Directed Verdict (29 page)

31

AT 9:05 A.M.,
with all the players in their respective seats, Dr. Jeffrey Rydell took the stand for a second day. Brad noticed one female juror nudge the one next to her and wiggle her eyebrows. Rydell had boyish good looks, a full head of blond hair, and bright blue eyes. He was the all-American boy next door, except that he also happened to be a board-certified internist and seemed to know everything about emergency room medicine.

Brad had spent the first day of Rydell’s testimony rehashing his qualifications and his treatment of Charles and Sarah Reed. Today Brad planned to hone in on the critical medical issues of his case.

“Dr. Rydell, do you have an opinion, to a reasonable degree of medical certainty, as to whether cocaine was a contributing factor in the death of Charles Reed?”

“I do,” Rydell replied. One of the things Brad loved about this witness was that he always answered only the question asked and did not prattle on just to show his intelligence.

“What is that opinion, sir?”

“Objection,” Strobel said. Brad rolled his eyes. “Dr. Rydell is not a toxicologist and therefore should not be allowed to give opinion testimony on this subject.”

“I tend to agree with Mr. Strobel,” Ichabod said, to nobody’s surprise.

“Your Honor,” Brad pleaded, “he was the physician at the base hospital who personally treated Dr. Reed just prior to his death. Certainly he can give opinions as to the cause of that death based on what he observed.”

“May we approach?” Strobel asked. Without waiting for an answer, he moved toward Ichabod’s bench. Brad joined him.

“I don’t object if he talks about his treatment of Dr. Reed and what he observed,” Mack whispered. “But from his deposition testimony, it’s obvious that he also intends to talk about the toxicological tests performed both at King Faisal Specialist Hospital and the base hospital and then discuss the differences in levels of cocaine detected. He was not there for the King Faisal tests and is not an expert on absorption rates and other factors that would affect the significance of those levels—”

“Judge, he relied on those tests from the King Faisal Specialist Hospital when he treated Dr. Reed at the base hospital.” Brad’s interruption drew a glare from Strobel, which Brad ignored. “The reason Mr. Strobel does not want those tests admitted is because the tests at the base hospital showed a higher, not lower, level of cocaine. This could only mean someone injected Dr. Reed with cocaine very close to the time of his admittance to the first hospital, so that as the injected cocaine became absorbed into the blood and processed in the urine, it registered progressively higher levels between the time of his first admittance to the King Faisal Specialist Hospital and the time of his later admission to the base hospital.” Brad was speaking quickly, trying desperately to get Ichabod to appreciate the significance of this ruling.

She interrupted him with her outstretched palm.

“That’s quite an elaborate theory, Mr. Carson, and based on no small amount of speculation. It does, as Mr. Strobel suggests, depend on such things as absorption rates for cocaine into the bloodstream. Mr. Carson, do you have a toxicologist you plan on calling as an expert?”

“Yes, Judge, Dr. Shelhorse, but—”

“Mr. Carson,” Ichabod interrupted, “that was a yes or no question. Since you have a toxicologist, I’m ruling that the prior tests from the King Faisal Specialist Hospital are not admissible through this witness. We can deal with them when your toxicologist takes the stand.”

Brad looked at the judge and registered a silent protest.

“Thank you, gentlemen,” she said.

Brad huffed and stalked back to the podium.

“Dr. Rydell, please state your opinion as to whether cocaine contributed to the death of Dr. Reed, but in doing so, please do not discuss the prior drug tests from the King Faisal Specialist Hospital. Does that make sense?”

“No,” the doctor said, “but I’ll try.

“In my eleven years of experience in the management of critical-care patients, I have treated many who presented with various complications associated with cocaine usage. Cocaine is a powerful central nervous system stimulant that heightens alertness, inhibits appetite and the need for sleep, and provides intense feelings of pleasure. It is either snorted as a hydrochloric salt or boiled with sodium bicarbonate to produce a substance referred to on the street as ‘crack,’ which is then smoked and absorbed through the lungs. In rare instances, cocaine can be diluted with water and injected straight into the bloodstream.”

Rydell talked straight to the jurors, and Brad noticed that they all appeared to be listening—with the exception, of course, of juror number four, who seemed to be much more interested in the tops of his own shoes.

“Regardless of how it is absorbed, cocaine causes a number of potentially fatal complications, including some that directly affect the heart. Even in relatively small doses, cocaine increases blood pressure and constricts blood vessels. It also stimulates the formation of blood clots, disrupts normal heart rhythm, and can bind directly to heart-muscle cells, thereby weakening the heart’s ability to pump blood. A variety of cardiovascular conditions and diseases have been associated with cocaine use, including hypertension, arrhythmias, cardiomyopathy, strokes, aneurysms, myocarditis, and heart attacks. Many first-time users have experienced heart attacks that have proven to be fatal.

“In the case of Dr. Reed, the effect of an enormous dosage of cocaine, as revealed in toxicological tests taken at both hospitals—”

“Objection!” Strobel shouted.

“Sustained!” Ichabod snorted. “The jury will disregard that last statement. Dr. Rydell, you are in no way allowed to refer to the toxicological tests from the King Faisal Specialist Hospital. Is that clear?”

“It is now, Judge,” Rydell said, unfazed. “I thought before that you were just saying I couldn’t tell the jury about the precise levels.”

As Ichabod shook her head in disapproval, Rydell turned back to the jury with a level gaze and continued his lecture.

“Charles Reed already had a bad heart. He had fairly advanced coronary artery disease, which means that the flow of oxygen-rich blood to his heart was severely restricted. In my opinion, a combination of the stress from being arrested, the effects of the cocaine injected into his bloodstream, and the preexisting coronary artery disease all led to the death of Dr. Reed. The cocaine stimulated the formation of a blood clot that may not have been fatal in the arteries of a normal man, but it led to a total restriction of the flow of blood to the heart of Dr. Reed. In medical terms, we call it an acute myocardial infarction, but it simply means that the heart fails to receive any oxygen and is severely damaged as a result. In Dr. Reed’s case, it was fatal.”

Rydell looked back at Brad, apparently satisfied with his answer. So was Brad.

“You said Dr. Reed died from complications associated with an injection of cocaine; is that your testimony?” Brad wanted to make sure that no juror missed this crucial point.

“Yes, it was definitely an injection of cocaine.”

“Well, Doctor, how can you tell that the cocaine was injected into Dr. Reed as opposed to absorbed in some other way . . . like snorting or smoking?”

“My conclusion is based on the level of cocaine found in the urine of Dr. Reed at the base hospital,” Dr. Rydell explained. He looked again at the jurors. “This is not a level typically associated with snorting cocaine. When the drug is snorted, it actually narrows the blood vessels in the nose, reducing the flow of blood in that area and creating a slower absorption rate through the blood vessels into the bloodstream.

“On the other hand, the types of elevated readings we see in this case generally come from either injecting cocaine directly into a vein or smoking crack cocaine. Smoking crack, as it is called, delivers a concentrated amount of the drug to the lungs, brain, and bloodstream in mere seconds. That is why injecting cocaine or smoking crack gives users an immediate rush, whereas snorting cocaine can take several minutes to deliver a high. It all has to do with absorption rate. In my view, it would be nearly impossible to obtain the level of cocaine found in Dr. Reed from snorting cocaine several hours before the lab tests were run.”

“Dr. Rydell, that would seem to explain your conclusion that Dr. Reed did not snort the cocaine that led to his death. But how could you conclude that he did not smoke crack cocaine?” Brad asked. He was following the script that he and the doctor had carefully crafted the night before.

“Judge, I object.” Strobel was out of his seat again, sounding annoyed that he would have to bother to make another objection. “Same basis as before. Dr. Rydell is not a toxicologist, and he is very far afield with this line of testimony.”

This time Ichabod hesitated. “I’m going to overrule your objection, Mr. Strobel. If he strays outside his area of expertise while answering the question, I’ll strike the answer and instruct the jury to disregard the testimony.”

“May I answer?” Dr. Rydell asked politely, looking at the judge.

Brad turned and smiled at Leslie.

“Yes, just stay within your area of expertise,” Ichabod instructed.

Rydell nodded his head. “In my line of work it is customary to consult with specialists while treating patients. That is essentially what I did in the case of Dr. Reed. In this instance, I continued to consult with other specialists even after Dr. Reed’s death in order to piece together what happened.

“Do you have a copy of the lab reports from the hospital?” Dr. Rydell asked. This request looked spontaneous, but it was, of course, scripted.

Brad pulled out a thick black notebook and fumbled around until he found the right tab. “Let the record reflect that the lab reports from the base hospital have been previously admitted into evidence and marked as Plaintiff’s 37.”

Brad handed the report to Rydell.

“Here it is,” Rydell explained, pointing to a certain page. “This really didn’t mean anything to me the first time I looked at it because it wasn’t essential to Dr. Reed’s treatment, but this urine test has no positive finding for methylecgonidine.”

“And what is the significance of that, Dr. Rydell?”

“Well, you don’t really smoke cocaine, you smoke a form of freebase of the drug that we have been calling ‘crack.’” Rydell resumed his role as professor. “That freebase is made by boiling powdered cocaine with sodium bicarbonate, a process that frees the cocaine base from the cocaine hydrochloride. The base separates in chunks of crack cocaine. Then, when this product is smoked and absorbed into the bloodstream, it is processed by the body and produces a metabolite that will show up in a user’s urine. That metabolite is called ‘methylecgonidine.’ The presence or absence of certain quantities of this substance is how you tell a snorter from a smoker.

“In the case of Dr. Reed, after finding a positive screening for cocaine using an immunoassay test, the lab performed a more sophisticated analysis that tested for both cocaine and its metabolite. This more sophisticated test is called a gas chromatography with mass spectrum detection, which basically creates a drug fingerprint and quantifies the drug. The cocaine was confirmed, but its metabolite, this compound called methylecgonidine, was not present in quantities that exceeded a standardized cutoff level. Thus it was not reported as positive.”

“So if the user smoked crack cocaine, you would expect to find this substance. But you did not find it here?” Brad asked innocently. He wanted to make sure that every juror heard this at least twice.

“I object,” Strobel bellowed again. “That last question is a leading question and should be struck. But more important, Judge, this whole line of testimony is way outside this doctor’s area of expertise. May I voir dire the witness to show the court what I mean?”

“You’ve got to be kidding,” Brad responded. “He’s not allowed to voir dire my witness in the middle of his testimony. He can deal with this issue on cross.”

“I’ll allow a short voir dire,” Ichabod ruled, sitting back and crossing her arms.

Brad held up both palms in silent protest, then turned and took his seat. Strobel rose quickly to begin his examination, his look of disdain showing the jury he was not the least bit impressed with Rydell. Strobel started peppering the witness with questions even before he got to the podium.

“Dr. Rydell, you’re not a board-certified toxicologist, are you?”

“No.”

“In fact, if you had a patient who presented with an unusual toxicological symptom, you would get a consult from a specialist more skilled than you in this area. Correct?”

“That’s correct,” Rydell said, “but I wouldn’t call a cocaine overdose an unusual toxicological problem.”

“Your Honor,” Strobel pleaded, “please instruct the witness to just answer the question.”

“Dr. Rydell,” the judge chided, “please do not volunteer extraneous information.”

Before Rydell could answer, Strobel was on the attack again.

“These lab reports, including the urine test, were in Dr. Reed’s medical chart all the time, is that correct?”

“Yes, to my knowledge, they were,” Rydell responded.

“And as the treating physician, you would have presumably reviewed them. Correct?”

“That’s also true.”

“But the absence of methylecgonidine meant nothing to you at the time because you knew nothing about that substance. Correct?”

“The absence of the compound did not mean anything to me at the time. That doesn’t mean I knew nothing about the substance.”

“Well, Dr. Rydell, isn’t it fair to say that even when your deposition was taken in this case, some three months ago, you still hadn’t attached any significance to the absence of this substance?”

“Yes. At the time of my deposition, I had not realized the significance of this laboratory finding. Dr. Reed tested positive for a very high level of cocaine. The absence of significant amounts of its metabolite did not impress me at the time as being that important.”

“Dr. Rydell, you stated that these drug tests were confirmed with something called a gas chromatography with mass spectrum detection method, what you called a ‘fingerprint’ of the drug. Is that right?”