Court Opinion

ID: 9471203
Source: CourtListenerOpinion
Date Created: 2023-08-05 03:26:56.564642+00
Date Added: 2024-06-11T17:42:18.598303
License: Public Domain

WIDENER, Circuit Judge,
dissenting:
I respectfully dissent.
*902I
Schmerber, infra, has decided that an involuntary intrusion, made under protest, and even unaccompanied by court order or other process, into the human body is not necessarily a violation of the Fourth Amendment protection against unreasonable searches and seizures from the person. What we have to decide is whether a perfectly routine surgical procedure to extract a bullet nine-tenths of an inch below the surface of the skin imbedded in the deltoid muscle near the left collarbone violates the Fourth Amendment when accomplished under a general anesthetic.
Among the many remarkable things about this ease is the fact that the most nearly controlling authority is Perez v. Ledesma, 401 U.S. 82, 91 S.Ct. 674, 27 L.Ed.2d 701 (1971), which is nowhere mentioned in the opinion of the majority. Neither is the allied case of Younger v. Harris, 401 U.S. 37, 91 S.Ct. 746, 27 L.Ed.2d 669 (1971). While the explanation may be that the Commonwealth did not rely upon those cases in its brief, the doctrine of federal courts not interfering in ongoing state criminal prosecutions is so firmly imbedded in our jurisprudence that a decision authorizing such interference cannot be said, I think, to have been considered fully without stating the authority for its action. Absent judicial authority, 28 U.S.C. § 2283, literally read, of course would bar a federal court from staying the state court criminal proceeding, although Younger did not proceed on that premise, 401 U.S. at 54, 91 S.Ct. at 755. Even considering that suits under § 1983 have been held to be excepted from the prohibition of § 2283 in Mitchum v. Foster, 407 U.S. 225, 92 S.Ct. 2151, 32 L.Ed.2d 705 (1972), Perez, like Younger, did not rely upon § 2283 for its authority. Rather, as its reason for reversing injunctive interference with an ongoing state criminal prosecution, it described a federal court’s suppression of evidence in a pending state criminal prosecution: “It is difficult to imagine a more disruptive interference with the operation of the state criminal process short of an injunction against all state proceedings.” 401 U.S. at 84, 91 S.Ct. at 676. And Perez differed factually from the case at hand only to the extent that in Perez the evidence previously seized by the state (obscene literature) was sought to be suppressed, while here it is the very search itself. So the rule of the Perez case must be followed or else the disruptive interference with the operation of the state criminal process may not be authorized in any event.
Perez, in discussion, gave the rule for an occasion permitting such interference as follows: “Only in cases of proven harassment or prosecutions undertaken by state officials in bad faith without hope of obtaining a valid conviction or perhaps in other extraordinary circumstances where irreparable injury can be shown is federal injunctive relief against pending state prosecutions appropriate.” 401 U.S. at p. 85, 91 S.Ct. at p. 677. There is no harassment in this case, and no prosecution undertaken by the Commonwealth without hope of obtaining a valid conviction. Thus, we must have, to permit relief, “extraordinary circumstances where irreparable injury can be shown.” The irreparable injury of course cannot be the mere fact of a criminal prosecution. Younger, 401 U.S. at pp. 46-47, 91 S.Ct. at pp. 751-52. And it cannot be the mere intrusion into the body. Schmerber v. California, 384 U.S. 757, 86 S.Ct. 1826, 16 L.Ed.2d 908 (1966). As a matter of law, then, the extent of the intrusion must decide whether or not the injury is irreparable, and I think the standard is the same whether the case be considered under § 1983 or as one in habeas corpus.
II
Before passing, I should note that I do not agree that Lee did not have a full and fair opportunity to present his case in the state court. The majority, as did the district court, bases the lack of full and fair opportunity solely on the failure to grant a continuance to get another anesthesiologist to, and prepare for the testimony at, the hearing. The attorney involved at the time of the second hearing in the state court had been employed in the case for more than *903ten weeks. Remembering that the hearing in question was on October 21st, the attorney had told the court on August 11th that he had completed his investigation of the facts of the case but had not completed researching the law, and he asked for and was given a continuance of two weeks at that time for that purpose. He had already appeared at the first hearing in the state court and at a subsequent hearing in the district court, and in the Virginia Supreme Court, with respect to the very matter at hand. So any suggestion that he was not prepared as to the law of the case is so patently without merit that I take no stock in it whatsoever.
So far as being unable to examine or cross examine properly an anesthesiologist, the record speaks for itself, and is an entire contradiction of the fact finding of the majority as well as that of the district court. It is true that the attorney did not have at hand the consulting anesthesiologist he wanted to testify, for whom no subpoena had been issued, and whom he has been found by the majority and the district court unable to examine or cross examine properly. But he did better than that. He called as a witness Dr. C. Paul Boyan, who must be accepted as the prisoner’s treating physician and who had not testified before in the ease on behalf of anyone. Dr. Boyan was Professor Emeritus in the Department of anesthesiology in the Medical College of Virginia. Prior to becoming an anesthesiologist, Dr. Boyan had been a field surgeon with the Red Cross during World War II, treating the wounded as a surgeon and was familiar with the removal of bullets. He had performed the function of anesthesiologist in about 100,000 operations and had never lost a patient. To say that Dr. Boyan was vastly skilled and experienced in the exact procedure then in question before the court would be understatement. Not only that, Dr. Boyan had examined the patient and was one of the anesthesiologists who had been selected to administer the anesthetic at the operation. At the conclusion of the hearing in the state court, the attorney. indicated that he yet wished to call an independent anesthesiologist, the one that was unavailable that morning. Yet, he did not even contend to the court that any of Dr. Boyan’s answers were not absolutely truthful, and his only objection was that Dr. Boyan couldn’t quantify some statistics that the attorney’s reading of a text on anesthesiology told him should have been quantifiable. Indeed, the anesthesiologist whom he wanted to call was also on the staff of M.C.V.
The attorney’s examination of Dr. Boyan reveals anything but the inadequacy of an unprepared attorney, while decried in terms, necessarily implied by the majority opinion. It was skilled, precise, and correct, and displayed knowledge of the field in which inquiry was being made. I invite especially the reading of pages N-39 through N-66 of the appendix. The same may be said about his examination of Dr. Mendez-Picon who was called as a witness on behalf of the defendant at the second hearing in the state court. Dr. Mendez-Pi-con had previously testified for the Commonwealth at the first hearing in the state court. No problem existed with getting a surgeon to the second hearing on behalf of the defendant, for one had been called as a witness but was stopped from attending at the instance of the attorney. Remarkably, this physician also was on the staff of M.C.V. and was the one designated to perform the operation after Dr. Mendez-Picon withdrew.
As there may be no suit complaining of a statute alleging its constitutional invalidity unless the plaintiff has been injured by its operation, Ashwander v. TVA, 297 U.S. 288, 56 S.Ct. 466, 80 L.Ed. 688 (1936) (Justice Brandeis concurring at p. 347, 56 S.Ct. at p. 483), it also has to be the law that a due process violation may not be prosecuted unless the complaining party has been injured by not receiving the process he was due. On similar if less exaggerated facts, Unger v. Sarafite, 376 U.S. 575, 84 S.Ct. 841, 11 L.Ed.2d 921 (1964), held there was no due process violation. Even if the attorney’s examination of Dr. Boyan is not adequate to refute such a contention, and I think that it is, then the other facts do. The same *904attorney at the later hearing in the federal court did not call any anesthesiologist at all, although he had talked to four more by that time (one of whom had been consulted by the Commonwealth and declined to testify) and although he had employed associate counsel described by the majority as experienced in the areas of medical malpractice and anesthesiology. The setting would not be complete without mentioning that the district court based its critical fact finding “entirely from the transcript of the state court proceedings of October 21.” It found that the additional evidence submitted in the federal court was either cumulative or in the case of the X-ray prints incomprehensible.1 And I note especially at this point that the district judge before making those findings had seen the defendant’s only additional witness, a surgeon, and heard him testify. It formed its factual conclusions “looking in the same body of evidence [as in the state court record].”
I thus insist that Lee received all the process he was due in the state court proceeding and that even if the failure to continue the case by the state judge was too peremptory, then Lee was not harmed by it. The record I think will admit of no other conclusion.
I will, for now, accept the premise of the panel majority and the district court that Virginia courts would give collateral estoppel effect to the finding of the state courts and their premise that Allen v. McCurry, 449 U.S. 90, 101 S.Ct. 411, 66 L.Ed.2d 308 (1980), would bar reexamination of the issue in a suit under § 1983 if a fair opportunity to try the issue were presented.
A fair reading of the Virginia Supreme Court’s order indicates that it is a decision on the merits of the Fourth Amendment claim adverse to the prisoner, and the Commonwealth concedes that at oral argument. If the rule in Stone v. Powell, 428 U.S. 465, 486, 96 S.Ct. 3037, 3048, 49 L.Ed.2d 1067 (1976), is that no Fourth Amendment claims will be considered in federal habeas corpus collateral review of state searches, rather routing all of them through the state courts and then to the Supreme Court of the United States, then the failure of the petitioner to ask the Supreme Court for a stay of the Virginia Supreme Court’s order and to petition for certiorari would mean that an inferior federal habeas court may not consider the merits of the claim. The prisoner was no farther away from an appointment to consider a stay of the Virginia Supreme Court’s order than the nearest telephone. When, however, we consider that Stone placed emphasis on the lack of deterrent effect on officers by collateral federal post conviction review, months or even years later, then this underpinning of Stone is not present in this case, and federal habeas corpus review might not be barred by that decision. I think that so far as a claim of intrusion into the human body is concerned, properly presented and developed before conviction, as here, that the Supreme Court would decide that Stone v. Powell did not bar federal habeas corpus review of that question and apply it on those special facts only to post conviction review of the same subject matter.
I agree in part with the district court, however, in its analysis of the habeas corpus question and not with the panel majority. Lee had exhausted his state remedies by the decision on the merits by the Virginia Supreme Court. I accept the analysis of *905the district court that custody for one purpose is not necessarily custody for another and being held in jail to answer for a crime is not the same as being held in jail to answer for a crime and also submit to involuntary surgery. I also accept the analysis of the district court that the only fact finding of the state court which carries with it the presumption of correctness under § 2254 is that there was no material difference in the facts brought out at the first and second hearings in the state court. I also will accept its conclusion that the facts are different. The bullet at the second hearing was shown to be slightly less than an inch deep, while at the first hearing the depth it was imbedded in Lee’s muscle tissue was thought to be about two-tenths of an inch deep. The requirement of a general anesthetic was indicated only at the second hearing. So whether there was any difference in risk in removal of the bullet some seven-tenths of an inch deeper was the proper subject of analysis by the district court, I think, for the risk to the one being operated on is what must be analyzed under the cases in order to ascertain whether or not to permit the intrusion into the body by way of surgery.
Where I part company with the district court as well as in the analysis of the same subject matter by the panel is that neither opinion analyzes the risk to the patient as I will develop below.
III
At the rehearing in the state circuit court, the hearing with which we are principally concerned, Dr. Mendez-Picon, who up to that time had been Lee’s attending physician, testified that his earlier palpation had not revealed correctly the precise location of the bullet. In preparation for the surgery at MCV, the hospital had been able to localize the bullet by taking X-ray photographs of Lee’s shoulder, with a lead marker placed on his skin. The bullet had been localized 2.5-3.0cm. into the deltoid muscle. The bullet lay deeper but higher than he had previously thought. As a result of the localization, Dr. Mendez-Picon could state that he knew the bullet was 5.0-6.0cm. away from the pleural cavity, farther away from that cavity than it was thought to be on the basis of the clinical examination.
Dr. Mendez-Picon testified that under the new facts the proposed surgery would be a simple, minor procedure, which would take less than one-half hour. There were no foreseeable complications, and any bleeding would be minimal. Dr. Mendez-Picon stated that surgical removal of the bullet would not result in any permanent impairment to Lee’s arm or shoulder.
Dr. Mendez-Picon explained that the decision to use local or general anesthesia is solely within the province of the surgeon. Dr. Whitley, the surgeon who had replaced Dr. Mendez-Picon, decided, as a result of the depth of the bullet, to remove the bullet under a general anesthesia because the surgery would be safer under general than under local. Dr. Mendez-Picon concurred in Dr. Whitley’s decision; the proposed surgery would be less risky and involve fewer complications under general anesthesia because it would proceed more smoothly. Dr. Mendez-Picon explained that under general anesthesia the patient’s muscles are more relaxed and the patient experiences less pain. Under local anesthesia the muscles would contract when the patient felt pain, making extraction of the bullet and any fragments more difficult. The relaxed state of the patient’s muscles under general anesthesia allows retraction of muscle tissue and exposure of the bullet to be accomplished more easily: “... anything that does not have to be cut is not cut.”
In trying to estimate the risks involved in the proposed surgery, Dr. Mendez-Picon stated that the lack of similar cases prevented him from giving a certain figure on the chances of injury or complications. Without giving an exact figure, he said that the chances of injury, permanent or temporary, from removing the bullet surgically are very small.
The risks of anesthesia aside, the risk from the surgery was a little bit greater than before because the bullet was deeper than he had first supposed and the chances *906of infection and nerve damage are a little bit greater. Dr. Mendez-Picon estimated that the chance of injury from surgery was double that of before. Whereas before the risk was 1/100,000, now the risk might be 1/50,000. Elsewhere in his testimony, Dr. Mendez-Picon characterized the risk of dying from the surgery itself as being very small, in the order of one chance in 100,000.
Because the proposed surgery now would cut more deeply, it carried a greater possibility of nerve damage. Nerve damage would result in temporary tingling or numbness in Lee’s arm. If a nerve were cut, it would, however, regenerate. Dr. Mendez-Picon testified that the chances of the nerve being cut were very small, and, as mentioned, even smaller with general anesthesia because the relaxed state of the muscle tissue allows the surgeon to see the nerves more clearly. Dr. Mendez-Picon testified that a one percent risk of harm in medicine is considered substantial; a risk less than one percent would thus be insubstantial. Therefore, the only evidence in the record on which the district court relied admits of only one conclusion, namely, that the risk of the surgery is clearly insubstantial.
While admitting that his expertise lay outside the field of anesthesiology, Dr. Mendez-Picon opined that the risk of general anesthesia carries a higher risk than that of local anesthesia. Nevertheless, he would usually recommend general unless the patient faces a particular risk due to previous conditions, such as cardiac or pulmonary problems or old age. Surgery under general anesthesia is more comfortable for the patient, and most surgery is done under general anesthesia in spite of a slightly higher risk from the anesthetic even if the patient is older, because the general anesthesia reduces the stress and pain involved. Dr. Mendez-Picon’s testimony thus establishes that although in the abstract general anesthesia may involve slightly greater risks than local, those risks may be offset by the decrease in risk where, as here, the general anesthesia makes the surgery itself proceed more smoothly and safely. Dr. Mendez-Picon testified that the use of general anesthesia in minor surgery is commonplace. The outpatient department of MCV routinely uses general anesthesia; the patient receives the general anesthesia at 10 a.m., and he is ready to go home at 3 p.m.
Lee also called as his witness, Dr. C. Paul Boyan, the physician previously mentioned, Professor Emeritus in the Department of Anesthesiology at MCV. At the request of the Department of Surgery, Dr. Boyan performed an examination of Lee to determine the risks to Lee of using anesthesia. Dr. Boyan read Lee’s charts and talked with, and examined, Lee. He found that Lee was in good health, had had two previous anesthetics, and was a good risk for general anesthesia. Dr. Boyan, whose service as a surgeon during World War II often required him to remove bullets, testified that removing a bullet from a wound such as Lee’s was routine and unproblematic. Although Dr. Boyan had not looked at the X-rays of Lee’s shoulder, he had palpated the bullet and estimated that it was no more than a few centimeters under the skin. His palpation had thus meant to him that the bullet was where the X-rays ascertained it to be. On the basis of his examination, Dr. Boyan concluded that the bullet could be surgically removed under either local or general anesthesia.
Dr. Boyan’s testimony explicitly addressed the principal concern of the rehearing: what were the new risks injected into the case by the proposal to proceed with the surgery under general anesthesia. Dr. Boy-an stated that local anesthesia is usually safer because its use is associated with small, minor procedures, such as the surgery under consideration here, which are over in less than thirty or forty minutes. Dr. Boyan described the findings of a study, conducted at MCV, based on 150,000 patients who have received anesthesia at MCV over the course of 13 years. Taking all forms of anesthesia together, the study showed that the chance of death from anesthesia at MCV is one in 12,000. If children under 12 years are excluded, the chance is one in 14,500. These figures include all patients, 75 percent-of whom are in high *907risk groups. Dr. Boyan explained that patients are classified in four groups according to risk, and that Lee was in the lowest risk group, group one. Looking at only the good-risk group patients, in groups one and two, the MCV study found that the chance of dying from anesthesia is one in 50,000. Lee’s risk would thus be less than one in 50,000. Dr. Boyan quite aptly described this risk as “far fetched.” The MCV study, the results of which could not be extrapolated to other hospitals, found that the chances for all groups dying from anesthesia at MCV were roughly equal to the chances of being murdered in the United States within a year or dying in a car accident within 158 days.
Dr. Boyan stated that the MCV study did not, nor could he, statistically quantify the risks of local versus general anesthesia because comparisons had to be made for one type of surgery and one type of patient. Unlike statistical studies on cars, for example, which are supposed to be built to a single set of specifications, all patients are different, he explained. But for a given type of patient and surgery, assuming the involvement of a competent anesthesiologist, the risk of injury, whether temporary or permanent, or of death is the same for local and general anesthesia.
Lee had also called as a witness Dr. Whitley who was scheduled to perform the surgery. Because Lee primarily wanted Dr. Whitley to testify to his desire to perform the surgery under general anesthesia, to which Dr. Mendez-Picon had already testified, and the state circuit court accepted as stipulated, counsel for Lee decided to proceed without Dr. Whitley. Counsel stated that his main concern was with the evidence from the anesthesiologist, not from the surgeon, and that his only complaint about Dr. Boyan’s testimony was its failure to quantify statistics. Counsel suggested that if he had had more time he could have found an expert who would have been able to give specific statistical risks of harm to Lee. Of course, such evidence was never forthcoming in later federal court hearing when Lee had all the time he wanted to prepare. No anesthesiologist at all testified at that hearing.
The upshot of all of the testimony relied upon by the district court was that the removal of the bullet would be perfectly routine in every way. When questioned about the adverse effects of Xylocaine, for example, a local anesthetic, Dr. Boyan testified that there was no more risk connected with the injection of that drug into the body than the introduction of any other drug into the body, and he gave as an example Tylenol. I suggest the detailed description of a routine administration of a general anesthetic relied upon in considerable part by the panel for its decision is calculated almost wholly to emphasize the rude insult to the body and to the dignity of the person rather than the risk to the patient. And the same may be said of the district court’s less detailed description of the same thing. The same remarks apply to the detailed description of removal of the bullet which only describes a routine surgical procedure.
Thus, I think that unless we are going to establish a rule that the removal of bullets from the person more than skin-deep may not be accomplished under general anesthetic, the risk to the patient is the principal factor which must be considered. Because the only testimony in the record is that if a patient is uncooperative, then a general anesthetic, rather than a local, should be used, this rule places the determination of whether or not the bullet will be removed entirely in the hands of the prisoner. Therefore, I would not adopt such a per se rule as is bound to be the result of this decision by the majority. Although such a rule is not mentioned in the majority opinion, that result is almost bound to happen, for, artful as the language used may be, the description of the bullet removal is nothing more than that of a routine minor surgical procedure under general anesthetic.
It is true that the sensibilities are shocked by an involuntary intrusion into the human body, but it is just as true that they are similarly shocked when a man in an attempted robbery shoots his intended victim *908and then is able to withhold evidence of the crime at virtually no risk to himself. Had the assailant only been masked he would certainly go free under the majority opinion. Unless the rule of decision is going to necessarily include how much risk to the patient, and the cases2 indicate that such should be a principal consideration, decisions in such cases as the one before us will come to be unprincipled holdings. Any surgical procedure is shocking to some, few are shocking to others. The intrusion into the human body at hand shocks the writer, yet I cannot escape the conviction that under Schmerber an analysis of the amount of risk to the patient is necessary in each ease.
I submit the majority, as did the district court, has substituted an analysis of the rude insult to the body and to the dignity of the person, for risk to the patient. I do not believe these cases should be decided on that ground because there is no sufficient stated principle to guide the decisions of the courts. If we are going to have a rule that no bullet may be routinely removed under general anesthesia which is nine-tenths of an inch below the skin, it is better to say so than to recount in detail a routine minor operation and assign as reasons for our decision the known consequences. Any penetration of the skin, of course, involves risk; the question must be how much.
The evidence in this record shows that no analysis has been made of risk to the patient by either the district court or by the panel majority, and while I think there is little or no risk, I believe that matter is more properly entrusted to the district court for initial decision. I further believe that, while the fact that the contemplated operation was minor surgery is not disposi-tive of the case, that factor must be considered in arriving at any decision. Also to be considered is the state proceeding at hand and whether that procedure was fair. I cannot agree that the routine removal under general anesthetic of a bullet imbedded in a muscle nine-tenths of an inch beneath the skin, with virtually no risk to the patient, is per se in violation of the Fourth Amendment. Yet that is the very narrowest holding that the opinion of the majority will permit.
I believe that the statements in United States v. Crowder, 543 F.2d 312 (D.C.Cir.1976), cert. den. 429 U.S. 1062, 97 S.Ct. 788, 50 L.Ed.2d 779 (1977), supporting the opinion of that court of appeals are well considered. They are; was there any other way to obtain the evidence;3 whether the *909operation was major or minor, the precautions taken, the possible complications and risk; and the extent of adversary hearings prior to conducting the surgery. Crowder at 316.
I would thus vacate the judgment of the district court and remand the case to it for reconsideration under the principles I have set forth just above, taking care that an analysis of risk to the patient must be more than the self-evident proposition that it does exist.

. The majority relies on the testimony of the surgeon (a specialist in vasectomy we are told) who testified at the second federal habeas corpus hearing to set up inconsistencies in the expert testimony, the principal of which is the length of the operation caused by the uncertainty of the location of the bullet even with X-rays. Dr. Boyan knew exactly where the bullet was even without X-rays the first time he saw the patient. Dr. Mendez-Picon knew exactly where the bullet was with the aid of X-rays, although he had at first mistaken scar tissue for the bullet, which Dr. Boyan had not. The rejection by the district court of this testimony for whatever reason is well justified by the medical authorities which indicate that the location of bullets by X-ray or CT scan may be precisely accomplished. See, e.g., J. Lee, M.D., S. Sagel, M.D., & R. Stanley, M.D., eds., Computed Body Tomography 496 (N.Y.1983); J. Haaga, M.D. & N. Reich, D.O., Computed Tomography of Abdominal Abnormalities 270-72 (St. Louis 1978).

. For completeness, I find the following published cases have considered the removal of a bullet from the human body, not that there may not be others:
United States v. Crowder, 543 F.2d 312 (D.C.Cir.1976) (en banc), cert. denied, 429 U.S. 1062, 97 S.Ct. 788, 50 L.Ed.2d 779 (1977); South Carolina v. Allen, 277 S.C. 595, 291 S.E.2d 459 (1982); Doe v. Florida, 409 So.2d 25 (Fla.App.1982); Hughes v. United States, 429 A.2d 1339 (D.C.App.1981); Missouri v. Richards, 585 S.W.2d 505 (Mo.App.1979); Georgia v. Haynie, 240 Ga. 866, 242 S.E.2d 713 (1978); Missouri v. Overstreet, 551 S.W.2d 621 (Mo.1977) (en banc); Bowden v. Arkansas, 256 Ark. 820, 510 S.W.2d 879 (1974); New York v. Smith, 80 Misc.2d 210, 362 N.Y.S.2d 909 (1974); Allison v. Georgia, 129 Ga.App. 364, 199 S.E.2d 587 (1973), cert. denied, 414 U.S. 1145, 94 S.Ct. 899, 39 L.Ed.2d 101 (1974); Adams v. Indiana, 260 Ind. 663, 299 N.E.2d 834 (1973), cert. denied, 415 U.S. 935, 94 S.Ct. 1452, 39 L.Ed.2d 494 (1974); Creamer v. Georgia, 229 Ga. 511, 192 S.E.2d 350 (1972), cert. dismissed, 410 U.S. 975, 93 S.Ct. 1454, 35 L.Ed.2d 709 (1973).

. The majority opinion takes the position that a solid lead bullet already lodged in a human body for nine months may not now be probative as to caliber or land and groove marks because of the deterioration of the lead during the delay. (At p. 901 n. 15). I think this fact finding is without support in the record or in medical learning. A forensic sciences expert testified that a lead bullet may decompose over time, but carefully avoided specifying the duration that would be necessary. Dr. Mendez-Pi-con testified that the X-rays show an intact bullet that had retained its cylindrical shape and had a slightly bent nose.
The medical literature reveals that decomposition of a lead foreign body would lead to symptoms of plumbism or lead poisoning. Cagin, M.D., Diloy-Puray, M.D., & Westerman, M.D., Bullets, Lead Poisoning & Thyrotoxicosis, 89 Annals Internal Med. 509 (1978). The deterioration of a lead bullet is a rare phenomenon presumably because the human body readily encapsulates the bullet with dense avascular fibrous tissue. Switz, M.D., Elmorshidy, M.D. & Deyerle, M.D., Bullets, Joints, and Lead Intoxication, 136 Arch. Internal Med. 939 (1976). *909Dr. Switz has written that the symptoms of lead intoxication following decomposition is controlled by the solubility of lead in the body. Id. at 940. Blood serum is a relatively poor solvent, and would in any event have little contact with a bullet encapsulated in avascular tissue. Id. at 941. In Dr. Switz’s case study, the first in the English literature, symptoms of lead poisoning appeared only 40 years after a bullet was lodged in the ankle region, where the site of the bullet was aggravated by a later injury and thus exposed to increased blood flow and apparently to synovial fluid, which is more corrosive of lead than is blood serum. Id. at 939, 941. The recommendation of Dr. Switz that most bullets need not be removed, obviously because they do not deteriorate, is consistent with the recommendation made here that the bullet in question need not be removed for the sake of Lee’s health. But, the fact the bullet in question will not significantly deteriorate is an uncontradicted proclamation of its probative value.
The matter of the deterioration of the bullet, I think, should be the subject of further evidence, on remand if the prisoner desires it. Otherwise, I think the record will support only the conclusion that there has been and will be no significant deterioration during the pendency of the litigation.