Commonwealth v. Read — Trial ArchiveJustin Rice - Direct/Cross/Redirect
298 linesJUDGE CANNONE: All right, Mr. Lally, your next witness, please.
MR. LALLY: Yes. I call Dr. Justin Rice to the stand.
COURT OFFICER: Step right up, watch your step for me. Standing, face the clerk, raise your right hand.
COURT CLERK: [oath — largely unintelligible] ...to tell the truth, the whole truth, and nothing but the truth, so help you God?
JUDGE CANNONE: Thank you. There is a microphone in front of you — however you want to position that, it's flexible. Too far away? Is that better?
MR. LALLY: And what do you do for work, sir?
MR. LALLY: And how long have you been doing that?
MR. LALLY: And where is it that you work now?
MR. LALLY: And how long have you been working for South Shore Health?
MR. LALLY: And where did you work prior to that?
MR. LALLY: And how long was it that you worked at Good Samaritan?
MR. LALLY: Now, sir, if I could, I'd like to just talk a little bit about your educational background. Where did you go to school as far as your undergraduate is concerned?
MR. LALLY: And what kind of degrees did you graduate from there?
MR. LALLY: And following your graduation from there, where did you go to school after that?
DR. RICE: So after that I attended the University of Virginia for medical school. Is that what you asked me to spell, sir? That —
MR. LALLY: And following your graduation from medical school, where did you go after that?
DR. RICE: Then I did an emergency medicine residency in Philadelphia, at the University of Pennsylvania.
MR. LALLY: And what is a residency?
DR. RICE: So a residency is several years of training — that's where doctors will specialize. For me, in emergency medicine. Some people choose to be surgeons, pediatricians — that's more of the specialization, if you will, that happens in medical training.
MR. LALLY: And how long was your residency?
MR. LALLY: And following your residency, where did you go from there?
DR. RICE: So I finished residency in 2008. I worked for two years in Manassas, Virginia, at Prince William Hospital, for two years.
MR. LALLY: And are you board certified?
MR. LALLY: And what is it that you're board certified in, specifically?
MR. LALLY: And when you use that term, as far as board certification is concerned, what goes into that — what does that entail?
DR. RICE: So when I obtained board certification it was a two-step process where there was a written exam administered at one of the testing centers. And after you pass that, then there's an in-person oral exam, I guess is what they're called, where you're given like didactic or individual cases. Assuming you pass that, then you're board certified.
MR. LALLY: And your board certification is up to date currently?
MR. LALLY: Now, with reference to the time that you worked at Good Samaritan, as far as the emergency department is concerned, can you describe to the jury sort of what the emergency department of Good Samaritan looks like, as far as staffing, bedding, sort of layout like that?
DR. RICE: Sure. So at the time, and currently, there's 36 treatment rooms in the main ER. A lot of hallway stretchers as well. There's also an Express Care kind of area, but for the purposes of this conversation, 36 beds in the main ER. Staffing-wise, there'd be anywhere between four to five and 12 nurses. And for the purposes of this discussion, it would have been two docs on and probably one either nurse practitioner or physician assistant at that, in the morning.
MR. LALLY: And as far as the morning — what I'm going to turn your attention to is the morning of January 29th, 2022. Were you working at Good Samaritan on that day?
MR. LALLY: And is there a particular shift, or what kind of hours would you be working around that time?
DR. RICE: I'm pretty sure I started my shift at 6:00 a.m. that day. It was a 6:00 a.m. to 2 p.m. — it's either 6:00 to 2 or 6:00 to 3 p.m. — but the shift would have started at 6:00 a.m., as I recall.
MR. LALLY: And on that date at Good Samaritan, do you recall becoming involved with the treatment of a patient by the name of John O'Keefe?
JUDGE CANNONE: You may approach the witness.
MR. LALLY: I'm showing you this document — if you just take a look at that and look up. Do you want me to look through each page, or just acknowledge it? Just — do you recognize what that document is?
MR. LALLY: And what do you recognize that to be?
DR. RICE: So it looks like it's a transcription, or a copy, of the medical chart that I would have produced or dictated. And on the front page is also a — — it's called like a code sheet, which the nurses would have put together and I would have signed off on, detailing the resuscitative efforts — as in the specific details and timing of resuscitative efforts — that were performed on Mr. O'Keefe's behalf.
MR. LALLY: Thank you. With the court's permission, may the witness hold on to that during the rest of this testimony?
JUDGE CANNONE: Yes. And you'll proceed to introduce it in a minute?
MR. LALLY: The next exhibit would be a redacted copy of those same records.
PARENTHETICAL: [document handling]
JUDGE CANNONE: Okay. Is there any objection?
MS. LITTLE: Okay. Okay. Here you go, doctor.
MR. LALLY: This is it. Thanks.
JUDGE CANNONE: Okay, thank you. And Mr. Lally, I'll let you hold on to what's been marked as [exhibit] for identification.
MR. LALLY: Thank you. Now, Dr. Rice, with regard to Mr. O'Keefe, about what time did he come into your facility?
MR. LALLY: Sure — if you can't remember things and you need to reference the chart, you can do that, doctor.
DR. RICE: Okay, thanks. So it looks like, based on the code sheet, first line starting at 0647 — so I'll say 6:47 a.m.
MR. LALLY: And as far as Mr. O'Keefe's presentation when he came into the emergency department, how would you describe his presentation upon his arrival?
DR. RICE: So he would have been — well, he was unresponsive, and intubated, as in with a breathing tube into his airway via his mouth.
MR. LALLY: And as he came into the emergency department, what if anything was underway in regard to CPR or other resuscitative efforts?
DR. RICE: So he would have had CPR in progress, and also someone would have been ventilating his lungs via the endotracheal tube.
MR. LALLY: Now, there's mention within that record as far as a cardiac arrest — is that correct?
MR. LALLY: Sure. Let me just ask you — you're familiar with the term cardiac arrest?
MR. LALLY: Can you describe to the jury, based on your training and experience, what your understanding of that term is?
DR. RICE: Sure. So he arrived in cardiac arrest, which by definition means that his heart was not autonomously or independently pumping blood — or, in his case, without electrical activity of the heart as well.
MR. LALLY: And are you familiar with another term called perfusion?
MR. LALLY: And can you explain what perfusion is and how that relates to the condition of cardiac arrest?
DR. RICE: Sure. So, for example, you and I right now — because our heart is autonomously pumping blood — the heart is the pump, responsible for pushing blood throughout your body, therefore perfusing your body. In a scenario like this, where a patient — is in cardiac arrest, or asystole — or as in not having any electrical activity in his heart or mechanical activity of his heart — the perfusion that is happening is by CPR, as in the chest being pushed upon, indirectly pumping or moving blood flow. So there is perfusion, but it's significantly limited compared to someone not in cardiac arrest.
MR. LALLY: And as far as that perfusion process is concerned, what if any relation does that have to the organs within the body?
DR. RICE: Well, so, you know, if your perfusion is limited, then your organs are not getting the normal amount of blood flow, and therefore oxygen, and all the other nutrients that your blood's providing. So your organs will begin the process of failure.
MR. LALLY: You use the term in there as far as asystole — could you explain to the jury what you understand that term to mean?
DR. RICE: Sure. So asystole would be when you put the electrical leads on a patient's heart, the complete absence of intrinsic electrical activity from the heart would be asystole. So as in not having any observable or detectable electrical activity would be asystole.
MR. LALLY: Now as far as these conditions — as far as cardiac arrest and asystole — what if any concerns do that raise from a diagnostic perspective in relation to Mr. O'Keefe?
DR. RICE: I guess your question with respect to — from a diagnostic perspective — I don't know exactly what you're asking me there.
MR. LALLY: Let me rephrase that. So with regard to those conditions that are observed and noted within the medical chart for Mr. O'Keefe that you have before you, how would that relate to his condition, or sort of how he's presenting, and what if anything you're doing treatment-wise?
DR. RICE: Well, so, even with good CPR, the perfusion of the brain — for example — and this is what I think about frequently during resuscitative efforts like this — I couldn't tell you an exact time, but there's a certain — without perfusion of the brain for a certain amount of time — you're limited with respect to the concern that the patient, even if you resuscitate their body, there's potentially going to be brain death, or anoxia, or lack of oxygen to the brain, and a poor outcome with respect to neurological outcome.
MR. LALLY: Now as far as the resuscitative efforts are concerned, is there any sort of standard resuscitative protocols that would be undergone with someone who presents as Mr. O'Keefe?
MR. LALLY: And can you explain what those are?
DR. RICE: So, you know, in broad terms, there's ACLS, which is Advanced Cardiac Life Support. That's an algorithm that through medical training I've learned, and is frequently — the algorithm can be adjusted. There's also ATLS for trauma patients, so there's an algorithm there with respect to resuscitation, or guidelines with respect to resuscitation.
MR. LALLY: And within those guidelines or protocols, are you familiar with the medication called epinephrine?
MR. LALLY: And how would epinephrine play into the treatment of Mr. O'Keefe?
DR. RICE: So, you know, in the time that I've been practicing, epinephrine is probably the only medication or drug that has persistently been in the ACLS pathway. It's adrenaline. So the idea is, loosely, that you're attempting to affect upon the heart itself more squeeze — as in more pressure — and also to increase the potential, or if there is electrical activity, to increase the amplitude of that electrical function at the cellular level.
MR. LALLY: Now, in addition to the cardiac arrest and asystole, as far as Mr. O'Keefe was concerned, what if any presentation did he have related to hypothermia?
DR. RICE: So I know his initial temperature was low. I'd have to — I was going to say I'd have to look, but I can see here that the nursing wrote in their notes that his — I see T equals 80.1 R. So I interpret that to be his temperature was 80.1 degrees by rectal temperature.
MR. LALLY: And if you could explain to the jury your understanding as far as hypothermia — what is it, and how does that present itself?
DR. RICE: So, you know, as it pertains to this case, there are a few ways to get hypothermic. If I at 12:20 were to have a cardiac arrest right now and stop perfusing, my current temperature — I'm guessing is 98.6, a normal temperature — without perfusion, the core temperature will decrease over time. The specifics of that are beyond my knowledge and training, but — does that answer your question?
MR. LALLY: Yes. And so as far as hypothermia is concerned, is there a certain sort of baseline — or what is the typical temperature under which someone would be declared hypothermic, or treated as such?
DR. RICE: I don't know if I could give you a definition of — medically — what a quote diagnosis of hypothermia is. I couldn't tell you a number. I can tell you that 80 qualifies as hypothermia, but I couldn't tell you a number under which that definition applies. But the temperature that Mr. O'Keefe presented with certainly fits within those parameters.
MR. LALLY: Is that correct?
MR. LALLY: And as far as resuscitative efforts as they pertain to the core body temperature — or the low core body temperature of Mr. O'Keefe — what if anything was done with relation to treatment of that?
DR. RICE: Sure. So, as the nursing note mentions, a Bair Hugger was applied — so that's a blanket that has warmed air being pumped through it, so that's a way of externally warming someone. He also — having reviewed the chart earlier, I don't see it right in front of me — actually, I take that back — he had warm IV fluids running. So IV fluids not at room temperature, as in in a warmer of sorts, would have been given to him via intravenous or central venous access.
MR. LALLY: And as far as the body temperature is concerned, what if any relationship does the body temperature — and the warming process — have as to a declaration of deceased in relation to —
DR. RICE: Well, so, there's a goal in resuscitative medicine to attempt to rewarm a body. The idea, loosely, being that the heart, among other organs, will function better — or function at all — in a warmer environment. That's one goal of resuscitation. With him, as I recall, we — despite resuscitative efforts for approximately half an hour — — there was not a significant warming of his core temperature.
MR. LALLY: And so, sir, with reference to Mr. O'Keefe, at some point was he pronounced deceased by yourself?
MR. LALLY: And do you see any indication within the chart as to what time that was?
DR. RICE: Sure, I just need a moment here. According to my note, it looks like the time of death — the death declaration — was 7:50 in the morning.
MR. LALLY: [unintelligible] Now as far as the observations that you made — as far as asystole and the cardiac arrest that persist throughout the course of your treatment of Mr. O'Keefe —
MR. LALLY: — may I approach the witness?
JUDGE CANNONE: Yes. [unintelligible]
MR. LALLY: I direct your attention to the fourth page — the bottom of it says "2 of 4" — and I direct your attention to the top of that page. You see that?
MR. LALLY: And as far as this — let me ask you — can you describe what is listed at the top of that page?
DR. RICE: Sure. So this would have been my physical exam documentation of my note. So with respect to the head, it says — excuse me — the first word is "other," which I believe is a function of the computer system. I typed in there: "right superior orbital ridge region, approximately 7 mm laceration, and with surrounding soft tissue swelling / contusion."
MR. LALLY: Sir, if I could just stop you there — as far as what you're talking about with the right superior orbital ridge region, could you explain to the jury or demonstrate to the jury?
DR. RICE: Sure. So the orbital ridge is the bone above your eye — where your eyebrow is, or would normally be.
MR. LALLY: And as far as the other observations that you noted over the course of your physical exam or review of Mr. O'Keefe, what else did you observe?
DR. RICE: Well, according to my note, another observation — other than that — would be that he had breath sounds present bilaterally. He also — I observed that he was pulseless. His abdominal exam was atraumatic on my chart. And then extremity exam, or musculoskeletal exam, I wrote that he had superficial abrasions on the right forearm.
MR. LALLY: And from a medical perspective, when you use that term "abrasion," can you explain to the jury what you understand the term "abrasions" to mean?
MR. LALLY: And under neurological, there's a listing as far as a GCS 3 — is that correct?
MR. LALLY: And explain what that is and what that means.
DR. RICE: So, GC is what I charted — what I intended to write there was GCS, which is a Glasgow Coma Scale, which is a scoring system to identify someone's level of consciousness or unresponsiveness.
MR. LALLY: And as far as the three — where does the scale start, where does it go to, and where does three fit in?
DR. RICE: So there are three components: verbal function, motor function, and eye, or ocular, function. And someone who's completely unresponsive — as in no motor, no verbal, and no eye movement or function, completely unresponsive — the lowest you can get on the scale is three.
MR. LALLY: Thank you, sir. May I approach? [unintelligible]
JUDGE CANNONE: Yes.
MR. LALLY: Now, later on over the course of that same morning, did you have occasion to become involved in the treatment of another patient by the name of Karen Read?
MR. LALLY: And may I approach the witness again?
JUDGE CANNONE: Yes, sir.
MR. LALLY: I'm handing you another document. Just look at that to the extent you can recognize it, and look up whenever you're ready. In general, do you recognize what that is?
MR. LALLY: What do you recognize it to be?
DR. RICE: Uh, the first part I recognize would have been the medical record or medical note with respect to Miss Read, who is also a patient that morning.
MR. LALLY: Thank you. Your Honor, the Commonwealth will seek to introduce and admit as the next exhibit a redacted copy of those records.
MS. LITTLE: No objection, subject to redaction.
COURT CLERK: [Exhibit] 10.
MR. LALLY: Now, sir, if you know, about what time was it that Miss Read came into the emergency department at Good Samaritan that morning?
DR. RICE: I mean, I can tell you from this chart it looks like that her — at least the first posted vital signs — were from 7:51 in the morning.
MR. LALLY: And in reference to Miss Read, what is it that she came into Good Samaritan in regard to — why was she there?
MR. LALLY: Well, let me ask you this, sir. Was it in reference to Section 12? Do you recall?
MR. LALLY: And with regard to Section 12 — patients that come in in regard to that — what kind of involvement do you have, or who, if anyone, do you work with in regard to those types of patients?
DR. RICE: Sure. So Section 12, I would define as an involuntary detention of a person, usually for a mental health concern — whether that's self-harm or harm to others, or someone who's afflicted with schizophrenia or psychosis. Members of the public, or police, can bring someone to the hospital on a Section 12, which again involuntarily detains them for evaluation.
MR. LALLY: And in addition to yourself, is there other staff — you mentioned that there were physician assistants or nurses that were working. How much involvement would you typically have with someone who comes in on that kind of presentation?
DR. RICE: I would say, to answer your question, my involvement is variable and dependent — a lot of times on what that nurse practitioner or physician assistant feels like they need or want my involvement to be.
MR. LALLY: And what kind of involvement would you have as far as — when someone comes in with that kind of issue — what is sort of the typical protocol or policies that Good Samaritan would undergo with reference to that patient? What are you doing with reference to the patient when they arrive?
MR. LALLY: No, understood. Let me rephrase that. So with regard to a patient coming in on a Section 12, what happens with that person once they present in the ER?
DR. RICE: So whether they're evaluated by me or a nurse practitioner or physician assistant — if that person feels like, based on their evaluation, that they need a mental health consult or evaluation, then they would have that initiated, as well as what we do for a lot of patients — or all patients — vital signs and sometimes blood work as well.
MR. LALLY: And when it comes to that sort of blood work or assay, as far as what's being done with someone who comes in with that kind of report — what is sort of being tested and what is being looked at as far as the blood work is concerned?
DR. RICE: Well, there's a few reasons to get blood work, but in general, part of the evaluation is — with respect to the medical presentation — to make sure there's no medical emergencies present, in addition to whatever the mental health concern may be. There's also blood work drawn with respect to — excuse me — with respect to disposition. As far as some people — for example, it would be inappropriate to have a mental health evaluation if, for example, I were intoxicated on alcohol and my alcohol level were elevated, because I think the idea is that you're not getting, you know, a true presentation maybe of what's going on.
MR. LALLY: So am I correct that someone presents and then there's sort of — you medically clear that person as far as any sort of injuries or anything like that first?
DR. RICE: I wouldn't say "first" necessarily. I think a lot of times these processes happen in parallel — so in parallel you have the medical clearance and then sort of psychological clearance as well, sometimes yes.
MR. LALLY: And then sort of involved in both of those there would be blood drawn, and with reference to the Section 12, as far as a typical one, would be looking for sort of alcohol and drugs of abuse — things of that nature?
DR. RICE: I'm hesitant to answer yes because of the word "typical," because I wouldn't say there's really a typical presentation with respect to mental health presentations in the ER.
MR. LALLY: And from your memory and/or your review of the chart, was that done — as far as the blood work with regard to Miss Read on this day?
MR. LALLY: Yes.
DR. RICE: Um, I believe so. I have to double check. So yes, it looks like there was blood work drawn.
MR. LALLY: And among the things that were tested within the facility — within Good Samaritan — was the alcohol screening, is that correct?
MR. LALLY: And what is the result of that alcohol screen as contained within those records?
JUDGE CANNONE: Yes.
MR. LALLY: 93?
DR. RICE: I'd have to maybe look deeper in the chart to tell you the units of that measurement. I don't want to guess.
MR. LALLY: Just briefly on it — yes, I'm directing your attention to that portion of that. Do you see the unit that 93 pertains to contained in that record?
MR. LALLY: Thank you, sir. May I approach — just to retrieve?
JUDGE CANNONE: Yes. Thank you, sir.
MR. LALLY: I have no further questions of this witness.
JUDGE CANNONE: Ms. Little.
MS. LITTLE: Thank you. Good afternoon.
MS. LITTLE: You testified that you treated Miss Read when she arrived at the hospital on January 29th, correct?
MS. LITTLE: You actually wrote the reports regarding her care, correct?
MS. LITTLE: Would it refresh your recollection to take — the report — I believe we're talking about the note. The emergency room note was written by a nurse practitioner. But refresh your recollection to take a look at some additional reports from January 29th?
MS. LITTLE: May I approach?
JUDGE CANNONE: Yes. Yep.
MS. LITTLE: Okay, is your recollection refreshed? Do you recall treating Miss Read on January 29th?
MS. LITTLE: You recall writing a report that has your name — Justin Rice — on it from January 29th?
DR. RICE: No. It depends what you define "report" as. To best answer — well, do I recall writing this note? No. Is that what your question was?
MS. LITTLE: So is it your testimony that — do you recall treating Miss Read at all?
MS. LITTLE: Do you recall actually ordering her blood in this case?
MS. LITTLE: Do you recall sending it out to the labs at all?
MS. LITTLE: As you sit here today, you don't know who collected the blood?
MS. LITTLE: You don't know who packaged the blood — that would also be a fair assessment?
MS. LITTLE: And you don't know who submitted that to the lab?
MS. LITTLE: And it wasn't you?
DR. RICE: Correct. I can confidently say that I did not collect blood work — yeah, that I did not do that.
PARENTHETICAL: [someone]
MS. LITTLE: : Objection. Do you remember that?
MS. LITTLE: Okay. You testified that you treated Mr. O'Keefe upon arrival on January 29th, correct?
MS. LITTLE: Did a firefighter ever approach you on the morning of January 29th and tell you that he had information suggesting that the victim had been struck by a vehicle?
MS. LITTLE: So if a firefighter indicated that he informed you that he had information suggesting that Mr. O'Keefe had been in some sort of vehicular accident, that's something that you would have included in your report, correct?
MS. LITTLE: But as you sit here today, you have no recollection whatsoever of anyone telling you that the victim appeared to be in some sort of car accident?
DR. RICE: Correct. Well, I think — I don't have it in front of me, but I think my note that I prepared for Mr. O'Keefe states that per EMS —
MS. LITTLE: Sorry, Doctor, you have no record, so —
JUDGE CANNONE: I don't think he finished his answer.
DR. RICE: So — I think that what I was trying to say, right, was that on my note it says "per EMS report" — so one of the medics, as in one of the folks on the ambulance who brought Mr. O'Keefe in, again, I'm not right in front of my note, but as I recall it said something to the effect of "per EMS report, the patient may have been struck by a vehicle."
MS. LITTLE: Can I show you a copy of that report, please?
MS. LITTLE: Yes, take a look at that.
MS. LITTLE: So I'll ask the question — is your recollection refreshed?
MS. LITTLE: Is there anywhere on that report that says that the patient came in and there was a statement by EMS that the victim appeared to have been struck by a vehicle? Just give me a moment to read through.
MS. LITTLE: Correct?
MS. LITTLE: Dr. Rice, did you observe the victim's injuries when he arrived at the hospital that morning?
MS. LITTLE: Well, during the course of your treatment, did you inspect him for injuries?
MS. LITTLE: Yes, you testified that you observed certain abrasions and scratches on his right arm, correct?
MS. LITTLE: Aside from his injuries to his right arm, and I believe he described sort of a laceration above his eye, John O'Keefe did not have a single other injury on his body from the neck down, correct?
MS. LITTLE: Well, you didn't report a single injury to his shoulders, correct?
MS. LITTLE: You did not report a single injury to his chest, correct?
MS. LITTLE: You did not report a single injury to his torso, correct?
MS. LITTLE: You did not report a single injury to his back, correct?
MS. LITTLE: You also did not report a single injury to his ribs, correct?
MS. LITTLE: Injury to his hips, right?
MS. LITTLE: You observed no injury to his knees, correct?
MS. LITTLE: No injuries to his shins, correct?
MS. LITTLE: No injuries to his ankles, right?
MS. LITTLE: And no injury to his feet, correct?
MS. LITTLE: From the neck down, he did not have a single broken bone, right?
MS. LITTLE: You certainly didn't notate in your report that he had any broken bones from the neck down, correct?
DR. RICE: No, I did not. I'd be happy to explain that, but to answer your question, no, I did not.
MS. LITTLE: You did not report a single fracture from the neck down, correct?
MS. LITTLE: The injuries that you testified to today were that he had sort of an abrasion above his eyelid, correct?
MS. LITTLE: And the scratches on his right arm on the right forearm?
MS. LITTLE: No further questions.
MR. LALLY: Dr. Rice, with reference to fractures or broken bones, can you explain sort of why that may not have been noted, or why that wasn't included within the chart?
DR. RICE: Sure. Yeah, I'd like to. So with a patient like Mr. O'Keefe who came in, the focus of myself and the team — physician assistant, nurse practitioner, and nurses, whoever was helping in a case like this — the focus is in core resuscitative medicine: securing an airway, making sure he has a breathing tube in, making sure that the CPR is being applied at the right pressure to the right place, making sure that the core resuscitative elements of medicine are happening. And less — as in, the mind can only focus on so much. So I think in cases like this, because the attention is on resuscitation of someone's heartbeat, their life, there's less focus on injuries or observations that don't coincide with the resuscitation effort or are not pertinent to that resuscitative effort.
MR. LALLY: So in that vein, it's not like you're doing x-rays or a full skeletal survey or something like that?
MR. LALLY: Because you're more concerned with the fact that his body temperature is 80, his heart isn't pumping blood, and he's pulseless, correct?
DR. RICE: Correct. Unless there was an extremity injury that would be pertinent to his resuscitation — if he had had a traumatic amputation, as in removal of a leg for example, that would be pertinent to a resuscitation. But an otherwise intact extremity, you know, that is not necessarily within the realm of resuscitation.
JUDGE CANNONE: You may approach.
MR. LALLY: I'm going to direct your attention to a document — the date of discharge and clinical impression. If you could just read that, look up when you finish reading to yourself.
MR. LALLY: So as far as the chart is concerned, as far as your clinical impression of Mr. O'Keefe, can you read sort of what you —
DR. RICE: Sure. So I wrote: clinical impression — cardiac arrest, trauma, head trauma, exposure to environmental cold.
MR. LALLY: May I approach just to retrieve it?
JUDGE CANNONE: Yes.
MR. LALLY: No further questions.
JUDGE CANNONE: Anything further?
MS. LITTLE: No further questions.
JUDGE CANNONE: All right, thank you, Doctor. You are excused.
JUDGE CANNONE: Jurors can we do an abbreviated lunch today so we can get as much of testimony in as possible? So it's ten minutes to 1:00 why don't we come back here at 1:30. And can we go until 4:30 today? People seem to say yes.
COURT CLERK: All rise for the court please.
COURT CLERK: Thank you. Be seated.
JUDGE CANNONE: All right, so as far as the redactions — what you think should be there, Ms. Little, and you perhaps don't, Mr. Lally — I don't know if the testimony opened the door any on some of what may or may not have been there. I don't have it in front of me, I haven't seen it. So the two of you talk, and if you're not in agreement I would like a copy of both by 1:15 so that I can decide before it goes in, and then it will be the next exhibit either with or without the additional redactions.
MS. LITTLE: Okay.
MR. LALLY: Okay.
JUDGE CANNONE: All right, thank you.