4.Elizabeth Laposata — Direct/Cross/Redirect/Recross
314 linesBAILIFF: This court is back in session. You may be seated.
COURT CLERK: Your Honor, the Commonwealth versus Lindsay Clancy. All parties are present, including the defendant.
THE COURT: All right. Counsel, we all set?
MR. REDDINGTON: Yes.
THE COURT: All right. Ready for the jury?
MR. REDDINGTON: Yes.
BAILIFF: All rise, please. Jurors entering.
BAILIFF: The court is back in session. You may be seated.
COURT CLERK: Your Honor, for the purpose of the record, we return back to the trial of Commonwealth versus Lindsay Clancy. All parties are present, including the defendant and including the 18 jurors.
THE COURT: All right. Thank you, Madam Clerk. Members of the jury, I think we got everything fixed. So thank you for your patience. The next witness that's gonna testify is gonna be—testify either by Zoom or teleconference, as you can see. I just wanna tell you, this witness will be under oath, and you can consider her testimony the same as if she was testifying here live. Okay? All right. Mr. Reddington.
MR. REDDINGTON: Yes, thank you.
COURT CLERK: May I swear her in?
THE COURT: Yes.
COURT CLERK: Dr. Laposata, please raise your right hand. Do you solemnly swear that you shall make... Do you solemnly swear that the testimony and the evidence you shall give to the court and the jury in the matter now pending between the Commonwealth and the defendant at the bar shall be the truth, the whole truth, and nothing but the truth, so help you God?
ELIZABETH LAPOSATA: I do.
COURT CLERK: Thank you.
THE COURT: Counsel.
MR. REDDINGTON: Good afternoon, doctor. Can you hear me?
ELIZABETH LAPOSATA: You're a little echoey, but I can hear you.
MR. REDDINGTON: Okay. I'm just standing in the corner here so that everybody can hear you. Tell us your name and spell your last name, please.
ELIZABETH LAPOSATA: Dr. Elizabeth Laposata, L-A-P-O-S-A-T-A.
MR. REDDINGTON: And fair to say that you have some issues that require you to speak to us today by Zoom rather than appearing in person as you intended to do. Is that correct?
ELIZABETH LAPOSATA: Yes, that's correct.
MR. REDDINGTON: Okay. Tell us what you do for work, doctor.
ELIZABETH LAPOSATA: Well, I'm a medical doctor, board certified in anatomic and forensic pathology. So I have a active practice in forensic pathology where I review cases to understand how people get injured or how people die.
MR. REDDINGTON: And how... Can you tell us your educational background?
ELIZABETH LAPOSATA: Certainly. I graduated from Bucknell University in 1975, cum laude with honors in biology. I went to University of Maryland School of Medicine, where I graduated with a MD degree in 1979. I did my two years internship at Johns Hopkins Hospital in anatomic pathology, which is the study of diseases of the body. Then I trained in St. Louis, Missouri, with a fellowship in forensic pathology, which is understanding causes of death and how trauma affects the body.
MR. REDDINGTON: Do you hold any board certifications or any licensures in that field, doctor?
ELIZABETH LAPOSATA: Yes. In 1983, excuse me, I sat for my board exams and became board certified diplomate of the American Board of Pathology in anatomic and forensic pathology.
MR. REDDINGTON: And tell us your work history, if you would, please.
ELIZABETH LAPOSATA: Certainly. Since I became board certified in 1983, I've had faculty positions in St. Louis University School of Medicine at—where I also was the assistant medical examiner for the City of St. Louis. I then moved to Pennsylvania, Philadelphia, where I ran the autopsy service at the Hospital of the University of Pennsylvania. Had a faculty appointment there, a research lab, and I taught forensic pathology to medical students. I then... And I was also a City of Philadelphia medical examiner. After that I was a assistant medical examiner for the State of Delaware, and in 1993 I was selected to be chief medical examiner for the State of Rhode Island, which was a position I held until 2005, when I started my independent consulting practice.
MR. REDDINGTON: So you've been an independent consultant testifying in courts and working on cases since 2005?
ELIZABETH LAPOSATA: At my own business, yes, and certainly testifying on cases before that as medical examiners employed for the City of St. Louis, the City of Philadelphia, and the State of Delaware, and the State of Rhode Island.
MR. REDDINGTON: Okay. And now you're independent. On your own, as it were. Correct?
ELIZABETH LAPOSATA: I am, as it were, yes.
MR. REDDINGTON: Okay. Now, did I reach out to you on the case of the Commonwealth versus Lindsay Clancy and ask if you would help us out by looking at the discovery of the case?
ELIZABETH LAPOSATA: Yes, you did.
MR. REDDINGTON: And you're here to testify today. Can you tell the jurors what you actually reviewed as a basis of your opinion for your testimony?
ELIZABETH LAPOSATA: Certainly. I reviewed medical records, and I have a list here on Dawson, Dawson Clancy. I reviewed the office of the medical examiner entire file. I reviewed his EMS reports, his terminal hospitalization, the Duxbury Police supplemental narrative, Duxbury Police narrative, and his pediatric South Shore healthcare medical records.
MR. REDDINGTON: Could I just interrupt you for a minute?
ELIZABETH LAPOSATA: Sure.
MR. REDDINGTON: I apologize.
ELIZABETH LAPOSATA: Sure.
MR. REDDINGTON: Just in the interest of time, rather than going through every single... D- let me ask it this way.
ELIZABETH LAPOSATA: Okay.
MR. REDDINGTON: Did you look at police reports?
MR. REDDINGTON: Did you look at grand jury minutes?
MR. REDDINGTON: Did you look at medical records for Lindsay Clancy?
ELIZABETH LAPOSATA: Yes, I—yes, I did.
MR. REDDINGTON: Can you tell the jurors what medical records you looked at?
ELIZABETH LAPOSATA: For Dawson Clancy?
MR. REDDINGTON: No, for Lindsay—
ELIZABETH LAPOSATA: I looked at—
MR. REDDINGTON: No, no, no, not Dawson. For Lindsay Clancy.
ELIZABETH LAPOSATA: Oh, yes. I looked at her South Shore medical records when she was admitted on the evening of January 24th. I looked at her Brigham and Women's Hospital records, and photographs that were taken of her and published in her hospital records. I looked at the Department of State Police Crime Laboratory toxicology report, crime scene photos of the bedroom, the outside of the house, you know, crime scene photos, approximately 500 of them, grand jury proceedings, and photographs of the round exercise band.
MR. REDDINGTON: How about medical records? Did you review medical records pertinent to Lindsay and her treatment by healthcare providers in 2022 into 2023?
MR. REDDINGTON: Can you tell us what records you looked at?
ELIZABETH LAPOSATA: Well, I looked at her records from the post-injury records from South Shore Hospital, where she was first transported after she was found in the backyard of her house. And then I looked at her hospital records where she was transferred from South Shore Hospital to Brigham and Women's Hospital.
MR. REDDINGTON: Excellent. Doctor, in the course of preparing for your testimony here, did I direct you to a gentleman, a Mr. Drake, and ask him for help putting together a little diagram to illustrate your testimony?
ELIZABETH LAPOSATA: Yes, you did. I— Mr. Jeffrey Drake Graphics—
MR. REDDINGTON: Yes.
ELIZABETH LAPOSATA: … Under my direction, we put together some illustrations.
MR. REDDINGTON: And, Your Honor, could I— and we all know what I did. Could I admit this now?
THE COURT: If you wanna… Is there any objection?
MS. SPRAGUE: Just the prior objections.
THE COURT: Other than… Yeah, so same ruling. That may be admitted. Do you wanna pass out those—
MR. REDDINGTON: Sure, that'd be great.
THE COURT: Yeah.
THE COURT: And to the jury, if you could pass out copies of what was just introduced as the exhibit. And just, it's just so you can kind of follow along with the testimony. And at the end, you can ask them to pass them back to, for us.
THE COURT: Mark, mark that.
COURT REPORTER: 281.
MR. REDDINGTON: Thank you.
THE COURT: All right. All set?
MR. REDDINGTON: Yes, I think so.
THE COURT: Fine.
MR. REDDINGTON: Thank you. Now, Doctor, first of all, you made reference to Dawson Clancy, that you had a chance to review medical records and photographs and autopsy reports on Dawson Clancy?
ELIZABETH LAPOSATA: Yes, on Dawson, Cora, and Callan.
MR. REDDINGTON: All three. Okay. Three of the children.
MR. REDDINGTON: One of the questions that I have is that— of the photographs, the autopsy photographs that you would—
THE COURT: Do you wanna take that? It might be just kind of confusing with the… This, that, that's better. Then we can go back—
MR. REDDINGTON: Okay.
THE COURT: … When we get back to the charts we can do that. Okay, thank you.
MR. REDDINGTON: Thank you. The autopsy photographs, did you have a chance to review those, Doctor?
ELIZABETH LAPOSATA: Yes, I did.
MR. REDDINGTON: And in your extensive experience, have you had a chance to see autopsy photographs of young children, infants, adults, people being examined prior to an autopsy and of course during an autopsy?
ELIZABETH LAPOSATA: Oh, yes. Many, many, many.
MR. REDDINGTON: Now my question simply is, did you notice on the autopsy photographs of the children what, let's say, have been referred to as bruises to this jury? Have you seen, are you aware of that testimony?
MR. REDDINGTON: Okay.
ELIZABETH LAPOSATA: There were bruises consistent with active children jumping and running.
MR. REDDINGTON: And how about medical treatment and procedure? Did you make any observations in your opinion to a reasonable degree of medical certainty as to the cause, for example, on the infant, on the infant's head, bruising on the head, what appears to be bruising?
ELIZABETH LAPOSATA: Yes. On Callan when he was in the hospital, and there are even photographs of him in the hospital, he had EKG or EEG, electroencephalogram monitoring devices attached to his head so the doctors could follow his brain waves, and they are little round cup-like things. And so where they were attached, actually on both sides of his head, they did leave a small little brown kind of parallel mark, little lines there that were from medical treatment for monitoring his brain waves. He also had many puncture wounds and evidence of medical treatment in that way.
MR. REDDINGTON: And did you also notice that there would be, appear to be on occasion fluid that might be mistaken for a bruise?
ELIZABETH LAPOSATA: That's possible, yes. If there is some liquid fluid that's a little blood-tinged, you could see it on the surface of the skin, and it would be something you could wipe off.
MR. REDDINGTON: So for example, Doctor, to a reasonable degree of medical certainty on the photographs of the infant that show what you say were the cup-like marks on the area of the skull, they don't come from anybody squeezing, beating, pushing, or causing any injury to that child in your opinion. Is that correct?
ELIZABETH LAPOSATA: N- n- no. Absolutely not. No.
MR. REDDINGTON: Doctor, you also had a chance to review the medical records of Lindsay Clancy when she went to the South Shore Hospital and then subsequently went to the Brigham and Women's Hospital. Is that correct?
ELIZABETH LAPOSATA: Yes, that's correct.
MR. REDDINGTON: And you don't have to get into detail, we've heard it a number of times, but there were injuries to her left wrist, her right wrist, her neck. Is that correct?
ELIZABETH LAPOSATA: Yes, there were sharp force injuries to those areas.
MR. REDDINGTON: And in your practice as a pathologist, have you had occasion over the years and over the many cases that you have had involvement with to observe self-inflicted wounds to a person's wrist or their neck in the course of a suicide attempt?
ELIZABETH LAPOSATA: Oh, many times.
MR. REDDINGTON: And can you tell the jury to your opinion to a reasonable degree of medical certainty as to the nature of these injuries, and are they consistent with somebody trying, in your opinion, try... Wait a minute. Trying to kill themselves?
MS. SPRAGUE: Objection.
THE COURT: Sustained.
MR. REDDINGTON: So you would agree that there's an injury to the left wrist, injury to the right wrist that's a sharp incised wound. Is that correct?
ELIZABETH LAPOSATA: Yes. They're cutting type wounds made by a sharp object such as a knife.
MR. REDDINGTON: Okay. And how about the neck? Did that penetrate the fascia, or did that penetrate the skin? To what degree?
ELIZABETH LAPOSATA: Yes, there were also linear, superficial incised wounds to her neck. And there were several, several of them, and one or two of them went deeper. There was bleeding also from the wounds on her wrist, and there were numerous attempts at cutting the skin, which we call hesitation marks, which are a classic finding in suicide attempts. And they did, those incisions did cut in through the skin and cut blood vessels that were under the skin. And you can also tell from looking at the photos of Lindsay taken in the hospital when she was first admitted, and also when the photograph of the bedroom, her bedroom, you could see there was significant bloodshed event from those cutting injuries.
MR. REDDINGTON: Now, did she also sustain an injury to her neck from your review of the medical records?
MR. REDDINGTON: Can you tell us what type of injury, and if we could, and if it assists the jury with you, you can make reference to the pages of the little report in the diagrams, page four, five, and six, and tell us what we're looking at?
ELIZABETH LAPOSATA: Okay. Let's see. So are we ready to look at number four?
MR. REDDINGTON: Sure. Yep, start off with four.
ELIZABETH LAPOSATA: Okay. So—
THE COURT: Just so everybody...
ELIZABETH LAPOSATA: What was—
THE COURT: I think that's the first page that you have, so just...
ELIZABETH LAPOSATA: Yes, that's right. Yes. Page four is actually page one. Yeah, so what we have here is to show you... Lindsay was injured, and I got this from the scene photographs, from all her medical history, and my knowledge and training, understanding how injuries happen to the body. So if we look at the left-hand side of this panel, we see a depiction of the backside of the house, and the top window on the second floor is open. That's where she would have put her palms down on the windowsill and put her head out and precipitated down to fall on the hard frozen ground. During her fall headfirst, she had cuts on her wrists which were bleeding, and her coming head down on the side of that building would then transfer some of that blood onto the side of the building, which was found in the scene photograph.
ELIZABETH LAPOSATA: She then hits really headfirst, as her body descends that thirteen or fourteen feet. And if you look at the— So she really did a free fall dive headfirst. Then if you look on the right upper two diagrams that just show a skull, this illustrates the forces then that were applied to Lindsay's head from hitting the ground, and then her head bending a little bit. And what she got from that is what we call a characteristic burst fracture or a Jefferson fracture. And this is a fracture that we see with people who hit their head head-on, like if they've taken a dive into a swimming pool, and they hit their head on the bottom. It's a classic finding in people who have energy applied to the falling head. And what it does is that it takes the first cervical vertebrae, which kind of looks like a donut as you see up there in the middle, and it squashes it. The base of the skull then squashes that, and then like a donut, it kind of spreads it out.
And she had one, two, three, four, so six or seven fractures of that cervical vertebrae number one, the ring of that, and the fractures I have pointed to there with arrows. So that is called the characteristic Jefferson fracture from hitting your head, the top of your head in a dive first position. So it— You could also describe it as a bursting type fracture. But you don't get any spinal cord injury from that because the area, the hole in the middle is pretty big, so it just crushes down on the sides and fractures the ring around the spinal cord. So that tells me immediately that she landed headfirst and went down the window, went down headfirst. Then the energy is transmitted then from her head down her vertebral body, down the bony spine, and that then fractured and compressed C1. The lower right-hand panel there puts that cervical vertebral body in the context of the rest of her skeleton. The left upper hand, we see her jaw, and then the C1 is pointed out there, and there are little springs there to indicate they were squished and compressed together and fractured.
MR. REDDINGTON: Now, looking at the next page, which would be five, does that assist us in looking at the illustration of the injury to the spine?
ELIZABETH LAPOSATA: Yeah. So this is after her head hits. So she hits her head first, then there is some flexion of her body, and the energy from the impact is transmitted down her vertebral column. And what that did was it crushed a number of her thoracic vertebrae or vertebrae in the chest area and actually made thoracic vertebral body T5 go be compressed and move over the top of the lower vertebrae, and that is what injured her spinal cord. In the right-hand panel there, the yellow tube coming down is the spinal cord, and the T, thoracic vertebral five and six is pictured there, and you can see that her whole spinal column was compressed, and it moved forward and out of place, causing her spinal cord injury. There were also injuries that are indicated by little red stars there, and those are fractures of the transverse processes of the cervical vertebrae. So when they were compressed, the areas where the joints are between the vertebrae were compressed and fractured those transverse processes. So she had a bending injury, and she also had a right posterior rib injury. You can see on the left-hand panel her shoulders are also hitting the ground, and that caused a fracture of the right first rib in the back, and the flexion of her neck also damaged her thyroid gland and some of her voice box cartilages.
MR. REDDINGTON: And if we look at panel, page six, can you tell us what we're looking at there?
ELIZABETH LAPOSATA: Yes, this is the final resting position of Lindsay's body. It's documenting all the materials I reviewed, and it's on the left-hand side. So she is lying down on hard, frozen ground. Her clothing is what she has on, indoor clothing. The time that this occurred, it was dark and no sun. The temperature was in the low 30s, so she is going to be at risk of her body temperature going down, lying on that cold ground. In addition to now that her thoracic chest spine is fractured, that has totally disrupted the thermal regulation of the bottom half of her body. So she is going to lose heat from the lower half of her body, and as it to approach ambient temperature. So there she is lying there on the ground. Then if we go to the right side of that, this is a scene photograph showing the area where Lindsay's body landed. You can see on the right at the base area, there is some medical debris from the EMS emergency treatment. Then circled in, or put in a red square, is a little bit of snow that has some blood on it, which would correspond to her position lying down as we see it in the left-hand side there.
MR. REDDINGTON: And of the—
MR. REDDINGTON: Sorry, go ahead.
ELIZABETH LAPOSATA: Okay, then the last bit here is a X-ray of Lindsay, which was taken in early February after she had surgical stabilization of her fractured spine. So this is looking at the side of her, and you can see the hardware, which they look like little golf tees going to the left side. So this is the surgical metal hardware that was placed in her spine to open up and align her spine to try to preserve any function that was still available.
MR. REDDINGTON: Now, doctor, when she went to the Brigham and Women's Hospital, were you reviewing the medical records and able to discern that she actually coded as a result of her injuries?
ELIZABETH LAPOSATA: Yes, she did. She was in spinal shock and hypothermia, and her heart did stop.
MR. REDDINGTON: And did you observe that there were, and I quote, "massive blood transfusions" to treat her at Brigham and Women's?
ELIZABETH LAPOSATA: Yes. She lost a lot of blood around the muscles that hold the spine up because that was so damaged. So her hemoglobin and hematocrit and her red blood cell level was very low on admission.
MR. REDDINGTON: And the final question I have, doctor, is as it relates to the records, it showed that she had a core body temperature of eighty-two degrees as opposed to ninety-eight point six, which we're accustomed to. Can you tell the jury, in your opinion, to a reasonable degree of medical certainty, what does that mean and how did that happen? I mean, that's pretty low.
ELIZABETH LAPOSATA: Yes, that is low. That's like, you know, sixteen degrees below normal. And so her low body temperature came from lying on the hard, frozen ground, which would be thirty-two degrees, frozen ground. She had wet clothing on, so wet clothing is gonna transmit the body heat into the atmosphere quicker than dry clothing. She had—it was indoor clothes. She didn't have a big parka on. There was no sun at that time to keep her body temperature up. The ambient or the air temperature was around thirty degrees. She has a thin body, and also, most importantly, because of that thoracic spinal cord transection, she lost the ability to control her body temperature below that level. So that means all her blood vessels just dilate, and they just lose heat to the atmosphere.
MR. REDDINGTON: Thank you very much, doc.
THE COURT: Attorney Sprague.
MS. SPRAGUE: Thank you. Dr. Laposata?
MS. SPRAGUE: You were head of the Rhode Island Office of the Chief Medical Examiner when it was cited for ten violations in unsafe conditions, correct?
ELIZABETH LAPOSATA: Yes. The unsafe condition was a light bulb out in a hallway, a computer in a hallway, and a few other minor things. I was very happy to have the safety inspection.
MS. SPRAGUE: Right. Those were the unsafe conditions, but there were also ten other violations, correct?
ELIZABETH LAPOSATA: They were minimal. I don't recall now. It was twenty years ago.
MS. SPRAGUE: You didn't treat Ms. Clancy, correct?
ELIZABETH LAPOSATA: Correct.
MS. SPRAGUE: And you didn't examine her yourself, correct?
ELIZABETH LAPOSATA: Correct.
MS. SPRAGUE: Now, you talked about a Jefferson fracture and, or a C1 burst fracture and how it can be from hitting the top of your head, correct?
MS. SPRAGUE: Isn't it also true that you can sustain a burst fracture by hitting the back of your head or the top of your shoulders as well?
MS. SPRAGUE: You say that she fell from thirteen feet from the window sill onto her head, the top of her head, correct, onto the frozen ground?
MS. SPRAGUE: And you're saying that she fell with such force that she burst her C1 vertebrae, and then broke other vertebrae in her back and broke ribs, correct?
ELIZABETH LAPOSATA: Yes, just the force of a free-falling body, yes.
MS. SPRAGUE: Okay. But she had no injuries to her head, correct?
ELIZABETH LAPOSATA: She... I'm sure she had bruising to her scalp under her hair.
MS. SPRAGUE: You're sure?
ELIZABETH LAPOSATA: She did not, she did, she did not have a skull fracture.
MS. SPRAGUE: Right. She didn't have a skull fracture, correct?
MS. SPRAGUE: She didn't have any cuts or things that needed sutures, correct?
ELIZABETH LAPOSATA: Well, her... She needed sutures and the cutting wounds on her wrist.
MS. SPRAGUE: Well, we're talking about her head right now. She didn't need any sutures on her head, correct?
ELIZABETH LAPOSATA: Correct.
MS. SPRAGUE: She didn't have any large dents in her head, correct?
ELIZABETH LAPOSATA: Large dents? What, what, what do you mean?
MS. SPRAGUE: From hitting the frozen ground headfirst, there were no dents or bumps or sutures required on her head, correct?
ELIZABETH LAPOSATA: Her scalp was intact. The forces were transmitted to C1.
MS. SPRAGUE: So through her head-
ELIZABETH LAPOSATA: Very, very, a very common finding when you go headfirst and hit your head.
MS. SPRAGUE: So hitting the frozen ground, the icy frozen ground, not a bump or scratch or scrape on her top of her head, and then within her head there was no brain bleed, there was no hemorrhaging, there was no injury into her brain itself. Nothing showed up on the CT scans, correct?
ELIZABETH LAPOSATA: Right. Her brain was fine. Her skull was fine. I'm sure she probably had some scalp bruising under her hair.
MS. SPRAGUE: You're sure? You're sure because that goes along with what you're guessing at how the fall happened, correct? You can't be sure-
MS. SPRAGUE: ...because you didn't see the head, correct?
ELIZABETH LAPOSATA: No, I think you have to-
MS. SPRAGUE: You say you're sure, but you didn't see her head.
ELIZABETH LAPOSATA: I saw the medical records, and I examined all of those. I'm sure she had some bruise on the top of her head to the backside, as I showed in my diagram number four. I'm sure there was some bruising on her scalp under her hair, but that was not a major concern at the time she was taken into the hospital.
MS. SPRAGUE: You keep saying you're sure there were bruises, that you're sure that there was this or that, that's not shown in any photographs or medical evidence. So you're not sure, are you? You're assuming.
ELIZABETH LAPOSATA: No, I'm sure.
MS. SPRAGUE: Okay. Let me show you some photographs here.
MS. SPRAGUE: No. And let me show... I'm asking the questions. Let me show you some photographs here.
ELIZABETH LAPOSATA: Oh, okay. Go right ahead.
MS. SPRAGUE: Let me show you some photographs of the defendant that were taken at the hospital of her head.
MS. SPRAGUE: Showing you here photo of the top of the defendant's head. No blood—
ELIZABETH LAPOSATA: Yes, I see that.
MS. SPRAGUE: ... cuts, no swelling, correct?
ELIZABETH LAPOSATA: We just see her hair.
MS. SPRAGUE: There's no blood on the white sheet, correct?
ELIZABETH LAPOSATA: Wait, I'm sorry, I couldn't hear what you just asked me.
MS. SPRAGUE: There's no blood on that very white sheet, correct?
ELIZABETH LAPOSATA: Well, I don't see what's under her head, but that's not relevant to understanding that she did fall headfirst.
MS. SPRAGUE: Okay. So you're saying she fell headfirst from 13 feet onto hard frozen ground and had no visible injuries to the exterior of her head?
ELIZABETH LAPOSATA: Yes. I'm saying that there was some bru—
MS. SPRAGUE: And you're saying that she—
ELIZABETH LAPOSATA: Excuse me. I'm sure there was some bruising.
MS. SPRAGUE: It was a yes or no question, doctor.
THE COURT: Whoa, hold. Listen, hold on. Doctor—
THE COURT: ... listen to the question, answer the question, and then we'll just go from there. Go ahead.
ELIZABETH LAPOSATA: Oh, okay.
THE COURT: Ms. Sprague, if you want—
ELIZABETH LAPOSATA: Thank you.
THE COURT: ... Ms. Sprague, do you wanna re-ask that question?
MS. SPRAGUE: Doctor, yes or no, she fell to the ground, frozen ground, and then had no apparent injury to the exterior of her head, correct?
ELIZABETH LAPOSATA: Correct. As we see there.
MS. SPRAGUE: And she fell headfirst to the frozen ground, and not... with enough force to break several vertebrae and her ribs, but did not have a skull fracture, a brain bleed, or anything else, any other type of injury to her head, correct?
ELIZABETH LAPOSATA: That's absolutely correct.
MS. SPRAGUE: Move to put the photographs we were just showing into evidence.
THE COURT: Any objection? All right, they may be admitted.
COURT REPORTER: Exhibit 282.
MS. SPRAGUE: Doctor, in your report that you provided to defense counsel, you also talked about the strangulation of the children, correct?
ELIZABETH LAPOSATA: I did.
MS. SPRAGUE: And in your report, you wrote that it would have taken five to 10 seconds for unconsciousness to occur, correct?
MS. SPRAGUE: Okay. Now, do you recall testifying previously in State of Rhode Island versus Kimberly Frye, case number o- W1/2010-0413A? Do you recall testifying previously in that case?
ELIZABETH LAPOSATA: No, I don't.
MS. SPRAGUE: Let me refresh your memory.
ELIZABETH LAPOSATA: Oh, I don't.
MS. SPRAGUE: It was a woman who had killed her eight-year-old daughter by asphyxia, and you testified.
ELIZABETH LAPOSATA: Oh, yes. She strangled—manual strangulation. Yes.
MS. SPRAGUE: Yeah. So it ring a bell?
MS. SPRAGUE: Okay. And so you testified back in 2011 in that case, and you were asked, “If you have a very complete compress...” Strike that. You were asked, “Unconsciousness due to oxygenation can occur within 10 to 20 seconds.” And you said, “If you have a very complete compression of the blood vessels of the neck, you can become unconscious within te- 10 to 20 seconds.” And then you were asked, “I'm just saying hypothetically, just strangulation alone is 10 to 20 seconds.” And you said, “If it is effectively and continuously applied, like in a lateral vascular neck restraint, most times there's a struggle going on, so you can't quite get that.” So in that case there, you didn't testify that it was five to 10 seconds. You testified that it was 10 to 20 seconds, and that if there's any struggling, it could be longer. Correct?
ELIZABETH LAPOSATA: Yes, but that, in that case was defense-
MS. SPRAGUE: Well, that was a yes or no question.
MR. REDDINGTON: Your Honor, that's not a yes or no question.
THE COURT: All right.
MS. SPRAGUE: Defense can follow up.
THE COURT: Hold on, hold on. She's answered the question, and then we'll have a redirect if counsel would like to.
ELIZABETH LAPOSATA: Well, I don't remember what I said.
THE COURT: Hold on, Doctor. Why don't you-
ELIZABETH LAPOSATA: Oh, I'm sorry.
THE COURT: Doctor, Doctor, wait for a question.
MS. SPRAGUE: You were also asked in that same trial, Doctor, the question put to you in that trial was, “But once that unconsciousness set in, you agree with me that there had to have been a consistent application of pressure, either suffocation, strangulation, or compressions of the chest for two to three more minutes continuously while the child was unconscious, correct?” And you answered, “I think that's a fair statement.” And the question was, “You said that before yourself, correct?” And you answered, “Yes.” And then the question was, “I'm asking your opinion.” And you said aft... The question was, “After Camden became unconscious, after two to three minutes of continuous application of one of those three,” and you answered, “Correct.” Is that right?
ELIZABETH LAPOSATA: I have no memory of that. I'm sure you're reading it correctly.
MS. SPRAGUE: Well, you have memory of your medical knowledge, correct?
ELIZABETH LAPOSATA: Sure, I have memory of my medical knowledge.
MS. SPRAGUE: And so at that point in time in 2011, you testified that you would have to strangle someone 10 to 20 seconds at least to unconsciousness, and then you would have to continue to strangle them for two to three minutes for death to occur, and you said, "Correct." Is that still your medical knowledge?
ELIZABETH LAPOSATA: That's a different case.
MS. SPRAGUE: So—
ELIZABETH LAPOSATA: That was not ligature. That was a manual.
MS. SPRAGUE: So hand... Either way, you're talking about the compression of the neck causing a loss of oxygen and blood. Correct?
MR. REDDINGTON: I'm okay with the way she's answered. She's—
THE COURT: Yeah, I'll allow this question. Go ahead.
ELIZABETH LAPOSATA: Yeah, there are many ways that can occur, and the way the pressure is applied is very important in understanding how long it takes to become unconscious. These are—the children here were the victims of what we call ligature strangulation. The Fry case, that's coming back to me a little now. That was a manual strangulation and also a body compression, which is a totally different type of asphyxia.
MS. SPRAGUE: And you were asked about that in that case, and you were asked, "But once unconsciousness has set in, you agree with me that there has to be consistent application of pressure, either suffocation, strangulation, or compressions for two to three minutes more?" And you answered, "Correct." So not all three, you said either one of those could cause death after three minutes, correct?
MR. REDDINGTON: Three questions or two.
THE COURT: Yeah. Just if you could rephrase that question.
MS. SPRAGUE: You were asked, "But once unconsciousness set in, you agree with me that there had to have been consistent application of pressure, either suffocation, strangulation, or compressions of the chest for two to three minutes more continuously while they're unconscious?" And you said, "I think that's a fair statement." So that's what you said, correct?
ELIZABETH LAPOSATA: Yes. In order to become dead, brain dead, you need, you—the physiology is that the—you become unconscious within five to 10 seconds, and then you need, then you're unconscious. But that's not dead. Then that continued constriction of the blood flow has to be still continuously applied for the brain to die.
MS. SPRAGUE: Correct. So—
ELIZABETH LAPOSATA: Yeah. So that is what happens, and that's what happened to the Clancy children. The ligatures were wrapped around. They went unconscious in five to 10, maybe 20 seconds. Probably less than 20 seconds because it was a ligature, not a manual strangulation. So it was immediately compressed, unconsciousness within 10 seconds, and then death within five to 10 minutes after that. Or it was—
MS. SPRAGUE: With continuous pressure.
ELIZABETH LAPOSATA: Yeah.
MS. SPRAGUE: With continuous pressure—
ELIZABETH LAPOSATA: Yes, because—
MS. SPRAGUE: —around the neck.
ELIZABETH LAPOSATA: Yes, because this is a ligature strangulation.
MS. SPRAGUE: Thank you.
ELIZABETH LAPOSATA: Not manual.
MR. REDDINGTON: Okay. So when you're talking about ligature strangulation as opposed to manual strangulation, tell us in your mind what that means.
ELIZABETH LAPOSATA: Well, they're very, very different. Manual strangulation means that you had—somebody has used their hand, and they've pressed either side of the neck. Okay? That the hand is manual strangulation. Strangulation means that you have stopped the blood flow that comes out of your brain, and the carotid artery continues to pump oxygenated blood into your brain, but it can't drain out through the jugular veins. So with con- then you—with continuous pressure, then you—the blood can't get in because it can't flow out. It's kind of like stopping up a pipe. And then so you go unconscious within five to 10 seconds. But then with continued pressure, your brain dies. So the difference between manual and ligature is that manual can be kind of an off and on thing. You may put... You have a jugular vein on either side of your neck. So if you're using a hand, you might compress one greater than the other. You might let go. The person that you're trying to strangle may struggle and remove your hand a little bit. So it's a very different sequence of events to end up with brain death and asphyxia. Whereas wrapping a round loop resistance band, which is a ligature, immediately compresses those vessels. There's no, there's no coming off. There's no putting back on. So it's a very complete, one-time, immediate, non-varying compression with those exercise bands ligature, which causes unconsciousness effectively within four to 10 seconds.
MR. REDDINGTON: And in reference to the manual strangulation, where generally somebody would use their hands and perhaps press with their thumbs, that has a very common that you see many times fracture of what's called the hyoid bone. Correct?
ELIZABETH LAPOSATA: Yes, that can happen. Absolutely. A little U-shaped bone up underneath the jaw. So they both cause, you know, brain death from lack of oxygen to the brain, but the way they get there that's leading up to that is a totally different pathophysiologic process.
MR. REDDINGTON: So when counsel went through the Rhode Island case, whatever that name was, and was reading from a transcript and asking you questions about the time that a person through manual strangulation, and then she made reference to suffocation, she made reference to strangulation, she made reference to compression of the chest. That has nothing to do, in your opinion, with the ligature strangulation. Is that correct?
ELIZABETH LAPOSATA: It's a totally different mechanism of injury.
MR. REDDINGTON: Thank you.
THE COURT: Ms. Sprague.
MS. SPRAGUE: Doctor, as you said a few moments ago, the ligature causes unconsciousness, and then the pressure has to continuously be applied for several minutes to cause death. Correct?
MS. SPRAGUE: Thank you.
THE COURT: All right. Anything further?
MR. REDDINGTON: One other question. On the ligature, doctor, and we discussed this—
MR. REDDINGTON: ... is the ligature, does that require a person to stand over the body and continuously apply pressure to the ligature or walk away, leaving the ligature?
ELIZABETH LAPOSATA: No. In this case, these were elastic round loops, like, that were put around, you know, somewhat tightly, pinching the skin. You could see little lines where the skin was pinched, and it just stays there. So it's a immediate compression of those jugular veins, staying there, and then death occurs minutes later.
MR. REDDINGTON: Thank you.
MS. SPRAGUE: Doctor, did you see these exercise bands?
MS. SPRAGUE: And you know that they're one long line with a handle on each end, correct?
ELIZABETH LAPOSATA: Right. And they're round. They're a cylinder.
MS. SPRAGUE: Right. And you—
ELIZABETH LAPOSATA: They're not like a flat band.
MS. SPRAGUE: ... and you know they were wrapped around each child's neck and pulled to strangle them, correct?
ELIZABETH LAPOSATA: Well, they were. They were wrapped several times, firmly enough around the neck to close off the jugular veins.
MS. SPRAGUE: And you're not aware, there's been no testimony, no evidence, nothing showing that they were knotted and left there, correct?
MS. SPRAGUE: They weren't tied in a knot—
MS. SPRAGUE: ... and left around their necks according to any of the evidence. Correct?
ELIZABETH LAPOSATA: The important part to me was they were wrapped several times, and then whether it had a bow or a knot would not really be important. It was secure and wrapped around the neck several times.
ELIZABETH LAPOSATA: And I can tell that from the appearance of the skin on the neck that...
MS. SPRAGUE: The band, doctor, wrapped around the child's neck several times and then left there. I guess you can't see it from where you are, but it just fell apart.
ELIZABETH LAPOSATA: No, I can—
MS. SPRAGUE: It didn't stay in a circle.
ELIZABETH LAPOSATA: Yeah, I sort of saw what you did. So...
MS. SPRAGUE: What was that?
ELIZABETH LAPOSATA: I said I saw that.
MS. SPRAGUE: You saw it. So it was left there, and it fell apart. Correct?
ELIZABETH LAPOSATA: Yeah, what you just did. Sure.
MS. SPRAGUE: Yeah. Thank you.
MR. REDDINGTON: That's all I have.
THE COURT: All right. Thank you, doctor.
ELIZABETH LAPOSATA: Oh, thank you, Your Honor.
THE COURT: Okay. See you just for second.
THE COURT: Short break to take the equipment down. Took us hours to get it up. Hopefully, it'll take us about five minutes to take it down. So, I'm just gonna ask you a very quick break, and we'll bring you right back in and we'll call the next witness. Okay?
BAILIFF: All rise. Jurors exiting.
BAILIFF: Jurors have exited the courtroom. This court's in session. Please be seated.
THE COURT: All right. So we'll be in... I know we always say it, but we'll be in a short recess, come soon as we can get the equipment down. We'll bring— we'll come right back out and we'll take the next witness.