Commonwealth v. Read — Trial ArchiveIrini Scordi-Bello - Direct
343 linesJUDGE CANNONE: Okay, Mr. Brennan, who is your next witness?
MR. BRENNAN: Next witness is Dr. Scordi-Bello.
JUDGE CANNONE: Okay, Matt.
COURT OFFICER: Yes. Thank you. She'll be right in.
JUDGE CANNONE: Why don't I see counsel at sidebar, please?
COURT CLERK: Do you swear to tell the court and the jury in this case the truth, the whole truth, and nothing but the truth?
MR. BRENNAN: Good morning.
DR. SCORDI-BELLO: Good morning.
JUDGE CANNONE: All right, Mr. Brennan, whenever you're ready.
MR. BRENNAN: Thank you, your honor. Good morning. Could you please introduce yourself to the jury?
DR. SCORDI-BELLO: Good morning. My name is Irini Scordi-Bello. That's spelled I-R-I-N-I S-C-O-R-D-I-B-E-L-L-O. I am a medical examiner employed by the Commonwealth of Massachusetts.
MR. BRENNAN: How long have you been a medical examiner?
DR. SCORDI-BELLO: In the state of Massachusetts since December of 2016. In general, I have been a medical examiner since 2008.
MR. BRENNAN: Did you attend medical school?
DR. SCORDI-BELLO: Yes, I did.
MR. BRENNAN: Where did you attend medical school?
DR. SCORDI-BELLO: I completed medical school in New York City at the Mount Sinai School of Medicine, now known as Icahn School of Medicine.
MR. BRENNAN: Did you attend a residency?
DR. SCORDI-BELLO: Yes, I completed my residency in anatomic pathology at Mount Sinai Hospital.
MR. BRENNAN: Is that what you specialized in during your residency?
DR. SCORDI-BELLO: Yes.
MR. BRENNAN: After your residency, did you go right to the medical examiner's office or did you work anywhere else?
DR. SCORDI-BELLO: After my residency, I completed a one-year fellowship in forensic pathology that was done at the office of the chief medical examiner for the city of New York. And then I went to work as a medical examiner.
MR. BRENNAN: Is there a certain type of doctor you are? Do you have a particular —
DR. SCORDI-BELLO: Yes, I am a forensic pathologist.
MR. BRENNAN: What are your duties at the medical examiner's office?
DR. SCORDI-BELLO: My duties and responsibilities at the medical examiner's office include performing examinations and autopsies to determine the cause and manner of death in cases that fall under our jurisdiction.
MR. BRENNAN: How many other doctors work with you at the medical examiner's office?
DR. SCORDI-BELLO: I think there's close to 20 of us. I don't know the exact number at the medical examiner's office.
MR. BRENNAN: Are you responsible for all counties in Massachusetts as far as doing examinations and autopsies?
DR. SCORDI-BELLO: No. My primary location is in Westfield, Massachusetts, where one of our satellite offices is, and we cover Worcester County and the entire western part of the state. There are three offices in the state — the one in Westfield, the one in Boston, and the office at the Cape in Cape Cod.
MR. BRENNAN: You mentioned that part of what you do is to try to determine manner and cause of death.
DR. SCORDI-BELLO: Yes.
MR. BRENNAN: I use the word autopsy generally. Without too much detail, can you describe for the jury what the process is when you're trying to determine the manner and cause of death?
DR. SCORDI-BELLO: You would like me to explain what an autopsy is? An autopsy is a large surgical procedure with two main parts. The external examination, which is an examination of the outside of the body, where we document physical characteristics such as hair color, eye color, we document any identifying features such as scars or tattoos, height, weight, and then we also document any signs of disease or any signs of injury on the body. The second part of the autopsy is the internal examination, where we make surgical-type incisions on the body and we examine the internal organs of the neck, the chest, the abdomen and the pelvis, as well as the head and the brain.
DR. SCORDI-BELLO: Part of the autopsy procedure — and this depends on the kind of case we're doing an autopsy on — might include other studies such as taking evidence, toxicology, which is done on almost every case, and any additional dissections or any additional steps we might feel we have to take. But that's in general what an autopsy is.
MR. BRENNAN: Do you ever seek the assistance of any other doctors or professionals that have specialties in your determination in an autopsy about manner and cause of death?
DR. SCORDI-BELLO: Yes, absolutely. We often — like I mentioned before, we perform toxicology on almost all our cases, and those samples are sent to the toxicology state lab. We also have a board-certified neuropathologist and cardiac pathologist in our office, and very often we will consult with them in determining cause and manner of death.
MR. BRENNAN: Are cause of death and manner of death the same, or two different things?
DR. SCORDI-BELLO: They're two completely different things.
MR. BRENNAN: Can you explain to us what the difference is between the two of them?
DR. SCORDI-BELLO: Yes. Cause of death refers to the disease or the injury that initiates a sequence of events that ultimately leads to someone's death. So that disease or that injury can be a natural disease such as atherosclerosis or coronary artery disease, or it can be some sort of injury. The manner of death has to do with the circumstances that led to the death. So there are five manners of death that we use in our practice. The most common one is actually natural. Natural means that the person's cause of death — the disease that killed them — was due to natural causes. And that would include heart disease, diabetes, cancer — all those are natural processes that take place in the body that lead to death. And so the manner of death is natural.
DR. SCORDI-BELLO: If trauma or an injury is involved, then we have to decide — then let me back up. If trauma or an injury is involved, then the manner of death is no longer natural, and therefore it could be that the trauma was inflicted in an accidental manner, in which case the manner becomes accident. If it was inflicted by another person with the intent to cause harm, then the manner becomes a homicide. And if the trauma — and when I say trauma I should include both physical and chemical trauma, chemical when it comes to intoxications due to drugs, etc. — if the trauma was self-inflicted, then the manner of death is suicide. So we have natural, accident, homicide, suicide, and then the fifth one is what we call undetermined, or could not be determined.
DR. SCORDI-BELLO: That is when the circumstances in a case are not entirely known or clear to us, and the information that we have does not support one manner of death over another. In that case, we classify the manner of death as undetermined.
MR. BRENNAN: When you're conducting an autopsy and making an analysis and attempting to reach a conclusion — is what you do different in a prosecution's case?
DR. SCORDI-BELLO: Can you repeat the question? I'm not sure I understand.
MR. BRENNAN: When you're making your determinations about cause or manner of death, do you have any limitations?
DR. SCORDI-BELLO: Okay, so the cause of death is something that is determined by the autopsy. That is my opinion — or our office's opinion — as to the disease or injury that led to that person's death. I don't have any major limitations unless we're dealing with cases where the body is decomposed and we're not able to do all the testing necessary. But in most cases, the cause of death depends on my findings during the autopsy. The manner of death — yes, there are limitations, because it's circumstance-driven, and so the circumstances might not be known to us at the time of the autopsy. They might not be known to us ever. And therefore, while the cause of death is my medical opinion, the manner of death depends on information I get from other people.
MR. BRENNAN: Are you always able to reach a conclusion on manner of death?
DR. SCORDI-BELLO: No. That's why I said that in cases that we cannot, the manner of death is classified as undetermined.
MR. BRENNAN: I want to now ask you about whether or not you examined John O'Keefe.
DR. SCORDI-BELLO: Yes, I did the autopsy on Mr. O'Keefe.
MR. BRENNAN: When you examined Mr. O'Keefe, did you work with a team or by yourself?
DR. SCORDI-BELLO: No, we always work in a team. The team is made up of the medical examiner and a medical examiner's assistant that helps with the actual performance of the autopsy, especially when we examine the head. And then of course we work with the toxicology lab and, in this particular case, our neuropathologist.
MR. BRENNAN: The medical examiner's office — is that a division of the Massachusetts State Police?
MR. BRENNAN: Is it a division of the Norfolk County District Attorney's Office?
MR. BRENNAN: Is the medical examiner's office independent?
DR. SCORDI-BELLO: Yes.
MR. BRENNAN: When you conduct an autopsy, are representatives of law enforcement or the district attorney's office able or allowed to attend an autopsy?
DR. SCORDI-BELLO: Yes, they're usually allowed to attend the autopsy if they wish.
MR. BRENNAN: Is that an uncommon practice?
DR. SCORDI-BELLO: No, it's not uncommon.
MR. BRENNAN: Do you remember when your autopsy of Mr. O'Keefe occurred?
DR. SCORDI-BELLO: Yes. I performed the autopsy on January 31st of 2022.
MR. BRENNAN: If you have notes —
DR. SCORDI-BELLO: Yes, I do.
JUDGE CANNONE: I think you'll be able to use them, but we'll just want to indicate that you're reading from your notes if that's the case.
MR. BRENNAN: Thank you. So, you can use your notes, doctor. Just —
DR. SCORDI-BELLO: Thank you.
MR. BRENNAN: Thank you, your honor. When you began the autopsy of Mr. O'Keefe, do you know who, if any, representatives from the Massachusetts State Police or the Norfolk County District Attorney's Office were present?
DR. SCORDI-BELLO: I don't remember their names. I do believe there were two individuals, and every person who attends an autopsy has to sign a log, and their names would be logged in our records. I don't remember their names.
MR. BRENNAN: What is the role of law enforcement relative to the actual physical autopsy? Do they have any role?
DR. SCORDI-BELLO: No, they're not part of the autopsy. They don't have a role. Their role is to observe. Sometimes they will ask questions, and based on my findings, they might go on and do their investigation.
MR. BRENNAN: Does your office photograph things of interest, like injuries on the person that you're doing the autopsy on?
DR. SCORDI-BELLO: Yes, we do.
MR. BRENNAN: Is law enforcement allowed to take their own photographs as well?
DR. SCORDI-BELLO: Yes.
MR. BRENNAN: Did you in fact memorialize your findings in this case?
DR. SCORDI-BELLO: I did.
MR. BRENNAN: Are there a number of different ways in which you memorialize your findings?
DR. SCORDI-BELLO: Yes. I'm sorry. We — I took notes, physical notes, pen and paper. There's a report that's issued within 90 days of the completion of the autopsy, and then photographs, digital photographs.
MR. BRENNAN: You mentioned a report is due in 90 days. Is that often referred to as an autopsy report?
DR. SCORDI-BELLO: Yes.
MR. BRENNAN: Why 90 days?
DR. SCORDI-BELLO: That is the standard that is set by the National Association of Medical Examiners. We're part of NAME, and therefore we try to have a finalized report for all our cases within 90 days, because we know that people — families — are waiting for these reports, and therefore we do our best to finish a report within 90 days.
MR. BRENNAN: Did you in fact complete a so-called autopsy report in this case?
DR. SCORDI-BELLO: Yes, I did.
MR. BRENNAN: In addition to the autopsy report — well, included in the autopsy report — do you make handwritten notations about locations of injuries?
DR. SCORDI-BELLO: Yes.
MR. BRENNAN: And share with us — how is that done? Is there a picture or a graph?
DR. SCORDI-BELLO: There's a diagram, a body diagram, that we use to mark the location of injuries.
MR. BRENNAN: May I approach, your honor?
JUDGE CANNONE: Yes. [unintelligible] Yes.
MR. BRENNAN: Do you generally recognize what these ...documents are.
DR. SCORDI-BELLO: Yes. Um, these are my diagrams from Mr. O'Keefe's autopsy.
MR. BRENNAN: And can you very basically describe each one of them?
DR. SCORDI-BELLO: Some of them. Um, yes, the first one is a body diagram. A lot of things have been whited out, but it's the diagram that I would use to make note of any injuries. Uh, the second one is a diagram of the face and the skull. I would also use this diagram to make notes as to any injuries on the face. And the third one is a diagram of the inside of the skull, what we call the base of the skull, as well as different views of the brain itself. Again, I would make notes to point out different injuries.
MR. BRENNAN: As you were noting injuries in your autopsy report, these diagrams — they start off blank.
DR. SCORDI-BELLO: They start off blank and then they're filled out as we go along, and you fill out all the details you find important in your report. Correct.
MR. BRENNAN: For reference and to assist us, I have some blank diagrams that I may ask you to point out things on the blank diagram for us.
DR. SCORDI-BELLO: Okay.
MR. BRENNAN: And your honor, I'd ask permission — I've spoken to defense — to use these simply as a chalk.
JUDGE CANNONE: Sure.
MR. JACKSON: No objection.
MR. BRENNAN: Before you begin an autopsy, do you seek any medical records if available?
DR. SCORDI-BELLO: Yes. Um, when a case is called into our office, depending on the time and the day that it is called in, our intake department — who are the people initially on the phone taking the information — will start asking for both medical records as well as police reports. So, in the morning when we start the autopsy, it's possible that we have some records. Uh, sometimes if a decedent is brought to us from the hospital, there might be some records that come along with the body. But to answer your question, yes, we always ask for medical records — what we call PCP records, which are primary care physician records — any records from a hospital where the decedent may have been, and investigative reports, police reports.
MR. BRENNAN: Do you recall whether you had access to John O'Keefe's medical records from Good Samaritan Hospital?
DR. SCORDI-BELLO: I did have access. Yes. In the day — I believe the day of and the following day.
MR. BRENNAN: May I approach, your honor?
JUDGE CANNONE: Yes.
MR. BRENNAN: Subject to any later objections, I would move to admit the Good Samaritan records.
MR. JACKSON: No objection, your honor.
COURT CLERK: Give it 155.
MR. BRENNAN: At this time I would move for identification all photos of Mr. O'Keefe's injuries at Good Samaritan Hospital.
JUDGE CANNONE: Okay. [Exhibit] JJ for ID.
MR. BRENNAN: Further, at this time I'd move for identification all OCME photos.
JUDGE CANNONE: Okay. [Exhibit] KK.
MR. BRENNAN: One more. At this time I move all css-5 photos for identification.
JUDGE CANNONE: Okay.
MR. BRENNAN: With the court's permission — Miss Gilman, if you could put up the diagram — full body — if you could enlarge that a little more. Thank you very much. Could you explain this to us?
DR. SCORDI-BELLO: Yes. This is the diagram that we use during every autopsy. As you can see, we note the name of the decedent. Every case has its own number. In this case he was 22-1697, and then we take note of — as I mentioned during the external examination — physical characteristics such as hair, eyes, teeth. And then on this diagram we would note any scars we see on the body, any tattoos we see on the body, any injuries we see on the body, and any therapeutic interventions. Those would be things that are sometimes done either by emergency medical personnel or at the hospital. Everything would be noted on this diagram.
MR. BRENNAN: Now, if you could take us through — I'm going to ask you, we'll go body part by body part if that's okay. Going to ask you to begin with Mr. O'Keefe's face, the front of his face. And if you could enlarge that, Miss Gilman. Thank you very much. Did you notice any injuries on Mr. O'Keefe's face? And if so — I think there's a pointer available for you, doctor. If you could point out on the diagram what you observed.
DR. SCORDI-BELLO: So on the diagram — well, first of all, there was medical intervention on Mr. O'Keefe that included an endotracheal tube that had been placed to help him breathe. But once all the intervention — all the medical devices were removed — I observed on his right upper eyelid a 1 cm laceration. So as we're looking at the diagram, this is the right side and this is the left side. So on his right eyelid there was a small laceration. I also observed abrasions on the anterior and the left aspect of the nose. So the nose would be here on the front and the left aspect. Abrasions are scrapes. Lacerations are tears in the skin. I should probably explain that. Then there was some bleeding and some swelling of the eyelids of both eyes.
MR. BRENNAN: Does that complete your analysis for the front of the face?
DR. SCORDI-BELLO: Correct. Yes.
MR. BRENNAN: May I approach, your honor?
JUDGE CANNONE: Yes.
MR. BRENNAN: Doctor, I'm showing you a photograph. Do you recognize what's in that photograph?
DR. SCORDI-BELLO: Yes. This is a photograph of Mr. O'Keefe's face.
MR. BRENNAN: Does that photograph depict any of the observations or injuries you made that you just described in the area?
DR. SCORDI-BELLO: Yes. It shows the small laceration that I noted during the autopsy on the right eyelid. You can see some of the swelling and some of the bleeding over his eyelids. And that's pretty much all I can see because it's a side view.
MR. BRENNAN: Is there an apparatus?
DR. SCORDI-BELLO: There is an endotracheal tube, as well as a C collar, or C stabilization collar. That's something that would have been placed on him by medical personnel.
JUDGE CANNONE: All right. This is in evidence, and I have an instruction. All right. All right. So folks, during the testimony of Dr. Scordi-Bello, photos will be introduced to you. They're photographs of John O'Keefe from the autopsy. So you'll have them in the jury room with you. I'll put them in an envelope — or I'll ask that they be put in an envelope. So if you don't want to look at them now, you don't have to. At some point, we'd ask that you make sure you look at them. These photos are not pleasant and you may find that they're graphic. But what's important for you to know is that your verdict must not in any way be influenced by the fact that these photographs may be unpleasant or graphic.
JUDGE CANNONE: The defendant is entitled to a verdict based solely on the evidence and not based on pity or sympathy for Mr. O'Keefe, which might be occasioned by these photographs. So consider the photographs only as they draw your attention to a clinical medical status, or to the nature of Mr. O'Keefe's injuries, or to the nature of the incident itself. So they'll be displayed up on the screen for you as well.
COURT CLERK: The last exhibit is exhibit 156.
MR. BRENNAN: Miss Gilman, could you show the jury — and doctor, can you point out the injuries you were describing by using the diagram?
DR. SCORDI-BELLO: So, the laceration — the small laceration that I previously described — would be here on the right upper eyelid of Mr. O'Keefe. You can see some discoloration; that's bleeding under his eyelid, and what I would describe as swelling. The endotracheal tube and the neck collar are also present here. And the other injury which I noted was on the front and left side of his nose, which you cannot see here because this is looking at the right side of his face.
MR. BRENNAN: Okay. Take that down, please. You mentioned that there was something about his eyes that was notable.
DR. SCORDI-BELLO: Yes, there was bleeding, or hemorrhage as we call it, on the eyelids, as well as swelling.
MR. BRENNAN: I'm going to ask you more detail about that later, but was that observation important in your ultimate diagnosis or conclusions?
DR. SCORDI-BELLO: Yes.
MR. BRENNAN: May I approach, your honor?
JUDGE CANNONE: Yes.
MR. BRENNAN: I'm showing you another photograph. Do you recognize that?
DR. SCORDI-BELLO: Yes. This is another picture showing Mr. O'Keefe's face. Again, the medical intervention is present and you can see more clearly now the discoloration on the upper eyelids.
MR. BRENNAN: Is this vantage point helpful for your ultimate conclusions and diagnosis?
DR. SCORDI-BELLO: Yes.
MR. BRENNAN: I move this into evidence.
MR. JACKSON: No objection, your honor.
JUDGE CANNONE: Exhibit 157.
MR. BRENNAN: With the court's permission, I'd like to show this to the jury.
JUDGE CANNONE: Yes.
MR. BRENNAN: P645, please. Doctor, could you point out what was significant regarding Mr. O'Keefe's eye area?
DR. SCORDI-BELLO: So, I noted that there was discoloration — that's bleeding, that's blood that's under those eyelids. The eyelids appear puffy; that's what we call edema, or swelling. And then also there were two abrasions — two scratches — on Mr. O'Keefe's nose. You can see one here and then the other one on the more front part of his nose.
MR. BRENNAN: Okay. Could you take that down Please. If we could move down a bit to the chest and stomach area. Did you make any observations about this area, Dr. Scordi-Bello?
DR. SCORDI-BELLO: The observations that I made on the chest were that there was, as I mentioned before, defibrillator pads on the body and there was an abrasion that's very commonly seen in people who have undergone resuscitation. Internally, that abrasion and the whole resuscitation apparatus was associated with some anterior rib fractures, which are also seen in cases of resuscitation. But I didn't make any other notes in terms of trauma on the chest or abdomen.
MR. BRENNAN: Okay, I'd like to move to the arms and the hands if we come down just a little bit. Let's begin with Mr. O'Keefe's hand or hands. Did you make any observations regarding Mr. O'Keefe's hand or hands?
DR. SCORDI-BELLO: Yes. On his upper right arm, I noted that he had a superficial abrasion. So it would have been — can we move that down a little bit?
MR. BRENNAN: Move it down a little bit. Yeah, thank you. Nothing seems to be doing a very good job. Okay. Somehow doesn't want to work. Sorry if that's not working well. It's projecting here but not on the actual picture. Okay. There may be a second point.
DR. SCORDI-BELLO: I can do it here.
MR. BRENNAN: Okay. Great. Yeah.
DR. SCORDI-BELLO: So on the right upper medial arm — that would be the inner side of his arm — there was a superficial abrasion. Again, that's a scrape. Then on his right posterior arm and forearm — so not exactly on this aspect of the arm but on the back side of the arm, which would be in the back of the diagram — there were multiple abrasions which I described as ranging from 2 to 3 mm and up to 7 cm. Then, if you could move the diagram down please — there is a back to this diagram, I don't know if you could put that on the screen. There we go. So this is now the right side and this is the left. I noted that there were two bruises on the back of his right hand. Also a faint scratch on the back of his left hand.
DR. SCORDI-BELLO: And then moving down to the lower extremities, or the legs — if you could please show the front. There was a small abrasion, a small scrape, on the side of his right knee.
MR. BRENNAN: May I approach, your honor?
JUDGE CANNONE: Yes.
MR. BRENNAN: Doctor, I'm handing you a photograph. Do you recognize what's in that photograph?
DR. SCORDI-BELLO: Yes.
MR. BRENNAN: What is it?
DR. SCORDI-BELLO: This is the back of Mr. O'Keefe's right hand, I believe.
MR. BRENNAN: Is that a fair and accurate depiction of how his hand appeared? Could you examine that?
DR. SCORDI-BELLO: Yes.
MR. BRENNAN: Move this into evidence, please.
MR. JACKSON: No objection, your honor.
JUDGE CANNONE: Okay. Exhibit 158.
MR. BRENNAN: With the court's permission, I'd show P647 to the jury.
JUDGE CANNONE: Yes.
MR. BRENNAN: And could you explain — you said there were two bruises. Could you point those out for us?
DR. SCORDI-BELLO: Yes, there's one here and one here.
MR. BRENNAN: Did you attempt to assess those, determine whether you could conclude or opine on a cause of those?
DR. SCORDI-BELLO: No, I did not. Well, I take that back. I'm sorry. So this particular one has two small little pinpoint defects in the middle, which we sometimes see when emergency personnel tries to get access to a vein for intravenous fluids. So — but I did not put that in my report. I just described it as a contusion.
MR. BRENNAN: Is it common to see that type of coloration where medical personnel put intravenous or other types of support into somebody's hand?
DR. SCORDI-BELLO: Yes, it's very common for the skin to bruise when someone tries to get access to a blood vessel.
MR. BRENNAN: The other coloration that is unrelated to those two small points — would you have a description of what those are?
MR. BRENNAN: Okay. I'd also like to show you Exhibit Number 1. Exhibit Number 1, please. Thank you. You use the word "superficial." What does that mean?
DR. SCORDI-BELLO: Superficial means that the abrasion is on the superficial layers of the skin, usually the epidermis and sometimes the dermis. But there's no penetration of the skin.
MR. BRENNAN: When you're assessing to determine whether there's any penetration, do you measure the length of the wound?
DR. SCORDI-BELLO: Penetration would be measuring the depth. If there was actual penetration, I would have to measure how deep into the skin. For example, when we assess stab wounds, we have to measure the depth of the wound. In this particular case, you can see that these are scrapes or scratches and there's no exposed underlying fat or muscle. And therefore, to answer your question, I measured their length and gave a range, but I did not measure their depth as a routine practice during an autopsy.
MR. BRENNAN: Doctor, if there was penetration or depth, would you as a routine measure that?
DR. SCORDI-BELLO: I would make a note of it.
MR. BRENNAN: Are there any such notes in any of your autopsy findings or reports about depth?
DR. SCORDI-BELLO: No, I did not make a note on the depth of these ones.
MR. BRENNAN: Do you have an opinion to a reasonable degree of medical certainty as to how those superficial abrasions occurred?
DR. SCORDI-BELLO: I do not.
MR. BRENNAN: And I asked you about the hand which we just saw, and I should ask you the same question. Do you have an opinion to a reasonable degree of medical certainty how that coloration — aside from the medical intervention — do you have an opinion to a reasonable degree of medical certainty how the other discoloration happened on Mr. O'Keefe's hand?
DR. SCORDI-BELLO: I can state to a reasonable degree of medical certainty that that's a bruise, a contusion. But I cannot tell you how it occurred.
MR. BRENNAN: And to summarize — finally, what we've been through so far — regarding the scrape on Mr. O'Keefe's right eye: can you provide an opinion to a reasonable degree of medical certainty how that scrape occurred?
DR. SCORDI-BELLO: No, I cannot.
MR. BRENNAN: You mentioned for us that when you looked at Mr. O'Keefe's legs, you observed a small scratch on his right knee. Correct. I don't want to summarize it. Can you describe that more specifically?
DR. SCORDI-BELLO: Thank you. Yes. I described it as a half cm abrasion on the right lateral knee.
MR. BRENNAN: Did you see any marks or abrasions on his left knee?
DR. SCORDI-BELLO: No, I did not.
MR. BRENNAN: Was the mark or scratch on his right knee on the inside or the outside of the knee?
DR. SCORDI-BELLO: It was on the lateral aspect, which would be the outside.
MR. BRENNAN: Thank you. May I approach?
JUDGE CANNONE: Yes.
MR. BRENNAN: Thank you. Doctor, I'm handing you a photograph. Do you recognize what's in that photograph?
DR. SCORDI-BELLO: Yes.
MR. BRENNAN: What is it?
DR. SCORDI-BELLO: This is a picture of Mr. O'Keefe's lower extremities, his legs.
MR. BRENNAN: Is it a fair and accurate depiction of how his knee appeared?
DR. SCORDI-BELLO: Yes.
MR. BRENNAN: Move into evidence, please.
MR. JACKSON: No objection, your honor.
JUDGE CANNONE: Okay. Exhibit 159.
MR. BRENNAN: Thank you. With the court's permission, I'd like to show the jury P9467.
JUDGE CANNONE: Yes.
MR. BRENNAN: You use the word "lateral" and you talked about an abrasion or a scrape. Could you look at this photograph — and could we enlarge it, Miss Gilman? And could you point out to the jury and explain what it is that you saw?
DR. SCORDI-BELLO: Yes, you can see the abrasion here with a little bit of adjacent discoloration, but this is what I was describing.
MR. BRENNAN: If you could zoom back out, please. And you didn't see any similar type bruising or abrasions on the left knee?
MR. BRENNAN: During your autopsy, did you notice any injuries internally to Mr. O'Keefe's rib area?
DR. SCORDI-BELLO: Yes, I did note that there were rib fractures on the anterior — that would be the front — of his fourth and fifth ribs.
MR. BRENNAN: And so would that be his left or right side?
DR. SCORDI-BELLO: It would be both the right and the left, and it would be the part of the rib that is closer to the sternum.
MR. BRENNAN: Is there a number of ribs that had fractures, or are they connected as one?
DR. SCORDI-BELLO: The fourth and the fifth, both on the right and the left, close to the sternum.
MR. BRENNAN: Have you in your experience seen ribs fractured during first aid or medical intervention?
DR. SCORDI-BELLO: Very often, yes.
MR. BRENNAN: Given your experience and your study of Mr. O'Keefe's body, do you have an opinion to a reasonable degree of medical certainty how those rib fractures were obtained?
DR. SCORDI-BELLO: I believe those rib fractures were due to resuscitation.
MR. BRENNAN: And you have that opinion to a reasonable degree of medical certainty?
DR. SCORDI-BELLO: Yes.
MR. BRENNAN: I'd like to show you a different diagram — one of the head area. If we could enlarge the bottom right. Thank you. Using that diagram, could you assist us, doctor, and explain to us any observations you made about the back of John O'Keefe's head?
DR. SCORDI-BELLO: Yes. The main observation was a laceration — that is a skin tear — on the back of Mr. O'Keefe's head, to the right of midline. So this would be the midline. The laceration was somewhere here, in what we call the right occipital area. And associated with that there was an abrasion over it, that would have been here. So this was what we call a compound injury — an abraded laceration.
MR. BRENNAN: We'll turn in a few moments to your autopsy observations about the inside of Mr. O'Keefe's skull, but first I want to just show you a photograph relative to what you've described to us. May I approach, your honor?
JUDGE CANNONE: Yes.
MR. BRENNAN: Doctor, I'm handing you a photograph. Do you recognize who's in that photograph?
DR. SCORDI-BELLO: Yes. This is a picture taken at the time of autopsy. This is the back of Mr. O'Keefe's head. The hair has been shaved off so that the injury can be clearly photographed. And it's a laceration with an associated abrasion.
MR. BRENNAN: Thank you. [unintelligible] Okay.
MR. JACKSON: No objection, your honor.
JUDGE CANNONE: Thank you. Please.
MR. BRENNAN: When you examine the laceration, do you measure it?
DR. SCORDI-BELLO: Yes.
MR. BRENNAN: And did you measure it?
DR. SCORDI-BELLO: In this case, I did measure it.
MR. BRENNAN: How long was the laceration?
DR. SCORDI-BELLO: I measured it as 2.5 cm, which is close to an inch.
MR. BRENNAN: Do you examine a person's body before you begin to intrude — do you examine the outside of a person's body first, or is there a certain procedure or order?
DR. SCORDI-BELLO: Yes, the external examination is done first, and the internal examination is done second.
MR. BRENNAN: I want to show you that photograph that you just recognized and I would like you to explain what you see to the jury. Miss Gilman, with your assistance. Thank you.
DR. SCORDI-BELLO: This is the laceration that I noted, and this is the scrape that's associated with it.
MR. BRENNAN: Take that down, please. After you make observations, what are your next steps in an autopsy?
DR. SCORDI-BELLO: The internal examination.
MR. BRENNAN: And after the external is performed and pictures are taken?
DR. SCORDI-BELLO: Then we proceed with the internal examination of both — as I mentioned before — the torso, the body, as well as the head.
MR. BRENNAN: I'd like you to take us through the internal examination. Did you have a chance to look internally behind the laceration you saw on the back of Mr. O'Keefe's head?
DR. SCORDI-BELLO: Yes.
MR. BRENNAN: And when you did that, could you describe for us what you saw?
DR. SCORDI-BELLO: Yes. The way we examine the head is we make an incision with a scalpel behind the ear from one side to the other. That allows us to reflect, or pull back, the scalp, and that will expose the skull underneath. We do this carefully so that we don't disfigure the face. And when we reflected — when we pulled back the scalp — I noted that there was blood, or what we call hemorrhage, under the laceration, or associated with the laceration, on the back of the right head. And then furthermore, there were skull fractures associated with that laceration abrasion on the right side of the head.
MR. BRENNAN: Were the skull fractures in the same or different area?
DR. SCORDI-BELLO: The skull fractures were in multiple areas of the skull — what we call the base of the skull. You imagine the base of the skull is sort of a bowl and the brain sits on top, or in the bowl. When the brain is removed, you can have a very good view of the base of the skull. So when the brain was removed and we were able to look at the base of the skull, I noted that there were multiple fractures that appeared to be originating from the area of the laceration, or what would correspond to the area of the laceration.
MR. BRENNAN: When you made your examination of the fractures in the skull, did that lead you to your opinion, or was there more you needed to look at before you came to an opinion about the cause of death?
DR. SCORDI-BELLO: Well, that was part of the findings that led to my opinion. Yes, I removed the brain, and as is our protocol, I saved the brain in a special solution called formalin that allows the brain to become a little harder, so that our neuropathologist in Boston could go ahead and examine it. Because when I did look at the brain, I noted that there were injuries. There was bleeding on top of the brain, and therefore I saved it. The brain ultimately went to our Boston office and our neuropathologist Dr. Stonebridge examined it and issued a report.
MR. BRENNAN: Did you engage in any type of analysis on your own about any injury to Mr. O'Keefe's brain?
DR. SCORDI-BELLO: I noted the kinds of injuries I could see superficially on the brain, and I have looked at the brain after it was fixed and pictures of it, but I did not issue a report on it. The whole point was for our neuropathologist to examine it closely and issue a more detailed report.
MR. BRENNAN: I have a few more photos. Would now be an appropriate time for a break, your honor?
JUDGE CANNONE: Yes. So, jurors, why don't we take 15 or 20 minutes.
COURT OFFICER: All rise for the jury. [unintelligible — brief exchange, possibly sidebar request]
COURT OFFICER: The reporting is super clear. You get a live view of your pipeline, conversions, what's working, so you can focus on closing and not guessing. Right now, you can get a free 15-day trial of ODO's all-in-one business solution and see how it can make your life a little bit easier. Just scan the QR code on screen or head over to odo.com/livecrm. Court resumes — livestream returns from ad break
PARENTHETICAL: [gap — approximately 32-minute break, not captured]
COURT OFFICER: [unintelligible — sidebar discussion between counsel and judge regarding exhibits]
JUDGE CANNONE: You can sit or stand wherever you're more comfortable, doctor, for now. [unintelligible]
COURT OFFICER: All rise for the jury. Court is in session. Please be seated.
JUDGE CANNONE: All right, Mr. Brennan.
MR. BRENNAN: Doctor, when we left off, you had described all the injuries to the exterior of Mr. O'Keefe, and we had talked about your observations of both the fractures in his skull and also your observation of Mr. O'Keefe's brain. You mentioned earlier that you use other resources, other testing. Did you ask for any type of assistance on toxicology analysis from Mr. O'Keefe?
DR. SCORDI-BELLO: Yes, it is routine, and it is protocol, to submit toxicology specimens to the lab for examination.
MR. BRENNAN: May I approach, your honor?
JUDGE CANNONE: Yes.
MR. BRENNAN: Doctor, I'm handing you a document. Do you recognize that?
DR. SCORDI-BELLO: Yes. This is the report of toxicology from the state police crime lab for Mr. O'Keefe's autopsy.
MR. BRENNAN: Have you seen that document before?
DR. SCORDI-BELLO: Yes.
MR. BRENNAN: Is that a fair and accurate copy of the report you saw before?
DR. SCORDI-BELLO: Yes.
MR. BRENNAN: I'd like to introduce this as the next exhibit, please.
MR. JACKSON: No objection, your honor.
JUDGE CANNONE: Admitted as Exhibit 161.
MR. BRENNAN: In your experience, doctor, are you familiar with what the toxicology report and the testing involves?
DR. SCORDI-BELLO: I'm sorry, what was your question?
MR. BRENNAN: Are you familiar in your experience with what is involved in a toxicology test in general terms?
DR. SCORDI-BELLO: Yes.
MR. BRENNAN: And if you studied Mr. O'Keefe's toxicology report, was that important or part of your analysis in your ultimate conclusions?
DR. SCORDI-BELLO: It was one piece of evidence that I took into consideration. Yes.
MR. BRENNAN: In the toxicology testing, is there a search to see if there are any type of drugs or medications in Mr. O'Keefe's blood?
DR. SCORDI-BELLO: Yes.
MR. BRENNAN: And was there any — there were no prescription medications?
DR. SCORDI-BELLO: There were no illicit drugs in his system.
MR. BRENNAN: In a toxicology, is there also a test for blood alcohol content?
DR. SCORDI-BELLO: Yes.
MR. BRENNAN: What is the difference between ethanol in heart blood and ethanol in vitreous humor?
DR. SCORDI-BELLO: Yes. So we usually submit multiple specimens for toxicology. Some of the specimens are used for screening of classes of different drugs, and then other specimens are used to confirm the presence and quantify a particular drug. So in this particular case, the lab tested the heart blood, which showed that it had an ethanol level of 0.21 gram per deciliter, and they also tested the vitreous, which is the fluid that sits behind the eyeball. And in that specimen, the ethanol was slightly higher at 0.28.
MR. BRENNAN: Thank you, doctor. After your autopsy and observations of Mr. O'Keefe's body, did you come to a conclusion about the manner and cause of Mr. O'Keefe's death? And I'll ask you first about the cause. To a reasonable degree of medical certainty, did you reach a conclusion about the cause of Mr. O'Keefe's death?
DR. SCORDI-BELLO: Yes. The cause of death was determined to be blunt impact injuries of head and hypothermia.
MR. BRENNAN: You mentioned two different things — blunt impact and hypothermia. Was there a primary cause of death in your opinion?
DR. SCORDI-BELLO: The blunt impact injuries of head.
MR. BRENNAN: Hypothermia — was that sufficient to be a primary cause of death in your opinion?
DR. SCORDI-BELLO: In the absence of head trauma, hypothermia is a cause of death. But I am not able to make that determination in this case because we do have the blunt impact injuries of head.
MR. BRENNAN: So if I understand, you are not saying to a reasonable degree of medical certainty that hypothermia was the cause of death?
DR. SCORDI-BELLO: Not the primary. It contributed, but the primary cause of death was blunt impact injuries of head.
MR. BRENNAN: Did you learn what Mr. O'Keefe's body temperature was when he was brought to the hospital?
DR. SCORDI-BELLO: Yes. Some of the medical records stated that his body temperature was 80.1 degrees Fahrenheit.
MR. BRENNAN: And what is a normal body temperature?
DR. SCORDI-BELLO: 98.6.
MR. BRENNAN: Regarding the blunt force injuries as the cause of death to Mr. O'Keefe —
DR. SCORDI-BELLO: No, I was not.
MR. BRENNAN: After you complete your findings, including the manner of death and the cause of death, even if undetermined, are you required by statute, by law to file a report or document?
DR. SCORDI-BELLO: Yes.
MR. BRENNAN: And what is that document?
DR. SCORDI-BELLO: It's the death certificate.
MR. BRENNAN: Did you do so in this case?
DR. SCORDI-BELLO: Yes.
MR. BRENNAN: When you file a death certificate, do you include your ultimate conclusions regarding cause and manner of death?
DR. SCORDI-BELLO: Yes, there is a death certificate that is issued immediately after the autopsy. The death certificate is a document that is necessary for the family in order to make funeral arrangements and proceed with their plans. So a death certificate is always issued at the end of the autopsy. If the cause and manner of death are known at that point, they are stated on the death certificate. If they are not, or if we need to do additional studies, then both the cause and the manner are listed as pending, and that death certificate is sufficient for the family to make arrangements. Later, as we get more information, as we get more results from our studies back, we issue an amended death certificate. So that amended death certificate will have a cause and a manner.
DR. SCORDI-BELLO: The amended death certificate in this case stated that the cause was blunt impact injuries of head and hypothermia, and the manner was undetermined.
MR. BRENNAN: Okay. I approach, your honor.
JUDGE CANNONE: Yes.
MR. BRENNAN: Thank you. Doctor, I'm handing you a document. Do you recognize that document?
DR. SCORDI-BELLO: Yes.
MR. BRENNAN: And what is it?
DR. SCORDI-BELLO: This is the final or amended death certificate for Mr. O'Keefe, stating that the cause of death is blunt impact injuries of head and hypothermia, and that the manner of death could not be determined.
MR. BRENNAN: Do you recognize that document as accurate?
DR. SCORDI-BELLO: Yes.
MR. BRENNAN: Into evidence, please.
MR. JACKSON: No objection, your honor.
JUDGE CANNONE: Right. Thank you. 162.
MR. BRENNAN: After issuing the death certificate and after the 90 days passed, have you done any further study or investigation on this case, doctor?
MR. BRENNAN: Thank you. No further questions.
JUDGE CANNONE: Okay.