Opinion ID: 4464659
Heading Depth: 4
Heading Rank: 3

Heading: State’s Rebuttal Testimony from Dr. Happy

Text: On rebuttal direct examination, Dr. Happy testified that the weight of Wollaston’s heart was forty-two percent above 22  FOR PUBLICATION IN WEST’S HAWAIʻI REPORTS AND THE PACIFIC REPORTER  normal, not fifty percent above normal as testified by Dr. Navin. Also, according to Dr. Happy, Wollaston’s heart did not exhibit heart disease from alcoholism. Dr. Happy determined this by making a new tissue slide from the slice of Wollaston’s heart that was retained in a stock jar. Dr. Happy also testified that Wollaston had hypertension, which can make the heart get bigger and thicker. Wollaston did not have atherosclerosis, however, which is the underlying cause of most heart attacks. Regarding the impacts of marijuana on the heart, according to Dr. Happy, studies indicated the connection between marijuana use and sudden cardiac death was rare and usually associated with atherosclerosis. Further, the amount of an inactive form of THC in Wollaston’s blood, as reflected by the toxicology report, was very low, and “to think that this inactive metabolite would have caused her to have a heart attack” was “erroneous.” Regarding Wollaston’s heart, Dr. Happy acknowledged that he had not previously noticed the contraction band necrosis or wavy fibers. He explained epinephrine can cause contraction bands, and opined that Wollaston “had four sources of possibilities for her contraction bands.” He explained: She had a fight where her epinephrine was released from her adrenal gland. She had an intracranial hemorrhage which resulted in more epinephrine. And then she was given six 23  FOR PUBLICATION IN WEST’S HAWAIʻI REPORTS AND THE PACIFIC REPORTER  different shots of epinephrine, four . . . by the ambulance workers, and two by the emergency room doctors, and then she was defibrillated. And so sure enough Dr. Navin saw these contraction bands . . . . In Dr. Happy’s medical opinion, the contraction bands Dr. Navin observed were not attributed to myocardial infarction, and the timeline Dr. Navin presented for a myocardial infarction was correct for a person that is atherosclerotic, but Wollaston was not atherosclerotic. As to the wavy fibers, according to Dr. Happy, they could arise with increased epinephrine and had been seen in cases of fatal cranial trauma as well as with heart attacks. Dr. Happy then described the symptoms of a heart attack and what happens to the heart during a myocardial infarction. According to him, in particular, a heart attack causes extreme pain, and if Wollaston did have a fatal heart attack four hours prior to the fight, as Dr. Navin stated, “a significant amount of her heart muscle would have had to die.” According to Dr. Happy, the tissue slides did not reflect that had happened. Dr. Happy had prepared a report on Wollaston’s autopsy. During the autopsy he examined both Wollaston’s heart and brain. He testified that, contrary to Dr. Navin’s testimony, he did examine the cerebrum internally and documented it in the report, and a sample of Wollaston’s brainstem was placed in a tissue block and a slide was made of it. He testified that the heart 24  FOR PUBLICATION IN WEST’S HAWAIʻI REPORTS AND THE PACIFIC REPORTER  and brainstem tissues that Dr. Happy used to form his opinion were available to Dr. Navin for inspection. Dr. Happy opined that, to a reasonable degree of medical probability, Wollaston’s death was caused by “[b]lunt force head and neck injury.” The “mechanism of death” “was subarachnoid hemorrhage . . . around the brainstem.” On rebuttal cross-examination, he acknowledged he did not take tissue slides of the cerebrum, besides the brainstem, to examine the brain at the cellular level. On re-direct examination, Dr. Happy testified he had seen the note in the investigator’s report that Wollaston had a history of methamphetamine use, which was based upon the statement by Wollaston’s father, but did not find any evidence in her medical record of such use. On re-cross-examination, Dr. Happy stated that he received information about how Wollaston sustained her injuries from a detective attending the autopsy on the morning of July 21, 2014.