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TO: All ADAs FROM: Marjory D. Fisher, Bureau Chief DATE: December 10, 1999 SUBJECT: Transcript of Dr.- re: No Meds Here are some questions to ask (see the cross) when you have no meds in a sex crimes case. See me please if you want more questions. SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF QUEENS: CRIMINAL TERM, PART X-19 ------------------------------------------------------------------------ X THE PEOPLE OF THE STATE OF NEW YORK, 4291/97 JAMES EADDY, Defendant. Testimony of Dr. Ingrid Flores ------------------------------------------------------------------------- X July 6, 1999 Criminal Courts Building (and a jury of twelve plus three alternates.) Dr. Flores-Defense-Direct THE COURT: Defense will call their next witness. MR. PINCHAM: Defense will call Dr. Flores, please. INGRID FLORES, M.D., a witness called on behalf of the Defendant, a resident of New York County, after having first been duly sworn by the Clerk of the Court, took the witness stand and testified as follows: A: My name is Ingrid Elizabeth Flores-Freth. Q: And your last name is spelled F-L-O-R-E-S, help me. A: F-R-E-T-H. Flores hyphen Freth. My professional name is Dr. Flores. Q: What is your business, profession, occupation? A: I—m currently a medical doctor in a residency training program in obstetrics Q: Where did you do your undergraduate work? A: Undergraduate, I attended New York University. Q: And did you receive a degree from New York University? Q: And after receiving a Bachelor of Science degree from New York University, A: I attended the Mt. Sinai School of Medicine. Q: After receiving a Medical Doctorate degree, what then did you do? A: I am currently– what I—m doing now, which is in the residency program of OB-GYN, obstetrics and gynecology at Flushing Hospital. Q: And you have been there continuously and uninterruptedly since 1997 to the A: Obstetrics and gynecology are two divisions. They both are female only. Obstetrics deals with maternity and fetal, when a woman is pregnant, in that condition. And gynecology is directly with women—s health care. Q: And Obstetrics, OB-Gynecology, is your field of specialty? Q: And you—ve been in residency in that field for how long? A: I—m currently entering my third year. Q: How many days a week are you on duty? A: It varies. I—m working from Monday through Friday all the time, but I also have an on-call shift, which is every third night I—m on call or every second night. It varies. Q: Pursuant to your duties there, do you have occasion to examine patients who come in as emergency patients? A: Yes. Q: I will ask that you be presented with People—s Exhibit 19 in evidence and ask you if you would look at it, please. Have you seen People—s Exhibit 19 in evidence before? A: Yes, sir. Q: Would you tell the ladies and gentlemen, does People—s Exhibit 19 in evidence bear your signature? A: They do. Q: Does it bear your signature pursuant to your duties as residency doctor at Flushing Hospital? Q: Those are the medical records relating to one Tange Benson? Q: And those are medical records of Tange Benson being in the Flushing Hospital on the 25 of July, 1997? Q: Did you have occasion to have those records with you here in this build before today? Q: Did you have occasion to be in this building with those records before today with one of the assistant district attorneys? Q: And did you discuss those records with the district attorney in this building at some time earlier than today? MS. FISHER: Your Honor, I object to all these leading questions. It is his witness. THE COURT: These are preliminary matters. I remind counsel it is your witness, not to lead. MR. PINCHAM: All right. Q: When you were in this building with those records before, could you tell us, the ladies and gentlemen of the jury? MS. FISHER: Objection, your Honor, to leading. THE COURT: No, that—s overruled. Q: When were you here? The last time you were here. A: I believe about two weeks ago, week-and-a-half ago. Q: And did you have those records in your possession when you were here two weeks ago? Q: In whose office were you when you had those records two weeks ago? A: Miss Fisher—s office. Q: The lady sitting here before me? A: Yes, sir. Q: How long were you in the office with those records with her? A: Frankly, she gave me those toward the end of our discussions to review, maybe about five, ten minutes. I can—t really say. Q: And you had talked to Mr. Ed Hammock, had you not, at the hospital? Q: And finally, when did you first talk to me? Q: Dr. Flores, for the benefit of the ladies and gentlemen– THE COURT: Any objection to the use of the blowup of the hospital record? MS. FISHER: No objection. As each page– THE COURT: For the record, counsel made a blown-up copy of the hospital record and I direct before any such record be shown to the jury that you show it to the DA. MR. PINCHAM: I will show it to her. THE COURT: Are you asking that the witness testify as an expert in OB-GYN? MR. PINCHAM: Yes. THE COURT: Any objection? MS. FISHER: No, it just wasn—t requested. THE COURT: If you want a voir dire, I would give you one, Miss Fisher. MS. FISHER: No. So stipulated that this witness is an expert. THE COURT: Jury, the witness is testifying as an expert on obstetrics and gynecology and may state her opinion or explain medical terms to you. You may continue. Q: Doctor, may I invite your attention, please, to the Emergency Department Nursing Floor Sheet. Q: Is this a record of Tange Benson in the hospital on July 25, 1997? Q: I will ask you to look at the time on the document, what time was she recorded as having come into the hospital? Q: I will invite your attention, please, to the blood pressure, BP, on the document. Q: See where I—m pointing, 104 over 72? Q: 104 represents the pressure on the blood vessels as the heart is pumping; is that correct? Q: The 72 represents the pressure on the blood vessel when the heart is not pumping? Q: We don—t like to expose our infirmities; I—m having a little difficulty hearing. A: Yes. That is in normal range, both values. Q: Thank you very much. Q: The pulse is 84? Q: Will you tell the ladies and gentlemen of the jury what the pulse measurement represents? A: It—s a measure of the heart rate, per se. There is a range between 80 and 100, and this falls within this range. Q: So that—s the rate of the heartbeat? A: Yes. In the course of a minute. This is 84 beats per minute. Q: Would it be correct to say the heartbeat increases based upon excitement? Q: 84 is normal without those factors being present? Q: Respiration there is 20. Is that normal? Q: And what does respiration 20 represent? A: Twenty breaths per minute is what it represents. Q: That is 20 inhaling and exhaling per minute? Q: I see. And breathing is increased, is it not, depending on the circumstances confronting the body? MS. FISHER: Objection to leading. THE COURT: Sustained. Your witness. Q: What increases the breathing of an individual? A: Multiple factors. Physical exertion could increase the breathing rate. The emotional state, as well, can increase that. If there are other factors, beating of the heart in and of itself, that requires breathing to be accelerated to provide more oxygen to the body. And just physical conditions. Any abnormal condition of the lungs, per se, of the pulmonary condition of the lungs can always cause that. Q: Would pain cause the respiration to increase? MS. FISHER: Objection, your Honor, to leading. THE COURT: Sustained. Leading. Q: Are there any other factors that would cause the respiration to increase besides those that you—ve mentioned? A: Depending on the state of the person. I don—t know, if perhaps they—re in a circumstance or area where there is less oxygen, they would have to breathe a lot more. THE COURT: Referring to high elevation. THE WITNESS: Correct. Thank you. A: Like higher elevations. And they would have to breathe faster and more per minute to satisfy, to fulfill the oxygen requirement of the body. As I said, the physical conditions of the lungs and, I mentioned that, I—m sorry, I can give you all that. Q: Would anxiety cause it to increase or decrease? MS. FISHER: Objection. Leading. MR. PINCHAM: Not leading. Yes or no. THE COURT: What would be the affect of anxiety. Q: All right. What would be the effect of anxiety? A: Anxiety may cause in terms of ” sorry, in terms of the respiratory rate on vital signs? A: Anxiety may cause an increase in the respiratory rate. A: It could be either. It could be either less or more or normal. It depends. Q: What would be the affect of tension, if any, on breathing? A: The same. Either it could be normal, less or more. Q: But the 20 was normal breathing respiration? Q: Now, the patient testified before this Court and jury, well, before we get to that. This is 4:20 she was received in the emergency room, 4:20 a.m. Q: And the entry is made: Received patient in the emergency room accompanied by police with complaint of being sexually assaulted. See it there? Q: So she said that she had been sexually assaulted; is that right? Q: And the next entry is awake and responsive to all stimuli; is that right? Q: And the next entry is skin warm to touch; is that right? Q: For the skin to be warm and dry to touch? Q: Now, color. Would you help me pronounce this word please. Q: Would you tell us in our language what color, acyanotic is. A: Sure. Acyanotic means there is no cyanosis, no bluish discoloration which we would look for in terms of oxygenation. There is no evidence of that. A: Yes. There is no evidence of cyanosis. That—s what that means. A: Means without. There is no cyanosis. A: It could be. All this says is acyanotic. In the strict definition, that is all it says. Q: Now, I believe that the next entry is respiration regular and unlabored; is that correct? Q: And then the next entry is: Moving all extremities spontaneously; is that right? A: She—s able to move all of her arms and her legs. Q: Complains of quadrant abdominal pain. See it there? Q: Right lower quadrant abdominal pain. A: Lower quadrant is below the level of the umbilicus. The naval area to above the pubic area. So that is the lower abdomen. Q: That is what she is saying, she is having pain there? Q: And she is being examined by a doctor; is that right? A: She—s being examined by, yes, sir. A: Yes. She—s an emergency room attending physician. Q: Now, is there any indication here by the doctor that the doctor found any bruises or lacerations there? MS. FISHER: Your Honor, please. Objection to all this leading. THE COURT: Sustained to the leading. Q: What, if anything, do you find the doctor found at this point regarding abdominal -- the complaint that she made of abdominal pain of the lower quadrant? A: There is nothing. She would not know, necessarily. I—m sorry. So far nothing is there. Q: Now, your next entry is ” I believe it—s 6:15, at the bottom? Q: And that entry is: Blood drawn and sent to lab? Q: May I invite your attention, Doctor, again now to Page 2, at 6:32. See it there? Q: Rape kit was delivered to an Officer Tucker; is that right? Q: The patient, Tange Benson, testified before this Court and jury that when she was in the hospital she felt safe and she did not want to go home. Will you tell the ladies and gentlemen of the jury what is the entry for 6:43? A: 6:43 a.m. patient states wants to go home. Advised to wait for results of blood work. Period. Q: All right. She stated she was hungry; did she not? A: Yes. States hungry. Given a sandwich. Q: She was given a sandwich; is that right? Q: The next entry at night is 7:30 a.m.; is it not? Q: Again, the patient Tiffany Boswell testified before this Court and jury she was in the hospital and felt safe and did not want to go home. Q: I—m sorry, Tange Benson, sorry. Do you see the 7:30 a.m. Resting in bed. Period. Pending lab results. Period. Patient wants to leave, comma, attempted to walk out times two, refusing to sign AME. Q: Attempting to walk out times two. Refusing to sign, again, AME? A: Against medical advice. That—s what AME stands for. Q: Rocephin is an antibiotic for sexually transmitted disease; is it not? Q: Then after the entry, refusing rocephin, 250 milligrams, what—s the next entry? A: She was given an antibiotic pending the Beta HCG results. Q: Now after that is the result right here. Would you tell the Court and jury what is the next entry? A: I can—t make it out, sir. And blank have to be home before 10 a.m. Advised to Q: When it says again wants to leave, and that—s STS, is it not? A: I can—t quite make it out. It might be. I don—t know. THE COURT: If you don—t know, don—t guess. Q: Again wants to leave and STS have to be home before 10 a.m.; right? THE WITNESS: Excuse me, sir. What should I do? THE COURT: If you don—t know what it says, I don—t want you to speculate or guess. Q: That is, you don—t know what the next word after again wants to leave?] THE COURT: And jurors, I will give you the same instructions during the course of your deliberations. If you find a portion of the hospital record to be illegible, I will tell you to disregard it and not to guess at what it means. Q: But, I have to be home before 10 a.m. is there? Q: And that—s referring to what the patient Tange Benson is stating to the nurse? Q: I invite your attention please to the next page. The next entry, 8:55 a.m. Q: Yes, it is. Thank you. 8:50 a.m. Thank you. A: Complains of hungry, comma, breakfast given. Q: Then after that is the 8:55 a.m. entry? A: Beta HCG negative. Period. Floxin, 400 mm and doxycycline 100 mm PO given. Q: All right. And this is, these first three pages are referred to as the Nurses Floor Sheet? Q: Let me ask you this, please, before we leave it. There is a 9:00 a.m. entry there; is that correct? A: Written discharge instructions given by MD, period. Patient verbalized understands. Q: The MD that—s referred to who gave her the written discharge instructions; is that you, Doctor? A: It might have been or it might have been the emergency room attending. It doesn—t specify. Q: May I invite your attention, Doctor, now to the entry that has 7-25-97 at the top and 4:28 a.m. Q: Now, there is an entry under additional physician—s notes. You see it there? Q: And the first writing there is 9 a.m. Q: And does it read refuses to, can you make out the next word? Q: Refuses to wait. What—s next, please? Q: And that—s referring to the patient and Tange Benson refusing to wait for the social worker? Q: Does the mean that the patient was in no distress? Q: Then under that is written something soft. I can—t make out what that is before it, can you? THE WITNESS: Excuse me one second, Judge. You said not to speculate. THE COURT: No. If you can—t, if it is illegible, just say it is illegible. If you can read it, tell us, but I don—t want you to speculate or guess. THE WITNESS: Fine. I can—t make that out. I know based on that what it might be referring to. THE COURT: You can tell from context? THE WITNESS: Yes. THE COURT: Then you an answer. Q: All right. Non-tender means just what, non-tender, I guess? A: The abdomen is not inflated, per se, or just grossly distended. That—s what that means. Q: Is that normal to have non-distension? Q: But the emblem there in front of it means non; does it not? A: That means negative, but I don—t know what the next word is. Q: I understand, but the negative, we are using negative and non synonymously. Q: That—s the same emblem before non-distension. Q: And there is another entry there with a non in front of it? A: Yes, sir. Q: Whatever it is, it wasn—t there. MR. FISHER: Objection, your Honor. Asking for speculation. THE COURT: Sustained. Move ahead. MR. PINCHAM: Judge, may I have a moment, please. MS. FISHER: No objection, your honor. Q: May I invite your attention now, Doctor, to the page that I—m now displaying to you and to the ladies and gentleman of the jury, it has at the top 7-25-97, 4:45 a.m. Q: Are you the person who made these entries here? A: I—m one of the persons that has made the entry, yes, sir. Q: Now, I would invite your attention, please, down to where it begins with presents, you see that there? Q: Right? This is what she—s saying happened? Q: Reports of physical abuse. See it there? Q: That—s what she—s saying happened; right? Q: Now, complains of facial trauma; is that right? A: This says positive right facial trauma. Q: Complains, that—s the emblem there, the plus is complains. A: That—s positive. That—s a plus, rectal. Q: Plus rectal bleeding and vaginal penetration. Q: That—s what she is complaining of? Q: And she says condom used and a cucumber. Other foreign object sharp. See that there? MS. FISHER: Objection, your Honor. This is all leading. MR. PINCHAM: Well, it is a document. THE COURT: It is permissible to read from an exhibit which is in evidence, so that—s permitted. Q: Then it says here, a circle with an N around it. See it there? It means no, does it not? A: I—m sorry, I don—t. Other foreign object, not sharp, no vaginal bleeding. Q: And is that the entry made by the person who is examining her? A: This is her report. All this is history. This is what she is telling us. Q: I understand. So she is telling you that there is no vaginal bleeding. Q: The nurse who did this is telling you from her examination she found no vaginal bleeding? A: This is my history. I—m writing it down as the patient is telling me. This is before any physical examination. Q: And did she tell you there was no vaginal bleeding? A: That is what I have written down. She told me no vaginal bleeding. A: No vaginal discharge that is the D/C. I apologize for all the abbreviations. No vaginal discharge. A: Rectal bleeding minimal. No nausea slash vomiting, no head injury or loss of consciousness, or ear, nose, throat bleeding. Period. Ambulating, comma, no dizziness, no urinary complaints. Period. Q: All right. No loss of consciousness, ear, nose, or throat bleeding; right? Q: Ambulatory, no dizziness and no urinary complaint; is that right? Q: Then you got, that—s no asthma, no hypertension; is that correct? A: Sure. Above, further above, sir, a little bit more. Two more above that. A: Right. Questionable left ovariectomy. Meaning removal of the ovary at eleven years old. Secondary to question of cancer. She—s not quite sure. A: This is a defect, a weakness of a muscle that allows the eye to move in different directions. And that can happen just for any number or reasons. And this happened with her maybe at some time earlier. Usually in childhood you would notice this, or at any point in time. So she had surgery for that. I didn—t write down the year. I don—t know Q: I see. Now, will you let me take you, please, to that part of the document that reads about physical exam. That—s right here; is it not? Q: Right here. All of those are normal? Q: And it says the patient alert and oriented as to person, place and time; is that correct? A: As with regards to that, she is alert to where she is, who she is and what time it is. Q: Now it says here patient sucking her thumb during examination. Q: Is that your writing or somebody else—s? Q: Do you know who that somebody else is? A: That is someone at the time who was my senior resident. She came down. Q: All right. Then it says here, does it not, head, ear, eyes, nose, throat, within normal limits; is that right? Q: And it says EOMI, that means extraocular muscles intact; is that right? A: Extraocular muscles, there are at least six, they have muscles that are ” okay. That is used -- it conducts the eye, the gaze, either right, left, up or down. Q: Then it also reads left eye, lazy eye squint. Is that the eye that had the squint? Q: Then it reads right face increase in swelling greater than left side of face? Q: Could you tell whether that swelling was current or from the interior or exterior of the face on the right side? A: It could be from either. It could be from interior, exterior. I couldn—t tell if it—s old or new. It was there at that time. Q: You couldn—t tell whether it was old swelling or new swelling, is that what you said? Q: You couldn—t tell whether it was swelling from inside the face, or outside; is that correct? Q: Then you observed, did you not, pupils equal reaction to light. Means pupils dilated appropriately to the light. Would that be a correct statement? Q: Doctor, may I invite your attention, please, to the page of the records that I—m now displaying before you. A: Yes, sir. Can I just have one minute. I—m sorry. THE WITNESS: Well, the staples are blocking, can I just ” THE COURT: Yes, you can remove the staple. Q: At the top is abdomen. I—m pointing to what means abdomen? Q: Vertical inferior umbilical scar. Soft mild lower quadrant tenderness to deep palpation. What does that mean? A: Okay. Abdomen soft, mild left lower quadrant tenderness to deep palpation. It means that the patient has expressed some pain upon examination when I pressed down on that side. That—s what that means. THE COURT: Can you answer the question. Did you observe tenderness? THE WITNESS: That is what I had written, that she is tender. THE COURT: You can tell that from examination? THE WITNESS: Yes, by exam. I listen to tenderness. Q: Then you have here pulmonary lung. Am I pointing to the lungs? A: No, sir, that is another page. Abdomen, underneath it is back, pelvic, rectal. A: No masses palpated. This one I don—t know. That is the entry of my senior. I don—t know what that is. Q: All right. Then it has here back; is that right? A: No costal vertebral angle tenderness. Q: Will you tell the ladies and gentleman what does that mean. A: It means she doesn—t have any signs of kidney infection. Q: No scratches or lesions noted; right? Q: No lesions noted. You—re talking about the pelvic area. A: Yes. Talking about the outside area, what we can see, the external genitalia. Q: The outside you could see you saw there was no bleeding. No lesions noted and no discharge? Q: Then beneath that, is that the vaginal vault? Q: That is, you observed no lacerations, no tenderness, no abrasions of any kind there. MS. FISHER: Objection to leading. THE COURT: Sustained. Q: Well, did you observe any in the vaginal vault? Q: What, if anything, did you observe in the vaginal vault? A: I just saw here just the vagina to my eye what I could see, nothing. By the eye. Q: The vault, of course, means the interior of the vagina? A: Lesion means anything that is abnormal, a lesion can be a break from what is considered the normal. In this case, the normal lining, the normal mucosa. Any lesion would be any tear, any cuts, anything different? Q: So it is correct to say that you observed the vaginal vault intact, no lesions inside the vagina. Now, did you insert a speculum into her vagina? Q: And did you open it up? A: Yes, sir. Q: Did you visualize the cervix in the interior of the vagina after you had inserted the speculum? Q: Where would you find that on this document? A: Where the word pelvic is, sir, above the little figure drawing. Higher up. See pelvic. That line you go down one and there you will see vaginal vault, speculum, no cervical lesions. Or the word is cut off for me in my Xerox copy. Q: No cervical lesion. Cervical in reference to the cervix. Q: That means no marks or bruises. Cervical. A: There are no lesions, yes, that—s what that—s in reference to. A: That—s what that—s in reference to, no lesions. A: No CMT is no cervical motion tenderness. Q: NO cervical motion tenderness; right? Q: Now, would that mean ” explain to the jury what no cervical motion tenderness would mean, please. A: This is a sign that we use if someone has had either some kind of infection or inflammation of the tubes or the ovaries, be it from an infectious nature or be it from a mass in the ovary, a cyst, anything. That is what we look for. We look for those signs to the cervix. Move from side to side. That is how we can elicit that there is something going on. Q: Did I ask you about no cervical motion tenderness? A: Yes, sir, that is what I just explained. A: When the cervix is moved from side to side, yes, there is no tenderness. Q: There is another entry there, no annexal tenderness? A: Annexa refers collectively to both fallopian tubes and ovaries together. Q: And did you find her uterus, did you examine her uterus as to size? A: A six-week size, a bulky size uterus. Q: Now, there is an entry here, right here, that—s rectal? Q: So you went beyond her anus into the rectal area? A: No masses noted. No foreign object, comma, intact, guac negative. Q: So you found no masses noted, no foreign object and intact; is that right? Q: Now, I—m sorry I didn—t catch this last word here. Q: What—s this word again, please, guac. A: A guac is ” that—s what we do of the stool to check for what we call occult, or if we could not see any blood in the stool we check for that with that kind of a test. Q: Now, after checking it and finding no blood in the stool, the next entry here is an entry from BC, what does that mean? A: I—m sorry. I don—t know. This is the entry from my senior. I don—t know. Q: Did you find any evidence of blood in her rectum? Q: Did you find any evidence of blood in her vaginal area? MS. FISHER: Your honor, objection to the leading. THE COURT: Sustained to leading. Q: Well, what did you find, if anything, in the vaginal area? A: There was no ” I don—t understand the question. I—m sorry. THE COURT: Did you find anything unusual about the vaginal area? THE WITNESS: No, sir. Q: Now, she was given a neurological examination, was she not? Q: And here again she was alerted as, oriented as to person, place, time. Reflex is normal. Sinus is normal. Skull normal. And let—s get to the skin. You see it there? Q: Were there any lacerations, scratches or marks on her skin? A: This entry from my resident says no. No evidence of lacerations or scratch marks. Q: Now, may I now invite your attention, please, to the document that says patient complaining of rectal bleeding. Do you see that there? Q: Would you help me point it out here on the document, please. Q: Patient complaining of rectal bleeding. Q: That—s to what the patient is saying, is that right, when she says she is complaining of rectal bleeding? Q: Now, did you examine her to see if there was any rectal bleeding? Q: And did you find any rectal bleeding? Q: And does it say so on the chart, none? A: That is what my senior resident has written, none. Q: None seen at present, right, you see that there? A: I don—t know what that says present. A: Patient complains of. I don—t understand. Q: Was blunt trauma found with the patient? A: That is a history. That is not something you can necessarily find. Q: Is there any evidence by whoever—s doing this examination that blunt trauma was found by any doctor? MS. FISHER: Objection to leading. THE COURT: Sustained. Q: What, if anything, was found with regard to blunt trauma? Q: And blunt trauma found in the vaginal area? MS. FISHER: Objection to leading, your Honor. THE COURT: No. That—s a leading question. Sustained as to form. Q: Was any blunt trauma found anyplace else on her body? MS. FISHER: Objection to leading. THE COURT: What, if anything. Q: What, if anything, else was found? Was any blunt trauma found in her rectal area? What, if anything, blunt was found in the rectal area so far as blunt trauma is concerned? A: So far by this, what is written, nothing. Q: May I invite your attention, please, now to the record that has 7-25-97 upside down on it, the entry at 4:45 a.m., seen by M.D. 4:45. MS. FISHER: May I see it. MR. PINCHAM: Please excuse me. MS. FISHER: No objection, your Honor. I—m on the same page. Q: I will invite your attention to the part of the document that reads complaining of rectal and vaginal pain and bleeding. You see it there? A: Maybe I—m on the wrong page. Oh, I—m sorry. I see it. Q: Will you point it out here to me, please. Q: Right here. Complaining of rectal and vaginal pain and bleeding. That—s a complaint. That—s what she is saying; is that right? Q: General assessment, 21-year old female in no acute distress, right, is that what Q: Alert and oriented to person, place and time? Q: Head, ears, eyes, nose and throat, normal exam. Pupils equal and reactive to Q: And it reads supple, no ecchymosis, bruises abrasions or tenderness; is that correct? Q: Dr. Fefferblit, right. Now, let me please invite you further on this page, other lab X-ray, it says again that she refused the antibiotic intramuscular injections, did she not? Q: And it also says there that the pelvic was done by a gynecologist consulting Q: Then there is a entry at 7:20 a.m. Do you see that entry there? Q: And that entry reads that the patient declines offer of social worker and psychological consultation; does it not? Q: May I now please invite your attention to ” MS. FISHER: Your Honor, can we approach for just a moment. THE COURT: Yes. (Whereupon, there was a discussion held at side bar as follows:) THE COURT: There is reference to her using birth control. MS. FISHER: I don—t think that needs to be there. MR. PINCHAM: What—s wrong with that? I—m not going to inquire about the birth control. MS. FISHER: Nobody—s business. MR. PINCHAM: I—m not going to inquire about it. MR. FISHER: But they will have it. MR. PINCHAM: I won—t direct attention to that. (Open court.) Q: Let me very briefly go back, please, to the term that you used earlier, I„ll just hold it up here. Guac. I—m sorry. Can you see where I—m ” A: That—s a test for any occult blood. THE COURT: Can you tell if the test was done? THE WITNESS: Yes. My documentation was done and found to be negative. Q: Negative means there was no blood found in the stool? Q: If there had been bleeding in the rectum or intestinal area, would the bleeding show up in the stool? Q: Now inviting your attention now to the medical record, sexual assault form. Q: And it says the physical examination? Q: Right side face ” what does it say there? A: Is greater than the left side, swollen. Q: And you couldn—t tell again whether it is the inside or outside, whether it is new or recent, old, the swelling; is that correct? A: This won—t tell me a cause, it only tells me that I see swelling. Q: You can—t tell whether it was recent, old or new; is that correct? Q: Left side swollen, inferior orbital area; is that right? Q: That means the left side of her face was swollen? A: The right side of the face, that is, my right side of the face. This is my senior writing. And she writes in the periorbital area around the eye is where she is noticing it. Q: Left side. Was there swelling on the left side of the periorbital area? Q: That—s the swelling on the left side. A: But in the periorbital area. This is written down. This is my senior—s writing. Q: Please. Now. Then in the physical examination, left lower quadrant mild Q: Now, also, under pelvic examination. Q: The uterus. Nothing was found; is that correct? Q: And the document is signed by you as examining health practitioner, Dr. MR. PINCHAM: May I have a moment, Judge. THE COURT: Yes. MR. PINCHAM: Your honor, I think that—s all I have on the document. THE COURT: Cross. (Whereupon, there was a side bar discussion held off the record.) Q: Dr. Flores, first of all, you and I met about two weeks ago, correct? Q: And that was the first time we ever met? Q: And counsel asked you whether you and I met in this building, remember Q: And you and I met in my office, correct? Q: And that—s down the street, correct? A: Yes, I—m sorry. We came here first, but then no one was here. We came here first, we had to meet with them first and no one was here and I got confused. I—m sorry, yes. Q: So you met with Mr. Hammock and then you met with me, correct? Q: We met in my office for approximately five minutes, correct? Q: And then I gave you the medical records and I—ve spoken to you on the phone Q: Now, you have just been on the stand for a little over an hour, correct? Q: And the sum total of your testimony based upon the records that I put into evidence was that there were no findings of vaginal injury, correct? Q: No findings of rectal injuries, correct? Q: And a positive right swelling to the face. Q: And positive pain to the abdomen, correct? Q: Now, Doctor, you have been a resident for two years? Q: So would it be accurate to say that this was one of the first rape exams you—d A: It is the first. It was the first time. Q: And you got some training for that in medical school? Q: But this is around the first one you ever did, correct? Q: And as well as doing a physical and genital exam, you also did the actual kit? Q: And the hospital that you work in, Flushing Hospital? Q: That—s a busy city emergency room, correct? Q: And when you were called to consult in the emergency room at Flushing Hospital as an OB-GYN consult, you are going in there to look for gross injury, correct? Q: And gross injury would be that you could see with the naked eye, correct? Q: And as a GY consult or OB consult in the emergency room, you—re going down there to quickly look at, find things that can be fixed, correct? Q: And to deliver a baby on occasion, correct? Q: And when you say gross injuries,„ you—re looking for things you can see with Q: Now, would you agree with me based upon your training and your designation as an expert in OB-Gynecology here in this courtroom, that only in about 10 to 13 percent of all rape cases ” MR. PINCHAM: Objection. THE COURT: Sustained. MS. FISHER: Your Honor, she—s been made ” MR. PINCHAM: Objection. THE COURT: Not similar cases at this point with this one. MS. FISHER: Can we approach. (Whereupon, there was a discussion held at side bar as follows:) MS. FISHER: Your Honor, she has been designated by counsel as an expert in the field of obstetrics and gynecology. Sexual assault is a subset of gynecology and she should be able testify as to what—s out there in the field of gynecology if she has been. THE COURT: Concerning the literature. MS. FISHER: Yes. THE COURT: You have to ask that. MR. PINCHAM: Judge, my objection is, simply stated, you have repeatedly kept us confined, and first of all, what goes on in other cases is totally irrelevant. THE COURT: Sustained to form, but as an expert in the field she may testify regarding literature in the field. MR. PINCHAM: We—re talking about this patient, this case. We don—t need an expert in the field. We—ve got a patient she examined and I suggest to you that it is erroneous to talk about generalities when you have a specific case here which she is involved. That—s my objection. THE COURT: She can testify regarding the specifics and also the literature. (Open court.) MS. FISHER: May I continue, your Honor? THE COURT: You may. Q: Doctor, would it be correct to say during the course of your medical school training and the course of your residency training you have become familiar as a subset of gynecology with the field of sexual assault? Q: And Doctor, would you agree with me that the literature in this field describes only in 10 to 13 percent of all rape cases is there genital injury obvious to the MR. PINCHAM: Objection. THE COURT: Overruled. Q: And Doctor, can you tell us, or would you agree that most injuries ” MR. PINCHAM: Objection. THE COURT: Overruled. It is cross. MR. PINCHAM: Most injuries. THE COURT: I didn—t hear the question. MR. PINCHAM: All right. MS. FISHER: May I finish. THE COURT: Please. Q: Doctor, would you agree with me that much of the injury that is visualized due to sexual assault is small, microscopic? MR. PINCHAM: Objection. THE COURT: Overruled. Is that correct? THE WITNESS: That is correct. Q: And that would consist of small lacerations and abrasions, would that be MR. PINCHAM: Objection. THE COURT: Overruled. Q: Now, Doctor, can you tell us, is there an instrument that is used to visualize the genitalia that is better than the naked eye? Q: Can you explain what the colposcope is to the jury. A: Okay. The colposcope is essentially a magnifying glass, and more oftentimes than not all the time you can see what is not obvious to the eye, and the abrasions, any kind of a lesion, again the same word, anything that is different, abnormal to the lining, you can see with a colposcope. Q: And, Doctor, a colposcope was not used in this case, was it? Q: Would it be correct to say the colposcope is used most often in cases where MR. PINCHAM: Objection. THE COURT: Overruled. Q: But as advances are being made in the field of sexual assault, it is being used in city emergency rooms to look at adult victims; is that correct? MR. PINCHAM: Objection. THE COURT: Overruled. Q: And, Doctor, is it being used in Flushing Hospital in the course of sexual Q: Now, Doctor, can you tell us, you said you looked at Tange Benson—s vagina Q: And you saw no injury; is that correct? Q: But you are aware here that the anal swab and vaginal swab in Tange—s panties came out positive for human blood as a result of the DNA analysis in this case. MR. PINCHAM: Objection. THE COURT: Sustained as to form. You can have her assume, or show her something. MS. FISHER: Could I have the stipulation. THE COURT: Yes. It is in the court file, the stipulation. THE COURT: The stipulation is in evidence and the witness may read it and interpret. Q: Doctor, can you just take a look at the first paragraph of the stipulation that—s been moved into evidence in this case after it is agreed. Q: Doctor, so, assuming now that based upon tests done in the New York Medical examiner—s DNA lab, the anal swab that you prepared in the rape kit, the vaginal swab and the panty all came back positive for the presence of Tange Benson—s human blood. Q: And, Doctor, would you agree with me, that a finding of human blood on an anal swab is indicative of some, how be it small, injury in the anus? Q: And when you prepare the anal swab, can you describe exactly what you do and what goes up there to prepare a rape kit? A: Essentially, just like a normal Q-tip cotton swab, just blindly insert the swab in the rectum and then place it in the culture. Q: And Doctor, when you do a vaginal swab, is that the same thing that you do in Q: And so you are aware, and you can assume based upon the DNA stipulation, that there was a positive finding for human blood up in her vagina, correct? Q: And it would be correct to say she was not menstruating at that time? Q: And Doctor, would you agree with me that the blood that is found is an indication of some kind of injury in these two areas? MR. PINCHAM: Objection. THE COURT: Sustained. Asked and answered. Q: Doctor, would you agree with me that the blood that is found in those two areas is consistent with a breaking of blood vessels. MR. PINCHAM: Objection. THE COURT: Overruled. Q: And would you agree with me that the blood that is found in those two areas could be consistent to a reasonable degree of medical certainty with some kind of laceration in those two areas? MR. PINCHAM: Objection. THE COURT: Overruled. Q: And what is a laceration? Explain that. A: A laceration is any break in the skin that goes beyond just that portion of the skin, deeper in the dermal area, just deeper, there has to be a cut. It is not just on the surface. There is a cut that goes inside. Some vessel has been opened. Q: Doctor, can you tell us, or would you agree with this statement, that the ability, the ability of the physician to visualize small cuts and bruises would increases dramatically with the use of a colposcope? Q: And that some cuts and bruises that are the result of a sexual assault can—t be Q: Doctor, are you familiar with a journal called the Journal of Obstetrics and Q: And is that one of the staple journals in your field? Q: And would you consider it to be an authoritative journal? Q: Doctor, would you agree with this statement from an article in the 1992 article in the American Journal of Obstetrics and Gynecology by Slaughter and Brown, the lack– THE COURT: You accept them as authoritative? THE WITNESS: That, yes, they are authority, yes. Q: The lack of magnification can drop the probability of detecting injury from 87 percent with a colposcope and a trained examiner to 10 to 30 percent with gross visualization alone. Would you agree with that statement? Q: And would you agree with me that the presence of blood on those swabs indicates an injury up there whether you could see it with the naked eye or not? MR. PINCHAM: Objection. THE COURT: Repetitive. Q: Doctor, would you agree that there are many factors affecting whether or not a woman is injured in a sexual assault? MR. PINCHAM: Objection. THE COURT: Overruled. Q: And Doctor, would you agree with me that first and foremost the vagina, the human female genitalia is built to accommodate a penis; is that correct? Q: And, in fact, the human genitalia, the vagina is built to accommodate a baby; Q: So would you agree with me that there is some elasticity in the vaginal Q: When you say quite a bit,„ can you explain what you mean? A: Sure. The vagina in and of itself, also the reason why it is difficult to see with the naked eye, is that it consists of many folds and elastic, so as much as a rubber band when you stretch it out it will fold back nicely and tight, but it can stretch up to 10 centimeters to accommodate a baby—s head. And at the same time it can go back to normal, you won—t necessarily see it. It doesn—t have to be stretched out, it can go back to a shape, to a pouch. You know. Q: Doctor, can you tell us with respect to the anal opening of a woman—s Q: And is it also built to accommodate sometimes a large item? Q: And would that item be a large stool? Q: And there aren—t necessarily, Doctor, injuries after something like that Q: Now, Doctor, does the presence or absence of lubrication, either natural or applied, affect the presence or absence of injury? Q: And Doctor, would it be correct to say that the vagina, the human vagina has Q: And would you agree with me that the presence of those natural lubricants in the vagina cut down or decrease the chance of the vagina getting injured? Q: And would you agree with me that those natural lubricants are there whether or not a person is having consensual sex or being forced to have sex? Q: And the impact of those lubricants is what? A: You would no necessarily see the impact of friction on the surface if you have any form of lubrication, jelly. Even normal physiological in a young healthy woman, you expect to find quite a bit of vaginal coating. You cannot necessarily see something sharp if it would end, you would not necessarily expect to see lacerations or abrasions. It can accommodate. Q: And that occurs whether there is a presence of passion or consent or not, isn—t Q: Now, Doctor, would you agree with me that the presence of lubrication in the Q: And would that decrease the incidence of injury in the anal area? Q: And is that true whether the anus, whether there is lubrication applied to the object that goes into the anus or whether it—s just natural lubrication. It is the Q: And Doctor, can you tell us if something is applied to an object that is placed in the vagina, some kind of lubricant, like KY Jelly, can that lubricant also affect, can it, and that happens first, can that lubricant sometimes affect the vagina as well? Q: If there is a large amount of KY Jelly applied to the area? MR. PINCHAM: Objection. COURT: I think you misstate the question. Sustained to form. Q: Doctor, can you tell us, would the presence of lubrication applied to an object that—s placed in the anus affect the presence or absence of injury? Q: And Doctor, could it, to a reasonable degree of medical certainty, decrease the chance of injury to that area? Q: Now, Doctor, would another factor that might affect the presence or absence of injury to the vagina or the anus be the size of what is placed in those areas? A: What happens is, even as a large object can go inside with lubrication, you may not necessarily see the impact of that size as you would think you would have it. Especially in those areas below, because of particularly that part of the anatomy, it is elastic and stretches and with lubrication you cannot see it, but it is affected. Q: Doctor, would you agree with me if the size of the object is rather small, the chance of injuries would decrease? Q: And Doctor, would the sharpness of the object affect the presence or absence of injury? Q: So Doctor, if you would agree with me, the penis isn—t sharp like a knife? Q: And if the object that goes into the anus or into the vagina is dull or small, the chance of injury would be less? Q: Now, Doctor, to a reasonable degree of medical certainty, in your opinion would the amount of struggle and movement going on affect whether a woman might have vaginal injury in the course of a sexual assault? MR. PINCHAM: Objection. THE COURT: Overruled. A: Okay. If someone is just not moving around and is just in a position, just stationary, and that could, would also not allow you to not see as much friction and therefore you might not see as much, any evidence of any trauma you couldn—t see that as opposed to movement. Someone is moving around physically there is more chance for evidence of some more even trauma or whatnot. There is a difference. Q: Doctor, to a reasonable degree of medical certainty, assume the following: If a woman is threatened and told to cooperate and there is a large difference in size between the perpetrator and the victim, and the victim is being held down and the victim remains stationary throughout the attack, the likelihood of vaginal or anal injury would be decreased? MR. PINCHAM: Objection. THE COURT: No. I will allow it. Q: And is that because of a lack of friction between whatever is going into those openings and the opening itself? MR. PINCHAM: Objection. THE COURT: Overruled. Q: So would you agree with me that if a woman doesn—t fight back and remain still, the expectation of injury would be less? Q: Now, Doctor, to a reasonable degree of medical certainty, would the fact that a woman is a prostitute, in other words, she has regular sexual interactions, sexual encounters with multiple partners, affect the elasticity of the vagina or anus? MR. PINCHAM: Objection. THE COURT: Overruled. MR. PINCHAM: Sorry. A: Yeah, sure. It does affect it. It makes it more elastic, a lot more elastic, a lot more distended by that simple fact. Q: And Doctor, would that have affect, the elasticity of the vagina or anus, have affect if it—s more elastic on the presence or absence of injury? Q: Now, Doctor, when we talk about anal injury and the penile penetration of the anus, and you mentioned that the anus is similarly expandable, is the anus and the rectum, are they controlled, the muscles controlled voluntarily? A: That means that we have the ability to either make it constrict or make it open. Q: And Doctor, is there rich blood supply in that area? Q: And Doctor, would healing be quick if there were and bleeding, may be stopped quickly in that area because of the rich blood supply to that area? MR. PINCHAM: I would object to that. I withdraw that objection. THE COURT: You can answer. Q: And Doctor, when Tange Benson was questioned by you about her history, I believe counsel asked you line by line about your history of her, her history to you was of minor rectal bleeding; is that correct? A: Actually, yes. Minimal rectal bleeding. Yes. Q: And Doctor, can the healing processes in that area come to bear so that there might be a little bleeding and that it can stop? Q: Now, Doctor, you were asked about a series of questions about Tange Benson—s emotional and neurological conditions. Do you remember those questions on direct examination? Q: And you said that her blood pressure was normal? Q: Now that—s not a measure of whether somebody was sexually assaulted, correct? MR. PINCHAM: Objection. THE COURT: Overruled. Q: And Doctor, you don—t know what Tange Benson—s normal blood pressure or normal heart rate is, do you? Q: Would it be correct to say that what you found when you examined her was within normal limits? Q: But you don—t know whether it was high or low for this particular patient; do you? Q: Now, you were questioned about the swelling to her face, the swelling to the right side of her face. And you testified on direct examination that you can—t tell whether it—s old or new? Q: Now, with swelling, assuming a situation with swelling and no bruising, does swelling have a color? A: Not necessarily. It could, not necessarily, no. Q: Would it be correct to say, Doctor, that you can—t date with precision swelling like you can with bruising? Q: However, her history that she gave you was that she had right facial trauma; correct? MR. PINCHAM: Objection. THE COURT: Overruled. Q: And the swelling. And Doctor, would the finding of right swelling to her face be consistent with a recent injury to her face? Q: And Doctor, would it be consistent with blunt force trauma to the face? Q: Would it be consistent with being hit on the face? Q: And her history, the sum total of it other than she gave you a sexual assault history; correct. Q: And she told you about pain to her face, correct? Q: And she told you she had a history of rectal bleeding and right trauma to the face, correct? Q: And when she says she has a history of being hit on the face and history of rectal bleeding, the findings, including the DNA findings, are consistent with that, correct? Q: When you did the rectal exam ” now, the rectum is inside the anus, correct? Q: Do you actually look up there with the naked eye or finger? Q: So is there anything like the speculum that you use to part the vagina that is used on the rectum? Q: So your examination of Tange Benson—s rectum was done with the finger, not your eye? Q: Now, you said she had a negative guac, G-U-A-C. Q: And that—s a test that tries to figure out whether there—s blood in the stool? MR. PINCHAM: Objection to the try. THE COURT: The witness can answer the question. MR. PINCHAM: I object to the form of the question. MS. FISHER: Excuse my inartful questioning, I—m not a doctor. Q: That looks for blood in the stool, correct? Q: And Doctor, would the, would it be correct to say that you can have false positive and false negatives with a guac, correct? Q: And the finding that is in the stipulation with respect to the blood on the anal swab, now that contradicts the guac, correct? Q: But with the guac you can have a false positive or a false negative, correct? Q: What does the DNA finding of human blood belonging to Tange Benson on the anal swab mean to you? MR. PINCHAM: I object to that. THE COURT: Overruled. MR. PINCHAM: Judge, she—s talking about another document that she has nothing to do with. THE COURT: The stipulation is evidence in the case. You may explain it. A: This weighs more. This is a definite proof as a positive. MR. PINCHAM: Object to that. She is evaluating. Just to read it. Objection. THE COURT: Explain what the DNA finding means. A: The DNA finding means you have evidence to 99.90 percent that this chromo for this particular type for this blood for this person is consistent. Whereas ” and that is a test that is highly specific, and we take it for certainty ” as compared to a guac test which is based on technique of the examiner as well as a material in there, if anything is wrong with that, guac, that it may come up either positive or negative and not be necessarily negative. It could just be all a matter of chance that leads to a false end, to where this cannot. If positive, it is. Q: Doctor, can you tell us, counsel asked you about a surgical consult that was done on this patient. A: The reason being because of the tenderness that is elicited in the abdominal examination requires that, that combined with what we have as a history, that there was blunt trauma, irrespective of whether it is true or not, with the history and finding we are mandated to evaluate this kind of pain. Q: And Doctor, would the finding of left quadrant abdominal pain be consistent with, where it is found in this case, with a forcible sexual encounter? MR. PINCHAM: Objection. THE COURT: Overruled. A: If there is penetration that, from vagina or even perirectum, hard enough, whether or not it is not felt in the vagina, per se, the nerve fibers such as it is in anatomy can be such that we can elicit pain in this area, although trauma could have been either through the vagina or to the anus, and we are not eliciting at that examination, we can find it there. Q: Doctor, in your opinion, to a reasonable degree of medical certainty, is it common after something is placed into the rectum forcefully for a patient to say that they have to have a bowel movement? MR. PINCHAM: Objection. THE COURT: Overruled. A: Yes. That is very common. Just any kind of stimulation to the sphincter in and of itself can cause that impulse, that reflect, to want to have a bowel movement. Q: Doctor, you were asked several questions about whether or not Tange Benson was alert and oriented, whether she had distress, remember those questions on direct examination? Q: Doctor, are you familiar, and have you become familiar in your training as a gynecologist, with the term rape trauma syndrome? Q: And would you tell us, is that a subset of post-traumatic stress disorder? Q: And Doctor, post-traumatic stress disorder is one of those mental disorders that—s found in the bible of mental disorder, DSM form, is that correct? MR. PINCHAM: Objection. THE COURT: Overruled. A: Yes, ma—am. Q: And that bible is used by psychologists, psychiatrists and doctors to designate certain mental problems, correct? MR. PINCHAM: Objection. THE COURT: Overruled. Q: And in the DSM 4, would it be correct to say that rape is one of the triggers of post-traumatic stress disorder? MR. PINCHAM: Objection. THE COURT: Overruled. Q: And without going all about what rape trauma syndrome is, would you agree that basically rape trauma syndrome states that you can have a variety of emotional reactions as a result of a rape, correct? MR. PINCHAM: Objection. THE COURT: Overruled. Q: So would you ever rule out the occurrence of a rape based upon a patient who arrives in an emergency room with flat affect? MR. PINCHAM: Objection. THE COURT: Overruled. Q: Doctor, would you agree with me that rape trauma syndrome includes both women who have no emotional reaction and women who are hysterical? MR. PINCHAM: Objection. THE COURT: Overruled. Q: Would you agree with me that rape trauma syndrome would tell you that a woman who is hysterical after a rape is just as possibly raped as a woman who arrives in the emergency room, is twenty-two years old, who has a flat affect but who is sucking her thumb? MR. PINCHAM: Objection. THE COURT: I—ll allow it. Q: And would you agree with me that rape trauma syndrome can also affect, and the emotions that accompany it, can also affect the actions that a woman takes after she—s raped? MR. PINCHAM: Objection. THE COURT: Overruled. Q: And could rape trauma syndrome dictate when a report is made of a rape? MR. PINCHAM: Objection. THE COURT: Sustained as to relevance in this case. Q: Doctor, could rape trauma syndrome dictate what a woman might want to do after she is raped? MR. PINCHAM: I object to that, if the court please. THE COURT: I will allow that. Q: Whether she wants to report or not report it? MR. PINCHAM: Objection. THE COURT: I will allow it. Q: And does it also have an impact on whether a woman wants to go to the hospital or go home? MR. PINCHAM: I object to that, if the Court please? THE COURT: Sustained as to form. Q: Doctor, can it have, would you agree with me that rape trauma syndrome can affect the actions a woman wants to take immediately after a rape? MR. PINCHAM: I object to that, if the Court please. THE COURT: Overruled. With a reasonable degree of medical certainty. Q: And would you agree with me that it dictates that a woman can want to delay a report of sexual assault of just go home? MR. PINCHAM: Objection. THE COURT: Overruled. Q: It means just that there are a variety of reactions due to this particular stress, correct? MR. PINCHAM: Objection, if your Honor please. THE COURT: Overruled. MS. FISHER: I have nothing further. THE COURT: Redirect? MR. PINCHAM: Yes. REDIRECT EXAMINATION BY MR. PINCHAM: Q: Doctor, from your examination you found no evidence of rectal bleeding; is that correct? Q: You found no evidence of rectal bleeding? Q: And you examined, you had an examination of a stool from her rectum, is that correct, there was an examination of a stool? A: It was an examination of whatever was on my finger, presumptively to be stool on that specimen for the guac test. Q: And that was microscopically examined, was it? A: After it is found on the finger, after a finger examination of the rectum is swabbed on a piece of paper, and that has a developer that we use a liquid on it. A: It will stain for any evidence of blood. Q: It is put there to determine if there is blood? Q: Now, the patient had a history of rectal bleeding, did she not? Q: And that means she had a history of rectal bleeding before this incident was alleged to have occurred; is that correct? MS. FISHER: Objection, your Honor. THE COURT: The witness can answer. Does that mean before or during the incident when you say history? THE WITNESS: The history of the bleeding, that is in reference to the incident. Q: The history of rectal bleeding is in reference to the incident? Q: Well, now, when you say no vaginal discharge, history or rectal bleeding. See Q: You see here history of rectal bleeding? A: Yes, sir. Minimal, no nausea, vomiting. A: Yes, that is her history. Not reporting any vaginal bleeding. She is telling me she is not having, for example, she is not having any foreign object, nothing sharp. No vaginal bleeding. That—s her history. She is not reporting vaginal bleeding. Q: And history of rectal bleeding. She says she has a history of rectal bleeding. Does that refer to prior or to the incident? Q: Did you find any bleeding to the incidence in question? A: No, sir. From my physical examination, no. Q: You found none in her rectum, did you? MS. FISHER: Objection. THE COURT: Sustained. THE COURT: We went over that on direct. New matters taken up on cross. Q: You talk about a woman having a baby; right? Q: The body accommodates the birth of a child, does it not? Q: In fact it is described by doctors, is it not, as the most excruciating pain a woman can endure, is it not? MS. FISHER: Objection, your Honor. THE COURT: Sustained to form. Q: Now, this woman wasn—t having any pain, was she? MS. FISHER: Objection, your Honor, to the leading and to the obvious. THE COURT: Sustained as to form. Q: Now, when you talk to ” oh, by the way, did you find any evidence of KY Jelly or KY fluid. A: No, I don—t look for that. Because as a matter of form ” Q: And did you find any kind of compound around her rectum or anus? A: The thing is I used that for examination so ” Q: All I—m asking, did you find any lubricant around her rectum? A: I don—t remember. I didn—t document. I don—t remember. Q: Did you find any lubricant around her vagina? Q: And you say the natural lubricant is designed to minimize friction or something going onto a woman—s vagina; is that correct? MS. FISHER: Objection to the leading, your Honor. It—s his witness. THE COURT: It—s your witness. You have to ask in the proper form. Sustained to form. What is the function. A: Just as a normal physiological function to keep everything in the vagina just moist, that is a pure natural function. It is there, daily basis. Q: Now, if a piece of metal object, a round metal object, you know what a club is on a car for, locking the car steering wheel? MS. FISHER: Objection, your Honor. THE COURT: Sustained. Q: If the metal object the size of a car club is inserted in a woman—s vagina to a point that she has excruciating pain where she can—t determine whether it—s in her rectum or in her vagina, and is inserted there for extended period of time. MS. FISHER: Objection, your Honor. Not the testimony. THE COURT: Sustained as to that. As to the time. There is no testimony regarding it. Q: Well, she said it was inserted in her rectum, inserted back there somewhere, so to the point that it was so excruciating she couldn—t tell whether it was in her vagina or in her rectum, would you say the lubricant was in force and effect? MS. FISHER: Objection. THE COURT: Understand the question? THE WITNESS: I don—t. THE COURT; Sustained as to form. Q: Would you say the lubricant was keeping her from being pained by the insertion? THE COURT: Can you answer the question the way it is phrased? MS. FISHER: As to the victim—s pain, your Honor. THE COURT: She testified regarding, would it be less painful or more painful if there were lubricant when an object is inserted in her rectum. THE WITNESS: Talking about the physicality of itself. It—s difficult to say. THE COURT: Just say you can—t answer it. A: I can—t, because this is a unique situation. I cannot. Q: Well, now, would the insertion of a sharp cucumber in a woman—s anus or in her vagina to the point that she—s screaming with pain, and it is being inserted into her vagina or into her anus, would you expect to find evidence of that when you examined? Q: Would you expect to find evidence of a metal tube being inserted into a woman—s vagina against her will? MS. FISHER: Objection to leading, your Honor, unless ” THE COURT: You can ask a hypothetical saying assume the following facts, otherwise you can—t lead the witness. Q: Well, assuming, Doctor, that a woman has had an iron tubing inserted into her anus as well as into her vagina over a period of five hours in which she states that the pain is so excruciating that she couldn—t tell whether it was in her anus or in her vagina, and she said that she was bleeding all over the place, would you expect to find blood in her rectum or anus from those insertions? MS. FISHER: Objection, your Honor, to five hours. THE COURT: Sustained. Q: Well, Doctor, if you assume a person had a piece of metal inserted into her vagina or into her anus to the point that she said she couldn—t tell which it was in because of excruciating pain, and she said she was bleeding and screaming, would you expect to find blood in her vagina from that insertion to a reasonable degree of medical certainty? MS. FISHER: Objection, your Honor. THE COURT: Can you answer question the way it is phrased? If you can answer it, answer it. If you can—t, indicate to the Court. THE WITNESS: I can—t answer it the way it is phrased. Q: Would you expect blood to be found in a woman—s rectum from the insertion of a cucumber, a sharp cucumber or a metal tubing of a club of an automobile, where she is complaining, that—s she—s screaming from the pain, and assuming further that she says blood is all over the seat and what have you, would you expect to find blood in her rectum? Q: Assuming that she said that the tubing was inserted into her vagina with pain and she was screaming, and that blood was flowing from her vagina, would you expect to find blood in her vagina, assuming? MS. FISHER: Objection. THE COURT: Sustained. I don—t want you to testify as to what was possible. I want you to give us an answer based on medical evidence. Not to speculate. All right. THE WITNESS: All right. Q: Assuming that, Doctor, would you expect to find blood in her vagina? MS. FISHER: Objection, your Honor. THE COURT: Sustained. MR. PINCHAM: I have nothing further. RECROSS EXAMINATION BY MS. FISHER: Q: Doctor, you say you use KY Jelly when you do a rectal exam? MR. PINCHAM: Objection. THE COURT: Overruled. Brought out on redirect. MR. PINCHAM: You sustained the objection when I talked about the KY Jelly, now she testified to it. MS. FISHER: May I continue? THE COURT: Yes. Q: Doctor, the purpose of the KY Jelly when you do a rectal exam is to diminish the possibility of any injury to the person you are examining, correct? MS. FISHER: Thank you. I have nothing further. THE COURT: Anything further, counsel? Limited to new matter brought out now. REDIRECT EXAMINATION BY MR. PINCHAM: Q: Wouldn—t you expect to find some kind of tenderness at least at the vaginal entry or in the vagina or the anal entry or at the rectum if a metal tube or if a cucumber had been inserted in her vagina, rectum? MS. FISHER: Objection, your Honor. THE COURT: Sustained. Improper redirect. You may step down. THE WITNESS: Thank you. (Witness excused.) CERTIFIED THAT THE FOREGOING IS A TRUE AND ACCURATE TRANSCRIPT OF THE ORIGINAL STENOGRAPHIC MINUTES IN THIS CASE.

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