Replies

I am not Evelyn Wood. I don't have time to read that entire transcript.

It's not that long. And taking the time (at your liesure) will be worth the effort.

I've found that the summaries posted here are often misrepresentation, and that the source material contradicts the conclusions asserted by the poster.

I assume you want to objectively reach your own conclusion, confronted with a cacophany of conflicting points of view. Source material is a powerful ally in that.

As for the deposition of WILLIAM CAMPBELL WALKER, M.D, dated November 21, 2003, the following excerpts may be of interest. I haven't carefully read the entire transcript, so don't be lulled into some sense that these excerpts represent the sum conclusion of Dr. Walker, pardon the length of the excerpts. It's still shorter than reading the entire transcript ;-) ...

6          Q     Now, because of the sentence structure,
7     I'm not sure if there is a single compression
8     fracture at L1 or a second compression fracture also
9     in the femur.
10         A     What this says is there's a compression
11    fracture of the lumbar vertebral body at L1 and an
12    additional radiographic abnormality, irregular
13    periosteal ossification along the femoral bone.
14    Periosteal ossification is not a compression
15    fracture.  It's a different kind of abnormality.
16         Q     And the ossification referred to in the
17    femur is primarily ventrally?
18         A     Ventral is that surface of the body
19    related to the belly.  Ventral is belly.  Dorsal is
20    back.
21         Q     So it was on the front side of the femur?
22         A     Correct.
23         Q     The abnormality was?
24         A     It would be on that side facing closer to
25    you if the patient was standing in front of you
?                                             22
1     looking at you.
2          Q     Okay.  And by "shaggy irregular
3     periosteal ossification," you are speaking there of
4     the information you got from the bone scan or from
5     the x-ray?
6          A     The radiograph.
7          Q     What does that word "shaggy" refer to?
8          A     It's just a descriptor like the shaggy
9     dog.
10         Q     Just means that the ossification is
11    not --
12         A     The opposite of smooth.
13         Q     Would you draw any conclusions from that
14    how old the ossification was?
15         A     You could say that it wasn't real old,
16    because typically, as we mentioned, the bone is a
17    dynamic structure, and it's constantly being
18    remodeled normally.  So the body tends to take away
19    extra bone eventually to remodel it to look like
20    normal bone.  So typically old bone injuries are
21    remodeled so that eventually they may almost
22    disappear, particularly in young people.  In the
23    very young, a fracture you won't even see in three
24    or four years, it will be totally erased.
25         Q     By "young," you mean?
?                                             23
1          A     Say a six- or eight- or ten-year-old.  As
2     you get older, the bone remodeling process slows
3     down, and so those injuries may persist for longer
4     and longer times, but it depends on the individual
5     too.  But I would say it would be more recent than
6     less recent; same with the bone scan.
7          Q     In an adult female in her twenties, would
8     a bone fracture be capable of being aged by a
9     radiologist?  In other words, could you look at an
10    image of a fracture and say is it a new fracture or
11    an old fracture?
12         A     I would have to refine that to say that
13    the bone scan actually gives you more information on
14    fracture age than a plain radiograph.  A plain
15    radiograph may give you some gross indication of
16    age.
17         Q     If this patient were to today have a bone
18    scan, would there likely be traces of these
19    abnormalities in her skeleton?
20         A     It would depend on the cause of the
21    abnormality.
22         Q     And that brings us to the next sentence
23    in the report, which is, "The patient has a history
24    of trauma."  What likely led you to that conclusion?
25         A     As I mentioned before, the indication
?                                             24
1     "evaluate for trauma" and the history of closed-head
2     injury and the fact that Dr. Carnahan is a rehab
3     doctor who typically works with patients who have
4     been severely injured and need to be rehabilitated.
5          Q     Anything else?
6          A     Not that I could speculate on at this
7     point in time, no.

[ STOP at page 24 - there is more following, regarding the injury to Terri's femur - the big bone of the upper leg - RESUME at page 28 ]


6          Q     So the skeleton is sort of a work in
7     progress?
8          A     It's always turning over, yes.
9          Q     The report goes on to say, "The
10    presumption is that the other multiple areas of
11    abnormal activity also relate to previous trauma."
12         A     That's what it says.
13         Q     And, again, that's based on the fact that
14    Dr. Carnahan is a rehab physician, that you were
15    asked to evaluate for trauma?
16         A     And the pattern of activity is fairly
17    typical of multiple traumatic injuries of relatively
18    recent origin.
19         Q     I realize you can't assign a cause to
20    these injuries that you picked up in this report.
21    But typically in your experience, what would be the
22    causes of this pattern of abnormality?
23         A     In somebody her age, an auto accident is
24    by far the most typical cause.
25         Q     Assume that she was not in an auto
?                                             29
1     accident but that she had suffered an anoxic or
2     hypoxic encephalopathy type of injury from a cardiac
3     arrest and had been bedridden for a year at this
4     point.  What might account for these abnormalities?
5          A     In my knowledge, that type of injury
6     would not account for this pattern of abnormalities.

[ STOP at page 29 - RESUME at page 33. I'm unable to summarize the doctor's conclusion here. There is later testimony on the same subject. ]


5          Q     Okay.  Is this a pattern of heterotrophic
6     ossification as reported in the literature that you
7     looked at?
8          A     Not typically.
9          Q     What makes it atypical?
10         A     Well, if I were to pick one thing, I
11    would say the activity in the ribs is not typical.
12    And typically heterotrophic ossification occurs
13    around the joints because they're not being moved.
14    And typically you will see on the radiographs
15    calcium deposits actually sitting there.  And they
16    don't look like periosteal reaction typically
17    either; they have a different appearance.
18         Q     The periosteal is where the membrane that
19    covers -- I guess that's the periosteum.  Right?
20         A     Right.
21         Q     That covers the bone, separates from the
22    bone?
23         A     Correct.
24         Q     And then calcium ossification occurs
25    between those two?
?                                             34
1          A     Correct, right.  And heterotrophic
2     ossification usually involves the actual joint and
3     the anatomic structures in and around the joint.
4          Q     Can you say, then, within a reasonable
5     degree of medical certainty whether this bone scan
6     is consistent with heterotrophic ossification?
7          A     In my knowledge, it's not consistent with
8     heterotrophic ossification as I typically see it.

All of the above testimony was elicited by counsel for the Schindlers. The deposition continues with testimony elicited by counsel for Schiavo.

19         Q     Is it possible that the abnormalities
20    occurring on the bone scan with respect to the
21    fracture of L1, the compressions fracture of L1 --
22    could that have occurred when the patient -- or if
23    the patient fell onto the floor from a standing
24    position?
25         A     That's possible.
?                                             40
1          Q     Is it possible that the abnormalities
2     that you noted on the right femoral diaphysis and
3     metaphysis could have occurred if the patient was
4     standing and suffered a cardiac arrest and fell to
5     the floor?
6          A     Probably not.  That wouldn't be a typical
7     mechanism of injury that would cause a periosteal
8     bruise.  Typically you need a direct blow of some
9     kind.  I suppose one could speculate that she fell
10    on a piece of furniture, that that could produce
11    that injury.  But just typically falling on the
12    floor would not do that.
13         Q     Okay.  Is there any way to tell from the
14    information in this report how many months or years
15    prior to the bone scan and the radiographs that the
16    bruise on the right femur occurred?
17         A     Because it is active on the bone scan, if
18    it were traumatic, it would probably would have
19    occurred within 18 months.
20         Q     You mentioned that the report indicates
21    multiple bilateral rib abnormalities and that that
22    was not consistent with heterotrophic ossification.
23    Is that right?
24         A     I mentioned that in this deposition, yes,
25    but not in the report.
?                                             41
1          Q     Okay.  Were you looking for heterotrophic
2     ossification when you read the bone scan and the
3     radiographs?  Do you know?
4          A     I think that's in our mind when we see a
5     rehabilitation patient because we don't know from
6     the history how old the injury was.  And, of course,
7     heterotrophic bone is something that occurs
8     particularly in people who are immobilized for long
9     periods of time.  So that would be something that we
10    would mention were we to see a typical pattern for
11    that, yes.
12         Q     Okay.  The abnormalities in the multiple
13    bilateral ribs, could that have occurred during an
14    attempt at resuscitation by the paramedics or
15    hospital staff?
16         A     A vigorous resuscitation could do that,
17    yes.

[ STOP at page 41 - RESUME at page 44 ]

22         Q     Okay.  Now, Dr. Ricciardello's indication
23    that there is no acute injury in either of the knees
24    is consistent with your findings and is not
25    inconsistent with your findings on the compression
?                                             45
1     fracture of L1.  Correct?
2          A     That's a -- I don't understand that
3     question.
4          Q     Okay.  His indication that there is no
5     acute injury on either of Ms. Schiavo's knees,
6     that's consistent with the radiographic report that
7     you issued on March 1991.  Correct?
8          A     I would have to say no, that's not
9     consistent, because the bone scan shows that there
10    is activity at the knees of some type.  The bone
11    scan can't be more specific than that because it
12    doesn't show anatomy.
13               Now, I don't know if this right-knee
14    image included the area that we're talking about as
15    the periosteal reaction or not.  I don't know
16    whether that includes that area or not.  And the
17    other problem with this is that these are obtained
18    portably in the nursing extended-care facility, and
19    these quality x-rays are typically of bad quality,
20    "quality" being a misnomer here.
21               So the fact that this doesn't even
22    describe periosteal reaction doesn't surprise me,
23    because that's a subtle finding that you probably
24    would not expect to see in this radiograph but that
25    I would expect to see in a hospital-based radiograph
?                                             46
1     because of the different equipment and the different
2     techniques.  So this -- except to the extent that it
3     doesn't show a big fracture -- is fairly
4     meaningless.
5          Q     Okay.
6          A     I think it probably is -- it doesn't show
7     any calcium in the joints, which you would expect to
8     see with heterotrophic ossification.  It does
9     describe osteopenia.  But, again, osteopenia is a
10    loss of bone substance, which is a fairly judgmental
11    call on a radiograph and depends a lot on the
12    technique too.  Osteopenia is, however, something
13    typically seen in someone who is bedridden because
14    the body tends to put more calcium in areas that are
15    stressed.
16               And if you're bedridden, your legs are
17    not under any stress anymore, so the body tends to
18    take some of the mineral away from those areas.  So
19    the osteopenia is consistent with someone who is
20    bedridden.  Beyond that, because I know the quality
21    of these films because I read them at that time too,
22    I wouldn't make a lot of judgment call on those.

[STOP at page 46 - RESUME at page 53 ]


6          Q     In that affidavit, Dr. Alcazaren gives
7     his interpretation of the radiologist's report dated
8     March 5, 1991 of the bone scan as an indication of
9     "heterotrophic ossification, not trauma."  Do you
10    see where it says that?
11         A     Yes, I do.
12         Q     Would you say that Dr. Alcazaren's
13    opinion is consistent with yours or inconsistent?
14         A     Again, this document was produced by a
15    physician whose area of expertise is not identical
16    with mine.  His findings are based again on clinical
17    findings.  He's not an imager.  I'm not a
18    rehabilitation physician.  So I would not be able to
19    comment on the significance of that except to say,
20    again, that the bone scan is not typical of
21    heterotrophic ossification.
22               They're saying that the clinical
23    findings, which are entirely different, may, in
24    fact, be consistent with that.  And I can't make a
25    judgment on that because I'm not a clinician.
?                                             54
1          Q     So you're not saying that Dr. Carnahan
2     and Dr. Alcazaren were wrong?
3          A     I couldn't say that because they're
4     commenting from an area of expertise that I don't
5     have.
6          Q     Okay.
7          A     So I would be presumptuous to say that
8     they were wrong.
9          Q     Okay.  The bone scan and radiographic
10    report shows only one fracture.  And that is a
11    compression fracture to L1.  Correct?
12         A     Well, I should clarify that by stating
13    that not all of the areas of bone-scan abnormality
14    were imaged concurrently.  Okay.  And that's
15    important.  In other words, we didn't x-ray every
16    area that was hot on there.  A couple of typical
17    areas were imaged but not all.  Of those areas that
18    were imaged, the only area that showed what was a
19    clear fracture was L1.
20         Q     Okay.  So of the documents that you had
21    the benefit of reviewing, the only fracture that
22    showed up was a compression fracture to L1?
23         A     You're speaking of the documents at the
24    time that this was interpreted?
25         Q     Correct.
?                                             55
1          A     Yes.  That's correct.
2          Q     The radiographs did not show any
3     fractures of the right femur.  Correct?
4          A     They don't show a typical fracture.  They
5     show periosteal reaction, which could be the result
6     of a bone bruise, which is a bone injury that's not
7     a loss of continuity of the structure of the bone.
8     So to the extent that you define fracture as a loss
9     of structural continuity, then, yes, that is an
10    actual fracture as is typically described.

There is more. The general sense I get from reading the deposition is that this doctor is unable to conclude how Terri obtained her injuries, but that the totality injuries is not consistent with a falling down incident, or with CPR, or with being manipulated by physical therapists, or due to bone weakening - skeleteal rearrangement due to being bedridden for a year.

Again, sorry for the length of the post. I hope you (and others) find it helpful.