THOMAS BENNETT, MD
CRIMINAL TRIAL


(586-636)

586

1 9:58 a.m., May 20, 1997; and proceedings commenced at

2 10:15 a.m., May 20, 1997, with the court, counsel and

3 defendant present.

 

4 COURT: Mr. Wadding?

 

5 MR. WADDING: Thank you, Your Honor. Call

 

6 Dr. Bennett to the stand.

 

7 THOMAS BENNETT,

8 called as a witness on behalf of the state, being first

9 duly sworn by the court, was examined and testified as

10 follows:

 

11 COURT: Mr. Wadding?

 

12 MR. WADDING: Thank you.

 

13 DIRECT EXAMINATION

 

14 BY MR. WADDING:

 

15 Q. Would you state your full name and spell your

16 last for the record, please.

 

17 A. My name is Thomas Bennett, B-E-N-N-E-T-T.

 

18 Q. And your occupation, sir?

 

19 A. I'm a physician, a pathologist by training

20 and forensic pathologist. I'm currently serving as the

21 Iowa State medical examiner.

 

22 Q. How long have you been serving as the state

23 medical examiner?

 

24 A. Governor Branstad first appointed me in March

25 of 1983, so I'm over 14 years now. I did take a year and

 

587

1 a half in 1985 and 1986 and went to Mississippi to serve

2 as their state medical examiner, but since October of

3 1986 I've been here continuously.

 

4 Q. And could you describe your education and

5 training in achieving your position?

 

6 A. I have a bachelor's degree from Des Moines,

7 Drake University in Des Moines. I have then my M.D. from

8 the University of Iowa College of Medicine where I

9 graduated in 1978. Once you get your M.D., you really

10 can't do much without your residency training, so I went

11 on to get, first off, hospital pathology training to

12 learn my general pathology, the anatomic and clinical

13 parts, the tissues and the fluids of the body, which

14 includes the biopsies, pap smears, blood tests, urine

15 tests and so forth. And then I went to North Carolina

16 and served as an assistant chief medical examiner for the

17 state of North Carolina learning forensic pathology at

18 that time.

19 When I finished my five years of residency

20 training, I was eligible then in June of 1983 to take

21 that four-day long test prepared by the American Board of

22 Pathology. And if you pass the test, you're certified by

23 the board or board certified. I took it in three areas:

24 the anatomic pathology, clinical pathology and forensic

25 pathology and passed, so I've been board certified since

 

588

1 then.

 

2 Q. And since 1983 you've been board certified?

 

3 A. Yes, sir.

 

4 Q. And since 1983 you've been state examiner

5 elsewhere for a brief hiatus, but state medical examiner

6 here in Iowa; is that correct?

 

7 A. That's correct.

 

8 Q. And could you briefly describe what your

9 duties are as a state medical examiner?

 

10 A. Yes, sir. The state medical examiner duties

11 are outlined in the statutes of Iowa. They are basically

12 five-fold. My first duty is to investigate all of the

13 sudden, violent, unnatural, unexpected deaths that occur

14 in Iowa. It's a big state. I serve instead as a

15 consultant working with the local county medical

16 examiners like Dr. Dolan or Dr. Bickley here in Black

17 Hawk County. I review their work. If they can't be

18 found, then I will pinch-hit for them on the firsthand

19 basis. I review their work, and I follow up on their

20 reports of investigation that are filed with my office.

21 My second duty is to do the forensic

22 autopsies when called upon, so it could be either the

23 county medical examiner, county attorney, law enforcement

24 officer who will notify me of the death and I can work

25 with them to do the autopsy. I promulgate rules and

 

589

1 regulations. I keep records of all that I do.

2 And my fifth duty is to teach. I give about

3 four to ten or more hours of lectures every week on

4 forensics around Iowa, the Midwest and other places, to

5 anyone dealing with these deaths that affect the public

6 interest.

 

7 Q. And were you requested or notified by Dr.

8 Bickley for autopsy -- to perform an autopsy with

9 reference to Juli Ann Farrell?

 

10 A. Yes, I was.

 

11 MR. WADDING: May I approach, Your Honor?

 

12 COURT: You may.

 

13 Q. I'm going to show you what's been marked as

14 State's Exhibit "M", marked for identification, ask you

15 if you recognize that?

 

16 A. Yes, sir, I do.

 

17 Q. And what do you recognize that as?

 

18 A. State's Exhibit "M" is a photocopy of what I

19 received from Dr. Bickley, his report of investigation by

20 medical examiner which includes everything that he wrote

21 by hand and was typed on there plus his dictation that

22 was typed and added to it. It's part of my permanent

23 record for this case, also another copy of this.

 

24 Q. And is that a record that you would normally

25 receive in -- when an autopsy is requested of you?

 

 

590

1 A. Yes, sir, it is.

 

2 Q. And is that a record that you would normally

3 receive and keep in your records with reference to that

4 autopsy?

 

5 A. Yes, sir.

 

6 MR. WADDING: Ask that State's Exhibit "M" be

7 entered into evidence, Your Honor.

 

8 COURT: Any objection, Mr. Correll?

 

9 MR. CORRELL: May I see that, Your Honor?

 

10 (Complied.) May I reserve my objection, if I have one,

11 and we could proceed.

 

12 COURT: When do you anticipate --

 

13 MR. CORRELL: Well, let me just double check

14 this. Maybe this is as good of a time as any.

 

15 COURT: All right.

 

16 MR. CORRELL: (Complied.) No objection.

 

17 COURT: Exhibit "M" is admitted.

18 Mr. Wadding?

 

19 MR. WADDING: Thank you.

 

20 Q. And did you conduct an autopsy with reference

21 to Juli Ann Farrell?

 

22 A. Yes, sir, I did.

 

23 MR. WADDING: And may I approach again, Your

24 Honor?

 

25 COURT: You may.

591

1 Q. For the purposes of efficiency, I'll see if I

2 can have you identify these documents. The first I'd

3 show you, a photo array packet marked State's Exhibits

4 "L-1" through "L-16", and ask you to review those.

 

5 A. (Complied.) Yes, sir.

 

6 Q. And do you recognize those, sir?

 

7 A. Yes, sir, I do.

 

8 Q. And what do you recognize those as?

 

9 A. "L-1" through "L-15" inclusive are

10 photographs which I took with my own camera in print form

11 and had duplicates of which I gave to you yesterday when

12 we met in the early afternoon to just discuss the case

13 briefly early -- or late morning I guess it was. I

14 maintain the negatives for these in my file.

15 "L-16" is another photograph taken during the

16 course of the autopsy. I didn't take this photograph.

17 It's my hands that are seen in this photograph, but it's

18 of Juli Farrell, again, taken during the course of the

19 autopsy to demonstrate the injuries which I -- helped

20 demonstrate some of the injuries we identified.

 

21 Q. Are those accurate depictions of -- well,

22 accurate depictions of certain processes of the autopsies

23 taken to represent?

 

24 A. Yes, sir. They are true and accurate and

25 depict what I saw at the autopsy.

592

 

1 MR. WADDING: At this time, Your Honor, I

2 would ask that State's Exhibits "L-1" through "L-16" be

3 entered into evidence.

 

4 COURT: Any objection, Mr. Correll?

 

5 MR. CORRELL: Well, Your Honor, as the

6 court's well aware, autopsy photos are generally

7 admissible in court. We do have an objection to --

8 there's been no showing that there are -- is a necessity

9 to have 16 autopsy photographs shown. It's -- it could

10 serve no legitimate purpose, and we would object as those

11 are repetitive and -- in nature, and they're designed to

12 be inflammatory, and they are inflammatory.

 

13 COURT: I'm not sure at this time, because

14 I -- I haven't heard what's described in the photographs

15 testified to or what's depicted in the photographs

16 testified to, so I'll reserve ruling on that and find out

17 whether the -- each photograph is significant for

18 something during the course of the examination.

 

19 Q. Now, I want to show you what's been marked as

20 State's Exhibit "N" and State's Exhibit "O", ask you if

21 you can identify that?

 

22 A. Yes, sir, I can.

 

23 Q. Okay. What is State's Exhibit "O"? How do

24 you identify that?

 

25 A. State's Exhibit "O", which is the reverse

 

593

1 side, is the -- is an enlargement of the -- is an

2 enlargement of the diagram which I prepared during the

3 course of the autopsy. I take a basic skeletal diagram,

4 and whatever I see during the autopsy, I make little

5 notations in my own handwriting. It's part of my

6 permanent record, part of the permanent report.

 

7 Q. And State's Exhibit "N"?

 

8 A. State's Exhibit "N" is a -- an enlarged copy

9 of the diagram I prepared using her outline, the outer

10 body surfaces both front and back, and, again, if I find

11 something I think significant, I note it on this in my

12 own handwriting, and I make this part of my permanent

13 report. I have the originals here with me today for both

14 of those.

 

15 MR. WADDING: And at this -- at this time I

16 would ask that State's Exhibits "N" and "O" be entered

17 into evidence, Your Honor.

 

18 COURT: Any objection, Mr. Correll?

 

19 MR. CORRELL: Could I just very briefly voir

20 dire this witness?

 

21 COURT: (Indicating.)

 

22 MR. CORRELL: Dr. Bennett, is what I'm going

23 to show you here, is "N", this diagram, enlarged without

24 any change?

 

25 WITNESS: But for the little red sticker in

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1 the lower corner, that's -- in the enlargement, that

2 appears to be the same diagram, yes, sir.

 

3 MR. CORRELL: Okay. On the back in what has

4 been marked as "O", is that, again, the same document or

5 the same skeletal views that were attached and made part

6 of your autopsy with the exception of the affixing of the

7 evidence sticker?

 

8 WITNESS: Yes, sir.

 

9 MR. CORRELL: Thank you. I have no

10 objection. Do you want me to put it back up for you?

 

11 MR. WADDING: Please.

 

12 COURT: "N" and "O" are admitted.

 

13 CONTINUED DIRECT EXAMINATION

 

14 BY MR. WADDING:

 

15 Q. And could you describe, or maybe in an

16 overview sense, how you perform a -- an autopsy?

 

17 A. Okay. In general I perform an autopsy by

18 going from the outside to the inside, large to small,

19 which you -- what I do is I start with the decedent,

20 their body as I receive it. In this case she was

21 received wrapped in a white cloth sheet with no other

22 clothing or possessions on her body. Sometimes I have

23 clothing, sometimes I have jewelry or other possessions,

24 sometimes there is fragments of trace evidence or

25 something else.

 

595

 

1 I examine her whole body. I take pictures to

2 help document and diagram or prepare exhibits for

3 whatever I have seen at the autopsy, and then I start to

4 wash her to look her a little -- at a little bit more

5 closely at her surfaces of her body. If appropriate,

6 I'll get x-rays. If x-rays have been taken already, such

7 as in this case, I won't duplicate them. And then I

8 start the internal part of the autopsy.

9 Now, just to stress, an autopsy is done in

10 such a way to answer the questions that are posed to us,

11 but we also have from memory. We want to be shown at the

12 funeral afterwards too, so we try and do things in such a

13 way that nothing would be seen at the funeral. The

14 internal organs of the chest are opened, are examined by

15 using a Y-shaped incision, and then the scalp is also

16 reflected so I can examine her brain. I remove the

17 organs from her body. I look at them individually, and I

18 take small samples for microscopic examination,

19 toxicology examination, whatever else is necessary. Then

20 I return everything to her body that I haven't saved for

21 other exams and return her to the funeral home.

 

22 Q. Thank you. And did you follow that course of

23 procedure in this instance?

 

24 A. Yes, sir, I did.

25 Q. And with regard to the external examination

 

596

1 of Juli Farrell, could you describe what observations you

2 made of any external injuries if -- and using State's

3 Exhibit "N" if possible.

 

4 A. Okay. State's Exhibit "N" is up here on the

5 board behind me. What I found during the course of the

6 autopsy is that Juli had received injuries to her chest

7 and her face, along the left-hand side of her face, which

8 I've indicated up here as being the prominent dicing over

9 her left face. Dicing is a term I use for multiple

10 superficial cuts, scratches and so forth, and even some

11 abrasions or scrapes along that surface. That indicates

12 that her face has been impacted by a rough surface, very

13 consistent with broken glass. The small pieces of glass,

14 especially in the side window, when they break, they

15 break up in little tiny squares. When those come in

16 contact with the face, you'll get this little pattern of

17 like a little checkerboard or little squares or irregular

18 pattern of cuts and scrapes.

19 I worked on down. She also had some

20 abrasions over her anterior chest and the top of her left

21 shoulder. Little Xs I have up here like on both sides of

22 her neck, Xs on the front of her elbows here, what we

23 call the antecubital fossae, and then down here in her

24 groin also, and in the back of her left hand, those are

25 all for needle stick marks. She had been through some

 

597

1 resuscitation trying to give her fluids to replace what

2 she had lost through bleeding. But then going back to

3 her chest, she had patterned abrasions. These are areas

4 of impact where she came in contact with a surface. It

5 left a scrape, left some bruising, left a pattern of

6 these injuries across her chest and especially her left

7 anterior chest and abdominal wall, which, again, I've

8 tried to diagram, rather crudely, but they're also seen

9 in the pictures, Exhibits "L".

 

10 MR. WADDING: May I approach?

 

11 COURT: You may.

 

12 Q. So when you describe the areas in the groin

13 and on the back of the hand, you're describing areas used

14 for medical purposes? Is that correct?

 

15 A. That's correct.

 

16 Q. And when you describe the area of the chest

17 and the face and the shoulder, are you describing areas

18 that were involved in the automobile accident?

 

19 A. Yes, sir.

 

20 Q. Okay. And you documented these by photograph

21 as well?

 

22 A. Yes, sir.

 

23 Q. Which photographs depict those?

 

24 A. The photograph "L-1" is a facial photograph

25 which depicts her as she looked on the autopsy table. I

 

598

 

1 have washed away some of the debris and so forth from her

2 face. That can be seen that she has some abrasions, and

3 the dicing along the left face plus some abrasions of her

4 eyelid and nose. Exhibits "L-2" and "L-3" show the right

5 and left sides of her face respectively, going along with

6 what's in "L-1", but also depicts her ears and the sides

7 of her neck, can also see the needle stick marks and so

8 forth which were from the resuscitation.

 

9 Q. All right. And the -- you also -- did you

10 have a photo depicting the area of, I believe, the chest

11 that you described?

 

12 A. Yes, sir, I do.

 

13 Q. As an impact area?

 

14 A. Yes, sir. In fact, photographs "L-4" through

15 "L-9" inclusive are all of the external surfaces of her

16 body. The patterned injury to her chest is seen best in

17 Exhibit "L-9". And, again, I have my ruler in here to

18 help organize its size and so forth because it was

19 patterned. The bruising can be seen around it, which is

20 more a dusky reddish-brown color and the patterned

21 abrasion on the skin surface.

 

22 Q. And you describe that as a -- a patterned

23 abrasion?

 

24 A. Yes, sir.

 

25 Q. Why do you describe it with those words?

 

599

 

1 A. In general, if you just come in contact with

2 the rough surface like a floor or gravel or something,

3 you have just a -- a scraping away of the skin surfaces

4 but no real pattern to it. On the other hand, this

5 appeared to be something that had a somewhat square

6 shape. There are three radiating scratches out --

7 actually, it's above this area. The ruler is in the

8 lower left-hand corner as you look at it here with

9 respect to her body, so this would be the top of her head

10 more towards the end where the little red numbers are.

11 It has, again, a square shape to it, scratch marks coming

12 off to the side. It's consistent with her impacting

13 something of about that configuration.

 

14 Q. And what other observations did you make

15 externally?

 

16 A. I also observed externally and specifically

17 over her back, that but for a little bit of an abrasion

18 here on the back outer surface of her left thigh, which

19 is seen in Exhibit "L-5", and also documented up here on

20 the right-hand or back part of Exhibit "N", her back is

21 fairly clean. There is no evidence of any other trauma

22 to her back. The pattern of the pale area here is

23 because of the pooling of the blood, the lividity of

24 postmortem events. Most injuries were to her left side

25 and left front side.

600

 

1 The other three photographs, which I've

2 mentioned, Exhibits "L-6", "L-7" and "L-8". "L-6" is a

3 photograph of her left -- of her right upper side going

4 her total body length. It just helps document that the

5 right side of her face was without many scratches, no

6 real injuries down the right side of her body but for the

7 resuscitation of what I call the three-quarter inch

8 sutured incision up here from a chest tube that was

9 inserted. That was from resusitation. 

10 Photograph "L-7" is of her left chest. It

11 diagrams these various abrasions or depicts these various

12 abrasions plus that thoracotomy, which is where her

13 thorax or chest was opened trying to resuscitate her when

14 she bled so massively.

 

15 And then also State's Exhibit "L-8", the last

16 external picture, which depicts the other patterned

17 abrasion down here on her left anterior chest and

18 abdominal wall extending downwards from that thoracotomy

19 incision.

 

20 Q. Thank you. And the external injuries that

21 you described as patterned injuries, are -- were the

22 consistent with the history of an automobile accident in

23 this instance?

 

24 A. Yes, sir, they were.

25 Q. And what did you understand that history to

 

601

1 be?

 

2 MR. CORRELL: Excuse me, Your Honor. I'm

3 going to object to that. That calls for hearsay.

 

4 COURT: Sustained.

 

5 MR. WADDING: May I approach?

 

6 COURT: You may.

 

7 Q. I'm going to show you -- is there anything

8 else remarkable about State's Exhibit "N" or the external

9 examination?

 

10 A. I think we've covered most all the pertinent

11 points on that one.

 

12 Q. Now, I want to make reference to State's

13 Exhibit "O", marked for identification, State's Exhibit

14 "O", and ask you, you know, just what is that?

 

15 A. State's Exhibit "O" is an outline of the

16 skeleton, and I wrote on it everything I observed during

17 the autopsy as far as where there was damage between her

18 ribs and just where those damages were located.

 

19 Q. And is that more in reference to the internal

20 examination?

 

21 A. It's more in reference to the internal

22 examination plus what I saw by examining her limbs

23 individually. Now, we say we do a complete autopsy, but

24 there are many parts that I don't directly examine

25 because it's not necessary for the course of the autopsy.

602

 

1 I know that she had pelvic wing fractures. However, I

2 did not cut into that area because it would make it very

3 difficult for the funeral director. It wasn't necessary

4 because it was documented elsewhere. I did not see any

5 fresh fractures, so I did not depict any on here. She,

6 indeed, did have some pelvic fractures of the left wing

7 and then down in the ischial area, I-S-C-H-I-A-L, which

8 is where you sit on your pelvis, that part that you sit

9 on. That was not something I would examine during the

10 autopsy. I saw no fractures of her rib cage though skull

11 extremities.

 

12 Q. What are you depicting then in State's

13 Exhibit "O"?

 

14 A. The major two things I'm depicting in State's

15 Exhibit "O" would be that there were tears from the crash

16 between her second and third ribs, those little muscles

17 that hold the ribs together that assist with breathing.

18 Those were torn, and when I opened her chest cavity, on

19 the left side there was a big gap in that area that had

20 torn through that normal, smooth, like Saran Wrap lining

21 of the chest cavity. Lower on down here on the left side

22 between the sixth and the seventh ribs, the surgeons had

23 opened that area to go into her chest cavity directly to

24 find her heart and try and resuscitate her and also try

25 and see if they could find where the damage to the aorta,

603

 

1 to the major blood vessels that they felt was present was

2 located.

 

3 Q. And did you depict those -- did you depict

4 any of those skeletal comments you just made by

5 photograph?

 

6 A. Yes, sir, I did.

 

7 Q. And could you describe which ones?

 

8 A. Yes, sir. Those can be seen in photographs

9 "L-10", "L-11", "L-13" and "L-16". In each of those

10 first three, "L-10", "11" and "13", if the photographs

11 are held with the digital numbers, those little red

12 numbers down in the lower left-hand corner, it would be

13 just as if her head was at the top of the picture and her

14 left side of her body was off to the right side as --

15 your right side as you're looking at the pictures. You

16 can see the tear between the second and third ribs above

17 the thoracotomy incision, shows the dark purplish-red

18 discoloration because of blood back in the back chest

19 cavity in each of these. They show from the far side in

20 State's Exhibit "L-10" to the mid-back of State's Exhibit

21 "L-11" to the full back view in State's Exhibit "L-13".

22 They each depict different aspects of this, so you can't

23 see necessarily all of it in each -- or in any one

24 picture.

 

25 Q. Thank you. Now, with the injuries that we

 

604

 

1 have -- that you've made reference to so far in State's

2 Exhibit "O", state's exhibit, and were any of these --

3 that you could attribute to the accident, were any of

4 these fatal at this point?

 

5 MR. CORRELL: Excuse me. I'm going to object

6 to that form of that question as leading.

 

7 COURT: Overruled. You may answer.

 

8 A. Okay. What I identified as far as the facial

9 injuries, the dicing, the abrasions and so forth of her

10 body, no, those would not be fatal. Those were

11 cosmetically bad. They looked very bad, but those would

12 not be fatal, nor would that tear necessarily between her

13 second and third ribs be fatal. It was a serious injury.

14 It would make it very difficult and painful to breathe on

15 that left side, but it would not be fatal. So nothing

16 I've described so far would be fatal.

17 Q. And did your examination discover, or did you

18 find an injury that would, in fact, have been fatal?

 

19 A. Yes, sir, I did.

 

20 Q. Could you describe that?

 

21 A. Okay. During the course of the autopsy, I

22 found that she had sustained a tear to the aorta. The

23 aorta is the large blood vessel leading from your heart,

24 the left ventricle as an arch going first up and then

25 down along the left-hand side of your body along your

605

 

1 spine that carries the blood from your heart to basically

2 the rest of your body. The first two branches are to the

3 heart itself. Next three branches go to the arms and the

4 head, and then it courses down the back. Just after the

5 branch to the left arm originates, which is fairly high

6 up there in the arch, just below that, about a half inch,

7 I found that there was a half-inch tear completely

8 through the aorta wall. Now, that leads not directly

9 into the chest cavity, it leads instead into the soft

10 tissues that are in the mid-part of your chest between

11 each of the chest cavities where the lungs are located.

12 It leads first into this soft tissue area that was filled

13 with blood. The blood that was leading down along the

14 back of the left chest is eventually continuous with

15 that, but it's going through spongy soft tissue, not a

16 real space like the chest cavity would be. The rest of

17 her aorta was fine. I saw no underlying disease of her

18 aorta, but she had this half-inch long tear that was

19 completely through the aorta wall.

 

20 COURT: Where was that tear again?

 

21 WITNESS: About one-half inch below where the

22 left subclavian artery starts. It's quite high. It's

23 just where the aorta made its curve over the top and

24 starts going straight down toward the abdomen. Way up

25 there at the top is where that tear was.

 

606

 

1 Q. And did you document that by photograph?

 

2 A. Yes, sir, I did.

 

3 Q. And could you describe which photographs

4 depict that?

 

5 A. That can be seen in State's Exhibits "L-14",

6 "L-15" and "L-16", all three.

7 Q. And could you describe what you're attempting

8 to depict in those photographs?

9 A. Yes, sir. Okay. I'll start with State's

10 Exhibits "L-14" and "L-15", which are pictures I took

11 myself. If you hold the photographs with the numbers in

12 the right-hand corner, lower right-hand corner, then the

13 center of the photograph that looks pale yellow is the

14 aorta, the inside of the aorta. You see there are four

15 holes going across the middle part of the aorta. The

16 first three holes are the branches to the right arm and

17 side of the head, then the left side of the head, then

18 the left arm. The fourth hole is the tear. So it's just

19 below where the left arm branch is located. Now, I used

20 both of these because they're taken with different focus

21 points. One is taken a little bit more superficial

22 focus, one a little bit deeper focus, so you can see

23 things clearly in one that you can't see in the other,

24 but you can see it's a jagged tear, no evidence of

25 healing. It's a very fresh injury to the aorta tearing

607

 

1 through an otherwise normal part of the aorta.

 

2 Q. And "L-16", I believe there's another

3 photograph there as well?

 

4 A. Yes, sir.

 

5 Q. "L-16"?

6 A. "L-16" is a good overall photograph, which I

7 believe was taken by law enforcement during the course of

8 the autopsy. Two individuals from the Waterloo Police

9 Department, Keith Smith and Bill Sauerbrei, were both

10 there, and they assisted in taking pictures. As I'm

11 holding the arch of the aorta there, after I've removed

12 her lungs and so forth, you can see the thoracotomy

13 incision, that tear between the second and third ribs and

14 then that sort of diamond-shaped dark red tear in the

15 center of the yellow lining of the aorta, which I

16 described in "L-14" and "L-15".

 

17 Q. And the type of injury that -- well, this

18 tear to the aorta, would you consider that to be a fatal

19 injury?

 

20 A. Yes, I did.

 

21 Q. And the -- how does an injury like that

22 occur?

 

23 A. Okay. What -- what we're finding is it's

24 important to know the type of a crash itself, because

25 that's something I would rely upon in helping make my

608

 

1 diagnosis as far as -- as how this injury occurred and i 

2 part of what we do in forensics, so I asked like the

3 Waterloo Police Department and also Mr. Ferguson and Joel

4 Dalrymple from the Waterloo Black Hawk County Attorney's

5 Office, I asked the type of a crash. But, in general,

6 what happens is in this crash, when the vehicles

7 collided, she received a blow to the left side of her

8 head -- left side of her body and her chest, and in

9 general here it pushed the left side of her chest in like

10 this. Now, she was restrained, I was told, so her

11 shoulder strap and seat belt are both in place. They

12 didn't necessarily contribute to or even really protect

13 her that much in this crash because it came from the

14 side. According to the reports and what they had told

15 me --

 

16 MR. CORRELL: Excuse me, Your Honor. I'm

17 going to object to the witness incorporating that as

18 hearsay.

 

19 COURT: Overruled. You may answer.

 

20 A. Okay. According to what they had told me, is

21 that the results of an unrestrained passenger in the

22 front seat, so when her car and the driver, Juli Farrell,

23 are being pushed to the left, by inertia the right front

24 seat passenger is coming across, so she is actually being

25 squeezed in the process of having the left side of her

 

609

 

1 chest pushed in and being compressed. From this side it

2 actually pushes in and up. Right where this tear in the

3 aorta occurs is where the aorta goes from being  

4 free-floating part of the central chest cavity to being

5 something that's attached quite tightly to fibrous

6 tissues along the spine. When you push in from the chest

7 cavity on the side like this, it pushes the heart, the

8 chest, everything inside it up. Anything that's

9 free-floating gets pushed up. What is attached to the

10 spine back here on the other part the descending aorta

11 stays in place, and right where this junction between the

12 attached and free-floating part of the aorta is, is where

13 this tear occurred. So what it is, it's the compression,

14 the pushing of her chest that tears the aorta like this.

 

15 MR. WADDING: I don't have any other

16 questions. Thank you.

17 COURT: Mr. Correll?

 

18 MR. CORRELL: Your Honor, on the issue of the

19 photographs, based on the testimony, I do not object to

20 "14", "15" or "16" as identified, "L-14", "15" or "16" as

21 identified by the witness. I believe the photos one --

22 "L-1" through "13" are not relevant to the issue of the

23 cause of death.

 

24 COURT: May I see the photographs, please?

25 (Complied.) "L-1" through "L-16" are admitted. I

 

610

 

1 haven't -- I haven't heard "L-12" described. I'm not

2 sure what that is, so I -- I'll continue to reserve

3 ruling on that.

 

4 Mr. Correll?

 

5 MR. CORRELL: Thank you.

 

6 CROSS-EXAMINATION

 

7 BY MR. CORRELL:

 

8 Q. Dr. Bennett, have you, in preparation for

9 your testimony today or in your evaluation of Ms.

10 Farrell, have you reviewed any of the medical reports

11 from any of the attending medical providers?

 

12 A. Yes, sir, I have.

 

13 Q. And do you have available to you, Doctor, the

14 records regarding Ms. Farrell at Sartori Hospital?

 

15 A. Yes, sir, I believe I do.

 

16 Q. And have you reviewed those documents?

 

17 A. Yes, sir, I have.

 

18 Q. When did you first review those, sir?

 

19 A. I think I first received them over a month

20 ago.

 

21 Q. You did not have them at the time you

22 prepared your autopsy report; is that a fair statement?

 

23 A. That's correct. I had verbal reports of

24 them, but I did not have this packet of records. It may

25 have been even more than a month ago, but I did not have

 

611

 

1 them at the time of the autopsy.

 

2 Q. Is it correct that shortly after her arrival

3 that the medical records that you had reviewed from

4 Sartori Hospital indicate that Ms. Farrell was alert and

5 communicative?

 

6 A. Yes, sir.

 

7 Q. She was able to answer questions and respond,

8 and it indicates that she was, in fact, oriented, does it

9 not?

 

10 A. Yes, sir. That's how I understand it.

 

11 Q. And when you read those reports, would it not

12 be a fair reading of those reports to indicate that those

13 reports, prepared relative to the time of her admission

14 to the emergency room, there was nothing in those reports

15 that indicated that it was not anticipated a full

16 recovery by her; is that not correct?

 

17 MR. WADDING: I'm going to object, Your

18 Honor, as to relevance.

 

19 COURT: Overruled. You may answer.

 

20 A. Okay. I did not see anything that I noted

21 a -- I don't recall seeing anything where the doctor said

22 she should recover, she should not recover. My reading

23 of what the initial examination found, the studies and so

24 forth of what I see in folks that usually recover, I

25 would have expected, based upon what I saw in those

612

 

1 initial records, that she would have recovered.

 

2 Q. And my -- but my question is, there is

3 nothing in those reports that they thought otherwise as

4 well the people at Sartori; is that correct?

 

5 MR. WADDING: Well, I'm going to object, Your

 

6 Honor. It's asked and answered.

 

7 COURT: Overruled.

 

8 A. Okay. I don't recall anything where they say

9 they didn't think she wouldn't recover.

 

10 Q. And, in fact, she was put on a floor where

11 it -- the type of care and monitoring that she would have

12 been given through the balance of that night would have

13 been consistent with an expectation of recovery; would

14 that be a fair statement?

 

15 A. Yes, sir. She was not placed in the

16 intensive care unit or so forth at that time. To my

17 understanding she was placed in a closely watched bed but

18 not intensive care bed.

 

19 Q. And is it not a fair statement to say that

20 that would give some indication as to how they viewed the

21 life-threatening extent of her injuries?

 

22 MR. WADDING: I'm going to object, Your

23 Honor. Calls for speculation.

 

24 COURT: Overruled.

 

25 A. It's consistent with that, that the doctors

613

 

1 and the medical staff there all worked to place them in

2 the best bed to not over-utilize services.

 

3 Q. And do you have any understanding, sir, of

4 any of the other people from her car, Ms. Farrell's car,

5 were transferred to any other hospital?

 

6 A. Wasn't one other person transferred to

7 University Hospitals? I'm not sure who else was -- where

8 the others had gone, but -- wherever they had gone, but

9 one person, at least I saw, was transferred.

 

10 Q. And is that, I think her name was Tamara, was

11 transferred first to Covenant and then to University

 

12 Hospitals; are you aware of that?

 

13 A. Okay. I did not follow her, so that -- that

14 could be. I'll just take your word for that.

 

15 Q. And based upon your general experience in

16 the -- this area, is it fairly common that when someone

17 is hurt, they are transferred to the hospital that is

18 best able to treat that specific need?

 

19 MR. WADDING: Again, I'm going to object,

20 Your Honor, on the grounds of relevance.

 

21 COURT: Sustained.

 

22 Q. Would you, assuming the record would indicate

23 in this case that one young woman was transferred from

24 Sartori to Covenant, what would be your opinion as to why

25 she would have been transferred there?

 

614

1 MR. WADDING: I'm going to object again, Your

2 Honor. It calls for speculation, and it's irrelevant.

 

3 COURT: Sustained.

 

4 Q. With regard to Ms. Farrell, she remained at

5 Sartori from the time of her admission, which was

6 approximately 11:25 p.m. on October 4; would that be

7 correct?

 

8 A. That's as I remember, yes, sir. It was

9 between 11 p.m. and midnight.

 

10 Q. And she would have remained there until -- at

11 Sartori Hospital until approximately 4:45 p.m. on

12 October 5 when she was in the process of being then

13 transferred to Allen Hospital in Waterloo; is that also

14 your understanding?

 

15 A. I believe so, yes, sir.

 

16 Q. Now, during the course of your testimony, am

17 I correct that the injury which you, in your opinion

18 you've testified is fatal, was the injury to the aorta,

19 these other injuries would not have been -- not have

20 caused her death; is that correct?

 

21 A. She could have survived the other injuries.

22 The pelvic fracture, the tear between the ribs, certainly

23 the facial injuries, even the spleen laceration, the

24 capsule could be treated. Those -- those were not

25 immediately fatal nor even that serious that they could

 

615

1 not have easily been survived.

 

2 Q. Was there not an x-ray that was taken of Ms.

3 Farrell in the early morning hours shortly after her

4 arrival?

 

5 A. Yes, sir. I believe there was one taken

6 shortly after she arrived.

 

7 Q. Okay. And in that x-ray there was no mention

8 of the aortic tear, was there?

 

9 A. That's correct.

 

10 Q. And is it your opinion that she would have

11 had that aortic tear at the time that that x-ray would

12 have been taken?

 

13 A. Yes, sir.

 

14 Q. And isn't it fair to say that that reading of

15 that aortic tear was missed?

 

16 A. From a chest x-ray you would not see the

17 aortic tear. You would see bleeding from the aortic tear

18 if the bleeding got to the point that it would produce

19 the mass effect, an enlarged area, it would push away the

20 air containing lung and leave this blood containing blood

21 clot or blood in the chest or mediastinum. You wouldn't

22 see the aortic tear because the aorta is soft tissue and

23 it looks the same.

 

24 Q. Wasn't there an indication in that report

25 that there was clouding or pooling because of blood?

 

616

 

1 A. It says, "I do not believe the upper

2 mediastinum is abnormally widened." It says, "I cannot

3 exclude blood in the pleural space as a result of trauma.

4 However, the mediastinum does not appear abnormally

5 widened." He puts a question on the end of it. That's

6 Dr. Greg Raecker, R-A-E-C-K-E-R, his report on reading

7 the -- the x-ray. He doesn't really describe the

8 clouding until the next day, the next x-ray in the

9 afternoon.

 

10 Q. The blood that he is referring to in that

11 x-ray, that would have been the blood from this tear,

12 wouldn't it?

 

13 A. Yes, sir. There's also some blood from that

14 separation of the left ribs, the second and third ribs,

15 because you'll tear blood vessels in that area, and there

16 was obviously some bleeding associated with that, not

17 much, but there will be some bleeding from that.

 

18 Q. Would you grant that the bleeding, the blood

19 that the doctor referred to there, would have in

20 actuality been the blood from the tear in the aorta that

21 you have just described?

 

22 MR. WADDING: I'm going to object, Your

23 Honor. I think it calls for speculation and is

24 irrelevant.

 

25 COURT: I'll allow him to answer if he's able

 

617

 

1 to.

 

2 A. Okay. The majority of the blood would

3 probably be from the aortic tear. The blood at least in

4 the mediastinum, whatever amount of widening there may be

5 in the mediastinum could be that, in the left chest

6 cavity, could be either one. At this point it did not

7 bleed out that much, so you only had a small amount of

8 blood in those soft tissues.

 

9 Q. And what time was that radiologist -- was

10 that x-ray taken?

 

11 A. It says, according to the x-ray on the 5th,

12 it was taken at 1 p.m. It says, "Comparison with 10-4-96

13 at 22:49 hours," which is roughly 40 minutes before she

14 was admitted. I'm not sure whether the real status of

15 that the 22:49 is exact or not, it's an admission, chest

16 x-ray, whatever it would be. They say it was 10:49 p.m.

17 basically.

 

18 Q. And we know that somehow that was a

19 typographical error or mistake?

 

20 A. It could be. Maybe it's 23:49, somewhere in

21 there.

 

22 Q. But am I not correct that there was an

23 indication of blood in this area based on an x-ray that

24 was taken relatively shortly after her admission to the

25 hospital?

 

618

 

1 A. There is --

 

2 MR. WADDING: Again, Your Honor, I would

3 object as to relevance.

 

4 COURT: Overruled.

 

5 A. Okay. There is a mention of what he felt

6 could be some blood.

 

7 Q. Okay.

 

8 A. But he was not clear that it was blood. He

9 just said it could be some blood. These are described as

10 fairly mild findings actually.

 

11 Q. And isn't it fair to say that people who are

12 involved in automobile accident injuries, one of the

13 things that is always a concern is to whether there is an

14 aortic tear?

 

15 A. I think most emergency room physicians will

16 go through in their mind the differential to include that

17 if they have chest trauma. What's in the chest? The

18 aorta. What's very serious? The aorta. So that would

19 go through their differential. Now, whether they rule it

20 in or rule it out, how they make their diagnosis, that's

 

21 a treating physician's choice there, but they probably go

22 through it.

 

23 Q. That would be the most, if not the most, one

24 of the most serious and important structures to know it

25 status in the chest area, wouldn't it, that aortic arch?

 

619

 

1 A. The aortic arch, the heart, the major blood

2 vessels all through that, yes, they're all very

3 important.

 

4 Q. In hindsight, should not a person who reports

5 an automobile accident who reports chest pain as Juli

6 Farrell did and where there is a finding of blood

7 collecting in the area of the heart by x-ray, should not

8 that patient have been monitored in intensive care?

 

9 MR. WADDING: I'm going to object, Your

 

10 Honor. It calls for speculation.

 

11 COURT: Overruled.

 

12 A. Now, that's a treating physician's decision

13 at that point. I'm not a treating physician.

14 Pathologists always have 20/20 hindsight, so it's

15 probably something that as a pathologist I'd say maybe it

16 would have been best if she was in an intensive care

17 unit. Well, that's a safe statement now. I'd recommend

18 a treating physician answer that question for you. If

19 they feel they're stable enough to be on the floor, that

20 treating physician feels that, by a floor meaning not in

21 the intensive care unit, then that's that treating

22 physician's decision. That's part of medicine.

 

23 Q. And that treating physician could have

24 inadvertently made the wrong decision, could he not?

 

25 A. Can a doctor make the wrong decision? Yes.

 

620

 

1 Q. And in this tragic case, knowing those

2 findings some time shortly after her admission, isn't it

3 your opinion that she should have been admitted to an

4 intensive care environment?

 

5 MR. WADDING: I -- I'm going to object, Your

6 Honor, as to relevance. I believe that -- especially as

7 to relevance since Dr. Bennett has indicated that, you

8 know, from his position as a pathologist or forensic

9 pathologist that everything's 20/20 hindsight and that a

10 better person to answer that question would be a treating

11 physician.

 

12 COURT: Given his last responses to your

13 similar question, I'll sustain the objection.

 

14 Q. Wouldn't have hurt had she been admitted to

15 an intensive care environment, would it?

 

16 MR. WADDING: I'm going to object, Your

17 Honor, again, as to relevance.

 

18 COURT: Sustained.

 

19 Q. Doctor, in an intensive care environment, the

20 people or the patients are monitored more closely, are

21 they not?

 

22 A. That is the purpose for intensive care, yes.

 

23 Q. And they are monitored on all of their vital

24 signs on, what, a 15-minute basis, would that --

 

25 A. You'd have to see the protocol for the

 

621

 

1 hospital for that. I believe that's a standard for many,

2 if not all, hospitals, but you'd have to see what

3 their -- their standards are.

 

4 Q. And as time would progress, Juli Farrell lost

5 blood through that half-inch tear, didn't she?

 

6 A. She did lose blood through that half inch

7 tear. It was slowly. That had walled itself off to a

8 certain extent, but it's like a -- it's almost like a

9 false aneurysm where it started to balloon very, very

10 slowly. The monitoring said she was stable up to a

11 certain point. It's like when the balloon pops, you

12 don't have much choice then.

 

13 Q. And there would have been tests in intensive

14 care that would have shown that decrease -- or that loss

15 of blood, would there not?

 

16 MR. WADDING: I'm going to object again, Your

17 Honor, as to relevance.

 

18 COURT: Overruled.

 

19 A. Not necessarily. It depends what they're

20 doing for monitoring. If you're monitoring blood gasses

21 continuously and EKG as far as the heart rhythm and

22 electrical activity continuously, blood pressure

23 continuously and so forth, you can do many of those

24 things even on the floor if you check them every so

25 often, and she's fairly stable all the way along, that's

 

622

 

1 still doing the monitoring. It's a question of

2 frequency, but it's -- how often you checked. It depends

3 on what they have her hooked up to in intensive care,

4 also what machines she will be utilizing at that time.

 

5 Q. Would it not have been possible to determine

6 with medical supervision and implementation of medical

7 testing devices, blood pressure, et cetera, that she was

8 bleeding, would not that have been determinable by

9 3 o'clock in the morning?

 

10 A. By 3 o'clock in the morning? It was known

11 that she had trauma. It was known that she had the

12 fractures of her pelvis, I believe it said at that time.

13 I forget when those x-rays were taken. She was bleeding

14 because she had trauma. She had bruising that was seen

15 various places. I don't know if they knew she was

16 bleeding from a torn aorta. That would be a surprise

17 based upon what I see in the records, I believe.

 

18 Q. What -- but that was information that would

19 have been discoverable, would it not, at 3 o'clock a.m.?

 

20 MR. WADDING: Again, Your Honor, I would

21 object as to relevance.

 

22 COURT: Overruled. If you know, you may

 

23 answer.

 

24 A. Okay. It would be discoverable if they would

25 have done a very invasive test procedure called

 

623

 

1 angiography where you inject the dye into the aorta and

2 demonstrate that the blood's not staying all inside the

3 blood vessels but it's going out in the soft tissues.

4 Routine monitoring in an intensive care unit would not

5 necessarily pick this up.

 

6 Q. Do those records not indicate that her

7 condition deteriorated through the evening or the early

8 morning? And please make reference to the nurses' notes.

 

9 A. By deteriorating, was she -- she was still

10 communicating. By 8 a.m. she's voicing pain, then no

11 pain, voices headache, then back pain, then no pain.

12 Inconsistent there. Moves all extremities. Pedal pulse

13 they had. They could feel the pulse in her feet. When

14 they were checking, her feet were a little bit cool.

 

15 Q. And isn't that a significant indication, sir?

 

16 A. Oh, in retrospect. Can you have cool feet

17 for other reasons? Certainly. But, you know, is this

18 something that in retrospect, taken in the constellation

19 of everything else that I saw at the autopsy, it could

20 be. It's a very -- very non-specific finding, but it's

21 something to consider.

 

22 Q. And isn't it a fact that there is no report

23 in there about the -- her blood pressure being taken or

24 any tests taken during the approximate 6, 7, 8 o'clock in

25 the morning?

 

624

 

1 MR. WADDING: Again, Your Honor, I would

2 object to relevance.

 

3 COURT: Overruled.

 

4 A. I don't see a blood pressure given at those

5 times. There's one at 4:15 and one at 6 a.m.

 

6 Q. And don't those reports indicate some

7 difficulty?

 

8 A. She's deep breathing well at 4:15. She's --

 

9 Q. The blood pressure, doesn't the blood

10 pressure indicate some reason for follow-up?

 

11 A. At 4:15 the blood pressure was 130 over 50,

 

12 and at 6 o'clock the blood pressure is 136 over 60. My

13 blood pressure perks along at 95 over 50, so she's not

14 necessarily going into shock based upon that. This is --

15 her pulse is 110, her pulse is 88, pulse is 84 at

16 3:30 a.m., blood pressure 122 over 70. That's not

17 outside the realm of what you can see with young people.

18 Now, granted, she's in a hospital setting, but that's not

19 outside the realm of what we can see.

 

20 Q. Okay. Would you not agree, with those

21 figures, those test results, that she should have had

22 additional observation and additional tests run by

23 8 o'clock Saturday morning?

 

24 MR. WADDING: I'm going to object, Your

25 Honor. It calls for speculation.

 

625

 

1 COURT: Sustained.

 

2 Q. Do those records not indicate that during the

3 course of the morning her condition worsened?

 

4 A. Her status did worsen during the course of

5 the morning, which is why they took her to the CT scan at

6 1 o'clock and so on and did more testing.

 

7 Q. And there is a radiologist, I believe it's --

8 I don't know quite how to pronounce it, but it's like Dr.

9 Cammoun. Did you find his report there?

 

10 A. Yes. The emergency CT scan of chest.

 

11 Q. And wasn't it recommended -- and he's a

12 radiologist, is he not?

 

13 A. I believe so. I don't know him.

 

14 Q. Okay. Isn't it noted in those reports that

15 at 12:46 on October 5th that there was the -- this

16 finding by him, there is a sign of a tear, recommended

17 angiogram to rule out aortic tear?

 

18 A. That 12:46 down at the bottom is the time it

19 was transcribed, I believe on the 6th, which is the day

20 after. So I don't see where 12:46, as far as the time of

21 this CT scan, but it does state up here, "One should rule

22 out aortic tear. Hemothorax on the left with blood in

23 the mediastinum. Would recommend angiogram to rule out

24 aortic tear." Yes, sir, that's on the report. Now, when

25 that was taken, when it got to them, I don't know.

 

626

 

1 Q. And what that doctor was saying should be

2 ruled out is ultimately what caused her death, isn't it?

 

3 A. That's correct.

 

4 Q. And that was known some time while she was

5 still -- or that request for that angiogram was made

6 while she was still at Sartori Hospital obviously; isn't

7 that a fact?

 

8 A. Yes, sir. The -- I believe so. I'm not sure

9 when that request was transmitted to them. I don't know.

 

10 But she was at Sartori Hospital certainly when the

11 CT scan was taken.

 

12 Q. And do you recognize Dr. Robitaille? Was he

13 the emergency room treating physician?

 

14 A. Make sure I get their names right here. It's

15 not that I don't trust your pronunciation. I -- do you

16 have that page?

 

17 Q. I don't have it in order, but it's spelled

18 R-O-B-I-T-A-I-L-L-E.

 

19 A. Okay. That would be fine. I don't doubt

20 that. There's also an E.R. report from Dr. Dan Phillips

21 too.

 

22 Q. And in regard to Dr. Dan Phillips, in his

23 report that you have in front of you, does he not

24 indicate that the patient failed and began to

25 decompensate early in the a.m. with loss of blood

627

 

1 pressure which became crucial?

 

2 MR. WADDING: I'm going to object, Your

3 Honor, as to relevance.

 

4 COURT: Overruled.

 

5 A. It said, "And apparently early in the morning

6 had begun to decompensate slightly with loss of blood

7 pressure which became critical while attempting to do a

8 CT scan to delineate acute processes in her chest." So

9 slightly was the term. I don't know if you had mentioned

10 that term before.

 

11 Q. And that was at -- does he indicate that was

12 at 2:30 a.m.?

 

13 A. It says 2:30 in the afternoon. Dr. Dan

14 Phillips notes says approximately 2:30 in the afternoon

15 and then again 2:30 in the afternoon.

 

16 Q. With regard to the situation of Dr.

17 Robitaille, did he not dictate an addendum to his medical

18 records regarding Ms. Farrell?

 

19 A. Yes, sir, he did.

 

20 Q. And are addendums to medical reports usual or

21 unusual?

 

22 A. The majority of them don't have them. They

23 just issue another report, but I see them. I do it

24 myself.

 

25 Q. Does he not, in that addendum, indicate

628

 

1 verbatim, "This possibility of a pneumothorax had not

2 been reported by the other radiologist?"

 

3 MR. WADDING: I'm going to object, Your

4 Honor, as to relevance.

 

5 COURT: Overruled.

 

6 A. In the addendum I'm looking at I don't see

7 any mention of what you just said. What -- what are you

8 talking -- which part are you referring to?

 

9 Q. I believe -- maybe take the time, I believe

10 in your possession there is a report that includes the

11 language I just referenced dictated by Dr. Robitaille.

 

12 MR. WADDING: I just simply request that Mr.

13 Correll show it to him.

 

14 COURT: Would you, please, Mr. Correll.

 

15 MR. CORRELL: Pardon?

 

16 COURT: Would you please show it to him? It

17 might help speed things up here.

 

18 MR. CORRELL: (Complied.)

 

19 A. I was looking at at wrong addendum. He has

20 another addendum. There is one addendum at the bottom of

21 his E.R. report. There it is, the page before. The --

22 the addendum that he dictated on the 9th of October,

23 three days -- four days after her death.

 

24 Q. And would you read what he says relative to

25 that issue in that addendum?

 

629

 

1 A. Okay.

 

2 MR. WADDING: I'm going to object, Your

 

3 Honor, as to relevance.

 

4 COURT: Overruled.

 

5 A. The original chest x-ray they were looking at

6 to the left apex, what Dr. -- he and Dr. Cammoun see has

7 been described before by another radiologist as capping.

8 He thinks that this is possibly some blood. Dr. Cammoun

9 also mentioned that there is indication that there might

10 have been a pneumothorax to the right side, but we could

11 not see the line of the lung where there is a

12 pneumothorax. This possibility of pneumothorax had not

13 been reported either by the other radiologist.

 

14 Q. And isn't it fair to say that the first

15 radiologist they're referring to was the gentleman who

16 read the x-ray some time shortly after her admission?

 

17 A. I believe so.

 

18 Q. And during that reading of that x-ray there

19 was no mention of the pneumothorax, and is that -- isn't

20 that what she ultimately died of?

 

21 A. No. She did not die of a pneumothorax. She

22 died of a hemothorax, in essence, the blood loss.

 

23

Pneumothorax means there's air in the chest cavity from

24 the lung collapsing. This is blood in the cavity from

25 the aortic tear.

630

 

1 Q. Did not the first radiologist miss that?

 

2 MR. WADDING: I'm going to object, Your

3 Honor, as to relevance.

 

4 COURT: That's repetitive. We covered that

5 before. Sustained.

 

6 Q. Doctor, isn't it likely, had Juli Farrell

7 been transferred to another hospital earlier, that she

8 would not have died of these injuries?

 

9 MR. WADDING: I'm going to object to that,

10 Your Honor, as calls for speculation.

 

11 COURT: Sustained.

 

12 Q. Can a ruptured aorta be treated?

 

13 MR. WADDING: Object to that again, Your

14 Honor, as being speculation. Speculative and --

 

15 COURT: Overruled. You may answer if you're

16 able.

 

17 A. To answer the question can it, it can be. It

18 depends on location. It depends on many, many factors.

19 But there have been some successful treatments.

 

20 Q. And those would be treated by cardiovascular

21 surgery with a heart surgeon; would that typically be the

22 situation?

 

23 A. We've had them treated by emergency room

24 doctors at Broadlawn's Hospital from gunshot wounds where

25 they've just gotten in there and done it. The ideal

 

631

 

1 person would be a cardiovascular surgeon because they're

2 so trained in it. But can other doctors do it?

3 Certainly, and successfully too in those cases, in

4 certain cases.

 

5 Q. People can and have been successfully treated

6 for a half-inch tear in their aorta; is that not a fact,

7 sir?

 

8 A. Individuals have been successfully treated

9 for half-inch tears, that's correct. Depending upon

10 where it is in the aorta, this is very, very high and

11 hard to get to, but they have been treated successfully

12 in other cases.

 

13 Q. In that same area; isn't that a fact?

14 A. I can't answer that. It's a very, very high

 

15 injury here. It's a very inaccessible area, and it's in

16 a young girl where the tissues are very elastic and have

17 pulled back quite a ways. It's difficult.

 

18 Q. Would you have thought that should have been

19 tried?

 

20 MR. WADDING: I'm going to object, Your

21 Honor, calls for speculation.

 

22 COURT: Sustained.

 

23 Q. Isn't it fair to say that had that effort

24 been tried, you cannot rule out that she would have

25 survived her injuries?

 

632

 

1 MR. WADDING: Well, I'm going to object to

2 that as well, Your Honor. It calls for speculation.

 

3 COURT: Sustained.

 

4 MR. CORRELL: Nothing further.

 

5 COURT: Mr. Wadding?

 

6 REDIRECT EXAMINATION

 

7 BY MR. WADDING:

 

8 Q. The -- you indicated that tears in the aorta

9 have been successfully treated. Is that a fairly common

10 thing?

 

11 A. Fairly common to have them successfully

12 treated?

 

13 Q. Yes.

 

14 A. No. In my -- of course, my experiences are

15 not the ones that survive obviously, but in my readings

16 in the field and so forth, it's a very serious injury,

17 and oftentimes the death can occur right while they're on

18 the operating room table, because once you open it up to

19 get to that area, to close it off, you've taken off

20 everything that's walled off that area, so you've got

21 this major rupture through the major blood vessel.

22 That's the most critical time.

 

23 Q. And you say that's a major blood vessel.

 

24 What do you mean by that?

 

25 A. When I say it's the major blood vessel, it's

633

 

1 the largest blood vessel in the body with the highest

2 pressure of any artery in the body.

 

3 Q. If you were -- how would you describe the

4 procedure of fixing a tear of this nature?

 

5 A. It's like trying to -- I compare it to like

6 trying to sew a balloon back together just as it starts

7 to pop.

 

8 Q. Now, the -- can you describe the position of

9 this tear in relationship to the heart?

 

10 A. Yes, sir. If you imagine the heart being

11 like my fist right here, the arch, as it comes up, is

12 only about an inch or so as it comes up and starts to

13 make its curve, so it's only about probably two, two and

14 a half inches or so from where the aorta starts, the

15 valve coming out of the top of the heart to where this

16 tear is. It's very high up here. It's way in the back

17 of the mediastinum. And as can be seen in Exhibits "14",

18 "15" and "16", or "L-14", "15" and "16", it is way up at

19 the very top right where the blood vessels take off to

20 the -- to the left arm. In my experience, even with my

21 incision which is much larger than anything a surgeon

22 would ever use, it's hard to get to this area. It's very

23 hard to get to this area.

 

24 Q. And the tear that you observed in the aorta

25 of Juli Farrell, is that consistent with the history of

 

634

1 being involved in an automobile accident?

 

2 A. Yes, sir, it is.

 

3 Q. And the history that you were made aware of

4 in this instance?

 

5 A. Yes, sir, it is. Entirely.

 

6 MR. WADDING: That's all the questions I

7 have.

 

8 COURT: Mr. Correll?

 

9 MR. CORRELL: I have nothing further.

 

10 COURT: Thank you. I do have one question.

11 I probably missed it. When was the autopsy performed?

 

12 WITNESS: The autopsy was performed on the

13 6th, Sunday the 6th starting at 9 p.m. We went down to

14 Mercy Hospital at Iowa City to do it.

 

15 MR. WADDING: Your Honor, my apologies. I

16 would move to reopen.

 

17 COURT: To talk about "L-12"?

 

18 MR. WADDING: Yes. I just wanted to --

 

19 COURT: Go ahead.

 

20 FURTHER REDIRECT EXAMINATION

 

21 BY MR. WADDING:

 

22 Q. Dr. Bennett, could you grab the photograph

23 that is marked as State's Exhibit "L-12", and do you

24 recognize that, sir?

 

25 A. Yes, sir, I do.

 

635

 

1 Q. And what do you recognize that as?

 

2 A. State's Exhibit "L-12" is a photograph I took

3 myself of the spleen. It is about as big as the palm of

4 your hand, and it's up underneath the left rib cage just

5 under this left-hand side right in line where all the

6 other injuries were on her left side of her body.

 

7 Q. And that was -- was the spleen in this

8 instance also injured?

 

9 A. Yes, sir, it was, and that can be seen in

10 photograph "L-11." Exhibit "L-11", this fracture on the

11 outer surface of the spleen is where the capsule that's

12 otherwise like -- it's also like a Saran Wrap covering of

13 the spleen. It is split. She was bleeding from that

14 area also. Not much, but she was bleeding from this --

15 this laceration of her spleen.

 

16 Q. Okay. Have you described as "L-11", is that

17 actually "L-12"?

 

18 A. L with 12, yes, sir.

 

19 Q. And the -- is that consistent with the

20 injuries that you observed on the left side of Juli

21 Farrell?

 

22 A. Yes, sir, it is.

 

23 MR. WADDING: Ask that State's Exhibit "L-12"

24 be entered into evidence, Your Honor.

 

25 COURT: Mr. Correll?

 

636

 

1 MR. CORRELL: Same objection I previously

2 made.

 

3 COURT: "L-12" is admitted.

 

4 MR. WADDING: I don't have anything further,

5 Your Honor.

 

6 COURT: Anything further, Mr. Correll?

 

7 MR. CORRELL: No, Your Honor.

 

8 COURT: Thank you.

 

9 MR. WADDING: Your Honor, at this time the

10 state rests its case-in-chief.

updated 12/26/16