Commonwealth v. Read — Trial ArchiveMarie Russell - Direct
714 linesJUDGE CANNONE: So, Mr. Alessi, you're at the podium. Who is your witness?
MR. ALESSI: Thank you, your honor. The defense calls Dr. Marie Russell.
COURT OFFICER: Okay. Follow me. Follow me, please. Then you're going to step up and face the court. Raise your right hand.
COURT CLERK: Do you swear that the testimony you give to this court and jury in this case will be the truth, the whole truth, and nothing but the truth, so help you God?
DR. RUSSELL: I do.
JUDGE CANNONE: All right, Mr. Alessi, whenever you're ready.
MR. ALESSI: Thank you, your honor. Good morning.
DR. RUSSELL: Good morning.
MR. ALESSI: Could you please state your full name and spell your last name and introduce yourself to the jury?
DR. RUSSELL: Yes. Marie Russell, R-U-S-S-E-L-L.
MR. ALESSI: Can you summarize your professional background?
DR. RUSSELL: Yes. I am an emergency physician and a forensic pathologist.
MR. ALESSI: How long have you been an emergency medicine physician?
DR. RUSSELL: For over 30 years.
MR. ALESSI: How long have you been a forensic pathologist?
DR. RUSSELL: For over 30 years.
MR. ALESSI: Do you have a medical license?
DR. RUSSELL: I do. Several.
MR. ALESSI: When were you first licensed to practice medicine?
DR. RUSSELL: In 1988.
MR. ALESSI: What medical licenses do you currently hold?
DR. RUSSELL: Well, I have a physician and surgeon license in California. I have a medical license in Massachusetts, New York and Idaho.
MR. ALESSI: Where did you attend college?
DR. RUSSELL: I attended both MIT and Northeastern University here in Massachusetts.
MR. ALESSI: I'm sorry.
DR. RUSSELL: Oh, it's in Massachusetts.
MR. ALESSI: When did you attend premed and what was your major at MIT?
DR. RUSSELL: When I was at MIT, that was in 1972 to early 1974. I took premed courses and my major was biology, but took premed courses.
MR. ALESSI: Did you obtain a degree from MIT?
DR. RUSSELL: No.
MR. ALESSI: Why not?
DR. RUSSELL: Unfortunately, my mother became sick with cancer and I ended up going back to New York.
MR. ALESSI: Where did you ultimately obtain your bachelor's degree and which degree was it?
DR. RUSSELL: Well, after my mother passed away, I came back to Massachusetts and ultimately I obtained my degree at Northeastern University.
MR. ALESSI: And what was the other part of the question? Did you have any distinction with regard to your degree that you achieved from Northeastern?
DR. RUSSELL: Yes, I obtained the bachelor's degree with highest honors.
MR. ALESSI: After college, did you go on to receive a doctor of medicine?
DR. RUSSELL: Yes.
MR. ALESSI: Where did you attend medical school and when did you obtain your medical degree?
DR. RUSSELL: I attended the University of Massachusetts in Worcester medical school and I obtained the medical degree in 1987.
MR. ALESSI: Did you complete any residencies? And if you also could just explain to the jury very briefly what a residency is.
DR. RUSSELL: Yes. I completed an internship and residency in emergency medicine initially, and what that is — an internship and residency — both are very intense years of study and training and getting experience in a particular area. So I completed the internship and residency in emergency medicine.
MR. ALESSI: Where did you obtain those internships and residencies?
DR. RUSSELL: Well, I was interested in emergency medicine, so I went to Los Angeles because they had a very, very busy emergency medicine program.
MR. ALESSI: And it may be obvious, but let's just make it perfectly clear, why is Los Angeles very busy for an emergency medicine practice?
DR. RUSSELL: Well, it's a big city. And in this particular hospital that I was at, it was right in the heart of the city. It was near the downtown, but it was in a very, very busy and underserved area. So it was very busy.
MR. ALESSI: Did you complete any fellowships, and could you please explain to the jury the significance and prestige of a fellowship?
DR. RUSSELL: Yes. So after my residency in emergency medicine, I then decided to do a second residency, and that was in pathology, in anatomic pathology. Pathology, of course, is the study of disease, and so I did the two years of anatomic pathology also at the same busy medical center, and after that I did a fellowship — a two-year fellowship in forensic pathology — at the Los Angeles County Medical Examiner's Office.
MR. ALESSI: What did your forensic pathology fellowship involve?
DR. RUSSELL: Well, forensic pathology training involves the investigation of deaths, usually sudden and unexpected deaths. And so I investigated many death cases. I performed over 500 autopsies at the LA County Medical Examiner's Office for sudden and unexplained — sometimes unexplained, sometimes very obvious deaths — but sudden deaths. And in addition to that, there were classroom hours, there was on-scene time, there was time in the crime lab. We spent a week at the crime lab. I spent some time at the FBI. So it was a very, very comprehensive training program.
MR. ALESSI: Approximately how many autopsies were you performing a day?
DR. RUSSELL: Usually one to two, unless there was another assignment.
MR. ALESSI: In addition to performing the one or two autopsies a day, did you attend any conferences or participate in any forensic case discussions as part of the fellowship?
DR. RUSSELL: Yes. So it was very organized and we had conferences mostly on Thursdays, but also sometimes on Tuesdays — interesting case conferences, or very structured lectures.
MR. ALESSI: You spoke of cases. Can you briefly tell the jury so they have an understanding of the type of cases that you would typically work on as part of your forensic pathology fellowship?
DR. RUSSELL: Well, there were many unexplained deaths. So some of them would be natural deaths in somebody who might be a little younger than usual old age. And then there were cases where there might be a drug overdose — many cases were accident victims, including car accident victims and other kinds of accidents. There were quite a few homicides, and in fact many homicides, and quite a few suicides.
MR. ALESSI: Did any of those cases deal with wounds and wound patterns and wound identification?
DR. RUSSELL: Many of them. In fact, I would say almost most of them, because part of the examination — and a very important part of the examination — is the external examination of the body. So before I was allowed to even start an autopsy, I had to do a complete external examination of the decedent's body looking for any kinds of wounds or abnormalities.
MR. ALESSI: We'll come back to wound pattern recognition a little later, but again I think it's probably clear to most people, but just to be ultimately clear
MR. ALESSI: When you talk about external, can you just elaborate a little on what you mean by that?
DR. RUSSELL: So the external examination is of the exterior of the body — the skin, the hair, the eyes — looking for, amongst other things, things like rashes and scars and those sorts of things.
MR. ALESSI: So that's the external examination. And external, Dr. Russell, is to be contrasted with what?
DR. RUSSELL: Oh, with an internal examination. So after all of that is done — and there were some other things that had to be done too, like examining the clothing, or looking at x-rays if there were x-rays available from the medical examiner's office, and of course reading the medical record that was available — after all that was done, then I would proceed with the examination of the internal structures of the body, including the organs, the soft tissues and muscles underneath the skin, the bones, etc.
MR. ALESSI: Do you have any certifications?
DR. RUSSELL: Quite a few.
MR. ALESSI: Can you name them, please?
DR. RUSSELL: Well, I'm board cert—
MR. ALESSI: I'm sorry to interrupt you, doctor.
DR. RUSSELL: Okay. So, I'm board certified in emergency medicine, and that was, after the residency training, I had to take a qualifying examination, and then I've had to be recertified — I think it's three times now. I just recertified again. So, I'm certified for another five years.
MR. ALESSI: What do you have to do to get board certified and maintain that certification?
DR. RUSSELL: Well, presently to get board certified, one has to complete a residency in emergency medicine, and depending on the program, that is either three or four years long. I went to a four-year program, and then I had to take an examination — both a written examination, a very long written examination, and then an oral examination where I was questioned by many established emergency physicians on the various kinds of cases that might present to the emergency department. They would give you an unknown and you would have to talk about how you would care for that person.
MR. ALESSI: Do you have any affiliations with any professional organizations?
DR. RUSSELL: Yes. I'm a fellow of the American College of Emergency Physicians. I'm a fellow of the American Academy of Forensic Science. I'm a fellow of — oh, excuse me — the National Association of Medical Examiners. And then I have some memberships in some other organizations.
MR. ALESSI: What does it take to achieve fellow status that you just mentioned?
DR. RUSSELL: So in order to be a fellow, it depends on the organization. But in order to be a fellow, you usually have to be a member for a certain number of years — a member in good standing — and then for some of the organizations, you have to have attended some of their national meetings, and possibly have presented a study or a paper or something at the national meeting. Other organizations, it's a little bit variable — membership for a certain number of years.
MR. ALESSI: In addition to all of that education, background, and experience, do you have any specialized training and experience with regard to investigations of death?
DR. RUSSELL: Well, yes. So again, the focus of the forensic pathology fellowship was investigations of death. But also in my job as an emergency physician at the hospital I was at for 29 years, I had both clinical responsibilities — meaning in the ER, taking care of patients — and administrative responsibilities, meaning committees and office-type work. And so one of my responsibilities during that time was to be director of the quality improvement committee. And as director of the quality improvement committee, of course, I had to do death reviews — analyzing and studying the people who came to the emergency department who were subsequently either pronounced dead or died in the emergency department.
MR. ALESSI: So now let's move to a slightly different topic. Let's discuss your work experience. What do you currently do for work?
DR. RUSSELL: I work for the Medical Board of California, and I do some private consultation work.
MR. ALESSI: Describe your work briefly for the Medical Board of California — including what is the board, what are its responsibilities, and what do you do in your role working for the Medical Board of California?
DR. RUSSELL: So the Medical Board is a part of government that is established to basically police the doctors and some other health professionals. So the role of the Medical Board is to protect the public health — to protect them from misdeeds by health care professionals, particularly doctors. Would you like me to go on?
MR. ALESSI: So in terms of the Medical Board, just the last question with regard to that: what type of knowledge do you have to have with regard to the practice of medicine to be able to assist the board in evaluating whether certain doctors have met the standard of care in a whole host of areas of the practice of medicine?
DR. RUSSELL: Well, you certainly have to be up to date. You have to be quite knowledgeable on current treatment standards — what is considered the standard practice of medicine — and be up to date on the literature and on what is currently accepted as good practice of medicine.
MR. ALESSI: Prior to your current role, where did you work and when?
DR. RUSSELL: Well, before—
MR. ALESSI: Just so we can do it for maybe a little more context for the jury, if you could go just before the Medical Board — where you worked. Or do you want to do it from the beginning? Whatever way is best for you, doctor.
DR. RUSSELL: Doesn't really matter. Most recently I worked for the state of California, the prison system. I was the medical director — or what they called the chief medical executive — of one of the high-security prisons in California. I did that for five years, after retiring from my Los Angeles County job, which I held for 29 years.
MR. ALESSI: And briefly describe generally your duties in that role.
DR. RUSSELL: So as chief medical executive, it was my duty basically to run the medical department. So I hired physicians, I supervised the physicians, made sure that they were providing the standard of care to the inmates that they were assigned to take care of. I reviewed many of their charts. I reviewed transfers and requests for services outside, such as specialty services, orthopedic services, and other kinds of services. And I reviewed every single death that occurred during my years there.
MR. ALESSI: So you just said you investigated every single death that occurred at the prison during your time in that role?
DR. RUSSELL: Yes.
MR. ALESSI: Approximately how many death investigations were there that you performed?
DR. RUSSELL: I think approximately 60.
MR. ALESSI: Now, did you have any involvement there in examining or identifying wounds of deceased individuals?
DR. RUSSELL: I did. My office was in the medical building and it was very close to what was the equivalent of the urgent care center on site. And so when the patients would come in with an extreme injury — a very serious injury — or near death, I would frequently go right over to the urgent care, because that was my specialty. That was my interest. And even though there was a doctor or another practitioner assigned to care for the patient, I would oversee that. And I would also examine the patients, look for wounds, look for signs of injuries. There were some deaths and I would examine those bodies very carefully for any kinds of wounds, just as I had done in the coroner's office for those years.
MR. ALESSI: To move this along — before you became the chief medical executive at Corcoran, where did you work and what did you do?
DR. RUSSELL: So for 29 years I worked at what's called the Los Angeles County USC Medical Center. Now I know that's a lot to say. It was a county hospital that was affiliated with a medical school. It used to be called — prior to when I got there — it was called General Hospital. You know, it's a 19-story building, General Hospital. Well known. And now it's actually called LA General — or something of that nature. So anyways, that's where I worked for 29 years, and as I said, I had a variety of different roles there.
MR. ALESSI: Can you just briefly name off the roles that you had while at the General Hospital?
DR. RUSSELL: So as I mentioned earlier, there was always a clinical component to what I did. I always had shifts in the emergency department where I had to see patients and supervise interns, residents, physician assistants, nurse practitioners — so in addition to seeing my own patients, I would also supervise them as they were seeing their patients. That was the clinical role. Then there was an administrative role, and my administrative roles ranged from director of what they called life support training, which provided training to the trauma surgeons and the neurosurgeons regarding things such as advanced trauma life support, and also to ER doctors. Director of life support training, director of QA.
DR. RUSSELL: For many years I was director of the jail unit, which was a very unique unit at this hospital — for a hospital, it was a very unique unit in that it had three components: a dedicated ER for jail patients — for patients in custody — a dedicated clinic for in-custody patients, and a dedicated inpatient. So it's three sections dedicated to in-custody services. I was medical director of that for a while.
MR. ALESSI: In addition to all that, were you also a professor?
DR. RUSSELL: I was an assistant professor.
MR. ALESSI: Assistant professor. And what did you teach? Just a brief summary of what you taught.
DR. RUSSELL: Well, most of my teaching was clinical, bedside teaching. Rather than in lecture halls, I would occasionally give lectures to the residents — the residency group, which was about 50.
MR. ALESSI: And those residents are medical doctors, correct?
DR. RUSSELL: Yes, they are. Yes, they are medical doctors. So I would occasionally give lectures to them, but a lot of the teaching was actual bedside teaching.
MR. ALESSI: Switching gears just a little bit and segueing — over the course of your career as an emergency department physician and otherwise, did you treat individuals with animal-inflicted injuries?
DR. RUSSELL: Yes.
MR. ALESSI: And did any of those animal-inflicted injuries involve dogs?
DR. RUSSELL: Yes.
MR. ALESSI: And generally, is it correct to say that in terms of dogs, there's sort of the canine police dogs and then there's the civilian dogs with which most people have experience?
DR. RUSSELL: Yes.
MR. ALESSI: Are those two categories that you're familiar with? You're comfortable, as we discuss dogs, to have K9 versus civilian?
DR. RUSSELL: Yes, because the injury patterns are a little different.
MR. ALESSI: Okay. So what is the difference between a canine dog on the one hand and a civilian dog on the other?
DR. RUSSELL: Well, generally civilian dog bites are rather minor. Generally, puncture wounds, maybe slight avulsions — skin defects, slight skin defects — not usually major. Whereas in the canine, or trained police dog bites, the wounds I saw were extensive wounds where there was extensive ripping, tearing, crushing of tissue, and many times even injuries to the muscles and blood vessels underneath.
MR. ALESSI: From your experience, do you know why the injuries from a canine dog are as you describe them as opposed to injuries from a civilian dog?
DR. RUSSELL: Well, in the LA area at that time, the dogs were taught to bite and hold. So the canine dogs would get a grip on the individual that they were pursuing and then hold on, even if the individual was trying to pull away, and so there were often tearing injuries because that's how the dogs were trained at that time.
MR. ALESSI: Even with canine dogs, did you ever see injuries from canine dogs on humans that were not a complete bite — that were an incomplete bite?
DR. RUSSELL: Yes. So if the dog missed on the first attempt at a grab, the teeth might only scratch the surface of the — usually an extremity, by the way. And so you'd get what I'd consider an incomplete dog bite, because it was just scratch marks from the teeth. But the dog would then try a second time and a third time.
MR. ALESSI: Now let's go to civilian dogs — a term used for household pets that people have. Can you describe from your experience the type of wounds from those civilian dogs that you would see and contrast it with what you just described for a canine dog?
DR. RUSSELL: Generally they were minor. A scratch, a puncture wound, maybe a little tearing of the skin, a little skin flap. But generally much different.
MR. ALESSI: In your — did you say over 30 years of experience in the emergency medicine department?
DR. RUSSELL: Mm-hm.
MR. ALESSI: What did you see more of? Civilian dog wounds on humans or canine wounds?
DR. RUSSELL: Actually, it depended on where I was assigned at the time. So in the very beginning, because the jail unit was one of my first assignments, I saw these — I should say horrific — wounds, many of them. And I learned that what was in the textbooks about how to treat them was so wrong, because these patients needed hospital admission, intravenous antibiotics, and many of them needed surgery. And what I was reading in the textbook was that you could patch them up, clean up the wound, and send them home with, sometimes with antibiotics, sometimes without. But anyway, so what I was seeing a lot of in the very beginning was the law enforcement dog bites, because I was assigned to the jail unit.
DR. RUSSELL: And also I was very interested in this because I used to be a police officer, and before going to medical school I was a full-time police officer here in Massachusetts for seven years. And so I had this interest in law enforcement type injuries — injuries sustained during the arrest process, et cetera.
MR. ALESSI: So you had an early interest, with regard to dog-inflicted wounds on humans, as a police officer. Where were you a police officer in Massachusetts and when?
DR. RUSSELL: In the city of Malden. I was appointed as first woman police officer in 1977, to 1984, full-time.
MR. ALESSI: And while you were a police officer, were you doing that full-time and anything else? Were you pursuing school while you were a police officer — your college education — or was it separate?
DR. RUSSELL: No, I was a full-time police officer working the night shift, and I was attending Northeastern University part-time during the daytime to pursue my degree.
MR. ALESSI: Were you a sworn duty police officer?
DR. RUSSELL: Yes.
MR. ALESSI: Full member of the police force?
DR. RUSSELL: Yes.
MR. ALESSI: Did you attend academy?
DR. RUSSELL: Yes, I attended the Boston Police Academy.
MR. ALESSI: And how many years were you a Boston police officer?
DR. RUSSELL: No, I'm sorry. I'm not — [unintelligible]. I was a Malden police officer for seven years, full-time.
MR. ALESSI: Now let's go back to your emergency department and other experience. Can you approximate how many dog bite injuries you provided treatment for while an emergency department physician?
DR. RUSSELL: Overall — well, I don't know the exact answer, but I estimated it at a very conservative number of 500 dog bites. Would you like my methodology?
MR. ALESSI: Oh please.
DR. RUSSELL: Okay. So I considered that even though I worked there for 29 years, I would take 25 years and maybe 40 weeks out of the year, because the other weeks I might be assigned something special — a special rotation, or a special assignment, or vacation, or some kind of course. So 25 years, 40 weeks per year — that's a thousand weeks. So even if I only saw one dog bite at this busy trauma center, that would be a thousand dog bites in my career. But I just took it in half. I cut it in half and said — I think at least 500.
MR. ALESSI: In addition to the 500, did you oversee other physicians or healthcare professionals like physician assistants, nurse practitioners, who themselves were treating and observing dog-inflicted wounds on humans?
DR. RUSSELL: Yes.
MR. ALESSI: And approximately — just the number — approximately how many of those, in addition to the 500 you just calculated?
DR. RUSSELL: Well, I generally supervised about three to four people per shift — med students, interns, residents — and so I would say very conservatively another 500 in terms of others I oversaw.
MR. ALESSI: I want to shift just a little bit. In the emergency department, did you encounter injuries from persons involved in motor vehicle accidents?
DR. RUSSELL: Many.
MR. ALESSI: And you mentioned you were in Los Angeles. In terms of those, can you approximate how many humans you saw and treated and diagnosed in the emergency medicine department from motor vehicle accidents?
DR. RUSSELL: Well, it was a very busy level one trauma center.
MR. ALESSI: What is a level one trauma center?
DR. RUSSELL: So a level one trauma center is the highest designation that a trauma center can have, and there are many requirements in place in order for a medical center to be a level one, including 24-hour in-house neurosurgery, 24-hour in-house orthopedics, an active research program, and many more requirements, and a certain level of training for all of the ER docs and all of the trauma surgeons. So we were a level one trauma center, one of the busiest west of the Mississippi, and the hospital was located near some major freeways. So we saw lots of patients from motor vehicle accidents.
DR. RUSSELL: If I were just to — I would say if I took the thousand-week number again, if I saw at least three motor vehicle accidents per week, that's 3,000, at least — and that's just me, not the interns and residents I'm working with.
MR. ALESSI: Shifting again a little bit — as medical director of jail medical services at General Hospital, can you just describe a little bit about the work there? Similar to what you just described, or is it a little different?
DR. RUSSELL: So in the jail medical services, we dealt with people who were in custody. Some of them were drunk drivers under arrest. Some were arrested for a variety of reasons, anyways. And if they were in custody, rather than have them in the main emergency department, we had a special emergency department for them. And so we would see interesting cases there.
MR. ALESSI: In terms of being a professor, is that your — time as an adjunct professor at Cal State Los Angeles. Is that where you were an adjunct professor?
DR. RUSSELL: Yes. So while I was doing all this, I also had a part-time job teaching a course called legal medicine to graduate students — master's-level students — in the criminalistics master's program at Cal State University.
MR. ALESSI: And in terms of topics, just briefly, some of the topics you would have taught them, and particularly any that may be apropos to why you're here today.
DR. RUSSELL: So, knowing that many of these students were going to go on to work in crime labs or be crime lab directors someday, what I needed to do was to teach them about the aspects of a crime scene that dealt with a body, or someone who was injured or killed. And so we dealt with things such as time of death, post-mortem changes, wound analysis on the body, looking for different patterns of wounds or types of wounds that could direct them — to steer them in their investigation. So many other things.
MR. ALESSI: Yeah, there was a little bit of noise here when you were talking about wounds and patterns. Could you just repeat that aspect of it?
DR. RUSSELL: Sure. So when a criminalist, or a crime scene investigator, goes to the scene, they have certain duties to attend to, and they need to be aware that certain kinds of wounds might indicate certain types of deaths. For instance, gunshot wounds in certain locations, or lacerations or stab wounds in certain locations, might mean that this could be a suicide or a homicide. They need to know that if there's something that might look like or resemble a bite mark, that that area needs to be swabbed or photographed specially and so on. So that's basically it. It was very basic, but that's what I —
MR. ALESSI: Let's now shift again to your work at the County of Los Angeles Department of the Medical Examiner's Office, or as it's sometimes called the coroner's office. When did you have that work and what did that position involve?
DR. RUSSELL: So that was from 1993 to 1995. And as I mentioned, there were death investigations. I was assigned a certain number of cases myself, but we also reviewed cases that other doctors had. And given my curious mind, when I would do my autopsy I'd also look at whatever other cases were going on, and there were typically 10 to 15 cases going on on any given day. So I learned a lot, not only from my cases but from other cases.
MR. ALESSI: Did you ever conduct an autopsy of any individual that sustained dog-inflicted wounds?
DR. RUSSELL: Yes.
MR. ALESSI: Please describe that autopsy.
DR. RUSSELL: That was a case I'll never forget. It was a young boy who had been attacked by three large dogs — not specifically K-9, law-enforcement-trained dogs, but three large dogs. And the wounds — there were extensive wounds all over the body, as best I can remember, including a wide variety of puncture wounds, some scratches, abrasions, contusions. There were a number of different types of wounds.
MR. ALESSI: So let's now go — we've talked about dogs and motor vehicles. I'd want to go back, please, to motor vehicles. Did you, as a forensic pathologist, ever conduct autopsies of decedents that were involved in motor vehicle accidents?
DR. RUSSELL: Yes.
MR. ALESSI: Approximately how many?
DR. RUSSELL: Hard to say. I'm not sure really. Probably at least — well, motor vehicle accidents — probably at least 20 or 30.
MR. ALESSI: Did you conduct autopsies of victims of motor vehicle pedestrian incidents?
DR. RUSSELL: Yes.
MR. ALESSI: Now, prior to working at the coroner's office, you worked at the jail emergency department at General Hospital that you described, right?
DR. RUSSELL: Yes.
MR. ALESSI: And in that position, did you provide treatment to persons that suffered dog-inflicted injuries?
DR. RUSSELL: Yes.
MR. ALESSI: And just approximately how many? And then we'll move on to the next topic.
DR. RUSSELL: Approximately — personally, myself — about 40. But I worked as part of a team, and so I think we saw probably about 60 of these severe dog bites.
MR. ALESSI: We're going to shift again to keep it moving. Have you authored or edited any publications on dog-inflicted injuries on humans?
DR. RUSSELL: Yes.
MR. ALESSI: And what publications, please.
DR. RUSSELL: So I was a co-author on two peer-reviewed articles in major emergency medicine journals. One of them described the law enforcement dog bite injury patterns, and another one was more focused on the management of law enforcement dog bites.
MR. ALESSI: And those are ones you co-authored, correct?
DR. RUSSELL: Yes.
MR. ALESSI: Did you ever edit the work of others — articles or books — as part of a peer-review process?
DR. RUSSELL: Yes.
MR. ALESSI: Describe that please.
DR. RUSSELL: I was asked to be a co-editor of a two-volume series on forensic emergency medicine — a peer-reviewed series — and one of the chapters in one of those volumes was on bite wounds, written by Dr. Gerald Bale, V-A-L-E, who is a renowned, board-certified forensic odontologist.
MR. ALESSI: In terms of moving now from peer-reviewed articles you co-authored and peer-reviewed books and articles you edited — have you attended any seminars, talks, or lectures on wound identification and/or bite wounds?
DR. RUSSELL: Yes.
MR. ALESSI: Just briefly describe a couple to give the jury a flavor of what those were.
DR. RUSSELL: Well, there have been many lectures on wounds of all sorts. And in the emergency medicine program, of course, there were lectures on wounds from various types of animals and how to treat them. In the forensic arena, and at some of the professional organizations, there were lectures and talks on wounds, and also there was a yearly talk on bite wounds given by Dr. Bale at the coroner's office.
MR. ALESSI: To state perhaps the obvious — have you had a lifelong interest in dogs and dog-inflicted wounds?
DR. RUSSELL: Yes.
MR. ALESSI: And is that a professional and a personal interest?
DR. RUSSELL: It's mostly professional, as I've described.
MR. ALESSI: Let's now keep moving and go to another topic. Have you testified as an expert in court before?
DR. RUSSELL: Yes.
MR. ALESSI: Is that in state and federal court?
DR. RUSSELL: Yes.
MR. ALESSI: What topics have you testified to in state and federal court?
DR. RUSSELL: Causes of death, wounds, child abuse, domestic violence — mostly causes of death.
MR. ALESSI: Have you testified as an expert regarding emergency medicine?
DR. RUSSELL: Yes.
MR. ALESSI: Have you testified as an expert regarding forensic pathology?
DR. RUSSELL: Yes.
MR. ALESSI: Have you been found to be qualified as an expert in each of those categories in courts in the United States?
DR. RUSSELL: Yes.
MR. ALESSI: Have you ever not been qualified to testify in any court in the United States?
DR. RUSSELL: No.
MR. ALESSI: Have you ever testified as an expert regarding identifying dog-inflicted wounds on humans?
DR. RUSSELL: No.
MR. ALESSI: And why not?
DR. RUSSELL: Because — I mean, prior to this case — it's not a topic that comes up very often.
MR. ALESSI: So although it comes up often in your practice, in terms of whether it's an issue in court — is it your understanding from your answer that it just doesn't come up that frequently?
DR. RUSSELL: Correct.
MR. ALESSI: Are you aware of any other physician or practitioner who would be testifying in court frequently on this topic, given what you just said about the infrequency of it coming up?
DR. RUSSELL: No, I'm not.
MR. ALESSI: Now, as a last question on this line — give the jury a general idea of the types of wounds that were at issue and whether there were any pattern wound issues in those cases that you've testified about in court.
DR. RUSSELL: Well, many of them were stab wounds. Some were blunt force wounds from a variety of mechanisms, including assaults or motor vehicle accidents — a lot of wounds from accidents — and then of course gunshot wounds.
MR. ALESSI: Were those topics covering both living persons as well as deceased?
DR. RUSSELL: Yes.
MR. ALESSI: Let's now move to — you've mentioned wound pattern recognition. Are you familiar with the topic and the area of wound pattern recognition?
DR. RUSSELL: Yes.
MR. ALESSI: Can you please describe for the jury what you mean by wound pattern recognition in your practice and from your experience? What is it generally? And we'll get to some more specifics as we go through.
DR. RUSSELL: Well, generally, pattern recognition is very important in medicine. It's important in a lot of different fields, including radiology — they look for patterns on X-rays. Pathologists under a microscope look for certain patterns to identify cancer, cancerous cells for instance. So pattern recognition is very important. And then, as a subset, wound pattern recognition is of course very important to physicians that deal with patients who come in from, you know, the street, so to speak — who may have been assaulted, may have been child abuse victims, may have been domestic violence or elder abuse victims. Because sometimes you learn that what actually happened is not what the patient, or the relative, or the presenter said happened.
DR. RUSSELL: And so you have to discern or figure out what happened in a case. And so you have to be able to identify certain patterns and regions of the body — for instance, where wounds are — in order to make that determination. And so it's very important. It's emphasized in emergency medicine.
MR. ALESSI: When you were in residency, were you taught wound pattern recognition methodologies?
DR. RUSSELL: Yes.
MR. ALESSI: And is wound pattern recognition an area that you continue to learn and gain experience from over your 30 years as an emergency medicine physician?
DR. RUSSELL: Yes, it was emphasized in both emergency medicine and forensic pathology, in both fields. Very important.
MR. ALESSI: Is wound pattern recognition a generally accepted methodology that is applied in the practice of medicine?
DR. RUSSELL: Yes.
MR. ALESSI: And you've given a few examples of that pattern recognition methodology. Is that pattern recognition methodology generally accepted and discussed in the peer-reviewed medical literature?
DR. RUSSELL: It is in certain articles. Yes.
MR. ALESSI: And we'll be getting to some of those in terms of wound pattern recognition. Just roughly, how frequently in your experience as an emergency medicine physician did you have to exercise your skills in wound pattern recognition?
DR. RUSSELL: I would say probably weekly. Because I always questioned what the patient was telling me and did it fit, did the story make sense. So I did it quite often.
MR. ALESSI: And was that particularly important in child abuse cases where you may not be getting the story and you'd have to look at wounds and make your own determination?
DR. RUSSELL: Yes.
MR. ALESSI: Now, let's go and slightly move on to a very similar topic as to whether you ever had to determine the source of a wound without any input from a patient.
DR. RUSSELL: Oh yes, many times. Many, many patients arrived to the emergency department unconscious. And so that's just one example of others.
MR. ALESSI: And with regard to language barriers, did you ever encounter that as an obstacle to understanding what may have happened, and you therefore had to exercise your pattern recognition skills?
DR. RUSSELL: Yes.
MR. ALESSI: So now in terms of dog bites specifically, how often, if at all, did you have to look at a patient without input from anyone to determine whether it was from a dog?
DR. RUSSELL: Occasionally.
MR. ALESSI: And could you recall any specific instance, or is it just that you're recalling that you generally have had to do it but you can't recall a specific instance?
DR. RUSSELL: The second — that I generally had to do it. Sometimes there was a language barrier and people couldn't describe what it was that bit them, and it was important to know because treatment for different types of bite wounds is very, very different.
MR. ALESSI: And to be fair to the situation, you can't give any one specific instance — you remember this person was this age, et cetera. But you know that you did that on more than one occasion. I'll withdraw that and go to the next area. Let's now talk about wound pattern recognition in the area of forensic pathology. What role does pattern recognition play in forensic injury analysis? And could you please just let the jury know what you mean by forensic injury analysis as regards pattern recognition?
DR. RUSSELL: Okay. So forensic analysis, or forensic injury analysis, is the analysis of injuries from a medical legal perspective. In some areas of medicine, doctors are taught to just treat the injuries — no figuring out how it happened or what caused the injuries, so much as they treat. But in my case, both the emergency department and the forensic pathology training, I was interested in how the injury happened. That was a very important factor to me.
MR. ALESSI: Why is pattern recognition important in the field of forensic pathology?
DR. RUSSELL: Well, you could look at a wound all by itself — an abrasion, for instance. An abrasion is a scratch, and in and of itself it might not tell you how the wound occurred. But if there are a series of scratches or a series of lacerations — lacerations are cuts — they can tell you more about how it happened.
MR. ALESSI: And have you applied wound pattern recognition skills in your practice as a forensic pathologist?
DR. RUSSELL: Many times.
MR. ALESSI: Could you just give the jury a flavor of that? Just a few examples, maybe two.
DR. RUSSELL: Okay. Well, self-defense wounds, for instance — an issue that comes up often in court. If certain wounds were inflicted on purpose versus were they inflicted in self-defense — things like appearance and location can help you determine that. What was the question again?
MR. ALESSI: Just a few examples of applying pattern recognition skills in forensic pathology.
DR. RUSSELL: Oh yes. [unintelligible] People who are struck by cars. There are certain patterns that one expects to see when an individual is struck by a car. And we're taught to look for certain patterns, and that can help you determine if they were struck by a car.
MR. ALESSI: In terms of motor vehicle accidents and patterns, can you give an example of some of the patterns you would expect to see in someone — and that you have seen in someone — who is struck by a motor vehicle?
DR. RUSSELL: Often, lower extremity fractures, for instance. Lower extremity bruises and fractures are commonplace for someone who was struck by a car.
MR. ALESSI: And in your practice as an emergency medicine physician, a rough approximation of how many lower extremity injuries you have examined and evaluated with regard to motor vehicle accidents, including in the Los Angeles area?
DR. RUSSELL: Oh, I think probably hundreds.
MR. ALESSI: All right. So now let's continue with the topic that you were talking about. You called it defense injuries and wounds. I want to cover that topic. Are you familiar with the term posterior surface?
DR. RUSSELL: Yes.
MR. ALESSI: In terms of anatomy.
DR. RUSSELL: In terms of human anatomy.
MR. ALESSI: And with your honor's permission, could Dr. Russell point to her arm to show what she's referring to with regard to posterior surface for a defense injury?
JUDGE CANNONE: Sure. Go right ahead.
DR. RUSSELL: Let me explain just in general. Anterior is the front of the body —
MR. ALESSI: Excuse me, Dr. Russell. I'm sorry — if you want to stand up, with your honor's permission.
JUDGE CANNONE: Yes.
MR. ALESSI: Are you comfortable standing up and doing this?
DR. RUSSELL: Yes. Okay. So many years ago, anatomists decided on a nomenclature for describing parts of the body. And so the way the body descriptions go is that you take a person in what they call the standard anatomic position, which is upright with their arms, their palms facing forward. Palms facing forward. So that is the standard anatomic position. So anything in the front is anterior. Anything in the back is posterior.
MR. ALESSI: Could you point to the arm when you talk about anterior and posterior, please?
DR. RUSSELL: Yes. So with regard to the arm, if the palm is facing forward, that's the anterior. So the posterior part of the arm would be the back part that I'm touching right now. This back part of the arm, and the back part of the forearm, would be right here. So that's the posterior of the arm.
MR. ALESSI: And what relation does the posterior of the arm have in determining whether or not a wound is a defensive wound?
DR. RUSSELL: Well, often, when someone is being attacked, they will put their arm up to defend or protect their face, their neck, their chest — their vital organs, their vital parts of their body. So they put their arms up, and in doing so, the posterior part of the arm becomes presented to whoever is attacking them, or whatever is attacking them. So this is the part of the arm that often gets injured when someone is defending themselves.
MR. ALESSI: Thank you, doctor. How often have you observed and rendered conclusions regarding defensive wounds to the forearm?
DR. RUSSELL: Many times. I don't know — I don't have a number. Twenty, thirty — I don't know.
MR. ALESSI: In terms of decedents, and then in terms of live people?
DR. RUSSELL: Many, many more.
MR. ALESSI: And if we just start with the posterior part of the forearm that you've described, and you encounter wounds there — are those wounds indicative, or highly indicative, of anything?
DR. RUSSELL: Well, they're indicative of defensive wounds being caused during a defensive action.
MR. ALESSI: In your experience as a resident, a fellow, an emergency room physician, and a forensic pathologist, and your time at the Coroner's — have you experienced and taught the topic of defensive wounds?
DR. RUSSELL: Yes.
MR. ALESSI: Now, let's move on to another topic. Do you have knowledge of the dental features of dogs?
DR. RUSSELL: Yes.
MR. ALESSI: Where did you gain your knowledge about the dental features of dogs?
DR. RUSSELL: Generally from reading articles.
MR. ALESSI: And in terms of examining patients with dog-inflicted wounds, did that inform you anything about dog dentition or not?
DR. RUSSELL: Not specifically.
MR. ALESSI: In terms of dog dentition — your honor, may I approach?
JUDGE CANNONE: Okay.
MR. ALESSI: Thank you. May I approach?
COURT CLERK: Your honor.
JUDGE CANNONE: Yes.
MR. ALESSI: Your honor, may I have this depiction marked as an exhibit for identification?
JUDGE CANNONE: So, for ID?
MR. ALESSI: For ID only?
JUDGE CANNONE: Sure.
COURT CLERK: Yes. Is it O for identification?
MR. ALESSI: Thank you, madam court reporter. Your honor, may I hand it to the witness?
JUDGE CANNONE: approval
MR. ALESSI: I'm handing you, Dr. Russell, what has been marked for identification as O, as in orange. Dr. Russell, do you recognize that depiction?
DR. RUSSELL: Yes.
MR. ALESSI: What is it?
DR. RUSSELL: This is a diagram of K-9 dental anatomy.
MR. ALESSI: And could you please, just for the jury, briefly describe dog dentition and what we mean by the term dentition? I think most know, but just for the record.
DR. RUSSELL: So I believe dentition just means the teeth and the shape of the teeth, and of the mouth, of the animal or person. And what this diagram shows is that in general, dogs tend to have a triangular mouth, meaning it comes to a narrowing towards the front of the mouth. It shows how many teeth a normal dog will have, and what they — look like. There are different kinds of teeth, just like humans have different kinds of teeth.
MR. ALESSI: And, your honor, to assist the jury in the understanding of what Dr. Russell was speaking about, with your honor's permission, could we publish this as a chalk for the jury?
JUDGE CANNONE: Is there any objection? None.
MR. ALESSI: Thank you. Thank you, your honor. And will Mr. Woll enlarge the — Dr. Russell, where would you like to start with regard to this, just to give the jury a brief discussion of dog dentition? Which part of this should we zoom in on?
DR. RUSSELL: I think the lower half, around the triangular upper and lower jaws, right there. Right there.
MR. ALESSI: Very good. And Mr. Woll, if you could, just to start with, pull it down just so we can see the headings — and more importantly the jury can see the headings of those two diagrams that Dr. Russell has pointed out. Yes. And just enlarge that. Can you read what's on the left and what's on the right? It's slightly blurry.
DR. RUSSELL: Mandible — lower jaw. Maxilla — upper jaw.
MR. ALESSI: Yes, I got that right. All righty. So if we could then just reduce it back down so that it's not distorted. And then Dr. Russell, if you could just talk about it. And before we do that, I think it would be helpful — — Dr. Russell, can we go to the depiction up above, just to get the overall picture of the dog? All right. Is that — that's an overall picture, correct? Do you want to point out anything generally on that picture?
DR. RUSSELL: I don't have a pointer, but generally it's a side view, and it shows — it's a skeletal view so there's no skin — and it shows that there are some prominent teeth. They're called the canine teeth, and then there are some smaller teeth in front of that — or, excuse me, if I could interrupt. Pardon my interruption. I'm just going to try to locate in the courtroom a pointer, your honor.
MR. ALESSI: If there's nothing on that stand — I've got one. May I approach, your honor? Thank you. Here, Dr. Russell. Hopefully that will work for you.
DR. RUSSELL: Thank you. Excuse me. Okay. So this is a side view, and it shows many, many teeth. This is a skeletal view, obviously. And it shows these prominent teeth, which are called the canine teeth. Humans also have canine teeth, and ours are not quite as prominent. And then there are some teeth in front of that which are called incisors. So that's the overview, right? And just to put this in context,
MR. ALESSI: We are looking at this and talking about dogs. Have you had the opportunity to review any photos of the right arm of the decedent in this case?
DR. RUSSELL: Yes.
MR. ALESSI: And is one of the topics you're going to address whether those wounds are from a dog?
DR. RUSSELL: Yes.
MR. ALESSI: And so this background in terms of dog dentition is part of what you're going to cover for the jury later on?
DR. RUSSELL: Yes. And I want to make one more comment if I may, please. When a dog bites, they usually don't bite with all of their teeth. They usually don't get all the teeth impacted on the individual. So that's important to know. Often times it's the anterior, or the front teeth.
MR. ALESSI: Why, doctor, is it the case that a dog doesn't always get a complete bite — get all of the teeth? Why is that the case?
DR. RUSSELL: Well, often times there's movement. Often times the dogs aren't really trained on biting techniques. And so there's often times the person who's being bitten is pulling away and trying to avoid the bite. So often times there's only impact with a few of the teeth in the front.
MR. ALESSI: Great. Please continue, doctor. Dr. Russell, could I ask you to use this screen?
DR. RUSSELL: Oh yes, please.
MR. ALESSI: I think it's easier for counsel.
DR. RUSSELL: Oh, okay. So — overview — these large canine teeth. These are the anterior teeth. And as I said, it's very rare for all the teeth to be involved in the bite. It's usually just the front teeth and canine teeth.
MR. ALESSI: Are there certain teeth on this depiction that cause certain types of injuries — abrasions, tears, punctures? Is there any relation to the teeth in any of those categories, or can it be just general?
DR. RUSSELL: Well, often times because the canine teeth are so long compared to the others, they are the ones that seem to cause the large puncture wounds, and those are the ones that appear to get the grip on the person's skin.
MR. ALESSI: Is there a medical term for a puncture wound from a canine, or is it just a puncture wound from canines?
DR. RUSSELL: I'm not sure of the medical term.
MR. ALESSI: Please continue.
DR. RUSSELL: Okay. That's about it on this side view.
MR. ALESSI: And is there any other view on this exhibit that you would like to discuss with the jury?
DR. RUSSELL: Well, I was going to show that this — it's triangular again. The upper and lower jaws. They tend to be somewhat triangular.
MR. ALESSI: Is that also sometimes the shape referred to as an hourglass, or is it triangular — or do you prefer triangular?
DR. RUSSELL: I've heard it referred to as hourglass. I don't see an hourglass, but maybe in some dog breeds, because different dog breeds have different shapes of their mouths. But this is just a generalization.
MR. ALESSI: Okay, please continue.
DR. RUSSELL: I don't know that there's anything else.
MR. ALESSI: All righty. And so you — oh, actually yes?
DR. RUSSELL: So here — can you go back, please? So here you can see, again, the canines. And it's often times — this is the upper jaw, the maxilla. It's often times these teeth that do the impacting.
MR. ALESSI: I'm sorry, I didn't hear you — you said it's often these teeth that — what?
DR. RUSSELL: That do the impact. The upper jaw is often the part that actually makes contact with the skin. That's all.
MR. ALESSI: Thank you. We can take that down. Mr. Woll. Thank you, your honor. Now let's go to dog-inflicted injuries on humans generally. What type of injuries to humans can be caused by dog-inflicted bites?
DR. RUSSELL: Well, there are lots of different types of injuries. They could be extremely minor — from a minor scratch to puncture wounds by individual teeth, to actual punctures by several teeth. There could be several abrasions, because there are multiple teeth involved, and if they don't puncture, they at least scratch — they can scratch the skin. That's what I call an abrasion — a scratch. So they scratch the skin, but in parallel, because the teeth are lined up. So often times they have parallel lines. And then of course there are bruises that could occur because of crushing injury. And there can be what we call avulsions, which are where an actual flap of the skin is removed. And I can go further, but there's a wide extent of injuries.
MR. ALESSI: So there's a wide range. And can you just give one or two factors that are going to determine whether you're on the more minor side of the range to the more major part, as regards to the type of bite that the dog is able to get?
DR. RUSSELL: Well, I think that when there is penetration of the skin and pulling away of some of the tissue, I would consider that a more significant bite, because of what's needed for treatment.
MR. ALESSI: Just bear a moment, please. Thank you. So, in terms of the nails and claws of a dog, what type of injury, if any, can those cause?
DR. RUSSELL: So the nails — they're also somewhat pointy or triangular in configuration or shape. And so they can cause scratches, and actually they can cause even deeper wounds if the nail catches the victim's skin a certain way, but most of the time just scratches.
MR. ALESSI: From your experience — your medical experience, peer-reviewed article experience, your whole professional experience with dog-inflicted wounds on humans — do you have experience with just a part of the range, or the whole range of injuries that a dog can inflict?
DR. RUSSELL: Well, I think I have a very wide range of experiences. The very serious ones we talked about in the very beginning — where there were crushing and ripping injuries — those were the trained K-9 dog bites. Most emergency physicians don't even get to see those, they're so uncommon. But because I was assigned to the jail ward, that's how I got to see them. In the majority — in the main ER — we saw the more minor type of injuries.
MR. ALESSI: So, in terms of — if someone is bitten by a dog, where are they? Again, I think most people understand this, but just to be clear for the record — when someone gets a dog-inflicted wound, where do they usually go?
JUDGE CANNONE: Sustained.
MR. ALESSI: Doctor, are you aware of the medical facility, from your experience, where people go who have dog-inflicted wounds?
DR. RUSSELL: Well, if they feel like they need medical care, they will either go to a family doctor, or most likely the emergency department — because the emergency department is where the resources are, and the people with the experience. They go to the emergency department in general.
MR. ALESSI: From your experience, your literature review, and authoring of documents, do people with dog-inflicted wounds go to a veterinarian for treatment? I'll let you answer it.
DR. RUSSELL: Not from my experience.
MR. ALESSI: All righty. Now let's move to another category, and to keep this moving along — how did you initially become involved in this case?
DR. RUSSELL: Well, very interesting. I live in Los Angeles, and I saw something in the Boston Globe about this case, but I really didn't pay much attention to it. And then eventually I heard something — I'm not from this part of Massachusetts, you know, I'm from a different part of Massachusetts. So anyways, eventually I heard or saw something about there being an issue with some possible dog-inflicted injuries versus maybe car-inflicted injuries. So that got my attention. I thought, hm, that's interesting. And that's how I initially became aware of the case.
MR. ALESSI: Let's talk about the Boston Globe. How is a person from Los Angeles reading the Boston Globe, and why? Is it like a one-time thing, or why are you reading the Boston Globe?
DR. RUSSELL: You know, I had a subscription. I would, you know, not always read it. I lived in Massachusetts, I went to school in Massachusetts, I worked in Massachusetts as a police officer. So I have some interest in Massachusetts, but none of that was in this geographic area. It was all north of Boston. So that was the area I mostly paid attention to.
MR. ALESSI: Did you reach out to anyone after reading that article? And what do you recall from the article in the Boston Globe, if anything?
JUDGE CANNONE: I'm going to sustain that. Did you reach out to anyone after having read something in the Boston Globe?
DR. RUSSELL: Uh, yes. I thought the question was interesting.
JUDGE CANNONE: I'll let that stand, but just answer Mr. Alessi's question.
DR. RUSSELL: Yes, I did.
MR. ALESSI: Go ahead.
DR. RUSSELL: Okay. Yes. I reached out to one of the DAs in Los Angeles County.
MR. ALESSI: And at that point, what, if anything, did you know about this case?
PARENTHETICAL: [Sidebar]
MR. ALESSI: Your honor, in terms of Mr. Woll, if we could — and your honor, may we publish what is already in evidence, which is Exhibit 167?
DR. RUSSELL: I didn't know much. I just knew what I mentioned. And I knew that the decedent was a police officer, had been a police officer, and that interested me also because I was a police officer. Please keep your voice
JUDGE CANNONE: Up, Doctor.
DR. RUSSELL: I said that interested me also because I had been a police officer at one time. So that's about all I knew really.
MR. ALESSI: Right. So did you know anything about what the prosecution was claiming or the defense was claiming at all? Did you know anything?
JUDGE CANNONE: Sustained. What did you know, if anything, about the case?
MR. ALESSI: I'm going to take a sidebar, your honor.
JUDGE CANNONE: Okay.
MR. ALESSI: Dr. Russell, do you recognize Exhibit 167?
DR. RUSSELL: Yes.
MR. ALESSI: And how do you recognize that? Well, first — what is it, and then how do you recognize it?
DR. RUSSELL: It is a picture of the decedent's right arm and forearm.
MR. ALESSI: Now, without stating what it is, have you been able to form an opinion as to the source and nature of the wounds that are depicted in that exhibit?
DR. RUSSELL: Yes.
MR. ALESSI: Now, in terms of the next area, can you describe for the jury what method you used in forming your opinion, without yet stating what your opinion is?
DR. RUSSELL: Well, I use pattern recognition and differential diagnosis.
MR. ALESSI: So let's start with wound pattern recognition. Is that the wound pattern recognition you've been discussing up to this point in your testimony?
DR. RUSSELL: Yes.
MR. ALESSI: And did I hear you use the phrase "differential diagnosis"?
DR. RUSSELL: Yes.
MR. ALESSI: Please tell the jury what you mean by the term "differential diagnosis" as a physician, emergency medicine physician and forensic pathologist.
DR. RUSSELL: So when a physician sees a patient — or an image, in this case — and is attempting to make a diagnosis, it's very important that not only do they consider what they believe is the obvious, but also in their mind go through other possible diagnoses and determine if they can rule them out, so to speak — rule them in, rule them out — so that they are not just focused on one thing, but they've actually given consideration to other conditions that may be causing whatever it is that they see.
MR. ALESSI: So, Mr. Woll, if you could take that — we're going to come back to this, but I'd like to have it taken down until we have the need to. And if we could have the lights go back on. Your honor.
JUDGE CANNONE: Thank you.
MR. ALESSI: So, does applying a differential diagnosis — let me start out. Do you understand what confirmation bias is?
DR. RUSSELL: I believe so. Yes.
MR. ALESSI: And does differential diagnosis assist or not assist in avoiding confirmation bias?
DR. RUSSELL: I believe it assists in avoiding confirmation bias.
MR. ALESSI: So in terms of differential diagnosis, did you apply that concept in the beginning of your analysis of this case?
DR. RUSSELL: Yes.
MR. ALESSI: How did you apply differential diagnosis to, among other things, avoid confirmation bias in this case?
DR. RUSSELL: Well, in my mind I went through other possible causes of wounds on an arm and what they would look like and the configuration, the patterns, etc. And then I figured out why these other potential causes of wounds on the arm did not fit this case.
MR. ALESSI: So is phraseology a synonym for differential diagnosis? What doctors call "ruling out something" — is that another way to say it as well?
DR. RUSSELL: Yes.
MR. ALESSI: So we're going to come back to the differential diagnosis — I just wanted to have that framing first. Now let's switch to the materials that you considered in forming your opinion about the nature and source of the wounds to Mr. O'Keefe. Describe what you looked at in terms of coming to your opinion, conducting a differential diagnosis and avoiding confirmation bias. What did you look at?
DR. RUSSELL: Well, I looked at pictures similar to this. So there were pictures taken at the hospital. There were pictures taken at the medical examiner's office. I looked at the medical records. I looked at the autopsy report. And I looked at other reports from the Massachusetts State Police. And those are some of the things I looked at.
MR. ALESSI: Did you look at any photographs, including of clothing?
DR. RUSSELL: Of what?
MR. ALESSI: Clothing.
DR. RUSSELL: Oh, yes — clothing, of course.
MR. ALESSI: What clothing did you look at?
DR. RUSSELL: So there was a shirt — a shirt like a hoodie shirt — that I looked at that had many defects in it.
MR. ALESSI: And when you say defects, what do you mean by defects? Is there a more layperson's term?
DR. RUSSELL: Holes. Thank you.
MR. ALESSI: Did you look at any history of any dogs with regard to any municipalities and dog incidents?
JUDGE CANNONE: I'm going to sustain that. Mr. Alessi, did you look at any municipal records with regard to your review in this case? That's sustained. With regard to other documents, if any, could you describe any other documents that you looked at?
DR. RUSSELL: Well, I also —
JUDGE CANNONE: I'll see you at 1:00. Today we'll give you an hour for lunch. [Lunch recess]
MR. ALESSI: Okay. May I continue, your honor?
JUDGE CANNONE: Yes.
MR. ALESSI: Thank you. Thanks for your patience. Dr. Russell, we had broken off where you had described the materials that you had reviewed. And Mr. Woll, if we could please put the exhibit that we just had — and with your honor's permission, republish it. Thank you. Based on your review of all the materials that you had described and your experience that you had described, without stating it, were you able to come to any conclusions or opinions about the source and nature of the injuries that you see depicted on that exhibit?
DR. RUSSELL: Yes.
MR. ALESSI: And what is your opinion and conclusion concerning those injuries?
DR. RUSSELL: Those wounds were inflicted as the result of a dog attack.
MR. ALESSI: I'm sorry, I didn't hear you. Can you speak a little louder?
DR. RUSSELL: They were inflicted as the result of a dog attack.
MR. ALESSI: And how did you form that opinion? Just describe your thought process to the jury.
DR. RUSSELL: Well, there are multiple groupings of wounds. Do you have the pointer?
MR. ALESSI: I do. Let's see. And if you could use the screen that her honor has requested.
DR. RUSSELL: So there are multiple groupings of wounds right here. Here's one on what I'll consider the upper arm, which is above the elbow. Here's another grouping. Here's an interesting complex grouping at the elbow. These are all at the posterior surface of the arm. And there's another grouping down here on the forearm. These multiple groupings are patterns, and they are, in my opinion, inflicted by the teeth and claws of a dog.
MR. ALESSI: We've discussed previously pattern recognition skills and methodology, and you just mentioned the word "pattern" here. Can you elaborate on what you mean by "pattern" with regard to this exhibit?
DR. RUSSELL: So there are groupings, and one can see that these wounds are going essentially in the same direction. They're oriented in the same way — from almost the inner surface of the arm, or the anterior surface, towards the posterior surface.
MR. ALESSI: What is the significance, if any, of that orientation you just described?
DR. RUSSELL: So that gives me direction, and that tells me that the dog's teeth were over here — the dog is over on this side of the arm. And the teeth started their punctures or injuries over here. And through either the action of the dog, or a combination of the action of the dog and the action of the decedent pulling away, or the victim pulling away, the teeth made these abrasions in this direction from here down to here, and then here it's very complex because of the bending of the elbow. We don't know the exact configuration of what this elbow was in — in the arm. Was it fully extended, meaning it's fully stretched out? Or was it partially bent? Or was it fully bent? We don't know. But in addition to the pulling away movement, there's also the bending movement.
DR. RUSSELL: If we could just stop at that area. Have you observed in your experience what you call that complex area pattern? Have you seen that before?
DR. RUSSELL: Not that exact pattern. No.
MR. ALESSI: But have you seen any that is similar to it?
DR. RUSSELL: I've seen some characteristics of these patterns before. Yes.
MR. ALESSI: And is the appropriate methodology to just zero in on one section, or is the appropriate pattern methodology to look at all the wounds and then reach a conclusion?
DR. RUSSELL: The second — to look at all the wounds.
MR. ALESSI: And can you please des—
JUDGE CANNONE: Why don't we take our recess?
MR. ALESSI: Okay, your honor.
JUDGE CANNONE: Okay. Thank you. All right. Please close your books to
JUDGE CANNONE: Back in session. Right, Mr. Alessi? Whenever you're ready.
MR. ALESSI: Thank you, your honor. Good afternoon and welcome back, Dr. Russell.
DR. RUSSELL: Good afternoon, your honor.
MR. ALESSI: If we could please publish Exhibit 1 in evidence.
JUDGE CANNONE: Okay. Mr. Woll.
MR. ALESSI: Dr. Russell, do you recognize Exhibit 1 from your review of the documents in this case?
DR. RUSSELL: Yes.
MR. ALESSI: And what is it that Exhibit 1 represents?
DR. RUSSELL: It's a picture of the forearm of the decedent. We left off at lunch and I'm not going to cover too much old ground, just to reorient ourselves back to where we
MR. ALESSI: Were. You were discussing the basis of your opinion and conclusion — that you said that these wounds were caused by — excuse me. Let's just continue on. Can you go through what is in Exhibit 1 and describe how it is that you came to your opinion?
DR. RUSSELL: Well, I observed multiple patterns of striations, or linear abrasions.
MR. ALESSI: I'm sorry to interrupt you so soon. Do you have the pointer in case you want to use that?
DR. RUSSELL: Thank you. Thank you. So there are multiple groupings of linear abrasions. And linear means — similar, you know, like a linear one. So there are multiple of those. And here's one. Here's another one closer to the elbow. Here's another one closer to the wrist. And here's another array of linear abrasions near the elbow.
MR. ALESSI: In terms of these wounds, in assessing their source, do you look at them individually, collectively, or both?
DR. RUSSELL: Both. I look at them individually and then I put them in context of how they relate to one another.
MR. ALESSI: Is there a name for that methodology — how they relate to each other?
DR. RUSSELL: Well, I think it's a pattern methodology — pattern recognition.
MR. ALESSI: And what pattern is it that you see here with regard to all of these wounds on the right arm?
DR. RUSSELL: Well, I see multiple linear groupings together in an area from the mid arm to the mid forearm.
MR. ALESSI: Is there any analysis of direction that is involved in your analysis?
DR. RUSSELL: Yes.
MR. ALESSI: What is it?
DR. RUSSELL: I believe that these wounds were initiated closer to the anterior surface — or the front of the forearm. I'm sorry, Dr. Russell, to interrupt you, but there's a fan back here which I can hear, but if you could just keep your voice up, that would be great for me. Yes. I believe they all started closer to the anterior, or front portion of the arm — like they started up here, here, you know, up here — and the direction is towards the posterior portion of the arm.
MR. ALESSI: Now if we could just go back briefly, I want you to do a comparison. If we could go back, your honor — please — back to Exhibit 167, that we had up earlier. Okay. I'm sorry — 167. As between 167 and 1, which one is closer in time to when Mr. O'Keefe was located?
DR. RUSSELL: The previous one.
MR. ALESSI: All right. So let's go back to the previous one. So that one is closer in time to when Mr. O'Keefe was located on January 29 of 2022. Correct?
DR. RUSSELL: Yes.
MR. ALESSI: And so — January 29, 2022 — if we can go back to Exhibit 157 — or 67, excuse me — 167. Can you tell when this picture was taken from the depiction?
DR. RUSSELL: Well, it says January 31st.
MR. ALESSI: Okay. So — and is that the basis for you saying that Exhibit 1 was closer in time to when Mr. O'Keefe was located?
DR. RUSSELL: Yes.
MR. ALESSI: All right. So I want to do another comparison — have you do another comparison of the two. If we can go — if you can look at what is depicted in Exhibit 167, and now go back to 1 and see if you see any differences at all as to what's depicted. Do you see any differences with regard to the wounds on the arm, or the arm just in general? Let's go back to see that. Now let's go back to 167.
DR. RUSSELL: Well, the coloration of the photograph is slightly different.
MR. ALESSI: And what do you mean by the coloration?
DR. RUSSELL: Well, the skin tones here are more yellow than they are in the previous photograph.
MR. ALESSI: And — I'm sorry — do you have a conclusion as to why there is a difference in skin tone in this exhibit compared to Exhibit 1?
DR. RUSSELL: Well, it could just be technique — lighting technique. I do see some lividity on the chest — postmortem lividity — and what that means is pooling of the blood, which happens after death.
MR. ALESSI: Can you explain to the jury what lividity is?
DR. RUSSELL: Yes. So blood follows the laws of gravity and the blood will settle to the dependent parts of the body. In this case the body of Mr. O'Keefe is horizontal, and so the blood is going to settle from the top of the chest, which would probably be up here somewhere, down towards the back, which would be the inferior portion of the chest in that position. And likewise it would happen on the extremities too.
MR. ALESSI: So with — you just mentioned the extremities — do you see any lividity on the extremity here of the right arm?
DR. RUSSELL: You know, actually there is discoloration over here in the elbow area. There — I do see some lividity. Okay, so there are several areas of lividity on the arm. I'm sorry — there's some right here, this redness right here on the near the wrist. I believe that that's postmortem lividity. I believe that this redness in here near the elbow is also postmortem lividity. And yeah, that's what I believe — postmortem lividity.
MR. ALESSI: And again, lividity — you said something that sets in after death?
DR. RUSSELL: Yes, it's the pooling of blood.
MR. ALESSI: Is there — with regard to this depiction, do you see any bruising with regard to that elbow?
DR. RUSSELL: You know, I think that initially, earlier this morning, the — with
MR. ALESSI: And if we could go back to exhibit one — and you said this is the one that's closer in time to when Mr. O'Keefe was located. Do you see any lividity or bruising with regard to that photo?
DR. RUSSELL: I don't see any definite bruising. I do see some discoloration up here near the shoulder. I'm not sure if that's postmortem lividity or not. It could be early postmortem lividity.
MR. ALESSI: So, if we could — thank you. Mr. Woll, can we take that depiction down for the moment? What I'd like to do is — and we'll come back to that. If we could have the lights back on, please. Thank you. Have you had prior experience — prior to this case — in performing your pattern recognition methodology skills with regard to dog-inflicted wounds on humans? In other words, have you seen dog-inflicted wounds that have a pattern on humans?
DR. RUSSELL: I've seen dog wounds that have had a pattern. I didn't need to utilize that skill because I also had other information about the case. For instance, a police officer or the victim himself said, you know, I was attacked by a dog.
MR. ALESSI: Right. And for those — can you give an example like in the ER as to how you would come to have that knowledge, or otherwise how would you generally come to have the knowledge as to a potential source of the wound?
DR. RUSSELL: Oftentimes it's the victim that tells me, or in the case of the law enforcement dog bites, I had both victim and police officers tell me that the police dog inflicted these wounds.
MR. ALESSI: And how many times generally in your career — we discussed it this morning — how many times generally did someone present with dog-inflicted wounds and you were told that these wounds were from a dog? Roughly how many in your career?
DR. RUSSELL: Well, all of the law enforcement dog bites — that would be 40 to 60 or so of those, plus most of the non-law enforcement dog bites — patients or the mother have said, you know, a dog bit me, or a dog bit my son.
MR. ALESSI: And for those where someone said a dog bit my son, were the wounds that you saw similar to or different from the wounds that are depicted in exhibit one that we've had up on the screen — on the civilian dog bites?
DR. RUSSELL: There's some similarities, but not as many striations on the civilian dog bites.
MR. ALESSI: And are there more striations on what's depicted in exhibit one? Does that lead you to more easily conclude it's from a dog bite, or is it harder for you to conclude it's from a dog bite?
DR. RUSSELL: Neither.
MR. ALESSI: Right. So, your prior experience as an emergency room physician — as a physician in Cochran — does that experience allow you to exercise pattern recognition skills with regard to exhibit one and exhibit 157?
JUDGE CANNONE: Sustained.
MR. ALESSI: Did you use your pattern recognition skills in evaluating exhibit one and exhibit 157?
DR. RUSSELL: Yes.
MR. ALESSI: In terms of characteristics of dog bites, if we can go back to exhibit one, please. Is exhibit one highly characteristic of a dog bite or lowly characteristic of a dog bite?
DR. RUSSELL: Yes.
JUDGE CANNONE: Sustained.
MR. ALESSI: How would you describe the characteristics of what appears on exhibit one?
DR. RUSSELL: What I see on exhibit one is multiple strikes from a dog.
JUDGE CANNONE: I'm going to allow it. Can you please repeat your answer?
DR. RUSSELL: Yes. What I see are multiple strikes from a dog.
MR. ALESSI: And with regard to — do you see any characteristics in terms of a medical observation with regard to those strikes?
DR. RUSSELL: I don't understand the question.
MR. ALESSI: Okay. Are you familiar with the medical term "pathognomonic"?
DR. RUSSELL: Oh, yes.
MR. ALESSI: What is the definition of "pathognomonic"?
DR. RUSSELL: Pathognomonic in medicine means that the characteristics of a condition are so highly specific and unique that they basically say that it can only be from a certain condition and no other condition. So, to the exclusion of all other conditions, that's what is meant by pathognomonic. At least that's my understanding.
MR. ALESSI: Do you consider these wounds pathognomonic?
DR. RUSSELL: Yes.
MR. ALESSI: How do you evaluate these wounds in terms of what you call their characteristics?
DR. RUSSELL: I characterize them as highly specific for a dog attack.
JUDGE CANNONE: I'm going to strike the last word, Mr. Wilson.
MR. ALESSI: In terms of the characteristics that you have talked about, are there any other aspects of dog dentition that you can discern from exhibit one?
DR. RUSSELL: I don't understand the question.
MR. ALESSI: You mentioned earlier, when we had the dog dentition exhibit up, you mentioned an arch. Is there any aspect of exhibit one that concerns an arch?
DR. RUSSELL: Yes. In my opinion there is an arch-like structure right here towards the lower part of the forearm towards the wrist, suggesting that this here is made from the very front teeth of the dog. Now, when one looks at these injuries or wounds, one has to remember that, number one, this is not a mannequin. This is a person whose skin is somewhat elastic, whose skin will slide over the underlying bones. And so therefore some of the wounds may have been created by the exact same teeth, for instance, but look differently depending on the part of the anatomy, the elasticity of the skin, also depending on things like if there was clothing or something in between the teeth and the skin. So one has to consider — and also this — there may be motion artifact, motion effects.
DR. RUSSELL: The living victim could have been pulling away from the dog. The dog could have been pulling or jumping and only catching a slight bit of the skin with his teeth. So there's a lot of movement and things that one has to consider when an injury is inflicted on a body.
JUDGE CANNONE: I'm going to strike that.
MR. ALESSI: Can we approach, your honor?
JUDGE CANNONE: Sure.
MR. ALESSI: May I, your honor.
JUDGE CANNONE: Yes.
MR. ALESSI: Thank you. If we could put exhibit one back up on the screen, please. Mr. Woll. Dr. Russell, is what's depicted on the screen one dog bite or more than one dog bite?
JUDGE CANNONE: Ask it differently, Mr. Alessi.
MR. ALESSI: Dr. Russell, how do you evaluate this depiction with regard to dog bites?
DR. RUSSELL: Well, I see several groupings of wounds. Here's one grouping up near the shoulder. Here's another distinct grouping near the elbow, but above the elbow. Here is a third grouping around the back of the elbow and the upper forearm. Here's some additional marks. I think they're separate, but I don't know exactly if they are separate dog bites or scratches. And then there's another grouping around the posterior forearm near the wrist. So, one, two, three, four. So there's at least four different types of either bites or combination bite and claw marks.
MR. ALESSI: You mentioned claw marks. Is there any evidence of claw marks in this exhibit?
DR. RUSSELL: It's hard to say exactly what these marks are — this one here, this one here, and even to a certain extent, this one here — it has some characteristics of both claw marks and bite.
MR. ALESSI: So, even though you may not be able to determine whether it's a claw mark or the specific type of mark, can you determine that those are from a dog?
DR. RUSSELL: I believe they are. Yes.
MR. ALESSI: So, now — you mentioned — we'll switch — we can leave that up for just a moment because we're going to come right back to it. And Dr. Russell, earlier on you used the phrase "incomplete dental impression." Do you recall that?
DR. RUSSELL: Something like that. Yes.
MR. ALESSI: What phrase would you like to use? Because you were describing whether a dog had a complete bite. What phrase would you like to use?
DR. RUSSELL: That's okay. Incomplete bite.
MR. ALESSI: Okay. Do you see any evidence of an incomplete bite on exhibit one?
DR. RUSSELL: I believe all of the bites here are incomplete.
MR. ALESSI: Why do you come to that conclusion?
DR. RUSSELL: Because in my opinion, they don't penetrate the skin, which I would consider more of a bite, or more of a complete bite. So they're just scratches on the surface of the skin.
MR. ALESSI: When you say they don't penetrate the skin — we see the marks that are on there. What do you mean that they don't penetrate the skin?
DR. RUSSELL: They don't penetrate the full thickness of the skin and extend into the soft tissue underneath.
MR. ALESSI: And in terms of incompleteness that you just described, have you observed incomplete dog bites in your career?
DR. RUSSELL: Many.
MR. ALESSI: Roughly how many incomplete dog bites have you observed and treated in your career?
DR. RUSSELL: Over a hundred.
MR. ALESSI: And are incomplete bites the majority of bites from civilian dogs, or are they a minority of the bites from civilian dogs?
DR. RUSSELL: I believe they're the majority of the bites from civilian dogs.
MR. ALESSI: Did you determine whether these wounds occurred at the same time?
DR. RUSSELL: I believe they did.
MR. ALESSI: Why do you come to the conclusion that they occurred at the same time?
DR. RUSSELL: Because of the wound characteristics, the coloration of the wounds, the tissue reaction to the wounds. So they all — timing — are around the same time.
MR. ALESSI: Did you determine whether these wounds were sustained by Mr. O'Keefe before or after he died?
DR. RUSSELL: Before he died.
MR. ALESSI: How do you reach the conclusion that these wounds were suffered by Mr. O'Keefe before he died?
DR. RUSSELL: Because they have what we call a vital reaction. So there is ever so slight vital reaction or inflammation around the edges of the wounds, and so that supports the fact that they were inflicted during life.
MR. ALESSI: Dr. Russell, did you observe Mr. O'Keefe's right arm personally?
DR. RUSSELL: No.
MR. ALESSI: Is it generally accepted in the practice of medicine, particularly emergency or pathology, to observe and determine the source of a wound from a photograph after death?
DR. RUSSELL: It is generally accepted.
MR. ALESSI: And have you in your career used photographs to determine wounds and patterns of wounds?
DR. RUSSELL: Yes.
MR. ALESSI: And is that an accepted practice?
DR. RUSSELL: Yes.
MR. ALESSI: And is it a generally accepted practice?
DR. RUSSELL: Yes.
MR. ALESSI: Now, in conducting your — we're going to switch a little bit now to what you call the differential diagnosis. In conducting your differential diagnosis with regard to motor vehicle accidents, describe for the jury how you performed that differential diagnosis with regard to the decedent. And we can leave that up for just a moment. Go ahead, Dr. Russell.
DR. RUSSELL: So, I'm going to need to see you. Sorry, folks.
MR. ALESSI: May I proceed, your honor?
JUDGE CANNONE: Yes.
MR. ALESSI: Miss — uh, with your honor's permission to republish exhibit one. Thank you for your patience. Dr. Russell, are the wounds you see on exhibit one consistent or inconsistent with what you have seen from your experience with regard to motor vehicle accident victims?
DR. RUSSELL: Inconsistent.
MR. ALESSI: If I could have exhibit 206, which is in evidence, published, your honor. Do you recognize exhibit 206?
DR. RUSSELL: Yes.
MR. ALESSI: Did you review that as part of any report in this case?
DR. RUSSELL: Yes.
MR. ALESSI: And can you describe how you reviewed this document as part of your evaluation of this case?
DR. RUSSELL: Well, I reviewed the injuries, which — so this is a decedent, a picture of a decedent, a different case — not the decedent in this case, totally separate case.
MR. ALESSI: And is this from Dr. Welcher's report that you reviewed?
DR. RUSSELL: Yes.
MR. ALESSI: All right. So continue, please.
DR. RUSSELL: And so this is a person, deceased, looks like in the street, and he's got multiple injuries, and this is allegedly from an auto versus pedestrian accident.
MR. ALESSI: So if we could — are you able to discern any injuries to any limbs from this? If you could zoom in on the limbs. Mr. Woll. Thank you.
DR. RUSSELL: So there is a very extensive degloving — partially degloving — avulsion injury to the forearm of this individual. The extensive skin loss, damage to the subcutaneous tissue, possibly damage to other tissues beneath that.
MR. ALESSI: And Mr. Woll, if you could zoom back out and go to the list that is highlighted in the original of this — and Dr. Russell, can you tell me whether you evaluated the list and if so, how did you evaluate that list in connection with the photo?
DR. RUSSELL: Well, the photo is limited only really to the upper chest and the right arm. And so I can't comment on any of the CAT scan findings here on this list, but this was a list of numerous traumatic injuries to this person. And regarding the arm, it says "right upper extremity wound with vascular injury, clinical."
MR. ALESSI: What does that mean, if anything, to you?
DR. RUSSELL: Well, that suggests it's a soft tissue wound. However, what they're saying is "clinical," so they're not commenting on if there were any X-ray findings, for instance — and an X-ray, but I mean, it would be a postmortem X-ray, and this is just a clinical diagnosis, or a visual, hands-on diagnosis.
MR. ALESSI: Do you know whether that line that you just read relates to any part of the photograph? Any part of the photograph?
DR. RUSSELL: Well, I believe it relates to that injury that we pointed out in the previous photograph.
MR. ALESSI: Can you switch back to that please, Mr. Woll? And if you could just zoom in — just, what does —
DR. RUSSELL: So this is the wound that they are talking about. It's a large gaping wound, soft tissue wound.
MR. ALESSI: If we could go back to the list, please — zoom in. Thank you. But — oh, please continue.
DR. RUSSELL: No, what I was going to say is that there are multiple other injuries in this person. Multiple serious, significant injuries: subdural hemorrhage, subarachnoid hemorrhage, intraventricular hemorrhage, liver laceration, hemopneumothorax — that's blood and air in the chest cavity outside of the lungs. So it's in an area where it shouldn't be. This person had numerous injuries.
MR. ALESSI: Are you able to compare these injuries in that photo in exhibit 206? And did you compare them to your review of the autopsy report and other medical records of Mr. O'Keefe? [unintelligible]: Sister, answer the question. Oh, okay. You can take that down. From your review, did Mr. O'Keefe sustain any liver laceration?
DR. RUSSELL: No.
MR. ALESSI: Did Mr. O'Keefe sustain any gaping, as you called it, lacerations to the right forearm?
DR. RUSSELL: No.
MR. ALESSI: Did Mr. O'Keefe sustain any hemopneumothorax injuries that you were describing with regard to 206?
DR. RUSSELL: No.
MR. ALESSI: Hemopneumothorax. In terms — let's switch to another topic. Let's talk about clothing of the decedent. In forming your opinion, did you consider Mr. O'Keefe's clothing in relation to his wounds?
DR. RUSSELL: Yes.
MR. ALESSI: If we could, your honor, have exhibit 150 in evidence published.
JUDGE CANNONE: Okay.
MR. ALESSI: Do you recognize what's depicted in exhibit 150?
DR. RUSSELL: Yes.
MR. ALESSI: And what is it?
DR. RUSSELL: It's a picture of part of the hoodie, sweatshirt or shirt, that Mr. O'Keefe was wearing at the time of his death.
MR. ALESSI: And did you evaluate this photo as part of your review of the autopsy report?
DR. RUSSELL: Yes.
MR. ALESSI: And we're going to come back to this. If we could please switch to — your honor — 147C in evidence.
JUDGE CANNONE: Okay.
MR. ALESSI: Thank you. And what is 147C?
DR. RUSSELL: So, this is a closeup of the sleeve of that shirt that we just saw on the previous image. And there's a hole or defect here in the sleeve, which I'm circling with the pointer. And there's a label that labels it number one. And so I see this hole that is rather round and appears to have some fabric coming out of the hole towards the exterior of the jacket or the shirt.
MR. ALESSI: Did you attribute any significance to the shape of the hole? And if so, what significance?
DR. RUSSELL: The shape of the hole? Yes. So it's rounded. I actually attributed a lot of significance to that.
MR. ALESSI: Describe the significance that you attributed to this hole.
DR. RUSSELL: Well, I believe this hole was made by a canine tooth, and with the tooth going into the shirt, reaching the skin, and then coming out of the shirt, pulling out some fabric with it.
MR. ALESSI: And we'll come back to this. If we could, Mr. Woll, go to 147D, as in David. That's in evidence. Do you recognize this photo?
DR. RUSSELL: Yes.
MR. ALESSI: What is it?
DR. RUSSELL: A hole. A round hole in the shirt. Again with some fabric fibers pointing towards the outside of the shirt.
MR. ALESSI: Is this the same hole that we just saw on 147C or a different hole?
DR. RUSSELL: Could we go back? I don't know.
MR. ALESSI: Okay. So, let's now go back to exhibit 150. What significance, if any, do you give to the various triangles that are on the hoodie? Could you describe to the jury what those are and what's their purpose?
DR. RUSSELL: So, the triangles are labels that were placed by — either the police or the crime lab or someone — and the point of the triangle generally is pointing towards a hole in the shirt. As you can see, there are multiple ones here. And I want to make sure that you don't confuse it with this rather large defect, which is caused by something else. So, let's start with each one and we'll go through these quickly. Let's start and zoom in on number one.
MR. ALESSI: What did you conclude about the source of that hole in the hoodie?
JUDGE CANNONE: Sustained.
MR. ALESSI: Did you evaluate what is depicted as number one in that slide as part of your review?
DR. RUSSELL: Yes.
MR. ALESSI: And what was your evaluation —
JUDGE CANNONE: Sustained.
MR. ALESSI: In terms — let's go back and zoom out. Have you in your career examined clothing either as part of your forensic pathology practice or your emergency medicine practice to determine the source of defects in clothing?
DR. RUSSELL: Yes.
MR. ALESSI: How many times have you done that approximately in your career?
DR. RUSSELL: Several hundred.
MR. ALESSI: And in those several hundred times, have you ever had to reach a conclusion as to whether there was any connection between defects in clothing and wounds to humans?
DR. RUSSELL: Many times.
MR. ALESSI: Can you give some examples of the many times you've had to look at clothing and defects in clothing to assist you in determining wound recognition in a human?
DR. RUSSELL: Yes. So, let me clarify — it's mostly used in forensic pathology, not so much in emergency medicine. The clothing and the cause of the wound is not as important in emergency medicine as the treatment of the wound. But in forensic pathology, it's a key component to any examination where you think that it was an unnatural death. So I've done it in gunshot wounds, in stab wounds multiple times — looking at the defects, looking at the direction of what I think the bullet track was, determining entry and exit wounds; and in stab wounds, I've utilized them to help determine offensive and defensive wounds or injuries. So yes, many times.
MR. ALESSI: You mentioned — you testified earlier to 500 to a thousand evaluations of dog-inflicted wounds on humans. Have you ever performed the analysis of defects in clothing and compared them to wounds on humans in the context of dog-inflicted wounds on humans?
DR. RUSSELL: I don't think so. Perhaps in that one. Well, yes.
MR. ALESSI: So — in terms of — have there been any instances of doing that in your career? Have you done that at all in your career?
DR. RUSSELL: Maybe that one child.
MR. ALESSI: All right. So, let's go now to — you were discussing the defects in the arm as well as the wounds in the arm and then the defects in the clothing. In terms of — back to exhibit one — in terms of that pattern that is in the arm, and in terms — let's go back to the hoodie. I'll strike that. Have you in your career, in terms of evaluating motor vehicle accidents, have you evaluated the clothing of victims of motor vehicle accidents?
DR. RUSSELL: Yes.
MR. ALESSI: How many times roughly have you evaluated what clothing looks like in terms of motor vehicle accidents?
DR. RUSSELL: Well, in many cases I had to cut off the clothing in the emergency department. So I observed the clothing then, and then in the post-mortem cases I evaluated the clothing, but oftentimes — you know, sometimes it wasn't helpful.
MR. ALESSI: Have you ever evaluated clothing in determining whether or not the defects in the clothing are consistent or inconsistent with a motor vehicle accident? Have you ever evaluated that as a forensic pathologist?
DR. RUSSELL: Not specifically.
MR. ALESSI: Right. And in terms of your observations in either emergency medicine or forensic pathology, have you ever observed defects from motor vehicle accidents in clothing?
DR. RUSSELL: Yes.
MR. ALESSI: Is what is depicted in this exhibit consistent or inconsistent with a motor vehicle accident? In determining — let's go back to exhibit one, please. In determining and reaching your opinion with regard to the source of these wounds, is it necessary for you to reach that opinion to see a specific dog to determine whether the wounds are from a dog in general?
DR. RUSSELL: No.
MR. ALESSI: And in your experience that you talked about earlier today — the 500 to 1,000 — was it ever necessary in that experience to go locate the dog, to see the dog, to treat or evaluate the patient?
DR. RUSSELL: No.
MR. ALESSI: Why is it? Well, in terms of — we're going to move to another category: studies. Did you review any studies informing your opinions in this case?
DR. RUSSELL: Yes.
MR. ALESSI: Can we put the lights on and take this?
JUDGE CANNONE: Yes.
MR. ALESSI: Thank you, your honor.
DR. RUSSELL: Yes.
MR. ALESSI: And did those studies that you reviewed support or not support your conclusions in this case?
JUDGE CANNONE: Sustained.
MR. ALESSI: Which studies did you rely upon?
DR. RUSSELL: Well, I reviewed quite a few — 10 to 20 in depth — and I relied a lot on two of the articles.
MR. ALESSI: Do you recall the names of the lead authors in the studies that you just referenced?
DR. RUSSELL: Yes. One of them was Demunyck.
MR. ALESSI: Could you spell that, please?
DR. RUSSELL: I wish. D-E-M-U-N-Y-C-K, I believe.
MR. ALESSI: And was there — and then there was another one?
DR. RUSSELL: Pollack. P-O-L-L-A-C-K.
MR. ALESSI: May I approach, your honor?
JUDGE CANNONE: Yes.
MR. ALESSI: Thank you, your honor. My recollection is correct. We've already pre-marked as exhibits for identification these studies — two studies. I may be incorrect in that. If so, I have studies. I'm going to show them to Mr. Woll. Yes. Thank you. So we can just — just make sure I have all the pages. Do you have these? Okay. If I can just have them around. Okay, I've got them. These are them. If I could have marked for identification as one document, please. PPP — [unintelligible] — one more. Thank you. Exhibit QQQ for ID.
JUDGE CANNONE: Yes, your honor.
MR. ALESSI: So Exhibit PPP is the Demunyck and Exhibit QQQ is Pollack — those are the lead author names.
JUDGE CANNONE: You're welcome.
MR. ALESSI: Yeah, I'll leave them with the witness, your honor.
JUDGE CANNONE: Yes.
MR. ALESSI: Thank you. Thank you, Dr. Russell. I have provided you with those two exhibits. I would ask you to just briefly take a look at them and let me know whether you recognize those as the articles that you were referencing before.
DR. RUSSELL: Yes.
MR. ALESSI: Now let's start out with the Demunyck study. Is that Exhibit PPP?
DR. RUSSELL: PPP, right?
MR. ALESSI: So is this the study that you referenced earlier in your testimony?
DR. RUSSELL: Yes.
MR. ALESSI: Can you briefly describe for the jury how that study related to the opinions in this case?
JUDGE CANNONE: Objection. Sustained.
MR. ALESSI: Are these the studies that you cite as a basis for support for your opinions in this case?
DR. RUSSELL: Yes.
MR. ALESSI: And is QQQ a study that also supports your opinion in this case?
DR. RUSSELL: Yes.
MR. ALESSI: Now, in terms of your conclusions — if we can go back once more to exhibit number one — with regard to your opinion on the cause of these injuries, can you once again state your opinion as to the cause of these injuries?
DR. RUSSELL: I believe these injuries were caused by a dog attack.
MR. ALESSI: I'll strike that word. So, Dr. Russell, if you could — with regard to bite parlance — can you state what your opinion is with regard to [unintelligible] bites? Do you have an opinion as to what caused these injuries?
DR. RUSSELL: Yes. I believe that these injuries are the result of dog bites and/or claw marks.
MR. ALESSI: And do you hold that opinion to a reasonable degree of medical certainty?
DR. RUSSELL: Yes.
MR. ALESSI: That is all the questions I have for this witness at this time.
JUDGE CANNONE: All right.