10A28641 2 2011-09-28 DepositionOfDrGeraldTGowittMD Ocr

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IN THE STATE COURT OF DEKALB COUNTY STATE OF GEORGIA

PATRICK C. DESMOND and * MARY C. DESMOND, Individually * and MARY C. DESMOND, as * Administratrix of the Estate * of PATRIC W. DESMOND, *

* Plaintiffs

vs.

CIVIL ACTION FILE NO.: 10 A 28641 2

Page 1

NARCONON OF GEORGIA INC.; DELGADO DEVELOPMENT, INC.; SOVEREIGN PLACE, LLC; SOVEREIGN PLACE APARTMENT MANAGEMENT, INC.; LISA CAROLINA ROBBINS, M.D.;

" * * * * * * *

DEPOSITION OF GERALD T. GOWITT, M.D.

(With Signature Waived)

THE ROBBINS GROUP, INC.; and NARCONON INTERNATIONAL,

Defendants

* * * * * * * *

September 28, 2011 1:00 P.M.

3550 Kensington Road Decatur, Georgia 30032 - 1328

Sharon S. Kelly, CCR, B-1594 ELITE REPORTING, I NC. 4070 Commodore Drive

Chamblee, Georgia 30341 770-457-1276

T " h nr ·rn ~:. t :~ :~ -·~' · .s.~~


Deposition of Gerald T. Gowitt, M.D.

IN THE Sf ATE COURT OF DEKALB COUNTY STATE OF GEORGIA

PAlRICK C. DESMOND and * MARY C. DESMOND, Individually * and MARY C, DESMOND, as * Administratrix of the Estate * of PATIUC W. DESMOND, *

* Plaintiffs *

* vs. *

* NARCONON OF GEORGIA INC.; * DELGADO DEVELOPMENT, INC.; * SOVEREIGN PLACE, LLC; * SOVEREIGN PLACE APARTMENT * MANAGEMENT, INC.; LISA * CAROLINA ROBBINS, M.D.; * THE ROBBINS GROUP, INC.; * and NARCONON INTeRNATIONAL, *

Defendants * * *

CIVIL ACTION FILE NO.: 10 A 28641 2

DEPOSmONOF GERALDT. GOWITT, M.D.

{With Signature Waived)

September 28, 2011 1:00 P.M •.

3550 Kensington Road Decatur, Georgia 30032-1328

STATE OF GEORGIA COUNTY OF DEKALB

Sharon S, Kelly, CCR, B-1594 EliTE REPORTING, INC. 4070 Commodore Drive

Chamblee, Georgia 30341 770·457-1276

DISCLOSURE

Deposition of: Gerald T. Gowitt, r"vl.D. Taken: September :28, 2011

Pursuant to Article 10.B of the Rules and Regulations of he Board of Court Reporting of the Judicial Council of Georgia, I make the follo\'ling disclosure:

I am a Georgia Certified Court Reporter;

I am not disqualified for a relationship of Interest under the provisions ofO.C.G.A. Section 9·11·:28(c);

I am here as a representative of Elite Reporting, Inc.;

Elite Reporting, Inc. was contacted by Weinberg, Wheeler, Hudgins, Gunn & Dial to provide court reporting servlces for this proceeding; ancl

Elite Reporting, Inc. will not be taking this proceeding under any contract that is prohibited by Georgia law.

Tills, the 16th day of October 2011.

SHARON S. KELLY, CCR B-1594

• 2 -

APPEARANCES OF COUNSEL

On behalf of Plaintiffs: JEFFREY R. HARRIS, ESQ. Harris, Penn, Lowry, LLP 405 East Perry Street Savannah, Georgia 31401 912-651-9967

On behalf of Defendants Narconon of Georgia, Inc. and Narconon International:

BARBARA A, MARSCHALl<, ESQ. Drew, Ecld, Farnham P.O. Box 7600 Atlanta, Georgia 30357·0600 404-885-6322

On behalf of Defendants Usa Carolina Robbins, M.D. and The Robbins Group, Inc.:

ROBERT G. TANNER, ESQ. Weinberg, Wheeler, Hudgins, Gunn & Dlal, LLC 3344 Peachtree Road, NE, Suite 2400 Atlanta, Georgia 30326 404-876·2700

On behalf of Defendant Delgado Development, Inc.: SEAN L HYNES, ESQ. Downey & Cleveland, LLP 288 Washington Avenue Manetta, Georgia 30060 770·422·3233

. 3.

INDEX TO DEPOSffiON

Cross-examination by Ms. Marschalk Cross-examination by Mr. Tanner Cross-examination by t-1r. Hynes Direct examination by Mr. Harris

INDEX TO EXHIBITS Defendant's Exhibit No. Description

1 CV of Gerald T. Gowitt, M.D. 2 Testimony list 3 Dr. Gowitt's Entire File (original file

retained by Dr. Gowitt) 4 Letter from DavidS. Bills to Gerald

T. Gowitt, M.D. Dated May 29, 2009 5 Investigator's Report 6 Initial Notification of Death,

Investigator Notes 7 Samples Taken 8 External Examination Report 9 GBI Toxicology Report 10 GBI Blood Alcohol Report

Plaintiffs Exhibit No. Description

1 Northside Hospital Lab Reports

-4 ·

Page 5, 91 71,92

76 80

Page Marked

5 8 21

26

33 35

51 54 65 65

Page Marked

87

Elite Reporting, Inc. 770·457·1276


Deposition of Gerald T. Gowitt, M.D. 1

2 MS. MARSCHAll<: This will be the deposition of

3 Dr. Gerald T. Gowitt, taken pursuant to notice and by

4 agreement of the parties for discovery and all purposes

s allowed under the Georgia Civil Practice Act. Jeff, can 6 we have the agreement that all objections, except for to 7 form of the question or responsiveness of the answer, are

8 reserved until first use of the deposition?

9 MR. HARRIS: What do you think?

10 MS. MARSCHALK: I think the answer Is yes.

11 MR. HARRIS: Absolutely. 12 MS. MARSCHAll<: And, Dr. Gowitt, have you 13 thought about whether you wanted to reserve signature or

14 walveit? 15 DR. GOWITT: I'd prefer to waive.

16 MS. MARSCHALK: Okay. Would you please swear

17 Dr. Gowltt. 18 Whereupon,

19 GERALD T. GOWITT, ~1.0.,

20 having been first duly sworn, was deposed and testified as

21 follows: 22 CROSS-EXAMINATION

23 BY MS. MARSCHALK: 24 Q Dr. Gow1tt1 I Introduced myself to you just a couple

25 of minutes ago. My name Is Barbara Marschaik. I'm a lawyer -5-

1 at Drew1 Eckl and Farnham here n town and my firm represents

2 Narconon of Georgia In a lawsuit that has been brought against 3 It and other entities by the family of Patrick Desmond, And I 4 understand that you were Involved somewhat with respect to

5 doing the Inquiry and an external examination of Patrick

6 Desmond after he died? 7 A That's correct.

8 Q Before we got started thls afternoon, you gave me

9 the opportunity to look through your original file and we're

10 going to talk about that In a moment, but I think we'll be 11 able to shortcut a lot of the questions that I have about your

12 background if we mark your OJ as Exhibit No. 1.

13 (Defendant's Exhibit No. 1 was marked for

1'4 Identification.) 15 Q And I'll just hand you what we've marked as Exhibit

16 No. 1, Doctor. Is that a copy of your most current CV?

17 A Yes.

18 Q And does that Cl/ accurately reflect your education? 19 A Yes. 20 Q Does It accurately reflect your experience?

21 A Yes.

22 Q And does it accurately reflect your publications?

23 A It does. 24 Q Is there anything -- I see that this has been

25 revised September of 2011?

-6-

A Correct. 1

2 Q Is there anything that needs to be added or changed

3 on this OJ?

4 A No.

5 Q And I also understand, Doctor1 that you have 6 prepared a Jist, a very lengthy list of all of your -- is it

7 fair to say that this Is civil testimony?

8 A It's civil testimony and civil -- It's cMI 9 depositions and civil trials going back to the year 2000. It

10 really needs to be thinned out but that Is for the I ast ten

11 years, eleven years or so.

12 Q Okay. This does not Include whatever testimony you

13 may have given In criminal cases? 14 A There are no criminal cases in that document.

15 Q Does this include cases sort of like this one where

16 you're not actually being -- you haven't actually been 17 retained by one of the parties?

18 A Yes. And the way you can tell that, Counselor, ls

19 here I've put ''wrongful death, plaintiff_" Somewhere on here

20 I've probably got a defense one, but wrongful death,

21 plaintiff, wrongful death, plaintiff, etcetera, et cetera. 22 On the ones that are part of my official duties that come to

23 deposition, I might put "wrongful death" but It will be

24 neutral because I haven't been retained by either side. I

25 haven't met with either side on this particular case. One -7-

1 attorney1 I did meet with him, but I don't think he's alive

2 anymore. 3 Q Did you meet with Kirk?

4 A Kirk and another attorney. !forget who. I've 5 never heard another word from him.

6 Q David Bills? 7 A Correct.

8 Q And we'll talk about that in just a couple of 9 minutes.

10 What I'd like to do Is mark your testimony list as

11 Exhibit No. 2, and sitting here today on September the 28th 12 2011, do you know when this Is current through?

13 (Defendant's EXhibit No. 2 was marked for 14 Identification.)

15 A Oh, sure. It's through today.

16 Q Does this Include actually the Desmond case on It?

17 A No. It would not because, you know1 I never know if 18 y'all are going to show up or not. But It includes through 19 September 7th which was my last deposition, Cole versus 20 Georgia-Carolina Foods1 Inc.

21 Q So the only update that would need to be made to

22 Exhibit No. 2 Is the deposition that you're giving here today 23 in this case? 24 A Correct.

25 Q This also identifies the name of the case, the type

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Deposition of Gerald T. Gowitt, M.D. 1 of case that It is, the attorneys Involved In the case?

· 2 A Just the ones that retained me, not who took my

3 deposition; 4 Q And the date of the testimony7

5 A And where It was given. 6 Q Perfect. Very briefly, I'm not going to run through

7 all the specifics in your OJ, Doctor, but tell me when you

8 graduated from medical school.

9 A 1982. 10 Q And where did you do your residency?

11 A Emory. Well, It's actually Emory University 12 Affiliated Hospitals and at the time that was Emory, Grady and

13 the Atlanta Veterans Hospital. 14 Q And when were you actually licensed as a physician?

15 A 1983 here in Georgia. 16 Q Have you held licenses In any other states?

17 A No. 18 Q Has your licence in Georgia ever been disciplined In

19 anyway?

20 A No.

21 Q Did you do a fe[Jowshlp?

22 A Yes.

23 . Q Where was your fellowship? 24 A Fulton County Medical Examiner's Office In the field

25 of forensic pathology. . 9.

1 Q And are you board certified?

2 A I am.

3 Q In what?

4 A Anatomic, Clinical and Forensic Pathology.

5 Q When did you become board certified?

6 A Anatomic and Clinical, 1986 and Forensic in 1987.

7 Q Have you practiced as a forensic pathologist since

8 graduating from medical school?

9 A Yes. 10 Q Have you ever held any other jobs as far as, you 11 know, maybe da.bbled In internal medicine or any other field?

12 A Oh, no. I've dabbled In other fields of pathology.

13 I was a hospital pathologist part time from, roughly, '87

14 through '92. l'm still the director of the laboratory at 15 Georgia Regional Hospital here In Atlanta.

16 Q I saw that. How long have you been the director oF

17 the laboratory there? 18 A At least twenty years. Let's see here. From 1989

19 through today. 20 Q Tell me what your responsibilities are as directory

21 of that laboratory. 22 A I make a site visit there once a month. It's

23 largely an administrative role. I go over the quality control

24 surveys, occasionally write a letter disciplining somebody, 25 oversee raises and things like that but I don't do any

- 10-

1 actually hands-on work there, if that's what you mean. 2 Q Are you involved in any way with the development or

3 implementation of policies and procedures in that lab?

4 A Just In the lab.

5 Q Give me an example on that. 6 A When the urinalysis Is done, when a microscopic is

7 reported, what are the critical values for notifying a

8 clinician for In the laboratory tests, the low and the high.

9 As a mater of fact, we just revamped all of that for some

10 organization you may know called the JCAHO.

11 Q Yes, sir. How often are those policies and

12 procedures revised?

13 A They're looked at once a year. They may not be 14 revised very often. It depends on if they need revision. But

15 we just looked at them all about six months ago and revised a

16 good many of them.

17 Q ~s there like a group of people who are involved In 18 that process? 19 A It would be me and the laboratory supervisor.

20 Q Are you the chief medical examiner of DeKalb County?

21 A I am. 22 Q And I thought I saw somewhere that you were an

23 independent contractor?

24 A I am.

25 Q Do you have a separate company that you actually

- 11-

1 work for? 2 A Correct.

3 Q And what's the name of that company?

4 A Forensic Medicine Associates, Incorporated.

5 Q Do you own that company?

6 A My wife and I own it together.

7 Q How many employees does it have? S A Well, let's see. W-2, It would be one, two, three,

9 four, five, six and then 1099, probably another half dozen.

10 Q How many physicians are employed with that group? 11 A Three.

12 Q Who are they? You?

13 A Or. Geoffrey, spelled G·e·o (spelling) ffrey Smith

14 and Dr. Jon, spelled J·o·n (spelling) Eisenstat, 15 E·l·s·e·n-s-t-a·t (spelling).

16 Q And how long have you had this company?

17 A Since 1994.

18 Q Have you been contracting as the DeKalb County chief 19 medical examiner through that company?

20 A Yes. If you were to look at my contract, Counselor,

21 It's not with me.

22 Q Right.

23 A DeKalb County has entered into an agreement with 24 Forensic Medicine Associates.

25 Q When did y'all enter Into that agreement? - 12-



Deposition of Gerald T. Gowitt, M.D. fDJ.ftJ.g§filfi1f(.I§If;p ~~----------------~--------~----~--~~~--~~~---1 A 2000. 1 Q Just to C?nflrm, Doctor, you are appearing here

2 Q Did you contract with another county before 2 today as an Independent witness?

3 contracting with ·- 3 A Correct. 4 A Oh, I was the deputy chief medical examiner prior to 4 Q You have not been retained by any party to act as an

5 that time from '95 through 2000 here when Joseph Burton was 5 expert witness?

6 the chief medical examiner. 6 A Correct. 7 Q I know him very well. I understand that you also 7 Q Tell me how you became Involved with Patrick

8 act as a medical examiner for other counties? 8 Desmond. 9 A Sure. 9 A Okay, Mr. Desmond's death was reported to our

10 Q What counties are those? 10 office, specifically, Investigator John Henson, on June 10th

11 A Hall, Henry, Whlte1 Rockdale, sometimes Barrow1 and 11 2008 at 6:40P.M. At that time Investigator Henson was

12 occasionally Gwinnett. 12 contacted by Trlsha Buice1 a nurse a Northside Hospital1 who

13 Q When you say "occasionally/ what does thatmean? 13 reported the death to us.

14 A I cover for Dr. Terry when she's out of town or If 14 Q Once this death Is reported to your investigator,

15 she's in court or something !Ike that. It might be very 15 how did things proceed? 16 impromptu. She might call me up tomorrow morning and say1 can 16 A He gets as much Information as he can from that

17 you handle some cases at my facility because I need to be out 17 nurse at the time and then, If he deddes to accept 18 of town. 18 jurisdiction In the case1 and he did In this case, then he

19 Q Does your company contract with those counties as 19 would call our transport service to go pick up the body.

20 well? 20 Q Why would Northside Hospital call your office on

21 A There's no written contract with any of them, as 21 this type of situation? 22 strange as that may sound. It's all on a handshake. 22 A Because It's the Jaw. Under Georgia Code 45-16-20

23 Q Is It your und~rstanding that you have an 23 any nonnatural death that initiated in DeKafb County is

24 Independent contractor relationship with those counties? 24 reportable to our office. 25 A Oh, absolutely. They don't take any withholding, 25 Q And, once that Is reported to your office1 your

- 13- - 15-

1 social security or anything like that out of my check.

2 Q How are you compensated by those counties? Is it 3 based on the number of cases that you review?

4 A In Hall and In Henry It's just a monthly fee. In

5 Rockdale It's per case and in Barrow It's per case.

6 Q Have you been affiliated with the GBI7 7 A I have,

8 Q When were you affiliated with the GBI?

9 A 1989 through 1996.

10 Q In what capacity were you affiliated with the GBl? 11 A More or less a consulting medical examiner. I was

12 the deputy chief medical examiner of Fulton County at the time

13 and our office In Fulton had a contract with the GBI that the

14 doctors In Fulton would provide medical examiner services for 15 the GBI certain days of the week.

16 Q Who was the chief medical examiner at the time?

17 A Dr. Safi, 5-a·l-i (spelling), Zakl, Z-a·k-1

18 (spelling). You've got a lot of names here today that are

19 going to require spelling. 20 Q So1 when you left Fulton County, your affiliation

21 with the GBI ended? 22 A It did. 23 Q Because you no longer were part of the county that

24 had the contract?

25 A That's correct. - 14-

1 Investigators then perform some Investigation? 2 A Yes.

3 Q And, based upon that Investigation, to make a

4 determination about whether or not to accept the case?

5 A That's also correct.

6 Q And when you say that he made the decision to accept 7 jurisdlction1 what does that mean?

8 A That It now becomes our death. In other words, it's

9 no longer Northside Hospital's problem, so to speak. It's our

10 problem of what to do next. 11 Q And what factors go into your Investigator's

12 decision process In formulating that decision?

13 A It's really following the Georgia Code, If someone

14 dies nonnaturally and we consider Mr. Desmond to have not died 15 a natural death, then that's an automatic acceptance for us.

16 We may not bring the body In on all of these, but we would

17 certainly accept jurisdiction because the only people who can 18 sign a death certificate In a nonnatural death Is a coroner or

19 a medical examiner. And, since there's no coroner in DeKalb 20 County1 that leaves It to me.

21 Q Right. And when you're talking about statutory,

22 you're talking about the Georgia Death Investigation Act? 23 A That's correct.

24 Q And I think that the statute Is actually noted in 25 your records?

- 16.



Deposition of Gerald T. Gowitt, M.D. 1 A It Is. 45·16·20.

2 Q O.C.G.A. 45·16·20, correct?

3 A Correct.

4 Q Now when you say the bodies are not always brought

5 in here, who makes that determination? 6 A Most often my investigator but if they have any

7 questions, they'll call me or the doctor on call.

8 Q And, again, what types of factors go into your 9 Investigator's decision tree process when making that

10 dedslim7

11 A If you're going to do anything to a body, you want 12. to be able to answer a question or one or more questions,

13 actually. In this particular case, the question I want to 14 answer Is: Was there any evidence of trauma to this young man?

15 Q And when you say you wanted that question answered,

16 did your Investigator contact you to discuss the

17 circumstances?

18 A No. 19 Q Is that something that your Investigator made the

20 call to do was to bring him in, bring Patrick Desmond's body

2.1 In? 22 A Absolutely.

23 Q Backing up for just a minute, Doctor, can you tell 24 me what your fee schedule is when you're acting as an expert

25 witness retained by a party in a clvil case? . 17-

1 A Is that for chart revlew or deposition or trial or

2 which part of that? 3 Q Excellent clarlfication. Let's break it down. My

4 guess Is that you have a rate structure --

5 A I do. 6 Q --based upon the type of work that you're doing?

7 A Correct. 8 Q And that structure Includes a fee associated with

9 chart review?

10 A Correct. 11 Q And what Is that hourly rate?

12 A Four hundred per hour.

13 Q And do you break It down hourly or by increments

14 within that hour? 15 A No; just hourly.

16 Q In other words, If you spend seventeen minutes

17 looking at a file, do you bill the entire hour?

18 A I do not, I won't bill anything for something like

19 that. 20 Q Okay, So it's four hundred dollars an hour for a

21 chart review?

22 A Correct. 2.3 Q What about consultation with attorneys?

24 A Same thing.

25 Q Four hundred dollars per hour?

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A Correct. 2 Q And what about deposition testimony?

3 A Ave hundred for the first hour, one hour minimum

4 and then each hour after that is prorated on the half hour.

5 So If we were to go till 2:15,let's say, I would bfll you or 6 somebody seven hundred and fifty dollars.

7 Q When you say that It's prorated, how Is that

8 prorated?

9 A On the half hour. 10 Q Okay. But it's still five hundred dollars an hour?

11 A Correct.

12 Q It doesn't go up? In other words, I've had some ·

13 doctors whO, after the first hour, the fee goes up. 14 A Well, after thts deposition, Counselor, you're going

15 to have to show me how to justify that because that sounds

16 like a right smart idea to me. In other words, I could be 17 charging a thousand from 2:00 to 3:007

18 Q It happens.

19 A Personally, I think that's unethical.

20 Q Well, I appreciate that, Doctor, and so do my

21 clients. 22 Tell me what you charge for trial testimony.

23 A Where are we golng?

24 Q Well, sounds like there's a caveat in there. Are 25 there different fee structures depending on which counties you

- 19-

1 testify In 7 2. A Which place I go. For Instance, if we go to the

3 metro area, It's twenty· five hundred dollars a day. Outside

4 the metro area, It's three thousand dollars a day but still in

5 the state of Georgia. And then outside the state of Georgia, 6 it's five thousand dollars a day.

7 Q When you say "metro area," which counties do you 8 consider to be within the metro area?

9 A The ten that are In the Atlanta Regional Commission,

10 I can tick them off if you like, but that's what I would 11 consider the metro area.

12. Q All right. And, again, nobody has paid you from

13 either side of this civil case? Nobody has given you any

14 money outside of what you'll be paid for your deposition 15 testimony here today?

16 A That's correct.

17 Q If we could, Doctor, we talke~ a little bit about 18 this before your deposition. What I would like to do at this 19 time Is mark your entire file as Exhibit No. 3.

20 MS. MARSCHALK: And for the r&ord, the parties

21 have agreed to aU ow Dr. Gowitt to maintain possession of 22 the origlnal of Exhibit No.3 and what we will do is we 23 will cull o1.1t certain documents and make them separate

24 exhibits if we want to talk about them separately; falr?

25 MR. TANNER: Right. • 20-

Elite Reporting, Inc. 770-457-1276


Deposition of Gerald T. Gowitt, M.D. L

2

MR. HARRIS: That's fine.

MR. HYNES: Fair.


4 Identification.)

5 Q (By Ms. Marschalk) Doctor, just for the record,

6 what I'd like to do is tick off the different folders that you

7 have In the record that you have brought here today. First,

B let me ask you this: Is what we have marked as Exhibit No. 3,

9 does this constitute the entire file that you have concerning

10 Patrick Desmond?

11 A lt does. 12· Q Has anything been removed from the file?

13 A Not be me.

14 Q Looking through the file before your deposition, did

15 you notice anything conspicuously missing?

16 A No, not at all.

17 Q And it [oaks like you have actually organized the

18 file Into separate file folders?

19 A Yes.

20 Q And those file folders are marked Investigator's

21 Report?

22 A Correct.

23 Q And there's one for the deposition notice?

24 A Yes.

25 Q Correspondence?

- 21-

1 A Yes.

2 Q M.E. Report?

3 A Correct.

4 Q Photos?

5 A Correct.

6 Q DeKalb Fire Rescue?

7 A Yes.

8 Q Death certificate?

9 A Yes.

10 Q Northside Hospital records 7

11 A Correct.

12 Q Which appears to be a portion of the full record?

13 A That's also correct.

14 Q And then there's another folder that sort of looks

15 like a hodgepodge?

16 A Yes. That's what It Is actually. Miscellaneous for

17 documents that I don't feel are particularly Important to our

18 discussion today. 19 Q And then you have a blue folder in here marked for

20 Northside medical records? 21 A Yeah. That should be the complete record.

22 Q In preparing for your deposition, Doctor, did you

23 review the documents contained In Exhibit No. 37

24 A Yes.

25 Q Did you review any other documents? -22-

1 A Yeah. Sure, It would have just been a quick peek

2 at the therapeutic and lethal levels of morphine. I can never

3 remember these things.

4 Q I'm shocked,

5 A There's people who can but I'm not one of them.

6. Alcohol, yeah1 because I see it all the trme. Morphine, not

7 so much.

8 Q And we're going to talk about this separately. So

9 it looks like maybe you did some research about the

10 therapeutic and lethal levels of morphine?

11 A Correct.

12 Q Did you do any-- Rrst of all, how did you do this

13 research?

14 A 1 have three or four toxicology books I can pull rt

15 out of. Basert, B-a-s-e-1-t (spelling) toxicology book.

16 There's another one but the name escapes me that I keep on my

17 desk and then there's some printouts by Dr. Charles Winek, 18 W+n-e-k (spelling) will also give therapeutic and toxic and

19 lethal levels of medications. There you go. You've got one

20 right there.

21 Q Wlnek's Drug and Chemical Blood-Level data?

22 A Yeah. The only reason I don't use that too much

23 anymore, look at the date on It, I mean, It's like ten years

24 old and there's been a lot written since then. And there's

25 more books that have a little bit better delineation. In his

- 23-

1 you've got to constantly change the units on it. This Is all

2 reported out In mflligrams or micrograms per liter. He

3 reports a lot of stuff in micrograms per milllllter. You've

4 got to be careful with the decimal points.

5 Q Or nanograms per--

6 A Even more careful when you get there.

7 Q Right. Do you remember which source you went to,

8 Doctor?

9 A Not right off the top of my had. But If you see the

10 way I wrote it down, and there was a special way I wrote it

11 down. The therapeutic is up to a hundred micrograms per !Iter

12 but the lethal can be as low as fifty. So what you have,

13 Counselor, let me just draw this real quick. Instead of

14 having therapeutic and letha[1 you've got therapeutic, toxic,

15 and lethal that all overlap each other. Quite a bit of

16 overlap, in fact.

17 Q You have concentric circles?

18 A Yeah, that's right. 19 Q And not necessarily separate?

20 A Yeah, that's right

21 Q And we're going to talk about that in just a few

22 minutes.

23 A I'm getting back to your original question. That

24 would have been the only other research or documents that I

25 would have looked at In preparation for today.

- 24-



Deposition of Gerald T. Gowitt, M.D. 1 Q Okay. Have you been given, Doctor·· And I think I

2 know the answer to this, but have you been given any documents

3 associated with this civlllawsult?

4 A No. 5 Q Have you been given any of the depositions?

6 A No.

7 Q Have you discussed this civil lawsuit with anybody?

8 A No.

9 Q I understand that at some point you had some

10 correspondence or discussions with a fellow by the name of 11 Kirk Post?

12 A Correct. 13 Q And Kirk was, from my understanding, a hybrid of

14 sort of an lnvesti gator {attorney? 15 A Yeah. I guess you look at It that way. He was a

16 hybrid all right. 17 Q And Klri<, unfortunately, is no longer among the

18 living?

19 A Correct.

20 Q Can you tell me, do you know when you were first

21 contacted by Kirk? 22 A I think we can go to the correspondence file and

23 . find a l.etter In here from Mr. Bills that would probably

24 answer your question. I have a letter from David Bills dated

25 May 29th 2009 and that was asking me to retain any blood - 25.

1 samples we had on Mr. Desmond, and1 I believe we had met

2 either just before or just after that.

3 Q And when you say ''we had met:," who was at that

4 meeting?

5 A Kirk Post, Mr. Bills, and probably one of my staff,

6 probably John Henson who was the chief investigator on this

7 case.

8 Q Do you remember generally what the circumstances of

9 that meeting were?

10 A You know, I really don't remember very much about

11 it. It didn't Impress me a whole lot, I guess. I don't

12 remember really very much of what was sald other than we would

13 get the blood back from the crime lab and hang on to it for

14 them. 15 Q And one of the things that I note in the letter from

16 Mr. Bills •• and we'll mark this, Doctor. If we could pull

17 this out because it looks like you actually have an extra

18 copy.

19 A Um-hum.

20 Q So what we'll do Is I'll mark the copy as Exhibit

21 No. 4.


23 identification.)

24 Q And it looks like In this letter that Mr. Bills

25 wanted you to consider ordering additional lab tests -

- 26-

1 A Correct.

2 Q -· checking different substances?

3 A Correct.

4 Q And he wanted you to specifically check, It looks

5 like six different levels?

6 A Also correct.

7 Q Did you actually send the blood out for additional

8 testing?

9 A Absolutely not.

10 Q It looked like from my review of the correspondence

11 file that your response was that he was more than welcome to

12 do that?

13 A If he wants the blood -- In fact, we still have the

14 blood, which Is two years later, and, If he wants to send it

15 out for additional testing, he's perfectly welcome to do that.

16 Q Do you know whether or not he's ever requested the

17 blood to send it for additional testing?

18 A Not as far as I know.

19 Q Do you know, Doctor, whether anybody has requested

20 the blood to send It for additional testing?

21 A Again, not as far as I know,

22 Q Does Forensic Medicine Associates still have Patrick

23 Desmond's blood?

24 A Well, it would actually be the DeKatb Medical

:25 Examiner's Office but, yes, we do. - 27-

1 Q How is it being stored?

2 A In a cooler. We have bins with different years on

3 them and his would be in the 2008 year.

4 Q Would the Integrity of the sample be affected In any

5 way by the amount of time that has gone by?

6 A I think so. It wouldn't be much of what you would

7 analyze today.

8 Q And that's because of the amount of time that has

9 been elapsed since the blood was originally drawn?

10 A That's correct, You know, Counselor, these drugs

11 deteriorate perhap·s at a slower rate If you have a

12 preservative in them and we have tubes With preservative but

13 they still deteriorate over time. So, while you might still

14 get a positive morphine level, I would submit to you that it

15 would probably be lower than what we got when we analyzed

16 Patrick's blood for the first time. And, by the way, we

17 didn't use autopsy blood the first time either. So that blood

18 really hasn't been analyzed.

19 Q Right. I'm going to talk to you about the different

20 types of blood samples that we have available.

21 Outside of this meeting that took place sometime

22 around the time frame of May the 29th 2009, do you recall

23 having any other meetings with Mr. Bills?

24 A I don't.

25 Q Do you recall having any other meetings with Mr.

- 28.

Elite Reporting, Inc. 770-457 ·1276


Deposition of Gerald T. Gowitt, M.D. ®.11!~IIi.l§vil£~i.f@ --~--~------------~--------------.--------------------1 Post specifically about this? 1 seeing this?

2 A No. I don't think I even -- Well, he may have come 2 A l don't.

3 by about something else but not about this. 3 Q It looks like my firm actually requested records

4 Q Since the May 2009 time frame, Str, have you had any 4 generated by this office associated with the death of Patrick

5 communicatlons with any lawyers other than the request for the 5 Desmond on August the 3rd of 2010. Do you have any

6 medical records that you have received from the various 6 recollection of speaking with anybody from my office about

7 parties? 7 this? 8 A No. 8 A No. Generally, these record requests don't go

9 Q If I could just take a quick peek, what we'll do Is 9 through me. 10 make a copy of Exhibit 4 and put !t back in your file. 10 Q Do you have somebody else who handles that?

11 A Okay. 11 A Either Pat Bailey, John Henson, or our records

12 Q Let me just take a quick peek at this correspondence 12 clerk.

13 file and see if there is anything else that we need to delve 13 Q And then finally It looks like there are a couple of

14 Into. 14 email pages In here about the scheduling of this deposition?

15 It looks !Ike you were ortglnally contacted by a 15 A Yes.

16 lawyer in Viera, Florida by the name of Gregory·- I'm going 16 Q To your knowledge, Doctor1 Is there any additional

i 7 to butcher this -- Eisenmenger on July the 3rd 2008? 17 correspondence relating to the death of Patrick Desmond that

18 A Mr. Bailey might have been contacted. It wasn't me. 18 Is not contained within this file?

19 Mr. Batley Is our office manager. 19 A Not that l'm aware of,

20 Q You don't remember having any conversations with Mr. 20 Q Dld you generate any documents outside of those that

21 Eisenmenger? 21 are contained in Exhibit No. 37 22 A I do not, 22 A No.

23 Q It looks like somebody from Narconon also requested 23 Q It appears from a review of the file, Sir, that the

24 the autopsy report on September the 26th 2008? 24 source of Information that you would have about Patrick

25 A Yeah, that's correct. They would have sent It to 25 Desmond's death, all of those sources would be contained

- 29- - 31-

1 our records custodian at the time, who was Adres (phonetic)

2 Dennis,

3 Q Did you have any communication with anybody from

4 Narconon of Georgia that you can recall?

5 A No.

6 Q It looks like another woman by the name of Susan

7 Friend has requested a copy of the autopsy report and any

8 other records pertaining to the death of Patrick Desmond. And

9 it looks like Susan Friend made this request pursuant to the

10 Open Records Act on November the 19th 2008 and that your

11 office responded on February the 6th 2009?

12 A Correct.

13 Q Do you know who Susan Friend Is?

14 A I have no Idea. 15 Q You don't remember having any conversations with

16 her?

17 A No.

18 Q All right. It looks like there may be one

19 additional letter In here from Mr. Bills and it looks like it

20 may have been sent to Patrick Bailey which is why you don't

21 have any specific recollection of it. It looks like It's just

22 a letter of representation and a request for the records along

23 with a copy of the letters of administration?

24 A Correct.

25 Q Do you have any knowledge or recollection of you

- 30-

1 within Exhibit No. 3?

2 A Correct.

· 3 Q · And by sources, we're talking about thinks like the

4 Northside Hospital records and your investigator's background

5 Investigation?

6 A Correct. The EMS report. And I think that would be

7 pretty much it.

8 Q In other words, I just need to make sure that I

9 confirm for the record that you yourself have not conducted

10 any personal investigation outside of what rs contained In 11 Exhibit No. 3?


13 Q For example, you haven't interviewed nurses at

14 Northside Hospital?

15 A No.

16 Q You haven't spoken with the family?

17 A No.

18 Q You told me earlier about consulting one or more of

19 the toxtcology books that you use as references here in your

20 office, Do you know whether or not, Doctor1 you did any

21 online research? 22 · A l did not.

23 Q We talked a little bit, sir, about how you came to

24 be involved In this case under the Georgia Death Investigation

25 Act.

- 32-



Deposition of Gerald T. Gowitt, M.D. 1 A Yes. 2 Q And I believe that you told me that your

3 investigator took the initial Intake?

4 A That's correct. 5 Q And performed some background Investigation?

6 A Correct. 7 Q And that based upon that background investigation,

8 made the determination to maintain jurisdiction and bring the

9 body here? 10 A Correct. 11 Q And It's my understanding, sir, that you actually

12 generated an Investigator's Report?

13 A Yes, that's true. 14 Q And this report Is actually contained within Exhibit

15 No. 37

16 A Yes. 17 Q The report appears to be a three page report?

18 A Yes.

19 Q And it's signed by John Henson?

20 A Correct. 21 Q And what I'll do Is I actually have extra copies of

22 that so 1'11 mark that. 23 (Defendant's Exhibit No. !:i was marked for

24 ldentiflcatlon.)

25 Q I'm going to hand you, sir, what I've marked as • 33.

1 Exhibit No. 5. Does that appear to be a copy of what is

2 contained within your original file? 3 A Yes, it does.

4 Q And this Investigator's Report, the title seems to

5 Indicate that it's actually prepared by your Investigator?

6 A It is.

7 Q Are you involved In the preparation of

8 Investigator's Reports?

9 A Generally, no. 10 Q Do you typically review the Investigator's Reports? 11 A Let me tell you how the process works.

12 Q That'll be perfect.

13 A John would have written up this what we call a pink

14 sheet so that when I have the body In front of me the next ·

15 day, I have this information. He dictates this and one of our 16 secretaries transcribe it but It might be several days before

17 you get that back. Generally, before I sign a case out, I'll

18 review the Investigator's Report probably at the tlme I get 19 the toxicology back. 20 Q So at the tlme you performed the actual examination

21 or autopsy, depending on what you're going to perform, you

22 have access to what you refer to as the pink sheet?

23 A Correct. 24 Q And what we'll do, Doctor, is we'll mark the pink

25 sheet as Exhibit No. 6. - 34-


2 Identification.) 3 Q It looks like this is a handwritten document

4 entitled Initial Notification of Death, Investigator Notes?

5 A Correct. 6 Q And the writing on this would be written by your

7 Investigator?

8 A Itwould. 9 Q And you would review this at the time that you

10 received the body?

11 A Correct.

12 Q And then before you finally sign off on your report

13 or dictate your report or fi nallze your report, however you 14 want to phrase It, you would then have access to the

15 Investigator's Report?

16 A Nso correct. 17 Q You don't go back and double·check the facts

18 contained in the Investigator's report?

19 A Generally, no.

20 Q You are simply relying on the Information that he 21 has put on the pink sheet and the typewritten Investigator's

22 Report?

23 A That's correct. 24 Q And then my understanding is that you performed an

25 external evaluation of-- or external examination of Mr •

- 35-

1 Desmond?

2 A That's also correct. 3 Q And tell me why the decision was made to just do an

4 external examination versus an autopsy?

5 . A Because he had been In the hospital for the better

6 part of twenty hours. Tl1ey had done a head CAT scan on him 7 which didn't show much of anything, and he was otherwise

·s healthy as far as we knew except for hls addiction problems

9 and historical information provided to us sounded like a drug

10 and/or alcohol Intoxication problem.

11 Q If you would have done an autopsy -- My

12 understanding is as far as what you do in a more specific 13 autopsy Is that you're looking more for a mechanism of death?

14 A Well, you can be looking for a cause too. As I say, 15 a lot of that had been done for me by the hospital

16 particularly the head and laboratory studies showing no

17 significant abnormalities.

18 Q Did you speak with the family about doing an

19 autopsy?

20 A No. 21 Q Had the family requested an autopsy, would you have 22 performed one?

23 A I don't honestly know the answer to that question,

24 Counselor. I tty not to cut open too many people. You know,

25 the State has given me an enormous amount of authority to • 36.

Elite Reporting, Inc. 770·457 ·1276


Deposition of Gerald T. Gowitt, M.D. 1 autopsy anybody that I want family permission, but I

2 think you have to use that power wisely. If I think It's

3 necessary, I'H do It, but if I think It's not-- just to open

4 people for the sake of opening people is not really how I

5 practice medicine. so, If the family had asked me and they

6 had asked me that they needed a reason why, I would ask th~m,

7 well, why would you want an autopsy and it would depend on

8 thefr answer. If they told me they were never going to be

9 able to rest unless they had an autopsy, I'd probably go ahead 10 and do It. If they told me they needed an autopsy to

11 facilitate a civil suit, I would give them the name of

12 somebody else that could do that for them,

13 Q Do you perform private autopsies -·

14 A Many.

15 Q •• at the request of family members?

16 A Many.

17 Q And that's outside your duties as medical examiner?

18 A It is.

19 Q How do people find you?

20 A I have no earthly Idea, But I guess I've been

21 around long enough that·· me and Mr. Tanner, probably, that

22 they know us. l don't advertise. Never have.

23 Q That was my next questlon Is whether or not you

24 advertise your services as a private pathologist?

25 A I do not. • 37.

1 Q Regardless, nobody asked you to perform an autopsy

2 on Patrick Desmond?

3 A It would have probably come through John Henson.

4 They wouldn't have gotten me direct!Y· If I answered .every

5 call here that was directed to me, I never have time to do

6 anything else. ·But John would have answered it and If he

7 couldn't convince the family we didn't need one, then he'd

8 come to me, and I don't remember him coming to me about it

9 Q Let's do this: When you perform your external

10 examination, Doctor, do you have access to any other records

11 outside of the plnk sheet?

12 A I would have had those little blurbs out of

13 Northside Hospital. They're here someplace. Here they are.

14 Q And by "little blurbs," you're talking about the

15 documents that are contained In the file marked -- in the

16 manilla file marked "NHS Records"?

17 A Correct.

18 Q That appears to contain a portion of Mr. Desmond's

19 hospital admission records?

20 A It does.

21 Q And the portion -- It looks like It contains his

22 face sheet? 23 . A It does.

24 Q And his lab results?

25 A Correct. • 36.

1 Q don't see any other records outside of this face

2 sheet and lab results.

3 A I think that would be It,

4 Q Would you have reviewed these at the time of

5 conducting your external examination?

6 A Let me see if I can help you with that. The answer

7 would be yes. The reason I say the answer is yes is do you

8 see the time that they were faxed to irs?

9 Q Yes, sir. It looks like they were faxed to you at

10 6:54 on June the 11th.

11 A That's right. He was reported to our office at 6:00

12 o'clock on June the 11th, so four minutes later they sent

13 this. Mr. Henson would have Included that with the pink

14 sheet, so I had these to go over before I started the

15 examination. 16 Q And can you tell me, Doctor, you've got a couple of

17 notes contained within these records flagged. If you could,

18 tell me the significance of those flags.

19 A One1 that his blood alcohol at Northside Hospital on

20 admission was 194 milligrams percent, w~lch In English Is a

21 .194.

22 Q Yes, srr. So the way that most civilians know with

23 respect to what's DUI1 this converts to a .1947 24 A That's correct, So he Is roughly two and a half

25 times the legal limit of being intoxicated as least with -39-

1 respect to operating a motor vehicle In this state.

2 Q can you tell me how or what time that test was run

3 on him?

4 A At 2:30 A.M. on June 11th.

5

6 Q And Is it a blood test or urine test?

A No. No. It's a blood test but we need to be a

7 little more specific, Counselor.

8 Q Yes, sir.

9 A This Is what we call a medical blood alcohol. It's

10 performed on serum, you know1 the water part of blood. But

11 the crime lab does not perform their blood alcohol on serum.

12 They perform It on whole blood, ceUs, and the fluid part, so

13 they generally get a level that's about 10 to 15 percent lower

14 than the hospital does,

15 Q wny would the hospital perform their test on serum

16 versus whole blood?

17 A Because that's the only machine they have. It's

18 cheap and easy. wnereas, the crime lab does this by gas

19 chromatography which Is a much more expensive and

20 sophisticated test. It's also much more accurate. So, when

21 you look at the crime lab blood done on the same sample that

22 this was done on1 you're going to see a different result.

23 Q Right. And I think the crime lab blood, which is

24 contained In your report, you've noted as .157?

25 A Right. And that would be about right You take 15 -40.

Elite Reporting, Inc. 770·457-1276

http://ReachingForTheTippingPoint.nett

Deposition of Gerald T. Gowitt, M.D. 1 percent-- you know, .157 times 15 percent1 you get something

2 ·erose to .19. 3 Q And this would have been based on a blood draw taken

4 during Mr. Desmond's admission at Northside Hospital?

5 A Correct. 6 Q While he was still alive?

7 A Well1 that's a good question. You know, he was not

8 alive when he got ~here.

9 Q Right. 10 A And, yeah1 they got him back but he was never Mr. 11 Desmond again. So I would say this was taken at some point

12 after he was, In the loosest sense of the word, successfully

13 resuscitated. 14 Q Right. And do we know how long he had been dead?

15 A Well1 that's hard to say. When the EMS got there1

16 he had no pulse. When I say "there" to wherever he was In the

17 back of the car. He had no pulse1 no blood pressure. So who

18 knows. 19 Q Would that affect the levels of the blood alcohol as

20 tested at the hospital?

21 A It should not. 22 Q The fact that he may or may not have had some period

23 of t1 me when he was technically dead should not affect those

24 levels? 25 A It should not.

-41-

1 Q I assume that you're familiar with postmortem

2 redistribution? 3 A lam.

4 Q You don't think that there would be any indication

5 of postmortem redistribution In this case?

6 A Well, first of all, In alcohol there probably is not

7 postmortem redistribution. Secondly, in the opiate drugs like

8 morphine1 and he may have taken heroin, I don't know, but

9 let's just call it the opiates In general, morphine being one

10 of them, yeah, because of their pH and all, there Is a 11 possibility for postmortem redistribution. But I tried to

12 eliminate that by using the hospital blood. The hospital

13 blood was not drawn centrally. It was drawn peripherally.

14 and if you do It peripherally, you should eliminate, at least 15 to some degree, Counselor, the potential for postmortem

16 redistribution.

17 Q And take a layperson through centrally versus --

18 A Oh, okay, sure. Centrally would be out of the heart

19 and peripherally would be out of the femoral vein or the 20 cubital vein or the baslUc vein, you know, In the arms.

21 Q Yes, sir. 22 A Generally, the hospital Is going to obtain that 23 blood from a peripheral source. They're not going to stick

24 his heart for it. So that's why I felt that the blood that 25 was sent to the crime -- that's why we asked for the admission

- 42 -

1 blood. Number one1 it would be the most accurate and, number 2 two1 It would certainly be peripheral. Did I clear that up?

3 Q Yes1 sir. Central blood Is cardiac blood? 4 A Yeah. Or aortic1 to be technical.

5 Q So, while there may be some possibility for

6 postmortem redistribution of morphine, you don't think that

7 that is going to play a significant role, if any role, in Mr.

a Desmond's case given the fact that you're using hospital blood

9 that you be!ieve would have been drawn centrally?

10 A Periphera lly. 11 Q Peripherally?

12 A Yes. 13 Q I came so close to getting that right.

14 A It's the last word that tripped you up.

15 And, because he's a potential drug OD for us here,

16 let's say there was no hospital blood and we had to rely on

17 the autopsy, we would have stuck the femoral artery or the 18 femoral vein trying to get as close to peripheral as possible.

19 Q Now, tell me when you have this blood alcohol

20 flagged1 going back to my original question, you've got it

21 flagged as a .194. Is it your testimony, Doctor, that that is 22 not an accurate number of his blood alcohol level and that the

23 mare accurate number would be that number that's contained

24 within the GBI tox report?

25 A can I word It just a hair differently!

- 43 -

1 Q By all means.

2 A It's not that it's not accurate. It's accurate by

3 their machinery, by their equipment. It's not a true value. 4 Because you're using both -- you're using solely the water

5 part of the blood. The more correct value or the more true

6 value would be the one that the crime lab produces because 7 they use both cells and the fluid part of the blood to do

8 their analysis which gives them a slightly lower value. 9 Q So If we are trying to determine as close to

10 accurately as possible what Patrick Desmond's blood alcohol 11 level was as of 2:30A.M. on June the 11th 2008, we would look 12 to the level contained In the GBI's tox report?

13 A I think that's fair. 14 Q And that's .1577

15 A Yes1 that's correct.

16 Q What Is the next flag that you have marked In this

17 smidgeon of records from Northside Hospital?

18 A At the bottom of page -- well, I better not say the

19 page, page four of the fax, I've looked at his total protein, 20 albumln1 bilirubin, and alkaline phosphatase levels. If you

21 recall earlier, you asked me why didn't I do an autopsy? 22 Q Yes, sir.

23 A Because this is kind of an autopsy done for me.

24 This gentleman here has perfectly normal liver functions 25 Including his albumin and he has a negative head CAT scan and

-44 -



Deposition of Gerald T. Gowitt, M.D. 1 he had normal renal function when he got there, so you see the 2 point that I'm needing to do an autopsy less and Jess when I

3 look at all of this data. 4 Q Because the lab values don't indicate any breakdown

5 or the organs? 6 A Correct. They will later on because of he was In

7 shock for so long. But the ones that are there when he hits 8 the door at 2:30 are the Important ones, and they're an

9 normal. 10 Q Can you tell what time the blood was actually drawn

11 for these labs?

12 A No. And to be honest with you, l'm not sure if

13 that's drawn or reported. I could probably work backwards by 14 seeing what time he got there. 15 Q Well, it's not a tenible big deal but I'm just··

16 Close to around 2:307 17 A Right. I mean, If we can put It within forty 18 minutes either way it's probably not going to matter a whole

19 lot. 20 Q So the second tab that you have noted there is

21 basically just to indicate the function of his liver and

22 kidneys?

23 A Well, I didn't highlight the kidneys, but, yes, the

24 kidneys too.

25 Q And what about the third tab? What Importance does • 45.

1 that Infer? 2 A There was a urine drug screen done at, well, it says

3 either drawn or collected at 2:43 on 6·11 and his urine was

4 positive for opiates.

5 Q What time was that that it was collected?

5 A 2:43A.M.

7 Q I think that there was an Initial urine screen from

8 Northside that was negative? 9 A Can you show me that?

10 Q I can. That's actually one of the things I was

11 going to ask you about. Let me work off of your record.

12 A Okay. Counselor, while you're doing that, we've

13 been at this about an hour.

14 MS. MARSCHALK: Let's take a break. 15 THE WITNESS: Can we take about a five-minute

16 break? 17 MS. MARSCHALK: Absolutely. 18 (Whereupon, a break was taken.)

19 Q {By Ms. Marschalk) Okay. We have taken a break and

20 I have culled through the records and it lookS like on the

21 original record that you were pointing to that you have tabbed

22 and highlighted In the manilla folder marked "NHS Records/ it 23 lookS likes there were two tax screens done for opiates?

24 A Correct. 25 Q And a plethora of other drugs?

-46-

1 2 Q And it lookS like the first urine screen was done on

3 6·11 at 2:43A.M.?

4 A Correct.

5 Q And that shows negative? 6 A Correct. 7 Q And then It lookS like they did another urine screen

8 at 4:15A.M. and that was positive for opiates?

9 A Right. 10 Q Tell me how you can have disparate results? First

11 of all, do we know whether they used the same -- they couldn't

12 have used the same urine, right?

13 A Oh, no, they would not have used the same urine, l'm ·

14 pretty sure about that. How can you have different results

15 like that? 16 Q Yes, sir. 17 A It's going to take awhile for enough opl~te to get

18 In from your blood to spill out through your kidneys to 19 Indicate a positive test.

20 . Q Right. It has to go from your blood through your

21 liver where It's metabolized, right? 22 A Right. Yeah.

23 Q And then It makes It In your renal system --24 A Correct.

25 Q -· and that is excreted In through your urine? • 47-

1 A Right. But it has to be a certain level too. In

2 other words, there's a cutoff for every drug that's tested in 3 the urine, and if your urine concentration Isn't above that

4 cutoff1 it's going to be reported out as a negative even

5 though it may be there.

6 Q Right. And It could be that It just hadn't had 7 enough time to metabolize and make it's way out into the

8 urine? 9 A It hadn't had enough time to get to the

10 concentration that they call a positive.

11 Q Is It possible --This doesn't actually measure the

12 level. This just simply measures the presence?

13 A Yes, that's right. There or not. And I don't know

14 what their cutoff is. Today most labs will give you what 15 their cutoff is. 16 Q All right. Finally, It lookS like at some point you 17 received the entire Northside Hospital record? 18 A Yes.

19 Q And that you have flagged -- well1 you flagged one

20 page here today but before today, you flagged another page? 21 A Correct.

22 Q Can you tell me what this Is and why you -- what Its 23 significance Is?

24 A It's a summary that just outlines his hospital

25 course, you know, for the brief time that he was there, . 48.

Elite Repo~ing, Inc. 770·457-1276


Deposition of Gerald T. Gowitt, M.D. 1 That's the only reason I flagged that. 2 Q And this Is because it's basically a quick place to

3 look up all of the Information that's contained In the record?

4 A Sure; without having to read through every nurses

5 note. 6 Q And it's actually typed instead of handwritten by

7 various nurses?

8 A That's helpful, too. 9 Q Okay. Let me go back a little bit. When you're

10 doing your external exam, do we know -- are we able to tell

11 from reading any records Who was present during that exam?

12 A We usually put the tech's name on the label. Robert

13 Mills was the tech on that one. 14 Q So would it have been you and Mr. Mills?

15 A And any other number of people that come and go from

16 myoffice.

17 Q And I understand that there were photographs taken?

18 A Yes. 19 Q And those are contained within Exhibit No. 37 20 A Correct. 21 Q Are there any other photographs that maybe did not 22 make It Into Exhlblt No. 3?

23 A l would think not. 24 Q Are you keeping nates of your exam as you go along,

25 or are you dictating? - 49-

1 A On an external exam like this, I generally just

2 dictate It as I go along. Now1 my techs will come by and do 3 body diagrams and take notes in case the dictation gets fouled

4 up, the tape gets broken, so we have something to go back to

5 and we can reconstruct the report with.

6 Q Do we have any such handwritten records In this

7 case? 8 A Oh, sure.

9 Q Can you find those for me?

10 A Yeah. That file that you call the --

11 Q The hodgepodge? 12 A That's it. They're In here. I can find them for

13 you If you'd like. 14 Q Let me just take a qulck peek. That's the orange as 15 opposed to the pink sheet?

16 A Yeah, I guess you could look at it that way. 17 Q Let's pull -- It looks like l do have contained in

18 ·here, It looks like there's a diagram.

19 A That's one for where he's got tattoos. There'll be

20 others for other things. 21 Q It looks like you've got a couple of sheets in here

22 about, you know, clothing present, accessories present--23 A Correct.

24 Q -- and that type of thing. There's also a form,

25 which we'll mark as Exhibit No. 7. This looks like It -50-

1 identifies samples that you received from the hospital?

2 A No. Those would have been taken at the time of the 3 autopsy.


5 identification.) 6 Q All right. Let's talk about that. When you say

7 "autopsy," you mean examination?

8 A Examination. I'm sorry.

9 Q Okay. And what was taken at the tl me of the 10 examination?

11 A Three gray top tubes, one red top tube and twenty 12 cc's of urine.

13 Q What is a gray top tube versus a red top tube? 14 A A gray top tube has sodium fluoride In it. It's a

15 preservative. You're tJying to keep the drugs that.are in

16 there from --

17 Q Deteriorating? 18 A That's right. And the red top tube does not have a

19 preservative. Some drugs don't like a preservative and it

20 Interferes with their analysis, so we always send both, if we 21 have both.

22 Q And can you tell where you drew the blood from?

23 A It would have been somewhere peripherally because

24 this Is a potential drug OD case. 99 percent of the

25 peripheral blood sticks we do here are going. to be from the -51-

1 femoral area . .

2 Q And can you tell what time you collected it? 3 A At or about the time we did the autopsy, An

4 external exam probably doesn't take twenty minutes, sa

5 sometime during that time.

6 Q What about, It looks like you also collected twenty 7 cc's of urine?

8 A Correct.

9 Q Would that have been from a catheter?

10 A Well, let's see what he had In him at the time that 11 I saw him, and that way I can tell you a little better. He

12 did not have a catheter In, sol imagine we did a suprapubic, 13 you know, just above the groin stick with a needle and j ust

14 drew the urine aut that way.

15 Q And you to91d me that the ME's office still has 16 possession of the blood?

17 A It does.

18 Q What about the urine? 19 A Itdoes.

20 Q You told me earlier that you would not rely on the 21 lab levels of the drug in the blood?

22 A I wouldn't build your case around that.

23 Q It's not my case, Doctor.

24 A Well, your defense around it.

25 Q And what about the urine? Would It similarly be • 52 -

Elite Reporting, Inc. 770·457 -1276


Deposition of Gerald T. Gowitt, M.D. 1 affected by •• 2 A Even more so. Because1 one1 there's no

3 preservative, and, two1 It doesn't give levels to begin with.

4 It just gives a positive or a negative.

5 Q Okay. It looks like, according to the green sheet,

6 the body sign-In form1 that y'all received the body at a:25

7 P.M.?

8 A Yes; on June 11th 2008,

9 Q And that we, and by we, I mean you, released the

10 body on the 13th of June 2008 at 1:02 P.M.?

11 A At 1:02 P.M., right. Released by Pat Bailey.

12 Q Are there any other handwritten notes contained

13 within this hodgepodge file that would assist you in

14 recreating the external exam If you needed to?

15 A This would be one. 16 Q And you're tali<Jng about the document that's marked

17 tattoos, the diagram that's marked tattoos?

18 A Correct. This would be another showing that he

19 shows up without any clothing on. This would be another

20 showing that he doesn't have any rings or valuables. I think

21 that would be basically it. And we also have-- if we have to 22 recreate thlngs,lt's not just all diagrams and all, it's the

23 photographs, too, that we have. So we've got several backups

24 in case something goes wrong with the dictation, which, you

25 know, has happened every now and then. -53-

1 Q I'm sure. Take me through -- As a civilian who has

2 never seen an external exam of a dead body, take me through

3 what you do.

4 A Arst we take the hospital gown off the person. We

5 would take pictures, and then we examine the body much like a 6 physical exam from head to toe looi<Jng for any evidence of

7 trauma or natural disease. At that time, I would document

8 what medical devices he might have in his body, document where

9 his tattoos are, take a height and weight, and then look for

10 anything else that I think might be pertinent. In his case, I

11 saw tiny puncture wounds In the bend of his elbow, which I

12 thought were pertinent.

13 Q And I want to talk to you about the tiny puncture

14 wounds, Let's first go to your actual external examination

15 report. And, Doctor, I've got an extra copy here and I'm

16 going to marl< It as Exhibit No. 8.

17 (Defendant's Exhibit No. a was marked for

18 Identification.) 19 Q If you could do me a favor, sir-- and I'm just

20 talking about the three page report-- we'll talk about the

21 tox reports and diagrams separately. If you would compare

22 Exhibit No. 8 to what you have in your file as far as your

23 typewritten report and tell me If that's a fairly accurate

24 copy.

25 A All I can say Is yours ls missing the front sheet. • 54.

1 Q Is this the front sheet? 2 A There you go. Now you're complete,

3 Q Why don't we add the front sheet on the back, so

4 that we have a full copy of Exhibit No. 8. Fair enough?

5 A Yes, that's fine.

6 Q And what I want to do, Doctor, fs walk through this,

7 and we'll start with the front sheet, what you've got on the

8 front. Basically, this just gives us the Information about

9 Mr. Desmond, correct? 10 A Hold on just a second.

11 Q Yes, sir.

12 A We've got him as black on the front. I believe he's

13 white. I didn't see that until -·

14 Q Sure. That's just a clerical error, so to speak?

15 A It Is nice that you agree with me that I can blame

16 my secretary for that Instead of my··

17 Q And I'm not focused too much on the error on this,

18 but thls Is basically klnd of typewritten Information, basic

19 information about Patrick Desmond?

20 A It is.

. 21 Q And then when you tum the page of this External

22 Examination Report1 this Is really kind of the meat of the

23 examination?


25 Q And it looks like the first section is titled -55-

1- General Information?

2 A Yes,

3 Q Walk me through the general Information that's

4 contained In your report.

5 A All of this Information Is what I would gain from

6 Investigator Henson's report. It's more or less, I think what

7 you would call hearsay. It's nothing that I generated myself.

a Q And that's basically based upon your review of the

9 pink sheet?

10 A Correct.

11 Q Or the typewritten Investigator's Report?

12 A Well, 1 don't think It would have been typewritten

13 at the time that I dictated my report, so it's probably off

14 the pink sheet or what he might have told me verbally.

15 Q You told me that you typically dictate this, the

16 External Examination Report?

17 A Yes.

18 Q And you typically dictate that at the time of the 19 exam?

20 A Correct.

21 Q And that one of the secretaries then types it-·

22 A Correct.

23 Q -- sometime later?

24 A Yes.

25 Q If you'd look on your signature page1 Sir, It looks

-56-

Elite Reporting, Inc. 770-457·1276


Deposition of Gerald T. Gowitt, M.D. 1 like you can tell the initials of the person who transcribed

2 this are KH?

3 A Right. 4 Q And then it looks llke it was transcribed on

5 6·13·2008?

6 A Fine. Sure. 7 Q Let's go back to the first page. Do you normally

8 review the typewritten report before you sign it?

9 A Yes. 10 Q Let's walk through the general information. You

11 said that this is Information that you would have taken from

12 the pink sheet? 13 A Or verbally from Investigator Henson. 14 Q And then the next section is External Examination?

15 A Correct. 16 Q It looks like on this you identify that there Is no

17 clothes? 18 A That's true, 19 Q No jewelry? 20 A That's true.

21 Q You Identify five medical devices?

22 A Correct. 2.3 Q You note that Mr. Desmond Is seventy-four inches In

24 length and weighed two hundred and one pounds?

25 A Yes. -57-

1 Q Then, on the next page, your notes continue and you

2 note, you know, his hair and the color of his eyes. Then you 3 say -- Do you see where it says· "a tattoo of a skull is noted 4 on the lateral aspect of the left upper arm"?

5 A Yes.

6 Q And then you say, "A few tiny puncture wounds are 7 seen In both antecubital fossae?

8 A Yeah. The bend in your elbow here (indicating), 9 Q When you say "a few," do you remember how many there

10 were? 11 A No, I sure wouldn't.

12 Q And you said earlier that that was significant to

13 you which Is why you noted it? 14 A Yeah. These puncture wounds were smaller than what

15 you would get from blood drawing or Insertion of an IV

16 catheter. They were tiny. So that meant something to me

17 since the man has a history of heroin addition and his urine

18 is positive for opiates. 19 Q Did they appear to be needle marks--20 A Yes.

21 Q -- associated with administering heroin?

22 A Well, let's just say needle marks but not needle

2.3 marks that would have been created by the hospital personnel.

24 Q And he had them In both arms?

25 A Yes. -58-

1 Q Do we have photographs of those? 2 A No. I looked but we didn't take any. They're hard

3 to photograph.

4 Q Sure. Because they're tiny?

5 A They're tiny and It's just hard to see them 6 sometimes,

7 Q Could you tell when those were made? In other

8 words, could you tell whether or not they were recent?

9 A Well, they hadn't healed at all, so I'd say probably 10 within the last twenty-four hours or so,

11 Q One of the things that you just said was that he had 12 a history of heroin addiction. My understanding, and I mean,

13 I could be wrong, but my understanding Is that he has a 14 history or narcotic addition to crack cocaine and alcohol but

15 I have not been able to find any history of an actual heroin 16 addition. Do you know where you would have obtained that

17 information from?

18 A The pink sheet says here drugs, heroin, Hold it

19 just a second. We're looking for Investigator Henson's

20 report. Most of the stuff that I get is from my Investigator.

21 It's not from me. 22 Q Yes, sir.

23 A According to Investigator Henson, he made telephone

24 contact with Marte Verges who was the, at least at that time, 25 administrator of the rehab place where Mr. Desmond was

-59-

1 reslding. And, according to Investigator Henson, she further

2 reported that Mr. Desmond was, in fact, a patient of the

3 halfway house and that he had been there approximately one

4 month and had been suffering from heroin addiction. Again, 5 Counselor, we're only going by what people tell us. 6 Q Sure. And I just want to nail down that you don't 7 have any independent facts outside of what's contained in the 8 Investigator's report about that? 9 ·A I don't.

10 Q Okay. And you don't know any actual facts about

11 what Mr. Desmond was doing on the night or early morning hours 12 that he actually passed away?

13 A Well, I would submit to you that he was drinking and 14 taking narcotics. 15 Q Heroin or some type of morphine?

16 A Well, It's just opiates. We don't have to say 17 heroin.

18 Q Can you tell from the records that we have, Doctor,

19 what he was drinking or how much he consumed? 20 A Well, let's look at It this way: It matters now what

21 he was drinking. You have alcohol, right. Whatever he drank

22 elevated hls blood alcohol to .15, If you want an example, 23 let's say, on an average-size person, average-size being a

24 hundred and eighty pounds, let's say, if you want to get his 25 blood alcohol up to .1, and let's use beer because it's easier

. 60.

Elite Reporting, rnc. 770-457-1276


Deposition of Gerald T. Gowitt, M.D. q:if6J.£li.Q~~~\llK.ttig~ij@ --~--~~~~~----~--------------~-------------------1 to work with, he'd have to drlnk five beers In an hour to get 1 then but it would certainly be a significantly lower value

2 to a .1. So to get to a .2, you'd have to drink ten beers. 2 than we have right now. So if you're going to try and get the

3 Actually, eleven beers in an hour because you're goh1g to 3 best results, you get the ones that are at least adulterated

4 metabolize one every hour. So you'd have to drink quite a bit 4 and that would be the hospital admission ones.

5 In an hour to get your blood alcohol up to .15. 5 Q Yes, sir. And then it looks like, based upon the 6 Q And, given the fact that he was two hundred pounds, 6 Information that you had received at the time you did the exam

7 so he's slightly above the hundred and eighty, would the fact 7 as well as the reports that you received afterwards including

8 that he has a history of alcohol abuse affect his ability to 8 the hospital records and the state crime Jab tox reports, that

9 metabolize the alcohol? 9 you have placed or identified the cause of death being

10 A It would only if he was drinking regularly all the 10 intoxication with ethanol and morphine?

11 time. The history that I have, though, Counselor, Is that 11 A Correct.

12 he's been in rehab for a month, and I'm making an assumption, 12 Q And morphine -- Is it fair to say that we don't know

13 and this may be a wrong assumption, but he hasn't consumed any 13 what type of drug he took; we just know it was something v..1th

14 alcohol in a month. And the way that you become one of these 14 morphine?

15 quote, unquote, power drinkers where you can out drink anybody 15 A If you go back to Mr. Bills' letter, he wanted me to

16 is that you rev up your liver enzymes by drinking all the 16 do additional testing to determine what kind it was. That's

17 time, therefore, you can metabolize the alcohol quicker and 17 why we told him, If you want to know that, you know, we have

18 get It out of your system quicker so you can consume more. 18 the blood. And let's just go back and say that I don't think

19 However, a month of being dry Is a lifetime and your liver 19 our office should spend the money to figure out whether it was

20 enzymes are going to revert back to normal by that time and 20 morphine, heroin or whatever. It was an opiate and the

21 you're not going to be able to tolerate alcohol any better 21 concentration contributed to his death.

22 than you or I. 22 Q Sure. And I certainly didn't mean to --

23 Q Can you tell, based on the liver-- Do we have liver 23 A No. No. No. That's why Mr. Bills wanted that

24 enzyme tests? 24 stuff and that's why we didn't do it.

25 A Um-hum. 25 Q The tests that were run tested for the presence and -61-

1 Q Cafl we tell from that whether or not he had an

2 Increased tolerance for alcohol?

3 A You can't really. All I can tell you is that his

4 liver enzymes are normal. He doesn't have a sick liver,

5 period.

6 Q It looks like, going back to page two of your report

7 which we've also marked as Exhibit No. 8 to your deposition,

8 you've got another section called Other Procedures?

9 A Yes.

10 Q And you note that hospital admission blood was sent

11 to the state crime laboratory for toxicology?

12 A Correct.

13 Q And that the autopsy blood and urine are retained in

14 the medical examiner's report?

15 A Office.

16 Q Office. You didn't actua!ly send the autopsy blood

17 or urine off for any tax reports?

18 A No.

19 Q And that's because you thought that the hospital

20 admission blood would be a better sample?

21 A It would have to be, Counselor. He doesn't die for,

22 what, now? Sixteen hours or something like that?

23 Q Yes, slr.

24 A All the alcohol would be gone out of him by that

25 time. And the morphine, I'm not sure It would all be gone by

- 62-

-63-

1 then the level of the opiate and morphine?

2 A Correct.

3 Q But you didn't run a separate test for heroin or

4 other types of drugs that might contain or metabolize Into

5 morphine?

6 A No. You probably wouldn't run a test for heroin.

7 You'd run a test for 6 monoacetylmorphine, a 6 MAM or MOM, I

8 forget the abbreviation for tt. But, an'('Nay, the point being

9 Is that heroin breaks out the 6 monoacetylmorphine. So If you

10 have 6 monoacetylmorphlne and morphine in the blood, it means

11 they're taking heroin.

12 Q You also noted that the manner of death was an

13 accident?

14 A Correct.

15 Q What are the different categories that you can use

16 when determining the manner of death?

17 A Accident would be one. Suicide would be another.

18 Homicide would be another. Undetermined is another and

19 natural. And that's lt.

20 Q When making that determination -- Let me back up.

21 Approximately how many drug overdose cases are you involved

22 with as a forensic pathologist each year?

23 A Good god, more than any other -- Well, except for

24 natural, more than any other type of death. I'll bet this

25 office, out of the seventeen hur~dred reported cases a year,

- 64-



Deposition of Gerald T. Gowitt, M.D. ~fM!N!Q§ffil'?.tK~!(;.f@ ~~--~--------~--~~~~--~----~~~~~--~--~~-

1 and maybe the twelve hundred we accept jurisdiction on, it Q Is this something about the way the machine is

2 probably has two hundred and fifty to three hundred drug 2 calibrated? 3 deaths a year. Also, the deaths that we have that are pending 3 A I have no earthly Idea. Try and get a straight

4 something, are pending toxicology. It's Incredible how many 4 answer out of the crime lab sometime. I haven't been able to. 5 drug deaths there are here. 5 Q Well, it looks like they've tested It at least at 6 A If you'll turn to the final page of your report 6 eighty-one micrograms per liter. It could be either sixteen

7 marked as Exhibit No. a, do you see where it says "Comment"? 7 less or sixteen more? 8 A Yes. a A It could be less.

9 Q And It says the postmortem blood contained the 9 Q Then Exhibit No. 10 Is actually the blood alcohol 10 following? 10 level which has a much less margin of error?

11 A Yeah. And that's a mistake too. 11 A It's done by the same methodology on top of It all 12 Q That's what I was going to ask about.

13 A You'd never believe that I really read these before

14 I sign them, would you? 15 Q I just wanted to clarlfy when you say the postmortem

16 blood, you're not talking about the blood that was drawn here?

17 A No. This Is the hospital admission blood. That's 18 how that should read.

19 Q This is just an error?

20 A Correct. 21 Q Then, Sir, if you'll look at the lab reports, I'm 22 going to mark them separately as 9 and 10.

23 (Defendant's Exhibit Nos •. 9 and 10 were marked

24 for Identification.)

25 Q You've got two lab reports, rlght7 - 65-

1 A Yeah; one for blood alcohol and one for drug screen

2 results. 3 Q I'm going to show you what we've marked as

4 Defendant's Exhibit No. 9 and just represent to you that this

5 is a copy of the blood alcohol report that we received from

6 your office and this Is the one for the morphine?

7 A Correct.

8 Q According to this report, it looks like the report

9 was made on July the 26th and that, according to the blood 10 received, it was positive for opiates, opioids, positive for 11 morphine, eighty-one micrograms per liter?

12 A Correct.

13 Q And then this plus or minus 16 percent, Is that the

14 error rate on the test?

15 A It's hard to believe, Isn't It? It is but it's hard

16 to believe. When you're doing these things by gas

17 chromatography or mass spectrometry that you could have an

18 error rate of 16 percent. Would you go to your doctor and 19 have your blood drawn and be told your hematocrit might be 16

20 percent higher or lower than what I'm telling you It is? I

21 wouldn't? We don't use them anymore. 22 Q You don't use this particular lab?

23 A It's the state crime lab. We use them very 24 sparingly. When you don't pay for stuff, you can see the

25 product that you get. • 66-

12 by gas chromatography methodology. I mean, that's such a low

13 level. It's going to be .15. That's so you can take the 7 14 off and it's going to be .15 one way or the other.

15 Q Let's talk a little bit about these particular

16 numbers. Is .15 ··Is a blood alcohol reading of .15, is that

17 a fatal range of alcohol that you would expect to see? Would

18 somebody die for having a blood alcohol level of.15? 19 A It depends on how old you are?

20 Q What about a twenty·eight·year·old mate? 21 A Generally not.

22 Q What Is the normal range that would be for fatal

23 alcohol deaths?

24 A It's controversial. It used to be above .4. In

25 this office l've seen a number of people .25 and higher·· • 67.

1 without any.other drugs, by the way .. that have died of 2 alcohol intoxication.

3 Q Right. And I think ..

4 A I think it depends, Counselor, on how fast you get

5 from zero to .25. If you get up there real fast, you're

6 likely to die from lt.

7 Q But, typically, In the range of .15 In an otherwise

a healthy mate, you're not going to expect .15 to kill them?

9 A That's right. You might be pretty drunk but you 10 shouldn't die from lt. 11 Q What about this morphine level? You said that you

12 went back and you consulted some of your toxicology books

13 about the morphine level?

14 A I can make It therapeutic, toxic, or lethal1

15 whatever you'd like. The way I looked at this case, though,

16 would be, I think it's worthy of about thirty seconds time or

17 so. When you take two respiratory depressants .. and It's

18 clear-cut. It's clear-cut that alcohol is a respiratory 19 depressant and morphine or heroin or whatever opiate you want

20 to use is a respiratory depressant. One Is at a level that's

21 going to make you fairly drunk and the other one is at a-22 let's call it therapeutic level, I consider that those two

23 combined enough to take someone's life. Furthermore, I'm

24 making the assumption that he's a naive user of these two

25 compounds and he's been in rehab for a month and he hasn't . 68.


hthhhtttpppp://ReachingForTheTippingPoint.net

Deposition of Gerald T. Gowitt, M.D. %11!B.!fiiP.tit!Ktfilij%y --~--------------------~----------------~--------~----~~--~-1 been drinking and shooting heroin during that time; therefore, 1 A I would agree with that. I think we've said

2 these two levels, to me, were enough to cause his death. 2 repeatedly a .15 blood alcohol, generally, in a healthy person

3 Q Can we push It one step further? Because I think- 3 Isn't going to be enough to take your life. 4 that I understood you to say that the alcohol alone wouldn't 4 Q Have the opinions that you have given me here today,

5 have caused the death? 5 Doctor, been within the reasonable degree of medical 6 A Probably not. 6 probability?

7 Q The heroin alone, given the fact that he was a naive 7 A Yes.

8 user, could have caused the death? 8 MS. MARSCHALK: I do not have any other

9 A It may have. I'm not really sure on that, 9 questJons. 10 Counselor. I'm really not. Again, It would depend on whether 10 MR. TANNER: Let me ask you just a few other

11 he shot up a little bit three or four times over an hour or 11 things to be sure on.

12 did he shoot up enough to get this level all at once, was he 12 CROSS-EXAMINATION

13 drinking a lot all at the same time? I think these are 13 BY MR. TANNER:

14 variables In the case that we're never going to be able to 14 Q You mentioned that you saw some small little holes

15 correct for because we don't know exactly what happened In the 15 In the antecubital fossae?

16 back of that car that night. But I would submit to you that 16 A Yes.

17 the faster he drinks and the faster he gets his morphine level 17 Q That was both arms? 18 -up to eighty-one, the more likely it is he's going to die 18 A Yes.

19 particularly if he's a naive user. 19 Q And those are not the kind of holes that you would

20 Q If you took the alcohol out of the picture, have you 20 expect to find In a patient who's been In a hospital having

21 seen reported cases of heroin overdoses as low as fifty 21 blood drawn and that sort of thing?

22 micrograms per liter? 22 A That's also correct.

23 A We're talking about morphine now not heroin? 23 Q You mentioned that the holes that you saw had not

24 Q Sorry. Yes, sir. 24 healed? 25 A Yes, I have. 25 A Correct,

-69-

1 Q And I understand that the therapeutic range can go

2 up to a hundred?

3 A That's right.

4 Q And somebody's tolerance to the drug is dependent

5 upon a variety of factors?

6 A Generally liver and renal function and repeated use. 7 Q If your liver and renal function are normal, would

8 you expect somebody to be able to tolerate up to a hundred

9 micrograms per liter?

10 A Probably. 11 Q Who then would you expect to-- what types of

12 Individuals would you expect to die at the 50 microgram level?

13 A Without any other drugs on board?

14 Q Yes, sir. 15 A Okay. Somebody who's got terminal cancer who's real

16 sick to begin With. Somebody with emphysema who's -- you and

17 I might tolerate this just fine but they're having all the

18 work in the world just to breathe. Someone whose hematocrit 19 is very low because they have kidney failure. Let's just put

20 a major league illness in all of that and I don't think it's

21 too hard to imagine that you could die at a lower revel of

22 morphine. But If you're talking about a twenty-eight-year-old 23 otherwise healthy person, maybe. 24 Q Would you agree that without the heroin on board

25 that Patrick Desmond would not have died?

- 70-

- 71-

1 Q And I think you said there was a figure of

2 twenty-four hours or so?

3 A Yeah. Again, that Is just a ballpark, Mr. Tanner.

4 Q What I want to be sure of Is: Would that be

5 twenty-four hours from the time of death?

6 A No. Twenty-four hours from the time of infliction.

7 Q In other words, you would expect if the holes had

8 not healed, there would be at feast twenty-four hours from the 9 time of Infliction tllf the time of death?

10 A That's correct. And what I mean by not healed, they 11 hadn't crusted over and, you know, there wasn't any evidence

12 that there was any redness around them, so to me there's no

13 healing. And your first signs of healing take usually about

14 t\venty-four hours.

15 Q Now on the Issue of the morphine, the report shows 16 81 units and then there's another figure. Can you find that

17 for us?

18 A On the crime lab reporter now, Counselor? 19 Q Actually, on the report that you signed. It says

20 "morphine-81 ug/L."

21 A Yeah. Micrograms per liter.

22 Q And that's per liter of what? 23 A Blood.

24 Q In the average male of approximately two hundred

25 pounds, mid twenties age, how many liters of blood would you -72-



Deposition of Gerald T. Gowitt, M.D. 1 expect the body to hold? 2 A Do any of y'all have a calculator? I can tell you

3 exactly. 4 Q I think somebody does have a calculator.

5 A Divide two hundred and one by two point two and tell

6 me what that is. 7 MR. HYNES: Divide two hundred and one by two

8 pointtwo. 9 THE WITNESS: And you come up with ninety-one

10 times seventy-five. 11 MR. HYNES: Multiply that by seventy-five?

12 THE WITNESS: Yes, sir.

13 A (Continuing) Okay. You have about six thousand 14 eight hundred· and fifty cc's of blood which is roughly six 15 point eight liters. The formula, Mr. Tanner, is seventy-five

16 cc's of blood per kilogram of body weight. And that's In a

17 male. And so if you just multiply that out, you get a

18 ballpark of how much blood that you're going to have

19 circulating.

20 Q (By Mr. Tanner) Six point eight··

21 A Uters of blood. 22 Q .. liters. If you had elghty·one units per liter,

23 then the total, approximately, would be eighty-one times six

24 point elght7

25 A I don't know If you can make that calculation. And • 73.

1 the reason that I say that Is that whatever blood sample you

2 take1 it ought to have eighty-one micrograms per liter in it. 3 Q Right. So If you had six point eight liters and

4 each liter had eighty-one micrograms, then wouldn't the total

5 In the system··- I'm talking about the total -· I'm trying to

6 get some idea of the total number of .. 7 A The total micrograms of morphine?

8 Q Right. 9 A Yeah. That's be somewhere at six point eight times

10 eighty-one.

11 Q And that's somewhere In the vicinity of five hundred

12 micrograms?

13 A Yeah; roughly.

14 Q Can you give us some Idea about what a person would 15 have to do to get five hundred micrograms Into the system

16 circulating In their blood?

17 A Of morphine?

18 Q Of morphine. 19 A Well, the usual dose of morphine IV, a therapeutic

20 dose is one to five milligrams, which would be one thousand to

21 five thousand micrograms. So they'd have to take just a half

22 of a milligram to get that circulating In their blood. 23 Q And you Indicated that people could take an amount

24 of that •• Well, strike that. 25 Could a person take an amount of one half of the

• 74.

1 gr~m that you just mentioned at one time, or could you take it

2 a total over several occasions?

3 A Yeah. That's the variable you can't really correct

4 for here because we don't know •• I don't know anyway whether

5 Mr. Desmond took several hits of morphine over a thirty-minute 6 period or whether he took one hit one time. And I know that

7 there's multiple puncture wounds but who's to say that he

8 didn't have trouble finding a vein.

9 Q And j ust one other question. The information you

10 got was that he had been at the halfway house, I think you

11 call it, for a month before the autopsy·· not autopsy --

12 examination?

13 A Yeah; before the death. That would be given to us 14 by the facility's administrator.

15 Q Right. NOW1 If, In fact, he had been drinking and

16 taking drugs as recently as the middle part of May, that would

17 be significant for you to know If you're seeing him on June 18 the 11th and 12th?

19 A Yes.

20 Q And if he was taking drugs and alcohol as recently

21 as the mlddl.e of May, would hls system still be less subject 22 to shock?

.23 A You've got almost three weeks to four weeks that 24 have gone by and I think in that time your revved up liver

25 enzymes are going to come back to where yours and mine are. I

- 75-

1 mean, if you talk to me about a few days later, yeah, but

2 three or four weeks late, they should be back and he should 3 have all that junk out of your system. Maybe not out of your

4 head but out of your blood and urine. 5 Q Thank you,

6 MR. TANNER: That's all I have. 7 MR. HYNES: I just have a few question.

8 CROSS-EXAMINATION

9 BY MR. HYNES:

10 Q Do you have any opinion as to whether or not the

11 blood samples that are stlfl here would contain any of the 12 6· MAM metabolite?

13 A Yeah, it might. I don't know that they would be 14 renective of the level, Counselor, but they might still have 15 the compound In it. So, if you get a number back .. you're

16 always going to get a number back. It might not be an 17 accurate number, but it may indicate that It's there.

18 Q So If he was using heroin, you would expect there to 19 be some level of the 6-MAM metabolite In the blood samples 20 that you still have 7 21 A Correct.

22 Q Do you have any opinion as to whether or not there's 23 a baseline value for either his alcohol level or the morphine 24 level?

25 . A \Nhen you say "baseline," help me on that.

- 76 -



1 Q Prior to consuming any of those or Ingesting either

2 of those substances.

3 A Well, hopefully, it'd be zero.

4 Q Zero for both of those?

5 A Yeah.

6 Q And you said that the alcohol and morphine

7 lntoxlcation resulted In his death and I don't know that you

8 explicitly said it, but was that because of respiratory

9 depression? 10 A That'd be my opinion, yes, sir.

11 Q And your opinion Is that he stopped breathing as a

12 result of the Intoxication?

13 A Correct.

14 Q You were talking about the two urine screens on June

15 11th, one at 2:43A.M. and one at 4:15 A.M., the first being

16 negative and the second being positive?

17 A Yes. 18 Q Does that give you-- Does the fact that one was

19 negative and the later one was positive allow you to form any

20 sort of opinion as to when it was ingested?

21 A Well, assuming the drug screen Is correct, and I

22 would have to make that assumption, then it would look like he

23 did all of this maybe at one time or not too far back from

24 when he arrested.

25 Q And not too far back could mean anything. Could you

- 77-

1 be a little more specific? 2 A I don't know if I can. It would be guessing and I

3 want you to know that up front. I mean, maybe fifteen twenty

4 minutes before. About what I said earlier, and I think It

5 stlll holds true. The more quickly he got this stuff into

6 him, the more likely he's going to dye of respiratory

7 depression.

8 Q And is it your medical opinion that there's probably

9 a short window of time, under an hour, before he went into

10 resptratory distress that he had ingested the substances?

11 A If you want to use that time, I would agree with it,

12 okay. It may not be the right time, but I would agree with

13 it. 14 Q On the notes that you have, the paragraph four where

15 you detail the medical findings, you said there was a puncture

16 wound on his wrfst.

17 A Maybe you can help me with that.

18 Q Under External Examination (Indicating),

19 A Oh, yeah, I see. This is a wound that has white

20 gauze taped over it. I don't describe It a second time

21 because I think that's a therapeutic injury.

2.2 Q And that's just what I wanted to find out if you had

23 an opinion on lt. But puncture wound on hi~ wrist you think

24 it had something to do with his treatment at the hospital?

25 A I do, Probably some type of a blood gas or IV or - 78.

1 something like that. But, see, the hospital took the time to

2 tape that over.

3 Q And by Jooldng at the puncture wounds that you

4 mentioned or Injection sites on both of his elbows, were you

5 able to formulate any opinion or conclusion regarding wliether

6 or not he had injected something Into his veins or was it like

7 a fatty tissue Injection?

8 A You would shoot for the vein but he may not have

9 gotten lt.

10 Q Do you recall any other details about looklng at the

11 arms that led you to conclude whether or not he got his vein

12 or it wa.s fatty tissue?

13 A No. I really don't.

14 Q Are you familiar with the term of place

15 conditioning?

16 A No.

17 Q Okay. You have morphine at 81 ug/L? A Correct. 18

19 Q And that abbreviation, the ug/L stands for

20 micrograms per liter?

21 A Micrograms per liter, right.

22 Q When you talk about levels of morphine or opiates In

23 someone's body, Is there another standard measurement that's

2.4 used?

2.5 A Oh, there's a bunch. There's milligrams per liter. • 79.

1 There's nanograms per milliliter. It just depends on the lab

2 what units they use. I wish ali the labs would use the same

3 units, It would make my life a lot easter. Yeah, there are

4 several others that are acceptable.

5 Q And the ones that we've talked about today have ali

6 been the ug/L or micrograms per liter?

7 A Correct.

8 Q Okay.

9 MR. HYNES: Thank you, Doctor.

10 MR. HARRIS: Dr. Gowitt, are we going Into the

11 thousand dollar an hour range?

12 (Whereupon, the discussion continued off the

13 record.)

14 DIRECT EXAMINATION

15 BY MR. HARRlS:

16 Q My name Is Jeff Harris. I represent the Desmond

17 family, and I've got a few questions. I'm gotng to bounce

18 around a little bit and I apologize for that.

19 You signed the death certificate, right?

20 A Correct.

21 Q And the cause of death is listed as lntoxlcation

22 with ethanol and morphine?

23 A Yes.

24 Q Now, you do not have an opinion to a reasonable

25 degree of medical probability regarding whether or not the -80 .



Deposition of Gerald T. Gowitt, M.D. 1 morphine alone was sufficient to kill Mr. Desmond1 do you?

2 A I don't.

3 Q The only opinion that you've rendered to a

4 reasonable degree of medtcal probability is that the

5 combtnation of ethanol and morphine resulted in his death,

6 correct? 7 A I th!nk there's one other. The alcohol by itself

8 probably wouldn't have taken his fife.

9 Q I was getting there. But you belleve that the

10 alcohol, the fifteen or so that he blew or didn't blOW1 but

11 his blood sugar would not have been sufficient to kill him?

12 A Correct. 13 Q And that's because he was, as far as you could tell,

14 a healthy young man, right?

15 A Yeah.

16 Q So the only thing, just to clear the record, the

17 only thing that you can state with a reasonable degree of 18 medical probability, or the two things are alcohol alone

19 didn't do it1 light? 20 A correct.

21 Q And It was a combination of alcohol and morphine?

22 A Yes.

23 Q Now, you talked a little bit earlier about there

24 being some literature that delineates the different levels or

25 therapeutic versus lethal. And what was the middle category?

-81-

A Toxlc.

2 Q Is there any generally accepted range or any range 3 that you're comfortable With in terms of outlining those three

4 categories?

5 A The only reason I'm not comfortable, Counselor, Is 6 that there Is so muct1 overlap of these that you actually have

7 to know the person a little better to make those

8 determinations. Somebody who always takes heroin or let's

9 just say morphine every day is going to be able to tolerate a

10 lot more than somebody who doesn't. Someone who takes it for

11 .the first time and takes it-- or not for the first time, but

12 let's just say a naive user and takes it with alcohol is more

13 likely to have a bad outcome. So, I can bring you books ln

14 here that have the toxic, therapeutic, and lethal ranges, but

15 I'm not sure they mean much.

16 Q What sources did you look at In order to get those

17 ranges?

18 A You can look in Baselt'sr B-a-s-e-1-t (spelling),

19 Counselor here has Dr. Winek's resource and there's a book on

20 my desk. [ forget the name of it, but It also lists the

21 toxic, therapeutic, and lethal levels.

22 Q Well, let me ask it a different way. Is there a

23 level that you're comfortable In tellfng me that If you saw

24 that level, you would not expect, based on your experience,

25 that the person would die from that level of morphine?

- 82-

1 A Oh, probably .1 or something to that affect. Even 2 those levels you have to be careful of. Because1 Counselor

3 here asked me about why would you die at a .5 or a .3? The

4 terminal cancer patient. [ can go back and restate all of

5 that, but people that have serious and life-threatening

6 illnesses1 it doesn't take much morphine to push them over the

7 lid. 8 Q And I'm going to get into that. Actually, l'm glad

9 you brought that up. Do you know anything about what f'vlr.

10 Desmond's course of treatment or the therapy was that he was

11 receiving In the month priorto his death?

12 A No. We didn't subpoena any records from the

13 facility.

14 Q Do you know anything about the Narconon treatment--

15 A No.

16 Q ·- program?

17 A No. I wouldn't even pretend to.

18 Q Were you aware of the fact that as part of his

19 treatment program before his death, he was subjected to

20 repeated dally uses of a sauna as part of what Narconon

21 believed was a drug treatment program? Did you know that?

22 A No.

23 Q Did you know that that treatment program was

24 something that Narconon believed was effective In helping

25 people address drug and alcohol problems?

-83-

A No. 1

2 Q Now, I want you to assume for me that if that's true 3 and Mr. Desmond was In a sauna and had, you know, repeated

4 exposure to a sauna for multiple hours per day, is that the

5 klnd of thing that In any way would make him more susceptible

6 to overdosing on morphine?

7 A I can't think of a mechanism whereby It would. I

8 mean, I think you may be talking about did he get dehydrated

9 from that. Well, his lab work doesn't indicate that he was.

10 {Whereupon, there was an outside Interruption.)

11 A (Continuing) I'm sorry. Go ahead.

12 Q (By f'vlr. Harris) And the reality Is, though, you

13 don't know whether or not when he presented at the hospital

14 Immediately whether or not he was dehydrated or not, do you?

15 A No, I don't.

16 Q And you really can't tell because presumable they

17 would have put some !Vs In him and started ·-

18 A They were going to put !Vs In him whether he was

19 dehydrated or not.

20 Q Exactly, So you have absolutely no idea whether or

2L not this man presents to the hospital in a dehydrated

22 condition?

23 A Correct.

24 Q But if he had been dehydrated, ls that something

25 that would have made him more susceptible?

-84-

Elite Reporting, Inc. 770•457 R1276


Deposition of Gerald T. Gowitt, M.D. 1

2

A Yeah. Sure.

Q Yes? 3 A Let's make It easy to understand. If we take this 4 bottle full and put a certain amount of morphine in it, you'll

5 get a concentration of so many micrograms per liter. Do you

6 agree?

7 Q Sure. 8 (Whereupon, there was an outside interruption.)

9 A (COntinuing) Let's say we take the same bottle1

10 counselor1 we reduce the level of fluid in it half but we put

11 the same amount of morphine in. What's your concentration

12 going to be? It's going to be twice as much as It was when

13 the bottle was fu!l. I hope that makes sense. 14 Q (By Mr. Harris) It makes perfect sense. 15 A Yeah. And that's the whole point of dehydration.

16 If you're severely dehydrated and you're down, you know,

17 several liters of fluid, let's say, then you're going to be 18 more susceptible to the administration of the same amount of 19 morphine as-- more susceptible to the same amount of morphine

20 as when the bottle was full. 21 Q And you would agree with me -- I think it's pretty 22 dear that you would agree with me that If you're in a sauna ·

23 for three to five hours a day, if not more, at temperatures 24 over a hundred degrees that's the kind of condition that's

25 going to make the average person dehydrated? -85-

1 MR. TANNER: Object to form.

2 MS; MARSCHALK: Object to form.

3 THE WITNESS: It could If you're going to be

4 sweating out a lot. It depends on whether your fluids

5 get replaced afterward or not. 6 Q (By Mr. Harris) But, nevertheless, If he presented 7 In a dehydrated condition, you would agree with me that that's

8 the kind of condition that would make him more susceptible to

9 overdose on morphine?

10 A And alcohol. 11 Q And alcohol?

12 A Sure,

13 Q Okay. Now, similarly, were you aware of a regimen

14 that Narconon used where people who were treating there took 15 mega doses of vitamins?

16 A No.

17 Q In particular mega doses of niacin. Did you know

18 that? 19 A No. I saw in Mr. BHfs letter he wanted me to do

20 ntacln and some othervltamln levels In this case.

21 Q And I understand you elected not to do that. And

22 I'm not trying to quibble about that. But I'm asking you a 23 different question. Is that the kind of thing, if you receive

24 mega doses of vitamins over a period of days leading up to a

25 morphine overdose, Is that the kind of thing that would make -86-

1 you more susceptible to overdosing? 2 A Maybe you can help me. I don't understand a

3 mechanism of why it would. 4 Q That's why I'm asking you. 5 A No, I don't. I don't. 5 Q And that's why I'm asking the questions.

7 Any physiological mechanism that you can think of

8 that if a patient consumed mega doses of vitamins or amounts

9 of vitamins that were far In excess of the amounts that were 10 recommended that that would make you susceptible to either

11 overdosing on morphine or alcohol? 12 A I'm going to say not that I'm aware but that doesn't 13. exclude that there might be something out there that I'm not

14 aware of. is Q That's not something that you really looked into,

16 fair? 17 A No, not at all. 18 Q Okay. Now, you have a number of lab reports that

19 are In your file and, frankly1 I'm a little bit confused about

20 which ones you've got and which ones you don't, but I'm going

21 to try this a different way. I'm going to mark this set that

22 I'm going to hand you as Plaintiff's Exhibit No. 1.

23 (Plaintiffs Exhibit No. 1 was marked for 24 identification.)

25 Q What I've handed you Is a stack of lab reports from • 87-

1 Northside Hospital that we've marked as Plaintifrs Exhibit No.

2 1 and It runs a Bates range at the bottom from 00423 up to 3 00435. Can you tell me whether or not the lab reports In

4 Exhibit 1 are ones that you had or that you reviewed?

5 A Well, I'm supposed to have a complete copy of the

6 medical record here, so let's see. It looks like they're all 7 the same.

8 Q Okay. Great. So Plaintiffs Exhibit No. 1 that I've

9 marked that set, you had all of those in -- those are an In 10 your fi le?

11 A Yes.

12 Q The testimony that you gave earlier about these two

13 marks in Mr. Desmond's arm, I just want to be clear about it.

14 There were multiple pinholes in each elbow? 15 A I just said a few. A few.

16 Q And that's what I'm after. Was it more than --17 A I don't know. I didn't count them. And I certainly

18 can't go back and do it now.

19 Q Is there any way to tell based on your examination of

20 them whether or not this was the first time he ever used 21 heroin?

22. A I didn't see any track marks.

23 Q And you've look at a bunch of heroin addicts over the 24 years? 25 A Oh, good god, yes. We have our share.

- 88-

Elite Reporting, Inc. 770·457-1276

httpppp://ReachingForTheTippingPoint.net

Deposition of Gerald T. Gowitt, M.D. Wiil!iif!~f}l§v:!f.t.~'l[tif> --~------------~--~--------------------~~~---~----~ 1 Q And It is common with people who are heroin addicts 1 A It wouldn't be on this. 2 to have numerous track marks that scar and are all over their 2 Q But I thought you mentioned something about kidney

3 bodies, Is It not? 3 function? 4 A If they've been addicts long enough, yes. 4 A His was marginal to begin with when he got to the 5 Q But it's fair to say there wasn't anything like that 5 hospital. However, It's a little bit difficult to Interpret

6 on Mr. Desmond's body? 6 because he gets to the hospital with zero pulse, zero blood

7 A I didn't see that. 7 pressure, zero respiration, you know, that alone is going to

8 Q And so what you did see was some number of marks that 8 alter some of the lab work.

9 you believe were not put there therapeutically? 9 Q But you don't know how his kidneys were functioning 10 A Correct. 10 the night he Ingested the morphine?

11 Q And you can't tell me whether or not this was the 11 A I don't, no. 12 first time that Mr. Desmond had ever Ingested any kind of 12 RECROSS-EXAMINATION

13 heroin based on those marks atone? 14 A I couldn't tell you.

15 Q And just to be clear on this, the Information about 16 him having a heroin addiction and being treated for that In the

17 rehab program that he was In, that's pure hearsay. You don't 18 have any Independent kllow!edge of that, do you?

19 A None whatsoever. 20 Q And, apparently, that came exclusively from some

21 woman named--

22 A Marie Verges. 23 Q So If we want to know about that, we need to talk to

24 her, right? 25 A I would assume, yes.

-89-

1 Q You mentioned that you looked •.• I thlnk there were

2 some lab reports that you'd flagged or highlighted and you 3 looked at his pH levels and his protein, his bilirubin and so 4 forth. Was there anything that you noticed in any of the blood

5 work that you looked at including the ones that you talked

6 about earlier that you noticed was abnormal or out of line? 7 A His blood gases and his pH was very low, I can look

8 again to see.

9 Q If you would.

10 A Sure. Let's see here. If you turn to the first page 11 of the lab work ·-12 Q And just read the pH level that you're saying --

13 A Hold on. I hate to hold you up.

14 Q That's fine. 15 A This Is In a different section of the medical record.

16 His pH Is six point nine. The normal pH is seven point three

17 five to seven point four five. His PCo2 is much too high.

1B It's seventy-seven. The normal there Is thirty-five to 19 forty-five. And that's It on this page. But those are

20 significant derangements in his acid base balance.

21 Q And what does that mean? 22 A Something has happened where he's not breathing

23 properly or his kidneys are not functioning properly. Probably

24 breathing In this case since I know what happened to him.

25 Q And the kidney function? - 90-

13 BY MS. MARSCHALK: 14 Q If I could just drill down a little deeper into a

15 couple of the opinions that Mr. Harris asked you about. I

16 think we're all straight on the fact that alcohol alone would 17 not have caused Mr. Desmond's death?

18 A Yes, that's right

19 Q And I understood you to believe that heroin could 20 have -- It's possible that heroin could have-- heroin alone

21 could have caused his death but If he had -- we just need to 22 know a little bit more information about that?

23 A Correct.

24 Q And given our lack of Information, you can't tell us

25 to a reasonable degree of medical certainty whether or not the

- 91-

1 heroin alone could have caused his death?

2 A I think that's fair. 3 Q You don't have any opinion, Doctor, that Mr. Desmond

4 was dehydrated at the time of admission to the hospital, do

5 you? 6 A I don't know one way or the other.

7 Q Can alcohol cause somebody to be dehydrated?

8 A Theoretically If you drink enough. It's a diuretic,

9 you're going to pee out some fluid.

10 Q So can alcohol cause dehydration? 11 A Theoretically.

12 Q To some extent?

13 A Yeah; theoretically.

14 Q Okay. 15 MS. MARSCHALK: That's all the questions I 16 have,

17 RECROSS-EXAMINATION

18 BY MR. TANNER:

19 Q Doctor, on this dehydration question, if a patient 20 was extremely dehydrated, would you expect the patient's skin 21 to show some sign of that?

22 A Yes, sir. UsuaHy It's lack of turgor. 23 Q And If there was normal skin turgor found on

24 admission to the hospital, would that be consistent or 25 inconsistent with severe dehydration?

- 92-


http:////ReachingForTheTippingPoint.net

Deposition of Gerald T. Gowitt, M.D. 1 A It would be inconsistent. 2 Q Likewise, If a patient was severely dehydrated, what

3 would you expect to be the result on the patient's blood

4 sodium levels? 5 A They should be high. And also if we're going to 6 talk about lab work, Counselor, let's go back to the lab work. 7 Q Would you expect them to be significantly elevated

8 In sodium If the patient, In fact, had severe dehydration?

9 A I would. 10 Q Let me ask you to assume that at Northside Hospital 11 the normal range of sodium when examined in the patient's

12 blood is one thlrty·slx to one forty-four. And let me ask you 13 to assume that when the patient's blood was drawn at 02:30

14 hours the sodium was found to be one forty-five or one point

15 over the normal range. Would that be consistent or

16 Inconsistent wlth severe dehydration? 17 A It would be inconsistent. And remember there's a 18 margin of error of about 1 percent In these lab tests. So If

19 you ran It again, It could be in the normal range.

20 Q That's all I have. 21 MR. TANNER: Thank you, sir. 22 MS. MARSCHALl<: Thank you, Doctor.

23 (Whereupon, the deposition was concluded at

24 3:32P.M.)

25 -93-

CERTIFICATE

STATE OF GEORGIA:

COUNTY OF DEKALB: I hereby certify that the foregoing transcript was taken

down, as stated in the caption, and the questions and answers

thereto were reduced to typewriting under my direction; that the foregoing pages 1 through 93 represent a true, correct, and

complete transcript ofthe evidence given upon said proceedings;

that I am not of kin or counsel to the partles In the case; that

I am not in the regular employ of counsel for any of said parties; nor am I in anywise interested In the result of said

case.

This, the 16th day of October 2011.

SHARON 5. KELLY, CCR B-1594

• 94-



.1 ... 60, 61, 83 3:00 ... 19 85 assist ... 53 81,87,91

.1 .... 61 3:32 ... 93 administrative ... 10 associated ... 18, 25, black ... 55

.15 ... 60, 61, 67, 68, 3rd ... 29, 31 administrator ... 59, 75 31,58 blame ... 55 71 4 ... 26, 29, 47, 67, 77 admission ... 38, 39, Ass9ciates ... 12, 27 blew ... 81

.15 .... 60, 61' 67 4:15 ... 47, 77 41' 42, 62, 63, 65, assumption ... 61, 68, blood ... 23, 25-28,

.157 ... 40, 41,44 45 ... 15, 17 92 77 39-45,47,51,52,

.19 .... 41 5 ... 33, 34,83 Adres ... 30 Atlanta ... 9, 1 0, 20 58, 60-67, 71-74, .194 ... 39,43 50 ... 70 adulterated ... 63 attorney ... 8, 25 76, 78, 81 , 90, 91, .194 .... 39,43 6 ... 15, 34, 35, 39, advertise ... 37 attorneys ... 9, 18 93 .2 ... 61 46,47,57,64, 76 affect ... 41, 61, 83 August ... 31 blow ... 81 .25 ... 67,68 6:00 ... 39 affected ... 28, 53 authority ... 36 blue ... 22 .25 .... 68 6:40 ... 15 affiliated ... 9, 14 automatic ... 16 blurbs ... 38 .3 ... 83 6:54 ... 39 affiliation ... 14 autopsies ... 37 board ... 10, 70 .4 .... 67 6th ... 30 afternoon ... 6 autopsy ... 28-30, 34, bodies ... 17, 89 .5 ... 83 7 ... 50, 51 , 67 against ... 6 36-38, 43·45, 51, body ... 15-17, 33-35, 00423 ... 88 7th ... 8 age ... 72 52,62, 75 50, 53, 54, 73, 79, 00435 ... 88 8 ... 53-55, 62, 65 agree ... 55, 70, 71, available ... 28 89 02:30 ... 93 8:25 ... 53 78, 85, 86 average ... 60, 72, 85 book ... 23, 82 1 ... 6, 53, 60, 61, 83, 81 ... 72, 79 agreed ... 20 aware ... 31, 83, 86, 87 books ... 23, 32, 68, 82

87, 88, 93 9 ... 65, 66 agreement ... 5, 12 awhile ... 47 both ... 44, 51, 58, 71, 1:02 ... 53 99 ... 51 ahead ... 37, 84 B 77, 79 10 ... 40, 65, 67 A albumin ... 44

back ... 7, 24, 26, 29, bottle ... 85 1099 ... 12 alcohol ... 23, 36, bottom ... 44, 88 10th ... 15 A.M. ... 40, 44, 46, 47,

39-44, 59-62, 34, 35, 41, 43, 49, bounce ... 80

11 ... 46,47 77 66-69, 71, 75-77, 50, 55, 57, 61-64,

break ... 18, 46 11th ... 39, 40, 44, 53, abbreviation ... 64, 79

81-83, 86, 87, 91, 68, 69, 75-77, 83, breakdown ... 45

75, 77 ability ... 61 92 88, 93

breaks ... 64 12th ... 75 able ... 6, 17, 37, 49,

alive ... 8, 41 background .. . 6, 32, breathe ... 70

13 ... 57 59, 61' 67, 69, alkaline ... 44 33 breathing ... 77, 90

13th ... 53 70, 79, 82 allow ... 20,77 Backing ... 17

brief ... 48 15 ... 19, 40, 41, 47,

abnormal ... 90 allowed ... 5 backups. ... 53

broken ... 50 60, 61, 67, 68, 71,

abnormalities ... 36 alone ... 69, 81, 89, 91, backwards ... 45

brought ... 6, 17, 21, 77 above ... 48, 52, 61,

92 Bailey ... 29-31, 53 83

16 ... 15, 17, 66 67 alter ... 91 balance ... 90

Buice ... 15 194 ... 39, 43 abuse ... 61

among ... 25 ballpark .. . 72, 73 build ... 52

1982 ... 9 accept ... 15, 16, 65 amount ... 28, 36, 74, Barbara ... 5

bunch ... 79, 88 "1983 ... 9 acceptable ... 80

85 Barrow ... 13, 14 Burton ... 13

1986 ... 10 acceptance ... 16 amounts ... 87 base ... 90

butcher ... 29 1987 ... 10 accepted ... 82

analysis ... 44, 51 based ... 14, 16, 18, c 1989 ... 10, 14 access ... 34, 35, 38 analyze ... 28 33, 41, 56, 61, 63,

1994 ... 12 accessories ... 50 analyzed ... 28 82,88,89 calculation ... 73

1996 ... 14 accident ... 64

Anatomic ... 10 baseline ... 76 calculator .. . 73

19th ... 30 according ... 53, 59, antecubital ... 58, 71 Basel! ... 23 callbrated ... 67

2 ... 8, 12, 19, 40, 60,66 anymore ... 8, 23, 66 basic ... 55 call ... 13, 15, 17, 34,

44-47, 61,77 accurate ... 40, 43,

anyway ... 64, 75 basil ic ... 42 38, 40, 42, 48, 50,

2:00 ... 1~ 44, 54,76 aortic ... 43 Bates ... 88 56,68, 75

2:15 ... 19 accurately ... 6, ~4 apologize ... 80 became ... 15 called ... 11, 62

2:30 ... 40, 44, 45 acid ... 90 apparently ... 89 become .. . 10, 61 Can ... 5, 7, 13, 15-17,

2:43 ... 46, 47, 77 act ... 5, 13, 15, 16, appear ... 34, 58 becomes ... 16 . 20, 23-25, 30, 36,

20 ... 15, 17 30, 32 appearing ... 15

beer ... 60 39, 40, 43, 45-48,

2000 ... 7, 13 acting ... 17 appears ... 22, 31, 33, beers ... 61 50-52, 54, 55, 57,

2008 ... 15, 28-30, 44, actual ... 34, 54, 59,

38 believed ... 83 60-62, 64, 66-70,

53,57 60'

appreciate ... 19 bend ... 64,58 72-74, 78, 81-83,

2009 ... 25, 28-30 add ... 55

approximately ... 60, bet ... 64 87,88,90,92

2010 ... 31 added ... 7 64, 72, 73 big ... 45 cancer ... 70, 83

201 1 ... 6, 8 addiction ... 36, 59,

area ... 20,52 bilirubin ... 44, 90 capacity ... 14

26th ... 29,66 60, 89

arm ... 58, 88 bill .. . 18, 19 car ... 41,69

28th ... 8 addicts ... 88, 89 arms .. . 42, 58, 71, 79 Bills ... 8, 25, 26, 28, cardiac ... 43

29th ... 25, 28 addition ... 56, 59 arrested ... 77 30,63, 86 careful ... 24, 83

3 ... 19-22, 31-33, 49, address ... 83 artery ... 43 bins ... 28 Carolina ... 8

83, 93 administering ... 58 aspect ... 58 bit ... 20, 23, 24, 32, case ... 7-9, 14-17, 20, administration ... 30, 49, 61, 67, 69, 80, 26, 32, 34, 42, 43,



50-54, 68, 69, 86, come ... 7, 29, 38, 49, conversations ... 29, deeper ... 91 disciplining ... 10 90 50, 73, 75 30 defense ... 7, 52 discovery ... 5

cases ... 7, 13, 14, 64, comfortable ... 82 converts ... 39 degree ... 42, 71, 80, discussions ... 25 69 coming ... 38 convince ... 38 81, 91 disease ... 54

CAT ... 36,44 Comment ... 65 cooler ... 28 degrees ... 65 disparate ... 47 categories ... 64, 82 Commission ... 20 copies ... 33 dehydrated ... 84-86, distress ... 78 category ... 81 common ... 89 copy ... 6, 26, 29, 30, 92,93 diuretic ... 92 catheter ... 52, 58 communication ... 30 34,54,55,66,88 dehydration ... 85, 92, Divide ... 73 cause ... 36, 63, 69, communications ... 29 coroner ... 16 93 Doctor ... 6, 7, 9, 15,

80,92 company .. . 11-13 correspondence ... 21, DeKalb ... 11,12, 15, 17. 19-22, 24-27, caused ... 69, 91, 92 compare ... 54 25,27,29,31 16,22,27 31, 32, 34, 38, 39, caveat ... 19 compensated ... 14 Counselor ... 7, 12, 19, delineates ... 81 43, 52, 54, 55, 60, cells ... 40,44 complete ... 22, 55, 24, 28, 36, 40, 42, delineation ... 23 66, 71, 80,92, 93 Central ... 43 88 46, 60-62, 68, 69, delve ... 29 doctors ... 14, 19 Centrally ... 42, 43 compound ... 76 72, 76, 82, 83, 85, Dennis ... 30 document ... 7, 35, 53, certain ... 14, 20, 48, compounds ... 68 93 dependent ... 70 54

85 concentration ... 48, count ... 88 · deposed ... 5 documents ... 20, 22, certainly ... 16, 43, 63, 63, 85 counties ... 13, 14, 19, deposition ... 5, 7-9, 24,25,31,38

88 concentric ... 24 20 18-22, 31, 62, 93 · dollar ... 80 certainty ... 91 concerning ... 21 County ... 9, 11-16 depositions ... 7, 25 dollars ... 18-20 certificate ... 16, 22, 80 conclude ... 79 couple ... 5, 8, 31, 39, depressant ... 68 door ... 45 certified ... 10 concluded ... 93 50,91 depressants ... 68 dose ... 74 cetera ... 7 conclusion ... 79 course ... 48, 83 depression ... 77, 78 doses ... 86, 87 change ... 24 condition ... 84-86 court ... 13 deputy ... 13, 14 double .. . 35 changed ... 7 conditioning ... 79 cover ... 13 derangements ... 90 dozen ... 12 charge .. . 19 conducted .. . 32 crack .. . 59 describe ... 78 Dr ... 5, 12-14, 20, 23, charging ... 19 conducting ... 39 created ... 68 desk ... 23, 82 80,82 Charles ... 23 confirm .. . 15, 32 crime ... 26, 40, 42, 44, Desmond ... 6, 8, 16, drank ... 60 chart ... 18 confused ... 87 62,63,66,67, 72 16, 21, 26, 30, 31, draw ... 24, 41 cheap ... 40 consider ... 16, 20, criminal ... 7 36, 38, 41, 55, 57, drawing ... 58 check ... 14, 27, 35 26,68 critical ... 11 59, 60, 70, 75, 80, drawn ... 28, 42, 43, checking ... 27 consistent ... 92, 93 CROSS ... 5, 71, 76 81,84,89,92 45, 46, 65, 66, 71, Chemical ... 23 conspicuously ... 21 crusted ... 72 deteriorate ... 28 93 chief ... 11-14, 26 constantly ... 24 cubital ... 42 Deteriorating ... 51 Drew ... 6, 51, 52 chromatography ... 40, constitute ... 21 cull .. . 20 determination ... 16, drill ... 91

66,67 consultation ... 18 culled ... 46 17,33, 64 drink ... 61, 92 circles ... 24 consulted ... 68 current ... 6, 8 determinations ... 82 drinkers ... 61 circulating ... 73, 74 consulting ... 14, 32 custodian ... 30 determine ... 44, 63 drinking ... 60, 61, 69, circumstances ... 17, consume ... 61 cu t ... 36,68 determining ... 64 75

26 consumed ... 60, 61, cutoff ... 48 development ... 11 drinks .. . 69 civil ... 5, 7, 17, 20, 25, 87 cv ... 6, 7, 9 devices ... 54, 57 drug ... 23, 36, 43, 46,

37 consuming ... 77 D diagram ... 50, 53 48, 51, 52, 63-66, civilian ... 54 contact ... 17, 59

d.abbled ... 10 diagrams ... 50, 53, 54 70,77,83

civilians ... 39 contacted ... 15, 25, dictate ... 35, 50, 56 drugs ... 28, 42, 46, clarification ... 18 29 dally ... 83 dictated ... 56 51, 59, 64, 68, 70, clarify ... 65 contain ... 38, 64, 76 data ... 23,45 dictates ... 34 75 clerical ... 55 contained ... 22, date ... 9, 23 dictating ... 49 drunk ... 68 clerk ... 31 31-35, 38-40, 43, dated ... 25

dictation ... 50, 53 dry ... 61 clients ... 19 44, 49, 50, 53, David ... 8, 25

die ... 62, 67-70, 82, 83 DUI ... 39 Clinical ... 1 0 56,60,65 day ... 20, 34, 82, 84, died ... 6, 16, 68, 70 duly ... 5 clinician ... 11 contains ... 38 85 dies ... 16 duties ... 7, 37 close ... 41, 43-45 continue ... 58 days ... 14, 34, 76, 86

different ... 19, 21 , 27, dye ... 78 clothes ... 57 continued ... 80 dead ... 41,54 28, 40, 47, 64, 81, E clothing ... 50, 53 Continuing ... 73, 84, deal ... 45 82,86,87,90 cocaine ... 59 85 death ... 7, 15, 16, 22, differently ... 43 each ... 19, 24, 64, 74,

Code ... 15, 16 contract ... 12-14 30-32, 35, 36, 63, difficult ... 91 88

Cole ... 8 contracting ... 12, 13 64, 69, 72, 75, 77, directed ... 38 earlier ... 32, 44, 52,

collected ... 46, 52 contractor ... 11 , 13 80, 81, 83, 91, 92 directly ... 38 58, 78,81, 88,90

color ... 58 contributed ... 63 deaths ... 65, 67 director ... 1 0 early ... 60

combination ... 81 control ... 10 decides ... 15 directory . .. 10 earthly ... 37, 67

combined ... 68 controversial ... 57 decimal ... 24 disciplined ... 9 easier ... 60, 80 decision ... 16, 17, 36 easy .. , 40, 85

Elite Reporting, Jnc. 770-457-1276

hthhhhh tp://ReachingForTheTippingPoint.net

D

Eckl ... 6 93 25, 28, 42, 47, 54, gentleman ... 44 hard ... 41, 59, 66, 70 education ... 6 expensive ... 40 55, 57, 72, 77, 82, Geoffrey ... 12 Harris ... 5, 21, 80, effective ... 83 experience ... 6, 82 88-90 Georgia ... 5, 6, 8-10, 84-86, 91 eight ... 67, 70, 73, 74 expert ... 15, 17 five ... 12, 19, 20, 46, 15, 16,20,30,32 hate ... 90 eighty ... 60, 61, 66, explicitly ... 77 57, 61, 73, 74, 85, Gerald ... 5 head ... 36, 44, 54, 76

67,69, 73,74 exposure ... 84 90, 93 get ... 24, 26, 28, 34, healed ... 59, 71, 72 Eisenmenger ... 29 External ... 6, 35, 36, flag ... 44 40, 41, 43, 47, 48, healing ... 72 Eisenstat ... 12 38, 39, 49, 50, flagged ... 39, 43, 48, 58-61, 63, 66-69, healthy ... 36, 68, 70, elapsed ... 28 62-57, 78 49,90 73, 74, 76, 82-86 71,81 elbow ... 54, 58, 88 extra ... 26, 33, 54 flags ... 39 gels ... 15, 50, 69, 91 heard ... 8 elbows ... 79 eyes ... 58 Florida ... 29 give ... 11, 23, 37, 48, hearsay ... 56, 89 elected ... 86 F fluid ... 40, 44, 85, 92 53, 74, 77 heart ... 42 elevated ... 60, 93

face ... 38,39 fluids ... 86 given ... 7, 9, 20, 25, height ... 54

eleven ... 7, 61 fluoride ... 51 36, 43, 61, 69, 71, held ... 9, 10 eliminate ... 42 facilitate ... 37

focused ... 55 75,91 help ... 39, 76, 78, 87 email ... 31 facility ... 13, 83

folder ... 22, 46 gives ... 44, 53, 55 helpful ... 49 Emory ... 9 factors ... 16, 17, 70 folders ... 21 glad ... 83 helping ... 83 emphysema ... 70 failure ... 70

following ... 16, 65 go ... 10, 16-17, 19, hematocrit ... 66, 70 fair ... 7, 20, 21, 44, employed ... 12 55,63,87,89,92 follows ... 5 20, 23, 25, 31' 35, Henry ... 13, 14

employees ... 12 fairly ... 54, 68 Foods ... 8 37, 39, 47, 49, 50, Henson .. . 15, 26, 31 ,

EMS ... 32,41 Forensic ... 9, 10, 12, 54, 55, 57, 63. 66, 33, 38, 39, 57, 59, English ... 39 family ... 6, 32, 36-38, 27,64 70, 83,84,88, 93 60 enormous ... 36 80

forget ... 8, 64, 82 going ... 6-9, 14, 17, heroin ... 42, 58-60, enter ... 12 far ... 10, 27, 36, 54, form ... 5, 50, 53, 77, 19, 23, 24, 28, 29, 63, 64, 68-70, 76, entered ... 12 77,81 , 87 86 33, 34, 37, 40, 42, 82, 88,89, 91, 92 entire .... 18, 20, 21, 48 Farnham ... 6 formula ... 73 43, 45-48, 51, 54, high ... 11' 90, 93 fast ... 68 entities ... 6

faster ... 69 formulate ... 79 60-63, 65-69, 71' higher ... 66, 67 entitled ... 35

fatal ... 67 formulating ... 16 73, 75, 76, 78, 80, highl ight ... 45 enzyme ... 61

fatty ... 79 forth ... 90 82-87, 91-93 highlighted ... 46, 90

enzymes ... 61, 62, 75 favor ... 54

forty ... 45, 90, 93 gone ... 28, 62, 75 historical ... 36 equipment ... 44

fax ... 44 fossae ... 58, 71 Good ... 11 , 41, 64, 88 history ... 58, 59, 61

error .. . 55, 65-67, 93 faxed ... 39 fouled ... 50 Gowitt ... 5, 20, 80 hit ... 75

escapes ... 23 February ... 30 found ... 92, 93 gown ... 54 hils ... 45, 75

et ... 7 four ... 12, 18, 23, 39, graduated ... 9 hodgepodge ... 22, 50, ethanol ... 63, 80, 81 tee ... 14, 17-19 44, 57, 59, 69, 72, graduating ... 10 53 feel ... 22 evaluation ... 35

fellow ... 25 75, 76, 78, 90, 93 Grady ... 9 Hold ... 55, 59, 73, 90 evidence ... 17, 54, 72

fellowship ... 9 frame ... 28, 29 gram ... 75 holds ... 78

exam ... 49, 50, 52-54, felt ... 42

frankly ... 87 gray: .. 51 holes ... 71, 72 56,63

femoral ... 42, 43, 52 Friend ... 30 green ... 53 Homicide ... 64

examination ... 5, 6, front ... 34, 54, 55, 78 Gregory .. . 29 honest ... 45 34-36, 38, 39, 51, ffrey ... 12

full ... 22, 55, 85 groin .. . 52 honestly ... 36 54-57, 71, 75, 76, field ... 9, 10 Fulton ... 9, 14 group ... 11, 12 hope ... 85 78, 80, 88, 91, 92 fields ... 10 function ... 45, 70, 90, guess ... 18, 25, 26, hopefully ... 77

fifteen ... 78, 81 examine ... 54 fifty ... 19, 24, 65, 69,

91 37,50 Hospital ... 9, 10, 15, examined ... 93 functioning ... 90, 91 guessing ... 78 22, 32, 36, 38-44, Examiner ... 11-14, 16, 73

functions ... 44 Gwinnett ... 13 . 48, 51, 54, 58, 62, 37 f igure ... 63, 72

further ... 60, 69 H 63, 65, 71 , 78, 79, example ... 11, 32, 60 file ... 6, 18, 20, 21,

Furthermore ... 68 84, 88, 91-93 25, 27, 29, 31, hair ... 43, 58 Excellent... 18 34, 38, 50, 53, G half. .. 12, 19, 39, 74, Hospitals ... 9

except ... 5,36,64 hour ... 18, 19, 46, 61, excess ... 87 54,87,88 gain ... 56 85 69, 78, 80 exclude ... 87 final ... 65 gas ... 40, 66, 67, 78 halfway ... 60, 75

hourly ... 18 exclusively ... 89 finalize ... 35 gases ... 90 Hall ... 13, 14

hours ... 36, 59, 60, excreted ... 4 7 find ... 25, 37, 50, 59, gauze ... 78 hand ... 6, 33, 87 62, 72,84,85,93 Exhibit ... 6, 8, 20-22, 71,72,78 gave ... 6 , 88 handed ... 87

house ... 60, 75 26, 29, 31-35, finding ... 75 GBI ... 14,43 handle ... 13

hundred ... 18-20, 24, 49-51, 54, 55, 62, findings .. . 78 general ... 42, 56, 57 handles ... 31 57, 60, 61, 64, 65, 65-67, 87, 88 fine ... 21, 55, 57, 70, generally ... 26, 31 , 34, hands ... 11

70, 72-74, 85 exhibits ... 20 90 35, 40, 42, 50, 67, handshake ... 13

hybrid ... 25 expect ... 67, 68, Fire ... 22 7o, n . s2 handwritten ... 35, 49,

HYNES ... 21, 73, 76, 70-73, 76, 82, 92, firm ... 6, 31 generate ... 31 50, 53

80 first ... 5, 1 9, 21, 23, generated ... 31, 33, 56 hang ... 26


http://RRRRReaeaeeachchchchchininii gFgggg orTheTippingPoint.net

identification ... 6, 8, 21, 26, 33, 35, 51, 54,65, 87

identified ... 63 identifies ... 8, 51 illness ... 70 illnesses ... 83 imagine ... 52 70 immediately . .'. 84 implementation ... 11 importance ... 45 ~mportant ... 22, 45 Impress ... 26 impromptu ... 13 Inc ... 8 inches ... 57 inconsistent ... 92, 93 Incorporated ... 12 increased ... 62 incredible ... 65 increments ... 18 indicated ... 74 indicating ... 68, 78 indication ... 42 Infer ... 46 infliction ... 72 ingested ... 77, 78 89 91 I I

ingesting ... 77 initial ... 33, 35 46 initials ... 57 ' initiated ... 15 injected ... 79 injection ... 79 injury ... 78 inquiry ... 6 Insertion ... 58 Intake .. . 33 integrity ... 28 interferes ... 51 internal ... 1 o interpret ... 91 interruption ... 84, 85 Interviewed ... 32 intoxicated ... 39 intoxication .. . 36, 63,

68, 77, 80 introduced ... 5 Investigation ... 16, 32

33 •

investigator ... 15, 17 25, 26, 33-35 56 57, 59, 60 f I

investigators ... 16 issue ... 72 IV ... 58, 74, 78 IVs ... 84

J JCAHO ... 11

jewelry ... 57 jobs ... 10 John ... 15, 26 31

33,34,381

'

Jon ... 12 Joseph ... 13 July ... 29, 66 June ... 15, 39, 40,

44,53, 75,77 junk ... 76 jurisdiction ... 15, 16

33,65 ' justify ... 19

K KH ... 57 kidney ... 70, go 91 kidneys ... 45, 4l 90

91 • f

kill ... 68, 81 kilogram ... 73 Kirk ... 8, 25, 26 knowledge ... 30, 31

89 I

knows ... 41

L lab ... 11, 26, 38-40,

44, 45, 52, 63, 65-67, 72, 80 84 87, 88, 90, 9{ 93

label ... 49 laboratory ... 1 o, 11,

36,62 labs ... 45, 48, 80 lack ... 91, 92 largely ... 10 !ale ... 76 later ... 27, 39, 45, 56

76,77 I

lateral ... 58 lawsuit ... 6, 25 lawyer ... 5, 29 lawyers ... 29 layperson ... 42 leading ... 86 league ... 70 leaves ... 16 led ... 79 left ... 14, 58 legal .. . 39 length ... 57 lengthy ... 7 lethal ... 23, 24, 68,

81, 82 letter ... 10, 25, 26,

30,63,86 letters ... 30 level ... 23, 28, 40, 43,

44, 48, 64,67-70 76, 82, 85, 90 I

levels ... 23, 27, 41 , 44, 52, 53, 69, 79, 81-83, 86 90 93

licence ... 9 ' ' licensed ... 9 licenses ... 9 lid ... 83 lifetime ... 61 Likewise ... 93 limit ... 39 line ... 90 list ... 7, 8 listed .. . 80 lists ... 82 liter · · · 24, 66 67 69

70, 72-74, 79 80 85 I I

literature ... 81 liters ... 72-74 85 liver ... 44, 45: 47, 61,

62, 70, 75 long··· 10, 12, 37 41

45,89 f '

longer ... 14, 16, 25 look ... 6, 12, 23, 25,

40, 44, 45, 49, 50, 54, 56, 60, 65, 77, 82,88,90

looked ... 11, 24, 27, 44,59,68,87 90

Looking ... 18, 21,'36, 54,59, 79

loosest ... 41 lot ··· 6, 14, 23 24 26

36, 45, 69: eo: 8z: 86

low··· 11, 24, 67, 69, 70, 90

lower ... 28, 40, 44, 63 66,70 •

M M.D .... 6 M.E .... 22 machine ... 40 67 machinery ... 44 maintain ... 20 33 major ... 70 ' make··· 10, 16, 20, 29,

32, 48, 49, 68, 73, 77, 80, 82, 84-87

making ... 17, 61 54 68 • •

male ... 67, 68, 72, 73 MAM ... 64,76 man ... 17, 58, 81, 84 manager ... 29 manilla ... 38, 46 many··· 11, 12, 36, 37,

58,64,65, 72,85 margin ... 67, 93 marginal ... 91


Marie ... 59, 89 mark ... 6, 8, 20, 26,

33,34, 50,54, 65 87 '

marked ... 6, 8, 21, 22, 26, 33, 35, 38, 44, 46, 51, 53, 54, 62, 65,66, 87,88

marks ... 58, 88, 89 MARSCHALK ... 5, 20,

21, 46, 71, 86, 91 -93

mass ... 66 mater .. . 11 matters ... 60 means ... 44, 64 meant ... 58 measure ... 48 measurement ... 79 measures ... 48 meat ... 55 mechanism ... 36, 84

87 •

medical ... 9-14, 16 , 22, 27, 29, 37, 40, 54, 57, 62, 71, 78, 80,81,88,90 91

medications ... 23' medicine ... 10, 12, 27

37 I

meet ... 8 meeting ... 26, 28 meetings ... 28 mega ... 86, 87 members ... 37 met ... 7, 26 metabolite ... 76 metabolize ... 48, 61

64 I

metabolized ... 47 methodology ... 67 metro ... 20 microgram ... 70 micrograms ... 24, 66,

67, 69, 70, 72, 74, 79,80,85

microscopic ... 11 milligram ... 74 milligrams ... 24, 39,

74, 79 milliliter ... 24, 80 Mills ... 49 mine .. . 75 minimum ... 19 minus ... 66 Miscellaneous ... 22 missing ... 21. 54 mistake ... 65 MOM ... 64 money ... 20, 63 monoacetyl morphine

... 64 month ... 10, 60, 61,

68, 75, 83 monthly ... 14 months ... 11 morning ... 13, 60 morphine ... 23 28

42, 43, 6o,'s2-e4 66, 68-70 72 I

74-77, 79~87,.91 motor ... 40 much··· 15, 23, 26, 28,

32,36,40,54,55 60, 67, 73, 82, 83

1

85,90 ' multiple ... 75, 84 88 multiply ... 73 ' . N

nail ... 60 naive ... 68, 69, 82 named ... 89 names ... 14 nanograms ... 24, 80 Narconon ... 6, 29, 30

83,86 ' narcotic ... 59 narcotics ... 60 natural ... 16, 54, 64 necessary ... 37 needed ... 37, 53 needing ... 45 needle ... 52, 58 neutral ... 7 nevertheless ... 86 NHS ... 38,46 niacin ... 86 nice ... 55 night ... 60, 69 91 nine ... 90 ' ninety ... 73 Nobody .. . 20, 38 nonnatural ... 16, 16 nonnaturally ... 16 normal ... 44, 45 61

62,67, 7o,9o, 92 93 I

normally ... 57 Northside ... 15, 16,

22,32,38,39,41 44, 46, 48, 88, 93

1

Nos ... 65 note-·· 26, 49, 57, 58,

62 noted ... 16, 40 45 58

64 O 0

I

Notes ... 35, 39 49 50, 53, 58,

1

78 ' notice ... 5, 21 Notification ... 35 notifying ... 11 November ... 30


numbers ... 67 P.M .... 15, 53, 93 50,56,57,59 60,62,65,66, 72 nurse ... 15 paid ... 20 place ... 20, 28, 49, 59, reportable ... 15 nurses ... 32, 49 particularly ... 22, 36, 79

quality ... 10 reported ... 11, 15, 24,

0 69 placed ... 63 quibble ... 86

39, 45, 48, 60, 64, parties ... 5, 7, 20, 29 Plaintiff ... 7 69

O.C.G.A. ... 17 party ... 15, 17 play ... 43 quick ... 23, 24, 29, 49, reporter ... 72 Object ... 86 50

reports ... 24, 34, 54, passed ... 60 plethora ... 46 quicker ... 61 objections ... 5 Pat ... 31,53 pointing ... 46 quickly ... 78

62, 63, 65, 87, 88, obtain ... 42 pathologist ... 10, 37, points ... 24 90 obtained ... 59 64 policies ... 11

quote ... 61 representat ion ... 30

occasionally ... 10, 13 pathology ... 9, 10 portion ... 22, 38 R request .. . 29, 30, 37 occasions ... 75 patient ... 60, 71, 83, positive ... 28, 46-48, raises ... 10 requested ... 27, 29-31, 00 ... 43,51 87,92,93 53,58,66, 77 ran ... 93 36 of.15 ... 67 Patrick ... 6, 15, 17, possession ... 20, 52 range ... 67, 68, 70, requests ... 31 office ... 9, 14, 15, 27, 21, 27, 30, 31, possibility ... 42, 43 80,82,88,93 require ... 14

29-32, 39, 49, 52, 38,44,55, 70 . Post ... 25, 26, 29 ranges ... 82 Rescue ... 22 62-64, 66, 67 pay ... 66 postmortem ... 42, 43, rate ... 18, 28, 66 research ... 23, 24, 32

official ... 7 PCo2 ... 90 65 reality ... 84 reserve ... 5 often ... 11, 17 pee ... 92 potential ... 42, 43, 51 reason ... 23, 37, 39, residency ... 9 old ... 23, 67, 70 peek ... 23, 29, 50 pounds ... 57, 60, 61, 49, 74,82 residing ... 60 one ... 7, 12, 17, 19, pending ... 65 72 reasonable ... 71, 80, resource ... 82

21' 23, 26, 30, 32, people ... 11, 16, 23, power ... 37, 61 81, 91 .respect ... 6, 39, 40 34, 36, 38, 39, 36, 37, 49, 60, practice ... 5, 37 receive ... 86 respiration ... 91 42-44, 46,48-51, 67, 74,83,86,89 practiced ... 10 received ... 29, 35, 48, respiratory ... 68, 77, 53, 56, 57, 59-61' percent ... 39-41, 51, prefer ... 5 51,53,63, 66 78 64, 66-69, 73-75, 66,93 preparation ... 24, 34 receiving ... 83 responded ... 30 77, 81, 92, 93 perfect ... 9, 34, 85 prepared ... 7, 34 recent ... 59 response ... 27

ones ... 7, 9, 45, 63, perfectly ... 27, 44 preparing ... 22 recently ... 75 responslbflitles ... 10 80,87,88,90 perform ... 16, 34, 37, presence ... 48, 63 recommended ... 87 responsiveness ... 5

online ... 32 38,40 present ... 49, 50 reconstruct ... 50 result ... 40, 77, 93 open ... 30, 36, 37 performed ... 33-36, presented ... 84, 86 Records ... 16, 22, resulted ... 77, 81 opening ... 37 40 presents ... 84 29-32, 38, 39, 44, results ... 38, 39, 47, operating ... 40 perhaps ... 28 preseNative ... 28, 51, 46, 49, 50, 60, 63, 63,66 opiate ... 42, 47, 63, period ... 41, 62, 75, 53 83 resuscitated ... 41

64,68 86 pressure ... 41 , 91 recreate ... 53 retain ... 25 opiates ... 42, 46, 47, peripheral ... 42, 43, presumable ... 84 recreating ... 53 retained ... 7, 9, 15, 17,

58,60,66, 79 51 pretend ... 83 RECROSS ... 91, 92 62 opinion .. . 76-81, 92 peripherally ... 42, 43, printouts ... 23 red ... 51 rev ... 61 opinions ... 71, 91 51 prior ... 13, 77, 83 redistribution ... 42, 43 revamped ... 11 opioids ... 66 permission ... 37 private ... 37 redness ... 72 revert ... 61 opposed ... 50 person ... 54, 57, 60, probability ... 71, 80, reduce ... 85 reviewed ... 39, 88 orange ... 50 70, 71,74, 82,85 81 references ... 32 revised ... 6, 11 order ... 82 personal ... 32 problem ... 16, 36 reflect ... 6 revision .. . 11 ordering ... 26 Personally ... 19 problems ... 36, 83 reflective ... 76 rewed ... 75 organization ... 11 personnel ... 58 procedures ... 11, 62 reg imen ... 86 rings ... 53 organized ... 21 pH ... 42,90 proceed ... 15 Regional ... 10, 20 Robert ... 49 organs ... 45 phosphatase ... 44 produces ... 44 regularly ... 61 Rockdale ... 13, 14 original ... 6, 20, 24, photograph ... 59 product ... 66 rehab ... 59, 61, 68, 89 role ... 10, 43

34,43,46 photographs ... 49, program ... 83, 89 relationship ... 13 run ... 9, 40, 63, 64 originally ... 28, 29 53,59 properly ... 90 Released ... 53 runs ... 88 otherwise ... 36, 68, 70 Photos ... 22 prorated ... 19 rely ... 43, 52 s outcome ... 82 phrase ... 35 protein ... 44, 90 relying ... 35

sake .. . 37 outlines ... 48 physical ... 54 provide ... 14 removed ... 21 Sail ... 14 outlining ... 82 physician ... 9 provided ... 36 renal ... 45, 47, 70 sample ... 28, 40, 62, overdose ... 64, 86 physicians ... 12 publications ... 6 rendered ... 81

74 overdoses ... 69 physiological .. . 87 pull ... 23, 26, 50 repeated .. . 70, 83, 84 samples .. . 26, 28, 51, . overdosing ... 84, 87 pick ... 15 pulse ... 41, 91 repeatedly ... 71

76 overlap ... 24, 82 picture ... 69 puncture ... 54, 58, 75, replaced ... 86 sauna ... 83-85 oversee ... 10 pictures ... 54 78, 79 report ... 21, 22, 29, saw ... 10, 11, 52, 54, own ... 12 pinholes ... 88 pure ... 89 30, 32-35, 40, 43,

71,82,86 p pink ... 34, 35, 38, 39, pursuant ... 5, 30 44, 50, 64-57, 59, scan .. . 36, 44



De

scar ... 89 significant ... 36, 43, straight ... 67, 91 therapeutic .. , 23, tripped ... 43 schedule ... 17 68,75,90 strange ... 13 68, 70, 74, 78, 81' Trisha ... 15 scheduling ... 31 significantly ... 63, 93 strike ... 74 82 trouble ... 75 school ... 9, 10 signs ... 72 structure ... 18 therapeutically ... 89 lube ... 51 screen ... 46, 47, 66, similarly ... 52, 86 structures ... 19 therapy ... 83 lubes ... 28, 51

77 simply ... 35, 48 stuck ... 43 therefore ... 61, 69 turgor ... 92 screens ... 46, 77 site ... 10 studies ... 36 the;:;e ... 16, 23, 28, 31, turn ... 55, 65, 90 second ... 45, 55, 59, sites ... 79 subjected ... 83 39, 45, 58, 61' twelve ... 65

77, 78 sitting ... 8 subpoena ... 83 65-69, 82, 88, 93 twenties ... 72 Secondly ... 42 situation ... 15 substances ... 27, 77, thinned ... 7 twenty ... 10, 20, 36, seconds ... 68 six ... 11, 12, 27, 73, 78 third ... 45 51' 52, 59, 67, 70, secretaries ... 34, 56 74,90,93 successfully ... 41 thirty ... 68, 75, 90, 93 72, 78 secretary ... 55 sixteen ... 62, 67 suffering ... 60 thousand ... 19, 20, 73, twice ... 85 security ... 14 size ... 60 sufficient ... 81 74, 80 two ... 12, 27, 39, 43, see ... 6, 10, 12, 23, skin ... 92 sugar ... 81 threatening ... 83 46, 53, 57, 61, 62,

24, 29, 39, 40, 45, skull ... 58 Suicide ... 64 three ... 12, 20, 23, 33, 65, 68, 69, 72, 73, 52, 55, 58, 59, slightly ... 44, 61 suit ... 37 51' 54, 65, 69, 75, 77,81,88 65-67, 78, 79, slower ... 28 summary ... 48 76,82,85,90 typed ... 49 88-90 small ... 71 supervisor ... 11 tick ... 20, 21 types ... 17, 28, 56, 64,

seeing ... 31, 45, 75 smaller ... 58 supposed ... 88 time ... 9, 10, 13-15, 70 seen ... 54, 58, 67, 69 smart ... 19 suprapubic ... 52 20, 23, 28-30, 34, typewritten ... 35, sent .. . 29, 30, 39, 42, smidgeon ... 44 surveys ... 10 35, 38-41' 45, 46, 54-57

62 Smith ... 12 Susan ... 30 48, 51' 52, 54, 56, typically ... 34, 56, 68 separate ... 11, 20, 21, social ... 14 susceptible ... 84-87 59, 61-63, 68, 69, u 24,64 sodium ... 51, 93 swear ... 5 72, 75, 77-79, 82,

ug ... 72, 79, 80 separately ... 20, 23, solely ... 44 sweating ... 86 88, 89, 92 54,65 someplace ... 38 sworn ... 5 times ... 39, 41, 69, 73, understood ... 69, 91

September ... 6, 8, 29 somewhat ... 6 system ... 47, 61, 74 Undetermined ... 64 unethical ... 19 serious ... 83 sophisticated ... 40 74-76 tiny ... 54, 58, 59 unfortunately ... 25 serum ... 40 sound ... 13 T tissue ... 79

service ... 15 sounded ... 36 tilfe ... 34 units ... 24, 72, 73, 80

services ... 14, 37 sounds ... 19 tab ... 45 'titled ... 55 University .. . 9

set ... 87, 88 source ... 24, 31, 42 tabbed ... 46

to9ld ... 52 unless ... 37

seven ... 19, 90 sources ... 31, 32, 82 taking ... 60, 64, 75 today ... 8, 10, 14, 15, unquote ... 61

seventeen .. . 18, 64 sparingly ... 66 TANNER ... 20, 37, 20-22, 24, 28, 48, update ... 8

seventy ... 57, 73, 90 special ... 24 71-73, 76, 86, 92, 71,80 upper ... 58

several ... 34, 53, "75, specific ... 30, 36, 40, 93 toe ... 54 urinalysis ... 11

80,85 78 tape ... 50, 79 tolerance ... 62, 70 urine ... 40, 46-48, 51,

severe ... 92, 93 specifics ... 9 taped ... 78 tolerate ... 61, 70, 82 52,58,62, 76,77

severely ... 85, 93 spectrometry ... 66 tattoo ... 58 tomorrow ... 13 user ... 68, 69, 82

share ... 88 spelled ... 12 tattoos ... 50, 53, 54 took .. . 9, 28, 33, 63, uses ... 83

sheet ... 34, 35, 38, 39, spelling ... 12, 14, 23, tech ... 49 69, 75,79,86 using ... 42.-44, 76 technical ... 43 v 50, 63-57, 59 82 technically ... 41

lop ... 24, 51, 67 sheets ... 50 spend ... 18, 63 total ... 44, 73-75 valuables ... 53 shock ... 45, 75 spill ... 47 techs ... 50

town ... 6, 13 value ... 44, 63, 76 shocked ... 23 spoken ... 32 telephone ... 59 tox ... 43, 44, 46, 54, values ... 11,45 shoot ... 69, 79 stack ... 87 telling ... 66, 82 62,63 variable ... 75 shooting ... 69 staff ... 26 temperatures ... 85 toxic ... 23, 24, 68, 82 variables ... 69 shortcut ... 6 standard ... 79 ten ... 7, 20, 23, 61 toxicology ... 23, 32, variety ... 70 term ... 79 shot ... 69 stands ... 79

terminal ... 70, 83 34,62,65,68 vehicle ... 40

show ... 8, 19, 36, 46, start ... 55 terms ... 82

track ... 88, 89 vein ... 42, 43, 75, 79 66,92 started ... 6, 39, 84

terrible ... 45 transcribe .. . 34 veins ... 79

showing ... 36, 53 state ... 20, 36, 40, Terry ... 13

transcribed ... 57 Verges ... 59, 89 shows ... 47, 53, 72 62,63,66,81

test ... 40, 47, 64, 66 transport ... 15 versus ... 8, 36, 40, 42,

sick ... 62, 70 statute ... 16 tested ... 41, 48, 63, 67

trauma ... 17,54 51,81 side ... 7, 20 statutory ... 16

testimony ... 7·9, 19, treated ... 89 Veterans ... 9

sign ... 16, 34, 35, 53, step ... 69 treating ... 86 vicinity .. . 74 57,65,92 stick ... 42, 52 20,43,88

treatment ... 78, 83 Viera ... 29 signature ... 5, 56 sticks ... 51 testing ... 27, 63 tree ... 17 visit ... 10 signed ... 33, 72, 80 stopped ... 77 tests ... 11, 26, 61, 63, trial ... 18, 19 vitamin ... 86 93 significance ... 39, 48 stored ... 28

Theoretically ... 92 trials ... 7 vitamins ... 86, 87



Walk ... 55-57 wants ... 27 water ... 40, 44 week ... 14 weeks ... 75, 76 weighed ... 57 weight ... 54, 73 welcome ... 27 whatsoever ... 89 Whereas ... 40 whereby ... 84 Whereupon ... 5, 46,

80,84, 85,93 white ... 13, 55, 78 whole ... 26, 40, 45, 85 wife ... 12 Will ... 5, 7, 20, 23, 45,

48,50 window ... 78 Winek ... 2.3 wisely ... 37 wish ... 80 withholding ... 13 witness ... f5, 17, 46,

73,86 woman ... 30, 89 word ... 8, 41,43 words ... 16, 18, 19,

32, 48, 59, 72 work ... 11, 12, 18, 45,

46, 61, 70, 84, 90, 91,93

works ... 34 world ... 70 worthy ... 68 wound ... 78 wounds .. . 54, 58, 75,

79 wrist ... 78 write ... 10 writing ... 35 written ... 13, 23, 34,

36 wrongful ... 7 wrote ... 24

y year ... 7, 11, 28, 64,

65,67, 70 years ... 7, 10, 23, 27,

28,88 young ... 17, 81 yours ... 54, 75

z Zaki .. . 14 zero ... 68, 77, 91


10A28641 2 2011-09-28 DepositionOfDrGeraldTGowittMD Ocr

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Transcript of 10A28641 2 2011-09-28 DepositionOfDrGeraldTGowittMD Ocr