JAIME LINTEMOOT
(Coroner toxicologist and Criminalists)
DIRECT EXAMINATION BY MR. WALGREN:
Q GOOD AFTERNOON. MS. LINTEMOOT, WHERE ARE YOU EMPLOYED?
A I AM EMPLOYED AT THE LOS ANGELES COUNTY DEPARTMENT OF CORONER’S OFFICE.
Q WHAT DO YOU DO THERE?
A I AM A SENIOR CRIMINALIST.
Q WHAT IS A SENIOR CRIMINALIST AT THE CORONER’S OFFICE? WHAT ARE YOUR PRIMARY RESPONSIBILITIES AND DUTIES?
A AT THE CRIMINALIST — WELL, AS A CRIMINALIST, MY JOB IS TO STUDY SCIENCE OR DO RESEARCH IN SCIENCE AS IT PERTAINS TO THE LAW. AT THE CORONER’S OFFICE, I AM ACTUALLY INVOLVED IN THREE DISCIPLINES. MY MAIN JOB RESPONSIBILITY IS THAT OF A TOXICOLOGIST WHERE I ANALYZE BLOOD AND OTHER BIOLOGICAL SPECIMENS FOR THE PRESENCE OF DRUGS. ONE OF MY OTHER JOB DUTIES IS THAT OF A CONTROLLED SUBSTANCES ANALYST WHERE I ANALYZE MEDICAL EVIDENCE, PILLS AND OTHER THINGS, THAT MIGHT COME INTO THE OFFICE. AND LASTLY, ABOUT TEN TO 20 PERCENT OF MY JOB IS THAT OF A FIELD CRIMINALIST, SOMEONE WHO GOES OUT TO THE SCENE AND COLLECTS EVIDENCE FROM BODIES.
Q HOW LONG YOU BEEN EMPLOYED AS A CRIMINALIST AT THE L.A. COUNTY DEPARTMENT OF CORONER?
A FOR ABOUT NINE YEARS.
Q HAVE YOU RECEIVED FORMAL EDUCATION, COLLEGE OR OTHERWISE, TO PREPARE YOU FOR THAT APPOINTMENT?
A YES.
Q CAN YOU DESCRIBE YOUR EDUCATION?
A YES. I HAVE A BACHELOR’S OF SCIENCE IN FORENSIC CHEMISTRY FROM NORTHERN ARIZONA UNIVERSITY. I ALSO HAVE A CERTIFICATE FROM CAL STATE UNIVERSITY FULLERTON IN ADVANCED APPLIED FORENSIC SCIENCE. IN 2008, I WAS CERTIFIED AS A FELLOW OF THE AMERICAN BOARD OF CRIMINALISTS. IN ORDER TO ACHIEVE THIS CERTIFICATION, I HAD TO PASS AN EXAM IN COMPREHENSIVE CRIMINALISTICS AS WELL AS MAINTAIN A CERTAIN NUMBER OF CONTINUING EDUCATION CREDITS EVERY YEAR AND PASS AN ANNUAL PROFICIENCY.
Q THANK YOU. YOU INDICATED YOU HAD BEEN EMPLOYED NINE YEARS AT THE CORONER’S OFFICE. PRIOR TO YOUR FORMAL EMPLOYMENT, DID YOU WORK THERE IN SOME STUDENT CAPACITY OR INTERN CAPACITY?
A YES.
Q CAN YOU DESCRIBE THAT, PLEASE.
A IN MAY OF 2000, I ACTUALLY DID AN INTERNSHIP AT THE CORONER’S OFFICE IN ORDER TO COMPLETE MY DEGREE. FROM THEN, I WAS OFFERED A JOB AS A STUDENT PROFESSIONAL WORKER. AND THEN IN AUGUST 2001, THEY HIRED ME ON AS A CRIMINALIST.
Q WHEN YOU WERE HIRED ON THEN IN 2001, YOU HAVE EXPLAINED THAT THERE ARE THESE DIFFERENT FIELDS. CURRENTLY, YOU SAID THERE IS A FIELD TOXICOLOGY OR DISCIPLINE OF TOXICOLOGY, CONTROLLED SUBSTANCES, AS WELL AS BEING A FIELD CRIMINALIST, RIGHT?
A YES.
Q IN 2001, APPROXIMATELY FROM THAT POINT TO TODAY’S DATE, WERE YOU FOCUSED PRIMARILY ON A PARTICULAR FIELD?
A I WAS PUT INTO THE TOXICOLOGY DIVISION.
Q FROM THE OUTSET IN 2001?
A YES.
Q SINCE 2001 THEN, BEING ASSIGNED IN THE FILED OF TOXICOLOGY, IS IT FAIR TO SAY YOU HAVE CONDUCTED THOUSANDS UPON THOUSANDS OF TESTS AS IT RELATES TO TOXICOLOGY?
A YES.
Q I WANT TO ASK YOU SOME SPECIFIC QUESTIONS REGARDING PROPOFOL AND THE TESTING IN REGARD TO PROPOFOL. WERE YOU INSTRUMENTAL IN ESTABLISHING THE METHODOLOGY FOR PROPOFOL TESTING WITHIN THE CORONER’S OFFICE?
A YES, I WAS.
Q CAN YOU EXPLAIN THAT, PLEASE?
A PRIOR TO 2005, OUR OFFICE DID NOT HAVE A METHOD TO DETECT PROPOFOL. SO I CONDUCTED THE RESEARCH AND PERFORMED THE EXPERIMENTATION TO FIND A METHOD SUITABLE FOR TESTING FOR THAT DRUG AT OUR OFFICE. SO IN 2005, I HELPED ESTABLISH THAT METHOD AND VALIDATE IT.
Q IF YOU COULD JUST BRIEFLY EXPLAIN WHAT YOU MEAN BY THAT, ESTABLISHING THE METHOD AND VALIDATING. FIRST OF ALL, ESTABLISHING THE METHOD, JUST SIMPLY WHAT DID YOU DO?
A IN ORDER TO ESTABLISH THE METHOD, I HAD TO CONDUCT A SERIES OF EXPERIMENTS LOOKING AT DIFFERENT STANDARDS, INTERNAL STANDARDS. AN INTERNAL STANDARD IS A CHEMICAL THAT IS USED THAT MIMICS THE DRUG OF INTEREST. SO I HAD TO FIND A SUITABLE INTERNAL STANDARD. I HAD TO FIND AN EXPERIMENTAL TECHNIQUE THAT SHOWED A CONSISTENT RESPONSE. I HAD TO DO DUPLICATION STUDIES AND SHOW PARALLEL RUNS WHERE MY NUMBERS MATCHED UP WITH NUMBERS THAT OUTSIDE AGENCIES WERE GETTING. I HAD TO DETERMINE PERCENT RECOVERY. A BUNCH OF THINGS GO INTO ESTABLISHING A METHOD.
Q YOU INDICATED THAT WAS FOLLOWED BY THIS METHODOLOGY BEING VALIDATED. WHAT DOES THAT MEAN?
A VALIDATION IS THE PROCESS OF PARALLEL STUDIES, PARALLEL RUNS, PERCENT RECOVERY DETERMINATION, AND THINGS LIKE THAT.
Q THAT VALIDATION OCCURRED IN 2005 AS WELL?
A FROM A PERIOD OF 2005 TO 2008.
Q AND SINCE THE ESTABLISHMENT OF THAT METHODOLOGY, HAVE YOU BEEN THE PRIMARY ANALYST AS IT RELATES TO PROPOFOL CASES FOR THE L.A. COUNTY CORONER’S OFFICE?
A YES.
Q MORE GENERALLY ABOUT THE L.A. CORONER’S TOXICOLOGY LABORATORY OR CRIMINALIST LABORATORY, IS THERE CERTAIN ACCREDITATION THAT IS EARNED AND CARRIED BY THAT LABORATORY?
A THE L.A. COUNTY CORONER’S OFFICE FORENSIC LABORATORY IS ACCREDITED BY ASCLAD LAB. ASCLAD LAB IS THE AMERICAN SOCIETY OF CRIME LABORATORY DIRECTORS LABORATORY ACCREDITATION BOARD. THEY MAINTAIN NATIONAL STANDARDS AND MAKE SURE THAT YOU ARE ABIDING BY THOSESTANDARDS.
Q AND THE LAB IS SO ACCREDITED?
A YES.
Q NOW, I WANT TO ASK YOU SOME GENERAL QUESTIONS ABOUT THE PROCEDURES THAT ARE FOLLOWED IN REGARD TO BIOLOGICAL TESTING, AND I’M JUST SPEAKING GENERALLY. IF YOU HAVE A BIOLOGICAL SAMPLE, LET’S SAY A BLOOD SAMPLE OR OTHERWISE, A BIOLOGICAL SAMPLE, WHAT IS THE FIRST PROCESS OR WHAT DO YOU BEGIN WITH IN YOUR PROCESS AS FAR AS TESTING FOR A PARTICULAR AGENT WITHIN THAT BIOLOGICAL SPECIMEN?
A WELL, IT DEPENDS ON THE TEST THAT IS BEING CONDUCTED. AT OUR OFFICE, BECAUSE WE SEE SO MANY CASES A YEAR, IT IS DONE IN ASSEMBLY LINE FASHION. MULTIPLE ANALYSTS WILL WORK ON ONE CASE. I’M ASSIGNED SPECIFICALLY TO PROPOFOL, TO DRUGS OF ABUSE SCREENING, AND SOME OTHER SPECIALTIES. SO FOR ME TO START MY WORK, I HAVE TO RECEIVE A SERVICE REQUEST. A SERVICE REQUEST IS BASICALLY A REQUEST GENERATED BY THE DOCTOR ASKING FOR A SPECIFIC DRUG TO BE TESTED.
Q ONCE YOU GET THAT SERVICE REQUEST AND YOU BEGIN YOUR ACTUAL — YOU SIT DOWN AT THE LAB AND BEGIN YOUR TESTING, ARE THERE CERTAIN STANDARDS AND CONTROLS THAT YOU BEGIN WITH BEFORE YOU BEGIN THE PROCESS?
A THE FIRST THING THAT I’M GOING TO DO AFTER I RECEIVE A SERVICE REQUEST IS TO CREATE A WORK LIST. THE WORK LIST IS GOING TO HAVE THE NECESSARY CONTROLS AS WELL AS THE CASES THAT I NEED TO SAMPLE AND ADDITIONAL INFORMATION. I THEN GO AND I HAVE PULLED THE SAMPLES FROM THE TOXICOLOGY COOLER. I INDICATE THE INFORMATION FROMTHE BOTTLE OR THE SAMPLE ONTO MY WORK LIST SO THE CHAIN OF CUSTODY IS MAINTAINED AT ALL TIMES. THEN I PERFORM WHAT WE CALL AN EXTRACTION. EXTRACTION IS A SERIES OF CHEMICAL STEPS THAT IS USED TO ISOLATE OR GET THE DRUG INTO A MEDIUM THAT IS SUITABLE FOR INSTRUMENTAL ANALYSIS.
Q WHAT IS THE NEXT, ONCE YOU HAVE THIS SUITABLE MEDIUM, WHAT IS THE NEXT STEP?
A THEN I’M GOING TO PLACE IT ON OUR DRUG DETECTION INSTRUMENTS. I’LL ALLOW IT TO RUN OVERNIGHT, AND THE NEXT DAY I’LL PROCESS THE DATA AND EVALUATE IT.
Q IN EVALUATING THE DATA, ARE YOU THEN ABLE TO MAKE CONCLUSIONS AS TO THE PARTICULAR MEDICINE OR AGENTS THAT ARE IN THAT BIOLOGICAL SAMPLE FOR NARCOTICS?
A YES.
Q AS IT RELATES TO BIOLOGICAL EVIDENCE, ARE YOU ABLE TO GIVE LEVELS OF THE PARTICULAR AGENT CONTAINED WITHIN THAT BIOLOGICAL SAMPLE?
A YES.
Q NOW, IN THIS CASE, DID YOU CONDUCT TESTING AS IT RELATES TO PROPOFOL ON THE BLOOD VIALS OF MICHAEL JACKSON THAT WERE ACTUALLY LOGGED IN UNDER THE NAME OF TRAUMA, GERSHWIN?
A I DID.
Q AND THAT WOULD BE CONSIDERED BIOLOGICAL TESTING BECAUSE THE BLOOD WOULD BE THE BIOLOGICAL SAMPLE FROM THE DECEDENT IN THIS CASE?
A YES.
Q SO THAT WOULD FOLLOW THE PROCEDURES YOU HAVE JUST OUTLINED WITH THE STANDARDS AND CONTROLS AND EXTRACTIONS AND OBTAINING A SUITABLE MEDIUM, RESULTING IN DATA THAT YOU WOULD THEN ANALYZE TO DRAW CONCLUSIONS?
A YES.
Q ON JUNE 29, 2009, WAS THERE A PRELIMINARY SCREENING ON THESE BIOLOGICAL BLOOD VIAL SAMPLES TO TEST FOR PROPOFOL?
A THERE WAS.
Q WHAT WERE THE RESULTS OF THOSE PRELIMINARY SCREENINGS?
A THE PRELIMINARY SCREEN INDICATED THAT PROPOFOL WAS PRESENT.
Q FOLLOWING THAT, ON THE FOLLOWING DAY, JUNE 30, 2009, DID YOU DO A FULL TISSUE DISTRIBUTION ANALYSIS ON THOSE SAMPLES AS IT RELATES TO PROPOFOL?
A YES, I DID.
Q WHAT IS A FULL TISSUE DISTRIBUTION?
A IN THIS PARTICULAR CASE, I EXAMINED AND EXTRACTED EVERY SPECIMEN THAT WAS RECOVERED AT AUTOPSY. SO I TESTED THE HEART BLOOD, THE HOSPITAL BLOOD, THE FEMORAL BLOOD, GASTRIC CONTENTS, LIVER, URINE, AND URINE SCREEN, AND VITREOUS.
Q TESTING ALL THOSE VARIOUS SPECIMENS, THAT IS WHAT YOU REFERRED TO WHEN YOU CALLED IT A FULL TISSUE DISTRIBUTION TEST?
A YES.
Q IN THIS BIOLOGICAL TESTING OF THESE BLOOD VIALS, WERE YOU, IN ADDITION TO TESTING WHETHER PROPOFOL AND OTHER AGENTS WERE PRESENT, WERE YOU ABLE TO DO A QUANTIFICATION OF THOSE VARIOUS AGENTS?
A I DID QUANTIFICATION FOR PROPOFOL, YES.
Q FOR PROPOFOL. YOU WERE ABLE TO DETERMINE THE LEVELS OF PROPOFOL FOUND IN THOSE VARIOUS SAMPLES?
A YES.
Q NOW, AS A RESULT OF THIS BIOLOGICAL TESTING, WAS AN EIGHT-PAGE REPORT CREATED THAT LISTS ALL THE VARIOUS FINDINGS AS IT RELATES BOTH TO PROPOFOL, OTHER BENZODIAZEPINES, LIDOCAINE, AND OTHER AGENTS IN THOSE SAMPLES?
A A LABORATORY SUMMARY REPORT WAS GENERATED THAT INCLUDED ALL OF MY FINDINGS AS WELL AS THE WORK DONE BY MY FELLOW CO-WORKERS.
Q AND TO BE CLEAR, I’M TALKING ABOUT THE BIOLOGICAL TESTING. YOU SPECIFICALLY HANDLED THE PROPOFOL, CORRECT?
A YES.
Q AND THEN OTHER CRIMINALISTS WERE ASSIGNED. FOR EXAMPLE, CRIMINALIST FU APPEARS TO HAVE DONE LIDOCAINE TESTING AND OTHER AGENTS?
A YES.
Q SOME OF THE BENZODIAZEPINES WERE DONE BY OTHER CRIMINALISTS?
A UH-HUH.
Q IS THAT YES?
A YES.
Q AND THE EIGHT-PAGE REPORT I REFERENCED HAS THE FINDINGS OF ALL OF THE CRIMINALISTS AS IT RELATES TO THE VARIOUS SPECIMEN SAMPLES?
A YES.
MR. WALGREN: COULD I HAVE THIS EIGHT-PAGE REPORT ENTITLED FORENSIC SCIENCE LABORATORIES, DEPARTMENT OF CORONER, COUNTY OF LOS ANGELES, LABORATORY ANALYSIS SUMMARY REPORT, AGAIN EIGHT PAGES IN LENGTH, MAY THIS BE MARKED PEOPLE’S 67 FOR IDENTIFICATION?
THE COURT: YES, IT IS.
MR. WALGREN: IT HAS BEEN SHOWN TO DEFENSE COUNSEL.
THE COURT: THANK YOU.
MR. WALGREN: AT THIS TIME, YOUR HONOR, I ALSO HAVE A SUMMARY OF POSITIVE TOXICOLOGICAL FINDINGS. SHOWING IT 28 TO DEFENSE COUNSEL. IT IS A ONE-PAGE REPORT SUMMARIZING THE POSITIVE FINDINGS. MAY THAT BE MARKED PEOPLE’S 68 FOR IDENTIFICATION?
THE COURT: YES.
(THE ABOVE-MENTIONED ITEMS WERE MARKED FOR IDENTIFICATION AS PEOPLE’S EXHIBITS NOS. 67 AND 68.)
Q BY MR. WALGREN: MS. LINTEMOOT, LET ME SHOW YOU WHAT HAS BEEN MARKED PEOPLE’S 67 AND JUST GO THROUGH IT BRIEFLY, THEN I’LL MOVE ON TO THE SUMMARY REPORT. IS THIS THE FIRST PAGE OF THE EIGHT-PAGE REPORT YOU HAVE MENTIONED THAT GOES THROUGH EACH SPECIMEN SAMPLE?
A YES. THAT IS OUR OFFICIAL LABORATORY ANALYSIS SUMMARY REPORT.
Q AND, FOR EXAMPLE, IT BEGINS WITH THE FEMORAL BLOOD HERE ON THE LEFT AND HAS FINDINGS, INCLUDING PROPOFOL, WITH YOUR NAME, J. LINTEMOOT, AS THE ANALYST?
A THAT IS CORRECT.
Q THEN GOING THROUGH, THE HEART BLOOD WAS ANALYZED. ON PAGE 3 OF 8, THE HOSPITAL BLOOD, PAGE 4 OF 8. THE BOTTOM, THE LIVER, AND THE VARIOUS CONTENTS NOTED THROUGHOUT THAT REPORT. IS THAT ACCURATE?
A YES.
Q LOOKING AT PEOPLE’S 68 THEN, IS THIS REPORT THEN A SUMMARY OF PEOPLE’S 67 LISTING ALL THE POSITIVE FINDINGS THAT WERE NOTED?
A YES.
MR. WALGREN: MAY I APPROACH THE WITNESS, YOUR HONOR?
THE COURT: YES.
Q BY MR. WALGREN: MS. LINTEMOOT, LOOK AT PEOPLE’S 68. IF YOU COULD JUST TAKE A MOMENT TO LOOK AT THAT YOURSELF. IS THAT THE SUMMARY OF THE POSITIVE FINDINGS THAT WERE FOUND BY YOURSELF AND YOUR OTHER CRIMINALISTS AND SUMMARIZED IN YOUR REPORT?
A YES, IT IS.
Q CAN YOU DESCRIBE THIS DOCUMENT. AND AGAIN LOOKING AT THE HEADING OF PEOPLE’S 68, IT IS A LITTLE BLURRY ON THE SCREEN. WHAT DOES IT SAY HERE IN THE UPPER HEADING?
A IT SAYS SPECIMEN, AND THEN IT GIVES TWO UNITS OF MEASUREMENT: MICROGRAM PER MILLILITER, OR MICROGRAM PER GRAM.
THE COURT: EXCUSE ME. IS THERE A WAY TO CLEAR IT UP?
Q BY MR. WALGREN: LET ME SEE IF I CAN FOCUS IT MORE. MS. LINTEMOOT, YOU WERE TALKING ABOUT THE UPPER HEADING WHERE IT GIVES THE SPECIMEN AND THE APPLICABLE POSSIBLE MEASUREMENTS?
A YES.
Q AND THEN IN THIS LEFT-MOST COLUMN, YOU HAVE THE DRUG. AS WELL AS GOING FROM RIGHT TO LEFT FROM THE WORD DRUG, THESE REPRESENT THE VARIOUS SAMPLES THAT WERE EXAMINED?
A YES, THE DIFFERENT BIOLOGICAL SPECIMENS THAT WERE TESTED.
Q AND THEN GOING DOWN BENEATH THE WORD DRUG ARE LISTED PROPOFOL, LIDOCAINE, DIAZEPAM, NORDIAZEPAM, LORAZEPAM, MIDAZOLAM, AND EPHEDRINE. ARE THOSE THE ITEMS THAT WERE FOUND TO BE POSITIVE WITHIN THESE VARIOUS RELEVANT SPECIMENS?
A YES.
Q THE QUESTION ON THAT, ARE ALL OF THESE ACTUAL MEDICINES THAT ARE LISTED UNDER DRUG, OR NARCOTICS OR CHEMICAL AGENTS?
A MOST OF THEM, YES. HOWEVER, THE NORDIAZEPAM IS TYPICALLY WHAT WE CONSIDER TO BE A METABOLITE. A METABOLITE IS SOMETHING THE BODY FORMS AS IT IS PROCESSING THE DRUG THROUGH YOUR SYSTEM.
Q SO ALL OF THESE, BUT FOR NORDIAZEPAM. NORDIAZEPAM IS A METABOLITE CREATED BIOLOGICALLY IN YOUR SYSTEM?
A YES.
Q IT IS NOT A CAPSULE OF PILLS OR INJECTABLE THAT YOU WOULD CONSUME?
A NOT THAT I’M AWARE OF.
Q AND DOES THIS REPORT THEN ACCURATELY SUMMARIZE THE POSITIVE FINDINGS OF YOURSELF AND OTHER CRIMINALISTS REGARDING THESE VARIOUS ITEMS?
A YES.
Q IF YOU COULD, REGARDING PROPOFOL, THE TOXICOLOGY FINDINGS WERE POSITIVE FOR PROPOFOL; IS THAT CORRECT?
A YES.
Q AND DIFFERENT NUMERICAL VALUES OR LEVELS WERE FOUND IN EACH OF THE PARTICULAR SPECIMENS?
A THAT IS CORRECT.
Q COULD YOU WALK US THROUGH THOSE LEVELS, PLEASE, REGARDING PROPOFOL?
A OKAY. IN THE HEART BLOOD, THE PROPOFOL LEVEL I FOUND TO BE 3.2 MICROGRAMS PER MILLILITER. IN THE HOSPITAL BLOOD, 4.1 MICROGRAMS PER MILLILITER. IN THE FEMORAL BLOOD, 2.6 MICROGRAMS PER MILLILITER. IN THE VITREOUS, I REPORTED IT OUT AS PRESENT BUT LESS THAN 0.40 MICROGRAMS PER MILLILITER.THE LIVER WAS 6.2 MICROGRAMS PER GRAM.THE GASTRIC CONTENTS, 0.13 MILLIGRAMS. THE URINE, 0.15 MICROGRAMS PER MILLILITER. AND THE SCENE URINE WAS REPORTED AS PRESENT BUT LESS THAN 0.10 MICROGRAMS PER MILLILITER.
Q REGARDING LIDOCAINE, DID THE SPECIMEN SAMPLES TEST POSITIVE FOR THE PRESENCE OF LIDOCAINE?
A YES.
Q WHAT WERE THOSE RESULTS, PLEASE?
A LIDOCAINE LEVEL IN THE HEART BLOOD WAS 0.68 MICROGRAMS PER MILLILITER. IN THE HOSPITAL BLOOD, IT WAS 0.51 MICROGRAMS PER MILLILITER. IN THE FEMORAL BLOOD, I BELIEVE IT SAYS 0.84 MICROGRAMS PER MILLILITER. THE LIVER WAS 0.45 MICROGRAMS PER GRAM. THE GASTRIC CONTENT, 1.6 MILLIGRAMS, AND PRESENT IN BOTH URINE AND SCENE URINE.
Q AND DIAZEPAM, IS THAT THE SAME AS VALIUM?
A YES.
Q WHAT WERE THE RESULTS FOR DIAZEPAM?
A THE DIAZEPAM IN THE HEART BLOOD WAS PRESENT, BUT LESS THAN 0.10 MICROGRAMS PER MILLILITER. AND IT WAS PRESENT IN THE HOSPITAL BLOOD.
Q THEN GOING TO THE METABOLITE, NORDIAZEPAM, WHAT WERE THOSE RESULTS?
A THE NORDIAZEPAM WAS FOUND TO BE PRESENT IN THE HEART BLOOD AT A LEVEL PRESENT, BUT LESS THAN 0.05 MICROGRAMS PER MILLILITER.
Q GOING TO LORAZEPAM?
A LORAZEPAM WAS IN THE HEART BLOOD AT A LEVEL OF 0.162 MICROGRAMS PER MILLILITER. AND IN THE FEMORAL BLOOD, 0.169 MICROGRAMS PER MILLILITER.
Q AND AGAIN, GOING TO THE POSITIVE FINDING FOR MIDAZOLAM?
A MIDAZOLAM WAS FOUND IN THE HEART BLOOD, 0.0046 MICROGRAMS PER MILLILITER. IN THE URINE, 0.0068 MICROGRAMS PER MILLILITER. AND THE SCENE URINE, 0.025 MICROGRAMS PER MILLILITER.
Q AND LASTLY, EPHEDRINE?
A THE EPHEDRINE WAS REPORTED POSITIVE IN THE URINE AND THE SCENE URINE, BUT NEGATIVE IN THE HEART BLOOD.
Q THAT LAST COLUMN, SCENE URINE, IS THAT THE URINE RECOVERED FROM THE JUG AS FAR AS YOU KNOW?
A YES.
Q MS. LINTEMOOT, IN ADDITION TO THESE BIOLOGICAL FINDINGS — NAMELY, THE POSITIVE FINDINGS FOR PROPOFOL, LIDOCAINE, DIAZEPAM, NORDIAZEPAM, LORAZEPAM, MIDAZOLAM, AND EPHEDRINE — DID YOU ALSO CONDUCT TESTING OF MEDICAL EVIDENCE AS OPPOSED TO BIOLOGICAL EVIDENCE?
A YES, I DID.
Q AND SPECIFICALLY DIRECTING YOUR ATTENTION TO WHAT WAS LOGGED AS MEDICAL EVIDENCE NO. 1, WHICH INCLUDED A SYRINGE AND SEPARATE DETACHED NEEDLE, DID YOU CONDUCT TESTING ON THAT MEDICAL EVIDENCE ITEM NO. 1?
A YES.
Q IS THAT HANDLED DIFFERENTLY THAN BIOLOGICAL SAMPLES IN REGARD TO TESTING?
A YES.
Q CAN YOU EXPLAIN THAT, BRIEFLY?
A THE TESTING FOR MEDICAL EVIDENCE IS A QUALITATIVE TEST. WE DO NOT HAVE A METHOD FOR QUANTITATION OF THE LEVELS. SO WE ARE JUST LOOKING FOR WHAT IS THERE, WHAT IS PRESENT.
Q DID YOU DO THAT TESTING REGARDING MEDICAL EVIDENCE NO. 1, BEING THE SYRINGE AND THE DETACHED NEEDLE?
A I TESTED THE SYRINGE BARREL, YES.
Q SYRINGE BARREL IS WHAT WE COMMONLY REFER TO AS THE SYRINGE, THE PLASTIC BARREL WITH THE PLUNGER THAT IS INSERTED INSIDE OF IT?
A THAT IS CORRECT.
Q AND WHAT WERE THE RESULTS OF YOUR TESTING ON MEDICAL EVIDENCE NO. 1?
A I FOUND THE SYRINGE BARREL WITH PLUNGER TO HAVE LIDOCAINE AND PROPOFOL PRESENT.
Q DID YOU ALSO, FOLLOWING THE TESTING OF MEDICAL EVIDENCE NO. 1, DID YOU CONDUCT THE SAME TYPE OF MEDICAL EVIDENCE TESTING ON AN I.V. KIT THAT WAS LOGGED IN UNDER MEDICAL EVIDENCE NO. 2?
A YES, I DID.
Q DID YOU ALSO CREATE A DIAGRAM, A BASIC DIAGRAM, OF THE I.V. KIT THAT WAS LOGGED IN AS MEDICAL EVIDENCE NO. 2?
A YES, I DID.
MR. WALGREN: YOUR HONOR, I HAVE A HANDWRITTEN DIAGRAM WITH ACCOMPANYING LEGEND. MAY THIS BE MARKED PEOPLE’S 69 FOR IDENTIFICATION?
THE COURT: YES.
MR. WALGREN: DEFENSE COUNSEL HAS SEEN IT PREVIOUSLY.
(THE ABOVE-MENTIONED ITEM WAS MARKED FOR IDENTIFICATION AS PEOPLE’S EXHIBIT NO. 69.)
Q BY MR. WALGREN: MS. LINTEMOOT, LOOKING AT PEOPLE’S 69 ON THE SCREEN AS WELL AS THE COPY BEFORE YOU, DID YOU DRAW THAT DIAGRAM?
A YES, I DID.
Q THAT IS NOT TO SCALE; IS THAT CORRECT?
A THAT IS CORRECT.
Q BUT THIS IS A BASIC DIAGRAM OF THE I.V. KIT, INCLUDING THE I.V. BAG, AS WELL AS THE ACCOMPANYING I.V. PLUG, TUBING, THUMB CLAMP, WHITE CLAMP, A Y-FORK, AS WELL AS THE SYRINGE, AND THE SHORT TUBING?
A YES.
Q LET’S JUST BEGIN THEN WITH ITEM “A” SHOWN IN THE TOP LEFT PORTION OF YOUR DIAGRAM. WHAT IS THAT?
A ITEM “A” IS A DIAGRAM OF THE I.V. BAG. IT WAS NOT ATTACHED TO THE REST OF THE SYSTEM AT THE TIME THAT I RECEIVED IT FOR ANALYSIS.
Q ON YOUR DIAGRAM THEN IN THE LOWER LEFT CORNER, THERE IS A LEGEND INDICATING WHICH ITEMS OR WHICH LABELS APPLY TO WHICH ITEMS?
A YES.
Q SO LET’S GO IN ORDER THEN. “B” IS THE SYRINGE. THAT IS DEPICTED HERE WHERE I’M POINTING WITH THE RED LASER POINTER?
A YES.
Q THAT AGAIN IS A BARREL WITH THE PLUNGER INSERTED INSIDE OF IT?
A YES.
Q AND “C” ON YOUR LEGEND YOU DESCRIBE AS A “Y” CONNECTOR. THAT IS WHERE I’M POINTING HERE, THIS PLASTIC. IS THAT PLASTIC, IF YOU KNOW?
A I DON’T RECALL SPECIFICALLY.
Q BUT THIS “Y” CONNECTOR HERE, CAN YOU DESCRIBE WHAT THAT IS?
A IT WAS A “Y” CONNECTION PIECE. THE SYRINGE WAS GOING INTO ONE END, A PIECE OF SHORT TUBING COMING OUT THE OTHER END, AND A PIECE OF LONG TUBING GOING INTO THE THIRD END.
Q SO GOING NEXT, THE SHORT TUBING YOU INDICATE IS “D.” ON THIS DIAGRAM, THAT IS BELOW THE “Y” CONNECTOR?
A YES.
Q AND THE SHORT TUBING THEN PROCEEDS TO “E,” WHICH YOU LABEL AS CLEAR TIP. WHAT IS THAT?
A IT WAS A CLEAR TIP THAT HAD A LITTLE BIT OF RED FLUID OR RED STAINING ON THE END OF IT.
Q AND THEN “F” IS THE LONG TUBING. WITH THE “Y” PORT OR THE “Y” CONNECTOR, YOU HAVE A SHORT TUBE COMING OUT OF THE BOTTOM, THE SYRINGE GOING IN THROUGH THE TOP, THEN YOU ALSO HAVE THE LONG TUBING COMING OUT THE THIRD AND FINAL PORT; IS THAT RIGHT?
A CORRECT.
Q AND “G” YOU HAVE INDICATED WITH A SQUARE, AND IT IS INDICATED AS WHITE CLAMP?
A YES. IT WAS A WHITE CLAMP THAT WAS ATTACHED TO THE TUBING.
Q AND GOING ALONG THE TUBING THEN TO “H,” YOU SPECIFY THAT AS A WHITE THUMB CLAMP?
A THAT IS CORRECT.
Q AND YOU LABEL “I” AS AN I.V. BAG PLUG. WHAT IS THAT? CAN YOU DESCRIBE IT IN ANY FURTHER DETAIL?
A IT WAS A CYLINDRICAL PIECE THAT THE LONG TUBING WAS ATTACHED TO WITH A SPIKE ON THE END. TYPICALLY, IT GOES INTO THE I.V. BAG.
Q IN YOUR TESTING OF MEDICAL EVIDENCE NO. 2, DID YOU BREAK THAT DOWN INTO CERTAIN COMPONENTS AS IT RELATES TO YOUR TESTING?
A YES. I BROKE IT DOWN INTO FOUR DIFFERENT SECTIONS THAT I ANALYZED.
Q BEFORE WE GET INTO THE RESULTS, CAN YOU TELL US THE FOUR DIFFERENT SECTIONS THAT YOU ANALYZED?
A YES. I TESTED CONTENTS FROM THE I.V. BAG, WHICH IS DIAGRAM NO. “A” OR LETTER “A.” I TESTED THE LONG TUBING SECTION, WHICH IS INDICATED BY THE LETTER “F.” I TESTED THE SYRINGE, LETTER “B,” AND THE SHORT TUBING, LETTER “D.”
Q OKAY. IN REGARD TO THE LONG SECTION OF TUBING, WHICH WOULD BE COMING FROM THE I.V. BAG PLUG TO ITS ENTRY INTO THE “Y” PORT, DID YOU NOTICE OR DETECT ANY ITEMS OF RELEVANCE IN THAT LONG TUBING?
A I DID NOT DETECT ANY DRUGS.
Q IN REGARD TO THE I.V. BAG, AS DISPLAYED AS ITEM “A” ON YOUR DIAGRAM, DID YOU DETECT ANY DRUGS IN THE I.V. BAG?
A I DID NOT DETECT ANY DRUGS IN THE I.V. BAG.
Q SO NO DRUGS IN THE I.V. BAG. NO DRUGS IN THE LONG TUBING THAT WOULD COME FROM THE I.V. BAG. LET’S THEN TALK ABOUT ON YOUR DIAGRAM THE SYRINGE LABELED “B” ON YOUR DIAGRAM. DID YOU DETECT ANY DRUGS IN THE SYRINGE?
A YES, I DID.
Q WHAT DID YOU DETECT?
A I DETECTED LIDOCAINE, PROPOFOL, AND FLUMAZENIL.
Q AND THEN LASTLY, IF YOU WERE TO GO THROUGH THAT “Y” CONNECTOR TO WHERE THE SHORT TUBING IS WHICH YOU LABEL AS “D,” DID YOU TEST THAT FOR DRUGS AND WHAT WERE THE RESULTS?
A I DID TEST IT FOR DRUGS, AND I FOUND PROPOFOL, LIDOCAINE, AND FLUMAZENIL.
MR. WALGREN: YOUR HONOR, I HAVE A MEDICAL EVIDENCE ANALYSIS SUMMARY REPORT. MAY THIS BE MARKED PEOPLE’S 70 FOR IDENTIFICATION?
THE COURT: YES.
(THE ABOVE-MENTIONED ITEM WAS MARKED FOR IDENTIFICATION AS PEOPLE’S EXHIBIT NO. 70.)
Q BY MR. WALGREN: MS. LINTEMOOT, LOOKING UP AT THE SCREEN AT PEOPLE’S 70, IS THAT THE MEDICAL EVIDENCE SUMMARY REPORT LISTING THE RESULTS YOU HAVE INDICATED? NAMELY, THAT MEDICAL EVIDENCE NO. 1 WAS POSITIVE FOR PROPOFOL AND LIDOCAINE?
A YES.
Q AS WELL AS MEDICAL EVIDENCE NO. 2, THE SYRINGE, WAS POSITIVE FOR PROPOFOL, LIDOCAINE, AND FLUMAZENIL. AND THE SHORT SECTION OF TUBING WAS POSITIVE FOR PROPOFOL, LIDOCAINE, AND FLUMAZENIL?
A THAT IS CORRECT.
MR. WALGREN: THANK YOU. I HAVE NOTHING FURTHER, YOUR HONOR.
THE COURT: MR. WALGREN, THANK YOU.
CROSS-EXAMINATION, MR. FLANAGAN.
MR. FLANAGAN: YES, YOUR HONOR. THANK YOU.
CROSS-EXAMINATION BY MR. FLANAGAN:
Q GOOD AFTERNOON.
A GOOD AFTERNOON.
Q WHO ASKED YOU TO DO THESE ANALYSES ON THE BLOOD?
A TYPICALLY, THE MEDICAL EXAMINER REQUESTS WHAT DRUGS TO BE TESTED FOR, AND THIS IS BASED ON INFORMATION FROM THE SCENE INVESTIGATOR.
MR. FLANAGAN: COULD I APPROACH, YOUR HONOR?
THE COURT: SURE.
Q BY MR. FLANAGAN: I’LL PUT THESE UP THERE.
A OKAY.
Q CAN YOU SEE UP THERE WITHOUT HAVING THEM IN FRONT OF YOU?
THE COURT: THE WITNESS IS SHAKING HER HAND.
THE WITNESS: IF IT IS ZOOMED, YES, I CAN SEE IT.
Q BY MR. FLANAGAN: FEMORAL BLOOD, YOU DIDN’T TEST FOR ANYTHING OTHER THAN WHAT APPEARS UP THERE?
A I ONLY TESTED THE PROPOFOL.
Q AND THEN THERE WAS NO OTHER TEST FOR ANY OTHER SUBSTANCES TO YOUR KNOWLEDGE THAN WHAT IS THERE?
A THAT IS CORRECT.
Q SO IT WAS ONLY TESTED FOR LIDOCAINE, LORAZEPAM, AND PROPOFOL?
A YES.
Q NOW, CAN YOU SEE THOSE NUMBERS FROM WHERE YOU ARE?
A NOT CLEARLY.
Q THE NUMBER FOR THE LIDOCAINE IS WHAT?
THE COURT: AND THE WITNESS HAS BEEN PROVIDED WITH THE DOCUMENT.
MR. FLANAGAN: EXHIBIT 67.
THE COURT: THANK YOU.
Q BY MR. FLANAGAN: THE LIDOCAINE LEVEL IS 0.84 MICROGRAMS PER MILLILITER, AND THE PROPOFOL LEVEL IS WHAT?
A THE PROPOFOL LEVEL IS 2.6 MICROGRAMS PER MILLILITER.
Q SO THERE IS A RELATIONSHIP THERE OF ABOUT ONE PART OF LIDOCAINE FOR THREE PARTS OF PROPOFOL?
A I CAN’T SAY ANYTHING TO THE RELATIONSHIP.
Q THE RATIO, THE PERCENTAGES. THERE IS THREE TIMES AS MUCH PROPOFOL AS THERE IS LIDOCAINE?
A BASED ON NUMBERS ALONE, YES.
Q IS THERE ANOTHER BASIS TO DO THE CALCULATION? I MEAN, AM I WRONG? IT IS NOT ABOUT THREE TO ONE?
A THAT IS ABOUT THREE TO ONE.
Q I NOTICE YOU USE NANOGRAMS FOR THE LORAZEPAM. WHAT IS THE DIFFERENCE BETWEEN A NANOGRAM AND MICROGRAM?
A IT IS A DIFFERENCE OF A THOUSAND. THERE IS A THOUSAND NANOGRAMS IN ONE MICROGRAM.
Q SO IF YOU PUT IT ALL IN THE SAME — WHY DID YOU USE DIFFERENT UNITS FOR LORAZEPAM AS OPPOSED TO THE PROPOFOL?
A TESTING IS GENERALLY DONE IN THE THERAPEUTIC RANGE. THE THERAPEUTIC RANGE FOR A LOT OF THE BENZO’S ARE IN THE NANOGRAM PER MILLILITER. THAT IS HOW WE REPORT OUT THE NUMBERS. BUT WE CAN BACK CALCULATE TO WHAT THAT LEVEL WOULD BE AS A MICROGRAM PER MILLILITER.
Q WHAT IS THE THERAPEUTIC RANGE FOR LORAZEPAM?
A THE LORAZEPAM IS NOT MY SERVICE, SO I DON’T KNOW.
Q YOU WOULDN’T KNOW. BUT IN THE FEMORAL BLOOD, IT IS ABOUT THREE TO ONE PROPOFOL OVER LIDOCAINE. GOING ON TO THE HEART BLOOD, THE HEART BLOOD IS 3.2 PROPOFOL?
A YES.
Q WHY IS IT DIFFERENT FROM THE FEMORAL BLOOD?
MR. WALGREN: OBJECTION. CALLS FOR SPECULATION.
THE COURT: DO YOU HAVE ANY EXPERTISE IN THAT DISTINCTION?
THE WITNESS: SOME.
THE COURT: I’LL OVERRULE THE OBJECTION UNDER 801 OF THE EVIDENCE CODE. YOU MAY ANSWER THE QUESTION.
THE WITNESS: OKAY. IT IS NOT UNCOMMON FOR US TO HAVE A DIFFERENCE BETWEEN FEMORAL BLOOD AND HEART BLOOD. TYPICALLY, THE FEMORAL BLOOD IS CONSIDERED A GOLD STANDARD FOR TOXICOLOGISTS. THOSE ARE THE NUMBERS WE RELY ON THE MOST. THERE IS LESS CHANCE FOR CONTAMINATION.
Q BY MR. FLANAGAN: SO IF YOU WOULD WANT TO COUNT, IF YOU WERE GOING TO GO WITH AN OVERALL BLOOD LEVEL, YOU RELY MORE ON FEMORAL BLOOD THAN ANY OTHER BLOOD?
A YES.
Q NOW, THE RELATIONSHIP BETWEEN THE FEMORAL BLOOD AND THE LIDOCAINE, IS THAT ABOUT THREE TO ONE?
A NO. IN THE HEART BLOOD, IT IS ABOUT FOUR TO ONE, ISN’T IT?
Q FOUR-AND-A-HALF TO ONE?
A IT IS 3.2 MICROGRAMS PROPOFOL COMPARED TO 0.68 MICROGRAMS PER MILLILITER LIDOCAINE.
Q SO ACTUALLY, THAT IS ABOUT FOUR-AND-A-HALF TO ONE, ISN’T IT?
A YES, BETWEEN FOUR AND FIVE TO ONE.
Q NOW, WHY WOULD THE FEMORAL BLOOD BE THREE TO ONE, AND THEN THE HEART BLOOD BE FOUR-AND-A-HALF TO ONE?
A THERE ARE DIFFERENT DRUGS. THEY ARE DIFFERENT SPECIMEN SOURCES. THERE IS A WIDE VARIETY OF DIFFERENCE HERE THAT COULD ACCOUNT FOR DIFFERENCES IN RATIOS.
Q IN EXTRACTING FEMORAL BLOOD, IS THE FEMORAL ARTERY TAPPED INTO?
A EVERY DOCTOR DOES IT DIFFERENTLY. YOU WOULD HAVE TO ASK THE DOCTOR.
Q IN GETTING HEART BLOOD, WOULD THAT BE BLOOD THAT WAS CONTAINED WITHIN THE HEART AT AUTOPSY?
A TYPICALLY, YES, BUT AGAIN YOU WOULD HAVE TO ASK THE DOCTOR HOW HE COLLECTED THAT SAMPLE.
Q I WAS JUST THINKING IT WAS STRANGE THAT THE BLOOD, WHETHER IT WAS IN THE HEART, WHETHER IT WAS IN THE FEMORAL AREA, OR IN THE VENOUS SYSTEM, I WAS WONDERING WHY WOULD THEY BE MUCH DIFFERENT RATIOS, SUCH AS FEMORAL BLOOD BEING THREE TO ONE AND HEART BLOOD BEING FOUR-AND-A-HALF TO ONE. DO YOU KNOW THAT?
A ONE OF THE BIG THINGS IN FORENSIC TOXICOLOGY IS SOMETHING CALLED POSTMORTEM REDISTRIBUTION. AFTER SOMEBODY DIES, THE DRUGS CAN KIND OF LEACH OUT OF THE OTHER TISSUES IN THE BODY, ARTIFICIALLY ELEVATING THINGS LIKE THE HEART BLOOD.
Q NOW, THE HOSPITAL BLOOD, WHERE IS THAT TAKEN FROM?
A I DON’T KNOW.
Q I NOTICE THAT THE HOSPITAL BLOOD SAYS THAT THE PROPOFOL MEASUREMENT IS 4.1; IS THAT CORRECT?
A THAT IS CORRECT.
Q AND THE LIDOCAINE MEASUREMENT IS 0.51?
A THAT IS CORRECT.
Q WELL, IN THIS PARTICULAR SAMPLE, THE RATIO OF PROPOFOL AND LIDOCAINE IS EIGHT TO ONE?
A THAT IS CORRECT.
Q SO WE HAVE GOT FEMORAL BLOOD AT THREE TO ONE, HEART BLOOD AT FOUR-AND-A-HALF TO ONE, AND THE HOSPITAL BLOOD AT EIGHT TO ONE?
A THAT IS CORRECT.
Q THEN THOSE ARE ALL MEASURED IN MICROGRAMS PER MILLILITER, CORRECT?
A YES.
Q NOW, THE LIVER MEASUREMENT. FIRST OF ALL, MILLILITER, THAT IS A VOLUMETRIC MEASUREMENT?
A YES.
Q NOW, THE LIVER. YOU ANALYZED THAT, AND YOU DETERMINED THAT THERE WAS PROPOFOL AT 6.2 MICROGRAMS PER GRAM; IS THAT CORRECT?
A THAT IS CORRECT.
Q SO THAT IS NOT A FLUID ANALYSIS. THAT IS A TISSUE ANALYSIS?
A YES.
Q SO THAT IS WHY IT IS STATED IN GRAMS BECAUSE GRAM IS A WEIGHT QUANTITY, ISN’T IT?
A YES.
Q SO THE HEART BLOOD, HOSPITAL BLOOD, FEMORAL
BLOOD, ARE ALL VOLUMETRIC FOR FLUIDS. THE LIVER IS VOLUMETRIC FOR WEIGHT OF THE LIVER?
A MAY I EXPLAIN?
Q SURE.
A IN ORDER TO DO A LIVER ANALYSIS, WE HAVE TO TRANSFORM THE LIVER INTO A LIQUID. SO WE DO WHAT WE CALL HOMOGENIZE IT, PUT IT IN A BLENDER, GRIND IT UP SO EVERYTHING IS THE SAME AND IN LIQUID FORMAT. THAT IS HOW WE CAN CONDUCT THE VOLUMETRIC MEASUREMENT.
Q I WOULD IMAGINE, THOUGH, IN MAKING IT INTO A LIQUID, YOU HAVE TO KEEP TRACK OF HOW MUCH WEIGHT YOU MAKE THAT LIQUID OUT OF?
A WE INITIALLY WEIGH IT BEFORE WE DO ANYTHING.
Q NOW, THE LIVER PROPOFOL IS 6.2, AND THE LIDOCAINE IS 0.45; IS THAT CORRECT?
A THAT IS CORRECT.
Q NOW, THAT IS IN A RELATIONSHIP OF WHAT, ABOUT 13 TO ONE?
A MAYBE 12 TO ONE.
Q TWELVE TO ONE. SO WE HAVE ALL OF THESE RELATIONSHIPS. PROPOFOL IS THE BIG QUANTITY, AND IT IS THREE TO ONE, FOUR-AND-A-HALF TO ONE, EIGHT TO ONE, AND NOW 12 TO ONE, CORRECT?
A CORRECT.
Q NOW, IN THE VITREOUS, YOU HAVE GOT DOWN HERE THAT IT WAS — THAT LITTLE SYMBOL IS LESS THAN 0.40?
A YES.
Q WHY DO YOU COME UP WITH THE 0.40? WHY DO YOU USE THAT NUMBER?
A FOR MY ORIGINAL ANALYSIS, THERE WAS VERY LIMITED SAMPLE VOLUME FOR THE VITREOUS. TYPICALLY, I NEED TWO MILLILITERS, WHICH IS ABOUT TWO THIMBLEFULS OF LIQUID TO DO ANALYSIS. IN THIS CASE, THERE WAS A LOT LESS SAMPLE TO BEGIN WITH. SO I EXAMINED ONLY 0.5 OR HALF A MILLILITER. SO FOUR TIMES LESS THAN WHAT I NORMALLY WOULD. THE PROPOFOL WAS PRESENT, BUT IT WAS BELOW MY LEVEL OF QUANTITATION BUT ABOVE MY LIMIT OF DETECTION. I WAS ABLE TO REPORT IT OUT AS PRESENT, BUT I COULDN’T GIVE IT AN EXACT NUMBER.
Q WHAT IS YOUR LEVEL OF DETECTION?
A MY LEVEL OF DETECTION IS ABOUT 0.02.
Q SO IS IT ACCURATE TO STATE IT IS SOMEWHERE BETWEEN 0.02 AND 0.40?
A FOR THE ACTUAL ANALYSIS BETWEEN 0.02 AND 0.10, MY LIMIT OF QUANTITATION IS THE 0.10. SO I TAKE MY LIMIT OF QUANTITATION AND I WILL MULTIPLY IT BY FOUR BECAUSE OF MY SAMPLING ONLY HALF A MILLILITER TO BEGIN WITH.
Q WELL, HOW MUCH LESS? THESE ARE MICROGRAMS PER MILLILITER. VITREOUS IS A FLUID, RIGHT?
A RIGHT.
Q A FLUID IN THE EYE.
A YES.
Q HOW MUCH LESS THAN 0.40 WAS IT, OR HAVE YOU ANY WAY OF TELLING?
A I CAN’T GIVE AN EXACT NUMBER, BUT IT WOULD BE BETWEEN .08 AND 0.4.
Q NOW, THE URINE CONTENTS, THE URINE AT THE SCENE, DID YOU SEE WHERE THEY GOT THAT?
A NO.
Q THE URINE THAT YOU HAVE THERE, 0.15, WAS THAT URINE TAKEN FROM THE DECEDENT AT THE TIME OF AUTOPSY?
A 0.15 MICROGRAMS PER MILLILITER IS THE URINE CONCENTRATION FROM THE URINE TAKEN AT AUTOPSY.
Q I SEE WHERE YOU HAVE THE LIDOCAINE THERE SAYS PRESENT. BY SAYING IT IS PRESENT, DOES THAT MEAN, WELL, IT IS POSITIVE BUT LESS THAN 0.15?
A THE LIDOCAINE HAS NOTHING TO DO WITH THE PROPOFOL. IT WOULD DEPEND ON THE LIDOCAINE ANALYSIS THEY HAVE UP THERE, AND THEY HAVE ANALYZED IT AND SAID PRESENT.
Q WOULDN’T THEY PUT A NUMBER UP THERE IF THEY HAD A SIGNIFICANT NUMBER?
A I DON’T KNOW IF THEY QUANTITATED IT. I DON’T KNOW IF THEY ONLY DID A SCREEN FOR IT AND FOUND IT TO BE QUALITATIVELY PRESENT. I’M NOT SURE WHAT THE ANALYST DID ON THAT.
Q OKAY. IT SAYS GASTRIC CONTENTS. YOU ANALYZED FOR PROPOFOL IN GASTRIC CONTENTS, CORRECT?
A YES, THAT IS CORRECT.
Q I NOTICE THAT THE AUTOPSY REPORT SAYS THAT THE STOMACH IS NOT DISTENDED. IT CONTAINS 70 GRAMS OF DARK FLUID. IS THAT DARK FLUID THAT YOU ANALYZE FOR PROPOFOL?
A YES.
Q AND IN THAT DARK FLUID, IT WAS DETERMINED IT WAS 0.13 MICROGRAMS PER MILLILITER OF PROPOFOL?
A THAT IS INCORRECT. IT WAS 0.13 MILLIGRAMS.
Q 0.13 MILLIGRAMS. THAT IS NOT A PERCENTAGE, IS IT?
A NO.
Q IN THE 70 GRAMS OF DARK FLUID IN THE STOMACH, IS THAT THE TOTAL AMOUNT OF PROPOFOL THAT WAS IN THERE?
A YES.
Q SO HOW DO YOU MAKE THAT DETERMINATION?
A WHEN WE START OUR GASTRIC ANALYSIS, WE WEIGH OUT THE TOTAL SAMPLE THAT WE HAVE. WE THEN FACTOR THAT INTO OUR CALCULATIONS BY MULTIPLYING OUR QUANTITATIVE VALUE BY THE AMOUNT OF THE STOMACH CONTENTS TO ACHIEVE A TOTAL AMOUNT IN THE STOMACH.
Q SO YOU DETERMINED IT WAS 0.13 MILLIGRAMS IN THAT 70 GRAMS THAT IS IN THE STOMACH?
A YES.
Q THAT IS 70 GRAMS. TELL ME EXACTLY WHAT IT LOOKED LIKE?
A I DON’T RECALL SPECIFICALLY WHAT IT LOOKED LIKE.
Q DID YOU DO ANY ANALYSIS TO DETERMINE WHAT THIS FLUID WAS FROM A GROSS STANDPOINT?
A I WAS NOT THE ANALYST WHO DID THE INITIAL EXAMINATION OF THE STOMACH CONTENTS, BUT SOMEBODY IN THE OFFICE DID. AND THEY WOULD HAVE DONE A GROSS EXAMINATION WHERE THEY LOOKED AT IT TO SEE IF THEY COULD FIND ANY PILLS OR ANYTHING ELSE IDENTIFIABLE IN IT AND HOMOGENIZED IT TO MAKE A UNIFORM SAMPLE BY THE TIME I GOT TO IT.
Q BUT I’M JUST KIND OF WONDERING WHAT THIS DARK FLUID CONSISTED OF OTHER THAN PROPOFOL, AND I BELIEVE THERE IS SOME LIDOCAINE IN IT, CORRECT?
A THERE WAS LIDOCAINE AND PROPOFOL FOUND IN THE STOMACH.
Q AND THAT IS 0.13 MILLIGRAMS, AND WE HAVE 1.6 MILLIGRAMS. WELL, WE HAVE ANOTHER 69 GRAMS PLUS THAT WAS SOMETHING OTHER THAN PROPOFOL AND LIDOCAINE?
A THOSE ARE — I MEAN, STOMACH CONTENTS COULD BE ANYTHING FROM FOOD OR DRINKS. I DON’T KNOW.
Q COULD BE JUICE?
A THERE IS A POSSIBILITY.
Q OR GRAPE JUICE?
MR. WALGREN: OBJECTION. RELEVANCE. SPECULATION.
THE COURT: SUSTAINED.
Q BY MR. FLANAGAN: WE KNOW THAT IT IS IN A RELATIONSHIP OF ABOUT 12 TO ONE UP THERE, ISN’T IT?
A THAT IS TRUE.
Q THIS ONE IS 12 PARTS OF LIDOCAINE FOR ONE PART PROPOFOL?
A IN THE STOMACH?
Q YES.
A YES, 12 TO ONE.
Q NOW, SO WE HAVE GOT 3.31 IN THE FEMORAL BLOOD PROPOFOL, EIGHT TO ONE IN THE HOSPITAL BLOOD PROPOFOL, FOUR-AND-A-HALF TO ONE IN THE HEART BLOOD PROPOFOL. IN THE LIVER, IT IS 12 TO ONE PROPOFOL OVER LIDOCAINE. NOW, FOR THE FIRST TIME THERE IS A PREPONDERANCE OF LIDOCAINE, 12 TO ONE OVER PROPOFOL, CORRECT?
A YES.
Q NOW, YOU ALSO ANALYZED WHAT WE HAVE REFERRED TO AS MEDICAL EVIDENCE NO. 1. MEDICAL EVIDENCE NO. 1, THAT IS WHAT HAS BEEN REFERRED TO WITH OTHER DOCUMENTATION ORIGINALLY AS THE BROKEN SYRINGE?
A YES.
Q BUT IT IS, IN FACT, ACCORDING TO MS. FLEAK, A SYRINGE THAT HAS BEEN UNSCREWED, CORRECT?
A THE MEDICAL EVIDENCE NO. 1 THAT I RECEIVED WAS IN TWO PIECES.
Q DID IT APPEAR TO BE BROKEN OR TAKEN APART?
A IT APPEARED TO HAVE BEEN TAKEN APART.
Q AM I CORRECT IN ASSUMING FROM YOUR SUMMARY UP HERE THAT ONLY THE BARREL WAS ANALYZED?
A THE BARREL WITH PLUNGER SIDE WAS ANALYZED.
Q WHAT ABOUT THE NEEDLE PORTION. WAS THAT ANALYZED FOR INTERIOR COMPONENTS?
A NO.
Q BUT THE NEEDLE DID FIT THE BARREL?
A I DID NOT ATTEMPT TO PUT THEM TOGETHER.
Q THEY WERE DELIVERED TO YOU TOGETHER, THOUGH?
A THEY WERE DELIVERED TO ME IN THE SAME BAG, BUT THEY WERE NOT TOGETHER.
Q NOW, I NOTICE THAT IT TESTED, I THINK YOU SAID, YOU FOUND PROPOFOL AND LIDOCAINE IN THAT PLUNGER OR IN THAT BARREL?
A YES.
Q DO YOU KNOW HOW MUCH PROPOFOL VERSUS HOW MUCH LIDOCAINE WAS IN THAT BARREL?
A NO.
Q SO AS FAR AS YOU KNOW, IT COULD BE A THOUSAND TO ONE?
A I DON’T KNOW WHAT THE RELATIONSHIP IS.
Q COULD IT BE THE SAME AMOUNT? COULD IT BE VASTLY DIFFERENT? YOU JUST DON’T KNOW?
A THAT IS CORRECT.
Q MEDICAL EVIDENCE NO. 2, YOU ANALYZED THAT ALSO?
A YES, I DID.
Q AS MEDICAL EVIDENCE NO. 2, THAT IS BASICALLY THIS DRAWING, ISN’T IT?
A I ANALYZED COMPONENTS OF THAT DRAWING, YES.
THE COURT: INDICATING WHAT EXHIBIT, PLEASE.
MR. FLANAGAN: I HAVE PUT THE DRAWING UP THERE AS 79.
THE COURT: I THINK IT IS 69.
Q BY MR. FLANAGAN: OR 69. THE SUMMARY REPORT THAT WE WERE JUST PREVIOUSLY LOOKING AT WAS 70. NOW, IN MEDICAL EVIDENCE NO. 2, AS IT IS ITEMIZED IN YOUR SUMMARY REPORT, IT IS ONLY THINGS ON THAT DRAWING, ISN’T IT?
A YES.
Q AND EVERYTHING THAT WAS ANALYZED ON THAT LOG IS IN THE MEDICAL EVIDENCE SUMMARY?
A YES.
Q YOU ANALYZED “A,” WHICH IS THE SALINE BAG?
A IT WAS AN I.V. BAG.
Q I.V. BAG. WHAT DID IT HAVE IN IT?
A I DID NOT FIND ANY DRUGS.
Q WHAT DID IT HAVE IN IT?
A I DON’T KNOW.
Q YOU ANALYZED SOMETHING FOR DRUGS. WAS THERE A LIQUID IN IT?
A THERE WAS SOME RESIDUE LIQUID, A CLEAR FLUID.
Q A CLEAR FLUID. YOU DON’T KNOW WHAT IT IS?
A I DON’T KNOW WHAT IT IS.
Q DID THE BAG HAVE ANY WRITING ON IT?
A IT DID.
Q DID IT SAY IT WAS A SALINE BAG?
A I DON’T RECALL.
Q NOW, YOU ANALYZED THE TUBE THAT COMES FROM THE SALINE BAG OR IN THE I.V. BAG ALL THE WAY DOWN TO THE INJECTION PORT, CORRECT?
A I ANALYZED ALL THE FLUID IN THE LONG TUBING THAT WENT FROM THE PLUG, THE SPIKE WHICH IS LABELED AS “I,” DOWN TO THE “Y” CONNECTOR, BUT NOT WHAT WAS IN THE “Y” CONNECTOR.
Q AND SO THAT TUBE WHICH IS LABELED UP THERE AS “F,” THAT TUBE WHICH IS LABELED “F” DOWN TO HERE, THERE WERE NO DRUGS WHATSOEVER?
A THAT IS CORRECT.
Q SO BASED UPON YOUR ANALYSIS, YOU WOULD HAVE TO CONCLUDE THERE WERE NO DRUGS COMING OUT OF THAT “A” BAG TOWARDS THE “Y” CONNECTOR?
MR. WALGREN: OBJECTION. VAGUE. CALLS FOR SPECULATION.
THE COURT: SUSTAINED.
Q BY MR. FLANAGAN: WELL, IF THERE HAD BEEN DRUGS COMING OUT OF THAT BAG, THE “A” BAG, AND THAT “F” TUBE, WOULD YOU HAVE BEEN ABLE TO DETECT THEM?
MR. WALGREN: VAGUE. CALLS FOR SPECULATION. VAGUE AS TO TIME. IT COULD HAVE BEEN FLUSHED. THERE ARE A NUMBER OF VARIABLES.
THE COURT: THE OBJECTION IS SUSTAINED TO THE FORM OF THE QUESTION.
Q BY MR. FLANAGAN: DID YOU DO THE SAME ANALYSIS ON THAT “F” TUBE THAT YOU DID ON THE, I GUESS IT IS, THE “D” TUBE?
A YES.
Q NOW, THE “D” TUBE HAD DRUGS IN IT, DIDN’T IT?
A YES.
Q THE “D” TUBE HAD PROPOFOL, AND LIDOCAINE, AND FLUMAZENIL?
A YES.
Q NOW, DID YOU EVER ANALYZE THE BLOOD STREAM OF ANY OF THE BLOOD FOR FLUMAZENIL?
A WE DO NOT HAVE A METHODOLOGY AT THE CORONER’S OFFICE FOR ANALYZING FOR FLUMAZENIL.
Q YOU CAN ANALYZE FOR FLUMAZENIL IN AN I.V. TUBE BUT CAN’T ANALYZE FOR IT IN A BLOOD SAMPLE?
A THE MEDICAL EVIDENCE ANALYSIS IS A DILUTE AND SHOOT. IT IS VERY COMPREHENSIVE. THE BIOLOGICAL EXTRACTIONS ARE MORE SPECIFIC TO A SPECIFIC TYPE DRUG. THE EXTRACTION HAS TO BE TAILORED TO THAT DRAWING IN ORDER TO GET IT TO ISOLATE IT. WE DON’T HAVE AN EXTRACTION METHOD TO BE ABLE TO SEE FLUMAZENIL.
Q SO YOU DON’T KNOW HOW TO ANALYZE FOR FLUMAZENIL IN THE BODY?
A WE DO NOT HAVE A METHOD FOR IT.
Q THE FLUMAZENIL, LIDOCAINE, AND PROPOFOL THAT WERE IN THAT LOWER TUBE LABELED “D,” DO YOU KNOW HOW MUCH OF EACH WAS THERE?
A NO.
Q WOULD YOU SAY IT WAS PRIMARILY FLUMAZENIL WITH HINTS OF PROPOFOL AND LIDOCAINE?
MR. WALGREN: OBJECTION. CALLS FOR SPECULATION.
THE COURT: THAT IS IN THERE, “HINTS”?
Q BY MR. FLANAGAN: HINTS. I’M TRYING TO FIGURE OUT WHOSE WORD IT IS WHERE IT SAYS HINT OF LIDOCAINE AND PROPOFOL.
THE COURT: MS. LINTEMOOT DIDN’T DO THAT ANALYSIS.
MR. FLANAGAN: YES, SHE DID.
THE COURT: I’M SAYING FOR HINTS.
MR. FLANAGAN: HINTS?
THE COURT: THE WORD IS ACTUALLY THERE?
MR. FLANAGAN: H-I-N-T-S.
THE COURT: ALL RIGHT. THE OBJECTION IS OVERRULED.
Q BY MR. FLANAGAN: WAS THERE A HINT OF PROPOFOL AND LIDOCAINE IN THAT TUBE?
A THEY WERE PRESENT.
Q DO YOU KNOW IF THEY WERE PRESENT IN SIGNIFICANT QUANTITIES COMPARED TO THE FLUMAZENIL?
A I CAN’T SAY. I ONLY DID A QUALITATIVE ANALYSIS. I WAS LOOKING FOR DRUGS TO BE PRESENT. I WASN’T TRYING TO FIND OUT HOW MUCH OF EACH DRUG WAS THERE.
Q SO IT COULD BE A THOUSAND PARTS OF FLUMAZENIL AND ONE PART OF LIDOCAINE OR PROPOFOL, AND YOU WOULDN’T KNOW?
MR. WALGREN: OBJECTION. CALLS FOR SPECULATION.
THE COURT: THE OBJECTION IS SUSTAINED. THE ANSWER IS WHAT IT IS. IT IS MERELY PRESENCE OR ABSENCE; IS THAT RIGHT?
THE WITNESS: CORRECT.
MR. FLANAGAN: THE QUESTION JUST CALLED FOR HER TO SAY IT WOULD CALL FOR SPECULATION. I WAS CALLING FOR SPECULATION THERE BECAUSE I THINK SPECULATION IS RELEVANT HERE.
MR. WALGREN: WE ARE IN AGREEMENT THAT IT CALLED FOR SPECULATION, AND WE OBJECT.
THE COURT: ONCE WE GET TO THAT POINT THEN, SPECULATION IS NOT RELEVANT. SUSTAINED.
Q BY MR. FLANAGAN: SO AS IT STANDS, WITHOUT SPECULATING, YOU COULDN’T TELL ANYTHING ABOUT THE QUANTITATION OF LIDOCAINE AND PROPOFOL IN THAT LOWER SECTION “D”?
A I CAN’T SAY HOW MUCH WAS THERE.
Q OKAY. NOW, “B” UP THERE, THAT IS THE SYRINGE, CORRECT?
A YES.
Q THAT WAS FULLY INTACT?
A YES.
Q IT HASN’T BEEN UNSCREWED OR MANIPULATED?
MR. WALGREN: OBJECTION. VAGUE.
THE COURT: SUSTAINED.
Q BY MR. FLANAGAN: IT IS NOT LIKE THE OTHER SYRINGE THAT HAD BEEN BROKEN DOWN AND TAKEN APART?
MR. WALGREN: OBJECTION. ASSUMES FACTS NOT IN EVIDENCE.
THE COURT: SUSTAINED. JUST REASK IT, PLEASE.
Q BY MR. FLANAGAN: WE HAVE ONE SYRINGE YOU HAVE ANALYZED THAT HAD BEEN TAKEN APART, AND YOU ONLY ANALYZED THE BARREL?
MR. WALGREN: OBJECTION. ASSUMES FACTS NOT IN EVIDENCE.
THE COURT: OBJECTION IS SUSTAINED TO TAKEN APART. THEY ARE TWO SEPARATE PIECES. THAT IS WHAT WE KNOW. WE DON’T KNOW ANYTHING ELSE ABOUT THE METHODOLOGY.
Q BY MR. FLANAGAN: IT APPEARED TO BE TAKEN APART AS OPPOSED TO BROKEN?
MR. WALGREN: ASSUMES FACTS NOT IN EVIDENCE.
MR. FLANAGAN: SHE SAID THAT.
THE COURT: I KNOW THAT. WE HAVE BEEN THERE. YOU DON’T KNOW HOW IT GOT TO BE IN ITS STATE. YOU JUST KNOW THEY WERE SEPARATE?
THE WITNESS: THAT IS CORRECT.
THE COURT: NEXT.
Q BY MR. FLANAGAN: WE HAVE A FULL INTACT SYRINGE WITH A BARREL AND A PLUNGER HERE AT “B,” CORRECT?
A YES.
Q AND THAT HAD HOW MUCH FLUID IN IT?
A I DON’T RECALL THE SPECIFIC NUMBER OFF THE TOP OF MY HEAD.
Q YOUR SUMMARY REPORT WOULD INDICATE 0.17 GRAMS?
A THAT IS CORRECT.
Q YOU ANALYZED THE COMPONENTS OF THAT?
A YES.
Q AND ONCE AGAIN, AS WAS FOUND IN THE LOWER TUBING “D,” IT WAS POSITIVE FOR FLUMAZENIL, LIDOCAINE, AND PROPOFOL?
A YES.
Q NOW, WERE YOU ABLE TO DETERMINE THE QUANTITIES OF EACH OF THESE DRUGS IN THAT SYRINGE?
A NO.
MR. WALGREN: OBJECTION. ASKED AND ANSWERED.
THE COURT: OVERRULED.
Q BY MR. FLANAGAN: WERE YOU ABLE TO MAKE A DETERMINATION WHETHER THE QUANTITIES IN SYRINGE “B” AND LOWER TUBING “D” WERE THE SAME?
A I DID NOT DO A QUANTITATION OF THE DRUGS IN THE SYRINGE OR THE TUBING. QUALITATIVELY, THE SAME DRUGS WERE PRESENT.
Q QUALITATIVELY, THE SAME, BUT YOU DON’T KNOW IF THEY WERE QUANTITATIVELY THE SAME?
A CORRECT.
Q DID YOU ANALYZE ANY OTHER PHYSICAL EVIDENCE FOR PROPOFOL?
A NO.
Q I’M SPECIFICALLY REFERRING TO WERE YOU ASKED TO ANALYZE ANY FRUIT JUICE CONTAINERS FOR PROPOFOL?
A NO.
Q I’M TALKING ABOUT QUALITATIVELY OR QUANTITATIVELY.
A FOR THE QUALITATIVE TEST, THE MEDICAL EVIDENCE, THE ONLY THING THAT I ANALYZED WAS THE SYRINGE AND BARREL FROM MEDICAL EVIDENCE NO. 1, AND THE SYRINGE, THE I.V. SYSTEM FOR MEDICAL EVIDENCE NO. 2. IT IS A COMPREHENSIVE TEST, THOUGH, THAT WOULD DETECT A WIDE VARIETY OF DRUGS. AS FAR AS BIOLOGICAL SPECIMENS, I DID A TARGETED ANALYSIS FOR PROPOFOL ON NOT ONLY THE CASE IN QUESTION, BUT ALSO ON A SERIES OF CONTROLS AND EXTERNAL CONTROLS, ET CETERA.
MR. FLANAGAN: NOTHING FURTHER AT THIS TIME, YOUR HONOR.
THE COURT: MR. FLANAGAN, THANK YOU. DO YOU NEED A MOMENT?
MR. FLANAGAN: YES. MAY I JUST HAVE 15 SECONDS.
(DEFENSE COUNSEL CONFER.)
MR. FLANAGAN: NO FURTHER QUESTIONS.
THE COURT: THANK YOU, MR. FLANAGAN.
MR. WALGREN, REDIRECT?
MR. WALGREN: NO. THANK YOU, YOUR HONOR.
THE COURT: MS. LINTEMOOT, THANK YOU FOR YOUR
TESTIMONY.