Commonwealth v. Read — Trial ArchiveIrini Scordi-Bello - Direct/Cross/Redirect
412 linesCOURT OFFICER: Hear ye, hear ye, hear ye, all persons having anything to do before The Honorable Beverly Cannone, Justice of the Superior Court, now sitting within and for the County of Norfolk, draw near, give your attendance, and you shall be heard. God save the Commonwealth of Massachusetts. This court is in session. Please be seated.
COURT CLERK: 22-117, the Commonwealth versus Karen Read.
JUDGE CANNONE: All right. Good morning, counsel. Good morning, Miss Read. Good morning. I asked you those same three questions. Were you all able to follow the instructions and refrain from discussing this case with anyone since we left yesterday? Everyone said yes and nodded affirmatively. Were you also able to follow the instructions and refrain from doing any independent research or investigation into this case? Everyone said yes and nodded affirmatively. Did anyone happen to see, hear, or read anything about this case since we left here yesterday? Everyone said no. Thank you very much. Do we have Dr. Scordi-Bello?
COURT CLERK: Please rise. Do you swear to tell the truth, the whole truth, and nothing but the truth?
DR. SCORDI-BELLO: I do.
JUDGE CANNONE: Whenever you're ready, Mr. Lally.
MR. LALLY: Good morning, Doctor.
DR. SCORDI-BELLO: Good morning.
MR. LALLY: Good morning, Dr. Scordi-Bello. If I could ask you some questions, turning back a little bit from what you were testifying to about yesterday. You had mentioned in your testimony yesterday that you had received — in addition to the internal and external examination that you conducted of Mr. O'Keefe — you also received some other material that you had reviewed. Correct?
DR. SCORDI-BELLO: Correct.
MR. LALLY: Now, included within that material was some material from the state police, as far as the investigating agency investigating Mr. O'Keefe's death. Correct?
DR. SCORDI-BELLO: Correct.
MR. LALLY: Now, is that something — is that typical, is that abnormal? If you could describe, sort of in general terms, as far as what, if any, communication would you typically have with the investigating body or agency in relation to any sort of autopsy or examination you're doing?
DR. SCORDI-BELLO: Yes. In Massachusetts, under Massachusetts law, the medical examiner's office is responsible, and our role is to determine the cause and manner of death by doing an autopsy. The scene of death, or the place where the decedent is found, is controlled by the District Attorney's office and state police, who will do an investigation. When we accept a case into our office, we request reports — police reports — to explain and describe the circumstances of the death. It could be a house, it could be somewhere else, could be outside. Every case comes with a police report, and we review that police report, and if we feel that we need more information, then we contact the investigating body and ask for more information, again depending on the case.
MR. LALLY: And specifically in this case, in regards to Mr. O'Keefe, did you reach out to get some more information?
DR. SCORDI-BELLO: I did reach out, yes.
MR. LALLY: And was that in part in relation to what you were talking about in your testimony yesterday, as far as the diagnosis of hypothermia and trying to sort of better understand the circumstances?
MS. LITTLE: Objection.
JUDGE CANNONE: Sustained.
MR. LALLY: Why did you reach out?
DR. SCORDI-BELLO: I reached out because when the case was presented to us, and after I did the autopsy, I did not have all the information that I needed in order to certify the manner. The cause of death, to me — I was able to determine the cause of death from the autopsy. When an event is unwitnessed, we usually reach out to the investigating agency and ask them whether they have any more information than they did on the day that the autopsy was done, because investigations sometimes take some time. So in the days and the weeks following the autopsy, I reached out and asked if there was any more information than what I was originally presented with. Was there any video from the surrounding areas? Did anybody come forward to say that they actually witnessed whatever happened?
DR. SCORDI-BELLO: And again, by the time I was ready to finalize the case — and we have approximately three months or 90 days from the day of the autopsy until we issue a report — I was not provided with enough information for me to be able to determine the manner.
MR. LALLY: Now, Doctor, do you recall specifically who it was that you spoke with from the state police?
DR. SCORDI-BELLO: Yes. I documented that I spoke with Trooper Proctor, I believe, twice.
MR. LALLY: And with reference — not asking you anything as far as what that conversation consisted of, but as far as the tone of that conversation — did you feel pressured or coerced to come up with a certain determination?
DR. SCORDI-BELLO: No, I did not.
MR. LALLY: And even if you had been, what would your response have been in reference to that?
DR. SCORDI-BELLO: My response was that I am responsible for what goes on the death certificate, and unless I have enough information — clear and convincing evidence — I cannot determine a manner.
MR. LALLY: Doctor, I'm showing you five photographs that I gave to you yesterday. Do you recognize those?
DR. SCORDI-BELLO: Yes, I do.
MR. LALLY: And what do you recognize those to be?
DR. SCORDI-BELLO: I recognize these as photographs of Mr. O'Keefe's body. I believe these were taken at the hospital. One of them is a photograph taken at the time of autopsy.
MR. LALLY: Thank you. May I approach?
JUDGE CANNONE: Yes.
MR. LALLY: Approaches to introduce exhibits.
MS. LITTLE: No objection.
JUDGE CANNONE: Thank you. [Exhibit] 64. Thank you very much.
MR. LALLY: May I have a moment? I just want to make sure they're in.
JUDGE CANNONE: Yes.
MR. LALLY: May I approach again?
JUDGE CANNONE: Yes.
MR. LALLY: With the Court's permission, may I publish for the jury?
JUDGE CANNONE: Yes. So — remember the instruction I gave you yesterday on these photographs? Okay. Let's — if I can have photograph 2853.
MR. LALLY: Doctor, do you recognize what's up on the screen?
DR. SCORDI-BELLO: Yes. This is a picture taken of Mr. O'Keefe's body.
MR. LALLY: And, Doctor, if you could, using the laser pointer, direct the jury's attention to what, if anything, you observe of significance in this photograph related to the injuries that you were testifying about.
DR. SCORDI-BELLO: Yes. So the first thing you notice is the medical intervention, which I talked about yesterday. There's the defibrillator adhesive pads on the chest. There is what's known as a cervical collar — a cervical stabilization collar for the neck — and he has been intubated prior to going to the hospital. The injuries that are obvious in this picture include the abrasions on his right forearm and arm. And you can see here there is this coloration of the upper eyelid of the right eye with some blood that's dripping — that's the orbital or supraorbital ecchymosis that I described before. We're too far to see the very small laceration that is present there, but that's what's causing the bleeding.
MR. LALLY: And if I can have photograph 57 — now, Doctor, this is not before you at the current time. Is it currently marked as [Exhibit] 442? Do you recognize what's up on the screen?
DR. SCORDI-BELLO: Yes. This is a picture of the abrasions that I described in my report — posterior upper arm and forearm. You can see that they have some sort of pattern to it. Anytime we see a pattern, we try to document it as best as we possibly can.
MR. LALLY: Now, Doctor, with reference to these injuries, as far as Mr. O'Keefe's right arm — what kind of role do they play as far as your determination as to cause of death?
DR. SCORDI-BELLO: These are superficial abrasions to the skin. They are not lethal. They're not contributory to the cause of death. The trauma that I observed on the head, along with the hypothermia, are the two factors contributing to his death. These are present, they're noted, they're described, they're photographed, but I do not know how they came to be, and I did not contribute them to the cause of death.
MR. LALLY: Miss Gilman, if I could have photograph 286. Doctor, returning to the exhibit of photos that you have before you, do you recognize what's on the screen here?
DR. SCORDI-BELLO: Yes. This is a photograph of Mr. O'Keefe's right hand. This is the dorsum, or the dorsal aspect of the hand, as opposed to the palm. And you can see that there are some contusions or bruises — there's a larger one here and two very small ones here. This particular contusion has two pinpoint small defects associated with it. I believe this could be due to attempts at gaining IV access during the many attempts at resuscitation, but I cannot be absolutely sure.
MR. LALLY: If I can have photograph 265. And, Doctor, if you could again, using the laser pointer, direct the jury's attention to anything of significance you note in this photograph.
DR. SCORDI-BELLO: Again, this is a slightly closer view of Mr. O'Keefe's face. You can see the discoloration — the ecchymosis — on the right eye with a slight amount of bleeding. You can see here that there's also some discoloration of his left eye, left eyelid.
MR. LALLY: And, Doctor, with reference to the other injuries that you were testifying about yesterday, as far as the small abrasions or lacerations, are those visible in this photograph as well?
DR. SCORDI-BELLO: I can't hear your question. If you could just repeat it, a little louder.
MR. LALLY: Sure, my apologies. With reference to this photograph, as far as your testimony yesterday in regard to the other smaller injuries around the nose and eyes area of Mr. O'Keefe, are those visible in this photograph as well?
DR. SCORDI-BELLO: You can see some discoloration of the nose, but this is not a very good picture of it. I think there's a linear abrasion on the left side of the nose that I described, and it's probably this — photograph 2877.
MR. LALLY: And, Doctor, if you could again, using the laser pointer, direct the jury's attention to anything significant you observe in this
DR. SCORDI-BELLO: Yes, this is a view of the left side of Mr. O'Keefe's face. You can see the discoloration of the left eyelid, and now you can see this linear abrasion on his nose, and a small abrasion more towards the middle of his nose.
MR. LALLY: Lastly from this set, I have photograph 9488. And Doctor, if you could, using the laser, direct the jury's attention to what, if anything of significance, you observe.
DR. SCORDI-BELLO: This is the laceration to the back of Mr. O'Keefe's head. You can see this defect here — it's ragged, it's a typical, classic blunt impact injury — and you can see the abrasion, the scrape, that is adjacent to it.
MR. LALLY: Thank you. I'm— We get out the light. Thank you. Now, Doctor, with reference to what you were testifying about yesterday as far as the sub-scalp bleeding — bleeding under the scalp — is that more or less prominent on one side versus the other side of Mr. O'Keefe's scalp?
DR. SCORDI-BELLO: Yes, it was more prominent under that laceration that we just looked at.
MR. LALLY: And so with that being more prominent on the right side, is that correct?
DR. SCORDI-BELLO: Yes.
MR. LALLY: Now, you testified yesterday about a blunt object's injury in relation to the injury to the back of the head, then leading to the fractures and the bleeding in the brain, correct?
DR. SCORDI-BELLO: Correct.
MR. LALLY: And then further leading to the ecchymosis — is that correct — in the eyes?
DR. SCORDI-BELLO: Yes.
MR. LALLY: Now, that blunt object — what, if anything, can you say about what that blunt object would be?
DR. SCORDI-BELLO: Could be any blunt object.
MR. LALLY: Now, from your training and experience, with reference to the number of autopsies and examinations that you've conducted over the years, would that blunt object's possibilities include the ground, especially if it was frozen ground?
MS. LITTLE: Objection. Ask the question differently.
MR. LALLY: The injuries that you observed to the back of Mr. O'Keefe's head — the skull fracture — would that be consistent with a fall to the ground?
DR. SCORDI-BELLO: It could be.
MR. LALLY: Would that be consistent with being projected — say, in a pedestrian collision — and then striking your head on the ground?
DR. SCORDI-BELLO: It's possible.
MR. LALLY: The arm injuries that you observed — would those be consistent with scratches from either glass, or a piece of plastic, or a piece of metal?
DR. SCORDI-BELLO: It's possible.
MR. LALLY: And the injuries that you observed — would that be consistent with injuries that you've observed in other cases of a pedestrian collision?
DR. SCORDI-BELLO: They're not the classic pedestrian injuries that we observe. No.
MR. LALLY: And to that point — when you say "classic" as far as a pedestrian collision is concerned — you've conducted autopsies on a number of different pedestrian collisions over the course of your career, is that correct?
DR. SCORDI-BELLO: Yes, I have.
MR. LALLY: Do they all sort of mirror each other? Is there a disparity depending on how the person interacted with the—
MS. LITTLE: Objection.
JUDGE CANNONE: Sustained. Watch the form, Mr. Lally.
MR. LALLY: Are injuries from a pedestrian collision ever the same?
DR. SCORDI-BELLO: No. No.
MR. LALLY: And why not?
DR. SCORDI-BELLO: It depends on many factors. It depends on the position of the body — of the pedestrian, or the person being struck. It depends on whether they are moving or standing still. It depends on the speed of the car. It depends on whether the brakes were applied or not. There are a lot of factors that come into play.
MR. LALLY: Would another factor be the shape of— —the vehicle that strikes the pedestrian?
DR. SCORDI-BELLO: That's also possible, yes — that's a factor.
MR. LALLY: And did you have occasion to see — or have you seen — any photographs in relation to the defendant's vehicle in this case?
DR. SCORDI-BELLO: I have seen photographs, yes.
MR. LALLY: And the size or shape of that vehicle — what, if any, significance does that have to you as far as your examination?
JUDGE CANNONE: I'll allow it.
DR. SCORDI-BELLO: When we have a potential vehicle, clearly we look at the height, because one of the things that we do in most or all pedestrian — or people struck by a motor vehicle — is look at the legs, because in the majority we see injuries to the legs from the bumper of the— —car. Again, depending on the kind of car, the size of the car, and the height of the bumper. So in Mr. O'Keefe's case, I did not see any injuries in the lower extremities. And looking at the car, I did note that it was a much bigger car, with much higher — I would say much higher — tail light, bumper. It was not a sedan or a car that's low to the ground where the bumper would be at the level of, let's say, the knee, or slightly above or slightly below.
MR. LALLY: And again, I believe yesterday in your testimony you indicated that the skull is a pretty thick bone, is that correct?
DR. SCORDI-BELLO: Yes.
JUDGE CANNONE: Sustained.
MR. LALLY: With regard to the thickness of the skull bone, what, if anything, can you say as far as the type or amount of force that would be necessary to cause the fracture that you observed?
MS. LITTLE: Objection.
JUDGE CANNONE: Overruled.
DR. SCORDI-BELLO: I would consider the amount of force to be significant — again, without being able to quantify it.
MR. LALLY: May I have a moment?
JUDGE CANNONE: Yes.
MR. LALLY: Doctor, from the internal and external examination that you conducted in regard to Mr. O'Keefe, as well as the other materials that you reviewed, were you able to come to an opinion, to a reasonable degree of medical certainty, as to the cause of death of John O'Keefe?
DR. SCORDI-BELLO: Yes. The cause of death was due to blunt impact injuries of the head and hypothermia.
MR. LALLY: Thank you, Doctor. I have no further questions.
COURT CLERK: Cross-examination.
MS. LITTLE: Good morning, Dr. Scordi-Bello.
DR. SCORDI-BELLO: Good morning.
JUDGE CANNONE: Miss Little, keep your voice up.
MS. LITTLE: Absolutely. You testified regarding a number of injuries that you referred to as blunt impact injuries, correct?
DR. SCORDI-BELLO: Yes.
MS. LITTLE: And to be clear, blunt impact injuries are a very, very large category that includes contusions, lacerations, abrasions, and fractures, correct?
DR. SCORDI-BELLO: Correct.
MS. LITTLE: And you testified similarly that a blunt object can also refer to a large range of objects, is that right?
DR. SCORDI-BELLO: Correct.
MS. LITTLE: And I think yesterday you gave the example of a microphone being a blunt object, correct?
DR. SCORDI-BELLO: Correct.
MS. LITTLE: It could also include something like a baseball bat, correct?
DR. SCORDI-BELLO: Correct.
MS. LITTLE: A dumbbell?
DR. SCORDI-BELLO: Could be.
MS. LITTLE: The ground?
DR. SCORDI-BELLO: Yes.
MS. LITTLE: Or a German Shepherd's claws?
DR. SCORDI-BELLO: Possibly, yes.
MS. LITTLE: You'd agree that John O'Keefe had a number of blunt impact injuries on his face, on his head, and his right arm?
DR. SCORDI-BELLO: Yes.
MS. LITTLE: Besides his right arm — which we'll discuss in a second — taking his body from the neck down, he did not have any significant injuries from the neck down, correct?
DR. SCORDI-BELLO: Not significant, no.
MS. LITTLE: Let's take those one at a time. No injury whatsoever to his shoulders, correct?
DR. SCORDI-BELLO: Correct.
MS. LITTLE: No injury whatsoever to his chest area, aside from the CPR-related injuries that you discussed?
DR. SCORDI-BELLO: Yes, correct.
MS. LITTLE: And that was in the ribs, just adjacent to the sternum, is that right?
DR. SCORDI-BELLO: It was in the ribs, just adjacent to the sternum, yes.
MS. LITTLE: Okay. No injuries to his torso other than that?
MS. LITTLE: No injuries to his back?
MS. LITTLE: No injuries to his hips, correct?
DR. SCORDI-BELLO: Correct.
MS. LITTLE: No injuries to his pelvis, correct?
DR. SCORDI-BELLO: Correct.
MS. LITTLE: No injuries to his thighs?
MS. LITTLE: No injuries to his knees, correct?
DR. SCORDI-BELLO: Correct.
MS. LITTLE: No injuries to his shins, correct?
DR. SCORDI-BELLO: Correct.
MS. LITTLE: No injuries to his ankles, correct?
DR. SCORDI-BELLO: Correct.
MS. LITTLE: No injuries to his feet, correct?
DR. SCORDI-BELLO: Correct.
MS. LITTLE: From the neck down, he did not have a single broken bone — again, aside from those CPR-related injuries you discussed — correct?
DR. SCORDI-BELLO: That's correct.
MS. LITTLE: Not a single fracture other than CPR, correct?
DR. SCORDI-BELLO: Correct.
MS. LITTLE: And you spoke earlier about how the bumper was a little higher than on, say, a regular sedan, correct?
DR. SCORDI-BELLO: Correct.
MS. LITTLE: And so usually in a pedestrian collision you would see injuries to the knees, is that right?
MR. LALLY: Objection.
DR. SCORDI-BELLO: Oh, depending on the kind of car, depending on the speed, depending on the height of the individual and the car, you might see injuries to their lower extremity.
MS. LITTLE: But in this case, you didn't see any injuries to his thighs, to his pelvis, anything — even at the height of the bumper — is that correct?
DR. SCORDI-BELLO: Correct — at a very minor abrasion to the side of his right knee.
MS. LITTLE: So surely you'd agree that John O'Keefe's injuries, or lack thereof, are inconsistent with having been struck by a 7,000-pound vehicle at 24 miles per hour and being projected 30 feet?
MR. LALLY: Objection.
JUDGE CANNONE: Sustained. Break it down.
MS. LITTLE: Would you agree that John O'Keefe's injuries, or lack thereof, are inconsistent with having been struck by a vehicle at 24 miles per hour?
DR. SCORDI-BELLO: I would say it's likely and unlikely at the same time, depending on the position of the— —body and the vehicle in question.
MS. LITTLE: Well, let me give you a hypothetical. Let's say the person were standing with their arm like this, and they were struck by the rear tail light of a vehicle at 24 miles per hour — would you agree that his injuries are inconsistent with that scenario?
MR. LALLY: Objection.
JUDGE CANNONE: Sustained. May we approach? Sure.
PARENTHETICAL: [bench conference]
COURT OFFICER: You are unmuted.
MS. LITTLE: Would you agree that John O'Keefe's injuries to his arm — let's start there — are inconsistent with having been struck by a vehicle at 24 miles per hour, and then causing him to spin around and be projected 30 feet?
JUDGE CANNONE: Okay, so you need to break it down.
MS. LITTLE: Would you agree that John O'Keefe's injury to his arm is inconsistent with having been struck by a vehicle at 24 miles per hour?
DR. SCORDI-BELLO: I don't know. I am not a reconstruction expert. I'm not a biomechanics expert. I never personally inspected the car, so I can't offer an opinion on that.
MS. LITTLE: You did examine John O'Keefe's arm, correct?
DR. SCORDI-BELLO: Yes.
MS. LITTLE: You observed no significant bruising, correct?
DR. SCORDI-BELLO: Correct.
MS. LITTLE: No fractures, correct?
DR. SCORDI-BELLO: Correct.
MS. LITTLE: And no broken bones, correct?
DR. SCORDI-BELLO: Correct.
MS. LITTLE: I'd like to talk about the injuries to John O'Keefe's face. You testified that Mr. O'Keefe had a laceration on his right upper eyelid, correct?
DR. SCORDI-BELLO: Yes.
MS. LITTLE: You also described multiple abrasions on his nose — two?
DR. SCORDI-BELLO: Yes.
MS. LITTLE: Although these injuries may not have been the ultimate cause of his death, you'd agree that less severe injuries— ...can still be very important in interpreting the manner or the context in which that person died, correct?
DR. SCORDI-BELLO: Correct.
MS. LITTLE: And in furtherance of that, you've been taught that when doing an autopsy, details matter, correct — no matter how small, correct?
DR. SCORDI-BELLO: Correct.
MS. LITTLE: And that's one of the reasons, as a medical examiner, you have to notate every single injury you find on a person, correct?
DR. SCORDI-BELLO: Correct.
MS. LITTLE: If I could show you — can I approach, your honor?
JUDGE CANNONE: Yes.
MS. LITTLE: Show Miss Gilman. Do you recognize that photograph?
DR. SCORDI-BELLO: I do.
MS. LITTLE: And is that a photograph that was taken in connection with your autopsy?
DR. SCORDI-BELLO: Yes, it was taken at the time of autopsy, after the face was cleaned.
MS. LITTLE: I'm sorry — after what?
DR. SCORDI-BELLO: The face was cleaned up.
MS. LITTLE: Okay. I move to admit, your honor.
JUDGE CANNONE: Any objection, Mr. Lally?
MR. LALLY: No.
PARENTHETICAL: [someone]
JUDGE CANNONE: : Yes.
JUDGE CANNONE: Okay. [Exhibit] 65. Permission to publish?
MS. LITTLE: Are these the facial injuries that you were testifying to earlier?
DR. SCORDI-BELLO: Yes.
MS. LITTLE: And could you kind of describe, in that photograph, what injuries you observed?
DR. SCORDI-BELLO: The orbital ecchymosis on both eyes, the small laceration to the right eyelid, the abrasions on the nose.
MS. LITTLE: And you testified that the injuries to his face were also the result of blunt force trauma, correct?
DR. SCORDI-BELLO: So that's the laceration to the eye and the two abrasions that we see there on his nose, correct.
MS. LITTLE: And you agree that those injuries don't just manifest out of nowhere, right?
DR. SCORDI-BELLO: Absolutely.
MS. LITTLE: They have to originate from something?
DR. SCORDI-BELLO: Yes.
MS. LITTLE: Would you agree that his injuries to his face are consistent with having been punched?
DR. SCORDI-BELLO: That is a possibility.
MS. LITTLE: Take that down, Mr. B. Thank you. Your internal examination notes also cite a tongue laceration on the right front of the victim's tongue. Do you recall that?
DR. SCORDI-BELLO: Yes.
MS. LITTLE: And you'd agree that a tongue laceration can also be caused by— —blunt force trauma, correct?
DR. SCORDI-BELLO: Correct.
MS. LITTLE: And that could also include something like a punch to the victim's face or jaw?
DR. SCORDI-BELLO: That's a possibility.
MS. LITTLE: In addition to the facial injuries, you described that Mr. O'Keefe had a significant laceration on the back of his head. He had one laceration to the back of his head, correct?
DR. SCORDI-BELLO: Correct.
MS. LITTLE: I believe we saw a photograph of that a little bit earlier. You testified that the skin around the laceration on the back of his head was also scratched — you recall that?
DR. SCORDI-BELLO: I do.
MS. LITTLE: But you did not testify as to how that might have happened.
MS. LITTLE: Would you agree that someone could certainly get scratched on the back of their head— —if they were, for instance, dragged on the ground?
DR. SCORDI-BELLO: It's possible.
MS. LITTLE: You described the open wound to the back of his head as a laceration, which is sort of a blunt force injury — that's not the result of sharp force trauma, is that right?
DR. SCORDI-BELLO: Yes.
MS. LITTLE: And you'd agree that Mr. O'Keefe's head injury came from some sort of blow to the back of the head, whether it be an object or the ground, is that right?
DR. SCORDI-BELLO: Yes.
MS. LITTLE: And that injury could be the result of falling backward from a standing position onto concrete?
DR. SCORDI-BELLO: It's possible.
MS. LITTLE: It could also be the result of being struck with a large object, such as a baseball bat or a barbell?
DR. SCORDI-BELLO: It's possible.
MS. LITTLE: In other words, it was an— —irregular laceration that resulted from blunt force trauma, correct?
DR. SCORDI-BELLO: Correct.
MS. LITTLE: I'd like to sort of circle back to those injuries to Mr. O'Keefe's arm. You testified that there were again no fractures, no broken bones, no significant contusions, correct?
DR. SCORDI-BELLO: Correct.
MS. LITTLE: But you did describe the wounds to Mr. O'Keefe's arm as having discrete linear abrasions, which were caused by some sort of blunt object, correct?
DR. SCORDI-BELLO: Yes.
MS. LITTLE: What does "discrete" mean?
DR. SCORDI-BELLO: It means each one is an individual injury, as opposed to confluent, where it would be all meshed together.
MS. LITTLE: Your honor, if I could publish what's been previously marked as Exhibit 19?
JUDGE CANNONE: Okay.
MS. LITTLE: And these are sort of the linear wounds that you're referring to?
DR. SCORDI-BELLO: Yes.
MS. LITTLE: And you testified that these also sort of appear in clusters or groups — you call them pattern abrasions, is that right?
DR. SCORDI-BELLO: Yes, I did.
MS. LITTLE: And you'd agree that, for example, road rash does not result in this type of discrete linear wounds?
DR. SCORDI-BELLO: It could, but not exactly like this.
MS. LITTLE: Well, typically road rash covers sort of a large area of the skin — it would be a large abrasion — and you've seen numerous cases of road rash in your career, and it doesn't look like that, correct?
DR. SCORDI-BELLO: Correct.
MS. LITTLE: Blunt force trauma can include injuries from various objects, as you testified, including an animal claw, correct?
DR. SCORDI-BELLO: Correct.
MS. LITTLE: And you'd agree that these— —discrete linear abrasions are inconsistent with having been struck by a smooth rear tail light at 24 miles per hour?
MR. LALLY: Objection.
MS. LITTLE: Can you answer that, Doctor?
DR. SCORDI-BELLO: I can't — by a smooth — uh, no.
MS. LITTLE: All right, next question. By a smooth rear tail light — you said that is not what you would see at 24 miles per hour, correct?
MR. LALLY: Objection.
JUDGE CANNONE: Sustained.
MS. LITTLE: As you testified earlier, you've indicated that based on the facts that were presented to you, you don't know what caused those significant scratches on Mr. O'Keefe's right arm?
DR. SCORDI-BELLO: I do not.
MS. LITTLE: May I approach?
JUDGE CANNONE: Sure.
MS. LITTLE: If I could just — see what was — oh, I'm sorry. Do you recognize that photograph?
DR. SCORDI-BELLO: I do.
PARENTHETICAL: [Bench conference]
MS. LITTLE: It's a photograph of Mr. O'Keefe's right hand. May I mark that as the next [exhibit]?
PARENTHETICAL: [someone]
JUDGE CANNONE: : Was it — cleared to be published? Appropriately?
PARENTHETICAL: [someone]
JUDGE CANNONE: : Yes, your honor. Okay.
MR. LALLY: Objection. May we approach?
JUDGE CANNONE: Okay.
MS. LITTLE: Thank you, your honor.
JUDGE CANNONE: We'll mark it first — we'll mark it for identification, and then when it's appropriate it will be transferred to being an exhibit. But thank you. But yes, you can publish.
MS. LITTLE: Dr. Scordi-Bello, you indicated on direct examination that at least one of the bruises on Mr. O'Keefe's right hand could potentially be attributed to an attempt to get IV fluid into the hand, is that correct?
DR. SCORDI-BELLO: Correct.
MS. LITTLE: During the course of your autopsy, you reviewed records from the Canton Fire Department and EMS, as well as Good Samaritan Hospital, is that correct?
DR. SCORDI-BELLO: I did.
MS. LITTLE: And do you recall reviewing records indicating that the IV fluids in this particular case were administered through the tibia, and then later through a catheter at the hospital?
DR. SCORDI-BELLO: Yes, they were administered through intraosseous lines in both legs' shins, and at the hospital they were administered through a femoral central line.
MS. LITTLE: Yes. And you'd agree that bruising on the backs of hands is also consistent with defensive wounds?
DR. SCORDI-BELLO: That's — yes, that's correct.
MS. LITTLE: And there are actually four separate distinct bruises, outside of the one that you discussed earlier, on this right hand, correct?
DR. SCORDI-BELLO: Yes. I would say three, but— —I can see how you would say four. One, two, three — that might be one together. But yes, I can see how you would say four.
MS. LITTLE: And you testified yesterday that there was also an injury to Mr. O'Keefe's left hand?
DR. SCORDI-BELLO: There was a vague contusion on his left hand, correct.
MS. LITTLE: Can we take this down now, Miss Gilman?
COURT OFFICER: Yes, sir.
MS. LITTLE: You testified on direct examination that you didn't see any sort of obvious signs of a fight, because Mr. O'Keefe's fingernails were intact and you didn't observe any fractures on his hands, is that right?
DR. SCORDI-BELLO: Correct.
MS. LITTLE: But broken fingernails and fractured hands aren't the only observable signs of a fight, isn't that correct?
DR. SCORDI-BELLO: That's correct.
MS. LITTLE: In fact, you noted a laceration over his eye?
DR. SCORDI-BELLO: Yes.
MS. LITTLE: You noticed multiple — abrasions on his nose?
DR. SCORDI-BELLO: Yes. Multiple abrasions on his nose, correct.
MS. LITTLE: You noticed a laceration to his tongue?
DR. SCORDI-BELLO: Yes.
MS. LITTLE: You noted the contusions on the back of his right hand, correct?
DR. SCORDI-BELLO: Correct.
MS. LITTLE: The contusion to his left hand as well, correct?
DR. SCORDI-BELLO: Correct.
MS. LITTLE: And as you just testified, bruising on the back of hands may be consistent with defensive wounds?
PARENTHETICAL: [Bench conference]
DR. SCORDI-BELLO: It could be.
MS. LITTLE: So in fact, if you have a body that presents with a laceration to one of the brows, a laceration or abrasions to the nose, an ecchymosis over an eye, contusions and abrasions on the hands, and a laceration to the— —tongue — these injuries are consistent with a physical altercation, correct?
MR. LALLY: Objection.
JUDGE CANNONE: Sustained.
MS. LITTLE: Are those injuries consistent with a physical altercation?
MR. LALLY: Objection.
MS. LITTLE: Your honor, may we approach?
JUDGE CANNONE: Sure.
MS. LITTLE: Shifting gears for a second. You indicated on direct examination that you reviewed some photographs from law enforcement that showed no footprints in the snow. Do you recall that testimony?
DR. SCORDI-BELLO: I do.
MS. LITTLE: Were those provided to you by Trooper Proctor?
DR. SCORDI-BELLO: Yes.
MS. LITTLE: Do you have those photographs with you?
DR. SCORDI-BELLO: No, I don't.
MS. LITTLE: Do you recall what was depicted in those photographs?
DR. SCORDI-BELLO: Yes. If I remember correctly, it was the area of the fire hydrant and the area where Mr. O'Keefe's body was discovered — the front of the house, the area of the fire hydrant, and I believe the flag pole.
MS. LITTLE: Thank you. You testified that Mr. O'Keefe had multiple fractures to his skull, but that they seem to be originating from a single point of impact on the back of his head, is that correct?
DR. SCORDI-BELLO: It appeared so, yes.
MS. LITTLE: Are you reasonably certain that all of his injuries were the result of a single impact to the back of the head?
DR. SCORDI-BELLO: It could be a single impact, but it also could be multiple impacts, correct. It could be, yes.
MS. LITTLE: Because, as you just testified, Mr. O'Keefe suffered multiple injuries to the front of his face as well, correct?
DR. SCORDI-BELLO: Correct.
MS. LITTLE: In other words, he could have— — suffered a trauma to the face and then fallen and sustained the injury to the back of the head?
DR. SCORDI-BELLO: That is possible, yes.
MS. LITTLE: And you testified before the state grand jury that the areas of bruising to the brain were likely due to a fall. Is that correct?
DR. SCORDI-BELLO: Yes.
MS. LITTLE: In your expert medical opinion, is it possible for someone to get punched in the face hard enough to lose consciousness and fall backward?
MR. LALLY: Objection.
JUDGE CANNONE: I'll allow it.
DR. SCORDI-BELLO: It's possible.
MS. LITTLE: If I have permission to publish what's been previously admitted as Exhibit 19—
JUDGE CANNONE: Yes.
MS. LITTLE: Dr. Scordi-Bello, it's kind of hard to see in this picture, but there's some redness that you observe on the body by the ribs — that we observed in some of the other photographs that were presented by Mr. Lally. I'd like to show you what's been previously marked as People's Exhibit 648. To court staff: Miss G — Mr. B, could you take that down? Court staff: Yeah. Miss G, would it be possible to display 648? 648? Court staff — exhibit noted. May I approach?
JUDGE CANNONE: Yes.
MS. LITTLE: You were shown this photograph by Mr. Lally on direct examination?
DR. SCORDI-BELLO: Yes.
MS. LITTLE: You see the red — sort of — next to his rib cage on the bottom?
DR. SCORDI-BELLO: Correct. Yes.
MS. LITTLE: What is that?
DR. SCORDI-BELLO: That is livor lividity.
MS. LITTLE: Lividity. Yes. Can you describe for the jury what lividity is?
DR. SCORDI-BELLO: Yes. Lividity is the pooling of blood to the dependent areas of the body after someone is deceased.
MS. LITTLE: So even though it sort of appears to look like a bruise, that's lividity?
DR. SCORDI-BELLO: That is lividity, yes. Goes all the way down and it's not the result of an injury.
MS. LITTLE: No. Thank you. No further questions.
JUDGE CANNONE: Okay. The lights, please. Thank you, Mr. —.
MR. LALLY: And Dr. Scordi-Bello, you did observe a minor abrasion to Mr. O'Keefe's right knee. Is that correct?
DR. SCORDI-BELLO: Correct.
MR. LALLY: And what part of the knee was that on, if you recall?
DR. SCORDI-BELLO: It was on the side — on the lateral side of his right knee.
MR. LALLY: And by lateral, sort of the side that faces away from the body. Is that correct?
DR. SCORDI-BELLO: Correct.
MR. LALLY: We were asked whether or not the small injuries on Mr. O'Keefe's face could possibly be from a punch. Is that correct?
DR. SCORDI-BELLO: Correct.
MR. LALLY: You said that's one of the possibilities. Is that correct?
DR. SCORDI-BELLO: Yes.
MR. LALLY: What are some of the other possibilities?
DR. SCORDI-BELLO: Could be impact during a fall. It could be coming in contact with any blunt object.
MR. LALLY: In the snow — would glass be a possibility as—
DR. SCORDI-BELLO: — as a blunt object? It could be, under certain circumstances. A piece of plastic, under certain circumstances—
MR. LALLY: As far as a blunt object, would that also be a possibility?
DR. SCORDI-BELLO: Correct. Yes.
MR. LALLY: Now as far as the abrasion near the laceration on the back of Mr. O'Keefe — you said you were asked questions about whether or not that could be from dragging. Correct?
DR. SCORDI-BELLO: Correct.
MR. LALLY: Now as far as injuries or abrasions concerning dragging, would it be typical to see just one isolated abrasion in the area of laceration?
DR. SCORDI-BELLO: Not typical, but possible.
MR. LALLY: Could that also be a result of blunt impact — as one of the possibilities you've testified before — — from hitting the ground?
DR. SCORDI-BELLO: Yes.
MR. LALLY: Now you were asked about hitting the ground, and specifically hitting concrete. Would the injuries to the back of Mr. O'Keefe's head also be consistent with striking his head on frozen ground?
JUDGE CANNONE: Sure. I'll allow it. Can you repeat the question?
MR. LALLY: You were asked a question on cross-examination about the laceration and abrasion to the back of Mr. O'Keefe's head being consistent with striking his head on concrete. Correct?
DR. SCORDI-BELLO: Yes.
MR. LALLY: Would that also be consistent with striking his head on frozen ground?
DR. SCORDI-BELLO: Could be, yes.
MR. LALLY: You were asked about certain wounds as being a possibility of defensive wounds. What are some of the other types of defensive wounds that you would expect to see that you did not see in this case?
DR. SCORDI-BELLO: I would expect to see — or I have seen — multiple bruising to the — again — posterior aspects of the forearms. I have seen cuts, lacerations, depending on how a person might be defending themselves, the position of their arms. And with that, also includes breaks in the fingernails and fractures to the hands.
JUDGE CANNONE: Watch the form, Mr. Lally. Sustained.
MR. LALLY: What, if anything else, would that include?
DR. SCORDI-BELLO: It might include bruising to the knuckles. It might include broken fingers.
MR. LALLY: Now with reference to the injuries that you were asked about with respect— — to Mr. O'Keefe's right hand, would those also be consistent with impact from a blunt object as well?
DR. SCORDI-BELLO: They are blunt impact injuries, yes.
MR. LALLY: Now again — with reference to — you were asked about different possibilities with the skull fractures and bleeding in the brain. What is your opinion as to how that was caused, and if you could again just go through your opinion as to the head injuries, the skull fracture—
MS. LITTLE: Objection.
JUDGE CANNONE: Ask it again, Mr. Lally, in a different way.
MR. LALLY: You were asked about some possibilities. What is your opinion as to how those injuries were sustained or manifested— — in Mr. O'Keefe?
DR. SCORDI-BELLO: I don't know how they came to be. I described them, and I stated previously that they are consistent with a fall to the back of the head.
MR. LALLY: So — I'm sorry, Doctor — my question is more geared towards, as far as the single impact to the back of the skull, and then sort of radiating fractures in the skull, if you could explain that in reference to the subarachnoid hemorrhage and the ecchymosis that you're observing.
DR. SCORDI-BELLO: Again, a single impact with a fall could cause all the injuries that were seen in the brain and the skull.
MR. LALLY: Thank you. No further questions.