(The hearing reopened at 1304 hours, 10 July 1970.)
COL ROCK: This hearing will come to order. Let the record reflect that those parties who were present at the time of the break are currently in this session. Please proceed.
CPT SOMERS: The government calls Major Straub.
MR. EISMAN: Excuse me; I was under the impression before the break that Pamela Kalin was going to be called next.
CPT SOMERS: It is necessary to change the order.
COL ROCK: Unfortunately you weren't here when this change occurred. I was notified about fifteen minutes ago. Would you please explain, counsel for the government, why the change of the witnesses?
CPT SOMERS: Well, sir, it became necessary to change the witnesses because in the testimony of Pamela Kalin, there are many things that we wish to -- and some evidence that we wish to use. In attempting to gather this together and present it out of order, which we're trying to do, we simply are incapable of doing it at this point, and we don't anticipate being able to do it now until Monday.
MR. EISMAN: If we might have a brief recess, I might discuss the matter with counsel. I might wish to speak with Major Straub before he testifies as I wasn't aware that he was going to testify at this time. If I may have about ten minutes.
COL ROCK: Certainly. This hearing will be recessed for ten minutes.
(The hearing recessed at 1306 hours, 10 July 1970.)
(The hearing reopened at 1322 hours, 10 July 1970.)
COL ROCK: The hearing will come to order. Is the counsel for the government ready to proceed?
CPT SOMERS: Yes, sir.
COL ROCK: Please bring your next witness.
CPT SOMERS: I call Major Straub.
(Major William H. Straub was called as a witness by the government, was sworn, and testified as follows.)
Questions by CPT SOMERS:
Q Would you state your full name, please?
A William Henry Straub.
Q Your grade?
Q Your organization?
A Womack Army Hospital.
Q Your station?
A Fort Bragg.
Q And your armed force?
Q What degree do you hold, sir?
A I hold a Bachelor of Arts and Doctorate of Medicine degree.
Q Where did you receive your MD degree?
A Georgetown University.
Q And have you done an internship?
MR. EISMAN: If the investigating office would permit us, I would agree to stipulate to the qualifications of Major Straub, that he is a qualified physician so that we can save time. I have no questions about his qualifications.
CPT SOMERS: I'd like to ask just one or two more questions.
COL ROCK: All right, proceed.
CPT SOMERS: You have done an internship, sir?
A Yes, I interned at the University Hospital in Seattle, Washington.
Q Have you done a residency, sir?
A I did a three year residency in radiology at the University of Michigan.
Q And have you been certified by the American Board of Radiologists?
A I am certified by the American Board of Radiology.
CPT SOMERS: I do offer this witness as an expert medical witness.
MR. EISMAN: No objection and no questions.
Q Doctor Straub, what were your duties on the night of 16th and 17th of February of this year?
A Well, I was assigned to the Emergency Room at Womack Army Hospital as one of the physicians on duty.
Q And during the course of your duties that evening did you have an occasion to see Captain MacDonald?
A Yes, I did.
Q How did that come about, sir?
A I was -- had retired. We had cleaned the emergency room out of patients and I had laid down. I was awakened by one of the nurses who told me to come quickly, that a doctor had been stabbed and that his family had been killed.
Q And what did you do then?
A I walked back to the room which they had wheeled Captain MacDonald into and quickly examined him.
Q And what was the result of your examination? What did you find?
A He was conscious. He was naked from the waist up and had some dried blood on his face; had a wound in his right chest which had been covered with a piece of gauze, Vaseline gauze. He had a bruise on his left forehead and a stab or laceration of the upper abdominal wall which was actually a superficial laceration. It did go into the muscle, but I didn't -- on looking at it feel that it was in the peritoneal cavity. He also had a, what looked to me like a stab wound of the left arm, approximately in this area.
Q You are indicating midway between your elbow and your shoulder?
Q On the inner side of your bicep?
A As I recall, it was on the outer side.
Q Now how long was this injury of the left side you described as not puncturing the peritoneal cavity?
A I'd estimate it was about three inches long.
Q Would you tell us what you mean when you say it did not enter the peritoneal cavity?
A We judge the seriousness of abdominal stab wounds by their depth. Once you enter the peritoneal cavity you enter into an area which is -- where everything is, and you have a chance of damaging critical organs and that particular wound didn't appear to have gone through, but it was into the muscle so we don't really classify it as a superficial laceration.
Q If I may put it in another term, are you saying, sir, that this wound did not puncture the muscle wall?
A It did puncture the muscle wall.
Q Did it go through the muscle?
A Well, I didn't probe down to see if it reached the level of the peritoneum, but it was through the muscle.
Q But you don't know if it was in the peritoneum?
A I think it would be better to query one of the surgeons who may have examined that wound more closely.
Q Was Captain MacDonald in shock when you saw him?
A That depends -- what you mean by shock.
Q Was he in cardiovascular shock?
A Well, as I recall, when I reached him he was on the stretcher. He was lying down and the blood pressure and pulse had been recorded on his sheet and I glanced at it. I don't recall what it is; I don't know whether it is in the records or anything, but judging from what I saw I wasn't immediately concerned that he was in severe cardiovascular collapse. Of course, people, we see people who have been in shock, whether they are standing up or when you lie them down and the blood pressure may return to normal: then you set them up, they are immediately in shock, so I think that, you know, that one examination I'm sure was taken when he was lying down. I'm not sure of the validity of that in evaluating whether he was in cardiovascular shock.
COL ROCK: Did you have any conversation with him?
WITNESS: The only thing he said to me was, “Am I gonna be all right, doc, am I gonna be all right?”, and I said, “Yes, I think you are.”
COL ROCK: Did he seem to be coherent in that question?
WITNESS: He was excitable, but he was coherent.
Q What treatment did he receive?
A The most important treatment he received was the piece of Vaseline gauze which I imagine one of the corpsmen or nurses applied to the wound in the right chest. I gave him no treatment at all and we just wheeled him very -- after I continued my examination I thought that he may have a collapsed right lung because in listening to his chest there seemed to be decreased breath sounds on the right side, and so I thought we ought to get an x-ray of his chest right away.
Q Was this done?
A He was only in the emergency room about two or three minutes. We quickly wheeled him to the x-ray department and took a chest x-ray there.
Q Did you have an opportunity to see those x-rays?
A I saw the initial film that was taken, yes.
Q And what conclusion did you draw?
A He had a partial collapse of the right lung.
Q Can you give us any idea how much that lung was collapsed?
A It was approximately -- I'd just look at the -- I had forgotten but I had just looked at the medical records -- approximately 20% was the reading that I gave to the emergency room at that time.
Q Did you treat him subsequent to that?
A I never saw him after that. I just helped Doctor Jacobson who was the Surgical Officer of the day in charge that night. He came down to the emergency room right away. We both wheeled him over to the x-ray department and then I left and went back to the emergency room to take care of some auto accident victims that had come in.
Q Would you characterize his condition that morning as critical?
A That depends on what time. When I saw him I thought he was seriously injured. It depends on how you define critical or serious, any of these.
COL ROCK: Are you familiar with how this terminology is used by the hospital?
WITNESS: No, I am not. No, I am not, in my own examination I would say he was seriously injured, as I think anybody is with a partial collapse of the lung.
Q How would you define critically injured? Put it in your own terminology. In your own terminology, was he critically injured?
MR. EISMAN: Now, I'm going to object to this question. I don't think the question is properly phrased. He's been asked the general question what he thought the condition was. Now he's being led into -- the witness is being led into trying to attempt to give his medical opinion about some condition which is not before the investigating officer.
CPT SOMERS: I simply want to know --
CPT BEALE: Just a second, counselor. The objection is sustained.
CPT SOMERS: I have no further questions.
Questions by MR. EISMAN:
Q Doctor, the second wound which you described, the wound to the stomach -- you testified that that was approximately three inches long?
A As I recall -- I'd like to more or less preface these statements by the fact that I was faced with a man who was wheeled in stabbed and my primary duty there was to see that he doesn't die on me in the emergency room.
Q And you were primarily concerned then --
A I wanted to see how serious these wounds were. Now when I was told that he had a stab wound in the chest which had been bubbling and which had been -- already covered with gauze, I said that's the most serious wound, and I looked down and see that he had a laceration on the abdominal wall and I, of course, wanted to look how deep it was so I spread it apart as I recall and saw that it had gone through a great deal of the muscle of the abdominal wall, but from what I saw I didn't think it had entered the peritoneal cavity. So as long as it hadn't entered the peritoneal cavity area, the fact that it wasn't bleeding a great deal, you know, its importance becomes very relative to the wound in the chest which I saw as a serious wound.
Q And it would be normal procedure that you would be concerned with the most serious wound first and anything that was as not as serious to at least wait until the most serious wound was treated?
A Absolutely, that's the way you have to operate in an emergency, to take care of anything that might be life threatening first, and anything else waits.
Q You have said that the wound that you observed in the chest you considered to be serious. Could you please explain to the investigating officer why that type of wound would be considered serious from a medical standpoint?
A Well, with a partial collapse of a lung, although it may be like I described, 20% when I see it initially, thirty seconds later it could be completely collapsed which can be a life threatening condition.
Q Well, what would it mean if a lung completely collapsed at that point?
A Well, if you completely collapse your lung, first of all you are concerned with the tension, the various types of pneumothorax, one of which is the tension pneumothorax which you can get from a stab wound, which you breathe in --
Q Just a -- you have mentioned a medical term which I think that the reporter and the investigating officer would like to hear again, and I would ask you to spell it for the reporter so that she could relate the word, the medical term which you have just mentioned which was pneumothorax.
A It is just spelled p-n-e-u-m-o-t-h-o-r-a-x.
Q Now in layman's terms, for my own edification, what is the layman's definition of a pneumothorax?
A For all practical purposes a pneumothorax is a collapse of the lung in which free air is -- the lung normally occupies a potential space when it is expanded, now, and it's in a vacuum. Now if you let air in from the outside, such as you have in a stab wound, you eliminate this vacuum and the lung collapses. What was formerly occupied by this potential space, which was formerly occupied by air, the lung now collapses away from it and it is occupied by air that instead of being in the lung, it's outside the lung, and it is not useful air and the lung continues to collapse and you just don't know where it is going to stop and that's why these are followed, you know, like every four to six hours, usually by a chest x-ray, to see whether the lung is going to expand itself or whether it is going to collapse further, and that will usually determine what the course of treatment is.
Q Now, doctor, the area which this wound, in which you saw the wound, behind the lung or in the area of the lung, are there other vital organs of the body in that area?
A As I recall -- I really don't, from recall, know exactly where that wound was right now, but thinking on it I was concerned. Depending on the course of an instrument that -- knife or whatever it could have been -- that it could hit the heart, really, or the liver. That is one thing I wanted to look at in the chest film, which we didn't have a pneumopericardial or something, that had to do with the heart. But just from the entrance of the wound you have no way of knowing what has gone on inside, up, down, sideways, or what.
Q Is there any practical way for a person, in a hypothetical situation, to stab himself, to know how serious that wound would be, whether or not it would be fatal in that type of pneumothorax?
A I'd rather not answer hypothetical questions, if possible.
Q If you can't answer it, I withdraw the question, doctor. I don't want to ask you a question which you don't feel you should answer, but this type of a wound has been known to be fatal. Is that correct?
A Pneumothoracies have been known to be fatal.
Q And prior to the receiving of the pneumothorax would there be any way for sure, as a doctor to know what the results of the -- the final medical results would be of such a wound?
A Maybe I misunderstood your question. You mean if a person has a pneumothorax, does he, himself, going to know whether it is 10%, 20% or 70%?
Q And what the medical result would be so far as life is concerned, would you know in advance? Is there any way to know in advance?
A You don't know -- no, I don't see how you could know in advance what sort of collapse you are going to get from a lung. If you puncture a lung you don't know whether you are going to get a 10% collapse or a 100% collapse. It just depends on the dynamics going on in there; you have no way of predicting it. For example, pneumothoracies occur spontaneously many times in which people pop blisters and perforates a lot, and just depending on the dynamics and how fast it closes, it may collapse 10% and it may collapse totally.
Q According to your knowledge of this case, if you don't wish to answer the question you can give the appropriate answer, but was further treatment of this wound required to your knowledge, as far as other than what you did?
A I heard that the lung had collapsed further and that it was necessary to put in a chest tube because as I say, many of these questions, I think about the treatment of the pneumothorax, the shock aspects, et cetera could best be answered by the surgeon who was on call and took care of him. I saw him only for about three minutes in the emergency room and that was all.
Q And did you consider this in your medical judgment to be a serious injury?
MR. EISMAN: No further questions.
COL ROCK: Counsel for the government?
Questions by CPT SOMERS:
Q Doctor, is total collapse of one lung necessarily fatal?
A Not necessarily, no.
Q If one lung totally collapses, is that necessarily going to collapse the other one?
A Not necessarily, but I can assure you with one lung totally collapsed and the other one collapses, death is imminent.
CPT SOMERS: I'm sure it is. I have no further questions.
MR. EISMAN: I have no further questions, doctor. Thank you very much.
COL ROCK: Does either counsel wish to excuse this witness subject to further recall, or are you willing to excuse him permanently?
MR. EISMAN: On behalf of the accused, I see no further need to burden Doctor Straub.
CPT SOMERS: Nor I, sir. I would be willing to see Doctor Straub excused permanently.
COL ROCK: Major Straub, you are advised that you will discuss your testimony with no person other than either counsel. Do you have any questions on that?
WITNESS: No, sir.
COL ROCK: You are excused permanently.
(The witness saluted the IO and departed the hearing room.)