Opinion ID: 618716
Heading Depth: 3
Heading Rank: 1

Heading: Expert's Testimony

Text: DR. COHEN The prosecution's first expert, Dr. Cohen, testified first as to Mrs. Chromy's head and brain injuries. Then, he clarified that the immediate cause of Mrs. Chromy's death was a ruptured aneurysm near her heart in the aorta. His exact testimony was as follows: [Prosecutor]: And let's step back to the trauma from the brain. [Cohen]: Okay. [Prosecutor]: It is not what ultimately killed her? [Cohen]: This trauma (indicating)? [Prosecutor]: Yes. [Cohen]: It may have contributed. I can't be certain. It may certainly have. Are you talking about the brain injury itself? [Prosecutor]: Yes. [Cohen]: It's possible that it contributed to some extent. Whether it was 2 percent or 5 percent or 40 percent. It is possible. I don't know the answer to it. Aided by a photo of Mrs. Chromy's preserved heart, Dr. Cohen described the physical mechanism of the aortic aneurysm. He stated at one point that he agreed with Dr. Garber's conclusion that the immediate cause of Mrs. Chromy's death was a dissecting aortic aneurysm, a tear in the aorta. When asked how such a tear happens, he listed more than one possible cause. However, he prefaced this by explaining that the most common cause of an aortic tear overall is long-standing hypertension. Another cause he described as fairly common is plaque and atherosclerosis on the inner surface of the aorta, which causes the wall to weaken. This weakness predisposes a person to having a rupture or a break in the blood vessel. Finally, he listed other less common causes, such as trauma and certain syndromes. At this point, the prosecutor asked him to confirm that Mrs. Chromy had a history of hypertension and atherosclerosis, which he did. Next, the prosecutor attempted to elicit from Dr. Cohen an opinion as to whether the trauma Mrs. Chromy suffered during the carjacking contributed to the aortic tear. His testimony was as follows: [Prosecutor]: Now, in this particular case, what about the trauma that she suffered, thethe beating she took bouncing on the road? What did that contribute to this tear? [Cohen]: Well, again, that's debatable. The trauma that she sustained 30 days prior clearly did not help her. And if she had a weakness like this already from her atherosclerosiswhich she did have severe atherosclerosis and she did have hypertension. So she already had enough to explain a weakness in this wall. And the trauma certainly did not help her. It could only have hurt her. [Prosecutor]: Okay. So is your opinion, then, this trauma hurt her or aggravated [Cohen]: I can't answer that. I wish I could. I can't answer for sure if this trauma actually contributed. It absolutely did not help her. It could only have hurt her. And the fact that it's in relatively close proximity to her injury, I'm very suspicious of it. And I'm very concerned that it did contribute. Whether it was a percent or 5 percent or 40 or 80 percent, I don't know. I don't know the answer to that. In the preserved heart, Dr. Cohen also observed signs of bleeding into the inner wall lining of the aorta, which he opined had existed for days, weeks or even two months before death. However, he also acknowledged that the bleeding could have started minutes before death. In his opinion, this bleeding was what ultimately dissected the aortic tissue, causing Mrs. Chromy's death. The prosecution concluded Dr. Cohen's testimony with a description of how high blood pressure could exacerbate a person's propensity for these types of tears, and how blunt-force injury to the torso causes the tissues to react. When asked by the prosecution whether significant forces to the torso, transmitted to the tissues, would cause or start a tear, Dr. Cohen opined that [t]hey certainly would not help it, and they could hurt it. The defense opened cross-examination with a recitation of the admissible findings within Dr. Garber's autopsy report, particularly the fact that Mrs. Chromy's heart exhibited hypertrophy consistent with long-standing hypertension and severe atherosclerosis of the aorta. Upon questioning, Dr. Cohen admitted that 80 or 90 percent of people who suffer a dissecting aortic aneurysm tend to be hypertensive. He also testified that Dr. Garber's autopsy report identified an enlarged heart, a condition that results from the hypertrophy that comes with long-standing hypertension. Defense counsel then cross-examined Dr. Cohen regarding Mrs. Chromy's brain injuries. When asked about any correlation or connection between these types of brain injuries and a dissecting aortic aneurysm, he admitted that he wasn't aware of any other cases with such a correlation. When asked whether he had not just provided an opinion that such a connection did exist in this case, Dr. Cohen then clarified his testimony and retracted his opinion: [Defense counsel]: Well, you have testified, have you not, that there is a connection between Miss Chromy's brain damage, the subdural, subarachnoid hematomas, and the dissecting aortic aneurysm? [Cohen]: I don't believe I have today. Between the posthe possibility of the trauma to the torso, the chest trauma, and the dissection, I think I've partially addressed that. But not head trauma and dissection. [Defense counsel]: So just to clarify, you have not expressed an opinion today as to whether or not the head trauma that Miss Chromy experienced was a contributing factor in her dissecting aortic aneurysm? [Cohen]: I don't think I have today, no. Throughout the rest of Dr. Cohen's cross-examination, defense counsel continued to question Dr. Cohen only as to the admissible factual findings of the autopsy report. DR. BLOOR The prosecution's second expert, Dr. Bloor, agreed that the immediate cause of Mrs. Chromy's death was acute aortic dissection. When asked about Mrs. Chromy's thoracic trauma, he responded, I consider the trauma to be a contributory factor to the aortic dissection that was the immediate cause of death. He testified that although it is rare for a person to die of an aortic dissection thirty days after bodily trauma, it has been noted in medical literature. However, when asked on cross-examination about the head trauma, he opined that Mrs. Chromy's brain injury was not a contributing factor to the aortic dissection: [Defense]: So the short answer to my question is that the injury to her brain did notwas not a contributing factor to herinas a cause of death? [Bloor]: It was not a contributing factor to what I consider to be the immediate cause of death, namely, the dissection through the aortic wall. Dr. Bloor testified at length about whether the bleeding observed from Dr. Garber's autopsy report was recent or longstanding. He explained that the actual tear all the way through the aortic wall was sudden and probably took place within the last twelve to twenty-four hours of Mrs. Chromy's life. However, he believed that the tear probably began at an earlier stage, and was related to the time of the trauma. Finally, he testified that Mrs. Chromy's heart rate was high and that her blood pressure went through fluctuations in the period between the carjacking and her death. He concluded that these fluctuations, combined with Mrs. Chromy's pre-existing hypertension, also could have exacerbated the aortic tear. DR. HERRMANN The defense pathologist, Dr. Herrmann, gave his opinion that Mrs. Chromy died from a spontaneous rupture of a dissecting aneurysm of the aorta. He found no connection with her previous injuries from the carjacking. Dr. Herrmann did observe that Mrs. Chromy's high blood pressure predisposed her to the rupture of the inner lining of the aorta, and that she had pretty severe arteriosclerosis of the ascending aorta. [3] He expressed his opinion that dissecting aneurysms of the aorta rupture more frequently in the presence of arteriosclerosis, and certainly more frequently with people who have high blood pressure. Dr. Herrmann disagreed with Dr. Cohen's observation of an older hemorrhage. He explained that if it were older, it would then display physical evidence of healing but that instead, all of the bleeding is very fresh, and [there is] no evidence of healing. So, he concluded, [the tear was] probably well within 4 days of Mrs. Chromy's death. He also stated explicitly that the injuries Mrs. Chromy suffered to her head had no causal relation to her death. On cross-examination, despite repeated defense objections, the court permitted the prosecution to elicit testimony from Dr. Herrmann about Dr. Garber's opinion of the cause of death. Dr. Herrmann disagreed with Dr. Garber's opinion that head injuries contributed to Mrs. Chromy's death from an aortic aneurysm. He also disagreed with Dr. Cohen's opinion that bodily trauma contributed to the aneurysm. Specifically, the following exchange took place: [Prosecutor]: You're aware that [Dr. Garber's] opinion was that this trauma caused to [Mrs. Chromy] did contribute to her death and cause[d] her death? You're aware of that? [Herrmann]: I believe he said that the head injuries, in his opinion, contributed to her death. Yes. [Defense]: Your Honor, I object. Hearsay because Dr. Garber has not testified. The findings in his report are relied upon by experts, but the opinion itself is a matter of his testimony which has not been presented by the People. We're not [Court]: Overruled. [Defense]: in a position to cross-examine Dr. Garber here. [Court]: Overruled. [Prosecutor]: So your opinionyou differ with Dr. Garber's opinion about the cause of death in this case? [Herrmann]: Well, let's see what his how he actually states his cause of death. Iit's been a while since I looked at it. His conclusion was that death was caused by ruptured dissecting aortic aneurysm. And then under other conditions, whether he means that this contributes or not, it'she just says other conditions is blunt-force trauma to the head. That's what it says in his autopsy. [Prosecutor]: Okay. And then on the later page, page 3, the basis of the autopsy findings itself: Evidence that the 78-year-old woman suffered from ruptured dissecting aortic aneurysm which resulted in her demise. In addition, blunt-force trauma to the head also contributed to her death. [Defense]: May I have a continuing objection, Your Honor? [Court]: Sure. Yes. [Prosecutor]: Is that correct? [Herrmann]: Shall I [Court]: Yes. You can answer. I'm sorry. [Herrmann]: Yes. That's what he says. In addition, blunt-force trauma to the head also contributed to her death. [Defense]: Your Honor, may Imay I have a constitutional objection on Sixth Amendment grounds? [Court]: Sure. [Defense]: Thank you. [Prosecutor]: Nowso your opinion differs with his? [Herrmann]: Yes. I don't think the blunt-force trauma to her head contributed to her death. [Prosecutor]: And he's the person who performed the autopsy? [Herrmann]: He is. [Prosecutor]: And he testified at [the] preliminary hearing that the blunt-force trauma also contributedto her body contributed to her death; is that correct? [Herrmann]: Yes, he did. [Prosecutor]: And you differ with that opinion as well? [Herrmann]: Yes. Particularly his testimony I wouldI would disagree with. After this exchange, the prosecutor went on to cross-examine Dr. Herrmann with the preliminary hearing testimony from 1998. At one point Dr. Herrmann appeared to contradict his prior testimony, though he attempted to explain the apparent discrepancy. Defense counsel also revisited the prior testimony on re-direct. Dr. Herrmann stated that where a patient had pre-existing hypertension, a sudden rise in blood pressure could be the last thing to push a person over the edge, and that if pushed over the edge, you would expect the person to die at that time, to rupture their aneurysm. Finally, on further redirect examination, Dr. Herrmann clarified his opinion for the jury: [Defense]: In your opinion, Doctor, did Helen Chromy suffer a tear to her aorta when she suffered these other injuries to her body? [Herrmann]: No. She didn't. There's no evidence that that tear took place at that time.