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Trial Testimony - Day 5
Written by Mike Mayleben   
Saturday, 12 September 2009 19:31

Friday, March 27, 2009

PROSECUTION WITNESS:

Dr. Jeff Lee, chief forensic pathologist and deputy coroner for Licking County coroner's office

Background information: One year specialty forensic fellowship, worked two years at Central District of Office of chief medical examiner, assistant chief medical examiner, did death investigations, forensic pathologist, nine years experience in the field of forensic pathology.

Lee's professional organizations: National Association of Medical Examiners, College of American Pathologists

He is not board certified in pathology, but in osteopathic medicine.
Lee has performed roughly 240-250 autopsies per year.

Prosecutor John Arnold begins to show Lee autopsy pictures of Sarah Widmer.

Lee did not conduct an autopsy on Sarah, but reviewed autopsy reports, ER reports and medical reports back to her teenage years.  

Lee says he agrees with conclusion that Sarah drowned.

“There were several injuries you don’t typically see with drowning. There were a few lacerations or cuts to her upper lip,” Lee says. “There was a bruise to her neck, there was a bruise on the left part of the chest, near the armpit, and there was an abrasion right next to her armpit.”

Lee tells the jury that lacerations to her upper lip are seen usually after a fight, fall or when someone is being intubated.

The EMS team say they attempted to stick the IV in Sarah’s neck a few times and on the third time, they were successful.

Arnold shows an autopsy picture of the back of Sarah’s neck to Lee and the jury. “In a drowning it’s not usual to see a bump or bruise on the head or neck,” Lee says.

...Exhibit 416 another picture of Sarah’s neck is shown to Lee and the jury. This picture shows a deeper incision to the neck and the evidence of bruising.

Lee points out bruise on right side of Sarah's middle to lower neck on photo.  He describes these bruises as the result of blunt force. These injuries are not consistent with life-saving techniques.  “There’s no reason for someone to mess with the neck during CPR,” Lee says.

Lee tells the jury that he’s seen patients that have gone through CPR efforts all the time and that he’s never seen these types of injuries associated with a drowning victim.

There’s a bruise on the front of her neck and the right side of her neck.  Arnold shows the jury those autopsy photographs. Using the computer screen, Lee points out the areas where those bruises were located.
He does the same thing with another autopsy photo; he describes the injuries as bruises due to some type of blunt force to Sarah’s neck.

“I’ve never seen anyone who’s been through CPR have injuries on their neck,” Lee says.

Arnold asks Lee to tell the jury why are we seeing something different on the 15th, than the photos on the 12th?

"The injury on the back of the neck had occurred before. The infusion on the left was due to the IV that was inserted, that’s why it was different," Lee says.  He also says that if it’s a true strangulation, then it’s more injury than that.

Lee tells the jury that there were three bruises under Sarah’s scalp. Arnold shows the jury an autopsy photo of Sarah’s scalp with the three bruises. Lee circles the areas that he describes to give the jury a better understanding of what he’s talking about. He says he believes those bruises are a result of blunt force.

“When there are four distinct injuries on her head, that’s worrisome and I don’t think that’s accidental,” Lee says.

(Some members of the jury take notes.)  

Lee explains about burst blood vessels in Sarah's eyelid, which he said are commonly found in hanging, strangling or drowning victims. He says those shown in photo likely result of drowning.

...Bodies are often kept in cooler an additional day because bruises sometimes reveal themselves with a little additional time. Blood decomposition sometimes aids this process, because broken-down hemoglobin sometimes changes colors and becomes more easily seen.

...Arnold shows photo from second autopsy that shows bruising on left side of Sarah's neck.
Shows bruising that he describes as being from IV tube, but also what he says is a distinct second bruise. Different coloration suggests these are seperate injuries, he says.

Says his opinion is that someone grabbed Sarah's neck with right hand.  When strangulation is cause of death, more bruising typically seen.  No fracture to hyoid bone, which typically occurs during strangulation.

Lee says he does not recall seeing additional external injuries to Sarah's body, but he begins discussing internal injuries. For example, he notes three bruises seen when scalp reflected during autopsy.

Three distinct bruises noted on underside of scalp, near area behind right ear. Photo shown.

...Lee says Sarah likely dead when brought to hospital, where she was pronounced dead.

Sarah’s body was tested several times to determined if she had any medical problems. Lee reviewed those records and says that he didn’t find anything serious. He says her cholesterol was only three points higher than normal.

“She was a relatively healthy person,” Lee says.

...Lee believes that Sarah’s cause of death was a homicide because of the injuries found during the autopsy.

...Meds administered at ER not listed on autopsy toxicology report, but those meds could not be pumped from left side of neck to portion of body where blood was drawn during autopsy. Suggests no circulation at that point, Lee says.

...Sarah's medical history contained no indication that she had any underlying medical problems, including seizures, Lee says.

...Lee says Sarah had regular contact with physicians, likely yearly checkups. Lot of contact for a healthy person, he says.

...Lee says no evidence in existing medical reports, including autopsy, would suggest heart or brain problems, although he did not examine either organ himself.

...Seizures often genetic, Lee says, and no one in Sarah's family suffered from that conditon, so unlikely she did.

...Lee says phsyicians typically try to rule out most common conditions when examining patients and then move on to less common things as those are ruled out. "When you hear hoofbeats, you try to think of horses, not zebras," he says.

...Sarah's body being dry and hair being damp could be used as factor to determine manner of death, Lee says. Defendant's claim that wife floating face down could be another factor. That story doesn't match evidence of dry body, damp hair, he says.

"Is it going to be logical that she was floating face down and then in a manner of minutes is dry, or is that not logical," Lee asks.

After reviewing everything, in addition to police reports, he believes this is a homicide. Lee says too many peculiar injuries to be accidental. Only seen one suicidal drowning, so that's very rare, so this has to be a homicide.

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DEFENSE CROSS EXAM:


...Lee was hired in January 2009; months after Dr. Uptegrove's autopsy.

...Lee says drowning typically takes 3 to 4 minutes.

...EMT records show Sarah's body hot to touch. Lee is aware that those records show Sarah's hair wet.

Carpet samples that showed foamy, frothy blood taken from underneath body were also wet, according to a crime lab tech. Lee was not aware of those samples or of blood evidence but Lee says he'll take Rittgers word for it.

Rittgers begins to list places around the house where there were no signs of a struggle. He also points out that there were no wet towels found.

Rittgers asks Dr.Jeffrey Lee if he was aware that there were no signs of any struggle. Lee never heard whether wet towels or rugs were found or not.  

Rittgers asks Lee if he was aware that Ryan didn’t have a mark on him.  Lee knows Ryan was interviewed the night of Sarah's death, but was not aware whether Ryan had any marks or injuries. Lee says knowing whether he had such marks might have influenced his findings.

Prosecutor Arnold objects but Judge Bronson sustains the motion.

...Rittgers says there was no sign of any hair lost. Rittgers then asks Lee if he was aware that her skull wasn’t cracked, no injury to the brain, or the jaw bone.

Lee agrees that no chunks of hair appeared to have been pulled from Sarah's head, and saw that hair appeared to have been wet and dried. Not sure if it might have been crushed.  Lee was also aware that skull not cracked and no deep injuries existed inside skull or to brain.

Lee says he believes attempts at resuscitation took about an hour, until she was pronounced dead at 11:41 p.m. He's aware that medics performed almost constant chest compressions.  He's aware of three failed attempts at intubation, but some prior testimony has indicated five such attempts.

...Rittgers ask the judge if they can approach the bench. The defense team and the prosecution team approach the bench to talk to Judge Bronson.

...Rittgers asks Lee if he has an opinion of how Sarah died.

Lee thinks Sarah was pushed or held with her head completely immersed underwater, either with her head in a  sink, tub or toilet. Could have been running water, not submerged in water.  He doesn't believe her body was submerged in water.

Rittgers asks Lee to demonstrate how he believe Sarah died. The younger Charlie Rittgers acts as a stand-in for Sarah.  Using edge of jury box as prop, he begins to push Rittgers's head down.

Prosecutor Arnold objects and asks if they can approach the bench.

Both the defense and prosecution approach. Afterwards, Lee continues to show the jury how he believes Sarah died. Turning the younger Rittgers so his back faces jury, Lee suggests her face could have been held face up and submerged or pushed under running water.  Lee says he cannot know which might have happened, but that's his theory.

...Rittgers says there were no injuries to Sarah's knees, toes, feet, and Lee agrees. No significant bruising on legs, no bruises on shoulders or back, no signicant hair loss. So how is it that you believe her head was put in toilet and drowned?

...Not sure if toilet, sink or bathtub, he says. He hasn't been to the scene or made any measurements.

...Photo shown of master bathroom sinks (double his-n-hers style). Lee has seen this photo before, he says. Toothbrushes, maybe a razor sitting neatly around basins.

Rittgers asks Lee if he was aware that there was no blood found on the sink, he then tells Lee that the photos were taken the night Sarah died.

Lee claims he didn’t know when the photos were taken. Rittgers again indicates that there were no signs of a struggle. Rittgers shows a side view picture of the bathroom sinks.  “Do you see any water dripping from the sink, or anything misplaced, or any damage to the counter,” Rittgers asks.

“No,” Lee says.

Rittgers asks Lee to describe the situations possible if there was a struggle, based on the picture.
Lee says items are typically strewn about, and it doesn't look like one occurred, but can't say one didn't occur.

Rittgers points out Sarah's rings, asks if she might have taken them off before bath. Some do, some don't, he says.  Another view of sinks is shown. Other than comb, hair straightener, toothpaste, all would appear to be in order?   Lee agrees.

No water appears to stain mirror or on counter, no visible damage to counter or cabinets.
Another view of sinks shown, with items on floor visible. Toiletries bag, magazine, towel sitting on floor. Lee says could be evidence of struggle, says infinite number of ways that a struggle could have taken place.

Rittgers asks him to again describe how Sarah, in his opinion, died that night.

“Sarah in my opinion died because her head was pushed over the edge of a sink or a bathtub, or toilet, either forward or backwards,  and held under water, either pooled or running.” Lee says.

...Lee would not agree that Ryan would necessarily have suffered defensive wounds in a face-to-face struggle.
Says victims sometimes suffer injuries to hands in struggle with assailants. Lee was not aware of any forensic testing results on Sarah's hands, which had no wounds that were noted in autospy exams. Only unknown female DNA, Rittgers says.  Ryan's hands at some point, or a hand, was on front of neck and/or back of neck, Lee says.

...Lee hasn't heard much in reports he saw, about whether walls near tub were wet, or whether tub was wet. Rittgers asks if that information might contradict his opinion about a struggle in tub. No, because water may be wiped away.

Prosecutor Arnold objects to a gesture by Rittgers.

...Rittgers asks Lee if he was aware no evidence found to suggest that water had been wiped or cleaned up, and Lee says he was not.

Rittgers then asks Lee, “Were you aware that there wasn’t any wet towels found?”

Lee says "yes, but water can dry."

Lee says Sarah might have possibly been thrashing, and Lee says bruises suggest she may have been unconscious. Rittgers says, "Whoa," and judge asks him not to say things like that. Unconsciousness does not always occur from skull fractures or injuries to brain.

...Rittgers asks if Lee has heard of the theory fight or flight?  "Yes", Lee says.

...Lee says he's not sure if he'd agree that Sarah would have to fight to save her life. If person attacking her stopped, that would also save her life and injuries don't always leave marks. Injuries are variable, Lee says.

Rittgers then asks Lee if he was aware that there was no skull fracture or damage to the fingernails or bruises to the hands. Rittgers is trying to suggest that there was no struggle or fight from Sarah.

“It would be to her benefit if she had fought back,” Lee says.

The abrasions on Sarah were brought back up. Lee describes that because some of the abrasions found were still red, it indicates that they happened while Sarah’s heart was still pumping.

Rittgers brings up the point that if she was struggling to keep Ryan off of her, then her knees or nails would be damaged.

The autopsy revealed that those areas were not damaged on Sarah’s body.

...Lee has met Dr. Spitz a couple of times, agrees that he's a world-renowned pathologist. Has 3rd and 4th editions of his textbook.

...Lee says he hasn't done any CPR for about 15 years, during a hospital internship

...Lee says intubation is very stressful and he did not like doing it. If EMS personnel had to manipulate head to get right view to intubate, could that have caused bruise to back of head? No, Lee says. If heart not beating, can't effectively form a bruise. Medics never got a heartbeat despite working with her for nearly an hour, he says.

Rittgers asks, What about chest compressions? Aren't you moving blood column 20 to 25 percent its normal volume? "You're trying to", Lee says, but he's not sure how successful they may have been. Lee says all bruising he saw in autopsy likely formed around time of death, but hemorrhaging and infusing of blood from left jugular may have occurred post-mortem.

...Lee says bruising shown on Sarah's arm during second autopsy is not, in fact, a bruise, but blood infusion from a needle stick. Basically blood leaking from a broken vein.



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PROSECUTION REDIRECT:


..." You're familiar with Dr. Spitz and his books?"  Yes, I have two of them. Has 3rd and 4th editions of his textbook.

Would you agree with his statement that contusions are usually the result of a squeeze or blow that breaks blood vessels but not the skin?  Lee would agree.

What about this statement: Hemorrhage in anterior neck muscles does not usually occur in drowning and should always raise suspicions? Lee would agree with that statement, and that it applies to this case.

Lee is excused from the stand.

The State of Ohio Rests.


+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++


The Defense Begins.


FIRST WITNESS:  Amy Karabaic, went to dental hygiene school with Sarah Widmer

She and Sarah became close friends in school, became closer afterward. Continued friendship after she moved away in 2006. Spoke frequently on phone, visited Sarah three times here and Sarah visited her at her home. Stayed with Sarah and Ryan.

She tells the jury she never noticed the two of them fighting or arguing and that she didn’t believe Ryan ever abused Sarah.

Defense attorney, Rob Dziech asks Karabaic about Ryan’s demeanor. She says he was overall a pretty nice guy. She didn’t notice any financial problems or drinking problems.  She has nothing negative to say about him.
Sarah never indicated Ryan had drinking problem, and remembers Sarah purchased kegerator for Ryan's birthday.
She has no recollections of mental or psychological abuse.

She says she had no indication that either Ryan or Sarah were having an affair. Recalls they had planned to purchase boxer puppy, take trip to Cancun in October.

Defense asks Karabaic if she was aware of any health problems with Sarah.

Karabaic missed call from Sarah around 5 p.m., returned call around 7 p.m. “We talked briefly and she said that she had a headache and that the back of her neck was hurting. ”  They made plans to talk again the following Friday. Nothing unusual about conversation, except Sarah sounded tired and like she didn't feel well. Knew that Ryan was home. Heard Sarah say something to him during phone call.  Sarah did not sound angry or distressed.

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PROSECUTION CROSS EXAM:  


...She recalls Sarah's father passed away in March, but not exact date (March 3). Knew he had long illness, terminal cancer.

...Did not know about Sarah's doctor exam in March. Met at Raymond Walters College in 2004. Does not recall seeing her fall asleep in class or while working with patients in clinical work.

...Has consumed alcohol with Sarah, but not much. She never saw Sarah fall asleep in public or stay out especially late, she says. She agrees Sarah was a private person, didn't share a lot of private life with others. She does not know what Sarah shared with others.

...Knew Sarah often went to lake house with family and friends, but witness never joined them.

...Sarah complained of headaches during school, possibly other times. A frequent complaint. Doesn't know if related to sinus or allergy problems.

...Agrees she doesn't know Ryan very well, only through Sarah. Never knew of Sarah falling asleep in bathtub or having convulsive seizure.

...Witness says she spoke frequently with Sarah, but not for great lengths of time.

...Doesn't know if Sarah took medication for headache. Sarah did not often speak specifically about Ryan.

Witness excused.  Court adjourned for the day.