Lindsay Clancy Trial: The ER Doctor Who Treated Lindsay Clancy After Her Fall Recounts Her Injuries

[00:00:00] Kelly McDonough: Hey, good morning. Good morning. May I inquire? Thank you. Yes, please. Good morning. Could you please tell the jurors your first and last name? Kelly McDonough. Can you spell your last name for the record? M-C-D-O-N-O-U-G-H. And what do you do for a living? I'm an emergency medicine physician. And how long have you been a physician? 11 years. Can you tell us a little bit about your educational background? I went to medical school at the University of New England in Maine. I did my residency at Kent Hospital in Rhode Island. I subsequently worked at Kearney Hospital in Dorchester. And I've been at South Shore Hospital since 2021. [00:00:44] Speaker 2: And are you primarily in the emergency department at South Shore Hospital? Correct. Have you been in any other department at South Shore Hospital? No. Are you licensed to practice in Massachusetts? Yes. I'm going to draw your attention to January 24th of 2023. Were you working in the emergency department that evening? I was. At some point, were you advised that a patient was being brought into your emergency department? I was. And were you aware of that patient being Lindsay Clancy with a date of birth of 8-11-90? Yes. And what kind of information were you given upon learning that the patient was coming here? What were you expecting to receive? [00:01:31] Kelly McDonough: I was expecting a trauma 1 response. A patient who had fallen out of a window from a height and didn't know much more than that. [00:01:41] Speaker 2: Okay. And so when you say trauma 1, what does that mean for you? [00:01:45] Kelly McDonough: So we had two designations for trauma responses. A trauma 1 and a trauma 2. And there's certain criteria for each. And there's a long list of criteria that are determined by the resource nurse who receives the EMS call. [00:01:57] Speaker 2: Okay. And so when we say 1 and 2, which is more serious than the other? [00:02:01] Kelly McDonough: Trauma 1. [00:02:02] Speaker 2: And so what do you do to prepare when a patient is coming in and you know coming in that it's likely a trauma 1 situation? [00:02:12] Kelly McDonough: So we gather in the trauma room and make sure that we have all available staff needed to take care of the patient. [00:02:17] Speaker 2: And what kind of staff are with you in the room, in the trauma room? [00:02:21] Kelly McDonough: So for a trauma 1 response, it would be the emergency medicine physician. It would be anesthesia, the trauma surgeons. Sometimes neurosurgery will be there. [00:02:31] Speaker 2: And fair to say you also have a whole host of other staff, including nurses, emergency room techs. All of those people are also available to assist if you need it. Correct. So when this individual came in, when Lindsay Clancy came into the emergency department, were you aware from EMS that she had already come in with some sort of neurological deficits? [00:02:55] Kelly McDonough: I think that from my best recollection, we knew that she was unresponsive, found down outside of her home. [00:03:02] Speaker 2: Were you advised that it appeared she might have a spinal injury? Yes. And that she may have been moving her arms and her head, but not her legs? Correct. Now, when the team was assessing her in the emergency department, what types of steps do you take to perform that assessment of the patient? [00:03:22] Kelly McDonough: So there's a series of steps that we go through to assess a trauma patient that are followed every single time. ABCs, are we breathing circulation? And then we do a secondary survey. [00:03:31] Speaker 2: Okay. And in this circumstance, was the patient breathing? Yes. And when she came into the emergency department, was she breathing on her own or intubated? She was breathing on her own. At some point, did the ER staff have to intubate her? Yes. And why was that? [00:03:49] Kelly McDonough: For airway protection. There was a concern that maybe she would have a head injury and she would decompensate later. And so to protect her airway, she was intubated. [00:03:57] Speaker 2: Now, is that a standard protocol when there's concern for head injury? Yes. Did you see any obvious signs of a head injury when she arrived into the emergency department? [00:04:07] Speaker ?: No. [00:04:08] Speaker 2: What kinds of things would you see if somebody had an obvious head injury? [00:04:12] Kelly McDonough: You might see bleeding or lacerations or abrasions. [00:04:16] Speaker 2: Now, did you observe any other obvious injuries to this patient? [00:04:22] Kelly McDonough: I did. She had some superficial lacerations of her neck and wrists bilaterally. [00:04:26] Speaker 2: Do you recall if she came in on a backboard with a C-collar? She did. And do you remove the C-collar at some point to assess the patient for injuries? [00:04:36] Kelly McDonough: We didn't completely remove it. We remove it temporarily to visualize and feel her neck and then put it right back on. [00:04:42] Speaker 2: Okay, and you said you did observe some injuries to her neck, correct? Yes. I'm just going to show you some photos that have been already marked, if that's okay, on the screen next to you. This has been marked as exhibit number 111. Is that an accurate representation of the neck injuries you observed? [00:05:04] Kelly McDonough: Yes. [00:05:04] Speaker 2: You also indicated that she had some other injuries to her wrists? [00:05:09] Kelly McDonough: Yes. [00:05:10] Speaker 2: And I'm just going to show you 112. Is that accurate as to the injuries to the wrist you observed? Yes. Now, you described the injuries to a superficial. The injury that's kind of in the middle of the photograph there, can you describe what part of the body that injury is? [00:05:31] Kelly McDonough: You're describing the one that's sort of open? Yes. Yeah, so that's the anterior aspect of her wrist. [00:05:36] Speaker 2: And were you able to examine that injury? [00:05:39] Kelly McDonough: Not in detail. [00:05:41] Speaker 2: Okay. Was it something in your emergency, your assessment of the trauma one situation, was that something acute that you had to address? [00:05:48] Kelly McDonough: No. [00:05:49] Speaker 2: And is it fair to say that that injury goes through kind of the subcutaneous tissue of the skin? [00:05:55] Kelly McDonough: Yes. [00:05:56] Speaker 2: Did you observe any injuries to an artery or a vein or anything in that area? [00:06:01] Kelly McDonough: I did not. [00:06:02] Speaker 2: And then just showing you exhibit 113, which is the other wrist, same thing. Did you observe anything in your assessment, your trauma one assessment, to say whether these were acute at the time? [00:06:14] Kelly McDonough: I assume that they're acute. [00:06:16] Speaker 2: Okay. But as far as treatment of them, did they require you to immediately address it? No. To manage blood flow? [00:06:21] Kelly McDonough: No. No. [00:06:24] Speaker 2: What was the more serious, or what was the focus of your assessment of her in the emergency department? [00:06:34] Kelly McDonough: I think the main concern was for a head injury and/or a spinal cord injury. [00:06:39] Speaker ?: Okay. [00:06:40] Speaker 2: And you said that as part of the assessment team, you had a neurosurgeon available as well as a trauma surgeon, correct? There was no neurosurgeon there that day. Okay. Was there a trauma surgeon? [00:06:50] Kelly McDonough: There was. Who was that? Dr. Christina Carpio. [00:06:53] Speaker 2: Did you order any series of tests in order to help you assess the nature of whether there was any head injury or what the extent of the spinal injury could have been? Yes. What kinds of tests did you order? Dr. Christina Carpio. Cat scans. As part of the emergency room protocol, do you also draw blood for patients that come in? Yes. Dr. Christina Carpio: And how is that usually done? [00:07:17] Kelly McDonough: It's usually done on arrival by the nursing staff. [00:07:20] Speaker 2: Dr. Christina Carpio: And do they draw blood according to a physician's orders, or do they draw blood for various purposes? Explain to us how that works. [00:07:32] Kelly McDonough: Mm-hmm. So it's usually like what we call a rainbow. So they just draw all the tubes of blood as soon as the patient arrives in anticipation for orders. [00:07:39] Speaker 2: Okay. And so what happens to the blood after somebody in the emergency department takes it from the patient? [00:07:44] Kelly McDonough: Where does it go? Dr. Christina Carpio: It gets tube to the lab. [00:07:46] Speaker 2: And fair to say that at South Shore Hospital, they have a pneumatic tube system, correct? Correct. And that it goes to a separate laboratory? Correct. And once a physician then assesses the patient and determines what kinds of testing needs to be done on those samples, how do you communicate that to the laboratory? [00:08:08] Kelly McDonough: So orders are put into a computer and they go through the computer to the lab. [00:08:12] Speaker 2: And as you're treating a patient, is it oftentimes necessary to change the orders or order additional tests? [00:08:20] Speaker ?: Yes. [00:08:21] Speaker 2: And so in this particular case, blood and urine was collected from Lindsay Clancy upon her arrival, correct? Correct. Dr. Christina Carpio: Yes. [00:08:30] Speaker ?: Okay. [00:08:31] Speaker 2: Dr. Christina Carpio: Now going back to the imaging tests, you said that there were some CT scans that were ordered? Correct. Dr. Christina Carpio: Correct. Dr. Christina Carpio: What areas of the body were the CT scans for? [00:08:43] Kelly McDonough: It was her entire body, her head, her neck, her chest, her abdomen, and her pelvis. [00:08:48] Speaker 2: Dr. Christina Carpio: Now as far as the CTs for her head, were there more than one CT test for the head? I don't remember. I'd have to look at my record. Dr. Christina Carpio: Well, what are the normal or what are the options for CT head scans? [00:09:15] Kelly McDonough: Dr. Christina Carpio: Usually just a CT head plane, but you could also do a CT angiogram, depending on your concern for injury. Dr. Christina Carpio: And do you recall which one you ordered here? Dr. Christina Carpio: For a trauma one, it would be a plane CT head. Dr. Christina Carpio: Okay. Dr. Christina Carpio: And why do you order that particular test? Dr. Christina Carpio: Well, we're trying to assess for skull fractures, intracranial bleeding, things like that. [00:09:43] Speaker 2: Dr. Christina Carpio: And when you say a plane CT, what's the exact order that's put in for that type of a CT? Dr. Christina Carpio: CT head. Dr. Christina Carpio: Okay. And are there CT heads with contrast? Dr. Christina Carpio: There are. Dr. Christina Carpio: And are there CT head scans without contrast? Dr. Christina Carpio: Yes. Dr. Christina Carpio: Okay. [00:10:06] Speaker ?: Dr. Christina Carpio: May I approach the witness? [00:10:07] Speaker 2: Dr. Christina Carpio: I'm just going to show you some documents if that's okay. Dr. Christina Carpio: Sure. Dr. Christina Carpio: I apologize, there's a little series of pagination, so I'm just going to draw your attention to this page that's black, if you could just take a look at it. Dr. Christina Carpio: Sure. Dr. Christina Carpio: Mm-hmm. Dr. Christina Carpio: Okay, and I'm just going to flip to the next page is blank, but is this the extent of what you would have received as far as information regarding a head CT that was done without contrast? [00:10:52] Kelly McDonough: Dr. Christina Carpio: Yes. [00:10:53] Speaker 2: Dr. Christina Carpio: And I'm going to just draw your attention again to another flag page here towards the end. It's actually two pages from the end of the document, if you could take a look at that. Dr. Christina Carpio: Mm-hmm. Dr. Christina Carpio: And does that reflect the report you would have received for the head CT ordered with contrast? Dr. Christina Carpio: Yes. Dr. Christina Carpio: And in addition to getting a report from imaging, you also receive some actual images, correct? Dr. Christina Carpio: Yes. Dr. Christina Carpio: And do you review those? Dr. Christina Carpio: Yes. Dr. Christina Carpio: In this particular circumstance, when it came to the patient of Lindsay Clancy, was there anything remarkable in either of those head CTs? [00:11:38] Kelly McDonough: Dr. Christina Carpio: Not that I recall. [00:11:40] Speaker 2: Dr. Christina Carpio: And in fact, the head CT with contrast indicated the impression was unremarkable, CAAF had no evidence, intracranial aneurysm, artevenous malformation, or abrupt occlusion, correct? Dr. Christina Carpio: Correct. Dr. Christina Carpio: What does that mean? [00:11:59] Kelly McDonough: Dr. Christina Carpio: It essentially means it's a normal study. Dr. Christina Carpio: Okay. [00:12:03] Speaker 2: Dr. Christina Carpio: Now, as far as the other CT scans that were conducted, there were findings, remarkable findings, on some of the others, correct? Dr. Christina Carpio: Correct. Dr. Christina Carpio: And what did they reflect in your experience as far as her injury goes? [00:12:16] Kelly McDonough: Dr. Christina Carpio: From what I can recall, I know she had a thoracic spine injury. [00:12:24] Speaker 2: Dr. Christina Carpio: And how about the CT that was done of the chest area? Dr. Christina Carpio: I don't recall. [00:12:30] Speaker ?: Dr. Christina Carpio: Okay. [00:12:31] Speaker 2: Dr. Christina Carpio: If I may approach. [00:12:36] Speaker ?: Dr. Christina Carpio: Thank you. Dr. Christina Carpio: Does that refresh your memory? Dr. Christina Carpio: Yes. [00:12:41] Speaker 2: Dr. Christina Carpio: And what was the extent of the result from the chest CT? [00:12:54] Kelly McDonough: Dr. Christina Carpio: So it talks about her thoracic spine injuries. [00:12:56] Speaker ?: Dr. Christina Carpio: Okay. [00:12:58] Speaker 2: Dr. Christina Carpio: Now, after reviewing all of the images, all of the CT scans that were done here, the cervical spine, the head CTs, the thoracic spine, what was the plan for this particular patient? Dr. Christina Carpio: Was she able to be treated further at South Shore Hospital? [00:13:26] Kelly McDonough: Dr. Christina Carpio: The decision was made by the team that her injuries were too severe to stay at South Shore Hospital, and the decision was made to transfer her to a tertiary care center. [00:13:36] Speaker 2: Dr. Christina Carpio: Were you able to stabilize her before transporting? Dr. Christina Carpio: Yes. Dr. Christina Carpio: Is that something that's important to make sure our patient is stable before sending them off in the ambulance or helicopter? Dr. Christina Carpio: Yes. Dr. Christina Carpio: So as far as this particular patient goes, are you aware of whether any surgical intervention had to be done before she was stabilized and transported? [00:13:57] Kelly McDonough: Dr. Christina Carpio: I was not aware of any intervention being done. [00:14:00] Speaker 2: Dr. Christina Carpio: And again, you had Dr. Carpio, who was also there to assess that? Dr. Christina Carpio: Correct. [00:14:06] Kelly McDonough: We work as a team. Dr. Christina Carpio: Okay. [00:14:08] Speaker 2: Dr. Christina Carpio: Kind of going back to those injuries on her neck and her wrist, very briefly. Dr. Christina Carpio: Can you explain to us the difference between bleeding and maybe an artery or a vein and how that might present itself in an emergency situation? [00:14:28] Kelly McDonough: Dr. Christina Carpio: Venous bleed would be a little bit slower, darker blood, and arterial bleed would be pulsatile and bright red. [00:14:36] Speaker 2: Dr. Christina Carpio: And is it fair to say that when you strike either an artery or a vein, they're of different pressure systems, and so the manner in which the blood comes out is different? [00:14:48] Kelly McDonough: Dr. Christina Carpio: Yes. [00:14:49] Speaker 2: Dr. Christina Carpio: In either a circumstance where an artery or a vein is struck or nicked or cut, would that be something that you'd have to stabilize for a patient in order to make sure that they don't bleed out? Dr. Christina Carpio: Yes. Dr. Christina Carpio: Was that done here? Dr. Christina Carpio: It wasn't necessary. Dr. Christina Carpio: Now, this particular patient at some point was noted to be, I think, it was referred to as hypothermic. Dr. Christina Carpio: Mm-hmm. Dr. Christina Carpio: Do you recall that? Dr. Christina Carpio: Yes. Dr. Christina Carpio: Do you recall at what point in your treatment of her was that noted? Was it as she was coming into the emergency department or did that develop while she was in the emergency department? [00:15:33] Kelly McDonough: Dr. Christina Carpio: I don't recall. [00:15:35] Speaker 2: Dr. Christina Carpio: What was the course of treatment for a low body temperature? [00:15:40] Kelly McDonough: Dr. Christina Carpio: We placed something called a bear hugger on them, which is a warming blanket. [00:15:44] Speaker 2: Dr. Christina Carpio: And can you explain to us what could cause a person's body temperature to drop to, I think it was 82.1? [00:15:54] Kelly McDonough: Dr. Christina Carpio: There are many reasons, but it could be a metabolic disarray or exposure. [00:15:58] Speaker 2: Dr. Christina Carpio: In this circumstance, did you know what the source of the drop in the body temperature was for Ms. Clancy? [00:16:07] Kelly McDonough: Dr. Christina Carpio: No. [00:16:09] Speaker 2: Dr. Christina Carpio: And do you recall how long she was in the emergency department before she was transported approximately to the Brigham? Dr. Christina Carpio: I think it was about four hours. Dr. Christina Carpio: At this time, Your Honor, I would move to enter. Dr. Christina Carpio: I would move to enter into evidence a copy of the South Shore Hospital medical records for Lindsay Clancy from January 24, 23 as the next exhibit. [00:16:35] Speaker 3: Dr. Christina Carpio: Is that by agreement? Dr. Christina Carpio: That may be admitted. Dr. Christina Carpio: Or they may be admitted. [00:16:42] Speaker 2: Dr. Christina Carpio: And I would also move to enter as the next exhibit a certified copy of imaging records from the South Shore Hospital for Lindsay Clancy from January 24, 2023. Dr. Christina Carpio: So finally, Dr. McDonough, did this defendant receive surgery at South Shore Hospital? Dr. Christina Carpio: Not that I'm aware. Dr. Christina Carpio: Did you observe any cuts, abrasions, or blood on the area of her head? Dr. Christina Carpio: No. Dr. Christina Carpio: And based on your review of those findings on the CT scans, was there any noted injury from the head CTs that you could tell? [00:17:33] Speaker ?: Dr. Christina Carpio: No. [00:17:34] Speaker 2: Dr. Christina Carpio: And were you able, after using that bear hugger device, able to get her blood, excuse me, her body, her core body temperature back up to normal? Dr. Christina Carpio: I don't recall. Dr. Christina Carpio: Did you ever observe those wounds that you observed on her neck, or her wrists, ever start bleeding actively again? Dr. Christina Carpio: No. Dr. Christina Carpio: I have nothing further. Dr. Christina Carpio: Mr. Reddington. [00:18:00] Speaker ?: Dr. Christina Carpio: Morning. [00:18:01] Speaker 3: Dr. Christina Carpio: Morning. Dr. Christina Carpio: So, would you agree with me that when Lindsay was brought into the South Shore Hospital, that she was unconscious? [00:18:14] Kelly McDonough: Dr. Christina Carpio: I recall her eyes being open, but she was non-verbal. Dr. Christina Carpio: Okay. [00:18:20] Speaker 3: Dr. Christina Carpio: Okay. Dr. Christina Carpio: So, as an experienced emergency room doctor, can you tell me when someone's unconscious, what is that, what is the symptomology of it? Dr. Christina Carpio: What does that mean? [00:18:31] Kelly McDonough: Dr. Christina Carpio: It usually means they're completely unresponsive with eyes closed. [00:18:35] Speaker 3: Dr. Christina Carpio: Okay. Dr. Christina Carpio: Was she responsive? [00:18:38] Kelly McDonough: Dr. Christina Carpio: Not verbally. [00:18:39] Speaker 3: Dr. Christina Carpio: Was she responsive at all? [00:18:42] Kelly McDonough: Dr. Christina Carpio: She was responsive to pain. [00:18:44] Speaker 3: Dr. Christina Carpio: So, that means that you would do something to cause pain, perhaps the bottom of the foot or whatever it is to see if they have a reaction? Dr. Christina Carpio: Correct. Dr. Christina Carpio: And would you agree with me that when people even have very, very serious brain injuries, that they can respond to pain stimuli? [00:19:03] Kelly McDonough: Dr. Christina Carpio: Sometimes. [00:19:05] Speaker 3: Dr. Christina Carpio: Sometimes. Dr. Christina Carpio: So, her eyes were open. Dr. Christina Carpio: Were her pupils equal and reactive to light? Dr. Christina Carpio: I don't recall. [00:19:13] Kelly McDonough: Dr. Christina Carpio: You don't recall? [00:19:14] Speaker 3: Dr. Christina Carpio: No. Dr. Christina Carpio: What does it mean with P-E-R-L, pupils equal reactive to light? Dr. Christina Carpio: What does that mean? [00:19:20] Kelly McDonough: Dr. Christina Carpio: Exactly what you just said. Dr. Christina Carpio: It means her pupils are equal and reactive to light. [00:19:24] Speaker 3: Dr. Christina Carpio: And as a doctor, what does that tell you? [00:19:26] Kelly McDonough: Dr. Christina Carpio: It tells me that there's no significant neurologic injury. [00:19:30] Speaker 3: Dr. Christina Carpio: And in this case, you don't recall if her pupils were equal or reactive to light? [00:19:36] Kelly McDonough: Dr. Christina Carpio: I don't. [00:19:37] Speaker 3: Dr. Christina Carpio: Okay. Dr. Christina Carpio: And that's when you take the little flashlight sometimes and you put it over the eye and see if there's constriction of the pupil? [00:19:45] Kelly McDonough: Dr. Christina Carpio: Correct. [00:19:46] Speaker 3: Dr. Christina Carpio: Did you do additional evaluations of her to see what her neurological function was? [00:19:54] Kelly McDonough: Dr. Christina Carpio: She was pretty quickly intubated from what I recall. Dr. Christina Carpio: So after that, it would be difficult to assess her neurologically. [00:20:02] Speaker 3: Dr. Christina Carpio: Sure. Dr. Christina Carpio: Was she on any pain medication, if you remember? [00:20:06] Kelly McDonough: Dr. Christina Carpio: I don't remember. [00:20:07] Speaker 3: Dr. Christina Carpio: Do you recall, did she have difficulty being intubated? I mean, would you agree with me that if you're not under some type of medication or sedation or unconscious, it hurts to be intubated, doesn't it? [00:20:23] Kelly McDonough: Dr. Christina Carpio: We wouldn't intubate somebody without first giving them some induction medicines. [00:20:27] Speaker 3: Dr. Christina Carpio: Okay. Dr. Christina Carpio: So what would the induction medicines be? Dr. Christina Carpio: They're not universal. [00:20:32] Kelly McDonough: Dr. Christina Carpio: Well, that would depend on the case. [00:20:33] Speaker 3: Dr. Christina Carpio: What are the induction medicines that you used on Lindsay Clancy? Dr. Christina Carpio: I don't know. [00:20:37] Kelly McDonough: I'd have to refer to my record. And also, I wasn't the one who did the intubation. [00:20:41] Speaker 3: Dr. Christina Carpio: So she was intubated, had the tube coming out of her mouth, she's laying on the table, and you are continuing an assessment. You were the lead doctor in the emergency route for Lindsay Clancy, right? [00:20:52] Kelly McDonough: Dr. Christina Carpio: I wouldn't say I was the lead. I think the trauma surgeon and I worked together. [00:20:56] Speaker 3: Dr. Christina Carpio: Right. Dr. Christina Carpio: Her temperature, her core body temperature was 82 degrees. Is that right? [00:21:02] Kelly McDonough: Dr. Christina Carpio: If that's what the record states, then yes. [00:21:04] Speaker 3: Dr. Christina Carpio: I'm sorry? [00:21:05] Kelly McDonough: Dr. Christina Carpio: If that's what her medical record states, then yes. [00:21:07] Speaker 3: Dr. Christina Carpio: Well, as you sit here, you don't know what her core body temperature was? [00:21:10] Kelly McDonough: Dr. Christina Carpio: I saw her three years ago. I see about 200 patients a month. [00:21:13] Speaker 3: Dr. Christina Carpio: I'm sure you're very busy, but this is a murder trial doctor. Did you review your records and your notes? [00:21:18] Kelly McDonough: Dr. Christina Carpio: I'm happy to look at my record if you bring it here. [00:21:20] Speaker 3: Dr. Christina Carpio: Did you review your records and notes before you came in here today to testify on this case? [00:21:25] Kelly McDonough: Dr. Christina Carpio: Sorry I did, but I don't have a photographic memory. [00:21:29] Speaker 3: Dr. Christina Carpio: Did she regain consciousness at all while she was in your emergency room? Dr. Christina Carpio: No. Dr. Christina Carpio: Can you tell me what CSF is? Dr. Christina Carpio: Cerebrospinal fluid? [00:21:43] Kelly McDonough: Dr. Christina Carpio: Yeah. Dr. Christina Carpio: Is that what that is? [00:21:47] Speaker 3: Dr. Christina Carpio: It could be. [00:21:48] Kelly McDonough: Dr. Christina Carpio: I'm not sure in what context you're referring to it. [00:21:50] Speaker 3: Dr. Christina Carpio: Well, how about if there's a massive leakage of CSF from her nose? What does that tell you as a doctor? Dr. Christina Carpio: It could mean that there's a skull fracture. Dr. Christina Carpio: Did you notice any clear fluid coming from her nose? [00:22:04] Kelly McDonough: Dr. Christina Carpio: I did not. [00:22:05] Speaker 3: Dr. Christina Carpio: Is that something you would look for? [00:22:07] Kelly McDonough: Dr. Christina Carpio: Yes. [00:22:08] Speaker 3: Dr. Christina Carpio: How quickly do you get the results of the x-rays? Dr. Christina Carpio: When you're in the emergency room? [00:22:15] Kelly McDonough: Dr. Christina Carpio: Well, these were CT scans, but fairly quickly in a trauma. Dr. Christina Carpio: I'm sorry. [00:22:19] Speaker 3: Dr. Christina Carpio: CT scans, x-rays. Dr. Christina Carpio: So you had CT scans that were able to show you the damage to her neck and upper chest. Dr. Christina Carpio: Is that right? [00:22:32] Kelly McDonough: Dr. Christina Carpio: Yes. [00:22:33] Speaker 3: Dr. Christina Carpio: And what did those CT scans show you? [00:22:36] Kelly McDonough: Dr. Christina Carpio: Well, what I remember is a thoracic spine injury. [00:22:40] Speaker 3: Dr. Christina Carpio: And when you say a thoracic spine injury, would you agree that the top part of your neck, your throat area, would be cervical, right? Dr. Christina Carpio: Correct. Dr. Christina Carpio: And that's when the numbers go C1, 2, or whatever they are. Dr. Christina Carpio: That would be the actual vertebrae in the cervical area of the upper body, correct? [00:23:01] Kelly McDonough: Dr. Christina Carpio: Yes, the cervical spine. [00:23:03] Speaker 3: Dr. Christina Carpio: Okay. Dr. Christina Carpio: And then below the cervical spine would be the thoracic spine. Is that correct? [00:23:09] Kelly McDonough: Dr. Christina Carpio: Correct. [00:23:10] Speaker 3: Dr. Christina Carpio: And the thoracic spine would be, and sometimes they're delineated as T1, T2, meaning thoracic one, thoracic two, all the way down to what, five or six? [00:23:19] Kelly McDonough: Dr. Christina Carpio: 12. [00:23:20] Speaker 3: Dr. Christina Carpio: I'm sorry? Dr. Christina Carpio: 12. Dr. Christina Carpio: 12. Dr. Christina Carpio: 12. Dr. Christina Carpio: And the lower portion would be the lumbar. Dr. Christina Carpio: Correct. Dr. Christina Carpio: Is that right? Dr. Christina Carpio: Now, when you looked at the CAT scans, did you determine the extent of the injury to the spinal cord? [00:23:36] Kelly McDonough: Dr. Christina Carpio: I could determine the extent of the injury to the bony thoracic spine. Dr. Christina Carpio: Okay. What was that? Dr. Christina Carpio: I don't recall exactly the level. I would have to look at the report. [00:23:45] Speaker 3: Dr. Christina Carpio: What does that mean, the level of the T? Dr. Christina Carpio: Correct. Dr. Christina Carpio: Was her cervical spine injured? Dr. Christina Carpio: I don't recall. [00:23:52] Kelly McDonough: I'd have to look at the report. [00:23:53] Speaker 3: Dr. Christina Carpio: Were you aware that her thyroid was crushed? [00:23:56] Kelly McDonough: Dr. Christina Carpio: I don't recall. [00:23:58] Speaker 3: Dr. Christina Carpio: Do you know that her cervical spine vertebrae was fractured, destroyed? Dr. Christina Carpio: I don't recall. Dr. Christina Carpio: Doesn't that control a person's breathing? Dr. Christina Carpio: Does that have anything to do with breathing? Dr. Christina Carpio: It can. Dr. Christina Carpio: What do you remember about looking at the damage to the spinal cord depicted on the CAT scan? [00:24:23] Kelly McDonough: Dr. Christina Carpio: What sticks out most in my mind is her thoracic. Dr. Christina Carpio: Okay. [00:24:26] Speaker 3: Dr. Christina Carpio: And what was the thoracic injury? [00:24:28] Kelly McDonough: Dr. Christina Carpio: I don't recall the exact level. [00:24:30] Speaker 3: Dr. Christina Carpio: What does it mean by effect level? Dr. Christina Carpio: The exact level. Dr. Christina Carpio: I'm sorry. Dr. Christina Carpio: Were you aware that there was a complete transection of the spinal cord on T5 and T6? [00:24:43] Kelly McDonough: Dr. Christina Carpio: I'm sure I was aware at the time, yes. [00:24:46] Speaker 3: Dr. Christina Carpio: Okay. Dr. Christina Carpio: And just can you tell me what does it mean when it says a complete transection of the spinal cord at a particular, apparently that would be at thoracic 5 and thoracic 6, right? Dr. Christina Carpio: Mm-hmm. Dr. Christina Carpio: What does that mean with a complete transection? [00:25:00] Kelly McDonough: Dr. Christina Carpio: It means the bones are no longer one on top of the other. They're moved apart. [00:25:05] Speaker 3: Dr. Christina Carpio: Were you aware that there was a significant edema noted in her chest? Dr. Christina Carpio: If that's what the report says. Dr. Christina Carpio: Okay. Dr. Christina Carpio: Okay. Dr. Christina Carpio: And what is edema? [00:25:17] Kelly McDonough: Dr. Christina Carpio: Swelling. [00:25:18] Speaker 3: Dr. Christina Carpio: And does it also refer to fluid? Dr. Christina Carpio: It can. Dr. Christina Carpio: Did it refer to fluid in this case? Dr. Christina Carpio: I'm not sure. [00:25:24] Kelly McDonough: I would have to read the report. [00:25:26] Speaker 3: Dr. Christina Carpio: So in addition to the edema that was noted, was there edema noted around C7, T1, T2, T3 to T4? [00:25:37] Kelly McDonough: Dr. Christina Carpio: Again, I would have to have the report in front of me. [00:25:40] Speaker 3: Dr. Christina Carpio: When you noted her... Dr. Christina Carpio: Her base temperature as being 82 degrees, what does that tell you as a doctor? [00:25:50] Kelly McDonough: Dr. Christina Carpio: It means that her body temperature is lower than normal. [00:25:53] Speaker 3: Dr. Christina Carpio: And what is normal? [00:25:55] Kelly McDonough: Dr. Christina Carpio: 98.6. [00:25:56] Speaker 3: Dr. Christina Carpio: And if a person goes from 98.6 to 82 degrees before you place her in the bear hugger, Dr. Christina Carpio: what does that tell you? Dr. Christina Carpio: Does that affect the body at all? Dr. Christina Carpio: Yes. [00:26:08] Kelly McDonough: Dr. Christina Carpio: The body works ideally at 98.6. Dr. Christina Carpio: So anything outside of that range, not ideal. [00:26:14] Speaker 3: Dr. Christina Carpio: To what effect as a doctor? Dr. Christina Carpio: What effect, if any, on the body? Dr. Christina Carpio: If a person has an 82 degrees base temperature? [00:26:22] Kelly McDonough: Dr. Christina Carpio: The list of things that could go awry is quite long. [00:26:26] Speaker 3: Dr. Christina Carpio: Can you give me an idea? Dr. Christina Carpio: Maybe the top three? [00:26:30] Kelly McDonough: Dr. Christina Carpio: She could have a metabolic derangement. Dr. Christina Carpio: What's a metabolic derangement? Dr. Christina Carpio: Meaning her body wouldn't be processing things the way that it was before. Dr. Christina Carpio: Her cells are not working the way that they should because it's too cold. [00:26:45] Speaker 3: Dr. Christina Carpio: Would you agree with me that when you were looking at the injuries to the wrist and to both wrists actually, you noted lacerations in the volar aspect of the wrist? Dr. Christina Carpio: Yes. Dr. Christina Carpio: What is a volar? Dr. Christina Carpio: What does that mean? Dr. Christina Carpio: It's the anterior aspect. [00:27:03] Kelly McDonough: Dr. Christina Carpio: Interior? [00:27:04] Speaker 3: Dr. Christina Carpio: Okay, thank you. Dr. Christina Carpio: Would you agree that on both wrists there was deep laceration? Dr. Christina Carpio: I wouldn't characterize them as deep. Dr. Christina Carpio: You would not? Dr. Christina Carpio: And you made reference to her being transferred to a tertiary care center. Dr. Christina Carpio: What does that mean? [00:27:20] Kelly McDonough: Dr. Christina Carpio: It means that it's a hospital that has more services and specialized care than we do at our hospital. [00:27:25] Speaker 3: Dr. Christina Carpio: Now, when she was at the South Shore Hospital, counsel asked you about whether or not you noted any injuries to her head. You did not notice any bleeding or scrapes or bruises of that nature, right? Dr. Christina Carpio: Not that I recall. Dr. Christina Carpio: Did you notice any injuries to her lower body, her legs, her feet? Dr. Christina Carpio: Let's say her feet or her buttocks? [00:27:51] Kelly McDonough: Dr. Christina Carpio: I don't recall. [00:27:55] Speaker 3: Dr. Christina Carpio: At any time while she was at South Shore Hospital, did she have a cardiac arrest? [00:28:04] Kelly McDonough: Dr. Christina Carpio: Not that I recall. [00:28:07] Speaker 3: Dr. Christina Carpio: Do you know she had a cardiac arrest when brought to the Boston Hospital? [00:28:11] Kelly McDonough: Dr. Christina Carpio: I did not know that. [00:28:13] Speaker 3: Dr. Christina Carpio: How about blood? Dr. Christina Carpio: Was there any blood transfusion at South Shore Hospital Medical Center? [00:28:21] Kelly McDonough: Dr. Christina Carpio: I don't recall. [00:28:22] Speaker 3: Dr. Christina Carpio: Are you aware that she had a massive transfusion of blood once she hit Brigham and Women's? Dr. Christina Carpio: No. Dr. Christina Carpio: What does that tell you? Massive transfusion of blood. What does that mean? [00:28:32] Kelly McDonough: Dr. Christina Carpio: I couldn't comment on why they gave it to her. [00:28:35] Speaker 3: Dr. Christina Carpio: Were the police in the hospital when she was there with you? Dr. Christina Carpio: I don't recall. [00:28:43] Kelly McDonough: Dr. Christina Carpio: Was she chained to the bed by handcuffs? Dr. Christina Carpio: I don't recall. [00:28:45] Speaker ?: Dr. Christina Carpio: Go ahead. [00:28:46] Speaker 3: Dr. Christina Carpio: You redirect? Dr. Christina Carpio: Right, briefly. [00:28:48] Speaker 2: Dr. Christina Carpio: Dr. Christina Carpio, I'm just going to give you your notes, if that's okay. Dr. Christina Carpio: Sure. Dr. Christina Carpio: Thank you. Dr. Christina Carpio: I'm going to just take a look at it and then take your time and just look up when you're done. Dr. Christina Carpio: Okay. [00:29:10] Speaker ?: Dr. Christina Carpio: You need this one? Dr. Christina Carpio: Do you want to just flip through the rest of them to see if that makes sense of the note that you've had in the records? Dr. Christina Carpio: Okay. Dr. Christina Carpio: You need this one? Dr. Christina Carpio: Do you want to just flip through the rest of them to see if that makes sense of the note that you've had in the records? Dr. Christina Carpio: Okay. Dr. Christina Carpio: Do you want to just flip through the rest of them to see if that makes sense of the note that you've had in the records? Dr. Christina Carpio: Okay. Dr. Christina Carpio: You need this one? Dr. Christina Carpio: Do you want to just flip through the rest of them to see if that's the extent of the note that you've had in the records? Dr. Christina Carpio: Okay. Dr. Christina Carpio: You need this one? [00:29:21] Speaker 2: Dr. Christina Carpio: Do you want to just flip through the rest of them to see if that makes sense of the note that you've had in the records? [00:29:37] Speaker ?: Dr. Christina Carpio: Okay. Dr. Christina Carpio: Okay. Dr. Christina Carpio: Okay. Dr. Christina Carpio: Do you want to just flip through the rest of them to see if that makes sense of the note that you've had in the records? Dr. Christina Carpio: Okay. Dr. Christina Carpio: Okay. Dr. Christina Carpio: Thank you. Dr. Christina Carpio: Thank you. Dr. Christina Carpio: Now, counsel asked you on cross-examination about pupils, right? Dr. Christina Carpio: Right? Dr. Christina Carpio: Right? Dr. Christina Carpio: Right? Dr. Christina Carpio: Right? Dr. Christina Carpio: Right? 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