Commonwealth v. Read — Trial ArchiveElizabeth Laposata - Direct (Part 1)
432 linesJUDGE CANNONE: Okay, Mr. Jackson.
MR. JACKSON: Thank you. We would ask to call Dr. Elizabeth Laposata.
JUDGE CANNONE: Okay.
COURT OFFICER: And you're going to step up, face, and raise your right hand.
COURT CLERK: Do you swear that the evidence you give the jury in the case now in hearing shall be the truth, the whole truth, and nothing but the truth?
DR. LAPOSATA: I do.
MR. JACKSON: Good afternoon, doctor.
DR. LAPOSATA: Good afternoon.
MR. JACKSON: Your honor, may I inquire?
JUDGE CANNONE: Yes. And doctor, please speak right into that microphone. Okay. Thank you.
MR. JACKSON: Dr., can you please state your full name and spell your last name for the jurors?
DR. LAPOSATA: Yes. Dr. Elizabeth Laposata, spelled L-A-P-O-S-A-T-A.
JUDGE CANNONE: I'm going to ask you — you have a softer voice — I'm going to ask you to pull that microphone right under your chin if you don't mind. It's pretty adjustable. Okay. Better.
MR. JACKSON: That's better. That's better. Doctor, can you tell the jurors what you do for a living?
DR. LAPOSATA: Yes. I'm a medical doctor and I subspecialize in forensic pathology.
MR. JACKSON: Can you summarize your professional background?
DR. LAPOSATA: Certainly. I graduated in 1975 from Bucknell University with a bachelor of science in biology. I went to University of Maryland School of Medicine where I graduated in 1979 with a doctor of medicine. I did my internship and fellowship at Johns Hopkins Hospital in Baltimore where I studied anatomic pathology, which is the study of the diseases of the body. I then did my subspecialty fellowship in St. Louis in forensic pathology, which is understanding causes of death and injuries to the body, currently.
MR. JACKSON: Are you a professor?
DR. LAPOSATA: Yes, I am.
MR. JACKSON: And tell us where you work.
DR. LAPOSATA: I own my own independent consulting practice and I'm also an associate professor at Brown University School of Medicine.
MR. JACKSON: How long have you taught at Brown University School of Medicine?
DR. LAPOSATA: Since 1993.
MR. JACKSON: And how long have you been a clinical associate professor of pathology, either at Brown or before that?
DR. LAPOSATA: Oh, gee. That would have been — since at least the late '80s, I've been associate professor at the universities and medical schools where I've worked.
MR. JACKSON: Doctor, at Brown University — let's take Brown first. What do you teach there?
DR. LAPOSATA: I teach the second-year medical students. I teach a lecture in diseases of the heart, cardiomyopathy and myocarditis, and I've been asked to give some specialized lectures in toxicology and forensic pathology.
MR. JACKSON: Are you responsible for training medical students in the field of forensic pathology?
DR. LAPOSATA: When I was chief medical examiner, yes, we would have medical students, residents come into the office so they could learn about what we do to understand cause and circumstances of death.
MR. JACKSON: When you first got your medical license, did you then undertake to get certain board certifications and the like?
DR. LAPOSATA: Yes.
MR. JACKSON: Before we get to those board certifications, did you begin a practice in forensic pathology in some way or another?
DR. LAPOSATA: When I finished my medical school and my anatomic fellowships and forensic pathology fellowships, I was working in medical examiner's offices where I was examining deceased people to understand how they died.
MR. JACKSON: When do you get a medical license? Is that statewide or is that nationwide?
DR. LAPOSATA: Usually you get a state medical license.
MR. JACKSON: And do you hold a state medical license?
DR. LAPOSATA: Yes.
MR. JACKSON: How many?
DR. LAPOSATA: I have an active medical license in Rhode Island, where I have my consulting practice, and I have inactive licenses in Maryland, Delaware, Missouri, and Pennsylvania.
MR. JACKSON: And you've been previously — at least before they were inactive — you were licensed in all five of those states.
DR. LAPOSATA: Yes.
MR. JACKSON: You already told us a little bit about your college. You mentioned Bucknell University, your bachelor of science degree?
DR. LAPOSATA: I think I did. Yes.
MR. JACKSON: At some point after you graduated from the University of Maryland School of Medicine, did you complete any residencies?
DR. LAPOSATA: Yes, I did my residency — excuse me — at Johns Hopkins Hospital in Baltimore in anatomic pathology.
MR. JACKSON: Forensic pathology is different from anatomic pathology. Correct.
DR. LAPOSATA: Yes.
MR. JACKSON: Did you also do any kind of residency in forensic pathology?
DR. LAPOSATA: Yes, I did a fellowship in forensic pathology.
MR. JACKSON: And what is the difference between — if you can sort of take us through that little by little — what is the difference between forensic pathology and anatomic pathology?
DR. LAPOSATA: Anatomic pathology is sort of hospital-based pathology where we understand diseases of patients who are in the hospital and try to make clinical pathologic correlations to see if their diagnoses were correct, if the laboratory tests actually showed what we find at post-mortem. And then forensic pathology deals more with understanding why the body stops functioning at a particular time. So that would be cause of death, and that can be sudden unexpected death or death due to violence.
MR. JACKSON: And in forensic pathology, is that often associated with testimony in court cases that may deal with either on the civil side or the criminal side, coming in and testifying about things like cause of death and manner of death?
DR. LAPOSATA: Yes.
MR. JACKSON: What types of cases did you work on during your forensic pathology residency?
DR. LAPOSATA: Sudden unexpected natural death, gunshot wounds, knife wounds, sudden infant deaths, blunt force trauma, skeletonized remains, decomposed bodies, strangulation — the whole gamut of ways people can die unnaturally.
MR. JACKSON: And to contrast that, what types of cases did you work on during your anatomic pathology residency?
DR. LAPOSATA: There you're mainly dealing with natural diseases and understanding heart disease, or how somebody gets pneumonia, or looking at the brain to understand if a stroke was present. And that's especially important then to the doctors who are treating those patients, that they can see if the diagnostic tests were appropriate or if their treatments worked.
MR. JACKSON: You mentioned fellowship a little earlier in your testimony. What is a fellowship?
DR. LAPOSATA: A fellowship is after you've done your internship and residency. A fellowship is more specialized training, and I did that in forensic pathology.
MR. JACKSON: So that answers my next question. You do hold a post-graduate fellowship position, correct?
DR. LAPOSATA: Yes. Yes.
MR. JACKSON: And that was in forensic pathology specifically?
DR. LAPOSATA: I'm board certified in anatomic and forensic pathology.
MR. JACKSON: Were you a research associate at the department of pathology and laboratory medicine at University of Pennsylvania School of Law? I'm sorry. School of Medicine.
DR. LAPOSATA: Yes.
MR. JACKSON: Old habits. What about post-doctoral research fellow? Were you ever a post-doctoral research fellow?
DR. LAPOSATA: Yes, I did. I had an NIH research grant where I worked on how alcohol affects the heart.
MR. JACKSON: Where was that?
DR. LAPOSATA: That was at St. Louis University, and then when I was on staff at the hospital of the University of Pennsylvania in Philadelphia.
MR. JACKSON: What about post-doctoral research fellow doing — dealing with the cardiovascular division of the department of medicine at Washington University?
DR. LAPOSATA: Yes, that's where I did research on how alcohol affects the heart.
MR. JACKSON: Was all this in furtherance of your broad education and training as a pathologist?
DR. LAPOSATA: Yes.
MR. JACKSON: I think you indicated that you have served as a chief medical examiner in answering one of the previous questions. Can you tell me a little bit about that?
DR. LAPOSATA: Yes. I was appointed chief medical examiner for the state of Rhode Island in 1993, where I was responsible for all unexpected, unnatural deaths or deaths that involve violence in the state of Rhode Island. So I had to supervise the office, made sure I have adequate staff, made sure my forensic pathology staff were doing a good job, made sure I had an adequate scene investigative staff. So, running the whole office.
MR. JACKSON: Is that the highest appointment in the CME's office?
DR. LAPOSATA: Yes, it is.
MR. JACKSON: In that position, did you oversee every single medical examiner in the state of Rhode Island?
DR. LAPOSATA: Yes.
MR. JACKSON: Did you also hold a position as co-chair of the child fatality review committee in the state of Rhode Island?
DR. LAPOSATA: Yes, as part of being chief medical examiner.
MR. JACKSON: Tell us a little bit about that. What was that appointment?
DR. LAPOSATA: Well, there's a big concern about infants who die and children who die. So those are reviewed specifically by a group of doctors — the pediatricians and also the medical examiner's office. So we look at every child and infant death.
MR. JACKSON: How long did you serve as the chief medical examiner in the state of Rhode Island?
DR. LAPOSATA: For 12 years.
MR. JACKSON: Starting when and ending when?
DR. LAPOSATA: Starting in 1993 and ending in 2005.
MR. JACKSON: As the chief medical examiner for Rhode Island, did you ever have the responsibility to work on any mass disaster cases?
DR. LAPOSATA: Unfortunately, yes.
MR. JACKSON: Okay. Tell us a little bit about that. If you could start with the EgyptAir issue —
DR. LAPOSATA: Excuse me. I'm so sorry. In 1999, EgyptAir 990 took off from New York airport and it crashed off the coast of Massachusetts. And 265 passengers died. And because of the force of the airplane going into the water, all the bodies were fragmented. So they were brought — all the fragments were brought to my medical examiner's office. They actually vacuumed the ocean floor, and we had 2,600-some fragmented remains from that airplane crash. And that involved working with the FBI and TSA to identify those individuals and understand exactly why they died.
MR. JACKSON: What was your role and the role of your staff that you supervised in dealing with those other government agencies — the FBI, the NTSB, other entities — in terms of the fatalities that you did review as a medical examiner, the chief medical examiner of Rhode Island?
DR. LAPOSATA: Well, I dealt with families from around the globe who had relatives on that flight, and then the FBI was looking into what may have caused the crash. The Egyptian government, who owned the airplane, was also there and interested in understanding what happened, and we were also tasked with identifying everybody who was on the plane and to see if that matched the passenger manifest list. So were there people on the plane who shouldn't have been on the plane? So that sort of thing.
MR. JACKSON: In terms of matching that manifest, were you the head of the department for the medical examiner's office that was responsible for trying to figure out who was on the plane and match those remains with the individuals that were on the manifest?
DR. LAPOSATA: Yes. We made the positive forensic identifications and returned the fragmented human remains to their families.
MR. JACKSON: Doctor, did you also deal with the tragic Station nightclub fire?
DR. LAPOSATA: Yes.
MR. JACKSON: In what capacity did you deal with that?
DR. LAPOSATA: Again, this was a nightclub that burned down. It burned down very rapidly with a very hot fire, and that was in Rhode Island, and there were 100 fatalities from that. So those come to the medical examiner's office. I had my investigator at the scene throughout that time of recovering the bodies, and I was charged with determining the identity and the cause of death.
MR. JACKSON: Were you successful, or your staff successful, in determining the identity of most of those individuals who perished?
DR. LAPOSATA: Yes, all of them. We worked around the clock for three days to get that done.
MR. JACKSON: And you were the head of that task force. Before you became the chief medical examiner in Rhode Island, did you previously work as a medical examiner under somebody else?
DR. LAPOSATA: Yes.
MR. JACKSON: Tell me about that. What was your first post as an assistant medical examiner?
DR. LAPOSATA: My first post was after I did my fellowship training in St. Louis, Missouri. I was an assistant medical examiner for the city of St. Louis.
MR. JACKSON: Were you ever an assistant medical examiner in Philadelphia?
DR. LAPOSATA: Yes. So after St. Louis, I moved to Philadelphia where I was on staff at the Hospital of the University of Pennsylvania and I ran the autopsy service there at the hospital, and I was also an assistant medical examiner for the city of Philadelphia. After that, I was an assistant medical examiner for the state of Delaware, and then I came to Rhode Island as I was chosen to be chief.
MR. JACKSON: Dr. Laposata, can we put dates on that? Assistant medical examiner in St. Louis from when to when, do you remember?
DR. LAPOSATA: Oh my. Let's see. May I look at my CV?
MR. JACKSON: Sure. With the court's permission.
JUDGE CANNONE: Yeah.
DR. LAPOSATA: Okay. Yes. From 1983 to '85, I was an assistant medical examiner for the city of St. Louis. Then in '87 to '89, I was the assistant medical examiner for the city of Philadelphia. '91 to '93, assistant medical examiner for the state of Delaware. And then 1993 to 2005, I was chief medical examiner for the state of Rhode Island.
MR. JACKSON: Thank you for that. Dr. Laposata, have you held any faculty positions in the field of forensic pathology that qualify you as an expert in this case?
DR. LAPOSATA: Yes. Every medical examiner's office I worked in, I also had faculty appointments to teach medical students and pathology residents. So I had faculty appointments at Washington University School of Medicine in St. Louis, at the Hospital of the University of Pennsylvania in Philadelphia, and in Rhode Island.
MR. JACKSON: Let's talk about those one at a time. Describe your teaching responsibilities at Brown Medical School, if you wouldn't mind. And by the way, that's from 1994 to present, correct?
DR. LAPOSATA: '93 to — well, as a medical examiner it was 1993 to 2005, and there I would teach the medical students — we had rotations through the medical examiner's office — and also the pathology residents would rotate through the medical examiner's office, where I would teach them how to do a medical legal autopsy, how to understand cause and manner of death, especially non-natural and traumatic deaths.
MR. JACKSON: With regard to your teaching responsibilities specifically, are you still teaching?
DR. LAPOSATA: I'm teaching in the cardiovascular section now, but since I'm not chief of the medical examiner's office, I obviously don't have students rotating through there anymore.
MR. JACKSON: Were you a lecturer in the role of the medical examiner? Did you do a seminar in that regard at or associated with Brown University School of Medicine?
DR. LAPOSATA: Yes.
MR. JACKSON: Did you do some sort of a forensic pathology rotation or for pathology residents from 1994 to 1995 in that capacity as well?
DR. LAPOSATA: Yes. We would have the pathology residents who were at the hospital studying anatomic pathology come to the medical examiner's office so they could understand the discipline of forensic pathology.
MR. JACKSON: What is cardiomyopathy?
DR. LAPOSATA: Cardiomyopathy is a muscular disease of the muscles of the heart.
MR. JACKSON: And what is myocarditis?
DR. LAPOSATA: Inflammation of the heart muscle.
MR. JACKSON: Did you ever teach or lecture on those issues?
DR. LAPOSATA: Yes. I teach — every year I teach the second-year medical students about those heart diseases.
MR. JACKSON: Have you ever taught anatomy and physiology to EMTs?
DR. LAPOSATA: Yes.
MR. JACKSON: Or in the EMT setting?
DR. LAPOSATA: Yes.
MR. JACKSON: And what about a class known as the two-hour primer on forensic pathology?
DR. LAPOSATA: I've taught a lot. I don't recall that particular.
MR. JACKSON: How about pathology residents morning conference in 2009?
DR. LAPOSATA: Oh yes. Yes. I give lectures to the pathology residents at Brown Medical School in forensic pathology.
MR. JACKSON: You also mentioned that you were an adjunct professor for — I'm sorry — biomedical forensic sciences and forensic anthropology in the department of anatomy and neurology. Is that a division of the graduate school, Boston University School of Medicine?
DR. LAPOSATA: Yes. I taught in the master's program in the medical school at Boston University School of Medicine for a master's in forensic science, where I taught a 40-hour course on forensic pathology and another 40-hour course on medical legal death investigation.
MR. JACKSON: Were you actually the course director in that position?
DR. LAPOSATA: Yes.
MR. JACKSON: And were you also a course director in medical legal death investigation from 2006 to 2013?
DR. LAPOSATA: Yes.
MR. JACKSON: And what about course director in forensic toxicology from 2006 to 2012?
DR. LAPOSATA: Correct.
MR. JACKSON: Did you direct the studies in biomedical forensic sciences GMS from 2012 to present?
DR. LAPOSATA: Yes.
MR. JACKSON: Describe that. What is that?
DR. LAPOSATA: The graduate medical sciences.
MR. JACKSON: Correct. Okay.
DR. LAPOSATA: Yeah. I would review and be on the board to examine projects that the students were doing to get a master's degree.
MR. JACKSON: Were you also an assistant professor in the department of pathology and laboratory medicine at University of Pennsylvania School of Medicine?
DR. LAPOSATA: Yes.
MR. JACKSON: Okay. Without going into every single class that you taught, did you teach from 1987 to 1991 attending staff medical pathology?
DR. LAPOSATA: Yes.
MR. JACKSON: What is that, just a general outline of what that teaching course was?
DR. LAPOSATA: That's when I was at the hospital, the University of Pennsylvania. I ran the autopsy service. So I taught medical students and pathology residents about autopsy practice.
MR. JACKSON: I want to ask you sort of broadly — can you describe your major teaching and clinical responsibilities when you were at University of — I'm sorry — University of Pennsylvania School of Medicine in the field of forensic pathology? What were your main clinical and teaching positions?
DR. LAPOSATA: Well, I ran the autopsy service there. So I taught the medical residents and medical students autopsy pathology, and I was also an assistant medical examiner there. So I taught and started the forensic fellowship in forensic pathology.
MR. JACKSON: Have you ever been qualified as an expert witness in forensic and anatomic pathology in state and federal courts?
DR. LAPOSATA: Yes.
MR. JACKSON: How many times would you say you've qualified as an expert?
DR. LAPOSATA: Over 40 years, maybe several hundred.
MR. JACKSON: How about in Massachusetts?
DR. LAPOSATA: That includes all of them.
MR. JACKSON: Okay. Have you ever qualified — let me list a couple of states. In Massachusetts?
DR. LAPOSATA: Yes.
MR. JACKSON: California?
DR. LAPOSATA: Yes.
MR. JACKSON: Connecticut?
DR. LAPOSATA: Yes.
MR. JACKSON: Delaware?
DR. LAPOSATA: Yes.
MR. JACKSON: Florida?
DR. LAPOSATA: Yes.
MR. JACKSON: Illinois?
DR. LAPOSATA: Yes.
MR. JACKSON: Maryland?
DR. LAPOSATA: Yes.
MR. JACKSON: Minnesota?
DR. LAPOSATA: Yes.
MR. JACKSON: Missouri?
DR. LAPOSATA: Yes.
MR. JACKSON: New York?
DR. LAPOSATA: Yes.
MR. JACKSON: Pennsylvania?
DR. LAPOSATA: Yes.
MR. JACKSON: Rhode Island?
DR. LAPOSATA: Rhode Island. Yes.
MR. JACKSON: Have I left anything out?
DR. LAPOSATA: Did you say Massachusetts?
MR. JACKSON: I did. We started with Massachusetts.
DR. LAPOSATA: Okay, you're fine.
MR. JACKSON: What types of topics have you qualified to testify about as an expert forensic and anatomic pathologist?
DR. LAPOSATA: Really anything that has to do with circumstances and cause of death. It doesn't really matter what type of injury, or a sudden unexpected death. Usually it involves examination, a study of information from the scene, information from the autopsy, police and investigation of medical records, and we put that all together and figure out the circumstances as to how someone died and why their body stopped functioning. So that's the basis of forensic pathology.
JUDGE CANNONE: Dr., will you excuse me for just a moment? Just two minutes. I'm going to ask you to step down, and you can go back to that back room. Okay? Rather than send you downstairs and back up the stairs to come back in five minutes, we're just going to be in recess for five minutes while we sit. You can have a seat here.
DR. LAPOSATA: Certainly.
MR. JACKSON: May I inquire?
JUDGE CANNONE: Yes.
MR. JACKSON: Thank you. You mentioned several topics about which you — I'm sorry — testified about as an expert in several different states, several different courtrooms. Have you been qualified as an expert by those courts in those topics about which you just discussed?
DR. LAPOSATA: Yes.
MR. JACKSON: Do you hold any specialty certifications in the field of forensic pathology?
DR. LAPOSATA: Well, I'm board certified in forensic pathology.
MR. JACKSON: What about the American Board of Pathology?
DR. LAPOSATA: Yes, the American Board of Pathology puts forth examinations that are a two-day examination in the various disciplines of pathology. And if you successfully complete those examinations, then you become a diplomate of the American Board of Pathology in whichever subspecialty you're in. And I became a diplomate in the subspecialty of anatomic and forensic pathology.
MR. JACKSON: What about a certification in basic bloodstain pattern analysis, the International Association of Identification?
DR. LAPOSATA: Yes, I had a week-long course in understanding bloodstain pattern analysis.
MR. JACKSON: Could you tell us a little bit about the National Registry emergency medical technician certification that you hold?
DR. LAPOSATA: Yes, I took a training to become an EMT.
MR. JACKSON: Have you received a number of honors and awards in the field of forensic pathology?
DR. LAPOSATA: I have.
MR. JACKSON: What do those awards include?
DR. LAPOSATA: May I look at my CV again?
MR. JACKSON: Sure.
DR. LAPOSATA: Thank you. I had teaching awards from Brown University School of Medicine. I was featured in a book by Faces of Public Health as having run a good medical examiner's office. I was nominated for woman of the year in Rhode Island for my work as chief medical examiner and improving the office and handling those two mass disasters. I was honored by victim's rights and services awards because I've always been aware of the fact that as a forensic pathologist, I am the last doctor this person is going to have. So I try to help the family understand what happened. I was honored for my work in the mass disaster in the EgyptAir 990 plane crash. And I was outstanding woman in public service for Providence, Rhode Island. I've gotten teaching awards from Brown University School of Medicine.
DR. LAPOSATA: I was elected to the board of trustees in the Delaware SIDS Foundation and the Philadelphia SIDS Foundation. And then we're back to my medical school.
JUDGE CANNONE: If you could pull the microphone a little closer to your chin.
DR. LAPOSATA: It's very hard because the chair doesn't push in.
JUDGE CANNONE: It does.
DR. LAPOSATA: The chair doesn't move.
JUDGE CANNONE: Okay.
DR. LAPOSATA: I got it. I moved.
JUDGE CANNONE: We'll make do. Okay.
MR. JACKSON: Thank you, Dr. Laposata. What is the American Academy of Forensic Sciences?
DR. LAPOSATA: That's one of our medical associations that is specific to forensic sciences.
MR. JACKSON: Have you ever held a chaired position there? Yes. What position was that?
DR. LAPOSATA: I was voted into a fellowship position.
MR. JACKSON: Were you the chairman of the forensic science research committee?
DR. LAPOSATA: Yes.
MR. JACKSON: What's the National Association of Medical Examiners?
DR. LAPOSATA: It's also called NAME. It's another international association of forensic pathologists.
MR. JACKSON: Were you a member of that organization?
DR. LAPOSATA: Yes.
MR. JACKSON: And at some point did you get elected to the board of directors for that organization?
DR. LAPOSATA: Yes.
MR. JACKSON: And ultimately did you become a fellow for that organization?
DR. LAPOSATA: I did.
MR. JACKSON: What is the American Society of Clinical Pathologists?
DR. LAPOSATA: That's a society that is for people who practice anatomic pathology and understand how to interpret laboratory results and biopsies.
MR. JACKSON: Did you become a fellow in 1991 until present for that organization?
DR. LAPOSATA: Yes.
MR. JACKSON: What's the difference between a member and a fellow?
DR. LAPOSATA: A member is a lower level, and then you can be promoted to fellow if the board of directors feels that you've contributed in your field.
MR. JACKSON: And were you associated with the College of American Pathologists?
DR. LAPOSATA: Yes.
MR. JACKSON: Are you a fellow there as well?
DR. LAPOSATA: Yes.
MR. JACKSON: What about the World Association for Medical Law?
DR. LAPOSATA: Yes.
MR. JACKSON: What about the American Association for Clinical Chemistry?
DR. LAPOSATA: Yes, I'm a member.
MR. JACKSON: Rhode Island Medical Women's Association. What is that?
DR. LAPOSATA: It's basically what it says. It's women doctors in Rhode Island.
MR. JACKSON: Were you elected to the board of directors for that organization?
DR. LAPOSATA: Yes.
MR. JACKSON: Ultimately, were you elected as the president of that organization?
DR. LAPOSATA: I was.
MR. JACKSON: Rhode Island Medical Society. What is that?
DR. LAPOSATA: It's an organization of doctors who practice in Rhode Island.
MR. JACKSON: Are you a council member there?
DR. LAPOSATA: Yes.
MR. JACKSON: And what about the Massachusetts Medical Legal Society?
DR. LAPOSATA: Yes, I was a member there. They have disbanded since.
MR. JACKSON: It doesn't exist anymore?
DR. LAPOSATA: No.
MR. JACKSON: When it was up and running, you were a member in good standing.
DR. LAPOSATA: Yes.
MR. JACKSON: Good. Pennsylvania Association of Pathologists. What about that?
DR. LAPOSATA: Yes. When I practiced in Pennsylvania, I was a member of that organization.
MR. JACKSON: In addition to being a member there, did you also hold a chaired position? Were you the chairman for the committee on forensic pathology?
DR. LAPOSATA: Yes.
MR. JACKSON: Have you served on any editorial boards of any scholarly journals or publications?
DR. LAPOSATA: I've reviewed articles submitted for the Journal of Forensic Sciences and the National Association of Medical Examiners journals.
MR. JACKSON: Did you also hold an editorial position for the American Journal of Forensic Medicine and Pathology?
DR. LAPOSATA: Yes.
MR. JACKSON: Is that one of the medical journals that is used throughout the country by other medical professionals, other medical examiners?
DR. LAPOSATA: Yes. It's a resource. Yes. And a text.
MR. JACKSON: Correct. Have you authored any peer-reviewed publications in the field of forensic pathology?
DR. LAPOSATA: Yes, I have.
MR. JACKSON: Can you tell us about some of those publications?
DR. LAPOSATA: I've written chapters in textbooks about medical legal death investigation and forensic pathology. I've published articles involving alcohol metabolism, some drugs, cocaine, alcohol metabolism in the heart I mentioned. I've published 22 papers and I've written several chapters.
MR. JACKSON: You already said that you're board certified, double board certified in anatomic and forensic pathology. Is that correct?
DR. LAPOSATA: Yes.
MR. JACKSON: Now that you've gone through your education, training, background, publications, teaching positions, and chairs that you've held, I want to ask you a really simple question. What does a forensic pathologist do?
DR. LAPOSATA: We are the last doctor that the dead person has, and we figure out what happened to the body to cause their death and we sign the death certificate that says how the body came to die and also indicates the circumstances under which the death occurred. Our medical examiner is also tasked with determining both manner and cause, not just one or the other. Both.
MR. JACKSON: Yes. What is the manner of death and how is it distinguished from the cause of death?
DR. LAPOSATA: The cause of death is what happens to the body to cause it to stop functioning. And the manner of death refers to circumstances under which the death occurred. So there are hundreds of thousands of causes of death, or why the body stops functioning. But there are only a few manners of death, which would be natural, accident, suicide, homicide, or undetermined. Those five main categories of manner of death.
MR. JACKSON: Is that the responsibility, or one of the responsibilities, of a forensic medical examiner — to determine that the death fits into one of those five categories?
DR. LAPOSATA: Correct.
MR. JACKSON: What does it mean when the death is deemed undetermined?
DR. LAPOSATA: When the manner of death is undetermined, that means at the time the death certificate was signed, there was not enough information to put it into either accident, natural, suicide, or homicide. So at the time the death certificate was signed, there was not enough information to put it into one of those other categories. It doesn't mean that if more investigation takes place, then you might not be able to put it into one of those other categories.
MR. JACKSON: If a manner of death is deemed undetermined at a particular time, it's because it lacks sufficient information. Is that correct?
DR. LAPOSATA: Correct.
MR. JACKSON: What types of information does a medical examiner, forensic pathologist consider in making these determinations between natural, accident, homicide, suicide, undetermined?
DR. LAPOSATA: Well, first you have the findings from the examination of the body. So that's sort of a starting place to see what happened to the body. Then you need to also look at the scene investigation. You need to look at any police reports and witness statements and also medical history of the deceased. And using those four sources of information and using your training and experience, you can either say this is a natural death, this is a self-inflicted death, it's a suicide, it's an accidental death, it's a homicide. Or if all that information doesn't allow you to put it to a reasonable degree of medical certainty into any one of those categories, then you have to leave the manner undetermined. And if more information becomes available later, then you can change that death certificate.
MR. JACKSON: What if no more information comes available later?
DR. LAPOSATA: It just stays as undetermined. There are cases where there's just not enough information to put it in one of those other categories.
MR. JACKSON: Without getting into what they may be, did you reach any opinions and conclusions in connection with this case?
DR. LAPOSATA: Yes.
MR. JACKSON: What materials and information did you consider in reaching your opinions and conclusions in this particular case?
DR. LAPOSATA: I have my list of materials I reviewed. I reviewed Mr. O'Keefe's autopsy report, the report of the examination of his brain, the toxicology report, and the entire medical examiner file. I studied autopsy photos including photographs of the brain, and then there were 70 other photographs at autopsy taken by a state trooper who was at the examination. I reviewed Mr. O'Keefe's medical records from Good Samaritan Medical Center and the EMS run sheet. I reviewed photographs of Mr. O'Keefe's clothes that were taken at the crime lab. I reviewed photographs of pieces of tail light, hard plastic, clear, black, red. I reviewed photographs of the outside of Karen Read's SUV. I reviewed the Canton Police Department incident report on the death.
DR. LAPOSATA: I reviewed some photographs taken by Canton police of the outside of the house at 34 Fairview Road in Canton. I reviewed some photographs taken by the real estate agent who was going to sell the house of the inside.
MR. JACKSON: In total, putting them in categories. Did you review the forensic autopsy?
DR. LAPOSATA: Yes.
MR. JACKSON: Did you review all of the files associated with the medical examiner's office in this particular case related to the autopsy of John O'Keefe?
DR. LAPOSATA: Yes.
MR. JACKSON: Did you review the scene investigation through police reports and other things?
DR. LAPOSATA: Yes.
MR. JACKSON: Photographs as well?
DR. LAPOSATA: Yes.
MR. JACKSON: Did you review the police reports that were associated with the initial investigation in this case as well as follow-ups?
DR. LAPOSATA: Yes.
MR. JACKSON: Did you review witness statements and things of that sort?
DR. LAPOSATA: Yes. If they were included in the police report—
MR. JACKSON: That was my next question. Those witness statements would be included in the police reports that you otherwise reviewed. Correct?
DR. LAPOSATA: Yes.
MR. JACKSON: What about Mr. O'Keefe's medical history as much as you had of it?
DR. LAPOSATA: Yes, I reviewed his medical history.
MR. JACKSON: And what about hospital records?
DR. LAPOSATA: His medical history was in the hospital records.
MR. JACKSON: Understood. What method or methodology did you use in forming the opinion that we'll get to in just a few minutes?
DR. LAPOSATA: Well, in order to arrive at a conclusion of how somebody dies and what the cause of death is, we have to put all our facts out and then we say how could these facts have come to be. So it's called like a differential diagnosis. So like if you go to your doctor and you have a white blood cell count, then the doctor would say, well, how many ways do you get this white blood cell count. So that's a differential diagnosis and then you go from that list and pare it down by getting more data till you come to one final diagnosis. So that's the process of determining how somebody dies and the circumstance around it.
MR. JACKSON: Is it fair to say that you have a pretty significant background, training and experience regarding coming to the conclusion of cause and manner of death?
DR. LAPOSATA: Yeah, 40-plus years.
MR. JACKSON: And how many autopsies in total?
DR. LAPOSATA: Well, myself, I've probably done over 3,000 and then I have observed and reviewed maybe 7,000 more. So that's in total over 10,000 autopsies, if you were to estimate, over 40 years probably.
MR. JACKSON: In addition to just autopsies, how many death investigations separate and apart from autopsies have you been involved with?
DR. LAPOSATA: Well, the autopsy usually has a corresponding death investigation with it.
MR. JACKSON: Do you have experience in examining, identifying wounds? Not necessarily the cause and manner of death, but wounds that are associated with someone on whom you're performing an autopsy or you're supervising an autopsy?
DR. LAPOSATA: Yes. So looking at the injuries on the body and understanding what caused them is a huge part of forensic pathology.
MR. JACKSON: Have you ever conducted or overseen any autopsies of individuals involved in vehicle pedestrian collisions?
DR. LAPOSATA: Yes.
MR. JACKSON: How many times if you had to estimate?
DR. LAPOSATA: Hundreds.
MR. JACKSON: Hundred or hundreds?
DR. LAPOSATA: Hundreds.
MR. JACKSON: When was it that you first started training on the issue of wound pattern recognition that helps assist you with coming to your conclusions, whether it be auto pedestrian incidents or otherwise?
DR. LAPOSATA: Well, understanding wound patterns and injuries is a big part of forensic pathology because we want to identify what caused a particular pattern. So understanding that whole complex bag of injuries begins when you start your forensic pathology training, which was when I started back in '81.
MR. JACKSON: In addition to the cause of death, which might be whatever — a gunshot, something — does the pathologist also undertake an examination of the rest of the body that's not so obvious, other wounds, etc., that might tell a more defined story?
DR. LAPOSATA: Yes, we look at the entire body. We look at the clothing. We look at the outside of the body. Then we do the internal examination in order to understand not only why the body stopped functioning, which is the cause of death, but also things that could have contributed to it or helped to understand the circumstances around how that death occurred.
MR. JACKSON: When you say the body — you mentioned the clothing — why is the clothing important? Is that part of the body for a forensic medical examiner?
DR. LAPOSATA: Oh yes it is. You always have to look at the clothing because it has materials on it that may be important as to how injuries occurred. So it's — every time you do an autopsy, you have to always make sure you have the clothing. Many times it would have been taken off at the hospital, but then I would always ask my staff, tell the police, we've got to get the clothes, have to look at the clothes.
MR. JACKSON: What is a gross examination?
DR. LAPOSATA: A gross examination is not actually like gross grotesque, but it means like without microscopes. It means just looking with your naked eye.
MR. JACKSON: Is it important to look at a body, a deceased person, when you're conducting an autopsy from head to toe for outside obvious wounds that you can see on the gross anatomy outside?
DR. LAPOSATA: Oh yes. And also to collect any trace evidence that may be present on the body.
MR. JACKSON: Are forensic medical examiners trained to do that?
DR. LAPOSATA: Oh yes.
MR. JACKSON: Are you trained to do that?
DR. LAPOSATA: Absolutely.
MR. JACKSON: In addition to a gross examination on the outside of the body, is it also important to look on the inside of the body?
DR. LAPOSATA: Yes.
MR. JACKSON: Are there wounds and injuries that might be hidden by the dermis, for instance, the skin, that might not be so obvious on a gross examination of a body?
DR. LAPOSATA: Yes. You have to look inside the body.
MR. JACKSON: And what's the mechanism of doing that?
DR. LAPOSATA: We make surgical incisions in the body so we can examine the brain, the neck, all the organs in the chest, all the organs in the abdomen, and depending on the case, we may make incisions in the arms and legs to look for evidence of injuries.
MR. JACKSON: What about x-rays? Are x-rays an important part of an examination in an autopsy?
DR. LAPOSATA: Yes, they're usually done before the autopsy is started and we look for changes in the bones or any foreign material that might be present in the body like a bullet.
MR. JACKSON: Dr. Laposata, have you ever exercised wound pattern recognition in your position as a forensic pathologist or do you do it every time?
DR. LAPOSATA: Oh, all the time.
MR. JACKSON: Have you ever taught any courses or given lectures on wound identification and wound pattern recognition?
DR. LAPOSATA: Yes, it's part of understanding blunt force trauma, sharp force trauma, gunshot wounds. They all make injury patterns on the body that the pathologist can then relate to what caused that injury.
MR. JACKSON: With regard to the case that's before us, what injuries did you observe with regard to Mr. O'Keefe's head specifically?
DR. LAPOSATA: I observed that he had evidence of blunt force trauma to the back of his head.
MR. JACKSON: Are those injuries consistent with a particular type or pattern of patterned injury?
DR. LAPOSATA: Yes.
MR. JACKSON: Describe that for us, please.
DR. LAPOSATA: In the back of his head, a little bit to the right-hand side, was a horizontal tearing of the scalp and that's called a laceration, and surrounding that were linear scrapes that were vertical in orientation. So that is an injury pattern, and then you have to think, well, what could cause that injury pattern? And then you go from there.
MR. JACKSON: Did you also — in addition to looking at — by the way, how did you make that assessment about the injury, was it photographs?
DR. LAPOSATA: Yes.
MR. JACKSON: Is that a normal way for forensic pathologists to make an assessment? Is that an acceptable methodology to make an assessment of a wound pattern by the use of anatomical photographs?
DR. LAPOSATA: Oh absolutely.
MR. JACKSON: Have you done it before?
DR. LAPOSATA: Oh, hundreds of times.
MR. JACKSON: What is a coup contra coup injury?
DR. LAPOSATA: It's a very interesting, peculiar injury to the head. When you have a blow to the head, the blow can either be the stationary head and there's a blow to it, or you can have the head that's moving and gets the blow. So looking at a pattern of coup contra coup helps the forensic pathologist differentiate that. A coup contra coup injury examines the coup, which is where the impact occurred, and then we look at what's 180 degrees opposite that impact and that's called the contra coup, or like opposite the coup. And that injury pattern helps us determine whether a person was just having a fixed head and somebody hit it, or whether the head was just standing and went down to the ground.
DR. LAPOSATA: The coup contra coup of a falling or being pushed backward has injury patterns where the impact occurred, but then there's also injury patterns 180 degrees opposite from that. And that happens because the brain is floating in cerebrospinal fluid. And when the head comes down, the brain is a little bit behind. So you get the bang on the back of the head, but then because the brain is floating, it hits the inside of the opposite side of the head. And so that makes the contra coup pattern. And that tells us that there's been a fall backwards and hitting the head.
MR. JACKSON: Is that consistent? Just in general, a coup contra coup injury consistent with a linear acceleration of the head by a fall, an—
DR. LAPOSATA: Unbroken fall straight back. Correct. There's also some angular force in that as well.
MR. JACKSON: Understood. In order to determine whether or not Mr. O'Keefe suffered from a coup contra coup injury, can that be done by a gross examination or does it have to be surgical?
DR. LAPOSATA: We would look at — well, first we look at the outside, but then we have to look at injuries to the scalp and we look at the skull, see where the skull fractures are, and in particular to look at the brain and see where the damage is to the brain. And there should be — in a fall backwards, you have damage to the brain at the site of impact, but you also have damage to the brain 180 degrees opposite from that. And that tells you it's a fall backwards.
MR. JACKSON: In the case before us, dealing with John O'Keefe, were you able to look at the scalp and the injuries associated with the scalp from a gross perspective?
DR. LAPOSATA: Yes.
MR. JACKSON: Were you also able to look at the skull and possible fractures that Mr. O'Keefe suffered on his skull?
DR. LAPOSATA: Yes.
MR. JACKSON: And what about the brain? Were you able — did you have evidence of a dissection such that you could see the brain and determine whether or not there was a coup contra coup injury associated with the brain?
DR. LAPOSATA: Yes, I had a full examination of the brain available.
MR. JACKSON: Were Mr. O'Keefe's head injuries consistent with a coup contra coup injury?
DR. LAPOSATA: Yes.
MR. JACKSON: Could you describe that specifically — his head injuries to the jurors, please?
DR. LAPOSATA: He has a pattern head injury on the back of his scalp where there is a tearing of the scalp, and then vertically above that there are some little areas of scraping to the skin. So that tells me that Mr. O'Keefe went backwards onto something that had a little ridge, but it also had some irregularity to it to cause the different scrapes before you get to the tearing of the scalp. Then when we look at the skull, he had massive skull fractures that originated starting in the back of his head. They came around to the front. They went under the base of his brain, under the skull, under the base of the brain, and it came into the front of the skull at the orbital plates and fractured that, and that caused some bleeding in his upper eyelids.
DR. LAPOSATA: When the brain was examined, inside the brain I could see that the brain had become swollen and parts of it had herniated or moved down — the area where the spinal cord is — and that's called brain stem herniation, and that is why the brain stops functioning and why your body stops functioning when you have a severe head injury.
MR. JACKSON: You indicated that the wound pattern suggested a ridge or ledged surface.
DR. LAPOSATA: Yes.
MR. JACKSON: Could you explain that in more detail, please?
DR. LAPOSATA: Yes. So if I were looking at it, I would see the break in the scalp. Then I would see several sort of irregularly placed scrapes of the skin that kind of look like pencil marks. And so that means that something with granularity hit — he hit first, then it moved up a little, broke the scalp, and then moved on a little bit above that.
MR. JACKSON: Would you expect to see that if Mr. O'Keefe had fallen backward onto a perfectly flat surface?
DR. LAPOSATA: No. It has to be a surface that has some small ridges in it to make those little vertical patterns.
MR. JACKSON: Dr. Laposata, what is ecchymosis?
DR. LAPOSATA: Ecchymosis is a medical term for bruise.
MR. JACKSON: Did you see any ecchymosis on Mr. O'Keefe that he suffered as a result of the coup contra coup injury to the back of his head?
DR. LAPOSATA: He had a bruise on his brain at the back of the brain and at the front of the brain.
MR. JACKSON: What would you see around his eyes regarding ecchymosis?
DR. LAPOSATA: Yes, when the brain slaps forcefully against the base of the skull, the delicate bones above the eye break, and that's again the coup contra coup, where the brain slaps forward. And when those delicate bones are broken, there's bleeding, and that bleeding then goes right down into the upper eyelids. So it kind of looks like you have black eyes, but there has not been any punch to the face. It's only come from the skull fracture. That's sometimes called raccoon eyes, because you look like a little raccoon.
MR. JACKSON: Did you see any skin injury to either one of Mr. O'Keefe's upper eyelids?
DR. LAPOSATA: Yes, he had a small, kind of slit-like defect, horizontal, on his right upper eyelid.
MR. JACKSON: Would the ecchymosis on its own produce that type of injury — that laceration over his right eye?
DR. LAPOSATA: No. The blood seeping down into his upper eyelids was from the skull fractures.
MR. JACKSON: Was the laceration above his eyelid on the right side a separate injury altogether?
DR. LAPOSATA: Yes, it was.
MR. JACKSON: Based on your training and experience, do you have an opinion as to what that eyelid laceration might be consistent with?
DR. LAPOSATA: Some application of force which broke the skin.
MR. JACKSON: Could that be from an object?
DR. LAPOSATA: Possible.
MR. JACKSON: Could it be from a fist?
DR. LAPOSATA: Possible.
JUDGE CANNONE: Sustained, Mr. Jackson. Give me some possibilities of what might cause that laceration above his right eyelid.
MR. JACKSON: Yeah. So, it's not possibilities — give me in your opinion what you believe could have caused or produced the injury to the upper right eyelid.
JUDGE CANNONE: So I'm going to call a sidebar here.
MR. JACKSON: May I inquire?
JUDGE CANNONE: Yes.
MR. JACKSON: Thank you. Dr. Laposata, you just mentioned that the laceration above the right eyelid was consistent with the application of force. Correct?
DR. LAPOSATA: Correct.
MR. JACKSON: You said it could come from some object. Is that right?
DR. LAPOSATA: Correct. It was fairly small. Could be some sort of object.
MR. JACKSON: Is it also consistent with a fist?
DR. LAPOSATA: Sure. A fist is an object.
MR. JACKSON: Okay. Your honor, at this point, I hate to do this again. May we approach?
JUDGE CANNONE: This is probably a good time. We talked about it at the sidebar. Can you do anything to fill up the jury's time for the next 10 minutes and then we can do this?
MR. JACKSON: Not without what we discussed at sidebar.
JUDGE CANNONE: Okay. One minute. Okay, both of you come up. judge cannone addresses jury: I'm told that we're still on track. We will start — I'm going to have you show up a half hour later than we normally do, because I expect to have 10 minutes with the lawyers, but we see sometimes the 10 minutes, naturally in the course of any case, can turn into more. So I don't want you to be waiting as much as you waited today. So you have a half hour more to get in here. Whatever time you normally meet, the court officers will tell you. We'll see you tomorrow morning. Tomorrow will be a full day, and we will make every effort that it's filled with as much time here in court for you — without sidebar conferences, without delays — for us to have a hearing. So, tomorrow, plan on a full day.
JUDGE CANNONE: Please do not discuss this case with anyone. Don't do any independent research or investigation into the case. If you happen to see or read anything about the case, please disregard it and let us know. Be careful again with your social media and news, and we'll see you tomorrow. So, Doctor—
DR. LAPOSATA: Thank you, your honor. Good to see you.