2.Andrew Capraro — Direct
86 linesMS. SPRAGUE: Commonwealth calls Dr. Andrew Capraro.
COURT CLERK: Thank you. You may have a seat, sir.
THE COURT: All right. Good morning, doctor.
ANDREW CAPRARO: Morning.
MS. SPRAGUE: If I may?
THE COURT: Yes, please.
MS. SPRAGUE: Thank you. Good morning. Can you please state and spell your name for the record?
ANDREW CAPRARO: My name's Dr. Andrew Capraro. Last name C-A-P-R-A-R-O.
MS. SPRAGUE: And your date of birth, please?
ANDREW CAPRARO: July 9th, 1970.
MS. SPRAGUE: What do you do for a living?
ANDREW CAPRARO: I'm an attending physician in the emergency department at Boston Children's Hospital.
MS. SPRAGUE: And how long have you done that?
ANDREW CAPRARO: For the last 26 years.
MS. SPRAGUE: Can you just briefly describe for us the training and education you had to qualify for that role?
ANDREW CAPRARO: I went to Providence College undergrad and then went to Brown Medical School. Subsequently I went to Connecticut Children's Medical Center for my pediatric residency, and then did fellowship training in pediatric emergency medicine at Boston Children's Hospital from 2000 to 2003, and have been an attending there ever since.
MS. SPRAGUE: And what's involved with being an attending at Boston Children's Hospital?
ANDREW CAPRARO: It means that I am guiding the care and treatment for the patients that I am seeing during my particular shift.
MS. SPRAGUE: And are you assigned to a specific location or area of the hospital?
ANDREW CAPRARO: I'm always in the emergency department, and the emergency department is broken up into different zones, of which I am sort of the primary attending for one set of rooms.
MS. SPRAGUE: I want to direct your attention to January 24th, 2023. Were you working that evening?
ANDREW CAPRARO: I was.
MS. SPRAGUE: And at some point in time, did you learn that a patient named Callan Clancy was going to be transported to your hospital?
ANDREW CAPRARO: I did.
MS. SPRAGUE: And do you recall where he was being brought from?
ANDREW CAPRARO: From Beth Israel Plymouth, I believe.
MS. SPRAGUE: And was he being med-flighted to your facility?
ANDREW CAPRARO: Correct.
MS. SPRAGUE: And were you provided with some information about the patient in order to prepare for his arrival?
ANDREW CAPRARO: I was.
MS. SPRAGUE: And what did you learn?
ANDREW CAPRARO: We have a communication center where facilities that are transferring patients to us call to let us know that the patient is coming. And so that comm center had been notified about this patient, who then got in touch with me as the attending who would be caring for the patient, to let me know what had happened there and the condition of the patient when he was arriving.
MS. SPRAGUE: And what did you learn about the condition of the patient, Callan Clancy, as he was being flown to your hospital?
ANDREW CAPRARO: What I was told was that it was believed that the patient had been strangled. And when he arrived at Plymouth, he was in cardiac arrest, that they had intubated him and initiated CPR, and they had gotten return of spontaneous circulation, and that they were then going to transfer him to us for further evaluation and care.
MS. SPRAGUE: And at some point in time, did Callan arrive at your hospital?
ANDREW CAPRARO: That is correct.
MS. SPRAGUE: And were you able to observe him physically?
ANDREW CAPRARO: Yes.
MS. SPRAGUE: What observations did you make about his physical condition?
ANDREW CAPRARO: He was cold on arrival, and he was quite limp, was not making any purposeful movements on his own. His pupils were fixed and dilated, and he had ligature marks about his neck with some swelling of the neck.
MS. SPRAGUE: And his pupils being fixed and dilated, is that medically significant for you?
ANDREW CAPRARO: Yes, it is.
MS. SPRAGUE: And why is that?
ANDREW CAPRARO: It typically means that significant injury has happened to the brain, such that there is brain swelling that has sort of over—what do I wanna say? It has overwhelmed the capacity of the skull, such that the swelling has made the brain sort of herniate through the base of the skull.
MS. SPRAGUE: Does that mean the brain's swelling so much it's pushing through the skull?
ANDREW CAPRARO: Correct.
MS. SPRAGUE: And what observations did you make of his heart rate?
ANDREW CAPRARO: His heart was beating, and we did have to provide him with an epinephrine drip to keep his heart rate and his blood pressure within normal limits, but it was beating on its own.
MS. SPRAGUE: And how did you know that you had to provide the epinephrine for him to stabilize that heart rate?
ANDREW CAPRARO: It was initiated at BI because they had noticed that his blood pressure was low, and you need to have normal blood pressure for the blood to perfuse your organs and keep them healthy. And so we were looking for certain parameters to sort of maintain that, which we did on that epinephrine drip.
MS. SPRAGUE: And when you say BI, you're referring to Beth Israel?
ANDREW CAPRARO: Yes. I'm sorry about that.
MS. SPRAGUE: It's okay. And so as far as his breathing, how was—was he breathing on his own?
ANDREW CAPRARO: He had been intubated at the outside hospital, and he was needing a ventilator to breathe for him. Occasionally, he would have sort of a breath on his own, we would notice. We were able to see that because when he attempted to take a breath on his own, he would trigger the ventilator to continue that breath. But it was rare. For sure, he needed the ventilator to maintain his ventilation.
MS. SPRAGUE: Would it be fair to say that the majority of his breathing was being done by the ventilator?
ANDREW CAPRARO: Yes. The vast majority of his breathing.
MS. SPRAGUE: Now, once you have received this information while he's coming in, and then you've made your own physical observations of Callan, are there certain tests that you have run on him?
ANDREW CAPRARO: Yeah. Our job, once we received him, was to perform further evaluation and stabilization to help determine what the next steps of his medical care would be. So prior to him arriving, we had contacted our trauma team and our ICU doctors to let them know that he was coming and that we would need their assistance. And then under my care, we performed some routine blood work, so a head CT, a neck CT, and a chest X-ray to sort of help us guide the next steps.
MS. SPRAGUE: And from the head CT and the other testing that you did, what were you able to learn from the results of those tests?
ANDREW CAPRARO: The head CT in particular showed significant brain swelling consistent with hypoxic-ischemic injury, which was most likely—or which was the most significant finding that we found.
MS. SPRAGUE: So could you please explain for us what is hypoxic-ischemic injury?
ANDREW CAPRARO: Hypoxic is just a fancy word for not getting enough oxygen, and ischemic is just a fancy word for not getting enough blood flow. And so when your organs don't get enough oxygen and blood, they sort of suffer injury and therefore get to swelling. And so his brain was showing evidence of that.
MS. SPRAGUE: So would it be fair to say that his brain wasn't getting enough oxygen and blood flow, and then because of that, it was damaged and swelling?
ANDREW CAPRARO: Correct.
MS. SPRAGUE: Now, this type of swelling and injury, as you're describing it, can that be caused by strangulation, the injury of the brain?
ANDREW CAPRARO: Most certainly.
MS. SPRAGUE: And you mentioned earlier that you did see some marks around his neck. Is that correct?
ANDREW CAPRARO: Correct.
MS. SPRAGUE: And what were those consistent with?
ANDREW CAPRARO: Strangulation of some sort, most likely from an object based upon the linear aspect of the bruising.
MS. SPRAGUE: And when you say the linear aspect of the bruising, does that mean it's in a straight line?
ANDREW CAPRARO: Correct.
MS. SPRAGUE: Now, once you had the results of this testing, was there—did you make a decision on what to do next?
ANDREW CAPRARO: Yeah. You know, the main thing was to help us figure out: did the patient need to go to the operating room for some sort of other procedure to help with this, or was this something that could be dealt with medically? And so once we had the results of the head CT and then the neck CT as well, it was felt that the next appropriate step in his medical care would be to be transitioned to the intensive care unit for them to take over care.
MS. SPRAGUE: Why was it that surgery was not an option to help Callan in this situation?
ANDREW CAPRARO: Yeah, you know, the neurosurgery doctors were there to sort of help us make that decision. There was no significant bleeding, for example, that would need to be evacuated. There was nothing that they felt from a surgical point of view would help alleviate the problems that we saw on the CT.
MS. SPRAGUE: Okay. And so was his care transferred to the ICU?
ANDREW CAPRARO: That is correct.
MS. SPRAGUE: And once Callan was transferred to the intensive care unit, did your care for him end at that point?
ANDREW CAPRARO: Correct.
MS. SPRAGUE: I have nothing further. Thank you.
THE COURT: Thank you. Mr. Reddington?
MR. REDDINGTON: No questions. Thank you.
THE COURT: Oh, that's good. Thank you, Doc. You may step down.
ANDREW CAPRARO: Thank you.
THE COURT: Watch your step, please.