Now, doctor, on the 17th, if you felt that you had been unable to adequately examine Mr. Simpson on the 15th, you had an opportunity to conduct any additional examinations you required; isn't that correct?
That's not a physical examination. That's a mental status examination; is that correct?
And, doctor, do you have any specialized training in psychology, psychiatry or neurology?
Being a general internist, I guess is--you know, considering 50 percent of the patients are non-concrete medical diagnosis cases, that would be I guess the extent of it.
Fair to say as an internist, you're supposed to be a Jack of all trades, but not necessarily an expert in any particular subspecialty of medicine?
Don't pull a muscle. Basically what I did was, no. 1, to reassess the patient's mental status; no. 2, to, most importantly, from the internal medicine standpoint, take another swing at this very perplexing constellation of findings with the drenching night sweats, the family history and personal history of cancer, the carcinoid cancer, which was assumed to be benign initially, and the modest elevation in the sedimentation rate and his finger clubbing. Also, we rethought about various aspects there. Obviously considering the magnitude of the case and I was the only one feeling his lymph nodes originally, I repeated that exam and looked at all the lymph node areas very closely.
You didn't find any enlarged lymph node under the left armpit, did you, at that time?
You had previously identified an enlarged lymph node under the right armpit; is that right?
And I'll touch base with you on this a little bit further. By the way, are those some notes you have?
Well, the other issues that I was--attempted to do that day was, we were doing a very sophisticated evaluation of his bleeding function and basically went through another history pertinent to whether he had any tendency to bleed excessively or to clot excessively, any problem of that nature. I also wanted to look very carefully whether, given my fears of cancer at that time, there was any brain condition that would be pertinent and went through a neurologic examination at that time. I also of course, given the constraints and my suspicion also of infection being high, wanted to repeat a temperature. And the skin tests were also felt to be important based on his initial constellation of complaints and skin tests, both cocci, tuberculosis and mumps skin test as a control replace, and, again, we then were able to send off a whole litany of esoteric serology tests and coagulation tests at that time. And those were the major thrusts of my reevaluation at that time. It was mainly to do laboratory very frankly, but--
And the bottom line, doctor, is, you did no further orthopedic evaluation of Mr. Simpson on the 17th; isn't that correct?
I believe--that is not--I don't have an orthopedic evaluation in the notes there.
And, doctor, again, those notes were to highlight what you thought to be the most significant findings, correct?
Given the whole scenario to do, correct, what I thought was the most significant findings and that--in the constraints of time that I put down and dictated immediately there, yes.
Well, again, did you feel constraints of time that precluded you from doing an orthopedic examination that you felt you were precluded from doing on June 15th because of the press of other business?
The orthopedic evaluation was extremely complete on the 15th. You are correct that the description of the gait was omitted, and that's a correct observation on your part.
And in fact, as an internist, you are trained how to conduct a hand examination to assess the distinction between osteoarthritis and rheumatoid arthritis; isn't that correct?
No, that is not correct. That would be quite a specialized or very difficult differentiation.
Doctor, have you ever had training and experience in identifying osteoarthritis based upon the hard nature, the bony nature of the sensation when you feel around the joint such as the proximal interphalangeal joint of one of the fingers?
I think the crepitation, the noise and the creaking that you feel when you move joints can be very difficult to differentiate on that basis alone rheumatoid from osteoarthritis.
That was not my question, doctor. My question is that when you feel the area of the joint, it feels, in osteoarthritis, hard bony like, which is different than it feels if it's rheumatoid arthritis. Ever had any training in that, doctor?
Well, I think that there are different phases of osteoarthritis. There are early phase where it can be quite--
Excuse me. I move to strike as nonresponsive. The question is asking if he's had training to identify osteo--
In your training, have you been taught for identifying osteoarthritis, that when you feel around the joint, you expect to find a hardening type of feeling, a bony type of feeling?
And have you also been taught--rheumatoid arthritis is an inflammatory disease; is it not?
Were you taught that when you feel around that same joint from rheumatoid arthritis, it would feel soft in nature?
And, doctor, so you've had some experience, haven't you, in examining the joints to distinguish the sensation of hardness versus softness?
Now, doctor, did Mr. Simpson ever complain to you on the 15th that he suffered from rheumatoid arthritis?
And in fact, in your report, you make mention of a Dr. Maltz, m-a-l-t-z, and you list him as a rheumatologist; is that correct?
So at that time, did you expect or believe that Mr. Simpson had at least been seen by somebody specializing in rheumatoid arthritis?
I knew he had been seen by someone specialling in rheumatoid arthritis, I knew he had a family history of rheumatoid arthritis. He was vague on exactly whether he had rheumatoid arthritis or it was a questionable disease. He was exhibiting many of the clinical features of rheumatoid arthritis, although the features which include symmetrical arthritis, greater than three joint areas, the hand and wrist involvement as well as certain other clinical findings in rheumatoid arthritis can be relatively difficult and there can be overlap with osteoarthritis.
So very frankly, there was some confusion on the 15th about exactly what types of arthritis there were. And I think in arrears, it turned out that he is a--quite a strong denier of the rheumatoid arthritis, and that's part of the problem and why he went off his rheumatoid arthritis--he never really accepted that he had rheumatoid arthritis and he certainly was not admitting it to me on that exam, although I kind of figured it out based on the doctors he went to and some of the things that he had been through and the medications that he had been exposed to. But that was definitely not clear on the 15th.
Doctor, is it your testimony you specifically asked Mr. Simpson on June 15th, "Do you suffer from rheumatoid arthritis"?
And where in your report if anywhere is there any aspect in which you've described his equivocation regarding possible rheumatoid arthritis as you've just testified?
There are numerous areas where I didn't dictate it in. We talked straight through and--I don't have two hours of dictated notes in that, no. That's a collation, and some of the important things, as you've pointed out, may have been omitted and that's--and that would be, you know, an error and alls I can do is say what happened.
Now, doctor, in doing a careful hand examination, did you try and evaluate whether there was a bony hard sensation around the hand joints versus a soft sensation?
That's not listed. Again, I did every single orthopedic area, every single neurologic area and didn't mention some of the things, and certainly in his case, they were more consistent with osteoarthritis because they were quite firm and bony.
Doctor, in fact, let me--I'm going to mark your report, if I could, your Honor, as--
May it be marked, your Honor--it has page numbers or chronological numbers from one of those continuous counters that starts on 433 and ends with 440--collectively then as 507?
And if I could ask Mr. Fairtlough to help me out, putting on page 5 of this report. Could we--I'm sorry, Mr. Fairtlough--raise it so we can get the bottom part of the document?
And in fact, Mr. Fairtlough, the only one I'm interested in is the last one there, "Ortho."
Doctor, that is the complete summary of your orthopedic examination on June 15th, 1994 of Mr. Simpson; is it not?
Now, doctor, if you're concerned about rheumatoid arthritis, there's something called a grip test that can be done, isn't there?
It requires some specialized things because typically you do it with a bulb with a gauge, and we don't have that at our office.
Well, doctor, can't it be done in fact using a blood pressure device? You do have a blood pressure device, you know, those cuff things that you pump up and then you have a column, a sphygmomanometer I think is the fancy name for it, right?
And in fact, if you wanted to do a grip test, all you have to do is roll the cuff up, have Mr. Simpson put it in his hand, pump it up to about 20 millimeters of mercury and then have him squeeze and watch on the column to see how high he can get the little mercury thing to go, right?
I think a much better and simpler test is just to do a grip test right on two fingers, and that was done.
Well, doctor, excuse me. That's not the question I asked. You could have done this test; could you not?
I could have done that test, but that's not a typical thing to do and would be totally inappropriate for this exam.
If a rheumatologist said it's a very typical test to do and gives you some objective standard because you can measure it against the column level of mercury, would you have any basis to disagree with that, sir?
Yeah, I would say that that's totally inappropriate because basically, here's a patient that came to my office for an evaluation of his mental state and to try to see if there are any extenuating circumstances in his current situation. The rheumatologic evaluation, the orthopedic evaluation is a total throw away. This is something that I was not asked to do, had no pertinence as far as I was concerned that day. I was particularly interested in, a, his mental status, which was why I was called to see him. No. 2, I was very interested about trauma, and I looked very carefully for any evidence of acute problems or any damage that he sustained. The entire orthopedic exam for--if--if--I think what we need to do is review a typical one- or two-hour evaluation in the community at large, the United States. I think that that's--that's quite an adequate evaluation. The rheumatologic evaluation when there was still some questions--at this point in time, I had no old records, I had no indication that he had rheumatoid arthritis. I think to do a grip test with a sphygmomanometer would have been wholly inappropriately especially since his grip was tested because I did that in the thorough neurologic exam when we test his median nerve. You do basically a wrist dorsi flexion strength, you do a grip and you do the fingers apart and that tests the three different nerves coming down the arm. And so I think it would be quite repetitive and I don't really see why you would gain any information. I'm not sure why you would be going in that direction in a person where it didn't appear to be an appropriate thing to do in the first two days of this particular man's evaluation, and that didn't seem to be in his--you know, it didn't seem to be something that was time efficacious or cost efficacious or appropriate at that time given, you know, the situation.
Hold on. Let him take a breath. Let the court reporter catch up. All right. Doctor, would you please slow down.
In fact, didn't you send Mr. Shapiro--indicating you were going to bill all of this through Mr. Simpson's insurance?
So is it your statement, doctor, that you did not do a complete and thorough orthopedic exam, that what you did was a throw-away exam?
I did a complete and thorough orthopedic exam. Typically what you do is, when you get an abnormality, then you go further on it. In other words, if I had done a grip test here, which is basically asking you to squeeze as hard as you can, if that grip test is abnormal and you are following them as a rheumatologist on an ongoing basis, then to do that test is perfectly appropriate when you have a situation like this and individual who is in the state he was in, who is having trouble staying awake because of sleep deprivation. To be going through esoteric tests that are really not of any immediate value I think would be absolutely inappropriate. So I absolutely have to disagree with you.
KEY QUOTEDoctor, where is it recorded the grip strength test result in your report of June 15th?
Well, there are numerous things that are normal that aren't reported. As I said, two hours of our interreaction are certainly not recorded here.
So your opinion was, from the grip test, that Mr. Simpson, whatever the findings with respect to the enlarged area of the joints, he had normal grip strength in your judgment, correct, doctor?
And there was nothing of urgency--I mean, you told us on direct examination about, he's going to be a candidate for a knee replacement I think was what you said; is that correct?
Down the line, there was no evidence that you felt apparent at that time that Mr. Simpson needed a knee replacement, right, on June 15th?
On June 15th, I think there was because he had significant crepitation, he had significant pain and he had, by history, significant limitations that were affecting the quality of life. And knowing the natural history, again, based on some information that was given to me later in terms of review of x-rays and further history, on further information, that opinion was based, not solely on what I found history and physical wise on the 15th.
Well, doctor, what my question was though--and, please, again, if you would listen carefully to the question. My question was, on the 15th, did you think he needed a knee replacement?
On the 15th, I thought that he was in trouble with his knee and his ankle, and my plan was, based on the fact that I didn't really have a tremendous high suspicion about the rheumatoid arthritis, was that he needed an orthopedic reevaluation. And that was one of my initial points; is that when this whole thing was cleared up, he needed some help with his knee and his ankle so that he would be able to play golf and not be in the pain every morning that he was in.
Your Honor, I must move to strike as nonresponsive. My question asked him did he need--
Doctor, please listen. My question was, on June 15th, did Mr. Simpson in your opinion need a knee replacement?
And in fact, you made no effort to have him seen by an orthopedist after June 15th, between the June 15th and June 17th examinations; is that correct?
The orthopedic problems were chronic and something that would bother him over a many year period and were not of an acute nature, certainly not as acute as his other pressing problems.
And in fact, your opinion was that he had no evidence of an acute arthritic problem, that is a flare-up of any arthritic condition, whether it be osteoarthritis or rheumatoid arthritis on June 15th, 1994; is that correct, doctor?
Well then, doctor, what evidence did you have that he had an acute flare-up of either the osteo or the rheumatoid?
Some of which came by in terms of arrears. But he had a very painful knee, he had a very painful ankle, and those conditions subsequently responded to treatment. Also, when we found out that the drenching night sweats and some of his other systemic symptoms responded to rheumatoid arthritis treatment, some of this is deduced in arrears. But when he came to me, he was--he had joint pain and it was unclear what the exact ideology was.
I made the assumption originally based on his history and my physical exam that they were predominantly orthopedic problems based on his previous wear and tear injuries. I think that based on further work-up of his drenching night sweats and enlarged lymph node, which I believe indicated rheumatoid arthritis in the end, and the fact that I found out later he had unbeknownst to me stopped his rheumatoid arthritis medication approximately a month ago, that some of his problems which then subsequently cleared significantly were due to rheumatoid arthritis. But it was very difficult for me given the constraints at that time and the fact that I didn't get a full history and therefore couldn't do some of the specialized testing you're indicating it would have been nice to do, that I wasn't able to deduce that right on the 15th.
Your Honor, I've asked Mr. Fairtlough now to put up page 6, doctor, of your report, at least the copy I've been provided, and it lists, at least on the copy I have, various what are under assessment plan--
This document shows--this is the document I've been provided. It shows items 2 through 16, right, doctor?
Now, doctor, in essence, is this your effort to summarize in order of significance your findings?
It's a review--it's a review process where I try to lump different symptoms into broad categories so that I could rethink his various problems, but not necessarily on a direct prioritization, although typically no. 1 is your main problem.
Now, doctor--and whatever no. 1 may be, it wasn't acute rheumatoid arthritis, right?
It wasn't anything that dealt with his physical capability to murder two human beings on June 12th, 1994, was it?
Doctor, was item no. 1 anything to do with Mr. Simpson's physical ability to murder two human beings on June 12th, 1994?
Doctor, was there any finding made by you in--covered in whatever item no. 1 is which dealt with any physical limitation of Mr. Simpson's which in your opinion would have prevented him from murdering two human beings using a single-edged knife on June 12th of 1994?
And there is no entry here on the 2 through 16 that are listed for an acute phase of any kind of arthritis, right?
Well, the right angle instability in the--is of unknown duration. You know, I wrote basically "Right ankle instability with chronic pain," but I thought that that could be an acute problem. And of course, the left knee was very bothersome. I had no idea whether that was acute, better or worse. I just knew it looked bad at that point.
Doctor, the terms "Acute" and "Chronic" are medical terms that have significance, don't they?
And in fact, you specifically used the word "Chronic" to describe the right angle instability, meaning it's been of long-standing duration?
And you had some more lab work done on a sample drawn on June 17th. That's the one in the photograph where Mr. Simpson appears to be grimacing in reaction to the needle extracting the blood; is that correct?
Incidentally, you have no idea on the 17th whether Mr. Simpson was putting on an act of the pain relationship to having the needle injection or the needle inserted to withdraw the blood or in fact he really was reacting to pain from that procedure, right? You have no way of knowing?
But you do know he was seeing you at the request of his attorney again; isn't that correct?
I was asked to make a house call to further evaluate a variety of medical problems.
My question was, you did know on the 17th that you were seeing him again at the request of his attorney?
This was not a situation of a patient calling you up and saying, "I'd like to come in and be evaluated," right?
Now, doctor, let's start with the laboratory tests. If one were looking for evidence of acute rheumatoid arthritis--
And, your Honor, I have another document to be marked. It's got our page number 446. May this be then I guess it's 508?
And because I think it might go faster, I'm going to hold on to it and do the marking and then ask Mr. Fairtlough to put it up on the--
All right. Doctor, there is a lab test done for something called CRP. That's one of the tests, right?
And it can be generated in response to inflammation in the body; is that correct?
And in fact, if somebody had--and when I use the term "Acute," I'm talking about an onset, not a chronic problem, but one where you've got an onset of new symptoms or renewed pain, that kind of thing. You understand how I'm using the term?
If one had an acute onset of rheumatoid arthritis episode, one would expect to see a positive CRP very quickly, wouldn't you?
And it would then come down only after the episode, the acute episode had passed; is that correct?
And that is another aspect of looking for a finding associated with rheumatoid arthritis, right?
And would it be accurate to say that the RA test is a slower test to show the presence of an acute episode of rheumatoid arthritis than the CRP test?
I'm asking Mr. Fairtlough now to put this exhibit 4--I'm sorry--508 up, and I've outlined in blue the two areas we've been talking about. Now, the first area--and Mr. Fairtlough's got it there--that's what we were talking about, this CRP, this liver-generated protein, right?
And if we move to the right where it says "Neg," that's the test result, correct?
If we move to the next full word, "Negative," and go up a bit, there's some preprinted information reference range; is that correct?
And that is to give the doctor some indication of what you would expect in a healthy patient, right?
And so in this particular test for CRP Quant, it's negative, which is exactly what you would expect in the healthy patient, right?
And the result, doctor, that's a little mathematical symbol meaning less than 17.3, whatever units are being used, right?
And the reference range for a normal person would be any result which was less than 20.0, correct?
And again, this would suggest that Mr. Simpson did not have an active episode of rheumatoid arthritis, correct?
And, doctor, then you talked about something called a sedimentation rate test, right?
That's to reference when the blood sample was drawn, right? Is that correct, doctor?
So this test, series of tests is from a blood sample of Mr. Simpson's drawn on June 15th?
All right. Now, on this document, is there any reference to a sedimentation rate test?
Doctor, would you pull out whatever result you have of a sedimentation rate test done from a sample drawn on the 15th?
And, doctor, let me get the page number then so that I'll have a reference on that. This is on page I think 450 for counsel's information. Doctor, this form.
The other test results were sent out. In other words, we did an initial CBC. You can see that that's part of it. So that's his complete blood count because we wanted to know instantly what his white blood count was.
Now, you had a second sedimentation rate test run on a sample from the 17th; is that correct?
I would say mild elevation, probably a shoulder shrug. You don't know which way to interpret it, but certainly not sky high.
Well, pathonomic would mean something where you see a result, and you're--it's compelling evidence toward a certain diagnosis.
Would it be accurate to say just given what you testified, that a sedimentation rate of 17 or 24 would not be considered pathonomic for an acute episode of rheumatoid arthritis?
Again, rheumatoid arthritis is very difficult because it's not a lab test disease. Rheumatoid arthritis is a clinical disease and the diagnosis itself is based on seven clinical criteria, only one of which is really a lab test and one of which is an x-ray. So usually rheumatologists in counterdistinction to many other medical subspecialties don't rely that heavily on lab tests although they certainly have a role. And as far as I'm concerned, when I saw that result instantly, that's part of the reason why I didn't pursue rheumatoid arthritis initially, because I was led away from it by these initial two results--three results that you've pointed out. And that's why I was going the osteoarthritis route initially in my mind, not the rheumatoid arthritis route as a cause of all or a preponderance of his orthopedic joint complaints.
Now, as you testified, I believe you said in arrears several times. You got information after June 17th of prior medical care Mr. Simpson had received; is that correct?
And in fact, you spoke to Dr. Maltz for the first time, did you not, on June 27th of 1994?
So was it accurate to say that you felt nothing from your evaluations of the 15th or 17th dictated an immediate consultation with Dr. Maltz?
And in getting the records from Dr. Maltz, did you find that in 1992, when Mr. Simpson had complaints that had him go to Dr. Maltz, that Dr. Maltz had a sedimentation rate test run? Did you find that to be the case?
I'm not that familiar with his records. So if you could tell me what it was, I'd believe you.
Well, if the doctor--I'm not sure the doctor has an original. I think he has a copy and we got a copy somehow. Unfortunately, the date, I'm not sure if that's June 27th, 1992. Probably not. I'm not sure what month it is. But whatever it is, if--Mr. Fairtlough, just leave it right there.
And is it accurate to say from your understanding of rheumatology, doctor, that a patient tends to have a pattern; that when there are acute episodes of an onset of the inflammation causing symptoms of discomfort and so forth, that a pattern continues such that you would see a similar sedimentation rate result in earlier and later episodes?
I'm not really aware of any research that shows, you know, a similar sedimentation rate with each flare. So I really can't comment on that. I have no knowledge that that is in fact factual.
All right. Would you describe a 34 as something of greater significance to you if you had that result than the 24 and the 17?
Honestly, I regarded everything in my own mind up in that range as modestly, mildly elevated. So no, I wouldn't say there's much of a difference between 24 and 34 very frankly.
Now, incidentally, I think you mentioned that from your understanding of rheumatology, that it tends to be a bilateral, a symmetrical kind of disease, a fancy way of saying if you see something on the left middle finger, you should expect to see something on the right middle finger, that kind of thing, correct?
I agree. And that in fact is one of the seven diagnostic criteria for rheumatoid arthritis.
When you examined in the orthopedic examination of June 13th, did you see such symmetry between the left and right hands of Mr. Simpson?
There wasn't--no. There wasn't striking similarity because the left wrist was so much more--was severely involved and the right wrist seemed relatively normal.
Doctor, would you show us--and perhaps you need me to be the patient--how the grip test you did was conducted? May I, your Honor? Let's start with the right hand.
Okay. Basically, I'll say take my two--actually I do it with both because I want to compare simultaneously.
--squeeze as hard as you can. And then I'll sometimes fight to try to get out, and that basically assesses your grip (Demonstrating).
Now, is there any way at that time that you can truly assess the level of cooperation of the patient?
Although if the patient doesn't cooperate or is weak, then you refer them for further tests including ENG--ENG and whatnot, and you may better assess that, but--
Doctor, is it important in evaluating patients to provide some record that is of some objective nature so that doctors who may see the patient down the line in time and who may not have been present for the earlier exam can evaluate any changes between your exam and later exams?
And without some objective standard for evaluating the grip test you did, how would a doctor be able to assess whether or not there's a change down the road given your subjective evaluation that his grip test result was normal?
Well, if his grip was weak or one side was weaker than the other, then you would have to assume that there was a change that needed evaluating.
But weakness is a subjective evaluation. There are tests that quantify the grip strength, correct?
Yes. That's true. But if you have a firm strong grip strength and it's equal on both sides, typically there's no need to further go into it. In other words, you can keep doing tests. You can say I'm healthy and you can do an EKG and a stress test and a stress thallium and then you can--you know, are you going to do an angiogram on everyone. How far do you push on someone where your initial tests are revealing general normalcy.
And that's why you didn't have any further orthopedic tests ordered from the June 15th examination, right?
No. There is a plan. Put--proba--put appropriately or not, to have him see an orthopedist in the future for his ankle and knee problems which I didn't think were commiserate with a good quality of life and with the ability to play golf in a pain free state. So there was a plan, but certainly that was not something that needed to be done over a very brief period of time.
A number of areas I want to talk about, but I have just a few minutes to talk before we break for the day apparently. You talked about observing what you thought to be somewhat ragged edges in at least one if not more of the cuts on Mr. Simpson's hand; is that correct?
--is there an immunological reaction that releases something called phagocytes, P-H-A-G-O-C-Y-T-E-S, into the injured area?
Actually initially, in the first 24 hours, it's inflammatory cells. So it's more neutrophils would come in within the first 24 hours. So phagocytes is a later stage, and that--actually monocytes is a better name for that cell, and that typically won't arrive at the sight of the injury until more like the second to the fifth day.
And assuming that these injuries were sustained in the evening of June 12th, that would now mean the examination is taking place almost three days later, two and a half to closing in on three days later, right?
Assuming, doctor, that these injuries were sustained, some or all, on June 12th around 10:15 in the evening and your examination is taking place between noon and 2:00 o'clock in the afternoon on June 15th, we've got more than two and a half days that have passed, correct?
And if--we'll use your term "Monocytes." The monocytes you would expect could have been already working on the injured area, right?
And, doctor, in fact, don't such cells in essence eat up the damaged area before the body starts to lay down new cells?
It creates erythema, redness around the rim. The ragged edge that I was referring to specifically on the left fourth index finger was the slight snake like appearance, the in and out components rather than just a nice smooth slit like you might expect with more like a surgical knife or some other, you know, instrument of that nature.
My question though, doctor, was, will such monocytes, phagocytes if you want to use my term, leave evidence of a ragged appearance to the area of the injured tissue where they have begun to work?
Right where the point of the incision is, I don't believe so. What happens is, especially the wound over the third was widened because that was different than the other ones because it was right at a joint line. And so what happens is, there's this kind of this fibrinous exudate that--that--this--you know, it's a scab basically that--that--you know, the yellow stuff that comes out after cuts secretes in there. And that wound--then the one here was substantially more open than his other wounds (Indicating).
Your question--and I understand it--is, when you look at the edge, can you tell if it's a serrated or an undulating line or a straight slice and is that affected by the several days of this battle going on, first with the inflammatory, then the monocyte phase before the collagen and the scarring state sets in. And certainly, with relative hydration and dehydration, you could get edges that might potentially confuse you. I'd have to say that that's probably true.
And, doctor, you said in response to Mr. Shapiro's question that a knife could give the appearance of a cut that you believe was due to glass; is that correct?
I think with a knife, if you're--if you're a surgeon, you can mimic a lot of things.
Well, doctor, in your experience, in the ER room, with respect to--I'll use the term "Sharp force injury" from a sharp knife in general, the history is not terribly important to you if you see a wound that is bleeding, right?
No. That's not true because obviously the first thing you want to know in a wound that's bleeding is what's the infection, what's the time that the wound has been open because we know in the first six to eight hours, that bacteria multiplies, that you have a hundred million, you know, bacteria per millimeter. That's very important. So the history is crucial in cuts as well as every other part unless the person is bleeding in such a state that you feel their myodynamic status is going to be compromised. So you act quickly to negate the artery bleeding.
Doctor, in the kinds of cuts that you saw Mr. Simpson had, these were not life-threatening obviously?
But when you see such cuts in an emergency room, one of the issues is, do I have to suture it or is it going to heal naturally, right?
And that has more to do with the depth of the injury than the source of the injury, correct?
There are many factors that go into whether or not you will suture a wound, including depth, position over movable joints, cosmetic factors and convenience factors.
But the question was, it's more important, the depth than worrying about the cause, correct?
It's more important, the depth. You want to do it in the cheapest way possible, and obviously very deep lesions are less likely to heal spontaneously than very superficial injuries.
Sounds good to me. All right. Ladies and gentlemen, we are going to take our recess for the noon hour. Please remember all my admonitions to you; don't discuss the case amongst yourselves, don't form any opinions about the case, conduct any deliberations until the matter has been submitted to you, do not allow anybody to communicate with you with regard to the case. As far as the jury is concerned, we'll stand in recess until 9:00 A.M. Monday. Doctor, you may step down. You are ordered to return Monday morning 9:00 o'clock. All right. We'll stand in recess.
No, there was not.
The rheumatologic evaluation, the orthopedic evaluation is a total throw away.
I did a complete and thorough orthopedic exam. Typically what you do is, when you get an abnormality, then you go further on it.
certainly, with relative hydration and dehydration, you could get edges that might potentially confuse you. I'd have to say that that's probably true.
Cost efficacious, doctor?