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Trial Testimony - Day 4
Saturday, 12 September 2009 19:31

Thursday, March 26, 2009


PROSECUTION WITNESS: Dr. Russell Uptegrove, forensic pathologist and Warren County Coroner


...explains his duties and credentials

Autopsy photos shown on big screen; Some of Sarah's family members do not look at the pictures.

...uptegrove says he was told the night of her death that she was presumed drowned, she was an otherwise healthy 24-year-old, and had not responded to live-saving efforts.  He says a healthy young woman drowning in the bathtub was alarming, and raised suspicions.

“She had a large amount of white frosty fluid that was dried on her face and also found in her lungs,” Uptegrove says. This white frosty fluid coming out of her mouth indicated a drowning.

“She had an IV coming out of her neck and a tracheal tube coming out of her mouth,” says Uptegrove.

...Picture of Sarah when she arrived at the lab is shown to courtroom.
...Side view of Sarah's head and upper torso shown.  A sheet or some loose garment is covering her body and a tracheal tub is protruding from her mouth.   Needle punction from IV on inside of elbow, he says.

"What’s the first thing you do to begin the autopsy process?" Prosecutor John Arnold asks.

“First thing we do would be to take pictures. The next thing will be evidence collection. We’ll also do swabs of oral, mouth, vaginal area also the rectum. We also do nail scrapings, looking at the hands. After the trace evidence is done, the person will be clean for the next set of pictures," Uptegrove says.

...Uptegrove IDs head shot of Sarah's face taken at time of autopsy.

...Picture of Sarah’s forehead with a faint bruise is shown.  “I did notice she did have a faint bruise on her forehead,” Uptegrove says.

...Picture of Sarah’s eye is shown.  “I did locate a few hemorrhages below her eyes” Uptegrove says.
Sometimes seen in drowning or as result of CPR, strangling.

...Photo shown of gloved hands pulling open her right eyelids. Blood vessels broken on bottom of eyelid. Not numerous.

...Examination of Sarah’s lips is shown to the courtroom.
...Some cuts, brusies on her upper lip.  He says the injuries to lip could have been caused by intubation attempt, but he's never seen a case that looked like this.  Bruises looked to him like Sarah had been struck somehow in the mouth.

“You could see that she had some irregular lacerations on her lips,” Uptegrove says.

"Is it possible to cause trauma to her lips during incubation," Arnold asks.

“The most common cause of injury to a lip would be a blunt force trauma,” Uptegrove says.

"Getting hit in the mouth?" Arnold asks.

“Yes,” Uptegrove says.

...The Coroner testifies that external injuries are not always present during unexpected deaths.

...The pink frothy fluid found near Sarah's mouth usually comes from blood vessels in pulmonary system. Often found in drug OD victims, but can also be sign of drowning, Uptegrove says,

...Bruising, scraping on left side of neck. Uptegrove associates those with IV.   Left armpit showed 3/4-inch abrasion. Maybe a half inch from armpit hair stubble, closer to side of body.  Some broken/cut skin, purplish brusing, some apparent swelling.

...He's explains how he makes Y-shaped incision to expose the internal organs.

...Photo shown of incision pulled apart to reveal hemorrhaging in neck. Some darker areas amid reddish-pink tissue and yellowish fatty tissue, which he IDs as hemorrhages.   

Uptegrove says he's never observed similar injuries on other drowning victims. Says they appear to have been caused by blunt force or compression.

...Uptegrove says he's seen injuries caused by CPR, but never on a person's neck like those found on Sarah's body.

...Uptegrove is explaining how rib cage is removed to expose internal organs, which are then removed and examined. Neck organs (larnyx, cartilage, glands, etc.) are the last to be removed.

Uptegrove is giving a brief anatomy lesson about the neck and throat, and he's explaining how he collects evidence from that area.   Photo shown of Sarah's trachea, which has been removed from her body and placed on a white surface. Uptegrove notes an area of hemorrhaging on the front of that organ.

Uptegrove says these injuries to the trachea are not commonly seen as result of CPR, intubation. Those can cause injuries, he says, but not like the ones he found when examining Sarah's body.

...The tracheal tube is usually left in the victim's throat to ascertain whether it was properly placed or might have caused injuries. In this case, he says it was inserted properly and did not cause the injuries he saw.

...Pink frothy fluid, which he said was consistent with drowning, which was their theory going in to autopsy.

...Looking at photo of Sarah's lungs. They are violet-red in some portions, darker red in others.

...Some white frothy fluid found in some parts of lungs, which is caused by trying to move air through fluid, as during drowning

...Examined heart, digestive system and various glands, and no signs of disease or abnormality found.

...Medics found evidence of vaginal bleeding at crime scene, so Uptegrove looked for possible causes. No injuries to vagina, uterus or rectum discovered, he says.

...No fractures to neck cartilage, fluid found in sinus cavity.

...Uptegrove explains how to examine brain.  No hemorrhaging, aneurysm found on surface of brain. Disection revealed no abnormalities, including hemorrhaging, aneurysm or tumors.

...Some contusions discovered when scalp peeled back to access brain.    Hard to say where they would have been located, because the scalp appears to have been essentially flipped inside out from front to back of skull. One large, dark spot toward front of exposed flap, with a couple of smaller ones trailing in opposite direction in roughly descending size.

...Photo showing incision to back of neck. Hairline is at top of photo. Then another photo of deeper incision to look for fractures to bony projections.

...Toxicology report indicated no evidence of chemical impairment, Uptegrove says.

...No evidence found of abnormalities, defects, seizures, etc., Uptegrove says.   Most healthy young people who die suddenly and unexpectedly do so as a result of accidents, gunshot/trauma or drug/alcohol ODs, he says.   Must rule out possible natural causes.

...He says many young people don't go to the doctor, so some conditions go undetected. Blood clots or aneurysms can cause sudden and unexpected deaths, so they must be ruled out. Infections, meningitis, pneumonia, etc. also looked for during autopsies.

...Cause of death: Drowning.

...Manner of death must also be listed, by Ohio law.

...Determined by studying autopsy results, scene investigation, medical history, other investigations (witness questioning, etc.).

He spoke to some of Sarah's family members about her medical history, examined medical records from when she was brought to Bethesda Arrow Springs ER, talked to first responders.

She was essentially without a heartbeat while medical personnel worked on her, and was pronounced dead not long after arrival at hospital. Not much info on that medical report, so he examined records from previous doctor visits.

Those are entered into evidence.

Nothing unusual noted from Sarah's previous medical history. No problems or conditions suggested during routine exam, Uptegrove says.   Conducted June 20, 2008, almost two months before her death.

Previous medical exam notes torn ACL from a prior skiing accident, Uptegrove says. But nothing to suggest natural cause of sudden death, he says.  How can otherwise healthy person who is not impaired drown in bathtub, he says. Use common sense, he says.

"I did not find one case that combines narcolepsy and drowning in forensic literature. I did attempt to find if there was any documented case out there and I couldn't do so"  he adds.

"She has this significant debris of neck hemorrhage. The hemorrhage in her neck can be a result from CPR, when you got people performing chest compressions but no hemorrhage was found. That was a major concern." Uptegrove says.

...He talks about bruises, hemorrhages, contusions found on her body. She's not a kickboxer, etc., and they weren't likely caused by CPR. No hemorrhaging found in soft tissue in area where chest compressions performed, he says.

Uptegrove is going over the photos again, to his conclusion that her manner of death was homicide.

...Neck injury in conjunction with drowning raised alarm, he says.  He is discussing how neck injuries could be consistent with strangling, hanging or choking.  He goes into some anatomical details using examples from injuries sustained during martial arts.

Uptegrove says Sarah's bruising could have been caused by strangling or similar cause without fracturing neck cartilage.

Photo shown of Sarah's head, face, neck and shoulder. Uptegrove notes brusing around her neck area, to left and right, and small bruise near right eye.   Uptegrove says he believes Sarah's injuries not all caused by one thing but didn't elaborate.

Uptegrove says he has seen drowning victims with pruning. First responders previously testified that they saw none on Sarah's hands or feet. Neither did Uptegrove.

Uptegrove says he found no evidence of seizures, brain injuries or other medical conditions or abnormalities that would have contributed to Sarah's death.  Nothing in her previous medical history would support that possibility, he says.  In his opinion, no natural cause contibuted to Sarah's death.  No accidental cause could be found, in his opinion.

Heart disease, sleep disorder, drugs/alcohol can be ruled out as contributing factors, he says.

Uptegrove says the cause of death was drowning, but the manner of death was homicide.

Dr. Uptegrove is excused from the stand but asked to return after lunch.

COURT IN RECESS


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DEFENSE CROSS EXAM:

"When you did your autopsy you did not have your EMS or ER report yet. Is that correct?"  Rittgers ask.

"Yes, I hadn't looked at them,"  Uptegrove says.

"After the autopsy you said that you looked at the EMS records and concluded that this was a homicide. Did you review these records after the autopsy, immediately after?"  Rittgers asks.

"I can't remember exactly, but it was later on in that day," Uptegrove says.

He remembers testifying Aug. 15, 2008 during a grand jury hearing. Says he discussed autopsy findings and ER records from Bethesda Arrow Springs.  He knew police were collecting information to build a case against Ryan.

...Rittgers shows a Sept. 9 request by prosecutors asking for Bethesda records.
Rittgers shows the request on overhead projector.  Uptegrove gave no one those records, Rittgers says.

Rittgers asks him about October meeting with prosecutors, and letter sent Oct. 27 by defense to coroner. He remembers that letter.

Prosecution's objecting to all kinds of things on technicalities.

uptegrove says he did not review ER records until after the autopsy was conducted.

Rittgers goes to this morning's testimony about sleeper holds, martial arts.

"Do you know if Ryan has martial arts training? Are you suggesting Ryan grabbed Sarah and did these holds?"
Rittgers asks.   "No," Uptegrove says.

"Are you telling the jury that these brusies on the neck are the result of strangulation?" Rittgers asks.  "I can't rule that out," he says.

"Cause of death no doubt drowning?" Rittger asks.  "Yes, that is correct", Uptegrove says.

Rittgers shows photo of deep incision to nape of Sarah's neck.  Uptegrove steps down off the witness stand and shows the jury how he made his incision on the back of Sarah's neck using Rittgers neck as prop.

Shows photo of incision spread open, no bruising shown in fatty tissue or near spine. "Correct," Uptegrove agrees. Hemorrhage shown in muscle tissue to right of spine, slightly below nape.

...Photo of even deeper incision. Uptegrove points out muscle tissue, no injuries present.
Photo of flesh pulled away from left side of spine. No injuries noted to spine or area close to it.  Hemorrhage on back of neck superficial.  "A superficial injury is closer to the surface area," Uptegrove says.

"It's a minor injury correct?" Rittgers asks.   "Yes," says Uptegrove.

No evidence that Sarah used drugs, Uptegrove agrees. Evidence from autopsy shows death consistent with drowning process.

"The white fluid found inside Sarah's body; that is contingent with the drowning process correct? Rittgers asks.

"Absolutely." replies Uptegrove

...Side photo of Sarah's head, upper torso. Tracheal tube present.

"It is possible that the hemorrhaging on the back of the neck can then result from the strap or head block that was used to carry Sarah's body?" Rittgers asks.  "Yes, you are correct," he says.  There are examples of different types of injuries from therapeutic devices, Uptegrove says. He says injury he found appeared to be in different area and doesn't fit descriptions in medical literature, but guesses it could be possible.  Small capillary injury  within realm of possibility in post mortem period.

Rittgers is suggesting that injuries might have been caused after death by trach tube strap or slab the body was laid upon. Or attempts at resucitation, manipulation of neck during CPR, intubation.   Could those attempts possibly have broken capillaries, caused one-inch hemorrhage?  "It's possible," Uptegrove says.   

...No semen found when Sarah's body swabbed, Uptegrove says.

...Picture of Sarah's eyes shown  to the courtroom.

Rittgers asks, "Could the bruising up under her eye be a result from the drowning?  "Yes, that's correct," he says.

Uptegrove says he cannot tell when contusion near scalp, on forehead, might have been caused. Didn't see that particular contusion underneath skin when scalp was peeled back during autopsy.

...Photo shown of abrasion near armpit.  Abrasion about 3/4 inch long, about half inch from armpit stubble, closer to side of body.   Rittgers approaches witness, raises arm to ask Uptegrove to point out where abrasion would be.

...Photo shown of cuts, bruises to inside of Sarah's upper lip. "Lacerations," Uptegrove says. Three noted. No evidence of injuries outside of mouth, he says. Wouldn't be able to see it if mouth closed.

Rittgers asks if patients' teeth sometimes broken during intubation and Uptegrove agrees.
Rittgers asks if there was any evidence of lacerations outside of her lip or any indication of a broken nose. Uptegrove says no.

...Photo shown of bruising to left side of neck, and Uptegrove agrees that it was result of medical intervention (i.e., IV). Uptegrove recalls previous meeting when he said Sarah had thick neck and would possibly be "a difficult stick." That means, fleshy neck could cover over some veins and thus make inserting needle somewhat difficult, he says.  

We all know she drowned and brusing around neck (photos shown) present, Rittgers says. One photo from first autopsy, second photo from Spitz's. Neck bruising has grown larger and turned more reddish between those two autopsies.

...Photo shown of Sarah's body.

Uptegrove circles the reddish pink bruising on Sarah's body.  Uptegrove says he doesn't believe areas of bruising all from same cause (e.g. needle stick from IV).  Uptegrove points out top of his own sternum, and Rittgers asks if that's where CPR performed. He says those compressions usually performed a few inches to left to better manipulate the heart.

"Would those injuries be consistent with failed attempts at intubations?" Rittgers asks
Uptegrove agrees that Sarah received a lot of efforts to resucitate, and it's difficult to perform in the field.

"I heard you say that you hadn't seen injuries like this as aggressive CPR in your experience,"  Rittgers states.

"You would agree with me that the 45 minutes of chest compressions and the five intubations was a lot?" Rittgers asks.

'Yes,"  Uptegrove says.  He agrees that Sarah received a lot of efforts to resucitate, and it's difficult to perform in the field.

...People with known seizure disorders are advised not to take unsupervised baths? Uptegrove agrees.

...Uptegrove has performed autopsy of a person who drowned in bathtub, and it was the result of a seizure.

...He ruled that as accidental, because that person had prior history of seizure disorder.
That ruling could have been different if that person had no prior history?  Uptegrove agrees.

...Uptegrove describes U-shaped bone at top of larnyx that can often be broken when a person was strangled. He noted no fracture to that bone or nearby cartilage.  If so, that would have been strong indicator of strangulation, Uptegrove says.

Rittgers noted that Uptegrove was not board-certified when going through credentials in court.  American Board of Pathology issues such a certification, Uptegrove says, but agrees statement is correct.

...Uptegrove agrees that Dr. Werner Spitz is a world-renowned pathologist.

...Now showing photo of Sarah's arm. Bruise present on apparent inside, near elbow. Caused by EMS inserting IV fluids.   Uptegrove said no IV present when he did autopsy, but ER records not present then, but injury consistent with IV.

In photo on screen, the bruise is perhaps as big as the area covered by a hand gripping the arm.  Uptegrove says injury larger than what he'd typically observe, but this photo taken during second autopsy, which he doesn't typically perform.   

Uptegrove says bruise is diffused, associated with early stages of decomposition.  Drowning process, decomposition, attempts to restore circulation could influence appearance of bruising.   Incision shown of same arm, showing extensive hemorrhaging under surface of skin, Uptegrove agrees.

...Uptegrove has been trained in CPR, but hasn't maintained his certification.  There are variations in attempts to perform CPR, depending on the person making the attempt, he says.  He's not sure if CPR attempts are intended to move blood column inside chest.

...Shows photo of contusions noted underneath Sarah's scalp.

The contusion shown earlier on outside of scalp was not discernible in this photo, Uptegrove agrees.   Uptegrove can't say if those under-scalp bruises occurred when Sarah was pulled from the tub or when medics attempted to revive her.   He characterizes those as "minor" bruises to scalp because no crush injuries are in surrounding tissue. Crush injuries would create laceration or tearing of skin.

Rittgers asks about brain injury of actress who died last week.   (Natasha Richardson)

He says her injury was fairly unusual, but most common brain injuries happen when people fall and hit their head.  Uptegrove goes through some brain injury explanations but he found no evidence of the type of brain injuries associated with falls or blunt force trauma.

...Rittgers says a Significant number of people who are known to have died from seizures show no signs of brain abnormality during autopsy.  Uptegrove agrees.

...Some people who have died from cardiac arrythmia, similar problems, showed no signs of heart trouble, no warning signs.  Uptegrove agrees.

...Uptegrove says the autopsy report indicates anyone who is particpating in the autopsy procedure, but not everyone that is present. Lt. Jeff Braley and coroner investigator Doyle Burke were present, he says, but not included in his report.

TRIAL REPORTER COMMENT - Jurors look a little bored right now.

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PROSECUTOR REDIRECT:

Asst. Prosecutor Arnold asks about CPR possibly causing broken blood vessels in eyes. Uptegrove says more likely caused by drowning than CPR.

Uptegrove says he did not see the type of bruising normally associated with vigorous CPR. He says injuries from that more typically are broken ribs or sternum fracture, or even lacerated liver.

Bite marks to tongue typical among seizure victims, and loss of control of bladder/bowels. But incontinence common among most people who've died, he says.

Uptegrove is a full-time forensic pathologist in addition to being Warren Co. coroner. He's also essentially the deputy coroner in Butler Co.

Does not have a private practice, which he said was fairly common in his field.

Took board's pathology exam and passed, but has no desire to engage in hospital or private practice of pathology. Board doesn't certify those who practice what he does, so has never sought certification for other practice.

Uptegrove not sure how long Sarah had been without oxygen before attempts to revive her.  Uptegrove would look for bruises, other signs that seizure had occurred.

Nothing from medical history appeared to have contributed to Sarah's death, Uptegrove says.

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DEFENSE RE-CROSS EXAM:


"Are you telling jury that all seizure victims bite tongue, leaving marks, or become incontinent?" Rittgers asks.   Uptegrove says he is not saying that.

Uptegrove says he noted no damage to liver, but he's aware Spitz did during his own autopsy.  Liver of an adult about football size, on right side, below diaphragm and rib cage, Uptegrove says.

Chest plate is cut open to remove organs, examine them.  If liver showed significant injury, a lot of blood would have been present in the abdomen. None was, so he believes injury was not sustained during attempts to revive Sarah. Could have been injured during first autopsy (his), while cutting open chest plate.

Noted in report another injury, which was in area lateral to uterus.  He's talking about syringes used to draw blood, which he did in area near uterus, vagina. Some blood drawn from organs can be forced out, he says.

"You just don't have the desire to be board-certified, is that correct?"  Rittgers asks.
Study for a year to take test on material I don't need for work? uptegrove says No. He would rather spend time with children than do that.

Board certification could lead to better job opportunities, higher pay. You're from South Carolina?  Yes. Would like to move back there one day?  Uptegrove replies Yes.

"Would be nice to be board-certified, wouldn't it?" Rittgers asks. Uptegrove says he probably wouldn't do what he is doing now if he moved back to South Carolina. Doesn't specify anything about possible future plans, defense has no further questions.

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LUNCH BREAK

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PROSECUTION WITNESS:  Dr. William M. Rogers III, attending ER physician at McCullough-Hyde Hospital


Rogers gives background information about himself.

Board certified, he was the medical director for Springdale Fire Department. Currently he's the medical director for Union Fire Department.

He's published books on medical legal action and emergency medicine.

Prosecutor John Arnold begins the questioning. He hands over paperwork to Rogers. Rogers begins to explain what it is.

...State's Exhibit #4, Bethesda Medical Records.
...State's Exhibit #7, Obstetrics and Gynecology Records for Sarah Widmer
...State's Exhibit #8, Optometry records

"I did not find any serious health problem for Sarah Widmer," Rogers says. Her neck examinations were normal, no thyroid disease. There were no indicators for neurological disease."

...Exhibit #385, an autopsy picture of Sarah's body is shown to the courtroom.
...Exhibit #389, an autopsy picture of Sarah's neck is shown to the courtroom.

Dr. Rogers examined photos taken during autopsy, noted bruising on arm and left side of neck from IV punctures.

Dr. Rogers explains the blue, purplish marks on her neck.

"Assuming the paramedics inserted this IV line with one attempt, is this type of bruising normal?" Arnold asks.

"It seems to be more bruising for just one attempt," Rogers says.

...Exhibit #394, an autopsy picture of the inside of Sarah's lips is shown to the courtroom.

Rogers says the lacerations can happen as a result from the CPR process. "These are common in failed intubations and in successful intubations."   Rogers says he's familiar with tracheal tubes, and procedure for inserting them. Says it's easier to intubate at hospital than in field.  "These types of injuries are also common if there was a direct blow to the mouth,"  Rogers says.

...Pink frothy fluid found on Sarah's mouth common among drowning victims, he says.

...Photo of Sarah's mouth, with upper lip pulled up to reveal lacerations on inside of mouth.  Those lacerations common as the result of fights, car accidents, etc.   

...Exhibit #295, picture of Sarah's scalp is shown.

"These are not injuries likely to be produced by CPR,"  Rogers says.

...Exhibit#494, another autopsy picture of Sarah's body is shown.

Rogers points out the bruising on the front side of her neck.  He's explaining trachea tube and strap used to hold it into place. He says it's lightweight, has velcro. Never seen an injury from strap itself, but other parts of device can cause injuries, he says.

...Exhibit #397, a picture of the inside of Sarah's neck.

Dr. Rogers explains the hemorrhaging within the left side of her neck.  Bruising on Sarah's neck could have been caused by multiple attempts to insert IV tube, Rogers says.

...Faint bruise at right hairline and three distinct bruises on inside of scalp on rear right side of scalp, essentially above the ear, he says.

...Photo shown of Sarah's torso and face with deep incision from autopsy across chest.

Bruise noted at lower right side of her neck, Rogers says.  Rogers explains the Sellick maneuver, which is used to align parts of the throat to insert tracheal tube. He says the pressure applied during this maneuver is fairly light, and would not likely have caused the bruise he noted.  

Rogers says bruises likely caused by some sort of pressure, possibly as in strangulation. Does not see marks that would likely have been present if assailant was facing her.

Bruising is mostly to her neck, not her torso. No knee bruises noted by investigators.  Rogers says hemorrhaging in back of neck, which has been dissected in the photo shown on the screen, are not consistent with medical intervention.

Rogers notes hemorrhaging in fatty tissue and muscle on trachea, which has been removed in the photo shown on the projector.

Photo shown of the rear of Sarah's neck, with incision made. Says injuries not consistent with CPR or medical intervention

Says anything that could cause bruising could have caused those injuries, whether by sudden force or slow pressure. Not likely caused by medical intervention.

Photo shown of bruising on left side of the neck and on shouler. Says bruise on front of throat in this photo is likely a separate bruise from discoloration on side and shoulder.

Rogers says cardiovascular is one of the top killers in the country, so he's treated many patients suffering from such a condition. Says no evidence that Sarah suffered from such problems. No family history, either.

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DEFENSE CROSS EXAM:


Rogers talks about study conducted on all known epileptics that he mentioned in prosecution testimony and assessed risk for drowning.   Study looked only at those with history of epilespy, and Rogers agrees that he cannot say for certain whether or not Sarah had epilepsy.

Sometimes this condition can't be detected in autopsies, he agrees.   Can't completely exclude sudden cardiac arrythmia as a contributor, Rogers says. Sometimes this condition can't be detected in autopsy, he says.

...Rittgers shows report from routine March 30 medical exam, when she complained for feeling tired and sleeping often. No follow up, and Rogers agrees this symptom could be from some undiagnosed pathology.

...Rittgers Shows photo of lip lacerations, and Rogers agrees they are consistent with injuries that could have been suffered by efforts to resucitate.  

...Rittgers asks if bruising to trachea consistent with intubation efforts. Rogers thinks soft tissue bruising is consistent with that, but not muscular bruising.

...Rittgers asks if the letter he sent to Rogers before the trial said bruising to muscular tissue could have been caused by intubation, and Rogers answered it had. Rogers testifies that the letter had been misleading/misstated, but Rittgers asks if he hadn't urged Rogers to contact him with questions/concerns. Rogers admits he hadn't done so.

...Rogers admits that a forensic pathologist might be better qualified to testify about hemorrhaging.

...Rogers says abrasion found near left armpit could have been caused during resucitation efforts.

...Bruises on Sarah's neck could have been caused by strangulation, Rogers says, but not likely by overzealous EMS workers checking for pulse. Sense of touch diminished as more pressure applied, he says.   

...He admits that frantic efforts by an unskilled medic might possibly cause such an injury, but he says location would have required that medic to have "manifestly lost their way in looking for that pulse."

...Rittgers asked Rogers via letter about his analysis of autopsy photos.

"You indicated that the bruising on Exhibit #408 is consistent with the intubation efforts?" Ritters asks.

“Not all of it,” Rogers says.

The picture from the back of Sarah’s neck is shown again to the jury. The picture of the bruising on Sarah’s arm is shown.

“Could the bruising be caused be rescue efforts?” Rittgers asks.

“Yes sir, it could be.” Rogers says.

"Would that depend on the scale of the EMS personnel?" Rittgers asks.

Rogers agrees it would.

...Rittgers implied that Rogers had told him something different in that response than what he's said today, but Rogers said the letter contained a misleading question that resulted in an imprecise answer. Rittgers asks him why he didn't contact him to clear up the issue, as he'd urged him to do.
Rogers said that judging a bruise's age is an inexact science.

...Rittgers asks if chest compressions during CPR would move chest blood column 20 to 25 percent. Rogers agrees.

Rittgers asks What is the success rate for intubations in state of Ohio?" Rogers isn't sure, but he says data likely available. He agrees that data is likely to vary from department to department.

Rogers says blood can be diluted by water during drowning, which Rittgers suggests can exacerbate bruising, but admits that he's not qualified to offer an opinion on that.

...Rittgers shows a photo of large bruise to inside of Sarah's elbow. Rogers agrees that it likely was caused by IV.

"Can you tell the ladies and gentlemen of the jury what’s involved when you stick someone?" Rittgers asks.

“You use an IV cap, which is a needle with plastic over the top, and that slides into the vessel. You’re trying to find the external jugular,” he says. “In that area (referring to the bruising on the arm) that can account for the bruising and hemorrhaging to that tissue.”

This photo was taken during second autopsy, and Rittgers asks if it's a rather extensive bruise. Rogers says it's hard to say, but consistent with possibly multiple attempts to insert needle.

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PROSECUTION REDIRECT:


If paramedic who inserted IV line testified that it took him one attempt to do so, would that be consistent with your investigation?  "No, not inconsistent", Rogers says but he's not attempting to cast aspersions on EMT workers.

Prosecutor Arnold asks, "Would young woman working four days, 40 hrs a week with a long commute possibly be tired?"    Yes, Rogers agrees that she might complain of being tired without it being a sign of some other health problem.

"How much force is applied to neck muscles when inserting a needle into the jugular?' asks Arnold.  "Not much", Rogers says.

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DEFENSE RECROSS EXAM:


Rogers says blood did not appear to be diluted to him, but there was coagulated hemorrhage.

Dr. Rogers has been excused.

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COMMENT from Trial Reporter ----

The blood dilution is related to the size of the bruise examined and examined during the second autopsy. If you were to wrap your hand around the inside of your elbow, roughly where you have blood drawn, the surface area of your hand is about the size of that bruise. The defense says it got so large because Sarah's blood was diluted by water absorbed by her lungs.   Essentially, according to defense attorney Robert Dziech, diluted blood would spread more quickly that nondiluted.