Opinion ID: 4464659
Heading Depth: 3
Heading Rank: 1

Heading: Evidentiary Portion of Jury Trial

Text: A jury trial was held between February 22 and March 3, 2016 before the circuit court.6
In summary, various witnesses called by the State testified as follows regarding evidence relevant to the questions on certiorari. (. . . continued) Murder in the second degree. (1) Except as provided in section 707-701, a person commits the offense of murder in the second degree if the person intentionally or knowingly causes the death of another person. (2) Murder in the second degree is a felony for which the defendant shall be sentenced to imprisonment as provided in section 706-656. 4 HRS § 706-656 provides in pertinent part as follows: Terms of imprisonment for first and second degree murder and attempted first and second degree murder. . . . . (2) Except as provided in section 706-657, pertaining to enhanced sentence for second degree murder, persons convicted of second degree murder and attempted second degree murder shall be sentenced to life imprisonment with possibility of parole. 5 The indictment stated: On or about July 21, 2014, in the City and County of Honolulu, State of Hawai̒i, KIMBERLY J. UDO did intentionally or knowingly cause the death of Sandra Lee Wollaston thereby committing the offense of Murder in the Second Degree, in violation of Sections 707-701.5 and 706656 of the Hawai̒i Revised Statutes. 6 The Honorable Rom A. Trader presided. 5  FOR PUBLICATION IN WEST’S HAWAIʻI REPORTS AND THE PACIFIC REPORTER  Paramedic Kelly Kihe (“Kihe”) responded to a 911 call for assistance at 1150 Bishop Street on July 21, 2014. When Kihe arrived on the scene, Wollaston was lying motionless on her back; Wollaston could not speak and her vital signs were weak. At 4:40 a.m., while in the ambulance, Wollaston lost her pulse, her heart stopped beating on its own, and she no longer breathed spontaneously. The paramedics used a defibrillator on Wollaston and also administered four doses of epinephrine in attempts to resuscitate her. Kihe’s clinical impression was that Wollaston had a closed head injury and that Wollaston was deceased upon arrival at QMC. Kihe did not have any information indicating that Wollaston was experiencing a heart attack. Charlotte Carter, the medical examiner’s investigator who investigated Wollaston’s death, spoke with Wollaston’s father, who stated Wollaston had a history of prior use of marijuana and methamphetamines. (The jury was instructed, however, not to consider Wollaston’s father’s comments for the truth of the matter asserted.) HPD Officer Jarrett De Soto (“Officer De Soto”), approached Udo on Hotel Street after hearing a suspect description on the morning of July 21, 2014. When he told Udo she was a suspect in 6  FOR PUBLICATION IN WEST’S HAWAIʻI REPORTS AND THE PACIFIC REPORTER  an assault case, Udo stated, “[S]he hit me first so I went pound her.” Using photographic exhibits, Toy Stech (“Stech”), an evidence specialist with the City and County of Honolulu, pointed out possible injuries to Udo’s upper right cheek, right hand, and right foot on July 21, 2014. HPD Detective Peter Boyle (“Boyle”) went to HPD’s Central Receiving Division to process Udo. While informing Udo that they would be gathering evidence from her, Udo uttered that “she gets beat up all the time in town and the first time she fights back she gets arrested.” According to HPD Detective Daniel Tsue (“Detective Tsue”), the lead detective in Udo’s case, on the morning of July 21, 2014, Kingston appeared to understand his questioning, offered responsive answers, and was understandable. Kazmierski, however, was not responsive to questions, and Detective Tsue did not interview Supee because Supee was asleep during the incident. Detective Tsue confirmed there were no external surveillance cameras near the scene of the incident. Kingston testified as the only eyewitness. Kingston had lived in Hawai‘i for twelve years and had been on and off the streets. When on the streets, he slept by a Bible store at the 7  FOR PUBLICATION IN WEST’S HAWAIʻI REPORTS AND THE PACIFIC REPORTER  corner of Adams and Bishop Streets. He had known Wollaston for a couple years. At around 10:00 p.m. on the night of July 20, 2014, Kingston, Wollaston, Kazmierski, Supee, and Clinton went to sleep in front of Ninja Sushi after drinking together. At around 2:45 a.m., Kingston, Wollaston, and Kazmierski awoke and had shots of vodka. At around 4:20 a.m., Kingston saw a woman slamming her dog against a wall. Kingston identified Udo as the woman he saw that morning. According to Kingston, Wollaston was also awake and said something to Udo. Udo then responded to Wollaston from about three feet away, cursing, then approached Wollaston, who had been sitting down. Kingston told Wollaston, “Don’t do it, [Wollaston].” Wollaston responded, “No, Chaz, stay out of it. This is mine.” Then Wollaston “stood up and they scrapped, pulled hair, kicked, punched, whatever. They fell over [Clinton]. And it got out of hand.” Kingston called 911, and an ambulance arrived within a few minutes. Kingston was a couple of feet from Wollaston during the incident. When Wollaston and Udo fell over Clinton, Wollaston’s head hit the ground, and Udo kicked Wollaston in the face until Kingston pulled her away. Udo left then returned three to four times, and each time, she kicked Wollaston in the head and neck 8  FOR PUBLICATION IN WEST’S HAWAIʻI REPORTS AND THE PACIFIC REPORTER  area, “stomp[ed]” on Wollaston, and uttered phrases such as “I’ll kill you.” After the final kick, Wollaston had “a death stare,” was motionless, and was lifeless. According to Kingston, during the incident, Clinton was present, Supee was passed out, and Kazmierski was at a store getting Wollaston a sandwich. Udo then left in the direction of Union Mall. Kingston tried to care for Wollaston, but she remained motionless and was not breathing or speaking. After HPD arrived, Kingston wrote a statement and identified Udo in a field show-up near Union Mall. On cross-examination, Kingston testified he had consumed a few shots or a half-pint of vodka the night prior to trial. He stated he was not intoxicated throughout the period of July 20 to July 21, 2014, but had drunk about a pint of vodka on July 20, 2014 and less than half a pint the morning of the incident. Kingston also testified that when Wollaston saw Udo abusing the dog, she cursed out Udo, asking what she was doing with the dog. According to Kingston, Wollaston voluntarily entered into the fight with Udo despite Kingston trying to stop her. As its final witness,7 the State presented Christopher Happy, M.D. (“Dr. Happy”), the chief medical examiner for the 7 Before presenting its final witness, the State also presented the following witnesses: (1) Veronica De Mello, a police evidence specialist for HPD, who photographed and diagrammed the crime scene; (2) HPD Sergeant Eric (continued. . .) 9  FOR PUBLICATION IN WEST’S HAWAIʻI REPORTS AND THE PACIFIC REPORTER  City and County of Honolulu. The court qualified Dr. Happy as “a medical expert with a specialization in forensic pathology.” According to Dr. Happy, Wollaston was pronounced dead at 5:42 in the morning on July 21, 2014. Dr. Happy performed Wollaston’s autopsy on July 21, 2014. Dr. Happy described the physiology of a human spine, neck, and brain. He explained that “the brainstem regulates heart rate and respiratory rate,” and injury to the brainstem can cause death. Before and during Wollaston’s autopsy, Dr. Happy noticed several injuries consistent with a kick or a punch on Wollaston’s head, face, and brain: (1) two contusions on the right side of her face; (2) an abrasion and a contusion in the external left occipital region of Wollaston’s head; (3) a subscalp hemorrhage in the right occipital subscalp area; (4) a (. . . continued) Fong, who responded to the scene and noted that Clinton, Kazmierski, and Kingston were all present, but Supee remained asleep; (3) HPD Corporal Arnold Sagucio, who went to the crime scene, and testified that Kazmierski was “extremely intoxicated” when he interacted with him, Supee remained asleep, and there were no surveillance cameras in the crime scene area; (4) HPD Officer Brian Goda, who placed an all-points bulletin with Udo’s description, took Kingston to the field show-up, and could not say “how intoxicated [Kingston] was” the morning of July 21, 2014; (5) HPD Officer Dustin Hao, who was on duty at QMC’s Emergency Room and confirmed that Wollaston’s body was not tampered with between the time it was at QMC and the time it was transported in a sealed body bag to the medical examiner’s office; and (6) HPD evidence specialist, Doryn Matsuda, who photographed Wollaston’s body and swabbed her hands for evidence. None of those witnesses who were crossexamined about drug paraphernalia testified to seeing any drug paraphernalia around the crime scene or in Wollaston’s belongings. 10  FOR PUBLICATION IN WEST’S HAWAIʻI REPORTS AND THE PACIFIC REPORTER  two-by-one-and-one-half-inch abraded red and purple contusion with associated swelling in the occipital parietal scalp above Wollaston’s left ear; (5) a subscalp hemorrhage on the left occipital region more extensive than the exterior injury; (6) a “two-inch horizontally oriented fracture extending from the posterior part of the temporal bone to about the mid portion of the left temporal bone” of Wollaston’s skull; (7) four subscalp hemorrhages on the top of the head, indicating four different impacts; (8) bleeding in multiple locations between the dura and the surface of the brain -- subdural and subarachnoid hemorrhages;8 and (9) “a very small four millimeter laceration” on Wollaston’s brainstem, along with hemorrhaging. A tissue slide was made of Wollaston’s brainstem. At the completion of Dr. Happy’s testimony the State rested. Udo moved for, but was denied, a judgment of acquittal.
Udo then called Dr. Navin as her only witness. Dr. Navin stated that he had testified “as an expert in anatomical, 8 Dr. Happy testified that subdural hemorrhages are caused “[w]hen the brain moves relative to the dura, usually due to an acceleration and a sudden deceleration . . . those bridging veins tear and . . . they cause subdural hemorrhage. Subarachnoid hemorrhage . . . is usually caused by a direct blow to the surface of the brain with deformation of either the skull or an impact of the brain on the insides of the skull.” 11  FOR PUBLICATION IN WEST’S HAWAIʻI REPORTS AND THE PACIFIC REPORTER  clinical pathology” for the State and for the defense over 100 times each.9 On direct examination, Dr. Navin testified he had reviewed all the reports in the case and the slides that were taken by Dr. Happy. When he reviewed Dr. Happy’s autopsy report, he noticed indications of previous heart damage. Those indicators included the presence of boxcar nuclei, which could increase the risk of a heart attack, as well as areas of fibrosis. Dr. Navin also testified that Wollaston’s blood alcohol level was 0.278 and there was evidence of marijuana in high levels, which could increase the risk of heart attack. Citing an article in National Geographic, he testified that marijuana use “can cause doubling of the heart rate and greatly increases the risk of heart attacks,” and given Wollaston’s heart condition, he opined that the potential impact of combining marijuana and alcohol consumption is death. 9 Although not raised by the defense, during the February 25, 2016 questioning of Dr. Navin, the DPA also inserted the Higa case into his voir dire questioning regarding Dr. Navin’s qualifications: Q. Okay. Do you remember testifying on January 26, 2010, just down the hall, in the case of State of Hawaii versus Matthew Higa? A. Of what? Q. Matthew Higa was the defendant. Do you remember that case? A. Yes. 12  FOR PUBLICATION IN WEST’S HAWAIʻI REPORTS AND THE PACIFIC REPORTER  Upon his request, the medical examiner’s office resliced paraffin slides of Wollaston’s heart, and Dr. Navin discovered that contraction band necrosis was present in Wollaston’s heart. Dr. Navin explained that contraction band necrosis was not a specific diagnosis of a heart attack and had many possible causes. Dr. Navin testified that in forming his opinions, he also considered Wollaston’s long history of alcoholism, drug abuse, which included methamphetamines and marijuana, and substandard living conditions. It was Dr. Navin’s theory that Wollaston’s death resulted from the mixture of alcohol, marijuana, Wollaston’s pre-existing heart condition, and the physical activity of the fight. Dr. Navin testified that Wollaston could not speak when police arrived because a myocardial infarction can have a similar effect on the vocal chords as a brainstem injury. Dr. Navin opined that Dr. Happy failed to examine sections of the brain and that Wollaston’s brain was not actually swollen. According to Dr. Navin, however, Wollaston’s heart was abnormally enlarged by fifty percent. Dr. Navin testified that the autopsy report did not note “contraction band necrosis and other cellular changes indicative of myocardial infarction present in both the original slides and the recuts.” 13  FOR PUBLICATION IN WEST’S HAWAIʻI REPORTS AND THE PACIFIC REPORTER  Dr. Navin testified that the presence of wavy fibers, although a non-specific finding, in conjunction with the contraction band necrosis found in a whole area of Wollaston’s heart just “four hours old” supported his conclusion. Dr. Navin also opined that the contraction band necrosis was more likely from a heart attack than from epinephrine or the external cardiac massage because the bands were not isolated, and Wollaston had granules throughout her heart and edema caused by cellular injury that could have appeared hours prior to the fight. Dr. Navin also explained that if Wollaston only exhibited the granules and contraction band necrosis, it would be consistent with external massage. The edema and holes indicating cellular injury could have occurred prior to the fight and were independent of any blunt trauma. As to Wollaston’s head injuries, Dr. Navin testified the abrasion on the back of Wollaston’s head was more likely caused by hitting her head when she fell, but could have been from a kick. Dr. Navin did not believe Wollaston’s head injuries were fatal because they consisted of “just a bruise” in the scalp and “surface hemorrhages” on the brain. According to Dr. Navin, the injury to the brainstem could have contributed to her death, but that was unclear to him because he did not have cut sections of the brain to review. The tear in the brainstem could have been 14  FOR PUBLICATION IN WEST’S HAWAIʻI REPORTS AND THE PACIFIC REPORTER  the primary cause of death instead of the heart attack, he acknowledged, or “it could add more stress to an already existing stressful situation.” According to Dr. Navin, without a heart attack, it was entirely possible that Wollaston would have survived the left temporal bone fracture. As to Wollaston’s vertebral artery injury in the neck, he stated it was not typically a fatal injury but could be depending on the circumstances, and he shared a story of a woman who died from such an injury. In his opinion, Wollaston’s injuries to her medulla were survivable. On cross-examination, Dr. Navin agreed his experience in cytopathology, pap smears, and rabies did not relate to myocardial infarction or the kinds of injuries sustained by Wollaston during the July 21, 2014 incident. Regarding his experience as an expert witness, Dr. Navin stated he had previously testified for the public defender’s office on death cases but also for the Honolulu prosecutor’s office, primarily in sexual assault cases. He could not remember if he had testified for the prosecutor’s office within the past five years. The DPA then questioned Dr. Navin regarding his testimony in two murder cases on behalf of the defense: the Lankford trial in 2008 and the Higa trial in 2010. In response to the DPA’s 15  FOR PUBLICATION IN WEST’S HAWAIʻI REPORTS AND THE PACIFIC REPORTER  questions, Dr. Navin testified the Lankford trial involved a missing Japanese student, Masumi Watanabe, whose disappearance resulted in a large-scale police investigation. Dr. Navin testified he could not recall his fee schedule in the Lankford case. The DPA then began questioning Dr. Navin about a hypothetical question asked by Lankford’s defense counsel during that trial: Q. Do you recall [defense counsel] posing a hypothetical to you: A vehicle travelling 40 miles an hour with a woman, five feet two inches tall, 100 pounds, seated in the right front passenger seat. Thereafter the woman opens the door, falls out of the right front passenger seat and strikes her head against a rock that’s on the ground. Do you remember that hypothetical being put to you? A. Yes. Q. And then you testified, based on that hypothetical, that the woman based on your training and experience would be dead under those circumstances, right? A. She could be, yes. Q. She could be. But in your testimony on that day, you would agree that you speculated about what could have happened based on that hypothetical, right? A. I don’t remember. To refresh Dr. Navin’s memory, the State turned Dr. Navin’s attention to a binder including the transcript of his testimony in the Lankford trial and asked him to read a number of lines.10 10 The State asked, “would reviewing your testimony of March 20th, 2008 refresh your recollection as to what you testified to in another case?” Udo’s counsel promptly objected and requested to approach the bench. Udo’s counsel argued the State was offering a different case to refresh Dr. Navin’s recollection, and requested the court to compel the State to provide Dr. Navin with the document related to the hypothetical to refresh his recollection. The court declined the request because no rule of evidence applied to compel the document to be provided. Udo’s counsel insisted the (continued. . .) 16  FOR PUBLICATION IN WEST’S HAWAIʻI REPORTS AND THE PACIFIC REPORTER  The following line of inquiry between the DPA and Dr. Navin then transpired. We refer to the underlined passage that Udo raises on appeal as the “Lankford Question”: Q. [DPA] Okay. So you recall the defense attorney giving you a hypothetical example of a woman, five feet two inches tall, a hundred pounds, falling out of the front seat-- A. [DR. NAVIN] Jumping out. Q. Jump -- jump, that’s right, jumping out of the front seat of the car and striking her head against a rock? A. Yes. Q. Okay. And you testified that based under those circumstances, that hypothetical, the woman would be dead? A. She could be. Q. She could be. But isn’t it true that Mr. Wilkerson[, the defense attorney in Lankford,] asked you to speculate about what could have caused her death? [Udo’s counsel]: Objection, your honor. Lack of foundation. The Court: All right. Well, overruled at this time. Q. [DPA] In fact, turn to pages 75, doctor. Lines 4 and 5, the defense attorney asked you, “Could you tell us the things that could have happened?” That was the question that was put to you, right? A. Yes. Q. And then your response, you said, “She could have torn blood vessels. She could have torn the brainstem.” So you were speculating as to what could have happened based on a hypothetical given to you by the defense attorney, right? A. Well, there are a whole list of possibilities, but yeah. Q. Well, based on your training and experience, you know that an injury to the brainstem can cause death? A. It can, yes. Q. And that’s what you testified to in the Lankford case on March 20th, 2008, that damage to the brainstem can cause death? A. Yes, depending on the severity. Q. Isn’t it true, Dr. Navin, that with regards to the hypothetical that was given to you in the Lankford murder case, the facts of the hypothetical came directly from the defendant? He told you his version of the events? A. Yes. . . . . Q. So to be clear, on March 20th, 2008, in that murder trial you testified to a hypothetical based on information provided to you by the accused, right? A. Yes, he told me what -- (. . . continued) court was biased in its decision-making, to which the court responded it was not making “any decisions based upon any sort of bias for or against anyone.” 17  FOR PUBLICATION IN WEST’S HAWAIʻI REPORTS AND THE PACIFIC REPORTER  Q. He believed happened? A. What he said happened. Q. And you would agree that based on all of the information that you reviewed in the Lankford case there was no independent corroboration of defendant Lankford’s version of the events? A. That’s correct. Q. Okay. A. Now what he said actually was that she jumped out of the car. She didn’t speak English and he didn’t speak Japanese, and she was frightened and she jumped and hit her head and when he got -- he stopped the truck, got out, that she had no pulse, no respirations. Q. And that’s what she -- that’s what he told you? A. Yes. Q. And you took it at face value, right? A. He’s the only witness. Q. So in this case, in that case, sorry, the Lankford case, you took the word of the murder -- the accused murderer without any independent corroboration to support his version of events; that’s what you did, right? A. There wasn’t anybody left. As to Higa trial, the following line of inquiry occurred; the underlined portions that Udo raises on appeal are referred to as the “Higa Questions”: Q. Now do you remember on January 26, 2010 testifying in the case of State of Hawaii versus Matthew Higa? It’s case number 08-1-0132. It’s that other murder case. A. The kid off the bridge? Q. The kid off the bridge. Do you remember that? A. Yes. Q. There was an allegation that Matthew Higa threw an infant off of the bridge? A. Yes. Q. And this was on the H-1 overpass, right? A. Yes. Q. And you were retained by the defense in that case? A. Yes. Q. Right? And that defense attorney was Randy Oyama; do you remember him? A. Yes. Q. And what was your retention schedule in that case, how much were you paid? A. Oh, I don’t know. Q. All right. But you recall Mr. Oyama calling you and agreeing to take the case? A. Yes. Q. Isn’t it true that in the Matthew Higa case you testified as an expert witness that the infant was either 18  FOR PUBLICATION IN WEST’S HAWAIʻI REPORTS AND THE PACIFIC REPORTER  unconscious or dead before it struck the H-1 freeway? You testified -- A. I didn’t say that. Q. You didn’t? A. No. Q. Turn to page -- turn to Exhibit 86. A. Oh, oh. Wait, wait. No. Yes, I did say that. I’m sorry. Q. Okay. A. It was the opposite part that I -- oh, no. Right, I did. Q. Okay. Let’s take our time. I don’t want to -- A. Yeah. No, no. Q. I want to make sure we understand each other. A. There were two aspects to it. One of them is that they asked if she -- if the kid was dead and I said probably. And the reason the kid was probably dead is when -- when he threw the body, number one, he carried the body underneath his coat down to the bridge and two people saw him walk by and they didn’t see the kid. Okay? Then he gets down to the bridge and he throws the kid off and from all the -- what the witnesses saw, the kid’s arms, they never moved, nothing ever moved and there was no yelling or screaming. So I said, well, there’s good chance he was already unconscious or dead -- when the body was going through the air. Q. So the purpose of your testimony, as you think back, was to say that the defendant, Matthew Higa, couldn’t be guilty of murder because the baby he threw off the overpass was already dead when it hit the pavement; that was the purpose of your testimony, wasn’t it? A. No, it wasn’t. The purpose of the testimony was establishing what I thought the condition of the child was, if he was killed before by Matthew Higa or somebody else and that -- that would explain it. If he was not, then -- Q. You recall that the injuries obviously to the infant were devastating? A. The what? Q. The injuries to the infant were devastating, remember? A. The brain’s out in the middle of the highway. Q. That’s right. And you testified as an expert that you couldn’t determine whether the intracranial injuries you saw to the infant were caused before it was thrown off the highway overpass or when it hit the ground, that’s what you testified to? A. That’s correct. Q. You also testified as an expert witness in that case that you couldn’t rule out if the infant’s skull was fractured before it was thrown off the overpass or when it impacted the freeway, you testified to that, right? A. Correct. Q. But wasn’t the purpose of your testimony to present evidence in that case that Matthew Higa wasn’t guilty of murder because the infant could have been already dead before he threw it off the overpass? 19  FOR PUBLICATION IN WEST’S HAWAIʻI REPORTS AND THE PACIFIC REPORTER  A. No. Because he could have killed him before. With respect to the instant case, Dr. Navin testified he had not determined his fee schedule yet, but had received one advance check of $5,000 and was to receive a negotiated amount after testifying. Regarding the materials he consulted prior to testifying, Dr. Navin testified he had consulted Wikipedia. He also acknowledged that none of Wollaston’s charts contained proof of methamphetamine in Wollaston’s body, and that the source of that information came from Wollaston’s father’s statement, as recorded by the medical examiner’s office, which Dr. Navin had not corroborated. When the prosecution likened Dr. Navin’s failure to confirm the information to his testimony in Lankford, defense counsel objected for mischaracterization of the evidence. Before the bench, the State contended that the “offer of proof demonstrates that [Dr. Navin’s] methodology is to accept at face value those assertions that seem to support his theories and conclusions without verifying the underlying. That’s exactly the point that’s being made . . . . That’s what he did in Lankford. That’s what he’s doing here.” The court overruled the objection. Dr. Navin also acknowledged on cross-examination that he made changes to his expert report up until the morning of his 20  FOR PUBLICATION IN WEST’S HAWAIʻI REPORTS AND THE PACIFIC REPORTER  trial testimony, and previously made changes to the report after speaking with defense counsel about the report. He also acknowledged that he referenced an article in National Geographic, which is not a scientific or peer-reviewed journal. Additionally, he acknowledged that Wollaston’s blood contained an inactive form of tetrahydrocannabinol (“THC”) from marijuana, which does not have pharmacological effects. Further, when the State clarified that Dr. Navin did not consider statements made by Kingston in forming his opinion because Kingston did not state that Wollaston was only blocking punches after she fell, defense counsel objected, but was overruled. Dr. Navin also acknowledged that acute subdural hemorrhages are life-threatening, Wollaston’s injuries could have been caused by a direct impact such as a stomp, and the subdural hemorrhaging was not a direct result of myocardial infarction. Regarding Wollaston’s brainstem, Dr. Navin testified that he did not see the slides of Wollaston’s brainstem “until after [his] report went out.” Dr. Navin agreed that a tear to the brainstem could impact someone’s ability to speak, but was not necessarily the reason that Wollaston could not speak the morning of July 21, 2014. As to the vertebral artery injury, blunt force trauma to the back of the neck or side of the neck could have caused such an injury. 21  FOR PUBLICATION IN WEST’S HAWAIʻI REPORTS AND THE PACIFIC REPORTER  Dr. Navin agreed that nothing in the record from Kingston’s statements or other witnesses indicated that Wollaston experienced any of the tell-tale signs of a heart attack, such as dizziness, chest pains, or shortness of breath, on the morning of July 21, 2014. He also admitted that there was no evidence that Wollaston had hardening of the arteries, which could cause a heart attack. Further, Dr. Navin acknowledged that epinephrine, which Wollaston received, can cause contraction band necrosis, and that he did not know the dosage of epinephrine that was administered to Wollaston. He opined, however, that the defibrillation and epinephrine that Wollaston received was less likely than the myocardial infarction to have caused Wollaston’s contraction band necrosis, “because one part of the heart has it, the other part doesn’t.” On re-direct, Dr. Navin testified that it was possible that Wollaston would have survived the head injury if she had not had a heart attack. He further testified he did not receive any instructions from defense counsel when he was retained other than to look at the case and share his opinion.
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.