1338 1 IN THE CIRCUIT COURT OF THE NINTH JUDICIAL CIRCUIT IN AND 2 FOR ORANGE COUNTY, FLORIDA 3 LAWRENCE M. DESTEFANO, 4 Plaintiff, 5 vs. CASE NO.: 48-2000-CA-007265-O 6 ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE 7 CORPORATION; ADVENTIST HEALTH SYSTEM/SUNBELT, INC.: ROLLINS 8 BEDFORD CORPORATION, d/b/a Sunbelt Healthcare & Subacute 9 Center; SHCC SERVICES, INC., and ORLANDO REGIONAL 10 HEALTHCARE SYSTEM, INC., 11 Defendants. 12 ------------------------------------------------------ 13 VOLUME XI 14 The transcript of the proceedings held on Friday, 15 October 21, 2005, beginning at 7:47 o'clock a.m., at the 16 Orange County Courthouse, Orlando, Florida, Courtroom 17 19-D, before the Honorable Renee A. Roche, Judge of the 18 Circuit Court. 19 A P P E A R A N C E S: 20 WILLIAM G. OSBORNE, ESQUIRE 21 538 East Washington Street Orlando, Florida 32803 22 For the Plaintiff. 23 24 25 CENTRAL FLORIDA REPORTERS, INC. 1339 1 A P P E A R A N C E S: - CONT. 2 BRADLEY CONWAY, ESQUIRE 390 North Orange Avenue, Suite 3 Orlando, Florida 32801 4 For the Plaintiff. 5 TRACY MARSHALL, ATTORNEY and DYANA PETRO, ATTORNEY of 6 Gray Robinson, P.A. 301 East Pine Street, Suite 1400 7 Orlando, Florida 32801 8 For the Defendant/Adventist. 9 LARRY J. TOWNSEND, ESQUIRE and DAVID EVANS, ESQUIRE of 10 Mateer and Harbert, P.A. 225 East Robinson Street, Suite 500 11 Orlando, Florida 32801 12 For the Defendant/ORHS. 13 14 15 16 17 18 19 20 21 22 23 24 25 CENTRAL FLORIDA REPORTERS, INC. 1340 1 I N D E X - VOLUME XI 2 TESTIMONY OF STUART JAMES 3 Direct Examination by Mr. Osborne 1346 Cross Examination by Ms. Marshall 1376 4 Redirect Examination by Mr. Osborne 1400 5 VIDEOTAPED DEPOSITION OF DR. STEELY - CONT. 6 Direct Examination by Mr. Glick - Cont. 1408 Cross Examination by Ms. Marshall 1428 7 Redirect Examination by Mr. Glick 1440 8 VIDEOTAPED DEPOSITION OF DR. LYNN WILSON 9 Direct Examination by Mr. Glick 1452 Cross Examination by Mr. Grower 1489 10 Cross Examination by Mr. Townsend 1495 Redirect Examination by Mr. Glick 1496 11 12 E X H I B I T S 13 Plaintiff's Exhibit No. 12 1366 Plaintiff's Exhibit No. 13 1374 14 Plaintiff's Exhibit No. 14 1447 15 16 17 18 19 20 21 22 23 24 25 CENTRAL FLORIDA REPORTERS, INC. 1341 1 THE COURT: Please be seated. Thanks for 2 getting here early this morning. I smelled coffee 3 as I walked by the jury room. I'm sure they're 4 happy and appreciative. Now, let's see, do we have 5 our realtime back up? Is there anything to address 6 before we begin? 7 MR. OSBORNE: No, Your Honor. 8 MS. MARSHALL: No, Your Honor. 9 MR. EVANS: No, ma'am. 10 MR. OSBORNE: Larry, you might want to tell 11 her about Lillian Folley. 12 MR. TOWNSEND: You asked me to call 13 Ms. Folley, and I did not get ahold of her until 14 10:30. 15 THE COURT: You did get ahold of her? 16 MR. TOWNSEND: I did, and she had already made 17 plans for the day and requested that she be allowed 18 to stay on the plan for Monday. 19 THE COURT: Well, let's see how we -- 20 MS. MARSHALL: I was able to get ahold of 21 Michelle Fetters, and she will be here so she can 22 testify. 23 MR. OSBORNE: I think we'll be okay, Judge. 24 THE COURT: Do you? 25 MR. OSBORNE: If we get the depos back of CENTRAL FLORIDA REPORTERS, INC. 1342 1 Kelly Pipkin and Dr. Krop, that's probably three 2 hours right there. 3 THE COURT: Okay. 4 MR. TOWNSEND: If we get all that in, we're in 5 pretty good shape. 6 MR. OSBORNE: I think we'll be doing pretty 7 well on time. 8 MS. MARSHALL: Then on Monday what's the 9 agenda? 10 MR. OSBORNE: I'll tell you all -- 11 THE COURT: I'll address that in a moment 12 unless there's some reason you need to know about a 13 particular witness, Ms. Marshall. 14 MS. MARSHALL: No, Your Honor. The end of the 15 day is fine. 16 THE COURT: Okay. Do you want to go ahead and 17 get the television? 18 MR. OSBORNE: Judge, we have a live witness. 19 THE COURT: Oh, you're going to do that? 20 You're going to break that up? 21 MR. OSBORNE: Well -- 22 THE COURT: All right. I'll tell them what 23 you're doing. 24 MR. OSBORNE: And then what we're going to do, 25 Judge, is bring the TV back in and finish up CENTRAL FLORIDA REPORTERS, INC. 1343 1 Dr. Steely and then we've got -- 2 THE COURT: That's fine, Bill, that's fine. 3 MR. MCCOLLOUGH: Because I have to pull that 4 out. I'll need just a minute or two, Judge, to 5 pull that out. 6 THE COURT: That's fine, Terry, that's good. 7 Let's see how we're going this morning before we 8 see if we're going to have to give them a short 9 lunch today. We'll try to address that around 10 mid-morning. And if we're really doing well and 11 you guys feel confident, then I'll think about 12 whether we need to ask them to cut their lunch 13 short. I'd like to get this done, but I don't want 14 us all to be damaged in the meantime. 15 (Off the record discussion was had.) 16 THE COURT: Talk with your clients and see how 17 long we're going to wait. 18 MR. OSBORNE: This is the alternate, right? 19 THE COURT: Yes, it is. 20 MR. OSBORNE: Judge, our vote over here is 21 that if she's not here by 8:15 we move on without 22 her. 23 THE COURT: What do you guys say? 24 MR. TOWNSEND: Your Honor, we would prefer to 25 give her a little longer, maybe 'til 8:30 and CENTRAL FLORIDA REPORTERS, INC. 1344 1 readdress it. It's a little scary going on without 2 an alternate. We've got this much invested in the 3 trial and -- 4 MR. OSBORNE: That's fine. 5 MR. TOWNSEND: We can pick up 30 minutes 6 somewhere. 7 THE COURT: We're already picking up three and 8 a half hours. 9 MR. TOWNSEND: It will be up to us to shorten 10 our deal to make it a -- 11 MR. OSBORNE: Judge, I can tell you the east 12 side of the Expressway was closed this morning. 13 THE COURT: I'm sorry, Bill, I didn't hear 14 you. 15 MR. OSBORNE: East-West coming in eastbound 16 was closed. 17 THE COURT: Yeah, that's what I heard. 18 MR. OSBORNE: There was an accident last 19 night. 20 THE COURT: Well, I see that you're here. 21 MR. OSBORNE: I come from the west. 22 THE COURT: Oh, it's on the east side? 23 MR. OSBORNE: Yeah, it's the eastbound. 24 MS. PIERCE: Bumby and 408. 25 THE COURT: It looks like she would have CENTRAL FLORIDA REPORTERS, INC. 1345 1 called but -- 2 (Whereupon, there was had a recess from 8:00 3 o'clock a.m to reconvene at 8:15 o'clock a.m., in 4 the presence of the Jury.) 5 THE COURT: And please be seated. Good 6 morning. Mr. Osborne, are you prepared to call 7 your next witness? 8 MR. OSBORNE: Yes, Your Honor. 9 THE COURT: Ladies and Gentlemen, just for 10 your information, these lawyers have worked very 11 hard and are doing an excellent job at trying to 12 take advantage of all the time that we have. Now, 13 as part of that, Mr. Osborne yesterday began with a 14 videotaped deposition of Dr. Steely which was not 15 completed. 16 We're not going to go immediately back to 17 that, he's going to call a live witness, and then 18 we're going to finish Dr. Steely's deposition. So 19 just get that straight in your mind. We're just 20 trying to accommodate our time constraints and we 21 will go back to that videotaped deposition next. 22 Call your next witness. 23 MR. OSBORNE: Thank you, Your Honor. Call 24 Stuart James. 25 STUART JAMES, CENTRAL FLORIDA REPORTERS, INC. 1346 1 having been first duly sworn testified as follows: 2 MR. OSBORNE: Madam Clerk, could I have 3 Plaintiff's S for identification, please? 4 DIRECT EXAMINATION 5 BY MR. OSBORNE: 6 Q State your full name for the Court and the 7 Jury, please. 8 A Yes. Can you all hear me okay? Yes. My full 9 name is Stuart, middle initial H., and my last name is 10 James. My first name is spelled S-t-u-a-r-t. 11 Q And where are you from, Mr. James? 12 A I currently live in Ft. Lauderdale. 13 Q Tell the Jury what your profession or 14 occupation is. 15 A I am a consulting forensic scientist, and I 16 have been a private consultant since 1981. And I 17 examine physical evidence. I primarily concentrate on 18 blood stain pattern analysis, which is the study of the 19 size, shape and distribution of blood stains that occur 20 during various bloodshed events. 21 Q How long have you been doing this? 22 A I've been a forensic scientist for 23 approximately 32 years. 24 Q Give the Jury the benefit of your educational 25 background in this field, please, or just generally what CENTRAL FLORIDA REPORTERS, INC. 1347 1 your educational background is. 2 A Yes. My formal education includes a BA degree 3 in chemistry and biology which I received from Hobart 4 College, which is in Upstate New York, in 1962. In 1963 5 I completed a one-year resident internship at St. Mary's 6 Hospital in Tucson, Arizona, and ultimately became 7 licensed as a medical technologist, one who perform 8 various types of clinical laboratory procedures. And I 9 actually worked as a medical technologist for several 10 years. 11 Ultimately I took some graduate courses at 12 Hobart College located in Upstate New York, and those 13 courses involved homicide investigation, forensic 14 microscopy as far as a basic -- which was a graduate 15 level course at the time, blood stain pattern analysis. 16 That was between 1977 and 1981. And that's my formal 17 education, which has been supplemented over the years 18 with regular -- what I would call, you know, ongoing 19 training by participation in various conferences in the 20 forensic science, including my membership in the 21 American Academy of Forensic Sciences and other 22 organizations. 23 And I've completed probably four or 500 hours 24 of training in forensic science and death investigation, 25 as well as basic and advanced blood stain pattern CENTRAL FLORIDA REPORTERS, INC. 1348 1 analysis. 2 Q You said four or 500 hours? 3 A Yes. 4 Q Where did you get that training? 5 A In various locations. I'll give you a few 6 examples. And these are institutions that offer these 7 courses, whether they be two-day, three-day, five-day 8 courses. John Jay College of Criminal Justice in New 9 York, Colby College, New York University School of 10 Medicine and other institutions around the country. And 11 sometimes they'll -- you know, in conjunction with the 12 Academy of Forensic Science or other forensic science 13 groups. 14 Q What is the Academy of Forensic Science? 15 A It's an organization that began in 1948, 16 comprised presently of probably eight or nine sections, 17 which defines an area of specialty for individuals in 18 the group. They have pathology, they have 19 criminalistics, they have jurisprudence, which is a 20 group of lawyers in our group. We have a general 21 section. We have one for forensic dentistry and the 22 various aspects of forensic science. 23 Q What does the -- just the term forensics mean 24 in terms of your profession when you say forensic 25 science? CENTRAL FLORIDA REPORTERS, INC. 1349 1 A Well, science, you know, is the application of 2 the principles of science. And when you say forensic 3 science, it means you take the knowledge and the facts 4 you derive from science into a court of law. Forensic 5 from the Latin actually means debate. And forensic 6 science is, you know, science and the law combined. 7 Q Give the Jury a flavor for your -- what type 8 of professional employment and experience you've had in 9 your 32 years in the profession. Is it blood spatter or 10 blood stain analysis? How do you refer to yourself? 11 A In the general science, blood stain pattern 12 analysis. 13 Q And tell the Jury -- give us a flavor of what 14 your professional employment and experience has been in 15 that field, please. 16 A Well, I began doing blood stain pattern 17 analysis back in the mid '70's, and I had taken my first 18 course in '70, first formal course in it. And at the 19 time I was a supervisor of a crime laboratory up in 20 Binghamton, New York, and held that position for four 21 years until the labs became part of the New York State 22 Police Laboratory System. 23 And during that period of time myself and the 24 people in my laboratory, we provided scientific support 25 to approximately 65 agencies in Upstate New York, which CENTRAL FLORIDA REPORTERS, INC. 1350 1 comprised about 13 or 14 counties, most of them being 2 rural. And so we did a lot of work with the state 3 police and with the local sheriff departments and in 4 some cases, you know, local police departments in terms 5 of crime scene analysis, which often included 6 interpretation or analysis of blood stains on both, you 7 know, objects at a scene, as well as on clothing and 8 other materials that may be become bloody. 9 Q What other professional employment and 10 experience have you had since then just in terms of -- 11 A Well, since 1981 I've been in the private 12 sector. And I've been, you know, providing my knowledge 13 and my, you know, analysis of crime scenes to attorneys, 14 you know, throughout the country and actually abroad as 15 well. And I've been consulting on primarily homicide 16 cases since 1981. Currently I'm running about 60 to 62 17 per year. 18 Q 62 -- 60 to 62 investigations that you're 19 working on? 20 A Death investigations and homicides. 21 Q In terms of criminal versus civil, what's 22 generally the mix of that in terms of investigations 23 that you get involved in? 24 A Well, it's not really a mix. I do an 25 occasional civil case. Most of the time -- I'd say well CENTRAL FLORIDA REPORTERS, INC. 1351 1 over 90 percent of my cases are criminal in nature. 2 Many are capital cases, you know, where death penalty is 3 an issue. Occasionally a civil case such as this. 4 Q Do you have any teaching experience in the 5 blood stain analysis field? 6 A Yes, I do. 7 Q Give the Jury an idea of what you've done in 8 terms of teaching. 9 A Well, I have been involved in the instruction 10 in the blood stain pattern analysis, both in the basic 11 level and advanced level, for probably the past 15 or 20 12 years. And more recently I had been teaching with a 13 fellow from New York State, Paul Kich. And we teach 14 basic and advanced courses to law enforcement 15 pathologists in various locations throughout the 16 country. 17 We've also been invited and have taught in the 18 Netherlands, in England twice and Canada and again other 19 places around the U.S. 20 Q Are you published in this field? 21 A Yes, I am. 22 Q Give the Jury an idea of what types of 23 publications you've done. 24 A Well, I've been involved as a co-author and 25 also as a co-editor in several books in forensic science CENTRAL FLORIDA REPORTERS, INC. 1352 1 with particular reference to blood stain pattern 2 analysis. I co-authored a book entitled Interpretation 3 of Blood Stain Evidence at Crime Scenes back in 1988. 4 That book carried through to its second edition, and 5 just this year has been replaced with a brand-new book 6 which includes two new co-authors, Paul Kich and 7 Paulette Sutton. 8 Paulette Sutton is at the medical examiner's 9 office in Memphis, and Paulette I mentioned is from New 10 York. And that book is called Principles of Blood Stain 11 Pattern Analysis Theory and Practice. And it came out I 12 believe in May. 13 And I'm also co-editor of a second edition 14 book now of Introduction to Forensic Science, which is 15 used by numerous colleges as their introductory forensic 16 science course. 17 Q Do you hold any license or certifications? 18 A Currently I don't have any licenses. Over the 19 years I have been in a position, such as at the crime 20 laboratory, to be licensed as a legal blood alcohol 21 analyst. I'm actually still licensed as a medical 22 technologist, although I don't practice laboratory 23 medicine at the present time. But there are no licenses 24 or specific certifications for blood stain pattern 25 analysis. CENTRAL FLORIDA REPORTERS, INC. 1353 1 Q Have you made formal scientific presentations 2 over the course of your 32 years in the field of blood 3 stain analysis? 4 A Yes, on numerous occasions. 5 Q And again, what type of topics would you be 6 addressing in those? 7 A Well, over the years I've addressed various 8 groups from -- actually I taught at the college level 9 forensic science courses for probably over a period of 10 ten or 12 years in Upstate New York, in Binghamton. But 11 in terms of giving presentations, I've been invited to 12 speak to various bar associations, you know, legal, 13 seminars. I've been invited to teach at various police 14 agencies, as well as even groups of nurses and 15 paramedics. 16 Q Give the Jury an idea of the kind of cases 17 that you are called in on, a few examples of the types 18 of analysis that you do, the factual settings that you 19 confront. 20 A Well, the usual -- I guess there's no usual 21 case, but the types of cases that I get involved in and 22 consulted -- that I consult on are usually cases of 23 violent death. That is where there's been issues of 24 beatings, stabbings, you know, shootings, some vehicular 25 accidents, things of that sort, where I'm asked to give CENTRAL FLORIDA REPORTERS, INC. 1354 1 an opinion on the nature, the size, shape and 2 distribution of blood stains at the scene where blood 3 was shed as a means or a tool, along with other forensic 4 evidence, to reconstruct events that took place. 5 And this also includes examination of 6 clothing, bloody clothing of the victim as well as, you 7 know, potential suspects and persons who are being 8 questioned. And that also involves analysis of blood 9 stains on clothing to determine what mechanism may have 10 produced them. Is it something significant, that they 11 were involved in the beating or shooting, or did they 12 come by later and just cradle the person, things of that 13 sort. We try to answer questions ultimately that come 14 up in a court of law. 15 Q How many times do you think you've testified 16 in court? 17 A Totally probably over 300 times. 18 Q And in the state of Florida as well, been 19 qualified as an expert in the state of Florida? 20 A Yes, I have. I've testified in probably seven 21 or eight counties in Florida, including Orange County. 22 Q What's the last case you testified about in 23 Orange County? 24 A The last case I appeared in Orange County 25 actually was the Tommy Ziegler hearing back in December. CENTRAL FLORIDA REPORTERS, INC. 1355 1 Q And what were the blood stain facts in that 2 case that you were called in to testify about? 3 A Well, that was a case involving a lot of blood 4 stains. There were four victims in the case, happened 5 back in '76 I believe. At any rate, that was an issue 6 of, you know, analyzing, reanalyzing, since I wasn't 7 involved in the case when it occurred, blood stains at 8 the scene. Blood stains on Mr. Ziegler's clothing came 9 into issue. 10 Q Were you asked to evaluate a blood stain 11 pattern in this case? 12 A Well, I was asked to examine essentially a 13 couple of blood stains. I wouldn't call it a pattern. 14 A pattern usually is comprised of numerous stains in a 15 particular area. 16 Q Okay. Now, you're not a medical doctor, are 17 you? 18 A No, sir. 19 Q If I call you Dr. James by accident, will you 20 correct me? 21 A I certainly will. 22 Q Thank you. What materials were provided to 23 you that you utilized in formulating your opinions which 24 resulted in your report in this case? 25 A Well, essentially back in 2004 my involvement CENTRAL FLORIDA REPORTERS, INC. 1356 1 was really to examine a bed pad that was brought, you 2 know, to my office on August 29th actually of 2002. The 3 report was prepared in 2004. That was a few years ago. 4 And I examined that bed pad and ultimately performed 5 some experiments to see if I could come to a reasonable 6 conclusion as to the mechanism that may have been 7 responsible for producing that particular blood stain. 8 Q If you don't mind, Mr. James, why don't you 9 come on down front and let's talk a little bit about the 10 pad? 11 MS. MARSHALL: Your Honor, may I stand in the 12 corner so I can see? 13 THE WITNESS: May I step down, Your Honor. 14 THE COURT: Certainly. 15 BY MR. OSBORNE: 16 Q Do you have a pointer on you, there? 17 A Yes, I do. 18 Q Okay. I guess it's more of a laser pointer, 19 right? 20 A Yes. 21 Q I've got the old-fashioned one here. Tell the 22 Jury what you -- what stain it was that you examined. 23 A Well, this is the actual bed pad that I 24 examined initially. And of interest to me was this 25 elongated stain here, which we haven't talked much about CENTRAL FLORIDA REPORTERS, INC. 1357 1 the classification of blood stains, but there are two 2 primary classifications. And simply they're called 3 passive, meaning not a lot of energy required to produce 4 them; such as a drop of blood falling on the floor, my 5 bloody hand touching this bar here, pooling of blood, 6 saturation of blood on a mattress. We call those 7 passive stains. 8 And on the other side of the tree we have what 9 we call spattering stains. And spatter stains are 10 defined as, you know, small droplets that have broken 11 away from a larger volume of blood due to an impact or 12 force, such as exhalation of blood producing many tiny 13 droplets. Beatings and shootings produce tiny droplets 14 which may deposit on walls, even cast-off coming off a 15 weapon in motion and flipping blood up on the ceiling. 16 We call it spatter, okay? 17 In this case we're dealing with passive 18 stains. And the objective is to determine, well, let's 19 look at the size and shape and distribution or character 20 of the stain. And you have a central area here with 21 kind of a tailing down, and it's definitely a passive 22 stain. There's -- very little energy was utilized to 23 produce that. 24 There's another small passive stain over here 25 and there's a discoloration here. In fact, there's a CENTRAL FLORIDA REPORTERS, INC. 1358 1 lot of discoloration here. And this being a bed pad, 2 the history of this particular pad, it's not surprising 3 that it's soiled, you know, with body materials. 4 Now, there's also a -- I have to find this. 5 It's been awhile since I've seen this. 6 Q Do you want to take the plastic off? 7 A It's in my photograph here -- hold on. It'll 8 turn up. At any rate, this was the major area of stain 9 that we were concerned with. 10 Q Okay. And tell me a little bit about -- in 11 terms of the pad being soiled, tell the Jury what the 12 significance is of blood on a host material that is 13 soiled when you're doing an analysis. 14 A Well, any time -- I mean, there are very few 15 blood stain analyses that I've ever performed at a crime 16 scene on or clothing that are in pristine condition. 17 The only time you'll seen that is at our schools where 18 we have students produce blood stains. We have 13, 14 19 experiments they do. 20 They drip blood, they spatter blood. They go 21 through the whole series of experiments. And the target 22 source is like cardboard so those are pristine, but 23 that's not what a crime seen is. And bloody clothing, I 24 mean, the clothing worn by people that get involved in 25 bloody incidents, they may be mechanics, they may be CENTRAL FLORIDA REPORTERS, INC. 1359 1 cooks, they may be anything. The clothing is not always 2 clean. 3 The same goes for the environment that the 4 stains are produced; greasy floors, dirty walls, black 5 walls, green walls. So the background you have to deal 6 with. In this case, I mean, with -- the history of this 7 would certainly indicate that there could be fecal 8 material, there could be urine, epithelial cells that 9 slough off the person lying on it. So these are not 10 unexpected things to occur. 11 Q Is it common in your practice when you're 12 looking at clothing, for example, to find epithelial 13 skin cells in the clothing when you're doing an 14 examination? 15 A Yeah, that's the DNA issue. But I will say 16 that I've been involved in many cases where the wearer 17 of the clothing or the wearer of the shoes or the socks, 18 whatever type of clothing is important, has been 19 identified by what they call the habitual wearer DNA. 20 And that is the clothing of that wearer contains 21 epithelial cells to one extent or another. And in many 22 case it's identified as this being my shirt or my shoes. 23 Q Is there a thought or a doctrine in blood 24 stain analysis about overlay? 25 A Yes. CENTRAL FLORIDA REPORTERS, INC. 1360 1 Q What is overlay? 2 A Well, overlay is simply -- in terms of what 3 we're talking about is consider the surface that the 4 stain is on, and there may be other materials present. 5 If you're interested in what -- you know, how unique 6 those materials are, you take a control sample where 7 it's not blood stained and see if you have the same 8 materials. 9 But in this particular case, I mean, the 10 character of the shape of the stain does not affect the 11 contents of the stain. It may contain epithelial cells 12 and mucus, et cetera, but also you would expect the 13 other -- you must check the other areas of the pad to 14 make sure that that particular stain is not unique in 15 that area. It's called a control sample. It's done in 16 DNA testing. It's done in virtually every form of 17 forensic science testing. 18 Q I'd like you to assume that there's been 19 testimony in this case, Doctor, that -- 20 A I'm not a doctor. 21 Q Thank you. I knew I was going to do it. 22 A I'd like to be, but I certainly am not. 23 Q All right. Mr. James, I'd like you to assume 24 there's testimony in this case that Carolina Destefano 25 had been lying on this pad for hours prior to the pad CENTRAL FLORIDA REPORTERS, INC. 1361 1 being removed from the bed. Would you expect, in terms 2 of this overlay, to find that the blood was overlaying 3 upon other materials found on the pad if that were the 4 case? 5 A Yes. I mean, it would be expected. 6 Q Okay. And I think you said sloughing off of 7 epithelial skin cells. What did you mean by that? 8 A Just simply the friction removal of the upper 9 layer of the skin, the epithelial cells by contact, 10 they're removed. I mean, it happens typically in our 11 line all the time. 12 Q You can take the stand and we'll talk for a 13 few minutes, then we'll come back down here. 14 A Thank you. 15 Q Have you ever investigated cases, Mr. James, 16 where someone attempted to give a false trail or planted 17 blood to throw off the investigator by leaving blood in 18 a certain manner? 19 A Yes, I have. 20 Q Tell the Jury about that type of experience 21 you've had. 22 A Well, I can recall two incidents that I was 23 involved in, one more than the other. The first was 24 quite a while ago. It turned out to be a medical 25 technologist, such as myself, who proceeded to spray CENTRAL FLORIDA REPORTERS, INC. 1362 1 blood around her kitchen with a syringe and needle 2 and -- in an effort to, you know, provide some -- 3 something -- some boyfriend issue that she was involved 4 in, which then became a police matter because they 5 investigated. 6 And she finally, you know, after the analysis 7 was completed admitted that she had done this herself. 8 And it was able to be determined because of the location 9 of the stains and the nature of them, you know, no 10 source of blood, you know, being available at the time. 11 The second was a psychologist who proceeded to 12 spray his blood with a squirt gun around his house in an 13 attempt to collect some insurance or something. But 14 they were both sort of non-criminal but they became 15 misdemeanors, you know, afterwards. 16 Q So in terms of your training and experience, 17 you are trained to look for that type of thing, too, if 18 somebody -- if it's not a naturally-occurring blood 19 stain, you are trained to detect that as well, correct? 20 A Well, I mean, you do it based on the history 21 of your case and where the blood stains are located. In 22 the case of the psychologist, I mean, he had sprayed, 23 you know, just blood everywhere. And it certainly was 24 something that wouldn't have been done by a normal 25 bleeding event, and it was a clue right away. CENTRAL FLORIDA REPORTERS, INC. 1363 1 Q Mr. James, this is a case where there are 2 medical records that talk about rectal bleeding of 3 Carolina Destefano. Tell the Jury what you would expect 4 to see in a blood stain pattern when somebody is 5 bleeding from the rectum and is lying in a bed. 6 A Well, I mean, I can base that on my own 7 experiences, you know, criminal investigations involving 8 sexual assault, for example. But a person is either -- 9 you know, living victims or deceased have been involved 10 in some penetration activity, either, you know, 11 vaginally or rectally where bleeding has occurred. And 12 I've examined, you know, bedding in these cases over the 13 years. 14 And you generally see -- of course, the amount 15 of bleeding is an issue, too. But in the area of 16 bleeding, you can generally tell what part of that 17 person was on top of that blood stain because of the 18 impression and the way the blood would conform around 19 that part of the body. 20 So it's sometimes the position of the people 21 based upon the fact that when someone is lying on 22 something and with blood beneath or bleeding down, that 23 the pressure of the body is going to, you know, spread 24 it in a certain direction. But here we have a pristine 25 stain. I mean, there's no alteration of that stain CENTRAL FLORIDA REPORTERS, INC. 1364 1 whatsoever. 2 Q What would you expect to see, Mr. James, if 3 this was a true compression stain? What would you 4 expect to see if it was truly something that had come 5 out of Mrs. Destefano's rectum and she was lying in that 6 area? What would you expect to see in terms of the 7 shape of that stain? 8 A Well, what I would expect to see, I mean, if 9 she were lying on it, you would expect it to be a little 10 more diffused out and not looking so pristine. 11 Q What do you mean by pristine? 12 A Pristine means undisturbed basically. For 13 lack of a better world, sometimes pristine is referred 14 to as clean or, you know, unaltered. 15 Q And in terms of these compression stains, have 16 you had experiences where you can actually see the shape 17 of the person's buttocks or the shape of another body 18 part by looking at the stain? 19 A Yes, it's not really that uncommon. In fact, 20 in my book I've got at least one example of an entire 21 body, outline of a body that has been removed from the 22 floor. I mean, you can tell exactly where each part of 23 the body was just the way the stain looks. 24 Q Now, as a part of your work that you did in 25 this case, did you try -- did you make an attempt to try CENTRAL FLORIDA REPORTERS, INC. 1365 1 to recreate this stain to opine about what might have 2 placed this stain on this bed pad? 3 A Yes. I conducted just a series of simple 4 experiments using different instruments just to see, you 5 know, what it would take to produce that type of stain. 6 I started with the simplest mechanism and just went on 7 from there. 8 MR. OSBORNE: I'm going to move into evidence 9 Plaintiff's Exhibit S for identification. 10 BY MR. OSBORNE: 11 Q First I'll ask the Doctor to -- 12 A Doctor again. 13 Q There, I did it again. Thank you. Ask 14 Mr. James to tell me if those appear to be the pictures 15 of the experiments that you were conducting. 16 A Yes, there's two pictures of -- there's 17 actually three images of the original stain, and then 18 the rest are images of the experiments that I ran. 19 MR. OSBORNE: I would move Exhibit S into 20 evidence. 21 THE COURT: Objection? 22 MS. MARSHALL: No objection. 23 MR. TOWNSEND: No objection. 24 THE COURT: It will be admitted. 25 THE CLERK: Plaintiff's 12. CENTRAL FLORIDA REPORTERS, INC. 1366 1 (Plaintiff's Exhibit No. 12 was marked into 2 evidence.) 3 BY MR. OSBORNE: 4 Q Come on down here if you would, Mr. James. 5 Let's talk about your experiments, what you did. Feel 6 free to use your pointer again, and make sure you don't 7 block the Jury view there. Thank you. Tell the Jury 8 what the first exhibit is here. 9 A Okay. This first exhibit is a bed pad that I 10 utilized. And you'll see the numbers, one, two, three, 11 four. Those numbers refer to the type of instrument 12 that I used to create the stain. Number one -- and this 13 is true throughout, but I'll repeat them as we go 14 further. 15 Number one is a narrow-aperture pipette stain. 16 And what I mean by that is like a medicine dropper. In 17 the laboratory we call them pipettes. They come in 18 different length and widths, et cetera. Number two is a 19 wide-aperture pipette. And what that does essentially 20 is change the blood volume. The smaller aperture would 21 be a smaller drop. 22 Number three is I used a syringe with a 23 22-gauge needle. And, of course, the needle has a 24 smaller aperture than the pipette so you get even a 25 smaller stain. And number four is a syringe without the CENTRAL FLORIDA REPORTERS, INC. 1367 1 needle, so it's just the stub of the syringe where the 2 needle attaches. 3 Q Why did you -- and what's the 90 degrees mean 4 up there? 5 A Well, the 90 degrees, that simply represents 6 the fact that I dripped the blood, one drop each, from a 7 three-inch height. And I had the surface flat so the 8 blood is dripping at 90 degrees. 9 Q Okay. 10 A That's to give me a baseline and how is blood 11 going to react on the fabric. 12 Q This is just a baseline you're trying to get 13 here? 14 A Yes, yes. 15 Q Okay. What is the second photograph of? 16 A Okay. The second again utilizes the same four 17 mechanisms; one being the small-aperture pipette, two 18 being the wider aperture, three being the syringe with 19 the 22-gauge needle, and number four being the syringe 20 without the needle. So nothing changed along there. I 21 used the same dropping height of three inches. 22 However, this time I dripped the -- I 23 positioned the pad at a 45-degree angle, meaning that 24 with 90 degrees I had it like this and the blood is 25 dripping down. At 45 it was about like this, you know, CENTRAL FLORIDA REPORTERS, INC. 1368 1 approximately 45 degrees for the four drops. 2 Q And why do you use different angles when 3 you're doing these baselines? 4 A Well, I know from the original stain that we 5 were questioning here that it's an elongated stain. 6 And, you know, the angle of impact determines the 7 elong -- how much the stain will elongate. So I wanted 8 to see with this fabric what would 45 degrees look like. 9 You get a little bit more elongation here, but you get 10 the skipping effect, which is an effect of the droplet. 11 And this is when the drop has fallen from a 12 height above. And I didn't do any further inches 13 higher, but I really didn't need to. I got the 14 information I needed. 15 Q And what information was it that you got that 16 you needed from these first two? 17 A Well, that the stains -- the stain in question 18 was not -- at this point in my experiment, I could not 19 reproduce it by dripping blood on the surface at an 20 angle. 21 Q Okay. What is the third picture of? 22 A The third one, I call it contact volume, again 23 using the same four mechanisms; number one being the 24 small-aperture pipette, number two the wide-aperture 25 pipette, three the syringe with needle, and four the CENTRAL FLORIDA REPORTERS, INC. 1369 1 syringe without the needle. 2 Q And how did you put -- how did you apply the 3 blood on each of these four examples? 4 A Well, in this case it's greater than a drop of 5 blood. I estimated I believe it was like four or five 6 drops, probably a little more than that required. And 7 what I did, I put the tip of the pipette just in contact 8 and just kind of ran it down in a -- more or less of a 9 straight line. 10 And I did the same thing with the other three 11 mechanisms. And over here, this may have been caused by 12 a little fold in the material. But at any rate -- 13 Q And this is at 90 degrees again? 14 A No, there's no degrees involved because I'm in 15 contact with it, okay? There's no distance falling from 16 either 90 or 45 or anything. This is contact with the 17 particular apparatus and just coming down like this. 18 Q Is this an elongated -- would you call it an 19 elongated blood stain? 20 A Yes. 21 Q And is that also a passive blood stain? 22 A Yes, that is a passive blood stain. There's 23 very -- there's no impact energy, no exhalation energy, 24 no cast-off energy applied to it. It's simply a passive 25 stain. CENTRAL FLORIDA REPORTERS, INC. 1370 1 Q Now, are you starting to approximate here by 2 doing this experiment the blood stain that's found on 3 the bed pad? 4 A In terms of its overall characteristic, yes. 5 And that would apply to number one and number four more 6 than it would two and three. 7 Q I'll show you your next picture here. And 8 tell the Jury what this one is. 9 A Okay. This one, it's essentially the same. 10 But what I did here was I did give it an angulation 11 because I wanted to see if the gravity flow would cause 12 any difference than simply without. The 45 degrees does 13 not apply to distance falling at 45 degrees but simply 14 to allow gravity to, you know, also accompany the 15 movement. 16 I did the same way as the prior one using, 17 number one, the narrow-aperture pipette, two, the 18 wide-aperture, three the syringe with needle, and four 19 the syringe without and again, applying it lightly here 20 and just having it run down. And here we also have -- 21 like one and four have more features of the original 22 stain than two and three. 23 Q And just so we can look at that side-by-side, 24 tell me what the features are you're talking about. 25 A Well, the features are the large central area CENTRAL FLORIDA REPORTERS, INC. 1371 1 at the top and the elongation flow that comes down 2 below. I mean, it's not going to be reproduced exactly, 3 that wasn't my intent, but just to tell me, well, what 4 type of mechanism are we dealing with? Does it involve 5 contact, is it a dripping, you know, and some of these 6 questions I've been able to address. 7 Q Okay. Let's talk about another picture you 8 got here. What is this? What were you doing on this 9 particular experiment? 10 A Well, just to sum up what I had already done, 11 I wanted to apply a few more mechanisms that are 12 commonly encountered. One is a transfer, that is any 13 object wet with blood touching a second surface that is 14 free of blood, it will leave a transfer. And sometimes 15 it's recognizable, sometimes it wasn't. That goes back 16 to, you know, someone bleeding in a criminal matter on a 17 surface and being able to recognize the type of transfer 18 that we're dealing with. 19 And here I just simply used my own finger. By 20 the way, this is all human blood. I know because it's 21 my own that I had drawn. And just created a transfer 22 stain with the flat side of my finger, as well the side. 23 Q Okay. So in terms of looking at the finger 24 and comparing it to the pad, do you have an opinion 25 about whether that stain was caused by somebody putting CENTRAL FLORIDA REPORTERS, INC. 1372 1 blood on their finger and wiping it on the pad? 2 A Well, this wasn't a wipe. This is just, you 3 know, contact. 4 Q Okay. 5 A But, no, this does not look at all like the 6 stain in question. 7 Q And what about this particular one? 8 A Now, this is what we call a wipe. In blood 9 stain analysis we have wipes and swipes, which is kind 10 of like -- you know, a little bit too much detail. But 11 a swipe is if I had a bloody hand and I just moved it 12 across the surface, that's a swipe. A wipe is when you 13 wipe something up. 14 In this case blood is already on the surface 15 and you wipe through it to alter it. And you can see I 16 was able to create a small alteration in the downward 17 direction but nothing that would look anything like the 18 stain in question. 19 Q Okay. You can -- 20 A These were just, you know, basic common 21 mechanisms that I utilized. 22 Q Okay. And did you come up with an opinion as 23 to what the type of mechanism was that caused this blood 24 stain? 25 A Yes. Well, essentially the mechanism is a CENTRAL FLORIDA REPORTERS, INC. 1373 1 small aperture, okay? It's not a large volume of blood. 2 And in my conclusions here I said it was able to be 3 reasonably duplicated utilizing a pipette and syringe 4 without needle by contact and drawing out a volume on to 5 the fabric is my basic conclusion. And I went on to say 6 not consistent with drainage, you know, from the rectum. 7 Q Go ahead and let's talk about that. You can 8 take your chair again back over there. Why is this not 9 consistent with blood drainage of an individual laying 10 on a bed pad? 11 A Well, I believe for the reasons I stated. 12 One, laying on a bed pad would have an opportunity for 13 that stain to be compressed and to be altered. And as I 14 said before, that stain is pristine. 15 Q Doctor, I'd like you to -- I did it again. 16 Mr. James, I'm going to publish something that's in 17 evidence. This is in the Florida Hospital records, and 18 it's a triage form from -- excuse me. 19 MR. OSBORNE: I need to move into evidence the 20 Orlando Regional records, which are No. 3. 21 THE COURT: No objection? 22 MR. TOWNSEND: No objection, Your Honor. 23 THE COURT: No objection? 24 MS. MARSHALL: No objection, Your Honor. 25 THE COURT: It'll be admitted. CENTRAL FLORIDA REPORTERS, INC. 1374 1 MR. OSBORNE: D, sorry. 2 THE CLERK: It's D. D will be No. 13. 3 (Plaintiff's Exhibit No. 13 was marked into 4 evidence.) 5 BY MR. OSBORNE: 6 Q All right. Now I can talk about the Orlando 7 Regional records, Mr. James. And this is a report about 8 using an endoscope where there's a finding of no blood, 9 fissure. No obvious source of bleeding, no hemorrhoids 10 and talks about diagnostic endoscopy. Patient was 11 placed on left side and a scope lubricant was inserted. 12 No obvious source of bleeding. No internal or external 13 signs of trauma. Patient tolerated well. 14 And I'd also like you to assume, Doctor -- or 15 Mr. James, that Dr. Black testified from Florida 16 Hospital that he did an examination of Mrs. Destefano 17 and found no evidence of rectal bleeding. Are these 18 facts consistent with your opinion that the -- that this 19 blood did not come from the rectum and bleeding of 20 Carolina Destefano? 21 MS. MARSHALL: Objection, Your Honor. He's 22 not a doctor. 23 THE COURT: Approach the Bench. 24 (Whereupon there was had a discussion at the 25 Bench outside the hearing of the Jury.) CENTRAL FLORIDA REPORTERS, INC. 1375 1 MR. OSBORNE: I'm only talking about the fact 2 that he's determined this is not rectal bleeding 3 I'm just asking if the evidence is also that there 4 was no medical record of -- 5 THE COURT: Sustained. 6 (Whereupon the discussion at the Bench was 7 concluded, and following proceedings were had in 8 the hearing of the Jury.) 9 BY MR. OSBORNE: 10 Q Do you have an opinion, Doctor, we've talked 11 about your opinion about that was not caused from blood 12 from the rectum, as to the probable source or mechanism 13 of this blood that became on the pad? I think we've 14 already talked about it. Can you just summarize again 15 for us what that is? 16 A Yeah. Basically a small aperture with a 17 relatively small volume making contact. And I guess I 18 can't comment about the medical findings. 19 Q No, no. So in terms of what you did, what you 20 showed the Jury, you artificially created the blood 21 stain on the pad? 22 A Yes. 23 Q Do you have an opinion that that's how that 24 the blood stain got on there, it's artificially created? 25 A That certainly is consistent with that, yes. CENTRAL FLORIDA REPORTERS, INC. 1376 1 MR. OSBORNE: All right. No further 2 questions. 3 - - - - - 4 CROSS EXAMINATION 5 BY MS. MARSHALL: 6 Q Now, Mr. James, you don't have a medical 7 degree, correct? 8 A Although I've been called doctor many times 9 this morning, I do not. 10 Q Okay. You're not a pathologist, are you? 11 A No. I would be required to be a doctor to be 12 a pathologist. 13 Q You don't do autopsies, do you? 14 A Not presently, no. I have done them in the 15 past under supervision. 16 Q Under supervision of a medical doctor, 17 correct? 18 A Correct. 19 Q And you're not qualified to do any kind of DNA 20 analysis of blood, are you? 21 A No. I'm not a DNA analyst, no. 22 Q And you don't have any advanced degrees beyond 23 your BA in biology and chemistry, do you? 24 A Just a degree in medical technology. 25 Q And that was -- and that's something that you CENTRAL FLORIDA REPORTERS, INC. 1377 1 received at -- in Arizona? 2 A Right, after 12 months, yes. 3 Q That's the license that you talked about 4 that's not current anymore, is that correct? 5 A No, I'm still registered as a medical 6 technologist. The license that's not current I believe 7 is the -- when I talked about it -- about legal blood 8 alcohol analyst. 9 Q Okay. Now, most of your work involves 10 criminal matters, correct? 11 A That's correct. 12 Q Generally you work for attorneys who 13 represent -- who are representing people who have been 14 accused of a crime? 15 A Yes. 16 Q And in the Ziegler case that you testified, 17 were you representing or working for the attorneys that 18 represented Mr. Ziegler? 19 A Yes, I was hired by them, but I was also -- 20 not ordered, but I was asked to be here by the 21 prosecution as well as it turned out. 22 Q Okay. You were hired by Mr. Ziegler to look 23 at -- 24 A By his attorney. 25 Q Okay. Look at evidence to get him off of CENTRAL FLORIDA REPORTERS, INC. 1378 1 death row, is that originally what you were hired for? 2 A Well, that's a big jump. I mean, if you look 3 at it in the practical matter, I was asked to look at 4 the evidence in conjunction with some other DNA evidence 5 at the time, to see if the version of events that 6 Mr. Ziegler had given early on had more credibility than 7 they did at the trial. That's basically it. But 8 ultimately that was -- Mr. Ziegler's objective was to 9 get off death row. 10 Q And most of the cases that you deal with are 11 violent assaults, beatings, stabbings, shootings and 12 fatal vehicle accidents where blood stain pattern 13 analysis will assist with the possible reconstruction of 14 events, correct? 15 A I think that's a fair statement. 16 Q And is it fair to say that these murders and 17 assaults are generally characterized by large amounts of 18 blood? 19 A Sometimes. I mean, often but not always. 20 Q Most of the time though, right? 21 A It depends. I mean, if you're talking about a 22 scene in a blunt beating or a stabbing, you may have 23 significant amount of blood. A lot of it may be pooling 24 of blood where the equation gets imbalanced. The amount 25 of blood on an assailant's clothing can vary from none CENTRAL FLORIDA REPORTERS, INC. 1379 1 to a little to a lot. And that's an equally important 2 aspect of the examination. 3 Q You haven't testified in any civil cases in 4 the past five years, have you? 5 A Geez, I really don't remember. I may have. I 6 know I've been involved in a few, but I don't -- none 7 comes to mind. If you can refresh my memory but -- 8 Q And you haven't testified in any case where 9 one party was alleging that the other party planted 10 blood, have you? 11 A No. Not anything like this case at all, no. 12 Q And you said that you're a blood stain pattern 13 interpretation expert, correct? 14 A No, I said -- well, that's the same thing. I 15 refer to it as blood stain pattern analyst. But 16 interpretation is a word that, you know, with our study 17 group at the FBI we're trying to get away from. So 18 we're -- but essentially that's true. 19 Q And you've testified that you have authored or 20 co-authored a few books, is that right? 21 A Correct. 22 Q And Principles of Blood Stain Pattern 23 Analysis, is this one of the books that you've authored? 24 A Yes. That's the most recent. 25 Q Co-authored? Now, that book is about reading CENTRAL FLORIDA REPORTERS, INC. 1380 1 the pattern of blood primarily at crime scenes, correct? 2 A No, actually it's got quite a bit more 3 information than that. It talks about anatomic sites of 4 injuries, a chapter done by a pathologist. It's got 5 theory of -- in the physics of blood stain pattern 6 analysis. It's got a chapter on Luminol, you know, the 7 chemical that makes blood glow in the dark. 8 It's got a chapter on chemical enhancement, 9 fingerprint and footwear impression. It's got a 10 computer analysis chapter. It's got a lot of things in 11 it. Whereas blood stain pattern analysis at crime 12 scenes is an integral but not a total part of the book. 13 Q Okay. The chapters on chemical analysis, 14 those are not chapters that you authored, were they? 15 A On the chemical, no, they weren't. 16 Q 'Cause you're not qualified to do that, are 17 you? 18 A To do what? 19 Q The chemical analysis of blood. 20 A Well, sure, certainly I am. I do Luminol all 21 the time. I just had someone else write the chapter who 22 had more experience than I did. 23 Q That's not primarily what you do, is it? 24 A What? 25 Q Chemical analysis of blood. CENTRAL FLORIDA REPORTERS, INC. 1381 1 A No. It's something I do when needed. And 2 when you say chemical analysis, what I'm -- what I think 3 you mean from my perspective is the chemical 4 enhancement, okay, looking for blood that has been wiped 5 up or cleaned. That's when you use Luminol or use Amido 6 Black or other enhancement chemicals to make it more 7 visible. That is not exactly chemical analysis of 8 blood. I've done that before in toxicology. That's a 9 different subject. 10 Q Isn't it true, Mr. James, that the temperature 11 of the environment affects the flow and the speed of 12 drying blood? 13 A Of drying blood? 14 Q Yes. 15 A The temperature affects the -- 16 Q The temperature of the environment affects the 17 flow and the speed of drying blood? 18 A Well, it would affect more the drying of 19 blood, the flow of blood. It would affect the flow of 20 blood if the temperature was extreme. I've had two or 21 three cases where homicides have occurred in freezers of 22 fast-food restaurants. And the blood, you know, freezes 23 quite quickly because it's in, you know, freezing 24 temperature. So that extreme will certainly affect 25 flow, yes. CENTRAL FLORIDA REPORTERS, INC. 1382 1 Q So it affects both flow and speed of drying 2 blood, correct? 3 A Depending on -- the two may not be 4 co-existing, but those are two factors that can affect 5 drying. Heat will accelerate drying, cold will retard 6 it. But cold will also retard flow. If it's cold 7 enough it'll freeze. 8 Q So the answer to my question is yes? 9 A It's a two-fold question and I thought I just 10 explained it. 11 Q Well, I want you -- I'd like for you to answer 12 the question. Does the temperature of the environment 13 affect the flow and the speed of drying blood? 14 A It can, yes. 15 Q Thank you. And would you agree with me that 16 the estimation of degree of clotting and drying time of 17 blood at crime scenes should be reproduced 18 experimentally using freshly drawn human blood of 19 similar volume, placed on an identical surface with 20 similar environmental conditions existing during the 21 experiment as were observed at the scene? 22 A Yes. 23 Q Okay. So you should have same type of blood, 24 same blood, identical surface and similar environmental 25 conditions? CENTRAL FLORIDA REPORTERS, INC. 1383 1 A Yes. 2 Q Did you take any temperature readings from the 3 nursing home that Mrs. Destefano was staying at? 4 A No. Well, you're referring to the drying of 5 blood. I didn't get involved with any experiments with 6 the drying of blood. I was just trying to reproduce a 7 pattern. 8 Q Well, do you know what the -- well, the 9 pattern is affected by how the blood was dried, isn't 10 it? 11 A No. 12 Q Well, this is dried blood, is it not? 13 A Yes, but the pattern looks the same as it did 14 when I produced it. It's just dry. 15 Q And the way that it's shaped? This is dried 16 blood? 17 A Now it is, yeah. 18 Q And that's going to be affected by things such 19 as temperature and environment? 20 A Yeah, but to what purpose? I mean, it looks 21 the same as it did when it was wet. 22 Q Were you there when it was wet? 23 A I made it myself, yes. 24 Q No, I'm talking about this, sir. 25 A Oh, that? No. I thought you were talking CENTRAL FLORIDA REPORTERS, INC. 1384 1 about the experiment. 2 Q No, I'm talking about this. 3 A No. The stain is there. It's pristine and it 4 dried eventually, sure. 5 Q And so -- but you don't know one way or the 6 other what the temperature was from -- at the nursing 7 home from where this bed pad was removed? 8 A I don't know the temperature, no. 9 Q And do you know anything about the lighting at 10 the nursing home? 11 A The lighting? No. 12 Q So you weren't really able to recreate the 13 same environmental conditions because you don't know 14 what the environmental conditions were at the nursing 15 home? 16 A I don't know what they were, no. 17 Q Now, isn't it true that blood from anemic 18 people will generally be diluted, have different 19 properties than somebody who's not anemic? 20 A In experiments they've done it requires 21 extremely anemic people, people who would otherwise not 22 be ambulatory or able to move around much. 23 Q And this is your blood, correct, that you did 24 on your experiments? 25 A Correct. CENTRAL FLORIDA REPORTERS, INC. 1385 1 Q And you're not anemic, is that correct? 2 A No, I'm not currently. No, I never was. 3 Q Okay. So if Mrs. Destefano was anemic, then 4 using your blood wouldn't really be using the same -- 5 blood with the same properties as what was on this bed 6 pad, correct? 7 A Well, I mean, no, but I can look at that stain 8 and say that that blood is not diluted so that's a moot 9 question. 10 Q Now, you also did not find a bed pad that was 11 identical to this bed pad, did you? 12 A Correct. I asked if I could use a portion of 13 that and it was denied. 14 Q Okay. 15 A But I did make the attempt. 16 Q If you look at this bed pad, it looks almost 17 like a flannely surface, doesn't it? 18 A Yes, ma'am. 19 Q And the bed pad that you used is sort of a 20 gauzy surface, is it not? 21 A Right. That's the only one I could find. 22 Q So even though you're supposed to reproduce 23 using the same environmental conditions on the identical 24 surface, you didn't do either of those two things in 25 this particular experiment, did you? CENTRAL FLORIDA REPORTERS, INC. 1386 1 A I wasn't permitted to. 2 Q Now, you didn't perform any tests on the 3 actual stain to determine any of the properties of the 4 blood, did you? 5 A I didn't do any testing whatsoever. 6 Q So you didn't swab the blood and look at that 7 under the microscope in any way, did you? 8 A No. In fact, that was something else I was 9 forbidden to do so I couldn't do it. 10 Q Well, sir, you're aware, are you not, that our 11 expert did do that, correct? 12 A Well, that's probably why I wasn't allowed to. 13 You had control over the material. 14 Q Okay. And did you request permission to do 15 that? 16 A I did. 17 Q And you were denied that by the Plaintiff? 18 A I don't know. I just -- I was told I could 19 not alter the stain. 20 Q Okay. 21 A No destructive testing. 22 Q But did you look at the blood stain under the 23 microscope, a microscope, right? 24 A A stereomicroscope, just on the fabric itself. 25 Q And that was about a 30 magnitude? CENTRAL FLORIDA REPORTERS, INC. 1387 1 A Magnification. 2 Q Magnification? 3 A Correct. 4 Q Okay. And is this, Mr. James, approximately 5 what a 30 magnification would reveal? 6 A I'm not even sure what I'm looking at here. 7 Q Well, it's a dime that's been blown up or 8 looked at at a magnitude of 30. 9 A It looks like it's got some website on here, 10 www.niceice.com. 11 Q Correct. 12 A I have no idea what that is. 13 Q Well, let me just ask you whether looking at 14 something under a 30 magnitude, does that allow you to 15 see cells? 16 A No. 17 Q Does that allow you to see any properties of 18 the blood itself? 19 A Properties? 20 Q Composition of the blood itself? 21 A No, it doesn't. 22 Q And basically something that's magnified at 30 23 percent, that's not much better than what you could see 24 with the naked eye, is it? 25 A Oh, it sure is much better. It's 30 times CENTRAL FLORIDA REPORTERS, INC. 1388 1 better. 2 Q And there's magnifiers that go up in the 3 thousands, right? 4 A Well beyond that if you're talking about 5 scanning electron microscopy. You can get up into the 6 100,000 magnification if you wanted to. 7 Q And you didn't use any high-powered microscope 8 to look at this blood stain on this bed pad, did you? 9 A Again, I was forbidden. I mean, in order to 10 do that, it would require some destructive testing and 11 removal of the sample to put it on a glass slide, to 12 mount it. You're removing material. I was not 13 permitted to do that. In fact, I would defer that to a 14 pathologist anyway. 15 Q 'Cause that's not something you'd be qualified 16 to do? 17 A Correct. 18 Q All right. Now, since you didn't take any 19 swabs, you weren't able to determine if there was 20 anything consistent with mucus in this blood stain, did 21 you? 22 A Correct. 23 Q Okay. And isn't it true that mucus in blood 24 can leave strands within the pattern? 25 A We occasionally see mucus mixed with blood, CENTRAL FLORIDA REPORTERS, INC. 1389 1 especially aspirated blood and coughing of blood. Yes, 2 I've seen it before. 3 Q Now, before you had performed your experiments 4 in this case, you had talked to the Defendant's (sic) 5 attorneys regarding the case, correct? 6 A Yeah. They called me and made an appointment 7 to bring the pad to my office basically, right. 8 Q And they asked you to determine what 9 mechanisms could have produced the stain, is that 10 correct? 11 A Essentially, yes. I think I may have used the 12 word mechanism when I was talking to him, but how did 13 this happen, that was essentially the question. 14 Q Well, Mr. James, you didn't do any experiments 15 as to whether this stain could have been produced by 16 something other than a pipette, a syringe or smearing 17 blood on the pad, did you? 18 A No, you're seeing the results of my 19 experiments. I did it -- I went as far as I needed to 20 to show that it could be produced by an artificial 21 mechanism. There could be 50 or 100 other objects or 22 devices that can do that. 23 Q That's correct. You looked at all artificial 24 mechanisms? 25 A No, I didn't look at all, I just looked at CENTRAL FLORIDA REPORTERS, INC. 1390 1 some. And I was able to reproduce it with the syringe 2 and the pipette basically. 3 Q Let me rephrase that. Of the mechanisms that 4 you looked at, they were all artificial? 5 A Well, yeah. If you want to use that term, 6 yes. They were mechanical production, yes. 7 Q And you didn't cut yourself and see if your 8 blood on it could also reproduce the same pattern on the 9 bed pad, did you? 10 A Well, I did actually, you know, place blood on 11 there and then try to wipe it down with my finger, which 12 I didn't cut my finger, but I had my blood drawn 13 previously and put it on there. 14 Q My question is is you didn't do any 15 experience -- any experiments with whether this pattern 16 can also be reproduced by a naturally-occurring event, 17 did you? 18 A Well, I gave it as much thought as I could. 19 And for reasons I have testified to, I didn't think I 20 would be able to reproduce it in any other reasonable 21 manner. I'm not saying it can't be done, but I think 22 that the fact that -- the compression of someone lying 23 on a bed pad, you know, kind of comprises any kind of 24 experiment that you'd expect it to look different than 25 pristine, that's all. CENTRAL FLORIDA REPORTERS, INC. 1391 1 Q Sir, I'd -- 2 MS. MARSHALL: If I could request the Court to 3 have the witness answer the question that I asked. 4 THE WITNESS: I thought I did. 5 THE COURT: Ask another question, Counselor. 6 BY MS. MARSHALL: 7 Q Isn't it true, Mr. James, that you did not do 8 any experiments to look at -- verify one way or the 9 other whether the pattern on this bed pad could be 10 reproduced through natural means? 11 A You mean a bleeding person? 12 Q Correct. 13 A No. 14 Q Now, you were told by Mr. Destefano's attorney 15 that the position of Mrs. Destefano on the bed pad was 16 that she was lying directly on it, correct? 17 A My understanding she was lying on the bed pad. 18 Q On her back in a supine position, is that 19 correct? 20 A Yes. 21 Q And you didn't consider any other positions, 22 possible positions, did you? 23 A Any other possible positions? It was my 24 understanding that she was bleeding from the rectum. 25 And in order to get the blood where it is, she'd have to CENTRAL FLORIDA REPORTERS, INC. 1392 1 have that part of her body in proximity to the surface. 2 If not, then there would be more blood around. 3 Q All right. Mr. James, my question is you were 4 told that she was lying on her back in a supine 5 position, correct? 6 A Yes. 7 Q And you didn't look at any other possibilities 8 about what her positioning might be? 9 A No. 10 Q You didn't look at whether she could have been 11 on her stomach, did you? 12 A Well, in bleeding from the rectum and leaving 13 blood under her body, it doesn't make any sense. 14 Q And you didn't look at whether she could have 15 been on her side, did you? 16 A No. 17 Q And you didn't look at whether her feet could 18 have been propped up, did you? 19 A No. 20 Q Do you agree that it is important to observe 21 the evidence without a preconceived notion or 22 objection -- or objective? 23 A Could you repeat that, please? 24 Q Well, when you go into an assignment, you 25 should go in there without any preconceived notions or CENTRAL FLORIDA REPORTERS, INC. 1393 1 objectives of what it is that you're looking at? 2 A I don't do that. In fact, I teach people not 3 to do that. And I didn't do it in this case. 4 Q So you would agree that that is something that 5 you should -- you should not do? You shouldn't go in 6 there with a preconceived notion or objective? 7 A Yeah. You want to get the most unbiased 8 opinion you can get, and that's what I believe I did. 9 Q Isn't it true that in this case, Mr. James, 10 that you started with an assumption from Mr. Destefano's 11 attorneys that this blood had been planted, and your 12 assignment was to see if you could reconstruct this 13 stain? 14 A It's totally incorrect. 15 Q Now, you said -- 16 A I went into this case -- he asked me how did 17 the stain get here. I went in with no -- I had no -- I 18 mean, it was going to be a very interesting experiment 19 for me to do. And I don't like being accused of things 20 like that when they're not true. 21 Q All right. Well, Mr. James, we just 22 established that you didn't do any experiments that 23 would look at whether this pad -- or this blood pattern 24 could be produced by a naturally-occurring event, 25 correct? CENTRAL FLORIDA REPORTERS, INC. 1394 1 A I did no experiments in that regard. 2 Q Okay. So you only did experiments that used 3 artificial mechanisms, correct? 4 A Yes. 5 Q And isn't it true that you don't have an 6 opinion about whether or not these stains were a result 7 of a naturally-occurring event or not? Your testimony 8 is limited to what you've been able to do mechanically 9 to get a stain that's similar in appearance to the one 10 that's on the bed pad? 11 A That's what I did, yes. 12 Q So it's true you don't have an opinion about 13 whether or not these stains are a result of a 14 naturally-occurring event? 15 A Yes. I mean, I wasn't there. 16 Q Okay. Your answer is yes -- 17 A Yes. 18 Q -- correct? You have no opinion on that? 19 A No opinion to the extent that you're asking, 20 yes. 21 Q Okay. Now, let's look at -- I notice that you 22 haven't blown -- do you have a picture or anything where 23 you've blown the blood on the bed pad up to be the same 24 size as your pictures of your experiment? 25 A No, I didn't do those. I didn't make those up CENTRAL FLORIDA REPORTERS, INC. 1395 1 so I don't know. That's all there is. 2 Q Okay. Is -- let me just get the one that you 3 said is most like the bed pad. Is that this one, the 4 one without the needle? 5 A Well, that's one of them, yes. That shows the 6 mirror image where the material is folded when the blood 7 was still wet. 8 Q Okay. Tell me what's on the -- is it this 9 one, number four? This is the one that you said looks 10 the most like -- 11 A Well, that's similar, yes. 12 Q Is that the one that you've testified in your 13 opinion was the one that was most -- 14 A Yes, one and four that are more similar than 15 two and three. 16 Q Okay. Now, and you would agree, would you 17 not, that this -- do you have a copy of those in your 18 file? 19 A Of the pictures? 20 Q Yes. 21 A Yes. 22 Q Okay. Okay. Would you agree that number four 23 on your -- on your exhibit, that the color is pretty 24 uniform throughout the stain? 25 A On number four? CENTRAL FLORIDA REPORTERS, INC. 1396 1 Q Yeah, the one that you've testified to was the 2 most like the one that was on the bed pad. 3 A Yes, I'd say it is. 4 Q And if you look at the bed pad -- and you can 5 step down if you want. 6 A Sure. 7 Q If you look at the bed pad, isn't the tip here 8 much darker than the tail? 9 A It appears to be a little darker. It's more 10 concentrated, yes. 11 Q More concentrated, more similar to a 12 saturation there? 13 A Well, there's saturation on both my 14 experiments and both saturation. 15 Q And on the bed pad, the outside around the 16 edge, it's very well defined, is it not? It's not 17 spreading? 18 A Not very much, no. 19 Q Okay. And then over here on this one where 20 you've reproduced, you have a whole bunch of feathering 21 or spreading, do you not? 22 A Yes, there's more on that. It's not the same 23 material, so it's a function of the fabric. 24 Q So it could be a function of the composition 25 of the blood, couldn't it? CENTRAL FLORIDA REPORTERS, INC. 1397 1 A I'd say more fabric. 2 Q Well, you've looked at blood that has mucus in 3 it, have you not? 4 A I've looked at blood patterns that have mucus 5 strands among them, yes. 6 Q Okay. And in fact, in your book on page 166, 7 you have patterns with mucus strands within an expirated 8 blood pattern? 9 A That's exactly what I'm talking about. You 10 have blood stains and you also have mucus strands, which 11 are distinct from the blood stains. 12 Q And on the actual blood stain itself that's 13 right here, the edges of it are very well defined, are 14 they not? 15 A That's not a consistent feature that often, 16 but in that particular case it is. 17 Q And those are kind of tadpole shaped patterns, 18 are they not? 19 A Not to be compared to this but they're actual 20 strands. They're not tadpole shaped. You use that with 21 a larger volume of blood. 22 Q They're elongated? 23 A They're strands, they're mucus strands. 24 Q With well-defined edges? 25 A If you want to call it well defined, yes. I CENTRAL FLORIDA REPORTERS, INC. 1398 1 think they're just normal. 2 Q Now, right up here, again on the head of this 3 stain, doesn't it look like there's -- that part of the 4 blood stain is thicker than the rest of it? 5 A It looks a little darker. It may have 6 saturated in a little more, I don't know. 'Cause, see, 7 what we don't know here in either case is what the 8 volume is that may have soaked in the pad. So that may 9 reflect itself in a more dense area so I don't know. 10 Q And -- you can sit down. 11 A Thank you. 12 Q And actually in your -- I believe in your 13 book, that's one of the things besides getting -- having 14 consistent environmental factors, having the same 15 material that you do the experiment on, you're supposed 16 to use the same volume of blood, correct? 17 A Not if you don't know what it is. 18 Q Well, that's what you try -- 19 A The only way I could have even estimated that 20 volume was to have been -- to cut up that original bed 21 pad, which again that was not allowed. So you have to 22 kind of go with what you can do. And the volume in this 23 case to me was not a big issue. 24 Q So you didn't know the volume? 25 A There's no way to know. CENTRAL FLORIDA REPORTERS, INC. 1399 1 Q Now, Mr. James, would it surprise you that 2 there is only one sentence in your book that has to do 3 with rectal bleeding? 4 A Not at all. There's a lot more in there than 5 that, believe me. 6 Q There's one sentence that has to do with 7 rectal bleeding, is that -- 8 A Well, that's not unusual. 9 Q Okay. 10 A It's not often a fatal condition as far as 11 that goes. 12 Q And how much are -- what kind of compensation 13 are you receiving for being here today? 14 A Well, I haven't made up a bill yet, but I'll 15 probably charge half a day's worth of court time, which 16 is 850. 17 Q $850 for today? 18 A Correct. 19 MS. MARSHALL: Thank you. I have no further 20 questions. 21 THE COURT: Mr. Townsend? 22 MR. TOWNSEND: No questions, Your Honor. 23 THE COURT: Redirect? 24 MR. OSBORNE: Yes, Your Honor. 25 - - - - - CENTRAL FLORIDA REPORTERS, INC. 1400 1 REDIRECT EXAMINATION 2 BY MR. OSBORNE: 3 Q Mr. James, do you have an opinion as to 4 whether or not this was -- you said this was an 5 elongated passive blood stain, correct? 6 A Correct. 7 Q Whether or not that elongated passive blood 8 stain is consistent with drainage of blood from the 9 rectum of an individual lying on a bed pad? 10 A Yes. Based on my work it's not consistent 11 with that for the reasons I stated. Again, I wasn't 12 there. 13 Q What do you mean, you weren't there? What 14 does that mean? 15 A I wasn't there at the time the blood was shed, 16 so I can't be that definitive. 17 Q You can't say 100 percent 'cause you'd -- to 18 say 100 percent you'd have to be there to see it, 19 correct? 20 A Right. When I said no opinion, you have to 21 take my findings with other -- the findings of others to 22 get the total picture here. I'm only providing you part 23 of the data. 24 Q But is your finding -- your opinion that this 25 blood stain is not consistent with blood coming from the CENTRAL FLORIDA REPORTERS, INC. 1401 1 rectum of an individual lying on a bed based upon 2 reasonable scientific probability based upon your 3 training and experience? 4 A Yes. In my opinion, yes. 5 Q So what you're saying is that to get the whole 6 picture, that you have to look at the medical evidence 7 to see if there's any source of the bleeding? 8 A Correct. That's the bottom line. 9 Q Take the two of those together? 10 A Correct. 11 Q And your other opinion -- so the one opinion 12 is is that within reasonable scientific probability this 13 blood stain did not come from the rectum of an 14 individual lying in the bed, correct? 15 MS. MARSHALL: Objection, Your Honor. 16 THE COURT: Grounds? 17 MS. MARSHALL: He's not a medical doctor. 18 THE COURT: I'll allow him to answer. 19 Overruled. 20 BY MR. OSBORNE: 21 Q Go ahead, Mr. James. 22 A Yeah. Based upon my experience and based upon 23 the experiment, my experience and experiment, it's 24 inconsistent. It's not consistent with rectal 25 bleeding -- CENTRAL FLORIDA REPORTERS, INC. 1402 1 Q And was it -- 2 A -- or from that particular source. 3 Q Okay. And let's go back to your basis for 4 that. Because when rectal bleeding occurs with someone 5 lying in bed there's a different pattern, correct? 6 A Yeah. In my experience if someone is on a 7 surface, the blood coming out of an orifice, you can 8 generally, you know, see it from the patterns what that 9 orifice is. 10 Q Well, let me give you another example. If 11 you're lying on your side and you have rectal bleeding 12 and the blood runs down the side of your buttocks, it's 13 still going to have a compression -- you're going to 14 have a compression stain, aren't you? 15 A Yes. 16 Q So it doesn't matter where the body is, what 17 position the body is in? If it pools under the body, 18 it'll pool under the body no matter what the position 19 is, correct? 20 A Yeah, depending upon, you know, the folds of 21 the skin and et cetera. 22 Q And you're still going to have a compression 23 stain versus pristine stain no matter what position the 24 body is in? 25 A Yeah, as long as the stain is still wet. Once CENTRAL FLORIDA REPORTERS, INC. 1403 1 it dries, you can't alter the stain by compressing it. 2 Q And you also have the opinion that this -- 3 based upon your training, experience and the experiments 4 you did, that this particular pristine blood stain was 5 created artificially and not naturally, correct? 6 A Well, based on my experiments it's easily, 7 easily duplicated artificially, yes. 8 MR. OSBORNE: No further questions, Your 9 Honor. 10 THE COURT: Ladies and Gentlemen of the Jury, 11 do any of you have question for this witness? Just 12 write your question down and our court deputy 13 sheriff will retrieve it. Counsel, approach the 14 Bench. 15 (Whereupon there was had a discussion at the 16 Bench outside the hearing of the Jury.) 17 THE COURT: Could a blood stain in such a 18 shape/pattern possibly be caused by open wound or 19 sore on the body and when moving or kicking the 20 blood was dragged on the pad? Is it possible 21 this -- that's the first question. Is it possible 22 this stain could have come from an open wound on a 23 heel? 24 MR. OSBORNE: That's fine. 25 MS. MARSHALL: That's fine. CENTRAL FLORIDA REPORTERS, INC. 1404 1 THE COURT: Hold on. Your Honor, the pictures 2 shown in the book I could not see. Was I supposed 3 to? 4 MS. MARSHALL: Can I give -- can I publish 5 that to the Jury? 6 THE COURT: Are you -- it's not admitted into 7 evidence. 8 MS. MARSHALL: Yeah. 9 THE COURT: No. 10 MR. OSBORNE: I think you should answer that 11 for her, Judge. 12 THE COURT: Okay. One, what orientation was 13 Mrs. Destefano -- this is confusing. I'll show it 14 to you in a minute. What orientation was 15 Mrs. Destefano in reference to the pad? Let me 16 start again. Up at the top it says not necessarily 17 for the witness, but I would like to know. One, 18 just -- yeah, I think that pretty much ends it. 19 MR. OSBORNE: Yeah, I think that does, too. 20 THE COURT: I will answer this. Could we see 21 the bed pad up close? It's going back with them 22 for deliberations, I would tell them that, no 23 problem. 24 MR. OSBORNE: That's fine. 25 MS. MARSHALL: Um-hum. CENTRAL FLORIDA REPORTERS, INC. 1405 1 THE COURT: Okay. 2 (Whereupon the discussion at the Bench was 3 concluded, and the following proceedings were had 4 in the hearing of the Jury.) 5 THE COURT: All right. Ladies and Gentlemen, 6 I'm going to start with the easy part first, then 7 I'll ask the witness the question. The pictures 8 shown in the book, you were not supposed to see 9 those. Those were part of the examination of the 10 witness. 11 With respect to the questions not necessarily 12 for the witness, that's not a proper question. The 13 question is do you have a question for this 14 witness. If so, you need to ask it. What I will 15 tell you out of those three questions, though, is 16 the bed pad is in evidence and you're going to take 17 it back to the jury room to deliberate, just as you 18 will with all pieces of evidence. So you will see 19 that up close. 20 Now, I'm going to pose these two questions to 21 the witness. These are from the Jury. If you 22 would respond by turning and answering to the Jury. 23 THE WITNESS: Correct. 24 THE COURT: Could a blood stain in such a 25 shape/pattern possibly be caused by open wound or CENTRAL FLORIDA REPORTERS, INC. 1406 1 sore on the body and when moving or kicking the 2 blood was dragged on the pad? If you'd answer the 3 question, please. 4 THE WITNESS: Well, certainly a blood flow can 5 be produced by a sore or other bleeding part of the 6 body, but in this case I don't see any alteration 7 of the stain where that portion of the body could 8 have come off. It looks very pristine, if that 9 answers your question. 10 I don't know the medical issues. It's my 11 understanding there was no -- there was no injuries 12 on the victim, on her -- the rest of her body 13 allegedly that had any bleeding episode, but if 14 there were it certainly can be -- produce a blood 15 stain. But in this case I don't see one that's 16 been altered in that fashion that you would expect. 17 THE COURT: Were you finished? 18 THE WITNESS: Yeah, I'm sorry. 19 THE COURT: Is it possible the stain could 20 have come from an open wound on a heel? 21 THE WITNESS: On a heel? Possibly. If it 22 were -- if it were bleeding slowly and then -- just 23 slowly, if you have a small aperture bringing it 24 down, possibly. I would say it's possible. 25 THE COURT: Any other questions from the Jury? CENTRAL FLORIDA REPORTERS, INC. 1407 1 Any follow-up questions on that, anything further? 2 Are you all writing down questions or are you 3 writing -- no questions? If you'd just indicate to 4 me. Thank you. Any follow-up questions, beginning 5 with you, Mr. Osborne? 6 MR. OSBORNE: Your Honor, excuse me. 7 THE COURT: Do you have any follow-up 8 questions for the witness? 9 MR. OSBORNE: I do not. 10 MS. MARSHALL: No, Your Honor. 11 THE COURT: Mr. Townsend, I take it you do 12 not? 13 MR. TOWNSEND: No, Your Honor. 14 THE COURT: Mr. James, you are free to go. 15 Thank you very much, sir. 16 THE WITNESS: Thank you, Your Honor. 17 MR. OSBORNE: We're going to need a moment to 18 set up the television. 19 THE COURT: Why don't we take a real fast 20 break, five minutes or so. Let's try to keep it to 21 five if we possibly can. 22 (Whereupon, there was had a recess from 9:43 23 o'clock a.m., to reconvene at 9:50 o'clock a.m., in 24 the presence of the Jury.) 25 THE COURT: And be seated. Ladies and CENTRAL FLORIDA REPORTERS, INC. 1408 1 Gentlemen, we're now going to continue with the 2 deposition -- video deposition of Dr. Steely. I 3 would ask you to be thinking, and we'll take a 4 short break and I'll get your thoughts about this 5 during the break after Dr. Steely's deposition, 6 whether you would like to conduct as you did 7 yesterday, have lunch brought in, take a very short 8 lunch break and get right back at it at 12:30, or 9 if you prefer to have an hour lunch. And just 10 think about that, and I'll get with you during the 11 break at 11:00 o'clock or so. Go ahead. 12 (Whereupon the playing of the videotaped 13 deposition of Dr. Steely was resumed.) 14 DIRECT EXAMINATION - CONT. 15 A And the swallow, to note, that she should 16 remain NPO. 17 Q And did she also demonstrate the dragging of 18 the mother? 19 A I don't recall. 20 Q Okay. That's something that she just told 21 you? 22 A Correct. All of this is what she -- what I 23 recall her telling me. 24 Q But at that time, Doctor, as you wrote your 25 weekend note, but you didn't write down those specific CENTRAL FLORIDA REPORTERS, INC. 1409 1 allegations? 2 A Correct. At the time I didn't feel that they 3 were a concern. 4 Q Okay. All right. Doctor, have you had an 5 opportunity to review the Sunbelt Nursing Home records 6 of Mrs. Destefano? 7 A No. 8 Q All right. And let me ask you, first of all, 9 before we take a look at those, have you had any -- did 10 you have any contact with Sunbelt during this time 11 period? 12 A No. 13 Q And did you know or speak to Rachel Bean 14 during this time period? She was the director of 15 nursing there. 16 A At Sunbelt? 17 Q At sunbelt. 18 A No. 19 Q And how about Mary Thornton, the nurse manager 20 over there? Did you know her or ever speak to her? 21 A No, not as first-year interns, we didn't have 22 any contact with Sunbelt. 23 Q And did you know anyone who worked at Sunbelt? 24 A No. 25 Q All right. Now, have you had an CENTRAL FLORIDA REPORTERS, INC. 1410 1 opportunity -- you said you haven't read the Sunbelt -- 2 you have read none of the Sunbelt records? 3 A No. 4 Q Have you read Rachel Bean's statement at all 5 that was in the Sunbelt records? 6 A No. 7 Q All right. Let me show you that, Doctor, if I 8 can. And just for the record, we have marked as Exhibit 9 3 your stand-alone 9/17/99 note just so the record's 10 clear. 11 All right. Doctor, let me show you now part 12 of Rachel Bean's note, which I have marked as Exhibit 13 No. 5 to this deposition. There's a skip there. I 14 skipped Exhibit No. 4. We haven't discussed it and I'm 15 probably not going to refer to it. 16 This was a note, Doctor, and your counsel can 17 correct me if I'm wrong or if she feels I'm wrong, a 18 note written by Rachel Bean after she had an incident 19 with Mr. Destefano. And I want you to just take a look 20 at the bottom portion of the letter, of the note of 21 Rachel Bean's. That's Exhibit 5 that I have 22 highlighted, and trust me that everybody in this case 23 has read this many times, so I'm going to try to read it 24 rather than you drying to decipher her handwriting. 25 It says I received a call from Dr. Black at CENTRAL FLORIDA REPORTERS, INC. 1411 1 approximately 1:00 p.m. in re: inappropriate behavior at 2 the hospital from the son. Dr. Steely had passed on 3 that the resident's son was kneeing her in the back, 4 telling her to stand up, and was literally dragging her 5 across the room, telling her to walk, causing the 6 dressing to come off. Do you see where that's written? 7 A Yes. 8 Q All right. Now, I also want to hand you what 9 I have marked as Exhibit No. 6, and I'll give your 10 counsel a copy of that. Actually this is my only copy 11 so I'll -- if you can maybe take a look at that first, 12 Tracy. I'm just going to ask him about the highlighted 13 portion. 14 Exhibit No. 6, the highlighted portion, says 15 he then put water in his mother's mouth. He was holding 16 her head and kept telling her to swallow and was kissing 17 her face. 18 Now, Doctor, this note was clearly written on 19 September 21st, 1999. I want you to assume that 20 Mrs. Bean, the director of nursing at Sunbelt, wrote 21 both of these notes. They're part of one long note on 22 September 21st, 1999. 23 MS. MARSHALL: Can you refer to them by the 24 exhibit number, please, for the record? 25 MR. GLICK: Yes, sure. It's Exhibits Nos. 5 CENTRAL FLORIDA REPORTERS, INC. 1412 1 and 6. 2 BY MR. GLICK: 3 Q Now, I want you to also note here that 4 Mrs. Bean alleges kneeing in the back and literally 5 dragging her across the room and telling her to walk, 6 causing the dressing to come off. And then in Exhibit 6 7 she notes putting water in his mother's mouth, holding 8 her head and kept telling her to swallow. 9 And, Doctor, would you agree with me that 10 these allegations are strikingly similar to the 11 allegations that are noted in your September 22nd, 1999 12 letter that we have marked as Exhibit No. 1? 13 A They're similar, yes. 14 Q Okay. As a matter of fact, your note of 15 September 22nd, 1999, would in fact corroborate the note 16 written by Rachel Bean? 17 A I mean, they're similar. 18 Q Okay. That would support her version of the 19 facts? 20 A I believe so. I mean, she's saying that they 21 heard it from me so -- 22 Q Okay. And your note, however, Dr. Steely, was 23 written after Rachel Bean's and contains allegations 24 that do not appear anywhere in the Florida Hospital 25 chart, except for what you have written? CENTRAL FLORIDA REPORTERS, INC. 1413 1 A Correct. 2 Q Okay. Doctor, I want to ask you about the 3 gagging notation that you made in your September 22nd, 4 1999 letter. And I want to ask you, Doctor, if the 5 gagging note actually came from either a conversation 6 with Rachel Bean or review of anything that she wrote? 7 A I don't know who Rachel Bean is. 8 Q You never spoke to Rachel Bean and you never 9 reviewed any of her records? 10 A Correct. 11 Q You're absolutely positive of that? 12 A Absolutely positive. 13 Q Doctor, isn't it a fact that Frances Wiegand 14 from risk management or anyone -- or somebody from risk 15 manage for sure came to you, and you've already told us 16 that they told you to write the letter of September 17 22nd, 1999? And as a matter of fact, the reason that 18 they came to you was because Rachel Bean had already 19 written these notes and wanted you to write your letter 20 to support her allegations? 21 A Like I said, I don't -- I was just asked to 22 write a note. I didn't know what the context or the 23 reason was at the time. 24 Q All right. Let's take a look at Ms. Bean's 25 note a little further then. She says in the note that CENTRAL FLORIDA REPORTERS, INC. 1414 1 she got a call from -- I'm going back now to Exhibit 5. 2 She got a call from Dr. Black at approximately 1:00 p.m. 3 in re: inappropriate behavior at the hospital from the 4 son. 5 Dr. Steely had passed on that resident's son 6 was kneeing her in the back, telling her to stand up, 7 and was literally dragging her across the room, telling 8 her to walk, causing the dressing to come off. You see 9 that, Doctor, right? 10 A Yes. 11 Q I'm going to ask you again, Doctor, did you 12 tell this directly to Rachel Bean? 13 A No. 14 Q All right. Did you tell this to Dr. Black? 15 A It may have been in our discussion on rounds. 16 Q You say it may have been in your discussion on 17 rounds. Are you absolutely positive that you told this 18 to Dr. Black? 19 A I don't recall. 20 Q Okay. If Dr. Black has testified that you did 21 not advise him in September of 1999 of any inappropriate 22 behavior visited by Mr. Destefano upon his mother, such 23 as kneeing in the back, dragging her or force feeding 24 her, if he has testified that you did not advise him of 25 any of that, would you have any reason to quarrel with CENTRAL FLORIDA REPORTERS, INC. 1415 1 Dr. Black's testimony on that? 2 A I guess my only question would be that he 3 states here that he got a call from Dr. Black where this 4 had been passed on by me. 5 Q Well, that's what Rachel Bean writes here. 6 A Right. 7 Q This is Rachel Bean's writing. 8 A Okay. But it says it's a call from Dr. Block. 9 Q Dr. Black? 10 A Black, I'm sorry. 11 Q Right. 12 A That Dr. Steely had passed on the resident's 13 son was kneeing her in the back. 14 Q Right. 15 A My interpretation is that that's what 16 Dr. Black told her. 17 Q Okay. But what I'm asking you to assume is, 18 assume that Dr. Black has testified that you didn't tell 19 him anything about that and that he didn't tell Rachel 20 Bean anything about that. Would you have any reason to 21 disbelieve or to quarrel with Dr. Black's testimony? 22 MS. MARSHALL: Form objection. 23 A Like I say, I mean, this is four or five years 24 ago. I can't really make any kind of speculation on 25 whether or not he remembers what we said or what we CENTRAL FLORIDA REPORTERS, INC. 1416 1 didn't say. I can't really comment on it. 2 Q All right. Do you have any knowledge, 3 specific knowledge of Dr. Black speaking to Rachel Bean? 4 A No. 5 Q Do you have any reason to believe that 6 Dr. Black would falsely state that you never told him 7 anything about Mr. Destefano displaying inappropriate 8 behavior toward his mother? 9 MS. MARSHALL: Object to the form. 10 A Yeah. Like I said, I mean, this happened four 11 or five years ago. I mean, you know, I don't know if I 12 told Dr. Black or not. I can't really speculate on what 13 he is thinking or what he might remember or might not 14 remember. 15 Q You're not sure what -- you're not sure if you 16 told Dr. Black anything back in September of '99? 17 A Like I said, I just reported everything that 18 occurred, what I recall is everything that occurred on 19 rounds, that we had talked about on rounds. 20 Q Okay. 21 A But I don't have any recollection specifically 22 telling Dr. Black or just my rounding team is the only 23 thing I discussed the case to. 24 Q Was Dr. Black present on rounds at that time 25 when you discussed this? CENTRAL FLORIDA REPORTERS, INC. 1417 1 A I don't know. I don't recall. 2 Q Okay. Now, who was on the rounding team? 3 A I don't remember -- 4 Q All right. 5 A -- who the attending exactly was, it was 6 admitted to Dr. Fleming, but I don't recall whom the 7 attending was. 8 Q Are you able to tell us specifically what you 9 said, if anything, regarding Larry Destefano and 10 Carolina Destefano to the rounding team? 11 A No. 12 Q All right. Doctor, you had stated earlier 13 that when you wrote your note of 9/17/99 -- which I've 14 forgotten what exhibit that is. It's the weekend note. 15 Do you see that? 16 A Exhibit 3? 17 Q Yes. You referred to it, you said nursing 18 believes son providing inappropriate care. But you 19 didn't at that time give specific examples of the 20 inappropriate care of the kneeing or the dragging or the 21 force feeding, correct? 22 A Correct. 23 Q And then later when risk management asked you 24 to write a letter describing what you knew about Larry 25 and Carolina Destefano, you did decide to go ahead and CENTRAL FLORIDA REPORTERS, INC. 1418 1 write specific examples. 2 A Uh-huh. 3 Q Can you please tell us why at that time you 4 decided to for the first time put in specific examples 5 of kneeing in the back, dragging his mother across the 6 room and force feeding her? 7 A I don't recall. I think they asked for 8 specifics. 9 Q Okay. So risk management asked for specifics 10 of any abuse that was visited upon Mrs. Destefano? 11 A I don't know if the word abuse was used. I 12 don't recall. 13 Q Do you remember if risk management asked for 14 any examples of inappropriate care? 15 A Could have been, but I don't really recall. 16 Q Okay. Because that kind of brings me to my 17 next question, Doctor. In your -- in the letter of 18 9/22/99, Exhibit 1, you state -- towards the end of the 19 letter you say I cannot say in good faith that -- and I 20 realize that this is kind of muddy on the side there, 21 but we believe it says I cannot say in good faith that 22 Mr. Destefano abuses his mother. Do you see that? 23 A Um-hum. 24 Q Yes? 25 A Yes, I see that. CENTRAL FLORIDA REPORTERS, INC. 1419 1 Q Okay. Why did you make that statement? 2 A I don't recall. 3 Q Did someone ask you from risk management 4 whether he abused his mother? 5 A I don't recall. 6 Q Okay. Now, let me show you what has been 7 previously marked -- I'm looking for it here. It's 8 not -- oh, here it is, sorry. 9 We marked this as Exhibit No. 7 to the 10 deposition. And it is -- I only have one copy of it, 11 but it is a fax cover sheet from Rachel Bean to the 12 Department of Children and Family Services. Have you 13 ever seen that before? 14 A No, sir. 15 Q And do you see at least that it represents on 16 the cover page of the fax that it is an 11-page fax? 17 A Yes. 18 Q And it is dated 9/24/99? 19 A September 24th, 1999, uh-huh. 20 Q All right. Now turn the page. 21 A Okay. 22 Q And there is your letter of September 22nd, 23 1999, do you see that? 24 A Yes, sir. 25 Q All right. And I want to be fair with you, CENTRAL FLORIDA REPORTERS, INC. 1420 1 Doctor. When the Department of Children and Family 2 Services produced their records, that's how they 3 produced them. The cover page was first, your letter 4 was second, and the rest of the fax was after that. If 5 you look at the header on the top of your letter -- 6 A Okay. 7 Q -- it says page two of two. Do you see that? 8 A Okay. 9 Q All right. I just want to -- there seems to 10 be some conflict there, but I just wanted to point that 11 out to you to be fair to you. But when you look at your 12 letter, it says September 24th, 1999, 9:50 from -- it 13 looks like Sunbelt Subacute to a certain fax number. Do 14 you see that, Doctor? 15 A Yes. 16 Q All right. And this -- I want you to assume 17 for me that the, the phone number or the fax number that 18 the letter is purported to be faxed to is the Department 19 of Children and Family Services. Okay? 20 A Okay. 21 Q Do you -- was it your understanding that your 22 letter was being faxed from -- strike that. Let me ask 23 you this way, Doctor. 24 Do you deny that your letter was faxed from 25 Sunbelt Nursing Home to the Department of Children and CENTRAL FLORIDA REPORTERS, INC. 1421 1 Family Services? 2 A Do I deny it? 3 Q Yes. 4 A You're telling me that this is the fax number 5 of the Family and Children's Services. It looks like it 6 was faxed to that number from Sunbelt. 7 Q Right. You have no reason to believe that 8 your letter was not faxed from Sunbelt to DCFS? 9 A Correct. 10 Q Now, Doctor, do you -- did you, in fact, take 11 the -- that letter or a copy of the letter that's 12 Exhibit 1 over to Sunbelt to have it faxed to DCFS? 13 A No. 14 Q You're absolutely certain of that? 15 A Yes. 16 Q Do you know who could have possibly done that? 17 A No. 18 Q How far away is Sunbelt from Florida Hospital? 19 A Across the street. 20 Q All right. Would it have -- do you know if 21 there would have been any difficulty for anybody from 22 risk management at Florida Hospital to walk across the 23 street and fax this -- your letter over to DCFS? 24 A I would imagine there wouldn't be any 25 difficulty. CENTRAL FLORIDA REPORTERS, INC. 1422 1 Q Okay. All right. Now, at the time -- strike 2 that. 3 Doctor, assuming that you returned the letter 4 to risk management after you drafted it -- 5 A Correct. 6 Q -- do you have any idea as to what risk 7 management did with the letter afterwards? 8 A No. 9 Q Doctor, did you in fact deliver the letter, 10 whether it was at Sunbelt or anywhere else, to Rachel 11 Bean? 12 A No. 13 Q Doctor, did you go over to Sunbelt with the 14 letter and see Rachel Bean and actually have an 15 opportunity to go into Carolina Destefano's room? 16 A No. 17 Q Absolutely positive of that? 18 A Positive. 19 Q All right. Let me show you, Doctor, documents 20 that have been marked previously as Exhibits Nos. 10 and 21 11. And these are the bed pads. Here are the actual 22 photos. They are marked on the laser copies as 10 and 23 11. 24 MS. MARSHALL: Which ones do you want him to 25 look at? CENTRAL FLORIDA REPORTERS, INC. 1423 1 MR. GLICK: Both of them. 2 BY MR. GLICK: 3 Q Close-up is 11, the broader view of the whole 4 pad is 10. 5 A Okay. 6 Q You can give those to the court reporter. 7 Doctor, have -- did you -- in fact, have you ever seen 8 those photographs before, first of all? 9 A No. 10 Q Have you ever seen Carolina Destefano's bed 11 pad at Sunbelt Nursing Home where those blood stains 12 were there? 13 A No. 14 Q Did you ever witness Rachel Bean or anyone 15 else actually putting blood stains on the bed pad of 16 Carolina Destefano? 17 A No. 18 Q Did you in fact go to Carolina Destefano's 19 room with Rachel Bean and participate in putting that 20 blood on the bed pads? 21 A No. 22 Q All right. Now, Doctor, have you reviewed any 23 of the Department of Children and Family Services 24 records -- 25 A No. CENTRAL FLORIDA REPORTERS, INC. 1424 1 Q -- other than the fax that I gave you? I want 2 you now to take a look at what has been marked as 3 Exhibit No. 8, which is an abuse report, the first two 4 pages of it. And the second page is all I'm going to 5 ask you to take a look at. It's highlighted. 6 A You said the second page? 7 Q Yes. And it -- there's a highlighted part 8 that says Carolina was transported to Florida Hospital 9 South for examination. He followed her there and trying 10 to make her walk. He drug her around the floor pulling 11 a bandage off of one ankle that has decubitus on it. 12 He forced her mouth open and pours water in 13 her mouth trying to force her to drink which endangers 14 her. There are serious concerns regarding abuse period, 15 neglect period. Do you see that, Doctor? 16 A Yes, sir. 17 Q And my question to you is the information that 18 you placed in your September 22nd, 1999 letter, is it 19 possible that you have reviewed this abuse report before 20 you placed -- before you placed -- before you authored 21 your letter? 22 A No. 23 Q Would you agree with me that the verbiage is 24 very similar to the verbiage contained within your 25 report, your letter? CENTRAL FLORIDA REPORTERS, INC. 1425 1 A The wording is similar. 2 Q All right, sir. And I think the last exhibit 3 that I have, which is Exhibit No. 9, it's an Adult 4 Protective Investigations Report. This was produced by 5 the Department of Children and Family Services, pages 15 6 and 16 of their notes, and there is -- excuse me. At 7 the bottom I've highlighted, it says Ivan, who is Ivan 8 Maldonado, who is an Adult Protective Services 9 investigator, called Dr. Steely, left a message to call 10 and it says urgent. Do you see that? 11 A Yes. 12 Q Do you remember speaking with Mr. Maldonado? 13 A I don't recall. 14 Q And then on the second page there, the second 15 page of Exhibit No. -- what is that, Exhibit No. 9, it 16 says APIS, Adult Protective Investigator Ivan Maldonado 17 told Wiegand, that's Frances Wiegand, that we do not 18 have enough evidence due to Dr. Olson nor Dr. Steely 19 returning our urgent messages to call us back in 20 reference to medical documentation that requires skilled 21 care and/or nursing home placement. 22 Do you remember -- you told us you don't 23 remember talking to Ivan Maldonado or you don't recall 24 if you did. Do you recall getting the message from Ivan 25 Maldonado? CENTRAL FLORIDA REPORTERS, INC. 1426 1 A I don't recall. 2 Q Do you recall talking to Frances Wiegand at 3 that time and her asking you to return Mr. Maldonado's 4 phone call? 5 A No, I don't recall. 6 Q Do you recall Frances Wiegand at that time 7 telling you that you didn't need to return 8 Mr. Maldonado's phone call and that she would just 9 simply take care of it or words to that effect? 10 A I don't recall. 11 Q Did you ever receive any messages from DCFS 12 regarding Mr. Destefano or Mrs. Destefano at all? 13 A Not that I remember. 14 Q Did you have a secretary at that time? 15 A A personal secretary? 16 Q Yes. Let me -- strike that question. 17 Let me ask you this way. How would you get 18 like phone messages from outside of Florida Hospital? 19 A If they called the clinic directly, whoever 20 answered the phone could potentially have paged me or 21 waited, put a message in my box, we have mailboxes in 22 our office, or they could have used our electronic 23 medical records to E-mail me. 24 Q All right. Were they generally reliable about 25 getting you messages? CENTRAL FLORIDA REPORTERS, INC. 1427 1 A Usually, yes. 2 Q Okay. Do you remember there being any times 3 where somebody would say, hey, doctor, I've been calling 4 you for three days and you haven't returned my calls, 5 and you said I didn't get any message? 6 A Not specifically. 7 Q Now, Doctor, months after this you were told 8 in the doctor's area of the clinic by a doctor that you 9 said in your earlier deposition you think it might have 10 been Dr. Black, but you weren't totally sure, that a 11 doctor had told you that he had heard that Mr. Destefano 12 had performed oral sex on his mother. Do you recall 13 that? 14 A I don't recall. I remember reading it in my 15 deposition. 16 Q Okay. If you stated it in your earlier 17 deposition, you wouldn't deny that? 18 A Correct. 19 Q All right. Now you don't remember that? 20 A Correct. 21 Q All right. And do you recall that in your 22 deposition, in your earlier deposition you stated that 23 your reaction to that was you were surprised when you 24 heard that statement? 25 A If that's what was in my deposition. CENTRAL FLORIDA REPORTERS, INC. 1428 1 Q All right. And was that because, from what 2 you had observed, Mr. Destefano had always appeared to 3 be a concerned, loving son to his mother from what you 4 observed? 5 A Correct. 6 - - - - - 7 CROSS EXAMINATION 8 BY MS. MARSHALL: 9 Q Dr. Steely, would you look at what's been 10 marked as Exhibit No. 1, please, which is your September 11 22nd, 1999 letter that we've been referring to in this 12 deposition? 13 A Okay, okay. 14 Q Would you say that your recollection about the 15 events of September of 1999 are better today or were 16 better back when you wrote this letter dated September 17 the 22nd, 1999? 18 A It was better when I wrote the letter. 19 Q Was part of the purpose of writing the letter 20 to document what you had personally seen and heard and 21 observed in the treatment of this patient? 22 A I was just asked to write a letter to the 23 specifics of what I had been told. 24 Q Were you asked to write anything that was not 25 true? CENTRAL FLORIDA REPORTERS, INC. 1429 1 A No. 2 Q Were you asked to write what you had 3 personally seen, observed and heard regarding 4 Mrs. Destefano's stay at Florida Hospital? 5 A Yes. 6 Q Is there anything in the letter dated 7 September 22nd, 1999, that is inaccurate or false? 8 A I would say, no, when I wrote the letter. 9 Q Is it your practice and procedure as a medical 10 doctor to ignore phone calls or phone messages that come 11 in? 12 A No. 13 Q If you would have received the message from 14 Ivan Mal -- 15 A Maldonado. 16 Q -- Maldonado from the Department of Children 17 and Families, would you have deemed that to be an 18 important phone call? 19 A Yes. 20 Q Would you have returned his call had you 21 received the message? 22 A Yes. 23 Q That would have been your standard practice 24 and procedure? 25 A Standard practice and procedures, yes. CENTRAL FLORIDA REPORTERS, INC. 1430 1 Q You talked earlier about the physicians that 2 were part of the rounding team. Do you remember that? 3 A Yes. 4 Q And were all of them, all members of the team 5 always present when you discussed files or cases? 6 A Usually. 7 Q Who would have been your direct supervisor 8 with regards to the care of Mrs. Destefano? 9 A It would have been the attending physician. 10 Q And that was not Dr. Black, correct? 11 A Correct, no. He was just a resident. 12 Q Can you tell from the file who was the 13 attending physician? 14 A Well, the attending was Dr. Fleming, but the 15 round -- one of the rounding physicians was Dr. Clay 16 Powell. 17 Q Okay. When you were reviewing the Florida 18 Hospital file, there were some notes that were marked in 19 that file with tabs. 20 A Okay. 21 Q Can you turn to the first one, please? 22 A Okay. 23 Q At the -- I believe it's the bottom of the 24 page, there's a note that is written by you. 25 A It's an order. CENTRAL FLORIDA REPORTERS, INC. 1431 1 Q Okay. Could you read what that says? 2 A Nursing and PT to provide care. Social 3 services eval for POT, which abbreviated potential, 4 abuse in family situation. 5 Q What's the date of that record? 6 A 9/17. 7 Q Was that written on or about 9/17? 8 A Correct. 9 Q And that's 1999, correct? 10 A Yes. 11 Q And that is in your handwriting, correct? 12 A That's my handwriting. 13 Q And what was the purpose of that note? 14 A It had been told that Mr. Destefano had been 15 trying to obtain -- to care for his mother that was not 16 for her best interests. And so I wanted nursing and 17 physical therapy just to provide her care until 18 Mr. Destefano was better able to be trained on how to 19 handle his mother. That was the ultimate plan. 20 Q Was that notation made prior to her being 21 transferred to Sunbelt? 22 A Correct. 23 Q And if you could, please, turn to the next 24 tab. 25 A Okay. CENTRAL FLORIDA REPORTERS, INC. 1432 1 Q Could you tell me who the typewritten portion 2 of that is written by? 3 A It's R. Hatfield, who's a licensed clinical 4 social worker in case management. 5 Q And what's the date of that notation? 6 A 9/17 and at 1523 hours. 7 Q And could you read what that says as well? 8 A Yes. Spoke with son who is adamant in his 9 wanting to fulfill his obligation to care for mother at 10 home. He wants patient to spend time in TCF for wound 11 care and IV ANTIBX, then have her home with help from 12 Hospice. 13 At this time he does not have a home but says 14 he's looking for an apartment. Son needs considerable 15 supervision and instruction in giving care to patient. 16 Hospice is interested in being involved in home care. 17 Please write order for TCF evaluation. Will follow for 18 D/C planning. R. Hatfield, licensed clinical social 19 worker, and then her initials. 20 Q Okay. And again, that was written prior -- on 21 the 17th of September, 1999, correct? 22 A Correct. 23 Q And that was prior to Mrs. Destefano being 24 transferred to Sunbelt? 25 A Correct. CENTRAL FLORIDA REPORTERS, INC. 1433 1 Q COuld you turn to the next tabbed portion of 2 the Florida Hospital records, please? 3 A Okay. 4 Q And could you read what that says? 5 A That's my -- you mean down below that or -- 6 Q Yes, on the previous page. 7 A Okay. 8 Q Yes. 9 A It's a note dated 9/18/99 at 8:15 hours. 10 MFPU, which was our multi-family practice unit, 11 Manicheri, Hitchcock, they cover the weekend. Patient 12 sleeping but arousable. Disoriented. Slept well in 13 p.m. Can't remember the call. Generally when she's 14 sleeping, her vital signs; temperature is 98, pulse 71, 15 respiration 24, sats are 98 percent, blood pressure is 16 118 over 60. 17 Heart, there's an S2 positive heart murmur at 18 the left external border, grade two out of six. Lungs 19 are clear to auscultation. Abdomen, soft and tender. 20 No distension. Extremities, left foot, ulcer with 21 bandage. Receiving wound care. Skin, ulcers over 22 coccyx area. Assessment plan. 71-year-old female 23 admitted for MSA, mental status changes. Hospital day 24 number three. Mental status changes. Urosepsis. On 25 treatment with Loraprin. Dementia, decubitus ulcers. CENTRAL FLORIDA REPORTERS, INC. 1434 1 Disposition. Patient to be evaluated by TCF 2 and transferred there for wound care. Then attending. 3 Patient discussed with Dr. Hitchcock. Poor responsive 4 VSS AF exam as above. Plan as above. Stable for 5 discharge to TCF or ECF. 6 Q Discharge to whom? 7 A TCE or ECF. It's just an abbreviation for a 8 transitional care facility or extended care facility, a 9 nursing home. 10 Q The next page I think is also. Could you read 11 that one? 12 A Yeah, that's my weekend note. It's a 13 check-off note for the person who is coming on for the 14 weekend. 15 Q What's the date of that? 16 A 9/17 of '99. 17 Q Okay. Was that written on September 17th, 18 1999? 19 A Yes, at 3:28. 20 Q Okay. And can you read what it says? 21 A 71 year old with dementia, acute mental status 22 changes. I'm sorry. Okay. 71 year old with dementia. 23 Admitted for urosepsis and acute mental status changes, 24 back to baseline. Currently waiting transfer to TCF and 25 Hospice if placed. Son has power of attorney and has CENTRAL FLORIDA REPORTERS, INC. 1435 1 provided care for the past eight months in Arizona. 2 Recently moved back to Orlando. No home. Was living 3 off of disability from mom. 4 Nursing believes son providing inappropriate 5 care from not knowing home and is interfering in care of 6 patient in hospital. He's currently trying to find an 7 apartment. Issues stated above have Social Services 8 involved for situation, potential counseling and 9 education. To TCF for PT, which is physical therapy 10 wound care 'til home placement and Hospice in house. 11 Will go on ten days of Levaquin. Nursing to do care and 12 may teach son if able. 13 Q What was the basis for you stating in your 14 weekend note that nursing believes son was providing 15 inappropriate care? 16 A What was -- had been told by the nurse about 17 the back and the dragging. 18 Q And were those the same facts that you later 19 put in your September 22nd, 1999 letter? 20 A Correct. 21 Q On the next marked page, which I believe is 22 9/16 of 1999. 23 A Uh-huh. 24 Q Do you see that? 25 A Yes. CENTRAL FLORIDA REPORTERS, INC. 1436 1 Q Okay. Can you read the last portion of that 2 down there? 3 A Okay. The impression, urosepsis. Increased 4 white blood cell count. Mental status changes relative. 5 Patient with slight improvement per son. On two liters 6 of O2 to maintain sat. Dementia. Still unresponsive 7 per exam yesterday. Social Service will have Hospice 8 care if appropriate for patient. PT consulted for 9 possible rehab and wound care. 10 Q Why was Social Services being consulted? 11 A At the time it was for a possible placement 12 for Hospice care as well as at that time and for 13 potential wound care. 14 Q Okay. Can you turn to the -- I believe these 15 are the ones that we had referred to. Are those the 16 nurse's notes that we were talking about before? 17 A Uh-huh. 18 Q On the very first notation, I think it says 19 son. Can you read what that says, if you can? 20 A Son in with mother. Verbally something mother 21 to get out of bed now in quotation marks. Is that the 22 one or the one at the top? 23 Q Okay. Do you know who the nurse was that 24 wrote those statements? 25 A No, I don't see a name. CENTRAL FLORIDA REPORTERS, INC. 1437 1 Q Okay. And then on the very last notation, can 2 you read what that says? 3 A Son at bedside. Responds to touch only. Son 4 forcefully walking mother who is bent over to the waist. 5 Q Okay. When you were questioned regarding 6 whether there was any documentation in the Florida 7 Hospital records that supported what you ultimately 8 wrote in your September 22nd, 1999 letter, would this 9 nurse's record have been one of those things that 10 supported that letter? 11 A Yes. 12 Q And the previous weekend note that we just 13 talked about, would that have been something that was in 14 support of this letter as well that was in the medical 15 records? 16 A Correct. 17 Q Have you been contacted by anyone on behalf of 18 Mr. Destefano within the last year and a half? 19 A Yes. 20 Q Can you tell us about that? 21 A In September the private investigators for 22 Mr. Destefano showed up at my house on two indications 23 and at my workplace. 24 Q Is he sitting in the room today? 25 A Yes. CENTRAL FLORIDA REPORTERS, INC. 1438 1 Q Okay. And what did he contact you about? 2 A Well, initially he was -- he said he would 3 like to meet with me. The attorneys who were covering 4 the case now had basically dropped me and left me out on 5 my own. 6 Q Is that what he told you? 7 A Yes. And that he would just like to go over 8 and discuss some few things with me. That he -- 9 basically they had gotten in touch with the nurse who 10 had -- she had reported all of these incidents and she 11 denied all of that. And he would just like for me to go 12 over there and read that again, and maybe if I feel like 13 it to sign an affidavit saying that I was incorrect in 14 what I had said in my earlier deposition. 15 Q Was he encouraging you to sign this affidavit? 16 A Yes. 17 Q Was this affidavit contrary to the facts? 18 A Correct. This was contrary to what I had 19 stated in my deposition. 20 Q Is it contrary to the truth? 21 A Yes. 22 Q So he was asking you to sign a false 23 affidavit? 24 A Correct. 25 Q Now, the note that was attached to your first CENTRAL FLORIDA REPORTERS, INC. 1439 1 deposition, if you could look at that. 2 A Okay. 3 Q Mr. Glick briefly referred to that. It was a 4 January of 2000 memo. 5 A Okay. 6 Q Was that documentation the result of a phone 7 call that you had had with Mr. Destefano? 8 A Correct. 9 Q And what transpired during that telephone 10 conference? 11 A I called him from my home at work, and I just 12 remember saying that he would get ugly with me. That I 13 wouldn't like what would happen to me. That he was able 14 to get people fired at Sunbelt, and that he would stand 15 out and picket that I had made all of these accusations 16 against him. 17 Q Did he threaten you? 18 A He said he would get ugly with me. 19 Q Did he also threaten to try to get you to lose 20 your job? 21 A Correct. 22 Q Did you in fact feel threatened by that? 23 A Yes. 24 Q Did you feel -- or did you have any indication 25 of why he was threatening you? CENTRAL FLORIDA REPORTERS, INC. 1440 1 A Not at the time, no. 2 Q Did you subsequently become aware of why he 3 was threatening you? 4 A Once I had talked -- once I wrote the letter 5 and discussed with Dr. Powell, he referred me to 6 Dr. Milholm, who subsequently referred me to John Amick, 7 who was security risk management. 8 Q Security risk management, is he responsible 9 for looking after the safety of the employees at Florida 10 Hospital? 11 A Correct. 12 Q And is that why you were referred to him? 13 A Correct. 14 Q Were you afraid? 15 A Yes. 16 Q Were you afraid for your family? 17 A Yes. 18 MS. MARSHALL: Thank you. I have no further 19 questions. 20 MR. GLICK: Just a few questions on redirect, 21 Doctor. 22 - - - - - 23 REDIRECT EXAMINATION 24 BY MR. GLICK: 25 Q First of all, is there anywhere in the CENTRAL FLORIDA REPORTERS, INC. 1441 1 telephone encounter note where you note that 2 Mr. Destefano was threatening your family at all? 3 A No. 4 Q Did he threaten your family at all? 5 A No. 6 Q Okay. Did he -- other than the statement, 7 which you can interpret it however you like, get ugly 8 with me, did he say he was -- did he say he was going to 9 do any physical harm to you in any way? 10 A Not specifically. 11 Q All right. Now, let me talk to you about the 12 affidavit that you referred to that was -- that the 13 investigator from -- on behalf of the Plaintiff talked 14 to you about. Do you have a copy of that affidavit? 15 A No. I refused to meet with him. 16 Q Okay. Did you ever see a written affidavit? 17 A No. 18 Q Well, when you referred to the affidavit, that 19 was just a word that the investigator had used? 20 A Correct. 21 Q All right. Did the investigator ever say to 22 you that I want you to lie or to perjure yourself in any 23 way? 24 A No, just to change my testimony to what I 25 stated in my deposition. CENTRAL FLORIDA REPORTERS, INC. 1442 1 Q Okay. Did the investigator -- did it appear 2 to you that the investigator believed that what you had 3 stated in your earlier testimony was inaccurate? 4 A I don't know what his thoughts were. 5 Q Is that a possibility, Doctor? 6 A Is it a possibility that -- 7 Q Let me ask you this. Is it a possibility that 8 the investigator was trying to get you to sign an 9 affidavit or trying to get you to meet with him so that 10 he could provide you with information that had -- strike 11 that. 12 Did the investigator tell you that he had -- 13 that there had been testimony taken that was contrary to 14 yours since your deposition was taken? 15 A Correct. 16 Q Okay. Did the investigator wish you to listen 17 to what he had to say about that testimony, and then 18 decide if you would sign an affidavit that may have been 19 inconsistent with your previous testimony? 20 A Correct. 21 Q But the investigator at no time ever 22 encouraged you to lie or not tell the truth in any way? 23 A He asked me to -- what he -- what I recall is 24 that he said that the nurse that had reported telling me 25 all of this stuff denied all of this. And he would just CENTRAL FLORIDA REPORTERS, INC. 1443 1 like for me to look over the record and then sign an 2 affidavit stating that I may have been mistaken. 3 Q Okay. Did he at any time make any threats 4 towards you in any way? 5 A No, but I did feel threatened. 6 Q Why did you feel threatened? 7 A Because they showed up at my house when I was 8 in there with my two little children. 9 Q All right. But the investigator didn't make 10 any, any verbal threats? 11 A He told me that the hospital had abandoned me 12 and that I was going to be left alone to take the fall. 13 Q Did you in fact agree to meet with the 14 investigator? 15 A No. 16 Q At any time? 17 A Correct. I did ask him to leave and not to 18 come back. I contacted to find out who the new attorney 19 was that was covering the case. And once I found out 20 that I was covered and discussed with Tracy what 21 curtailed, and I was instructed to -- 22 MS. MARSHALL: I'm going to object, not to -- 23 not to reveal what we talked about. 24 THE WITNESS: Not to reveal anything? Okay. 25 BY MR. GLICK: CENTRAL FLORIDA REPORTERS, INC. 1444 1 Q Did you -- at one point the investigator saw 2 you at his office -- at your office? You say he came 3 over to your office at one point? 4 A Correct. 5 Q And at that point did you speak with him and 6 tell him to come back after hours and talk to you? 7 A No. I was on my way to lunch, and I was 8 just -- I didn't know why he was there, but I had a 9 prior engagement. So I left without -- I just told him 10 I would come back, and then that's when all of the 11 information started. 12 Q Okay. So when you came back, you did talk to 13 him? 14 A Yes. 15 Q Okay. And at that time you didn't tell him to 16 go away or get off of my property or anything like that? 17 A Not at that time. 18 Q Okay. It was later when he came to your 19 house, is that what you're saying? 20 A I don't recall the specific events. 21 Q Okay. But at no time did the investigator 22 make any threats of physical harm to you? 23 A No. 24 Q Or economic harm or any kind of harm to you in 25 any way, isn't that accurate? CENTRAL FLORIDA REPORTERS, INC. 1445 1 A Would that not be reported, that the hospital 2 had left me out to take the fall. 3 Q Okay. 4 A But no specifics. 5 Q But not threats that either -- that anybody 6 from the Plaintiff's side was going to harm you in any 7 way? 8 A He did not make those threats, no. 9 Q All right. Doctor, let me go, go back to just 10 a couple of things and we will be done. You read a few 11 notes out of the hospital record, the Florida Hospital 12 record. And correct me if I'm wrong, but none of those 13 notes that you referred to used the phrases kneeing in 14 the back or dragging Mrs. Destefano or feeding her too 15 much or force feeding her or gagging or anything of that 16 nature? 17 A Correct. 18 Q Okay. Now, one last thing. Ms. Marshall 19 asked you a question, and I probably can't ask it 20 exactly as she did, but it'll be close. 21 She asked you if anything that you wrote in 22 the 9/22/99 letter, which is labeled Exhibit No. 1, was 23 not true or was false. And your answer was, no, when I 24 wrote the letter. Do you remember giving that answer? 25 A Correct. CENTRAL FLORIDA REPORTERS, INC. 1446 1 Q Now do you, after -- now do you see that there 2 may be some things in your letter that are false? 3 A No. I mean, like I said, it's been four 4 years, five years since I wrote the letter specifically. 5 At the time I wrote the letter, I wrote what I knew to 6 be truthful at that point. 7 Q Okay. 8 A So I would have to go with what I wrote in the 9 letter. That's when the recollection would have been 10 the best. 11 Q But at this time now is there any part of the 12 letter that you don't feel is true? 13 A I believe the letter is true. 14 MR. GLICK: Okay. I thank you. I have 15 nothing else. 16 (Whereupon the videotaped deposition of Dr. 17 John Steely was concluded, and the following 18 proceedings were had.) 19 MR. OSBORNE: Judge, while we are -- 20 THE COURT: Hold on just a minute. Yes, 21 ma'am? 22 JUROR: What was the date of the video? 23 THE COURT: What was the date of the 24 deposition? 25 MS. MARSHALL: August 12th, 2004. CENTRAL FLORIDA REPORTERS, INC. 1447 1 MR. OSBORNE: August 12th, 2004. Judge, I do 2 have one document that was published in the 3 deposition I'd like to move into evidence. 4 MS. MARSHALL: No objection. 5 MR. TOWNSEND: No objection. 6 THE COURT: Admitted -- it would be admitted 7 as Plaintiff's next numbered exhibit. 8 MR. OSBORNE: And I would like to publish it 9 to the Jury while we're queuing up, if I could. 10 THE CLERK: That would be Plaintiff's 13. I'm 11 sorry, Plaintiff's 14. 12 (Plaintiff's Exhibit No. 14 was marked into 13 evidence.) 14 JUROR: Your Honor, when he goes to read 15 something, the witness, it's a little difficult to 16 hear. 17 THE COURT: On the video? 18 JUROR: Yes. 19 THE COURT: Okay. You think if we turn the 20 volume up that would help? 21 JUROR: Just a little bit. 22 THE COURT: Just a little bit? Okay. We'll 23 do that. 24 MR. OSBORNE: May I approach? 25 THE COURT: Yeah, go ahead. Just read that CENTRAL FLORIDA REPORTERS, INC. 1448 1 and pass it down. The next witness will also be by 2 videotaped deposition, which will last just under 3 an hour, which should bring us right to noon. And 4 I'm going to ask you to allow us to have about 5 another five minutes or so. 6 If you want to just leave that exhibit where 7 you're sitting, don't take it back with you. And 8 I'll come back and chat with you about what your 9 preference is for lunch. So if you would kindly 10 follow our deputy sheriff into the jury room. Just 11 leave that exhibit right there. 12 COURT DEPUTY: All rise for the Jury. 13 (Whereupon the Jury exited the courtroom, and 14 an off the record discussion was had.) 15 THE COURT: Okay. Be seated. The Jury seems 16 to be in favor of the truncated schedule, 17 compression of the lunch hour, 30-minute lunch and 18 then returning at 12:30 to take up the remainder of 19 the testimony. 20 And I just wondered if that was objectionable 21 in any way or imposes a hardship. Because I would 22 really like to get -- if we have Dr. Krop's video 23 or will have it late this afternoon, I'd like to 24 get through that today. 25 MR. OSBORNE: That's fine with us, Your Honor. CENTRAL FLORIDA REPORTERS, INC. 1449 1 THE COURT: Is that a hardship or do you 2 object? I know it's a little unorthodox for me to 3 feed these people. I can't feed them from the 4 County budget, but if you would agree to do that, I 5 think they seem to be interested in sort of 6 compressing the schedule a little bit. And if 7 you'll all share the costs, we won't say anything 8 about where the food came from. I just wondered if 9 there's any objection to that. 10 MR. OSBORNE: No objection. 11 MS. MARSHALL: No objection, Your Honor. 12 THE COURT: Are you all wearing down? Are you 13 all okay here? Can you push it through today do 14 you think? 15 MS. MARSHALL: Yeah, we're fine. 16 MR. OSBORNE: We got two video depositions, it 17 saves wear and tear on us. 18 THE COURT: All right. 19 MS. MARSHALL: So that would be after lunch we 20 would start with Chuck Sherer and then Michelle 21 Fetters. 22 THE COURT: Yes. And then Pipkin's. Now, we 23 may -- 24 MR. TOWNSEND: And Tamara Trimble, she can be 25 here at 3:00 so -- CENTRAL FLORIDA REPORTERS, INC. 1450 1 THE COURT: Okay. Well, we may break Pipkin's 2 video then to get her in so she doesn't have to 3 wait, if we can do that, and then start Dr. Krop's. 4 Of course, we're going to take some little breaks 5 here and there. I'm not going to sit them down for 6 20 minutes. We're going to take some breaks. The 7 way I figure it, we may be able to finish this 8 tonight between 6:30 and 7:00 and get through 9 Krop's depo. No objection to that? 10 MS. MARSHALL: No objection. 11 MR. OSBORNE: No objection. 12 THE COURT: All right. 13 MR. EVANS: Somebody does need to make the 14 lunch arrangements for the jurors. I think that 15 was kind of on hold. Is that done? 16 MR. MCCOLLOUGH: I've taken care of it. I was 17 waiting for word from the Court. 18 THE COURT: You're going to handle that today, 19 Terry? Okay. We'll try not to make a ruckus about 20 that. I wonder if we could get another deputy up 21 here about quarter 'til 12:00 or so? Is your staff 22 understaffed today? 23 COURT DEPUTY: I will call the corporal. 24 THE COURT: Just see if we can get somebody up 25 there just so we won't have to have someone come in CENTRAL FLORIDA REPORTERS, INC. 1451 1 saying it's here and there's buzz in the courtroom, 2 there's a little bit too much of that anyway, and 3 have somebody out there waiting and -- 4 COURT DEPUTY: What time again? 5 THE COURT: About quarter 'til 12:00. And 6 just wait until it gets there and take it right 7 back to the Jury room so they have their lunch at 8 12:00. 9 COURT DEPUTY: Yes, ma'am. 10 MR. OSBORNE: I just told the attorney for 11 Mr. Sherer that -- 12:30 for him to be here. So he 12 was here, I just let him go 'til 12:30. 13 THE COURT: All right. Let's take a brief 14 recess, and I'll go chat with them and hopefully 15 that will be satisfactory. 16 (Whereupon, there was had a recess from 10:50 17 o'clock a.m., to reconvene at 11:00 o'clock a.m.) 18 THE COURT: Ladies and Gentlemen -- Ladies and 19 Gentlemen of the Jury, if any of you have a 20 question similar to the question asked earlier 21 about when was that deposition given, the 22 particulars or the mechanics of it, feel free to 23 ask it when we close. Just raise your hand. I'm 24 happy to see that you're not hesitant to do that. 25 Just feel free to do that and we'll consider it our CENTRAL FLORIDA REPORTERS, INC. 1452 1 best answer for you. Mr. Osborne, call your next 2 witness. 3 MR. OSBORNE: Call Dr. Lynn Wilson. 4 THE COURT: And how long is this video? 5 MR. OSBORNE: 54 minutes. 6 (Whereupon the videotaped deposition of Dr. 7 Lynn Wilson was played for the Jury.) 8 LYNN WILSON, M.D., 9 having been first duly sworn testified as follows: 10 DIRECT EXAMINATION 11 BY MR. GLICK: 12 Q Good morning, Dr. Wilson. Could you please 13 state for the record your name and your home address? 14 A Lynn Wilson. 12453 Castleman Trail, Orlando, 15 Florida, 32828. 16 Q All right. And, Dr. Wilson, by whom are you 17 currently employed? 18 THE COURT: Terry, that's too loud. 19 A ORMC. 20 Q And what is your position with ORMC? 21 A I'm a third-year resident in the emergency 22 room. 23 Q And for how long have you been an employee of 24 Orlando Regional Medical Center? 25 A Almost three years. CENTRAL FLORIDA REPORTERS, INC. 1453 1 Q Where did you go to medical school? 2 A Bowman Gray School of Medicine. 3 Q And where is that? 4 A Winston-Salem, North Carolina. 5 Q All right. Dr. Wilson, prior to coming here 6 today, did you have an opportunity to review any 7 records? 8 A Yes, I did. 9 Q And can you tell me what records you 10 specifically reviewed? 11 A My -- the chart, my emergency room chart to 12 this case. 13 Q Okay. And did you have an opportunity to 14 discuss this case with anyone prior to coming here 15 today? 16 A Mr. Townsend. 17 Q All right. All right. I want to ask 18 you -- well, first of all, let me ask you, do you -- 19 other than looking -- besides looking at your records, 20 do you recall a patient named Carolina Destefano? 21 A Yes. 22 Q Besides looking at your records, do you recall 23 the patient's son, Lawrence Destefano? 24 A Yes. 25 Q Okay. All right. I'm going to -- I want to CENTRAL FLORIDA REPORTERS, INC. 1454 1 go through the Orlando Regional Medical Center chart 2 with you, and so I'm going to ask if your counsel could 3 supply you with a copy of the records. 4 And the first thing I want to ask you, 5 Dr. Wilson, is can you tell me what -- on what pages of 6 the chart you actually wrote on? 7 A Six and seven. 8 Q Okay. Those are the only two pages? 9 A Yes. 10 MR. GLICK: Okay. All right. Let me -- those 11 are page six and seven. Now, I guess they were 12 originally marked at Larry Destefano's deposition 13 and -- 14 MR. TOWNSEND: And they were also marked again 15 during the deposition of -- 16 MR. GLICK: Kelly Pipkin. 17 MR. TOWNSEND: -- Kelly Pipkin. 18 BY MR. GLICK: 19 Q Okay. And they're, they're labeled triage 20 care record? 21 A Yes, what you're reading there. 22 MR. GROWER: You're referring to page six? 23 THE WITNESS: Yes. 24 BY MR. GLICK: 25 Q Okay. All right. Is the -- let's look at CENTRAL FLORIDA REPORTERS, INC. 1455 1 page six, first of all. Can, can you tell us, is 2 everything on that page written by you? 3 A No. 4 Q Okay. Tell me where your handwriting appears 5 on page six. 6 A Where it says time, 1420. 7 Q I see that. I see 1350 is crossed off. 8 A Correct. 9 Q Did you write that and cross that off? 10 A No. That was another physician. That's -- 11 one of the senior residents had picked the chart up 12 initially and got tied up with a sick patient on the 13 trauma bay or something and couldn't get to the patient. 14 So they passed the chart to me because I was free. So 15 she crossed that out because she couldn't try to -- she 16 couldn't make it to the patient's room, and 1420 is when 17 I saw the patient. 18 Q Okay. All right. And did you write next to 19 that rectal bleeding per nursing home? 20 A Yes. 21 Q Okay. Can you tell me how you -- did you 22 write rectal bleeding per nursing home even before you 23 examined the patient? 24 A Well, no. 25 Q Okay. CENTRAL FLORIDA REPORTERS, INC. 1456 1 A I didn't write any of this until after I 2 examined the patient. 3 Q Okay. Let me ask you this. As far as rectal 4 bleeding per nursing home, how did you get that 5 information? 6 A On the top of the chart right here -- 7 Q Uh-huh. 8 A -- it under assessment says nursing home staff 9 reports bright red blood on bed at rectum. Abdomen 10 non-soft. Usually they write non-tender and soft. I 11 don't know why it's not -- 12 Q Okay. And that was Nurse Pipkin wrote that? 13 A I believe that's her signature. 14 Q Okay. Do you recall Kelly Pipkin? 15 A No. 16 Q Okay. 17 A It was my first month in the emergency room. 18 I didn't know any of the nurses. 19 Q Okay. All right. And so when you wrote 20 rectal bleeding per nursing home, you were just merely 21 writing down what was written a few lines above you? 22 A Correct. Because I -- after going and trying 23 to interview the patient, the patient was unable to give 24 us information herself. 25 Q Okay. At 1420 when you went in to see CENTRAL FLORIDA REPORTERS, INC. 1457 1 Mrs. Destefano, was her -- was any family members there? 2 A No. 3 Q Okay. Was that -- would that be something you 4 would have recorded at that time if there was a family 5 member there? 6 A Yes. I would put who told me the history. I 7 put nursing home because I didn't have anyone else to 8 talk to. 9 Q Okay. All right. And now under that it says 10 patient, 71 year old, and then it goes on. Is that your 11 handwriting? 12 A Yes. 13 Q All right. Could you read that for me, 14 please? 15 A Patient is a 71-year-old white female with 16 history of dementia. Nursing staff reports chronic 17 constipation and is status post de -- I wrote 18 decompaction, but it should be discompaction, and has 19 had bright red blood per rectum. Sent to ED. Patient 20 unable to communicate and does not interact. 21 Q Okay. All right. First of all, what is -- is 22 ED emergency department? 23 A Yes. 24 Q Okay. Now, with -- where did you get the 25 information that you wrote in that paragraph that she's CENTRAL FLORIDA REPORTERS, INC. 1458 1 a 70 year old -- 71-year-old white female and a history 2 of dementia? Where did you get that information? 3 A She -- I don't recall, but it appears from 4 what I've written that she had nursing home records with 5 her. 6 Q Okay. And then it says nursing staff reports 7 chronic constipation and is status post decompaction and 8 has had bright red blood per rectum. When you write 9 nursing staff, are you referring to the nursing staff at 10 the nursing home or the nursing staff at ORMC? 11 A The nursing staff at ORMC told me that. 12 Q Okay. 13 A And it was my understanding that she had 14 spoken to the nursing staff at the nursing home. 15 Q Okay. Do you recall who at -- who from the 16 nursing staff at ORMC reported to you the facts that she 17 had chronic constipation, that she was status post 18 decompaction and had bright red blood per her rectum? 19 A I don't recall. 20 Q Okay. But that -- but that is information 21 that was told to you by -- from your understanding by a 22 nurse at ORMC that she had received from people at the 23 nursing home? 24 A Correct. 25 Q Okay. All right. All right. Then the next CENTRAL FLORIDA REPORTERS, INC. 1459 1 thing looks like in big letters written unable to 2 obtain -- 3 A Secondary to patient unable to communicate. 4 That's a review of systems. These are questions you 5 generally ask the patient -- 6 Q Okay. 7 A -- and I wasn't able to ask them to her. 8 Q Okay. All right. And then did -- does your 9 handwriting appear anywhere else on page six? 10 A Yes. 11 Q Okay. Could you tell me where else it 12 appears? 13 A Under the section marked history, I circled 14 could not obtain secondary to patient's dementia. 15 Q Uh-huh. 16 A And then there's a family history of heart 17 disease and hypertension per the Florida Hospital 18 records that I had -- 19 Q Okay. 20 A -- and that she did not drink, smoke or do 21 drugs per hospital Florida records. 22 Q All right. Do you recall if those were the 23 Florida Hospital records or the Sunbelt Nursing Home 24 records or did you have both or do you recall? 25 A I don't recall. CENTRAL FLORIDA REPORTERS, INC. 1460 1 Q And then it says history, 71-year-old white 2 female. Is that your handwriting? 3 A No. 4 Q Okay. Would that be the nurse's handwriting? 5 A No. That's the attending note. That is 6 Dr. Brennan's handwriting. He was my attending that 7 day. I was the resident. 8 Q Okay. Do -- excuse my ignorance, but do you 9 go around with Dr. Brennan and do everything with him? 10 I mean, are you there at the same time or is it -- are 11 you -- 12 A We're there at the same time. The residents 13 manage the case primarily, but they check in with the 14 attending and the attending also does an exam. 15 Q Okay. Were you with Dr. -- present with 16 Dr. Brennan when he did his exam? 17 A No. 18 Q Okay. Did you perform an examination on 19 Carolina Destefano? 20 A Yes. It's on page seven. 21 Q Okay. Okay. We'll get to that then. Are 22 you familiar -- let me just ask you if you could read 23 Dr. Brennan's note under the history -- 24 A Okay. 25 Q -- if you're able to. CENTRAL FLORIDA REPORTERS, INC. 1461 1 A 71-year-old white female with history of 2 dementia with constipation. Today with some bright red 3 blood per rectum. Patient non-verbal, alert -- 4 Q Let me just stop for this. He -- it says 5 today with some bright red blood per rectum. Do you 6 know if Dr. Brennan actually found that or is that 7 something that he was given information about or -- 8 A That's his history. 9 Q Okay. You can answer the question. 10 A Okay. That's in his history, so that's not 11 his exam. If he found it, it would be in his exam. 12 Q Okay. And what does the physical exam say? 13 A Alert but non-verbal. Abdomen soft, 14 non-tender. Bowel sounds positive. Decubitus in sacrum 15 and heels dressed. Patient clean. No signs of trauma. 16 Rectal within normal limits. Anoscopy, see page two. 17 Assessment and plan. One, history of constipation, 18 rectal bleeding. Two, follow up with primary MD. 19 Q Okay. Again rectal bleeding is mentioned, but 20 that's not saying that he found rectal bleeding? 21 A No. 22 Q Okay. All right. Does your handwriting 23 appear on any other part of page six? 24 A Yes. 25 Q Okay. Is the -- it says 1740. Is that your CENTRAL FLORIDA REPORTERS, INC. 1462 1 handwriting? 2 A Yes. 3 Q Okay. That's your print there? 4 A Yes. 5 Q Okay. And then I see the -- it looks like 6 your signature under that, also. 7 A Correct. 8 Q All right. At 1740 you spoke with Florida 9 Hospital's transfer service, a Dr. Young there? 10 A Yes. 11 Q Do you know -- do you know Dr. Young? 12 A No. 13 Q Okay. Do you remember speaking with Dr. Young 14 that day? 15 A I don't -- not verbatim but, yes. 16 Q Okay. And tell me, using your own 17 recollection and the records together, what did 18 Dr. Young tell you? 19 A Dr. Young was paged at 3:00 o'clock. He 20 called back -- I mean at 1500, yeah, 3:00 o'clock. And 21 he was made aware of the situation and that we were 22 talking to the nursing home and trying to figure out the 23 disposition for this patient. And he was repaged at 24 1700. 25 And then I'm assuming the 1740 is when he CENTRAL FLORIDA REPORTERS, INC. 1463 1 called back. And he felt that she did not need to be 2 admitted to the hospital and that he would call Sunbelt 3 himself and get back to me on the disposition of that 4 patient. 5 Q Okay. 6 A And then he was repaged at 1900 and called 7 back at 1910. My shift ended at 1900 but when I left, 8 the understanding with Dr. Young was that this patient 9 would be transferred to Florida Hospital. 10 Q Okay. All right. Dr. Young felt there was no 11 reason why that the -- no reason for the patient to be 12 admitted? 13 A No medical reason. If the patient had bright 14 red blood at the -- at the nursing home, she needed to 15 be seen by a physician. She needed -- a transfer to an 16 emergency room was appropriate. 17 Q Okay. And if that in fact was untrue, that 18 she never had bright red blood at the nursing home, were 19 there any other medical reasons to transfer her to ORMC? 20 MR. GROWER: Form. 21 MR. TOWNSEND: Object to the form. No -- 22 BY MR. GLICK: 23 Q That you're aware of? 24 A People from nursing homes get sent for 25 constipation to the emergency room all the time. CENTRAL FLORIDA REPORTERS, INC. 1464 1 Q Okay. All right. All right. Does 2 Dr. Young -- based on your record on page six, does 3 Dr. Young note that he is going to call Sunbelt to 4 discuss with the director of nursing Ms. Destefano's 5 return to Sunbelt? 6 A That's what my chart says. I don't recall him 7 specifically saying he was going to -- you know, who he 8 was going to call. 9 Q Okay. All right. Then at 1800 there's a 10 note, spoke with Mr. Sherer, administrator at Sunbelt. 11 And it looks like it says, and correct me if I'm wrong, 12 and he refuses to take patient back to Sunbelt facility. 13 A Correct. 14 Q Do you remember talking to Mr. Sherer? 15 A I don't remember -- again, I don't remember 16 the specifics of the conversation, but I remember that I 17 did have a -- that there was conversation with him. 18 Q Okay. Other than what is stated in the record 19 there that he just refused to take her back, do you 20 remember anything else of the conversation? 21 A No. 22 Q Do you remember when you spoke with him if he 23 gave any reason why he refused to take her back? 24 A The only thing I recall about the whole thing 25 was that he said that members of his staff were scared CENTRAL FLORIDA REPORTERS, INC. 1465 1 of Mr. Destefano. 2 Q Okay. Do you recall if Mr. -- the demeanor of 3 Mr. Sherer when you spoke to him? 4 A No. 5 Q That he was angry or excited -- 6 A I don't recall. 7 Q -- or anything? Okay. What time did your 8 shift end? 9 A 1900. 10 Q You said earlier that you -- that Dr. Young 11 was called at 1500. Why was Dr. Young called? 12 A That's not my handwriting. I didn't initiate 13 the phone call to Dr. Young. 14 Q Okay. 15 A I believe it was Dr. Brennan, but again I'm 16 guessing there. 17 Q Oh, is Dr. Young the transfer service? Is 18 that what -- 19 A I believe he was on-call for his -- for the 20 primary physician. 21 Q Okay. 22 A And whenever you don't have nursing home 23 placement for a patient, it is procedure to call the 24 primary care physician. 25 Q Okay. All right. And so would I be correct CENTRAL FLORIDA REPORTERS, INC. 1466 1 in saying that as early as 1500 there was discussion 2 about returning Mrs. Destefano to Sunbelt? 3 A Correct. 4 Q Now, he responded at 1510. Do you know what 5 the conversation was at 1510? 6 A No. 7 MR. GROWER: Form. 8 BY MR. GLICK: 9 Q Okay. And then at 1700 he was called again? 10 A Correct. 11 Q And at that time did you speak with him? 12 A Yes. That's my handwriting. I document the 13 conversation on the front of the chart. 14 Q Okay. And then the 1900 telephone call to 15 Dr. Young, you were not involved in that? 16 A I was still in the department. I spoke with 17 him and I was -- we were going to send the patient to 18 Florida Hospital. 19 Q Okay. 20 A And that's the last contact I had with the 21 case. 22 Q Okay. So at that time some arrangements had 23 been made to send her back? 24 A Uh-huh. 25 Q Yes? CENTRAL FLORIDA REPORTERS, INC. 1467 1 A Yes. 2 Q Okay. All right. Let's look at page seven. 3 And is that entire page your handwriting? 4 A Except for the procedure signature down here. 5 Dr. Brennan wrote a quick note. Under decisions and 6 procedure, the -- underneath the diagnostic anoscopy 7 there's a boxed-in area where Dr. Brennan wrote. 8 Q Can you read what he wrote? 9 A Procedure performed by PGI-1, that's me, and 10 with attending present throughout. D. Brennan. 11 Q Okay. And that's all he wrote? 12 A Uh-huh. 13 Q All right. Then at the top of page seven I 14 guess is the general examination that you performed upon 15 her? 16 A Correct. 17 Q All right. Can we go to the GI portion? And 18 it says H-E-M-E, negative rectal. Is that what that 19 says? 20 A Correct. 21 Q What does that mean? 22 A There was no blood in her stool. 23 Q Okay. And how do you determine whether 24 there's blood in her stool or not? 25 A You do a rectal exam and you take a smear of CENTRAL FLORIDA REPORTERS, INC. 1468 1 the stool on one of the hemoccult developer cards, and 2 you put chemicals on it which reacts with blood and 3 changes the color. 4 Q Okay. All right. And then it's -- what does 5 it say after there? It says -- there's a circle with a 6 line through with it, blood, and a circle with a line 7 through it, fissure. What does that mean? 8 A No blood, no fissure was identified on exam. 9 Q And how -- how do you -- how do you determine 10 that there was no blood other than the hemoccult? 11 A The hemoccult and also looking. 12 Q Okay. 13 A And sometimes you don't have to do a 14 hemoccult. 15 Q Okay. All right. So -- and by -- when you 16 say by looking, I guess you put your, your fingers into 17 her rectum? 18 A I also performed an anoscope. 19 Q Okay. All right. And what were the results 20 of the anoscope? 21 A It's down here under procedures. 22 Q Uh-huh. 23 A Diagnostic anoscopy. Patient was placed on 24 her left side. Anoscope with lubrication was inserted. 25 No obvious source of bleeding. No external or internal CENTRAL FLORIDA REPORTERS, INC. 1469 1 hemorrhage. Signs -- no signs of trauma. Patient 2 tolerated well. No fecal impaction. 3 Q Okay. So the hemoccult study revealed no sign 4 of blood? 5 A Correct. 6 Q Your visual and -- your visual exam showed no 7 sign of blood, correct? 8 A Correct. 9 Q And when you put your fingers in 10 Mrs. Destefano's rectum, you didn't find any blood? 11 A Correct. 12 Q And the anoscope showed no signs of blood? 13 A Correct. 14 Q And there was no fissures and no sign of 15 trauma? 16 A Correct. 17 Q Okay. 18 A It's -- small fissures are hard to identify, 19 though. They're often missed on a clinical exam. 20 Q Okay. Would the anoscope show fissures? 21 A That's what I mean. Small fissures are often 22 missed. They're difficult to identify, especially if 23 they're no longer bleeding. 24 Q Okay. All right. Have you -- does a 25 dis -- when a patient is disimpacted when they're CENTRAL FLORIDA REPORTERS, INC. 1470 1 constipated, does that often leave fissures? 2 A It can cause trauma. It can -- like, you 3 know, have a small area of scratch or some kind of 4 abrasion where it can bleed and stop. 5 Q Okay. Is that -- are you talking about a -- 6 is that a fissure where you're talking about? 7 A A fissure's a crack. 8 Q Okay. 9 A So it can happen from trauma. 10 Q Okay. And disimpaction? 11 A Yes. 12 Q All right. Do usually they show up, though, 13 on a physical exam? 14 A If they're big, yes. Or it depends on where 15 they're located, how high up they are. 16 Q Okay. All right. Does disimpaction always 17 cause some sign of trauma? 18 A No. 19 Q Okay. 20 A It usually doesn't. 21 Q Okay. All right. So -- and with the -- and 22 the anoscope exam, there was no obvious source of 23 bleeding, no hemorrhoids, and what does it say, distal 24 stool? 25 A No distal stool. CENTRAL FLORIDA REPORTERS, INC. 1471 1 Q Well, what -- 2 A She was not impacted. 3 Q Okay. All right. And then, then the 4 differential diagnosis, you said hemorrhoids, fissures, 5 diverticulitis, trauma due to decompaction. Those 6 are -- and what that means is -- differential diagnosis 7 means those are the things that, before you examined 8 her, you thought it might be? 9 A Correct. 10 Q Okay. All right. Now, then it says family 11 consult discussion. 12 A Where are you reading? 13 Q I'm reading across from medical decision, 14 differential diagnosis. 15 A Okay. 16 Q It says record lab review. Then it says 17 nursing home RN, 1500. Do you see that? 18 A Oh, the family consult discussion circled and 19 nursing home RN, that's Dr. Brennan's handwriting I 20 believe. 21 Q Okay. How about the 1500? 22 A That's mine. 23 Q Okay. Excuse me. And what did you write 24 there, 1500? 25 A Spoke with the DON at nursing home and plan to CENTRAL FLORIDA REPORTERS, INC. 1472 1 DC patient back to home, but she refuses transfer at 2 this time. 3 Q Do you recall who the DON was, her name? 4 A No, I do not. 5 Q Okay. Do you recall anything about that 6 conversation other than I guess telling the 7 nurse -- telling the DON that you had -- you planned to 8 return her back to the nursing home? 9 A I don't recall anything else. 10 Q Okay. It says that she refused transfer at 11 this time. Do you recall any further -- any discussion 12 as to why she refused the transfer? 13 THE COURT: Terry, you need to stop the video 14 for a minute. 15 A The nursing staff was scared of Mr. Destefano 16 is the only thing I recall. 17 Q Okay. At any time did -- 18 (Whereupon the videotaped deposition was 19 paused.) 20 THE COURT: You have a note? Oh, you're 21 just -- I see, you're finished with the exhibit? 22 All right. You can turn it back on. 23 (Whereupon the videotaped deposition was 24 resumed.) 25 Q At any time did -- when you spoke with her at CENTRAL FLORIDA REPORTERS, INC. 1473 1 1500, did she tell you at that time that Mr. Destefano 2 had engaged in any inappropriate conduct with his 3 mother? 4 A Not that I recall. 5 Q When you spoke with Mr. Sherer at 1740, where 6 you recorded on page six, at that time did he say that 7 Mr. Destefano had engaged in any inappropriate conduct 8 with his mother? 9 A Not that I recall. 10 Q Okay. And at 1500 were you aware that there 11 had been allegations that Mr. Destefano had engaged in 12 any inappropriate conduct either at ORMC or at Sunbelt? 13 MR. GROWER: Form. 14 A Not that I recall. I don't -- at 1500 -- 15 I'm -- the nurse told me -- 16 MR. TOWNSEND: The question was at seven -- at 17 1500. 18 A Oh. Oh, I'm sorry. 1500, no. 19 Q Okay. All right. All right. Then we have 20 the diagnostic -- how do you pronounce that? 21 A Anoscopy. 22 Q Anoscopy. All right. Is that -- is that also 23 done with rape victims? 24 A I don't examine rape victims in this county. 25 Q Okay. Do you know if an anoscopy is part of a CENTRAL FLORIDA REPORTERS, INC. 1474 1 rape examination? 2 A I don't know what a rape examination in this 3 county consists of. I've never been involved with one. 4 Q Okay. Have you been involved in a rape 5 examination anywhere? 6 A No. 7 Q Okay. All right. All right. So correct me 8 if I'm wrong. I know you went over this already, but I 9 just wanted to ask you some questions about it because 10 we kind of got it out of order a little bit. 11 It says patient was placed on the left side 12 and the anoscope with lubrication was inserted and you 13 found no obvious source of bleeding, no external or 14 internal signs of trauma and patient tolerated the 15 procedure well. 16 A Um-hum. 17 Q Yes? 18 A Correct. 19 Q Okay. And then it says no fecal impaction. 20 Tell me what that means, no -- negative for fecal 21 impaction or -- 22 A Correct. 23 Q All right. Does that mean you didn't fecally 24 impact her? I mean -- that's a bad question. Is -- 25 what does that mean, negative for fecal impaction? CENTRAL FLORIDA REPORTERS, INC. 1475 1 A That there was no distal stool in her rectum. 2 Q Okay. All right. Now, who wrote rectal 3 bleeding resolved? 4 A Me. 5 Q Okay. Now, tell me, why did you write rectal 6 bleeding resolved? 7 A A lot of our diagnoses are based on history, 8 and the history was this patient had rectal bleeding and 9 at the time of exam she didn't have any, so it was 10 resolved. 11 Q Okay. You, you don't know -- other than the 12 history that was given to you, you don't know for a fact 13 whether or not she ever had rectal bleeding? 14 A Correct, but 80 percent of our diagnoses are 15 made on history. 16 Q Right. I understand that. I understand that. 17 I understand that. Okay. Now, on the bottom left-hand 18 corner of page seven it says 1700, and that's your 19 handwriting, also? 20 A Correct. 21 Q Informed that son is with patient in her room 22 and nurse witnessed inappropriate kissing between son 23 and mother. Security and police have been notified. 24 A Correct. 25 Q Okay. Let me ask you, first of all, how CENTRAL FLORIDA REPORTERS, INC. 1476 1 quickly after you were informed of that allegation did 2 you make your note there? 3 A I don't recall. Sometimes it takes an hour 4 for me to get back to write on the chart because I'm 5 taking care of about eight to ten patients at a time in 6 the emergency room, so I don't know when I wrote that. 7 Q Okay. Now, when you write 1700, does that 8 mean that that's when you were told of it? 9 A It's an estimate of when I was told about it, 10 yes. 11 Q Okay. So it's not necessarily when you wrote 12 it, it's when you're told of it? 13 A Correct. 14 Q Okay. All right. And do you recall which 15 nurse it was that told you that? 16 A I don't recall. 17 Q Can you describe the nurse that told you that? 18 A No. 19 Q Okay. 20 MR. TOWNSEND: Remember if she was white or 21 black? 22 THE WITNESS: I believe she was white. 23 BY MR. GLICK: 24 Q Okay. Can you give me any approximation as to 25 her age? CENTRAL FLORIDA REPORTERS, INC. 1477 1 A No. 2 Q Do you recall if she was, you know, a young 3 woman like yourself or if she was, you know, in her 50's 4 or 60's? 5 A I don't recall. I work with -- it was my 6 first month in the emergency room. There's 30 nurses 7 there at a time. I didn't know any of their names, and 8 I worked with all of them on -- you know, I probably saw 9 20, 30 patients that day with the same nurses over and 10 over again, and so I don't recall. 11 Q Okay. 12 A I didn't know any of their names at that time. 13 Q Okay. Now, sitting here today do you have a 14 recollection of that happening, the nurse coming over to 15 you and saying that there was inappropriate kissing? 16 A I remember where the room was. I remember 17 where I was standing at the counter. 18 Q Okay. And how far away from the room is the 19 counter? Her room was 22. 20 A Right. I, I don' t know. It's probably 30 21 feet. 22 Q Okay. 23 A But he was already -- by the time I was 24 informed, Mr. Destefano was no longer in the room. 25 Q Okay. CENTRAL FLORIDA REPORTERS, INC. 1478 1 A Security had already been called and it was 2 over, he was gone, and I never spoke with Mr. Destefano 3 again. 4 Q Okay. When did you speak with Mr. Destefano? 5 A I saw him when he first arrived at his 6 mother's bedside. I went in and I told him about the 7 exam on his mother and told him the plans to send her -- 8 that she didn't need to be admitted to the hospital, 9 that she could go back to the nursing home. 10 Q And what did he say? 11 A He was not happy with Sunbelt Nursing Home. 12 Q Okay. 13 A He did not want her to go there. 14 Q All right. Do you recall what he said 15 exactly? 16 A No. 17 Q Okay. Do you recall any other details of the 18 conversation? 19 A Yes. Some woman had shown up and said that 20 she was his wife, and she showed up before he did. And 21 she called I believe him on the phone and said that she 22 found his mother and that they were at ORMC. And when I 23 went in to talk to Mr. Destefano, I said something along 24 the lines, I said I told your wife she can go back to 25 the nursing home. And he said she's not my wife. I CENTRAL FLORIDA REPORTERS, INC. 1479 1 don't want you talking to that woman and giving her any 2 medical information about my mother. 3 Q Okay. Do you recall what that woman looked 4 like? 5 A No, I don't. 6 Q And then -- and then what do you remember 7 Mr. Destefano saying as far as -- besides the fact that 8 he didn't want her to go back to the nursing home? 9 A That's about all I remember. 10 Q Okay. Did he give you any reason why? 11 A No. 12 Q All right. And that was the only conversation 13 you've ever had with him? 14 A Correct. 15 Q All right. Now, that would have been before 16 the 1700? 17 A Correct. 18 Q All right. Do you remember about what time 19 that would have been? 20 A No. I didn't document when I spoke with him. 21 Q All right. Now, when the nurse came over to 22 you and said that she -- do you recall if she used the 23 words inappropriate kissing or what words she used? 24 A I don't recall. 25 Q Okay. Do you recall if she -- if she CENTRAL FLORIDA REPORTERS, INC. 1480 1 described the kissing in any further detail other than 2 inappropriate? 3 A Not that I recall. 4 Q Do you recall if the nurse used the term 5 French-kissing? 6 A Not that I recall. 7 Q Do you recall if the nurse said that 8 Mr. Destefano was actually lying on top of his mother 9 kissing her? 10 A Not that I know of. 11 Q Do you recall the nurse saying any words to 12 the effect of that he was kissing her the way a romantic 13 couple would kiss each other? 14 A I don't remember the specifics of the 15 conversation other than what I wrote. 16 Q Okay. And the nurse told you at that time 17 security and police had been notified? 18 A That was my understanding, yes. 19 Q Okay. Let me ask you this. It says 20 inappropriate kissing between son and mother. Did the 21 nurse -- did you get the impression that the nurse was 22 telling you that Mr. Destefano and his mother were 23 kissing each other or that he was just kissing his 24 mother? 25 A His mother was incapable of kissing anybody at CENTRAL FLORIDA REPORTERS, INC. 1481 1 that time medically. 2 Q Okay. So it was your impression that he was 3 just doing the kissing? 4 A Yes. That's how I interpreted what she said. 5 Q Do you remember if Mrs. Destefano was -- if 6 when she -- when she lied in bed and was just lying 7 there, I assume, that her -- whether her mouth was 8 normally open or closed? 9 A Open. 10 Q Other than what you -- what has been written 11 in the chart here, do you have any recollection of doing 12 any further examination on Mrs. Destefano? 13 A No. 14 Q At any time that you saw Mr. Destefano with 15 his mother, did you ever see him do anything that you 16 thought was inappropriate? 17 A No. 18 Q Do you recall -- other than the -- you had 19 this conversation with the director of nursing at 1500, 20 do you recall any other conversations with the director 21 of nursing at Sunbelt? 22 A At 1500? 23 Q There's one at 1500 where you note that. 24 A All right. I don't recall. 25 Q Okay. At any time do you recall -- let me ask CENTRAL FLORIDA REPORTERS, INC. 1482 1 you, in that 1500 conversation, do you remember who 2 called who? 3 A I called them. 4 Q Okay. Do you recall telling the director of 5 nursing at any time that Mr. Destefano was inappropriate 6 at ORMC? 7 A He hadn't been at that time. I mean, I had no 8 reason to -- at that time to think he had been. 9 Q Okay. Did you ever tell the director of 10 nursing that he was -- that the police had been called 11 to ORMC and that Mr. Destefano had been removed from the 12 property? 13 A Not that I recall. 14 Q And other than Mr. Sherer and the director of 15 nursing, is there anybody else you spoke with at Sunbelt 16 to the best of your recollection? 17 A Not that I recall. 18 Q Other than this mention of inappropriate 19 kissing by the nurse at -- by the nurse in the emergency 20 room at ORMC, do you remember hearing anything else 21 about Mr. Destefano and his contact with his mother? 22 A No. 23 Q All right. Did there ever come a time when 24 Mr. Destefano, that you can recall, wanted to speak with 25 you about your mother's care, about -- I'm sorry, strike CENTRAL FLORIDA REPORTERS, INC. 1483 1 that. 2 Did there ever come a time when Mr. Destefano 3 wanted to speak with you about his mother's care and you 4 refused to speak to him? 5 A No. 6 Q Okay. Do you ever remember, you know, 7 saying -- putting your hand up and waving him off, that 8 you would not talk to him? 9 A No. 10 Q All right. Did you ever have the opportunity 11 to speak with either -- with -- well, let's go this way, 12 with the Department of Children and Family Services 13 about this case? 14 A I never did. 15 Q How about the Orlando Police Department? 16 A I never did. 17 Q Do you know who Lillian Folley is? 18 A She's a social worker at our hospital. 19 Q Okay. Is she an RN, also? 20 A I don't know. 21 Q Okay. Did you -- did you recall -- do you 22 recall discussing this case that day or the day after 23 with Lillian Folley? 24 A When -- at 1500 when the nursing home refused 25 to take her back -- CENTRAL FLORIDA REPORTERS, INC. 1484 1 Q Um-hum. 2 A -- we did put a social work consult in for her 3 to help us with the nursing home placement. 4 Q Okay. 5 A So she was involved with the case trying to 6 find her disposition. 7 Q Okay. And did you -- do you recall ever 8 telling Ms. Folley -- did you report to Ms. Folley that 9 you didn't find any signs of trauma? 10 A I don't recall. I do -- usually I would just 11 tell her that she was ready for, for discharge and 12 wouldn't go into the medical aspect of it just because 13 she's involved in the social aspect of the case. 14 Q Okay. Would it surprise you at all that in 15 the police report it says that Lillian advised that 16 Dr. Lynn Wilson had advised her after a rectal 17 examination that there was absolutely no indication of 18 trauma to Carolina's rectal area? That would be 19 consistent with what you found? 20 A That would be consistent with her reading my 21 chart, yes. 22 Q Okay. As you know, probably from before and 23 from this deposition, this is a case where Mr. Destefano 24 is alleging that people at ORMC and Sunbelt have made 25 allegations against him that are -- that he believes to CENTRAL FLORIDA REPORTERS, INC. 1485 1 be false regarding inappropriate contact with his 2 mother. 3 Other than what we've already talked about 4 here today, did you discuss anything that would lend 5 credence to either the fact that he was inappropriate 6 with his mother or he wasn't inappropriate with his 7 mother? Is there anything else that you have heard 8 regarding allegations of inappropriate conduct by 9 Mr. Destefano? 10 A No. 11 Q And Mr. Townsend's the only one you've spoken 12 with really about this case -- 13 A Correct. 14 Q -- other than the nurse who gave you the 15 information -- 16 A Correct. 17 Q -- about him being inappropriate, kissing, 18 correct? 19 A Correct. 20 Q All right. And you may have spoken with -- do 21 you remember if you actually spoke with Mrs. Folley 22 about any inappropriate conduct? 23 A I don't recall. 24 Q At 1700 when the nurse told you that there was 25 inappropriate kissing, did you report that to anybody? CENTRAL FLORIDA REPORTERS, INC. 1486 1 A No. They told me it would already -- it was 2 reported and Mr. Destefano had already left the room. 3 Q Okay. And so you didn't feel there was a need 4 to report it to anybody else? 5 A No. 6 Q The contact with Mr. Sherer, the phone call at 7 1500 I think or 7 -- 1740 -- 8 A 1800. 9 Q 1800, yeah. Do you remember if you called 10 Mr. Sherer or if he called you? 11 A I don't recall. 12 Q Okay. How many rooms are there in the 13 emergency room? 14 A On the adult side there's 23 numbered, plus 15 GYN one and two, plus the eye room so that's, what, 26. 16 Plus there's 13 beds in the pediatric side. 17 Q Uh-huh. 18 A And there's another ten beds back in Fast 19 Track -- 20 Q Okay. 21 A -- extended care. 22 Q Where would Mrs. Destefano have been? Would 23 she have been in the -- 24 A In the adult side. 25 Q Okay. CENTRAL FLORIDA REPORTERS, INC. 1487 1 A The acute adult side. 2 Q And how many emergency room staff are there on 3 any given night? 4 A I don't know. 5 Q Okay. 6 A You mean doctors? 7 Q Doctors and nurses. 8 A There's usually three residents on the adult 9 side and two attendings. There's usually at least one 10 or two residents on the pediatric side and another 11 attending and usually a PA back in the extended care, 12 Fast Track area. 13 Q How about nurses, do you know how many nurses 14 there are usually? 15 A On average a nurse has anywhere from three to 16 four beds. 17 Q Okay. And then there's, you know, aides and 18 other types of people there, also? 19 A There's also the trauma bay -- 20 Q Uh-hum. 21 A -- which is another six beds that sees nothing 22 but the traumas, and they have a couple nurses in there 23 as well. 24 Q Okay. Do you recall on that evening whether 25 it was a busy day or slow or -- CENTRAL FLORIDA REPORTERS, INC. 1488 1 A I don't recall. They're all busy. 2 Q Okay. Do you recall how many times you went 3 into Mrs. Destefano's room that evening? 4 A No. 5 Q Okay. Did you ever physically see 6 Mr. Destefano leave the facility? 7 A No. 8 Q Did you ever physically see police or security 9 come to the facility? 10 A No. 11 Q Is there a police officer actually stationed 12 in the hospital? 13 A In the triage area there's usually one, yes. 14 Q All right. Is that somebody from the OPD? 15 A Yes. 16 Q And is it the same person each time or is 17 it -- 18 A No. 19 Q Just always different? 20 A I'm not -- I don't know them. There's just 21 someone standing there in a uniform. 22 Q Okay. You don't know any of their names? 23 A No. 24 Q Now, when the nurse came over to you and told 25 you that there had been inappropriate kissing, what was CENTRAL FLORIDA REPORTERS, INC. 1489 1 your reaction? 2 A I don't recall. I just -- she already told me 3 that it was taken care of so -- 4 Q Uh-huh. Was there -- did you have a feeling 5 of shock by it at all? 6 A I don't recall. 7 Q Do you -- did you have a feeling that this was 8 some type of sexual abuse? 9 A I don't remember how I felt at the time. 10 Q Do you remember the nurse's demeanor when she 11 came over? Was she nervous, excited or whether it was 12 just like a matter -- like reporting any other medical 13 problem? 14 A I don't remember her being -- just a normal 15 conversation. Other than that, I don't remember her 16 being excited or upset or anything. Again, it was after 17 the fact and Mr. Destefano was already out of the room. 18 MR. GLICK: Okay. Thank you. I have no 19 questions, no further questions. 20 - - - - - 21 CROSS EXAMINATION 22 BY MR. GROWER: 23 Q Dr. Wilson, good morning. My name is Mason 24 Grower and I represent Florida Hospital. Would you look 25 at page seven of the chart, please? I believe you CENTRAL FLORIDA REPORTERS, INC. 1490 1 indicated that the information at the top where it's 2 circled, was that written by you? 3 A Yes. 4 Q In other words, when you look across under 5 general at the top of the page where it says -- what is 6 that word, cachectic? 7 A Cachectic, yes. 8 Q What does that mean? 9 A Very thin. 10 Q And the next thing you marked was 11 malnourished? 12 A Correct. 13 Q You were describing Mrs. Destefano? 14 A Yes. 15 Q Okay. Would you look at page 11, please, the 16 nurses' notes? 17 A Okay. 18 Q And specifically note -- the note at 1310 19 states that patient transported, excuse me, from the 20 nursing home with reports of findings BRB, you interpret 21 that to be bright red blood -- 22 A Correct. 23 Q -- on sheets of bed, right? 24 A Yes. 25 Q SP is status post discussion with son by CENTRAL FLORIDA REPORTERS, INC. 1491 1 nursing home staff, para reports. What is a para? 2 A Paramedic. She was transported by an 3 ambulance. 4 Q So that would be the person who actually 5 brought Mrs. Destefano to the hospital? 6 A Correct. 7 Q Just read for us what the other nurse wrote. 8 A Okay. The patient was transported from the 9 nursing home with reports of finding bright red blood on 10 the sheets of bed. Status post discussion with son by 11 nursing home staff. Para reports per nursing home staff 12 her son disimpacted her. I don't know what that word 13 is. 14 Q Okay. The history then that you would have 15 gotten -- 16 A Sunday maybe. 17 Q The history that you would have gotten then 18 would have been that the patient had been disimpacted 19 prior to the time that she arrived at the hospital? 20 A Correct. 21 Q And prior to the time that you examined her? 22 A Correct. 23 Q Now, when we go back to your examination, you 24 found that there was no stool in the rectal vault, 25 correct? CENTRAL FLORIDA REPORTERS, INC. 1492 1 A Correct. 2 Q Which would be consistent with that history? 3 A Yes. 4 Q In other words, once a patient is digitally 5 disimpacted, that means that the fecal matter would have 6 been removed from the rectal vault and you would not 7 expect to find any stool, correct? 8 A Correct. 9 Q Which is exactly what you found in this case, 10 correct? 11 A Correct. 12 Q Okay. Now, if we go up to the history that 13 was provided to you, did anyone at any time provide you 14 with a history suggesting that Mrs. Destefano had been 15 raped? 16 A No. 17 Q If in fact someone had given you that type of 18 a history, you would have certainly written that in the 19 chart, would you not? 20 A I would have not have done the exam. We would 21 have called the county rape person. There's a doctor 22 who's designated to do rape cases. 23 Q I see. And did you call such a person? 24 A No. I was not told of any rape. 25 Q Okay. And I need to expand on that because CENTRAL FLORIDA REPORTERS, INC. 1493 1 the allegations are actually in three parts. The 2 allegations are that there -- that someone said or 3 reported that she had been anally raped or that there 4 had been evidence of anal intercourse. Did you receive 5 such a history? 6 A No. 7 Q Did you ever receive any evidence of such an 8 event? 9 A No. 10 Q Same question with regard to vaginal rape. 11 You never received any history -- 12 A No. 13 Q -- or any suggestion that that had occurred, 14 did you? 15 A No. 16 Q Same thing with regard to oral sex. Did you 17 ever receive any history or report of oral sex -- 18 A No. 19 Q -- with regard to this patient? The 20 allegations, ma'am, are that the employees of Florida 21 hospital or the Sunbelt Nursing Home have conspired with 22 employees at Florida Hospital, such as your -- excuse 23 me, at ORMC, such as yourself, to libel and slander 24 Mr. Destefano. 25 Have you engaged in any type of conspiracy or CENTRAL FLORIDA REPORTERS, INC. 1494 1 agreement to slander or libel Mr. Destefano? 2 Q No. 3 MR. GLICK: Object to the form. 4 A No. 5 Q Are you aware of any -- anyone who has such 6 a -- done such a thing? 7 A No. 8 Q Now, on your differential diagnosis, you wrote 9 down hemorrhoid, fissure, diverticulitis and trauma 10 secondary to decompaction. Do you see that? 11 A Yes. It should be disimpaction. 12 Q Thank you. Can hemorrhoids cause bleeding? 13 A Yes. 14 Q And can a bleeding hemorrhoid, I guess it 15 doesn't cure itself, but does it stop bleeding? 16 A Oh, absolutely. 17 Q Okay. You told us already a fissure can stop 18 bleeding, correct? 19 A Correct. 20 Q What is diverticulitis? 21 A It is outpouchings of the usually sigmoid 22 colon, which happens as we get older. And if it erodes 23 into a bleeder, it can bleed and it can start and stop 24 as well. 25 Q And finally you told us about trauma CENTRAL FLORIDA REPORTERS, INC. 1495 1 associated with dis -- 2 A Disimpaction. 3 Q -- disimpaction. That can also cause minor 4 bleedings that can start and stop, correct? 5 A Correct. 6 MR. GROWER: Thank you, ma'am. That's all I 7 have. 8 - - - - - 9 CROSS EXAMINATION 10 BY MR. TOWNSEND: 11 Q Just briefly, the -- Doctor, on the page 12 seven, lower left-hand corner where you made a note 13 about the nurse reporting the inappropriate behavior to 14 you -- 15 A Yes. 16 Q -- you've indicated that you think you wrote 17 that some time after the time that's designated on that 18 note -- 19 A Yes. 20 Q -- when you had time to come back and write 21 it, is that correct? 22 A Yes. 23 Q And would you agree that that time is just 24 your -- was your rough approximation at the time? 25 A Yes. CENTRAL FLORIDA REPORTERS, INC. 1496 1 Q Okay. So it could be off a few minutes one 2 way or the other? 3 A Correct. 4 MR. TOWNSEND: Okay. That's all I have. 5 MR. GLICK: I just have a few follow-up 6 questions. 7 - - - - - 8 REDIRECT EXAMINATION 9 BY MR. GLICK: 10 Q The term bright red blood, what does that 11 mean? 12 A It usually -- it's not absolute, but it 13 usually implies that it's a source of lower GI bleeding 14 instead of upper GI bleeding because the blood hasn't 15 had a chance to be partially digested and where it would 16 be a dark, melanic blood if it was upper GI. 17 Q Okay. Does that mean usually that it's fresh 18 blood? 19 A It usually means it's lower GI bleeding to 20 where it wasn't digested so -- 21 Q I mean, recent -- wasn't like -- it's not -- 22 bright red blood wouldn't be something that would 23 abstain there for any length of time? 24 A I wouldn't think so, no. 25 Q Okay. CENTRAL FLORIDA REPORTERS, INC. 1497 1 A But that's not usually how we use it. 2 Q Okay. As far as disimpacting, you don't know 3 who disimpacted Mrs. Destefano before she came to ORMC, 4 do you? 5 A No. 6 Q You don't know when she was last disimpacted, 7 do you? 8 A No. 9 Q Okay. And you found in your anoscope exam, 10 and the other exams that you performed, you found no 11 evidence of hemorrhoids, correct? 12 A Correct. 13 Q Okay. You found -- if -- considering that you 14 found no evidence of hemorrhoids, are you able to give 15 me any type of an opinion within reasonable medical 16 probability if she had had hemorrhoids recently, when 17 she last would have had them? 18 A No, I can't. 19 Q Do you understand my question? 20 A No. You can't guess when somebody had a 21 hemorrhoid. 22 Q Okay. All right. What I'm saying is if you 23 found no evidence of hemorrhoids on your examination on 24 September 21st, does that mean that she didn't have any 25 hemorrhoids on September the 20th, a day before? CENTRAL FLORIDA REPORTERS, INC. 1498 1 A She probably didn't. If it was, it was a very 2 small one. 3 Q Okay. How about on September the 19th? 4 A I -- usually hemorrhoids, you can see them. 5 They're still there. 6 Q At -- for how long? 7 A I don't know. That would vary from individual 8 to individual. 9 Q Okay. How about fissures, how long -- if you 10 didn't find any evidence of fissures, are you able to 11 tell me on the 21st -- strike that. 12 If you didn't find any evidence of fissures on 13 the 21st, do you know if she had any evidence of -- any 14 fissures on the 20th? 15 A Fissures are different than hemorrhoids. 16 Q Okay. 17 A Hemorrhoids usually are located in a specific 18 area. And you can look that -- at that area and say, 19 okay, there's no hemorrhoid. There's probably not a 20 hemorrhoid. 21 Q Okay. 22 A Fissures are different. They can be anywhere. 23 Fissures are easy to miss on exam. She may have had one 24 the day I examined her. 25 Q Okay. CENTRAL FLORIDA REPORTERS, INC. 1499 1 A But if it wasn't actively bleeding, I wouldn't 2 see it. 3 Q All right. Now, as far as -- and how about no 4 evidence of trauma? If you didn't find any evidence of 5 trauma on the 21st, would there have been any trauma say 6 perhaps on the 20th? 7 MR. GROWER: Form, speculation. 8 A I don't know. 9 Q Okay. From your -- okay. Strike that. 10 MR. GLICK: Okay. I have nothing further. 11 (Whereupon the videotaped deposition was 12 concluded, after which the following proceedings 13 were had.) 14 THE COURT: Ladies and Gentlemen of the Jury, 15 I ask you to step into the jury room. If your 16 lunch is not here yet, it will be here momentarily. 17 Thank you. 18 (Whereupon the Jury exited the courtroom.) 19 THE COURT: We'll be in brief recess until 20 12:30. 21 (The proceedings were adjourned at 11:55 22 o'clock a.m., to reconvene at 12:32 o'clock p.m.) 23 * * * * * 24 Continued to Volume XII 25 CENTRAL FLORIDA REPORTERS, INC. 1500 1 C E R T I F I C A T E 2 STATE OF FLORIDA) 3 COUNTY OF ORANGE) 4 I, SHARON L. TRAMONTE, R.M.R., certify that I was 5 authorized to and did stenographically report the 6 foregoing proceedings and that the transcript is a true 7 and accurate record. 8 Dated this 30th day of May, 2006. 9 10 11 ___________________________________ 12 SHARON L. TRAMONTE, RMR AND NOTARY PUBLIC 13 14 15 16 17 18 19 20 21 22 23 24 25 CENTRAL FLORIDA REPORTERS, INC.