A I THINK THERE ARE CERTAIN GLASS CUTS THAT CAN MIMIC KNIFE CUTS.
Q AND THERE ARE KNIFE CUTS THAT CAN MIMIC GLASS CUTS, RIGHT?
A I THINK WITH A KNIFE, IF YOU'RE -- IF YOU'RE A SURGEON, YOU CAN MIMIC A LOT OF THINGS.
Q WELL, DOCTOR, IN YOUR EXPERIENCE, IN THE ER ROOM, WITH RESPECT TO -- I'LL USE THE TERM "SHARP FORCE INJURY" FROM A SHARP KNIFE IN GENERAL, THE HISTORY IS NOT TERRIBLY IMPORTANT TO YOU IF YOU SEE A WOUND THAT IS BLEEDING, RIGHT?
A NO. THAT'S NOT TRUE BECAUSE OBVIOUSLY THE FIRST THING YOU WANT TO KNOW IN A WOUND THAT'S BLEEDING IS WHAT'S THE INFECTION, WHAT'S THE TIME THAT THE WOUND HAS BEEN OPEN BECAUSE WE KNOW IN THE FIRST SIX TO EIGHT HOURS, THAT BACTERIA MULTIPLIES, THAT YOU HAVE A HUNDRED MILLION, YOU KNOW, BACTERIA PER MILLIMETER.
THAT'S VERY IMPORTANT. SO THE HISTORY IS CRUCIAL IN CUTS AS WELL AS EVERY OTHER PART UNLESS THE PERSON IS BLEEDING IN SUCH A STATE THAT YOU FEEL THEIR MYODYNAMIC STATUS IS GOING TO BE COMPROMISED. SO YOU ACT QUICKLY TO NEGATE THE ARTERY BLEEDING.
Q DOCTOR, IN THE KINDS OF CUTS THAT YOU SAW MR. SIMPSON HAD, THESE WERE NOT LIFE-THREATENING OBVIOUSLY?
A NO, THEY WERE NOT.
Q BUT WHEN YOU SEE SUCH CUTS IN AN EMERGENCY ROOM, ONE OF THE ISSUES IS, DO I HAVE TO SUTURE IT OR IS IT GOING TO HEAL NATURALLY, RIGHT?
A THAT'S ABSOLUTELY CORRECT.
Q AND THAT HAS MORE TO DO WITH THE DEPTH OF THE INJURY THAN THE SOURCE OF THE INJURY, CORRECT?
A THERE ARE MANY FACTORS THAT GO INTO WHETHER OR NOT YOU WILL SUTURE A WOUND, INCLUDING DEPTH, POSITION OVER MOVABLE JOINTS, COSMETIC FACTORS AND CONVENIENCE FACTORS.
Q BUT THE QUESTION WAS, IT'S MORE IMPORTANT, THE DEPTH THAN WORRYING ABOUT THE CAUSE, CORRECT?
A IT'S MORE IMPORTANT, THE DEPTH. YOU WANT TO DO IT IN THE CHEAPEST WAY POSSIBLE, AND OBVIOUSLY VERY DEEP LESIONS ARE LESS LIKELY TO HEAL SPONTANEOUSLY THAN VERY SUPERFICIAL INJURIES.
MR. KELBERG: YOUR HONOR, WHEREVER THE COURT WISHES TO TAKE A RECESS.
THE COURT: SOUNDS GOOD TO ME.
ALL RIGHT.
LADIES AND GENTLEMEN, WE ARE GOING TO TAKE OUR RECESS FOR THE NOON HOUR.
PLEASE REMEMBER ALL MY ADMONITIONS TO YOU; DON'T DISCUSS THE CASE AMONGST YOURSELVES, DON'T FORM ANY OPINIONS ABOUT THE CASE, CONDUCT ANY DELIBERATIONS UNTIL THE MATTER HAS BEEN SUBMITTED TO YOU, DO NOT ALLOW ANYBODY TO COMMUNICATE WITH YOU WITH REGARD TO THE CASE.
AS FAR AS THE JURY IS CONCERNED, WE'LL STAND IN RECESS UNTIL 9:00 A.M. MONDAY.
DOCTOR, YOU MAY STEP DOWN. YOU ARE ORDERED TO RETURN MONDAY MORNING 9:00 O'CLOCK.