7.Michael Vulfovich — Direct
127 linesMR. REDDINGTON: Afternoon.
MICHAEL VULFOVICH: Afternoon.
MR. REDDINGTON: Can you tell us your name and spell your name?
MICHAEL VULFOVICH: It's Michael Vulfovich. It's V as in Victor, U-L, F as in Frank, O, V as in Victor, I-C-H.
MR. REDDINGTON: And what do you do for work, sir?
MICHAEL VULFOVICH: I'm an emergency medicine doctor. I work full-time at Newton-Wellesley Hospital.
MR. REDDINGTON: Newton-Wellesley?
MICHAEL VULFOVICH: Yes.
MR. REDDINGTON: And can you tell us your... Are you board certified, sir?
MICHAEL VULFOVICH: I am. I'm board certified in emergency medicine.
MR. REDDINGTON: And that would be by the American Board of Emergency Medicine?
MICHAEL VULFOVICH: Correct.
MR. REDDINGTON: And how long have you been practicing emergency medicine?
MICHAEL VULFOVICH: I did three years of residency, and this is my 13th year as a full-time attending.
MR. REDDINGTON: And you're presently employed, where is it?
MICHAEL VULFOVICH: Newton-Wellesley Hospital primarily, and then I do some additional shifts at Emerson Hospital in Concord.
MR. REDDINGTON: How about medical school? Where'd you go to med school?
MICHAEL VULFOVICH: St. Louis University School of Medicine.
MR. REDDINGTON: And what year did you graduate?
MICHAEL VULFOVICH: 2011.
MR. REDDINGTON: Obviously licensed in the Commonwealth?
MICHAEL VULFOVICH: Yes, sir.
MR. REDDINGTON: In the course of your training and experience, sir, do you work full-time in a particular field of medicine?
MICHAEL VULFOVICH: Just emergency medicine. So basically we see any and all comers, anything from ankle sprains to traumas.
MR. REDDINGTON: Okay. Did I ask you to review some documents regarding this particular case involving Lindsay Clancy?
MICHAEL VULFOVICH: You did. You asked me to review the—
MICHAEL VULFOVICH: Oh, sorry. You asked me to review the photos from the crime scene, and then the emergency medical records from South Shore Hospital, Brigham and Women's Hospital, and then the records from her hospital stay at Brigham and Women's Hospital.
MR. REDDINGTON: So in reviewing all of those various hospital records, sir, you're aware that on January 24th of 2023, she initially was transported to South Shore Hospital. Is that correct?
MICHAEL VULFOVICH: Yes, sir.
MR. REDDINGTON: And can you tell the jurors what treatment she received at the South Shore Hospital briefly?
MICHAEL VULFOVICH: So she arrived with a GCS of 10, meaning she was not really very responsive and—
MR. REDDINGTON: Let me interrupt you just so that... What did you say? A G6?
MICHAEL VULFOVICH: GCS. Glasgow Coma Scale.
MR. REDDINGTON: GS. Okay, slow down. Cause I don't understand. What is a GCS?
MICHAEL VULFOVICH: It's a Glasgow Coma Scale. It's a series of things that we look at to determine how responsive somebody is, you know, whether their eyes are opening spontaneously, whether they're able to speak on their own, and whether you're able to understand what they're saying, and then how much, if at all, they're moving, whether they're moving spontaneously, whether they can follow commands, that kind of thing.
MR. REDDINGTON: Okay. So the Glasgow Coma Scale, GCS of 10, what does that tell you as an emergency room doctor?
MICHAEL VULFOVICH: Tells us that she was not very responsive on arrival. It sounds like she was not speaking intelligibly, and the doctors at South Shore Hospital were concerned about her ability to maintain her own airway, and made the decision to intubate her, which means putting a breathing tube down her throat into her lungs, and placing her on a ventilator and sedating her.
MR. REDDINGTON: Was she also, what would be, I guess, referred to as hypothermic?
MICHAEL VULFOVICH: She was.
MR. REDDINGTON: What does that mean?
MICHAEL VULFOVICH: It means that her body temperature was below what's considered normal. So in her case, her core body temperature was, I believe, 82.1 degrees, which would put her into severe hypothermia.
MR. REDDINGTON: And did you note that she was tachycardic and hypotensive?
MICHAEL VULFOVICH: Yes.
MR. REDDINGTON: What did that mean?
MICHAEL VULFOVICH: So it means that her heart rate was above 100, and hypotensive means that her blood pressure was below what is considered normal.
MR. REDDINGTON: And South Shore Hospital, were they able to stabilize her?
MICHAEL VULFOVICH: It sounds like they were able to stabilize her by placing a breathing tube in her neck, in her throat, to help with her breathing, and then they basically proceeded to obtain a bunch of imaging, started her on medications to sedate her and artificially raise her blood pressure. They started working on rewarming her, and then in conjunction with the trauma team there, they made the decision that she would be better served at a hospital with a higher level of care.
MR. REDDINGTON: Okay. And can you tell us what the injuries were that she presented herself with to the South Shore Hospital?
MICHAEL VULFOVICH: So there were multiple injuries. She had lacerations to bilateral wrists, bili-
MR. REDDINGTON: When you say lateral, what does that mean?
MICHAEL VULFOVICH: Bilateral, both sides. So she had a laceration, both to her left wrist and to her right wrist, and then multiple superficial lacerations as well. And then she also had multiple superficial lacerations to both sides of her neck, the front of her neck, and two deeper lacerations to the sides of her neck.
MR. REDDINGTON: So when you say superficial lacerations and then deeper lacerations, do you recall—what's the standard? What do you look for in something like that?
MICHAEL VULFOVICH: So it's tough. Everybody will describe them a little bit differently. In her case, I would describe multiple superficial lacerations, which would typically mean kind of scrapes on the surface of the skin, nothing that actually gets through the full thickness of the skin. And then she also had full thickness lacerations, meaning that she made it all the way through the skin into the subcutaneous tissue, the fatty tissue, and then you would need to describe it further if any additional structures were injured, which in her case they were not.
MR. REDDINGTON: Now, in your experience, for a number of years in the emergency room, have you had occasion to treat people that have tried to commit suicide or have successfully committed suicide by cutting their throat?
MICHAEL VULFOVICH: Multiple times.
MR. REDDINGTON: Multiple times. And can you tell us, in your opinion to a reasonable degree of medical certainty, sir, as to whether or not this injury or these injuries that you observe were consistent with what you've seen in other suicide attempts?
MS. SPRAGUE: Objection.
THE COURT: Sustained.
MR. REDDINGTON: Well, can you tell us, did that look like an effort to pretend or a fake of suicide?
MS. SPRAGUE: Objection.
THE COURT: Sustained.
MR. REDDINGTON: Well, when you looked at the injuries, did you make a determination that they appeared to have some impact on the human body of Ms. Clancy?
MICHAEL VULFOVICH: Yes.
MR. REDDINGTON: And what was that?
MICHAEL VULFOVICH: They were consistent with self-injurious behavior. The intent, I can't gauge, but—
MS. SPRAGUE: Anything further? Non-responsive.
MR. REDDINGTON: Okay.
THE COURT: Next question.
MR. REDDINGTON: Yep. Thank you. How about the wrist? What did you observe about the wrist injuries, sir?
MICHAEL VULFOVICH: So she had two full thickness lacerations, one on the left and one on the right.
MR. REDDINGTON: What does that mean?
MICHAEL VULFOVICH: It means that she made it all the way through the epidermis and the dermis, which is what makes up the skin in the wrist, and into the fatty tissue, which is the next layer.
MR. REDDINGTON: Okay. Are you familiar in your experience, sir, with hesitation wounds in a suicide attempt?
MICHAEL VULFOVICH: Yes, to some extent.
MR. REDDINGTON: What does that mean?
MICHAEL VULFOVICH: It means typically that they're more kind of subtle, weaker attempts to hurt yourself, not necessarily anything that's gonna be deep to the structures of the skin, but more just scrapes along the surface.
MR. REDDINGTON: Okay. And you noticed some of those on the neck area as well, is that correct?
MICHAEL VULFOVICH: There were multiple of those on both the neck and the wrists.
MR. REDDINGTON: As it relates to the injuries to the wrist, the wrists, did you observe any vascular structures or penetration of the, what's, cervical, strike that, the fascia?
MICHAEL VULFOVICH: There was not.
MR. REDDINGTON: Okay. What other injuries did you recall from reviewing the medical records?
MICHAEL VULFOVICH: So she also had multiple fractures in her cervical spine, which are the vertebrae that make up her neck, including what's called a burst fracture of C1, and then other fractures of C4. She also had fractures of multiple levels of the thoracic spine. I believe she had multiple transverse process fractures on both the right and left. And then—
MR. REDDINGTON: What does that mean, transverse fractures?
MICHAEL VULFOVICH: Transverse processes are lateral projections, basically projections that go sideways off of the bone, that allow the ribs to articulate, connect with the spine, and they also allow muscles to connect, and they help support the basically overall ring structure of the spinal canal.
MR. REDDINGTON: And was she then transported by med flight or life flight to a Boston hospital?
MICHAEL VULFOVICH: She was.
MR. REDDINGTON: What does that tell you as an emergency surgeon when someone's transported by med flight or life flight?
MICHAEL VULFOVICH: Typically means that her injuries are thought, are felt to be severe enough that she needs immediate intervention and further treatment, that the hospital that is basically necessitating the transport is saying that they cannot provide at their facility.
MR. REDDINGTON: She was then transported to what hospital?
MICHAEL VULFOVICH: Brigham and Women's Hospital in Boston.
MR. REDDINGTON: And she was admitted to what unit?
MICHAEL VULFOVICH: Surgical ICU.
MR. REDDINGTON: And you had a chance to review all those medical records as well?
MICHAEL VULFOVICH: I did.
MR. REDDINGTON: Did she suffer a particular event that night that you recall from looking at the records?
MICHAEL VULFOVICH: She did. Shortly after arriving in the surgical ICU, it sounds like they were moving her, and when they moved her, they noticed that her blood pressure dropped, her pulse became faint, and subsequently she actually suffered a complete cardiac arrest and required two rounds of cardiopulmonary resuscitation with compressions and medications before she was able to be revived.
MR. REDDINGTON: And she also, to your knowledge, had suffered significant hemorrhage and had to have a fairly massive blood transfusion?
MICHAEL VULFOVICH: Yes. They placed chest tubes, which are basically plastic tubes that go into the chest cavity on both sides, and had about three hundred ccs of blood come out from each side. And there was also noted to be significant hemorrhage around the spine and into the mediastinum, which is the portion of the chest that houses a lot of the organs like your esophagus, your trachea, blood vessels, that kind of thing.
MR. REDDINGTON: Now, if there's a fracture or a serious fracture to, I believe it's C1, does that interfere possibly with a person's ability to breathe?
MICHAEL VULFOVICH: It does.
MR. REDDINGTON: And how does that work?
MICHAEL VULFOVICH: So if you have a fracture that affects the spinal cord above a certain level, typically above the third cervical vertebrae, it basically removes your ability to initiate breathing on your own. Your third, fourth, and fifth cervical vertebrae, the nerves that lead from there are the ones that are responsible for telling your diaphragm to go up and down and help you breathe. And so if you lose the ability to send that signal down to your diaphragm, you lose the ability to breathe.
MR. REDDINGTON: Now, as it relates to your review of the medical records and review of the history, are you aware of the mechanism of the injuries that she suffered that you just described for the jury?
MICHAEL VULFOVICH: I am.
MR. REDDINGTON: Tell us what that was to your knowledge.
MICHAEL VULFOVICH: That she went out of her second story window.
MR. REDDINGTON: And going out of the window, obviously, did she strike the ground or...?
MICHAEL VULFOVICH: She did.
MR. REDDINGTON: And that caused the injuries, the mechanism of injury?
MICHAEL VULFOVICH: Yes, it's consistent with all of her injuries.
MR. REDDINGTON: Now, with your experience, sir, with, as you indicated, dealing with people in the emergency room and treating people that have been involved with sequential acts of self-harm, do you have an opinion to a reasonable degree of medical certainty, as an emergency board-certified physician, as to the effect of the combination of the multiple sequential injuries that you saw?
MS. SPRAGUE: Objection.
THE COURT: Can I see counsel at sidebar, please?
MR. REDDINGTON: I can withdraw it, Judge. I'll withdraw it. Just... Thank you very much.
MS. SPRAGUE: No questions.
THE COURT: All right. Thank you, doctor.
MICHAEL VULFOVICH: Thank you.
THE COURT: All right. Counsel, now could I see you at sidebar?
THE COURT: All right. Members of the jury, I told you it was gonna be stop and start, right? So we're gonna start, stop now, but we're gonna stop now for the day for you. I'm gonna come back. I've gotta talk to counsel about setting some things up logistically for tomorrow. All right, so tomorrow the plan would be, hopefully we'll start right, right at 9:00 or right as close as we can. And we'd hope to have a pretty full day in regards to the witnesses. All right? So I'm gonna excuse you till tomorrow at 9:00. I'm gonna remind you, don't talk about this case. Don't read anything about it or anything about any similar cases. Don't do any research. Don't listen to anything. Don't post anything. You kinda know where I'm going, right? So I'm gonna ask you to follow those instructions. Again, I'm gonna give you those questions. And I hope you have a nice evening. We'll see you tomorrow morning. Okay? Thank you.
BAILIFF: All rise, please. Jurors exiting.
THE COURT: Hey, counsel, could I see you at sidebar just really in regards to tomorrow? Not very long.
THE COURT: All right. Thank you, counsel. All right. Anything else you should address before tomorrow morning, Commonwealth?
MS. SPRAGUE: No, Your Honor.
THE COURT: All right. Mr. Reddington?
MR. REDDINGTON: No, Your Honor.
THE COURT: All right. So I appreciate everybody's patience and work on this, this morning and this afternoon. So we'll be in recess on this matter till nine o'clock tomorrow. Thank you.
BAILIFF: Court, all rise.