FULL TESTIMONY — Medical Examiner Barbara Vidal testifies at Lindsay Clancy's murder trial

[00:00:00] Speaker 1: And speak into that microphone if you would. Okay. All right. Have a break. Thank you, Your Honor. [00:00:05] Speaker 2: Good afternoon. Can you please state and spell your name for the record? My name is Dr. Barbara Olson, B-A-R-B-A-R-A-O-L-S-O-N. I previously practiced under my maiden name, Barbara Vidal, B-I-D-A-L. Can you describe for us your educational background, please? I completed my undergraduate studies at the University of New Mexico. I also completed four years of medical school at the University of New Mexico School of Medicine. Afterwards, I came to Boston to study the field of pathology at Beth Israel Deaconess Medical Center. I completed a four-year residency program there, studying both anatomical pathology and clinical pathology. And after my residency, I did a surgical pathology fellowship studying the gastrointestinal tract, liver, and pancreas. And I ended my training doing a fellowship of forensic pathology at the Boston office of the Office of the Chief Medical Examiner. I am board certified in anatomical pathology, clinical pathology, and forensic pathology. [00:01:03] Speaker 3: And what is forensic pathology? [00:01:05] Speaker 2: It is essentially the study of diseases, disorders, or trauma that results in sudden, unexpected, or non-natural deaths. [00:01:15] Speaker 3: And do you currently work at the Office of the Chief Medical Examiner? [00:01:18] Speaker 2: Yes, I'm a medical examiner at the Cape Cod office of the Office of the Chief Medical Examiner. How long have you worked there? Since 2021. And approximately how many autopsies have you performed? I have examined over 1,900 bodies and performed over 800 autopsies. [00:01:34] Speaker 3: And when performing an autopsy, is there a specific process or procedure that you follow? [00:01:42] Speaker 2: Yes. So an autopsy is composed of many parts. The first part being documentation review. And the second part being the examination of the body, which is broken up into two parts. The first part being the external examination, where I look for identifying characteristics of a decedent, such as eye color or hair color. I also look for any evidence of natural disease or trauma on the outside of the body. And the second part is the internal examination, where I create a Y-like incision on the chest and abdomen, and examine the soft tissues, bones, and organs, looking for any evidence of natural disease and trauma. I also examine the brain. [00:02:22] Speaker 3: And did you perform an autopsy on Cora Clancy on January 25th, 2023? Yes. And did you follow that same process with Cora Clancy? Yes. And so that started with a document review, is that correct? Yes. And what type of documents are you reviewing when you do that? [00:02:38] Speaker 2: Typically, I have a preliminary police report to review, as well as either EMS records or records from the emergency department. [00:02:48] Speaker 3: And did you start with an external examination of Cora? Yes. And what did you observe during that external examination? [00:02:55] Speaker 2: The external examination of Cora, I saw evidence of medical intervention. She was intubated, had various EKG pads and defibrillator pads on her body. She also had a catheter on her right hand and puncture sites on her left hand and her left groin. She had her neck stabilized with a cervical collar, and she had an intraosseous catheter, which is a type of IV that they put directly into the bone on her right lower leg. Her hands, at the time of my external examination, were covered by police evidence bags, and they were secured at the wrist with tape. When I removed those, the fingers showed no evidence of injury, and the fingernails were all of equal length and intact. And then I noted evidence of trauma of the neck with associated injuries of her head and minor injuries of her right arm and of her legs as well. [00:03:46] Speaker 3: And in terms of the injuries that you observed, evidence of trauma to her neck, were there also injuries to her face and neck area that seemed to go along with the trauma to her neck? [00:04:10] Speaker 2: Yes, there were findings of the head that were associated with the trauma of the neck. And what were those? So on her neck, she had a ligature furrow. A ligature is an object used to apply external force to the neck or compress the neck, and a furrow is simply the pattern of injury that develops underneath the side of compression. So for Cora, her ligature furrow consisted of a linear, horizontally-oriented area of pallor or paleness around her neck with distinct superior and inferior edges. On the front part of her neck, the lower half of the ligature furrow was associated with additional red abrasions, ranging from one to two millimeters in size. And on the back of her neck, the superior and inferior edges of the ligature furrow had developed some linear bruising as well. [00:05:00] Speaker 3: And what do you mean by a furrow? [00:05:03] Speaker 2: So, again, the furrow is, a ligature is when you have external compression by an object on the neck, and a furrow is simply a pattern of injury that occurs beneath it. It can be an imprint, it could be a pattern, or it could be more developed types of injuries, such as bruising or abrasions. [00:05:20] Speaker 3: You had described previously the injuries to Cora's neck, were there also injuries on her face that correlated to those marks? [00:05:46] Speaker 2: Yes, on examination of her face, she showed diffuse particular hemorrhages of the skin of the face, most prominently around the skin of the eyes. She showed particular hemorrhages on the inside of her eyelids, as well as the inside of her lips. And if I could have a photo, 2246, please. [00:06:09] Speaker 3: Dr., there's a remote here, if you press and hold the top button, you can highlight what you're talking about in the photo when it comes up. What are we seeing here? Is that the area of the petechial hemorrhage? [00:06:26] Speaker 2: Yes, in this photo, I have the lower lip pulled down, and on the inside of the lower lip, we can see punctate hemorrhages, which are the petechial hemorrhages. [00:06:34] Speaker 3: Okay. And if you could, is that working for you? No. I can just, let me just see that. This area here? Yes. Okay. You just hold that top button and then hold it down. And so we can remove that photo. When you talked about petechial hemorrhage in the eyes and eyelids, did it look similar to that? Yes. And basically, it's those red marks all around the mouth, and then those same red marks were on the eyes, the eyelids. [00:07:08] Speaker 2: You tell me where they were. So they are pinpoint hemorrhages that occur, and again, they were located on the inside of the eyelids. So I inverted the eyelids, and I looked open the inside of the lips, and they were also in those locations. [00:07:22] Speaker 3: And if we could have a photo of 7, 7, 8, 4, please. If you could tell us what injuries we're seeing here in this photo. [00:07:32] Speaker 2: In this photo, we are looking at the body from the left, and you can see the ligature furrow in this photo. Here is the linear area of pallor with the distinct superior and inferior edge. You can also appreciate in this photo some small punctate hemorrhages or the petechial hemorrhages of the face. [00:07:52] Speaker 3: And if you could show a photo, 7, 7, 8, 2, please. What are we seeing here in terms of injuries? [00:08:01] Speaker 2: In this photo, we are looking at the front of the neck, again, focused on the ligature furrow, which is this distinct area, linear area of pallor. And on the front of her neck, the lower half of this ligature furrow had scattered red abrasions associated with it. [00:08:17] Speaker 3: You can take down the photo. What are abrasions in terms of what you do? [00:08:22] Speaker 2: So abrasion occurs when there is sufficient friction against the skin to cause a removal of the superficial layer of the skin. [00:08:30] Speaker 3: Is it basically a scrape? [00:08:31] Speaker 2: Yes. [00:08:34] Speaker 3: And can we have photo 2256, please? You can tell us what we're looking at here, please. [00:08:42] Speaker 2: This is a close-up photo of the back of the neck. Here is the linear area of pallor with the distinct superior and inferior linear edges. You can appreciate that the linear edges in this photo started to develop linear bruising. [00:08:57] Speaker 3: And were there other injuries on the body other than those on the neck and the face? [00:09:02] Speaker 2: Yes. She had injuries to her right arm and on her legs. [00:09:06] Speaker 3: And if I could show you photograph 7789. Are you able to tell us what we're looking at here? [00:09:16] Speaker 2: This is an up-close photo where we can see a very small, faint bruise. All of the bruises on her legs as well as her right arm consisted of small, scattered bruises. [00:09:27] Speaker 3: And if we could have photo 7770, what are we seeing here? [00:09:35] Speaker 2: This is an image focused on her right leg. Here we see three bruises on her knee and two bruises on her left lower leg. This is a site of medical intervention, the intraosseous catheter site where the needle enters the bone. [00:09:49] Speaker 3: And if we could see 7790, please. What are we seeing here? [00:09:58] Speaker 2: This is a photo, a close-up photo of her left leg. Again, we can see a bruise here as well as a bruise here on her left lower leg. [00:10:07] Speaker 3: And then the last photo, 2233. Oh, I'm sorry, one more after that. What are we seeing here in this photograph? [00:10:15] Speaker 2: In this photo, we can see the bruises I described earlier as well as the inside of her left ankle. We're seeing two additional bruises. [00:10:24] Speaker 3: And if we could see photograph 7794. What is shown in this photo? [00:10:32] Speaker 2: This is an image of her left leg. Again, showing the two bruises close to her left ankle and then additional bruises on her left lower leg. [00:10:40] Speaker 3: And then 7775, please. What are we seeing in this photo? [00:10:48] Speaker 2: This is an image of her right arm extended. And I have the image focused on her right bicep where there was three small bruises. [00:10:56] Speaker 3: And in terms of bruising, are you able to tell the age of a bruise by looking at it? No. Can you tell whether it's a fresh or an old bruise? [00:11:11] Speaker 2: So generally speaking, we can appreciate the color of bruises. So red, blue, purple bruises tend to be bruises that occur more recently. And as they heal over time, they start to take on a yellow or green appearance. [00:11:24] Speaker 3: And the bruises that you observed on Cora's body, how did they appear? They all had versions of red appearance to their shapes. So because they had red appearance, does that mean that they are fresh wounds? They occurred recently. And again, you can't tell how they occurred or the exact time and date they occurred? Correct. Is there any information you can glean from the location of the wounds where some of the bruises were close together, like the three on the knee or the two on the lower right leg? [00:12:00] Speaker 2: No, I can only document where they are and their measurements. Now, if I may have a moment. [00:12:14] Speaker 3: Sure. Going back to the injuries on her neck, what do those tell you based on your training experience? When you're trying to determine the cause of death, what do those wounds tell you? [00:12:32] Speaker 2: When I see a ligature furrow that is horizontally oriented in association with significant particular hemorrhages, those findings are consistent with a ligature strangulation. [00:12:43] Speaker 3: And what is ligature strangulation? [00:12:45] Speaker 2: Again, a ligature is an object used to apply external force to the neck and a strangulation is when it is done by someone else. [00:12:53] Speaker 3: And when that happens, what effect does it have on the body? How does it, what is the mechanism of death? [00:13:01] Speaker 2: So ligature strangulation results in a category of asphyxial type of deaths. Asphyxia means that the body is deprived of oxygen and in this case, specifically the brain. So when you have compression on the outside of the neck, well, blood is how oxygen is delivered throughout our body. So the right side of the heart delivers blood to our lungs, where during breathing and respiration, we then put oxygen into our blood. It then moves to the right side of our heart and gets pushed out to our body through blood vessels we call arteries. Once the oxygen is released at its targeted site, it then recirculates to the right side of the heart through blood vessels called veins. And the process starts all over again. It's a continuous circulation. But when you have compression of the neck, first and foremost, your airways reduce, it's compressed. So you can have a reduction in your ability to breathe or complete inhibition in your ability to breathe. When you have compressions of the veins of the neck, there's no, the blood cannot drain from the head. And so then the blood actually has a backwards flow of pressure that meets the arterial blood. And that results in an increase of blood pressure within the blood vessels, as well as an overall increase in intracranial pressure. And with the compression of the artery, there's no oxygenated blood being delivered to the brain. [00:14:18] Speaker 3: And as this blood is gathering in the face and head area, is that kind of causing the same type of pressure as a balloon filling up? Yes, or like a water pipe as well. And what happens as that blood pools and causes that pressure in the face and the head? [00:14:39] Speaker 2: What normally happens is, first and foremost, the brain just has a reduced ability to take in oxygen. And in the smallest vessels in the face and brain, such as capillaries or venules, they are subject to rupture. [00:14:53] Speaker 3: And as that pressure is building in those veins and are rupturing, is that painful? [00:15:00] Speaker 2: So just like our blood vessels run throughout all of our body, there are nerves throughout all of our body as well. And so there is a component of pain present until loss of consciousness occurs. [00:15:11] Speaker 3: And how long can it take, or does it take, for loss of consciousness to happen? [00:15:18] Speaker 2: I cannot put a specific time on it for the interval. There is multiple variables to consider in a case-by-case basis. The type of ligature used, the force of the ligature used against the neck, as well as the intensity and duration of the altercation. However, in situations where there is complete oxygen deprivation, loss of consciousness can occur as early as 10 to 30 seconds, with brain damage beginning at the one-minute mark and irreversible brain damage and subsequent death occurring around as early as five minutes. Again, with the caveat that there are variables that might accelerate or decelerate that time frame. [00:15:57] Speaker 3: Is there a type of constant pressure that's required to cause that loss of consciousness? [00:16:04] Speaker 2: Ultimately, once the brain has a critically low level of oxygen, a loss of consciousness will occur. It takes an average of four pounds to compress the veins of the neck and an average of around 10 pounds to compress the arteries of the neck. [00:16:20] Speaker 3: And so if someone's squeezing something or pulling something around the neck at that four pounds or 10 pounds of pressure in a consistent basis without any resistance, does unconsciousness happen faster? It could occur faster, yes. What if someone's resisting or struggling or pulling away? Could that take longer? [00:16:40] Speaker 2: When the body is in a state of stress, you have a stress response that demands an actual increase in oxygen utilization by our body. So in the presence of an increased demand with a decreased amount being delivered to the brain, it can accelerate the timeline to loss of consciousness. [00:16:56] Speaker 3: What do you mean by accelerate the time to loss of consciousness? It's obvious what you mean. [00:17:01] Speaker 2: Overall, you can ask. It would just make it occur faster. [00:17:05] Speaker 3: And so if that pressure isn't constant, say someone struggles and is able to get free a little bit, and then you have to tighten it again, does that make it take longer? [00:17:15] Speaker 1: Sustain. Sustain. [00:17:18] Speaker 3: You said anywhere from five to 30 seconds. What are the factors? I'm sorry, you said 10 to 30 seconds. Is that correct? Yes, for loss of consciousness. What are the factors that are at play for whether it's 10 seconds or 30 seconds? [00:17:30] Speaker 2: Again, there's multiple variables. So the force of the ligature against the neck, the actual ligature itself, and the intensity and duration of the altercation. And once someone loses consciousness, do they immediately die? No. So if there's no intervention, the brain continues to have a lack of oxygen. And so until the brain cells start to die, it's irreversible injury to the brain. The person is alive until the body can no longer sustain the lack of oxygen. [00:18:00] Speaker 3: If someone is strangled to the point of unconsciousness and the strangulation stops, can they wake up? Without intervention is very unlikely. So do you recall testifying previously that when asked if a person were to use a ligature around someone's neck to the point where they pass out? But, counsel, we've had that answer, right? It's an inconsistent statement. [00:18:26] Speaker 1: This is your witness. [00:18:27] Speaker 3: I know, and I can impeach with an inconsistent statement. [00:18:30] Speaker 1: I see it's sidebar. [00:18:31] Speaker ?: Thank you. [00:19:01] Speaker 3: Doctor, do you have to continue to strangle someone past the 30 seconds to cause death? [00:19:21] Speaker 2: No. Once the brain is subject to oxygen deprivation and brain cells start to die, it's irreversible. And so it will continue to progress towards death if there's no intervention. [00:19:34] Speaker 3: What do you mean by intervention? [00:19:36] Speaker 2: Resuscitative efforts. [00:19:37] Speaker 3: If somebody tried to give CP off, then after losing consciousness to cause death? [00:19:42] Speaker 1: Sustained. [00:19:43] Speaker 3: Hold on. [00:19:44] Speaker 1: Sustained. Next question. [00:19:49] Speaker 3: So your testimony is that you can strangle someone for 30 seconds, let go, and then they die? [00:19:55] Speaker 2: I said that in this presence of complete oxygen deprivation, there is a general time frame. And so 30 seconds, I cannot give a specific number to that. Once strangulation occurs, again, the brain starts to be subjected to a lack of oxygen. So whether the ligature is present or whether the ligature is not present, the oxygen deprivation and irreversible brain damage is already occurring. And there's no coming back from that? Not without intervention. It's very unlikely. Again, the brain cannot heal those cells. [00:20:33] Speaker 3: Did you form an opinion to a reasonable degree of professional certainty, to medical certainty as the cause of death of Cora? Yes. And what was that? Asphyxia. And was that by manual strangulation? By strangulation. Mechanical strangulation, I mean. Yes. Did you also examine or do an autopsy on Dawson Clancy? Yes. And when was that? January 25th. And did you observe injuries on Dawson Clancy when you did the external examination? [00:21:10] Speaker 2: I did observe injuries to Dawson. He had trauma to his neck with associated injuries of the head, as well as minor injuries to his left arm and his legs. [00:21:20] Speaker 3: And if we could pull up photo 2166. What are we seeing in this photo? [00:21:42] Speaker 2: This photo is a picture of the lower lip of Dawson being pulled down. And we can see, again, similar to Cora, these petechial hemorrhages on the inside of the mouth. [00:21:53] Speaker 3: And can you also see them on the eyes in this photo? [00:21:55] Speaker 2: You can see periorbital petechial hemorrhages, so the skin around the eye. [00:22:00] Speaker 3: And were there also those same type of hemorrhages when you lifted the eyelid? [00:22:04] Speaker 2: Yes. [00:22:05] Speaker 3: And if we could have photo 2149. What are we seeing here? [00:22:14] Speaker 2: Dawson on his neck, similar to Cora, had a linear horizontally oriented ligature furrow consisting of an area of pallor around the neck. He had distinct superior and inferior edges to his furrow as well. This is on the backside of the neck where we can also appreciate abrasions that are in line or parallel with the inferior and superior edges of the furrow. [00:22:37] Speaker 3: And if we could have photo 2147, please. What are we seeing in this photograph? [00:22:45] Speaker 2: In this photograph, we can appreciate the distinct area of pallor here on the neck, again, representing the ligature furrow with diffused petechial hemorrhages of the skin of the face. [00:22:56] Speaker 3: And what are we seeing there on his shoulder? [00:22:58] Speaker 2: This is just some dried body fluid. [00:23:01] Speaker 3: And if we could see photo 2151, please. What is depicted in this photograph? [00:23:14] Speaker 2: This is a similar photograph to the one just shown here where you can see the distinct area of pallor representing the ligature furrow with superior and inferior edges. And again, the diffused petechial hemorrhages of the face. [00:23:27] Speaker 3: And these photos of Dawson's face, the petechial hemorrhaging on the face, appear to be darker than those and more expansive than those on Cora's face, correct? [00:23:36] Speaker 2: They appear more prominent in Dawson than in Cora, yes. [00:23:39] Speaker 3: And what can cause the damage being more prominent and more dispersed over the face? [00:23:47] Speaker 2: Again, petechial hemorrhages occur as a result of rupturing of small vessels in the skin. And so the fact that there are more present in Dawson is indicative that there were moments where some blood did reach or push through the furrow or the ligature in little spikes or peaks, which would just result in momentary increases in blood pressure that would result in more petechial hemorrhages. [00:24:11] Speaker 3: And what would cause that blood being able to flow? [00:24:15] Speaker 2: Any movement against the carotid arteries. The carotid arteries are thicker and more muscular than the veins, so they're more likely to push through with the blood. So that could be movement of the ligature or movement of the person handling the ligature or movement of Dawson himself. [00:24:31] Speaker 3: So it could be from Dawson struggling, or it could be from more pressure or force of the ligature? [00:24:37] Speaker 2: Yes, changes in the pressure of the ligature. [00:24:40] Speaker 3: And if I could see a photo 2143, please. What are we seeing in this photo? [00:24:48] Speaker 2: This is the back of his left forearm. It is a little pale with the light, but there were three small bruises on the back of his left forearm. [00:25:01] Speaker 3: And going to photo 2155, what are we seeing in this photo? [00:25:11] Speaker 2: This is a picture of us. So at this position, Dawson is face down, so we're looking at the side of his right leg, and we can see a small faint bruise here. [00:25:24] Speaker 3: And then going to photo 2144. What are we seeing in this photograph? [00:25:31] Speaker 2: This is an up-close photograph, but I can appreciate that there are small bruises in the center of the image. [00:25:39] Speaker 3: And photograph 2156. What are we seeing in this photograph? [00:25:45] Speaker 2: In this photograph, we're looking at the back of the legs. The one closest to us is the left leg. The one farthest from us is the right. You can see bruises here, here, and here, as well as the inside of the right knee. [00:25:57] Speaker 3: And so when you said here, here, and here, that was the outer portion of the... [00:26:01] Speaker 2: Of the left upper leg. [00:26:02] Speaker 3: Thank you. We could have photo 2119, please. What is depicted in this photograph? [00:26:10] Speaker 2: This is an up-close photo of his hand. [00:26:13] Speaker 3: And is there any significance to the blueness of the fingernails? [00:26:19] Speaker 2: I would not have called these necessarily blue or cyanotic. That would be more of the discoloration of his face. There is some subtle blueness to the nail beds, which is, again, a sign of cyanosis, which is just reflective of a decrease in oxygen in the body. [00:26:34] Speaker 3: And the last photo is the PDF, please. What are we seeing here? [00:26:41] Speaker 2: This image, Dawson, is face up. And we can see his right and left legs. Here on his right lower leg, we see small bruises. On his left knee, we are seeing a bruise. And here is a site of medical intervention, the intraosseous catheter site. [00:26:58] Speaker 3: And what are you able to tell us about the bruises on Dawson in terms of whether they're fresh or old? [00:27:05] Speaker 2: They were all red and purple in appearance, so they were more recent. [00:27:27] Speaker 3: And based on your examination of Dawson, were you able to determine a cause of death? Yes. And did you determine that to a reasonable degree of medical certainty? Yes. And what was that? Asphyxia. Your Honor, I'd move to submit the original photos of Cora and Dawson as for identification and the other, [00:27:55] Speaker ?: the ones that were just shown to the jury as exhibits. [00:27:59] Speaker 1: So mark the first set for identification. [00:28:04] Speaker ?: And it's M and O for identification. Aye. [00:28:10] Speaker 1: And then over the defendant's objection, using the same analysis as stated in the sidebar, those other photographs may be admitted. [00:28:22] Speaker 3: The photos of Cora and then Dawson as the next exhibits, please. [00:28:29] Speaker 2: This is 228 and 229. [00:28:41] Speaker 3: And then the certificate of Cora and Marie Clancy as the next exhibit. [00:28:52] Speaker 1: I have no objection to that. All right. That may be admitted. [00:28:56] Speaker 3: It's your journey. And the death certificate of Dawson William Clancy as the next exhibit. I have nothing further. Thank you. [00:29:09] Speaker 1: It's great. Thank you, Dr. May. Step down. [00:29:13] Speaker 3: Thank you, Your Honor.