July 30, 1979
Dr. Merrill Bronstein, M.D.
Scans of original transcript
MR. BLACKBURN: Your Honor, we call Dr. Merrill Bronstein.
(Whereupon, DR. MERRILL H. BRONSTEIN was called as a witness, duly sworn, and testified as follows:)
D I R E C T E X A M I N A T I O N 10:53 a.m.
BY MR. BLACKBURN:
Q Please state your name, sir?
A Merrill Hersch Bronstein.
Q Dr. Bronstein, please, if you would, speak loudly enouch so everyone can hear you. Dr. Bronstein, where do you presently live?
A In San Francisco, California.
Q How are you employed?
A I am in private practice of heart surgery.
Q What education -- what is your educational background, sir?
A I went to college and medical school and did residencies in general surgery and in thoracic and cardiovascular surgery.
Q Where did you go to college?
A I went to Kenyon College at Gambier, Ohio. I went to Chicago Medical School in Chicago, Illinois. I did my internship at Jefferson Hospital in Philadelphia; residency and general surgery at Temple University in Philadelphia; residency in thoracic and cardiovascular surgery in the University of California in San Francisco.
Q Now, directing your attention to February of 1970, did you have an occasion to be employed at Womack Hospital?
A Yes. I was a captain in the United States Air Force, and I was stationed in the Department of Surgery at the Womack Army Hospital at Fort Bragg, North Carolina. I was in charge of a surgical ward there.
MR. BLACKBURN: Your Honor, at this time, we would offer this witness as an expert in the field of medical science.
THE COURT: Very well.
BY MR. BLACKBURN:
Q Dr. Bronstein, who was in charge, if you know, sir, of the Department of General Surgery at that time?
A Dr. Frank Gemma.
Q Where were you in the pecking order, so to speak?
A I was a partially-trained general surgeon. The department consisted of about ten or 12 doctors, the majority of whom were Board-certified general surgeons. At that time, I had been there a long time, so I was in charge of a ward; so, in the pecking order, I would say that I was about average.
Q Now, in February of 1970, did you have an occasion to know the Defendant, Jeffrey MacDonald?
Q How long had you known him, sir?
A A few months.
Q How did you first meet him?
A We met through our outside employment. Both of us worked moonlighting in the Emergency Room of the Cape Fear Valley Hospital. It was outside of our military positions.
Q Did you know each other on a social basis or was it purely professional?
A It was an acquaintanceship. For example, we would work shifts as physicians, and we would often be in shifts that were back-to-back so that either I would be going and he would be coming or vice-versa. We would talk and discuss patients who either of us might be responsible for that the other had seen or to get follow-up on patients we had seen on previous times that we were working in that Emergency Room.
Q Now, directing your attention to the 17th of February, 1970, and as a result of being employed at Womack Hospital, did you have an occasion to go to the hospital early that morning?
A Yes. I was the Staff Surgeon on call for the Department of Surgery at Womack Army Hospital on that night. I was called in the early morning hours.
Q Do you recall who telephoned you?
A Yes, Dr. Jacobson. He was the Surgical Resident. He was the resident in general surgery, and he was the Staff Surgeon responsible for the hospital that night. He was staying in the hospital that night. I lived on the post about a mile from the hospital, and he called me.
Q Do you recall the approximate time, sir?
A I think it was probably before 5:00 o'clock -- maybe 4:30 or quarter to 5:00 -- somewhere in there.
Q What did Dr. Jacobson say to you, as best you can recall?
A He said that a doctor of our mutual acquaintance had been admitted to the hospital and had been stabbed and that his family had been killed, and could I please come to the hospital and help him out.
Q As a result of that telephone call, what did you do?
A I got dressed and went to the hospital.
Q Approximately how long did it take you to get to the hospital?
A A few minutes, I would imagine. I am certain that it was not more than -- I mean it couldn't have been a half hour -- probably 15 minutes to get dressed and get over there.
Q When you got there, where did you first go?
A To the Intensive Care Unit.
Q And you saw Dr. MacDonald there, I presume?
A Yes. When I came into the Intensive Care Unit, Dr. MacDonald was there and he was in one of the cubicles in the Intensive Care Unit.
Q When did you first actually see Dr. MacDonald? Is that when you first saw him?
A I saw him from the instant that I walked into the Intensive Care Unit.
Q Who else besides yourself and Dr. MacDonald were present, if you can recall?
A I don't recall.
Q How was Dr. MacDonald dressed?
A He had his pajama bottoms on and that is all.
Q You were able then to view his entire chest area and arm area; is that correct?
A Well, I went in and I talked to him and then I examined him. I think -- well, I don't remember the exact order, but I know that when I examined him, I had him to take off his pajama bottoms.
Q Now, where did this examination take place?
A In the bed in the Intensive Care Unit.
Q When you went in, was he lying down or was he sitting up?
A He was lying down on the bed.
Q With respect to the examination, where did you first examine him on his body?
A I looked at him, I guess, all over. I mean, I was, I am sure, not concentrating on any specific area.
Q With respect to his head area, what examination, if any, did you conduct there, sir?
A Well, I conducted a pretty thorough examination because I was very upset -- he was upset. He was tearful and very obviously anxious and I guess I was very intent on relieving his discomfort -- his general agitation -- and I wanted to give him medications to calm him down. It was this intention of mine which maybe was medically questionable, but I felt so bad that I didn't know how else to make him comfortable. He had told me that he had been knocked out. In medical terms, that is a concussion, and he had a bruise on his forehead. I felt that I should examine his head very carefully and be darn sure that I wasn't about to compromise him from a medical point of view and do him some damage --
Q (Interposing) Is that what you mean by "medically questionable"?
A Yes. In other words, if a person has a head injury or a concussion, generally, we would hold narcotics and sedatives because you want to observe the patient's symptoms to be sure they don't lapse into coma again. If you make them sedate with medication, then you are not really capable of judging their medical condition.
Q And in your opinion, Dr. MacDonald was capable of taking medication; is that correct?
A Yes. I gave him medication.
Q Now, in your examination of his head, how many bumps or lumps or bruises could you find?
A I only found one bruise. It was a contusion of his forehead and, as I recall, it was on the left side just above the eye.
Q After you examined his head area, what next part of his body did you observe?
A I looked him over pretty carefully, and he had a couple of lacerations and a stab wound, and some abrasions.
Q Now, where were the lacerations?
A He had a cut on his left upper outer arm, and it was, I guess, an inch or so long; and he had a cut on his left upper abdomen. In medical terms, it is below the costal margin, below the edge of the ribs, maybe two inches down. And it was about an inch and a half or two long, and it was through the skin and through the fat.
Q Well, with respect to the first laceration that you mentioned -- the one on the left arm -- what medication, if any, did you use to treat that?
A I don't recall that I did anything to treat it, other than clean it off.
Q How would you classify that wound?
A As a laceration.
Q As a superficial or non-superficial?
A It was non-superficial, in that it was through the skin, but it did not appear to be deeper than that, and there was no bleeding from it. And there was no compromise of the motion of the arm.
Q With respect to the second wound that you mentioned, you said it went down to the fat; is that correct?
A It went through the fat. You could see the fascia. It is kind of a flat tendon of the middle muscle of the belly called the rectus muscle -- rectus abdominus. I could see the white fascia, but it wasn't bleeding. It was not superficial, in that it is through the skin and through the subcutaneous tissue, but was not through the fascia.
Q What about with respect to the third wound that you mentioned?
A He had a stab wound of his right chest. I think it was over the top of about the sixth rib, and it was in what we call the anterior axillary line, which is a line that you would draw from the front of your armpit down your side.
Q Approximately how long was this, if you can remember?
A I would say a centimeter and a half -- a little more than half an inch.
Q Do you have an opinion, sir, satisfactory to yourself, as to what type of weapon could have caused that particular wound?
A I think it would just have to be something with a blade.
Q How long did your observation of Dr. MacDonald last?
A Well, I think that I gave him sedation pretty soon after I got there, so I would imagine my examination involved the first 15 or 20 minutes that I spent with him; but I spent almost the whole first day with him in that cubicle.
Q How many ice pick wounds did you see on the body of Dr. MacDonald?
Q After this first 15 or 20 minutes went by, Dr. Bronstein, what did you do next in your medical treatment of Dr. MacDonald?
A We cleaned up his wounds, and I ordered some sedation. I don't recall exactly what I ordered; but then, I think very promptly, we had a visitor. An MP came in.
Q Was this still down in the cubicle?
A Yes; my only contact with Dr. MacDonald as his physician was in that cubicle.
Q Now, did there come a time, sir, when Dr. MacDonald went to x-ray in the hospital?
A He had been x-rayed before I saw him, and he did not leave while I was there to go anywhere.
Q How long did you stay at the hospital this first morning?
A I was at the hospital up until about 7:00 o'clock and before that, I had called Dr. Gemma and Dr. Dreupple -- that was the Chief of the hospital. Dr. Gemma was my immediate superior. Then Dr. Gemma came around 7:00 o'clock and I went home. I showered and shaved. Then I came back to the hospital around 7:30.
Q Now, before you left the hospital this first time, what medical treatment, if any, did you give, as you recall, to the stab wound up in the right chest area?
A None, except for cleaning. We had reviewed the x-ray -- Dr. Jacobson and I -- and he had a partial collapse of his lung; but since he was not short of breath, and since, from a medical point of view, I was most concerned about his agitation, I decided that I did not want to put a chest tube in.
Q Now, after you went home, did you have occasion to come back to the hospital?
A Yes; I came back very promptly.
Q Do you recall approximately what time that was?
A Around 7:30.
Q What did you do when you went back to the hospital?
A I went right back to the Intensive Care Unit.
Q And saw Dr. MacDonald?
A Yes, sir.
Q At that time, what medical treatment, if any, did you give to Dr. MacDonald?
A I don't believe I gave him any more medical treatment, except for maybe I ordered more sedation.
Q How long did you remain Dr. MacDonald's doctor?
A Until the afternoon of that day, when I asked Dr. Gemma to relieve me of that role.
Q Why did you do that?
A I was too upset. I found the whole thing very uncomfortable. I knew and liked Dr. MacDonald on a personal and professional basis. He was very upset, and my wife was pregnant, and I just felt very uncomfortable, since I was not able to do anything else. I was uncomfortable leaving him alone, because he didn't want to be alone. He kept asking me to please stay with him, and so I had to, you know, be supportive, because he asked me to. And I had to call his family and be there when they all found out; and I just did not want to be there anymore.
Q Dr. Bronstein, do you have an opinion, sir, satisfactory to yourself, as to whether or not Dr. MacDonald could have passed out from loss of blood?
A I do not think Dr. MacDonald passed out from loss of blood.
Q Now, when you came back to the hospital the second time, did you have an occasion to meet up with Dr. Frank Gemma?
Q And what did you say to him, sir, and what did he say to you?
A At that time, I don't know. I don't recall.
Q Did you ever have any conversation with him with respect to the insertion of the chest tube?
A No; he decided that it should be done, and he did it.
Q Now, you spoke a moment ago of Dr. MacDonald asking you to get in touch with his family; is that correct?
Q Who, specifically, did he ask you to get in touch with?
A With his mom and with his in-laws.
Q As a result of that, what did you do?
A I found out their phone numbers and I called them all up.
Q And what did you tell them?
A I told them that I was Jeff's doctor, and that he was in the hospital, and there had been some trouble; and it was very important, if they could, to please come down to North Carolina.
Q Now, during this time that you first observed Dr. MacDonald, I believe you said he was very agitated and you had given him medication?
Q In your opinion, sir, was he oriented as to where he was and what was going on?
Q Did you have any difficulty in communicating with him?
Q How long was it, sir, before Dr. MacDonald was taken from the Emergency Room area up to the Intensive Care area?
A I don't know.
Q Was it that morning sometime, or do you recall?
A It had to have been. I was called, I guess, a little bit before 5:00 -- say, quarter to 5:00 -- and I got there between 5:00 and 5:15. I came in through the Emergency Room door and he wasn't there. I went right up to the Intensive Care Unit, so it must have been in that interval.
Q I believe you testified that you stayed there how long that first day?
A I was there until the early afternoon -- say, about 2:00 or 3:00 o'clock.
Q Were you present in the room when any of the interviews of Dr. MacDonald were conducted that day?
A Yes. I was present whenever anybody else was in the room.
Q Who do you recall, sir, came to talk with Dr. MacDonald?
A First, an MP came and then later, a man from the CID came. Later on, I think a couple of FBI agents came. As I recall, there were three interviews that morning.
Q Did you observe these agents taking notes of the interviews when they were conducted?
A Yes. They all had -- the MP had a pad and everybody else had a clipboard.
Q What did you hear, if anything, Dr. MacDonald said to these agents concerning what happened to him and his family?
A He told about how his family had been attacked by four people. He told a very frightening story. He told the same story each time to all of the three different interviewers.
Q Now, did you hear Dr. MacDonald give any description of the individuals to the agents?
Q What descriotions did you hear him give, sir?
A He described a woman with long hair and a floppy hat and two white men and a black man.
Q Did you hear him give any particular characteristics of the individuals or were they fairly average characteristics?
A The woman he described as having long, light brown hair, and the men he said had relatively short hair, but they were not military cuts. I would say they were fairly general characteristics. I don't recall that they were specific. I don't think that I could have, you know, pinpointed anybody from those descriptions.
Q Now, Dr. Bronstein, in your opinion, sir, did Dr. MacDonald appear to be alert and responsive to these individual agents?
Q What, if anything, did the Defendant, Dr. MacDonald, say about his family to you -- by "his family," I mean his wife and children?
A Well, before I went home, he was very concerned about where they were. He had a lot of ambivalence. He wanted me to be with him and he didn't want me to leave him, but he kept asking me why I didn't go to help them. He kept wondering where they were. He kept asking me what was going on and why was he there. He wanted to see them and why didn't I go find out what, you know, was happening to them.
Q What did you say to Dr. MacDonald?
A I said that I had been the doctor assigned to take care of him and that other doctors were taking care of them and that, you know, I could stay with him and people would give us reports when there was information. That was in the early morning hours because when I came back from my shower, he already knew that they were dead.
Q Were you there, sir, when his mother and his in-laws arrived?
Q When did that take place, sir, if you can recall?
A It was sometime during that day -- either late in the morning or early in the afternoon, but I don't recall.
Q Dr. Bronstein, would you tell us precisely in your own words what a pneumothorax is?
A Our chest is architecturally supported by a rib cage and internally divided into three major spaces. One on each side contains the lung, so to go, for example, to another picture, assume that one side of the chest is like a box and in that box, the lung is blown up like a spongefilled balloon. The lung is kept expanded by pressure down through our airway in that box just as if someone's mouth was blowing up a balloon inside a box. When there is a hole made in the chest wall or in the lung itself, the space between the lung and the chest wall or between the balloon and the box becomes filled with air, and so, the lung or the balloon in the box moves away from that wall. That is what a pneumothorax is.
Q What is a tension pneumothorax?
A That is when pressure builds up in that space as that balloon or lung would collapse away from the box or from the chest wall if air accumulated in that space and could not escape, it had no way out. In other words, air was coming in from some place, but say that the tissues which permitted air to come into the chest did not permit air to go out of the chest. The pressure in the chest could build up to collapse the lung completely and push over the heart and blood vessels which are in the middle of the chest so that a tension pneumothorax is a completely different physiological situation from a pneumothorax, but it begins architecturally the same way.
Q Do you know, sir, whether Jeffrey MacDonald ever had a tension pneumothorax?
A Jeffrey MacDonald never had a tension pneumothorax while I cared for him.
Q Now, in this part of your chest, and I believe you have already testified that you saw a stab wound and an incised wound at the seventh intercostal space; is that correct?
Q What internal organs are under that place?
A Well, usually, the lung, but in a sitting position, the diaphragm would rise up so that the top part of the liver might approximate the area in the front of the chest -- not on the side.
Q What if the person stood up? What would happen?
A Your diaphragm and liver tend to go down so that in the area that we are talking about, the liver might or might not be immediately behind the area. In a very obese person with a distended abdomen, a pregnant lady, yes, indeed, the liver would, indeed, be at that level. In a thin adult man, unlikely.
Q In a thin adult man, how far down would you have to go to hit the liver?
A You could probably hit it at the seventh interspace.
Q How deep is what I am trying to say?
A How far in?
Q Yes, sir.
A Probably three to four inches.
Q How far in or how deep in, I should say, would you have to go to puncture the lung?
A An inch or an inch and a half.
Q How far deep do you have to go to get through the chest wall area?
A An inch or an inch and a half. The lung is closely approximated to the chest wall so that you could go through the chest wall without puncturing the lung, but in general, what happens is that when you puncture the chest wall, because air gets into the chest, the lung falls away so that usually, you probably would not hit lung either.
Q How long were you at Womack Hospital?
A I was there two years.
Q During your time there, did you ever have occasion to see many patients who had a pneumothorax?
A I would say that I probably saw more than any other doctor in the Western World during that brief period.
Q That was fairly common; is that what you are saying?
A Yes. I would say that it is one of the two most common diseases that we treated there among the young soldiers at Womack Army Hospital, but it was usually spontaneous. In other words, each of us have little bubbles on our lung and these bubbles sometimes break and spontaneous pneumothorax is very common among young men.
Q Well, now in your study of medicine, Dr. Bronstein, do you know whether or not causing a pneumothorax was ever used or has ever been used as a medical treatment of any disease?
A Yes, it was the standard treatment for tuberculosis for many years prior to the introduction of antibiotics to treat tuberculosis.
Q Now, I believe you testified earlier this morning that after a period of time you asked to be relieved as Jeffrey MacDonald's physician, is that correct?
Q Who took over from you?
A Dr. Gemma.
Q Now, after Dr. Gemma took over from you, did you ever have an occasion to see Dr. MacDonald again in the hospital?
A Yes, I saw him every day.
Q What would be the basis for that?
A Purely social. I was the head doctor on Ward 2-A, and he was staying in a private room at the beginning of the ward, so when I walked on the ward in the morning I would see him.
Q Do you know, sir, approximately how long his medical recovery took in the hospital?
A I think about a week or so.
Q Did you ever meet an individual friend of Dr. MacDonald's by the name of Ron Harrison?
A Yes, I did.
Q Where did you meet him?
A I met him in Dr. MacDonald's room. I met him one day when I was either walking on or off the ward.
Q Did you ever have occasion to talk with him at all?
A Yes, I did.
Q What did you say to him and what did he say to you?
A I did not say much to him, but he frightened me a lot. He told me that he was --
MR. SMITH: (Interposing) We OBJECT.
THE COURT: Yes, I don't know what he is going to say; but whatever somebody else told him, of course, would be objectionable as hearsay.
MR. BLACKBURN: Your Honor, may I have just one moment?
BY MR. BLACKBURN:
Q Now, Dr. Bronstein, in your observing of Dr. MacDonald's body, did you have an occasion to observe anything around his navel area?
A I might have noted an abrasion there, but he had a few abrasions, kind of like a scraping of the top layer of the skin, you know, sometimes get little spotty crusts if you get a scratch; but other than that there was no other injury on his abdomen. The reason I am sure of that is that he had this laceration of his upper abdomen, and I elected not to do anything more about that. Essentially, when someone has a cut of their abdominal wall, and if it does penetrate the skin and the tissue underneath it, one of the common treatments is to do a surgical exploration, what's called a laparotomy -- to take the patient right to the operating room to find out if an instrument penetrated further in a way that is not observable from externally. I elected not to do that because his abdomen was soft, and he didn't have any tenderness, and I didn't want to have him have any operations that morning.
Q Did you ever have an occasion to observe the back of Dr. MacDonald?
A Uh-huh (yes). I looked at his back, and I don't recall any, you know, major injuries or cuts or anything.
Q What about his right arm?
A Didn't have anything on his right arm.
Q What about his wrists or hands?
A His hands were dirty. He was dirty; he was real dirty -- a lot of dirt under his fingernails.
Q I take it then -- you say you observed his wrists and his hands?
A Yes, he was a very, very clean-cut guy, I mean very noticeably a very clean person, very meticulous in his appearance. He had a very neat military haircut, and I was kind of unkempt, always tend to be a little bit shaggy; so that I would say that he looked, you know, much less neat than usual when I saw him.
Q But you did not observe any injuries on his wrists or hands?
A No, none whatsoever.
MR. BLACKBURN: Your Honor, that completes our examination of Dr. Bronstein.
THE COURT: All right, we will take our morning recess, and we will come back at 11:45. Members of the Jury, don't talk about the case. Come back at 11:45, please.
(This proceeding was recessed at 11:27 a.m., to reconvene at 11:45 a.m., this same day.)
F U R T H E R P R O C E E D I N G S 11:45 a.m.
(The following proceedings were held in the presence of the jury and alternates.)
(Whereupon, DR. MERRILL H. BRONSTEIN, the witness on the stand at the time of recess, resumed the stand and testified further as follows:)
C R O S S - E X A M I N A T I O N 11:46 a.m.
BY MR. SMITH:
Q Dr. Bronstein, you indicated on direct examination that you had met Dr. MacDonald previously, but I did not get from your testimony how long prior to the 17th of February of 1970 it was that you had met him.
A I don't know. I mean it was on several occasions, and it was usually in the Emergency Room at Cape Fear Valley Hospital, although we had seen each other on the Post a couple times.
Q When you would be in his presence at Cape Fear Hospital at the Emergency Room, how long normally would you be with him -- how many minutes or hours?
A Usually a few minutes. It would be, you know, while he was finishing up taking care of patients or signing over patients who were there who were in the middle of either diagnosis or treatment or while he would get together his things or while I would be getting together my things.
Q Yes, sir. Were you both assigned at that hospital Emergency Room duties?
A Yeah; we were contracted by the hospital. We weren't assigned there. This is a job that we both undertook.
Q I understand. So your job was specifically the Emergency Room?
Q Did you work the same shift usually; that is, would the both of you be working at the same time?
A No; no; we would be there at alternate times and the times that we saw each other was, one of us would be coming or the other one going or vice versa.
Q On any of those occasions, did you ever have an opportunity to chat with Dr. MacDonald about his family?
A Yes; I did.
Q Did you ever have an opportunity to chat with Dr. MacDonald about his children, for example?
A Yes; I did. Dr. MacDonald often talked about his children, and he showed me pictures of his little girls, and he showed me pictures -- actually he had bought them a pony -- and he showed me pictures of them with their pony, and he talked about his family a lot.
Q When he showed you the photographs of his children with the pony, do you recall whether that was sometime during the 30 days preceding the 17th of February?
Q Could it have been?
Q You don't remember specifically then when you actually contracted with the Cape Fear Valley Hospital for the work you were doing so that you could relate it to the photograph of the pony?
A I know when I did. I started there in November of 1968, but I don't know when Dr. MacDonald started.
Q I understand.
A I think he started after I did, but I am not sure.
Q Yes, sir; but at least he often talked about his family?
A Yeah; I mean that is one of the things that I remember. You know, in obviously a casual acquaintanceship,that is something that stands out in my mind that we talked about.
Q Did you have the feeling that when he was talking about his family that he was proud of his children?
A Sure; I think that, you know, it is rare that a casual acquaintance will show you pictures of his family unless they are meaningful to him.
Q Sure. What did you feel about his professional credentials when you were working with him at Cape Fear Valley Hospital?
A I was impressed by his professional credentials, not so much from working with him at Cape Fear Valley Hospital but we had had mutual friends and he had gone to a very fine medical school and had a very nice internship and one of my friends was an intern with him, and I think he was "Intern of the Year" when he was in his internship, so I thought that his credentials were good.
Q Did you have any impression about his dedication to his profession?
A Yes; I was always aware that he would want to know how a patient had done who he had treated when he had signed over that patient to me.
Q Yes, sir; he was not sloppy, then, in his work?
A No; not at all -- the opposite.
Q As Emergency Room physicians, would you say that you and Dr. MacDonald were dedicated to saving life?
A Yes; I think that that's a role of a physician.
Q And did you find that quality in Dr. MacDonald; that is, a dedication to saving life?
MR. BLACKBURN: Your Honor, we would OBJECT to this point as being outside the scope of direct examination.
THE COURT: Well, I will restrict counsel to direct questioning in matters of this kind. He's your witness for this purpose.
MR. SMITH: Thank you, Your Honor.
BY MR. SMITH:
Q Did you find that Dr. MacDonald was dedicated to saving of lives as a physician in the Emergency Room?
MR. BLACKBURN: OBJECTION.
THE COURT: OVERRULED.
THE WITNESS: I thought he did a nice job.
BY MR. SMITH:
Q You indicated that Dr. MacDonald was usually a neat, clean person; is that correct?
Q When you saw him in the Emergency Room on the 17th of February, did you observe blood about his body anywhere?
A I didn't see him in the Emergency Room.
Q Well, whenever you saw him on the 17th of February?
A I saw him in the Intensive Care Unit and there was no blood about his body.
Q Had he been washed at that point as far as you know?
Q Did you see any blood on his face anywhere?
Q Do you recall seeing blood about his mouth?
Q Now, how long were you with him that day?
A Mostly the whole day up from the time I arrived until early afternoon, say, 2:00 or 3:00 o'clock in the afternoon.
Q How frequently did he cry during that time?
A A lot.
Q Could you amplify that answer? For example, would he cry every five minutes or would there be periods during which he would cry for an hour?
A It just seemed that he had tears in his eyes. He wasn't sobbing hysterically. He was just very agitated and seemed very saddened.
Q Yes; I believe at some point in your testimony on previous occasions you used the phrase "remarkably pale"; do you remember that?
Q Was he remarkably pale when you saw him?
A Yes; when I first saw him, the things that I noted about him were his paleness and his agitation and the fact that he seemed dirty to me.
Q Did you observe in him what you might describe as hysteria on any occasion?
Q Did you observe bewilderment?
A In the sense that he was asking me, you know, where was his family, what had happened to them -- yes; he was bewildered about the course of events.
Q Did you have the impression, Dr. Bronstein, that Dr. MacDonald was more concerned about his family than he was about his own well-being at that time?
A Yes; that's mostly what he wanted to know from me. He didn't, you know, want to know what my medical opinion was of his condition, but he wanted me to tell him where they were.
Q Did you or anyone else in your presence perform any tests for drugs or alcohol on Dr. MacDonald?
A I don't recall.
Q Do you have an opinion satisfactory to yourself, based on reasonable medical certainty, whether Dr. MacDonald was under the influence of alcohol when you saw him?
A He was not under the influence of alcohol when I saw him.
Q Was he under the influence of drugs when you saw him?
A Only those I administered.
Q So, when you first observed him and prior to the time you administered any drugs, did you have the impression that he was under the influence of any drug whatsoever?
Q Was he cooperative with you; that is, doing the things you asked him to do as his physician?
Q You were concerned, I believe, Dr. Bronstein, not only about his physical condition but about his emotional condition; weren't you?
Q You indicated on direct examination that you might have done something that maybe was not exactly medically sound. What was that?
A Giving sedatives and narcotics to a person who had an obvious head injury who, by history, had sustained a concussion.
Q Did you do that because you wanted to help him and you felt that under the circumstances he needed the narcotic drugs?
Q Do you remember what kind of narcotic drugs you gave him?
A I don't recall, but it was probably a barbiturate and maybe a morphine or maybe some Valium. I would guess it was probably Nembutal or Valium -- something like that.
Q In direct you indicated Demerol and Nembutal; would that probably be correct?
Q Did you give those drugs in fairly large quantities to him?
A As I recall, it sticks in my mind that I gave him more than I would have given a usual person just for relief of pain because it did not seem to suppress his agitation.
Q Yes; for example, would a 200 milligram dose of Nembutal -- would that be a pretty good-sized dose?
A It is a sedative dose. It is not hypnotic.
Q What do you mean by that?
A In other words, usually you start off by giving a patient 100 or 200 milligrams of Nembutal so that they will be able to sleep. Usually that will put a usual person to sleep, but it wouldn't make them totally unresponsive. You could rouse them from that sleep.
Q Yes; what about a 50 milligram dosage of Demerol -- would that be a standard dosage or fairly high?
A Small to standard.
Q Yes, sir. You don't have any records, I take it, with you on the witness stand as to the time that you gave the dosages and the amounts?
A No; I don't.
Q Would it be fair to say that the dosages you gave him were more than you normally would give under that kind of circumstance because you were concerned about Dr. MacDonald; would that be correct?
A Normally you wouldn't give any.
Q All right. Would you normally not give any because of the fact that you observed at least some injury to his head and he indicated to you that at least for some period of time he had lost consciousness?
A No matter whether he had had any head injury or not, it is the history of loss of consciousness that is critical.
Q Yes, sir. Under, that kind of circumstance normally you would not give any sedatives or narcotics?
Q Now, you indicated that you observed an injury to his arm that you said was not a superficial injury and you observed an injury to his abdomen that you would say was not superficial; is that correct?
Q And then you indicated that you observed the injury to his chest. Now, Dr. Bronstein, you, I think, said that you observed the injury at the anterior axillary location; did that you state that on direct?
A (Witness nods affirmatively.)
Q Let me ask you to refresh your recollection and state whether you don't recall that that injury was mid-clavicular.
A No; it was not mid-clavicular. It was the anterior axillary line.
Q Just pointing out on your body, Dr. Bronstein, where would mid-clavicular be, and if you could maybe stand so the jury could see you? Say, on the right side of your body, where would mid-clavicular be?
A The clavicle is the bone going from the sternum, the breast bone, to the shoulder and can be felt on everyone right here, and a mid-clavicular line is a point taken on the mid-portion of the clavicle and running straight down the body.
Q All right, now, while you are standing, please, if you don't mind, would you show the jury where an anterior axillary wound would be on the body?
A To draw a straight line down the body from the front of the armpit that line would be the anterior axillary line.
Q Would that be more under your arm?
A No; it is not under the arm. It is in front of the arm. In other words, this line right here and the other line is right there so they are about two inches apart.
Q All right, well, then, if you will let me refer to a part of your body as the nipple -- for lack of any better phrase as far as I am concerned -- would the wound that you recall on Dr. MacDonald have been to the right of your nipple or to the left of your nipple?
A To the right laterally.
Q All right, would you then point out to the jury where you recall the wound to Dr. MacDonald. If you don't mind, just stand again.
A In the anterior axillary line right about here (indicating).
Q All right, to the right and below your nipple?
Q All right, you may be seated again, please. Dr. Bronstein, were you present when any tube was inserted in Dr. MacDonald?
Q Did you ever see him with a tube inserted?
Q Was the tube that you saw inserted in Dr. MacDonald's body at anterior axillary position?
A I don't recall.
Q Normally, would it be in the same place the original wound is located which caused it?
Q It would not?
Q Not necessarily?
A No, not usually. The reason being that if there are foreign bodies in a wound, you would not want to introduce them into the chest cavity by passing a tube and pushing them further in.
Q Dr. Bronstein, there was no way, I take it, that you could determine the actual depth of the stab wound which caused the pneumothorax?
A I had a presumption that it entered the chest cavity because he had a pneumothorax.
Q Yes, sir, but it could have gone on deeper into the lung; couldn't it?
A Yes, it could have.
Q You usually would not probe that kind of wound; would you?
A Not usually.
Q And in this event, as far as you know, that wound was not probed?
A I did not probe that wound.
Q All right, if you would, then tell the jury, Dr. Bronstein, the range of depth that wound could have gone -- that is, from an inch and a half, I believe you have described, until how deep?
A It could be to any depth. It could have been just through the skin, or since I didn't see any place where it came out, it could have been anywhere on the other side of his body.
Q It could have been then from an inch and a half to say three or four inches or more?
A It might have been much less than an inch and a half and it could have been, you know, ten inches.
Q Well, if a person should sustain a wound at mid-clavicular, say, seventh intercostal space, would that be closer to the liver than anterior axillary?
Q Would, as a matter of fact, seventh intercostal space mid-clavicular be almost over the liver?
A It depends on how the person was situated. If a person was hunched over and sitting down like I am now, yes, indeed. If a person was standing up in deep inspiration, I doubt it.
Q Would a mid-clavicular wound, say, below the nipple, be a much more dangerous place to sustain a stab wound than anterior axillary?
A I think it really depends on the circumstances, the instrument, the position of the person. I think that it is hard just from choosing a site on the outside of the body to say what is going to go on inside. I have seen people with almost no injury have severe internal injuries and vice-versa.
Q Dr. Bronstein, have you ever had an opportunity to examine the medical record or clinical record in this case?
Q Have you ever exarnined the notes -- the typewritten notes -- prepared by Dr. Frank Gemma?
A I don't recall. The last time I saw that chart was in 1974.
Q You did not, then, have an opportunity to examine this material prior to testifying?
A Yes, I did, in 1974.
Q Okay, Dr. Bronstein, to refresh your recollection, let me read you something from Dr. Gemma's notes, and ask you if you agree with the notes or if you recall reading them. In his description of the injuries and the wounds sustained by Dr. MacDonald, he makes this statement: "Chest symmetrical, one centimeter stab wound in the sixth intercostal space in the mid-clavicular line." Do you recall ever reading that?
Q If Dr. Gemma said that the wound was in the sixth intercostal space in the mid-clavicular lung, do you disagree with Dr. Gemma?
MR. SMITH: No further questions, Your Honor.
MR. BLACKBURN: Your Honor, we have just a few questions on Redirect.
THE COURT: All right.
R E D I R E C T E X A M I N A T I O N 12:05 p.m.
BY MR. BLACKBURN:
Q You spoke a moment ago of the history of loss of consciousness. From where did you get any history that the patient lost consciousness?
A From the patient. He told me that he had been knocked out.
Q Now, I believe you said that you gave him some sedatives; is that correct?
Q After you gave the sedatives to him, did he still appear to you to be alert and coherent?
A Yes. He was alert and coherent throughout the morning. That is the reason I gave him, I think, one or two different drugs and gave him extra doses because he was still agitated. After I gave him the drugs, he just calmed down to a level where he seemed to be able to accept the reality of what was happening -- people coming in and talking to him and asking about very upsetting events.
Q How would you rate his general condition? Was it good, fair, poor, or what?
A He was in good condition.
Q What personal knowledge, if any, do you have as to the family relationship between his wife and himself and his family?
A Well, as I said before, he would show me pictures of his children. The only other contact we had was because I worked at the hosoital and I had spent some time in the Department of Obstetrics and Gynecology. Jeff had asked me to arrange for one of the hospital's obstetricians to cover his wife. He had called me and I had arranged for one of my friends there to take care of his wife.
Q Why do you mean that he wanted to get someone to take care of his wife?
A Well, she was pregnant, and if you present yourself to the hospital, you can be cared for by anyone under any circumstances. It is just always nicer to have a personal introduction to a physician.
Q Did you ever contact anyone?
A Yes, but I don't recall who.
Q Would it have been Dr. Healey?
A Could have been.
MR. BLACKBURN: Your Honor, just one second.
BY MR. BLACKBURN:
Q You spoke on cross-examination that the wound to the chest area, I think, you said as deep as ten inches; is that correct?
A It is possible. I mean, I have seen almost every variety of things. I have seen a lady take a .38 caliber pistol, a big hand weapon, and out it in her right fifth intercostal space and shoot herself with the intent of doing herself in, and I have seen the hole of exit from the left eighth interspace in the mid-clavicular line --the mid-scapular line -- in the back. So you would presume that it would go right through the heart. After I examined her and watched her for 24 hours, I discharged her to a psychiatrist, so I don't know. I think that anything that is possible can happen. There are no "always" or "never" in medicine. It is not an exact science.
Q What evidence, if any, did you see of hemorrhaging in Dr. MacDonald as a result of the stab wound?
MR. BLACKBURN: No further questions.
THE COURT: Call your next witness.