Rolling Back the Roll Back of the Clock
Dr. Jeff Smith was the sole defense witness today.
Associate professor of emergency medicine, director of clinical operations at George Washington University Hospital, teacher, author, lecturer, board certified in emergency and internal medicine…you can see where this is going. Amy Richardson for the defense moves admitting Dr. Smith as an expert; Judge Leibovitz agrees, stipulating expert in emergency medicine. This will be important later.
Dr. Smith didn’t treat Robert, but reviewed ER records, EMT run sheets, the autopsy, and trial testimony of Dr. Goslinosky and EMT Jeff Baker.
Some basic facts were established. Robert was admitted to GW as “Trauma Yellow” – the highest level of mortal danger. Dr. Smith discussed the typical team on hand for Trauma Yellow:
1 supervising doctor, 2 interns, 1 supervising surgeon, 2 senior surgical residents, 1 senior anesthesthiologist, a minimum of 2 nurses, 2 technicians, 1 radiology technician and 1 respiratory therapist. All in an area about 10′ x 12′.
That’s 13 professionals, who were by record focused on the immediate conditions: young male, sharp force trauma, and PEA – pulseless clinical activity. The phrase ‘sharp force trauma’ is the second thing that will feature later.
From hereon, what can be said definitively – in court at least – is the subject of great debate.
Earlier we discussed PEA – what it is and what it signifies. “It signifies a dying heart,” said Dr. Smith, continuing, “…and it has a finite period of time. It would last no more than 12 minutes…” Untreated PEA, that is.
12 minutes: number three on the list of items that will become important later.
PEA was first detected by EMTs when Robert was put in the ambulance – as PEA can only be officially diagnosed with an EKG and a negative pulse. This happens at 11:59.
“This is an example of a perfect storm,” offered Dr. Smith, citing four reasons. “First, there’s the stab wound to the heart, and as a result of tamponade — ”
Dr. Smith gets no further before Judge Leibovitz asks the witness to step down for a bench conference. After several minutes of the scrum at the bench – and the husher blaring – Judge Leibovitz asks the witness to leave the courtroom so counsel can have a clear discussion. This is never done lightly.
Amy Richardson began, but quickly David Schertler stepped in to argue for what became obvious the defense wanted on the record.
Initially, everyone talked around it. Judge Leibovitz: “You haven’t laid the foundation to let this witness go there.” Schertler: “Your Honor, with all respect, we disagree, as this witness seems the best qualified to discuss his experience with PEA…”
In character, Leibovitz cut to the matter: “(this witness)…can’t testify as to the time of the stabbing…”
Not that it was a surprise. It was clear to courtroom observers the defense was working to “walk back the clock”, as the judge later termed it. In short: 11:59 PEA detected, PEA can’t last longer than 12 minutes, tamponade occurs within seconds of the knife wound…where’s the clock? 11:47, just a few moments before the 9-1-1 call at 11:49.
Post hoc, ergo propter hoc. Judge Leibovitz would have none of it. “Anybody can add and subtract as well as I can,” she offered, later adding, following vigorous argument from Schertler, “…I understand the argument, but it is not something that he (Smith) can say as an expert.”
Defense asked to move for break…lasting until 4:05. Amy Richardson began:
Richardson: Assuming there was tamponade, when would PEA have begun?
Smith: It depends on the acuteness of the tamponade. In this case —
Richardson: Assuming tamponade, when would PEA have begun?
Smith: PEA would have occured within several minutes of tamponade.
Lynn Leibovitz: Is tamponade a process or an event?
Smith: It’s a process.
Leibovitz: Once the process is underway, how long can it last?
Smith: You have to look at the acuteness of the trauma…
Leibovitz: Is there an end result, an end point of tamponade?
Smith: …you can still have pulse and tamponade.
At this point, the bench reminds counsel Dr. Smith is admitted as an expert in emergency medicine, but not cardiac tamponade. Meaning the following is not given the extra weight of expert testimony:
Richardson: Assuming acute injuries such as Robert experienced, how long before he would experience tamponade?
Smith: Within a minute or two…
Richardson: And when would PEA occur?
Smith: PEA will occur several minutes after.
Cross by Patrick Martin followed, attempting to raise questions as to how long untreated PEA could occur, when it was first detected, and what foundation exists for his :12 minute assertion.
Martin gained ground citing GWU nurse Luhan’s notes of PEA at 12:17, and lost ground when he tried to introduce a text critical of Smith’s theory, which Smith quickly rejected as non-definitive, out-dated and un-cited.
This, even with his own contribution to volume 2’s chapter on burns. Chuckles in the courtroom.
The levity soon evaporated. At Martin’s rest, Leibovitz prodded Dr. Smith for citations for the :12 minute claim. How do we know :12 minutes? “How many journals could I find that (make this claim…)” she pressed.
Back and forth following, with the judge telling the witness, in effect, ‘it doesn’t seem there’s any citation for this claim.’ This, and other interactions throughout the day, seemed to suggest not only Leibovitz’ experience in medical issues (malpractice, specifically), but a deeper gulf of language and practice between doctors and lawyers. Go figure.
Very brief redirect from Richardson and Bernie Grimm followed. Grimm introduced a peer-reviewed article from a publication (we didn’t catch what it was) regarding “Blunt Trauma…and Pulseless Electrical Activity: A Poor Ending Assured.”
The findings of the study, that PEA lead to death in about 9-some odd seconds, apparently bolstered Dr. Smith’s :12 minute assertion. But what was that title?
“Blunt Trauma…” Patrick Martin rose in objection to this item’s admission…notably as Robert died of Sharp Force Trauma. “I can read the title…” Leibovitz offered. Martin smiled; objection withdrawn.
Finally at 4:50, Dr. Smith was released from his interrogation.
“What’s the plan?”, asked Leibovitz on Dr. Smith’s departure. David Schertler said the defense may rest as early as Tuesday, with only six (possibly) witnesses.
See you Monday morning at 9:45am.