10A28641 2 2011-09-28 DepositionOfDrGeraldTGowittMD Ocr

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IN THE STATE COURT OF DEKALB COUNTY
STATE OF GEORGIA
PATRICK C. DESMOND and *
MARY C. DESMOND, Individually *
and MARY C. DESMOND, as *
Administratrix of the Estate *
of PATRIC W. DESMOND, *
*
Plaintiffs
vs.
CIVIL ACTION FILE
NO.: 10 A 28641 2
Page 1
NARCONON OF GEORGIA INC.;
DELGADO DEVELOPMENT, INC.;
SOVEREIGN PLACE, LLC;
SOVEREIGN PLACE APARTMENT
MANAGEMENT, INC.; LISA
CAROLINA ROBBINS, M.D.;
" *
*
*
*
*
*
*
DEPOSITION OF
GERALD T. GOWITT, M.D.
(With Signature Waived)
THE ROBBINS GROUP, INC.;
and NARCONON INTERNATIONAL,
Defendants
*
*
*
*
*
*
*
*
September 28, 2011
1:00 P.M.
3550 Kensington Road
Decatur, Georgia 30032 - 1328
Sharon S. Kelly, CCR, B-1594
ELITE REPORTING, I NC.
4070 Commodore Drive
Chamblee, Georgia 30341
770-457-1276
T " h nr
rn
Deposition of Gerald T. Gowitt, M.D.
IN THE Sf ATE COURT OF DEKALB COUNTY
STATE OF GEORGIA
PAlRICK C. DESMOND and
*
MARY C. DESMOND, Individually
*
and MARY C, DESMOND, as
*
Administratrix of the Estate
*
of PATIUC W. DESMOND,
*
*
Plaintiffs
*
*
vs.
*
*
NARCONON OF GEORGIA INC.; *
DELGADO DEVELOPMENT, INC.; *
SOVEREIGN PLACE, LLC; *
SOVEREIGN PLACE APARTMENT *
MANAGEMENT, INC.; LISA *
CAROLINA ROBBINS, M.D.; *
THE ROBBINS GROUP, INC.; *
and NARCONON INTeRNATIONAL, *
Defendants
*
*
*
CIVIL ACTION FILE
NO.: 10 A 28641 2
DEPOSmONOF
GERALDT. GOWITT, M.D.
{With Signature Waived)
September 28, 2011
1:00 P.M .
3550 Kensington Road
Decatur, Georgia 30032-1328
STATE OF GEORGIA
COUNTY OF DEKALB
Sharon S, Kelly, CCR, B-1594
EliTE REPORTING, INC.
4070 Commodore Drive
Chamblee, Georgia 30341
770457-1276
DISCLOSURE
Deposition of: Gerald T. Gowitt, r"vl.D.
Taken: September :28, 2011
Pursuant to Article 10.B of the Rules and Regulations of he
Board of Court Reporting of the Judicial Council of Georgia, I
make the follo\'ling disclosure:
I am a Georgia Certified Court Reporter;
I am not disqualified for a relationship of Interest under
the provisions ofO.C.G.A. Section 911:28(c);
I am here as a representative of Elite Reporting, Inc.;
Elite Reporting, Inc. was contacted by Weinberg, Wheeler,
Hudgins, Gunn & Dial to provide court reporting servlces for
this proceeding; ancl
Elite Reporting, Inc. will not be taking this proceeding
under any contract that is prohibited by Georgia law.
Tills, the 16th day of October 2011.
SHARON S. KELLY, CCR B-1594
2 -
APPEARANCES OF COUNSEL
On behalf of Plaintiffs:
JEFFREY R. HARRIS, ESQ.
Harris, Penn, Lowry, LLP
405 East Perry Street
Savannah, Georgia 31401
912-651-9967
On behalf of Defendants Narconon of Georgia, Inc. and
Narconon International:
BARBARA A, MARSCHALl<, ESQ.
Drew, Ecld, Farnham
P.O. Box 7600
Atlanta, Georgia 303570600
404-885-6322
On behalf of Defendants Usa Carolina Robbins, M.D. and
The Robbins Group, Inc.:
ROBERT G. TANNER, ESQ.
Weinberg, Wheeler, Hudgins, Gunn & Dlal, LLC
3344 Peachtree Road, NE, Suite 2400
Atlanta, Georgia 30326
404-8762700
On behalf of Defendant Delgado Development, Inc.:
SEAN L HYNES, ESQ.
Downey & Cleveland, LLP
288 Washington Avenue
Manetta, Georgia 30060
7704223233
. 3.
INDEX TO DEPOSffiON
Cross-examination by Ms. Marschalk
Cross-examination by Mr. Tanner
Cross-examination by t-1r. Hynes
Direct examination by Mr. Harris
INDEX TO EXHIBITS
Defendant's
Exhibit No. Description
1 CV of Gerald T. Gowitt, M.D.
2 Testimony list
3 Dr. Gowitt's Entire File (original file
retained by Dr. Gowitt)
4 Letter from DavidS. Bills to Gerald
T. Gowitt, M.D. Dated May 29, 2009
5 Investigator's Report
6 Initial Notification of Death,
Investigator Notes
7 Samples Taken
8 External Examination Report
9 GBI Toxicology Report
10 GBI Blood Alcohol Report
Plaintiffs
Exhibit No. Description
1 Northside Hospital Lab Reports
-4
Page
5, 91
71,92
76
80
Page
Marked
5
8
21
26
33
35
51
54
65
65
Page
Marked
87
Elite Reporting, Inc.
7704571276
1
2 MS. MARSCHAll<: This will be the deposition of
3 Dr. Gerald T. Gowitt, taken pursuant to notice and by
4 agreement of the parties for discovery and all purposes
s allowed under the Georgia Civil Practice Act. Jeff, can
6 we have the agreement that all objections, except for to
7 form of the question or responsiveness of the answer, are
8 reserved until first use of the deposition?
9 MR. HARRIS: What do you think?
10 MS. MARSCHALK: I think the answer Is yes.
11 MR. HARRIS: Absolutely.
12 MS. MARSCHAll<: And, Dr. Gowitt, have you
13 thought about whether you wanted to reserve signature or
14 walveit?
15 DR. GOWITT: I'd prefer to waive.
16 MS. MARSCHALK: Okay. Would you please swear
17 Dr. Gowltt.
18 Whereupon,
19 GERALD T. GOWITT, ~ 1 . 0 . ,
20 having been first duly sworn, was deposed and testified as
21 follows:
22 CROSS-EXAMINATION
23 BY MS. MARSCHALK:
24 Q Dr. Gow1tt
1
I Introduced myself to you just a couple
25 of minutes ago. My name Is Barbara Marschaik. I'm a lawyer
-5-
1 at Drew
1
Eckl and Farnham here n town and my firm represents
2 Narconon of Georgia In a lawsuit that has been brought against
3 It and other entities by the family of Patrick Desmond, And I
4 understand that you were Involved somewhat with respect to
5 doing the Inquiry and an external examination of Patrick
6 Desmond after he died?
7 A That's correct.
8 Q Before we got started thls afternoon, you gave me
9 the opportunity to look through your original file and we're
10 going to talk about that In a moment, but I think we'll be
11 able to shortcut a lot of the questions that I have about your
12 background if we mark your OJ as Exhibit No. 1.
13 (Defendant's Exhibit No. 1 was marked for
1'4 Identification.)
15 Q And I'll just hand you what we've marked as Exhibit
16 No. 1, Doctor. Is that a copy of your most current CV?
17 A Yes.
18 Q And does that Cl/ accurately reflect your education?
19 A Yes.
20 Q Does It accurately reflect your experience?
21 A Yes.
22 Q And does it accurately reflect your publications?
23 A It does.
24 Q Is there anything -- I see that this has been
25 revised September of 2011?
-6-
A Correct. 1
2 Q Is there anything that needs to be added or changed
3 on this OJ?
4 A No.
5 Q And I also understand, Doctor
1
that you have
6 prepared a Jist, a very lengthy list of all of your -- is it
7 fair to say that this Is civil testimony?
8 A It's civil testimony and civil -- It's cMI
9 depositions and civil trials going back to the year 2000. It
10 really needs to be thinned out but that Is for the I ast ten
11 years, eleven years or so.
12 Q Okay. This does not Include whatever testimony you
13 may have given In criminal cases?
14 A There are no criminal cases in that document.
15 Q Does this include cases sort of like this one where
16 you're not actually being -- you haven't actually been
17 retained by one of the parties?
18 A Yes. And the way you can tell that, Counselor, ls
19 here I've put ''wrongful death, plaintiff_" Somewhere on here
20 I've probably got a defense one, but wrongful death,
21 plaintiff, wrongful death, plaintiff, etcetera, et cetera.
22 On the ones that are part of my official duties that come to
23 deposition, I might put "wrongful death" but It will be
24 neutral because I haven't been retained by either side. I
25 haven't met with either side on this particular case. One
-7-
1 attorney
1
I did meet with him, but I don't think he's alive
2 anymore.
3 Q Did you meet with Kirk?
4 A Kirk and another attorney. !forget who. I've
5 never heard another word from him.
6 Q David Bills?
7 A Correct.
8 Q And we'll talk about that in just a couple of
9 minutes.
10 What I'd like to do Is mark your testimony list as
11 Exhibit No. 2, and sitting here today on September the 28th
12 2011, do you know when this Is current through?
13 (Defendant's EXhibit No. 2 was marked for
14 Identification.)
15 A Oh, sure. It's through today.
16 Q Does this Include actually the Desmond case on It?
17 A No. It would not because, you know
1
I never know if
18 y'all are going to show up or not. But It includes through
19 September 7th which was my last deposition, Cole versus
20 Georgia-Carolina Foods
1
Inc.
21 Q So the only update that would need to be made to
22 Exhibit No. 2 Is the deposition that you're giving here today
23 in this case?
24 A Correct.
25 Q This also identifies the name of the case, the type
- 8-
7704571276
1 of case that It is, the attorneys Involved In the case?
2 A Just the ones that retained me, not who took my
3 deposition;
4 Q And the date of the testimony7
5 A And where It was given.
6 Q Perfect. Very briefly, I'm not going to run through
7 all the specifics in your OJ, Doctor, but tell me when you
8 graduated from medical school.
9 A 1982.
10 Q And where did you do your residency?
11 A Emory. Well, It's actually Emory University
12 Affiliated Hospitals and at the time that was Emory, Grady and
13 the Atlanta Veterans Hospital .
14 Q And when were you actually licensed as a physician?
15 A 1983 here in Georgia.
16 Q Have you held licenses In any other states?
17 A No.
18 Q Has your licence in Georgia ever been disciplined In
19 anyway?
20 A No.
21 Q Did you do a fe[Jowshlp?
22 A Yes.
23 . Q Where was your fellowship?
24 A Fulton County Medical Examiner's Office In the field
25 of forensic pathology.
. 9.
1
Q
And are you board certified?
2 A I am.
3 Q In what?
4 A Anatomic, Clinical and Forensic Pathology.
5 Q
When did you become board certified?
6 A Anatomic and Clinical, 1986 and Forensic in 1987.
7 Q
Have you practiced as a forensic pathologist since
8 graduating from medical school?
9 A Yes.
10 Q Have you ever held any other jobs as far as, you
11 know, maybe da.bbled In internal medicine or any other field?
12 A Oh, no. I've dabbled In other fields of pathology.
13 I was a hospital pathologist part time from, roughly, '87
14 through '92. l'm still the director of the laboratory at
15 Georgia Regional Hospital here In Atlanta.
16 Q I saw that. How long have you been the director oF
17 the laboratory there?
18 A At least twenty years. Let's see here. From 1989
19 through today.
20 Q Tell me what your responsibilities are as directory
21 of that laboratory.
22 A I make a site visit there once a month. It's
23 largely an administrative role. I go over the quality control
24 surveys, occasionally write a letter disciplining somebody,
25 oversee raises and things like that but I don't do any
- 10-
1 actually hands-on work there, if that's what you mean.
2 Q Are you involved in any way with the development or
3 implementation of policies and procedures in that lab?
4 A Just In the lab.
5 Q Give me an example on that.
6 A When the urinalysis Is done, when a microscopic is
7 reported, what are the critical values for notifying a
8 clinician for In the laboratory tests, the low and the high.
9 As a mater of fact, we just revamped all of that for some
10 organization you may know called the JCAHO.
11 Q Yes, sir. How often are those policies and
12 procedures revised?
13 A They're looked at once a year. They may not be
14 revised very often. It depends on if they need revision. But
15 we just looked at them all about six months ago and revised a
16 good many of them.
17 Q ~ s there like a group of people who are involved In
18 that process?
19 A It would be me and the laboratory supervisor.
20 Q Are you the chief medical examiner of DeKalb County?
21 A I am.
22 Q And I thought I saw somewhere that you were an
23 independent contractor?
24 A I am.
25 Q Do you have a separate company that you actually
- 11-
1 work for?
2 A Correct.
3 Q And what's the name of that company?
4 A Forensic Medicine Associates, Incorporated.
5 Q Do you own that company?
6 A My wife and I own it together.
7 Q How many employees does it have?
S A Well, let's see. W-2, It would be one, two, three,
9 four, five, six and then 1099, probably another half dozen.
10 Q How many physicians are employed with that group?
11 A Three.
12 Q Who are they? You?
13 A Or. Geoffrey, spelled Geo (spelling) ffrey Smith
14 and Dr. Jon, spelled Jon (spelling) Eisenstat,
15 Elsen-s-t-at (spelling).
16 Q And how long have you had this company?
17 A Since 1994.
18 Q Have you been contracting as the DeKalb County chief
19 medical examiner through that company?
20 A Yes. If you were to look at my contract, Counselor,
21 It's not with me.
22 Q Right.
23 A DeKalb County has entered into an agreement with
24 Forensic Medicine Associates.
25 Q When did y'all enter Into that agreement?
- 12-
7704571276
Deposition of Gerald T. Gowitt, M.D. fDJ.ftJ.gfilfi1f(.IIf;p

1 A 2000. 1 Q Just to C?nflrm, Doctor, you are appearing here
2 Q Did you contract with another county before 2 today as an Independent witness?
3 contracting with - 3 A Correct.
4 A Oh, I was the deputy chief medical examiner prior to 4 Q You have not been retained by any party to act as an
5 that time from '95 through 2000 here when Joseph Burton was 5 expert witness?
6 the chief medical examiner. 6 A Correct.
7 Q I know him very well. I understand that you also 7 Q Tell me how you became Involved with Patrick
8 act as a medical examiner for other counties? 8 Desmond.
9 A Sure. 9 A Okay, Mr. Desmond's death was reported to our
10 Q What counties are those? 10 office, specifically, Investigator John Henson, on June 10th
11 A Hall, Henry, Whlte
1
Rockdale, sometimes Barrow
1
and 11 2008 at 6:40P.M. At that time Investigator Henson was
12 occasionally Gwinnett. 12 contacted by Trlsha Buice
1
a nurse a Northside Hospital
1
who
13 Q When you say "occasionally/ what does thatmean? 13 reported the death to us.
14 A I cover for Dr. Terry when she's out of town or If 14 Q Once this death Is reported to your investigator,
15 she's in court or something !Ike that. It might be very 15 how did things proceed?
16 impromptu. She might call me up tomorrow morning and say
1
can 16 A He gets as much Information as he can from that
17 you handle some cases at my facility because I need to be out 17 nurse at the time and then, If he deddes to accept
18 of town. 18 jurisdiction In the case
1
and he did In this case, then he
19 Q Does your company contract with those counties as 19 would call our transport service to go pick up the body.
20 well? 20 Q Why would Northside Hospital call your office on
21 A There's no written contract with any of them, as 21 this type of situation?
22 strange as that may sound. It's all on a handshake. 22 A Because It's the Jaw. Under Georgia Code 45-16-20
23 Q Is It your that you have an 23 any nonnatural death that initiated in DeKafb County is
24 Independent contractor relationship with those counties? 24 reportable to our office.
25 A Oh, absolutely. They don't take any withholding, 25 Q And, once that Is reported to your office
1
your
- 13- - 15-
1 social security or anything like that out of my check.
2 Q How are you compensated by those counties? Is it
3 based on the number of cases that you review?
4 A In Hall and In Henry It's just a monthly fee. In
5 Rockdale It's per case and in Barrow It's per case.
6 Q Have you been affiliated with the GBI7
7 A I have,
8 Q When were you affiliated with the GBI?
9 A 1989 through 1996.
10 Q In what capacity were you affiliated with the GBl?
11 A More or less a consulting medical examiner. I was
12 the deputy chief medical examiner of Fulton County at the time
13 and our office In Fulton had a contract with the GBI that the
14 doctors In Fulton would provide medical examiner services for
15 the GBI certain days of the week.
16 Q Who was the chief medical examiner at the time?
17 A Dr. Safi, 5-al-i (spelling), Zakl, Z-ak-1
18 (spelling). You've got a lot of names here today that are
19 going to require spelling.
20 Q So
1
when you left Fulton County, your affiliation
21 with the GBI ended?
22 A It did.
23 Q Because you no longer were part of the county that
24 had the contract?
25 A That's correct.
- 14-
1 Investigators then perform some Investigation?
2 A Yes.
3 Q And, based upon that Investigation, to make a
4 determination about whether or not to accept the case?
5 A That's also correct.
6 Q And when you say that he made the decision to accept
7 jurisdlction
1
what does that mean?
8 A That It now becomes our death. In other words, it's
9 no longer Northside Hospital's problem, so to speak. It's our
10 problem of what to do next.
11 Q And what factors go into your Investigator's
12 decision process In formulating that decision?
13 A It's really following the Georgia Code, If someone
14 dies nonnaturally and we consider Mr. Desmond to have not died
15 a natural death, then that's an automatic acceptance for us.
16 We may not bring the body In on all of these, but we would
17 certainly accept jurisdiction because the only people who can
18 sign a death certificate In a nonnatural death Is a coroner or
19 a medical examiner. And, since there's no coroner in DeKalb
20 County
1
that leaves It to me.
21 Q Right. And when you're talking about statutory,
22 you're talking about the Georgia Death Investigation Act?
24 Q And I think that the statute Is actually noted in
25 your records?
- 16.
7704571276
1 A It Is. 451620.
2 Q O.C.G.A. 451620, correct?
3 A Correct.
4 Q Now when you say the bodies are not always brought
5 in here, who makes that determination?
6 A Most often my investigator but if they have any
7 questions, they'll call me or the doctor on call.
8 Q And, again, what types of factors go into your
9 Investigator's decision tree process when making that
10 dedslim7
11 A If you're going to do anything to a body, you want
12. to be able to answer a question or one or more questions,
13 actually. In this particular case, the question I want to
14 answer Is: Was there any evidence of trauma to this young man?
15 Q And when you say you wanted that question answered,
16 did your Investigator contact you to discuss the
17 circumstances?
18 A No.
19 Q Is that something that your Investigator made the
20 call to do was to bring him in, bring Patrick Desmond's body
2.1 In?
22 A Absolutely.
23 Q Backing up for just a minute, Doctor, can you tell
24 me what your fee schedule is when you're acting as an expert
25 witness retained by a party in a clvil case?
. 17-
1 A Is that for chart revlew or deposition or trial or
2 which part of that?
3 Q Excellent clarlfication. Let's break it down. My
4 guess Is that you have a rate structure --
5 A I do.
6 Q --based upon the type of work that you're doing?
7 A Correct.
8 Q And that structure Includes a fee associated with
9 chart review?
10 A Correct.
11 Q And what Is that hourly rate?
12 A Four hundred per hour.
13 Q And do you break It down hourly or by increments
14 within that hour?
15 A No; just hourly.
16 Q In other words, If you spend seventeen minutes
17 looking at a file, do you bill the entire hour?
18 A I do not, I won't bill anything for something like
19 that.
20 Q Okay, So it's four hundred dollars an hour for a
21 chart review?
22 A Correct.
2.3 Q What about consultation with attorneys?
24 A Same thing.
25 Q Four hundred dollars per hour?
- 18-
A Correct.
2 Q And what about deposition testimony?
3 A Ave hundred for the first hour, one hour minimum
4 and then each hour after that is prorated on the half hour.
5 So If we were to go till 2:15,let's say, I would bfll you or
6 somebody seven hundred and fifty dollars.
7 Q When you say that It's prorated, how Is that
8 prorated?
9 A On the half hour.
10 Q Okay. But it's still five hundred dollars an hour?
11 A Correct.
12 Q It doesn't go up? In other words, I've had some
13 doctors whO, after the first hour, the fee goes up.
14 A Well, after thts deposition, Counselor, you're going
15 to have to show me how to justify that because that sounds
16 like a right smart idea to me. In other words, I could be
17 charging a thousand from 2:00 to 3:007
18 Q It happens.
19 A Personally, I think that's unethical.
20 Q Well, I appreciate that, Doctor, and so do my
21 clients.
22 Tell me what you charge for trial testimony.
23 A Where are we golng?
24 Q Well, sounds like there's a caveat in there. Are
25 there different fee structures depending on which counties you
- 19-
1 testify In 7
2. A Which place I go. For Instance, if we go to the
3 metro area, It's twenty five hundred dollars a day. Outside
4 the metro area, It's three thousand dollars a day but still in
5 the state of Georgia. And then outside the state of Georgia,
6 it's five thousand dollars a day.
7 Q When you say "metro area," which counties do you
8 consider to be within the metro area?
9 A The ten that are In the Atlanta Regional Commission,
10 I can tick them off if you like, but that's what I would
11 consider the metro area.
12. Q All right. And, again, nobody has paid you from
13 either side of this civil case? Nobody has given you any
14 money outside of what you'll be paid for your deposition
15 testimony here today?
17 Q If we could, Doctor, we t a l k e ~ a little bit about
18 this before your deposition. What I would like to do at this
19 time Is mark your entire file as Exhibit No. 3.
20 MS. MARSCHALK: And for the r&ord, the parties
21 have agreed to aU ow Dr. Gowitt to maintain possession of
22 the origlnal of Exhibit No.3 and what we will do is we
23 will cull o1.1t certain documents and make them separate
24 exhibits if we want to talk about them separately; falr?
25 MR. TANNER: Right.
20-
770-457-1276
L
2
MR. HARRIS: That's fine.
MR. HYNES: Fair.
4 Identification.)
5 Q (By Ms. Marschalk) Doctor, just for the record,
6 what I'd like to do is tick off the different folders that you
7 have In the record that you have brought here today. First,
B let me ask you this: Is what we have marked as Exhibit No. 3,
9 does this constitute the entire file that you have concerning
10 Patrick Desmond?
11 A lt does.
12 Q Has anything been removed from the file?
13 A Not be me.
14 Q Looking through the file before your deposition, did
15 you notice anything conspicuously missing?
16 A No, not at all.
17 Q And it [oaks like you have actually organized the
18 file Into separate file folders?
19 A Yes.
20 Q And those file folders are marked Investigator's
21 Report?
22 A Correct.
23 Q
And there's one for the deposition notice?
24 A Yes.
25
Q
Correspondence?
- 21-
1 A Yes.
2
Q
M.E. Report?
3 A Correct.
4 Q
Photos?
5 A Correct.
6 Q DeKalb Fire Rescue?
7 A Yes.
8 Q
Death certificate?
9 A Yes.
10 Q Northside Hospital records 7
11 A Correct.
12
Q
Which appears to be a portion of the full record?
14 Q And then there's another folder that sort of looks
15 like a hodgepodge?
16 A Yes. That's what It Is actually. Miscellaneous for
17 documents that I don't feel are particularly Important to our
18 discussion today.
19 Q And then you have a blue folder in here marked for
20 Northside medical records?
21 A Yeah. That should be the complete record.
22 Q In preparing for your deposition, Doctor, did you
23 review the documents contained In Exhibit No. 37
24 A Yes.
25 Q Did you review any other documents?
-22-
1 A Yeah. Sure, It would have just been a quick peek
2 at the therapeutic and lethal levels of morphine. I can never
3 remember these things.
4 Q I'm shocked,
5 A There's people who can but I'm not one of them.
6. Alcohol, yeah
1
because I see it all the trme. Morphine, not
7 so much.
8 Q And we're going to talk about this separately. So
9 it looks like maybe you did some research about the
10 therapeutic and lethal levels of morphine?
11 A Correct.
12 Q Did you do any-- Rrst of all, how did you do this
13 research?
14 A 1 have three or four toxicology books I can pull rt
15 out of. Basert, B-a-s-e-1-t (spelling) toxicology book.
16 There's another one but the name escapes me that I keep on my
17 desk and then there's some printouts by Dr. Charles Winek,
18 W+n-e-k (spelling) will also give therapeutic and toxic and
19 lethal levels of medications. There you go. You've got one
20 right there.
21 Q Wlnek's Drug and Chemical Blood-Level data?
22 A Yeah. The only reason I don't use that too much
23 anymore, look at the date on It, I mean, It's like ten years
24 old and there's been a lot written since then. And there's
25 more books that have a little bit better delineation. In his
- 23-
1 you've got to constantly change the units on it. This Is all
2 reported out In mflligrams or micrograms per liter. He
3 reports a lot of stuff in micrograms per milllllter. You've
4 got to be careful with the decimal points.
5 Q Or nanograms per--
6 A Even more careful when you get there.
7 Q Right. Do you remember which source you went to,
8 Doctor?
9 A Not right off the top of my had. But If you see the
10 way I wrote it down, and there was a special way I wrote it
11 down. The therapeutic is up to a hundred micrograms per !Iter
12 but the lethal can be as low as fifty. So what you have,
13 Counselor, let me just draw this real quick. Instead of
14 having therapeutic and letha[
1
you've got therapeutic, toxic,
15 and lethal that all overlap each other. Quite a bit of
16 overlap, in fact.
17 Q You have concentric circles?
18 A Yeah, that's right.
19 Q And not necessarily separate?
20 A Yeah, that's right
21 Q And we're going to talk about that in just a few
22 minutes.
23 A I'm getting back to your original question. That
24 would have been the only other research or documents that I
25 would have looked at In preparation for today.
- 24-
7704571276
1 Q Okay. Have you been given, Doctor And I think I
2 know the answer to this, but have you been given any documents
3 associated with this civlllawsult?
4 A No.
5 Q Have you been given any of the depositions?
6 A No.
7 Q Have you discussed this civil lawsuit with anybody?
8 A No.
9 Q I understand that at some point you had some
10 correspondence or discussions with a fellow by the name of
11 Kirk Post?
12 A Correct.
13 Q And Kirk was, from my understanding, a hybrid of
14 sort of an lnvesti gator {attorney?
15 A Yeah. I guess you look at It that way. He was a
16 hybrid all right.
17 Q And Klri<, unfortunately, is no longer among the
18 living?
19 A Correct.
20 Q Can you tell me, do you know when you were first
21 contacted by Kirk?
22 A I think we can go to the correspondence file and
23 . find a l.etter In here from Mr. Bills that would probably
24 answer your question. I have a letter from David Bills dated
25 May 29th 2009 and that was asking me to retain any blood
- 25.
1 samples we had on Mr. Desmond, and
1
I believe we had met
2 either just before or just after that.
3 Q And when you say ''we had met:," who was at that
4 meeting?
5 A Kirk Post, Mr. Bills, and probably one of my staff,
6 probably John Henson who was the chief investigator on this
7 case.
8 Q Do you remember generally what the circumstances of
9 that meeting were?
10 A You know, I really don't remember very much about
11 it. It didn't Impress me a whole lot, I guess. I don't
12 remember really very much of what was sald other than we would
13 get the blood back from the crime lab and hang on to it for
14 them.
15 Q And one of the things that I note in the letter from
16 Mr. Bills and we'll mark this, Doctor. If we could pull
17 this out because it looks like you actually have an extra
18 copy.
19 A Um-hum.
20 Q So what we'll do Is I'll mark the copy as Exhibit
21 No. 4.
23 identification.)
24 Q And it looks like In this letter that Mr. Bills
25 wanted you to consider ordering additional lab tests --
- 26-
1 A Correct.
2 Q
- checking different substances?
3 A Correct.
4 Q
And he wanted you to specifically check, It looks
5 like six different levels?
6 A Also correct.
7 Q Did you actually send the blood out for additional
8 testing?
9 A Absolutely not.
10 Q It looked like from my review of the correspondence
11 file that your response was that he was more than welcome to
12 do that?
13 A If he wants the blood -- In fact, we still have the
14 blood, which Is two years later, and, If he wants to send it
15 out for additional testing, he's perfectly welcome to do that.
16 Q Do you know whether or not he's ever requested the
17 blood to send it for additional testing?
18 A Not as far as I know.
19 Q Do you know, Doctor, whether anybody has requested
20 the blood to send It for additional testing?
21 A Again, not as far as I know,
22 Q Does Forensic Medicine Associates still have Patrick
23 Desmond's blood?
24 A Well, it would actually be the DeKatb Medical
:25 Examiner's Office but, yes, we do.
- 27-
1 Q How is it being stored?
2 A In a cooler. We have bins with different years on
3 them and his would be in the 2008 year.
4 Q Would the Integrity of the sample be affected In any
5 way by the amount of time that has gone by?
6 A I think so. It wouldn't be much of what you would
7 analyze today.
8 Q And that's because of the amount of time that has
9 been elapsed since the blood was originally drawn?
10 A That's correct, You know, Counselor, these drugs
11 deteriorate perhaps at a slower rate If you have a
12 preservative in them and we have tubes With preservative but
13 they still deteriorate over time. So, while you might still
14 get a positive morphine level, I would submit to you that it
15 would probably be lower than what we got when we analyzed
16 Patrick's blood for the first time. And, by the way, we
17 didn't use autopsy blood the first time either. So that blood
18 really hasn't been analyzed.
19 Q Right. I'm going to talk to you about the different
20 types of blood samples that we have available.
21 Outside of this meeting that took place sometime
22 around the time frame of May the 29th 2009, do you recall
23 having any other meetings with Mr. Bills?
24 A I don't.
25 Q Do you recall having any other meetings with Mr.
- 28.
770-457 1276

1 Post specifically about this? 1 seeing this?
2 A No. I don't think I even -- Well, he may have come 2 A l don't.
3 by about something else but not about this. 3 Q It looks like my firm actually requested records
4 Q Since the May 2009 time frame, Str, have you had any 4 generated by this office associated with the death of Patrick
5 communicatlons with any lawyers other than the request for the 5 Desmond on August the 3rd of 2010. Do you have any
6 medical records that you have received from the various 6 recollection of speaking with anybody from my office about
7 parties? 7 this?
8 A No. 8 A No. Generally, these record requests don't go
9 Q If I could just take a quick peek, what we'll do Is 9 through me.
10 make a copy of Exhibit 4 and put !t back in your file. 10 Q Do you have somebody else who handles that?
11 A Okay. 11 A Either Pat Bailey, John Henson, or our records
12 Q Let me just take a quick peek at this correspondence 12 clerk.
13 file and see if there is anything else that we need to delve 13 Q And then finally It looks like there are a couple of
14 Into. 14 email pages In here about the scheduling of this deposition?
15 It looks !Ike you were ortglnally contacted by a 15 A Yes.
16 lawyer in Viera, Florida by the name of Gregory- I'm going 16 Q To your knowledge, Doctor
1
Is there any additional
i 7 to butcher this -- Eisenmenger on July the 3rd 2008? 17 correspondence relating to the death of Patrick Desmond that
18 A Mr. Bailey might have been contacted. It wasn't me. 18 Is not contained within this file?
19 Mr. Batley Is our office manager. 19 A Not that l'm aware of,
20 Q You don't remember having any conversations with Mr. 20 Q Dld you generate any documents outside of those that
21 Eisenmenger? 21 are contained in Exhibit No. 37
22 A I do not, 22 A No.
23 Q It looks like somebody from Narconon also requested 23 Q It appears from a review of the file, Sir, that the
24 the autopsy report on September the 26th 2008? 24 source of Information that you would have about Patrick
25 A Yeah, that's correct. They would have sent It to 25 Desmond's death, all of those sources would be contained
- 29- - 31-
1 our records custodian at the time, who was Adres (phonetic)
2 Dennis,
3 Q Did you have any communication with anybody from
4 Narconon of Georgia that you can recall?
5 A No.
6 Q It looks like another woman by the name of Susan
7 Friend has requested a copy of the autopsy report and any
8 other records pertaining to the death of Patrick Desmond. And
9 it looks like Susan Friend made this request pursuant to the
10 Open Records Act on November the 19th 2008 and that your
11 office responded on February the 6th 2009?
12 A Correct.
13 Q Do you know who Susan Friend Is?
14 A I have no Idea.
15 Q You don't remember having any conversations with
16 her?
17 A No.
18 Q All right. It looks like there may be one
19 additional letter In here from Mr. Bills and it looks like it
20 may have been sent to Patrick Bailey which is why you don't
21 have any specific recollection of it. It looks like It's just
22 a letter of representation and a request for the records along
23 with a copy of the letters of administration?
24 A Correct.
25 Q Do you have any knowledge or recollection of you
- 30-
1 within Exhibit No. 3?
2 A Correct.
3 Q And by sources, we're talking about thinks like the
4 Northside Hospital records and your investigator's background
5 Investigation?
6 A Correct. The EMS report. And I think that would be
7 pretty much it.
8 Q In other words, I just need to make sure that I
9 confirm for the record that you yourself have not conducted
10 any personal investigation outside of what rs contained In
11 Exhibit No. 3?
13 Q For example, you haven't interviewed nurses at
14 Northside Hospital?
15 A No.
16 Q You haven't spoken with the family?
17 A No.
18 Q You told me earlier about consulting one or more of
19 the toxtcology books that you use as references here in your
20 office, Do you know whether or not, Doctor
1
you did any
21 online research?
22 A l did not.
23 Q We talked a little bit, sir, about how you came to
24 be involved In this case under the Georgia Death Investigation
25 Act.
- 32-
770-457 1276
1 A Yes.
2 Q And I believe that you told me that your
3 investigator took the initial Intake?
4 A That's correct.
5 Q And performed some background Investigation?
6 A Correct.
7 Q And that based upon that background investigation,
8 made the determination to maintain jurisdiction and bring the
9 body here?
10 A Correct.
11 Q And It's my understanding, sir, that you actually
12 generated an Investigator's Report?
13 A Yes, that's true.
14 Q And this report Is actually contained within Exhibit
15 No. 37
16 A Yes.
17 Q The report appears to be a three page report?
18 A Yes.
19 Q And it's signed by John Henson?
20 A Correct.
21 Q And what I'll do Is I actually have extra copies of
22 that so 1'11 mark that.
23 (Defendant's Exhibit No. !:i was marked for
24 ldentiflcatlon.)
25 Q I'm going to hand you, sir, what I've marked as
33.
1 Exhibit No. 5. Does that appear to be a copy of what is
2 contained within your original file?
3 A Yes, it does.
4 Q And this Investigator's Report, the title seems to
5 Indicate that it's actually prepared by your Investigator?
6 A It is.
7 Q Are you involved In the preparation of
8 Investigator's Reports?
9 A Generally, no.
10 Q Do you typically review the Investigator's Reports?
11 A Let me tell you how the process works.
12 Q That'll be perfect.
13 A John would have written up this what we call a pink
14 sheet so that when I have the body In front of me the next
15 day, I have this information. He dictates this and one of our
16 secretaries transcribe it but It might be several days before
17 you get that back. Generally, before I sign a case out, I'll
18 review the Investigator's Report probably at the tlme I get
19 the toxicology back.
20 Q So at the tlme you performed the actual examination
21 or autopsy, depending on what you're going to perform, you
22 have access to what you refer to as the pink sheet?
23 A Correct.
24 Q And what we'll do, Doctor, is we'll mark the pink
25 sheet as Exhibit No. 6.
- 34-
2 Identification.)
3 Q It looks like this is a handwritten document
4 entitled Initial Notification of Death, Investigator Notes?
5 A Correct.
6 Q And the writing on this would be written by your
7 Investigator?
8 A Itwould.
9 Q And you would review this at the time that you
10 received the body?
11 A Correct.
12 Q And then before you finally sign off on your report
13 or dictate your report or fi nallze your report, however you
14 want to phrase It, you would then have access to the
15 Investigator's Report?
16 A Nso correct.
17 Q You don't go back and doublecheck the facts
18 contained in the Investigator's report?
19 A Generally, no.
20 Q You are simply relying on the Information that he
21 has put on the pink sheet and the typewritten Investigator's
22 Report?
24 Q And then my understanding is that you performed an
25 external evaluation of-- or external examination of Mr
- 35-
1 Desmond?
3 Q And tell me why the decision was made to just do an
4 external examination versus an autopsy?
5 . A Because he had been In the hospital for the better
6 part of twenty hours. Tl1ey had done a head CAT scan on him
7 which didn't show much of anything, and he was otherwise
s healthy as far as we knew except for hls addiction problems
9 and historical information provided to us sounded like a drug
10 and/or alcohol Intoxication problem.
11 Q If you would have done an autopsy -- My
12 understanding is as far as what you do in a more specific
13 autopsy Is that you're looking more for a mechanism of death?
14 A Well, you can be looking for a cause too. As I say,
15 a lot of that had been done for me by the hospital
16 particularly the head and laboratory studies showing no
17 significant abnormalities.
18 Q Did you speak with the family about doing an
19 autopsy?
20 A No.
21 Q Had the family requested an autopsy, would you have
22 performed one?
23 A I don't honestly know the answer to that question,
24 Counselor. I tty not to cut open too many people. You know,
25 the State has given me an enormous amount of authority to
36.
770457 1276
1 autopsy anybody that I want family permission, but I
2 think you have to use that power wisely. If I think It's
3 necessary, I'H do It, but if I think It's not-- just to open
4 people for the sake of opening people is not really how I
5 practice medicine. so, If the family had asked me and they
6 had asked me that they needed a reason why, I would ask
7 well, why would you want an autopsy and it would depend on
8 thefr answer. If they told me they were never going to be
9 able to rest unless they had an autopsy, I'd probably go ahead
10 and do It. If they told me they needed an autopsy to
11 facilitate a civil suit, I would give them the name of
12 somebody else that could do that for them,
13 Q Do you perform private autopsies -
14 A Many.
15 Q at the request of family members?
16 A Many.
17 Q And that's outside your duties as medical examiner?
18 A It is.
19 Q How do people find you?
20 A I have no earthly Idea, But I guess I've been
21 around long enough that me and Mr. Tanner, probably, that
22 they know us. l don't advertise. Never have.
23 Q That was my next questlon Is whether or not you
24 advertise your services as a private pathologist?
25 A I do not.
37.
1 Q Regardless, nobody asked you to perform an autopsy
2 on Patrick Desmond?
3 A It would have probably come through John Henson.
4 They wouldn't have gotten me direct!Y If I answered .every
5 call here that was directed to me, I never have time to do
6 anything else. But John would have answered it and If he
7 couldn't convince the family we didn't need one, then he'd
8 come to me, and I don't remember him coming to me about it
9 Q Let's do this: When you perform your external
10 examination, Doctor, do you have access to any other records
11 outside of the plnk sheet?
12 A I would have had those little blurbs out of
13 Northside Hospital. They're here someplace. Here they are.
14 Q And by "little blurbs," you're talking about the
15 documents that are contained In the file marked -- in the
16 manilla file marked "NHS Records"?
17 A Correct.
18 Q That appears to contain a portion of Mr. Desmond's
19 hospital admission records?
20 A It does.
21 Q And the portion -- It looks like It contains his
22 face sheet?
23 . A It does.
24 Q And his lab results?
25 A Correct.
36.
1 Q don't see any other records outside of this face
2 sheet and lab results.
3 A I think that would be It,
4 Q Would you have reviewed these at the time of
5 conducting your external examination?
6 A Let me see if I can help you with that. The answer
7 would be yes. The reason I say the answer is yes is do you
8 see the time that they were faxed to irs?
9 Q Yes, sir. It looks like they were faxed to you at
10 6:54 on June the 11th.
11 A That's right. He was reported to our office at 6:00
12 o'clock on June the 11th, so four minutes later they sent
13 this. Mr. Henson would have Included that with the pink
14 sheet, so I had these to go over before I started the
15 examination.
16 Q And can you tell me, Doctor, you've got a couple of
17 notes contained within these records flagged. If you could,
18 tell me the significance of those flags.
19 A One
1
that his blood alcohol at Northside Hospital on
20 admission was 194 milligrams percent, In English Is a
21 .194.
22 Q Yes, srr. So the way that most civilians know with
23 respect to what's DUI
1
this converts to a .1947
24 A That's correct, So he Is roughly two and a half
25 times the legal limit of being intoxicated as least with
-39-
1 respect to operating a motor vehicle In this state.
2 Q can you tell me how or what time that test was run
3 on him?
4 A At 2:30 A.M. on June 11th.
5
6
Q And Is it a blood test or urine test?
A No. No. It's a blood test but we need to be a
7 little more specific, Counselor.
8 Q Yes, sir.
9 A This Is what we call a medical blood alcohol. It's
10 performed on serum, you know
1
the water part of blood. But
11 the crime lab does not perform their blood alcohol on serum.
12 They perform It on whole blood, ceUs, and the fluid part, so
13 they generally get a level that's about 10 to 15 percent lower
14 than the hospital does,
15 Q wny would the hospital perform their test on serum
16 versus whole blood?
17 A Because that's the only machine they have. It's
18 cheap and easy. wnereas, the crime lab does this by gas
19 chromatography which Is a much more expensive and
20 sophisticated test. It's also much more accurate. So, when
21 you look at the crime lab blood done on the same sample that
22 this was done on
1
you're going to see a different result.
23 Q Right. And I think the crime lab blood, which is
24 contained In your report, you've noted as .157?
25 A Right. And that would be about right You take 15
-40.
770457-1276
http://ReachingForTheTippingPoint.nett
1 percent-- you know, .157 times 15 percent
1
you get something
2 erose to .19.
3 Q And this would have been based on a blood draw taken
4 during Mr. Desmond's admission at Northside Hospital?
5 A Correct.
6 Q While he was still alive?
7 A Well
1
that's a good question. You know, he was not
8 alive when he got ~ h e r e .
9 Q Right.
10 A And, yeah
1
they got him back but he was never Mr.
11 Desmond again. So I would say this was taken at some point
12 after he was, In the loosest sense of the word, successfully
13 resuscitated.
14 Q Right. And do we know how long he had been dead?
15 A Well
1
that's hard to say. When the EMS got there
1
16 he had no pulse. When I say "there" to wherever he was In the
17 back of the car. He had no pulse
1
no blood pressure. So who
18 knows.
19 Q Would that affect the levels of the blood alcohol as
20 tested at the hospital?
21 A It should not.
22 Q The fact that he may or may not have had some period
23 of t1 me when he was technically dead should not affect those
24 levels?
25 A It should not.
-41-
1 Q I assume that you're familiar with postmortem
2 redistribution?
3 A lam.
4 Q You don't think that there would be any indication
5 of postmortem redistribution In this case?
6 A Well, first of all, In alcohol there probably is not
7 postmortem redistribution. Secondly, in the opiate drugs like
8 morphine
1
and he may have taken heroin, I don't know, but
9 let's just call it the opiates In general, morphine being one
10 of them, yeah, because of their pH and all, there Is a
11 possibility for postmortem redistribution. But I tried to
12 eli minate that by using the hospital blood. The hospital
13 blood was not drawn centrally. It was drawn peripherally.
14 and if you do It peripherally, you should eliminate, at least
15 to some degree, Counselor, the potential for postmortem
16 redistribution.
17 Q And take a layperson through centrally versus --
18 A Oh, okay, sure. Centrally would be out of the heart
19 and peripherally would be out of the femoral vein or the
20 cubital vein or the baslUc vein, you know, In the arms.
21 Q Yes, sir.
22 A Generally, the hospital Is going to obtain that
23 blood from a peripheral source. They're not going to stick
24 his heart for it. So that's why I felt that the blood that
25 was sent to the crime -- that's why we asked for the admission
- 42 -
1 blood. Number one
1
it would be the most accurate and, number
2 two
1
It would certainly be peripheral. Did I clear that up?
3 Q Yes
1
sir. Central blood Is cardiac blood?
4 A Yeah. Or aortic
1
to be technical.
5 Q So, while there may be some possibility for
6 postmortem redistribution of morphine, you don't think that
7 that is going to play a significant role, if any role, in Mr.
a Desmond's case given the fact that you're usi ng hospital blood
9 that you be!ieve would have been drawn centrally?
10 A Peripherally.
11 Q Peripherally?
12 A Yes.
13 Q I came so close to getting that right.
14 A It's the last word that tripped you up.
15 And, because he's a potential drug OD for us here,
16 let's say there was no hospital blood and we had to rely on
17 the autopsy, we would have stuck the femoral artery or the
18 femoral vein trying to get as close to peripheral as possible.
19 Q Now, tell me when you have this blood alcohol
20 flagged
1
going back to my original question, you've got it
21 flagged as a .194. Is it your testimony, Doctor, that that is
22 not an accurate number of hi s blood alcohol level and that the
23 mare accurate number would be that number that's contained
24 within the GBI tox report?
25 A can I word It just a hair differently!
- 43 -
1 Q By all means.
2 A It's not that it's not accurate. It's accurate by
3 their machinery, by their equipment. It's not a true value.
4 Because you're using both -- you're using solely the water
5 part of the blood. The more correct value or the more true
6 value would be the one that the crime lab produces because
7 they use both cells and the fluid part of the blood to do
8 their analysis which gives them a slightly lower value.
9 Q So If we are trying to determine as close to
10 accurately as possible what Patrick Desmond's blood alcohol
11 level was as of 2:30A.M. on June the 11th 2008, we would look
12 to the level contained In the GBI's tox report?
13 A I think that's fair.
14 Q And that's .1577
15 A Yes
1
that's correct.
16 Q What Is the next flag that you have marked In this
17 smidgeon of records from Northside Hospital?
18 A At the bottom of page -- well, I better not say the
19 page, page four of the fax, I've looked at his total protein,
20 albumln
1
bilirubin, and alkaline phosphatase levels. If you
21 recall earl ier, you asked me why didn't I do an autopsy?
22 Q Yes, sir.
23 A Because this is kind of an autopsy done for me.
24 This gentleman here has perfectly normal liver functions
25 Including his albumin and he has a negative head CAT scan and
-44 -
770457 1276
1 he had normal renal function when he got there, so you see the
2 point that I'm needing to do an autopsy less and Jess when I
3 look at all of this data.
4 Q Because the lab values don't indicate any breakdown
5 or the organs?
6 A Correct. They will later on because of he was In
7 shock for so long. But the ones that are there when he hits
8 the door at 2:30 are the Important ones, and they're an
9 normal.
10 Q Can you tell what time the blood was actually drawn
11 for these labs?
12 A No. And to be honest with you, l'm not sure if
13 that's drawn or reported. I could probably work backwards by
14 seeing what time he got there.
15 Q Well, it's not a tenible big deal but I'm just
16 Close to around 2:307
17 A Right. I mean, If we can put It within forty
18 minutes either way it's probably not going to matter a whole
19 lot.
20 Q So the second tab that you have noted there is
21 basically just to indicate the function of his liver and
22 kidneys?
23 A Well, I didn't highlight the kidneys, but, yes, the
24 kidneys too.
25 Q And what about the third tab? What Importance does
45.
1 that Infer?
2 A There was a urine drug screen done at, well, it says
3 either drawn or collected at 2:43 on 611 and his urine was
4 positive for opiates.
5 Q What time was that that it was collected?
5 A 2:43A.M.
7 Q I think that there was an Initial urine screen from
8 Northside that was negative?
9 A Can you show me that?
10 Q I can. That's actually one of the things I was
11 going to ask you about. Let me work off of your record.
12 A Okay. Counselor, while you're doing that, we've
13 been at this about an hour.
14 MS. MARSCHALK: Let's take a break.
15 THE WITNESS: Can we take about a five-minute
16 break?
17 MS. MARSCHALK: Absolutely.
18 (Whereupon, a break was taken.)
19 Q {By Ms. Marschalk) Okay. We have taken a break and
20 I have culled through the records and it lookS like on the
21 original record that you were pointing to that you have tabbed
22 and highlighted In the manilla folder marked "NHS Records/ it
23 lookS likes there were two tax screens done for opiates?
24 A Correct.
25 Q And a plethora of other drugs?
-46-
1
2 Q And it lookS like the first urine screen was done on
3 611 at 2:43A.M.?
4 A Correct.
5 Q And that shows negative?
6 A Correct.
7 Q And then It lookS like they did another urine screen
8 at 4:15A.M. and that was positive for opiates?
9 A Right.
10 Q Tell me how you can have disparate results? First
11 of all, do we know whether they used the same -- they couldn't
12 have used the same urine, right?
13 A Oh, no, they would not have used the same urine, l'm
14 pretty sure about that. How can you have different results
15 like that?
16 Q Yes, sir.
17 A It's going to take awhile for enough to get
18 In from your blood to spill out through your kidneys to
19 Indicate a positive test.
20 . Q Right. It has to go from your blood through your
21 liver where It's metabolized, right?
22 A Right. Yeah.
23 Q And then It makes It In your renal system --
24 A Correct.
25 Q - and that is excreted In through your urine?
47-
1 A Right. But it has to be a certain level too. In
2 other words, there's a cutoff for every drug that's tested in
3 the urine, and if your urine concentration Isn't above that
4 cutoff
1
it's going to be reported out as a negative even
5 though it may be there.
6 Q Right. And It could be that It just hadn't had
7 enough time to metabolize and make it's way out into the
8 urine?
9 A It hadn't had enough time to get to the
10 concentration that they call a positive.
11 Q Is It possible --This doesn't actually measure the
12 level. This just simply measures the presence?
13 A Yes, that's right. There or not. And I don't know
14 what their cutoff is. Today most labs will give you what
15 their cutoff is.
16 Q All right. Finally, It lookS like at some point you
17 received the entire Northside Hospital record?
18 A Yes.
19 Q And that you have flagged -- well
1
you flagged one
20 page here today but before today, you flagged another page?
21 A Correct.
22 Q Can you tell me what this Is and why you -- what Its
23 significance Is?
24 A It's a summary that just outlines his hospital
25 course, you know, for the brief time that he was there,
. 48.
Elite Inc.
770457-1276
1 That's the only reason I flagged that.
2 Q And this Is because it's basically a quick place to
3 look up all of the Information that's contained In the record?
4 A Sure; without having to read through every nurses
5 note.
6 Q And it's actually typed instead of handwritten by
7 various nurses?
8 A That's helpful, too.
9 Q Okay. Let me go back a little bit. When you're
10 doing your external exam, do we know -- are we able to tell
11 from reading any records Who was present during that exam?
12 A We usually put the tech's name on the label. Robert
13 Mills was the tech on that one.
14 Q So would it have been you and Mr. Mills?
15 A And any other number of people that come and go from
16 myoffice.
17 Q And I understand that there were photographs taken?
18 A Yes.
19 Q And those are contained within Exhibit No. 37
20 A Correct.
21 Q Are there any other photographs that maybe did not
22 make It Into Exhlblt No. 3?
23 A l would think not.
24 Q Are you keeping nates of your exam as you go along,
25 or are you dictating?
- 49-
1 A On an external exam like this, I generally just
2 dictate It as I go along. Now
1
my techs will come by and do
3 body diagrams and take notes in case the dictation gets fouled
4 up, the tape gets broken, so we have something to go back to
5 and we can reconstruct the report with.
6 Q Do we have any such handwritten records In this
7 case?
8 A Oh, sure.
9 Q Can you find those for me?
10 A Yeah. That file that you call the --
11 Q The hodgepodge?
12 A That's it. They're In here. I can find them for
13 you If you'd like.
14 Q Let me just take a qulck peek. That's the orange as
15 opposed to the pink sheet?
16 A Yeah, I guess you could look at it that way.
17 Q Let's pull -- It looks like l do have contained in
18 here, It looks like there's a diagram.
19 A That's one for where he's got tattoos. There'll be
20 others for other things.
21 Q It looks like you've got a couple of sheets in here
22 about, you know, clothing present, accessori es present--
23 A Correct.
24 Q -- and that type of thing. There's also a form,
25 which we'll mark as Exhibit No. 7. This looks like It
-50-
1 identifies samples that you received from the hospital?
2 A No. Those would have been taken at the time of the
3 autopsy.
5 identification.)
6 Q All right. Let's talk about that. When you say
7 "autopsy," you mean examination?
8 A Examination. I'm sorry.
9 Q Okay. And what was taken at the tl me of the
10 examination?
11 A Three gray top tubes, one red top tube and twenty
12 cc's of urine.
13 Q What is a gray top tube versus a red top tube?
14 A A gray top tube has sodium fluoride In it. It's a
15 preservative. You're tJying to keep the drugs that.are in
16 there from --
17 Q Deteriorating?
18 A That's right. And the red top tube does not have a
19 preservative. Some drugs don't like a preservative and it
20 Interferes with their analysis, so we always send both, if we
21 have both.
22 Q And can you tell where you drew the blood from?
23 A It would have been somewhere peripherally because
24 this Is a potential drug OD case. 99 percent of the
25 peripheral blood sticks we do here are going. to be from the
-51-
1 femoral area . .
2 Q And can you tell what time you collected it?
3 A At or about the time we did the autopsy, An
4 external exam probably doesn't take twenty minutes, sa
5 sometime during that time.
6 Q What about, It looks like you also collected twenty
7 cc's of urine?
8 A Correct.
9 Q Would that have been from a catheter?
10 A Well, let's see what he had In him at the time that
11 I saw him, and that way I can tell you a little better. He
12 did not have a catheter In, sol imagine we did a suprapubic,
13 you know, just above the groin stick with a needle and j ust
14 drew the urine aut that way.
15 Q And you to91d me that the ME's office still has
16 possession of the blood?
17 A It does.
18 Q What about the urine?
19 A Itdoes.
20 Q You told me earlier that you would not rely on the
21 lab levels of the drug in the blood?
22 A I wouldn't build your case around that.
23 Q It's not my case, Doctor.
24 A Well, your defense around it.
25 Q And what about the urine? Would It similarly be
52 -
770457 -1276
1 affected by
2 A Even more so. Because
1
one
1
there's no
3 preservative, and, two
1
It doesn't give levels to begin with.
4 It just gives a positive or a negative.
5 Q Okay. It looks like, according to the green sheet,
6 the body sign-In form
1
that y'all received the body at a:25
7 P.M.?
8 A Yes; on June 11th 2008,
9 Q And that we, and by we, I mean you, released the
10 body on the 13th of June 2008 at 1:02 P.M.?
11 A At 1:02 P.M., right. Released by Pat Bailey.
12 Q Are there any other handwritten notes contained
13 within this hodgepodge file that would assist you in
14 recreating the external exam If you needed to?
15 A This would be one.
16 Q And you're tali<Jng about the document that's marked
17 tattoos, the diagram that's marked tattoos?
18 A Correct. This would be another showing that he
19 shows up without any clothing on. This would be another
20 showing that he doesn't have any rings or valuables. I think
21 that would be basically it. And we also have-- if we have to
22 recreate thlngs,lt's not just all diagrams and all, it's the
23 photographs, too, that we have. So we've got several backups
24 in case something goes wrong with the dictation, which, you
25 know, has happened every now and then.
-53-
1 Q I'm sure. Take me through -- As a civilian who has
2 never seen an external exam of a dead body, take me through
3 what you do.
4 A Arst we take the hospital gown off the person. We
5 would take pictures, and then we examine the body much like a
6 physical exam from head to toe looi<Jng for any evidence of
7 trauma or natural disease. At that time, I would document
8 what medical devices he might have in his body, document where
9 his tattoos are, take a height and weight, and then look for
10 anything else that I think might be pertinent. In his case, I
11 saw tiny puncture wounds In the bend of his elbow, which I
12 thought were pertinent.
13 Q And I want to talk to you about the tiny puncture
14 wounds, Let's first go to your actual external examination
15 report. And, Doctor, I've got an extra copy here and I'm
16 going to marl< It as Exhibit No. 8.
17 (Defendant's Exhibit No. a was marked for
18 Identification.)
19 Q If you could do me a favor, sir-- and I'm just
20 talking about the three page report-- we'll talk about the
21 tox reports and diagrams separately. If you would compare
22 Exhibit No. 8 to what you have in your file as far as your
23 typewritten report and tell me If that's a fairly accurate
24 copy.
25 A All I can say Is yours ls missing the front sheet.
54.
1 Q Is this the front sheet?
2 A There you go. Now you're complete,
3 Q Why don't we add the front sheet on the back, so
4 that we have a full copy of Exhibit No. 8. Fair enough?
5 A Yes, that's fine.
6 Q And what I want to do, Doctor, fs walk through this,
7 and we'll start with the front sheet, what you've got on the
8 front. Basically, this just gives us the Information about
9 Mr. Desmond, correct?
10 A Hold on just a second.
11 Q Yes, sir.
12 A We've got him as black on the front. I beli eve he's
13 white. I didn't see that until -
14 Q Sure. That's just a clerical error, so to speak?
15 A It Is nice that you agree with me that I can blame
16 my secretary for that Instead of my
17 Q And I'm not focused too much on the error on this,
18 but thls Is basically klnd of typewritten Information, basic
19 information about Patrick Desmond?
20 A It is.
. 21 Q And then when you tum the page of this External
22 Examination Report
1
this Is really kind of the meat of the
23 examination?
25 Q And it looks like the first section is titled
-55-
1- General Information?
2 A Yes,
3 Q Walk me through the general Information that's
4 contained In your report.
5 A All of this Information Is what I would gain from
6 Investigator Henson's report. It's more or less, I think what
7 you would call hearsay. It's nothing that I generated myself.
a Q And that's basically based upon your review of the
9 pink sheet?
10 A Correct.
11 Q Or the typewritten Investigator's Report?
12 A Well, 1 don't think It would have been typewritten
13 at the time that I dictated my report, so it's probably off
14 the pink sheet or what he might have told me verbally.
15 Q You told me that you typically dictate this, the
16 External Examination Report?
17 A Yes.
18 Q And you typically dictate that at the time of the
19 exam?
20 A Correct.
21 Q And that one of the secretaries then types it-
22 A Correct.
23 Q -- sometime later?
24 A Yes.
25 Q If you'd look on your signature page
1
Sir, It looks
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770-4571276
1 like you can tell the initials of the person who transcribed
2 this are KH?
3 A Right.
4 Q And then it looks llke it was transcribed on
5 6 132008?
6 A Fine. Sure.
7 Q Let's go back to the first page. Do you normally
8 review the typewritten report before you sign it?
9 A Yes.
10 Q Let's walk through the general information. You
11 said that this is Information that you would have taken from
12 the pink sheet?
13 A Or verbally from Investigator Henson.
14 Q And then the next section is External Examination?
15 A Correct.
16 Q It looks like on this you identify that there Is no
17 clothes?
18 A That's true,
19 Q No jewelry?
20 A That's true.
21 Q You Identify five medical devices?
22 A Correct.
2.3 Q You note that Mr. Desmond Is seventy-four inches In
24 length and weighed two hundred and one pounds?
25 A Yes.
-57-
1 Q Then, on the next page, your notes continue and you
2 note, you know, his hair and the color of his eyes. Then you
3 say -- Do you see where it says "a tattoo of a skull is noted
4 on the lateral aspect of the left upper arm"?
5 A Yes.
6 Q And then you say, "A few tiny puncture wounds are
7 seen In both antecubital fossae?
8 A Yeah. The bend in your elbow here (indicating),
9 Q When you say "a few," do you remember how many there
10 were?
11 A No, I sure wouldn't.
12 Q And you said earlier that that was significant to
13 you which Is why you noted it?
14 A Yeah. These puncture wounds were smaller than what
15 you would get from blood drawing or Insertion of an IV
16 catheter. They were tiny. So that meant something to me
17 since the man has a history of heroin addition and his urine
18 is positive for opiates.
19 Q Did they appear to be needle marks--
20 A Yes.
21 Q -- associated with administering heroin?
22 A Well, let's just say needle marks but not needle
2.3 marks that would have been created by the hospital personnel.
24 Q And he had them In both arms?
25 A Yes.
-58-
1 Q Do we have photographs of those?
2 A No. I looked but we didn't take any. They're hard
3 to photograph.
4 Q Sure. Because they're tiny?
5 A They're tiny and It's just hard to see them
6 sometimes,
7 Q Could you tell when those were made? In other
8 words, could you tell whether or not they were recent?
9 A Well, they hadn't healed at all, so I'd say probably
10 within the last twenty-four hours or so,
11 Q One of the things that you just said was that he had
12 a history of heroin addiction. My understanding, and I mean,
13 I could be wrong, but my understanding Is that he has a
14 history or narcotic addition to crack cocaine and alcohol but
15 I have not been able to find any history of an actual heroin
16 addition. Do you know where you would have obtained that
17 information from?
18 A The pink sheet says here drugs, heroin, Hold it
19 just a second. We're looking for Investigator Henson's
20 report. Most of the stuff that I get is from my Investigator.
21 It's not from me.
22 Q Yes, sir.
23 A According to Investigator Henson, he made telephone
24 contact with Marte Verges who was the, at least at that time,
25 administrator of the rehab place where Mr. Desmond was
-59-
1 reslding. And, according to Investigator Henson, she further
2 reported that Mr. Desmond was, in fact, a patient of the
3 halfway house and that he had been there approximately one
4 month and had been suffering from heroin addiction. Again,
5 Counselor, we're only going by what people tell us.
6 Q Sure. And I just want to nail down that you don't
7 have any independent facts outside of what's contained in the
8 Investigator's report about that?
9 A I don't.
10 Q Okay. And you don't know any actual facts about
11 what Mr. Desmond was doing on the night or early morning hours
12 that he actually passed away?
13 A Well, I would submit to you that he was drinking and
14 taking narcotics.
15 Q Heroin or some type of morphine?
16 A Well, It's just opiates. We don't have to say
17 heroin.
18 Q Can you tell from the records that we have, Doctor,
19 what he was drinking or how much he consumed?
20 A Well, let's look at It this way: It matters now what
21 he was drinking. You have alcohol, right. Whatever he drank
22 elevated hls blood alcohol to .15, If you want an example,
23 let's say, on an average-size person, average-size being a
24 hundred and eighty pounds, let's say, if you want to get his
25 blood alcohol up to .1, and let's use beer because it's easier
. 60.
Elite Reporting, rnc.
770-457-1276

1 to work with, he'd have to drlnk five beers In an hour to get 1 then but it would certainly be a significantly lower value
2 to a .1. So to get to a .2, you'd have to drink ten beers. 2 than we have right now. So if you're going to try and get the
3 Actually, eleven beers in an hour because you're goh1g to 3 best results, you get the ones that are at least adulterated
4 metabolize one every hour. So you'd have to drink quite a bit 4 and that would be the hospital admission ones.
5 In an hour to get your blood alcohol up to .15. 5 Q Yes, sir. And then it looks like, based upon the
6 Q And, given the fact that he was two hundred pounds, 6 Information that you had received at the time you did the exam
7 so he's slightly above the hundred and eighty, would the fact 7 as well as the reports that you received afterwards including
8 that he has a history of alcohol abuse affect his ability to 8 the hospital records and the state crime Jab tox reports, that
9 metabolize the alcohol? 9 you have placed or identified the cause of death being
10 A It would only if he was drinking regularly all the 10 intoxication with ethanol and morphine?
11 time. The history that I have, though, Counselor, Is that 11 A Correct.
12 he's been in rehab for a month, and I'm making an assumption, 12 Q And morphine- - Is it fair to say that we don't know
13 and this may be a wrong assumption, but he hasn't consumed any 13 what type of drug he took; we just know it was something v..1th
14 alcohol in a month. And the way that you become one of these 14 morphine?
15 quote, unquote, power drinkers where you can out drink anybody 15 A If you go back to Mr. Bills' letter, he wanted me to
16 is that you rev up your liver enzymes by drinking all the 16 do additional testing to determine what kind it was. That's
17 time, therefore, you can metabolize the alcohol quicker and 17 why we told him, If you want to know that, you know, we have
18 get It out of your system quicker so you can consume more. 18 the blood. And let's just go back and say that I don't think
19 However, a month of being dry Is a lifetime and your liver 19 our office should spend the money to figure out whether it was
20 enzymes are going to revert back to normal by that time and 20 morphine, heroin or whatever. It was an opiate and the
21 you're not going to be able to tolerate alcohol any better 21 concentration contributed to his death.
22 than you or I. 22 Q Sure. And I certainly didn't mean to --
23 Q Can you tell, based on the liver-- Do we have liver 23 A No. No. No. That's why Mr. Bills wanted that
24 enzyme tests? 24 stuff and that's why we didn't do it.
25 A Um-hum. 25 Q The tests that were run tested for the presence and
-61-
1 Q Cafl we tell from that whether or not he had an
2 Increased tolerance for alcohol?
3 A You can't really. All I can tell you is that his
4 liver enzymes are normal. He doesn't have a sick liver,
5 period.
6 Q It looks like, going back to page two of your report
7 which we've also marked as Exhibit No. 8 to your deposition,
8 you've got another section called Other Procedures?
9 A Yes.
10 Q And you note that hospital admission blood was sent
11 to the state crime laboratory for toxicology?
12 A Correct.
13 Q And that the autopsy blood and urine are retained in
14 the medical examiner's report?
15 A Office.
16 Q Office. You didn't actua!ly send the autopsy blood
17 or urine off for any tax reports?
18 A No.
19 Q And that's because you thought that the hospital
20 admission blood would be a better sample?
21 A It would have to be, Counselor. He doesn't die for,
22 what, now? Sixteen hours or something like that?
23 Q Yes, slr.
24 A All the alcohol would be gone out of him by that
25 time. And the morphine, I'm not sure It would all be gone by
- 62-
-63-
1 then the level of the opiate and morphine?
2 A Correct.
3 Q But you didn't run a separate test for heroin or
4 other types of drugs that might contain or metabolize Into
5 morphine?
6 A No. You probably wouldn't run a test for heroin.
7 You'd run a test for 6 monoacetylmorphine, a 6 MAM or MOM, I
8 forget the abbreviation for tt. But, an'('Nay, the point being
9 Is that heroin breaks out the 6 monoacetylmorphine. So If you
10 have 6 monoacetylmorphlne and morphine in the blood, it means
11 they're taking heroin.
12 Q You also noted that the manner of death was an
13 accident?
14 A Correct.
15 Q What are the different categories that you can use
16 when determining the manner of death?
17 A Accident would be one. Suicide would be another.
18 Homicide would be another. Undetermined is another and
19 natural. And that's lt.
20 Q When making that determination -- Let me back up.
21 Approximately how many drug overdose cases are you involved
22 with as a forensic pathologist each year?
23 A Good god, more than any other -- Well, except for
24 natural, more than any other type of death. I'll bet this
25 office, out of the seventeen reported cases a year,
- 64-
7704571276

1 and maybe the twelve hundred we accept jurisdiction on, it Q Is this something about the way the machine is
2 probably has two hundred and fifty to three hundred drug 2 calibrated?
3 deaths a year. Also, the deaths that we have that are pending 3 A I have no earthly Idea. Try and get a straight
4 something, are pending toxicology. It's Incredible how many 4 answer out of the crime lab sometime. I haven't been able to.
5 drug deaths there are here. 5 Q Well, it looks like they've tested It at least at
6 A If you'll turn to the final page of your report 6 eighty-one micrograms per liter. It could be either sixteen
7 marked as Exhibit No. a, do you see where it says "Comment"? 7 less or sixteen more?
8 A Yes. a A It could be less.
9 Q And It says the postmortem blood contained the 9 Q Then Exhibit No. 10 Is actually the blood alcohol
10 following? 10 level which has a much less margin of error?
11 A Yeah. And that's a mistake too. 11 A It's done by the same methodology on top of It all
12 Q That's what I was going to ask about.
13 A You'd never believe that I really read these before
14 I sign them, would you?
15 Q I just wanted to clarlfy when you say the postmortem
16 blood, you're not talking about the blood that was drawn here?
17 A No. This Is the hospital admission blood. That's
18 how that should read.
19 Q This is just an error?
20 A Correct.
21 Q Then, Sir, if you'll look at the lab reports, I'm
22 going to mark them separately as 9 and 10.
23 (Defendant's Exhibit Nos . 9 and 10 were marked
24 for Identification.)
25 Q You've got two lab reports, rlght7
- 65-
1 A Yeah; one for blood alcohol and one for drug screen
2 results.
3 Q I'm going to show you what we've marked as
4 Defendant's Exhibit No. 9 and just represent to you that this
5 is a copy of the blood alcohol report that we received from
6 your office and this Is the one for the morphine?
7 A Correct.
8 Q According to this report, it looks like the report
9 was made on July the 26th and that, according to the blood
10 received, it was positive for opiates, opioids, positive for
11 morphine, eighty-one micrograms per liter?
12 A Correct.
13 Q And then this plus or minus 16 percent, Is that the
14 error rate on the test?
15 A It's hard to believe, Isn't It? It is but it's hard
16 to believe. When you're doing these things by gas
17 chromatography or mass spectrometry that you could have an
18 error rate of 16 percent. Would you go to your doctor and
19 have your blood drawn and be told your hematocrit might be 16
20 percent higher or lower than what I'm telling you It is? I
21 wouldn't? We don't use them anymore.
22 Q You don't use this particular lab?
23 A It's the state crime lab. We use them very
24 sparingly. When you don't pay for stuff, you can see the
25 product that you get.
66-
12 by gas chromatography methodology. I mean, that's such a low
13 level. It's going to be .15. That's so you can take the 7
14 off and it's going to be .15 one way or the other.
15 Q Let's talk a little bit about these particular
16 numbers. Is .15 Is a blood alcohol reading of .15, is that
17 a fatal range of alcohol that you would expect to see? Would
18 somebody die for having a blood alcohol level of.15?
19 A It depends on how old you are?
20 Q What about a twenty eightyearold mate?
21 A Generally not.
22 Q What Is the normal range that would be for fatal
23 alcohol deaths?
24 A It's controversial. It used to be above .4. In
25 this office l've seen a number of people .25 and higher
67.
1 without any.other drugs, by the way .. that have died of
2 alcohol intoxication.
3 Q Right. And I think ..
4 A I think it depends, Counselor, on how fast you get
5 from zero to .25. If you get up there real fast, you're
6 likely to die from lt.
7 Q But, typically, In the range of .15 In an otherwise
a healthy mate, you're not going to expect .15 to kill them?
9 A That's right. You might be pretty drunk but you
10 shouldn't die from lt.
11 Q What about this morphine level? You said that you
12 went back and you consulted some of your toxicology books
13 about the morphine level?
14 A I can make It therapeutic, toxic, or lethal
1
15 whatever you'd like. The way I looked at this case, though,
16 would be, I thi nk it's worthy of about thirty seconds time or
17 so. When you take two respiratory depressants .. and It's
18 clear-cut. It's clear-cut that alcohol is a respiratory
19 depressant and morphine or heroin or whatever opiate you want
20 to use is a respiratory depressant. One Is at a level that's
21 going to make you fairly drunk and the other one is at a-
22 let's call it therapeutic level, I consider that those two
23 combined enough to take someone's life. Furthermore, I'm
24 making the assumption that he's a naive user of these two
25 compounds and he's been in rehab for a month and he hasn't
. 68.
770-457-1276
ht hhht ttp ppp://ReachingForTheTippingPoint.net
Deposition of Gerald T. Gowitt, M.D. %11!B.!fiiP.tit!Ktfilij%y
- - ~ - - - - - - - - - - - - - - - - - - - - ~ - - - - - - - - - - - - - - - - ~ - - - - - - - - ~ - - - - ~ ~ - - ~ -
1 been drinking and shooting heroin during that time; therefore, 1 A I would agree with that. I think we've said
2 these two levels, to me, were enough to cause his death. 2 repeatedly a .15 blood alcohol, generally, in a healthy person
3 Q Can we push It one step further? Because I think- 3 Isn't going to be enough to take your life.
4 that I understood you to say that the alcohol alone wouldn't 4 Q Have the opinions that you have given me here today,
5 have caused the death? 5 Doctor, been within the reasonable degree of medical
6 A Probably not. 6 probability?
7 Q The heroin alone, given the fact that he was a naive 7 A Yes.
8 user, could have caused the death? 8 MS. MARSCHALK: I do not have any other
9 A It may have. I'm not really sure on that, 9 questJons.
10 Counselor. I'm really not. Again, It would depend on whether 10 MR. TANNER: Let me ask you just a few other
11 he shot up a little bit three or four times over an hour or 11 things to be sure on.
12 did he shoot up enough to get this level all at once, was he 12 CROSS-EXAMINATION
13 drinking a lot all at the same time? I think these are 13 BY MR. TANNER:
14 variables In the case that we're never going to be able to 14 Q You mentioned that you saw some small little holes
15 correct for because we don't know exactly what happened In the 15 In the antecubital fossae?
16 back of that car that night. But I would submit to you that 16 A Yes.
17 the faster he drinks and the faster he gets his morphine level 17 Q That was both arms?
18 -up to eighty-one, the more likely it is he's going to die 18 A Yes.
19 particularly if he's a naive user. 19 Q And those are not the kind of holes that you would
20 Q If you took the alcohol out of the picture, have you 20 expect to find In a patient who's been In a hospital having
21 seen reported cases of heroin overdoses as low as fifty 21 blood drawn and that sort of thing?
22 micrograms per liter? 22 A That's also correct.
23 A We're talking about morphine now not heroin? 23 Q You mentioned that the holes that you saw had not
24 Q Sorry. Yes, sir. 24 healed?
25 A Yes, I have. 25 A Correct,
-69-
1 Q And I understand that the therapeutic range can go
2 up to a hundred?
3 A That's right.
4 Q And somebody's tolerance to the drug is dependent
5 upon a variety of factors?
6 A Generally liver and renal function and repeated use.
7 Q If your liver and renal function are normal, would
8 you expect somebody to be able to tolerate up to a hundred
9 micrograms per liter?
10 A Probably.
11 Q Who then would you expect to-- what types of
12 Individuals would you expect to die at the 50 microgram level?
13 A Without any other drugs on board?
14 Q Yes, sir.
15 A Okay. Somebody who's got terminal cancer who's real
16 sick to begin With. Somebody with emphysema who's -- you and
17 I might tolerate this just fine but they're having all the
18 work in the world just to breathe. Someone whose hematocrit
19 is very low because they have kidney failure. Let's just put
20 a major league illness in all of that and I don't think it's
21 too hard to imagine that you could die at a lower revel of
22 morphine. But If you're talking about a twenty-eight-year-old
23 otherwise healthy person, maybe.
24 Q Would you agree that without the heroin on board
25 that Patrick Desmond would not have died?
- 70-
- 71-
1 Q And I think you said there was a figure of
2 twenty-four hours or so?
3 A Yeah. Again, that Is just a ballpark, Mr. Tanner.
4 Q What I want to be sure of Is: Would that be
5 twenty-four hours from the time of death?
6 A No. Twenty-four hours from the time of infliction.
7 Q In other words, you would expect if the holes had
8 not healed, there would be at feast twenty-four hours from the
9 time of Infliction tllf the time of death?
10 A That's correct. And what I mean by not healed, they
11 hadn't crusted over and, you know, there wasn't any evidence
12 that there was any redness around them, so to me there's no
13 healing. And your first signs of healing take usually about
14 t\venty-four hours.
15 Q Now on the Issue of the morphine, the report shows
16 81 units and then there's another figure. Can you find that
17 for us?
18 A On the crime lab reporter now, Counselor?
19 Q Actually, on the report that you signed. It says
20 "morphine-81 ug/L."
21 A Yeah. Micrograms per liter.
22 Q And that's per liter of what?
23 A Blood.
24 Q In the average male of approximately two hundred
25 pounds, mid twenties age, how many liters of blood would you
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770-457 1276
1 expect the body to hold?
2 A Do any of y'all have a calculator? I can tell you
3 exactly.
4 Q I think somebody does have a calculator.
5 A Divide two hundred and one by two point two and tell
6 me what that is.
7 MR. HYNES: Divide two hundred and one by two
8 pointtwo.
9 THE WITNESS: And you come up with ninety-one
10 times seventy-five.
11 MR. HYNES: Multiply that by seventy-five?
12 THE WITNESS: Yes, sir.
13 A (Continuing) Okay. You have about six thousand
14 eight hundred and fifty cc's of blood which is roughly six
15 point eight liters. The formula, Mr. Tanner, is seventy-five
16 cc's of blood per ki logram of body weight. And that's In a
17 male. And so if you just multiply that out, you get a
18 ballpark of how much blood that you're going to have
19 circulating.
20 Q (By Mr. Tanner) Six point eight
21 A Uters of blood.
22 Q .. liters. If you had elghtyone units per liter,
23 then the total, approximately, would be eighty-one times six
24 point elght7
25 A I don't know If you can make that calculation. And
73.
1 the reason that I say that Is that whatever blood sample you
2 take
1
it ought to have eighty-one micrograms per liter in it.
3 Q Right. So If you had six point eight liters and
4 each liter had eighty-one micrograms, then wouldn't the total
5 In the system- I'm talking about the total - I'm trying to
6 get some idea of the total number of ..
7 A The total micrograms of morphine?
8 Q Right.
9 A Yeah. That's be somewhere at six point eight times
10 eighty-one.
11 Q And that's somewhere In the vicinity of five hundred
12 micrograms?
13 A Yeah; roughly.
14 Q Can you give us some Idea about what a person would
15 have to do to get five hundred micrograms Into the system
16 circulating In their blood?
17 A Of morphine?
18 Q Of morphine.
19 A Well, the usual dose of morphine IV, a therapeutic
20 dose is one to five milligrams, which would be one thousand to
21 five thousand micrograms. So they'd have to take just a half
22 of a milligram to get that circulating In their blood.
23 Q And you Indicated that people could take an amount
24 of that Well, strike that.
25 Could a person take an amount of one half of the
74.
1 g r ~ m that you j ust mentioned at one time, or could you take it
2 a total over several occasions?
3 A Yeah. That's the variable you can't really correct
4 for here because we don't know I don't know anyway whether
5 Mr. Desmond took several hits of morphine over a thirty-minute
6 period or whether he took one hit one time. And I know that
7 there's multiple puncture wounds but who's to say that he
8 didn't have trouble finding a vein.
9 Q And j ust one other question. The information you
10 got was that he had been at the halfway house, I think you
11 call it, for a month before the autopsy not autopsy --
12 examination?
13 A Yeah; before the death. That would be given to us
14 by the facility's administrator.
15 Q Right. NOW
1
If, In fact, he had been drinking and
16 taking drugs as recently as the middle part of May, that would
17 be significant for you to know If you're seeing him on June
18 the 11th and 12th?
19 A Yes.
20 Q And if he was taking drugs and alcohol as recently
21 as the mlddl.e of May, would hls system still be less subject
22 to shock?
.23 A You've got almost three weeks to four weeks that
24 have gone by and I think in that time your revved up liver
25 enzymes are going to come back to where yours and mine are. I
- 75-
1 mean, if you talk to me about a few days later, yeah, but
2 three or four weeks late, they should be back and he should
3 have all that j unk out of your system. Maybe not out of your
4 head but out of your blood and urine.
5 Q Thank you,
6 MR. TANNER: That's all I have.
7 MR. HYNES: I just have a few question.
8 CROSS-EXAMINATION
9 BY MR. HYNES:
10 Q Do you have any opinion as to whether or not the
11 blood samples that are stlfl here would contain any of the
12 6 MAM metabolite?
13 A Yeah, it might. I don't know that they would be
14 renective of the level, Counselor, but they might still have
15 the compound In it. So, if you get a number back .. you're
16 always going to get a number back. It might not be an
17 accurate number, but it may indicate that It's there.
18 Q So If he was using heroin, you would expect there to
19 be some level of the 6-MAM metabolite In the blood samples
20 that you still have 7
21 A Correct.
22 Q Do you have any opinion as to whether or not there's
23 a baseline value for either his alcohol level or the morphine
24 level?
25 . A \Nhen you say "baseline," help me on that.
- 76 -
7704571276
1 Q Prior to consuming any of those or Ingesting either
2 of those substances.
3 A Well, hopefully, it'd be zero.
4 Q Zero for both of those?
5 A Yeah.
6 Q And you said that the alcohol and morphine
7 lntoxlcation resulted In his death and I don't know that you
8 explicitly said it, but was that because of respiratory
9 depression?
10 A That'd be my opinion, yes, sir.
11 Q And your opinion Is that he stopped breathing as a
12 result of the Intoxication?
13 A Correct.
14 Q You were talking about the two urine screens on June
15 11th, one at 2:43A.M. and one at 4:15 A.M., the first being
16 negative and the second being positive?
17 A Yes.
18 Q Does that give you-- Does the fact that one was
19 negative and the later one was positive allow you to form any
20 sort of opinion as to when it was ingested?
21 A Well, assuming the drug screen Is correct, and I
22 would have to make that assumption, then it would look like he
23 did all of this maybe at one time or not too far back from
24 when he arrested.
25 Q And not too far back could mean anything. Could you
- 77-
1 be a little more specific?
2 A I don't know if I can. It would be guessing and I
3 want you to know that up front. I mean, maybe fifteen twenty
4 minutes before. About what I said earlier, and I think It
5 stlll holds true. The more quickly he got this stuff into
6 him, the more likely he's going to dye of respiratory
7 depression.
8 Q And is it your medical opinion that there's probably
9 a short window of time, under an hour, before he went into
10 resptratory distress that he had ingested the substances?
11 A If you want to use that time, I would agree with it,
12 okay. It may not be the right time, but I would agree with
13 it.
14 Q On the notes that you have, the paragraph four where
15 you detail the medical findings, you said there was a puncture
16 wound on his wrfst.
17 A Maybe you can help me with that.
18 Q Under External Examination (Indicating),
19 A Oh, yeah, I see. This is a wound that has white
20 gauze taped over it. I don't describe It a second time
21 because I think that's a therapeutic injury.
2.2 Q And that's just what I wanted to find out if you had
23 an opinion on lt. But puncture wound on h i ~ wrist you think
24 it had something to do with his treatment at the hospital?
25 A I do, Probably some type of a bl ood gas or IV or
- 78.
1 something like that. But, see, the hospital took the time to
2 tape that over.
3 Q And by Jooldng at the puncture wounds that you
4 mentioned or Injection sites on both of his elbows, were you
5 able to formulate any opinion or conclusion regarding wliether
6 or not he had injected something Into his veins or was it like
7 a fatty tissue Injection?
8 A You would shoot for the vein but he may not have
9 gotten lt.
10 Q Do you recall any other details about looklng at the
11 arms that led you to conclude whether or not he got his vein
12 or it wa.s fatty tissue?
13 A No. I really don't.
14 Q Are you familiar with the term of place
15 conditioning?
16 A No.
17 Q Okay. You have morphine at 81 ug/L?
A Correct. 18
19 Q And that abbreviation, the ug/L stands for
20 micrograms per liter?
21 A Micrograms per liter, right.
22 Q When you talk about levels of morphine or opiates In
23 someone's body, Is there another standard measurement that's
2.4 used?
2.5 A Oh, there's a bunch. There's milligrams per liter.
79.
1 There's nanograms per milliliter. It just depends on the lab
2 what units they use. I wish ali the labs would use the same
3 units, It would make my life a lot easter. Yeah, there are
4 several others that are acceptable.
5 Q And the ones that we've talked about today have ali
6 been the ug/L or micrograms per liter?
7 A Correct.
8 Q Okay.
9 MR. HYNES: Thank you, Doctor.
10 MR. HARRIS: Dr. Gowitt, are we going Into the
11 thousand dollar an hour range?
12 (Whereupon, the discussion continued off the
13 record.)
14 DIRECT EXAMINATION
15 BY MR. HARRlS:
16 Q My name Is Jeff Harris. I represent the Desmond
17 family, and I've got a few questions. I'm gotng to bounce
18 around a little bit and I apologize for that.
19 You signed the death certificate, right?
20 A Correct.
21 Q And the cause of death is listed as lntoxlcation
22 with ethanol and morphine?
23 A Yes.
24 Q Now, you do not have an opinion to a reasonable
25 degree of medical probability regarding whether or not the
-80 .
7704571276
1 morphine alone was sufficient to kill Mr. Desmond
1
do you?
2 A I don't.
3 Q The only opinion that you've rendered to a
4 reasonable degree of medtcal probability is that the
5 combtnation of ethanol and morphine resulted in his death,
6 correct?
7 A I th!nk there's one other. The alcohol by itself
8 probably wouldn't have taken his fife.
9 Q I was getting there. But you belleve that the
10 alcohol, the fifteen or so that he blew or didn't blOW
1
but
11 his blood sugar would not have been sufficient to kill him?
12 A Correct.
13 Q And that's because he was, as far as you could tell,
14 a healthy young man, right?
15 A Yeah.
16 Q So the only thing, just to clear the record, the
17 only thing that you can state with a reasonable degree of
18 medical probability, or the two things are alcohol alone
19 didn't do it
1
light?
20 A correct.
21 Q And It was a combination of alcohol and morphine?
22 A Yes.
23 Q Now, you talked a little bit earlier about there
24 being some literature that delineates the different levels or
25 therapeutic versus lethal. And what was the middle category?
-81-
A Toxlc.
2 Q Is there any generally accepted range or any range
3 that you're comfortable With in terms of outlining those three
4 categories?
5 A The only reason I'm not comfortable, Counselor, Is
6 that there Is so muct1 overlap of these that you actually have
7 to know the person a little better to make those
8 determinations. Somebody who always takes heroin or let's
9 just say morphine every day is going to be able to tolerate a
10 lot more than somebody who doesn't. Someone who takes it for
11 .the first time and takes it-- or not for the first time, but
12 let's just say a naive user and takes it with alcohol is more
13 likely to have a bad outcome. So, I can bring you books ln
14 here that have the toxic, therapeutic, and lethal ranges, but
15 I'm not sure they mean much.
16 Q What sources did you look at In order to get those
17 ranges?
18 A You can look in Baselt'sr B-a-s-e-1-t (spelling),
19 Counselor here has Dr. Winek's resource and there's a book on
20 my desk. [ forget the name of it, but It also lists the
21 toxic, therapeutic, and lethal levels.
22 Q Well, let me ask it a different way. Is there a
23 level that you're comfortable In tellfng me that If you saw
24 that level, you would not expect, based on your experience,
25 that the person would die from that level of morphine?
- 82-
1 A Oh, probably .1 or something to that affect. Even
2 those levels you have to be careful of. Because
1
Counselor
3 here asked me about why would you die at a .5 or a .3? The
4 terminal cancer patient. [ can go back and restate all of
5 that, but people that have serious and life-threatening
6 illnesses
1
it doesn't take much morphine to push them over the
7 lid.
8 Q And I'm going to get into that. Actually, l'm glad
9 you brought that up. Do you know anything about what f'vlr.
10 Desmond's course of treatment or the therapy was that he was
11 receiving In the month priorto his death?
12 A No. We didn't subpoena any records from the
13 facility.
14 Q Do you know anything about the Narconon treatment--
15 A No.
16 Q - program?
17 A No. I wouldn't even pretend to.
18 Q Were you aware of the fact that as part of his
19 treatment program before his death, he was subjected to
20 repeated dally uses of a sauna as part of what Narconon
21 believed was a drug treatment program? Did you know that?
22 A No.
23 Q Did you know that that treatment program was
24 something that Narconon believed was effective In helping
25 people address drug and alcohol problems?
-83-
A No. 1
2 Q Now, I want you to assume for me that if that's true
3 and Mr. Desmond was In a sauna and had, you know, repeated
4 exposure to a sauna for multiple hours per day, is that the
5 klnd of thing that In any way would make him more susceptible
6 to overdosing on morphine?
7 A I can't think of a mechanism whereby It would. I
8 mean, I think you may be talking about did he get dehydrated
9 from that. Well, his lab work doesn't indicate that he was.
10 {Whereupon, there was an outside Interruption.)
11 A (Continuing) I'm sorry. Go ahead.
12 Q (By f'vlr. Harris) And the reality Is, though, you
13 don't know whether or not when he presented at the hospital
14 Immediately whether or not he was dehydrated or not, do you?
15 A No, I don't.
16 Q And you really can't tell because presumable they
17 would have put some !Vs In him and started -
18 A They were going to put !Vs In him whether he was
19 dehydrated or not.
20 Q Exactly, So you have absolutely no idea whether or
2L not this man presents to the hospital in a dehydrated
22 condition?
23 A Correct.
24 Q But if he had been dehydrated, ls that something
25 that would have made him more susceptible?
-84-
770457 R1276
1
2
A Yeah. Sure.
Q Yes?
3 A Let's make It easy to understand. If we take this
4 bottle full and put a certain amount of morphine in it, you'll
5 get a concentration of so many micrograms per liter. Do you
6 agree?
7 Q Sure.
8 (Whereupon, there was an outside interruption.)
9 A (COntinuing) Let's say we take the same bottle
1
10 counselor
1
we reduce the level of fluid in it half but we put
11 the same amount of morphine in. What's your concentration
12 going to be? It's going to be twice as much as It was when
13 the bottle was fu!l. I hope that makes sense.
14 Q (By Mr. Harris) It makes perfect sense.
15 A Yeah. And that's the whole point of dehydration.
16 If you're severely dehydrated and you're down, you know,
17 several liters of fluid, let's say, then you're going to be
18 more susceptible to the administration of the same amount of
19 morphine as-- more susceptible to the same amount of morphine
20 as when the bottle was full.
21 Q And you would agree with me -- I think it's pretty
22 dear that you would agree with me that If you're in a sauna
23 for three to five hours a day, if not more, at temperatures
24 over a hundred degrees that's the kind of condition that's
25 going to make the average person dehydrated?
-85-
1 MR. TANNER: Object to form.
2 MS; MARSCHALK: Object to form.
3 THE WITNESS: It could If you're going to be
4 sweating out a lot. It depends on whether your fluids
5 get replaced afterward or not.
6 Q (By Mr. Harris) But, nevertheless, If he presented
7 In a dehydrated condition, you would agree with me that that's
8 the kind of condition that would make him more susceptible to
9 overdose on morphine?
10 A And alcohol.
11 Q And alcohol?
12 A Sure,
13 Q Okay. Now, similarly, were you aware of a regimen
14 that Narconon used where people who were treating there took
15 mega doses of vitamins?
16 A No.
17 Q In particular mega doses of niacin. Did you know
18 that?
19 A No. I saw in Mr. BHfs letter he wanted me to do
20 ntacln and some othervltamln levels In this case.
21 Q And I understand you elected not to do that. And
22 I'm not trying to quibble about that. But I'm asking you a
23 different question. Is that the kind of thing, if you receive
24 mega doses of vitamins over a period of days leading up to a
25 morphine overdose, Is that the kind of thing that would make
-86-
1 you more susceptible to overdosing?
2 A Maybe you can help me. I don't understand a
3 mechanism of why it would.
4 Q That's why I'm asking you.
5 A No, I don't. I don't.
5 Q And that's why I'm asking the questions.
7 Any physiological mechanism that you can think of
8 that if a patient consumed mega doses of vitamins or amounts
9 of vitamins that were far In excess of the amounts that were
10 recommended that that would make you susceptible to either
11 overdosing on morphine or alcohol?
12 A I'm going to say not that I'm aware but that doesn't
13. exclude that there might be something out there that I'm not
14 aware of.
is Q That's not something that you really looked into,
16 fair?
17 A No, not at all.
18 Q Okay. Now, you have a number of lab reports that
19 are In your file and, frankly
1
I'm a little bit confused about
20 which ones you've got and which ones you don't, but I'm going
21 to try this a different way. I'm going to mark this set that
22 I'm going to hand you as Plaintiff's Exhibit No. 1.
23 (Plaintiffs Exhibit No. 1 was marked for
24 identification.)
25 Q What I've handed you Is a stack of lab reports from
87-
1 Northside Hospital that we've marked as Plaintifrs Exhibit No.
2 1 and It runs a Bates range at the bottom from 00423 up to
3 00435. Can you tell me whether or not the lab reports In
4 Exhibit 1 are ones that you had or that you reviewed?
5 A Well, I'm supposed to have a complete copy of the
6 medical record here, so let's see. It looks like they're all
7 the same.
8 Q Okay. Great. So Plaintiffs Exhibit No. 1 that I've
9 marked that set, you had all of those in -- those are an In
10 your fi le?
11 A Yes.
12 Q The testimony that you gave earlier about these two
13 marks in Mr. Desmond's arm, I just want to be clear about it.
14 There were multiple pinholes in each elbow?
15 A I just said a few. A few.
16 Q And that's what I'm after. Was it more than --
17 A I don't know. I didn't count them. And I certainly
18 can't go back and do it now.
19 Q Is there any way to tell based on your examination of
20 them whether or not this was the first time he ever used
21 heroin?
22. A I didn't see any track marks.
23 Q And you've look at a bunch of heroin addicts over the
24 years?
25 A Oh, good god, yes. We have our share.
- 88-
770457-1276
http ppp://ReachingForTheTippingPoint.net

1 Q And It is common with people who are heroin addicts 1 A It wouldn't be on this.
2 to have numerous track marks that scar and are all over their 2 Q But I thought you mentioned something about kidney
3 bodies, Is It not? 3 function?
4 A If they've been addicts long enough, yes. 4 A His was marginal to begin with when he got to the
5 Q But it's fair to say there wasn't anything like that 5 hospital. However, It's a little bit difficult to Interpret
6 on Mr. Desmond's body? 6 because he gets to the hospital with zero pulse, zero blood
7 A I didn't see that. 7 pressure, zero respiration, you know, that alone is going to
8 Q And so what you did see was some number of marks that 8 alter some of the lab work.
9 you believe were not put there therapeuti cally? 9 Q But you don't know how his kidneys were functioning
10 A Correct. 10 the night he Ingested the morphine?
11 Q And you can't tell me whether or not this was the 11 A I don't, no.
12 first time that Mr. Desmond had ever Ingested any kind of 12 RECROSS-EXAMINATION
13 heroin based on those marks atone?
14 A I couldn't tell you.
15 Q And just to be clear on this, the Information about
16 him having a heroin addiction and being treated for that In the
17 rehab program that he was In, that's pure hearsay. You don't
18 have any Independent kllow!edge of that, do you?
19 A None whatsoever.
20 Q And, apparently, that came exclusively from some
21 woman named--
22 A Marie Verges.
23 Q So If we want to know about that, we need to talk to
24 her, right?
25 A I would assume, yes.
-89-
1 Q You mentioned that you looked . I thlnk there were
2 some lab reports that you'd flagged or highlighted and you
3 looked at his pH levels and his protein, his bilirubin and so
4 forth. Was there anything that you noticed in any of the blood
5 work that you looked at including the ones that you talked
6 about earlier that you noticed was abnormal or out of line?
7 A His blood gases and his pH was very low, I can look
8 again to see.
9 Q If you would.
10 A Sure. Let's see here. If you turn to the first page
11 of the lab work -
12 Q And just read the pH level that you're saying --
13 A Hold on. I hate to hold you up.
14 Q That's fine.
15 A This Is In a different section of the medical record.
16 His pH Is six point nine. The normal pH is seven point three
17 five to seven point four five. His PCo2 is much too high.
1B It's seventy-seven. The normal there Is thirty-five to
19 forty-five. And that's It on this page. But those are
20 significant derangements in his acid base balance.
21 Q And what does that mean?
22 A Something has happened where he's not breathing
23 properly or his kidneys are not functioning properly. Probably
24 breathing In this case since I know what happened to him.
25 Q And the kidney function?
- 90-
13 BY MS. MARSCHALK:
14 Q If I could just drill down a little deeper into a
15 couple of the opinions that Mr. Harris asked you about. I
16 think we're all straight on the fact that alcohol alone would
17 not have caused Mr. Desmond's death?
18 A Yes, that's right
19 Q And I understood you to believe that heroin could
20 have-- It's possible that heroin could have-- heroin alone
21 could have caused his death but If he had -- we just need to
22 know a little bit more information about that?
23 A Correct.
24 Q And given our lack of Information, you can't tell us
25 to a reasonable degree of medical certainty whether or not the
- 91-
1 heroin alone could have caused his death?
2 A I think that's fair.
3 Q You don't have any opinion, Doctor, that Mr. Desmond
4 was dehydrated at the time of admission to the hospital, do
5 you?
6 A I don't know one way or the other.
7 Q Can alcohol cause somebody to be dehydrated?
8 A Theoretically If you drink enough. It's a diuretic,
9 you're going to pee out some fluid.
10 Q So can alcohol cause dehydration?
11 A Theoretically.
12 Q To some extent?
13 A Yeah; theoretically.
14 Q Okay.
15 MS. MARSCHALK: That's all the questions I
16 have,
17 RECROSS-EXAMINATION
18 BY MR. TANNER:
19 Q Doctor, on this dehydration question, if a patient
20 was extremely dehydrated, would you expect the patient's skin
21 to show some sign of that?
22 A Yes, sir. UsuaHy It's lack of turgor.
23 Q And If there was normal skin turgor found on
24 admission to the hospital, would that be consistent or
25 inconsistent with severe dehydration?
- 92-
770-457-1276
http:////ReachingForTheTippingPoint.net
1 A It would be inconsistent.
2 Q Likewise, If a patient was severely dehydrated, what
3 would you expect to be the result on the patient's blood
4 sodium levels?
5 A They should be high. And also if we're going to
6 talk about lab work, Counselor, let's go back to the lab work.
7 Q Would you expect them to be significantly elevated
8 In sodium If the patient, In fact, had severe dehydration?
9 A I would.
10 Q Let me ask you to assume that at Northside Hospital
11 the normal range of sodium when examined in the patient's
12 blood is one thlrtyslx to one forty-four. And let me ask you
13 to assume that when the patient's blood was drawn at 02:30
14 hours the sodium was found to be one forty-five or one point
15 over the normal range. Would that be consistent or
16 Inconsistent wlth severe dehydration?
17 A It would be inconsistent. And remember there's a
18 margin of error of about 1 percent In these lab tests. So If
19 you ran It again, It could be in the normal range.
20 Q That's all I have.
21 MR. TANNER: Thank you, sir.
22 MS. MARSCHALl<: Thank you, Doctor.
23 (Whereupon, the deposition was concluded at
24 3:32P.M.)
25
-93-
CERTIFICATE
STATE OF GEORGIA:
COUNTY OF DEKALB:
I hereby certify that the foregoing transcript was taken
down, as stated in the caption, and the questions and answers
thereto were reduced to typewriting under my direction; that the
foregoing pages 1 through 93 represent a true, correct, and
complete transcript ofthe evidence given upon said proceedings;
that I am not of kin or counsel to the partles In the case; that
I am not in the regular employ of counsel for any of said
parties; nor am I in anywise interested In the result of said
case.
This, the 16th day of October 2011.
SHARON 5. KELLY, CCR B-1594
94-
7704571276
.1 ... 60, 61, 83 3:00 ... 19 85 assist ... 53 81,87,91
.1 .... 61 3:32 ... 93 administrative ... 10 associated ... 18, 25, black ... 55
.15 ... 60, 61, 67, 68, 3rd ... 29, 31 administrator ... 59, 75 31,58 blame ... 55
71 4 ... 26, 29, 47, 67, 77 admission ... 38, 39, Ass9ciates ... 12, 27 blew ... 81
.15 .... 60, 61' 67 4:15 ... 47, 77 41' 42, 62, 63, 65, assumption ... 61, 68, blood ... 23, 25-28,
.157 ... 40, 41,44 45 ... 15, 17 92 77 39-45,47,51,52,
.19 .... 41 5 ... 33, 34,83 Adres ... 30 Atlanta ... 9, 1 0, 20 58, 60-67, 71-74,
.194 ... 39,43 50 ... 70 adulterated ... 63 attorney ... 8, 25 76, 78, 81 , 90, 91,
.194 .... 39,43 6 ... 15, 34, 35, 39, advertise ... 37 attorneys ... 9, 18 93
.2 ... 61 46,47,57,64, 76 affect ... 41, 61, 83 August ... 31 blow ... 81
.25 ... 67,68 6:00 ... 39 affected ... 28, 53 authority ... 36 blue ... 22
.25 .... 68 6:40 ... 15 affiliated ... 9, 14 automatic ... 16 blurbs ... 38
.3 ... 83 6:54 ... 39 affiliation ... 14 autopsies ... 37 board ... 10, 70
.4 .... 67 6th ... 30 afternoon ... 6 autopsy ... 28-30, 34, bodies ... 17, 89
.5 ... 83 7 ... 50, 51, 67 against ... 6 36-38, 4345, 51, body ... 15-17, 33-35,
00423 ... 88 7th ... 8 age ... 72 52,62, 75 50, 53, 54, 73, 79,
00435 ... 88 8 ... 53-55, 62, 65 agree ... 55, 70, 71, available ... 28 89
02:30 ... 93 8:25 ... 53 78, 85, 86 average ... 60, 72, 85 book ... 23, 82
1 ... 6, 53, 60, 61, 83, 81 ... 72, 79 agreed ... 20 aware ... 31, 83, 86, 87 books ... 23, 32, 68, 82
87, 88, 93 9 ... 65, 66 agreement ... 5, 12 awhile ... 47 both ... 44, 51, 58, 71,
1:02 ... 53 99 ... 51 ahead ... 37, 84
B
77, 79
10 ... 40, 65, 67
A
albumin ... 44
back ... 7, 24, 26, 29,
bottle ... 85
1099 ... 12 alcohol ... 23, 36,
bottom ... 44, 88
10th ... 15
A.M. ... 40, 44, 46, 47,
39-44, 59-62,
34, 35, 41, 43, 49,
bounce ... 80
11 ... 46,47
77
66-69, 71, 75-77,
50, 55, 57, 61-64,
break ... 18, 46
11th ... 39, 40, 44, 53,
abbreviation ... 64, 79
81-83, 86, 87, 91,
68, 69, 75-77, 83,
breakdown ... 45
75, 77
ability ... 61
92
88, 93
breaks .. . 64
12th ... 75
able ... 6, 17, 37, 49,
alive ... 8, 41
background .. . 6, 32,
breathe ... 70
13 ... 57
59, 61' 67, 69,
alkaline ... 44
33
breathing ... 77, 90
13th ... 53
70, 79, 82
allow ... 20,77
Backing ... 17
brief ... 48
15 ... 19, 40, 41, 47,
abnormal ... 90
allowed ... 5
backups. ... 53
broken ... 50
60, 61, 67, 68, 71,
abnormalities ... 36
alone ... 69, 81, 89, 91,
backwards ... 45
brought ... 6, 17, 21,
77
above ... 48, 52, 61,
92
Bailey ... 29-31, 53
83
16 ... 15, 17, 66
67
alter ... 91
balance ... 90
Buice ... 15
194 ... 39, 43
abuse ... 61
among ... 25
ballpar k .. . 72, 73
build ... 52
1982 ... 9
accept ... 15, 16, 65
amount ... 28, 36, 74,
Barbara ... 5
bunch ... 79, 88
"1983 ... 9
acceptable ... 80
85
Barrow ... 13, 14
Burton .. . 13
1986 ... 10
acceptance ... 16
amounts ... 87
base ... 90
butcher ... 29
1987 ... 10
accepted ... 82
analysis ... 44, 51
based ... 14, 16, 18,
c
1989 ... 10, 14
access ... 34, 35, 38
analyze ... 28
33, 41, 56, 61, 63,
1994 ... 12
accessories ... 50
analyzed ... 28
82,88,89 calculation ... 73
1996 ... 14
accident ... 64
Anatomic ... 10
baseline ... 76 calculator .. . 73
19th ... 30
according ... 53, 59,
antecubital ... 58, 71
Basel! ... 23 callbrated ... 67
2 ... 8, 12, 19, 40,
60,66
anymore ... 8, 23, 66
basic ... 55 call ... 13, 15, 17, 34,
44-47, 61,77
accurate ... 40, 43,
anyway ... 64, 75
basil ic ... 42 38, 40, 42, 48, 50,
2:00 ... 1 ~
44, 54,76
aortic ... 43
Bates ... 88 56,68, 75
2:15 ... 19
accurately ... 6, ~ 4
apologize ... 80
became ... 15 called ... 11, 62
2:30 ... 40, 44, 45
acid ... 90
apparently ... 89
become .. . 10, 61 Can ... 5, 7, 13, 15-17,
2:43 ... 46, 47, 77
act ... 5, 13, 15, 16,
appear ... 34, 58
becomes ... 16 . 20, 23-25, 30, 36,
20 ... 15, 17
30, 32
appearing ... 15
beer ... 60
39, 40, 43, 45-48,
2000 ... 7, 13
acting ... 17
appears ... 22, 31, 33,
beers ... 61
50-52, 54, 55, 57,
2008 ... 15, 28-30, 44,
actual ... 34, 54, 59,
38
believed ... 83
60-62, 64, 66-70,
53,57
60'
appreciate ... 19
bend ... 64,58 72-74, 78, 81-83,
2009 ... 25, 28-30
add ... 55
approximately ... 60,
bet ... 64
87,88,90,92
2010 ... 31
added ... 7
64, 72, 73
big ... 45
cancer ... 70, 83
201 1 ... 6, 8
addiction ... 36, 59,
area ... 20,52
bilirubin ... 44, 90 capacity ... 14
26th ... 29,66
60, 89
arm ... 58, 88
bill .. . 18, 19 car ... 41,69
28th ... 8
addicts ... 88, 89
arms .. . 42, 58, 71, 79
Bills ... 8, 25, 26, 28,
cardiac ... 43
29th ... 25, 28
addition ... 56, 59
arrested ... 77
30,63, 86
careful ... 24, 83
3 ... 19-22, 31-33, 49,
address ... 83
artery ... 43
bins ... 28 Carolina ... 8
83, 93
administering ... 58
aspect ... 58
bit ... 20, 23, 24, 32,
case ... 7-9, 14-17, 20,
administration ... 30, 49, 61, 67, 69, 80, 26, 32, 34, 42, 43,
770457 1276
50-54, 68, 69, 86, come ... 7, 29, 38, 49, conversations ... 29, deeper ... 91 disciplining ... 10
90 50, 73, 75 30 defense ... 7, 52 discovery ... 5
cases ... 7, 13, 14, 64, comfortable ... 82 converts ... 39 degree ... 42, 71, 80, discussions ... 25
69 coming ... 38 convince ... 38 81, 91 disease ... 54
CAT ... 36,44 Comment ... 65 cooler ... 28 degrees ... 65 disparate ... 47
categories ... 64, 82 Commission ... 20 copies ... 33 dehydrated ... 84-86, distress ... 78
category ... 81 common ... 89 copy ... 6, 26, 29, 30, 92,93 diuretic ... 92
catheter ... 52, 58 communication ... 30 34,54,55,66,88 dehydration ... 85, 92, Divide ... 73
cause ... 36, 63, 69, communications ... 29 coroner ... 16 93 Doctor ... 6, 7, 9, 15,
80,92 company .. . 11-13 correspondence ... 21, DeKalb ... 11,12, 15, 17. 19-22, 24-27,
caused ... 69, 91, 92 compare ... 54 25,27,29,31 16,22,27 31, 32, 34, 38, 39,
caveat ... 19 compensated ... 14 Counselor ... 7, 12, 19, delineates ... 81 43, 52, 54, 55, 60,
cells ... 40,44 complete ... 22, 55, 24, 28, 36, 40, 42, delineation ... 23 66, 71, 80,92, 93
Central ... 43 88 46, 60-62, 68, 69, delve ... 29 doctors ... 14, 19
Centrally ... 42, 43 compound ... 76 72, 76, 82, 83, 85, Dennis ... 30 document ... 7, 35, 53,
certain ... 14, 20, 48, compounds ... 68 93 dependent ... 70 54
85 concentration ... 48, count ... 88 deposed ... 5 documents ... 20, 22,
certainly ... 16, 43, 63, 63, 85 counties ... 13, 14, 19, deposition ... 5, 7-9, 24,25,31,38
88 concentric ... 24 20 18-22, 31, 62, 93 dollar ... 80
certainty ... 91 concerning ... 21 County ... 9, 11-16 depositions ... 7, 25 dollars ... 18-20
certificate ... 16, 22, 80 conclude ... 79 couple ... 5, 8, 31, 39, depressant ... 68 door ... 45
certified ... 10 concluded ... 93 50,91 depressants ... 68 dose ... 74
cetera ... 7 conclusion ... 79 course ... 48, 83 depression ... 77, 78 doses ... 86, 87
change ... 24 condition ... 84-86 court ... 13 deputy ... 13, 14 double .. . 35
changed ... 7 conditioning ... 79 cover ... 13 derangements ... 90 dozen ... 12
charge .. . 19 conducted .. . 32 crack .. . 59 describe ... 78 Dr ... 5, 12-14, 20, 23,
charging ... 19 conducting ... 39 created ... 68 desk ... 23, 82 80,82
Charles ... 23 confirm .. . 15, 32 crime ... 26, 40, 42, 44, Desmond ... 6, 8, 16, drank ... 60
chart ... 18 confused ... 87 62,63,66,67, 72 16, 21, 26, 30, 31, draw ... 24, 41
cheap ... 40 consider ... 16, 20, criminal ... 7 36, 38, 41, 55, 57, drawing ... 58
check ... 14, 27, 35 26,68 critical ... 11 59, 60, 70, 75, 80, drawn ... 28, 42, 43,
checking ... 27 consistent ... 92, 93 CROSS ... 5, 71, 76 81,84,89,92 45, 46, 65, 66, 71,
Chemical ... 23 conspicuously ... 21 crusted ... 72 deteriorate ... 28 93
chief ... 11-14, 26 constantly ... 24 cubital ... 42 Deteriorating ... 51 Drew ... 6, 51, 52
chromatography ... 40, constitute ... 21 cull .. . 20 determination ... 16, drill ... 91
66,67 consultation ... 18 culled ... 46 17,33, 64 drink ... 61, 92
circles ... 24 consulted ... 68 current ... 6, 8 determinations ... 82 drinkers ... 61
circulating ... 73, 74 consulting ... 14, 32 custodian ... 30 determine ... 44, 63 drinking ... 60, 61, 69,
circumstances ... 17, consume ... 61 cut ... 36,68 determining ... 64 75
26 consumed ... 60, 61, cutoff ... 48 development ... 11 drinks .. . 69
civil ... 5, 7, 17, 20, 25, 87 cv ... 6, 7, 9 devices ... 54, 57 drug ... 23, 36, 43, 46,
37 consuming ... 77
D
diagram ... 50, 53 48, 51, 52, 63-66,
civilian ... 54 contact ... 17, 59
d.abbled ... 10
diagrams ... 50, 53, 54 70,77,83
civilians ... 39 contacted ... 15, 25, dictate ... 35, 50, 56 drugs ... 28, 42, 46,
clarification ... 18 29
dally ... 83
dictated ... 56 51, 59, 64, 68, 70,
clarify ... 65 contain ... 38, 64, 76
data ... 23,45
dictates ... 34 75
clerical ... 55 contained ... 22,
date ... 9, 23
dictating ... 49 drunk ... 68
clerk ... 31 31-35, 38-40, 43,
dated ... 25
dictation ... 50, 53 dry ... 61
clients ... 19 44, 49, 50, 53,
David ... 8, 25
die ... 62, 67-70, 82, 83 DUI ... 39
Clinical ... 1 0 56,60,65
day ... 20, 34, 82, 84,
died ... 6, 16, 68, 70 duly ... 5
clinician ... 11 contains ... 38
85
dies ... 16 duties ... 7, 37
close ... 41, 43-45 continue ... 58
days ... 14, 34, 76, 86
different ... 19, 21, 27, dye ... 78
clothes ... 57 continued ... 80
dead ... 41,54
28, 40, 47, 64, 81,
E
clothing ... 50, 53 Continuing ... 73, 84,
deal ... 45
82,86,87,90
cocaine ... 59 85
death ... 7, 15, 16, 22,
differently ... 43
each ... 19, 24, 64, 74,
Code ... 15, 16 contract ... 12-14
30-32, 35, 36, 63,
difficult ... 91
88
Cole ... 8 contracting ... 12, 13
64, 69, 72, 75, 77,
directed ... 38
earlier ... 32, 44, 52,
coll ected ... 46, 52 contractor ... 11 , 13
80, 81, 83, 91, 92
directly ... 38
58, 78,81, 88,90
color ... 58 contributed ... 63
deaths ... 65, 67
director ... 1 0
early ... 60
combination ... 81 control ... 10
decides ... 15
directory . .. 10
earthly ... 37, 67
combined ... 68 controversial ... 57
decimal ... 24
disciplined ... 9
easier ... 60, 80
decision ... 16, 17, 36 easy .. , 40, 85
Elite Reporting, Jnc.
770-457-1276
ht hhhhh tp://ReachingForTheTippingPoint.net
D
Eckl ... 6 93 25, 28, 42, 47, 54, gentleman ... 44 hard ... 41, 59, 66, 70
education ... 6 expensive ... 40 55, 57, 72, 77, 82, Geoffrey ... 12 Harris ... 5, 21, 80,
effective ... 83 experience ... 6, 82 88-90 Georgia ... 5, 6, 8-10, 84-86, 91
eight ... 67, 70, 73, 74 expert ... 15, 17 five ... 12, 19, 20, 46, 15, 16,20,30,32 hate ... 90
eighty ... 60, 61, 66, explicitly ... 77 57, 61, 73, 74, 85, Gerald ... 5 head ... 36, 44, 54, 76
67,69, 73,74 exposure ... 84 90, 93 get ... 24, 26, 28, 34, healed ... 59, 71, 72
Eisenmenger ... 29 External ... 6, 35, 36, flag ... 44 40, 41, 43, 47, 48, healing ... 72
Eisenstat ... 12 38, 39, 49, 50, flagged ... 39, 43, 48, 58-61, 63, 66-69, healthy ... 36, 68, 70,
elapsed ... 28 62-57, 78 49,90 73, 74, 76, 82-86 71,81
elbow ... 54, 58, 88 extra ... 26, 33, 54 flags ... 39 gels ... 15, 50, 69, 91 heard ... 8
elbows ... 79 eyes ... 58 Florida ... 29 give ... 11, 23, 37, 48, hearsay ... 56, 89
elected ... 86
F
fluid ... 40, 44, 85, 92 53, 74, 77 heart ... 42
elevated ... 60, 93
face ... 38,39
fluids ... 86 given ... 7, 9, 20, 25, height ... 54
eleven ... 7, 61 fluoride ... 51 36, 43, 61, 69, 71, held ... 9, 10
eliminate ... 42
facilitate ... 37
focused ... 55 75,91 hel p ... 39, 76, 78, 87
email ... 31
facility ... 13, 83
folder ... 22, 46 gives ... 44, 53, 55 hel pful ... 49
Emory ... 9
factors ... 16, 17, 70
folders ... 21 glad ... 83 helpi ng ... 83
emphysema ... 70
fail ure ... 70
following ... 16, 65 go ... 10, 16-17, 19, hematocrit ... 66, 70
fair ... 7, 20, 21, 44,
employed ... 12
55,63,87,89,92
follows ... 5 20, 23, 25, 31' 35, Henry ... 13, 14
employees ... 12
fairly ... 54, 68
Foods ... 8 37, 39, 47, 49, 50, Henson .. . 15, 26, 31,
EMS ... 32,41 Forensic ... 9, 10, 12, 54, 55, 57, 63. 66, 33, 38, 39, 57, 59,
English ... 39
family ... 6, 32, 36-38,
27,64 70, 83,84,88, 93 60
enormous ... 36
80
forget ... 8, 64, 82 going ... 6-9, 14, 17, heroin ... 42, 58-60,
enter ... 12
far ... 10, 27, 36, 54,
form ... 5, 50, 53, 77, 19, 23, 24, 28, 29, 63, 64, 68-70, 76,
entered ... 12
77,81, 87
86 33, 34, 37, 40, 42, 82, 88,89, 91, 92
entire .... 18, 20, 21, 48
Farnham ... 6
formula ... 73 43, 45-48, 51, 54, high ... 11' 90, 93
fast ... 68
entities ... 6
faster ... 69
formulate ... 79 60-63, 65-69, 71' higher ... 66, 67
entitled ... 35
fatal ... 67
formulating ... 16 73, 75, 76, 78, 80, highl ight ... 45
enzyme ... 61
fatty ... 79
forth ... 90 82-87, 91-93 highlighted ... 46, 90
enzymes ... 61, 62, 75
favor ... 54
forty ... 45, 90, 93 gone ... 28, 62, 75 historical ... 36
equipment ... 44
fax ... 44
fossae ... 58, 71 Good ... 11 , 41, 64, 88 history ... 58, 59, 61
error .. . 55, 65-67, 93
faxed ... 39
fouled ... 50 Gowitt ... 5, 20, 80 hit ... 75
escapes ... 23
February ... 30
found ... 92, 93 gown ... 54 hils ... 45, 75
et ... 7 four ... 12, 18, 23, 39, graduated ... 9 hodgepodge ... 22, 50,
ethanol ... 63, 80, 81
tee ... 14, 17-19
44, 57, 59, 69, 72, graduating ... 10 53
feel ... 22
evaluation ... 35
fellow ... 25
75, 76, 78, 90, 93 Grady ... 9 Hold ... 55, 59, 73, 90
evidence ... 17, 54, 72
fellowshi p ... 9
frame ... 28, 29 gram ... 75 holds ... 78
exam ... 49, 50, 52-54,
felt ... 42
frankly ... 87 gray: .. 51 holes ... 71, 72
56,63
femoral ... 42, 43, 52
Friend ... 30 green ... 53 Homicide ... 64
examination ... 5, 6, front ... 34, 54, 55, 78 Gregory .. . 29 honest ... 45
34-36, 38, 39, 51,
ffrey ... 12
full ... 22, 55, 85 groin .. . 52 honestly ... 36
54-57, 71, 75, 76,
field ... 9, 10
Fulton ... 9, 14 group ... 11, 12 hope ... 85
78, 80, 88, 91, 92
fields ... 10
function ... 45, 70, 90, guess ... 18, 25, 26, hopefully ... 77
fifteen ... 78, 81
examine ... 54
fifty ... 19, 24, 65, 69,
91 37,50 Hospital ... 9, 10, 15,
examined ... 93 functioning ... 90, 91 guessing ... 78 22, 32, 36, 38-44,
Examiner ... 11-14, 16,
73
functi ons ... 44 Gwinnett ... 13 . 48, 51, 54, 58, 62,
37
f igure ... 63, 72
further ... 60, 69
H
63, 65, 71 , 78, 79,
example ... 11, 32, 60
file ... 6, 18, 20, 21,
Furthermore ... 68 84, 88, 91-93
25, 27, 29, 31, hair ... 43, 58
Excellent... 18
34, 38, 50, 53, G half. .. 12, 19, 39, 74,
Hospitals ... 9
except ... 5,36,64 hour ... 18, 19, 46, 61,
excess ... 87
54,87,88 gain ... 56 85
69, 78, 80
exclude ... 87
final ... 65 gas ... 40, 66, 67, 78 halfway ... 60, 75
hourly ... 18
exclusively ... 89
finalize ... 35 gases ... 90 Hall ... 13, 14
hours ... 36, 59, 60,
excreted ... 4 7
find ... 25, 37, 50, 59, gauze ... 78 hand ... 6, 33, 87
62, 72,84,85,93
Exhibit ... 6, 8, 20-22,
71,72,78 gave ... 6, 88 handed ... 87
house ... 60, 75
26, 29, 31-35,
finding ... 75 GBI ... 14,43 handle ... 13
hundred ... 18-20, 24,
49-51, 54, 55, 62,
findings .. . 78 general ... 42, 56, 57 handles ... 31
57, 60, 61, 64, 65,
65-67, 87, 88
fine ... 21, 55, 57, 70, generally ... 26, 31, 34, hands ... 11
70, 72-74, 85
exhibits ... 20
90 35, 40, 42, 50, 67, handshake ... 13
hybrid ... 25
expect ... 67, 68,
Fire ... 22 7o, n . s2 handwritten ... 35, 49,
HYNES ... 21, 73, 76,
70-73, 76, 82, 92,
firm ... 6, 31 generate ... 31 50, 53
80
first ... 5, 1 9, 21, 23, generated ... 31, 33, 56 hang ... 26
7704571276
http://RRRRRea ea eeach ch ch ch chin in ii gF gggg orTheTippingPoint.net
identification ... 6, 8,
21, 26, 33, 35, 51,
54,65, 87
identified ... 63
identifies ... 8, 51
illness ... 70
illnesses ... 83
imagine ... 52 70
immediately . .'. 84
implementation ... 11
importance ... 45
... 22, 45
Impress ... 26
impromptu ... 13
Inc ... 8
inches ... 57
inconsistent ... 92, 93
Incorporated ... 12
increased ... 62
i ncredible ... 65
increments ... 18
indicated ... 74
indicating ... 68, 78
indication ... 42
Infer ... 46
infliction ... 72
ingested ... 77, 78 89
91 I I
ingesting ... 77
initial ... 33, 35 46
initials ... 57 '
initiated ... 15
injected ... 79
injection ... 79
injury ... 78
inquiry ... 6
Insertion ... 58
Intake .. . 33
integrity ... 28
interferes ... 51
internal ... 1 o
interpret ... 91
interruption ... 84, 85
Interviewed ... 32
intoxicated ... 39
intoxication .. . 36, 63,
68, 77, 80
introduced ... 5
Investigation ... 16, 32
33
investigator ... 15, 17
25, 26, 33-35 56
57, 59, 60 f I
investigators ... 16
issue ... 72
IV ... 58, 74, 78
IVs ... 84
J
JCAHO ... 11
jewelry ... 57
jobs ... 10
John ... 15, 26 31
33,34,38
1
'
Jon ... 12
Joseph ... 13
July ... 29, 66
June ... 15, 39, 40,
44,53, 75,77
junk ... 76
jurisdiction ... 15, 16
33,65 '
justify ... 19
K
KH ... 57
kidney ... 70, go 91
kidneys ... 45, 4l 90
91 f
kill ... 68, 81
kilogram ... 73
Kirk ... 8, 25, 26
knowledge ... 30, 31
89 I
knows ... 41
L
lab ... 11, 26, 38-40,
44, 45, 52, 63,
65-67, 72, 80 84
87, 88, 90, 9{ 93
label ... 49
laboratory ... 1 o, 11,
36,62
labs ... 45, 48, 80
lack ... 91, 92
largely ... 10
!ale ... 76
later ... 27, 39, 45, 56
76,77 I
lateral ... 58
lawsuit ... 6, 25
lawyer ... 5, 29
lawyers ... 29
layperson ... 42
leading ... 86
league ... 70
leaves ... 16
led ... 79
left ... 14, 58
legal .. . 39
length ... 57
lengthy ... 7
lethal ... 23, 24, 68,
81, 82
letter ... 10, 25, 26,
30,63,86
letters ... 30
level ... 23, 28, 40, 43,
44, 48, 64,67-70
76, 82, 85, 90 I
levels ... 23, 27, 41,
44, 52, 53, 69, 79,
81-83, 86 90 93
licence ... 9 ' '
licensed ... 9
licenses ... 9
lid ... 83
lifetime ... 61
Likewise ... 93
limit ... 39
line ... 90
list ... 7, 8
listed .. . 80
lists ... 82
liter 24, 66 67 69
70, 72-74, 79 80
85 I I
literature ... 81
liters ... 72-74 85
liver ... 44, 45: 47, 61,
62, 70, 75
long 10, 12, 37 41
45,89 f '
longer ... 14, 16, 25
look ... 6, 12, 23, 25,
40, 44, 45, 49, 50,
54, 56, 60, 65, 77,
82,88,90
looked ... 11, 24, 27,
44,59,68,87 90
Looking ... 18, 21,'36,
54,59, 79
loosest ... 41
lot 6, 14, 23 24 26
36, 45, 69: eo: 8z:
86
low 11, 24, 67, 69,
70, 90
lower ... 28, 40, 44, 63
66,70
M
M.D .... 6
M.E .... 22
machine ... 40 67
machinery ... 44
maintain ... 20 33
major ... 70 '
make 10, 16, 20, 29,
32, 48, 49, 68, 73,
77, 80, 82, 84-87
making ... 17, 61 54
68
male ... 67, 68, 72, 73
MAM ... 64,76
man ... 17, 58, 81, 84
manager ... 29
manilla ... 38, 46
many 11, 12, 36, 37,
58,64,65, 72,85
margin ... 67, 93
marginal ... 91
7704571276
Marie ... 59, 89
mark ... 6, 8, 20, 26,
33,34, 50,54, 65
87 '
marked ... 6, 8, 21, 22,
26, 33, 35, 38, 44,
46, 51, 53, 54, 62,
65,66, 87,88
marks ... 58, 88, 89
MARSCHALK ... 5, 20,
21, 46, 71, 86,
91 -93
mass ... 66
mater .. . 11
matters ... 60
means ... 44, 64
meant ... 58
measure ... 48
measurement ... 79
measures ... 48
meat ... 55
mechanism ... 36, 84
87
medical ... 9-14, 16,
22, 27, 29, 37, 40,
54, 57, 62, 71, 78,
80,81,88,90 91
medications ... 23'
medicine ... 10, 12, 27
37 I
meet ... 8
meeting ... 26, 28
meetings ... 28
mega ... 86, 87
members ... 37
met ... 7, 26
metabolite ... 76
metabolize ... 48, 61
64 I
metabolized ... 47
methodology ... 67
metro ... 20
microgram ... 70
micrograms ... 24, 66,
67, 69, 70, 72, 74,
79,80,85
microscopic ... 11
milligram ... 74
milligrams ... 24, 39,
74, 79
milliliter ... 24, 80
Mills ... 49
mine .. . 75
minimum ... 19
minus ... 66
Miscellaneous ... 22
missing ... 21. 54
mistake ... 65
MOM ... 64
money ... 20, 63
monoacetyl morphine
... 64
month ... 10, 60, 61,
68, 75, 83
monthly ... 14
months ... 11
morning ... 13, 60
morphine ... 23 28
42, 43, 6o,'s2-e4
66, 68-70 72 I
74-77,
motor ... 40
much 15, 23, 26, 28,
32,36,40,54,55
60, 67, 73, 82, 83
1
85,90 '
multiple ... 75, 84 88
multiply ... 73 '
. N
nail ... 60
naive ... 68, 69, 82
named ... 89
names ... 14
nanograms ... 24, 80
Narconon ... 6, 29, 30
83,86 '
narcotic ... 59
narcotics ... 60
natural ... 16, 54, 64
necessary ... 37
needed ... 37, 53
needing ... 45
needle ... 52, 58
neutral ... 7
nevertheless ... 86
NHS ... 38,46
niacin ... 86
nice ... 55
night ... 60, 69 91
nine ... 90 '
ninety ... 73
Nobody .. . 20, 38
nonnatural ... 16, 16
nonnaturally ... 16
normal ... 44, 45 61
62,67, 7o,9o, 92
93 I
normally ... 57
Northside ... 15, 16,
22,32,38,39,41
44, 46, 48, 88, 93
1
Nos ... 65
note- 26, 49, 57, 58,
62
noted ... 16, 40 45 58
64 O
0
I
Notes ... 35, 39 49
50, 53, 58,
1
78 '
notice ... 5, 21
Notification ... 35
notifying ... 11
November ... 30
numbers ... 67 P.M .... 15, 53, 93 50,56,57,59 60,62,65,66, 72
nurse ... 15 paid ... 20 place ... 20, 28, 49, 59, reportable ... 15
nurses ... 32, 49 particularly ... 22, 36, 79
quality ... 10
reported ... 11, 15, 24,
0
69 placed ... 63
quibble ... 86
39, 45, 48, 60, 64,
parties ... 5, 7, 20, 29 Plaintiff ... 7 69
O.C.G.A. ... 17
party ... 15, 17 play ... 43
quick ... 23, 24, 29, 49,
reporter ... 72
Object ... 86 50
reports ... 24, 34, 54, passed ... 60 plethora ... 46
quicker ... 61 objections ... 5
Pat ... 31,53 pointing ... 46
quickly ... 78
62, 63, 65, 87, 88,
obtain ... 42
pathologist ... 10, 37, points ... 24 90
obtained ... 59
64 policies .. . 11
quote ... 61
representat ion ... 30
occasionally ... 10, 13
pathology ... 9, 10 portion ... 22, 38 R request .. . 29, 30, 37
occasions ... 75
patient ... 60, 71, 83, positive ... 28, 46-48, raises ... 10 requested ... 27, 29-31,
00 ... 43,51
87,92,93 53,58,66, 77 ran ... 93 36
of.15 ... 67
Patrick ... 6, 15, 17, possession ... 20, 52 range ... 67, 68, 70, requests ... 31
office ... 9, 14, 15, 27,
21, 27, 30, 31, possibility ... 42, 43 80,82,88,93 require ... 14
29-32, 39, 49, 52,
38,44,55, 70 . Post ... 25, 26, 29 ranges ... 82 Rescue ... 22
62-64, 66, 67
pay ... 66 postmortem ... 42, 43, rate ... 18, 28, 66 research ... 23, 24, 32
official ... 7
PCo2 ... 90 65 reality ... 84 reserve ... 5
often ... 11, 17
pee ... 92 potential ... 42, 43, 51 reason ... 23, 37, 39, residency ... 9
old ... 23, 67, 70
peek ... 23, 29, 50 pounds ... 57, 60, 61, 49, 74,82 residing ... 60
one ... 7, 12, 17, 19,
pending ... 65 72 reasonable ... 71, 80, resource ... 82
21' 23, 26, 30, 32,
people ... 11, 16, 23, power ... 37, 61 81, 91 .respect ... 6, 39, 40
34, 36, 38, 39,
36, 37, 49, 60, practice ... 5, 37 receive ... 86 respiration ... 91
42-44, 46,48-51,
67, 74,83,86,89 practiced ... 10 received ... 29, 35, 48, respiratory ... 68, 77,
53, 56, 57, 59-61'
percent ... 39-41, 51, prefer ... 5 51,53,63, 66 78
64, 66-69, 73-75,
66,93 preparation ... 24, 34 receiving ... 83 responded ... 30
77, 81, 92, 93
perfect ... 9, 34, 85 prepared ... 7, 34 recent ... 59 response ... 27
ones ... 7, 9, 45, 63,
perfectly ... 27, 44 preparing ... 22 recently ... 75 responslbflitles ... 10
80,87,88,90
perform ... 16, 34, 37, presence ... 48, 63 recommended ... 87 responsiveness ... 5
online ... 32
38,40 present ... 49, 50 reconstruct ... 50 result ... 40, 77, 93
open ... 30, 36, 37
performed ... 33-36, presented ... 84, 86 Records ... 16, 22, resulted ... 77, 81
opening ... 37
40 presents ... 84 29-32, 38, 39, 44, results ... 38, 39, 47,
operating ... 40
perhaps ... 28 preseNative ... 28, 51, 46, 49, 50, 60, 63, 63,66
opiate ... 42, 47, 63,
period ... 41, 62, 75, 53 83 resuscitated ... 41
64,68
86 pressure ... 41, 91 recreate ... 53 retain ... 25
opiates ... 42, 46, 47,
peripheral ... 42, 43, presumable ... 84 recreating ... 53 retained ... 7, 9, 15, 17,
58,60,66, 79
51 pretend ... 83 RECROSS ... 91, 92 62
opinion .. . 76-81, 92
peripherally ... 42, 43, printouts ... 23
red ... 51 rev ... 61
opinions ... 71, 91
51 prior ... 13, 77, 83 redistribution ... 42, 43 revamped ... 11
opioids ... 66
permission ... 37 private ... 37 redness ... 72 revert ... 61
opposed ... 50
person ... 54, 57, 60, probability ... 71, 80, reduce ... 85 reviewed ... 39, 88
orange ... 50
70, 71,74, 82,85 81
references ... 32 revised ... 6, 11
order ... 82
personal ... 32 problem ... 16, 36 reflect ... 6 revision .. . 11
ordering ... 26
Personally ... 19 problems ... 36, 83 reflective ... 76 rewed ... 75
organization ... 11
personnel ... 58 procedures ... 11, 62 regimen ... 86 rings ... 53
organized ... 21
pH ... 42,90 proceed ... 15 Regional ... 10, 20 Robert ... 49
organs ... 45
phosphatase ... 44 produces ... 44 regularly ... 61 Rockdale ... 13, 14
original ... 6, 20, 24,
photograph ... 59 product ... 66 rehab ... 59, 61, 68, 89 role ... 10, 43
34,43,46
photographs ... 49, program ... 83, 89 relationship ... 13 run ... 9, 40, 63, 64
originally ... 28, 29
53,59 properly ... 90 Released ... 53 runs ... 88
otherwise ... 36, 68, 70
Photos ... 22 prorated ... 19 rely ... 43, 52
s outcome ... 82
phrase ... 35 protein ... 44, 90 relying ... 35
sake .. . 37 outlines ... 48
physical ... 54 provide ... 14 removed ... 21
Sail ... 14 outlining ... 82
physician ... 9 provided ... 36 renal ... 45, 47, 70
sample ... 28, 40, 62, overdose ... 64, 86
physicians ... 12 publications ... 6
rendered ... 81
74 overdoses ... 69
physiological .. . 87 pull ... 23, 26, 50 repeated .. . 70, 83, 84
samples .. . 26, 28, 51, . overdosing ... 84, 87
pick ... 15 pulse ... 41, 91 repeatedly ... 71
76 overlap ... 24, 82
picture ... 69 puncture ... 54, 58, 75,
replaced ... 86
sauna ... 83-85 oversee ... 10
pictures ... 54 78, 79 report ... 21, 22, 29,
saw ... 10, 11, 52, 54, own ... 12
pinholes ... 88 pure ... 89 30, 32-35, 40, 43,
71,82,86
p
pink ... 34, 35, 38, 39, pursuant ... 5, 30
44, 50, 64-57, 59,
scan .. . 36, 44
7704571276
De
scar ... 89 significant ... 36, 43, straight ... 67, 91 therapeutic .. , 23, tripped ... 43
schedule ... 17 68,75,90 strange ... 13 68, 70, 74, 78, 81' Trisha ... 15
scheduling ... 31 significantly ... 63, 93 strike ... 74 82 trouble ... 75
school ... 9, 10 signs ... 72 structure ... 18 therapeutically ... 89 lube ... 51
screen ... 46, 47, 66, similarly ... 52, 86 structures ... 19 therapy ... 83 lubes ... 28, 51
77 simply ... 35, 48 stuck ... 43 therefore ... 61, 69 turgor ... 92
screens ... 46, 77 site ... 10 studies ... 36 the;:;e ... 16, 23, 28, 31, turn ... 55, 65, 90
second ... 45, 55, 59, sites ... 79 subjected ... 83 39, 45, 58, 61' twelve ... 65
77, 78 sitting ... 8 subpoena ... 83 65-69, 82, 88, 93 twenties ... 72
Secondly ... 42 situation ... 15 substances ... 27, 77, thinned ... 7 twenty ... 10, 20, 36,
seconds ... 68 six ... 11, 12, 27, 73, 78 third ... 45 51' 52, 59, 67, 70,
secretaries ... 34, 56 74,90,93 successfully ... 41 thirty ... 68, 75, 90, 93 72, 78
secretary ... 55 sixteen ... 62, 67 suffering ... 60 thousand ... 19, 20, 73, twice ... 85
security ... 14 size ... 60 sufficient ... 81 74, 80 two ... 12, 27, 39, 43,
see ... 6, 10, 12, 23, skin ... 92 sugar ... 81 threatening ... 83 46, 53, 57, 61, 62,
24, 29, 39, 40, 45, skull ... 58 Suicide ... 64 three ... 12, 20, 23, 33, 65, 68, 69, 72, 73,
52, 55, 58, 59, slightly ... 44, 61 suit ... 37 51' 54, 65, 69, 75, 77,81,88
65-67, 78, 79, slower ... 28 summary ... 48 76,82,85,90 typed ... 49
88-90 small ... 71 supervisor ... 11 tick ... 20, 21 types ... 17, 28, 56, 64,
seeing ... 31, 45, 75 smaller ... 58 supposed ... 88 time ... 9, 10, 13-15, 70
seen ... 54, 58, 67, 69 smart ... 19 suprapubic ... 52 20, 23, 28-30, 34, typewritten ... 35,
sent .. . 29, 30, 39, 42, smidgeon ... 44 surveys ... 10 35, 38-41' 45, 46, 54-57
62 Smith ... 12 Susan ... 30 48, 51' 52, 54, 56, typically ... 34, 56, 68
separate ... 11, 20, 21, social ... 14 susceptible ... 84-87 59, 61-63, 68, 69,
u
24,64 sodium ... 51, 93 swear ... 5 72, 75, 77-79, 82,
ug ... 72, 79, 80
separately ... 20, 23, solely ... 44 sweating ... 86 88, 89, 92
54,65 someplace ... 38 sworn ... 5 times ... 39, 41, 69, 73,
understood ... 69, 91
September ... 6, 8, 29 somewhat ... 6 system ... 47, 61, 74
Undetermined ... 64
unethical ... 19
serious ... 83 sophisticated ... 40 74-76 tiny ... 54, 58, 59
unfortunately ... 25
serum ... 40 sound ... 13
T
tissue ... 79
service ... 15 sounded ... 36 tilfe ... 34
units ... 24, 72, 73, 80
services ... 14, 37 sounds ... 19
tab ... 45
' titled ... 55
University .. . 9
set ... 87, 88 source ... 24, 31, 42
tabbed ... 46
to9ld ... 52
unless ... 37
seven ... 19, 90 sources ... 31, 32, 82
taking ... 60, 64, 75
today ... 8, 10, 14, 15,
unquote ... 61
seventeen .. . 18, 64 sparingly ... 66
TANNER ... 20, 37,
20-22, 24, 28, 48,
update ... 8
seventy ... 57, 73, 90 special ... 24
71-73, 76, 86, 92,
71,80
upper ... 58
several ... 34, 53, "75, specific ... 30, 36, 40,
93
toe ... 54
urinalysis ... 11
80,85 78
tape ... 50, 79
tolerance ... 62, 70
urine ... 40, 46-48, 51,
severe ... 92, 93 specifics ... 9
taped ... 78
tolerate ... 61, 70, 82
52,58,62, 76,77
severely ... 85, 93 spectrometry ... 66
tattoo ... 58
tomorrow ... 13
user ... 68, 69, 82
share ... 88 spelled ... 12
tattoos ... 50, 53, 54
took .. . 9, 28, 33, 63,
uses ... 83
sheet ... 34, 35, 38, 39, spelling ... 12, 14, 23,
tech ... 49
69, 75,79,86
using ... 42.-44, 76
technical ... 43
v 50, 63-57, 59 82
technically ... 41
lop ... 24, 51, 67
sheets ... 50 spend ... 18, 63 total ... 44, 73-75
valuables ... 53
shock ... 45, 75 spill ... 47
techs ... 50
town ... 6, 13
value ... 44, 63, 76
shocked ... 23 spoken ... 32
telephone ... 59
tox ... 43, 44, 46, 54,
values ... 11,45
shoot ... 69, 79 stack ... 87
telling ... 66, 82
62,63
variable ... 75
shooting ... 69 staff ... 26
temperatures ... 85
toxic ... 23, 24, 68, 82
variables ... 69
shortcut ... 6 standard ... 79
ten ... 7, 20, 23, 61
toxicology ... 23, 32,
variety ... 70
term ... 79
shot ... 69 stands ... 79
terminal ... 70, 83
34,62,65,68 vehicle ... 40
show ... 8, 19, 36, 46, start ... 55
terms ... 82
track ... 88, 89
vein ... 42, 43, 75, 79
66,92 started ... 6, 39, 84
terrible ... 45
transcribe .. . 34
veins ... 79
showing ... 36, 53 state ... 20, 36, 40,
Terry ... 13
transcribed ... 57
Verges ... 59, 89
shows ... 47, 53, 72 62,63,66,81
test ... 40, 47, 64, 66
transport ... 15
versus ... 8, 36, 40, 42,
sick ... 62, 70 statute ... 16
tested ... 41, 48, 63, 67
trauma ... 17,54
51,81
side ... 7, 20 statutory ... 16
testimony ... 79, 19,
treated ... 89
Veterans ... 9
sign ... 16, 34, 35, 53, step ... 69 treating ... 86
vicinity .. . 74
57,65,92 stick ... 42, 52
20,43,88
treatment ... 78, 83
Viera ... 29
signature ... 5, 56 sticks ... 51
testing ... 27, 63
tree ... 17
visit ... 10
signed ... 33, 72, 80 stopped ... 77
tests ... 11, 26, 61, 63,
trial ... 18, 19
vitamin ... 86
93
significance ... 39, 48 stored ... 28
Theoretically ... 92
trials ... 7
vitamins ... 86, 87
7704571276
Walk ... 55-57
wants ... 27
water ... 40, 44
week ... 14
weeks ... 75, 76
weighed ... 57
weight ... 54, 73
welcome ... 27
whatsoever ... 89
Whereas ... 40
whereby ... 84
Whereupon ... 5, 46,
80,84, 85,93
white ... 13, 55, 78
whole ... 26, 40, 45, 85
wife ... 12
Will ... 5, 7, 20, 23, 45,
48,50
window ... 78
Winek ... 2.3
wisely ... 37
wish ... 80
withholding ... 13
witness ... f5, 17, 46,
73,86
woman ... 30, 89
word ... 8, 41,43
words ... 16, 18, 19,
32, 48, 59, 72
work ... 11, 12, 18, 45,
46, 61, 70, 84, 90,
91,93
works ... 34
world ... 70
worthy ... 68
wound ... 78
wounds .. . 54, 58, 75,
79
wrist ... 78
write ... 10
writing ... 35
written ... 13, 23, 34,
36
wrongful ... 7
wrote ... 24
y
year ... 7, 11, 28, 64,
65,67, 70
years ... 7, 10, 23, 27,
28,88
young ... 17, 81
yours ... 54, 75
z
Zaki .. . 14
zero ... 68, 77, 91
7704571276

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