Commonwealth v. Read — Trial ArchiveElizabeth Laposata - Direct (Part 2)
474 linesCOURT OFFICER: Hear ye, hear ye, hear ye! All persons having any business before the Honorable Beverly Cannone, Justice of the Norfolk Superior Court for the County of Norfolk, give your attendance and you shall be heard. God save the Commonwealth of Massachusetts. Court is now open. You may be seated.
JUDGE CANNONE: Good morning, jurors. Thank you for your patience this morning. I know we brought you in late. Maybe should have brought you in a little bit later, but we've been working in an effort to sort of streamline things for you. So, I do have those questions I have to ask you. Is everyone able to follow my instructions and refrain from discussing this case with anyone since we left yesterday? Everyone said yes and nodded affirmatively. Were you also able to follow the instructions and refrain from doing any independent research or investigation into this case? Everyone said yes and nodded affirmatively. Did anyone happen to see, hear, or read anything about this case since we left yesterday? All right. Can we have Dr. Laposata back, please?
COURT OFFICER: Yeah, follow me.
JUDGE CANNONE: Dr. Laposata, I'll remind you you're still under oath.
DR. LAPOSATA: Thank you. Thank you. I will. Good morning. Morning, your honor.
JUDGE CANNONE: All right, Mr. Jackson, go right ahead.
MR. JACKSON: Thank you, your honor. Good morning, Dr. Laposata. Nice to see you again.
DR. LAPOSATA: Good morning. Glad to be here.
MR. JACKSON: Uh, yesterday when we last left off, we were talking about a small injury to the upper eyelid of Mr. O'Keefe. Do you recall that?
DR. LAPOSATA: I do.
MR. JACKSON: Could we have exhibit 165 with the —, please?
DR. LAPOSATA: Okay.
MR. JACKSON: I'd like you to take a look at a specific area. I could — there we go. Right here, on this exhibit — you see that area.
DR. LAPOSATA: Yes, I do.
MR. JACKSON: Tell us what that is.
DR. LAPOSATA: And that is a horizontal splitting of the skin which was caused by application of force that overcame the tissue's resistance. So the tissue split, and behind that we see the raccoon-eye discoloration of the eyelid from the basilar skull fractures.
MR. JACKSON: Can we have exhibit 13, please? I want to draw your attention to this area of the vehicle. First of all, do you recognize this photograph?
DR. LAPOSATA: Um, yes, I do.
MR. JACKSON: How do you recognize that photograph?
DR. LAPOSATA: I recognize it from looking at it in my materials reviewed — that it's the rear of Miss Read's SUV.
MR. JACKSON: Taking a look at the area that I'm highlighting right about there.
DR. LAPOSATA: Yes. Yes.
MR. JACKSON: Could we zoom in on that area? Do you see that overhang over the window?
DR. LAPOSATA: Yes, I do.
MR. JACKSON: If I use the word "spoiler," would you understand what I'm talking about?
DR. LAPOSATA: Yes, I do.
MR. JACKSON: Is the laceration to Mr. O'Keefe's upper eyelid that we just looked at — is that consistent, in your opinion, with a strike from that area of the vehicle if that vehicle were traveling in reverse at, say, 20-plus miles per hour?
DR. LAPOSATA: No, that projected, rounded, thick area would not cause that skin defect in his upper eyelid.
MR. JACKSON: If in fact a person were hit at, say, 20-plus miles an hour in the face with that rounded edge, what kind of injury would you
DR. LAPOSATA: Expect to see on that person's face? Um, I would expect to see a ribbon of bruise that would correspond to the height of that spoiler, and then it would go across the eyeball — that would hit the nose. So, I would expect to see some horizontal ribbon of bruise.
MR. JACKSON: Did you see anything consistent with that with Mr. O'Keefe's injuries?
DR. LAPOSATA: No, nothing.
MR. JACKSON: Thank you. We can take that down. We talked yesterday about this phenomenon known as coup-contrecoup injury to the brain. Correct.
DR. LAPOSATA: Yes.
MR. JACKSON: What happens to the brain after a significant coup-contrecoup injury?
DR. LAPOSATA: Um, yes — this was quite a severe brain injury. The brain was injured on the back and also the front. The falling back and impacting the back of the head made the skull fracture radiate along the base of the brain on the right and left sides. It also radiated around on the side of the skull, and that indicates a tremendous transfer of force and energy to the skull and then to the brain, and the brain is rattled around within the cerebrospinal fluid in the skull. So what that does is it breaks the connections between the neurons in the brain and causes small hemorrhages, and it causes the brain to swell. So when you get an injury — like if you get an injury on your arm, it starts to swell — the same thing happens when that injury energy is applied to the brain.
DR. LAPOSATA: The brain starts to swell, and unfortunately the brain when it swells doesn't have anywhere to go because it's encased in the skull. So what happens is that the brain stem under the brain starts to go down the opening in the base of the skull where your spinal cord goes, and that is a harbinger of death because that means that the brain stem is getting pushed down in this hole in the skull and compressing the areas in the brain stem which control the heartbeat and breathing. And that's called brain stem herniation. And that — you just die after that. So that's what happened to Mr. O'Keefe's brain.
MR. JACKSON: Your Honor, may I approach?
JUDGE CANNONE: Yes.
MR. JACKSON: Doctor, can you take a look at that document that I've just handed to you and tell me if you recognize it?
DR. LAPOSATA: Um, yes, I recognize this.
MR. JACKSON: How do you recognize that document?
DR. LAPOSATA: Um, from looking at the autopsy photos of Mr. O'Keefe's brain.
MR. JACKSON: And what portion of the brain are you looking at?
DR. LAPOSATA: Um — this shows a photograph looking up under the brain, and it shows a cross-section of the brain stem — the brain stem that went down in the hole in the base of the skull. And we see there's hemorrhage in it. And those have a special name. They're called Duret hemorrhages.
MR. JACKSON: How do you spell that?
DR. LAPOSATA: D-U-R-E-T, with a little — there's a little accent somewhere, here, it's over the E. Yes. And this shows that the brain stem is going down into the hole where the spinal cord goes. It's stretching the blood vessels and causes little hemorrhages and compresses the neurons in the brain stem which control your heart rate and your respiration. It's called brain stem herniation and that's a harbinger of immediate death.
MR. JACKSON: Your Honor, with that I would ask for the admission of — the next, uh, that document is next.
JUDGE CANNONE: Okay. So we'll take that into evidence.
MR. JACKSON: Yes. Your Honor, with the court's permission, uh, with the redaction, may I present the —
JUDGE CANNONE: Not yet. One minute. Um, jurors, I told you before that there were photographs that have been introduced into evidence that aren't pleasant. Um, and you may find that these photographs are graphic. And I'm instructing you again that your verdict must not in any way be influenced by the fact that these photographs — you'll see some more today, I believe — that have already been introduced into evidence. Um, so you're not to — your verdict must not in any way be influenced by the fact that these photographs may be unpleasant or graphic. The defendant is entitled to a verdict based solely on the evidence and not one based on pity or sympathy for the deceased, which might be occasioned by the photographs.
JUDGE CANNONE: Importantly, consider the photographs only as they may draw your attention to a clinical medical status, uh, or to the nature of Mr. O'Keefe's injuries, um, themselves. So again, these will be presented to you in the deliberation room in an envelope, but today you'll see some on the screen and I just wanted you to know that before you see it. So now you can display it.
MR. JACKSON: Your Honor, may I approach very briefly?
JUDGE CANNONE: Yes.
MR. JACKSON: If you wouldn't mind taking a look at that document. Is that a version — or a version of just the brain stem?
DR. LAPOSATA: Yes, this, uh, this, uh, photograph shows, um, the cross-section going this way of the brain stem with the hemorrhages caused by the brain stem going down into the foramen magnum.
MR. JACKSON: With that, Your Honor, actually, with the court's permission, I would tender that as the next exhibit rather than the unredacted version.
JUDGE CANNONE: All right. Is there any objection to switching the exhibits like that?
MR. JACKSON: Okay. And the arrows point to that on there. So this is going to be the next exhibit. That'll be it. Exhibit 225.
JUDGE CANNONE: Thank you. The other one will be ID for identification. The first one.
MR. JACKSON: Thank you, Your Honor. And that'll be FFF for ID.
JUDGE CANNONE: Okay, you can display it now.
MR. JACKSON: Thank you, Your Honor. Do you see what's displayed on the screen above your head?
DR. LAPOSATA: Yes.
MR. JACKSON: What is that?
DR. LAPOSATA: That's a cross-section across the brain stem of Mr. O'Keefe. And it shows — where the blue arrows I've put in there — show the red areas, which are areas of bleeding, um, which is, uh, the sign of brain stem herniation. All the background is white material and that's part of the appearance of neurons in the brain. So that shows that the brain stem, because of the cerebral — the brain swelling — pushed it down into the hole in the base of the skull where the spinal cord goes, and it pulls on the blood vessels, causing the blood vessels to break and the blood vessels to bleed, and that shows you that the brain stem has been compressed and damaged, causing death.
MR. JACKSON: May I approach?
JUDGE CANNONE: Yes.
MR. JACKSON: I'm holding a green laser pointer.
JUDGE CANNONE: Oh, thank you. Use the, uh, the display to your right so you can better see it. Could you point to the areas, uh, with that laser pointer, of the bleeding that you indicated causes the swelling?
DR. LAPOSATA: Okay. So, okay. Is that going on the —
COURT OFFICER: It is. It's probably hard for you to see.
JUDGE CANNONE: Oh, that's okay. So, this sort of roundish thing is the brain stem and the arrows are pointing to the red areas.
MR. JACKSON: Is this type of herniation life-threatening?
DR. LAPOSATA: It — oh, it causes death. Yes, it is life-threatening.
MR. JACKSON: How quickly — we can take that down — how quickly, Doctor, would you expect that this could cause — let's first talk about incapacitation. Yes. How quickly would someone be incapacitated after they suffer a coup-contrecoup injury of this magnitude, with the concomitant injuries that you see in the brain stem?
DR. LAPOSATA: Um, well, there would be, um, two parts to what that injury would cause the body to do. First, there would be immediate unconsciousness because of the transfer of all the energy to the brain and the massive skull fractures. So that — excuse me — so that would disrupt the normal function of the brain and produce immediate unconsciousness. Then the brain would start to swell, and within 15, 20 minutes or so, then that brain stem starts to go down the opening in the bottom of the skull, and then the blood vessels are broken. The brain stem gets compressed and the centers in that brain stem which control the heart and the respiration then stop. So you go unconscious, brain swells, then you die.
MR. JACKSON: Turning to the actual, uh, your review of the actual brain in this instance — uh, Mr. O'Keefe's injuries specifically — uh, did you reach any conclusion or opinion to a reasonable degree of medical certainty about his incapacitation, the length of time it would take for him to become first incapacitated and ultimately to, uh, to be rendered, uh, dead?
DR. LAPOSATA: He would be immediately incapacitated with a decreased level of consciousness once he received that, uh, impact on the back of the head. He would not be able to make any purposeful movements. Um, there might be some arm jerking or, or some seizure activity, but he would not be able to — he wouldn't be able to get up. He wouldn't be able to walk. He wouldn't be able to do any purposeful activity. He would be severely concussed, um, unconscious, not able to walk, not able to carry out purposeful activity. And then as the brain continues swelling and that brain stem gets compressed, then the heartbeat is disrupted, the breathing is disrupted, and then the heart and breathing stop, and within 15 or 20 minutes then he could be dead.
MR. JACKSON: Is that opinion to a reasonable degree of medical certainty?
DR. LAPOSATA: Yes, it is.
MR. JACKSON: You testified concerning wound pattern recognition pretty extensively during the course of your, uh, giving your qualifications. What is a patterned injury?
DR. LAPOSATA: Um, a patterned injury is very, uh, basic to the training in forensic pathology and medicine, because it helps us understand, um, some change on the body, some patterned injury that corresponds to the object that made it. So we can look at an injury and say — we can figure out what made that. Sometimes you can, sometimes you can't. But a patterned injury is very important for a forensic pathologist to recognize because it's going to really help the police investigation, because I can say, "Oh, this looks like it's a wound from a scissors. This looks like it's a wound from a screwdriver stab."
DR. LAPOSATA: So by looking at — by identifying the pattern that that object makes on the body, I can help the death investigation by helping the police say, you know, look for some screwdriver, look for some hammer. So identifying a patterned injury is really important — it's basic to the forensic pathologist's knowledge base, and then also very important, uh, to the, uh, investigation of the crime or incident.
MR. JACKSON: I'd like you to look at another photograph, an exhibit that's already been put into evidence — 160, please — with the court's permission.
JUDGE CANNONE: Yes, jurors. This may be one of the photographs as well. All right. Or there'll be a series.
MR. JACKSON: Dr. Laposata, I want to draw your attention to the center of this photograph. First of all, do you recognize what's depicted here?
DR. LAPOSATA: Yes, I do.
MR. JACKSON: How do you recognize it?
DR. LAPOSATA: I recognize it from reviewing the autopsy photographs of Mr. O'Keefe.
MR. JACKSON: You reviewed it in forming your opinions and conclusions?
DR. LAPOSATA: Yes.
MR. JACKSON: Can you describe what's depicted in this photograph? What are we looking at?
DR. LAPOSATA: Yes. So we're looking at the, uh, back of Mr. O'Keefe's head and an injury caused by the angular, um, acceleration going down and hitting his head in the back. And then this is also a patterned injury. So what we see is the horizontal tear of the scalp, and we can see it's undermined a little bit. So that means the direction is going from bottom to top. Also we see these sort of vertical lines in here and down below. So what that tells me is that the back of his head hit something that had a fine granular pattern to it, to cause those individual little marks. And then also something that had a linear or ridged pattern, that, that he went back on, that broke the scalp there. So we have two parts really to this patterned injury.
DR. LAPOSATA: We have the horizontal, um, tear of the scalp, made by impact with some sort of ridged surface. And then we have these vertical scrapings of the skin above and also below — they're obscured a little bit by the ruler there — which says that whatever he hit had some little, like, granularity to it, with each little sort of granule making those vertical marks, and then the ridged pattern having the major point of impact.
MR. JACKSON: What is the significance of the pattern? When you say ridged pattern, and there's two things we're looking at — the laceration, uh, or the abrasion, uh, versus
DR. LAPOSATA: — the defect above and below that laceration. Yeah. So what this injury tells me, and what I would tell the investigators, is that Mr. O'Keefe went back onto some object that had some sort of ridge to it to make that horizontal tear in the skin. But that ridge — it wasn't smooth. It had some little grainy things sticking up on it that would make each of these little marks. And then it's the job of the police to go back to the scene and look around for something which might fit that pattern. We can take that down.
MR. JACKSON: Did you, in furtherance of your investigation — coming to your opinions and conclusions — look at the area of 34 Fairview?
DR. LAPOSATA: The outside. Yes.
MR. JACKSON: Meaning photographs?
DR. LAPOSATA: Yes.
MR. JACKSON: Did you also see photographs of any significance to you related to the garage? The interior of the garage —
JUDGE CANNONE: Sustained. Jurors, disregard that question. What part of the area did you see? What part of the location did you see?
DR. LAPOSATA: Excuse me. I saw all the scene photographs taken by the police which showed the front yard in the area where Mr. O'Keefe was found. I also saw some photographs of the inside of the house and the inside of —
JUDGE CANNONE: I'm going to stop you there, Dr. Laposata. I'm striking — anything after — the pictures from outside. Mr. Jackson, move on. Let's stay with the outside of the home.
MR. JACKSON: Did you see the front lawn area?
DR. LAPOSATA: Yes, I did.
MR. JACKSON: What did you note about the front lawn area?
DR. LAPOSATA: Well, I was looking at the area where Mr. O'Keefe's body was found because we know once he came back and slammed his head, he's not going to get up and move around.
JUDGE CANNONE: Strike. I'm going to strike the second part of that. Answer the question specifically.
DR. LAPOSATA: Okay, I'll try, Your Honor. Thank you.
MR. JACKSON: Why were you interested in the outside area where his body was found?
DR. LAPOSATA: Because then I could identify an object possibly — — there that would have caused the injury on the back of his head.
MR. JACKSON: Did you see any such object in any of the photos that you reviewed?
DR. LAPOSATA: No, there was nothing. There was a flat grass surface.
MR. JACKSON: Would the flat grass — let's assume that the grass was very cold and very hard, the dirt was very cold and very hard. Would falling backward onto that dirt — hard or not — would that cause the patterned injury that we just saw in Exhibit 160?
DR. LAPOSATA: No.
MR. JACKSON: Why do you say that?
DR. LAPOSATA: Because if you fall back on a flat surface, many times the tear you get in the scalp can be more like a star, because you've just hit one part and then — the tears go in kind of a star pattern. And also because you would not have those discrete vertical scrapings of the skin. If you fell back on grass, you would tend to see — you might see grass in the wound, or you would tend to see an irregular kind of crisscross pattern of the flattened grass. And that's not what we have here on Mr. O'Keefe.
MR. JACKSON: Do you have any training or experience in diagnosing hypothermia in individuals?
DR. LAPOSATA: Oh, yes.
MR. JACKSON: Have you conducted autopsies of individuals who have suffered from or died from hypothermia?
DR. LAPOSATA: Yes, many.
MR. JACKSON: How many?
DR. LAPOSATA: Oh, a hundred or more. And then I've — — supervised my assistants who've also diagnosed death from decrease in body temperature.
MR. JACKSON: Have you ever engaged in any death investigation — aside from the actual autopsies — in which the cause of death was deemed to be hypothermia?
DR. LAPOSATA: Yes.
MR. JACKSON: How many times would you say you've undertaken that type of investigation?
DR. LAPOSATA: At least a hundred.
MR. JACKSON: Have you ever reviewed any peer-reviewed medical literature associated with or discussing hypothermia and something known as Wischnewski spots?
DR. LAPOSATA: Yes, that's in the medical literature and also in our forensic textbooks.
MR. JACKSON: Did you review the medical examiner's file — Dr. Scordi-Bello's file — as it — related to — well, in connection with this case, you reviewed the entire file, correct?
DR. LAPOSATA: I did.
MR. JACKSON: Did you conduct a differential diagnosis as it relates to the potential for hypothermia?
DR. LAPOSATA: Yes, I did.
MR. JACKSON: Describe — before we get into your findings or your conclusions and opinions — what is inferential thinking?
DR. LAPOSATA: Inferential thinking is another name for making a differential diagnosis — in other words, seeing a finding and then saying, "How many ways can I get that finding?" And then go and investigate each one of those ways and either rule them in or rule them out as being responsible for causing that — — finding.
MR. JACKSON: Did you note whether or not the medical examiner, Dr. Scordi-Bello, mentioned hypothermia as a potential cause of death in this case?
DR. LAPOSATA: She did put that on the death certificate, along with something else.
MR. JACKSON: Along with the blunt force head injury? Do you agree with or concur with the blunt force head injury as a cause of death?
DR. LAPOSATA: Yes. Mr. O'Keefe died from the blunt force head injury.
MR. JACKSON: Do you concur with the diagnosis of hypothermia?
DR. LAPOSATA: No. The body did not have any hypothermia.
MR. JACKSON: What led you to that conclusion?
DR. LAPOSATA: Well — we know that normal body temperature is around 98, and we know that at the hospital Mr. O'Keefe's rectal temperature was around 80. So we know that his temperature went down. There are two ways the body temperature can get down: it can get down while you're alive, or a dead body also cools when it's in a cold environment. So those are the two things you have to look at.
MR. JACKSON: You to take a look. Thank you. I apologize. Do you recognize what's depicted in that photograph?
DR. LAPOSATA: Yes, I do.
MR. JACKSON: What is that?
DR. LAPOSATA: This is a photograph I took from our forensic medical literature and it shows the lining of the stomach. The stomach is opened up and we look at the lining of the stomach and it — shows a characteristic pattern of small ulcerations throughout the stomach which are called — medically — Wischnewski ulcers. And that allows a forensic pathologist to diagnose death from being exposed to a cold environment, or death due to hypothermia. They're caused by — as the body gets colder and colder while it's alive — these small blood vessels in the lining of the stomach start to break, and then they're in the acidic environment of the stomach and you get tiny little ulcers which then look like small dots.
DR. LAPOSATA: And that is how — at postmortem examination or autopsy — this is one of the findings I look for to see if a person — died from hypothermia.
MR. JACKSON: What is gastric mucosa as it relates to the stomach lining?
DR. LAPOSATA: The gastric mucosa — when you open up the stomach and you look at the inside — the first cells lining that inside is called the mucosa.
MR. JACKSON: Is that what we're looking at in this photograph?
DR. LAPOSATA: Yes, we're looking at the mucosa with ulcerations — little craters that form in it due to hypothermia.
MR. JACKSON: Is that exemplar of what Wischnewski spots look like, as it relates to hypothermia, from literature that is peer-reviewed?
DR. LAPOSATA: Oh, yes.
MR. JACKSON: Is it widely accepted in the medical field?
DR. LAPOSATA: Yes, it is.
MR. JACKSON: And is it referenced by forensic pathologists and used in teaching?
DR. LAPOSATA: Yes.
MR. JACKSON: Your Honor, I'll move for the admission of that photograph.
JUDGE CANNONE: Okay. 226.
MR. JACKSON: Permission to display, Your Honor?
JUDGE CANNONE: Yes.
MR. JACKSON: Is this a fair representation of what you were just looking at?
DR. LAPOSATA: Yes.
MR. JACKSON: Describe what we're looking at.
DR. LAPOSATA: So this — I took this photograph from our forensic medical literature, and this was from a person who died from exposure to a cold environment. The stomach has been opened and we're looking at the inside of the stomach. The normal appearance is kind of pinky-white — that's how it should look. And what's abnormal here is all these black dots, which are the Wischnewski ulcers — — which are diagnostic of death due to exposure to the cold. So these areas are tiny craters, and they fill up with blood. We see that in over 90% of the cases of people who die from exposure to the cold.
MR. JACKSON: Did you also look at Mr. O'Keefe's stomach lining?
DR. LAPOSATA: Yes, I did.
MR. JACKSON: With the court's permission, Exhibit 164, please. Do you see the photograph on the right?
DR. LAPOSATA: Yes.
MR. JACKSON: What is that of?
DR. LAPOSATA: This is Mr. O'Keefe's stomach which has been opened up. Looking at the inside, we see that the mucosa is a little bit red and there's a little bit of increased blood flow here — but this is the — normal pattern of the inside of the stomach. It's kind of ridged — that's called rugae. Those are the normal folds inside the stomach. But there are no ulcerations here. So the diagnosis of death due to hypothermia is not appropriate in his case.
MR. JACKSON: Do you see any classic Wischnewski spots in Mr. O'Keefe's stomach lining or gastric mucosa?
DR. LAPOSATA: No.
MR. JACKSON: Do you observe any ulcers specific to Mr. O'Keefe's stomach lining?
DR. LAPOSATA: No. There are no ulcers. It's a normal appearance of what we would call a gross specimen. When you open the stomach at autopsy, you can see some redness of the normal lining of the — stomach.
MR. JACKSON: Do you have an opinion — to a reasonable degree of scientific certainty, based on the totality of your review and examination of the autopsy and its associated file — an opinion as to whether or not Mr. O'Keefe died of hypothermia or complications related to hypothermia?
DR. LAPOSATA: I do have an opinion.
MR. JACKSON: And what is that opinion?
DR. LAPOSATA: He did not die of hypothermia.
MR. JACKSON: And is that opinion to a reasonable degree of medical certainty?
DR. LAPOSATA: Yes.
MR. JACKSON: Taking a look at the darker red areas in the stomach lining of Mr. O'Keefe on the photograph to the right — that's Exhibit 164 — can you describe what those are? What are those darker areas?
DR. LAPOSATA: Um, like what? Well, here we see a little bit of bleeding. The darker areas are the areas of the lining that are at the bottom of the normal rugae, because the inside surface of the stomach sort of looks like it's covered with little mountains. And so we can get the redness in between the rugae in the stomach, and there's a little bit of increased redness here but no ulceration.
MR. JACKSON: Do you have an opinion, or were you able to form an opinion, as to what the increased redness might be or is associated with?
DR. LAPOSATA: Yes.
MR. JACKSON: Did you note anything of significance in the rest of your examination of the file — the autopsy file, the medical examiner's file — that was related to what you see in photograph 164?
DR. LAPOSATA: Yes.
MR. JACKSON: Right. Let's set it aside for just a minute here. We can take that down. May I continue?
JUDGE CANNONE: Yes.
MR. JACKSON: Thank you. With regard to the — it's my word not yours, doctor, so forgive me — the defects, the redder marks that you're mentioning on the rugae, or in and around the rugae on the gastric mucosa, did you note that there was a machine that was used for life-saving measures as it related to Mr. O'Keefe?
DR. LAPOSATA: Oh, yes. It caused some damage to the body.
MR. JACKSON: Okay, let's talk about that for just a quick second. What is that machine called?
DR. LAPOSATA: Um, it's a mechanical device to administer chest compressions, and the company that makes it is called Lucas, or one of the companies. So it's called a Lucas machine, and it can be attached to the body. Your arms go up over a ridge, and there's a plunger, and it goes around your back, and so it just plunges and it does mechanical resuscitation and chest compression, compressing the chest right over the lower sternum about two inches or so. And it's very helpful in a situation where the manual compressions — where the attendants and the EMT people get tired continually compressing for a long period of time. So the mechanical device was invented to prevent EMT fatigue when administering chest compressions.
MR. JACKSON: When you mention the sternum area of the body — needless to say — are there organs beneath the area that's being compressed by the mechanical Lucas machine?
DR. LAPOSATA: Oh, absolutely.
MR. JACKSON: What do those organs include?
DR. LAPOSATA: Well, ideally they include the heart, because that's what's supposed to be pumping the blood out. But it's also in a circular area that's right below the sternum, which includes the heart, but what is also under there is the esophagus and the interior of the stomach. So this area is right under where the machine is compressing, as well as part of the head of the pancreas, which is also right there under the lower sternum. And what can happen with the Lucas machine pushing in a hundred times a minute for a depth of about two or two and a half inches is that these organs right underneath it get compressed between the Lucas pump and the bony vertebral bodies along your back.
DR. LAPOSATA: So you have the Lucas machine compressing these organs, and they're compressing them against the vertebral bodies of your bony vertebral column in the back. So you can get other injuries — organ injuries — that are a complication of the automated mechanical resuscitation. You can get cardiac ruptures. You can get ruptures of the liver, because all those organs are clustered right there. And that machine is pushing those organs in between the pump and the back of the bony spinal column.
MR. JACKSON: Doctor, in your review of the medical records, was there any indication that an automated chest compression machine — a Lucas machine — was used on Mr. O'Keefe?
DR. LAPOSATA: Yes.
MR. JACKSON: May we — we can take this down?
JUDGE CANNONE: Yes.
MR. JACKSON: There are two documents that I'd like to show you. First, yes, that document, and then after you're finished, familiarize yourself first, and the second one. Taking the first document that addresses the Lucas machine — how do you recognize that photo, or the series of photos and graphs?
DR. LAPOSATA: These are illustrations I put in my report. One shows a generic patient with the Lucas machine in place around him to do the chest compressions. Then I have a photograph of the actual apparatus of the Lucas machine itself. Then I show what's recognized as medical complications and injury from that machine. I have an example of a CAT scan of a section through the body horizontally right where the plunger goes into the chest, and it shows in another patient a hemorrhage around the pancreas and around the top of the stomach. Then I have a diagram also taken from medical literature that shows the direction of force that compresses those organs between the resuscitation paddle and the vertebral body and the backbone.
MR. JACKSON: Doctor, are those photographs and graphs taken from peer-reviewed literature in the medical field that's normally relied on by other medical professionals?
DR. LAPOSATA: Yes.
MR. JACKSON: Your honor, I'd move for the admission of that first document.
JUDGE CANNONE: Right. Subject to redaction?
MR. LALLY: I don't think so. I think that one is not objected to.
JUDGE CANNONE: Okay.
MR. JACKSON: So, did you hear that?
DR. LAPOSATA: Sure.
MR. JACKSON: Thank you. Exhibit 227. Permission to display, your honor?
JUDGE CANNONE: Yes.
MR. JACKSON: Doctor, I know that's a little bit small and far away. We'll enlarge it as you need. It's not an eye test. Let's take the top half of the document. What is that to the left, and then what's the machine in the middle?
DR. LAPOSATA: Right. So what you see on the left is an anonymous patient showing how the Lucas machine is placed onto the patient, where the arms are pulled up and clasped against these rigid mechanical bridges. And then here is the engine which puts the pump. And that's the pump which just goes up and down, up and down, to do the chest compressions. And so that's how it's affixed to a patient.
MR. JACKSON: To be clear, doctor, that is not John O'Keefe.
DR. LAPOSATA: No, no, this could be a model, an unknown person.
MR. JACKSON: Okay. And then what are we looking at in terms of the actual machine?
DR. LAPOSATA: This shows the actual machine before it's put on a patient. You can see how it encircles the patient, and then there is this circular pump which is the compressor pump.
MR. JACKSON: If we can look at the — what is that, a picture of the highlighted portion?
DR. LAPOSATA: That's the circular part that actually is projected down onto the body that makes contact with the chest.
MR. JACKSON: Correct. And that has a spring in there that the engine above it gives a certain number of compressions per minute. And you said on average the compressions per minute would be about what?
DR. LAPOSATA: They should be around 100.
MR. JACKSON: Okay. If we could go to the bottom half of the page, or the graphics on the bottom. What are we looking at in this photograph?
DR. LAPOSATA: Here, we're looking at — on the left side, we're looking at a CAT scan of a person who's had some injury from the Lucas compression machine, and it shows a cross-section. So the arrow here is pointing to the head of the pancreas and the area of the esophagus. And then the machine would compress down onto that. And the important part — I don't know if that's working on there. The little thing that looks like — at the very bottom, that's circular and then has a little — looks like a little steer head — that's the vertebral column and that's bone. And so the pump is pushing in that area where the arrow is, pushing those organs against the bony vertebral column. Excuse me. And that's an actual patient that had that.
DR. LAPOSATA: Then on the right, it shows the schematic of the blue arrows indicating the force coming down. Then we see the organs, and the red arrows show how the pancreas can get hemorrhage and also some of the esophagus that goes into the top part of the stomach. And we see that — I can't really see where that — I think it stopped.
MR. JACKSON: May I approach?
JUDGE CANNONE: Yes.
DR. LAPOSATA: Oh, no. You've got it. Okay. And then we see at the bottom, with those three little things projecting from it, that is the vertebral body, which is made up of bone. So you can see how the chest compressions — not only hoping to save the life by keeping the heart and blood functioning — can also cause some injuries and damage, not life-threatening usually, to the other organs there.
MR. JACKSON: We can take that down. Doctor, take a look at the second document that's in front of you. Do you recognize what's depicted in that document?
DR. LAPOSATA: Yes.
MR. JACKSON: What is that?
DR. LAPOSATA: This is a picture of Mr. O'Keefe's chest while he's at the hospital, which shows a lot of the resuscitation equipment.
MR. JACKSON: Is that a true and accurate depiction of Mr. O'Keefe at the hospital based on your review of the medical file?
DR. LAPOSATA: Yes.
MR. JACKSON: I'll move for the admission of that.
JUDGE CANNONE: Admitted as Exhibit 228.
MR. JACKSON: Permission to display briefly.
JUDGE CANNONE: Okay.
MR. JACKSON: Taking a look at the photographs to the left and to the right, do you see any indication on Mr. O'Keefe's body indicating where the Lucas machine was situated?
DR. LAPOSATA: Yes. As I pointed out here with the blue arrows, that big circular mark there is the mark on the skin where the compression pump compressed the chest of Mr. O'Keefe. And it also caused some rib fractures, and it also caused reddening of the stomach lining and some hemorrhage in the pancreas.
MR. JACKSON: We can take that down. Doctor, based on your review of the medical records, did you calculate the approximate number of compressions that Mr. O'Keefe would have been subject to based on that Lucas
DR. LAPOSATA: Machine? Um, yes.
MR. JACKSON: What is that calculation?
DR. LAPOSATA: Um, his body was found around 6:00 in the morning and he got to the hospital around 6:37, I think. So if they put the Lucas machine on him when they got him into the ambulance and it's compressing at 100 times a minute, and that is from the time of the body being discovered to the time at the hospital, that's around 37 minutes. So if you multiply 37 minutes times 100 compressions a minute, that's around, you know, over 30,000 compressions that would have been done to Mr. O'Keefe's body in the course of his resuscitation efforts.
MR. JACKSON: Dr. Laposata, do you have an opinion as to what caused the hemorrhaging that we saw on Mr. O'Keefe's stomach lining?
DR. LAPOSATA: Yes.
MR. JACKSON: What is that opinion?
DR. LAPOSATA: Uh, it was from the blunt compression of the Lucas machine.
MR. JACKSON: Is that opinion to a reasonable degree of scientific certainty?
DR. LAPOSATA: Yes.
MR. JACKSON: You indicated earlier that there is a difference between someone dying of hypothermia or complications associated with hypothermia and a body that's already passed away just cooling. Correct?
DR. LAPOSATA: Correct.
MR. JACKSON: Do you have an opinion to a reasonable degree of medical certainty as to whether Mr. O'Keefe suffered from hypothermia?
DR. LAPOSATA: I do have an opinion.
MR. JACKSON: What is that opinion?
DR. LAPOSATA: He did not experience hypothermia.
MR. JACKSON: Did you observe any signs of frostbite?
DR. LAPOSATA: No.
MR. JACKSON: Did that have any weight concerning your opinion, your overall opinion as to whether or not Mr. O'Keefe died with complications associated with hypothermia?
DR. LAPOSATA: Well, if someone dies due to exposure to low temperatures, you expect to see not only the Wischnewski ulcers, but you expect to see some frostbite changes in the extremities.
MR. JACKSON: Based on your overall review of the medical records associated with Mr. O'Keefe, were you able to reach an opinion and conclusion as to the cause of death of Mr. O'Keefe?
DR. LAPOSATA: Yes.
MR. JACKSON: What is that opinion?
DR. LAPOSATA: He died of brain injuries and skull fractures due to blunt force trauma of the head.
MR. JACKSON: Do you hold that opinion for Mr. O'Keefe's cause of death to a reasonable degree of medical certainty?
DR. LAPOSATA: Yes.
MR. JACKSON: I want to shift gears for a minute, Dr. Laposata, and talk about patterned injuries elsewhere on Mr. O'Keefe's body. You've obviously talked about your training and experience as it relates to recognition of patterned wounds. Correct?
DR. LAPOSATA: Correct.
MR. JACKSON: That's something that you were trained in when you were training. Correct?
DR. LAPOSATA: Yes. It's very basic to the discipline of forensic pathology.
MR. JACKSON: And have you also trained others during the course of your 40-year career on the issue of wound pattern recognition?
DR. LAPOSATA: Yes.
MR. JACKSON: You've taught courses and given lectures. Is that right?
DR. LAPOSATA: Yes, I have.
MR. JACKSON: I'd like to show you Exhibit 167 with the court's permission.
JUDGE CANNONE: Okay.
MR. JACKSON: Do you recognize what's depicted in this photograph?
DR. LAPOSATA: Yes.
MR. JACKSON: How do you recognize it?
DR. LAPOSATA: It is a photograph of the right arm of Mr. O'Keefe.
MR. JACKSON: Did you review and consider this photograph and others in forming your opinions, coming to your conclusions and opinions in this case?
DR. LAPOSATA: Yes.
MR. JACKSON: In order to come to your ultimate opinion and conclusion — or opinions and conclusions — in this case, is it important to take all of the injuries that a decedent may have suffered into account rather than one or two piecemeal?
DR. LAPOSATA: You have to look at the whole picture to understand what happened to the body.
MR. JACKSON: Why is that? What's the importance of that? It may be obvious, but explain that for the jurors, please.
DR. LAPOSATA: Well, when you're looking at changes and injuries to the body and trying to understand what happened to the body, there are different patterns of injuries on different parts of the body. And by trying to separate those and understand what patterns were caused by certain things, then you're able to put together a sequence of events that happened to the body prior to death.
MR. JACKSON: What role do photographs play in a forensic medical examiner reviewing the medical evidence and coming to opinions and conclusions? How important are photographs?
DR. LAPOSATA: Oh, those are huge. It's standard practice to always document at the post-mortem examination important findings with photography.
MR. JACKSON: Were the photos in Mr. O'Keefe's case useful in coming to opinions and conclusions concerning his injuries altogether?
DR. LAPOSATA: Yes.
MR. JACKSON: What about the injuries to his right arm?
DR. LAPOSATA: Uh, yes, those photographs are very important to understand those injuries.
MR. JACKSON: Do you believe that there is a patterned injury on Mr. O'Keefe's right arm?
DR. LAPOSATA: Yes, there is a patterned injury there.
MR. JACKSON: Have you ever seen in your experience, either being taught or teaching, patterned injuries as they relate to animal wounds generally?
DR. LAPOSATA: Oh, absolutely. Very common.
MR. JACKSON: Do animal wounds include both claws and teeth? Dentition?
DR. LAPOSATA: Yes. So bite marks and claw marks might be two different types of patterned wounds that you may see in your evaluation, just in general. Correct.
MR. JACKSON: Because when an animal approaches the body, there may be damage from the claws and also from the mouth. Do you expect to see punctate wounds as well as linear abrasions?
DR. LAPOSATA: Yes.
MR. JACKSON: Do you expect to see certain bite patterns as well?
DR. LAPOSATA: Yes.
MR. JACKSON: What types of injuries? Let's talk about animals in general. What types of injuries do animals produce on the skin of human beings?
DR. LAPOSATA: Well, animals can produce — if you're talking about mammals — they can produce injuries from their claws, where you get parallel scrapes of the skin from the claws applied to the skin. Or you can see a pattern from the jaw configuration of the animal. Most mammals — animals that attack or get in contact with the body — have canines. So there's two canines on either side that make paired marks, and that would be called a pattern injury. So it makes parallel, sort of, gouges. And as the canines move in a horizontal pattern or vertical pattern the space between them can change.
DR. LAPOSATA: The other thing you see in an animal bite — you see not only the canines that come out, but depending on how the jaw is applied to the body, you can have little dot-like imprints in sort of a U-shaped pattern, which are from the incisors, the little incisors of the animal. So you look for punctures, you look for paired gouges — which would be the canines — and then you look for arced patterns of little dots, which can be the application of the incisors of an animal bite.
MR. JACKSON: What is an incised wound?
DR. LAPOSATA: An incised wound is a wound due to cutting from a sharp object.
MR. JACKSON: Would you expect to see incised wounds from an animal bite or claw?
DR. LAPOSATA: No. They don't cause — they're not like knife wounds. They cause more of a scraping injury.
MR. JACKSON: Do you see the injuries — looking at Exhibit 167 — are these more consistent with incised wounds or the scraping abrasions that you just talked about?
JUDGE CANNONE: Sustained.
MR. JACKSON: Were you able to determine from your review of the medical records whether the injuries that you see on Mr. O'Keefe's right arm were premortem or post-mortem?
DR. LAPOSATA: Uh, yes. I can determine that they were inflicted prior to death.
MR. JACKSON: Do you have an opinion as to whether or not the wounds that you see — the patterned injury that you see on Mr. O'Keefe's right arm — is consistent with an animal bite or claw marks?
DR. LAPOSATA: Yes, it is very much.
MR. JACKSON: Thank you. We can take that down. May I have just a moment, your honor? Actually, your honor, may we approach very briefly?
JUDGE CANNONE: Okay.
PARENTHETICAL: [sidebar]
MR. LALLY: May I inquire?
JUDGE CANNONE: Yes.
MR. LALLY: You indicated that, in your opinion, the wounds to Mr. O'Keefe's arms were premortem, not postmortem. Correct?
DR. LAPOSATA: Correct.
MR. LALLY: His right arm, I should say, were premortem, not postmortem. Correct?
DR. LAPOSATA: Correct.
MR. LALLY: What's the basis for that opinion?
DR. LAPOSATA: Well, a forensic pathologist has to be able to differentiate changes that happen to the body while the person is alive versus things that happen after the person is dead. For instance, there is something called post-mortem predation, where if the body is out in the woods and dead, then wolves and such can come and make — quote — injuries to the body. But we're able to tell from our training and experience that those were made after death. The usual way we tell is that when it's made during life, the blood vessels that are damaged — the heart's pumping blood through — so you can see a reddish color and maybe some blood around it.
DR. LAPOSATA: Whereas if the body is damaged after death, the changes to that body and those quote injuries look more yellowish and kind of brown because the blood is not flowing. So that's how you can tell if something done to the body is while the body was alive or whether it was done after death.
MR. LALLY: Do you
MR. JACKSON: ...have an opinion to a reasonable degree of medical certainty that the wounds on Mr. O'Keefe's right arm were premortem?
DR. LAPOSATA: Yes, they were done while he was alive and bleeding.
MR. JACKSON: You talked about death investigations. As a matter of fact, you mentioned something about what a forensic pathologist's role is in a death investigation — to potentially send investigators back out to answer certain questions. Correct?
DR. LAPOSATA: Yes.
MR. JACKSON: Did you see any evidence in the medical records or the medical examiner's complete records that any effort was made to send investigators to the location to see if there were any animals at the location at or around the time of John O'Keefe's death?
JUDGE CANNONE: Sustained.
MR. JACKSON: Do you believe it's important? Well, let me ask you a different way. Would following up with investigators be an important part of any forensic pathology investigation?
DR. LAPOSATA: Oh, absolutely. You're working as a team to figure out what happened to the body.
MR. JACKSON: Thank you. We talked about the theme and theory of differential diagnosis. Correct.
DR. LAPOSATA: Yes.
MR. JACKSON: How does engaging in the process of differential diagnosis avoid bias in an investigation?
DR. LAPOSATA: After you have your findings and you sit back and think, "Well, how many ways could I get this finding?" — bias sometimes means, "Oh, I think it's this," and then you just stop. So that's a sort of bias where you make a decision too quickly and you don't then stop to consider what other things could cause this same finding. So you have to consider not only what immediately comes to mind, but then you think: how else could we get this pattern of injuries?
MR. JACKSON: Did you engage in a differential diagnosis as it relates to this case?
DR. LAPOSATA: Yes.
MR. JACKSON: Did you consider whether the injuries could have been caused by a motor vehicle accident?
DR. LAPOSATA: I did consider that.
MR. JACKSON: Did you consider whether Mr. O'Keefe's right arm injuries specifically could have been caused by being hit by a motor vehicle?
DR. LAPOSATA: Yes, I did think about that.
MR. JACKSON: Were you able to rule that out?
DR. LAPOSATA: Absolutely.
JUDGE CANNONE: Objection sustained. Strike that answer.
MR. JACKSON: Did you come to an opinion or conclusion as to whether or not Mr. O'Keefe's injuries as a whole were produced by a motor vehicle pedestrian incident?
JUDGE CANNONE: Sustained.
MR. JACKSON: You indicated that you've done thousands of autopsies yourself. Correct.
DR. LAPOSATA: Yes.
MR. JACKSON: You've supervised many times more than that. Correct. How many of those autopsies that you've performed or supervised have involved motor vehicle incidents?
DR. LAPOSATA: Hundreds.
MR. JACKSON: How many of those hundreds have involved motor vehicle pedestrian incidents?
DR. LAPOSATA: Almost as many.
MR. JACKSON: Have you performed autopsies specifically on individuals known to be hit by vehicles?
DR. LAPOSATA: Yes.
MR. JACKSON: Have you performed autopsies on individuals believed to be hit by vehicles?
DR. LAPOSATA: Yes.
MR. JACKSON: Have you engaged in differential diagnosis and inferential thinking in terms of developing an opinion or conclusion to a medical certainty about whether or not the injuries that you see on a decedent are consistent or inconsistent with a motor vehicle pedestrian incident?
DR. LAPOSATA: Yes, that's part of what we figure out as a forensic pathologist.
MR. JACKSON: Did you do that in this case?
DR. LAPOSATA: Yes, I—
JUDGE CANNONE: Sustained.
MR. JACKSON: What are some of the injuries that you would expect generally to exist if a pedestrian is hit by a motor vehicle at speed — not one or two miles an hour, let's say 20-plus miles an hour?
DR. LAPOSATA: One of the things you see is a pedestrian standing upright being impacted by this blunt object of an automobile, van, or SUV. And what you see first and most is the tissue is crushed where the projections of the vehicle impact the tissue. And when you crush the tissue, that gives you a bruise. So that's the first part of the pattern of impact: it crushes the tissue; it gives you a bruise because it breaks the blood vessels underneath the skin. And then depending on how much more force is applied, the skin can break.
JUDGE CANNONE: I'm going to strike that. Next question. Mr. Jackson—
MR. JACKSON: In addition to bruising, what else might you expect to find in an individual who's been struck by a vehicle at speed?
JUDGE CANNONE: Let's come over.
MR. JACKSON: May I inquire?
JUDGE CANNONE: Yes.
MR. JACKSON: I forgot where I left off, so I'm just going to pick up. As best my memory can serve me — it has been suggested that Mr. O'Keefe's right arm, doctor, was injured by contact with the right rear tail light of Miss Read's 2021 Lexus LX 570.
MR. BRENNAN: Objection.
JUDGE CANNONE: No, I'm allowing that in.
MR. JACKSON: ...backed into him. That was a postulate put forward. Do you agree with that?
DR. LAPOSATA: Well, that's something to think—
JUDGE CANNONE: I'm going to strike that question and answer. Let me ask a different question.
MR. JACKSON: Do Mr. O'Keefe's patterned injuries on his right arm correspond to injuries that could have been produced by irregular fractured plastic pieces impacting his arm?
DR. LAPOSATA: No, not at all.
MR. JACKSON: Why do you say that?
DR. LAPOSATA: First of all, those injuries are patterned injuries from an animal bite. We have the canines; we have the incisors.
JUDGE CANNONE: I'm going to strike that. Let's see you at sidebar.
MR. JACKSON: May I, your honor?
JUDGE CANNONE: Yes.
MR. JACKSON: In your report, doctor, you indicated that Mr. O'Keefe's patterned injuries on his right arm do not correspond to injuries that could have been produced by irregular fractured plastic pieces impacting his arm. Do you recall putting that in your report?
DR. LAPOSATA: Yes, I wrote that.
MR. JACKSON: Do you stand by that?
DR. LAPOSATA: Yes, that's my conclusion.
MR. JACKSON: And you also wrote, "His arm had no tissue bruising from impact injury." Do you remember writing that?
DR. LAPOSATA: Yes.
MR. JACKSON: Do you stand by that?
DR. LAPOSATA: I do.
MR. JACKSON: You also wrote, "Neither did his skin show any array of irregular, unpredictable, randomly scattered cuts and scrapes at various angles and depths." Do you remember writing that?
DR. LAPOSATA: I did.
MR. JACKSON: Do you stand by that?
DR. LAPOSATA: I do.
MR. JACKSON: You also wrote that you noted Mr. O'Keefe had no bruising on his arms or torso. Is that right?
DR. LAPOSATA: Correct.
MR. JACKSON: And you also wrote, in particular, Mr. O'Keefe did not have bruises on his legs. Correct?
DR. LAPOSATA: Yes. Correct.
MR. JACKSON: And you indicated that that was shown by dissection of the leg tissue and muscle at autopsy. Is that right?
DR. LAPOSATA: Yes. There was a special leg dissection done to look for bumper impact.
MR. JACKSON: Okay. You reviewed the entirety of the medical records associated with the autopsy?
DR. LAPOSATA: Yes.
MR. JACKSON: Including photographs taken at the hospital.
DR. LAPOSATA: Yes.
MR. JACKSON: And autopsy photographs.
DR. LAPOSATA: Yes.
MR. JACKSON: And other data and documentation. Correct.
DR. LAPOSATA: Yes.
MR. JACKSON: Are x-rays an important part of an autopsy, generally?
DR. LAPOSATA: Oh yes, usually x-rays are taken of the body prior to the examination.
MR. JACKSON: What do x-rays show? Why are those important?
DR. LAPOSATA: They're important because they show foreign material in the body, like a bullet. They also image the skeleton, so we can look for fractures of the bones.
MR. JACKSON: May I approach?
JUDGE CANNONE: Okay.
COURT OFFICER: Please rise for the jury. [unintelligible] Be seated.
JUDGE CANNONE: Dr. Laposata, you can step out.
COURT OFFICER: All rise.
JUDGE CANNONE: I did receive another motion this morning for a curative instruction. I'm not going to even consider this today. We can consider this at the charge conference. So that's where we're at with that. All right. Work it out. If you can't work it out, let me know. I'll come out before the jury.
COURT OFFICER: All rise.
JUDGE CANNONE: Counsel, why don't I see you while the jury's coming?
MR. JACKSON: May I approach?
JUDGE CANNONE: Yes.
MR. JACKSON: On the court's bench, there's an item I'd like to retrieve back.
JUDGE CANNONE: Miss Gilman, we need that marked for identification. I need all three of them marked for identification. Okay. And we'll do that afterwards. Just please go ahead.
MR. JACKSON: You see any X-rays?
DR. LAPOSATA: I did.
MR. JACKSON: What were the X-rays of?
DR. LAPOSATA: The X-rays were taken of Mr. O'Keefe at the medical examiner's office, and they were X-rays of his chest, his arms, and his legs.
MR. JACKSON: Did you specifically review X-rays of his right hand, forearm, arm?
DR. LAPOSATA: Yes, they were included in the X-rays.
MR. JACKSON: Have you seen X-rays before?
DR. LAPOSATA: Oh, many times.
MR. JACKSON: How many times?
DR. LAPOSATA: Thousands, probably.
MR. JACKSON: Is part of your job to review X-rays to make a determination of whether or not they indicate broken bones, fractures, hairline fractures, things of that nature?
DR. LAPOSATA: Yes, it's part of the medical legal autopsy to study the X-rays of the deceased — that's done in the ordinary course of being a forensic pathologist.
MR. JACKSON: Is that right?
DR. LAPOSATA: Yes.
MR. JACKSON: Are you trained on how to read X-rays?
DR. LAPOSATA: Yes.
MR. JACKSON: You have to be a radiologist to [unintelligible] as a medical doctor?
DR. LAPOSATA: No. Medical doctors do that all the time. Correct. Yes. It's part of general medical training.
MR. JACKSON: And is it also part of specialized training for forensic pathologists?
DR. LAPOSATA: It falls under the rubric of general radiology that a doctor knows. There are some specialized areas in forensic pathology where you have to understand, like decompositional changes that you can see on an X-ray that aren't something that you would see in a clinical setting.
MR. JACKSON: Taking each appendage one at a time, did you look at the X-rays of Mr. O'Keefe's right hand?
DR. LAPOSATA: Yes.
MR. JACKSON: Did you see any defect in the bones of the right hand?
DR. LAPOSATA: No. No bony defects, and the tissue was normal.
MR. JACKSON: Did you take a look at the X-ray of Mr. O'Keefe's right arm?
DR. LAPOSATA: Yes.
MR. JACKSON: Did you notice any defects at all in the bones in the right arm?
DR. LAPOSATA: No. The bones in the right arm were intact. No breaks.
MR. JACKSON: Correct. No breaks, fractures, hairline fractures.
DR. LAPOSATA: No.
MR. JACKSON: Did you look at the upper arm X-ray of Mr. O'Keefe?
DR. LAPOSATA: Yes.
MR. JACKSON: Any defects in the bony structure of Mr. O'Keefe's upper arm?
DR. LAPOSATA: No. The bones were 100% intact. No breaks, fractures, hairline fractures. None of those.
MR. JACKSON: Was there any indication in your mind, based on your review of those three X-rays — the hand, the forearm — that that arm had suffered any kind of bone trauma at all?
JUDGE CANNONE: Sustained.
MR. JACKSON: Is there any indication, based on your review — is there an expert opinion — that his arm had been broken, fractured?
DR. LAPOSATA: No, the bones were intact. No breakage, no fractures.
MR. JACKSON: Thank you.
JUDGE CANNONE: Okay. Thank you. Cross-examination.
DR. LAPOSATA: Thank you.