Commonwealth v. Read — Trial ArchiveJustin Rice — Direct/Cross/Redirect
375 linesJUDGE CANNONE: Jurors, we took an abbreviated recess last time, and I think you may have seen it was to set up the courtroom a little bit differently. So why don't we take a morning recess. Why don't we take about 15 minutes or so.
(Whereupon, the jury is escorted from the courtroom and a brief recess was taken.)
(Court resumes.)
(Defendant present. Jury present.)
JUDGE CANNONE: All right, Mr. Lally. Your next witness, please.
MR. LALLY: Yes, Your Honor. The Commonwealth calls Dr. Justin Rice to the stand.
Whereupon, JUSTIN RICE, M.D. having been first duly sworn, was examined and testified as follows:
JUDGE CANNONE: All right, Mr. Lally. Whenever you're ready.
MR. LALLY: Thank you, Your Honor.
DIRECT EXAMINATION BY MR. LALLY:
MR. LALLY: Good afternoon, sir.
MR. LALLY: Could you please state your name and spell your last name for the jury?
MR. LALLY: And, sir, that microphone in front of you, however you want to position that, it's flexible. So if you want to bring it --
MR. LALLY: That's perfect. Thank you, sir. 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 undergrad was concerned?
MR. LALLY: And what, if any, degrees did you graduate from there with?
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? I'm sorry.
MR. LALLY: Yes. 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 University of Pennsylvania.
MR. LALLY: And what is a residency, sir?
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 when more of the specialization, if you will, 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 in 2008 finished residency. 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?
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 is an in-person oral exam, I guess, is what they are called, where you are 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 does the emergency department at Good Samaritan look like as far as staff, bedding, sort of layout? Can you describe that for the jury?
DR. RICE: Sure. So at the time and currently, there is 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 would be anywhere between four to five and 12 nurses. And, for the purposes of this discussion, there would be -- it would have been two docs on and probably one either nurse practitioner or physician assistant 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 the Good Samaritan on that day?
MR. LALLY: Is there a particular shift or what kind of hours would you be working around that time at Good Samaritan?
DR. RICE: I'm pretty sure I started my shift at 6:00 a.m. that day. There was a 6:00 a.m. to 2:00 p.m. -- it was either two or three -- excuse me. It was either 6:00 to 2:00 or 6:00 to 3:00 p.m. But the shift would have started at 6:00 a.m., as I recall.
MR. LALLY: And, on that day at good Samaritan, do you recall becoming involved with treatment of a patient by the name of John O'Keefe?
MR. LALLY: Your Honor, may I approach the witness?
JUDGE CANNONE: Yes.
BY MR. LALLY:
MR. LALLY: I am showing you a document. If you could just take a look at that and look when you're finished?
MR. LALLY: Just as far as do you recognize what that document is?
MR. LALLY: And what do you recognize that to be?
DR. RICE: So it looks like, is a transcription or a copy of the medical chart that I would have produced or dictated. And on the front page is also it's called like a code sheet which the nurses would have put together and I would have signed off on, detailing what resuscitative efforts, as in the specific details and timing of the resuscitative efforts that were performed on Mr. O'Keefe's behalf.
MR. LALLY: Your Honor, with the Court's permission, may the witness hold on to that during the course of his testimony?
JUDGE CANNONE: Yes.
MR. LALLY: And, Your Honor, what I would seek to introduce and admit as the next exhibit would be a redacted copy of those same records.
JUDGE CANNONE: Is there any objection?
MS. LITTLE: Your Honor, if we could just review those? Your Honor, if we could approach?
JUDGE CANNONE: You may.
(Whereupon, there was a sidebar conference as follows:)
JUDGE CANNONE: All right. Just so it's clear, you've had this in discovery for a long time, correct?
MS. LITTLE: Yes, redacted. It looks like there's narratives that are included that weren't redacted, which is rank hearsay.
JUDGE CANNONE: What do you say, Mr. Lally?
MR. LALLY: I think it goes to the medical diagnosis and treatment of the information he was provided.
JUDGE CANNONE: I can't hear you.
MR. LALLY: Sorry. I think it goes to the medical diagnosis and treatment of the information that he was provided in the course of treatment of this patient.
JUDGE CANNONE: All right. So he relied on that to treat the patient?
MR. LALLY: I think what counsel is referring to is there are reports via EMS as far as what they had reported. And all of those witnesses also testified.
MS. LITTLE: There's hearsay statements of EMS reporting what other people told them.
JUDGE CANNONE: All right. Did you intend to publish this in some form?
MR. LALLY: No.
JUDGE CANNONE: Then let's deal with this later and get some testimony going. Okay?
MR. LALLY: Sure.
JUDGE CANNONE: So I will mark the redacted copy for identification because if you get to put it in, this is what they will be what they put in. I need to look at it and I don't want to do that now.
MR. LALLY: Sure.
JUDGE CANNONE: All right. So for identification, please.
JUDGE CANNONE: Mr. Lally, I'll let you hold onto what has been marked as "SS" for Identification.
(Whereupon, redacted Good Samaritan medical records of John O'Keefe were entered and marked Exhibit "SS" for Identification.)
BY MR. LALLY:
MR. LALLY: Now, Dr. Rice, with regard to Mr. O'Keefe, about what time did he come into your facility at Good Samaritan?
JUDGE CANNONE: 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, the first line starting at 06:47, so I'll say 6:47 a.m.
BY MR. LALLY:
MR. LALLY: And, as far as his presentation, Mr. O'Keefe's presentation when he came into the emergency department, how would you describe his presentation upon his arrival there?
DR. RICE: So he would have been or 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 affixed in regard to CPR or other resuscitative efforts?
DR. RICE: So he would have had or had CPR in progress and also someone would have been ventilating him, his lungs, via the endotracheal tube.
MR. LALLY: Now, there is mentioned within that record as far as cardiac arrest; is that correct?
MR. LALLY: Sure. Well, let me just ask you, are you 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 as in he arrived in cardiac arrest, which, by definition, means that his heart was autonomously or independently pumping blood or, in his case, without electrical activity, as well, of the heart.
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. For example, you and I right now, because our heart is autonomously, you know, pumping blood, the heart is the pump and 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, as in not having any electrical activity in his heart, mechanical activity of his heart, the perfusion that is happening is by CPR, as in the chest being pushed upon, indirectly, we call it, maybe indirectly pumping or moving blood flow so there is perfusion but in a -- 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, you know, nutrients that your blood is providing. So your organs will begin the process of failure.
MR. LALLY: And you used 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 does that raise from a diagnostic perspective in relation to Mr. O'Keefe?
DR. RICE: I guess your question with respect from a diagnostic perspective, I don't know exactly what you're asking me there.
MR. LALLY: Sure. 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, as in I couldn't tell you an exact time, but there is a certain -- without perfusion of the brain for a certain amount of time, you're limited with respect to -- the concern is that the patient, even if you resuscitate their body, that there is potentially going to be brain death or anoxia or lack of oxygen to the brain anda poor outcome with respect to neurological outcome.
MR. LALLY: Now, as far as the resuscitative efforts or concern, is there any sort of standard sort of resuscitative protocols that would be undergone with someone who presents as Mr. O'Keefe did?
MR. LALLY: And can you explain what those are?
DR. RICE: So you know, in broad terms, there is ACLS, which is advanced cardiac life support. That is an algorithm that through medical training, you know, I have learned is frequently -- the algorithm can be adjusted. There is also ATLS for trauma patients. So there is an algorithm there with respect to resuscitation or guidelines, I guess, with respect to resuscitation.
MR. LALLY: And, within those sort of guidelines or protocols, are you familiar with a medication called epinephrine?
MR. LALLY: And how would epinephrine play into sort of the treatment or the diagnosis of Mr. O'Keefe?
DR. RICE: So 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 is adrenaline. So the idea is, loosely, that your 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 electric activity at the cellular level.
MR. LALLY: Now, in addition to the cardiac arrest and the 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 ICT equals 80.1R. 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 sort of 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 is 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 -- you know, my current temperature, I'm guessing, is 98.6, normal temperature. Without perfusion, the body will lose -- excuse me. The core temperature will decrease over time. The specifics of that, I could not -- are beyond my knowledge and training. But that's the -- does that answer your question? A Yes.
MR. LALLY: And so as far as hypothermia is concerned, is there a certain sort of baseline or what is sort of 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 -- 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.
MR. LALLY: But the temperature that Mr. O'Keefe presented with certainly fits within those parameters; is that correct?
MR. LALLY: And, as far as resuscitative efforts as they pertain to the core body temperature, 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 Bear Hugger was applied. So that's a blanket that has warmed air being pumped through it. So that is a way of externally warming someone. He also -- having reviewed the chart earlier, and 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 or oven 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 have and the warming process have as to a declaration of deceased in relation to Mr. O'Keefe?
DR. RICE: So there's a goal in resuscitative medicine to attempt to rewarm a body, loosely, the idea being that the heart, among other organs, will function better or function at all in a warmer environment. That is one goal of resuscitation. With him, as I recall, despite, you know, 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. One moment here. According to my note, it looks like the time of death was, or death declaration was 7:50. 7:50 in the morning.
MR. LALLY: Now, as far as the observations that you made as far as asystole and the cardiac arrest, did that persist throughout the course of your treatment of Mr. O'Keefe?
MR. LALLY: Your Honor, may I approach the witness?
JUDGE CANNONE: Yes.
BY MR. LALLY:
MR. LALLY: Directing your attention to the fourth page in, the bottom of it says, 2:04. And I direct your attention to the top of that page. Do you see that, sir?
MR. LALLY: And, as far as the -- this is sort of a listing of observations or -- well, let me ask you. Can you describe what is listed at the top of that page there?
DR. RICE: Sure. So this would have been the 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 as in I typed "right superior orbital ridge region, approximately 7mm laceration," and then "with surrounding soft-tissue swelling/contusion."
MR. LALLY: And, sir, if I could just stop you there. As far as what you are talking about with the right superior orbital ridge region, could you explain to the jury or demonstrate for the jury where that is?
DR. RICE: Sure. So the orbital ridge is the bone above your eye like where your eyebrow is or, you know, would normally be.
MR. LALLY: And, as far as the other sort of things that you noted over the course of your physical exam or review of Mr. O'Keefe, what, if anything else of note did you observe?
DR. RICE: According to my note, the only observations other than -- 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 for the jury what you understand the term "abrasions" to mean?
MR. LALLY: And, under neuro or neurological, there is a listing as far as a GC3; is that correct?
MR. LALLY: And can you explain what that is and what that means?
DR. RICE: So GC is what I charted -- I tended to write. The GCS 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, like, where does the scale start? Where does it go to and where does the three fit in?
DR. RICE: So there's three components: verbal function, motor function and eye or ocular function. 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.
MR. LALLY: Your Honor, may I approach just to retrieve?
JUDGE CANNONE: Yes.
BY MR. LALLY:
MR. LALLY: 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: May I approach the witness again, Your Honor?
JUDGE CANNONE: Yes.
BY MR. LALLY:
MR. LALLY: Sir, I'm showing you another document. I'd just ask you to look at that to the extent that you can recognize it and look up whenever you finish.
MR. LALLY: And, in general, sir, do you recognize what that is?
MR. LALLY: What do you recognize it to be?
DR. RICE: The first part I recognize would have been the medical record or medical note with respect to Ms. Read, who was also a patient that morning.
MR. LALLY: Thank you.
MR. LALLY: Your Honor, the Commonwealth would seek to introduce and admit as the next exhibit a redacted copy of those records.
MS. LITTLE: Your Honor, no objection, subject to the redactions. We can discuss that later.
COURT REPORTER: This will be Exhibit 106, Your Honor.
JUDGE CANNONE: Thank you.
(Whereupon, redacted Good Samaritan Hospital medical records for Karen Read were entered and marked Exhibit No. 106 in Evidence.)
BY MR. LALLY:
MR. LALLY: Now, sir, if you know, about what time was it that Ms. 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, 5-1, in the morning.
MR. LALLY: And, in reference to Ms. 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 a Section 12, if you recall?
MR. LALLY: Okay. 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 if someone who's, you know, afflicted with schizophrenia or psychosis, members of the public can bring someone, or the police or members of the public 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 physicians assistants or nurses that were working, what -- how much involvement would you typically have with someone who comes in on that kind of prognosis or diagnosis?
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 a typical protocol or policies that the 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 it. So with regard to a patient coming in ona 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 a 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, you know, 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 is also blood withdrawn with respect to disposition as far as some people. For example, it would be appropriate 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 know, you're not getting a true representation maybe of what's going on.
MR. LALLY: So am I correct in that someone presents and then there is like sort of you medically clean 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.
MR. LALLY: So in parallel you have the medical clearance and then sort of a psychological clearance, as well?
MR. LALLY: And then sort of psychological clearance, as well?
MR. LALLY: And then sort of involved in both of those, there would be blood drawn in reference to a 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 am hesitant to answer "yes" because of the word "typical." 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 view of the chart, was that done as far as the blood work done with regard to Ms. Read on this day?
MR. LALLY: Yes.
DR. RICE: I believe so. I'd 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 an alcohol screen; is that correct?
MR. LALLY: And what is the result of that alcohol screen as contained within those records?
MR. LALLY: Objection, Your Honor.
JUDGE CANNONE: I'll allow it.
JUDGE CANNONE: Yes.
DR. RICE: So it looks like 93, 9-3. I'd have to maybe look deeper in the chart to tell you the units of that measurement. I don't want to guess. But, to answer your question, 93.
MR. LALLY: May I approach just briefly, Your Honor?
JUDGE CANNONE: Yes.
BY MR. LALLY:
MR. LALLY: Sir, directing your attention to a previously tabbed portion of that and direct you to about the middle of the page here. Do you see the units that 93 pertains to contained within that record, sir?
MR. LALLY: Thank you, sir.
MR. LALLY: May I approach just to retrieve, Your Honor?
JUDGE CANNONE: Yes.
MR. LALLY: Thank you, sir. I have no further questions of this witness, Your Honor.
JUDGE CANNONE: Ms. Little?
MS. LITTLE: Thank you.
CROSS-EXAMINATION BY MS. LITTLE:
MS. LITTLE: Good afternoon.
MS. LITTLE: You testified that you treated Ms. 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 a look at your report?
DR. RICE: The report -- I believe that we're talking about the emergency room note that was written by a nurse practitioner.
MS. LITTLE: Would it refresh your recollection to take a look at some additional reports from January 29th?
MS. LITTLE: Thank you.
MS. LITTLE: May I approach?
JUDGE CANNONE: Yes.
BY MS. LITTLE:
MS. LITTLE: If you could take a look.
MS. LITTLE: Is your recollection refreshed? Do you recall treating Ms. Read on January 29th?
MS. LITTLE: Do you recall writing a report that has your name, Justine Rice, on it from January 29th?
DR. RICE: It depends on what you define a report as. To best answer your -- well, do I recall writing this note? No. Is that what your question was?
MS. LITTLE: So is it your testimony that you -- do you recall treating Ms. 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?
MS. LITTLE: And you don't know who submitted that to the lab?
MS. LITTLE: It wasn't you, correct?
DR. RICE: I can confidently say that I did not, like, collect blood work. Yeah. I did not do 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?
MR. LALLY: Objection.
JUDGE CANNONE: Do you remember that?
BY MS. LITTLE:
MS. LITTLE: So if a firefighter indicated that he informed you that 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 had appeared to be in some sort of car accident, correct?
DR. RICE: 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 --
COURT REPORTER: One moment, please.
JUDGE CANNONE: I don't think he finished his answer.
DR. RICE: So I think what I was trying to say 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?
MS. LITTLE: May I approach?
JUDGE CANNONE: Yes.
BY MS. LITTLE:
MS. LITTLE: If you could take a look at that?
MS. LITTLE: I'll ask the question.
MS. LITTLE: 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 patient appeared to have been struck by a vehicle?
MS. LITTLE: Sure.
MS. LITTLE: In fact, there is no mention of a vehicle whatsoever, correct?
MS. LITTLE: Dr. Rice, did you observe Mr. O'Keefe'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: 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 you described the laceration above his eye --
MS. LITTLE: -- 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: No 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 injuries to his feet?
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'm 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: But injuries that you testified to today were that he had sort of a laceration above his eyelid, correct?
MS. LITTLE: And the scratches on his right arm?
MS. LITTLE: No further questions.
JUDGE CANNONE: Okay. Mr. Lally?
REDIRECT EXAMINATION BY MR. LALLY:
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. I'd like to. So with a patient like Mr. O'Keefe who came in, the focus of myself and the team of physician assistants and nurse practitioners and nurses, whoever was helping in a case like this, the focus is in core resuscitative medicine of securing an airway, making sure he has a breathing tube in, making sure CPR is being applied with 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 is less focus on injuries or observations that don't coincide with the resuscitation effort or not pertinent to that resuscitative effort, if that answers your question.
MR. LALLY: And so in that vein, it's not like you're doing x-rays or full skeletal survey or something like that?
MR. LALLY: Because you're more concerned with the fact that his body core temperature is 80, his heart isn't pumping blood and he is 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.
MR. LALLY: Your Honor, may I approach the witness?
JUDGE CANNONE: Yes.
BY MR. LALLY:
MR. LALLY: Doctor, I direct your attention to the document which indicates "Discharge and Clinical Impression." If you could just read from that and look up when you've finished? Read it 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: Right. So I wrote (as read), "Clinical Impression: Cardiac arrest, head trauma, exposure to environmental cold."
MR. LALLY: May I approach just to retrieve, Your Honor?
JUDGE CANNONE: Yes.
MR. LALLY: Thank you. No further questions.
JUDGE CANNONE: Anything further, Ms. Little?
MS. LITTLE: No further questions.
JUDGE CANNONE: All right. Thank you, Doctor. You are also excused.
(Whereupon, the witness is excused.)
JUDGE CANNONE: So rather than -- where it's 10 minutes of 1:00, jurors, can we do an abbreviated lunch today so we can get as much testimony in as possible? So it's 10 minutes of 1:00. Why don't we come back here at 1:30. And can we go until 4:30 today? All right. People seem to say "yes." If that changes, just let Officer Delano or Officer Lydon know. Thank you. So we'll see you back here at 1:30.
(Whereupon, the jury is escorted from the courtroom for the luncheon recess.)
JUDGE CANNONE: All right. So as far as the redactions that 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 I can decide it before it goes in. And then it would be the next exhibit either with or without the additional redactions. Okay?
MS. LITTLE: Thank you, Your Honor.
JUDGE CANNONE: All right. Thank you.
(Whereupon, there was a luncheon recess taken.)
AFTERNOON SESSION
(Court resumes.)
(Defendant present. Jury present.)
JUDGE CANNONE: Your next witness, Mr. Lally?
MR. LALLY: Yes, Your Honor. The Commonwealth calls Dr. Garrey Faller to the stand.