Commonwealth v. Read — Trial ArchiveGary Faller - Direct/Cross/Redirect/Recross
185 linesMR. LALLY: Yes, Your Honor. The Commonwealth calls Dr. Gary Faller to the stand.
JUDGE CANNONE: All right. Your next witness, Mr. Lally?
COURT OFFICER: Raise your hand. juror count
COURT CLERK: Sir, raise your right hand, please. Do you swear to tell the truth, the whole truth, and nothing but the truth?
DR. FALLER: I do.
JUDGE CANNONE: Whenever you're ready, Mr. Lally.
MR. LALLY: Thank you, Your Honor. Good afternoon, sir.
DR. FALLER: Good afternoon.
MR. LALLY: Could you please state your name and spell your last name for the record?
DR. FALLER: Gary Faller. F-A-L-L-E-R.
JUDGE CANNONE: Sir, that microphone in front of you — you can move that any way you wish. If you want to bring it up or down, just adjust it, okay?
DR. FALLER: Okay.
MR. LALLY: And what do you do for a living, sir?
DR. FALLER: I'm a pathologist.
MR. LALLY: And where is it that you work?
DR. FALLER: I work at Good Samaritan Medical Center.
MR. LALLY: And how long have you been working as a pathologist at Good Samaritan?
DR. FALLER: Since November of 2015.
MR. LALLY: Now, if I could ask you just a few questions about your educational background — starting with your undergrad, where did you go to school and what, if anything, did you receive a degree in?
DR. FALLER: My undergraduate education — I went to Tufts University.
JUDGE CANNONE: All right, Doctor, I'm going to ask you to put the microphone perhaps underneath your mouth and speak into it, because in order to keep this room cool we need to have these fans going. If they can't compete with you we'll have to turn them off, and I think everybody would prefer to have them on. So please speak loudly.
DR. FALLER: How am I now?
JUDGE CANNONE: Okay, okay.
DR. FALLER: So, Tufts University — undergraduate, I have a degree in biology.
MR. LALLY: And after you received your degree in biology from Tufts, where did you go from there?
DR. FALLER: I went to Tufts Medical School in Boston for four years.
MR. LALLY: And after you graduated from medical school, where did you go from there?
DR. FALLER: I went to a residency in pathology — anatomic and clinical pathology — at Tufts Medical Center, so I stayed within the Tufts system.
MR. LALLY: And how long was that residency?
DR. FALLER: That residency was — at the time, a pathology residency was five years. It's now four years, I believe, but it was a five-year program. I finished the residency as the chief resident in pathology in my fifth year.
MR. LALLY: And then following your residency, where did you go for work?
DR. FALLER: In 1996 I finished residency and my first job was at Carney Hospital, beginning the end of June of 1996.
MR. LALLY: And how long did you work at Carney?
DR. FALLER: I'm still on medical staff at Carney. Ever since — I was transferred to help Good Samaritan Medical Center in 2015. My full-time job is at Good Samaritan now since 2015, but I still cover Carney Hospital every now and then.
MR. LALLY: And are you board certified?
DR. FALLER: I am board certified in both anatomic and clinical pathology.
MR. LALLY: You've used that term — and just if you could explain to the jury what your understanding of that term is, as far as pathology and the difference between anatomic pathology and clinical pathology?
DR. FALLER: Sure. In pathology, there are two sub-specialties. One is anatomic pathology, which is basically — if you, as a patient, go to a hospital or have a biopsy, a tissue biopsy, or an excision, or anything like that, it comes to the Pathology Department and an anatomic pathologist is responsible for making the diagnosis for that patient. We abbreviate that as AP. — anatomic pathologist. So in residency you can also train to become a clinical pathologist, and a clinical pathologist is a pathologist who basically deals with — to put it simply — if you have a blood test that gets sent to the lab, we are essentially responsible for the quality and the safety of that blood test, to help ensure the lab tests that are done on the specimens are accurate.
MR. LALLY: Now, with regard to your position at Good Samaritan, what is it that you do at Good Samaritan? What are your sort of duties and responsibilities in relation to that hospital?
DR. FALLER: I am the chief of pathologist at Good Samaritan Medical Center, also the laboratory medical director. So my job at Good Samaritan is to ensure quality of both the anatomic pathology side of things as well as the clinical pathology side of things. Ultimately my job is to help ensure that any laboratory report coming from Good Samaritan is accurate.
MR. LALLY: Now, the lab at Good Samaritan where the testing is done — is that accredited?
DR. FALLER: Yes it is.
MR. LALLY: And can you explain to the jury sort of what that accreditation means, who it's by, and sort of what goes into that accreditation process?
DR. FALLER: We are accredited by the College of American Pathologists. We abbreviate that as CAP — if I mention that later, just so you know. And the accreditation process — CAP has been in business for about 75 years, and they, according to their website, are the preeminent accrediting body for medical laboratories. So what that means is every two years we have an in-depth laboratory survey — that's every two years — and there are over maybe 3,000 elements, or checklist requirements, that the CAP will look at in our lab, which ranges from anywhere — for quality, mainly quality control — making sure that we have enough staff members, just about anything that can affect a laboratory result. There is essentially a checklist requirement that we need to fulfill and pass. So that's every two years.
MR. LALLY: And is that accreditation up to date as of now?
DR. FALLER: Yes it is. We will be having another inspection — our window opens in July, so it's coming up. We have a three-month window where the CAP can come anytime unannounced.
MR. LALLY: And was that accreditation up to date prior to January 29th, 2022? Now, as far as the clinical portion of the lab, what are some of the things that get tested as far as blood work is concerned?
DR. FALLER: Many different things. When you go to a hospital — as probably all of you know — you have your blood tested, and the physician is looking for different tests, such as a sodium, a potassium, a chloride — some basic tests that, if they show abnormality, could help the clinician make a diagnosis on you. So the most common things would be like a glucose, sodium, potassium, chloride — stuff like that.
MR. LALLY: Now, is there some sort of standard algorithm for things that are tested, or does it sort of depend on the patient's presentation?
DR. FALLER: I think it depends on the patient's presentation. There's no standard ordering test that one can order. So it depends mainly on what the doctor is thinking and his differential diagnosis — he will order a variety of different tests. Some tests are pretty standard when you go to a hospital — might order, you know, the tests that I just talked about, a CBC — they want to look at your complete blood count.
JUDGE CANNONE: Just a little louder, please.
DR. FALLER: Okay, sure. So things like that — want to look at your hemoglobin, hematocrit, maybe sodium, potassium — those are some of the really common tests that would get ordered in the hospital.
MR. LALLY: Now, as far as drugs of abuse, including alcohol — is that something that's dependent upon the presentation of a patient to your facility?
DR. FALLER: I think an alcohol test or drug of abuse test is not a routine type of order or test. It all depends on if the clinician or the primary care physician is suspecting drugs of abuse or alcohol on board, and they need to know if so to help treat the patient.
MR. LALLY: And would that also include sort of a patient that presents with regard to a mental health status or section 12 — drugs of abuse, would that be somewhat standard in relation to testing or blood work that's done in relation to that kind of patient?
DR. FALLER: As far as section 12, I do not know if there is a standing order for a routine ordering process for a patient that is admitted to Good Samaritan under section 12. So I'm not sure.
MR. LALLY: Would that be abnormal, though, as far as doing a blood draw, testing for alcohol, in someone presenting on section 12?
DR. FALLER: I don't think so. No.
MR. LALLY: Now, with regard to a blood draw in Good Samaritan Hospital, with reference to testing for alcohol specifically — what, if any, sort of policies or protocols are in place in reference to that type of blood draw?
DR. FALLER: I think a test for blood alcohol — the phlebotomist pretty much has to run through the same protocol that he or she needs to follow for any type of blood test, except for the fact that we do not want to use an alcohol swab to clean the area before the blood draw. In theory, if you use an alcohol swab and you're testing for alcohol, then you can contaminate the blood sample with some of the residual fluid of the alcohol. Some people say if you let the alcohol swab dry for 30 seconds it's not going to contaminate it, but we don't go by that process. We have specifically in our policy never to use an alcohol swab when an alcohol test is ordered.
MR. LALLY: Now, in that vein, Doctor, with reference to Good Samaritan in the emergency department — what, if any, precautions has your facility taken in regard to those types of blood draws in testing for alcohol, with regard to alcohol wipes?
DR. FALLER: My phlebotomy supervisor has removed essentially all — not 100%, but all — of the alcohol swabs down in the emergency room, so a phlebotomist who perhaps could, you know, forget — which they shouldn't, because we have competency policies for them — so we have that in place where she's removed almost all of them, to ensure somebody can't mistakenly use a swab down in the emergency room.
JUDGE CANNONE: Okay, so keep your voice up, please, Doctor — especially at the end of your sentences. Thank you.
MR. LALLY: And so does the removal of those alcohol wipes from the Emergency Department of Good Samaritan — does that predate January 29th, 2022?
DR. FALLER: It's been in place for a long time before that. Now, there was a policy where we would use Betadine for swabbing, but that policy has been in place for a long time.
MR. LALLY: And before that — before that day of 2022 — you've spoken a little bit about phlebotomists working within Good Samaritan. If you could just explain to the jury what a phlebotomist is and what it is that they do.
DR. FALLER: A phlebotomist is any person who is trained to draw your blood when you come to a hospital. So if you come in, we train people to draw the blood.
MR. LALLY: And as far as phlebotomists at Good Samaritan — you mentioned that there's some proficiency testing or some protocols that they have to adhere to. Can you explain that a little bit more to the jury as far as what's involved?
DR. FALLER: So with anybody who works in the laboratory, per CAP checklist requirements and the government's requirements, there has to be competency policies and assessments on anybody who works in our laboratory, including phlebotomists. So any new phlebotomist gets initial training, and they'll get a training and then have to be assessed to make sure that they know what their job requires, including knowledge of all policies. Then after initial training, our competency policy states that we need to assess them again at six months — we do the same thing, make sure they know what they're doing — and then six months from that, so that's a year from when they started working for us, and then annually thereafter.
DR. FALLER: So the CAP — we have all these competency policies for everyone to make sure the lab technicians know what they're doing. We also have competency policies for pathologists as well. So it's all about making sure the final result that comes from our lab is good quality.
MR. LALLY: May I approach the witness? I'm showing you two sets. Just in general, do you recognize what those are?
DR. FALLER: Yes.
MR. LALLY: And what do you recognize those as?
DR. FALLER: They're two of our policies that we have for Good Samaritan Medical Center — one for the phlebotomist and one for our laboratory technicians. The first one is a patient preparation for specimen collection policy, which defines our policy for drawing the blood for the phlebotomist. The second is an alcohol policy, which is one of — I don't know — thousands of policies that we have in the lab, to describe our policy for alcohol testing. Every laboratory test in our ...our hospital has a separate policy — everything from [unintelligible] to sodium to potassium chloride has its own policy.
MR. LALLY: Is that correct?
DR. FALLER: Correct.
MR. LALLY: And the policy you have before you, that's for alcohol testing?
DR. FALLER: Correct.
MR. LALLY: And the two policies that you have before you — were those policies what was in place on January 29th, 2022?
DR. FALLER: Correct. Yes.
MS. LITTLE: No objection.
MR. LALLY: May I introduce and admit these exhibits? Any objection?
JUDGE CANNONE: All right. So, Madam Clerk, I don't think we marked these into evidence, did we? Do we have that ready to go into evidence? court clerk: I don't believe so. All right, so these instead, Madam Clerk, will be the next two exhibits. Thank you. And would — is [Exhibit] 107 —
MR. LALLY: Madam Clerk — I believe 107 is in reference to the alcohol testing, and 108 would be in reference to the sample collection.
JUDGE CANNONE: All right, thank you.
MR. LALLY: May I approach the witness?
JUDGE CANNONE: Yes.
MR. LALLY: I'm just showing you a document as far as some medical records. Are you familiar with those records?
DR. FALLER: Yes. Those records are in relation to a patient named Karen Read who visited Good Samaritan on January 29th, 2022.
MR. LALLY: Is that correct?
DR. FALLER: Correct.
MR. LALLY: Now, with reference to — may I approach again, Your Honor? Just —
JUDGE CANNONE: Yes, sure.
MR. LALLY: Directing your attention to a previously tabbed portion of those records — do you see a result for alcohol within those records?
JUDGE CANNONE: Mr. Lally, you have to keep your voice up when you're here as well.
MR. LALLY: Let me say it again, sir. Doctor, with reference to those records, in the page that I've opened up to — do you see a record in regard to lab results for alcohol testing with regard to Miss Read?
DR. FALLER: Yes.
MR. LALLY: And what is it reported as, sir?
DR. FALLER: It is reported at 93 mg per deciliter.
MR. LALLY: And as far as milligrams per deciliter — is that a relatively standard way of reporting an alcohol result?
DR. FALLER: Yes, it is in our hospital systems.
MR. LALLY: Could you explain to the jury milligrams per deciliter — what that reading means as far as the metric that's used?
DR. FALLER: Well, it means 93 milligrams of alcohol per deciliter of the blood.
MR. LALLY: And if you could explain to the jury the testing process or the protocols that are in place at Good Samaritan — so the blood is drawn by the phlebotomist, and then what happens from there as far as the testing is concerned?
JUDGE CANNONE: Okay. So, before you do that, doctor — we might have to turn off the fans, which we don't want to do. I really need you to keep your voice up so that the court officer over there — so that folks down there can hear you, okay?
DR. FALLER: So at Good Samaritan, I can go through the process. The doctor will order the test. In the emergency room, we have two phlebotomists down in the emergency room. That test will print out — the order will print out down in the emergency room. It will print out a label for the blood tube. It will print out on that label the color of the blood tube to be ordered, and we also print out on the label what is to be tested in our lab. So that order will be seen by our phlebotomist in the emergency room. They will then locate the patient and perform the venipuncture — or the blood draw — and use the correct tube. They'll go through their process of the number one — one of the most important processes in testing somebody's blood is accurate patient identification.
DR. FALLER: So within our policy, we ask the patient to state his or her first and last name and date of birth. We have them say it out loud to make sure we have two forms of identification. Once that's confirmed, there's also a bracelet on the patient, so we'll match it up with a Good Samaritan ID number. So the first step is to make sure we have the correct patient. So then the phlebotomist has the order in front of her or him, and uses the correct tube. Before drawing, they have to find the correct vein — a good vein for the patient — which is usually in the forearm antecubital fossa area. They will find that vein, they will cleanse the area with a non-alcohol swab — which, in this case, the order was for alcohol. So —
JUDGE CANNONE: Doctor, I'm sorry — I'm going to stop you. I think part of it is that you're saying so much, and your voice is fine, and then it drops, and it's fine, and it drops. So — Paul, can we turn the fans off, please? It's important that all the jurors hear everything you say, doctor.
DR. FALLER: Yeah, sorry.
JUDGE CANNONE: Okay, so — speak into the mic. I'm going to bring it really close. All right, this should be better. Hopefully we can turn it back on when you get better at this. I'm sorry — it's hot.
DR. FALLER: I'm hot too. So, one is we make sure it's correct patient identification. We use the correct tube. We draw it — we don't use an alcohol swab, we use one that doesn't contain alcohol. Then the phlebotomist will put the labels on the tube or tubes in front of the patient, then bring it back to his or her area. They initial their name on the tube as well as the time. Then it will be put into a bag, and in the emergency room it goes through a chute and it goes directly to our laboratory for testing. Once we get it — it's called "receiving" — the blood work. A technician, a lab tech in our lab, will scan — there's a barcode on the label — they'll scan it, and that will document the time that we received it.
DR. FALLER: They will also manually enter the name of the phlebotomist and the time of the blood draw, so we have accurate records of what we received and the time. Once that's done, it's entered into our system, and then the technician will decide what needs to go next. In this case of an alcohol test, we're using a green top tube, which has lithium heparin — has an anticoagulant in it — to prevent clotting. So we'll get that tube, and once it's entered, we will centrifuge it. That is centrifuged for about 10 minutes or so, so that we can separate the layers of the blood. In the blood, when you first see blood, it's all red and there's no separation of the elements. But within blood, there are red blood cells, there are white cells or inflammatory cells, and there's the liquid portion of the blood.
DR. FALLER: So for alcohol testing, there's an anticoagulant in it, and so we will centrifuge it to separate the different layers of the blood. The red cells will go to the bottom, and the aqueous portion, or the plasma portion, will go to the top. And when we test for blood alcohol in our lab, we're testing the aqueous — the plasma portion — of the blood. So that's why it's important for us to centrifuge it and separate the components. Once that is done — that takes about 10 minutes or so, maybe a little bit longer — then that tube will be brought over to our machine, which is a Roche cobas machine. And it will be put onto the machine, and that machine will test for the alcohol, or whatever else is ordered for the patient. I think I covered everything.
MR. LALLY: Now with regard to — you use the term a couple of times — as far as a centrifuge, can you describe to the jury what that is and how that instrument works?
DR. FALLER: Sure. So, the tube that we take is a blood tube, and we want to test the aqueous plasma portion of the blood. The only way to get that plasma portion — or the watery solution of the blood — is we put it in a centrifuge, which will spin the blood at a rapid rate — something like 3,300 RPMs or so, which is fast — and it will separate the blood into those three layers. Also in the tubes that we use is a gel that comes in the tube, and it nicely separates the red blood cell component from the water, or aqueous plasma, component, and keeps those two portions of the blood separate, to make it easier for us to test on our machine.
MR. LALLY: Now, as far as the blood testing is concerned, is there a difference between what's known as whole blood versus serum and plasma?
DR. FALLER: There is a difference. Whole blood is basically the whole blood — when somebody has a test drawn and we test something on the entire blood without separating it, that would be whole blood. If we say we're testing on plasma or serum, we're actually separating the components of the blood by the centrifuge process.
MR. LALLY: Now, which of the two — as far as serum/plasma versus whole blood — which would record a higher percentage of alcohol in the testing?
DR. FALLER: Alcohol — the answer would be that plasma or serum would have a little bit higher blood alcohol content compared to whole blood.
MR. LALLY: As far as the separation that you're talking about, is there a specific area as far as the separation is concerned where alcohol tends to concentrate within?
DR. FALLER: Yes. Alcohol tends to go more into the watery, or the aqueous, component of the blood. So, serum or plasma has a reportedly 98% water component. Whole blood — if you look at the whole blood overall, it has a lesser percentage — if you look in the literature, it can be 86%, or there's a range. But since alcohol tends to go to the watery components, if you measure alcohol — like we do in hospitals — on the serum or plasma, the value that we get will always be a little bit higher than measuring on whole blood.
MR. LALLY: Are you aware of, through your training and experience, sort —
DR. FALLER: Of a conversion that can be done between sort of what's reported as a testing from serum plasma to a whole blood count. In the hospital, we're pretty much in the business of reporting alcohol in serum or plasma, and we're not in the business of — I guess — the legal aspects of alcohol testing. Because alcohol — what I understand is the alcohol legal limit in Massachusetts is 0.08 grams per deciliter. We don't make any conversions in a hospital; we're not in that business to do that. We just report on the serum percentage and/or the plasma level. And we don't make any attempts to do any official conversion to whole blood level. If we did, we'd have to validate, we'd have to do many studies, and we're just not in the business for that.
MR. LALLY: And I understand that's not how it's reported within your record or at your facility. What my question is: are you aware of a process by which you can sort of then mathematically convert from milligrams per deciliter to a grams —
DR. FALLER: I am aware of that. Recently I had to read about it, but up until recently I was not aware. We're not in the business of whole blood, but there is — a formula. I do know about it. And if someone — there is — if one wants to convert a serum or a plasma level to a whole blood, there are formulas. It's a simple formula, but there are varying opinions on which formula can be used.
MR. LALLY: Now, as far as this specific patient, the defendant, Miss Read — do you have any sense from the chart in front of you as far as sort of the timeline of when the blood was drawn, to when it was tested and reported and things of that nature?
DR. FALLER: I think the order was at 9:03 in the morning. Five minutes later — the phlebotomist — it happened pretty fast — five minutes later the phlebotomist got the labels printed, then five minutes after that they went in and drew it. It was very quickly. I don't have the numbers in front of me, but ultimately it was received in our lab I think 10 minutes after the order — the blood very quickly — and then the final result, when the alcohol level was reported in the computer system, was I think 50 minutes from the time of the —
MR. LALLY: May I approach?
JUDGE CANNONE: Okay.
MR. LALLY: And that lab result, done pursuant to the testing and the policies and protocols and everything in your lab, was 93 milligrams per deciliter. Is that correct?
DR. FALLER: Correct.
MR. LALLY: Thank you, Doctor. I have no further questions.
MS. LITTLE: Cross-examination. Good afternoon.
DR. FALLER: Good afternoon.
MS. LITTLE: You testified that hospitals are not in the legal business of calculating BACs — is that your testimony?
DR. FALLER: Yes.
MS. LITTLE: And you'd agree that there are differences between screening tests that are conducted at hospitals and forensic tests that are done in labs. Correct?
DR. FALLER: Correct.
MS. LITTLE: And the purpose of testing in a clinical setting at a hospital is to assist in the quick diagnosis and — treatment of a patient. Is that right?
DR. FALLER: Yes. Correct.
MS. LITTLE: And so your priorities may be different than those if you're in a forensic lab, where the goal is to ensure accuracy and reliability at all costs. Correct?
DR. FALLER: I don't agree. Not correct.
MS. LITTLE: Will hospitals use serum tests to screen for the presence of alcohol?
DR. FALLER: Correct.
MS. LITTLE: And you'd agree that serum testing does not measure alcohol directly, but it actually measures the presence of NADH. Correct?
DR. FALLER: Correct.
MS. LITTLE: And NADH is the byproduct that's created when the body breaks down alcohol. Correct?
DR. FALLER: Correct.
MS. LITTLE: And the reason hospitals use a serum test rather than a whole blood test is because it's quick and efficient — and you can get test results within about 20 minutes. Does that sound about right?
DR. FALLER: Correct.
MS. LITTLE: And you'd agree that NADH — which is what serum essentially tests for — can also be elevated by factors other than alcohol in the blood?
DR. FALLER: I'm not aware of that.
MS. LITTLE: Are you familiar — are you familiar with any medical literature —
DR. FALLER: Yes.
MS. LITTLE: — that's found that NADH is created when the body has elevated either lactate or LDH in the system. Correct?
DR. FALLER: That's — there are some — in our policy, there are some factors that can lead to falsely elevated or falsely lowered serum alcohol. One is lactic acid or LDH, and one is Waldenström's macroglobulinemia, which is a hematological problem. And other things that can interfere — not just alcohol, any test — lipids, high levels of lipids, or hemolysis, or high levels of bilirubin. But our machines are very sophisticated now. If there are any elevations of, let's say, hemolysis, or lipids, or bilirubin, the Roche machines will detect that and flag it as a possible interference, or won't even let us resolve the test. So with any test there can be interferences, and I'm sure there can be interferences with the forensic way of testing as well.
MS. LITTLE: All right. So there are other causes of high levels of LDH, and therefore NADH, that also include things like trauma, muscle weakness, and loss of muscle tissue, or abnormal tissue formation. Is that correct?
DR. FALLER: Have you read studies about that? I haven't read those studies, no.
MS. LITTLE: Would you agree that there may be other medical stressors or things that can't necessarily be captured by the technology, but that could cause error in testing?
DR. FALLER: I don't understand that question.
MS. LITTLE: Well, you testified that there can be certain errors in testing — that's something we see throughout all different types of scientific literature, which includes ethanol testing.
DR. FALLER: Yep.
MS. LITTLE: And there are certain factors that could cause a higher level of NADH that might not necessarily be picked up by the machines that you use at the hospital. Is that correct?
DR. FALLER: I am not familiar with this. If there is — it's not a very common phenomenon. Our methodology for doing many tests is based on this NADH enzyme methodology, and we've never had issues with it. I've read a lot — I haven't read about major faults of our methodology for testing. Most hospitals — when we actually have to do proficiency testing with any test that we do in a hospital — — we get sent unknown levels of alcohol, five samples, three times a year. And we're able to look at not only our results to make sure they're correct, but we're able to look at what other hospitals are doing across the nation. So when I last looked — and it's held true for over 10, maybe 20 years — of the I think 5,000 hospitals that are testing for alcohol, over 80% of them are using our methodology, which is the NAD alcohol dehydrogenase and NADH. And I can't imagine — if there were any major issues with — alcohol testing using that methodology — why it wouldn't be that high a percentage.
MS. LITTLE: As you testified, the goal in a clinical setting is obviously to test for the presence of alcohol, but you're not in the business of trying to sort of calculate BAC. Correct?
DR. FALLER: No, we don't. We don't.
MS. LITTLE: So your goals are to make sure that you're screening for the presence of alcohol, but you're not quite as concerned with the precise amount that you might see in, for instance, a whole blood test in a forensic lab?
DR. FALLER: Well, we result in terms of the serum. We know the Massachusetts laws and laws across the nation are based on whole blood. But there are formulas in the literature — — that one can use if it were a medical-legal case, to convert our level to a blood alcohol. We don't do it in a hospital; we won't report a serum alcohol and then do the conversion. But it's a very rare event that a level will end up in court. But there are forensic lab people that can provide that formula.
MS. LITTLE: And when you get a test result from a serum test, that information does not establish when alcohol was consumed. Correct?
DR. FALLER: Correct.
MS. LITTLE: And so you're just looking at a specific point in time to say — this is what the serum tested for at 9:08 a.m. on January 29th. Correct?
DR. FALLER: Correct.
MS. LITTLE: Thank you. No further questions.
JUDGE CANNONE: All right, Lally, any followup?
MR. LALLY: Just briefly. As far as the interferences, or anything that would lead to elevated levels — from your review of Miss Read, was there anything like that present?
DR. FALLER: I didn't see anything. No.
MR. LALLY: And the interferences would be accounted for in the sense that the machine would sort of vet them out and not result, or not be recorded in the chart, if that were to occur. Is that correct?
MS. LITTLE: Objection, Your Honor. Form of the question.
JUDGE CANNONE: I'll sustain the objection. You can ask it differently.
MR. LALLY: Sure. Dr. Faller, with regard to the — — interferences that you were talking about, what if any impact would that have on the results being reported?
DR. FALLER: If there were the three major things that could interfere with the result — like high lipids, hemolysis, or high bilirubin — our machine would flag that and we would have some information that our result may not be valid. And sometimes we will report a result with a disclaimer, or sometimes if those levels are so high we won't report it at all. But in this case there were no flags.
MR. LALLY: Nothing further.
JUDGE CANNONE: Anything Miss Little, or you all set?
MS. LITTLE: May I have one moment.
MS. LITTLE: No further questions.