IN THE CIRCUIT COURT OF THE SIXTH JUDICIAL CIRCUIT IN AND FOR PINELLAS COUNTY, STATE OF FLORIDA STATE ATTORNEY'S INVESTIGATION IN RE: LISA McPHERSON.. SWORN STATEMENT OF: TAKEN BY: DATE: TIME: PLACE: JOAN WOOD, M.D. DOUGLAS E. CROW, ESQUIRE Assistant State Attorney Criminal Justice Center 14250 - 49th Street North #1000 Clearwater, Florida 33762 June 1, 2000 10:15 a.m. to 12:30 p.m. Office of the State Attorney 14250 - 49th Street North, #1000 Clearwater, Florida 33762 REPORTED BY: Carla Jessal, RPR Notary Public, State of Florida at Large ORIGINAL Pages 1 through 68 KANABAY & KANABAY COURT REPORTERS (727) 821-3320 APPEARANCES: DOUGLAS E. CROW, ESQUIRE JAMES A. HELLICKSON, ESQUIRE Assistant State Attorneys 14250 - 49th Street North, #1000 Clearwater, Florida 33762 Counsel for the State DIANE BAILEY, ESQUIRE Bailey & Eckert, P.A. 200 Central Avenue, Suite 2200 St. Petersburg, Florida 33701 Counsel for Dr. Wood JAMES B. THOMPSON, JR., ESQUIRE JEFFREY M. GOODIS, ESQUIRE Thompson, Goodis & Thompson, P.A. 333 Third Avenue North St. Petersburg, Florida 33701 Counsel for Pinellas County Medical Examiner's Office PROCEEDINGS Thereupon, JOAN WOOD, M.D., the witness herein, being first duly sworn on oath, was examined and deposed as follows: EXAMINATION BY MR. CROW: Q. Would you state your name for the record? A. Joan Wood. Q. And, Dr. Wood, you're the Chief Medical Examiner for Fifth District? A. Sixth. Q. Sixth district. I should know that by now. And how long have you been Chief Medical Examiner? A. Since August of 1982. Q. I recall reading, I think from Bant's deposition, Mr. Weinberg representing that you had no board certifications. So let's clear that up right away. As I recall, you're board certified in clinical and anatomical, but you don't have a board certification in forensic? A. That's correct. Q. But you've been practicing in forensic for how many years now?. A. 25 years plus. Q. We're here taking an investigative statement; discovery hasn't been invoked. Jim Hellickson is working with me on the forensic issues in the Lisa McPherson case, and I want to talk to you about the changes in the autopsy report, get some explanations, and discuss that with you. And we also want to talk a little bit about the original autopsy and the original death certificate. I think I'll start out there to try to get a little chronology to it. Let's start out talking about Dr. Robert Davis. He was employed by your office for several years? A. Yes. Q. And in reviewing his personnel file, it appears that there was a fairly constant series of difficulties with him. A. Yes. Q. Including at least one point where he is arrested for trespass at I think an American Legion or a bar? A. A place like that. I can't say the name of it. Q. And I don't want to try to characterize it in too much detail, but there was at least in his personnel file a fairly detailed list of events from Larry detailing problems with him getting along with other people, him getting along with people outside the office, his interpersonal skills, and there was some, it looked like, unresolved concerns over alcohol use. A. Yes. Q. And at some point in 1995 was there a decision to terminate him or ask him to resign? A. Yes. Q. Now, that did not occur, apparently. It looked like that you retained Bob Walker -- A. Yes. Q. -- who, I guess, specializes in employee relations cases, and Dr. Davis retained a lawyer, and there was some indication from Dr. Davis' lawyer that he might have a claim under the ADA because he had been diagnosed with bipolar disorder or I guess what we used to call manic depression. A. Yes, that's what he stated. Q. And that resulted in a decision to have him stay on for almost another year. A. I don't have the file in front of me. Q. Okay. A. I don't recall it being that long. The decision was that rather than have a lawsuit from him, rather than go through an ADA action, that we would work out a situation. He had a daughter; he was divorced; he had three children. His youngest child was a girl with some type of learning and/or emotional problems who was attending a special school and living with him. We agreed to allow him to stay on for what I recall to be a short period of time, say from March until the end of the school year. That could be wrong. I don't have the paperwork in front of me. Q. Okay. A. And that he would leave at the end of that time. Q. Well, my recollection is a little bit -- I don't know the time -- that the initial discussions about firing started in '95, and then maybe in August or September is when this agreement was reached, and he stayed until the end of the school year. A. If you have the paperwork, your recollection may be better than mine. Q. Well, at any point -- A. Well, he -- well, that's possible, yes. Q. Well, let me see. This is a copy of the personnel file. Here is -- this is just one date that kind of references it. That's the, I think, detailed memo from Bob Walker that kind of sets forth some of this. August '95 is the date on that. You can look at anything you want in there. He actually left in May of '96. Does that sound approximately right? A. Yes. Q. And the point I was getting at is that it was in this interim period after the problems had come to a head -- there had been a decision to terminate him and an agreement to keep him on -- that he was assigned this case and did the Lisa McPherson autopsy in December of 1995. A. Yes. Q. And, again, my recollection is -- I may be off by a week or so -- he left in approximately May of 1996, and he had, according to his testimony, 24 or 25 autopsies at the time he left that had not been signed out, had not been finalized -- I'm not sure I'm using the correct term there -- and that Lisa McPherson would have been one of them. Does that sound approximately right? A. Yes. Q. Okay. A. I'm not certain. Q. The exact number is not particularly important to me. A. Then the answer is yes. Q. He made a number of accusations initially in the deposition and now at least one affidavit that I have -- I think he signed multiple affidavits -- that are inconsistent with some of the things you told me and inconsistent with some of the things that Larry Debore documented in the file. So we have some substantive and some non-substantive disputes between you and Dr. Davis, and I'm just trying to resolve that, if it can be resolved, or if he's just absolutely wrong, then make that decision. I want to ask a little bit about how this initial autopsy report got done and what your procedures were for the autopsy that he had outstanding. My recollection is that you signed out Lisa McPherson -- and signed out, again, may be the wrong term, but you signed out the autopsy on October 30th of 1996. A. Yes. Q. And there was a mistake, a miscommunication between you and Wayne Andrews, that resulted in that being released publicly. A. Yes. Q. Between Dr. Davis' leaving in the spring of that year and your signing it out, what discussions, if any, had you had with him about resolving that autopsy report, about him making a final -- well, what was left for Dr. Davis to do or not do in that case to finalize that case? A. I made the decision to finalize the case. I reviewed everything; I reached my conclusions; I called him; I told him what my conclusions were. He told me he agreed, and I signed out the case. Q. When you say you reviewed everything, that would mean the slides and the photos? A. Yes. Q. And your recollection is you were present during the autopsy and actually saw Lisa's body. Prior to autopsy, during autopsy, or -- A. I was present during portions of the autopsy. I was not there for the entire autopsy. Q. Okay. I guess what my general question is, is you didn't sign out any of his other cases; this is the only one that you signed --or did you? A. No, not that I recall. Q. And why did you do that in this particular case? Was it that he was not finalizing, was he failing to do something, or what was the reason that this was handled, at least superficially, different than the others? A. He had been gone several months. Significant, I felt, additional information had come in that had not available to him when he left. And as to specifically why I didn't send it to him, I cannot tell you. I just made a decision he's been gone several months now; I have everything here; I will take care of this. Q. Okay. And the additional information would be, in general terms, what? A. The additional information from the police as far as what information had been gathered about what had occurred during the time between the accident and her death. Q. Okay. Did you actually have police reports at that time or just oral reports from some of the detectives, or do you recall? A. I'm not certain. I think police reports, but I'm not certain. Q. It's my recollection -- and the reason I preface that is because after three years in the case, you know, Mark was involved early on and some of the early stuff I wasn't involved in detail -- that it was not until probably several months after the autopsy was signed that we knew of the existence of the caretaker notes and we knew some of the details of what we now believe happened to Lisa in her care. Just in general, what types of information did you have that would be pertinent to making a decision that there was bed rest and dehydration, or did that really not affect the conclusion? A. I do not recall. Q. Okay. A. I felt the case had been outstanding a year. It may have been, as I think back now, that we were getting no more information, that it appeared we had a blank slate in terms of information, and I made a decision, Look, you know, this has been sitting here long enough. We're just going to go ahead and sign it out because who knows what else we will get. I'd have to look at the file to see what came in and when. Q. Okay. A. It may well be that that was the case. Q. Okay. But it sounds like from what you're telling me, other than this conversation on the day or approximately the day you signed it out in which he acquiesced or agreed with your conclusions, you really didn't have any detailed discussions with Davis about what the cause of death was or what new facts had come in. There weren't any discussions -- nor did you say, "Can you finish this up?" This is something that you took on yourself? A. No, I know I didn't say, "Can you finish this up," and I don't recall any other conversations. Q. Okay. He has indicated in affidavit and also, I believe, in his sworn testimony -- you've read it, so I'm not going to try to quote it exactly -- that you never contacted him prior to signing out the case. And I think in his affidavit he even says that's a violation of the administrative rules because you didn't do that. Is that an inaccurate statement on his part? A. Yes, it is. Q. You are confident -- as I recall, you showed me a phone toll of October 30th from your office to his office that represented the phone call that you're talking about. A. I don't recall that. Q. Okay. But you're not saying -- A. But I know I spoke with him. Q. One of the things that was confusing to me -- there's no question in your mind that that conversation occurred? A. Absolutely none. Q. One of the things in going over at some point in time -- and I'll have to see if I can find it.-- that public records deposition, and I know that was kind of an arduous process, but my recollection from that is that at that time, which would have only been a couple months after it, you indicated that you hadn't talked to him. Let me get that and have you read it. I don't know if that was just a mistake or I'm misreading it. So let me see if I can find that. I've got it on page 82 and 83, and if you want to read a little before that and a little after. I don't think I've taken it out of context. I have Mr. Weinberg asking you: "Did you discuss the conclusions on the first page of your autopsy report it says severe dehydration and bed rest with Dr. Davis prior to issuing that? And your response being: "Not immediately prior to issuing it, but prior to his leaving our office, yes." A. I don't understand because he had left the office months before I issued it. Q. Well, I didn't understand it either. That's why I'm asking you about it. A. I don't understand it. I know I spoke with him before I finalized that front page of the autopsy and the death certificate. Q. Okay. A. And I would have to go through the rest of this to see if there is any other reference. Q. So his recollection -- his indication that you didn't talk to him prior to signing out is absolutely incorrect? A. Absolutely incorrect. Q. He also in the latest affidavit -- and I've got it here if you need to review that because I'm paraphrasing -- indicates, as I read it, that he made repeated requests to have access to the Lisa McPherson file after he left and was told by the head secretary, Well, that's locked up in Mr. Bedore's office. Is that true? A. To the best of my knowledge, not only is that not true, but the file, the microscopic slides, and his personnel file were sent to him via Fed Ex in the fall of the year after he left. Q. Actually, I believe the time frame on that is probably in either December or January after the autopsy report becomes public, according to -- A. Yes, it is after that time. Q. And in the affidavit, as I read it, he is talking about before you signed it out he is trying to get access to it, and he's either denied or told the file is in Bedore's office. That's how I read it. Do you want to look at that affidavit? A. There is no reason for anyone in my office to have told him he could not have access to that file before it was signed out. Q. Okay. So, as far as you know, there is no basis for that statement? A. No basis. Q. Okay. He also indicates that -- you mention that -- and I have a copy of Larry Bedore's notations in the M.E. file if you need to review that for time frame or anything. A. That might be helpful. Q. These are copies that were provided to us. Indicated in your file is investigative follow-up notes, which I assume that Larry -- those almost all appear to be his notes. MR. THOMPSON: I'm not sure what the question is. MR. CROW: Well, I haven't asked one yet. She said she wanted to review it, so I thought I'd let her review it before I asked it. THE WITNESS: Go ahead. BY MR. CROW: Q. My recollection is that you had thought it was the fall after he left in '96, but I believe, if you check, you'll find that Larry's notes indicated that you got a call December 21st of '96 from Dr. Davis indicating that he -- as a matter of fact, that orange tab there may be where it starts. A. 0819 hours, yes. Q. Indicating an investigator for the Church of Scientology showed up at his house over the weekend, and he was very distraught about it. A. Yes. Q. And according to Debore's notes, he requests the histological files and -- actually, I think he initially requests the information from the file and is faxed about 30 pages, and then he later requests the histological files be sent. A. The histological slides, slides, and if there are more hospital records. We told him -- and they spoke to him again, told him what slides we had. I told him about the visit we had had from a private investigator and agreed to work out a method to Fed Ex everything to him. Q. Okay. The reason I was letting you review that, he says in his affidavit that you contacted him -- and he's also told me this personally in my one meeting with him -- unsolicited and sent the file to him for him to review and for his comments. Is that true? A. No. Q. Are Mr. Bedore's notes accurate? A. Mr. Bedore's notes are accurate. There was a call from me back to Dr. Davis later on the morning of the phone call from Dr. Davis to Mr. Bedore regarding the investigator. Q. Uh-huh. (Indicates affirmatively). A. And I made an unsolicited call back to him that day to talk with him further. Q. Okay. What I'm getting at is he says -- I know that you, according to Larry's notes and your previous discussions with me, that you suggested he might want to review his own personnel file. There had been public records requests made of it, and he should know what's in there. A. Yes. Q. But other than the personnel file, the request for information came from him and it wasn't something that you thrust upon him or sent to him. So his recollection is wrong in that regard? A. That's correct. Q. He also -- and this is not something that you would know other than me telling you, so you're going to have to assume it for purposes of my question. He related to me -- well, let me strike that. Let me go on. He also in the latest affidavit -- and, again, I've got it and you can review it if you need to -- said that after you sent the stuff to him in what he thought was a very unusual fashion, which you've said is untrue, that you insisted that the items be returned by giving them to a taxicab and driving them over immediately. In looking at Mr. Bedore's notes, it seems like you had Fed Ex'd the stuff over and assumed that they would be Fed Ex'd back? A. Yes. Q. Did you insist that it be courier'd by taxicab back to your office? A. No, they did. Q. So, obviously, there is some substantial problems with Dr. Davis' memory from your perspective? A. Yes. Q. In his most recent affidavit, Dr. Davis has indicated -- and I don't know the technical terms -- that there was no stickiness of the internal organs and I think no interosseus wasting or some similar term that would be indicative of dehydration. My recollection is at least part of that is inconsistent with his initial testimony in the deposition in the civil case, but that's in his most recent affidavit. Were you in a position during the autopsy to note the condition of the internal organs or contradict what his current testimony is? A. Not with regard to stickiness of organs. I looked at her body carefully, and I looked very carefully at skin lesions that were on her forearms, hands and primarily somewhat similar ones or exactly similar ones appeared to be on her legs. I put on gloves. I spent the majority of my time looking at these injuries. I did not examine the internal organs by touching them or picking them up or in any way manipulating them. Q. Did you actually see the internal organs? Do you recall that? A. Yes, I saw them, but I didn't touch them. Q. Do you recall whether you saw the popliteal area and actually saw the thrombus itself, as opposed to looking at it later in photographs? A. No, I do not. Q. Do you recall whether you looked at the embolus at the time the chest was opened up? A. I believe that I did. Q. And did you examine those items in the Gross cup prior to signing out the autopsy? A. I didn't examine them in the Gross cup. I examined the slides. Q. And you looked at the photographs? A. Yes, and the photographs. Q. Let's -- I may go back to some of those questions on Dr. Davis and some of his accusations, but let's go forward and get to the primary reason that I need to talk to you today, and that's the changes in the autopsy. You had initially signed it out, Lisa McPherson's death, that is, as being a -- as a result of the pulmonary embolism that you said indicated resulted from dehydration and bed rest. A. Yes. Q. After the filing of criminal charges, the Church of Scientology, I guess through Mr. Goodis, submitted a large amount of material to you under your own administrative record relations to review the cause of death and to try to seek a change in that opinion, and you spent several months reviewing that. We also had retesting done of the vitreous and serum fluids during that period of time. And, ultimately, in February I believe you changed the death certificate. A. Yes. Q. Just tell me, and start out in narrative fashion, how that occurred and why you made the changes that you made. A. The case was a difficult case from the beginning. I reviewed everything I had available to me at the time I originally signed out the case. Of course, between that time and the time I changed the death certificate, large amounts of material became available to me that I had not previously had in the form of care-giver or taker records, in the form of scientific information from experts I had consulted, from experts that had provided information to the church, that had provided information to the State, and that had provided information to the civil attorneys. So I had a large volume of information to review. I reviewed all of that information, and I felt that there were several things that -- I was simply no longer comfortable. The volume of scientific information had become massive. I decided to seek the counsel of an individual who's been of great aid to me in the past, and that's Dr. Joseph Davis. I had shown him the autopsy report and the photographs. I was at a point where I felt I had to make a decision. I had reviewed all of the information. I still was not quite clear what decision I felt was the best decision in light of all of the facts, taking them all into account, because there were so many different factors -- Q. Hang on a second. (Brief recess taken.) BY MR. CROW: Q. I had the court reporter read back your response, and I think you were at the point of contacting Joe Davis, who is somebody you had relied on in the past for advice. A. Right. I spoke to Dr. Davis for about an hour and a half. We went over the facts of the case. Together he and I made a decision as to how -- well, he aided me in making a decision as to how I would change the death certificate. I did that. That is something that I do on occasion, and I'm comfortable with the fact that I did it based on my conversation with him and the information I had. Q. Okay. What changes did you make and why? A. I changed the death certificate to read acute pulmonary embolus, as it had before, due to trauma to the popliteal fossa because the slides showed hemorrhage indicating injury that was recent in that area. And under Part II, other significant conditions, I put down psychosis because the care-giver records indicated she was psychotic. And I put down the fact that she had been in a car accident because that is what started the chain of events that got her to the hospital and then to the Fort Harrison. Part II of the death certificate says factors related to death but unrelated to those in Part I. So it's a separation in the death certificate. Q. So psychosis and accident didn't contribute to the thromboembolism? A. No. I think one could make an argument, perhaps, that the psychosis did because she was fighting and flailing about. Clearly, absolutely, the car accident had nothing whatsoever to do with the fact that Lisa McPherson developed a pulmonary embolus. Q. And why was the traffic accident included as a cause? A. Because it was that event which set about the chain of factors, as I saw them, the accident, Morton Plant Hospital, Fort Harrison Hotel, and then to Pasco when she was pronounced dead. Q. But that information was known to you when you initially signed it out, and it had certainly been known at the time we filed the charges and you gave sworn testimony. A. Yes. Q. So I'm asking did Dr. Davis have a specific reason for advising you to include that? A. I don't recall regarding the car accident. He had very specific input regarding the psychosis. Q. And what was that? A. That she was clearly psychotic, that her psychosis was probably the precipitating factor for everything else that had happened to her, and that, indeed, she was psychotic when she had the car accident. Q. Let's go back to the evidence of trauma. You referred to the histological slides. When we talked to you previously, you said there was also evidence of trauma in the photograph of the popliteal area that's opened up. A. Yes. Q. You had reviewed those slides a number of times before and reviewed those photographs a number of times before. A. Yes. Q. And you reviewed them before you signed it out. A. Yes. Q. And you and I discussed that a number of times, and you had indicated there was no evidence of trauma either in the slides or in the photographs. A. I don't recall that. I recall our discussions being along the lines of trauma that could be related to a car accident 17 days prior playing a role in the formation of a thrombus. And my answers were directed towards that car accident and that there was nothing to indicate the car accident played any role in what happened. Q. So at the time you initially signed the death certificate, did you decide that trauma wasn't a factor? A. I did not feel that trauma from a car accident was a factor. Q. Let me rephrase that. I'm talking about the death certificate of October 30th, 1996. You don't list trauma as a factor in that. You do list dehydration and bed rest. I assume to determine that dehydration and bed rest were the only causes of the thromboembolism, you had to exclude trauma. A. I had to excluded trauma that was related to the car accident. With specificity, trauma to the popliteal fossa itself, I don't recall one way or the other. But I wasn't thinking in those terms at that time. I was thinking about the car accident, and that's where my sights were set. Q. Well, do you recall looking for evidence of red blood cells in the histological slides and indicating to me that you didn't see any evidence of that? A. No, I don't recall that. Q. Okay. When did you first realize that there was evidence of trauma? A. When I went over the- slides very shortly before I signed the case out and the day or two, I would guess, before when I went over them with Dr. Laura Hare in our office. Q. And why had you not seen that or noticed that before in the previous four years? A. I can't answer that. I didn't notice it. I don't know why. Q. So, I take it you were surprised to find that? A. I -- surprised -- Q. Let me rephrase it. A. I hadn't recalled it was there, and seeing it was an unexpected finding to me. Q. Is that one of the precipitating factors that caused you to change the death certificate? A. Yes. Q. So -- A. That, along with all of the other information I had, and my conversation with Dr. Davis. Q. What other information did you have to indicate that trauma was the cause of the thromboembolism other than the histological slides and the pictures? A. Nothing -- Q. We're focusing on that change. A. With trauma, nothing. Q. So in terms of changing the cause of the thromboembolism to trauma, that was the only factor? A. What I could see in the photographs when I went back and reviewed them and then looking at the autopsy slides, yes. Q. And what I'm a little unclear of is wouldn't that be something that you would obviously look for back when you signed it out in October of '96 as being due not to trauma but to bed rest and dehydration? Isn't that something you would have to routinely eliminate if you're going to contribute it to dehydration and bed rest? A. Yes, but, as I indicate, my thinking was more directed towards the car accident of 17 days prior, and there was no evidence of trauma from that car accident that could have caused the thromboembolus. That's where my sights were set, looking for any trauma from that accident. Q. Why? Why were you focused on that trauma as opposed to any other kind of trauma? A. Because I felt it might be raised as an issue as to a cause, that because she had been in the car accident. I didn't have a lot of detail about the accident. I thought it was low speed, but I wanted to be sure that she had no injury that one could argue could precipitate the thrombus as a result of trauma from the accident. Q. I'm still a little unclear. Maybe it's my question. You didn't eliminate -- when you signed out the autopsy on October 30th, 1996, you hadn't eliminated trauma other than the accident as a cause of the thromboembolism? A. That's correct. Q. And you just -- there is no explanation; you just missed the evidence in the slide and the photograph? A. I just didn't see it. Q. Okay. Why did you take dehydration out and bed rest out? A. I took bed rest out because the care-giver notes were not indicating a long period of coma, as one of my consultants had indicated would have been present, at least in terms that on Saturday she was attempting to move. Dehydration I had felt very comfortable with based on our initial analyses, but with all of the additional analyses that had been done and with the questions that had been raised about the analyses and in my consultation with Dr. Davis and in the advice he gave me, I made a decision to remove it. I do feel that it is a factor, but I removed it as a cause listed on the death certificate. Q. Okay. Why did you eliminate it as a cause or contributing factor if you feel it is a cause or contributing factor? Why did you talk it off the death certificate if you think it does, in fact, fall in one of those categories? A. Because it may or may not have played a role in this case because of the trauma to the popliteal fossa and also because of the advice that was given to me by Dr. Davis. Q. So you're not sure if it played a role? A. That's correct. Q. And what exactly was the advice given by Dr. Davis concerning dehydration and bed rest or both? A. I don't recall discussing bed rest with him. Regarding dehydration, his advice was that there had been a number of different tests performed at this time, that dehydration was clearly an issue that would be one of a very significant battleground, and it would be his advice that it would be in everyone's best interest not to list it on the death certificate. Q. Okay. I understood what you said. I'm not sure I follow the logic of why it's in everyone's best interest. Could you elucidate that a little bit further as far as why the fact that it was an issue or was going to be an issue or be a contested issue, it would be better it was not in the death certificate. Was there some uncertainty as to whether it was, correct? A. A, whether it was correct; B, whether it in and of itself was clearly a precipitating injury or issue in the face of injury. And for further elucidation, I have forgotten the details. You'd have to ask Dr. Davis. Q. Well, let's go back for a second to the bed rest. You're indicating the reason you removed that is because of the care-giver notes or caretaker notes, the documents that were allegedly contemporaneously made by the people who were watching Lisa? A. In part, and in part because, while one of my consultants was quite vehement that she had been comatose for 24 to 48 hours, I was not finding other consultants who were willing to accept that as a fact that with her lab values, if they were true, she would have been comatose. Q. Okay. And who did you consult with between the filing of the Information and the change in the death certificate that didn't confirm that? A. Well, Dr. Pickering did not definitely confirm that. Q. Did you talk with Dr. Pickering between the filing of the Information and your decision to change the death certificate? A. We talked with him, and I think it was after the timing of the Information. I didn't make a specific separate phone call to him. I also had access to the depositions of Dr. Coe and Dr. Bant, and Dr. Bant was particularly firm that she would not necessarily be comatose, but -- Q. Excuse me. I don't think you had that until the last couple weeks, at least I didn't. I don't think it was taken until April of this year. A. No, but I was well aware of Dr. Bant's opinions before that time. Q. From who? Because I wasn't, so I don't -- I mean, I talked to him a couple years ago. A. I can't answer that. I don't know. Q. And I don't recall Coe indicating that -- and I wasn't anticipating -- I don't recall you listing Dr. Coe as somebody that you relied on to change the death certificate in our previous conversation. So I didn't specifically review his deposition, but my recollection is he thought she was incapacitated for a significantly longer period of time. Your recollection is that it was shorter? A. That's my recollection. It's, perhaps, incorrect. MR. THOMPSON: It's your recollection. BY MR. CROW: Q. Do you recall I took sworn testimony from you prior to filing the Information? A. Yes. Q. And you confirmed the finding in the autopsy, including the fact that the thromboembolism resulted from bed rest and dehydration. A. Yes. Q. And do you recall that prior to us filing the response that we filed on December 6th, that I had you read over the forensic sections in that response that contained your conclusions that the thrombus and embolus resulted from dehydration and bed rest. And I asked you before I filed it, "Do I need to change this? Is this still your opinion?" Does that ring a bell? A. Yes. Q. And you confirmed it did, and that would have been as of December of 1999. A. That's correct. Q. And, certainly, you had the care-giver notes years prior to that, at least a year prior to that. A. Yes. Q. And you talked to Pickering prior to that. A. Yes. Q. So what has changed in terms of bed rest between those conversations -- what new information caused you to abandon bed rest as a cause of the thromboembolism? Was it just that you --it doesn't necessarily have to be new information that can change your mind; that's your prerogative. I'm trying to find out how the care-giver notes or how Dr. Pickering's testimony can be a basis for that. A. Perhaps that was a poor answer. It's the totality of the evidence that I've been given and that I've reviewed that has caused me to change my opinion. Q. And I'm trying to focus on what evidence relates to bed rest in the totality of stuff you were given, and I'm not -- because I've reviewed all that stuff at the ME's Office, and I thought -- correct me if I'm wrong --we talked the day that you changed the death certificate and we've talked several times since then, including one time with Mr. Hellickson here, and I thought you continued to reaffirm to me that your conclusions concerning how long she had been incapacitated had not changed. A. I do think that she was dehydrated and that she was in a coma for a period of time, but I'm not sure exactly how long based on everything that I've now read, and I have to add in the fact that there's trauma in the popliteal fossa and weigh that in the decision-making process. I reached a point where I no longer felt I could say the thromboembolus was as a result only of dehydration and bed rest. Perhaps immobility would have been a better word. I didn't feel I could say that anymore. I felt there was trauma in that region. And I still say she was incapacitated for a period of time and she was dehydrated for a period of time, but I no longer felt I could use those as an underlying cause on the death certificate. I changed my mind. Q. Well, I guess what I'm confused on is -- what is it in any of the submissions -- let me rephrase that. Has, in fact, your opinion changed between the time that I took sworn testimony from you prior to filing the Information, the time that we filed the response on December 6th, has your opinion changed as to the severity of dehydration that existed or the degree of incapacitation or the length of incapacitation? A. No, not in a significant fashion. Q. Okay. Then why --my question was not why -- I understand why you say that since you found trauma, the dehydration and bed rest can no longer be the sole cause of the thromboembolism. But my question is not that, but why have they been removed as contributing factors if, in fact, you feel they are contributing factors? Why were they removed from the death certificate? A. That was based upon the advice of Dr. Joe Davis. Q. I know that it was based on his advice, but why did you decide to do it? Because you're the one who made the decision, not Dr. Davis. Is it based upon a -- A. He gave me advice, as I've already indicated to you, and I gave that advice great weight. His advice was to remove it from the death certificate, and I took that advice. Q. Well, I -- A. And I can't go into great detail because at the moment I can't recall in great detail. Q. Okay. Was there a concern that leaving dehydration and bed rest or immobility in the death certificate would leave your opinions subject to impeachment or attack? A. No, that wasn't my concern. Q. Was there a -- did Dr. Davis indicate that in controversial cases that he always likes to choose the middle ground? A. Yes, he did. Q. What does that mean? A. You understand the words as well as I do. Q. Well, I wasn't there. A. When there is a difficult course, that the best course is the middle ground, the sure ground, the most firm ground. Q. And I guess that's what I'm getting at. Did you feel that the questions of dehydration and bed rest were more subject to dispute and less firm than the other conclusions that you left in? A. Yes. Q. So there was some concern about the correctness of those conclusions or whether they were defensible? A. Yes, there was a concern about that. I wasn't concerned about my impeachment, but, yes, there was concern about it. Q. And, of course, you understand that the burden of proof that we have in a criminal case is beyond and to the exclusion of every reasonable doubt. A. Yes. Q. Is there a greater standard than that for including stuff in a death certificate or a lesser standard? A. It depends upon one's philosophy. Q. What's your philosophy on that? A. Mine's probably to a higher standard than that. Q. And if in fact -- well, do you believe that --at the time you changed the death certificate, were you confident in your decision or did you vacillate in your decision? A. I vacillated because there was a great deal of information, but I became confident as time went on that I had made the correct decision. Q. Did you consider changing it? A. Yes. Q. And how did you consider changing it? A. I considered changing it back. I decided that I had -- that was not the correct thing to do, that I had spent months evaluating this case and that my decision had been made based upon the best information and the best experts with whom I could make contact, and that to go back now and second guess myself was incorrect. Q. Did you consider changing it to homicide? A. I did, yes. I decided not to because I feel this is a case of medical malpractice, and medical malpractice is not homicide. Q. But you're ambivalent on that? A. Yes. Q. Even after you initially made the changes? A. Yes. It was not an easy decision to make this change. And I didn't make it, put it in a drawer, shut the drawer, and never think about it again. Q. When did you become comfortable that --or are you comfortable now that, in fact, dehydration and bed rest were causative factors in the death? A. I think that it is reasonable to believe that they played a role in what occurred with Lisa and were part and parcel of what her clinical status was, which impacted what happened to her and ultimately what caused her death. (Whereupon, Mr. Goodis leaves the room.) BY MR. CROW: Q. Were they causative factors? A. I can't say because of the evidence of injury to the popliteal fossa. Absent that injury, they certainly would fall into the range of a reasonable belief that they were causative factors. I think they are associated. When you get to causative, I become -- I have difficulty with that word. Q. Okay. Well, describe what you mean by association, then. Maybe that's a -- A. They are present at the same time. They can have an affect and they may have had an affect. Causative, on the other hand, which you didn't ask but I assume is next, means one caused the other, and I can't state that. Q. Well, I mean causation in the sense that it was one contributing factor, not necessarily a sole contributing factor, but a contributing factor to the death. A. If you use causation in that definition then, yes, I would say it is. Q. And by what mechanism would it have contributed to the death? A. Dehydration is associated with sludging of the blood, and blood flow slows. There's inadequate fluid in the blood vessels to keep blood flow adequate. And as blood slows down, there is a tendency for clots to form in blood vessels, as there is in injured blood vessels. And all textbooks indicate that too many red blood cells in comparison to -- or too many cells in comparison to liquid portion of the blood are associated with the formation of emboli --or can be associated, to be more correct in my quote. Q. Well, I'm guess I'm asking how did it, in your opinion, contribute in this case? Did it contribute to the formation of a thrombus? Did it contribute to her death from the embolus after the embolus was thrown? What is the mechanism that you believe contributed to Lisa McPherson's death, if you believe that? A. I believe it contributed to her death after the thrombus was thrown. Q. Okay. And when did you reach that conclusion? A. Extremely recently in the reading in its entirety of Dr. Bant's deposition. Q. So at the time you made the change in the death certificate, you did not necessarily hold firmly to the opinion that it was a contributing cause to the cause of death. That's something that you recently concluded? A. Yes. Q. You haven't mentioned the issue of ketones being a factor in your decision so far. Was it an issue? A. Yes, it was. Q. And maybe I just didn't ask the right question, but how was that a factor and what did that relate to? A. In speaking with my clinical associates and talking about someone who was, if we believe the vitreous, severely dehydrated, how did we then justify the absence of ketones? And no one at that time was able to give me an answer. There was a single answer provided in a textbook called Guyton -- G-u-y-t-o-n -- but it talks about the absence of ketones after failure to eat and presumably become dehydrated for weeks, not for 17 days. So I didn't have an answer for how a woman could become this dehydrated and, presumably, therefore, consume • no significant nourishment and yet not have ketones. One would expect ketones in someone losing weight and not eating adequately and not drinking adequately. Q. Okay. Well, my question is how did that affect the change in the death certificate? A. I felt it made it more difficult to support the diagnosis of the dehydration. It made it more subject to attack, and I couldn't explain it. It was going to be a mountain in the information regarding dehydration to which I couldn't find an answer, despite hours of attempting, and it made me less certain of my ability to sustain the certainty of the degree of dehydration she had. Q. Did you have doubts about the degree of dehydration because of the ketone issue? A. Yes. MR. CROW: Let's take a break. (Brief recess taken.) BY MR. CROW: Q. I'm a little concerned because my recollection of things is significantly different from yours, and I'm not sure how do deal with that. So I guess the best way is to just ask you directly. A. Sure. Q. This is kind of in response to the last couple of answers. My recollection is that we talked on the day you decided to change the death certificate, and you told me the changes you were going to make. I asked you, "Do ketones have any affect on your finding of severe dehydration?" You told me no, and that your opinion that she had severe dehydration had not changed and that the change in the autopsy report would not reflect that. It seems to me that what you just said is kind of completely inconsistent with that conversation as I recall it. Do you recall that conversation with me and my -- A. As well as I can, yes, I recall it. I do recall giving you that answer. I do still feel she was severely dehydrated, but I cannot answer the ketone question. And I told you this time after time and I told you also time after time how much it bothered me. We couldn't get an answer from any of our various consultants, including one with whom you spoke with on multiple times who sent a resident off for two days to look for the answer for this, and we couldn't find the answer. And, yes, I felt that she was dehydrated and, yes, I'd still say that even though the ketones weren't present, but I didn't have any explanation for why the ketones weren't present and I couldn't find an explanation for why they weren't present. So perhaps over time, the fact that I have not been able to find an answer is more significant in my mind than it was that day when you asked that question. That may be the difference. I don't know. Q. Well, other than the letter to the editor in the one journal that the Church of Scientology provided you concerning a Malaysian study on ketones and dehydration, I have not found any literature that suggests that dehydration alone results in the presence of ketones. The individual that you're referring to that you talked to and I talked to, Dr. Whitworth, is not concerned about the absence of ketones, at least from what my conversation with him yesterday was. I have done some research, and I do have some articles that might relate to that, but I guess my confusion is are ketones a result of malnutrition or are ketones a result of dehydration? And since we have someone who is fed intermittently and so we don't really know what that status is, how would that affect the presence or absence of severe dehydration and its inclusion on the death certificate versus malnutrition? A. Well, as Dr. Whitworth has indicated to you and to me -- and, by the way, the last time I spoke to him he was very concerned because he couldn't explain the absence of ketones. Q. Okay. A. That was after the two day resident's search. We have long explained the dehydration in this case, particularly with regard to the urea nitrogen as being the result of pre-renal azotemia and protein catabolism, meaning that she was losing weight, and the giving to her of a high urea nitrogen source protein, namely, soy protein, in the drinks that she was given. Everything indicated that to get to urea nitrogen of 300, she had to undergo significant catabolism. She had to undergo significant weight loss. So once we get to the point where we say we explain the urea nitrogen by these three factors, one of which is severe weight loss, and we kick out the peg from underneath it by saying she doesn't have any ketones, then I've lost one of the three legs that hold up that triangle, and that's what his conversations and mine have been about time and again. That's why my concern, because I don't think that Lisa McPherson, based on the information we have, is a woman who was adequately nourished but dehydrated. She was dehydrated and severely malnourished. And once I say that, then the absence of ketones does concern me. Dr. Whitworth has never conveyed to me that the absence of ketones does not concern him. I believe you did. Q. Of course, I -- A. But I made reference to Guyton and I looked at Guyton, and it's talking about six weeks or something. We're talking about 17 days. I can't compare apples and oranges. Q. Okay. Well, is the ketone issue resolved in your mind now, or is it still a source of doubt? A. It's still a question. Q. Source of doubt? A. Source of doubt. I -- Q. So -- go ahead. A. I need to add that if we believe Dr. Whitworth, she is comatose for a couple days. So they can't feed her. So she should have ketones. So there's another problem. Q. Well, I guess let's talk about that. I don't pretend to have your medical expertise, but I spent a lot of time in the library trying to find the same articles that everybody else has. I haven't found anything definitive that deals with the presence or absence of ketones in an agonal process when someone is very close to death. All of the studies are basically with healthy people, mainly obese people, some lean, but the fasting or situations where they are really in very good health, and the metabolic process that are reflected in ketosis are there. I haven't seen anything or been able to find anything that would suggest what would occur in someone in Lisa's situation who is close to death and when we don't know exactly the nutritional status because of the absence of records and inconclusive testimony. Are there any studies that are really definitive in that area or textbooks that are definitive in that area or is that really beyond medical knowledge at this point in time? A. If it's available, it's probably available in the Nazi concentration camp records, which I have not been able to get. But there is no reason to believe that Lisa, who at her death was still of reasonable weight -- she was not cachectic; she was not a concentration camp looking individual -- would be that different from you or from me in terms of her production of ketone, from everything I know. Q. Okay. I guess the bottom line is, if you can't explain ketones, how can you conclude beyond and to the exclusion of a reasonable doubt that Lisa was severely dehydrated and the severe dehydration was a causative factor in her death? A. Exactly. Q. Well, I need a yes or a no, or can you conclude that or can you not conclude that? A. That wasn't a question. That was a statement. Q. Okay. Let me make sure I phrase it in terms of a question. If, in fact, you can't explain the absence of ketones, how can you conclude beyond and to the exclusion of a reasonable doubt that Lisa was as severely dehydrated as the test results suggest and that that dehydration was a causative factor of her death? A. I believe the medical evidence indicates that. I do feel that the absence of ketones is a weakness. I do feel that it's one good reason to leave it off the death certificate, but it was not sufficient reason for me to Leave it off the list of diagnoses on the autopsy report. But I do think it's a significant factor that has to be dealt with in this case. Q. Well, I guess my conclusion, and to some degree it's legal terminology, but if you felt that it was a weakness, sufficient weakness that it would be better not to include it on the death certificate, how do we explain that to the jury that that's not a reasonable doubt? How do I suggest to the jury that they should be convinced to the exclusion of a reasonable doubt when you felt there is a sufficient weakness there that would cause you to remove it from the death certificate? A. I don't know. Q. I did do some more research on ketones, I've got copies of stuff here, and I'd like to discuss a couple things with you. I may have actually found the article that Whitworth was looking for. I'm not sure. In researching the issue, I found a series of articles dealing with non-ketotic hyperosmolar diabetic coma. They, essentially, relate a situation in which people become hyperglycemic, their blood osmolarity skyrockets, and they go into coma because of that, yet they don't develop ketosis. In most of these situations the people are mildly diabetic and severe dehydration is a precipitating factor and condition. In researching that -- I haven't asked the question yet. Again, I'm giving my layman's uneducated view of that. So feel free to correct me in any conclusions that I've got that are suppositions to the question. It appears in the follow-up research on that in some animal and human studies there is a belief on the part of the researchers -- and I don't know if this is still a current belief or if it's dated at this point, so that's why I'm asking you -- that hyperosmolarity suppresses ketone production and that severe dehydration suppresses ketone production. I'm not sure if it's -- I'm not medically knowledgeable enough to tell from the studies whether it's a result of the body not breaking down the adipose tissues or a result of the liver not making the ketone bodies. I think the latter, but I'm not sure. Are you familiar with that condition, and is that something in your effort to resolve the ketone issues that you ran across and considered or is that something that you haven't really considered yet? A. I ran across those articles. I considered them. They are not germane because there is no evidence that Lisa was diabetic. Diabetes is a special entity with its own special metabolism, and one cannot use those articles and compare them to Lisa. Q. Okay. A. And that was one of the problems in trying to find articles, because they do all have diabetes in them. Q. And some of the diabetes, for instance, in animal studies was artificially induced with dextrose, and the studies suggest -- I don't know if they are valid conclusions or not -- that the hyperosmolarity doesn't have to come from the glucose and it will still suppress those things. I discussed that with Dr. Whitworth. But you don't feel that's a solution? A. You need to Dr. Whitworth. My only answer would be she's not diabetic, she has not been artificially induced to be diabetic, and I don't believe they apply to her. Q. But she is hyperosmolar? A. Yes, she is. Q. And she is severely dehydrated, you think? A. Yes. Q. Except for the doubts created by the absence of ketones. A. Yes. Q. I also ran across a study indicating that intermittent glucose feedings, if you provide enough carbohydrate to supply the brain's needs for carbohydrates, that ketones drop dramatically in a relatively short time. A. That's true. Q. And we know that Lisa was fed intermittently, but we don't know the situation of the last couple days. A. No, except that Dr. Whitworth says she was comatose. Q. Did he use that term or did he unresponsive? A. He told me comatose. Q. And was that before you signed the autopsy or was that before your interview with -- was it Inside Edition or -- A. It was before the interview with Inside Edition. Q. So you did not confer with him before you signed the autopsy off? A. Not again specifically, no. Q. Let me rephrase that. I'm talking about the original autopsy report. A. No, I didn't, because I had no reason to. I don't understand what you want. Q. Well, prior to signing the autopsy and the death certificate for Dr. Davis on October 30th of 1996 -- I think that's the correct date, but you know what I'm talking about, the first one -- did you confer with Dr. Whitworth? A. No, I did not. Q. How did you determine, then, that bed rest was a causative factor? A. I based it upon my own experience and knowledge and as a clinical pathologist and the laboratory values based on the vitreous. I then went on to confirm that with Dr. Whitworth, who gave me a period of time of 24 to 48 hours. Q. But that was after you had already made the conclusion. A. Yes, but I felt I could make the conclusion myself. He confirmed it. Q. Okay. A. I couldn't have said a number of hours. Q. Well, how long are you thinking bed rest was --if you couldn't say a number of hours, how was bed rest or immobility did you determine to be a factor in the thromboembolism if you couldn't quantify it? A. I couldn't give a number of hours, but I knew that it couldn't occur in a few hours. So I knew, you know, that she probably wasn't moving around for at least a couple of days. I had no knowledge regarding coma. Q. Okay. Going back a second to Dr. Davis' autopsy, did he order the vitreous testing or did you do that? A. I did. I told him that day to do it. Q. "That day" being the day of the autopsy? A. Yes. Q. And I assume you found out at some later point that it hadn't been done? A. That's correct. Q. So you ordered it? A. Yes. Q. So, if I'm understanding you correctly, was that normally the -- even though you told him to do it, was that normally a decision -- absent your instructions to him as the chief medical examiner, would that normally be a decision that would be up to the associate performing the autopsy? A. Yes. Q. As to which test to order and whether to order vitreous testing beyond the alcohol testing that you routinely do? A. Yes. Q. So the delay in the testing from the time of the autopsy until I guess it was in late January or late February, that was a result of Dr. Davis not pursuing what you directed him to do? A. True. Q. Do you know of any reason why he didn't do that or wouldn't have pursued that? A. No. Q. Do you recall having any discussions with him about why he failed to do that? I realize we're going back four or five years and it may be difficult. A. No, I don't. Q. He's indicated, and I don't think it's in the affidavit, but -- I think it's alluded to maybe in the affidavit, and I discussed this with you previously -- he is suggesting the language in the autopsy report, not the cause of death sheet but in the substance of the protocol, if that's the correct word, has been changed. Not necessarily substantively, but someone has gone and changed his wording. Can you respond to that? A. I did not change one word of any page of that autopsy protocol other than the front sheet. Q. So, again, that's another situation in which Dr. Davis is completely in error? A. Completely. Q. Do you recall when Davis was there did he seem to -- after the time that you became aware that he had been diagnosed with bipolar disorder, were you aware if he was on medication, whether his demeanor changed? Did he have memory problems? And that's as a lay person, as supervisor. I'm not asking for a diagnosis, even though you're a physician. Did you perceive the same type of memory problems while he was there that seem to be contributing to the differences in testimony between what he is saying happened and what your recollection and what Mr. Bedore's, as documented, occurred? A. Not -- no, not really. Not at all. There might have been a minor thing or two, but certainly nothing like -- Q. As apparent now? A. Nothing like this. Q. Are there -- did you ever discuss with Dr. Davis whether there was trauma in the popliteal area or not? A. No. Dr. Robert Davis? Q. I'm sorry, Dr. Robert Davis. We have two Dr. Davises. A. No, I haven't spoken to him. Q. I didn't see where you made any finding of that in the autopsy or any reference to that in the autopsy that he believed there was trauma to the popliteal area. A. No, he didn't. Q. Now, the histological slides, I assume that you can view those as easily as Dr. Robert Davis or any other expert; that there is not really any difference between the person who performs the autopsy and the person who views the slides later. Is that -- A. One can do each or both. Q. It's not an advantage having been the autopsy doctor when you're looking at the slides. The slides are pretty much going to look the same to any expert looking through a microscope. A. To me, yes. Q. Is the same true with the photographs? In other words, is it easier looking at the photographs to -- and what I'm referring to is you know Dr. Nelson and Dr. Joseph Davis do not feel that the photographs clearly reflect the trauma that you see there. I think they've probably communicated that to you. A. Dr. Nelson has. Q. At least that they may be more ambiguous, and where you at this point are seeing fairly clear evidence of trauma in the photograph. Is it easy looking at the photograph to determine what is a result of dissection versus what is preexisting trauma? And is Davis in a better position to do that, Robert Davis, would you be in an equal position, or -- A. He's probably in the best possession because he saw it originally. The photographs document it. Q. So you feel at this point confident that there is trauma there reflected in the photographs? A. I see trauma in the photo. Q. Were there any -- obviously, Robert Davis didn't note that trauma in the autopsy report, and we would have expected him to do that; would we not? A. We would have hoped he would have. Q. So are there any other inadequacies in hindsight, you think, in Dr. Davis' autopsy? A. Yes. Q. Would you tell me what you think they are? A. It would have been better to section all of the injuries that were present on the body, to further open the veins of the legs. I'm sure you're aware of the criticisms made by Dr. Joseph Davis about the autopsy, and my criticisms don't differ from his. Q. Well, go ahead and relate those, if you will. A. I'm trying to think what the rest of them are. More than one section of the popliteal fossa, particular sectioning with reference to the depth of hemorrhage of the bruise of the lateral superior left leg. Q. The lateral superior left leg, that's below the knee we're talking about? A. I meant knee, the lateral superior left knee, the region we talked about so many times.. Q. Is that the bruise on the side of the thigh that we're talking about? A. Yes, the lower thigh, just above the knee. Q. And that was not sectioned? A. No. Q. The only bruises that he sectioned were actually, in lay terms, the one on the calf area or down in the lower leg? A. As I recall, yes. Q. Okay. A. The failure to send the vitreous off at that time. That's what I recall right now. Q. Okay. He says in the affidavit, the latest affidavit, that he repeatedly questioned the validity of the vitreous results. What do you recall about any discussions you had with him? A. We never discussed it. Q. If I've accurately stated what's in the affidavit, that recollection would be in error? A. Yes. We never discussed the validity of vitreous electrolytes in Lisa McPherson. Q. What I'm referring to is they were -- the 300 urea nitrogen was so high, was he suggesting to you it was artificial, it was a mistake, and couldn't be correct? A. He never suggested that. We never had such a conversation. Q. Okay. Why did you change it from undetermined to accident on the death certificate? A. Because there was no evidence in any record that I could find that suggested anyone wished this woman's harm, number one; and, number two, far more importantly, I felt this was a case of medical malpractice. Cases of medical malpractice are not called homicides. They are called accidents. Q. And what had changed? Didn't you always feel it was a situation of medical neglect? A. Yes, but when I had signed the original death certificate back 11 months after her death or ten months, don't forget I had almost no information as to what had happened to her. Q. Okay. A. I didn't have much. Q. That's true, but prior to the review of the case, for the three years since then you did have all that information and you didn't change the death certificate. So why change it to accident at the point in time that you did rather than before the filing of charges? A. I changed it at that point in time when I had reviewed all of the information provided to me by the civil attorneys, the State Attorney's Office, the Church attorneys, and following my consultation with Dr. Davis. Q. Let me rephrase it again. I think all the information concerning --at least that we had concerning caretaker testimony, caretaker notes, was provided to you well before we filed the Information. And, again, we talked to you about your findings and you confirmed your findings prior to filing the Information. My question is why, since you had that information, decided not to change it at that point and to leave it undetermined, why did you conclude at some later time -- what new information came in that caused you to change it to accident? A. I reviewed the entire autopsy along with all of the evidence; I consulted with Dr. Davis; I discussed with him the possibility of homicide versus the possibility accident. After long discussion and the consideration that we felt this was medical malpractice, we came to a joint conclusion that the death certificate should read accident, and it was at that point that I changed it to read that way. Q. Had there been --in initiating the review process, did the representatives of the Church of Scientology suggest that there were certain prerequisites in terms of the change in the death certificate that had to be made to avoid litigation? In other words, that it should say accident rather than undetermined or homicide, that it had to list the traffic accident, that dehydration could not be in there as a cause of death? A. No. Q. So you don't recall them indicating that unless you change the death certificate in that fashion that there was a possibility of litigation or there was a possibility that they would attempt to impeach or attack you throughout the course of the civil or criminal case? A. Only in the sense that they attacked me in the media, they attacked both on telephone and in print. They provided information. They certainly let me know that they were not happy with my conclusions. They certainly pressured me, as did the civil side, as did the State in terms of providing of all types of documents. I certainly knew that they were not happy about the death certificate, but the opinion of the Church of Scientology as to what was on that death certificate had absolutely nothing to do with my decision to change it. I changed it based on my scientific and medical and ethical opinions. Q. I didn't ask you if it caused you to change it. I asked you did they indicate what their expectations were, what they wanted? A. No. I think they may have -- no. MR. CROW: Can we go off the record for a second. (Discussion had off the record.) BY MR. CROW: Q. Concerning the elevated urea nitrogen and pre-renal azotemia, I did find an article from probably the late sixties documenting the psychiatric consequences of azotemia, and there are like 90 subjects that had azotemia and had the confusion, the delirium, the various symptoms that azotemia causes psychologically. The article divided people up into their BUN readings, and half the group was over 250 and the other half was under it, and it also related to older studies back in the forties where -- obviously pre-dialysis -- 400 and above readings occurred. I mention that just so -- you had suggested, I think, that you were concerned about explaining the high reading and catabolism being necessary to show that. I'm not sure other experts have necessarily confirmed that, but I understand that's what your initial conversations were with Whitworth. That's what you were talking about, really. A. Yes. Q. That that and the protein feeding may have caused that to escalate and get out of sync with the creatine reading. A. The loss of weight, the pre-renal azotemia, and the feeding of protein high in urea nitrogen. Q. On the ketone issue, was there a point in time after the changing of the death certificate that you felt you had that resolved and then decided that it wasn't resolved? You made a reference to Guyton. Was there a point where you thought Guyton explained it and then in further consideration decided that Guyton wasn't a complete explanation? A. That's correct. Q. A possible, but not a complete explanation. A. Not complete because of the time period. Q. So even since changing of the death certificate, you've kind of changed your opinion going back and forth. It's a difficult position for you. Would that be a -- A. I think it's fair to say that prior to changing the death certificate, I couldn't explain the ketones. I changed the death certificate. The information that Guyton might offer the answer was provided. I looked at it. I did not feel it provided the answer because of the six weeks as the ordinate on the graph. Q. So there wasn't a point in time where you felt you had it explained and -- A. There was a point in time when Dr. Nelson called me and told me he thought he had found the answer in Guyton. I got Guyton out, I looked at it, and I began to look at the graph. I said, "Wait a minute. This doesn't fit. You know, this is six weeks. We're talking about 17 days. It doesn't fit." Q. The e-mail that you sent to Dr. Whitworth, although that's been made public, no one else knows that it was really to him. That hasn't been publicly released. That reflects not only concern with ketones, but it reflects that you feel like your career is in jeopardy as a result of the proceedings. What did you mean by that? A. I met that I felt that I was under extreme pressure from the civil side, from the Church, and from the State Attorney's Office; that in my 25-and-a-half years, I had been someone who worked closely with and had put a lot of time in with and spent a lot of time working together on cases with people in the State Attorney's Office; that I no longer felt that there was a level of cooperation or that my prior level of respect and judgment was present; that the situation had simply changed and I no longer knew where I stood. Q. Are you suggesting the State Attorney's Office put pressure on you? A. Only from the standpoint of the deposition today, which certainly puts pressure on me, and -- Q. Well, that's after you changed the autopsy report. I'm talking about -- A. But I had a right to do that. I'm talking about the information you provided me, the information the church provided, the information the civil side provided, that there's been tremendous pressure on me for over four years. Q. Okay. Well, I want to know what you're suggesting that either I or the State Attorney's Office put pressure on you to do, because I obviously disagree with that characterization. So, if you're going to paint with a broad brush, let's be specific. I don't recall telling you anything other than do what's scientifically accurate. MR. THOMPSON: Let me just interject. I don't think she said what you said. I think she said she felt like she was under pressure. I don't think she said the State Attorney's Office put pressure on her. MR. CROW: I thought she did. BY MR. CROW: Q. You can clarify if that's not what you said. A. You know, there have been weeks when we've spoken every day, sometimes two or three times a day, about experts, about various experts, about various articles, about read this, about call this person, see if you can find out about this, try to do that. I'm not saying they weren't justifiable parts of this case, but they've put a tremendous amount of pressure on me and kept me away from other things in my office that I needed to do. I no longer felt the sense of camaraderie that I felt. Q. This is before you changed the death certificate? A. Yeah. Q. And how does that relate to what was going on in this case? I mean, you're talking about -- A. I just -- Q. Were you dealing with anyone other than me concerning this case? A. No, but I'm not speaking just toward you. I'm saying -- I'm using the broad brush of the office. I just feel like my position is different. My position is different with you; it's different with Bernie. It's just different. Q. Are you talking about before you changed the autopsy certificate? A. Yes. Q. Okay. A. And probably for four years now, and during which time I have not been sure on a day-to-day basis what my future is going to be. Q. And did anybody suggest anything to you in terms of changing or not changing the death certificate? A. No. Q. Did I try to do anything other than be supportive in terms of getting whatever information you needed from us, whatever you needed to make a decision? A. No. Q. Did I try to suggest in any way that we wanted a specific result? A. No. Q. In fact, in all our conversations, even though I didn't ask you, didn't you up until the end repeatedly tell me that you had no intent on changing the death certificate? A. That's true. Q. And that's because that was your opinion. I wasn't asking you that. I was telling, "Wait. You got to look at the stuff. Take your time." A. Right, and I was telling you I wasn't going to. And then I reviewed everything, I went over it for weeks and then consulted with Dr. Davis, and then I made a decision that was different from what I had thought I was going to do, and that was to change the death certificate. Q. I understand that. I'm just clarifying that you weren't dealing with anyone else but me from our office, and I never suggested to you in any way that we wanted any particular result. A. No, you did not. Q. And, certainly, we had disagreements concerning your appearance on Inside Edition. A. Certainly, understandably. Q. That was not something we were happy with and that affected your relationship with the office to some degree. A. Yes, and I think that's understandable. I understand that completely. Q. There are probably other things that will pop into my head that I haven't asked that we may need to follow-up with. I know you're tired, so I don't want to take up anymore time. If there is something else that, you know, that I haven't asked that you feel needs explanation or that you want to say -- you know, there's been a number of criticisms, not necessarily from me, but in the public sector, certainly some criticism by Davis and in the latest pleadings by the Church of Scientology. If there is something that you feel I haven't given you the opportunity to respond to that you want to, I'll give you that opportunity now. I may have overlooked something that you feel need speaking to. A. Thank you. No. MR. CROW: Thank you. THE WITNESS: I'll read. (Thereupon, the sworn statement concluded at 12:35 p.m.) WITNESSES' SIGNATURE PAGE I have read the foregoing pages, and, except for any changes or amendments I have indicated on the sheet attached for such purposes, I hereby subscribe to the accuracy of this transcript. Joan Wood, M.D. DATE WITNESS TO SIGNATURE STATE OF FLORIDA COUNTY OF PINELLAS I, the undersigned authority, certify that Joan Wood, M.D., personally appeared before me and was duly sworn. WITNESS my hand and official seal this 2nd day of June, 2000. Carla Jessal, RPR Notary Public - State of Florida My Commission Expires: 2/27/01 Commission No. CC60833C REPORTER'S CERTIFICATE STATE OF FLORIDA COUNTY OF PINELLAS I, Carla Jessal, Registered Professional Reporter, certify that I was authorized to and did stenographically report the sworn statement of Joan Wood, M.D.; that a review of the transcript was requested; and that the transcript is a true and complete record of my stenographic notes. I further certify that I am not a relative, employee, attorney, or counsel of any of the parties, nor attorney or counsel connected with the action, nor am I financially interested in the action. Dated this 2nd day of June, 2000. KANABAY & KANABAY COURT REPORTERS (7 27) 821-3320