Thank you very kindly, your Honor. Good morning, ladies and gentlemen.
THE JURY: Good morning.
REDIRECT EXAMINATION BY MR. SHAPIRO
Those are terms that deal with the study of things that happen essentially after death with an obvious bent towards law, and you know, pathology of medicine as it relates to that.
And the term "Forensic" as it applies in the court setting deals with people who deal with legal issues related to their specialty; is that correct?
I take it that your primary focus is the practice--the private practice of medicine?
Now, you have indicated that you graduated from Harvard medical school. At the time you went to Harvard medical school how was that rated in the spectrum of medical schools in the country?
I think in terms of the rating by the deans and the difficulty in getting in it was probably the hardest school to get in.
And just like schools, do residencies differ in their programs and their prestige?
Again, it is difficult to exactly quantitate, but there is different levels of prestige and levels of quality and difficulty in getting in.
Typically two individuals from that class are chosen to teach the oncoming residents and to lead morning report and to round with the younger residents for educational purposes.
Well, presumably they are chosen by the chief of medicine based on whoever shows the most promise in terms of teaching and other physician attributes.
In terms of teaching, in addition to your private practice of medicine, have you maintained any teaching positions?
Umm, introduction to medicine, as well as attending for medical students and the residents on ward rounds.
Now, you've told us also that you were a doctor for the Los Angeles raiders, a football team?
There was one other team in Los Angeles area and there was one other internist for that team, and then during my tenure with the Los Angeles raiders there was also another football team that was there temporarily, so there was an internist for that team as well.
Why did you resign from that position after how many years--how many years did you serve in that position?
I resigned from that position because the team owner would not listen when I described in detail an incident that happened with the team orthopedist regarding an incident where a player was temporarily paralyzed. And essentially, to make a very tragic story short, was told face-to-face by the orthopedic surgeon, after he had information that said there was a problem in his cervical spine, that he was potentially at higher risk, according to numerous specialists of the neck, orthopedic neck specialists and neurosurgeons, he was looked at by the team orthopedist in his face and said based on that x-ray you are okay, you know, you can play next week. And of course I, as all these types of problems, went behind the scenes and made sure he got other opinions, but when the owner didn't back my position on this, that is why I resigned.
How do you value that? How highly, how strongly are you concerned about your integrity?
That is all I have as a physician is my reputation which I have worked hard to build over the last 21 years since I entered medicine.
KEY QUOTEIn the private practice of medicine do you function as an individual doctor for the purposes of your own income?
I have been reminded that some people might have some difficulty hearing. Would be kind enough to maybe move the microphone a little bit further.
And one of the doctors that you share office space with is my personal physician, Dr. Robert Koblin?
What are the other doctors who are included in your group now that practice out of the same office?
As a private practitioner, the source of your income for which you rely upon a living is patients?
Basically over a period of time individuals that feel you are providing them high quality medicine will refer acquaintances, friends or family members.
And you have told this jury already that you have never before testified in a case?
I think my focus was the same focus I have with every patient and that is that I sit them down in my office and ask them, you know, what are your problems and try to figure out if there are any other things going on that they may not be aware of, and essentially formulate a plan for their health. I, you know, approached him like I approach every other patient in my office, and really, besides requesting from you a photographer, given the fact that you told me on the phone he had cuts, really did nothing else different than I would do for another first time office visit, thorough physical examination.
So what you are saying is, in addition to the general examination that was requested by the patient, there was something additional and that was to take photographs--
Would you tell the ladies and gentlemen of the jury, in addition to the history and physical examination of Mr. Simpson, was there something additional that was requested by myself?
The remainder of the body as well, to document whether or not there were any other injuries.
Outside of that, was there anything else that was requested of you, when you saw Mr. Simpson as a patient, that was out of the ordinary?
Has there been--have you met with anybody in preparation for your testimony here today?
I met--I talked with you on the phone on Thursday for approximately--excuse me. You came to my office on Thursday evening for approximately fifteen to twenty minutes on Thursday night. I finished up seeing patients at approximately 7:30 to eight o'clock on Thursday night. I had not prepared whatsoever any special material and you came and gave me an idea what sorts of things you would be asking on Thursday evening. Before that I had one meeting at Mr. Cochran's office somewhere around the 1st, where there were a group of attorneys, you were present, as well as other attorneys, and I stood up and gave a brief summary of Mr. Simpson's medical problems.
And Sunday, which was in the middle of it, you said prepared before--Sunday in the middle of this testimony I went and watched the video that--actually didn't get to see this video; I saw the final product.
Were you given any instructions by myself or any other lawyers as to how to testify in this case?
Have you in any way tried to mislead this jury based on your medical findings and observations of Mr. Simpson on June the 15th?
Based on the standard practices for physicians in the Beverly Hills West Los Angeles area, is there a general standard of practice for a first evaluation of a patient?
Generally when you see a first time new patient you sit them down in your office and talk for approximately a half an hour to 45 minutes to even an hour, and essentially then move on and do a physical examination that typically takes somewhere around a half an hour to complete, and then the nurse gets the patient, either in the middle of that process or at the end, to do all the vital signs, to draw blood for tests, to do chest x-rays, to do a hearing test and a vision test, if that is needed. And then essentially occasionally, if it is appropriate, you know, other things may be done, such as seeing a dietitian in the office.
Would you explain to the ladies and gentlemen of the jury what that entails, what your function is as a doctor in that area?
Basically you are--someone--a family doctor, quote-unquote, is someone who did their four years of medical school, did one-year of internship and then he hangs his shingle. An internist basically does that first year where you kind of take all comers, but then you do an additional two years where do you essentially the same thing to hopefully get a little bit more understanding of those problems. And then in my case I did an extra year of chief residency, all basically evaluating every different sub-specialty, so my role is to try to see if I can take care of all of your problems. Obviously there are certain--I might be better in kidney disease and not so great in dermatology, or I might be very good in orthopedics for an internist and not so great in something like rheumatology. And then you basically, if you can handle their problems and you feel comfortable with their complaints, the buck stops there. You make the decisions and you devise a treatment plan. If that is not the case, then you make arrangements to have them see a second opinion, a sub-specialist who are going to know something about that area, but they hopefully will know somewhat more and then you refer them to that appropriate specialist.
And approximately how many sub-specialists are there that you would refer people to, just generally?
In terms of the classes of sub-specialties probably, you know, fifteen or twenty, although you can get very technical and you can break down some sub-specialties, even something like orthopedics, into people that do mostly ankles, knees or shoulders or neck or back, but I would say fifteen or twenty is a pretty good estimate.
Now, regarding OJ Simpson, did you conduct the examination that you described to the ladies and gentlemen of the jury as being a proper initial patient's valuation?
Yes, I did. Possibly because it, I believe, took about two hours, maybe in terms of doing the history and in terms of including time for the photographs, maybe it went an extra 15, 30 minutes over what I would normally spend, because we were pushed back, as I said, an hour into our afternoon.
Now, in terms of a physical examination, is there any real limitation on what a doctor can do in examining a human being?
No. Basically what you do is you start out and there is a standard examination. In other words, if you look at, say, something like the stomach, you can just do the routine things, which might be to listen to see if there is bowel sounds, to see if the intestines, the abdomen, is symmetrical, to feel if there are any masses or there is any tenderness or to--obviously I think I mentioned already--listen. If any of those are abnormal, that is the screening--let's just say, of the abdomen; look, listen, palpate. If any of those are abnormal, then for each abnormality there are ten more things that you could then move into, but there is--you know, you can't do every test and every person or you essentially would be there for twelve hours.
I mean, there are some examinations that perhaps the president of the United States would get on a yearly examination or heads of other states that might require a hospitalization and a battery of tests over a period of days; isn't that correct?
Okay. So there are limitations within an initial examination. Did you feel that within those limitations a proper initial examination was done of Mr. Simpson?
Yes, I did, in addition to which again dictating the report would be a little bit unusual. Usually you take cryptic notes and just noting certain things, so that would be the only other unusual thing about this evaluation.
Now, in doing an initial evaluation, are there certain areas that you do not go into in-depth until you find problems?
And if you find problems, is it then your job to see if the person is being treated by somebody in those areas?
Did you find--first let me ask you: When people see--do you have patients that see on you a routine basis?
In your history did you find out whether OJ Simpson had such a doctor in the last five years?
He does not have a regular doctor that he saw on regular basis for internal medicine.
Now, you've told us that you are--in response to a question by Mr. Kelberg, are you board certified in emergency medicine?
Mr. Simpson saw me for an acute stress reaction, situational depression, difficulty sleeping.
And did that lead you to investigate other areas of his health during that history?
And investigating other areas of his health you have told us that he had a condition and a disease known as arthritis?
Now, you have been cross-examined for about two days by Mr. Kelberg on arthritis?
If Mr. Simpson had no other doctor and you were the first person who saw this condition, would you have referred him to someone else?
And regarding the orthopedic--now, let me just ask you this: Was there--after that examination for two days is there any question in your mind, as of June 15th, 1994, whether or not OJ Simpson suffered from arthritis?
Yes, I would. You know, they say something, you know, in medicine, you know, when you standing in Montana and you hear hoof beats coming behind you, it could be zebras, but it is horses, and that is what you have to see. And in his case he had absolutely without question multiple areas where he had arthritis.
Is there anything in the two days of examination by Mr. Kelberg going over all minutia, all the reports--
Is there anything in the two days of examination of Mr. Kelberg on the issue of arthritis that changes your opinion as to whether or not on June 15th Mr. Simpson suffered from arthritis?
If Mr. Simpson did not have a specialist in orthopedics--an orthopedist, would you have referred him to one?
Are you familiar with the name of the orthopedist that Mr. Simpson was seeing, Dr. Frank Jobe?
If, as a hypothetical, that a doctor of Dr. Jobe's reputation, education and experience, evaluated Mr. Simpson and referred him to a rheumatologist named Dr. Bertram Maltz, would you as a doctor, expect your patient, Mr. Simpson, to follow that advice and go see Dr. Maltz?
And to your knowledge was Mr. Simpson treated for the last three and a half years for arthritis?
And do you believe that that was to set up some type of Defense for a crime that would be committed five years or four years later?
Do you believe it was some type of charade to fool Dr. Maltz three and a half years ago that he was suffering from a condition and treated for a condition that he didn't have?
You have told us that as a team doctor many athletes don't want to admit injuries because that would prevent them from playing; is that correct?
And that would be your job whether or not somebody was capable of playing or not; isn't that true?
So you are used to people not giving you a complete accurate history; is that correct?
And would you say you may be more used to that than ordinary doctors who practice internal medicine because of your experience in the NFL?
And your experience in the NFL as an internist, how many other doctors were acting in a professional capacity advising teams in the national football league when you were involved?
There were somewhere in the seventy to eighty range in terms of doctors that were affiliated with the 28 professional NFL football teams.
And is there an organization of those doctors--was there an organization of doctors?
In 1987 I was elected vice-president, president-elect and was president of the NFL physician's society from 1989 to 1991.
Now, Mr. Kelberg went through part of your curriculum that I did not bring up and that was things that you have done on television and on radio?
Were you selected to appear in certain venues on radio and television because of your expertise?
Do you know why you were selected to appear on certain radio and television shows?
In the past I have been hired by several shows to go on for a two or three-minute blurb to talk about general medical issues on a revolving basis.
Would you say that substantially almost all of your income come from your private practice of medicine, not from talking on radio or television?
In fact, were people highly critical in the football league of the book that you wrote?
Mr. Kelberg showed you a letter that is dated February 5th, 1995--may I show this to the witness which had post-it over it and that post-it was a question to my colleague, Mr. Carl Douglas; is that correct?
And as part of discovery were you aware that we turned that letter over to Mr. Kelberg?
And did you demonstrate some concern about not being able to find that in your file when Mr. Kelberg asked you about that yesterday?
I had reviewed my chart on that late Thursday night when I--after talking to you, and I remembered that it wasn't in the part of my notes that I reviewed, but in fact it was misfiled in a different part of this chart here, hadn't seen it.
Had you ever been asked by a criminal lawyer before to write a summary of your findings so that they could be turned over in a procedure we call discovery?
I had no idea how long he wanted the summary to be, whether he wanted it a half a page or five pages. I made it one page and I wasn't sure whether that was the type of in-depth presentation of the problems that he felt was appropriate, given the report he wanted me to generate.
Your question had nothing to do with accuracy or integrity of the report, but more the form of the report?
And that is not something you do when you do your patient evaluation the way you did for Mr. Simpson in the ordinary course of your practice; isn't that correct?
Now, in examining Mr. Simpson, you told us that you diagnosed a lymph node under his armpit?
Because given the whole constellation of his complaints, I was concerned that that could indicate some sort of infection, cancer or other acute process that needed to be resolved in the middle of everything else that was going on. And it presented many medical, as well as organizational problems to properly treat that problem. When you see an ordinary patient, you don't have the pressures that were faced in this case in terms of time, availability of the patient and other issues.
And did that have any effect on speeding up your next examination of Mr. Simpson?
Well, we needed to get in and draw more blood tests and put skin tests on to evaluate some of the possibilities for that abnormal lymph node.
And in your experience in this case, have you found it is more difficult to treat a patient in jail?
It is more difficult to treat a patient in jail than in the usual Beverly Hills setting.
Well, it was a very difficult situation because I was told when he went into jail that the admitting doctor who examined him said he didn't have a lymph node.
Objection, your Honor. I will move to strike as nonresponsive. The question is what did he do.
Followed up on the blood test and tried to gain access into the hospital so that I could have a cancer specialist evaluate the patient.
So this isn't--is not something you did on your own, but you again went to a sub-specialist?
That is correct, after initially going to an infectious disease specialist with the initial batch of results, and feeling that that probably wasn't our first line of attack.
That opinion differed because I was told the doctor that evaluated him on the night he went into the hospital felt there was no lymph node.
Tell the jury what you had to do to follow up on this and what steps you had to go through to properly treat Mr. Simpson?
That is not particularly relevant. What he actually did, what treatment he got is relevant.
Would you answer the Judge's question, what you actually did and what treatment he got?
After initially going through all his first batch of tests with an infectious disease specialist informally, since it was very difficult to gain access into the jail, I made arrangements first to get myself back in the jail to try to assess his lymph node as well as other continuing problems with the night sweats. And then when I ascertained that the lymph node was in fact still there, over a period of time arranged to have a cancer specialist get admittance into the jail and feel the lymph node to feel whether he felt it was a benign node or a pathological node based on his examination.
Well, Dr. Greg Sarnus saw him in the jail and felt that there was, given his history and physical examination that he conducted in the jail infirmary, that there was up to a ten percent chance that given this history and physical condition, he had something in the range of a Hodgkin's type cancer and a ninety percent chance that it was some other benign or infectious disease.
The recommendation made was to have him hospitalized and to excise this index right axillary node.
Did this have anything whatsoever to do with the Defense of OJ Simpson in this case?
Did you do any further studies relating to any issues regarding the Defense of OJ Simpson in this case?
The only other issues that I did were on the evaluation of the cancer on the 17th. I drew extra blood relating to his hematologic status, whether or not he had any proclivity to bleed or clot more quickly than the normal, at the request of Dr. Baden.
The result of that was that it appeared likely--coagulation studies were normal, although there are a couple very esoteric tests that were borderline and suggested a possibility of a very minor tendency to bleed more than a--what would be considered normal.
No, I have not. We have watched limited autopsies as part of a teaching process in the hospital, occasionally patients that expire in the teaching situation in the hospital, we will go down and have early morning autopsy viewings and discussions of organs.
Have you ever been asked to give an opinion of a decedent's injuries on a hand the way Mr. Kelberg asked you to?
Was that your purpose in coming here, to give an opinion on the injuries of a decedent?
Before you were asked these questions, other than on general knowledge, did you have any specific knowledge as to how these murders took place?
Let me ask you a general question: Describe to the ladies and gentlemen of the jury the basic range of patients you see by age.
Well, we probably see individuals all the way from 15 up to I think my oldest patient is 101, 102.
Excluding the young and the very old and the infirmed, is there any patient that you treat that would not be capable of handling a knife?
Is there any patient that you treat that would not be capable of cutting someone with a knife?
No, not unless they had a fracture on that arm or some type of obvious deformity.
And would you give the same answer to the general population of southern California with the exclusion of the young, the old and the infirmed?
Could you--do you recommend for your patients, between the ages of 15 and 101, any type of physical exercise?
Well, they range from basically in the case of my 101 year old patient, tell her to walk around her house on her walker on a daily basis, to discussing workout plans with professional athletes.
Regarding the video that you just saw, would you recommend that to any particular age group of patients you have?
I think that that is a very low impact and it is a relatively straightforward aerobically, and so that sort of level of exercise would probably be more appropriate for very healthy individuals, maybe all the way up to, you know, both men and women, assuming that you did kind of knee push-ups, all the way in the mid-seventies or higher certainly should be able to do what we saw on that tape.
I think additional pec strength, you know, if we expected people of that age to do push-ups.
I noticed you taking some notes during the playing of the video. Did you notice any breaks within that video?
And would you describe those to the jury as to what affect that would have on somebody doing the movements in that video?
Well, obviously when you take a break, you know, you recharge your batteries in terms of your aerobic mechanism and your heart rate is going to come way down and so you are not going to--you know, like running a treadmill, you are not going to poop out when you have those rest periods in terms of the movement. For certain types of arthritis, actually moving may help limber the joints. Certainly osteoarthritis, you know, sometimes after moving somewhat, you can warm up the joint a little bit.
Asked a lot of questions--is that okay? Asked you questions about professional football players?
Do you know when the last time Mr. Simpson played in a professional football game was?
As somebody who is familiar with sports, are you familiar with the oldtimers baseball game?
Regarding your experience with professional football players, are there positions known as skilled positions?
A skilled position is something in terms of a wide receiver, quarterback, running back.
And in your experience do players in skilled positions have to be mad to play football?
Are you aware that Mr. Simpson, through his four years of college and fifteen years in the NFL, carried the ball more times than any other runner in that period of history?
And if he didn't score a touchdown what would happen to him when he was carrying the ball?
And if he carried the ball more than any other player in the history of the NFL, up until that period of time, and in college up until that period of time, would you say then he was hit more than any other player?
He would be hit certainly while playing games more, and you know, practices would certainly add to that toll.
What is the effect on a running back carrying a football, being hit by one or more other players in a tackle?
When you get hit, in terms of the joints, you may occasionally damage ligaments and bony structures.
Was Mr. Simpson the type of player who had the reputation of being a friendly football player?
Are you aware that in the fifteen years that he played football he was only involved in one fight?
About this--this type of adrenaline rush, would that be the same for anyone who is in an emergency situation?
And in fact you talked about the fear syndrome. Would you say that adrenaline reaction would be the same if somebody was being attacked by more than one person with a knife?
And would you expect that they might fight back with more strength than they ordinarily would have?
Your Honor, I will object, outside the field of expertise. He said he is not a forensic pathologist.
You were asked a hypothetical question by Mr. Kelberg and he listed a series of ten witnesses and he said if some of these witnesses or one of these witnesses did not see Mr. Simpson limping. Do you remember that question?
Let me ask you another hypothetical. If an individual by the name of Jim McKay came to this court and testified that he had never met OJ Simpson before and on June the 8th of 1994 he played golf with him, and as a complete stranger he observed Mr. Simpson to be limping, would that confirm the conclusions you reached on June the 15th?
And do you believe that as a doctor with a trained eye you might be able to detect something that a lay person would call a limp more easily than a lay person who is not trained with your background, experience and education?
You talked--you were asked questions about a doctor Martel and x-rays of the elbow?
Did you review any other x-rays that Mr. Kelberg didn't ask you about from Dr. Martel?
There were some other findings that you wanted to relate in response to a question from Mr. Kelberg relating to Dr. Martel; is that correct?
Dr. Martel basically read the elbows as being normal and basically what I was starting to say, when he asked me that question or read that thing off the report, was that you can have rheumatoid arthritis of the elbow and you can have flexion contractures that is a possibility and still have a normal x-ray appearance. It is a very--it is a difficult call. This is why you have specialists. That certainly isn't in my bailiwick, but that is certainly what I was starting to bring up with him.
--is your opinion any different as to whether or not Mr. Simpson had any bruises on him when you observed him on the 15th of June?
After two days of cross-examination is your opinion that the cut on the top of the middle finger of the left hand was more consistent with glass?
I felt that was more consistent with glass because as it came around, it curved initially. If you remember the picture over his third--let's go to the left hand and do it the right way--as it curved, it came right over the joint and then it took an acute angle, approximately sixty degrees, and then that acute angle to me said, sure, it could be a five, there could be movement, but to me that said that is why I fell off of the fence on that cut as being more consistent with glass.
Assume that on Monday, June the 13th, Mr. Simpson--let me just check this date for a second.
On June the 13th in the afternoon a nurse employed by the County of Los Angeles named Mr. Peratis was called upon to examine Mr. Simpson's left hand, and assume that the only injury that he talked about was the cut that you have just described as a fishhook cut. Would that cause you to conclude that the injuries on the side of the finger were not there at that time?
Would a nurse be in a position, a county nurse be in a position to see the cuts that you've described to the jury, in your opinion, if he was properly trained and certified?
And if the nurse did not observe those cuts on the 12th, would that indicate that they occurred sometime after the 12th and that would be--would that be consistent with your finding?
Is the cut on the index finger of Mr. Simpson consistent with somebody who broke a drinking glass that you would find in a hotel bathroom?
The middle finger, this cut--the proximal or the distal? There is two cuts on that third finger.
I made a mistake. Mr. Cochran has corrected me. He works for the city of Los Angeles, the nurse. Would that change your opinion, rather than the county?
Let's get back to the glass. When you traveled with the football teams, do you guys stay had hotels around the country?
They have little glasses there with kind of little doilies and a little kind of thing on top that says "Sanitary" with a little blue insignia on it?
If that glass was broken when somebody was informed of the death of their ex-wife, could that type of glass cause that type of injury?
Could a drinking glass, similar to those glasses that you've observed, account for that type of injury?
Now, Mr. Kelberg asked you questions--and I don't remember the name of them--I'm not that familiar with them, about some kind of cells. He had one name for it you had another name for some kind of monocytes?
Well, he said that you start out with a wound and you have phagocytes there, but really you start out in an inflammatory phase with neutrocils and it moves to monocytes with another name for it can be phagocytes.
In any event, whatever they are called in the healing process. He talked about confusion. Are you confused as to whether the jagged edges were caused by cutting glass or by the healing process?
My opinion is that those injuries were caused by a sharp object and they are more consistent with glass than a knife, but they were caused by a sharp object.
In your experience, doctor, would professional football players--have you seen occasions when they act irrational?
Did you run a test on Mr. Simpson to see whether or not he was using anabolic steroids when you saw on him June the 15th?
That is all I have as a physician is my reputation which I have worked hard to build over the last 21 years since I entered medicine.
Tell the truth.
When you standing in Montana and you hear hoof beats coming behind you, it could be zebras, but it is horses, and that is what you have to see. And in his case he had absolutely without question multiple areas where he had arthritis.
I think one may be enough here.
Because they are all in an orthopedist's office.