Article 32 Hearing
September 9, 1970
Dr. Russell Fisher
(The hearing reopened at 1050 hours, 9 September 1970.)
COL ROCK: The hearing will come to order. Let the record reflect that those parties were present at the recess are currently in the hearing room. At this time is the government ready to proceed?
CPT SOMERS: It is, your honor. The government calls Doctor Russell Fisher.
(Doctor Russell S. Fisher was called as a witness, was sworn and testified as follows.)
Questions by CPT SOMERS:
Q Would you state your full name, please?
A Doctor Russell S. Fisher.
Q And your address, please?
A My office address is 111 Penn Street in Baltimore, Maryland.
Q And what is your occupation, sir?
A I am a physician, pathologist and full time specialist in so-called forensic pathology, the pathology of injury. I am Chief Medical Examiner for the State of Maryland and have been for twenty-one years. I am Professor of Forensic Pathology at the University of Maryland Medical School, and I'm appointed in both the Hopkins Medical School and the School of Hygiene at Hopkins in the capacity as lecturer, or whatever equivalent capacity they have for part-time people in the field.
MR. SEGAL: Excuse me, sir. I would agree that Doctor Fisher is a qualified pathologist. There is no reason to qualify him further.
CPT SOMERS: Sir, the government would like to go on with the doctor's qualifications.
MR. SEGAL: Go right ahead.
COL ROCK: Proceed.
Q Would you briefly, sir, state your professional training and background?
A I started in chemical engineering at Georgia Tech in 1937, B.S. I studied medicine in 1942 at the Medical College of Virginia. I spent two years at the Henry Ford Hospital in Detroit as an intern and assistant resident in medicine. During the assistant residency in medicine I spent three months on the chest ward where they treated patients with chest diseases. I was then in the Navy for a couple of years of activity duty, hardly training, beach party doctor on an APA. I was then, after the war, at the Harvard Medical School from July of '46 until September of '49 as a trainee and research fellow in forensic pathology. By forensic we mean the pathology of injury. Subsequent to that I went to Maryland and took the job as Chief Medical Examiner. I subsequently stood the pathology board examination so that I am a certified specialist in pathology, and in the sub-specialty of forensic pathology which was created in 1959, I was already nine years in my present position and training before that so I was grandfathered in. I am now on the American Board of Pathology, the board itself. I am charged there with examining young people who have been trained in forensic pathology. I think that's about the size of it.
Q Are you licensed to practice medicine, sir?
A In Virginia, Michigan, Massachusetts and Maryland.
Q Do you, sir, have a list of your publications?
A Yes, sir, I have published some total of 59 on this list and that is a list of them.
CPT SOMERS: I ask that this list be marked as a government exhibit.
WITNESS: I am consultant presently at the Armed Forces Institute of Pathology in pathology.
COL ROCK: Government Exhibit 110, publications by R. S. Fisher, M. D. Proceed, please.
Q What professional societies are you a member of?
A I'm a member of the Maryland Medical Society. It's called Medical and Chirurgical Faculty of Maryland. It's a medical society and I am the immediate past president of that society.
Q Would you spell that word?
A C-h-i-r-u-r-g-i-c-a-l. I am a member of the AMA; in fact I am in the AMA House of Delegates. I'm a member of the American Association Academy of Forensic Scientists. I was president of it some ten years ago for one year. And, I am a member of College of American Pathologists and American Society of Clinical Pathologists, and the American Society of Pathologists and Bacteriologists, International Academy of Pathology, and I suppose some more, but those are the major ones.
CPT SOMERS: Thank you, sir. Does the defense desire to cross-examine on qualifications of the witness?
MR. SEGAL: As I indicated before, sir, we accept Doctor Fisher's qualifications in pathology.
COL ROCK: It will be so noted.
Q Sir, what are your duties as the Chief Medical Examiner?
A Well, Maryland has a state-wide medical examiner system operated from the central office in Baltimore, and my job as Chief Medical Examiner is overall direction of this operations with deputy medical examiners, doctors, in each county who respond to headquarters for direction, assistance, and their reports are all made to us. So that I'm in charge of the investigation of the sudden and violent unexpected, unexplained, unattended deaths throughout the state of Maryland, and in a state with four million population, this amounts to some 7,000 cases a year; so that in the last twenty-one years it has been my responsibility to oversee, and indeed, to participate activity in a very great many of some 135 to 145 thousand official investigations of deaths held to be in the public interest, and conducted as an official part of government business.
Q Sir -- excuse me, go ahead.
A Now, we -- in this aspect, in those cases that are within the ready driving distance of Baltimore City Headquarters and indeed, we attempt to, within the city limits, we go to the scene of death, wherever it appears that our services may be useful and the collection of medical evidence or in interpreting medical evidence at the scene for the detectives and police investigators. We participate in these investigations pretty much from that point right on to -- the detectives are continually with us at the autopsy to see and learn what we can tell them about how a given might have occurred. The numbers of wounds, directions of fire, all that sort of business, and we in turn are expected on the one to help them evaluate possible theories in a given case, and not infrequently to suggest sequences of events, or other things based on our observations, that help to complete a theory as to a given violent death.
Q Sir, would tell us just a little bit about what a forensic pathologist is and does?
A Basically he must be a physician. He must be trained in pathology, and if he is to be a certified specialist, eventually stands an examination or he might have been grandfathered in of the 50 or 60 of who were in the field when we became active. Basically his responsibility is just that of handling the medical aspects of the investigation of death and non-fatal injuries in a fair number of cases, and interpreting the finding for the benefit of police investigators, the courts, wherever they may need information in facing a given issue, and generally the application of the scientific technique to the problems of medical evidence.
Q Sir, have you had occasion to have conversation with persons at Fort Bragg with respect to the MacDonald murder case?
A Yes, sir.
CPT SOMERS: At this time I ask that this document be marked as a government exhibit. Let the record reflect that it has already been shown to the defense who has a copy of it.
COL ROCK: Government Exhibit 111, statement of Doctor Russell Fisher dated 15 July 1970. I suggest that we have Doctor Fisher sign that after he identifies it.
CPT SOMERS: Very good, sir.
COL ROCK: For the purpose of authentication.
Q Doctor Fisher, I show you Government Exhibit G-111 and ask if you can identify it.
MR. SEGAL: Now this is objected to. We have followed the procedure in this case that where witnesses have given written statements to the government that those statements have been marked in evidence, but the purpose of starting off a case where you have the witness here who may have some opinions or information to offer, by giving him his statement so that that becomes his testimony is improper. We are entitled to have Doctor Fisher's statement given from his own lips. If he needs to refer to that statement, which I doubt very much, that may be an appropriate issue. But to start off by asking him to read his statement or to look at it as the basis for testimony is not the procedure we followed in this case and not the appropriate procedure for any legal proceedings.
CPT SOMERS: Sir, I am perfectly happy to have the doctor testify to what's in that statement. However, I did understand where there were sworn statements from any witness you wished them introduced and that's what I am attempting to do.
CPT BEALE: Mr. Segal, I think that counsel for the government has got a good point. The only thing that's missing is the fact that Doctor Fisher hasn't signed it. That would appear that this is some type of statement he is giving to someone on an earlier date and that is just like our witness statements.
MR. SEGAL: No, I didn't mean that it wasn't signed or something. What I am suggesting is that we have given the witnesses their own statement so they might refresh their recollect about what was said previously, and I have no objection to that procedure. But that's not what we are following. I think if Doctor Fisher is to be questioned, if he wants to refer to his statement, well, fine. It is not fair to start by having him identify it. It is not what we have done and I don't think it's appropriate.
CPT BEALE: What we want to have done is have Doctor Fisher just look at it, have him sign it, if in fact that's his statement, and then bring it back up here, and then you can let Doctor Fisher testify.
CPT SOMERS: Well, I'll follow that procedure if that's what you are directing. I thought it would save time on the record, for what he's going to testify to that's in that statement, simply to use it and he's available for cross-examination by the defense.
CPT BEALE: What you are saying, you are just going to let this stand as his testimony concerning whatever happened with Doctor MacDonald. Is that right?
CPT SOMERS: No, no. There are other things that beyond -- well. If it causes a difficulty, I'll be happy to have him testify.
CPT BEALE: Have him sign this and bring it up here.
Q Sir, did you already state what that was?
A Yes, sir, this is the written record of the statement that you took from me on July 15 and which I have read and indeed subscribe to.
CPT SOMERS: Very good. Would you sign on the bottom, please?
(Witness complied and G-111 was handed to the IO.)
Q Doctor, I note that you have a document in front of you. Could you tell us what that is?
A Well, that's a copy of the document you had which is now in evidence.
Q Doctor Fisher, did you speak to military doctors here at Fort Bragg with respect to Captain MacDonald?
A Yes, sir, I did.
Q To whom did you speak?
A I spoke to Dr Straub, to a Doctor Jacobson, to a Doctor Gemma, to a Doctor Bronstein, and directed questions to them concerning injuries that Doctor MacDonald had.
Q And what information did you obtain as a result of this conversation?
A Well, that these four physicians had all seen and or treated Doctor MacDonald at the time of his admission to the Army hospital here on the base on the 17th of February of 1970; that essentially his injuries could be described in five groups -- that one was a stab one, a puncture type wound in the right chest in the front and right side as distinguished from in the back; that this wound penetrated into the right pleural cavity around the lung and that it led to a partial collapse of the right lung; that in size it was between one and one-half centimeters in length, being an elongated thin wound.
The second area of injury involved some superficial puncture wounds of the left arm above the elbow, apparently two in nature, but of really no significance.
There were superficial, shallow, otherwise categorized; that there was also a superficial cut or incised wound in the left upper quadrant of the abdomen; that this was not sufficiently severe to require sutures to close it; that at one end of it did go through the skin and revealed the muscle structure immediately beneath the skin, but that was only at one end, and in the remainder it did not penetrate the full thickness of the skin and underlying subcutaneous tissue. That was described by some as a scratch and by others as a superficial laceration, a cutting injury.
There was a fourth area of injury which involved four tiny puncture marks in the skin of the left upper chest near the shoulder but on the chest over the muscle area. There were various and described as little pick marks or tiny perforations, not severe enough to require any specific treatment.
Finally, there was a bruise of the left forehead, swelling, mild discoloration, mildly abraded, according to one of the doctors, but all indicated that it was simply a bruise without significant laceration or destruction of the tissue, and that Doctor Bronstein indicated that on his examination that there was no evidence of neurological abnormalities associated with any injury to the head; specifically he saw nothing that indicated brain injury associated with this described bruise on the forehead.
Q Were any other injuries described to you, sir?
A No, sir.
Q Can you tell me, sir, what the effect of such injuries would be on a relatively healthy male?
A The effect of the -- all of the injuries except the first, would be essentially nothing. Granted, the bruise on the head or a cut in the skin needs perhaps some superficial bandaging or what have you, but they are of no real significance. The stab wound in the chest which the hospital records show did produce a degree of pneumothorax is obviously a wound that would require treatment. It, per se, is not a dangerous or critical wound because many people will sustain puncture wounds of the chest with relatively little collapse of the lung, or even with partial collapse. Some may require nothing other than a bandage with some Vaseline on it to make a sort of valve effect so as one inhales he pushes any air that's trapped in the chest cage out. That's when he exhales, and then when he inhales the Vaseline fills the hole so the air doesn't get back in and this may control a collapsing of the lung and the lung re-expands.
On the other hand, when a pneumothorax progresses beyond about 25% collapse of the lung, treatment is indicated to determine if pressure is developing in the space between the lining and the chest wall, and indeed if the collapsing phenomenon continues, then a tube is inserted to let the air out and let the lung re-expand. This was the case with Doctor MacDonald, although at the time of the first examination, as I understand it, the lung showed only 20% collapse and one would hardly think that this would produce any clinical symptomatology.
His blood pressure was recorded repeatedly as entirely normal or what one would consider perfectly safe and indicative of any effects of the wound so to speak of. His pulse rate, variously recorded in the 70's and 80's, is certainly normal pulse rate, and these recordings began around 5 o'clock in the morning. His respiratory rate was once or twice mildly elevated, but even this was never elevated to the point that it would suggest to me that he had any respiratory embarrassment of significance. So that despite the fact that this is potentially a wound of real significance, it did not become so in my judgment prior to the time that his treatment was instituted and thereafter it did not become so because of the effective treatment.
Q Doctor, would you commonly expect injuries such as this one to produce any significant danger of fatality?
A No, viewed as a single injury I would not feel any genuine concern about a fatal outcome in any patient who had it with a normal healthy individual. It might be a different thing if we were -- had tremendous emphysema or something, but taking the normal healthy individual, this is not a wound that would be associated with serious consequences in any recognizable percentage of cases, I would say.
Q Did the information you received give you any indication of Doctor MacDonald's general health prior to the incident in question?
A Well, I was aware that Doctor MacDonald was in the service and was active, and I believe I understood that he had been to jump school and all of this convinces me that he should be regarded as a physically healthy guy. Certainly it is necessary to have excellent medical evaluation before these things are entered into, and so I was convinced that he was at that time physically able and a healthy man.
Q Doctor, in your opinion, could these injuries have been self-inflicted?
A Yes, sir. Individually or collectively there is nothing about any one or all of them that makes me believe they could not or were not self-inflicted.
Q Now in the area that this particular wound which caused a pneumothorax was inflicted, would you expect in the average individual that a shallow wound would penetrate any major organ outside the lung?
A No, sir, not in this area.
Q How about the diaphragm?
A Well in the lateral part of the chest, from the anterior axillary line backwards, the diaphragm is at the level of the 9th rib and below, a couple of inches below where I understand this stab wound to have been. Therefore, there's little to no danger of a shallow wound, even though it penetrates into the air space, penetrating the diaphragm. The diaphragm is a couple of inches away from it.
Q Is there any difficulty -- well, let me withdraw that -- is there any serious possibility that the heart would be penetrated in this area or encountered in this area?
A No, one is safe in the presence of an upside-down heart, as they call it, which puts the heart on the right side of the chest. One would not be in any danger of reaching the heart because in the normal individual, the heart comes only an inch beyond the edge of the breastplate and that's several inches from the axillary line where this wound appears to have been, as has been described to me to have been.
Q Did Doctor Gemma give you any information which leads you to believe that the area of injury is where you described it?
A Yes, sir. Doctor Gemma described his insertion of the chest tube in the 7th intercostal space in the axilla, and he told me that it was right next to or near to the wound that Doctor MacDonald had when he came to the hospital. I indeed had misunderstood, and thought the chest tube had been put in the stab wound. I think one of the other doctors believed that at the time, but when we talked to Doctor Gemma, who put it in, he said, "no, I didn't put it through the stab wound. I put it nearby in the 7th inter space." So that it was obvious to Doctor Gemma that this was a safe and proper place to put a chest tube in to treat a pneumothorax.
Q Doctor, has a pneumothorax type of injury ever been used therapeutically?
A Yes, sir, for many years in the treatment of tuberculosis. In order to collapse cavities within the lung and rest that lung, we would put air in the chest, put a needle in -- in the axilla -- I've done it many times myself while on a chest ward as a resident -- and simply anesthetize the skin, the pleura beneath it, and shove the needle on in, and let a measure or quantity of air go in. We use to put in four to six hundred cc's of air, which means, 500 cc's is a quart, I'd say -- four to six hundred cc's as much as three times a week, in order to keep that lung down, having to refill it because it would absorb over a period of two to three days spontaneously, and we maintained people on pneumothorax in this fashion for months at a time. We did the same thing in the abdomen in some people, in order to help to restrict the expansion of the lung. We would inject the nerve to the diaphragm so that it would be inactive, and then pump air into the belly cavity in the same way so as to push the diaphragm up. Fortunately we don't have to do it anymore because we have drugs that tend to control the tubercle bacillus, so it has passed in vogue, but only because it is a better way to treat the disease.
Q Doctor, when you were at Fort Bragg, did you have an occasion to visit 544 Castle Drive?
A Yes, sir, I did.
Q Have you had occasion to see the laboratory reports as the results of this case?
A Yes, sir, I have.
Q How much time have you spent working in considering this case?
A I was thinking about this this morning, and I would say that by now I've spent 50 or more hours of actual time and study, observation and discussion on the case. I'm not talking about travel time, but actual work time.
Q Doctor, as a result of your expertise, and as a result of your investigation in this case, what is your opinion as to who probably committed this offense?
MR. SEGAL: Oh, that is outrageous. I object, sir. I have never ever heard such an improper question put in a proceeding like this in my life.
CPT BEALE: Sustained.
MR. SEGAL: And I would suggest further, sir, what makes so insulting is that we were given a statement of Doctor Fisher, which Doctor Fisher was good enough to discuss, which deals with medical facts about Doctor MacDonald's condition. Now we're asked --
COL ROCK: Your objection has been sustained.
MR. SEGAL: Yes, sir.
CPT SOMERS: You don't wish to hear the reasoning behind the question?
CPT BEALE: Captain Somers, that is a question which at this stage is for Colonel Rock to decide. And secondly, if this case goes to trial, it's for a jury to decide. This man is not qualified to determine whether or not this accused is guilty or innocent. I don't believe anyone is qualified to give us --
CPT SOMERS: If I may, sir, the only thing that I wish to do is explain the basis and except the rule.
CPT BEALE: There is no reason to explain the basis.
CPT SOMERS: Well, the defense, you see, has used an expert witness, a psychiatrist, to testify as to the likelihood, the probability, based on his expertise of the accused having committed this offense. Now all we wish to do is use an expert who could not be better qualified medically or in terms of his criminal background, his investigatory background, to draw such a conclusion.
CPT BEALE: Captain Somers, we believe that Doctor Sadoff's testimony was based psychiatrically. Now, if Doctor Fisher cares to give an elevation psychiatrically, okay, but in this field of forensic pathology and trying to extend it to guilt or innocence of a particular accused is certainly -- and I've never heard of it being used -- and I don't know in court that would permit it, sir. Now, maybe you've got something that I don't know about.
CPT SOMERS: No, I do not contend that a court would permit it. On the other hand I do not believe a court would permit the extent of the psychiatric testimony which has been introduced here either, and I feel that this is not a court, and since it's gone this far with other experts I felt justified in asking this question. Now, basically, all I wish to do is show that I have a reason, what I consider to be a legitimate reason for asking this question.
COL ROCK: The objection is sustained. Proceed, counselor.
CPT SOMERS: Very good, sir. Your witness.
Questions by MR. SEGAL:
Q Doctor Fisher, who was it who gave you the facts about the incident that took place in the MacDonald house on February 17th?
CPT SOMERS: I object to that. The doctor was not permitted to testify as to the incident, only as to the medical part of his evaluation.
MR. SEGAL: No one has asked the doctor to testify about the incident of February 17th. The question directs itself as to what were the sources of information that Doctor Fisher proceeded from, and of course, would any of his opinions or conclusions be changed, if in fact the sources were inadvertently or otherwise incorrect. It is a proper question.
CPT BEALE: Mr. Segal, now you are referring specifically to the statement or testimony he's already given. Is that correct?
MR. SEGAL: Yes, sir, he discussed -- Doctor Fisher discussed he was told a number of facts about the case which he had used ultimately in arriving at a medical conclusion, including he was told facts about the events that took place on February 17th. I'm not interested in the doctor's opinion about the events. I am interested, however, what were the sources of information that he had, which were used by him in arriving at his judgment on the medical issues, which is all that he's qualified to testify.
CPT BEALE: First of all, I think it's best if you do establish through questioning, the fact the doctor did use sources of his information to arrive at his medical opinions. If you can do that, then you can proceed on to the other point. Okay?
MR. SEGAL: Very good, sir.
Q Doctor, what I am inquiring of you is, in arriving at the opinion that you have given here this morning about the medical situation involving Doctor MacDonald, did you rely upon any other information or have or use other information other than the statements given to you by the four doctors already mentioned this morning?
A Well, there was the hospital record, which, of course, I relied upon. I think it must be obvious to all that I had some general information concerning the events that had occurred at Castle Drive, which culminated in Doctor MacDonald being taken to the hospital where Doctor Jacobson saw him. But I think in dealing with the material reported here, my source are the hospital records, the statements of the four physicians.
Q Well, now --
A This is not to say that I didn't talk to other physicians, but -- and examined other evidence -- but what we are talking about is what is here, and I believe the answer is correct to state that my basic overall knowledge and fact is deaths had occurred at this base at that address, and that what is recorded in the hospital record about Doctor MacDonald's injuries is the substance upon which I reached the opinions that are recorded here.
Q Doctor Fisher, you've also given us some opinion this morning as -- about the head injury that Doctor MacDonald suffered. Have you not?
A In our discussion, you asked me about head injuries and we did discuss it.
Q Also here in your testimony in court this morning, you made reference to it as one of the five areas of injury?
A Yes, sir.
Q Now did you not consider, in arriving at some opinion about the seriousness or non-seriousness of that injury, how the injury was inflicted on Captain MacDonald?
A That's a difficult thing to separate in reaching an opinion. The fact that one has been told that he made a statement that he had been hit on the head with some kind of weapon -- I would have to think that entered into my overall reason, sir.
Q And in fact you were told more than that he was struck in the head. Did you not also consider the fact that there was a specific weapon suggested to you, as the method by which the injury was inflicted on the head?
A I am certain that I have heard or seen the contents of a statement that Doctor MacDonald had made which describes some type of blunt weapon.
Q And who had shown you that statement?
A I believe I got it from Mr. Shaw.
Q And is it correct to say that Mr. Shaw and Mr. Ivory, investigators for the CID, gave you substantial briefing on the facts on the case as they saw it?
A Oh, yes.
Q And in regard to the head injury, you received information from both Mr. Ivory and Mrs. Shaw as to the location of the head injury as they saw it or they knew it to exist?
A I cannot say affirmatively that that's true, other than I knew -- that allegedly there was a blow to the left side of the head which I asked the doctors who had seen him specifically about. The inference is that this was common knowledge within the investigating team and I went to the best source available, namely the doctors, to ask them about this. I don't think I was influenced to any degree by what Mr. Shaw may have said about his head injury.
Q In regard to the head injury, you have indicated that you gave consideration to the condition of the injury on the left forehead. Is that right?
Q Now is that the only head injury that you gave consideration to in arriving at your opinion about the seriousness or lack of seriousness of the head injury?
A This was the only injury that I got a description of from the four doctors as being observed by them, and specifically at least one or two indicated that their examination did not reveal visible evidence to them of other injuries of any significance.
Q Now, if I were to tell you that two other physicians whom you have never had the pleasure of talking with have testified in these proceedings as to the existence of another injury to the right hairline, temple area, and one in the left rear of the head, in addition to the forehead, would that give you reason to perhaps consider further your judgment of the seriousness of head injuries?
A I would doubt very much that the presence of some evidence of a bruise or something in some other location would affect my reasoning, because basically we have described in the hospital record and by the doctors, a man who is brought into the hospital and is immediately described as being alert, indeed anxious, if -- I don't think the word hysterical was used -- but nearly excited; in other words, a man on whom the neurological examination is said to be negative for any evidence that he had sustained injury of his brain, and I would be forced, therefore, to assess the other evidence as being only evidence of inconsequential head injury in terms of the time that we know about, at five o'clock or shortly before that, in the morning.
Q Well, do you consider unconsciousness to be an inconsequential symptom in regard to head injury?
A I would hardly say it's consequential in terms of its immediate situation, but when one is knocked out and wakes up in a relatively short period of time, and if this isn't followed by things, such as headache and other evidence of neurological disturbance, then I think it's relatively insignificant in the overall picture. But to be sure I'm not going to say that for somebody to knock another individual out is inconsequential. At least to him at the time it's pretty real.
Q Not only to him at the time, but wouldn't you say, Doctor Fisher, that that is a medically significant fact that the person who sustained the head injury was in fact rendered unconscious, as opposed to a head injury which did not produce unconsciousness?
A Oh, indeed. The fact that there was force sufficient to produce concussion, which is the state of unconsciousness, associated with cerebral commotion. This means there was enough impact to knock him out -- to drop the medical word and just talk in English -- if you hit him hard enough to knock him out, it would be harder than if you hit him and don't knock him out, everything else being even.
Q Doctor Fisher, wouldn't you say that the size of the contusion as it appears on the head is frequently a misleading indication as to the seriousness of the head injury that may have been sustained by the individual?
A It is true that one can have serious head injury with relatively little bruising externally and conversely that one can have rather large bruising externally and not have any significant brain injury itself.
Q Is it not correct to say that frequently a, as a pathologist when you have a body to examine, that you find what would appear to be relatively superficial or moderate head injury, but on internal examination to find the existence of a subdural hematoma, which is in fact the cause of death?
A This is true.
Q Is the injury to the temple area, if it's inflicted by an instrument such as a bat or a piece of lumber, more likely to be a serious one or have some serious consequences in term of affecting consciousness than the one to the forehead?
A Consciousness alone, I don't know that I can say with any assurance that equal impact, in terms of consciousness -- either one would be apt to be either more severe than the other --
Q Well, let me put it this way. A blow to the -- delivered to the rear of the head -- is that likely to produce a more serious impact on the skull and brain? How would you rate that in regard to a blow to the front of the head?
A Well, it's well established that blows to the back of the head, particularly in the neck, where the force is transmitted directly to the brain stem, are more apt to produce unconsciousness, immediate unconsciousness, than similar blows to the front of the head. This is the whole story of the karate punch. You hit a guy with force that's transmitted to the relatively short distance, the vital centers that have to do with consciousness. If you hit him up here with the same blow it probably doesn't hurt him.
Q How about a blow to the temple? Would you say that is also a blow that has more serious consequences, than perhaps a blow of equal force to the forehead?
CPT SOMERS: I object. He's answered that.
CPT BEALE: Overruled.
A I think with respect to consciousness, I've already indicated I don't think that I can separate this one from this one. With respect to the possibility of other complications, it is of course true that the skull is generally thinner on the side, than in the front, and therefore with a blow of sufficient intensity to fracture the skull here (pointing to the temple), but one would not expect a fracture in the front. Thus, there is a certain potential there of a fracture then being complicated by secondary hemorrhage in this area. There is prone to be, if a fracture is sustained, some -- hemorrhage, hemorrhage between the skull of -- and the lining membrane so that this is the worst place to hit an individual (pointing to the temple) with a club if you take in all consequences than here (pointing to the forehead.)
Q Does it make some difference as to how the injury to the head has been inflicted?
A Yes, sir, it certainly does.
Q If the head is stationary at the time that a blow with a bat or club is inflicted, is that a more serious situation than if the head is moving at the time the bat or club is struck against the head?
A I'll have to answer you in two directions. With a stationary head, as compared with a moving head, the impact from a moving object, if the head is moving away from the object that obviously lessens the impacting force. This is why the prize fighter ducks. If, unfortunately, he ducks into the fist, he may get a lot more effect because the two velocities collide rather than the subtractive one from the other, so that while we are talking about moving objects and moving body depends entirely on which way we are moving. If we get to the falling head -- let's say --
Q Before we get to that, let me suggest to you that what I am asking you about is if the head is moving toward the club or the stick so that the blow is coming from the club or stick toward the head, the head is coming toward that stick -- is that a more serious type of injury than if the head was stationary and the same blow is inflicts?
A Yes, for the same swing of the club, you would have to add to it the same forward motion of the head, so that the resulting impact would be of more significance than if it were stationary with the impact.
Q Were you ever told that Captain MacDonald received a head injury as he was rising from the sofa, getting up, and that the blow was one inflicted upon him, driving him back down, and that in fact his head went into the collision path with the stick?
A I believe that this, in a general way, is recorded in the statement that I read, that he was attempting to get up when he was struck.
Q Now did you indicate also that a blow that is inflicted on the head by say, the head striking the ground or the floor, that that was also a serious type way in which injury is inflicted to the head?
A This is a situation in which the person is falling and suddenly strikes a hard object, the classical situation being the intoxicated individual who stumbles over backward and strikes his head on the pavement. This, of course, has the potential for very serious injury because of the fact decelerated injuries in which the moving head is suddenly arrested by striking a solid object is accompanied by more cerebral, more rotation of the brain within this box, and it's this rotation that tends to tear small blood vessels and leads to secondary hemorrhage, largely subdural. It's also true that it is concussive effect, the comaproducing effect or the knocking-out effect is related to the sudden deceleration of tissue with stresses within the tissue; build up of transmitted force, so that the individual who falls backward and strikes his head is quite prone to be knocked out.
Q What I had in mind --
A Whereas -- let me finish -- whereas the individual whose head is absolutely stationary can sustain a lot of trauma, a fixed head, without being knocked out. I cite the individual who has extensive fracture of the skull when his head was indeed crushed between the rear end of a truck and a brick wall, and he had a major fracture but he didn't lose consciousness then.
Q But he subsequently died after that?
A He died a few days later as a result of it, but the point is the motion and the sudden acceleration of the head or the sudden deceleration of the head is so interwoven with the state of consciousness, rather than, for example, the skull fracture. The concussion and coma are related to motion, and it's the suddenness of deceleration in the fall is much more apt to be significant or greater magnitude than the acceleration of an impact.
Q Doctor Fisher, were you ever made aware of the fact that from the position of the sofa Captain MacDonald was rising and struck on the head that he subsequently came to lying on the floor chest down?
A I'm aware that this statement was made, yes.
Q And would that indicate to you that there was a possibility of the head having suffered one of these decelerating type blows, that is the head striking against the wooden floor of the house?
A Based upon the statement that he awoke some time later on the floor in the hall, having gotten there in some unknown way, certainly the possibility exists that he fell and struck his head on the way down, when he went down.
Q Where a patient has some evidence that he's been unconscious, that he showed external signs of a blow to the head, in your experience, is the proper procedure, neurological procedure, to have the head x-rayed so that the extent of the injuries can be proper ascertained?
A Well, I think this becomes a matter of clinical judgment of the attending physician. If he has any misgivings about it, then sure, he should have it x-rayed, but if the neurological is noted -- the man is alert and he has no real complaints directed towards his head, and he's going to be able to observe him, then I don't think an x-ray is imperative. It is much more important if you can't watch the guy for twenty-four hours, because what we classically do is we put him in the hospital and watch his pulse and respiration, these signs are watched and if anything goes out of line, then obviously we look for trouble and x-ray and what have you, but in the absence of any clinical symptomatology of anything wrong, particularly in the orientation, this bit. No, I wouldn't say he should be x-rayed. It is a waste of x-ray and further exposure to x-rays, which we try to avoid, if we can.
Q I gather from that, that you would think if there is evidence of unconsciousness and visual evidence of a blow, of one or more blows to the head, that neurological status of the patient should be followed closely for at least the first twenty-four hours or more?
A I think it's a good idea to put such a patient in the hospital and watch him for twenty-four hours. It isn't done on a very broad scale in the civilian life simply because you can't stick apparently well people in the hospital and keep them twenty-four hours just because of a potential danger.
Q I wasn't suggesting apparently well people, but I was suggesting in this particular case, in view of the history the physicians had of assault, chest wound, and a head wound; did it strike you as an appropriate procedure to be followed to put the patient on a neurological status for watching for twenty-four hours or more?
CPT SOMERS: I object to this. I think he has answered this line of questions. Furthermore, it is not relevant.
MR. SEGAL: This is cross-examination; we are entitled to go into the basis of the doctor's conclusions. Doctor Fisher is quite willing to indicate -- to explain the significance of the procedures that were followed.
CPT BEALE: Your objection is overruled, Captain Somers.
COL ROCK: However, I am wondering how much longer this line of inquiry will be followed, counselor?
MR. SEGAL: On the head injuries?
COL ROCK: Right.
MR. SEGAL: I think that is about the end of it, sir.
COL ROCK: Okay.
WITNESS: Could I have the question again?
Q Surely, Doctor Fisher. What I was asking is, in a case such as this, where the physician observes a chest injury, head injury, and the patient is in the hospital, would it not seem appropriate to you that the proper procedure would be to have the neurological status of the patient watched closely for the first twenty-four hours or so in the hospital?
A I think this is automatic. This man has a tube in his chest and he's going to be confined right here in bed. There are nurses, doctors, in attendance; they're going to look at him. If he shows signs of neurological abnormality, it's gong to be attended, but I don't -- it's just my assessment, mind you, that had -- as he was admitted with the knowledge that he was going to be in the hospital and no evidence that his head injuries were of any significance at that time, and they didn't bother to write orders to follow his head injury. I think it attests more to the insignificance that they attached to his head injuries since they didn't write orders for complete neurological routine, assuming that he would have the standard sort of thing, and Doctor Bronstein did do a neurological examination. He wasn't much upset about it. But I would say it didn't matter whether they write an order or not, they're going to watch the patient.
Q Doctor Fisher, you aren't really suggesting to the investigating officer that because something wasn't done in the hospital, that means that it necessarily follow that that was the proper procedure to do things?
A Well, I wouldn't want to go so far to say that totally, but my point was that one reads the record, at least I am not impressed with any gross failure in not ordering further neurological investigation upon the background that we have the patient, we are going to be seeing him from time to time. It follows; we are going to be doing neurological checks as is necessary.
Q Well, now is there any evidence at all in the medical records to show that ever a single reasonable thorough neurological workup was ever done to satisfy the physician there was no serious head injury?
CPT SOMERS: I object to that, unless the counselor wants to define his terms of "reasonable thorough neurological" investigation, the term used by a layman to an expert.
Q Doctor Fisher, what does reasonable thorough --
A Could we look at the record a minute? I think there is something in the record about a neurological --
Q Absolutely, I'd be very glad to. Might we have it made available? Mine is not the official --
(A-28 was handed to Doctor Fisher.)
A In the original typed record, on page that is headed "Date of Admission, 17 February," the Narrative Summary, there are some points that have to do with his neurological examination. "Eyes -- pupils round, regular and reactive to light and accommodation." "Extremities -- full range of motion." This indicates to me there was definite attention paid to neurological status. Again, in Doctor Jacobson's notes, "No sensory or motor complaints pertinent to left -- " and I can't be sure whether that's "arm" or, but at any rate here "No sensory or motor complaints" indicates some degree of neurological examination, and there is the statement, "Patient does not know if he was unconscious." Then again, that statement, "Excited coherent healthy young man concerned about family." Again, they are giving some picture of his neurological situation.
Q Well, from those observations, Doctor Fisher, are you ready to conclude that anything more than emergency room procedure was followed in this case to just check the neurological symptoms?
A Well, I did ask Doctor Bronstein specifically and he did tell me they did a neurological examination. I haven't found his note in this record, but it is established that he did see the doctor and that he did some sort of examination and his statement was that he did a neurological and he found nothing wrong with it, no evidence of any consequences of his blows or whatever the terminology was. So I believe he had a neurological examination adequate to the situation at hand.
Q Did Doctor Bronstein make clear to you that the neurological checkup -- check that he made was in fact part of the emergency room procedure, and that the basic attention was directed to the chest wound, rather than a thorough examination for neurological injury?
A I would -- I have the impression, as I recollect his statement, that obviously they were paying attention to his chest. This was a more concrete thing to look at, but I also got very strongly the impression of having done a neurological assessment and he saw no problems. I believe the rest of the record indicates that there was no neurological complication of his head injuries.
Q That's a hindsight observation, of course?
A This is true, but I think before I would be critical of a judgment to not do more examination or more procedures, I would perhaps have to have some hindsight evidence that they were wrong.
COL ROCK: If I may interject here just a moment, Mr. Segal. Doctor Fisher, would you say that normal medical procedures were followed as you understand them in the case of this patient being admitted to the hospital?
WITNESS: Yes, sir.
COL ROCK: Do we need to follow this any further, Mr. Segal? I was under the impression that you were just about through
MR. SEGAL: Very, very briefly, sir.
Q What I want to clarify Doctor Fisher, is are you saying normal medical emergency room procedures were followed in this regards?
A I think with respect to medical treatment, emergency room and subsequent surgical treatment.
Q Let me make something clear. I wasn't suggesting that the doctors at the hospital did not do subsequently what they thought was the proper and, in fact, was proper, but what I am suggesting is that they may not have had adequate basis for your own conclusion about the seriousness of the head injury. In that regard, I want to put this question to you. Have you not made a number of references here this morning to the so-called coherence or clarity of Doctor MacDonald at the time as one of the symptoms or signs that led you to conclude that he wouldn't have had very much wrong with his head injury?
A I have indeed said that alertness, mental alertness, is a -- one of the bits of evidence that goes into assessing an individual as not having a post-concussive picture which is generally that of depression of mental functions, or slowness in thinking, of poor reflex activity, et cetera.
Q There is no indication that reflexes were ever checked?
A Well, there's a statement "normal motor activity," but by reflex I was thinking of cerebral reflex, the response to a question, this sort of stuff. I wasn't talking about motor reflexes.
Q All right, you are talking about responses to questions, the ability to relate things coherently. Would that be a good sign to indicate there's not much seriously wrong by the head injury, if a person can do that?
A To answer your questions coherently will indicate at that time he's not suffering from concussive effects, yes.
Q And the ability to perhaps tell things in logical order. Is that a sign of, you know, reasonably good orientation, and not suffering much effect from a head injury?
A Well, one would have to say if one cannot relate things in a normal order, and is not excited, emotionally upset, et cetera, et cetera, then one would ascribe this to brain injury, but the absence of a strict recall and recounting of events in perfect order doesn't lead me necessarily to the conclusion that it was concussive. You can consider the situation of the emotional involvement that must prevail in the instant case. There's plenty of explanation for any failure to relate coherently events simply because of emotional impact.
Q I gather from your testimony this morning that you didn't seem to think that there was much of that present in Doctor MacDonald's situation.
A I'm saying what they observed medically doesn't indicate this.
Q Now let me ask you this, Doctor Fisher. Were you ever told by anybody, for instance, that FBI agents who interviewed Doctor MacDonald on the 17th, found him to be lacking coherence, to be unable to recite things in reasonable, chronological order, who found him to be somewhat confused and generally difficult to question and get the facts? Have you ever been told that?
A I don't ever -- if I recall, the FBI agent, part of it, I was aware that his recounting the story of events was considerably clouded, and when he tried to recount it, it was difficult, as I recall.
Q Did anyone ever tell you that any investigator on the 17th found, in his professional judgment, that Captain MacDonald was incoherent?
A Certainly I was aware of the fact that in attempting to reconstruct the events of the night, that he had great difficulty in recalling and telling in a clear, orderly fashion what happened, if that's what you meant by incoherent.
Q No, I divide that, Doctor Fisher, into different points. That is, the ability to structure things in a reasonable order as one element. The ability to tell things coherently as another element, and am asking you whether anybody ever told you that FBI agents or any FBI agent or investigative agent observed this phenomena about Doctor MacDonald, that he wasn't doing both of those very well on the 17th of February?
A With respect to the events of the night before --
Q Or earlier the same day.
A Well, I'm certainly aware at some stage some such statement was made that he had difficulty in recollecting clearly what went on.
Q And difficulty in relating it in a reasonable coherent fashion?
A I'm not under the impression that that day he had incoherence as to the events that occurred. Let's say at eleven o'clock he was incoherent about events that occurred at 10:45, but rather that he was having difficulty in recall and reconstruction, if you will, of events that occurred the previous early morning hours, at a time when he's obviously under, would normally be expected to be under extreme emotional tension, knowing of the misfortune that had befallen his family.
MR. SEGAL: That's all that I have in this area, I think. It probably would be an appropriate juncture, if you want to move on to other matters, after lunch.
COL ROCK: This hearing will be recessed until 1330.
(The hearing recessed at 1204 hours, 9 September 1970.)
(The hearing reopened at 1309 hours, 9 September 1970.)
COL ROCK: This hearing will come to order. Let the record reflect that those parties who were present at the recess are currently in the hearing room.
COL ROCK: Doctor Fisher, I again remind you, sir that you are under oath. Proceed, counselor.
Continued questions by MR. SEGAL:
Q Doctor Fisher, I want to clarify in my own mind something in regard to injury to the lung. You did say, did you not, this morning, that you considered this to be potentially a wound of real significance?
A Certainly, I could not -- I don't believe I said exactly that -- I could not deny that a wound of this sort, untreated, might not become a serious wound, but I would not think that a wound of this sort with any reasonable medical treatment would indeed constitute any significant threat to life.
Q Do I gather that you don't think I have reiterated your words accurately when I say that my recollection was that you called it a wound potentially of real significance?
A I would think that that's not what I said, or certainly not what I intended to convey, because immediately one assumes that one would have medical treatment of a wound, and with this situation at hand I don't think it was a serious wound.
Q If not treated promptly, your judgment, I assume, would change?
A With no treatment whatsoever I would concede that this might become a serious wound.
Q And the greater the delay in getting the treatment the more serious the injury potentially has?
A From what we know, without knowing the exact time the wound was sustained, it was evident that at five o'clock it had not proceeded to any condition of seriousness. Indeed, it was quite some time later when they took the second x-ray and decided to insert the tube.
Q What I'm asking now, generally injury to the lung produces the kind of collapse that we are talking about to the lung -- the longer the wound goes unattended the more serious it is?
A This is true with any wound whatsoever. If you neglect it indefinitely it may become infected or otherwise complicated.
Q Are you suggesting that that's true with the other three separate body wounds that Captain MacDonald suffered?
A I suggest that that's true for any wound, when neglected, it may become infected.
Q Now, but really to put things in the proper perspective, you are not considering the other three sets of wounds to the body, as having the same potential or danger to life unattended as the lung would if not attended properly?
A I would not think that the others has as much potential as this, but I reiterate I don't think this had any serious potential, any danger of becoming a serious wound even if neglected for hours.
Q Let me ask you this. Did you ever examine Captain MacDonald?
A No, sir.
Q Did you ever ask to examine Captain MacDonald?
A No, sir.
Q On a number of occasions this morning I observed that you pointed on your own body to the place where the stab wound to the lung was inflicted, and if I am correct of my observation, I believe that you pointed repeatedly to the lower right-hand corner of your white shirt pocket. Is that right? Where you indicated the wound was?
A Well, I can't answer for where I pointed, with these bifocals, but I understand that the wound was located in or posterior to the anterior axillary line in the 7th interspace. I am told that is in the testimony.
Q All right, would you indicate for us, with your finger, please, sir, on your own body, where that wound would be located, the area that you've just described?
A I think I can count. If I counted right, this is between the 7th and 8th ribs, so it's therefore in the 7th interspace, and I would say that this is about the anterior axillary line.
Q Now where did you learn that the chest tube was inserted in Captain MacDonald?
A Near that, but more to the mid-axillary.
Q You say near, how close are you talking about?
A Within a centimeter or two, within an inch.
Q May I ask how you obtained the information as to where the wound that Captain MacDonald suffered to the lung was located?
A Well, I asked Doctor Gemma where he put in the chest tube. I think the record shows where the chest tube was put in. And Doctor Gemma said that he put it in near, and indicated to me this proximity in general.
Q Did you make any other inquiries as to where the exact location of the chest wound was?
A I had inquired of other people and was given information which was not contradicted by Doctor Gemma, because there was an impression that another doctor had that it was more to the front, but he admitted that he didn't see where the wound -- he stated that he didn't actually see the wound, but only the bandaging, and when we were seeking the best source of information, we went to the surgeon, and who indeed inserted the tube, and who obviously saw the wound, and this is what I obtained.
Q Well, you wouldn't consider that to be the best source? That would be second best to your own examination of the wounds on the body of Captain MacDonald?
A Now we are debating on whether Doctor Gemma's examination and memory would be better that my direct examination. I wouldn't deny that it's about as good a source as you can have to look at him yourself.
Q Is there any notation in any of the medical records as to the specific location of the chest wound?
A I do not believe it is adequately described in the record, sir.
Q And the conclusion that you arrived at, that the wound to the lung didn't endanger the diaphragm or the liver, was based upon your conclusion that the wound was delivered to the anterior axillary 7th interspace. Is that right?
A It was the 7th interspace and it was in or behind the anterior axillary line, and the anterior axillary line is an imaginary line that runs from the arm pit straight down to the body -- well, the axilla is this area in the arm pit from front to back in the armpit and that line drops down is the anterior axillary line. It separates, in effect, in front from the side of the chest, if one can imagine a line separating it for instruction in the two areas.
Q Now would you indicate on your own body, please, where is the mid-sternum line of the body?
A Mid-sternum? This is the mid-line of the body.
Q In other words, just about the center of the chest.
A Mid-sternum, yes.
Q Now, if I were to tell you that the record in this case indicates that the wound to Doctor MacDonald's lung was six centimeters from the mid-sternum, would that have any influence at all on your judgment about what organs were endangered in the body?
A The wound to the lung?
Q Right, was six centimeters from the mid-sternum of Captain MacDonald.
A I would have to find out how anybody knows where the injury to the lung was.
Q I'm talking about the external manifestation of the injury to the lung. That is where you see the position of where the hole in the body is, then you have some idea of what the organs are behind it. One could reasonably conclude, could they not, that when you see a hole over the position where the lung is, that there was an injury to the lung there?
A Well, I cannot conclude that you can even get in the 7th interspace if you are only six centimeters from the mid-sternum, which is the mid-line of the body, because at that point the air space is closed -- so there has to be something wrong about this measurement.
Q Something wrong about it. Are you saying to us that it's impossible for the knife wound to have been inflicted to Captain MacDonald's chest at a position that is six centimeters from the mid-sternum?
A Six centimeters is -- five centimeters is two inches -- so we are talking about two and a quarter inches. Two and a quarter inches from the mid-line of the body would not, in my judgment, get into the 7th intercostal space.
Q How many centimeters from the mid-sternum would be required before you could enter the 7th intercostal space?
A Well, may I have Captain --
Q With a man of Captain MacDonald's build?
A Well, I think this is a little bit speculative, because I really don't know the internal structure of the chest -- his chest -- at all.
COL ROCK: Counsel, could you indicate to me your line of questioning. It seems that if we are going to get into this, the best thing to do is to see if Doctor MacDonald would be willing to expose himself.
MR. SEGAL: That is exactly what I desire to do, sir.
COL ROCK: Okay, fine.
Q Before we get to that, if the wound to Captain MacDonald chest is 7 centimeters from the mid-sternum, would that change your judgment as to what organs internally were endangered by the wound, as opposed to your belief that it was located anterior --
A Certainly different anatomy would be exposed if it's around the front of the chest, than it is in the side of the chest.
Q Around the front of the chest, would the diaphragm be exposed to danger from such an injury?
A Just offhand, I don't know how far we have to go lateral to the mid-line to get into the 7th intercostal space. This is extremely variable.
Q We are talking about six or seven centimeters now.
A I'm saying that this varies greatly from person to person, and I don't even know if you'd get into the 7th intercostal space there.
MR. SEGAL: At this junction, if you will permit us, Colonel Rock, to allow Doctor Fisher to examine the actual marks on the body of Captain MacDonald.
COL ROCK: Since it may clarify it, I have no objection. Does counsel for the government?
CPT SOMERS: None, sir.
COL ROCK: If you wish to, you can do it out of the courtroom, or whatever appears to be most appropriate.
MR. SEGAL: I am agreeable to that, but I would request the presence of the investigating officer and the legal advisor.
COL ROCK: We'll take a recess now.
(The hearing recessed at 1320 hours, 9 September 1970.)
(The hearing reopened at 1324 hours, 9 September 1970.)
COL ROCK: This hearing will come to order. Let the record reflect that all parties who were present at the beginning of the recess are currently in the hearing room.
I again remind you, Doctor Fisher, that you are under oath.
The purpose of the recess was to provide Doctor Fisher, the witness, an opportunity to physically examine Captain MacDonald's upper torso.
Continued questions by MR. SEGAL:
Q Doctor Fisher, you've had an opportunity, I believe, in this interim, to take some measurements, based upon your examination of the bared chest of Captain MacDonald. Am I correct in that regard?
A Yes, sir.
Q Now would you indicate for us, what is the measurement from the mid-sternum, that is, the mid-chest line to the place where you found to be the healed scar of the chest wound?
A The site indicated as the healed scar is three and one half inches from the midline.
Q And the centimeters, as I unfortunately stated in that terminology before, would be what?
A Almost nine, eight and three-quarters.
Q And did you also find the location of what appeared to be the place where the chest tube had been inserted in Captain MacDonald's right chest?
A Yes, sir, I did.
Q And could you give us the location of that?
A This is square in the mid-axillary line, eight inches, around the chest from the midline.
Q Now is it fair to say that the place you found actually by examining Captain MacDonald, to be the locale of the chest tube insertion, is where you believe actually that the knife wound or ice pick wound has been made?
A I had believed that it was near the -- the stab wound was near the eight-inch wound for surgery, and such does not appear to be the case.
Q In fact, in view of the actual correct location of the stab wound being three and a half inches from the midline, would you now indicate to the investigating officer, what organs are endangered by a stab wound to that area of the chest?
A Well, that far around in front, I believe it entirely possible that the diaphragm could have been contacted, had this knife been inserted beyond the chest wall, and had it been say, inserted to a depth of -- I would say -- two inches or more, I think it might have contacted the liver.
Q When you say two inches from the outer section of the body to the liver?
A Yes, I think -- you see, the liver is rounded in that area and it retreats somewhat from the chest wall, but if you enter a couple of inches you are going to get it in the diaphragm and into the liver, if you are within three and a half inches of the midline in front.
Q So that your estimation, only a two-inch penetration by a stabbing instrument would be necessary to possibly touch the liver in Captain MacDonald's case?
A That's correct, in view of what we now know of the location.
Q Were you ever aware that there was more than one chest tube inserted in Captain MacDonald's body?
A Yes, sir, the second tube was subsequently put in the second interspace.
Q And when did you become aware of that?
A On the day I was down here talking to Doctor Gemma.
Q Now you characterized the chest wound that entered the lung as a shallow puncture wound. Would you tell the investigating officer to what depth that wound was?
A Well, all I intended to convey was that it would have, in order to penetrate the lung, it would need to penetrate only approximately half an inch, to skim the surface of the lung. I cannot say how deep it, in fact, penetrated, but a relatively shallow wound in the location around here, is capable of going through the chest wall and therefore, the tip of the instrument would stick into the lung. The chest wall is about half an inch in that area.
Q You are talking about the anterior area. Is that right?
A Well, the chest wall is pretty uniform, except in the back wall, of course, where it's --
Q Did any of the treating physicians tell you that they were able to measure the depth at which that stab wound was in the chest?
A No, sir.
Q If I were to tell you that the three surgeons and a fourth emergency room treating physician, who all dealt with Captain MacDonald the 17th of February, have testified or indicated that they considered the chest wound to be a life-threatening wound, would you disagree with their testimony, or their opinion?
A Well, in this location that's been actually established, I've already indicated that Doctor Gemma's statement misled me, or I was misled by it because certainly I cannot say that this wound is nearby the chest wound, which is what he told us, I would indicate as a superficial wound still capable of producing pneumothorax. It need not be a serious or fatal wound. But I would also qualify this by saying that if someone were to insert a knife two to four inches in that area, then this would change the picture considerably, and I would be very concerned less the liver be damaged and surgery be required, and all those things, which then makes it a serious business.
Q Well, I am not absolutely sure whether I understand you ultimately agree or disagree with what I am suggesting to you has been the testimony here that other persons who are surgeons with medical qualifications have testified and accept the language that they considered this to be a life-threatening wound, would you disagree?
A I would disagree with it, if they postulated it on the basis of a wound a half or three-quarters of an inch deep, which is the only positive information we have. We know there was a pneumothorax, hence we know it went in half an inch, and I wouldn't consider that any more serious in this location than I did around to the side. If on the other hand, they postulate, they base their answer on a two or three inch deep wound, then I would agree with them. It's simply that I think we now have to examine the situation upon which we reach a conclusion. Shallow wound -- still not very significant. Deep wound -- obviously a serious wound.
Q Couldn't you develop a tension pneumothorax with a wound to any depth in that particular area?
A One can develop a pneumothorax with a wound deep enough to penetrate the lung in any area, regardless of whether it is here or there.
Q And wouldn't you consider a tension pneumothorax as a life-threatening type of injury?
A No, I don't think a tension pneumothorax, with treatment, is of any great significance from a single stab wound. It's a different thing if you've got multiple fractures in ribs and all this sort of business, but a single tension thorax is readily treatable and I don't consider it a dangerous situation as long as it's -- it comes under treatment.
Q Well, then I gather you are disagreeing with the testimony of the surgeons who had suggested to you, adopted the language that they consider it to be a life-threatening type injury?
A I'm afraid that there's been no evidence put to me that there was a tension pneumothorax here at any stage of the game. Hence, I come back to the fact that he didn't have a tension pneumothorax, since I don't see the potential.
Q Let me perhaps clarify my question. Assuming this as a pneumothorax, without the tension pneumothorax, and that being the only facts that the surgeons who have been here have know of, a pneumothorax, you do therefore disagree with them when they say this is a life-threatening injury?
A Yes, sir, I don't think this is a life-threatening injury with any reasonable treatment at all.
Q And the reasonable treatment, in your judgment, means prompt medical treatment, I assume, in a hospital?
A Prompt, within a matter of hours, certainly.
Q Could a physician who attempted to self-inflict an injury to the chest and lung, as in the case of Captain MacDonald, absolutely know the medical consequences of stabbing himself in the lung with a sharp instrument?
A I'm afraid you are asking me to assume some things I don't know about Captain MacDonald, namely his knowledge of anatomy and so on and so forth. I would think that I could pretty well foresee the consequences of stabbing myself in this situation.
Q And when you say now, anticipate the consequences, maybe I don't fully comprehend. What would you consider to be consequences that you could reasonably anticipate if you stabbed yourself in your own right lung in the place where Captain MacDonald was stabbed?
A I would anticipate a pneumothorax, providing it was a reasonably shallow stab. Now, if it's a two or four inch deep stab wound that is another set of consequences, and I would admittedly be very -- of a different mind, with this deep stab wound that might damage the liver, than I would with a wound which doesn't damage the liver and produces only a pneumothorax, as was apparently the case here.
Q If you were using a knife which had a three or three and a half inch blade, is there any way that a physician would be able to determine with reasonable certainty a medical consequence of stabbing himself in the lung with such a knife?
A I can see how one, if he chose to do this, would simply not stab himself full hilt depth. This is not the procedure to do it, if one is being reasonably careful.
Q Well, is it possible to be reasonably careful in a stab wound inflicted to one's own lung in view of the breathing and the effect that that has on the movement of the liver and the diaphragm and other parts and other organs of the body in that area?
A Well, mind you, I don't advise doing it, but I could foresee how it -- again, I'm speculating about what someone else would do.
Q Let me --
COL ROCK: We recognize that, sir.
Q If I were to tell you that approximately four physicians who have testified under oath in this case have stated that they could not -- that in their judgment a physician could not absolutely know the medical consequences of stabbing himself in his own lung, would you agree or disagree with that statement by other physicians?
A I think I have answered in a qualified way, saying if it is shallow one would or should be reasonably able to anticipate what's going to happen. If it is four inches deep one should reasonably appreciate the danger of it, and I fail to understand why physicians, if they are well aware of the anatomy and so forth, wouldn't differentiate between these two situations, and have different opinions for the two situations.
Q You made reference to the fact that you were taking into consideration in your judgment about Captain MacDonald, the fact that his life signs did not seem to be very much out of line, including -- concluding his injuries wasn't terribly serious?
A Yes, sir, that's correct.
Q Were you aware at the time that there was information recorded in the health records that he had been previously given intravenous procedure, and he had previously been given medication?
A I know that he had medication started, certainly after he got to the hospital and IV, but he had no treatment of his pneumothorax, which was the thing that we are looking to be procedure abnormalities. So the facts are his pneumothorax is not advanced or was not of such degree such as to produce any evidence that he was in trouble from it.
Q I thought you indicated, Doctor Fisher, that this kind of chest injury, all you would need was a gauze bandage with some Vaseline around it. Now you are saying that you disagree with the treatment about the administration of medication to Doctor MacDonald?
A I don't know that I said all one needs for it. I said that the immediate treatment is to put the gauze -- Vaseline gauze on it. I don't at the moment understand why they started intravenous fluids in a patient who is in no way in shock, his blood pressure is classically normal, his pulse rate is classically normal. Perhaps they thought that trouble might be coming, and therefore they put the intravenous in. I also can't answer for the total reasoning of the physicians who prescribed medication for him, but it's clear that medication was prescribed as sedation, or this type of medication.
Q Doesn't that affect the pulse rate and blood pressure when you --
A It would return it to normal if it were abnormal from excitement. It wouldn't return it to normal if it was abnormal from embarrassment of the circulation by pneumothorax. But in this case it wasn't that far enough out of line to amount to anything anyway.
MR. SEGAL: I have nothing further, Doctor Fisher.
Questions by CPT SOMERS:
Q If the FBI agent who was alluded to in the cross-examination as having used the word "incoherent" were to have interviewed Doctor MacDonald while he was under sedation, would the sedation have something to do with the question of his coherence?
A I would certainly believe it would have because one of the effects of sedation is to interfere with the thought process in the normal coherence of reasoning.
Q Does the hospital records by treating doctors, insofar as you know, give you any evidence of damage to the liver or diaphragm in this case?
A There was no evidence whatsoever recorded, nor was I able to elicit any evidence from anybody that they thought they had injury to the liver, and specifically there is a statement that there was no hemothorax, which means there was no bloodshed into this space down here along with the air that entered. So one therefore could be relatively certain that he didn't stick his diaphragm and his liver because this would have bled and it would have accumulated right down here, nor did he go deeply into the lung because -- although this is more difficult to tell about -- the lung is resilient and may not bleed after significant penetration, but the liver bleeds, if it is penetrated -- that's all -- it bleeds.
Q Doctor, in talking to the doctors that you've alluded to, did you have occasion to ask them specifically about signs of neurological disorder?
A Yes, I recall asking one of the doctors -- my impression at the moment is Doctor Bronstein, although this can be corroborated if necessary -- specifically about neurological examination, and I was told that the neurological examination was negative, in addition to which, there was the general discussion about his neurological state, and I've indicated from the hospital records repeated references to alert, eye motions, the external eye muscles and so on and so forth being examined, and to the other gross signs of neurological normalcy, if you know what I mean. Very early, when you have neurological difficulties, one gets eye motions and reflexes and these things. Its movement, the ocular muscle, for example, the pupilary reaction is relatively sensitive, and these were recorded. While one may not make an obvious and specific detailed neurological examination, he can't fail to assess the neurological state of his patient when he comes in and does these things. If he sees abnormalities, then he obviously will follow with more detail in determining procedures, but I think whenever a doctor examines a patient, he does some degree of assessment of his neurological status by assessing his alertness, his eye motions, his reflexes, these sorts of things.
Q Do you find any evidence in any of your sources that Captain MacDonald suffered serious damage from the blows to the head?
A No, sir, I do not.
CPT SOMERS: No further questions.
MR. SEGAL: I have nothing further, sir.
Questions by COL ROCK:
COL ROCK: Doctor Fisher, is it possible that the pneumothorax could have been higher than 20% prior to the time that Doctor MacDonald was first seen by the physician in the emergency room?
WITNESS: No, sir, I do not believe so, because the lung, until a chest wound is closed, it only goes one way. It goes down. It doesn't return. Once you close the wound then it may return normally, but if one assumes that this wound was in nowise treated from the moment of inception until somebody put a bandage on it in the accident room then I don't believe his pneumothorax was at any higher degree at any time than it was when they did an x-ray.
COL ROCK: What would be your thought as to the result of a person with a 20% pneumothorax attempting to give mouth-to-mouth resuscitation to someone else? What effects would that have on that individual?
WITNESS: On the person with a 20%?
COL ROCK: Right, affirmative.
WITNESS: Oh, I would think, if anything, it might tend to decrease the rate of collapse of his lung because it would, in giving artificial resuscitation one raises some positive pressure, one blows. Well, this very thing would -- it could do both ways. I must admit you could blow air out into the space by doing this, but if the chest wall is open then it should go on out, escape. If the chest wound is closed, then one would not want to give -- to be the one to do the resuscitation because this would tend to compress the lung. But as long as the lung, the hole in the chest was open, I don't see where it would influence it significantly either way.
COL ROCK: In your estimation, would a 20% pneumothorax of itself, cause someone to lose consciousness?
WITNESS: No sir, I see no reason why it should.
COL ROCK: I have no further questions. Does either counsel?
MR. SEGAL: I have nothing, sir.
CPT SOMERS: Nothing by the government.
COL ROCK: I assume you wish the doctor excused.
Doctor Fisher, you are requested not to discuss your testimony with any person other than counsel for the government or counsel for the accused. I thank you for testifying in terminology today.
CPT SOMERS: At this time, sir, I think it would be appropriate to take a ten-minute recess.
COL ROCK: We will recess.
(The hearing recessed at 1346 hours, 9 September 1970.)