4.Kelly McDonough — Direct/Cross/Redirect
439 linesMS. BUCKINGHAM: Commonwealth would call Kelly McDonough as its next witness.
THE COURT: I'm sorry, if you—can you say the name again?
MS. BUCKINGHAM: Kelly McDonough.
THE COURT: Okay. Sure.
THE COURT: Good morning.
KELLY MCDONOUGH: Good morning.
MS. BUCKINGHAM: May I inquire? Thank you.
THE COURT: Yes, please.
MS. BUCKINGHAM: Good morning. Could you please tell the jurors your first and last name?
KELLY MCDONOUGH: Kelly McDonough.
MS. BUCKINGHAM: Can you spell your last name for the record?
KELLY MCDONOUGH: M-C-D-O-N-O-U-G-H.
MS. BUCKINGHAM: And what do you do for a living?
KELLY MCDONOUGH: I'm an emergency medicine physician.
MS. BUCKINGHAM: And how long have you been a physician?
KELLY MCDONOUGH: 11 years.
MS. BUCKINGHAM: Can you tell us a little bit about your educational background?
KELLY MCDONOUGH: Mm-hmm. I went to medical school at the University of New England in Maine. I did my residency at Kent Hospital in Rhode Island. I subsequently worked at Carney Hospital in Dorchester, and I've been at South Shore Hospital since 2021.
MS. BUCKINGHAM: And what... Are you primarily in the emergency department at South Shore Hospital?
KELLY MCDONOUGH: Correct.
MS. BUCKINGHAM: Have you been in any other department at South Shore Hospital?
MS. BUCKINGHAM: Are you licensed to practice in Massachusetts?
KELLY MCDONOUGH: Yes.
MS. BUCKINGHAM: I'm gonna draw your attention to January 24th of 2023. Were you working in the emergency department that evening?
KELLY MCDONOUGH: I was.
MS. BUCKINGHAM: At some point, were you advised that a patient was being brought into your emergency department?
KELLY MCDONOUGH: I was.
MS. BUCKINGHAM: And were you aware of that patient being Lindsay Clancy with a date of birth of 8/11/90?
KELLY MCDONOUGH: Yes.
MS. BUCKINGHAM: And what kind of information were you given upon learning that the patient was coming here? What were you expecting to receive?
KELLY MCDONOUGH: I was expecting a trauma one response. A patient who had fallen out of a window from a height. And didn't know much more than that.
MS. BUCKINGHAM: Okay, and so when you say trauma one, what does that mean for you?
KELLY MCDONOUGH: So we have two designations for trauma responses, a trauma one and a trauma two, and there's certain criteria for each. And there's a long list of criteria that are determined by the resource nurse who receives the EMS call.
MS. BUCKINGHAM: Okay, and so when we say one and two, which is more serious than the other?
KELLY MCDONOUGH: Trauma one.
MS. BUCKINGHAM: Okay. And so, what do you do to prepare when a patient is coming in and you know coming in that it's likely a trauma one situation?
KELLY MCDONOUGH: So we gather in the trauma room and make sure that we have all available staff needed to take care of the patient.
MS. BUCKINGHAM: And what kind of staff are with you in the room, in the trauma room?
KELLY MCDONOUGH: So for a trauma one response, it would be the emergency medicine physician, it would be anesthesia, the trauma surgeons, sometimes neurosurgery will be there.
MS. BUCKINGHAM: And fair to say you also have a whole host of other staff, including nurses, emergency room techs, all of those people are also available to assist in, if you need it?
KELLY MCDONOUGH: Correct.
MS. BUCKINGHAM: Now, when this individual came in, when Lindsay Clancy came into the emergency department, were you aware from EMS that she had already come in with some sort of neurological deficits?
KELLY MCDONOUGH: I think that from my best recollection, we knew that she was unresponsive, found down outside of her home.
MS. BUCKINGHAM: Okay. Were you advised that it appeared she might have a spinal injury?
KELLY MCDONOUGH: Yes.
MS. BUCKINGHAM: And that she was not mo— she may have been moving her arms and her head, but not her legs?
KELLY MCDONOUGH: Correct.
MS. BUCKINGHAM: Now when the team was assessing her in the emergency department, what types of steps do you take to perform that assessment of the patient?
KELLY MCDONOUGH: So there's a series of steps that we go through to assess a trauma patient that are followed every single time. ABC's: airway, breathing, circulation, and then we do a secondary survey.
MS. BUCKINGHAM: Okay. And in this circumstance, was the patient breathing?
KELLY MCDONOUGH: Yes.
MS. BUCKINGHAM: And when she came into the emergency department, was she breathing on her own or intubated?
KELLY MCDONOUGH: She was breathing on her own.
MS. BUCKINGHAM: At some point, did the ER staff have to intubate her?
KELLY MCDONOUGH: Yes.
MS. BUCKINGHAM: And why was that?
KELLY MCDONOUGH: For airway protection. There was a concern that maybe she would have a head injury and she would decompensate later. And so to protect her airway she was intubated.
MS. BUCKINGHAM: Now is that a standard protocol when there's concern for head injury?
KELLY MCDONOUGH: Yes.
MS. BUCKINGHAM: Did you see any obvious signs of a head injury when she arrived into the emergency department?
MS. BUCKINGHAM: What kinds of things would you see if somebody had an obvious head injury?
KELLY MCDONOUGH: You might see bleeding or lacerations or abrasions.
MS. BUCKINGHAM: Now, did you observe any other obvious injuries to this patient?
KELLY MCDONOUGH: I did. She had some superficial lacerations of her neck and wrists bilaterally.
MS. BUCKINGHAM: Do you recall if she came in on a backboard with a C-collar?
KELLY MCDONOUGH: She did.
MS. BUCKINGHAM: And do you remove the C-collar at some point to assess the patient for injuries?
KELLY MCDONOUGH: We didn't completely remove it, remove it temporarily to visualize and feel her neck and then put it right back on.
MS. BUCKINGHAM: Okay. And you said you did observe some injuries to her neck, correct?
KELLY MCDONOUGH: Yes.
MS. BUCKINGHAM: I'm just gonna show you some photos that have been already marked, if that's okay, on the screen next to you.
MS. BUCKINGHAM: This has been marked as exhibit number one eleven. Is that a accurate representation of the neck injuries you observed?
KELLY MCDONOUGH: Yes.
MS. BUCKINGHAM: You also indicated that she had some other injuries to her wrists.
KELLY MCDONOUGH: Yes.
MS. BUCKINGHAM: And I'm just gonna show you one twelve. Is that accurate as to the injuries to the wrist you observed?
KELLY MCDONOUGH: Yes.
MS. BUCKINGHAM: Now, you described the injuries to— as superficial. The injury that's kind of in the middle of the photograph there, can you describe what part of the body that injury is?
KELLY MCDONOUGH: You're describing the one that's sort of open?
MS. BUCKINGHAM: Yes.
KELLY MCDONOUGH: Yeah, so that's the anterior aspect of her wrist.
MS. BUCKINGHAM: And were you able to examine that injury?
KELLY MCDONOUGH: Not in detail.
MS. BUCKINGHAM: Okay. Was it something in your emergency—your assessment of the trauma one situation, was that something acute that you had to address?
MS. BUCKINGHAM: And is it fair to say that that injury goes through kind of the subcutaneous tissue of the skin?
KELLY MCDONOUGH: Yes.
MS. BUCKINGHAM: Did you observe any injuries to an artery or a vein or anything in that area?
KELLY MCDONOUGH: I did not.
MS. BUCKINGHAM: And then just showing you exhibit one thirteen, which is the other wrist. Same thing, did you observe anything in your assessment, your trauma one assessment to say whether these were acute at the time?
KELLY MCDONOUGH: I assume that they're acute.
MS. BUCKINGHAM: Okay. But as far as treatment of them, did they require you to immediately address it—
MS. BUCKINGHAM: …or manage blood flow?
KELLY MCDONOUGH: Mm-mm.
MS. BUCKINGHAM: Okay.
MS. BUCKINGHAM: What was the more serious, or what was the focus of your assessment of her in the emergency department?
KELLY MCDONOUGH: I think the main concern was for a head injury and/or a spinal cord injury.
MS. BUCKINGHAM: And you said that as part of the assessment team you had a neurosurgeon available as well as a trauma surgeon, correct?
KELLY MCDONOUGH: There was no neurosurgeon there that day.
MS. BUCKINGHAM: Okay. Was there a trauma surgeon?
KELLY MCDONOUGH: There was.
MS. BUCKINGHAM: Who was that?
KELLY MCDONOUGH: Dr. Christina Carpio.
MS. BUCKINGHAM: Did you order any series of tests in order to help you assess the nature of whether there was any head injury or what the extent of the spinal injury could have been?
KELLY MCDONOUGH: Yes.
MS. BUCKINGHAM: What kinds of tests did you order?
KELLY MCDONOUGH: CAT scans.
MS. BUCKINGHAM: As part of the emergency room protocol, do you also draw blood for patients that come in?
KELLY MCDONOUGH: Yes.
MS. BUCKINGHAM: And how is that usually done?
KELLY MCDONOUGH: It's usually done on arrival by the nursing staff.
MS. BUCKINGHAM: And do they draw blood according to a physician's orders, or do they draw… blood for various purposes? Explain to us how that works.
KELLY MCDONOUGH: Mm-hmm. So it's usually, like, what we call a rainbow. So they just draw all the tubes of blood as soon as the patient arrives—
MS. BUCKINGHAM: Mm-hmm.
KELLY MCDONOUGH: …in anticipation for orders.
MS. BUCKINGHAM: Okay. And so what happens to the blood after somebody in the emergency department takes it from the patient? Where does it go?
KELLY MCDONOUGH: It gets tubed to the lab.
MS. BUCKINGHAM: And fair to say that at South Shore Hospital they have a pneumatic tube system, correct?
KELLY MCDONOUGH: Correct.
MS. BUCKINGHAM: And that it goes to a separate laboratory?
KELLY MCDONOUGH: Correct.
MS. BUCKINGHAM: And once a physician then assesses a patient and determines what kinds of testing needs to be done on those samples, how do you communicate that to the laboratory?
KELLY MCDONOUGH: So orders are put into a computer, and they go through the computer to the lab.
MS. BUCKINGHAM: And as you're treating a patient, is it oftentimes necessary to change the orders or order additional tests?
KELLY MCDONOUGH: Yes.
MS. BUCKINGHAM: And so in this particular case, blood and urine was collected from Lindsay Clancy upon her arrival, correct?
KELLY MCDONOUGH: Correct.
MS. BUCKINGHAM: And then sent to the lab?
KELLY MCDONOUGH: Yes.
MS. BUCKINGHAM: Okay. Now, going back to the imaging tests, you said that there were some CT scans that were ordered?
KELLY MCDONOUGH: Correct.
MS. BUCKINGHAM: What areas of the body were the CT scans for?
KELLY MCDONOUGH: It was her entire body. Her head, her neck, her chest, her abdomen, and her pelvis.
MS. BUCKINGHAM: Now, as far as the...
MS. BUCKINGHAM: The CTs for her head, were there more than one CT test for the head?
KELLY MCDONOUGH: I don't remember. I'd have to look at my record.
MS. BUCKINGHAM: Okay.
MS. BUCKINGHAM: Well, what are the normal, or what are the options for CT head scans?
KELLY MCDONOUGH: Usually just a CT head plain, but you could also do a CT angiogram depending on your concern for injury.
MS. BUCKINGHAM: Okay. And do you recall which one you ordered here?
KELLY MCDONOUGH: For a trauma one, it would be a plain CT head.
MS. BUCKINGHAM: Okay. And why do you order that particular test?
KELLY MCDONOUGH: Well, we're trying to assess for skull fractures, intracranial bleeding, things like that.
MS. BUCKINGHAM: Okay. And when you say a plain CT, what's the exact order that's put in for that type of a CT?
KELLY MCDONOUGH: CT head.
MS. BUCKINGHAM: Okay. And are there CT heads with contrast?
KELLY MCDONOUGH: There are.
MS. BUCKINGHAM: And are there CT head scans without contrast?
KELLY MCDONOUGH: Yes.
MS. BUCKINGHAM: Okay.
MS. BUCKINGHAM: May I approach the witness?
THE COURT: Yes.
MS. BUCKINGHAM: Just gonna show you some documents, if that's okay.
KELLY MCDONOUGH: Sure.
MS. BUCKINGHAM: I apologize. There's a little—
KELLY MCDONOUGH: It's okay.
MS. BUCKINGHAM: ...series of pagination, so I'm just gonna draw your attention to this page that's flagged. If you could just take a look at it.
KELLY MCDONOUGH: Sure.
KELLY MCDONOUGH: Mm-hmm.
MS. BUCKINGHAM: Okay. And I'm just gonna flip to the next page as well. The next page is blank, but is this the extent of what you would have received as far as information regarding a head CT that was done without contrast?
KELLY MCDONOUGH: Yes.
MS. BUCKINGHAM: And I'm going to just draw your attention again to another flagged page here towards the end. It's actually two pages from the end of the document, if you could take a look at that.
KELLY MCDONOUGH: Mm-hmm.
MS. BUCKINGHAM: And does that reflect the report you would have received for the head CT ordered with contrast?
KELLY MCDONOUGH: Yes.
MS. BUCKINGHAM: And in addition to getting a report from imaging, you also receive some actual images, correct?
KELLY MCDONOUGH: Yes.
MS. BUCKINGHAM: And do you review those?
KELLY MCDONOUGH: Yes.
MS. BUCKINGHAM: In this particular circumstance, when it came to the patient of Lindsay Clancy, was there anything remarkable in either of those head CTs?
KELLY MCDONOUGH: Not that I recall.
MS. BUCKINGHAM: And in fact, the head CT with contrast indicated the impression was unremarkable CTA of head, no evidence intracranial aneurysm, arteriovenous malformation, or abrupt occlusion. Correct?
KELLY MCDONOUGH: Correct.
MS. BUCKINGHAM: What does that mean?
KELLY MCDONOUGH: It essentially means it's a normal study.
MS. BUCKINGHAM: Okay. Now, as far as the other CT scans that were conducted, there were findings, remarkable findings on some of the others, correct?
KELLY MCDONOUGH: Correct.
MS. BUCKINGHAM: And what did they reflect in your experience as far as her injury goes?
KELLY MCDONOUGH: From what I can recall, I know she had a thoracic spine injury.
MS. BUCKINGHAM: And how about the CT that was done of the chest area?
KELLY MCDONOUGH: I don't recall.
MS. BUCKINGHAM: Okay. If I may approach.
THE COURT: Approach.
MS. BUCKINGHAM: Thank you.
MS. BUCKINGHAM: Does that refresh your memory?
KELLY MCDONOUGH: Yes.
MS. BUCKINGHAM: And what was the extent of the results on the chest CT?
KELLY MCDONOUGH: So it talks about her thoracic spine injuries.
MS. BUCKINGHAM: Okay.
MS. BUCKINGHAM: Now, after reviewing all of the images, all of the CT scans that were done here, the cervical spine, the head CTs, the thoracic spine, what was the plan for this particular patient? Was she able to be treated further at South Shore Hospital?
KELLY MCDONOUGH: The decision was made by the team that her injuries were too severe to stay at South Shore Hospital, and the decision was made to transfer him to, her to a tertiary care center.
MS. BUCKINGHAM: Were you able to stabilize her before transporting?
KELLY MCDONOUGH: Yes.
MS. BUCKINGHAM: Is that something that's important to make sure a patient is stable before sending them off in the ambulance or a helicopter?
KELLY MCDONOUGH: Yes.
MS. BUCKINGHAM: And so as far as this particular patient goes, are you aware of when, whether any surgical intervention had to be done before she was stabilized and transported?
KELLY MCDONOUGH: I was not aware of any intervention being done.
MS. BUCKINGHAM: And again, you had Dr. Carpio who was also there to assess that.
KELLY MCDONOUGH: Correct. We work as a team.
MS. BUCKINGHAM: Okay. Kind of going back to those injuries on her neck and her wrist very briefly, can you explain to us the difference between bleeding in maybe an artery or a vein and how that might present itself in an emergency situation?
KELLY MCDONOUGH: A venous bleed would be a little bit slower, darker blood. An arterial bleed would be pulsatile and bright red.
MS. BUCKINGHAM: And is it fair to say that when you strike either an artery or a vein, that they're of different pressure systems, and so the manner in which the blood comes out is different?
KELLY MCDONOUGH: Yes.
MS. BUCKINGHAM: In either circumstance where an artery or a vein is struck or nicked or cut, would that be something that you'd have to stabilize for a patient in order to make sure that they don't bleed out?
KELLY MCDONOUGH: Yes.
MS. BUCKINGHAM: Was that done here?
KELLY MCDONOUGH: It wasn't necessary.
MS. BUCKINGHAM: Now, this particular patient at some point was noted to be, I think it's, was referred to as hypothermic.
KELLY MCDONOUGH: Mm-hmm.
MS. BUCKINGHAM: Do you recall that?
KELLY MCDONOUGH: Yes.
MS. BUCKINGHAM: Do you recall at what point in your treatment of her was that noted? Was it as she was coming into the emergency department, or did that develop while she was in the emergency department?
KELLY MCDONOUGH: I don't recall.
MS. BUCKINGHAM: What was the course of treatment for a low body temperature?
KELLY MCDONOUGH: We place something called a Bair Hugger on them, which is a warming blanket.
MS. BUCKINGHAM: And can you explain to us what could cause a person's body temperature to drop to, I think it was 82.1?
KELLY MCDONOUGH: There are many reasons, but it could be a metabolic disarray or exposure.
MS. BUCKINGHAM: In this circumstance, did you know what the source of the drop in the body temperature was for Ms. Clancy?
MS. BUCKINGHAM: And do you recall how long she was in the emergency department before she was transported approximately to the Brigham?
KELLY MCDONOUGH: I think it was about four hours.
MS. BUCKINGHAM: At this time, Your Honor, I would move to enter into evidence a copy of the South Shore Hospital medical records for Lindsay Clancy from January 24th, '23 as the next exhibit.
THE COURT: Is that by agreement? All right. That may be admitted. Or they may be admitted.
COURT REPORTER: Exhibit 138.
MS. BUCKINGHAM: And I would also move to enter as the next exhibit a certified copy of imaging records from the South Shore Hospital for Lindsay Clancy from January 24th, 2023.
THE COURT: All right. It may be admitted.
COURT REPORTER: Exhibit 139.
MS. BUCKINGHAM: So finally, Dr. McDonough, did this defendant receive surgery at Health South Shore Hospital?
KELLY MCDONOUGH: Not that I'm aware.
MS. BUCKINGHAM: Okay. Did you observe any cuts, abrasions, or blood on the area of her head?
MS. BUCKINGHAM: And based on your review of those findings on the CT scans, was there any noted injury from the head CTs that you could tell?
MS. BUCKINGHAM: And were you able, after using that Bair Hugger device, able to get her blood—or excuse me, her body, her core body temperature back up to normal?
KELLY MCDONOUGH: I don't recall.
MS. BUCKINGHAM: Did you ever observe those wounds that you observed on her neck or her wrist ever start bleeding actively again?
MS. BUCKINGHAM: I have nothing further.
THE COURT: Mr. Reddington.
MR. REDDINGTON: Morning.
KELLY MCDONOUGH: Morning.
MR. REDDINGTON: So, would you agree with me that when Lindsay was brought into the South Shore Hospital, that she was unconscious?
KELLY MCDONOUGH: I recall her eyes being open, but she was non-verbal.
MR. REDDINGTON: Okay. So as an experienced emergency room doctor, can you tell me when someone's unconscious, what is that? What are the symptomology of it? What does that mean?
KELLY MCDONOUGH: Usually means they're completely unresponsive with eyes closed.
MR. REDDINGTON: Okay. Was she responsive?
KELLY MCDONOUGH: Not verbally.
MR. REDDINGTON: Was she responsive at all?
KELLY MCDONOUGH: She was responsive to pain.
MR. REDDINGTON: So that means that you would do something to cause pain, perhaps the bottom of the foot or whatever it is, to see if they have a reaction?
KELLY MCDONOUGH: Correct.
MR. REDDINGTON: And would you agree with me that when people even have very, very serious brain injuries, that they can respond to pain stimuli?
KELLY MCDONOUGH: Sometimes.
MR. REDDINGTON: Sometimes. So her eyes were open. Were her pupils equal and reactive to light?
KELLY MCDONOUGH: I don't recall.
MR. REDDINGTON: You don't recall?
KELLY MCDONOUGH: Mm-mm.
MR. REDDINGTON: What does it mean with PERL, pupils equal reactive to light? What does that mean?
KELLY MCDONOUGH: Exactly what you just said. It means her pupils are equal and reactive to light.
MR. REDDINGTON: And as a doctor, what does that tell you?
KELLY MCDONOUGH: It tells me that there's no significant neurologic injury.
MR. REDDINGTON: And in this case, you don't recall if her pupils were equal or reactive to light?
KELLY MCDONOUGH: I don't.
MR. REDDINGTON: Okay. And that's when you take the little flashlight sometimes, and you put it over the eye and see if there's constriction of the pupil?
KELLY MCDONOUGH: Correct.
MR. REDDINGTON: Did you do additional evaluations of her to see what her neurological function was?
KELLY MCDONOUGH: She was pretty quickly intubated from what I recall. So after that, it would be difficult to assess her neurologically.
MR. REDDINGTON: Sure. Was she on any pain medication, if you remember?
KELLY MCDONOUGH: Don't remember.
MR. REDDINGTON: You recall, did she have difficulty being intubated? I mean, would you agree with me that if you're not under some type of medication or sedation or unconscious, it hurts to be intubated, doesn't it?
KELLY MCDONOUGH: We wouldn't intubate somebody without first giving them some induction medicines.
MR. REDDINGTON: Okay. So what would the induction medicines be?
KELLY MCDONOUGH: They're not universal.
MR. REDDINGTON: Well, what did-
KELLY MCDONOUGH: It would depend on the case.
MR. REDDINGTON: What are the induction medicines that you used on Lindsay Clancy?
KELLY MCDONOUGH: I don't know. I'd have to refer to my record, and also, I wasn't the one who did the intubation.
MR. REDDINGTON: So she was intubated, had the tube coming out of her mouth. She's laying on the table, and you are continuing an assessment. You were the lead doctor in the emergency room for Lindsay Clancy, right?
KELLY MCDONOUGH: I wouldn't say I was the lead. I think the trauma surgeon and I worked together.
MR. REDDINGTON: Right. Her temperature, her core body temperature was 82 degrees. Is that right?
KELLY MCDONOUGH: If that's what the record states, then yes.
MR. REDDINGTON: I'm sorry?
KELLY MCDONOUGH: If that's what her medical record states, then yes.
MR. REDDINGTON: But as you sit here, you don't know what her core body temperature was?
KELLY MCDONOUGH: I saw her three years ago. I see about 200 patients a month.
MR. REDDINGTON: I'm sure you're very busy, but this is a murder trial, Doctor.
MR. REDDINGTON: Did you review your records and your notes?
KELLY MCDONOUGH: I'm happy to look at my record if you bring it here.
MR. REDDINGTON: Did you review your records and notes before you came in here today to testify on this case?
KELLY MCDONOUGH: Sir, I did, but I don't have a photographic memory.
MR. REDDINGTON: Did she regain consciousness at all while she was in your emergency room?
MR. REDDINGTON: Can you tell me what CF, CSF is?
KELLY MCDONOUGH: Cerebrospinal fluid.
MR. REDDINGTON: Yeah. Is that what that is, CSF?
KELLY MCDONOUGH: It could be. I'm not sure in what context you're referring to it.
MR. REDDINGTON: Well, how about if there's a massive leakage of CSF from her nose, what does that tell you as a doctor?
KELLY MCDONOUGH: It could mean that there's a skull fracture.
MR. REDDINGTON: Did you notice any clear fluid coming from her nose?
KELLY MCDONOUGH: I did not.
MR. REDDINGTON: Is that something you would look for?
KELLY MCDONOUGH: Yes.
MR. REDDINGTON: How quickly do you get the results of the X-rays when you're in the emergency room?
KELLY MCDONOUGH: Well, these were CT scans, but fairly quickly in a trauma.
MR. REDDINGTON: I'm sorry. CT scans, X-rays... So you had CT scans that were able to show you the damage to her neck and upper chest, is that right?
KELLY MCDONOUGH: Yes.
MR. REDDINGTON: And what did those CT scans show you?
KELLY MCDONOUGH: Well, what I remember is a thoracic spine injury.
MR. REDDINGTON: And when you say a thoracic spine injury, would you agree that top part of your neck, your throat area would be cervical, right?
KELLY MCDONOUGH: Correct.
MR. REDDINGTON: And that's when the numbers go C one, two, or whatever they are. Those, that would be the actual vertebrae in the cervical area of the upper body, correct?
KELLY MCDONOUGH: Yes, the cervical spine.
MR. REDDINGTON: Okay. And then below the cervical spine would be the thoracic spine. Is that correct?
KELLY MCDONOUGH: Correct.
MR. REDDINGTON: And the thoracic spine would be, and sometimes they're delineated as T1, T2, meaning thoracic one, thoracic two, all the way down to what? Five or six?
MR. REDDINGTON: I'm sorry?
MR. REDDINGTON: 12. So when you looked at... And the lower portion would be the lumbar. Is that right?
KELLY MCDONOUGH: Correct.
MR. REDDINGTON: Now, when you looked at the CAT scans, did you determine the extent of the injury to the spinal cord?
KELLY MCDONOUGH: I could determine the extent of the injury to the bony thoracic spine.
MR. REDDINGTON: Okay. What was that?
KELLY MCDONOUGH: I don't recall exactly the level. I would have to look at the report.
MR. REDDINGTON: What does that mean? The level of the T?
KELLY MCDONOUGH: Correct.
MR. REDDINGTON: Was her cervical spine injured?
KELLY MCDONOUGH: I don't recall. I'd have to look at the report.
MR. REDDINGTON: Were you aware that her thyroid was crushed?
KELLY MCDONOUGH: I don't recall.
MR. REDDINGTON: Do you know that her cervical spine vertebrae was fractured, destroyed?
KELLY MCDONOUGH: I don't recall.
MR. REDDINGTON: Doesn't that control a person's breathing? Does that have anything to do with breathing?
KELLY MCDONOUGH: It can.
MR. REDDINGTON: What do you remember about looking at the damage to the spinal cord depicted on the CAT scan?
KELLY MCDONOUGH: What sticks out most in my mind is her thoracic injury.
MR. REDDINGTON: Okay. And what was the thoracic injury?
KELLY MCDONOUGH: I don't recall the exact level.
MR. REDDINGTON: What does it mean by effect level?
KELLY MCDONOUGH: The exact level.
MR. REDDINGTON: I'm sorry. Were you aware that there was a complete transection of the spinal cord on T5 and T6?
KELLY MCDONOUGH: I'm sure I was aware at the time, yes.
MR. REDDINGTON: Okay. And just can you tell me what does it mean when it says a complete transection of the spinal cord at a particular... Apparently, that would be at thoracic five and thoracic six, right?
KELLY MCDONOUGH: Mm-hmm.
MR. REDDINGTON: What does that mean with a complete transection?
KELLY MCDONOUGH: It means the bones are no longer one on top of the other. They're moved apart.
MR. REDDINGTON: Were you aware that there was a significant edema noted in her chest?
KELLY MCDONOUGH: If that's what the report says.
MR. REDDINGTON: Okay. And what is edema?
KELLY MCDONOUGH: Swelling.
MR. REDDINGTON: And does it also refer to fluid?
KELLY MCDONOUGH: It can.
MR. REDDINGTON: Did it refer to fluid in this case?
KELLY MCDONOUGH: I'm not sure. I would have to read the report.
MR. REDDINGTON: So in addition to the edema that was noted, was there edema noted around C7, T1, T2, T3 to T4?
KELLY MCDONOUGH: Again, I would have to have the report in front of me.
MR. REDDINGTON: When you noted her base temperature as being 82 degrees, what does that tell you as a doctor?
KELLY MCDONOUGH: It means that her body temperature is lower than normal.
MR. REDDINGTON: And what is normal?
KELLY MCDONOUGH: 98.6.
MR. REDDINGTON: And if a person goes from 98.6 to 82 degrees before you place her in the Bair Hugger, what does that tell you? Does that affect the body at all?
KELLY MCDONOUGH: Yes, the body works ideally at 98.6, so anything outside of that range, not ideal.
MR. REDDINGTON: To what effect, as a doctor? What effect, if any, on the body if a person has an 82 degrees base temperature?
KELLY MCDONOUGH: The list of things that could go awry is quite long.
MR. REDDINGTON: Can you give me an idea, maybe the top three?
KELLY MCDONOUGH: She could have a metabolic derangement.
MR. REDDINGTON: What's a metabolic derangement?
KELLY MCDONOUGH: Meaning her body wouldn't be processing things the way that it was before. Her cells are not working the way that they should because it's too cold.
MR. REDDINGTON: Would you agree with me that when you were looking at the injuries to the wrist, and to the—both wrists, actually—you noted lacerations in the volar aspect of the wrist?
KELLY MCDONOUGH: Yes.
MR. REDDINGTON: What is a volar? What does that mean?
KELLY MCDONOUGH: It's the anterior aspect of the wrist.
MR. REDDINGTON: Anterior? Okay, thank you. Would you agree that on both wrists there was deep laceration?
KELLY MCDONOUGH: I wouldn't characterize them as deep.
MR. REDDINGTON: You would not? And when you made reference to her being transferred to a tertiary care center, what does that mean?
KELLY MCDONOUGH: It means that it's a hospital that has more services and specialized care than we do at our hospital.
MR. REDDINGTON: Now, when she was at the South Shore Hospital, counsel asked you about whether or not you noted any injuries to her head. You did not notice any bleeding or scrapes or bruises of that nature, right?
KELLY MCDONOUGH: Not that I recall.
MR. REDDINGTON: Did you notice any injuries to her lower body, her legs, her feet, let's say her feet or her buttocks?
KELLY MCDONOUGH: I don't recall.
MR. REDDINGTON: At any time while she was at South Shore Hospital, did she have a cardiac arrest?
KELLY MCDONOUGH: Not that I recall.
MR. REDDINGTON: Do you know if she had a cardiac arrest when brought to the Boston hospital?
KELLY MCDONOUGH: Did not know that.
MR. REDDINGTON: How about blood? Was there any blood transfusion at South Shore Hospital Medical Center?
KELLY MCDONOUGH: I don't recall.
MR. REDDINGTON: Were you aware that she had a massive transfusion of blood once she hit Brigham and Women's?
MR. REDDINGTON: What does that tell you, massive transfusion of blood? What does that mean?
KELLY MCDONOUGH: I couldn't comment on why they gave it to her.
MR. REDDINGTON: Were the police in the hospital when she was there with you?
KELLY MCDONOUGH: I don't recall.
MR. REDDINGTON: Was she chained to the bed by handcuffs?
KELLY MCDONOUGH: I don't recall.
MR. REDDINGTON: Go ahead.
THE COURT: Any redirect?
MS. BUCKINGHAM: Very briefly.
MS. BUCKINGHAM: Dr. McDonough, I'm just gonna give you your notes, if that's okay.
KELLY MCDONOUGH: Sure. Thank you.
MS. BUCKINGHAM: You want to just take a look at it, and then take your time and just look up any notes
MS. BUCKINGHAM: that you want.
KELLY MCDONOUGH: Okay. You need this back?
MS. BUCKINGHAM: You want to just look through the rest of them to see if that makes sense of the note that you had in the records?
KELLY MCDONOUGH: Okay. Thank you.
MS. BUCKINGHAM: Thank you. Now, counsel asked you on cross-examination about pupils, right?
KELLY MCDONOUGH: Mm-hmm.
MS. BUCKINGHAM: Was there anything notable according to your now review of the notes about Lindsay Clancy's pupils?
MS. BUCKINGHAM: So what did that tell you about her possible head injury?
KELLY MCDONOUGH: It just indicates that there's no obvious head injury or brain herniation.
MS. BUCKINGHAM: Now you indicated that she was somewhat unresponsive, but her eyes were open. She was non-verbal, correct?
KELLY MCDONOUGH: Correct.
MS. BUCKINGHAM: Did you observe her to be moving her arms around at various points?
KELLY MCDONOUGH: She did move her arms on exam in response to painful stimuli.
MS. BUCKINGHAM: Okay. And as far as the intubation goes, you're aware that she was in fact sedated in order to maintain intubation?
KELLY MCDONOUGH: Again, I'm not certain of that because I was not the one who performed the intubation.
MS. BUCKINGHAM: Okay. And you were asked about CSF. Having now kind of looked through your notes with your interaction with this patient, was there any note of cerebral spinal fluid, excuse me, in either your assessment of them or your review of any of the CT results?
KELLY MCDONOUGH: I didn't see any mention of that in my physical exam.
MS. BUCKINGHAM: Okay. Now as an emergency department physician, you're not treating all of these spinal injuries, correct?
KELLY MCDONOUGH: Correct.
MS. BUCKINGHAM: Your focus is to assess, stabilize, and get them where they need to go, right?
KELLY MCDONOUGH: Correct.
MS. BUCKINGHAM: And so that's what you did with Ms. Clancy.
KELLY MCDONOUGH: Correct.
MS. BUCKINGHAM: When the injuries that were described as a Lawler aspect, counsel mentioned that terminology to you, right?
KELLY MCDONOUGH: Yes, yes.
MS. BUCKINGHAM: You've now, on direct examination, identified those injuries as superficial. What characteristics make you say superficial?
KELLY MCDONOUGH: Because I wasn't able to visualize any active bleeding or muscle tissue or injury to tendons.
MS. BUCKINGHAM: Okay. And is it fair to say that oftentimes, patients that come into the emergency department might be... If they have some sort of injury to their spine, you don't want them to move, right?
KELLY MCDONOUGH: Correct.
MS. BUCKINGHAM: So they might be, at some point kind of either put in soft restraints or restricted on the bed?
KELLY MCDONOUGH: Correct.
MS. BUCKINGHAM: Okay. Thank you. Nothing further.
THE COURT: Is there anything further? All right. Thank you, doctor.
KELLY MCDONOUGH: Thank you.