Judge (13:09):
Britt, are there any Harbison issues that we need to discuss?
Mr. Britt (13:13):
No, sir.
Judge (13:15):
Okay. That's one thing that I didn't bring up during our pretrial motions hearing. Did you say that we're waiting on an alternate?
Mr. Britt (13:25):
He's got an account. I think they just arrived.
Judge (13:29):
Okay. Let me know. Anything else we need to discuss, Mr. Britt?
Mr. Britt (13:31):
No, sir.
Judge (13:32):
On behalf of the state?
Ms. Smircic (13:33):
No, Your Honor.
Judge (13:33):
All right.
Speaker X (13:33):
[inaudible 00:14:11].
Bailiff (16:41):
Jury is seated, Your Honor.
Judge (16:41):
Thank you, sir. Let the record reflect that the jury has entered the courtroom. Madame Clerk, if we can empanel our jury.
Clerk (16:50):
Ladies and gentlemen of the jury, please stand. You have all been duly sworn. You are now in panel to try the issues wherein the State of North Carolina is the plaintiff and David Wesley Prevatte is the defendant. You will sit together, hear the evidence, and render your verdict accordingly. You may be seated.
Judge (17:10):
Thank you. If we can have the name tags and notebooks passed out, please.
Bailiff (17:15):
Yes, Your Honor.
Judge (17:19):
Member of the jury, the bailiff is going to pass out red name tags. Those need to be put on you in some places that's very visible. You're going to keep those on you throughout the day while you're here, while you're out at lunch. You will return them back to the bailiff at the end of the day, and each day, you will put them on and off.
Bailiff (17:47):
Notebooks now, Your Honor?
Judge (17:48):
Yes, please.
Bailiff (18:38):
[inaudible 00:18:01] Thank you. Please check your pens at this time to make sure they write. If they do not, please notify me.
Judge (19:00):
All right. Ladies and gentlemen, you have been selected and empaneled to serve as jurors in the case of the State of North Carolina v. David Wesley Prevatte. In this case, you will be allowed to take notes. When you begin your deliberations, you may use your notes to help refresh your memory as to what was said in court. I caution you, however, not to give your notes, or the notes of any of the other jurors, undue significance. While taking notes, a juror may fail to hear important portions of testimony. Any notes taken by you are not to be considered evidence in this case. Your notes are not an official transcript of the trial. For that reason, you must remember that in your jury deliberations, notes are not entitled to any greater weight than the individual recollections of other jurors. If you take notes, you may disclose them only to your fellow jurors during your deliberations. You may not show them to anyone else. While I will permit you to take notes, I instruct you to listen intently at all times to the testimony.
(20:06)
At this time, I want to explain to you the manner in which we will proceed as we attempt together to find the truth in this case. First, the attorneys will have an opportunity to make opening statements. The purpose of an opening statement is narrow and limited. It is an outline of what the attorney believes the competent and admissible evidence will be. An opening statement is not evidence, and must not be considered by you as evidence. Following opening statements, evidence will be offered. Witnesses will be placed under oath and questioned by the attorneys. It may be that documents and other tangible exhibits will be offered and received as evidence. If any exhibit is given to you to examine, you should examine it carefully, individually, and without comment.
(20:57)
It is the right of the attorneys to object when testimony or other evidence is offered that the attorney believes is not admissible. When the court sustains an objection to a question, the jurors must disregard the question, and the answer if one has been given, and draw no inference from the question or answer, or speculate as to what the witness would have said if permitted to answer. When the court overrules an objection to any evidence, you must not give such evidence any more weight than if the objection had not been made. If the court grants a motion to strike all or part of the answer of a witness to a question, you must disregard and not consider the evidence that has been stricken.
(21:43)
During the course of the trial, it may be that questions of law will arise that need to be considered by the court out of the presence of the jury. When this happens, I may ask you to go to the jury room for a few minutes. You should not worry or speculate about what takes place in the courtroom during your absence. We will merely be considering questions of law that have to be heard out of the presence of the jury. All of the competent evidence in the case will be presented while you are present in the courtroom.
(22:13)
When the evidence is completed, the attorneys will make their final statements or arguments. The final arguments of the attorneys are not evidence, but are given to you to assist you in evaluating the evidence. Your duty is to decide the facts from the evidence. You, and you alone, are the judges of the facts. It is important that you be fair and attentive during the trial. You will see and hear the evidence and decide the facts. You will then apply the law that I will give you to those facts. To be an effective juror, you must not be influenced to any degree by personal feelings, sympathy for, or prejudice against any of the parties involved in the case. The fact that a criminal charge has been filed against the defendant is not evidence. The defendant is innocent of any crime unless and until the state proves the defendant's guilt beyond a reasonable doubt.
(23:13)
Finally, before you retire to consider your verdict, you must obey the following rules. First, you must not talk about the case amongst yourselves. The only place this case may be discussed is in the jury room, and then only after you begin your deliberations. Second, you must not talk about this case with anyone else, including members of your families, or allow anyone else to talk with you or say anything in your presence about this case. If anyone communicates or attempts to communicate with you or in your presence about this case, you must notify the bailiff of that fact immediately.
(23:53)
In this age of instant electronic communication and research, I want to emphasize that in addition to not speaking face-to-face with anyone about the case, you should not engage in any form of electronic communication about the trial, including but not limited to Twitter or X, blogging, Facebook, text messaging, instant messaging, and any other such means of electronic communication. Third, you must keep all cell phones turned off when you are in the courtroom or the jury room. Fourth, while you sit as a juror in this case, you are not to form an opinion about the guilt or innocence of the defendant, nor are you to express to anyone any opinion about the case until I tell you to begin your deliberations. Fifth, you must not talk or communicate in any way with any of the parties, attorneys, or witnesses involved in the case. This rule applies inside as well as outside the courtroom and it prohibits any type of conversation, whether about the evidence in this case, or about the weather, or just to pass the time of day.
(25:02)
Sixth, you must not read or listen to any news media coverage of this case or trial, including television, newspaper, radio, or internet accounts. Newspaper, radio, television, and internet accounts may be inaccurate or they may contain references to matters which are not proper for your consideration. Your verdict must be based solely on the evidence presented during this trial, and no other source. This instruction is extremely important given that there is a broadcast of the trial. You are not allowed to discuss this case with any friends, family members, acquaintances, or coworkers, especially if those individuals are watching the trial through the broadcast or have seen clips of the trial online. You yourselves are not allowed to view any clips or videos of the trial that may be on Court TV, any social media platform, or any other news source. You must not seek it out, and you must not watch any portion of this trial online when you are outside of the courtroom, out for lunch, or retire to your homes.
(26:10)
Seventh, you must not allow what you have seen on popular television shows that concern the legal system or police investigations to influence you. Television shows may leave you with an improper preconceived idea about the legal system. As far as this case is concerned, you are not prohibited from watching such shows. However, there are many reasons why you cannot rely on television legal programs, including the fact that these shows are not subject to the rules of evidence and legal safeguards that apply in this courtroom, and are works of fiction that present unrealistic situations for dramatic effect. While entertaining, television legal dramas condense, distort, or even ignore many procedures that take place in real cases and real courtrooms. No matter how convincing they try to be, these shows simply cannot depict the reality of an actual trial or police investigation. You must put aside anything that you think you know about the legal system that you saw on television.
(27:15)
Eighth, you must not visit the scene or place that is the subject matter of this trial, or make any independent inquiry or investigation about this matter. You may not conduct any research, including internet research, to look for any information regarding this case. Each of you must obey each of these rules to the letter. Unless you do so, there is no way the parties can be assured of absolute fairness and impartiality. It is your duty while the trial is in progress, or while it is in recess, or while you are in the jury room to see that you remain a fair and impartial trier of the facts. If you violate these rules, you violate an order of the court, and this is contempt of court and could subject you to punishment as provided by law.
(28:03)
Now at this time, the attorneys will have an opportunity to provide you their opening statements, starting first with the state. Ms. Smircic, you may proceed.
Ms. Smircic (28:10):
Thank you, Judge. May I approach the jury?
Judge (28:12):
You may.
Ms. Smircic (28:13):
In the early morning hours of November 13th of 2017, David Prevatte carried his limp, unconscious niece, Paitin Fields, into the Pender ER. As the nurses and the doctor rushed to save her life, they immediately noticed ligature marks around her neck. They stabilized Paitin, they treated her, and they got her transferred to the pediatric ICU in Wilmington. When Paitin Fields arrived in Wilmington, the nurse got the attention of Dr. Stoiko. "Doctor, you need to look at this." She was about to put in a catheter. And they immediately noticed injuries to her genital area.
(29:05)
Sexual assault nurse examiners were called in. They observed, they documented, and they photographed injuries to Paitin. They noted injuries to her vestibule, her labia majora, her clitoral hood, and her anus. Unfortunately, Paitin Fields could not be saved, and on the morning of November 14th, 2017, she was brain dead. And on November 15th, her organs would be harvested and she would be taken off life support and pass away. Paitin Fields was five years old.
(29:55)
Now, for the state to show you what happened to Paitin, we need to go back a few days before November 13th. On November 10th of 2017, David Prevatte turned 19 years old. He got into a fight with his girlfriend and he moved back home to his parents at 104 Blackwater Drive here in Pender County. His parents, Lisa and Dale Hunt. Lisa is his mom and Dale is his stepdad, but Dale Hunt had raised him since he was 18 months old. At the time, Lisa and Dale had custody of Lisa's grandchildren, Paitin and Savannah Fields. Paitin was five years old, Savannah seven.
(30:47)
When David Prevatte moved back in, they had a normal family weekend. They went to Lumberton on Saturday to see family, and on Sunday afternoon, November 12th, David Prevatte was hanging out that afternoon in the yard of his parents house with Jamie Sites, one of his friends. They were hanging out, smoking weed, smoking cigarettes. At some point, Michael Hull, whose grandmother lived down the street, came by, said hello, talked to them for a little bit. And later that evening when Jamie left, Melissa Brown came and picked up David Prevatte from the house. They went riding around, smoking weed, drinking a little bit, just hanging out. And Melissa Brown drops David Prevatte back off at that house on Sunday night the 12th, around 10:00 PM.
(31:42)
Lisa Hunt lets David in the house and she locks the door behind him. At the time, the girls, Savannah and Paitin, were on the couch. That's where they typically slept, on the L-shaped couch in the living room. After Lisa let in David, she went back to her room with her husband, Dale, where they were sleeping. David went on to his room. As the night went on, what would happen would be unfathomable. In the early morning hours, around 3:00 AM on November 13th, Savannah Fields woke up. And as she woke up, she saw David Prevatte standing by the couch where her sister, Paitin, was. And as she woke up, she saw her uncle walk back to his room. And when she looked over at Paitin, she noticed something was wrong. Her eyes. Something was wrong with her eyes. Savannah Fields, at seven years old, went to go wake up her grandparents. She goes into Lisa and Dale's room and she tells them, "Paitin's acting silly. Paitin's acting funny." And her grandparents, who were asleep in their room, wake up, and they think she's just a child. She's cutting up. They didn't really think much of it. And Dale sends her back to bed, says, "Go back to bed. Don't wake up your sister." So Savannah, seven years old, she goes back into the living room. She gets up. She turns on the TV and she watches TV on the couch. Not long after, Lisa and Dale start to get up to start the day. Dale went to work pretty early. Lisa gets up to go out to make coffee, and that's when she sees Paitin in the living room, and she screams. She screams for Dale. She screams for help. Dale and David come out of their rooms. Lisa-
Ms. Smircic (34:00):
... Dale and David come out of their rooms. Lisa tries to call 911, but can't get through. Dale and David take Paitin to the Pender ER down the road. 911 gets through to Lisa. She tells them they're on the way. Something's wrong with her baby. And Lisa gets Savannah and they head to the hospital in Pender. At 3:50 AM, Paitin Fields was admitted to the Pender ER. And as you know, she will die a couple days later. Over the course of this trial, you're going to hear from a lot of witnesses, around 30. The first set of witnesses you will hear from today are the nurses and the doctors that treated Paitin. They will tell you about her injuries to her neck, how she was injured, how she would ultimately die. They will also tell you about the injuries to her genital area and what that shows you.
(35:05)
Unfortunately, you will have to see pictures of this. You will have to see photos of what happened to Paitin, but the state must put these on to prove our case, to show you what happened to her. You'll also hear from the witnesses who were there that night. You'll hear from Lisa Hunt, Dale Hunt, and Savannah Fields, who is now 16. And you will also hear from the people who spent time with David the evening before, Jamie Sykes, Melissa Brown, and Michael Hall. And as you can imagine, you're going to hear from a lot of law enforcement officers in this case. You'll hear from several members of the Pender County Sheriff's Office who conducted this investigation. They interviewed Lisa, Dale, David, and you're going to be able to hear those interviews. You'll also hear from detectives who went and processed 104 Blackwater Drive and processed the crime scene. You'll see photos of the house and you'll see the items of evidence they collected. I urge you to pay attention to a pair of red earbuds that they find in David's room.
(36:27)
And another large set of witnesses you will hear from will be lab analysts. There was a lot of evidence tested by the state crime lab and another lab in this case. These items of evidence were tested when this case first happened and they were tested later on after some advances in DNA technology. I urge you to pay attention to several items of evidence that will be tested. Paitin Fields' sexual assault kit and the swabbings from that, the penis swab taken from David Prevatte and the pair of red earbuds found in the home. Members of the jury, child sexual assault and murder does not occur out in the open. It happens behind closed doors. The eyewitness, Paitin Fields, is dead, but the evidence taken altogether can speak for her.
(37:35)
I urge you to use your reason and common sense that we talked about in jury selection. I urge you to follow the judge's instruction to weigh circumstantial and direct evidence the same. And as you listen to the testimony and the evidence in this case, use your common sense and reason to put the pieces of this puzzle together because the picture will be clear that Paitin Fields was sexually assaulted and murdered by her uncle, David Prevatte. And at the end of this trial, we are going to ask you to find him guilty of doing that. Thank you.
Judge (38:15):
Thank you, Ms. Smircic. Mr. Britt, you may provide your opening statement.
Luther Britt (38:19):
May it please the Court, counsel, ladies and gentlemen, good morning. David Prevatte did not rape, sexually assault or murder his niece, Paitin Fields. David Prevatte had moved back in to the house on November the 10th after an argument with his girlfriend. The girls, Savannah and Paitin, had been utilizing David's bedroom while he was absent from the home. You'll find out that there are clothes from both girls, toys from both the girls in that room. You also find out that's when David came home, that's where he slept. On the morning of November the 13th, 2017, David Prevatte was awakened by screams from his mother. He immediately got up. He had on the clothes that he had worn the day and night before. He goes into the den and he discovers that his niece, Paitin, is non-responsive. He takes Paitin from his mother and he begins to perform life-saving measures on her, pushing her chest, breathing for her because she was non-responsive.
(39:58)
911 was called, not once but twice. When 911 was called, David Hunt, Dale Hunt, who is David Prevatte's stepfather, came into the room as well. He went back to the bedroom, got dressed, and then he and David decided the best measure was to not wait for the ambulance, but to get in their car and drive from the house to the hospital. You'll hear about how fast they were driving. David was in the back seat with Paitin holding her in her arms, trying to get her to breathe, trying to get her to respond. You'll also learn that Paitin only had a single item of clothing, her underwear.
(40:54)
And while they were en route to the hospital here in Burgaw, Paitin urinated on David. Paitin defecated on David. David's clothing became soiled, it became wet, but he still maintained her in his arms. They arrived at the emergency room. David gets out of the car, he's cradling Paitin in his arms still. He goes in, asks for help. Paitin was turned over to the nurse and then she's taken back into the emergency room. David, you will see photographs of in the emergency room waiting, wondering what's happened to his niece. He paces some, he sits down some, he holds his head in his hands. He doesn't know the answers because he doesn't know what happened to her. He just knows that his mother was screaming and Paitin was non-responsive and he did what he would do just like anybody else. He was going to help his niece.
(42:13)
While he's there, David goes into the bathroom, the restroom, the hospital. There are feces, stains on his clothes. He tries to wash those off, but he doesn't change his clothes. He doesn't try to wash the urine out. Eventually the sheriff's department seizes those clothes. They do tests. You're going to hear a lot about DNA. You're going to hear about DNA in 2017. You're going to hear about DNA as it moved forward. What they found on David's clothing was there was a combination of DNA, a mixture. The mixture was made up of David's DNA quite naturally and Paitin's DNA. You will learn that DNA is contained in urine. It is contained in feces. It's just like any other fluid in the body, whether it's spit, whether it's blood, whether it is semen, it exists.
(43:23)
The clothing that David had on, there was DNA mixture on the exterior of his pants, inside his pants where it had soaked through and on his underwear where it likewise had soaked through. David immediately became the only suspect that the Pender County Sheriff's Department looked at, the only one. And they continued their investigation. They sent samples to the state lab for analysis and all they could say was there's a mixture of his and hers from the rape kit. There was a minute, let me repeat that, minute amount of unknown DNA found on Paitin's clitoral hood. They couldn't identify it as David's. They couldn't identify it as anyone's. It contained no male DNA. That's important.
(44:32)
Men and women, people, we all have DNA. Your DNA is made up from your father and your mother. The X or Y chromosome determines what sex you will be. There was no male DNA that was found on those swabs. And so the investigation continued, and continued, and continued. David was not arrested. He was interviewed multiple times. There were searches and then eventually the case became called. Detective Leatherwood, who was the original investigating officer, left the sheriff's department for a time. In 2022, Detective Short had started a review of the case. In 2022, the Pender County Sheriff's Department decided they had enough evidence to charge David Prevatte with this murder, this rape, this sexual assault.
(45:45)
As I said, you're going to hear a lot about DNA. Your job is to listen to all of the evidence to determine what is true, what is not. Here we are, 2026, November the 13th will be the ninth anniversary of Paitin Fields' death. They have no more evidence today than they had in the beginning of this investigation. David doesn't have to prove to you that he did not do this by his plea of not guilty to these charges. He has told you and the world that he did not kill his niece, he did not rape his niece, he did not sexually assault his niece. He became the victim of a witch hunt. Witch hunt that had evidence that was twisted and turned. You'll hear evidence about red earbuds, supposedly for ligature that were wrapped around Paitin's neck.
(46:55)
Pay particular attention to what the witnesses say about the red earbuds because there's DNA from both David and Paitin. Why? Because David used the earbuds to listen to music. Paitin played with those and the overwhelming majority of DNA on those earbuds are not on the cord or the section where it would've been used to strangle her, but on the actual earbuds that are placed in your ear. The state's going to argue that she was choked with those earbuds. You're going to hear testimony that was probably wrapped around her neck multiple times.
(47:40)
Your skin gives off DNA. It's pulled to create the tension, but yet in the area between the two earbuds, there is scant DNA to the extent one could argue no. The instrument was supposed to be used to strangle her does not confirm that that is what was used. In fact, at the autopsy, doctor who performed the autopsy, East Carolina, opined it was not the earbuds. She said it was more likely about a leash that had been found in the house. But as this case continued, Detective Short in his desire to solve this case, kept sending information back to labs, kept sending information back to the doctor asking, "Could this be it? Could this be it? All I need to know is, is this it? We can bring this nightmare to a close." The problem was it wasn't his nightmare. It was David's nightmare. It was Paitin's nightmare and the entire family.
(49:07)
You're going to hear from Samantha, pay particular attention. Remember Samantha was seven years old when this happened. You're going to hear about interview after interview after interview in which a forensic analyst talked to her about what happened. And in 2017, Samantha said Paitin was just acting funny. She was having a seizure. She doesn't say anything about David being in the room. She doesn't say anything about David at all. Again, they interview her in 2018. Again, she doesn't say anything about David being in the room. She doesn't say anything about David. Samantha and Paitin were in the custody of their grandparents, placed there by the Department of Social Services, and that's the reason they were living. You're going to hear a third interview, and the state's already told you they're going to play. It wasn't until long after this occurred, long after DSS took Savannah out of that house and placed her with her paternal aunt that Savannah ever said anything about David.
(50:46)
You're also going to hear about the fact that she was in this very courtroom just three weeks ago, sitting at this witness stand, answering questions presented by the prosecutor. It was practice. It's not unusual, but you're going to hear about something that happened during the course of that, that Savannah told her grandmother, "Oh, we were in the courtroom. They were asking me questions." They had to make my aunt leave because why? Because every time she was asked a question, Savannah would look to the back of the room where her aunt was to make sure she was saying what her aunt wanted her to say. She had been coached. She had been coached.
(51:50)
There was bias against David. The aunt was very biased against David, but that's who Savannah had been living with and continues to live with. Savannah's now almost 16 years old. In the end, the picture you were asked to reveal is just as cloudy as it was in 2017. It doesn't point to David Prevatte's guilt. What that picture points to, eventually the state cannot and has not and will not carry its burden of proving beyond a reasonable doubt that David Prevatte is guilty of these crimes. And when all the evidence is said and done, the state's going to ask for you to find him guilty. I'm going to ask you to find him not guilty because the evidence simply is not there, simple. Thank you.
Judge (52:57):
Thank you, Mr. Britt. State, you may call your first witness.
Ms. Smircic (53:03):
The state calls Crystal Beck.
Judge (53:19):
All right, Ms. Beck, if you want to make your way around here to the witness stand, please.
Speaker 1 (53:27):
This way, please continue. There's a step. Be careful.
Judge (53:31):
Before you take a seat, if you can place your left hand on the Bible, raise your right hand. The clerk will swear you in.
Clerk (53:36):
Do you solemnly swear that the testimony you give in court today will be the truth, the whole truth, nothing but the truth, so help you God?
Krystal Beck (53:42):
Yes, ma'am.
Ms. Smircic (53:43):
Thank you. You may be seated.
Speaker 1 (53:46):
[inaudible 00:53:46] for me, please, towards the microphone. Thank you.
Judge (53:50):
Ma'am, as you give your testimony here today, there are some very important things to remember. First and foremost, speak loudly and clearly into that microphone so everybody here can hear you. Second, please make sure all of your answers are out loud. No head nods or shakes or anything like that. Everything has to be a yes or a no. And third, please wait for the attorney to be done asking their question before you give a response. Makes it very difficult for a court reporter when two people are talking at the same time. Can you do that?
Krystal Beck (54:18):
Yes, sir.
Judge (54:19):
All right. Thank you. State, you may proceed.
Ms. Smircic (54:21):
Thank you, Judge. Good morning, Ms. Beck.
Krystal Beck (54:23):
Good morning.
Ms. Smircic (54:24):
Can you state your name and spell it for Madam Court Reporter, please?
Krystal Beck (54:27):
My name is Krystal Beck, K- R-Y-S-T-A-L. Last name is B-E-C-K.
Ms. Smircic (54:35):
Thank you. And Ms. Beck, what is your career?
Krystal Beck (54:41):
Registered nurse.
Ms. Smircic (54:43):
How long have you been a nurse?
Krystal Beck (54:45):
Since 2010.
Ms. Smircic (54:48):
What type of nursing fields have you worked in?
Krystal Beck (54:52):
I spent the bulk of my career in the emergency room as a nurse and then moved into a supervisor role. Have since switched careers a little due to becoming a mom, so I changed fields and went into oncology, rheumatology, and now I'm back as a supervisor role at a hospital.
Ms. Smircic (55:19):
Ms. Beck, back in 2017, November, where were you working?
Krystal Beck (55:24):
Pender Emergency Room.
Ms. Smircic (55:30):
Have you ever been a sexual assault nurse examiner?
Krystal Beck (55:33):
No, ma'am.
Ms. Smircic (55:34):
Does that require specialized training?
Krystal Beck (55:36):
Yes.
Ms. Smircic (55:42):
And what was your role at the Pender ER back in November of 2017?
Krystal Beck (55:48):
A nurse, registered nurse in the ER, one of two on duty during a night shift.
Ms. Smircic (56:02):
So there were two nurses on duty during the night shift at that time. What about ER doctors?
Krystal Beck (56:07):
There was just one.
Ms. Smircic (56:11):
So a pretty small ER?
Krystal Beck (56:13):
Correct.
Ms. Smircic (56:14):
Where is the Pender ER?
Krystal Beck (56:16):
Right down the street on Fremont Avenue.
Ms. Smircic (56:19):
Here in Burgaw?
Krystal Beck (56:20):
Yes.
Ms. Smircic (56:25):
And as a nurse in the Pender ER at that time, what would be your roles and responsibilities in general?
Krystal Beck (56:35):
In general, we handle intake of any patients that come in, do a quick triage, determine the level of care they need, collaborate with the doctor and treat them accordingly.
Ms. Smircic (56:53):
Can you describe the layout of the Pender ER a little bit for the jury?
Krystal Beck (57:01):
There's two main entrances or there's one main entrance, the front of the hospital. Patients would come into the waiting room, check in at the front desk and wait for a triage nurse to come up and see them. There's also the emergency room door where the ambulances come in, which is monitored also by a camera so we could see if somebody's coming in that way as well. It's a small facility. There's one main nurse's station with a couple of computers. There's 11 beds, 2 trauma bays where we would take more critical patients.
Ms. Smircic (57:42):
And Ms. Beck, back on November 13th, 2017, in those early morning hours, were you working the night shift at Pender ER?
Krystal Beck (57:51):
Yes, ma'am.
Ms. Smircic (57:52):
Do you remember who else was working with you?
Krystal Beck (57:55):
From what I remember, it was myself, my coworker, Britton, an emergency room tech, Ms. Carolyn, I think our unit clerk or registrar, Alyssa was working up at the front check-in area and Dr. McGrath was our physician.
Ms. Smircic (58:18):
You said Dr. McGrath?
Krystal Beck (58:20):
Yes, ma'am.
Ms. Smircic (58:22):
Can you tell me what happened?
Krystal Beck (58:28):
What I remember about that night?
Ms. Smircic (58:30):
Yes.
Krystal Beck (58:32):
It was early morning hours. I remember being at the desk with my coworkers and hearing a banging on the back door, the ambulance door. We were able to look in the camera and see that there was two men, one holding a unresponsive child, so we went and let them in and took them right back to one of the trauma rooms. And of course, being a small facility, everyone was in the room basically at the same time to assess the child who was placed on the bed. Per protocol, we put her on our monitor to get her vital signs and began treating her.
Ms. Smircic (59:26):
Do you recall around what time in the morning it was that banging on the door occurred and she was brought in?
Krystal Beck (59:35):
I believe it was shortly before 4:00 AM.
Ms. Smircic (59:46):
Do you recall any observations you made about the child when she came in?
Krystal Beck (59:56):
She was unresponsive, being carried by a young man. She only had on soiled underwear, and that's our initial assessment. We knew we had to work quickly to assess her.
Ms. Smircic (01:00:17):
Did you come to learn the child's name?
Krystal Beck (01:00:20):
Paitin. Yes, ma'am.
Ms. Smircic (01:00:21):
Paitin Fields?
Krystal Beck (01:00:22):
Yes, ma'am.
Ms. Smircic (01:00:24):
How old was she?
Krystal Beck (01:00:25):
Five years old.
Ms. Smircic (01:00:28):
Did you notice any... While you were assessing her and while you all were treating her, did you notice any injuries to her?
Krystal Beck (01:00:37):
Initially, not at first. Once we got her on the bed and we had everyone around her, I remember Dr. McGrath was at the top of the bed, and I looked up at him and looked at Paitin and I saw bruising around her neck.
Ms. Smircic (01:01:08):
What did you and Dr. McGrath and the other nurse and other members of the ER do to treat Paitin in general?
Krystal Beck (01:01:17):
In general, she was unresponsive with labored breathing, so our first priority was to stabilize her, which entailed starting an IV line and/or some sort of access to be able to give her medication so we could put a breathing tube down her throat. At the same time, we would be taking lab samples with our IV insertion in addition to getting her vital signs.
Ms. Smircic (01:01:51):
Was the goal to stabilize her?
Krystal Beck (01:01:54):
Absolutely.
Ms. Smircic (01:01:55):
Was there any intention to keep her at the Pender ER?
Krystal Beck (01:01:59):
No.
Ms. Smircic (01:02:00):
What was the intention?
Krystal Beck (01:02:02):
To stabilize for transfer to New Hanover where they have a pediatric ICU.
Ms. Smircic (01:02:13):
Do you recall if Paitin was ever moving about or thrashing about or anything like that?
Krystal Beck (01:02:22):
She was not. Like I said, she was limp when she was brought in. She was never thrashing about. She had very little movement responsive to pain, full stimuli. She had some eye twitching and her body was slightly... Her arms and legs were slightly turned inward, which we call posturing.
Ms. Smircic (01:03:01):
Ms. Beck, you mentioned earlier that this started when she arrived at the door by the ambulances, is that correct?
Krystal Beck (01:03:09):
Correct.
Ms. Smircic (01:03:22):
May I approach?
Judge (01:03:22):
You may.
Ms. Smircic (01:03:32):
Ms. Beck, I'm showing you State's 1, which is surveillance video from the Pender ER. Judge, at this time, I'd move to admit, given this was stipulated to.
Judge (01:03:42):
Given the stipulation, State's Exhibit 1 will be admitted into evidence.
Ms. Smircic (01:03:49):
And Judge, may I publish?
Judge (01:03:50):
You may.
Ms. Smircic (01:03:51):
And Judge, at this time I'm going to publish the first video clip on State's 1.
Judge (01:04:33):
Thank you.
Ms. Smircic (01:05:25):
For the record, I've stopped that at 33 seconds. Ms. Beck, is this the entrance to the ER where the ambulance bay is?
Krystal Beck (01:05:36):
Yes. Yes.
Ms. Smircic (01:05:38):
And is that the young man you saw carrying the child into the hospital?
Krystal Beck (01:05:43):
Yes.
Ms. Smircic (01:05:54):
Ms. Beck, I want to go back to your treatment of Paitin. At some point, did you and the other ER staff have a concern given the injuries to her neck?
Krystal Beck (01:06:12):
Yes.
Ms. Smircic (01:06:14):
Did you call 911?
Krystal Beck (01:06:16):
I did.
Ms. Smircic (01:06:17):
Why did you do that?
Krystal Beck (01:06:22):
As a nurse, you're an obligated reporter to protect children. So if you suspect anything, it's not our duty to make the decision, but we are to call Child Protective Services and let them know if we have a concern for them to investigate.
Ms. Smircic (01:06:42):
And obviously it wasn't normal business hours, right?
Krystal Beck (01:06:44):
Correct.
Ms. Smircic (01:06:45):
So you called 911?
Krystal Beck (01:06:46):
Mm-hmm.
Judge (01:06:48):
Sorry, is that a yes?
Krystal Beck (01:06:50):
Oh, yes.
Judge (01:06:51):
Thank you.
Ms. Smircic (01:06:51):
Judge, may I approach?
Judge (01:06:51):
You may.
Ms. Smircic (01:06:57):
Ms. Beck, I'm showing you what I've marked as State's Exhibit 2, which is a CD contained in a CD sleeve. Do you recognize this exhibit?
Krystal Beck (01:07:06):
Yes.
Ms. Smircic (01:07:06):
How do you recognize it?
Krystal Beck (01:07:07):
I listened to it yesterday morning confirming it was the 911 call I made.
Ms. Smircic (01:07:13):
And you initialed it and dated it?
Krystal Beck (01:07:14):
Yes.
Ms. Smircic (01:07:15):
And is this 911 call any changes, modifications, deletions, alterations to this call that you gave?
Krystal Beck (01:07:24):
No.
Ms. Smircic (01:07:26):
Is it in a substantially similar condition as when you made it?
Krystal Beck (01:07:29):
Yes.
Ms. Smircic (01:07:30):
Judge, I would move to enter State's Exhibit 2 into evidence for substantive purposes.
Judge (01:07:35):
Any objection?
Luther Britt (01:07:36):
No, sir.
Judge (01:07:37):
State's Exhibit 2 will be admitted into evidence.
Ms. Smircic (01:07:40):
And Judge, if I may publish State's Exhibit 2 in its entirety.
Judge (01:07:46):
You may.
Audio: Speaker 1 (01:08:14):
County Sheriff's Office.
Audio: Crystal (01:08:16):
Hi, this is Crystal with the emergency room.
Audio: Speaker 1 (01:08:19):
Yes, ma'am.
Audio: Crystal (01:08:20):
I need two things, please.
Audio: Speaker 1 (01:08:21):
Yes.
Audio: Crystal (01:08:23):
I need the on-call number for Child Protective Services.
Audio: Speaker 1 (01:08:33):
Hang on a second. I think we're just supposed to have them call you. We don't only...
Audio: Crystal (01:08:39):
That's perfectly fine as well.
Audio: Speaker 1 (01:08:43):
What's the best number to reach back at?
Audio: Crystal (01:08:44):
300-4055.
Audio: Speaker 1 (01:08:49):
Okay. And what's it in reference to? Is it an active case or is it new?
Audio: Crystal (01:08:53):
I have a five-year-old that was brought in who is now intubated and headed to New Hanover with unknown etiology and what strongly appears to be strangulation marks on her neck.
Audio: Speaker 1 (01:09:13):
Okay. And the second thing that you needed?
Audio: Crystal (01:09:18):
New Hanover had told me to ask if this was going to be a situation that local PD needed to come to New Hanover for. New Hanover would take care of it because they're going to be in New Hanover.
Audio: Speaker 1 (01:09:33):
If it occurred in Pender County, it would need to be reported in Pender County. What was the address that it occurred at, or that they were brought in from the home address?
Audio: Crystal (01:09:42):
104 Blackwater Drive.
Audio: Speaker 1 (01:09:44):
Okay. [inaudible 01:09:46] Pender. Okay. I will go ahead and put this in. Do you want me to go ahead and have an officer contact you guys or contact New Hanover?
Audio: Crystal (01:10:03):
They can contact New Hanover and I can give you the number for the nurse that's going to be taking care. She gave me her direct line.
Audio: Speaker 1 (01:10:12):
Perfect. What's her name?
Audio: Crystal (01:10:14):
Her name is Sarah.
Audio: Speaker 1 (01:10:15):
Okay.
Audio: Crystal (01:10:16):
And her phone number is 910-667-4824.
Audio: Speaker 1 (01:10:25):
Okay. All right. I'm going to go ahead and call for DSS. I'll have them contact you and then I will get our deputy to contact New Hanover.
Audio: Crystal (01:10:35):
Thank you so much.
Audio: Speaker 1 (01:10:36):
You're welcome. Bye.
Ms. Smircic (01:10:42):
And Ms. Beck, when you were treating Paitin Fields, did you ever take any urine samples for lab testing?
Krystal Beck (01:10:53):
Yes.
Ms. Smircic (01:10:55):
How many urine samples did you take from Paitin Fields?
Krystal Beck (01:10:59):
Just one.
Ms. Smircic (01:11:03):
And would you have documented that in the medical records?
Krystal Beck (01:11:08):
Yes.
Ms. Smircic (01:11:08):
Judge, may I approach?
Judge (01:11:08):
You may.
Ms. Smircic (01:12:09):
And Ms. Beck, I'm showing you what I've marked as State's Exhibit 3. Do those appear to be Paitin's Fields medical records from the Pender ER?
Krystal Beck (01:12:18):
Yes.
Ms. Smircic (01:12:19):
And Judge, at this time, the state would move to enter State's Exhibit 3 through affidavit.
Judge (01:12:24):
Any objection?
Luther Britt (01:12:25):
No, sir.
Judge (01:12:26):
State's Exhibit 3 will be admitted into evidence.
Ms. Smircic (01:12:37):
And Ms. Beck, did you make notes about what you had observed on Paitin in the medical records?
Krystal Beck (01:12:45):
Yes.
Ms. Smircic (01:12:46):
And let me draw your attention to the top of page nine. Did you make a note about the injury to Paitin's neck?
Krystal Beck (01:12:55):
Yes.
Ms. Smircic (01:12:55):
Could you read that for the jury?
Krystal Beck (01:12:58):
"Petechial rash noted to entire face and neck with a darker rash and bruise appearing around the patient's neck collar line."
Ms. Smircic (01:13:08):
Thank you. And Ms. Beck, would it also be noted in the nurse's notes where you collected urine as well?
Krystal Beck (01:13:35):
It should be, yes.
Ms. Smircic (01:13:40):
I'm going to turn to your notes here. I'm going to let you take a look at the notes here. Can you tell us when you took Paitin's urine sample?
Krystal Beck (01:14:18):
Maybe on-
Ms. Smircic (01:14:18):
Is it on this page? Okay.
Krystal Beck (01:14:18):
It's resolved there, so it had to be before then.
(01:15:17)
It was collected in the computer, which is when we would've documented collection at 4:15.
Ms. Smircic (01:15:24):
Thank you.
Judge (01:15:25):
And if I can get you to scoot closer to the microphone so it'll pick you up a little bit better. Thank you.
Ms. Smircic (01:15:38):
And Ms. Beck, can you explain to the jury how you would collect a urine sample from an unconscious five-year-old child?
Krystal Beck (01:15:48):
Yes. We would take what's called an in-and-out catheter sample. I believe the kits we were using at the time was a self-contained unit, which it consists of a small plastic tube that drains into a tube that's collected, that's attached to it. The tube itself is soft plastic, no bigger than the size of the lead in a pencil. It also contains cleaning swabs that we would use to clean the patient before taking the sample.
Ms. Smircic (01:16:29):
How would you clean the patient?
Krystal Beck (01:16:33):
With gentle swipes and a round motion.
Ms. Smircic (01:16:36):
And what are you using to clean the patient?
Krystal Beck (01:16:41):
It's a povidone iodine solution on a soft cotton, like a wet cotton ball on a stick.
Ms. Smircic (01:16:50):
You mentioned earlier that when Paitin Fields came into the ER, she had on underwear and they were soiled?
Krystal Beck (01:16:56):
Correct.
Ms. Smircic (01:16:57):
Would she have been cleaned up at some point during getting her stabilized?
Krystal Beck (01:17:03):
She may have been cleaned with some wet wipes in order to obtain the sample, yes.
Ms. Smircic (01:17:16):
And Ms. Beck, when you inserted the catheter to get the urine sample, would you have caused any damage to her or injuries to her?
Krystal Beck (01:17:29):
Unlikely, no.
Ms. Smircic (01:17:41):
Ms. Beck, can you also explain to the jury, in your training and experience as a nurse, how is a rectal temperature taken on a child?
Krystal Beck (01:17:56):
A rectal temperature is taken with a rectal thermometer, again, about the size, smaller than a pencil. A probe is placed on it and it's covered in a lubricating jelly. With one hand holding the patient's bottom, the probe is inserted maybe a half an inch into the rectum until it starts reading to give a temperature. It's very quick and painless.
Ms. Smircic (01:18:35):
And what is the size of that probe?
Krystal Beck (01:18:40):
Smaller than a pencil, a number two pencil, or about the size of that.
Ms. Smircic (01:18:51):
And when a rectal temperature is taken by a nurse, would that probe be lubed every time?
Krystal Beck (01:18:56):
Every time.
Ms. Smircic (01:19:03):
Ms. Beck, do you recall anything else about what happened at the ER that night?
Krystal Beck (01:19:15):
I do not.
Ms. Smircic (01:19:18):
one moment, Judge.
(01:19:24)
Nothing further, Judge.
Judge (01:19:25):
Cross examination?
Luther Britt (01:19:28):
Ms. Beck, at that point, how long had you been working as a nurse?
Krystal Beck (01:19:33):
Seven years.
Luther Britt (01:19:36):
You said that Paitin was wearing underwear?
Krystal Beck (01:19:38):
Yes, sir.
Luther Britt (01:19:39):
No other clothes?
Krystal Beck (01:19:40):
No other clothes.
Luther Britt (01:19:41):
Was the underwear soiled?
Krystal Beck (01:19:42):
Yes.
Luther Britt (01:19:43):
Was the underwear wet?
Krystal Beck (01:19:43):
Yes.
Luther Britt (01:19:43):
What, if anything, happened to that underwear?
Krystal Beck (01:19:43):
I didn't hear-
Luther Britt (01:19:43):
What happened to that underwear?
Krystal Beck (01:19:52):
I believe we bagged it and sent it with her to New Hanover.
Luther Britt (01:19:59):
Would that be reflected in your nurse's notes?
Krystal Beck (01:20:02):
I'm not sure.
Luther Britt (01:20:24):
Okay.
(01:20:24)
So the treatment that she received at Pender Memorial was to stabilize her?
Krystal Beck (01:20:30):
Yes.
Luther Britt (01:20:33):
Was she breathing on her own or had she been placed on oxygen?
Krystal Beck (01:20:37):
She had a breathing tube placed to breathe for her.
Luther Britt (01:20:40):
Okay. And that was done in the ER?
Krystal Beck (01:20:42):
Yes.
Luther Britt (01:20:42):
Did you do that or did someone else?
Krystal Beck (01:20:46):
The physician did that.
Luther Britt (01:20:48):
Okay. And so approximately how long was she in the Pender ER before leaving to go to New Hanover?
Krystal Beck (01:20:59):
I'd have to consult the notes. I think it was about two and a half hours.
Luther Britt (01:21:07):
Did anyone from DSS respond to your call?
Krystal Beck (01:21:16):
From DSS, I don't remember.
Luther Britt (01:21:18):
Did anyone from the Sheriff's Department respond to your call?
Krystal Beck (01:21:20):
I believe so.
Luther Britt (01:21:21):
Do you recall who that may have been?
Krystal Beck (01:21:23):
I do not.
Luther Britt (01:21:25):
And then how was she transported from Pender to New Hanover?
Krystal Beck (01:21:30):
It's called our VitaLink. It's a critical care transport that we use from New Hanover to Pender.
Luther Britt (01:21:38):
So it's an ambulance?
Krystal Beck (01:21:38):
Yes.
Luther Britt (01:21:49):
And in taking the history, who provided you the information?
Krystal Beck (01:21:58):
I think initially the two gentlemen that brought her in gave us some brief history.
Luther Britt (01:22:04):
And the young man that carried her in, can you describe the manner in which he was carrying her?
Krystal Beck (01:22:16):
I mean, frantically, the patient wasn't breathing and unresponsive, so...
Luther Britt (01:22:37):
And did you notice the clothing that the young man was wearing?
Krystal Beck (01:22:40):
I don't recall.
Luther Britt (01:22:53):
All right. Thank you. I don't have any other questions.
Judge (01:22:55):
Any redirect?
Ms. Smircic (01:22:57):
No, Judge.
Judge (01:22:57):
Is this witness subject to recall?
Ms. Smircic (01:22:59):
Not from the State, Judge.
Judge (01:23:00):
On behalf of the Defense?
Luther Britt (01:23:01):
No, sir.
Judge (01:23:02):
All right, ma'am, you're released from your obligations of your subpoena. You may step down. You're free to go.
Ms. Smircic (01:23:07):
Thank you.
Judge (01:23:21):
Thank you.
Luther Britt III (01:23:21):
Watch your step, please. Exit through the side.
Judge (01:23:21):
State, you may call your next witness.
Ms. Smircic (01:23:23):
State will call Britton Prosser to the stand.
Judge (01:23:27):
What was that last name?
Ms. Smircic (01:23:29):
P-R-O- S-S-E-R.
Judge (01:23:31):
Thank you.
Luther Britt III (01:23:33):
This way, please. [inaudible 01:23:36] walk around. [inaudible 01:23:39], be careful.
Judge (01:23:40):
All right, ma'am, before you have a seat, you can place your left hand on the Bible. Raise your right hand. The clerk will swear you in.
Clerk (01:23:46):
Do you solemnly swear that the testimony you give in court today will be the truth, the whole truth, nothing but the truth, so help you God?
Britton Prosser (01:23:51):
Yes.
Clerk (01:23:52):
Thank you.
Britton Prosser (01:23:52):
You may be seated.
Luther Britt III (01:23:58):
[inaudible 01:23:56] Thank you.
Judge (01:24:01):
Ma'am, as you testify here today, make sure to speak loudly and clearly into the microphone so everybody can hear you. Make sure all of your answers are out loud. No head shakes or nods or mm-hmms. Has to be yes or a no. Please wait for the attorneys to be done asking their question before you give a response. Can you do that?
Britton Prosser (01:24:17):
Yes.
Judge (01:24:18):
All right. Thank you. State, you may proceed.
Ms. Smircic (01:24:20):
Thank you, Judge. Can you state your name and spell it for Madam Court Reporter?
Britton Prosser (01:24:24):
Britton Prosser, B-R-I-T-T-O-N. Prosser is P-R-O-S-S- E-R.
Ms. Smircic (01:24:31):
And Ms. Prosser, where do you work?
Britton Prosser (01:24:33):
Pender ED.
Ms. Smircic (01:24:34):
Is that the emergency department?
Britton Prosser (01:24:37):
It is the emergency department.
Ms. Smircic (01:24:39):
And what is your role there?
Britton Prosser (01:24:41):
Currently charge nurse.
Ms. Smircic (01:24:44):
What does a charge nurse do?
Britton Prosser (01:24:46):
Oversees everyone in the department, ensures that all patients are being triaged appropriately, cared for appropriately, and that everybody's seen in a timely manner, just kind of organization of the department and caring for patients.
Ms. Smircic (01:25:00):
How long have you been a nurse of the Pender Emergency Department?
Britton Prosser (01:25:03):
Since January of 2017.
Ms. Smircic (01:25:10):
Have you always been an ER nurse or have you worked in other fields?
Britton Prosser (01:25:15):
I have been an emergency nurse for the entirety of my 11 years of nursing. I also am a PRN nursing supervisor at the hospital and attended sexual assault nurse examiner training in 2019, but do not actively practice.
Ms. Smircic (01:25:37):
So on November 13th of 2017, you were working as a nurse in the Pender Emergency Department?
Britton Prosser (01:25:45):
Correct.
Ms. Smircic (01:25:46):
Were you the charge nurse then or just a registered nurse with the ER?
Britton Prosser (01:25:49):
Two year staff nurse, just a nurse.
Judge (01:25:55):
Ma'am, I'm going to ask you to speak a lot louder into the microphone so it can pick you up, okay?
Britton Prosser (01:25:58):
Yes, sir.
Ms. Smircic (01:26:01):
Back in November of 2017, can you describe the Pender ER?
Britton Prosser (01:26:04):
The emergency department is at the front left corner of the hospital. The ambulance bay is on that corner. The entrance is to the right of the nurse's station. Nurse's station's in the middle, rooms all around, and we have resuscitation rooms right behind us at the nurse's station.
Ms. Smircic (01:26:21):
And in the early morning hours of November 13th, how many people would've been working in the Pender emergency department?
Britton Prosser (01:26:31):
Most likely two nurses, a tech, a hook or a registration clerk up front, one doctor, one respiratory therapist.
Ms. Smircic (01:26:38):
So a pretty small ER?
Britton Prosser (01:26:39):
Correct.
Ms. Smircic (01:26:44):
Can you tell me what happened around 3:40 AM on November 13th of 2017?
Britton Prosser (01:26:51):
I believe we got a call from dispatch saying they had been notified that they had received a call that there was a patient on the way that had possibly had a seizure and that we should be prepared to expect them. In that time, when we get a call from dispatch, we prepare for what could come. The resuscitation room was ready. All staff were alerted. Respiratory was on the way. The doctor was ready.
(01:27:21)
We waited for them to show up and they did to the emergency bay. We could see it on the camera. He was running up with the patient in his arms and started banging on the door. I believe Crystal opened the door and I met him in the hallway right in front of the ambulance bay and he said, "Where do we go?" And I pointed towards the cardiac room. We both went that direction. He laid Paitin on the stretcher, kind of initially didn't let go and I said, "I need you to let go so we can take care of her." And he did, he stepped back and walked out of the room. We had security walk him just so he'd know where to go, kind of walking back out of the room to give us space to work.
Ms. Smircic (01:28:09):
And you said Paitin, was the child that was brought in Paitin Fields?
Britton Prosser (01:28:12):
Correct.
Ms. Smircic (01:28:17):
Did you notice anything when Paitin Fields was laid down on that table?
Britton Prosser (01:28:23):
As soon as he laid her down, I could see the mark on her neck. All the staff were at bedside. I looked up at Dr. McGrath and he said, "We all see it. We're going to take care of her." And we moved on.
Ms. Smircic (01:28:39):
So there was some concern about her neck?
Britton Prosser (01:28:42):
Mm-hmm.
Judge (01:28:43):
Is that a yes?
Britton Prosser (01:28:44):
Yes.
Judge (01:28:44):
Thank you.
Ms. Smircic (01:28:48):
What was your role in treating Paitin?
Britton Prosser (01:28:50):
As a nurse, I would start IVs, give medications, monitor vital signs. All the staff was at bedside working together. The respiratory therapist and the doctor were preparing to intubate, meaning put a tube down her throat so that we could help her breathe. The goal is to stabilize the patient with the thought in the back of our minds that we're going to transfer her to a high level of care.
Ms. Smircic (01:29:23):
So the Pender ER was not equipped or the Pender Hospital to provide continuing care to Paitin Fields, is that right?
Britton Prosser (01:29:29):
Correct.
Ms. Smircic (01:29:30):
Where would she go once stabilized?
Britton Prosser (01:29:33):
To New Hanover Regional.
Ms. Smircic (01:29:35):
And that's in Wilmington?
Britton Prosser (01:29:36):
It is.
Ms. Smircic (01:29:43):
Would part of your role have been taking some vitals from Paitin?
Britton Prosser (01:29:47):
Yes, ma'am.
Ms. Smircic (01:29:50):
And at some point, did you take Paitin Fields' temperature rectally?
Britton Prosser (01:29:55):
I do believe I took her discharge vital signs, which have to be within 30 minutes of going to New Hanover, yes.
Ms. Smircic (01:30:03):
And can you explain to the jury how you take a rectal temperature?
Britton Prosser (01:30:08):
In Paitin's situation where she's intubated and laying flat on the stretcher, I gently roll her bottom to insert the pro rectally, whenever we take a rectal temperature, it has a probe cover on it and it is lubricated. It does not go in very far, and the monitor itself on the thermometer, it will start circling when it's monitoring. If you haven't gone in far enough, it'll put a little probe on there that says you need to go a tiny bit further, so it kind of guides us. But taking a rectal temperature is pretty standard for us in the emergency department.
Ms. Smircic (01:30:45):
You said it has a probe cover. What is that made of?
Britton Prosser (01:30:49):
Soft plastic. It's round on the end.
Ms. Smircic (01:30:54):
And at the time, Paitin was intubated, so she wasn't moving?
Britton Prosser (01:30:57):
Correct.
Ms. Smircic (01:31:00):
Would you have caused any injury to Paitin by taking her rectal thermometer?
Britton Prosser (01:31:04):
No.
Ms. Smircic (01:31:25):
And Ms. Prosser, the gentleman that brought Paitin Fields in, did you notice anything about him?
Britton Prosser (01:31:33):
Not in particular, just that he was carrying her and she needed help.
Ms. Smircic (01:31:39):
I don't have any further questions.
Judge (01:31:41):
Cross examination?
Luther Britt (01:31:42):
Once Paitin was placed on the table in the exam room, did you have any contact with the young man that brought her in?
Britton Prosser (01:31:52):
I just said that we needed to help her and I needed him to step back.
Luther Britt (01:31:56):
Did he appear to be visibly upset?
Britton Prosser (01:31:59):
Yes.
Luther Britt (01:32:09):
And was he the one who provided you with a history?
Britton Prosser (01:32:15):
I didn't talk to him past that. I started taking care of her.
Luther Britt (01:32:17):
All right. I don't have any other questions.
Judge (01:32:19):
Any redirect?
Ms. Smircic (01:32:20):
No, Judge.
Judge (01:32:21):
Is this witness subject to recall?
Ms. Smircic (01:32:23):
Not from the State.
Luther Britt (01:32:23):
[inaudible 01:32:25]-
Judge (01:32:25):
All right, ma'am. At this time ... Ma'am.
Britton Prosser (01:32:27):
Sorry.
Judge (01:32:28):
You are released from your obligations of your subpoena. You may step down. You're free to go.
Britton Prosser (01:32:31):
I appreciate it.
Judge (01:32:32):
Thank you.
Luther Britt III (01:32:33):
All right. Watch your stand, please. And exit to the center.
Judge (01:32:44):
State, you may call your next witness.
Speaker 2 (01:32:45):
State would call Carolyn Flowers.
Judge (01:32:52):
All right, ma'am, if you can make your way around to the witness stand.
Luther Britt III (01:33:05):
Watch your step, please.
Judge (01:33:07):
All right, ma'am, if you can please raise your right hand.
Clerk (01:33:11):
Do you affirm that the testimony you give in court today will be the whole truth, nothing but the truth, and that is your solid affirmation?
Carolyn Flowers (01:33:17):
Yes.
Clerk (01:33:18):
Thank you.
Judge (01:33:19):
All right. Thank you, ma'am.
Luther Britt III (01:33:19):
Now we're going to slide over to the microphone. Thank you. A bit further, please. Thank you.
Judge (01:33:26):
All right, ma'am. As you give your testimony here today, please make sure that all of your answers are out loud, no head shakes or nods or mm-hmms. Everything has to be a yes or a no. Speak loudly and clearly into the microphone. The closer you are, the better bet it will pick you up, and please make sure that you wait for the attorney to be done asking their question before you give a response so you're not talking at the same time, okay? Can you do that?
Carolyn Flowers (01:33:48):
Yes.
Judge (01:33:49):
Thank you, ma'am. State, you may proceed.
Speaker 2 (01:33:51):
Good morning, Ms. Flowers.
Carolyn Flowers (01:33:52):
Good morning.
Speaker 2 (01:33:53):
And can you state your name and spell it for the jury, please?
Carolyn Flowers (01:33:56):
Carolyn Flowers, C-A-R-O-L-Y-N, F-L- O-W-R-E-S.
Speaker 2 (01:34:01):
And how are you currently employed?
Carolyn Flowers (01:34:04):
I'm at Pender ED.
Speaker 2 (01:34:05):
Okay. And what are your jobs and responsibilities at-
Carolyn Flowers (01:34:09):
I'm a tech, ED tech, and I do vital signs and EKGs, whatever assistance that's needed with the nurses or with the patients.
Speaker 2 (01:34:20):
Okay. And how long have you been at Pender ED?
Carolyn Flowers (01:34:23):
Nine years.
Speaker 2 (01:34:25):
And I'm going to take you back to November 13th of 2017. Were you employed with the Pender ED as an ED tech then?
Carolyn Flowers (01:34:32):
Yes.
Speaker 2 (01:34:33):
And did you have the same job responsibilities of taking vital signs at that point in time?
Carolyn Flowers (01:34:38):
Yes.
Speaker 2 (01:34:40):
And do you remember on that particular early morning hours being involved with the treatment of Paitin Fields?
Carolyn Flowers (01:34:48):
Yes.
Speaker 2 (01:34:49):
And did you take her vital signs?
Carolyn Flowers (01:34:51):
Yes.
Speaker 2 (01:34:52):
And would you have documented your treatment in the medical records?
Carolyn Flowers (01:35:03):
Yeah, whenever we do it'll automatically populate into the system.
Speaker 2 (01:35:08):
Great. And can you explain the different ways of taking a temperature of a young girl? Well,
Carolyn Flowers (01:35:18):
At that age, if they're under two, we always do rectal, definitely. And at the state she was in, we had to do a rectal.
Speaker 2 (01:35:34):
Okay. Was there... If it's labeled in the medical records as temp source, A-X-I-L-L-A-R-Y, what is that?
Carolyn Flowers (01:35:44):
Axillary.
Speaker 2 (01:35:44):
Yes, ma'am. What is that?
Carolyn Flowers (01:35:47):
The axillary is under the arm.
Speaker 2 (01:35:48):
Okay. And would you have done an axillary temperature if it was noted in the medical records?
Carolyn Flowers (01:35:58):
If it was noted?
Speaker 2 (01:35:59):
Yes, ma'am.
Carolyn Flowers (01:36:00):
If it was... I mean, you would have to put it in there axillary.
Speaker 2 (01:36:04):
All right.
Carolyn Flowers (01:36:04):
Yeah.
Speaker 2 (01:36:05):
May I approach the witness, Judge?
Judge (01:36:06):
You may.
Speaker 2 (01:36:30):
I'm going to show you what's already been admitted as State's Exhibit 3. It's the medical records for Pender County Memorial. And I'm going to take you to page 11 and ask, just review page 11. Do you see some of your entries on page 11?
Carolyn Flowers (01:36:48):
Yes.
Speaker 2 (01:36:49):
Okay. Do you have an entry for taking the temperature of Paitin Fields on that page?
Carolyn Flowers (01:36:57):
Yes.
Speaker 2 (01:36:57):
And in what form did you take?
Carolyn Flowers (01:37:00):
It was axillary.
Speaker 2 (01:37:02):
Okay. And that's underneath the arm, correct?
Carolyn Flowers (01:37:03):
Underneath the arm.
Speaker 2 (01:37:05):
All right. And at some point, did you take a rectal temperature of Paitin Fields?
Carolyn Flowers (01:37:12):
Now that I don't recall doing that.
Speaker 2 (01:37:14):
Okay. I'm going to show you then page 21 of the same records and ask that you review page 21 of those records.
Carolyn Flowers (01:37:24):
Okay.
Speaker 2 (01:37:30):
Okay. By looking at those records, does that refresh your recollection of whether or not you took a rectal temperature of Paitin Fields?
Carolyn Flowers (01:37:37):
It's up there in the document, so obviously I probably did it, but so much was going on I can't remember everything nine years ago. So I probably did go back and do it again.
Speaker 2 (01:37:49):
Okay.
Carolyn Flowers (01:37:49):
Yeah.
Speaker 2 (01:37:50):
And explain how you take a rectal temperature.
Carolyn Flowers (01:37:57):
Well, you put it on the plastic part on the probe.
Speaker 2 (01:38:01):
Yes, ma'am.
Carolyn Flowers (01:38:02):
And put lubrication on it, insert gently in the rectum, wait till the thermometer show the temperature, and then you take it out.
Speaker 2 (01:38:17):
And for Paitin Fields that night, was she intubated when you took the temperatures that night or that morning? Do you remember?
Carolyn Flowers (01:38:28):
I can't remember.
Speaker 2 (01:38:31):
Let me ask you this. Do you usually take the rectal temperature the same way every time by putting a cover on the temperature?
Carolyn Flowers (01:38:39):
Oh yes. And lubricate it.
Speaker 2 (01:38:41):
And lubricating it. And would you have caused damage to Paitin's anus by doing it that way?
Carolyn Flowers (01:38:48):
No, sir.
Speaker 2 (01:38:51):
Outside of taking her vitals, would you have done any other or performed any other treatment at Paitin Fields?
Carolyn Flowers (01:38:58):
No. No.
Speaker 2 (01:39:00):
Judge, I don't have any further questions.
Judge (01:39:02):
Cross examination?
Luther Britt (01:39:03):
I don't have any questions.
Judge (01:39:04):
Is this witness subject to recall?
Speaker 2 (01:39:05):
No, your Honor.
Judge (01:39:06):
On behalf of Defense?
Luther Britt (01:39:07):
No, sir.
Judge (01:39:08):
All right, ma'am. At this time you're released from your obligations of your subpoena. You're free to go. Thank you.
Carolyn Flowers (01:39:12):
Okay.
Luther Britt III (01:39:12):
[inaudible 01:39:12] exited through the center.
Judge (01:39:25):
All right, members of the jury, we're going to go ahead and take our mid-morning break. Go ahead and close up your notebooks. As we break, I remind you and will remind you at every break, do not discuss this case amongst yourselves. Do not discuss this case with anyone else, including friends, family members, or coworkers. Do not allow anyone else to discuss this case in your presence. Do not go online to conduct any independent research regarding this case, especially on any news media sites. Do not have any contact with any of the parties, any of the attorneys or any of the witnesses, and do not post online on any social media sites regarding your experience as a juror. So go ahead and place your notebooks on your chairs. You'll be excused for about 15 minutes.
Luther Britt III (01:40:12):
Thank you, your honor. Make sure your notebooks are closed. You will leave those in your chairs.
Speaker 3 (01:40:14):
Everyone will please remain seated while the jury leave.
Luther Britt III (01:40:22):
Front rows, starting with you, sir, this way. This way, with me. [inaudible 01:40:29] please remain in line. Remain in line. Please remain in line.
(01:40:24)
Jury's left the courtroom, Your Honor.
Judge (01:40:55):
Thank you, sir. Let the record reflect that the jury has exited the courtroom. Is there anything we need to discuss before your break on behalf of the State?
Speaker 2 (01:41:02):
No, your Honor.
Judge (01:41:03):
On behalf of the defense?
Luther Britt (01:41:04):
No, sir.
Judge (01:41:04):
Okay. We'll be at ease for the next 15 minutes.
Luther Britt III (01:41:06):
We'll be at ease for 15 minutes.
Speaker 4 (02:00:15):
Jury is seated.
Judge (02:00:16):
Thank you, sir. Let the record reflect that the jury has reentered the courtroom. State, you may call your next witness.
Ms. Smircic (02:00:22):
Judge, the state calls Dr. Brian McGrath to the stand.
Speaker 4 (02:00:35):
This way, sir. Continue right there. Just a step-up. Be careful.
Judge (02:00:41):
All right, sir, before you have a seat, you can place your left hand on the Bible. Raise your right hand.
Speaker 6 (02:00:46):
Do you solemnly swear that the testimony you give in court today will be the truth, the whole truth, nothing but the truth, so help you God?
Dr. Brian McGrath (02:00:52):
I do.
Ms. Smircic (02:00:52):
Thank you.
Judge (02:00:53):
You may have a seat. Sir, as you give your testimony here today, please speak loudly and clearly into the microphone. The closer that you get, the better that it will pick you up. Second, please make sure all of your answers are out loud. No head shakes or nods or mm-hmms, everything has to be a yes or a no. And please wait for the attorney to be done asking their question before you give a response. Can you do that?
Dr. Brian McGrath (02:01:21):
Yes, sir.
Judge (02:01:21):
Thank you. State, you may proceed.
Ms. Smircic (02:01:24):
Thank you, Judge. Doctor, can you state your name and spell it for Madam Court Reporter?
Dr. Brian McGrath (02:01:26):
Brian McGrath, B-R-I-A-N M-C-G-R- A-T-H.
Ms. Smircic (02:01:31):
Where are you employed?
Dr. Brian McGrath (02:01:32):
I'm a physician with Eastern Carolina Emergency Physicians.
Ms. Smircic (02:01:37):
And what is your position there?
Dr. Brian McGrath (02:01:39):
Emergency medicine physician.
Ms. Smircic (02:01:42):
Are you licensed to practice medicine in this state?
Dr. Brian McGrath (02:01:44):
Yes.
Ms. Smircic (02:01:46):
When did you become licensed?
Dr. Brian McGrath (02:01:48):
2015.
Ms. Smircic (02:01:50):
Were you licensed in any other states?
Dr. Brian McGrath (02:01:53):
Yes. I've been licensed in the state of Kansas and New York.
Ms. Smircic (02:01:58):
How long have you been a doctor?
Dr. Brian McGrath (02:02:00):
Since 2007.
Ms. Smircic (02:02:02):
Can you tell us where and when you received your medical training?
Dr. Brian McGrath (02:02:05):
I did my undergraduate work at Georgetown University. I went to graduate school at Harvard and I went to medical school at Nova Southeastern University in Florida.
Ms. Smircic (02:02:16):
And it sounds like you got a specialty in medicine.
Dr. Brian McGrath (02:02:18):
Yeah, I did a four-year emergency medicine residency in New York City at St. Barnabas Hospital in the Bronx.
Ms. Smircic (02:02:25):
And can you describe your specialty of emergency medicine and what that involves?
Dr. Brian McGrath (02:02:30):
Emergency medicine, the specialty is based in the emergency department in the hospital, and we are responsible for treating, diagnosing patients who have unscheduled care that come into the ED.
Ms. Smircic (02:02:44):
And are you board certified in emergency medicine?
Dr. Brian McGrath (02:02:46):
Yes, ma'am.
Ms. Smircic (02:02:47):
What does board certification involve?
Dr. Brian McGrath (02:02:50):
Board certification, to be board eligible, you have to have completed your residency training, and then there are a series of exams, both written exams and oral exams, and sometimes clinical exams too, procedural stuff. And then there's a maintenance of certification where every year you're required to do a certain amount of continuing medical education. And then every several years, there's a maintenance of certification exam that makes sure that you're staying up to speed and up to standard to perform your job.
Ms. Smircic (02:03:23):
Are you a member of any professional organizations?
Dr. Brian McGrath (02:03:25):
I'm a fellow of the American Academy of Emergency Medicine.
Ms. Smircic (02:03:29):
And have you given any lectures in your field or participated in any scholarly activities?
Dr. Brian McGrath (02:03:34):
Yeah, quite a bit. I was a chief academic resident in my residency program. I was in the Army. I was a clinical instructor at the special operations combat medical course, and I teach residents and students at the hospital for UNC School of Medicine.
Ms. Smircic (02:03:54):
And so you did serve as a doctor in the Army for some time?
Dr. Brian McGrath (02:03:56):
Yes, ma'am.
Ms. Smircic (02:03:56):
How long did you do that?
Dr. Brian McGrath (02:03:58):
I was commissioned in 2003 and separated from military service in June of 2015.
Ms. Smircic (02:04:05):
And during your career as a military doctor, did you ever get deployed? Did you-
Dr. Brian McGrath (02:04:10):
Yeah, I was deployed to Afghanistan in 2012 and 2013.
Ms. Smircic (02:04:13):
May I approach?
Judge (02:04:22):
You may.
Ms. Smircic (02:04:30):
Dr. McGrath, I'm showing you what I've marked as State's Exhibit four, which is a two-page document. Do you recognize this document?
Dr. Brian McGrath (02:04:40):
Yes. This is my CV.
Ms. Smircic (02:04:42):
Okay. Is that your resume, basically?
Dr. Brian McGrath (02:04:43):
Yes. Yes, ma'am.
Ms. Smircic (02:04:44):
Everything on that accurate as to your education, qualifications, and certifications?
Dr. Brian McGrath (02:04:49):
That's correct.
Ms. Smircic (02:04:50):
No changes or modifications?
Dr. Brian McGrath (02:04:52):
No, ma'am.
Ms. Smircic (02:04:53):
Judge, the state would move to-
Dr. Brian McGrath (02:04:54):
I no longer have an active medical license in New York State or Kansas, but that's the only thing.
Ms. Smircic (02:05:01):
Do you have one here?
Dr. Brian McGrath (02:05:02):
Yes, ma'am.
Ms. Smircic (02:05:03):
Judge, the state would move to admit state's four into evidence.
Judge (02:05:07):
Any objection?
Speaker 5 (02:05:08):
No, sir.
Judge (02:05:09):
State's exhibit four will be admitted into evidence.
Ms. Smircic (02:05:12):
Judge, at this time, I would tender Dr. McGrath as an expert in emergency medicine.
Judge (02:05:17):
Any objection?
Speaker 5 (02:05:18):
No, sir.
Judge (02:05:19):
The witness will be called as an expert in the field of emergency medicine.
Ms. Smircic (02:05:24):
Thank you, Judge. Dr. McGrath, back on November 13th of 2017, where were you working?
Dr. Brian McGrath (02:05:33):
I was working the night shift at Pender Memorial Hospital here in Burgaw.
Ms. Smircic (02:05:37):
Can you describe the Pender ER at the hospital in Burgaw?
Dr. Brian McGrath (02:05:41):
It's a small critical access hospital, has 11 beds. There's two resuscitation rooms. It's a small, moderate volume emergency department with mixed acuity. We see some very minor things and some very serious things. The purpose of a critical access hospital is to provide medical care in medically underserved communities. And our responsibility is to provide good standard of care, similar to they would receive at any other location, and then to facilitate resuscitative care and ultimately transfer them to a higher level of care if necessary.
Ms. Smircic (02:06:27):
And did you come into contact and treat Paitin Fields in the early morning hours of November 13th at the Pender ER?
Dr. Brian McGrath (02:06:33):
I did.
Ms. Smircic (02:06:33):
May I approach?
Judge (02:06:33):
You may.
Ms. Smircic (02:06:45):
Dr. McGrath, I'm showing you state's three, which has already been admitted and accepted into evidence. Do these appear, looking at the first page of the medical records, to be Paitin Fields' medical records from that morning?
Dr. Brian McGrath (02:07:02):
Yes, ma'am.
Ms. Smircic (02:07:03):
Does it note on there what time Paitin Fields arrived at the emergency department?
Dr. Brian McGrath (02:07:09):
Arrival time, 3:50 AM.
Ms. Smircic (02:07:13):
Okay. And what time was she transferred to the hospital in Wilmington?
Dr. Brian McGrath (02:07:21):
6:22 AM.
Ms. Smircic (02:07:24):
Thank you. And I'll leave those with you in case you need to refer to your records. Dr. McGrath, can you tell us what you remember about Paitin Fields coming into the ER that night or that early morning?
Dr. Brian McGrath (02:07:44):
Yeah, it was a long time ago, but I remember the night very clearly. There was a bang on the door and a minimally responsive, actively seizing young woman was brought in respiratory distress being held by an adult male and another male individual.
Ms. Smircic (02:08:07):
And what do you mean actively seizing?
Dr. Brian McGrath (02:08:10):
She had some kind of decorticate posturing, which is a sign of brain injury. Seizure activity was subtle, but very present. She had some eye movements and some generalized movements of both her upper extremities and lower extremities that were consistent with seizure activity.
Ms. Smircic (02:08:31):
And can you describe what the posturing means?
Dr. Brian McGrath (02:08:35):
Decorticate posturing is a sign of a brain injury, usually from a lack of oxygen perfusion to the brain. It's when the upper part of the body kind of postures in, they rotate in medially to the core. It's a sign of a significant brain injury.
Ms. Smircic (02:08:58):
And the way you described her seizing, was she moving around, thrashing about in any way?
Dr. Brian McGrath (02:09:04):
Not thrashing. These are not like the Hollywood seizures that you see on television. This is kind of a more subtle fasciculation that was taking place.
Ms. Smircic (02:09:15):
And what do you mean by that?
Dr. Brian McGrath (02:09:17):
Her eyes were twitching, her arms were subtly twitching, and these were not purposeful movements.
Ms. Smircic (02:09:26):
How old was Paitin Fields when she came into the ER that morning?
Dr. Brian McGrath (02:09:29):
She was five.
Ms. Smircic (02:09:34):
Is her date of birth noted in the medical records?
Dr. Brian McGrath (02:09:50):
I honestly don't know where to find her date of birth on here.
Ms. Smircic (02:09:54):
If you could look at the top right, I think it should be up there.
Judge (02:09:58):
Her date of birth was 6/23/2000. Excuse me, 6/23/12.
Dr. Brian McGrath (02:10:05):
I see it now.
Judge (02:10:07):
All right.
Ms. Smircic (02:10:08):
Thank you, Judge. And Dr. McGrath, can you read that birthdate one more time?
Dr. Brian McGrath (02:10:11):
June 23rd, 2012.
Ms. Smircic (02:10:15):
Dr. McGrath, when she came in, what did you notice about her besides what you've described as seizing?
Dr. Brian McGrath (02:10:27):
This was a profoundly sick girl. She was critically ill. She was dying and we needed to get to work immediately to make every attempt to resuscitate her.
Ms. Smircic (02:10:41):
Did you notice anything about her neck?
Dr. Brian McGrath (02:10:43):
Yes. Yes. But a lot of things were happening at the same time. Very pertinent physical exam findings became obvious in a very short period of time, but we were also focused concomitantly on the immediate interventions that needed to take place in order to resuscitate her.
Ms. Smircic (02:11:05):
Can you describe to the jury what all you and the nurses were doing and how you were treating Paitin?
Dr. Brian McGrath (02:11:11):
Can I read from the medical record? I think this is probably the most accurate representation of what we did that day.
Ms. Smircic (02:11:18):
Yes. Dr. McGrath, if you'll read, did you make a note in the medical record of yourself?
Dr. Brian McGrath (02:11:26):
Yes.
Ms. Smircic (02:11:28):
Would you please read that note to the jury?
Dr. Brian McGrath (02:11:31):
So it says, "Paitin Fields is a five-year-old female who presents to the emergency department. Patient's uncle was banging on the back door to the emergency department with the patient. She appeared limp. She was obviously seizing. She was having labored respirations. She had been incontinent of stool and urine. I immediately noticed an extensive petechial rash on her face and neck. There were no other obvious signs of trauma. History of present illness was otherwise limited on arrival. Patient was immediately moved to the resuscitation room. Broselow tape was placed at bedside and patient was estimated to be 18 kilograms. Patient was placed on a non-rebreather mask and attached to cardiac monitor. Peripheral IV was attempted times one. Initial attempt was unsuccessful. I placed a right lower extremity intraosseous line. Bedside Accu-Chek was above 200. On second peripheral IV attempt, emergency department nursing staff was able to place a small gauge catheter in the left hand.
(02:12:27)
Patient received one milligram of Ativan and then a second dose of one milligram of Ativan. Respiratory therapist was at the bedside and we prepared to intubate the patient. After intubation, a chest x-ray was performed. Family members arrived to the emergency department. They note that patient had had a several day history of evolving upper respiratory infection-like symptoms. She was feeling fine yesterday and they thought that she had a common cold. She received a dose of ibuprofen and Dimetapp at bedtime. The family members note that they woke up approximately one hour prior to emergency department arrival. They state that the television was on and this caused them to wake up. At that time, they noticed that the patient was seizing. It is unknown for how long she had been seizing. They confirmed that the patient consistently seized for at least 45 minutes prior to emergency department arrival. History was from the uncle and grandparents. Biological mother does not have custody and lives in Lumberton." There's other parts of the medical record, including physical exam findings and procedures we performed. There's a medical decision making part at the end that's...
Ms. Smircic (02:13:40):
Dr. McGrath, let's start where you are. So was the main goal when she first came in to get her breathing essentially?
Dr. Brian McGrath (02:13:49):
Yeah, this is basic... It's not basic. It's advanced life support. It's ABCs, airway, breathing, circulation. She was in respiratory distress. She was neurologically unstable. Several things needed to happen at the same time. First is that we needed to make efforts to deliver medications that would stop the seizure while at the same time preparing to put an endotracheal tube in her trachea in order to breathe for her. She was not getting an adequate amount of oxygen and in the absence of oxygen, the brain does very poorly. Brain needs glucose and oxygen to survive. It was very obvious that she had a neurologic injury that was almost certainly from seizure activity and the deprivation of oxygen.
Ms. Smircic (02:14:50):
And you mentioned earlier that the Pender ER generally you stabilize people and get them if they need more care to go somewhere else. Were you trying to stabilize Paitin to get her to the hospital in Wilmington?
Dr. Brian McGrath (02:15:04):
Yes. Yeah, of course. Pender Memorial Hospital, critical access hospital doesn't have the capabilities for advanced sophisticated longitudinal care. Our job was to resuscitate. Now I want to be standard. She got the same level of care in the ED at Pender Memorial Hospital that she would've gotten in the emergency department at New Hanover Regional Medical Center. There wasn't a lower level of care that took place because she was here rather than there. But ultimately the critical care part of it is a lengthy, complex, very sophisticated thing. And Pender just doesn't provide that service. So ultimately it was to provide excellent resuscitative care and then stabilize her so she can receive excellent critical care in a more longitudinal fashion.
Ms. Smircic (02:15:59):
And Dr. McGrath, as you were treating Paitin, what did you notice about her neck-
Ms. Smircic (02:16:00):
... McGrath, as you were treating Paitin, what did you notice about her neck?
Dr. Brian McGrath (02:16:08):
Paitin had a unmistakable petechial line across the anterior portion of her neck, with hemorrhagic petechiae, bleeding, bruising, small evidence of bleeding and bruising on her face and neck. And it was very clear that the petechial line that was in the anterior portion of her neck was not anywhere else on her body, it was in the anterior portion of her neck and up, nowhere else.
Ms. Smircic (02:16:40):
What does that indicate to you as a doctor?
Dr. Brian McGrath (02:16:44):
The term we use is non-accidental trauma, and that's a catchall phrase for things that don't happen by accident. My concern very quickly was that she had been strangled.
Ms. Smircic (02:17:01):
And Dr. McGrath, in your experience up to that point as an ER doctor and a military doctor, had you seen patients who had been strangled before?
Dr. Brian McGrath (02:17:12):
Yeah, quite a bit. I mean, I've been doing this for 20 years, I've seen suicide attempts, assaults, domestic violence, so quite a bit. Yeah.
Ms. Smircic (02:17:28):
Have you ever seen it on a child this young?
Dr. Brian McGrath (02:17:31):
Unfortunately, yes.
Ms. Smircic (02:17:34):
Judge, may I approach to get [inaudible 02:17:36]?
Judge (02:17:36):
You may.
Ms. Smircic (02:17:36):
Thank you. Dr. McGrath, I'm turning to page seven of your medical records, you gave a description of what you noticed about her neck. Could you please read that to the jury?
Dr. Brian McGrath (02:18:04):
This was written at 5:58, "Despite multiple doses of Ativan, patient continues to seize. She received a dose of Versed and fentanyl prior to CT scan. Patient received a loading dose of Dilantin at 20 milligrams per kilogram, she received two doses of normal saline at 20 milligrams per kilogram. Given the petechial rash with status epilepticus, depressmentation and decorticate posturing, patient also received a dose of dexamethasone, ceftriaxone, and vancomycin. The facial and neck rash is very concerning, it is petechial in nature with hemorrhagic characteristics. The rash is not present anywhere besides her face and neck. The rash is sharply demarcated and horizontally linear across the anterior neck. While there are no other obvious signs of injury, I am concerned for the possibility of non-accidental trauma." Go on to say that case was discussed with Dr. Stoiko from the pediatric intensive care unit, and patient was accepted for transfer.
Ms. Smircic (02:19:08):
Dr. McGrath, can you explain to the jury what a petechial rash is and what that means?
Dr. Brian McGrath (02:19:15):
Petechiae is a medical term for small hemorrhage. It's bruising, it's blood beneath the skin. It's visible small blood beneath the skin.
Ms. Smircic (02:19:25):
And what causes that?
Dr. Brian McGrath (02:19:29):
Trauma.
Ms. Smircic (02:19:36):
And Dr. McGrath, you noted that what you saw in her neck was linear and had a clear demarcation. Can you explain what that indicated to you?
Dr. Brian McGrath (02:19:53):
I thought that these were consistent, I still think that these are consistent with strangulation.
Ms. Smircic (02:20:00):
Is there anything about her face and neck that indicated to you that it was something medical, a medical condition or sickness in any way?
Dr. Brian McGrath (02:20:17):
There's a term in medicine called differential diagnosis, which simply means a list of diagnostic possibilities, and those include things that are most likely, things that are most dangerous, things that are probable, things that are a shot in the dark, but you don't want to rule off. I certainly wanted to cover our bases. An example of that is we gave her empiric doses of antibiotics in the event that this turned out to be something medical or something infectious. We didn't want to jump to conclusions or make faulty assumptions. I think good medicine, you have to be both confident and tremendously humble in recognizing where uncertainty exists. I've been doing this for 20 years, I think I've probably seen 70,000 patients in my career, I spent a year in combat, I've seen every single way someone can die. I think that Paitin was strangled.
Ms. Smircic (02:21:27):
And Dr. McGrath, you, as you've testified, you observed her face and neck and to you that was consistent with strangulation?
Dr. Brian McGrath (02:21:39):
Yes.
Ms. Smircic (02:21:40):
May I approach?
Judge (02:21:41):
You may.
Speaker 2 (02:21:41):
Is that five?
Ms. Smircic (02:21:54):
Yes.
(02:21:54)
Dr. McGrath, I'm showing you state's Exhibit 5, which is a CD sleeve containing a CD. Do you recognize this exhibit?
Dr. Brian McGrath (02:22:03):
Yes, ma'am.
Ms. Smircic (02:22:04):
And what's on this disc?
Dr. Brian McGrath (02:22:06):
Photos of Paitin demonstrating some physical exam findings.
Ms. Smircic (02:22:11):
Okay. And you've reviewed these photographs prior to testifying here today?
Dr. Brian McGrath (02:22:16):
Yes, ma'am.
Ms. Smircic (02:22:16):
And you initialed it confirming that these are photos of Paitin?
Dr. Brian McGrath (02:22:20):
Yes.
Ms. Smircic (02:22:21):
Are these photographs a fair and accurate representation of what you observed about her face and neck in the Pender ER that night?
Dr. Brian McGrath (02:22:29):
Yes, ma'am.
Ms. Smircic (02:22:31):
And would they help illustrate your testimony here today?
Dr. Brian McGrath (02:22:34):
Yes.
Ms. Smircic (02:22:35):
Judge, the state would move to enter state's Exhibit 5 for illustrative purposes.
Judge (02:22:39):
Any objection?
(02:22:41)
State's Exhibit 5 will be admitted into evidence.
Ms. Smircic (02:22:44):
Judge, at this time, I'd ask to publish the photographs on state's Exhibit 5 and that they be excluded from the broadcast.
Judge (02:22:50):
All right. The photos on state's Exhibit 5 will be excluded from the broadcast.
Ms. Smircic (02:22:55):
For the record, Judge, there are three photographs that the state will be publishing through the TV.
Luther Britt (02:23:20):
Your Honor, may I change positions so I can see the TV?
Ms. Smircic (02:23:23):
It'll show up on-
Luther Britt (02:23:24):
It'll show up here?
Ms. Smircic (02:23:25):
Yes.
Luther Britt (02:23:25):
Okay.
Ms. Smircic (02:23:27):
Judge, at this time, the state's going to publish the photograph ending in 5870. Dr. McGrath, are you able to see that?
Dr. Brian McGrath (02:23:47):
Yes, ma'am.
Ms. Smircic (02:23:48):
Is that Paitin Fields?
Dr. Brian McGrath (02:23:52):
I assume it's Paitin Fields, it's consistent with what I remember from that night.
Ms. Smircic (02:23:57):
And can you explain to the jury what's being depicted in this photograph on her neck and face?
Dr. Brian McGrath (02:24:05):
So, I think it's probably valuable to orient people. So, the fingers looks like a left hand is holding up the anterior portion of her chin, and lifting up the chin, there's shiny stuff that's on the face that is holding the endotracheal tube, that's the breathing tube in place. I think the relevant physical exam findings are to look at the redness and the bruising that you see on her chin, on her cheek, and then in the anterior portion of her neck. And you can see laterally as you approach the right shoulder, there's a fine line there, right?
Ms. Smircic (02:24:51):
Dr. McGrath-
Dr. Brian McGrath (02:24:54):
And there's nothing inferior to that. There's nothing, there's not a single lesion. When you look at her face and her neck, there's nothing like that below that area.
Ms. Smircic (02:25:07):
Judge, may I ask Dr. McGrath to step down so he can point to the photograph?
Judge (02:25:12):
All right, sir, you may step down, please watch your step before you step down.
Ms. Smircic (02:25:21):
Dr. McGrath, I'm going to ask that you stand over here so that the jury can see you and the court reporter can see you, and I have a pointer you can use. Can you explain to the jury what you were talking about, the change in coloring and the mark you see?
Dr. Brian McGrath (02:25:38):
This is her left shoulder, this is her right shoulder, this is her chest wall. This is normal skin pigmentation. This is her right cheek, her right part of her neck, this is the anterior part of her neck. This is petechiae here, all these spots. You can see this linear characteristic here. This is bruising, this is all petechiae.
Ms. Smircic (02:26:02):
And Dr. McGrath, I'm going to publish for you a second photograph ending in 3310, can you describe that to the jury and what that shows?
Dr. Brian McGrath (02:26:17):
This is what I described in my note as anterior of linear contiguous petechial markings on the anterior portion of the neck. You can see this on her face and her neck here, and normal skin tissue below that.
Ms. Smircic (02:26:38):
And one more photograph I'll publish, the photograph ending in 3463. Can you talk about that photograph for the jury?
Dr. Brian McGrath (02:26:47):
Same thing. Anterior neck, petechial ligature marks, nothing inferior to that. Face is involved, anterior neck is involved, the chest doesn't have a single spot somewhere.
Ms. Smircic (02:27:04):
Thank you, Dr. McGrath. Dr. McGrath, based on your medical experience and training, when you treated Paitin Fields that morning, did you believe she was going to survive?
Dr. Brian McGrath (02:27:43):
I prayed that she would survive. I thought that she was as sick as you could possibly be and still be alive. I prayed that she would survive. I thought that based upon her neurologic findings, based on how... On the time of her arrival, how she responded to resuscitative interventions in the emergency department, I thought that she was going to have an irreversible neurologic brain injury. I thought that she would be brain-dead.
Ms. Smircic (02:28:27):
You mentioned earlier Paitin was transferred to Wilmington to the hospital there, and you spoke with Dr. Stoiko prior to her arriving?
Dr. Brian McGrath (02:28:38):
Yeah. When you facilitate transfers from one hospital to another, you go through a transfer center. It's usually, from my perspective, the emergency department initiates contact. You're speaking with a specialist at the other facility, the transfer center coordinates care and puts the two parties in contact, and then there's a conversation through the transfer center where you discuss the case, the medical interventions, and what the plan's going to be. And then the receiving facility then prepares to accept the patient. And then there's some behind the scenes logistical transfer stuff about getting a critical care transfer from where the patient is getting them transferred to the destination, where they're going to be treated.
Ms. Smircic (02:29:39):
Do you recall if Paitin Fields was transferred by helicopter or ambulance?
Dr. Brian McGrath (02:29:46):
I think that... I don't 100% remember the mode of transportation, I know that a Vitalink transfer team and these people work both on the airframe and on the trucks responded, and they took Paitin from the resuscitation room at Pender to the pediatric intention care unit at New Hanover Regional Medical Center.
Ms. Smircic (02:30:15):
And did you relay what you had observed in your treatment of Paitin to Dr. Stoiko for her arrival there?
Dr. Brian McGrath (02:30:22):
In great detail, yes.
Ms. Smircic (02:30:32):
And Dr. McGrath, when you were treating Paitin Fields at the Pender ER, did you ever observe or come into contact with her genital area?
Dr. Brian McGrath (02:30:42):
Her general or-
Ms. Smircic (02:30:43):
Genital area.
Dr. Brian McGrath (02:30:45):
No. She was fully disrobed during the resuscitate, and that's just part of the resuscitative is fully expose the patient. Look at everything so we have an entire clinical picture. But no, I had no... Other than a physical exam that was performed, the only procedure that I did in addition to intubating her, I was the one who did the endotracheal intubation, is that I placed a interosseous line, which is... I use a small drill to drill an IV into the anterior portion of the tibia to establish access to give medication. But no, I wasn't involved with her genitals at all.
Ms. Smircic (02:31:39):
Were you the only male working in the ER that night?
Dr. Brian McGrath (02:31:42):
Yes.
Ms. Smircic (02:31:49):
And Dr. McGrath, you've touched on this quite a bit, but based on your training and experience in emergency medicine, is it your opinion that Paitin Fields was strangled?
Dr. Brian McGrath (02:32:05):
100%, yeah. There's no medical... Things in medicine are supposed to make sense, they don't sometimes, but they're supposed to. And there's no disease, there's no infection that would cause the constellation of physical exam findings and devastating neurologic injury that she suffered.
Ms. Smircic (02:32:29):
And you believe this to be non-accidental?
Dr. Brian McGrath (02:32:31):
I do.
Ms. Smircic (02:32:31):
I don't have any further questions, Judge.
Judge (02:32:35):
Cross examination?
Luther Britt (02:32:37):
Yes, just briefly. Dr. McGrath you used the term demarcation of her neck. In the photographs that were shown, is that demarcation noted?
Dr. Brian McGrath (02:32:51):
In the three pictures that were... Yes, sir, I think they're clearly demarcated. Yes, sir.
Luther Britt (02:32:57):
And how many lines, so to speak, did you observe in her neck?
Dr. Brian McGrath (02:33:04):
The one that I refer to in my medical records, and I think the one you're asking about in the picture is a single line that demarcates, right? Separates one thing from another. There's a clear line on the anterior portion of her neck that separates normal skin tissue from abnormal skin tissue. That line is made up of... I'm not a forensic pathologist, hundreds, thousands, I don't know, of little petechiae that caused that physical exam finding.
Luther Britt (02:33:36):
So, the demarcation, was it a difference in color? For example, the lower portion of her neck did not have the petechia, the red rash.
Dr. Brian McGrath (02:33:47):
Right.
Luther Britt (02:33:50):
Did you observe anything that you believed to have been a ligature mark?
Dr. Brian McGrath (02:33:55):
Yes, I think that's what we're discussing. I think that this demarcated petechial line on the anterior portion of her neck, in my medical opinion, is consistent with a ligature mark.
Luther Britt (02:34:12):
And did you form any opinion as to what type of ligature would've caused that?
Dr. Brian McGrath (02:34:21):
I don't have any opinion on that. I think that it would... My opinion is that this is a ligature mark, I don't have any insight or evidence to suggest what caused that though.
Luther Britt (02:34:36):
And when you made this comment that she was a very sick little girl, that's based upon your exam here at Pender?
Dr. Brian McGrath (02:34:46):
Yes, sir.
Luther Britt (02:34:48):
Did you do any type of blood work to try to detect from the infection?
Dr. Brian McGrath (02:34:54):
Yes. We did a thorough medical workup, We did a CT scan of her brain, we did a chest X-ray, a urinalysis, a urine drug screen. We did a complete blood count, a metabolic panel, got blood cultures. So, as I was saying before, it's being clinically open-minded as to what could potentially cause something like this.
Luther Britt (02:35:20):
You weren't going to limit yourself in terms of the treatment, of the necessary treatment?
Dr. Brian McGrath (02:35:26):
No, this is... Emergency medicine, as a nutshell, is making really critical decisions that have long-term impacts based upon limited information. So, we have limited information that night, so we didn't want to leave any stone unturned.
Luther Britt (02:35:42):
All right. Thank you. I don't have any other questions.
Judge (02:35:42):
Redirect?
Ms. Smircic (02:35:45):
Just briefly, Judge. Dr. McGrath, when you testified that Paitin Fields was very sick, you were referring to her condition when she was brought into the ER, as in she couldn't breathe, you were trying to resuscitate her.
Dr. Brian McGrath (02:36:00):
Yes. And there's probably a more elegant way to say that. In the colloquial terms within medicine, kind of like people are bifurcated into sick or not sick, and sick means in extremis. Extremely ill, life is in jeopardy. And that's what I meant, that this girl was dying, this girl had an extremely dangerous situation taking place.
Ms. Smircic (02:36:34):
Nothing further, Judge.
Judge (02:36:35):
Any recross?
Luther Britt (02:36:36):
No, sir.
Judge (02:36:37):
Is this witness subject to recall?
Ms. Smircic (02:36:37):
No, Judge.
Luther Britt (02:36:37):
No, sir.
Judge (02:36:40):
All right, sir, you're released from your obligations of your subpoena, you may step down. You're free to go. I'll take that, thank you.
Dr. Brian McGrath (02:36:45):
Thank you.
Judge (02:36:45):
Thank you. State, you may call your next witness.
Speaker 2 (02:37:02):
State would call Dr. Michael Stoiko.
Bailiff (02:37:09):
This way sir.
Judge (02:37:15):
All right, sir, if you can place your left hand in the Bible, raise your right hand, the clerk will swear you in.
Clerk (02:37:19):
Do you solemnly swear that the testimony you give in court today will be the truth, the whole truth, nothing but the truth, so help you God?
Dr. Michael Stoiko (02:37:24):
I do.
Clerk (02:37:25):
Thank you, you may be seated.
Judge (02:37:32):
Sir, as you testify here today, please make sure to speak loudly and clearly into the microphone. Please make sure all of your answers are out loud, no head shakes or nods. Everything has to be yes or no. And please wait for the attorney to be done asking their question before you give a response. Can you do that?
Dr. Michael Stoiko (02:37:53):
I can.
Judge (02:37:53):
All right. Thank you. State, you may proceed.
Speaker 2 (02:37:53):
Thank you, Your Honor. Dr. Stoiko, can you state your name and spell it for the jury, please?
Dr. Michael Stoiko (02:37:56):
Yes. It's M-I-C-H-A-E-L, Stoiko, S-T-O-I-K-O.
Speaker 2 (02:38:03):
And how are you employed?
Dr. Michael Stoiko (02:38:05):
Currently, I'm not.
Speaker 2 (02:38:06):
You're retired, is that correct?
Dr. Michael Stoiko (02:38:07):
I just retired recently, yes.
Speaker 2 (02:38:09):
And how were you previously employed?
Dr. Michael Stoiko (02:38:12):
I worked as a pediatric critical care physician for about 40 years.
Speaker 2 (02:38:18):
And I'm going to slow it down and take you through your education and your training, okay? So, you've been a physician for 40 years, are you currently licensed anywhere?
Dr. Michael Stoiko (02:38:32):
I just let that expire in April.
Speaker 2 (02:38:35):
And in order to become a licensed physician, did you go to school?
Dr. Michael Stoiko (02:38:40):
Yes, I went to undergraduate at Colgate University in upstate New York, and I was a physics major, I then went to University of Maryland Medical School, and I did an MD-PhD program there. I then did a three-year residency in pediatrics at the University of Maryland Hospital, and then I did a fellowship in anesthesia and critical care at Massachusetts General Hospital in Boston, so 14 years after high school.
Speaker 2 (02:39:09):
Okay. And prior to retiring, were you board certified?
Dr. Michael Stoiko (02:39:13):
I was board certified in pediatrics and pediatric critical care.
Speaker 2 (02:39:17):
And will you explain to the jury what critical care means? When you say you were board certified in critical care, you practiced in critical care, what is critical care?
Dr. Michael Stoiko (02:39:28):
Well, similar to what Dr. McGrath referenced, there are children who are sick, and then there are children who have life-threatening injuries or illnesses. If they are really sick, where there's a concern that they could in fact have serious consequences or die from it, they usually get transferred to me, and my training is specifically in trying to stabilize, and if possible, save those kids when they're really, really sick.
Speaker 2 (02:39:54):
So, they would first come in, let's say in this particular case, somebody comes into the ER, they're stabilized, they're very, very, as you describe it, very, very sick, they transfer to your care and you put your critical care hat on and try to save their lives. Is that correct?
Dr. Michael Stoiko (02:40:13):
Yeah. I would just clarify often they can't be truly stabilized, but they do the best they can to try to save their lives, and get them to me where we can apply tertiary level, which very high level care, sometimes even putting them on heart lung machines or doing heart surgeries, or very, very high level care. So, it's only done at a relatively small number of institutions.
Speaker 2 (02:40:38):
And do we have one of those institutions in this area?
Dr. Michael Stoiko (02:40:41):
We do at New Hanover, formerly New Hanover. Sorry.
Speaker 2 (02:40:45):
Now it's Novant hospital down in Wilmington?
Dr. Michael Stoiko (02:40:46):
Yes.
Speaker 2 (02:40:47):
And how long were you employed down at New Hanover Regional Medical Center/Novant?
Dr. Michael Stoiko (02:40:52):
12 years.
Speaker 2 (02:40:54):
And in what area of medicine were you employed in?
Dr. Michael Stoiko (02:40:59):
I was the medical director of the pediatric intensive care unit, I was the chair of the Department of Pediatrics, and the year before I was retired, I was named head of the medical staff for the hospital.
Speaker 2 (02:41:12):
And the pediatric intensive care unit, it's PICU, is that correct?
Dr. Michael Stoiko (02:41:18):
It's... Yeah, abbreviated as PICU often.
Speaker 2 (02:41:20):
And explain to the jury what pediatric care is. What ages? When would they come to you and would they go to NICU or...
Dr. Michael Stoiko (02:41:32):
Okay. NICU, the neonatal intensive care unit is just that, it's for newborns. So, when a child is firstborn, whether it's prematurely or as a term infant that has some medical needs that require closer monitoring, they would go to the NICU. Once they have graduated from the NICU, which generally means they've gone home from the hospital, if they then develop a serious illness or injury, then they would come to the PICU up until sometimes age 20, 21, but just generally children.
Speaker 2 (02:42:04):
And what type of illnesses or trauma do you see in the PICU?
Dr. Michael Stoiko (02:42:13):
The most common thing we see probably is children who have been in various accidents or had various injuries, children with respiratory illnesses, children with seizures, and in previous iterations, other units I have worked in, we might also take care of the sickest kids that have cancer or other complex illnesses.
Speaker 2 (02:42:38):
How about strangulation cases?
Dr. Michael Stoiko (02:42:39):
Unfortunately, yes, I've seen quite a few over the years.
Speaker 2 (02:42:44):
How about child abuse cases?
Dr. Michael Stoiko (02:42:46):
Yes, I have seen... Well, I've actually testified in almost 100 cases of child abuse.
Speaker 2 (02:42:53):
And in addition to practicing medicine, have you also taught at maybe medical schools or other schools?
Dr. Michael Stoiko (02:43:02):
Yes, I have. I have been an instructor at Harvard Medical School, I've been a various level professor at University of Oklahoma, at Michigan State University, and at Chapel Hill in North Carolina.
Speaker 2 (02:43:18):
And have you published papers? Have you published in medical journals?
Dr. Michael Stoiko (02:43:24):
Yes. Most of my research, other than working on my doctorate degree, has been related to non-accidental trauma or abuse of children.
Speaker 2 (02:43:34):
You said before that you went through the MD-PhD program. Do you have a PhD?
Dr. Michael Stoiko (02:43:39):
I did not complete my doctoral thesis because I had started working as a physician, and then my son was born, and it kind of... I had to choose one or the other, and I chose to be a dad.
Speaker 2 (02:43:57):
Now, I'm going to take you back to some of your training and education with regards to strangulation, and you said that you do see cases of strangulation as a critical care doctor, is that correct?
Dr. Michael Stoiko (02:44:11):
Unfortunately, yes.
Speaker 2 (02:44:12):
And have you had any specialized training in strangulations?
Dr. Michael Stoiko (02:44:17):
I've certainly taught more than 1000 resident physicians about various forms of abuse, including non-accidental asphyxiation of children, because it's... While it's fortunately relatively rare, we see it. And we see a lot more accidental, where children get hung up in curtain cords or a kid standing on the door of a car and having the window come up and choke them or asphyxiate them. So, unfortunately, it's not as rare as you'd hope it would be.
Speaker 2 (02:44:56):
Approximately how many strangulation cases have you worked in your career?
Dr. Michael Stoiko (02:45:01):
I would say dozens, I can't give you an exact number, but...
Speaker 2 (02:45:04):
All right. At this time, Judge, I would tender Dr. Stoiko as an expert in both pediatric critical care and strangulation.
Judge (02:45:12):
Any objection?
Luther Britt (02:45:13):
No, sir.
Judge (02:45:15):
Witness will be tendered as an expert in the field of pediatric care... What was the second part?
Speaker 2 (02:45:20):
Strangulation.
Dr. Michael Stoiko (02:45:21):
And strangulation.
Speaker 2 (02:45:23):
May I approach the witness, Your Honor?
Dr. Michael Stoiko (02:45:24):
You may.
Speaker 2 (02:45:29):
I'm going to show you what's been marked as State's Exhibit 6 for identification purposes, and ask that you review this document.
Dr. Michael Stoiko (02:45:38):
Yes, this is a copy, older copy of my CV because I stopped upgrading it when I was getting ready to retire.
Speaker 2 (02:45:45):
Okay. And does it fairly and accurately depict your training, your time as a faculty member teaching, some of your publications and certifications?
Dr. Michael Stoiko (02:45:56):
Yes.
Speaker 2 (02:45:57):
Move to introduce state's Exhibit 6, Judge.
Judge (02:45:58):
Any objection?
Luther Britt (02:45:59):
No, sir.
Judge (02:46:00):
State's Exhibit 6 will be admitted into evidence.
Speaker 2 (02:46:09):
I'm going to take you to November 13th, 2017 and the days following November 13th, 2017. Where were you employed?
Dr. Michael Stoiko (02:46:19):
At that time, I was employed at New Hanover Regional Medical Center as the medical director of the pediatric critical care unit, and I was on duty that night.
Speaker 2 (02:46:28):
Do you remember, you were in the courtroom when Dr. McGrath testified, correct?
Dr. Michael Stoiko (02:46:33):
I was.
Speaker 2 (02:46:33):
Do you remember receiving a call from Dr. McGrath regarding patient Paitin Fields?
Dr. Michael Stoiko (02:46:39):
I do.
Speaker 2 (02:46:40):
And can you tell the jury about that conversation?
Dr. Michael Stoiko (02:46:43):
Yes. Well, as Dr. McGrath mentioned, anytime a child is going to be transferred from an outside institution or our emergency department up to the peds ICU, we have a direct conversation, doctor to doctor, where they explain what they have seen so far, what they have done so far, what their concerns are about the child, and why they're transferring the child to a higher level of care. During that time, it's a two-way conversation, I will often make suggestions as to additional things they can do for the child while we're waiting for the child to be transferred. He called me and said he had a child that looked like they had a asphyxia or strangulation, non-accidental trauma, and had a severe brain injury. And he was very, very worried the child was very critically ill.
(02:47:36)
But at the time we had spoken, he had gone ahead and gotten an airway into Paitin and they were breathing for her, and she was, I would say, still dying, but she was a bit more stable, and we were trying to move as quickly as we could to get her transferred over to our unit.
Speaker 2 (02:47:53):
Do you remember how she was transferred to your unit?
Dr. Michael Stoiko (02:47:56):
Yes. We initially called to try to get the helicopter to bring her, but I don't remember the specific weather we were having, but it was inclement weather where the helicopter had too low a ceiling so they couldn't fly. So, we had to arrange a ground transfer to drive over and get her and bring her back.
Speaker 2 (02:48:12):
Do you remember what time she arrived at your hospital?
Dr. Michael Stoiko (02:48:17):
Roughly 6:20, 6:30, I think. I could be more accurate if you want me to look.
Speaker 2 (02:48:22):
And when somebody arrives, you've already discussed this with an ED doctor, do they come straight to the PICU or do they go through to you when they arrive at New Hanover?
Dr. Michael Stoiko (02:48:35):
Unless it's extraordinary circumstances, we would try to avoid taking to our ED, we'd bring them directly to the PICU. We'd have the room all set up, we'd have usually two nurses assigned to care for them, and I would be waiting with them along with the respiratory therapist.
Speaker 2 (02:48:50):
And do you remember on the early morning hours of November 13th, 2017, were you the one waiting on Paitin to arrive at the hospital?
Dr. Michael Stoiko (02:49:00):
I was.
Speaker 2 (02:49:02):
And we'll come back to when she arrives, but during the course of a patient's care, in particular Paitin Fields' care, when she moves to your hospital, do you... I say you, doctors and nurses at New Hanover. Do you keep a separate record of your treatment of a patient in this particular case, Paitin Fields, separate from Pender County? When I say that, medical records, you have Pender County medical records and New Hanover medical records?
Dr. Michael Stoiko (02:49:34):
Correct.
Speaker 2 (02:49:36):
Okay. And what's the purpose of the medical records?
Dr. Michael Stoiko (02:49:42):
It's a critical piece of information to have because we try to document everything that we're learning about the patient in real time as much as we can. Any procedures that we do on the patient, we try to document those, and also that we are able to see trends in labs, trends in vital signs and so on. So, it ends up being...
Dr. Michael Stoiko (02:50:00):
... labs, trends in vital signs, and so on. So, it ends up being a really important piece of information we refer to frequently to help guide us with ongoing care.
Speaker 2 (02:50:12):
May I approach the witness, Judge?
Judge (02:50:12):
You may. That's fine.
Speaker 2 (02:50:33):
I'm going to show you what's been marked as State's Exhibit 7 for identification purposes, and 8 for identification purposes, and ask that you review State's Exhibit 7.
Dr. Michael Stoiko (02:50:59):
Yes, I have reviewed an electronic copy very similar to this. And it appears to be-
Speaker 2 (02:51:05):
The medical record?
Dr. Michael Stoiko (02:51:06):
From the medical record and representative of what I've seen.
Speaker 2 (02:51:09):
All right. And is this the medical record for Paitin Fields when you... Or when she was being treated at New Hanover Regional?
Dr. Michael Stoiko (02:51:15):
It is.
Speaker 2 (02:51:16):
All right. And fairly and accurately depict her treatment there and the documentation of such treatment?
Dr. Michael Stoiko (02:51:24):
Yes.
Speaker 2 (02:51:25):
Judge, move to introduce State's Exhibit 7 by way of affidavit.
Judge (02:51:29):
Any objection?
Mr. Britt (02:51:30):
No, sir.
Judge (02:51:30):
State's Exhibit 7 will be admitted into evidence.
Speaker 2 (02:51:33):
And then you said you've reviewed a digital copy of those, is that correct?
Dr. Michael Stoiko (02:51:37):
That's correct.
Speaker 2 (02:51:37):
I'm going to show you State's Exhibit 8 and ask that you review that disc.
Dr. Michael Stoiko (02:51:44):
Oh, yes. You had me look at this to make sure it was what I had reviewed. I agreed and I initialed it.
Speaker 2 (02:51:50):
All right. And this is just a digital version of State's Exhibit 7, is that correct?
Dr. Michael Stoiko (02:51:55):
Correct.
Speaker 2 (02:51:56):
At this time, move to introduce State's Exhibit 8 by way of affidavit, Judge.
Judge (02:52:00):
Any objection?
Mr. Britt (02:52:01):
No, sir.
Judge (02:52:02):
State's Exhibit 8 will be admitted into evidence.
Speaker 2 (02:52:11):
May I approach the witness again, Judge?
Judge (02:52:11):
You may.
Speaker 2 (02:52:15):
I'm going to leave that copy in case you have to refer back to it. So, I'm going to take you to when... Right before Paitin arrives at your hospital at 6:20 in the morning on November 13th, 2017, you have your team ready. Is that correct?
Dr. Michael Stoiko (02:52:37):
That's correct.
Speaker 2 (02:52:38):
And when she comes in, can you explain to the jury what you observed as she came into your unit?
Dr. Michael Stoiko (02:52:47):
When she arrived to the pediatric intensive care unit, Paitin was not awake. She was not responsive to her environment. The only thing that I saw her do at that time was that if you really stimulated her, like when they moved her over the stretcher onto the bed, she would make a movement, kind of like this, that Dr. McGrath referred to as posturing. But if you were to, say, pinch her finger or something, she would not withdraw it. She wasn't moving anything spontaneously. She was not...
(02:53:26)
She did not have her eyes open and she was being breathed for, mechanically ventilated by the transport team and then by our therapist.
Speaker 2 (02:53:36):
Did you notice anything about her appearance?
Dr. Michael Stoiko (02:53:39):
Several concerning things beyond the fact that she was not responding to us was that when you shine the light into her eyes to look at how her pupils would respond... Normally, healthy eyes would respond very briskly to a bright light. Hers were kind of a little slow and then slowly relaxed, but they were sluggish, which is concerning. And it was very clear that her head and upper part of her neck were quite purple. That there were hundreds, thousands of small hemorrhages under her skin on her head and there was a pretty sharp line around most of her neck.
Speaker 2 (02:54:20):
Let's go to the assessment of her pupils. You said that normally, they would react... Normal, healthy individuals, they would react pretty quickly, and hers, as you described, were sluggish. What does that mean to you as a critical care physician?
Dr. Michael Stoiko (02:54:39):
That's telling me that the deeper portions of her brain were not receiving and sending back the normal signals to her eyes. So, her injury to her brain was not just superficial. It was quite deep and very worrisome.
Speaker 2 (02:54:55):
And when you said that you saw her face was purple, there was a line of demarcation or a line on her neck and thousands of small hemorrhages, describe what those hemorrhages are.
Dr. Michael Stoiko (02:55:14):
You've heard the term petechiae or petechiae. Those refer to small blood vessels under the skin that have burst. In her case, it was because... When she had the ligature around her neck and was struggling against it, trying to breathe, she would be bearing down very, very hard to the point that it would actually cause small blood vessels under her skin to blow up, to burst. Once those have occurred, it takes a number of days for them to resolve, and oftentimes the rash develops. The number of petechiae that you see gets worse over the first day or two, just like any other bruise.
Speaker 2 (02:55:59):
So, you have a young, five-year-old. She was five at the time, is that correct?
Dr. Michael Stoiko (02:56:03):
That's my understanding.
Speaker 2 (02:56:04):
She comes to you with what you described as a brain injury, a deep brain injury, and petechiae or petechiae of her neck and her face. At that point in time, as you're doing your initial evaluation, what are you thinking?
Dr. Michael Stoiko (02:56:20):
Well, I was... I did not have a lot of information about how she was found at that time. She was... I heard Dr. McGrath's explanation, but I did not have any information about what she found hanging. Had somebody allowed her to fall into something where that obstructed her neck or... I had none of that information, but I could tell, by the severity of her brain injury and by the severity of these petechiae, that she had had her airway and maybe part of her blood flow to her brain cut off for a significant period of time. And without it being, again, not her being found hanging herself accidentally or something, this was intentional. Somebody did this to her.
Speaker 2 (02:57:08):
Okay. So, let's talk about that. You used the medical term asphyxia. And for the non-medical people in this room, what is asphyxia?
Dr. Michael Stoiko (02:57:16):
It basically refers to cutting off of airflow to the brain in particular. But I mean, your whole body can get asphyxiated, but your brain is particularly sensitive to that. In a matter of seconds after you start getting asphyxiated, you start panicking, and it's not a conscious response. You're not thinking, "Oh my gosh, I'm getting strangled." You actually will start thrashing and fighting. You have more nerve endings in your airway than many other parts of your body because if you can't keep your airway open, you die. So, your body is designed to protect your airway at all costs. And if somebody tries to obstruct your airway or if it becomes obstructed, it's like food going down the wrong hole times a hundred. That feeling of, "Oh my gosh, I'm choking." And you panic, and you start thrashing and fighting and moving and trying to get whatever it is obstructing off of you. And in doing so, massive pressure increase in the face, in the head, and blowing out of all these blood vessels.
Speaker 2 (02:58:20):
You said also that it can cut off the blood flow to your brain, is that correct?
Dr. Michael Stoiko (02:58:28):
Yes.
Speaker 2 (02:58:28):
And let's do a quick anatomy lesson of how does blood reach the brain?
Dr. Michael Stoiko (02:58:35):
The blood comes up through the carotid arteries, which run relatively deep on either side of your airway. It then distributes out around the brain, gets collected, and comes down the jugulars, which are fairly big, floppy veins that run just outside the carotid arteries in your neck, here and here.
Speaker 2 (02:58:55):
And when blood is cut off from your brain, what happens?
Dr. Michael Stoiko (02:59:02):
If you cut off the arterial flow, so there's absolutely no oxygen or sugar being delivered to your brain, you'll become unconscious in seconds. And if that persists, you could start to have brain damage within a few minutes.
Speaker 2 (02:59:20):
At that time, when you first initially, when Paitin came in, could you tell if she was... Her oxygen had been cut off from breathing or blood flow? Or could you tell that?
Dr. Michael Stoiko (02:59:35):
I could not say that with certainty when she first came in. Again, the broken blood vessels, petechiae, are evidence of some obstruction of her jugulars, but I would be speculating to say what percentage of her brain injury was caused by blood loss of blood flow versus loss of oxygen.
Speaker 2 (02:59:54):
But the petechiae or the petechiae is indicative of cutting off the blood flow from the jugulars. Is that what you said?
Dr. Michael Stoiko (03:00:01):
That contributed to it, yes.
Speaker 2 (03:00:03):
All right. So, you make this assessment. As a critical care doctor, what's your next steps? What are you looking to do?
Dr. Michael Stoiko (03:00:12):
Everything from that point is to try to get the rest of her body as stable as we can, to try to give her brain a chance to recover if there's any chance of it doing so. And that means we have to try to keep as normal a blood pressure as we can, good oxygen levels, and control how her kidneys are working and so on. So we were focused on, at that point, trying to really get her as stable as we could and keep her in that condition. Unfortunately, because of the brain injury was so severe, her brain function continued to deteriorate right in front of our eyes. And over the next 12 hours or so, her brain ceased to function.
Speaker 2 (03:00:54):
Have you ever heard of the term near drowning?
Dr. Michael Stoiko (03:00:58):
Yes.
Speaker 2 (03:00:59):
And what is near drowning?
Dr. Michael Stoiko (03:01:00):
Near drowning is a term that refers to somebody being submersed, usually in water, for a period of time where they are affected by it. They could become unconscious. They could struggle and end up aspirating water or whatever, but they don't die from it immediately. So, drowning's easy. I mean, you find somebody floating in a river or whatever, that's a drowning. But somebody who falls into a pool is brought out, resuscitated and brought to the hospital is a near drowning.
Speaker 2 (03:01:35):
Okay. And have you worked on patients that have had near-drowning experiences?
Dr. Michael Stoiko (03:01:40):
Many.
Speaker 2 (03:01:40):
And have you been able to bring... Have you seen them come in with unconscious or lack of brain function and then brought back?
Dr. Michael Stoiko (03:01:53):
If they come in... If they come in with a exam similar to Paitin's, they usually do not recover or they remain permanently vegetative. Kids who have... And I noted this in my initial note. Kids who have a near-drowning experience and come in unresponsive usually remain that way, or/and the kids that recover usually start to do so almost immediately. Usually within 24 hours or so, they're acting normally again. And we didn't see any... We saw no improvement with Paitin. She just continued to deteriorate.
Speaker 2 (03:02:29):
And at this time, you didn't believe this case is a near-drowning case, correct?
Dr. Michael Stoiko (03:02:33):
No, absolutely not.
Speaker 2 (03:02:34):
All right. But there are times when people can go, or kids can go unconscious, appear to have brain injury but recover fully.
Dr. Michael Stoiko (03:02:44):
Yes.
Speaker 2 (03:02:45):
This is not one of those cases?
Dr. Michael Stoiko (03:02:47):
Not even close, no.
Speaker 2 (03:02:48):
All right. So, explain then what your treatment would be for Paitin. As she's coming in, what her brain activity was? What her physical activity was? Meaning her... Was her body working? Was it not working?
Dr. Michael Stoiko (03:03:08):
Neurologically, we use what's called a Glasgow Coma Scale, which is an older scale, but it gives you an idea of globally what's happening with someone's brain. All of us in this room would hopefully have a scale of 15, meaning you would... Your cortex is working. Your brain stem's working. You're breathing. You're doing everything you're supposed to be doing. And if a neurologist examined you, they'd say, "Yeah, you're healthy, normal." That's a 15. A three means that you are, basically, doing nothing. Paitin was a five when I first met her, and deteriorated over the next 12 hours or so to a three.
(03:03:51)
So that, again, what we were focused on was I wanted to keep her oxygen level safe, keep her acid from building up in her blood. I also wanted to continue doing the diagnostic workup. So, we actually transported her that morning down and did CAT scans of her cervical spine, looking for evidence of fractures, of her chest, and of her abdomen and pelvis, looking for any other injuries or other things that could be going on. And then we obtained what's called an electroencephalogram or EEG, which is basically they just glue leads on your head and look at your brainwave patterns to see how normal or abnormal did hers look. And I would say, unfortunately, as expected, we actually saw what's called burst suppression. And that's a pattern. Instead of normal variable brainwaves, what we'd see is a period of just complete flat, absolutely no electrical activity, followed by a burst, followed by flat, followed by burst. And that pattern, particularly after an asphyxial event, I have actually never seen anybody recover from it.
(03:05:06)
Reportedly, there have been some babies that had that pattern that survived, but in a permanently vegetative state. But in older kids and adults, whenever I've seen that pattern, those patients progress on to be brain-dead. It's sort of a last ditch effort as the cells are dying. And we saw that the morning she came in.
Speaker 2 (03:05:26):
On the 13th?
Dr. Michael Stoiko (03:05:27):
Yes.
Speaker 2 (03:05:30):
Did you do any other exam? You said you did some diagnostic exams to look for other injuries. What did you find from those, if any?
Dr. Michael Stoiko (03:05:40):
The other thing that happened that is pertinent to this case is that when our nurse went to place a Foley catheter, which is like a silicone catheter that allows us to continuously measure her urine output, they called me over and asked me to look, and said everything looked very inflamed and it looked abnormal. Her vulva and her rectum looked very abnormal. And I immediately called our SANE team, which are a sexual abuse team of nurses that usually... They don't come to the PICU very often, but if we have concerns about that a child may have been sexually abused, we will call them in. They will do swabs and take pictures and, I guess, you'll hear more about that. But there was... The nurse, who was a very experienced nurse, was very concerned that her genitalia and her rectum looked abnormal, and that we should have the expert team come in and really take pictures and look at it.
Speaker 2 (03:06:43):
And when you say vulva, what is a vulva? For the [inaudible 03:06:48].
Dr. Michael Stoiko (03:06:48):
Just referring to a female genitalia. So the mons, the labia majora, minora, and the vagina.
Speaker 2 (03:06:58):
Did you observe firsthand this abnormality?
Dr. Michael Stoiko (03:07:05):
Yes. The nurse had spread her labia and was looking to place the catheter and said, "Look at that."
(03:07:12)
And I said, "Yeah, that does not look normal."
Speaker 2 (03:07:14):
What did it appear to you?
Dr. Michael Stoiko (03:07:16):
It was redder than it should be, and it looked like there were some areas that might be lacerations or abrasions.
Speaker 2 (03:07:22):
And are you familiar with catheters being placed to get a urine sample?
Dr. Michael Stoiko (03:07:31):
Very much so, yes.
Speaker 2 (03:07:31):
And have you ever seen a catheter cause damage to... A catheter for urine samples, have you ever seen them cause damage to the vagina?
Dr. Michael Stoiko (03:07:43):
I have not. They're very soft.
Speaker 2 (03:07:47):
And are you familiar with rectal temperatures or temperature probes?
Dr. Michael Stoiko (03:07:52):
Yes.
Speaker 2 (03:07:52):
Have you ever seen one of those cause lacerations to the anus?
Dr. Michael Stoiko (03:07:57):
I have not.
Speaker 2 (03:07:57):
I'm going to go back to what you observed about the neck. In your opinion, you'd seen strangulations prior to this case and probably post this case, is that correct?
Dr. Michael Stoiko (03:08:18):
Yes.
Speaker 2 (03:08:20):
What is your medical opinion as to what caused the line and the petechiae?
Dr. Michael Stoiko (03:08:31):
I couldn't see the pictures well that you published. New term for me, but what I could see from the pictures that I saw on the disc and in the chart, there's a area... And it's a combination, I think, of abrasion rubbing really hard and petechiae around the neck. And it's all across the front or anterior part of the neck, as Dr. McGrath said, but also continues around on the left side, all the way to the back. Then, it appears there's a small area where it's less intense. And if some of the pictures that you have were taken the morning that she came in, the 13th, but then the same team came back and re-imaged those the next day and you could see that they had really developed, they were more obvious. But to me, that suggests that somebody had, whatever the ligature was, and were holding it behind her head, probably off to the right, and pulling with sufficient force to cut off her airway and possibly some of the blood flow to her brain.
Speaker 2 (03:09:36):
How much force is necessary to cut off an airway and/or blood flow?
Dr. Michael Stoiko (03:09:40):
A lot of force. And also, because, as I mentioned before, even a five-year-old will put up a very, very strong resistance to having their airway cut off.
Speaker 2 (03:09:50):
May I approach the witness, Judge?
Judge (03:09:50):
You may.
Speaker 2 (03:10:00):
I'm going to show you what's been marked as State's Exhibit 9 for identification purposes. Do you recognize this disc?
Dr. Michael Stoiko (03:10:07):
Yes, I do.
Speaker 2 (03:10:08):
And what is this disc of?
Dr. Michael Stoiko (03:10:09):
This was a disc of a photograph obtained by the SANE team at the hospital. I looked at that and also initialed it.
Speaker 2 (03:10:16):
And did these photographs, and there's 19 of these photographs, do they fairly and accurately depict Paitin's condition when you saw it, specifically of the petechiae, her body, and some of the trauma that she had suffered?
Dr. Michael Stoiko (03:10:33):
They do.
Speaker 2 (03:10:34):
And how do you recognize this disc?
Dr. Michael Stoiko (03:10:39):
I had seen these pictures before. And then you asked me to look at the images on the disc and make sure that they were the ones that I had seen.
Speaker 2 (03:10:45):
And you initialed?
Dr. Michael Stoiko (03:10:46):
I did.
Speaker 2 (03:10:47):
All right. Move to introduce State's Exhibit 9.
Judge (03:10:49):
Any objection?
Mr. Britt (03:10:50):
No, sir.
Judge (03:10:50):
State's Exhibit 9 will be admitted into evidence.
Speaker 2 (03:10:53):
Judge, this is probably a good time for lunch break.
Judge (03:10:55):
Thank you, sir.
(03:10:57)
All right. Members of the jury, we're going to go ahead and break for lunch. Go ahead and close up your notebooks. As you break for lunch, remember, do not discuss this case amongst yourselves. Do not have any conversation with anyone else, including friends, family members, or coworkers about this case. And while you are out at lunch, do not allow anyone else to discuss this case in your presence. Do not have any contact with any of the parties, attorneys, or witnesses. Do not conduct any independent investigation or inquiry, especially online. If there are any places that were mentioned, you're not allowed to go to those places. If, by chance, your journey takes you past any of those locations, you may drive past them, but you are not allowed to stop or conduct any independent investigation. Also, you're not allowed to post online on any social media sites regarding your experience as a juror or any of the evidence that you've seen or heard. So, we'll go ahead and excuse you for lunch.
(03:12:01)
You are to return or we will start court back up again at 2:00. Thank you.
Speaker 7 (03:12:05):
Thank you, Your Honor. Make sure your notes are closed. You leave those in your chairs, [inaudible 03:12:11] front rows and back this way through.
Speaker 2 (03:13:14):
And standing at this TV, the camera was faced over on that side and some of the pictures were captured by a camera. We get... I think one of my staff members received a text from somebody that said we can see the pictures. We've asked that they be exempt from our broadcast, Judge.
Judge (03:13:37):
All right. Thank you. Anything you wish to say, Mr. Britt?
Mr. Britt (03:13:41):
No, sir. The photos were visible at this right.
Judge (03:13:46):
Okay. Anything else before we break?
Speaker 2 (03:13:48):
No, Your Honor.
Judge (03:13:49):
Okay. Anything else, Mr. Britt?
Mr. Britt (03:13:50):
No, sir.
Judge (03:13:51):
All right. We'll be in recess until 2:00 PM.
Speaker 7 (03:13:53):
Court will be in recess until 2:00 PM. 2:00 PM. Everyone must leave the court.
Judge (03:13:59):
I'm going to have him in my chambers, please.
Speaker 7 (03:14:01):
Yes, sir.
Speaker 8 (03:14:32):
[inaudible 03:14:25] I think he captured it on a laptop.
Speaker 9 (03:14:47):
[inaudible 03:14:38] Well, we can move that TV like this?
Speaker 8 (03:14:48):
I don't know. Yeah, we needs to [inaudible 03:14:58]
Speaker 10 (03:14:48):
I don't know. Hey, Shirley, [inaudible 03:15:14].
Speaker 9 (03:14:48):
I would say next week.
Speaker 10 (03:14:48):
Shirley. Shirley. [inaudible 03:16:01].
Speaker 8 (03:14:48):
Bye. Thank you. Is this evidence [inaudible 03:16:32]?
Speaker 9 (03:14:48):
I don't know, because I can't have it on me.
Speaker 7 (03:14:48):
Everything okay?
Speaker 9 (03:14:48):
I'm good.
Speaker 7 (03:14:48):
Make sure... I was trying to get your attention. [inaudible 03:17:06]
Speaker 8 (03:14:48):
Oh, yeah. [inaudible 03:17:12]
Speaker 9 (03:14:48):
And one.
Speaker 8 (03:14:48):
Celeste.
Speaker 9 (03:14:48):
3, 4, 5, 6, 7, 8, 9. [inaudible 03:18:06]
Speaker 11 (03:24:00):
(silence)
Speaker 12 (03:58:00):
(silence)
Judge (04:43:13):
You want to go ahead and retake the witness stand please.
The Court (04:43:23):
Watch your step [inaudible 04:43:29]
Judge (04:43:34):
And then if you can make sure if you can get as close to that microphone as you can, please. Thank you. All right, let's go ahead and bring the jury in.
The Court (04:43:49):
Bring in the jury. [inaudible 04:43:46] bring the jury. [inaudible 04:43:53] Jury seated, Your Honor.
Judge (04:44:30):
Thank you, sir. Let the record reflect that the jury has reentered the courtroom. All right. State, you may continue.
Speaker 2 (04:44:41):
Thank you, Your Honor. Dr. Stoiko, before we broke, we were talking about your observations of Paitin's injuries and some of your beliefs based upon your training and experience and your expertise in both critical care, pediatric critical care and strangulation. And based upon her injuries and how she presented to Dr. McGrath and yourself on 11/13/2017, could you opine about when this injury could have occurred?
Dr. Michael Stoiko (04:45:16):
Yes. After this severe hypoxic injury of her brain, she would not have regained consciousness. She would not in any way, shape or form be mistaken for acting normally. And unfortunately, by the time she had presented to the Pender ED, she was, as Dr. McGrath, I think stated, she was dying. So this would have been a period of maybe an hour, maybe longer, but not much. There's no way this happened earlier in the evening and then she suddenly deteriorated at three o'clock in the morning.
Speaker 2 (04:45:58):
You also began discussing she comes into your unit at 6:20 on the 13th and you continued to treat her until what day?
Dr. Michael Stoiko (04:46:12):
I continued to treat her until the following morning, the 14th, at about seven o'clock.
Speaker 2 (04:46:18):
And did you notice any change in her appearance from the 13th, when you first saw her, to the 14th?
Dr. Michael Stoiko (04:46:26):
Yes. As I mentioned earlier, this type of petechial rash or bruising around her neck and so on got more intense looking, got deeper in color and the number of these lesions increased over that 24 hours.
Speaker 2 (04:46:43):
Is there a medical reason for that?
Dr. Michael Stoiko (04:46:46):
Basically, if you have damaged or broken blood vessels and they're leaking fluid or leaking blood, that process continued for some period of time. Also, she was, as her condition overall deteriorated, I think her background color didn't look as good, so it made it look more prominent.
Speaker 2 (04:47:14):
Right before we broke, State admitted a series of photographs, State's Exhibit 9. Do you remember viewing those?
Dr. Michael Stoiko (04:47:21):
I do.
Speaker 2 (04:47:22):
And at this time, Judge, permission to publish State's Exhibit 9 and the 19 photographs that are inside the disc labeled State's Exhibit 9 to exclude from the broadcast.
Judge (04:47:34):
All right. State's Exhibit 9 may be published. They shall be excluded from the broadcast.
Speaker 2 (04:47:38):
Thank you. Dr. Stoiko, while you're sitting there, can you see the screen behind me?
Dr. Michael Stoiko (04:47:46):
It looks like I can, yes.
Speaker 2 (04:47:48):
Okay. And I'm going to show you, we're going to walk through the photographs, all nine of them, and then I will probably have you step down and describe what we're seeing in those photographs. Okay?
Dr. Michael Stoiko (04:47:59):
Okay.
Speaker 2 (04:48:07):
Now, Dr. Stoiko, I'm publishing State's Exhibit 9, photograph labeled with the last four 5289, also known as photograph F as in Frank. Do you see and can you see this photograph?
Dr. Michael Stoiko (04:48:23):
I can.
Speaker 2 (04:48:27):
Now I'm showing you State's Exhibit 9, photograph 5870, also labeled as G as in golf. Can you see this photograph?
Dr. Michael Stoiko (04:48:35):
I can.
Speaker 2 (04:48:41):
Photograph ending in 2663, photograph Y, can you see this?
Dr. Michael Stoiko (04:48:47):
Yes, sir.
Speaker 2 (04:48:51):
Photograph 3310, also labeled as photograph Z. Can you see this?
Dr. Michael Stoiko (04:48:59):
I can.
Speaker 2 (04:49:04):
Photograph 3463, also labeled as photograph AA. Can you see this?
Dr. Michael Stoiko (04:49:09):
I can.
Speaker 2 (04:49:12):
Photograph 3782, also labeled as photograph BB. Can you see this photograph?
Dr. Michael Stoiko (04:49:19):
Yes, sir.
Speaker 2 (04:49:21):
4976, labeled CC. Also, can you see this?
Dr. Michael Stoiko (04:49:26):
I can.
Speaker 2 (04:49:26):
Right. 5042, also labeled as DD?
Dr. Michael Stoiko (04:49:33):
I can see it. Yes, sir.
Speaker 2 (04:49:35):
Photograph 5620, labeled FF?
Dr. Michael Stoiko (04:49:39):
Yes.
Speaker 2 (04:49:41):
Photograph 3009, labeled ZZ?
Dr. Michael Stoiko (04:49:45):
Yes.
Speaker 2 (04:49:47):
Photograph 3229, labeled AAA?
Dr. Michael Stoiko (04:49:53):
Yes.
Speaker 2 (04:49:56):
Photograph 3641, labeled BBB?
Dr. Michael Stoiko (04:50:00):
Yes, sir.
Speaker 2 (04:50:02):
3677, labeled CCC?
Dr. Michael Stoiko (04:50:07):
Yes.
Speaker 2 (04:50:09):
3735, labeled DDD?
Dr. Michael Stoiko (04:50:13):
Yes.
Speaker 2 (04:50:15):
4033, labeled HHH?
Dr. Michael Stoiko (04:50:19):
Yes.
Speaker 2 (04:50:21):
4233, labeled III?
Dr. Michael Stoiko (04:50:24):
Yes, sir.
Speaker 2 (04:50:26):
4837, JJJ?
Dr. Michael Stoiko (04:50:29):
Yes, sir.
Speaker 2 (04:50:31):
60580... Strike that. 000?
Dr. Michael Stoiko (04:50:36):
Yes.
Speaker 2 (04:50:38):
6161, labeled PPP. Do you recognize every one of those photographs?
Dr. Michael Stoiko (04:50:45):
I do.
Speaker 2 (04:50:46):
Good. All right. We're going to go back and I'm going to start at the very beginning. Judge, may I have the witness step down?
Judge (04:50:53):
All right, sir, you may step down. Please watch your step as you come back. Thank you.
Speaker 2 (04:50:56):
And you were here for Dr. McGrath's testimony, correct?
Dr. Michael Stoiko (04:51:04):
I was.
Speaker 2 (04:51:04):
I'm going to have you stand in the same place and grab that pointer. Dr. McGrath, in this photograph...
Dr. Michael Stoiko (04:51:15):
Dr. Stoiko.
Speaker 2 (04:51:16):
I'm sorry. Dr. Stoiko can you see, Judge?
Judge (04:51:18):
I'm fine. Thank you.
Speaker 2 (04:51:20):
In this photograph labeled 5289, labeled F, what are we viewing here?
Dr. Michael Stoiko (04:51:28):
This was a photograph taken the morning of the 13th, shortly after Paitin arrived in the pediatric ICU. You can tell because the orange tape, this pinkish kind of tape that was used to secure her breathing tube was placed here in the emergency room. We replaced this later in the day with a different kind of tapes. So I know this was that morning when she first arrived. From what you can see, I think very, very clearly, particularly on the inner parts of both of her eyes and her eyelids are all, again, just too many to count purple petechiae or ruptured blood level under the skin, which again represents a tremendously high pressure in the area above her neck due to her struggling and trying to fight to get her airway back open.
Speaker 2 (04:52:27):
5870, labeled G, what are we looking at here?
Dr. Michael Stoiko (04:52:31):
So this again is based on the pink or orange tape is an early picture. This would have been taken a few hours after she arrived in the unit. And what it shows is less impressively, but it shows, again, an area of demarcation where below here, you don't see any petechiae or any abrasions. And above it, you see a lot of abrasions and petechiae, particularly dark ones here, which already looked quite bruised.
Speaker 2 (04:53:02):
And what does that signify to you?
Dr. Michael Stoiko (04:53:04):
To me, that additional bruising right above that line would suggest either that she was trying to grab the ligature around her neck to try to free herself or that the person who was strangling her had a knuckle or a thumb pressed against her neck at that point.
Speaker 2 (04:53:20):
What about the line on her neck?
Dr. Michael Stoiko (04:53:21):
The line on her neck is irregular. It hasn't really developed as fully as it is in the later pictures from the next day, but again, shows that there was some circumferentially around her neck, but that seems to be less prominent in the right back compared to the left back we'll see in the future pictures. So my thought of this is whoever was choking her was holding it from behind her head towards the right side and pulling so that the ligature was causing abrasions and petechiae all the way around the neck, except in that one spot.
Speaker 2 (04:54:02):
2663 labeled Y, what are we looking at here?
Dr. Michael Stoiko (04:54:06):
This is showing the same right side, but also showing how extensive the injuries to the skin were on the front or anterior part of the neck.
Speaker 2 (04:54:19):
3310?
Dr. Michael Stoiko (04:54:21):
Now you're coming around and again, you can see the anterior part of the neck and you can see more discoloration as the bruise is getting older, but that the ligature mark is much clearer rolling around the left side of the neck towards the back.
Speaker 2 (04:54:37):
3463?
Dr. Michael Stoiko (04:54:39):
And this is pretty much a straight on view. This, again, appears to be the second day because the other tape was gone, but you can see a combination here of abrasion plus petechiae around it because when you are being strangled whatever you use as ligature is going to slide to some degree particularly as you fight. So it's going to scrape the skin as well as cause petechiae injury.
Speaker 2 (04:55:09):
3782?
Dr. Michael Stoiko (04:55:11):
So you can see from here, this is her left side of her neck and the ligature was rubbing up against this side of the neck rather hard. So, again, they weren't holding it here, it would have been being held on the back of the neck to the right.
Speaker 2 (04:55:31):
4976?
Dr. Michael Stoiko (04:55:33):
And this is, again, the right side of her face on the second day, again, showing some of that bruising that you could see on the first day in this, again, not quite as strong ligature mark across her neck. But notice... Oops, go back to this one. But notice her face has sort of blossomed where you're seeing a lot more discoloration now of her whole face on the second day, which is what you expect.
Speaker 2 (04:55:58):
5042?
Dr. Michael Stoiko (04:56:13):
And this is overall view of how she looked on the bed that day. It shows all the support equipment in place, including the breathing tube connected to the ventilator, the specialized central venous line that I appraised, monitors, blood pressure, the IV actually [inaudible 04:56:22] here, and what's called an arterial catheter put in on this leg used to monitor her blood pressure and her urine catheter [inaudible 04:56:32] And that's the spot where Dr. McGrath placed the intraosseous line to give her emergency medications.
Speaker 2 (04:56:37):
And to clarify, you did not see any petechiae or petechiae below that demarcation line?
Dr. Michael Stoiko (04:56:44):
Yeah. You can see her skin below her neck looks normal.
Speaker 2 (04:56:55):
5620?
Dr. Michael Stoiko (04:56:57):
This, again, is showing her... Well, this is probably the third day. I don't know off the top of my head looking at it, but you can see in fact some of the petechiae around her eyes may be starting to fade a little bit, but it remained very dense around her chin and inside of her cheeks.
Speaker 2 (04:57:15):
3009?
Dr. Michael Stoiko (04:57:21):
And again, this is the same, this is slightly angled, but shows that she still had extensive petechiae around her eyes, around her mouth, and that the area above the ligature mark was particularly dark by the third day.
Speaker 2 (04:57:40):
3229?
Dr. Michael Stoiko (04:57:41):
And this, again, shows that right side of the neck with that area of bruising here that may have been from a knuckle or maybe a hand grab trying to get her ligature mark.
Speaker 2 (04:57:56):
3641?
Dr. Michael Stoiko (04:57:58):
And back to the left side, again, extensive, again, face really intense under her right ear and behind her right ear and showing, again, the ligature marks are pretty extensive, but starting to break up a little bit [inaudible 04:58:17]
Speaker 2 (04:58:17):
Go back. If you can see on this particular photo, you see the ruler there. It's labeled with a date. Can you see that?
Dr. Michael Stoiko (04:58:24):
Oh yeah.
Speaker 2 (04:58:25):
11/14.
Dr. Michael Stoiko (04:58:26):
That's 14.
Speaker 2 (04:58:26):
So that's day two?
Dr. Michael Stoiko (04:58:27):
Day two.
Speaker 2 (04:58:28):
All right.
Dr. Michael Stoiko (04:58:32):
And that's just, again, a close up of that left side of the ligature which was particularly prominent. So I think that's like the front took a lot of that force, a lot of friction on there and a lot of trauma.
Speaker 2 (04:58:45):
And this is photograph 3677 for the record. 3735, again on the 14th, according to the ruler, what are we looking at?
Dr. Michael Stoiko (04:58:57):
And, again, very extensive broken blood vessels and blood under the skin here, critical all the way across, but again, linear pattern. And once you get below this area where the ligature mark is causing trauma, everything looks clean.
Speaker 2 (04:59:08):
And 4033?
Dr. Michael Stoiko (04:59:17):
This is, I think, the first one you've shown of this group. It shows that the ligature mark continued around the back of her neck a little towards the right side. And then with the view we've seen from over here, it stopped a little short of that and it's here. So there was an area here where you couldn't see clear ligature mark. Again, that's why I believe it was wrapped around her to the right and from behind her.
Speaker 2 (04:59:44):
4233?
Dr. Michael Stoiko (04:59:46):
And that's again showing... This is her left side showing her ligature mark in the around almost the entire back of her neck.
Speaker 2 (04:59:50):
4837?
Dr. Michael Stoiko (04:59:59):
Somewhat redundant, but again, I think it really shows how extensively the broken blood vessels and bruising were on her face and that this is fairly wide. And I think the reason it's fairly wide is because as she was struggling trying to get her airway open, the ligature would be moving and whoever was strangling her would be trying to hold it and adjust it so it would be riding up and down to some degree and make a nice clean line.
Speaker 2 (05:00:30):
6058, what are we looking at here?
Dr. Michael Stoiko (05:00:32):
This is, well, she actually had some petechiae on her tongue too and she had some in her lip and tongue. It's not super well seen here, but it showed that it was her whole head that was involved with this in terms of the increase in pressure during this strangulation.
Speaker 2 (05:00:48):
And then 6161?
Dr. Michael Stoiko (05:00:55):
And I think, again, shows pretty much the same idea that you can see from right here, collar line basically on her skin that showed absolutely no bruising or petechiae on her face. [inaudible 05:01:14].
Speaker 2 (05:01:28):
Thank you, Doctor.
Judge (05:01:28):
Thank you.
Dr. Michael Stoiko (05:01:29):
Yes, sir.
Speaker 2 (05:01:37):
So Dr. Stoiko, you've talked about your treatment of Paitin on the 13th. Can you talk to the jury about then as we move into that 14th timeframe, you said that you wait 24 hours or in the past you've waited 24 hours to See if there's any recovery? As you're moving into the 14th, as the treating physician, what are you thinking and what are you doing?
Dr. Michael Stoiko (05:02:08):
So again, we were focusing on maintaining her other vital organs in a stable condition because we tried to give her brain some chance to recover if it could. She needed to be started on some blood pressure support medications. We made some minor adjustments to her ventilator. We broadened up her antibiotic coverage. We got additional cultures to make sure there was nothing infectious going on and gave her some additional antibiotics because it appeared that she had aspirated when she first came in. She had aspirated mucus and/or stomach contents down into her lungs when she was unconscious. So we broadened up her antibiotic coverage to try to protect her from developing what we call an aspiration pneumonia. Those cultures were all negative, but we continued the antibiotics.
(05:03:04)
Then she overnight developed two issues. She started to deteriorate neurologically where before we had been seeing her doing this decorticate posturing and also her pupils went from being just very sluggishly reactive to light to being fixed and dilated. And that means that the pons area, which is deep in your brain stem, had stopped working and was a warning sign that in fact her brain probably had stopped working. She then developed what's called diabetes insipidus or DI, and that told us that the portion of the brain that helps regulate fluid balance in your body had stopped working. And that's usually a pretty solid indicator that she was brain dead.
Speaker 2 (05:03:50):
And that was on what day?
Dr. Michael Stoiko (05:03:51):
That happened overnight, early in the morning of the 14th. The last thing was she developed episodes, what we call supraventricular tachycardia, irregular heart rhythms because of changes in her vascular system from her brain stopping. And so we had to treat a couple of those episodes at about 4:00 in the morning on the 14th. And by 5:30 or 6:00 in the morning on the 14th, I was certain that she was brain dead. The protocol that we have, which is an extremely conservative protocol, but it's one I wrote actually, is that when we believe a child is brain dead, we try to keep them as stable as possible. We do what's called a brain death protocol, which means we examine her, do a full examination for any evidence of neurologic function. We do some additional tests, among them seeing if she will make any breathing efforts over the ventilator to see if there's any residual breathing left. And Dr. Paulson, my partner, did that test on the morning of the 14th and found no evidence of brainstem function.
(05:05:05)
At that point, we did an additional electroencephalogram. It had previously shown the burst suppression, burst suppression pattern. It now is what we call isoelectric, meaning it was absolutely flat. There was absolutely no brainwave activity. So you do the first exam, you do the EEG, and then you wait 24 hours and see if something could have thrown it off so you weren't accurate or whatever just to be absolutely certain. We waited 24 hours and then Dr. Paulson had our pediatric neurologist, Dr. Taravath come, so it'd be a separate observer and again, complete the series of complete neurologic exam. And he confirmed that in fact her brain had stopped functioning. She was brain dead. And that means you're legally dead when your brain is dead because that means you can't function unless you're on life support and you'll never be awake, you'll never be cognitive, you can't hear, you can't see. So once-
Dr. Michael Stoiko (05:06:00):
... never be awake, you'll never be cognitive. You can't hear, you can't see. So once someone has become brain dead, you're not obligated to keep them on life support or, and you then have the option of them being an organ donor.
The Court (05:06:15):
And that was on the 14th that you declared her brain dead?
Dr. Michael Stoiko (05:06:18):
No, the first exam and the EEG suggested that she was. And then we waited 24 hours. Dr. Taravath did a second exam, and he confirmed that, in fact, she was brain dead.
The Court (05:06:29):
That's on the 15th?
Dr. Michael Stoiko (05:06:30):
On the 15th.
The Court (05:06:31):
All right. And at some point it was declared that she would be an organ donor. Is that correct?
Dr. Michael Stoiko (05:06:38):
I wouldn't say declared. But there was a family conference held and that was discussed as an option that she could potentially be an organ donor. We'd have to evaluate her.
(05:06:50)
The organ donation group will come in and see if any of her organs looked like they were in good enough shape to donate and they were. I wasn't there for that conference, but I was told by my partner that there was some resistance within the family initially, but they talked it through and decided they did want her to be an organ donor.
(05:07:10)
Then Carolina Family Services came in and actually did the organ retrieval.
The Court (05:07:17):
Okay. And do you know what day that was done on?
Dr. Michael Stoiko (05:07:19):
I think it was early in the morning on the 16th.
The Court (05:07:21):
Okay. Outside of... Well, let me ask you, did you find any other causes for the petechiae?
Dr. Michael Stoiko (05:07:37):
No.
The Court (05:07:39):
Are there potentially other causes for petechiae?
Dr. Michael Stoiko (05:07:43):
If you say grossly, what are all things that could cause a petechia or petechiae, there are lots of different things. But to see the petechial pattern that we saw in her where there is a line, and
above that line there petechiae and below that, the only thing that can cause that is some type of strangulation or asphyxiation.
The Court (05:08:14):
Just a minute, Your Honor.
Dr. Michael Stoiko (05:08:15):
Okay.
The Court (05:08:55):
No further questions, Judge.
Judge (05:08:57):
Cross examination?
Luther Britt III (05:08:58):
Yes, sir. Thank you. Dr. Stoiko, in viewing Paitin's neck, was there more than one ligature mark?
Dr. Michael Stoiko (05:09:15):
I don't know that I can say that. I can say that there was a wide area and variable area ligature, so I don't know if it was a single ligature that moved around as she struggled or could it be more than one? I guess, potentially.
Luther Britt III (05:09:28):
When you say there was a wide area, can you give us an approximation?
Dr. Michael Stoiko (05:09:33):
I would say it was... I didn't measure it directly, but less than a centimeter, but say five or six millimeters in a couple areas, narrower in others. But a small, a wire could do it. A cord could do it. It depends on how much it moved while she was struggling and there was pressure against her neck.
Luther Britt III (05:09:58):
And given the amount of petechiae, did you form an opinion as to whether or not it was just a single strand wrapped around her throat or was it a multiple strain?
Dr. Michael Stoiko (05:10:11):
I did not form an opinion about that.
Luther Britt III (05:10:18):
Were you ever interviewed by the sheriff's department?
Dr. Michael Stoiko (05:10:21):
Yes.
Luther Britt III (05:10:22):
Were you asked to describe what would've made such a ligature mark?
Dr. Michael Stoiko (05:10:32):
I was not asked specifically what type of ligature I thought it might be. So I, and again, I had very little information when she first arrived at the unit. And then after that, I was not given any detail about what was or wasn't at the crime scene.
Luther Britt III (05:10:47):
And was one suggested?
Dr. Michael Stoiko (05:10:52):
No.
Luther Britt III (05:11:03):
With regard to what you referred to as abrasion, it appeared that the ligature mark was going up and down, rubbing against the skin?
Dr. Michael Stoiko (05:11:11):
Well, back and forth, yes.
Luther Britt III (05:11:12):
Back and forth. Would that have been the result of inconsistent pressure or her ability just to get her fingers underneath it and loosen it somewhat?
Dr. Michael Stoiko (05:11:27):
Probably both in that, again, it's almost a reflexive thing to protect your airway. You don't have to think about it. If someone comes up from behind you and grabs your neck, you will respond to it.
(05:11:40)
So a five-year-old would put up a pretty strong fight to try to open her airway back up. So she would have been moving, so whatever the ligature was could slide.
(05:11:50)
And again, either she was grabbing at it or whoever was holding her had a knuckle or a thumb against her neck at that one point. So, if I've answered your question, it's probably a little bit of both.
Luther Britt III (05:12:00):
Okay. Other than the rash and DTI and the demarcation line, were there any other injuries that you noticed about her neck?
Dr. Michael Stoiko (05:12:13):
We did a CAT scan specifically of her neck that morning at about, I think, 11:00 that morning, maybe a little earlier. I took her down myself, and we were looking for evidence of fractures or foreign object, anything else that would be abnormal, and there was no evidence of any broken neck.
Luther Britt III (05:12:34):
Okay. And when you say fracture, you're specifically talking about neck portion?
Dr. Michael Stoiko (05:12:39):
Yes. From the base of the brain to the top of her chest.
Luther Britt III (05:12:45):
For example, was the thyroid examined?
Dr. Michael Stoiko (05:12:51):
You can't normally feel a thyroid unless it's enlarged, but certainly she did not have evidence of a goiter or an enlarged thyroid.
Luther Britt III (05:13:00):
Okay. How about the heinos bone?
Dr. Michael Stoiko (05:13:05):
Hyoid.
Luther Britt III (05:13:06):
Hyoid, excuse me.
Dr. Michael Stoiko (05:13:07):
Yeah. And that, unfortunately, in a five-year-old is very minimally ossified, so it's very hard to see, so I did not personally see it.
Luther Britt III (05:13:16):
Where is that located in the neck?
Dr. Michael Stoiko (05:13:18):
It's basically on the top of the larynx.
Luther Britt III (05:13:28):
Did you notice anything that resembled fingernail marks?
Dr. Michael Stoiko (05:13:32):
The only one that is the one that I commented on, on the right side of her neck looked like it could be-
Luther Britt III (05:13:37):
A thumb or a-
Dr. Michael Stoiko (05:13:39):
... a thumb or a fingernail mark, but it's a fairly deep, fairly non-specific bruise.
Luther Britt III (05:14:04):
And so from the first exam to the second exam, the 24 hours later, her condition worsened?
Dr. Michael Stoiko (05:14:13):
Are you referring to the 13th and 14th?
Luther Britt III (05:14:14):
Yes.
Dr. Michael Stoiko (05:14:16):
Yes. From the-
Luther Britt III (05:14:17):
[inaudible 05:14:17] protocol.
Dr. Michael Stoiko (05:14:18):
Oh, the brain death protocols. The first one was done by Dr. Paulson on the 14th, morning of the 14th and documented, I believe, about 9:00 AM. And then the second was done by Dr. Taravath about 9:00 AM on the next day. And there was no difference. They both were consistent with brain death.
Luther Britt III (05:14:39):
Okay. And so at that point, the only thing that was keeping her alive was the ventilator?
Dr. Michael Stoiko (05:14:42):
Correct.
Luther Britt III (05:14:44):
And the decision was made to terminate the use of the ventilator?
Dr. Michael Stoiko (05:14:49):
Yes. The discussion with the family was that, in fact, she had legally died. So the only options at that point were to discontinue the life support or consider her being an organ donor. And the family generously decided to allow her to be an organ donor.
Luther Britt III (05:15:06):
Now the organ donation, is that done by personnel in the hospital?
Dr. Michael Stoiko (05:15:10):
No.
Luther Britt III (05:15:11):
Who does that?
Dr. Michael Stoiko (05:15:12):
Depends on what hospital is going to accept the organs. What they'll do is they will send in a team. They'll literally fly them into our hospital. They'll take the child down to the operating room. They will go ahead and take the organs that are viable or could benefit another patient, and then the ventilator is turned off afterwards.
Luther Britt III (05:15:36):
Were you aware at the time that she had developed some pneumonia?
Dr. Michael Stoiko (05:15:46):
Yes. Her chest X-rays and her chest CT were both consistent with a, what we call an aspiration pneumonia, meaning that if you're laying on your back and you're unconscious and you're not protecting your airway, anything in your mouth, mucus, saliva, whatever, or if you vomit, food will go down into your airway.
(05:16:08)
And in this case, it was in the dependent part of her airway, which is consistent with what we call an aspiration pneumonia. And that's why we changed her antibiotics up to better cover her mouth germs.
Luther Britt III (05:16:19):
So would that aspiration pneumonia, would that have further restricted her airway?
Dr. Michael Stoiko (05:16:28):
It would increase her work of breathing so that she would have to breathe harder and it could potentially have lowered her oxygen levels.
Luther Britt III (05:16:37):
All right. Thank you. I don't have any other questions.
Judge (05:16:39):
Redirect?
The Court (05:16:40):
Just quick, Judge. Did she develop aspirated pneumonia at the hospital?
Dr. Michael Stoiko (05:16:46):
No.
The Court (05:16:47):
Okay.
Dr. Michael Stoiko (05:16:49):
Her first chest X-ray showed evidence of it.
The Court (05:16:52):
Okay. Could she have aspirated from the strangulation?
Dr. Michael Stoiko (05:17:02):
Or during or afterward, yes.
The Court (05:17:04):
Okay. No further questions, Judge.
Judge (05:17:11):
Recross?
Luther Britt III (05:17:12):
No, sir.
Judge (05:17:13):
Is this witness subject to recall?
The Court (05:17:15):
No, Your Honor. And I would ask that he be released from his subpoena.
Luther Britt III (05:17:20):
No, sir.
Judge (05:17:21):
All right, sir. At this time, you're released from your obligations of your subpoena. You may step down. You free to go.
Dr. Michael Stoiko (05:17:27):
Thank you, Your Honor.
Judge (05:17:45):
Thank you. The State may call your next witness.
Ms. Smircic (05:17:47):
The state calls Jessica McAlear to the stand.
Dr. Michael Stoiko (05:17:55):
May I approach, Your Honor?
Judge (05:17:55):
You may.
Speaker 13 (05:17:55):
Ma'am, this way.
Judge (05:18:11):
Ma'am, before having a seat, if you can place your left hand on the Bible, raise your right hand.
Ms. Smircic (05:18:14):
Do you solemnly swear that the testimony you give in court today will be the truth, the whole truth, nothing but the truth, so help you God?
Luther Britt III (05:18:19):
I do.
Ms. Smircic (05:18:19):
Thank you. You may be seated.
Speaker 13 (05:18:19):
Can you move forward, I'll move this chair for you?
Jessica McAlear (05:18:19):
Thank you.
Speaker 13 (05:18:20):
Thank you.
Judge (05:18:27):
Ma'am, as you testify here today, please make sure to speak loudly and clearly into that microphone.
Jessica McAlear (05:18:32):
Okay.
Judge (05:18:32):
Please make sure all of your answers are out loud. No head shakes or nods or mm-hmms. Everything has to be a yes or a no.
Jessica McAlear (05:18:39):
Okay.
Judge (05:18:40):
Please wait for the attorney to be done asking their question before you give a response.
Jessica McAlear (05:18:45):
Okay.
Judge (05:18:45):
Can you do that?
Jessica McAlear (05:18:45):
Yes.
Judge (05:18:45):
All right. Thank you. State, you may proceed.
Ms. Smircic (05:18:47):
Thank you, Judge. Could you spell your name and state it for Madam Court Reporter?
Jessica McAlear (05:18:51):
Sure. Jessica McAlear, J-E-S-S-I-C-A M-C-A-L-E-A-R.
Ms. Smircic (05:19:00):
Ms. McAlear, where do you work?
Jessica McAlear (05:19:02):
Novant New Hanover Regional Medical Center.
Ms. Smircic (05:19:05):
And what do you do there?
Jessica McAlear (05:19:07):
Current time, I'm a registered nurse, but I'm a clinical nurse educator for the emergency services line.
Ms. Smircic (05:19:13):
How long have you worked at the hospital in Wilmington?
Jessica McAlear (05:19:17):
20 years. Since 2006.
Ms. Smircic (05:19:21):
Over those 20 years, what are the various roles you've had at the hospital as a nurse?
Jessica McAlear (05:19:27):
The majority of the time has been in the emergency department. I've been a staff nurse in the emergency department, a charge nurse, and a clinical educator, also a sexual assault nurse examiner.
Ms. Smircic (05:19:41):
And over these 20 years, have you treated a lot of patients at the emergency department for New Hanover Regional Medical Center?
Jessica McAlear (05:19:48):
Yes.
Ms. Smircic (05:19:51):
Can you tell the jury a little bit about your training and experience?
Jessica McAlear (05:19:55):
Sure. I received my bachelor's degree from Wake Forest University in 1998, my nursing degree in 2001, associate degree in 2001, a BSN or a Bachelor's of Science in Nursing in 2024.
(05:20:14)
I went to adult adolescent sexual assault nurse examiner training in 2008, and the pediatric sexual assault training in 2012.
Ms. Smircic (05:20:31):
So you've had some training specific to the examination of victims of sexual assault, is that correct?
Jessica McAlear (05:20:38):
Yes.
Ms. Smircic (05:20:40):
Can you talk a little bit about that training and what you do as part of that training?
Jessica McAlear (05:20:46):
Sure. So for the adult adolescent training, that was in 2008, I went to a classroom training for a few days and then did exams of normal females to see what normal anatomy looked like and then did exams, proctored exams with someone else for sexual assault victims.
(05:21:07)
And then once that training was complete, then I started taking care of the sexual assault victims independently. The pediatric training was very similar, a little bit more intense.
(05:21:17)
We had to see more regular genital exams in children, and then did some proctored assault exams and some classroom training.
Ms. Smircic (05:21:28):
Ms. McAlear, since you've been certified as a sexual assault nurse examiner, is that called SANE for short?
Jessica McAlear (05:21:38):
Yes.
Ms. Smircic (05:21:39):
So since you've been a SANE nurse, about how many patients have you treated that presented for sexual assault?
Jessica McAlear (05:21:48):
Certainly in the hundreds. I would say probably between 300 and 500 over the years.
Ms. Smircic (05:21:57):
And about how many were children?
Jessica McAlear (05:22:02):
Best guess would be about 100, 50 to 100.
Ms. Smircic (05:22:12):
May I approach?
Judge (05:22:12):
You may.
Ms. Smircic (05:22:38):
Ms. McAlear, I'm showing you what I've marked as State's Exhibit 10. Do you recognize this document?
Jessica McAlear (05:22:43):
Yes.
Ms. Smircic (05:22:43):
What is it?
Jessica McAlear (05:22:44):
That is my resume or my CV.
Ms. Smircic (05:22:47):
And this lists all your training and qualifications as a nurse and a sexual assault nurse examiner?
Jessica McAlear (05:22:54):
Yes.
Ms. Smircic (05:22:56):
Any changes, modifications, deletions of any kind?
Jessica McAlear (05:23:00):
Nope.
Ms. Smircic (05:23:00):
Everything is accurate?
Jessica McAlear (05:23:01):
It is.
Ms. Smircic (05:23:02):
Judge, the state would move to enter State's Exhibit 10 into evidence.
Judge (05:23:05):
Any objection?
The Court (05:23:06):
No, Sir.
Judge (05:23:07):
State's Exhibit 10 will be admitted into evidence.
Ms. Smircic (05:23:12):
And Judge, at this time, I would tender Ms. McAlear as an expert in sexual assault nurse examination and emergency nursing.
Judge (05:23:26):
Any objection?
The Court (05:23:28):
No, sir.
Judge (05:23:28):
The witness will be tendered as an expert in the field of sexual assault, nurse examination and emergency nursing.
Ms. Smircic (05:23:35):
Thank you, Judge. Ms. McAlear, I want to take you to the morning hours of November 13th, 2017. Did you provide treatment to Paitin Fields?
Jessica McAlear (05:23:49):
Yes, I did.
Ms. Smircic (05:23:50):
Did you recall when she arrived at the hospital around what time?
Jessica McAlear (05:23:55):
I was contacted, I was working in the emergency department at that time. I was contacted somewhere around 7:30.
Ms. Smircic (05:24:03):
In the morning?
Jessica McAlear (05:24:03):
AM, yes.
Ms. Smircic (05:24:06):
Had you ever met Paitin Fields prior to examining her?
Jessica McAlear (05:24:10):
No, I had not.
Ms. Smircic (05:24:15):
And once you were called to examine her, what did you do?
Jessica McAlear (05:24:22):
I responded to the pediatric intensive care unit where she was, conducted a head to toe assessment looking for injury, and proceeded to do some photo documentation of the injury and evidence collection.
Ms. Smircic (05:24:39):
And I'll talk about what you did in a minute, but did you have the opportunity to examine and observe Paitin Fields multiple times throughout the period of time she was in the hospital?
Jessica McAlear (05:24:54):
Yes, I did.
Ms. Smircic (05:24:57):
And about how long was she in the hospital until she was taken off life support?
Jessica McAlear (05:25:03):
She presented on the morning of the 13th and she was declared brain dead on the 15th. And I believe taken off cardiac life support for the organ donation after that.
Ms. Smircic (05:25:20):
And throughout Paitin's stay in the hospital, you said you treated her multiple times or observed her, did anyone assist you?
Jessica McAlear (05:25:30):
Yes, I did contact a colleague of mine, Colleen Mistovich, to assist me with photo documentation to take more photos and help with positioning and injury identification.
Ms. Smircic (05:25:42):
Is it common for two SANE nurses to examine someone for sexual assault or was this unusual?
Jessica McAlear (05:25:51):
This was unusual because of the extent of her injuries and the fact that she had a breathing tube, so that's why I asked for assistance.
Ms. Smircic (05:26:01):
And Ms. Mistovich was also a SANE nurse as well?
Jessica McAlear (05:26:06):
Yes.
Ms. Smircic (05:26:09):
I want to go back to your initial exam of Paitin. Can you walk the jury through the procedure for a sexual assault examination and collection of evidence?
Jessica McAlear (05:26:22):
Certainly. The first thing that our protocol states or what we do is we look at the body or the patient from head to toe, looking for injury and document that injury in our computer documentation, but also by taking photos and proceed with evidence collection according to the sexual assault kit provided by our state.
Ms. Smircic (05:26:45):
And as part of the sexual assault examination, specifically with a patient like Paitin, what is the process like given her condition?
Jessica McAlear (05:27:00):
The process is the same, whether the patient is intubated, meaning having the breathing tube and very ill, or awake and alert. I mean, we're still looking at the body from head to toe.
(05:27:13)
With pediatric patients, it's a little bit different. We don't use a speculum. That's something that we insert for adult and adolescents into the vagina to look at the vaginal walls and at the cervix. And in pediatric patients, we don't do that.
(05:27:28)
And there are certain other things with evidence collection. With a prepubertal patient, which means someone who has not started puberty, meaning a child, we don't swab generally the vaginal walls and into the cervix because we don't want to go through the hymen, which is too painful.
Ms. Smircic (05:27:55):
What do you generally collect as part of your evidence collection?
Jessica McAlear (05:28:01):
It depends on the circumstances, but sometimes we collect oral specimens from the mouth. We collect buccal specimens on every case. A buccal specimen is inside the cheek, that's looking for the patient's DNA. We collect swabs in the genital area, vaginal swabs and rectal swabs.
(05:28:24)
In adult and adolescents, we do what I would call a pubic hair combing. We comb the pubic area looking for hair. In this case, because Paitin was five, there was no pubic hair, so I omitted that step. And sometimes we'll do pubic hair collection for adult adolescent victims.
Ms. Smircic (05:28:48):
And when you collect this evidence, what do you do with it?
Jessica McAlear (05:28:51):
It goes into an evidence collection box that is sealed and sent with law enforcement.
Ms. Smircic (05:29:01):
And Ms. McAlear, let's first talk about your physical examination of Paitin. Is that what you do first before you look at her genital area?
Jessica McAlear (05:29:12):
Yes.
Ms. Smircic (05:29:25):
When you examine and conduct one of your sexual assault examinations, do you document everything into a report?
Jessica McAlear (05:29:32):
Yes, I do.
Ms. Smircic (05:29:32):
Do you also note any injuries on diagrams?
Jessica McAlear (05:29:37):
Yes, I do.
Ms. Smircic (05:29:37):
May I approach?
Judge (05:29:37):
You may.
Ms. Smircic (05:29:37):
Ms. McAlear, I'm showing you what I've marked as State's Exhibit 11. I'll turn to the first page of these records. Is this your sexual assault nurse examiner report?
Jessica McAlear (05:30:57):
Yes, it is.
Ms. Smircic (05:30:58):
And Judge, the state at this time would move to admit State's Exhibit 11 through affidavit.
Judge (05:31:04):
Any objection?
The Court (05:31:05):
No, sir.
Judge (05:31:05):
State's Exhibit 11 will be admitted into evidence.
Ms. Smircic (05:31:09):
And if I may publish portions of State's 11, Judge.
Judge (05:31:12):
You may. And will that be allowed to be broadcast?
Ms. Smircic (05:31:20):
Wait a second, Judge. Yes, Judge.
Judge (05:31:26):
Okay. Thank you.
Ms. Smircic (05:31:27):
And if I may use that [foreign language 05:31:29]?
Judge (05:31:29):
You may.
Ms. Smircic (05:31:34):
Ms. McAlear, I want to first talk about, do you do a general examination of any physical injuries on her body?
Jessica McAlear (05:31:47):
Yes.
Ms. Smircic (05:31:49):
And I'm going to publish page four of these medical records. Is this the diagram you used to document any injuries you found on Paitin?
Jessica McAlear (05:32:00):
Yes.
Ms. Smircic (05:32:01):
And what did you find when you examined her body?
Jessica McAlear (05:32:05):
On the left flank area, she had a quarter sized area of brown discoloration.
Ms. Smircic (05:32:13):
Anything to note of that or you just documented it?
Jessica McAlear (05:32:16):
It was just something to note, but nothing, no, nothing further.
Ms. Smircic (05:32:23):
Publishing State's 11, page five, or excuse me, page six. Did you have, did you also conduct an examination of Paitin Field's hands?
Jessica McAlear (05:32:41):
Yes, I did.
Ms. Smircic (05:32:42):
And what did you find on her hands?
Jessica McAlear (05:32:46):
On her right hand, she had some fluid filled vesicles. What a vesicle is some kind of a structure that has some kind of clear fluid in it, almost like a blister, and she had five of those on the center of her hand.
Ms. Smircic (05:32:59):
Okay. And you documented that on this diagram?
Jessica McAlear (05:33:02):
Correct.
Ms. Smircic (05:33:09):
Looking at Paitin Field's head, what did you document that you noticed on her head or any injuries to her head?
Jessica McAlear (05:33:19):
She had petechiae all over her head and face, and then the ligature mark that Dr. Stoiko discussed to her neck and lower, I noted also the lower eyelids had petechiae. Basically, from the ligature mark up, she had petechiae.
Ms. Smircic (05:33:44):
Did you notice anything else in your physical examination before you examined her genital area?
Jessica McAlear (05:33:51):
I don't... No, I don't believe so.
Ms. Smircic (05:33:57):
And Ms. McAlear, I'm publishing page five of State's Exhibit 11. What is this a diagram of?
Jessica McAlear (05:34:08):
That's a diagram of a prepubertal child, female child, genital area.
Ms. Smircic (05:34:17):
And when you examined Paitin's genital area, did you notice several injuries?
Jessica McAlear (05:34:26):
I did.
Ms. Smircic (05:34:27):
Can you describe those for the jury in general?
Jessica McAlear (05:34:34):
Yes. She had several injuries to various locations, to the genital area. She had generalized redness to that area and several areas, what we call submucosal hemorrhaging. She had a bruise to her left labia majora, an abrasion.
(05:34:58)
We treat the genital area like a clock, and so some of my notes, and I do believe, hopefully I'll be able to explain that a little further to you, but the general area like a clock, and so you'll see on my notes, there were certain injuries at certain parts of the clock.
(05:35:12)
So for example, number two, I wrote a submucosal hemorrhage to three o'clock, so that is at the three o'clock mark. If you think of the opening, if you think of that area as a clock, it would be to the right on the three o'clock.
(05:35:28)
She had a laceration to her clitoral hood, another submucosal hemorrhage to 10 to 11 o'clock, the bruise, as I previously mentioned, to the left labia majora, which are the outer lips, so to speak, an abrasion to five o'clock in the vestibule.
(05:35:46)
And that is, the vestibule is the area from the top where the clitoral hood is and all the way down to the bottom where the posterior commissure is, and several lacerations to her anal opening.
Ms. Smircic (05:36:03):
And Judge, may I ask Ms. McAlear to step down?
Judge (05:36:05):
You may. Ma'am, at this time you may step down. Please watch your step as you come down.
Ms. Smircic (05:36:08):
Thank you. Ms. McAlear, if you'll stand over here so everyone can see you and hear you, and I'll give you this pointer that can be used.
(05:36:24)
Ms. McAlear, I want to talk about what you've noted on this diagram a little more in depth as number one. Would this be one of the injuries you observed on Paitin Fields?
Jessica McAlear (05:36:36):
Yes. So number one just talks about generalized redness to the vestibule to the periurethral bands. So may I give a little anatomy lesson here?
Ms. Smircic (05:36:45):
Yes, please do.
Jessica McAlear (05:36:48):
So with female children, our anatomy, the female child's anatomy looks a little bit different. So I'm going to describe it to you first. These are the labia majora, the outer lips.
(05:37:04)
Now on a female child, there are labia minora, which are the inner lips, and they don't extend all the way down like adults do. So they extend a little bit, maybe a third of the way down, depending on the age of the child.
(05:37:20)
At the top here, you have what we call the clitoral hood where the clitoris is housed. From this area where the clitoris is around the labia minora and down to where the labia majora, the big lips meet, that's called the posterior commissure.
(05:37:38)
That area inside here is called the vestibule. Okay? So the reason I'm describing that is I described, I documented redness to the vestibule. So that entire area was red.
(05:37:49)
And the periurethral bands are just bands that support the structure there, so those were red.
Ms. Smircic (05:37:58):
And taking with the other injuries, is that redness normal to see in a five-year-old child?
Jessica McAlear (05:38:03):
It's not normal, but it's kind of a non-specific finding. It's not indicative of anything.
Ms. Smircic (05:38:10):
Let's look at what you have on the marked as two. Can you explain that to the jury?
Jessica McAlear (05:38:19):
Sure. So, I've described what we call a submucosal hemorrhage to three o'clock. So remember the vestibule is this area. So three o'clock is over here, because this is our clock. So 12 o'clock, six o'clock, three o'clock, nine o'clock. Hopefully that makes sense.
(05:38:36)
So over here in the vestibule, this area at three o'clock, there was a submucosal hemorrhage. What a submucosal hemorrhage is is basically bleeding underneath the mucosal level, layer of the skin. Bruising almost, but bleeding underneath that layer.
Ms. Smircic (05:38:54):
A submucosal hemorrhage is bleeding under the layer of the skin in that area?
Jessica McAlear (05:39:00):
Correct.
Ms. Smircic (05:39:01):
Okay. Let's talk about what you've marked as injury number three on your diagram. Can you explain where and what that is to the jury?
Jessica McAlear (05:39:10):
So the clitoral hood is up here. There was a laceration to that area.
Ms. Smircic (05:39:17):
What do you mean by laceration?
Jessica McAlear (05:39:20):
A break in the skin. If you cut your arm or cut your hand, or breaking the skin.
Ms. Smircic (05:39:29):
All right. Let's talk about what you've marked as injury number four. Can you show where that is and what that is to the jury?
Jessica McAlear (05:39:37):
So that was another submucosal hemorrhage, so more bleeding under that mucosal level or that layer of skin. And that was over here at 10 to 11 o'clock in the vestibule, the same structure.
Ms. Smircic (05:39:51):
And what about what you've marked as number five? Can you explain that?
Jessica McAlear (05:39:56):
That was a bruise to the left labia majora. So the labia majora are the outer lips, so that would be here.
Jessica McAlear (05:40:00):
... are the outer lips. So that would be here. So it was out here.
Ms. Smircic (05:40:08):
And when you mean bruise, is that what everyone thinks of as a bruise?
Jessica McAlear (05:40:14):
Absolutely. Yep. Just something has hit the skin and caused some bleeding there.
Ms. Smircic (05:40:17):
Is a bruise less significant, more significant than a submucosal hemorrhage? Would be more force, less force?
Jessica McAlear (05:40:35):
I think that's hard to... I don't have an answer for that. Yeah. I think that's hard to determine.
Ms. Smircic (05:40:40):
And let's talk about what you've noted as number six.
Jessica McAlear (05:40:46):
So that is an abrasion. Again, this is the vestibule, this area, an abrasion to five o'clock, so kind of at the bottom. An abrasion is where the top layer of skin is rubbed away by friction. Like if you skin your knee that's an abrasion.
Ms. Smircic (05:41:05):
And number seven, can you explain that?
Jessica McAlear (05:41:10):
Several lacerations to the anal opening. We talk a lot about the rectum, the anus is the opening to the rectum. So there were several lacerations there.
Ms. Smircic (05:41:19):
And can you explain to the jury on this diagram about where her urethra would've been and her vagina opening?
Jessica McAlear (05:41:27):
So again, this is the vestibule. This is the top here where the clitoris is, the urinary meatus, where the urine comes out is underneath there. And the vagina, there's a structure called a hymen with prepubertal children that is very prominent. Generally you can see that pretty easily. And then behind the hymen is the vaginal opening. So it would be in here.
Ms. Smircic (05:41:56):
Thank you.
Jessica McAlear (05:41:59):
You're welcome.
Ms. Smircic (05:41:59):
You can retake the stand.
Jessica McAlear (05:42:09):
Thank you.
Ms. Smircic (05:42:18):
Ms. McAlear, as well as documenting everything in your medical records, did you also photograph the injuries you observed to Paitin?
Jessica McAlear (05:42:35):
Yes, I did.
Ms. Smircic (05:42:40):
And were these taken throughout Paitin's hospital stay?
Jessica McAlear (05:42:44):
Yes. The majority of them were taken the first day on the 13th when I arrived and within that first few hour period. But I did come back and take subsequent photos, yes.
Ms. Smircic (05:43:14):
May I approach?
The Court (05:43:15):
You may.
Ms. Smircic (05:43:16):
Ms. McAlear, I'm going to show you what I've marked as State's Exhibit 12. Did you have a chance to review or review your photographs prior to testifying here today?
Jessica McAlear (05:43:36):
Yes, I did.
Ms. Smircic (05:43:37):
May I re-approach?
The Court (05:43:49):
You may.
Ms. Smircic (05:43:49):
For the record, I'm going to show State's 12 to Ms. McAlear on my laptop. And Ms. McAlear, I'm going to show you the thumbnails of these photos on this disc. Do you recognize these photos as the ones you photographed for your report and the injuries you observed on Paitin Fields in the hospital?
Jessica McAlear (05:44:56):
Yes.
Ms. Smircic (05:44:59):
Again, are these a fair and accurate representation of the injuries you observed on Paitin?
Jessica McAlear (05:45:06):
Just waiting for it to load. Yes, they are.
Ms. Smircic (05:45:10):
And would they help illustrate your testimony here today?
Jessica McAlear (05:45:12):
Yes, they would.
Ms. Smircic (05:45:14):
Judge, I would move to admit State's 12 for illustrative purposes.
The Court (05:45:18):
Any objection?
The Defense (05:45:18):
No, sir.
The Court (05:45:19):
State's Exhibit 12 will be admitted into evidence.
Ms. Smircic (05:45:23):
And if I may publish photos from State's 12 and ask that they be excluded from the broadcast.
The Court (05:45:31):
You may publish State's Exhibit 12 and they will be excluded from the broadcast.
Ms. Smircic (05:45:34):
And Judge, may I ask Ms. McAlear to step back down so she can point to the photographs?
The Court (05:46:05):
All right, ma'am, you may step down. Please watch your step as you go down.
Ms. Smircic (05:46:16):
And Judge, I'll be publishing the first photograph is labeled B as in boy. Ms. McAlear, can you describe to the jury what is in this photograph?
Jessica McAlear (05:46:29):
So this is the first picture I took of her, of Paitin's genitalia. You can start to see a little bit of a redness here. And I will say that this is a very small area, okay. And because this was so many years ago, the technology has changed. So it's a very small area to photograph with various lighting challenges. When the patient's critically ill and we can't move them and position them very well. But yes, this is her genital area.
Ms. Smircic (05:47:06):
Now publishing State's I or State's 12 photograph marked I. Can you explain to the jury what is in this photograph?
Jessica McAlear (05:47:15):
Sure. So going back to the anatomy, okay? Remember we have the clitoral hood and clitoris on top. This here are the labia minora and the labia, the smaller labia aren't quite formed yet that haven't come down. I'm holding traction here, moving the labia majora out of the way. So this is the clitoral hood and there's an area, again, very difficult to see, right here where there's a laceration. You see kind of a deeper area of redness there.
Ms. Smircic (05:47:53):
And I'm going to publish at this time photograph marked Q. What is in this photograph?
Jessica McAlear (05:48:03):
So this is looking from a different angle, same structures. Some of these pictures I will note, some of these pictures, she has a catheter, a urinary catheter in and the earlier photos she doesn't because I got there before they put the urinary catheter in. So, but that is a urinary catheter that's going into the urinary meatus. So again, same structure. So this is the labia minora here, this is the laceration to the clitoral hood. And then you're starting to see here this three o'clock submucosal hemorrhage that we'll see in another photograph right here. There is some pulling of the skin up a little bit here, which is why the catheter seems to be lower. It's the way in which we were pulling the skin to expose the injuries.
Ms. Smircic (05:49:03):
And that submucosal hemorrhage, does the coloring appear different? Is that how you identify it?
Jessica McAlear (05:49:10):
Yes. If you can see it here, it's a darker, darker red.
Ms. Smircic (05:49:18):
Now publishing photograph U. Can you talk about the injuries observed in this photograph?
Jessica McAlear (05:49:29):
Yes. So again, labia minora here, clitoral hood here, you can see that laceration there. This is the area around 10 and 11 o'clock where there was another submucosal hemorrhage. By this photo, it looks like there's two, but pictures are a challenge sometimes. But the 10 and 11 o'clock and then again the three o'clock submucosal hemorrhage there.
Ms. Smircic (05:49:57):
Now publishing the photograph marked W. Can you talk about the injury in that photograph depicted?
Jessica McAlear (05:50:07):
So this is a more broad picture, so a little bit better view of overall. So here again, the labia minora, the clitoral hood, there's that submucosal hemorrhage at 10 to 11 o'clock here. And then this picture actually shows the redness pretty well. It is a vascular area. It is in children a little bit more red before the estrogen comes in and makes the skin and makes these areas more pale, but she certainly had extra redness.
Ms. Smircic (05:50:38):
And obviously the catheter is in this photo going into the urethra as well?
Jessica McAlear (05:50:42):
Yes. So the catheter's going into the urethra. This is actually her hymen and the opening to the vagina here.
Ms. Smircic (05:50:50):
And I'm going to zoom in on this photograph just a little bit. Can you once again point out the injuries in this photo?
Jessica McAlear (05:50:58):
So this is that submucosal hemorrhage at 10 to 11 o'clock and the overall redness you can see it here and all around the vestibule. So the vestibule, remember I talked about, starts here. So this is the clitoral hood, labia minora. So this entire part is the vestibule all the way around to the bottom here.
Ms. Smircic (05:51:25):
Now publishing the photograph labeled MMM. Can you talk to the jury about what's depicted in this photograph?
Jessica McAlear (05:51:34):
So again, I think probably you know what you're seeing with the labia minora here. Again, this extreme redness, you see a little bit of that submucosal hemorrhage and you're starting to see, I believe here there's our three o'clock submucosal, but starting to see the abrasion that is at five o'clock.
Ms. Smircic (05:52:00):
I'm now publishing the photo labeled P as in Paul. Can you describe the injuries depicted in this photograph?
Jessica McAlear (05:52:08):
That's the three o'clock submucosal hemorrhage.
Ms. Smircic (05:52:16):
Now publish what's been marked as photograph T. Can you describe that photograph to the jury?
Jessica McAlear (05:52:24):
So here we've lifted the catheter up. Okay, so it's a little bit out of the way. So you can see how the structure kind of moved upwards. That's why this looks a little bit different, but we have the three o'clock submucosal hemorrhage and then I believe this shows a little bit of that five o'clock abrasion here.
Ms. Smircic (05:52:44):
And I'll zoom in a little bit for you.
Jessica McAlear (05:52:47):
Yeah. It's hard. These pictures are hard. It's hard to tell, but five o'clock. So again, 12, three, nine, six. So five o'clock, that area of abrasion there.
Ms. Smircic (05:53:05):
I'm publishing photo L. What is that a photograph of?
Jessica McAlear (05:53:10):
So up here is the vestibule, okay. So this is the anal opening here. There is a break in the skin here, which is a laceration. And the way we do with the anal opening as well is we use a clock. Okay? So we characterize things on a clock. So this would be 12 o'clock, this would be about one o'clock. This was the initial photo I took just revealing that one there.
Ms. Smircic (05:53:42):
And again, what is a laceration in your terms?
Jessica McAlear (05:53:46):
A break in the skin.
Ms. Smircic (05:53:51):
Publishing photo M, can you describe the injuries in this photograph?
Jessica McAlear (05:53:56):
So you can see that same break in the skin or laceration here. It's harder on the screen to see this, but I had some suspicion by looking at this photograph once I started pulling some traction and looking that there were other breaks in the skin or other lacerations here.
Ms. Smircic (05:54:19):
So that's when you were looking at her anus?
Jessica McAlear (05:54:22):
Correct. Yes, that is the anus.
Ms. Smircic (05:54:26):
And publishing photo N.
Jessica McAlear (05:54:30):
And this is actually a better photograph of it. I don't know how well you guys can see it, but here you can see that the texture changes. And the texture of the anal opening, you know, there's something called rugae here. And it's not a smooth surface by any means, but it appeared that there were some other breaks in the skin in this region here.
Ms. Smircic (05:54:56):
And what do you do to further determine if there are breaks in the skin that you're seeing?
Jessica McAlear (05:55:05):
There's a tool called toluidine blue dye, and it's a chemical that we can apply to these areas that if the... So there's the top two layers of the skin. The first one's called the epidermis, second is called the dermis. So the epidermis is made of epithelial cells that don't suck up the dye, so to speak. But the durable layer, so if the epidermis is removed, the top layer of the skin is removed exposing the second layer. The second layer uptakes the dye or sucks in the dye into the area. So I was concerned that there might have been more injury here, so I applied toluidine blue dye to this area.
Ms. Smircic (05:55:51):
I'm going to publish what's marked as photo X. Is that toluidine dye that you're speaking of?
Jessica McAlear (05:56:02):
Yes, yes.
Ms. Smircic (05:56:03):
And what does that picture show you?
Jessica McAlear (05:56:05):
So the way that the application of toluidine blue is that we put it on the skin, then we take acetic acid vinegar or petroleum jelly or something and wipe across it so that anything that's on the surface goes away and anything that is soaked in to that dermal layer remains. So what this showed me is that this was the initial laceration that I saw, but then there were several others that were not visible to the naked eye, and that's why we use this tool.
Ms. Smircic (05:56:41):
And so does the dye... Anywhere there is dye, is that injury?
Jessica McAlear (05:56:47):
That is where the top layer of skin is gone, so yes.
Ms. Smircic (05:56:55):
And finally, I'll publish what's been marked as R. What is that a photograph of?
Jessica McAlear (05:57:02):
So this is just her external genitalia. Okay, we've got this labia majora here, clitoral hood here. Very difficult to tell in this photograph. This, I believe, this brown is extra Betadine. We use Betadine, it's a dye and a cleaner when we put Foley catheters or urinary catheters in. But down here, I'm not sure how visible this is, is a bruise.
Ms. Smircic (05:57:34):
And I'll zoom in for you. Can you show the jury where that is?
Jessica McAlear (05:57:38):
Right. Might be easier to be far away actually than me being close, but yes, right here.
Ms. Smircic (05:58:06):
Thank you, Ms. McAlear. You can take a seat. Ms. McAlear, can you explain to the jury how injuries of these nature would heal or... Let me put it this way. The injuries you saw on Paitin, when you first examined her on the 13th, were they healing injuries? Were they fresh injuries? Can you explain that to the jury?
Jessica McAlear (05:58:29):
That's a tough question, but I would classify them as acute injuries, you know, occurring within... With children, there's not a lot of research out there with healing times of injury, but most protocols in our protocol state we see the children within 72 hours of exam or of injury because that's when the majority of injuries are seen. So I can't tell you exactly when the injuries occurred, but they appeared to me to be acute, meaning within a day or two.
Ms. Smircic (05:59:11):
Could they also be... The acute injuries, could they be within several hours?
Jessica McAlear (05:59:16):
Absolutely, yes.
Ms. Smircic (05:59:18):
So maybe up to a day or two?
Jessica McAlear (05:59:19):
Yeah, up to a day or two. Again, it's hard. There's not a lot of literature or research out there with healing times. But yes, I would... From anytime from right before she entered the PICU to a day or two, that's my best guess.
Ms. Smircic (05:59:35):
And what about children? Do they generally heal faster than an older adult?
Jessica McAlear (05:59:40):
Children do heal very quickly, and especially those mucus membranes do heal very quickly.
Ms. Smircic (05:59:49):
How many of the injuries you observed in Paitin's vestibule were inside of the labia?
Jessica McAlear (05:59:58):
All of them, except for that bruise to the labia majora. So the labia, meaning the outer lips is what she's referring to.
Ms. Smircic (06:00:11):
And Ms. McAlear, looking at these injuries, based on your training, experience and expertise as a sexual assault nurse examiner, was her genital condition consistent with penetrating blunt force trauma?
Jessica McAlear (06:00:26):
Yes.
Ms. Smircic (06:00:28):
And in your expertise, can you say what she was penetrated with?
Jessica McAlear (06:00:34):
I cannot.
Ms. Smircic (06:00:36):
And you weren't there, obviously?
Jessica McAlear (06:00:37):
Correct.
Ms. Smircic (06:00:39):
Could she have been penetrated with an object?
Jessica McAlear (06:00:41):
Yes.
Ms. Smircic (06:00:42):
A penis?
Jessica McAlear (06:00:43):
Yes.
Ms. Smircic (06:00:44):
A finger?
Jessica McAlear (06:00:45):
Yes.
Ms. Smircic (06:00:49):
I want to go back and talk about your evidence collection.
Jessica McAlear (06:00:54):
Okay.
Ms. Smircic (06:00:55):
You said earlier that you also, in addition to documenting and photographing Paitin's injuries, you would do a, what we call a sexual assault kit. Is that right?
Jessica McAlear (06:01:05):
Yes, that's correct.
Ms. Smircic (06:01:33):
Can I get a moment, Judge?
The Court (06:01:33):
You may.
Ms. Smircic (06:01:33):
May I approach?
The Court (06:01:34):
You may.
Ms. Smircic (06:01:34):
May I approach?
The Court (06:01:54):
You may.
Ms. Smircic (06:01:54):
Ms. McAlear, I'm approaching with an evidence bag that I'm going to open. And I'm going to mark the box contained within as State's 13. Before you show it to the jury, I'm going to ask you do you recognize State's 13?
Jessica McAlear (06:02:42):
Yes, I do.
Ms. Smircic (06:02:43):
What is it?
Jessica McAlear (06:02:44):
This is the evidence collection kit that I collected on Paitin on the 13th.
Ms. Smircic (06:02:48):
And how do you know that?
Jessica McAlear (06:02:50):
My name is on it as signing it to the police.
Ms. Smircic (06:02:55):
And does it appear to be in a substantially similar condition as when you collected it besides going to the crime lab for testing?
Jessica McAlear (06:03:02):
Yes.
Ms. Smircic (06:03:04):
And what is contained inside this kit?
Jessica McAlear (06:03:07):
These are the swabs and the evidence that I collected off of her body that day.
Ms. Smircic (06:03:14):
And Judge, at this time, I'd move to enter State's 13 and its contents.
The Court (06:03:18):
Any objection?
The Defense (06:03:19):
No, sir.
The Court (06:03:20):
State's Exhibit 13 will be admitted into evidence.
Ms. Smircic (06:03:26):
Ms. McAlear, I'm going to take a moment and open State's 13. I'm going to give you a moment to look in State's 13. What do you see in there?
Jessica McAlear (06:04:14):
Envelopes containing samples that I collected from Paitin.
Ms. Smircic (06:04:20):
Okay. I'm going to need a moment to see those for a minute.
Jessica McAlear (06:04:22):
Okay.
Ms. Smircic (06:05:04):
I'm going to show you what's marked as 13A, 13B, and 13C. Can you identify what's contained in those envelopes?
Jessica McAlear (06:05:14):
13A is an envelope labeled with her name and it says "pulled head hairs." I denoted on here that I did not collect the sample. I did not collect head hair from her. I felt it was too traumatic on a pediatric patient, so I did not collect these. Exhibit 136, I think 136, Paitin Field's known blood sample. So this is a sample of her blood. I drew her blood. This is a card containing blood samples.
The Court (06:05:50):
I believe that's 13B.
Jessica McAlear (06:05:51):
13B.
Ms. Smircic (06:05:52):
I'm sorry, my handwriting's bad.
Jessica McAlear (06:05:53):
13B. Thank you.
The Court (06:05:54):
May I see that just to make sure?
Jessica McAlear (06:05:55):
Yeah, thank you.
The Court (06:05:57):
Yes, that's 13B.
Jessica McAlear (06:05:57):
Okay.
The Court (06:05:57):
Thank you.
Jessica McAlear (06:05:57):
And 13C?
The Court (06:05:57):
Correct, thank you.
Jessica McAlear (06:06:01):
Okay. Is a sample. What I've written on here, I've written her name and then I've written "alternate light source, bilateral ears." So another tool that we use is something called an alternate light source. It's a form of UV light that as part of the physical exam, I scan the body with this light. And if anything illuminates, it could be a bodily fluid. So in her case, when I scanned her body both ears illuminated, so I took swabs of her ears, external ears, and that's what's in here.
The Court (06:06:41):
Sorry, ma'am. Can you repeat what is 13B? What's inside?
Jessica McAlear (06:06:46):
Oh, known blood sample.
The Court (06:06:48):
Thank you.
Jessica McAlear (06:06:49):
Yes, you're welcome.
Ms. Smircic (06:06:52):
So that was some of what you collected in the sexual assault kit?
Jessica McAlear (06:06:54):
Yes. Some of what I collected.
Ms. Smircic (06:06:59):
Judge, this may be a good time for the afternoon recess.
The Court (06:07:01):
Okay. All right, members of the jury, we're going to go ahead and take our mid-afternoon break. Go ahead and close up your notebooks. Remember, do not discuss this case amongst yourselves. Do not discuss this case with anybody else, including friends, family members, or coworkers. Do not have any contact with any of the parties, attorneys, or witnesses. Do not conduct any independent investigation or inquiry, and do not post online on any social media sites. So we'll go ahead and excuse you for about 15 minutes. Thank you.
Bailiff (06:07:33):
Thank you, Your Honor. Once again, make sure your notebooks are closed, you'll leave those in your chairs. When ready the front row and back to this right place.
Ms. Smircic (06:07:41):
Judge, may I retrieve some evidence that hasn't been admitted?
The Court (06:07:54):
You may.
(06:07:54)
... we need to discuss on behalf of the State?
Ms. Smircic (06:08:37):
I don't think so, Judge.
The Court (06:08:38):
Behalf of the Defense?
The Defense (06:08:38):
No, sir.
The Court (06:08:39):
Okay. We'll be at ease for the next 15 minutes.
Bailiff (06:08:44):
Court will be at ease for 15 minutes. 15 minutes.
Speaker 14 (06:08:47):
Superior court's released for 15 minutes.
Speaker 15 (06:08:47):
[inaudible 06:09:44]. What was left up here.
Ms. Smircic (06:08:47):
Yeah, or you can put it back in.
Speaker 16 (06:08:47):
Spin it a little more.
Speaker 17 (06:08:47):
And tell him we're all in it together. All in it together. Can you understand?
Speaker 18 (06:08:47):
All right. We're-
Speaker 19 (06:08:47):
Are you just going to ask him?
Speaker 17 (06:08:47):
Yeah. He will say, "Can you go ahead?" to the jury.
Speaker 19 (06:08:47):
But you can do it all.
Speaker 16 (06:08:47):
Yeah.
Speaker 17 (06:08:47):
We can create the-
Speaker 20 (06:08:47):
Around this, that. This-
Speaker 16 (06:08:47):
Okay.
Speaker 20 (06:08:47):
... [inaudible 06:14:17]. Thanks.
Speaker 21 (06:08:47):
Thanks.
Speaker 20 (06:08:47):
She did have [inaudible 06:14:30] in that sense.
Speaker 22 (06:08:47):
Can you check the end?
Speaker 20 (06:08:47):
This is in. Yes. That's in. That's it.
Speaker 19 (06:08:47):
What's that? Wait. Can I?
Speaker 20 (06:08:47):
Okay. [inaudible 06:14:44].
Speaker 19 (06:08:47):
Wait. This is 32, 33, 34, 35.
Speaker 21 (06:08:47):
Yeah.
Speaker 20 (06:08:47):
Yeah. It's in order.
Speaker 19 (06:08:47):
Right. Okay.
Speaker 20 (06:08:47):
Yeah. [inaudible 06:14:56].
Speaker 21 (06:08:47):
You get it?
Speaker 20 (06:08:47):
Yes. We've earned this.
Speaker 21 (06:08:47):
[inaudible 06:15:06].
Speaker 19 (06:08:47):
What work we get.
Speaker 21 (06:08:47):
That's right.
Speaker 19 (06:08:47):
Looking at it that way.
Speaker 21 (06:08:47):
Everything should be over there.
Speaker 20 (06:08:47):
Yeah, that's right. Yeah.
Speaker 21 (06:08:47):
Tell him to go take a picture of the [inaudible 06:15:23] halls. Too late.
Speaker 20 (06:08:47):
Should I do it?
Speaker 19 (06:08:47):
Yeah, I'm going to [inaudible 06:15:27].
Speaker 22 (06:15:39):
Thought my shadow walked behind. A little bit taller.
Speaker 21 (06:15:40):
Yeah.
Speaker 19 (06:15:50):
Who's this? Who is this? [inaudible 06:15:51]-
Speaker 23 (06:15:50):
Hopefully.
Speaker 19 (06:15:50):
The mom is there. Is it? So sorry. Sorry.
Speaker 23 (06:15:50):
Unless they're driving.
Speaker 20 (06:15:50):
[inaudible 06:15:56]. Maybe it'd work.
Speaker 22 (06:15:50):
[inaudible 06:15:58].
Speaker 18 (06:15:50):
Listen to the mom. Ask me to [inaudible 06:16:04].
Speaker 24 (06:15:50):
Wait a second.
Speaker 25 (06:15:50):
You can wait there. You stand there. Stand there.
Speaker 26 (06:15:50):
Go ahead.
Speaker 25 (06:15:50):
Thank you.
Speaker 22 (06:15:50):
[inaudible 06:16:23] back there.
Speaker 25 (06:15:50):
That's it.
Speaker 27 (06:15:50):
Okay. Thank you.
The Court (06:15:50):
... discussed before we bring the jury back in?
Luther Britt III (06:15:50):
No, sir.
The Court (06:50:31):
The state?
Speaker 28 (06:50:32):
No, Your Honor. We apologize.
The Court (06:50:38):
Ma'am, if you can scoot all the way close to that microphone.
Jessica McAlear (06:50:40):
Okay.
The Court (06:50:40):
Bring the jury in.
Speaker 29 (06:50:40):
Bring in the jury. Jury is seated.
The Court (06:51:29):
Thank you, sir. Let the record reflect that the jury has reentered the courtroom. All right. State, you may continue.
Ms. Smircic (06:51:38):
Thank you. Ms. McAlear, we were talking about the evidence collection with the sexual assault kit before the break. You identified some of the items. Did you also collect other swabbings in the general area of Paitin Fields?
Jessica McAlear (06:51:57):
Yes, I did.
Ms. Smircic (06:51:57):
May I approach?
The Court (06:51:57):
You may.
Ms. Smircic (06:52:08):
Ms. McAlear, I'm going to show you what I marked as State's Exhibit 14. Do you recognize that envelope?
Jessica McAlear (06:52:14):
Yes, I do.
Ms. Smircic (06:52:15):
And what is it?
Jessica McAlear (06:52:17):
Swabs that I took from Paitin's clitoral hood.
Ms. Smircic (06:52:21):
And can you explain to the jury when you take a swab, how do you do that?
Jessica McAlear (06:52:28):
There's generally two swabs. The first one is moistened with something called sterile water, because if it's a dried secretion on the skin, then the moisture will pick the secretion up and then I follow it with another swab.
Ms. Smircic (06:52:42):
And why do you swab these areas?
Jessica McAlear (06:52:45):
I was swabbing that area to see if there could be any DNA collection.
Ms. Smircic (06:52:52):
And obviously, you don't do any of the test. So you just collected, is that correct?
Jessica McAlear (06:52:56):
Correct. Yes, I just collect.
Ms. Smircic (06:52:58):
And does State's Exhibit 14, the clitoral hood swabs, appear to be in a substantially similar condition as when you collected it besides being tested at laboratories?
Jessica McAlear (06:53:08):
Yes, that's correct.
Ms. Smircic (06:53:10):
Judge, the state would move to admit State's 14 into evidence.
The Court (06:53:12):
Any objection?
Luther Britt III (06:53:12):
No, sir.
The Court (06:53:12):
State's Exhibit 14 will be admitted into evidence.
Ms. Smircic (06:53:18):
Ms. McAlear, I'm going to show you what's an envelope that's been marked as State's 15. Can you identify that for us?
Jessica McAlear (06:53:27):
These are swabs that I collected and a smear from her rectal area, the anus.
Ms. Smircic (06:53:33):
What is the difference between a swab and a smear?
Jessica McAlear (06:53:35):
The swab is, it's like a Q-tip. It's a long cotton-tipped applicator, and then a smear is when I take the Q-tip and rub it on a plate.
Ms. Smircic (06:53:47):
And why do you do that?
Jessica McAlear (06:53:49):
It makes it easier for the lab to look at the cells and look for DNA.
Ms. Smircic (06:53:55):
So in this case for her rectal swabs, you did a swab and a smear?
Jessica McAlear (06:53:59):
Correct. Multiple swabs and then a smear.
Ms. Smircic (06:54:02):
And does this State's 15 appear to be in a substantially similar condition as when you collected it, besides going to the lab for testing?
Jessica McAlear (06:54:11):
Yes.
Ms. Smircic (06:54:13):
And when you packaged this up, you label it, initial it, and mark that you did it. Is that correct?
Jessica McAlear (06:54:18):
Yes, that's correct.
Ms. Smircic (06:54:20):
Judge, the state would move to enter State's 15 into evidence.
The Court (06:54:23):
Any objection?
Luther Britt III (06:54:24):
No, sir.
The Court (06:54:25):
State's Exhibit 15 will be admitted into evidence.
Ms. Smircic (06:54:30):
Ms. McAlear, I'm going to show you what's been marked as State's Exhibit 16 in another envelope. What is that?
Jessica McAlear (06:54:36):
These are swabs that I collected from the external genitalia, perineal area.
Ms. Smircic (06:54:43):
And once again, you swabbed the same way you've already described to the jury?
Jessica McAlear (06:54:48):
Yes. The same way I swabbed that clitoral hood area, yes, with the two swabs.
Ms. Smircic (06:54:54):
And does it appear State's 16 to be in a substantially similar condition as when you packaged it, other than going to the lab for testing?
Jessica McAlear (06:55:01):
Yes, it does.
Ms. Smircic (06:55:03):
State will move to enter State's 16 into evidence.
Luther Britt III (06:55:05):
No objection.
The Court (06:55:06):
State's Exhibit 16 will be admitted into evidence.
Ms. Smircic (06:55:09):
And Ms. McAlear, finally, I'm going to show you State's 17. Do you recognize that envelope?
Jessica McAlear (06:55:16):
Yes. That envelope contains the vaginal swabs and smear that I collected.
Ms. Smircic (06:55:22):
And you marked it and labeled it?
Jessica McAlear (06:55:24):
Yes.
Ms. Smircic (06:55:25):
Does it appear to be in a substantially similar condition as when you packaged it?
Jessica McAlear (06:55:30):
Yes.
Ms. Smircic (06:55:31):
Besides going to the lab?
Jessica McAlear (06:55:32):
Yes, it does.
Ms. Smircic (06:55:34):
Judge, the state would move to enter State's 17 into evidence.
Luther Britt III (06:55:37):
No objection.
The Court (06:55:38):
State's Exhibit 17 will be admitted in evidence.
Ms. Smircic (06:56:01):
May I approach, Judge?
The Court (06:56:02):
You may.
Ms. Smircic (06:56:15):
Ms. McAlear, I'm showing you what's been marked as State's 18, an envelope. What does that contain?
Jessica McAlear (06:56:21):
This envelope contains hair evidence. What is inside this envelope is actually the known cheek scraping. The state created this larger envelope to contain four different types, four different envelopes inside it. Of those four, I only collected the one, which was the known cheek scraping.
Ms. Smircic (06:56:40):
So you marked on here that you actually did not collect pubic hair scraping?
Jessica McAlear (06:56:44):
Correct.
Ms. Smircic (06:56:46):
Does it appear to be in a substantially similar condition as when you collected it?
Jessica McAlear (06:56:50):
Yes, it does.
Ms. Smircic (06:56:51):
Judge, the state would move to admit State's 18 into evidence.
The Court (06:56:55):
Any objection?
Luther Britt III (06:56:55):
No, sir.
The Court (06:56:57):
State's Exhibit 18 will be admitted into evidence.
Ms. Smircic (06:57:08):
Ms. McAlear, I want to talk a little bit more about those swabs using a diagram. If I may approach.
The Court (06:57:16):
You may.
Ms. Smircic (06:57:16):
Thank you. Ms. McAlear, I'm showing you what's been marked as State's 19. Do you recognize that diagram?
Jessica McAlear (06:57:40):
Sure. Yes, I do.
Ms. Smircic (06:57:41):
Just tell me what the diagram is.
Jessica McAlear (06:57:44):
It's the genital area of a prepubertal female, so a child that hasn't hit puberty yet.
Ms. Smircic (06:57:52):
Is that a fair and accurate representation of how a child's genital area, a female child would appear before puberty?
Jessica McAlear (06:58:00):
Yes, it is.
Ms. Smircic (06:58:01):
Would it help illustrate your testimony here today?
Jessica McAlear (06:58:03):
Yes, it would.
Ms. Smircic (06:58:04):
Judge, the state would move to enter State's 19 for illustrative purposes.
The Court (06:58:08):
Any objection?
Luther Britt III (06:58:08):
No, sir.
The Court (06:58:09):
State's Exhibit 19 will be admitted into evidence.
Ms. Smircic (06:58:12):
And may I publish on the ELMO?
The Court (06:58:19):
You may.
Ms. Smircic (06:58:19):
And may I ask Ms. McAlear to step down, please?
The Court (06:58:21):
Ma'am, you may step down, please.
Jessica McAlear (06:58:22):
Okay. Yeah.
Ms. Smircic (06:58:26):
Ms. McAlear, I'll give you this pointer again.
Jessica McAlear (06:58:38):
Thank you.
Ms. Smircic (06:58:39):
Can you describe first for the jury the areas on this diagram?
Jessica McAlear (06:58:48):
So we did talk about this a little bit earlier. Okay? This again is the external or the genital area. Up here is the clitoral hood. Okay? Out here are the labia majora, those outer lips. Okay. Then in here you have your clitoris. In here you have your labia minora. And in this instance, this drawing, the labia minora does kind of come down a little bit, but on younger children, it does happen. It stops about right here, depending on the age.
(06:59:25)
Down here, this is the hymenal opening. Okay? This is of course the hymen. And then where the hymen meets down here is called the fossa navicularis. This is the posterior, as I was talking about the posterior. It's a fourchette that it's characterized as a posterior fourchette in older adolescents. In young children, it's considered a posterior common core. And then here is the anus.
Ms. Smircic (06:59:53):
And what is the blue on the side there?
Jessica McAlear (06:59:58):
This is just discussing kind of the bottom of the hymen, the posterior hymenal rim here, with the bottom of the hymen.
Ms. Smircic (07:00:05):
And are there kind of figures depicted in this diagram holding it open?
Jessica McAlear (07:00:11):
Oh, yes. So these are gloved fingers holding traction, kind of opening the area to be visualized.
Ms. Smircic (07:00:17):
So this wouldn't be a diagram of how it would appear if no one was holding it open?
Jessica McAlear (07:00:23):
Correct. The labia majora would be covering the area, or mostly covering the area.
Ms. Smircic (07:00:31):
I want to talk about State's 14 where you took swabs of the clitoral hood. Can you explain to the jury where you swabbed using that diagram?
Jessica McAlear (07:00:41):
Right here in this area.
Ms. Smircic (07:00:45):
And State's 15, the rectal swabs and smear, where would you have swabbed for that?
Jessica McAlear (07:00:53):
Right here.
Ms. Smircic (07:00:57):
Would your swab have gone into the anus or were you swabbing around it or where did you do it?
Jessica McAlear (07:01:02):
One would go along the outside and one would be inside [inaudible 07:01:08].
Ms. Smircic (07:01:09):
And State's 16, where you took external perineal swabs, what area were you swabbing using the diagram?
Jessica McAlear (07:01:18):
That's a good question. I didn't notate exactly where, and I don't recall. It's been nine years. But my suspicion is that it would've been the labia majora, out on those outer lips out there.
Ms. Smircic (07:01:33):
Would it be the inside of the outer lips or where exactly were you swabbing?
Jessica McAlear (07:01:39):
Unfortunately, I can't recall. I wrote perineal area. Correct?
Ms. Smircic (07:01:44):
External perineal swabs.
Jessica McAlear (07:01:47):
My guess would be the labia majora outside.
Ms. Smircic (07:01:50):
And State's 17, the vaginal swabs and smear. Where would you have swabbed for that using the diagram?
Jessica McAlear (07:02:02):
It would be in here, inside the hymen. This, most children, as I stated earlier, we don't swab inside because this hymenal area, the hymen without estrogen is very tender to touch. Okay? Once estrogen enters the picture when puberty starts, it starts getting fluffier. It changes color. It's not painful to touch. So for most prepubertal children, we do not swab inside because we don't want to touch the hymen because it's too painful.
(07:02:40)
Now in this instance, she was intubated and sedated, okay? So she was unconscious and also we've given her medication to be unconscious. And the hymenal opening was open enough where I could enter through there without touching it to swab inside. Most children, a five-year- old, average five-year-old child would not tolerate that, would not be still enough for me to be able to go in there exactly and get that swab without touching the hymen. But in her case, I believe I did due to her condition.
Ms. Smircic (07:03:09):
Thank you, Ms. McAlear.
Jessica McAlear (07:03:09):
Yes, you're welcome. Thank you.
Ms. Smircic (07:03:34):
Ms. McAlear, I want to talk a little bit about Paitin Fields, where her injuries were. Were they visible? Besides the bruise on the labia majora, were they visible if she was just in a resting state?
Jessica McAlear (07:03:53):
No. They would not have been.
Ms. Smircic (07:03:57):
Okay. Can you explain... Let me put it this way. When you had to photograph the injuries to Paitin, you had the assistance of Ms. Mistovich?
Jessica McAlear (07:04:09):
Yes, I did.
Ms. Smircic (07:04:13):
And what was that to do?
Jessica McAlear (07:04:15):
To better visualize the area, to be able to hold what we call traction, to open the labia, to be able to visualize the area and photograph. It's difficult to hold what we call traction to open the area and take a photograph with only two hands, but it was basically to enable the photo documentation and to get a good look at the area.
Ms. Smircic (07:04:38):
So physically, you or Ms. Mistovich were spreading apart the labia?
Jessica McAlear (07:04:43):
Yes, we were.
Ms. Smircic (07:04:45):
And most of her injuries were behind, so to speak, once you open the labia or behind them, is that... How would you say that?
Jessica McAlear (07:04:57):
Yes. Yes. So if you think of the labia, the labia majora is like a barn door and you open the doors, okay? Everything else is inside. So we open the labia majora to expose the structures that are closer to the center of the body, if that makes sense.
Ms. Smircic (07:05:19):
Ms. McAlear, you've been a nurse for 20 years, is that right?
Jessica McAlear (07:05:22):
25 years.
Ms. Smircic (07:05:23):
25 years. Have you, in your experience as a nurse or a sexual assault nurse examiner, ever seen a catheter cause injuries like you observed on Paitin Fields?
Jessica McAlear (07:05:36):
No, I have not.
Ms. Smircic (07:05:37):
Have you ever seen a rectal thermometer cause injuries like you saw on Paitin Fields?
Jessica McAlear (07:05:45):
No, I have not.
Ms. Smircic (07:05:47):
And can you explain to the jury, and they've heard a little bit about this from other witnesses, but is there anything about the insertion of the catheter process or the taking of a rectal thermometer that could cause injuries to the vestibule or the rectum?
Jessica McAlear (07:06:07):
No. A urinary catheter is a very flexible tube, so it's going to... If it strikes something on the body and it's not going into the correct orifice, it's going to bend and not continue to cause trauma. The rectal thermometer, I have seen hundreds and hundreds of children and taken hundreds and hundreds of rectal temperatures and I've never seen injury from it. We do use a lubricant when we insert a rectal thermometer, so that ensures that it goes in smoothly and wouldn't cause any injury.
Ms. Smircic (07:06:45):
Have you ever met the defendant, David Prevatte?
Jessica McAlear (07:06:47):
No, I have not.
Ms. Smircic (07:06:52):
Can I get a moment, Judge?
The Court (07:06:53):
Please.
Ms. Smircic (07:06:56):
Nothing further, Judge.
The Court (07:06:58):
Cross examination?
Luther Britt III (07:07:00):
Yes, briefly. Ms. McCLear?
Jessica McAlear (07:07:00):
McAlear.
Luther Britt III (07:07:00):
McAlear, thank you. I want to make sure I pronounce it correctly. The certification that you received, who was the certifying authority?
Jessica McAlear (07:07:19):
Which certification?
Luther Britt III (07:07:20):
Either one or both.
Jessica McAlear (07:07:22):
For the sexual assault?
Luther Britt III (07:07:23):
Yes.
Jessica McAlear (07:07:23):
Okay. The adult adolescent, I was certified in the state of North Carolina, but also by the International Association of Forensic Nurses. It's an international certification for the pediatric by the state of North Carolina.
Luther Britt III (07:07:38):
Okay. And did you have to physically go somewhere? Was it a presentation at the hospital in Wilmington?
Jessica McAlear (07:07:46):
For the adult adolescent, for the state of North Carolina, it's a completion of a required number of exams and a completion of paperwork that's submitted. For the international certification for the adult adolescent, it's an exam.
Luther Britt III (07:08:00):
Okay. And was that something you were interested in doing at that time in your career or was opportunity presented itself and you were told to go do it?
Jessica McAlear (07:08:16):
Opportunity I was interested in to further my nursing career for both.
Luther Britt III (07:08:19):
And so over the course of your career as a SANE examiner, how many times had you ever conducted a SANE examination on a child, Paitin Field's age?
Jessica McAlear (07:08:37):
I think that question was already asked. Oh, Paitin's age?
Luther Britt III (07:08:40):
Should have been five at the time.
Jessica McAlear (07:08:45):
Probably about 10 times, I'd say.
Luther Britt III (07:08:53):
And how many of those 10 involved a child that was intubated and was unconscious?
Jessica McAlear (07:09:02):
She was the only one.
Luther Britt III (07:09:03):
She's the only one?
Jessica McAlear (07:09:04):
Mm-hmm.
Luther Britt III (07:09:21):
And does this exam take place like in the ER or outpatient operating room area?
Jessica McAlear (07:09:21):
This exam took place in the pediatric intensive care unit. The other exams have been in the emergency department.
Luther Britt III (07:09:37):
And other than the items that are contained in the sexual assault kit, what other tools, instruments do you use to collect the evidence?
Jessica McAlear (07:09:57):
We utilize that UV light, that alternate light source to look for bodily fluids, and then the toluidine blue dye for the anal area.
Luther Britt III (07:10:09):
Do you know what a colposcope is?
Jessica McAlear (07:10:09):
Yes.
Luther Britt III (07:10:10):
Can you explain to the jury what a colposcope is?
Jessica McAlear (07:10:12):
A colposcope is another device that can be used to magnify. It's similar to a camera. It uses increased amplification or gets a very close look at those areas. I would say a microscope, but it's brought to the patient, and it has like a camera lens that takes a look. And it can give you a much closer view.
Luther Britt III (07:10:47):
And in any of the exams that you've performed, have you ever used a colposcope? Are you trained with that instrument?
Jessica McAlear (07:10:52):
Yes, I have.
Luther Britt III (07:10:54):
In utilizing the colposcope, does it require you, for example, to insert the colposcope into the anal opening of the subject?
Jessica McAlear (07:11:03):
No, it does not.
Luther Britt III (07:11:04):
Does it require you to insert the colposcope into the vaginal area of the subject?
Jessica McAlear (07:11:11):
No, it does not.
Luther Britt III (07:11:14):
It's a light source, but also has a camera?
Jessica McAlear (07:11:16):
Mm-hmm. Essentially, yes.
Luther Britt III (07:11:17):
And did you utilize a colposcope in your exam of Paitin Fields?
Jessica McAlear (07:11:23):
No, I did not.
Luther Britt III (07:11:25):
How were the photographs that have been admitted? How were they taken?
Jessica McAlear (07:11:30):
With a iPhone camera that we used in our program that were immediately uploaded into the medical record from that camera.
Luther Britt III (07:11:55):
And with regard to the actual swabs and stains, you were being assisted by another SANE nurse?
Jessica McAlear (07:12:05):
Yes, I was.
Luther Britt III (07:12:10):
The labia majora were pulled back or opened, and how was that achieved?
Jessica McAlear (07:12:18):
So when I did the swabs, I completed most of that myself because I went up there, I went to the ICU intensive care unit very early on. They needed to do some other medical intervention, so I needed to do those swabs first. So the majority of the swabs were taken before I had an assistant. But to answer your question, fingers are placed on the labia majora and gently open the area.
Luther Britt III (07:12:46):
And a swab is similar to like a Q-tip?
Jessica McAlear (07:12:50):
Yes, it's very similar to a Q-tip.
Luther Britt III (07:12:52):
And for example, if you are taking the sample or using a swab in the labia majora, you're rubbing one side or wiping one side, do you use another swab to do the opposite side?
Jessica McAlear (07:13:08):
Yes.
Luther Britt III (07:13:09):
Okay. And those are labeled as to which was on the right, which was on the left?
Jessica McAlear (07:13:14):
In this instance, I don't know that I labeled them. It's not standard protocol to collect samples from the labia majora, so I think I labeled them external genitalia. So I'm not sure that they're labeled.
Luther Britt III (07:13:30):
Okay. But the same procedures follow with the hymenal opening vestibule in terms of swab?
Jessica McAlear (07:13:41):
Yes.
Luther Britt III (07:13:41):
There are multiple swabs?
Jessica McAlear (07:13:45):
Depends on... But yes, there are. Of the vaginal area, yes. And of the rectal area, yes. Our kit does not include specific swabs for the labia or for the vestibule or anything like that. So I would've pulled additional swabs from-
Luther Britt III (07:13:59):
And the information that you had been provided from Pender had Paitin's genital area been cleaned?
Jessica McAlear (07:14:08):
Yes.
Luther Britt III (07:14:11):
Had it been cleaned at New Hanover before you did your exam as well?
Jessica McAlear (07:14:16):
No, it had not been cleaned at New Hanover.
Luther Britt III (07:14:19):
Cleaning it, the genitalia area, that can have a tendency to remove evidence?
Jessica McAlear (07:14:27):
It can. Sometimes, yes.
Luther Britt III (07:14:33):
And then the light source you use, describe it, please.
Jessica McAlear (07:14:43):
We have two different types. One's called a Wood's lamp, and that is a lamp that it's kind of a magnifying glass that has a light on it. And the other one we had, and because it's been so long, I can't recall which one I used, the other one we have in our program is, it looks like a flashlight. And it's just a black light that is a UV light.
Luther Britt III (07:15:08):
And the purpose of either using the Wood light or... I'm just going to refer to the black light-
Jessica McAlear (07:15:17):
Sure.
Luther Britt III (07:15:17):
... is to identify potentially evidence that you can't see with your own eyes?
Jessica McAlear (07:15:25):
Right. It's to identify any secretions that might be on the skin that we could swab, yes.
Luther Britt III (07:15:35):
And in this examination, did you find evidence using the black light source?
Jessica McAlear (07:15:44):
There were two areas that illuminated, yes. I'm not sure if they're... What was on those swabs that I collected, but both ears illuminated. So I swabbed both ears.
Luther Britt III (07:15:53):
And so when a sensor lab, whatever is on the swab is identified there, not at-
Jessica McAlear (07:16:01):
Correct. I have no way to know. Yes, sir.
Luther Britt III (07:16:07):
And what two areas illuminated?
Jessica McAlear (07:16:11):
The external ear, her right ear and her left ear, the exterior.
Luther Britt III (07:16:16):
Her ears?
Jessica McAlear (07:16:17):
The ears. Yes, sir.
Luther Britt III (07:16:34):
All right. Thank you. I don't have any other questions.
The Court (07:16:34):
Redirect?
Ms. Smircic (07:16:37):
Briefly, Judge. Ms. McAlear, Mr. Britt asked you about a colposcope. Could you see the injuries to Paitin without one?
Jessica McAlear (07:16:47):
Yes. And in our experience in our program, we actually decided we could see just as well, and some studies have shown that too. We could see just as well with the magnification from the iPhone camera as with the colposcope.
Ms. Smircic (07:17:00):
And that was true back in 2017?
Jessica McAlear (07:17:02):
Yes.
Ms. Smircic (07:17:06):
Nothing further, Judge.
The Court (07:17:07):
Recross?
Luther Britt III (07:17:07):
No, sir.
The Court (07:17:08):
Is this witness subject to recall?
Ms. Smircic (07:17:09):
We'd ask to be released, Judge.
Luther Britt III (07:17:13):
No objection.
The Court (07:17:14):
All right. Ma'am, at this time, you're released from the obligations of your subpoena. You may step down. You're free to go.
Jessica McAlear (07:17:18):
Thank you.
The Court (07:17:18):
Thank you.
Speaker 29 (07:17:18):
And watch your step.
The Court (07:17:34):
State, you may call your next witness.
Speaker 28 (07:17:36):
State would call Colleen Mistovich.
The Court (07:17:37):
All right, ma'am, if you can make your way around here to the witness stand, please. Ma'am, if you can place your left hand on the Bible, raise your right hand.
Speaker 30 (07:17:56):
Do you solemnly swear that the testimony you'll give in court today will be the truth, the whole truth, nothing but the truth, so help you God?
Colleen Mistovich (07:18:03):
I do.
Speaker 30 (07:18:03):
Thank you. You may be seated.
The Court (07:18:10):
Ma'am, as you testify here today, please speak loudly and clearly into the microphone so everybody here can hear you. Please make sure all of your answers are out loud. No head shakes or nods or mm-hmms. Everything has to be a yes or a no. And please wait for the attorney to be done asking their question before you give a response. Can you do that?
Colleen Mistovich (07:18:28):
Yes, sir.
The Court (07:18:29):
Thank you. State, you may proceed.
Speaker 28 (07:18:30):
Thank you. Ms. Mistovich, can you state your name and please spell it for the jury, please?
Colleen Mistovich (07:18:35):
Good afternoon. My name is Colleen Mistovich. It's C-O-L-L-E-E-N. Last name Mistovich, M-I-S-T-O-V as in Victor, I-C-H.
Speaker 28 (07:18:47):
And how are you employed?
Colleen Mistovich (07:18:48):
I am employed at Novant New Hanover Regional Medical Center.
Speaker 28 (07:18:51):
And what are your duties and responsibilities there?
Colleen Mistovich (07:18:53):
I am a registered nurse and currently the manager of the emergency department.
Speaker 28 (07:18:59):
How long have you been the manager of the emergency department?
Colleen Mistovich (07:19:01):
I've been in my current role for four years.
Speaker 28 (07:19:04):
Back in 2017, what were your duties and responsibilities?
Colleen Mistovich (07:19:08):
I was the clinical coordinator for the Sexual Assault Nurse Examiner program and a clinical coordinator in the emergency department, everyday operations of the floor in the ED.
Speaker 28 (07:19:18):
What is a clinical coordinator?
Colleen Mistovich (07:19:21):
So my job in that role is to do the everyday operations of the emergency room. So assign your staff to their areas, you're problem solving, you're doing flow and throughput, assigning EMSs, working, putting up problems, patient concerns.
Speaker 28 (07:19:36):
And as a clinical coordinator for the same program, is that different than as a clinical coordinator for the ED?
Colleen Mistovich (07:19:43):
It was. So the sexual assault program originated around 2009. Me and Jessica McAlear started that program. And what that program did was enabled us to be able to care for victims of sexual assault in our emergency department. And we were certified to do that. And my role in that position was to oversee our education, making sure that everyone had the proper education to do it.
(07:20:09)
Me and Jessica were both trained and actually, we were able to teach Sexual Assault Nurse Examiner, adult and adolescent. That was through the North Carolina Board of Nursing. And then we would run the program. So my job would be to make sure the exams were done properly, effectively, and efficiently.
Speaker 28 (07:20:29):
Did you also conduct exams yourself at that time?
Colleen Mistovich (07:20:32):
Yes, sir.
Speaker 28 (07:20:33):
Let's talk about your education. Where were you trained?
Colleen Mistovich (07:20:38):
I was trained in Canada. I went to school. I graduated my nursing diploma in 1992. So Sandford Fleming College, Peterborough, Ontario.
Speaker 28 (07:20:49):
Is that where you're from, is Canada?
Colleen Mistovich (07:20:51):
Yes, sir.
Speaker 28 (07:20:52):
And did you go on to get a graduate-level degree?
Colleen Mistovich (07:20:57):
I did. In 2012, I went to Grand Canyon University and got my BSN, my bachelor's of nursing.
Speaker 28 (07:21:04):
How about any master's?
Colleen Mistovich (07:21:06):
In 2018, I went to Capella University and completed my master's of nursing in leadership.
Speaker 28 (07:21:11):
Okay. Any other postgraduate degrees?
Colleen Mistovich (07:21:16):
No.
Speaker 28 (07:21:17):
You said that you received your certification in the SANE program?
Colleen Mistovich (07:21:22):
Yes, sir.
Speaker 28 (07:21:23):
And what kind of training did you have to have for that?
Colleen Mistovich (07:21:26):
I did my training in 2008. Adolescent was done at UNC Wilmington here in town. It was, I believe, at that time, a two-week class that was in the classroom, and then we had a certain amount of exams that we needed to do, which I think at that time was around 40 to 50 exams, actual physical exams, including vaginal exams. And at that point, we worked alongside people in the community. So we would spend time with law enforcement, DSS, Department of Social Services, getting to know what other people in those areas do so we could work as a community group.
Speaker 28 (07:22:00):
And you were first certified in 2008 as a SANE nurse?
Speaker 2 (07:22:00):
And, let's see, you were first certified in 2008 as a SANE nurse?
Colleen Mistovich (07:22:04):
That's when I did my training, yes.
Speaker 2 (07:22:05):
And are you still certified as a SANE nurse?
Colleen Mistovich (07:22:10):
I had international... So the International Association of Forensic Nurses is where you can write the examination and be trained. You have to have so many hours, and you have to do so many things to have an international like for the certification.
(07:22:22)
I was trained up until, I believe 2023, and I let that lapse.
Speaker 2 (07:22:28):
And now you run the ED department, is that correct? You're-
Colleen Mistovich (07:22:32):
Yes, sir.
Speaker 2 (07:22:32):
All right. Approximately how many SANE examinations have you conducted over the course of your career?
Colleen Mistovich (07:22:39):
I have been a nurse for 33, will be going on 34 years now, well over 1500.
Speaker 2 (07:22:46):
And you've been in the courtroom all afternoon, and you've heard testimony about Paitin Fields. She was five years old at the time. Approximately how many SANE examinations have you conducted on someone Paitin's age, five years old?
Colleen Mistovich (07:23:02):
I would say at least 200.
Speaker 2 (07:23:04):
May I approach the witness, Judge?
Judge (07:23:08):
You may.
Speaker 2 (07:23:08):
I'm going to show you what's been marked as State's Exhibit 20. [inaudible 07:23:12] I'm going to show you what's been marked as State's Exhibit 20. Do you recognize State's Exhibit 20?
Colleen Mistovich (07:23:28):
Yes, sir.
Speaker 2 (07:23:29):
And what is State's Exhibit 20?
Colleen Mistovich (07:23:30):
This is my CV.
Speaker 2 (07:23:31):
And does it fairly and accurately depict your education, your training, your certifications?
Colleen Mistovich (07:23:37):
It does.
Speaker 2 (07:23:37):
And is it up-to-date?
Colleen Mistovich (07:23:39):
It is.
Speaker 2 (07:23:40):
All right. Move to introduce State's Exhibit 20.
Judge (07:23:41):
Any objection?
Luther Britt III (07:23:42):
No, sir.
Judge (07:23:43):
State's Exhibit 20 will be admitted into evidence.
Speaker 2 (07:23:51):
I'm going to take you to November 13th, 2017. Do you remember that day?
Colleen Mistovich (07:23:56):
Yes, sir.
Speaker 2 (07:23:58):
You said your duties and responsibilities on that day were what? Clinical coordinator?
Colleen Mistovich (07:24:02):
I would have been the SANE coordinator at that time.
Speaker 2 (07:24:06):
Okay, SANE coordinator. And did you work with Jessica McAlear at that time?
Colleen Mistovich (07:24:10):
I did.
Speaker 2 (07:24:11):
And doing SANE examinations and other nursing duties?
Colleen Mistovich (07:24:17):
Jessica was a clinical coordinator alongside of me. So we had three full-time nurses who were in clinical coordinator emergency department roles. So both of us were clinical coordinators and both of us were sexual assault nurses.
Speaker 2 (07:24:29):
All right. And at some point were you notified about Paitin Fields and her condition? Conditions, excuse me.
Colleen Mistovich (07:24:39):
I was called by Jessica sometime during the day to ask if I was available to come upstairs to help her to do photography, evidence collection photography.
Speaker 2 (07:24:48):
Okay. Jessica was the main... Paitin was her patient at that time, correct?
Colleen Mistovich (07:24:57):
Correct.
Speaker 2 (07:24:57):
And she was the main sexual assault nurse at that time for Paitin, correct?
Colleen Mistovich (07:25:02):
Yes, sir.
Speaker 2 (07:25:03):
And your duties were with what in regards to Paitin?
Colleen Mistovich (07:25:09):
Because Paitin was intubated, had the breathing tube down, was on the ventilator. When you do a child exam, you really want to be able to move them. The area is super small, so you want to be able to put them in what we call a frog knee position. So you want to be able to put them on their back and pull their legs up to be able to get a good visualization. To do a really good exam, you want to be able to flip them on their belly and kind of put them up in a, what we call a kneeling cat kind of position to be able to get a good visualization of the rectal area.
(07:25:35)
Paitin was unresponsive. She was intubated. She had the breathing tube down for her. She had IV fluids going. So it wasn't easy for Jessica to do the exam on her own because she could not move her around and be able to do.
(07:25:49)
And because she was unresponsive, she wasn't following directions, so she was unable to move her body the way it needed to be done. So Jessica reached out to ask me if I would be available to come up and help so we could do pictures.
Speaker 2 (07:26:01):
And did you do that?
Colleen Mistovich (07:26:02):
Yes, sir.
Speaker 2 (07:26:03):
And let's talk about when you went up there and you were helping, you were doing the traction and she was taking the picture, or she was doing the traction and you were taking the pictures. Do you remember?
Colleen Mistovich (07:26:12):
I do not recall.
Speaker 2 (07:26:14):
Okay.
Colleen Mistovich (07:26:14):
I do think that we were both taking back-and-forth kind of things because we were measuring wounds as well. So we were taking gloves on, gloves off and doing all the things. So I think we both did.
Speaker 2 (07:26:24):
Let's talk about then what did you observe about Paitin? Do you remember that time, could you tell the jury what you observed about Paitin?
Colleen Mistovich (07:26:32):
What I remember about Paitin is that she was on a ventilator. She was unresponsive. She had petechiae, bleeding blood vessels underneath her skin from her neck region to her head.
(07:26:46)
I do remember with her, specifically, her eyes. So if you pull down, you've got your conjunctiva, which is the kind of the lining of the eye here. It's usually pale or pink. I remember that she had horrible petechiae with bleeding spots underneath in both of her eyes.
(07:27:01)
She had ligature marks, so areas of her neck where it appeared something had been tied around to cause the circular injuries on her neck.
(07:27:10)
I do remember that she had vesicles, so open, not open, they were closed vesicles, almost like fluid filled blisters on the palms of her hand, but I can't remember. It was one hand. I can't remember which one.
(07:27:22)
I don't remember much about her torso. We do a head-to-toe assessment. So when the SANE nurses come in, our role is to really look at everything through and through.
(07:27:30)
I remember that she had some swelling, I believe, behind one of her ears and that she had something on the bottom of her foot. It was like a lesion or a mark on the bottom of her foot.
Speaker 2 (07:27:45):
Okay. While Jessica was doing the head-to-toe and you were assisting her, did you have a chance to see some of the injuries caused to her vaginal region?
Colleen Mistovich (07:27:55):
Yes, sir.
Speaker 2 (07:27:56):
And her anal region?
Colleen Mistovich (07:27:57):
Her anal reason, region, yes, sir.
Speaker 2 (07:28:00):
All right. Could you describe those for us?
Colleen Mistovich (07:28:02):
I can. Would I be able to have a copy?
Speaker 2 (07:28:04):
May I approach?
Judge (07:28:05):
You may.
Speaker 2 (07:28:22):
I'm going to show you what's already been admitted as State's Exhibit 11. Ask that you review that. Do you recognize State's Exhibit 11?
Colleen Mistovich (07:28:42):
Yes, sir.
Speaker 2 (07:28:43):
What is State's Exhibit 11?
Colleen Mistovich (07:28:45):
This is a copy of Paitin Field's medical record that was conducted by Jessica McAlear and part of the SANE record.
Speaker 2 (07:28:51):
All right. And I'm going to ask you again, do you remember some of the injuries to her vaginal area?
Colleen Mistovich (07:28:59):
I do.
Speaker 2 (07:28:59):
All right. And what were those injuries?
Colleen Mistovich (07:29:03):
I think Jessica did a lot of teaching already about the barn door. So when you first go in to look at a child, everything is, or an adult actually, but everything is usually closed.
(07:29:12)
You got the labia majora. So you open that up and like Jessica said, when we look at something, with the way we document is we're looking at the inside and we're looking at a clock. So at 12 o'clock, that is 12 o'clock, three o'clock, six o'clock and nine o'clock.
(07:29:25)
When we document injury, we're documenting in those areas so that we know that at two o'clock, this is where we've seen this injury, five o'clock. And it gives us and other medical people an idea of where we've seen it.
(07:29:37)
So for Paitin's, there was redness to the vestibule and the periurethral bands. So once again, the way I describe it, 12 o'clock, three o'clock, six o'clock and nine o'clock. You have the vaginal, so the hymen, and then the vaginal canal is here.
(07:29:53)
The periurethral bands kind of come down from the ureter. So your ureter is where your catheter would go in or where you pee from. The clitoral hood, it covers that a little bit. So the periurethral bands kind of connects everything right here. There was redness to that periurethral bands and the vestibule. Your vestibule is kind of this area here that attaches to the hymen.
(07:30:16)
There was a submucosal hemorrhage to three o'clock to the vestibule. So we're looking at right here. That's a little bit of bleeding, bruising underneath the first layer of skin. You see that mostly in areas of mucosal areas. So your mouth and your vagina, they have that mucusy kind of tissue.
(07:30:34)
There was a laceration to the clitoral hood. So your clitoris sits here, your clitoris has a piece of skin that kind of protects that and there was a laceration up under here, a laceration being a break in the skin. So anyone who's cut themselves knows if you have a break in the skin, it's separate and separated.
(07:30:52)
There was a mucosal hemorrhage to 10 and 11 o'clock within the vestibule. So you're looking right about here and that's that bruising, that kind of like that blood blister, I think you can name it, but something right underneath the skin.
(07:31:04)
There was a one centimeter by one centimeter bruise on the left labia majora. So those are your outer lips.
(07:31:10)
There was an abrasion to five o'clock in the vestibule. So once again, the vestibule is going to sit right up here underneath the hymen. So you're opening your hymen and then your vestibule is kind of that skin layer on the side. There was a marked abrasion there.
(07:31:23)
So an abrasion is an area that is, if there's friction, if there's rubbing, that type of thing will take that first layer off. And I think if you're on a bike and you fall, you can get an abrasion on your leg.
(07:31:34)
And then there was several lacerations to the anal opening, which were marked by the uptake of the Toluidine Blue dye.
Speaker 2 (07:31:41):
Okay. And you said you've done how many examinations over the course of your career?
Colleen Mistovich (07:31:45):
I have done a lot. So I've been a nurse for 33 years. I would say well close to 1500.
Speaker 2 (07:31:51):
I would tender at this time, tender Colleen Mistovich as a expert in sexual assault nurse examination.
Judge (07:32:00):
Any objection?
Luther Britt III (07:32:01):
No, sir.
Judge (07:32:02):
The witness will be tendered as an expert in the field of sexual assault nurse examination.
Speaker 2 (07:32:10):
What are these injuries? You saw these injuries with your own eyes, correct?
Colleen Mistovich (07:32:13):
Correct.
Speaker 2 (07:32:15):
And based upon your expertise, what are these injuries could be caused from?
Colleen Mistovich (07:32:23):
Some type of penetrative blunt force trauma.
Speaker 2 (07:32:27):
Okay. You've heard people talk, I think this afternoon, about Paitin came in soiled, and she had to require some cleaning. Based upon your experience, are these types of injuries that you see from cleaning by medical staff?
Colleen Mistovich (07:32:48):
No. I mean, we don't cause injury when we clean. So usually with children, you would use something soft and warm to wipe off and to not... We were not causing friction. We're not poking. We're not doing that. We're cleaning and wiping.
Speaker 2 (07:33:05):
Okay. And talking about the injuries to Paitin's anus, are you familiar with rectal thermometers?
Colleen Mistovich (07:33:10):
I am.
Speaker 2 (07:33:10):
And have you ever taken a rectal temperature?
Colleen Mistovich (07:33:13):
Many.
Speaker 2 (07:33:14):
And in the times that you've done sexual assault examinations and you've done rectal temperatures, have you seen a rectal thermometer cause injuries to an anus like you saw in Paitin?
Colleen Mistovich (07:33:26):
No, I have not.
Speaker 2 (07:33:28):
Same with catheters, whether a catheter to extract a urine sample, have you conducted those types of urine extractions with a catheter?
Colleen Mistovich (07:33:42):
Yes, sir.
Speaker 2 (07:33:42):
And have you seen those cause injury to any of the parts of the vagina, including the clitoral hood that you saw in Paitin?
Colleen Mistovich (07:33:54):
No, I have not. A child's catheter is much smaller than what you would see in an adult catheter. They're very tiny and they're very pliable.
(07:34:02)
So there's a, we call it five French or an eight French and very small, very tiny, and you push it in. If you hit here with, it'll bend. So you have to be inserting it into the urethra, or you're not going to get it to feed through.
Speaker 2 (07:34:19):
Now, did you assist Jessica just once or more than once throughout the time that Paitin was at the hospital?
Colleen Mistovich (07:34:30):
I assisted her on the 13th during that day, just for pictures.
(07:34:34)
The next morning I went back sometime during that morning and assisted her with, I think I obtained the fingernail clippings and swabbed underneath Paitin's nails.
Speaker 2 (07:34:44):
Okay. Did you also, you and Jessica, also take additional pictures on the 13th and the 14th?
Colleen Mistovich (07:34:53):
We did.
Speaker 2 (07:34:53):
Did you go back multiple times?
Colleen Mistovich (07:34:54):
Yes, sir.
Speaker 2 (07:34:55):
What's the purpose of that?
Colleen Mistovich (07:34:56):
Because wounds change over time and sometimes you don't get the picture that you want, or you may have more injury that we didn't see.
(07:35:03)
Jessica requested that I come up because sometimes you get a different... If you have two people looking at something, somebody might catch something that somebody else missed. And with bruising, it can progress. It can change colors. Things come up that you didn't see the first time.
(07:35:16)
So when you have a case like that, especially if it's an ICU case and you've got the capability and you've got a patient who's still going to be there, you want to go follow through and repeat your pictures and see if there's any changes.
Speaker 2 (07:35:28):
And what about wounds that heal? Do wounds heal over time?
Colleen Mistovich (07:35:33):
They do.
Speaker 2 (07:35:34):
And talk about wounds that heal, especially in the vaginal region. What's your experience based upon your... Well, what's your opinion based upon training and experience?
Colleen Mistovich (07:35:45):
You can never date or time the healing of a wound, so that's impossible because different people heal differently. But there is literature that shows the vagina area, the mouth area, the mucosal areas will heal faster. The rectal anal area will heal faster. It's a different type of tissue.
(07:36:02)
And really a woman's body is made to have a baby, have sex. Injuries happen there, but they also heal very quickly there.
Speaker 2 (07:36:09):
And again, based upon your training and experience and your expertise, were these wounds that you saw on Paitin on the 13th, were these healing wounds? Were they acute wounds? Do you have an opinion on that?
Colleen Mistovich (07:36:26):
Once again, I can't date or time a healing process. I can tell you that they appeared like they were new. So if you have a wound on your hand and you cut your hand with a knife, you can tell that the edges are not together, that you have an open wound.
(07:36:39)
On the laceration per se, she still had it open. There wasn't a different granulated scar tissue there. There wasn't like a healing. But for me to be able to say when that occurred, I can't date or time it.
Speaker 2 (07:36:50):
Sure. You said just a moment ago that you went back at some point and collected nail clippings and swabbings from Paitin's hands.
Colleen Mistovich (07:37:01):
That's correct.
Speaker 2 (07:37:01):
Correct. May I approach the witness, Judge?
Judge (07:37:03):
You may.
Speaker 2 (07:37:03):
Okay. All right.
Luther Britt III (07:37:03):
[inaudible 07:37:18].
Speaker 2 (07:37:25):
I'm going to show you what's been marked as State's Exhibit 21 for identification purposes and ask that you review the box number one, and then we'll continue after that. Do you recognize 21?
Colleen Mistovich (07:37:37):
Yes, sir. I do.
Speaker 2 (07:37:38):
And what is 21?
Colleen Mistovich (07:37:40):
21 is the North Carolina State Crime Lab Laboratory Sexual Assault Kit that I utilized that day to collect the fingernail swabs and the fingernail clippings.
Speaker 2 (07:37:50):
All right. And it says Sexual Assault Kit, but these aren't vaginal swabs like Jessica just previously testified. These are your swabbings. You use the same kit for swabbing.
Colleen Mistovich (07:38:00):
It's the same kit. You can actually utilize the envelopes that come in this kit if there's areas for different things. So we utilize one of the envelopes we can cross out and say, "This is Nail Clippings and Nail Swabs."
(07:38:13)
If there's areas that you want to be able to test and you don't have an envelope for, we can just cross out and write it on there so that the crime lab knows what we collected. And that is what I did with this kit.
Speaker 2 (07:38:23):
And how do you recognize 21 from just looking at the box?
Colleen Mistovich (07:38:26):
The chain of custody says that this was received from Colleen Mistovich, RN SANE A, and was also given to the Detective Leatherwood at 11:15:17 at 10:00 AM.
Speaker 2 (07:38:36):
All right. And I'm going to ask you to open that box, and then there's a series of envelopes in that box and ask that you review those envelopes.
Colleen Mistovich (07:38:47):
Would you like me to read these?
Speaker 2 (07:38:48):
Not yet. Do you recognize those envelopes?
Colleen Mistovich (07:39:06):
Yes, sir. I do.
Speaker 2 (07:39:07):
And what are those envelopes?
Colleen Mistovich (07:39:09):
We did individual fingernail clippings and swabs underneath the nail for each one. So this is the right middle finger.
Speaker 2 (07:39:18):
Hold on, let me do it. I'm going to do it. I've already got it marked, and I'll walk you through.
(07:39:34)
So I'm going to show you 21A and B. We're going to do two at a time. 21A is what?
Colleen Mistovich (07:39:41):
21A is the right hand, a thumb, and a nail bed.
Speaker 2 (07:39:45):
And is this a scraping or a clipping, do you know?
Colleen Mistovich (07:39:49):
I do not.
Speaker 2 (07:39:50):
Okay. Then 21B?
Colleen Mistovich (07:39:53):
21B would be the right index finger and nail bed.
Speaker 2 (07:39:56):
Okay. 21C?
Colleen Mistovich (07:40:03):
21C would be the right little finger and the nail bed.
Speaker 2 (07:40:06):
21D?
Colleen Mistovich (07:40:09):
21D would be the right finger and the nail bed.
Speaker 2 (07:40:12):
21E?
Colleen Mistovich (07:40:15):
21E is the right middle finger and nail bed?
Speaker 2 (07:40:19):
21F?
Colleen Mistovich (07:40:23):
21F is going to be the left index finger and nail bed.
Speaker 2 (07:40:26):
21G?
Colleen Mistovich (07:40:29):
21G will be the left middle finger and nail bed.
Speaker 2 (07:40:31):
21H?
Colleen Mistovich (07:40:35):
21H will be the left ring finger and nail bed.
Speaker 2 (07:40:38):
21I?
Colleen Mistovich (07:40:41):
21I will be the left baby finger and nail bed.
Speaker 2 (07:40:45):
21J?
Colleen Mistovich (07:40:47):
21J will be the left hand, thumb, and nail bed.
Speaker 2 (07:40:50):
And then finally, 21K?
Colleen Mistovich (07:40:54):
21K will be the left posterior foot.
Speaker 2 (07:40:58):
And you said earlier that you did, you took samples from Paitin's hands, left and right, and then you mentioned something on her foot. What did you do with the foot?
Colleen Mistovich (07:41:10):
I swabbed this along with Jessica, and I do not remember.
(07:41:14)
It is my practice that when we use the light source, so when you scan somebody, you're looking for any kind of illumination, that I would've probably seen something that illuminated and would've swabbed that.
Speaker 2 (07:41:26):
All right. And are State's Exhibits 21A through K in substantially the same condition as when you took the samples from Paitin?
Judge (07:41:38):
Yes, sir.
Speaker 2 (07:41:38):
All right. And move to introduce State's Exhibit 21 and then subsequently 21A through K, Judge.
Judge (07:41:47):
21D, what was that? Right...
Speaker 2 (07:41:50):
21D?
Colleen Mistovich (07:42:00):
21D would be the right ring finger and nail bed.
Judge (07:42:02):
Thank you. Any objection?
Luther Britt III (07:42:04):
No, sir.
Judge (07:42:06):
State's Exhibit 21 will be admitted into evidence with the underlying 21A through K also being admitted.
Speaker 2 (07:42:16):
Thank you.
(07:42:17)
And Colleen, after taking these samples, what else did you do, if anything, in this case regarding Paitin?
Colleen Mistovich (07:42:25):
I do remember that me and Jessica got together and reviewed the photos to look for injuries-
Speaker 2 (07:42:30):
Okay.
Colleen Mistovich (07:42:31):
... and to kind of talk to each other to say, "Are we seeing the same thing?" And kind of confer and share opinions.
Speaker 2 (07:42:37):
Okay. And during that conference, did you find the same or similar injuries, and were there any differences in your opinions on Paitin?
Colleen Mistovich (07:42:48):
No, sir. What I read out on that form of the injuries that Jessica had noted, I was in agreeance with.
Speaker 2 (07:42:54):
Okay. Okay. No further questions at this time, Judge.
Luther Britt III (07:43:00):
Counsel, can I approach?
Judge (07:43:20):
Cross examination?
Luther Britt III (07:43:21):
Yes, sir. Just brief. Ms. Muskovich?
Colleen Mistovich (07:43:29):
Mistovich.
Luther Britt III (07:43:33):
Mistovich. The purpose of clipping the nails and scraping the nail bed, can you explain what that's for?
Colleen Mistovich (07:43:41):
Yes. So what we were doing is you're looking for any type of DNA that might be underneath the nail bed, any type of foreign bodies that might be underneath there.
(07:43:49)
If it's a victim that can talk to you, you want to corroborate their story. So if someone tells you that they were on the beach and something happened to them and I swab underneath their nails and I find sand, that tells me that she was at the beach. So it just gives us an idea. It corroborates the story.
(07:44:02)
It also helps us find DNA. If somebody had an attacker and was trying to fight them off and they scratched them, we may be able to find DNA underneath there.
Luther Britt III (07:44:10):
So do you do the nail scrapings and the nail bed before you do the clippings?
Colleen Mistovich (07:44:17):
You would take the swab. It's a swab underneath the nail bed and then clip afterwards, sir.
Luther Britt III (07:44:22):
And so how far back do you got the nail?
Colleen Mistovich (07:44:24):
It all depends on how long the person's nail is. You don't want to do injury to them. So if they've got longer nails, you're going to clip back to here. If you're somebody like me who has no nails, then you're going to have a more difficult time.
Luther Britt III (07:44:38):
So anything that you may have collected on the swabs of the nail or the clippings and the nail bed, those matters wouldn't be visible?
Colleen Mistovich (07:44:45):
It depends. If there was blood underneath the nail bed and I swabbed that, I would expect to see a pinkish tint fluid on the Q-tip. If it's something that's a chemical or clear that I can't see, then no, I would not be able to see it.
Luther Britt III (07:44:57):
With Paitin's nails and her nail beds, did you see any blood?
Colleen Mistovich (07:45:01):
I do not recall.
Luther Britt III (07:45:04):
And that's packaged in the sexual assault kit box, given to the police and the sheriff's department and goes to the state lab?
Colleen Mistovich (07:45:11):
Yes, sir.
Luther Britt III (07:45:12):
All right. Thank you. I don't have any other questions.
Judge (07:45:12):
Redirect?
Speaker 2 (07:45:12):
No, Your Honor.
Judge (07:45:15):
Is this witness subject to recall?
Speaker 2 (07:45:16):
No, Judge.
Judge (07:45:17):
On behalf of the defense?
Luther Britt III (07:45:18):
No, sir.
Judge (07:45:19):
All right, ma'am. You're released from your obligations of your subpoena. You may step down. You're free to go.
Colleen Mistovich (07:45:23):
Thank you.
Judge (07:45:23):
Thank you.
Speaker 31 (07:45:23):
Please be careful. [inaudible 07:45:27].
Colleen Mistovich (07:45:23):
Thank you.
Judge (07:45:35):
All right, members of the jury, we're going to go ahead and break for the day, close up your notebooks, take off your red badges and clip them to your notebooks. It'll make it easier to pass out in the morning.
(07:45:49)
Members of the jury, as you go home, I remind you, do not talk amongst yourselves about this case. Do not talk with anybody else about this case, especially as you're going home and this is the first day of evidence. You cannot talk with anybody else, including friends, family members, or coworkers about this case. Do not have any contact with any of the parties, attorneys, or witnesses.
(07:46:15)
Do not conduct any independent investigation or inquiry. If you have to go by any of the locations that have been mentioned in this trial, you may pass by them, but you're not allowed to stop and conduct any independent investigation. You're especially not allowed to go online and look for more information about this case. You are not allowed to post online on any social media sites regarding your experience as a juror or any of the evidence you've seen or heard.
(07:46:43)
So we'll go ahead and excuse you, and we will reconvene tomorrow morning at 9:30.
Speaker 31 (07:46:48):
Thank you, Your Honor. Make sure that your closed notebook and juror bag are left in your chair. When you're ready, front row then back this way, please.
Jury (07:46:53):
[inaudible 07:46:58]
Speaker 32 (07:46:53):
Thank you.
Luther Britt III (07:46:53):
[inaudible 07:47:04]
Speaker 31 (07:46:53):
[inaudible 07:47:10] The jury's [inaudible 07:47:32]
Judge (07:47:32):
Thank you, sir. Let the record reflect that the jury has exited the courtroom. Is there anything that we need to discuss on behalf of the state before we break?
Speaker 2 (07:47:39):
No, Your Honor.
Judge (07:47:40):
On behalf of the defense?
Luther Britt III (07:47:42):
No, sir.
Judge (07:47:42):
We had one bench conference. I asked Mr. Britt whether or not he wanted to conduct his cross-examination today before we broke, and he said that his examination wouldn't last long. We'll be in recess until tomorrow morning at 9: 30.
Speaker 31 (07:48:06):
Court will be in recess till tomorrow morning at 9:30. 9-
