0001 1 2 UNITED STATES DISTRICT COURT 3 NORTHERN DISTRICT OF CALIFORNIA 4 BETTY LOU HESTON, individually Case No. 5 and ROBERT H. HESTON, C 05-03658 JW individually and as the personal 6 representatives of ROBERT C. HESTON, deceased, 7 Plaintiffs, 8 v. 9 10 CITY OF SALINAS and SALINAS POLICE DEPARTMENT, SALINAS 11 POLICE CHIEF DANIEL ORTEGA, SALINAS POLICE OFFICERS 12 MICHAEL DOMINICI, CRAIG FAIRBANKS, JAMES GOODWIN, 13 LEK LIVINGSTON, VALENTIN PAREDEZ, JUAN RUIZ and TIM 14 SIMPSON, TASER INTERNATIONAL, INC., and DOES 1 to 10, 15 Defendants. 16 ----------------------------------------x 17 DEPOSITION of CHARLES V. WETLI, M.D., taken by 18 Plaintiffs at the offices of Fink & Carney Reporting 19 and Video Services, 39 West 37th Street, New York, 20 New York 10018, on Monday, August 20, 2007, 21 commencing at 10:07 a.m., before Julia Moksin, a 22 Shorthand (Stenotype) Reporter and Notary Public 23 within and for the State of New York. 24 25 0002 1 2 A P P E A R A N C E S: 3 WILLIAMSON & KRAUSS 4 Attorneys for Plaintiffs 18801 Ventura Boulevard, Suite 206 5 Tarzana, California 91356 6 BY: PETER M. WILLIAMSON, ESQ. 7 TASER INTERNATIONAL, NATIONAL LITIGATION COUNSEL 8 Attorneys for Defendant: TASER International Worldwide Headquarters 9 17800 N. 85th Street Scottsdale, Arizona 85255 10 BY: MICHAEL BRAVE, ESQ. 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 0003 1 Wetli 2 C H A R L E S V. W E T L I, M.D., 3 called as a witness, having been first 4 duly sworn by Julia Moksin, a Notary 5 Public within and for the State of 6 New York, was examined and testified 7 as follows: 8 EXAMINATION 9 BY MR. WILLIAMSON: 10 Q Would you please state your full 11 name and spell your last name for the record? 12 A Dr. Charles Wetli, W-E-T-L-I. 13 Q Dr. Wetli, are you currently 14 employed? 15 A Self-employed, basically. I'm in 16 private practice at this time. 17 Q When you say "private practice," do 18 you mean in a medical-legal capacity, or are you 19 actually a clinician? 20 A As a forensic pathologist that 21 involves medical-legal work exclusively. 22 Q How long have you been 23 self-employed in that capacity? 24 A For about a year. Well, actually, 25 if I can clarify that; I've been doing 0004 1 Wetli 2 consultation-type work since 1995, and in 1995 3 up until August of last year I was employed 4 full-time as the chief medical examiner and 5 director of forensic science for Suffolk County, 6 New York. A year ago I retired from that 7 position, but I continue to do the private 8 practice. 9 Q I know that your medical-legal 10 experience encompasses quite a long period of 11 time, at least 12 years or so. 12 Can you break down for me during 13 that period of time the percentage of cases that 14 you've done on the defense side of a case? 15 Let's start with civil litigation 16 as opposed to -- I know you've done consulting 17 work on a criminal basis, but in civil 18 litigation, what's the breakdown of plaintiff 19 versus defense work? 20 A About 60 percent defense, 40 21 percent plaintiff. 22 Q And I'm just curious, in terms of 23 medical-legal, your work in the criminal 24 context, how much of it is on behalf of a 25 defendant in a case, what percentage or 0005 1 Wetli 2 breakdown versus that for the prosecution? 3 A In private cases, it's about 99 4 percent defense, because the attorneys will 5 obviously use -- the prosecution will obviously 6 use their own medical examiner or coroner. 7 Once in a while I'm asked by 8 prosecution to testify for one reason or 9 another. Of course the cases where I was the 10 medical examiner, I was exclusively for the 11 prosecution. 12 Q In your lengthy experience, 13 approximately how many depositions have you 14 given? 15 A I've been a forensic pathologist 16 now for about 30 years, so probably in the 17 thousands. Part of the reason for that is 18 because for 17 years I was the medical examiner 19 in the State of Florida, and in the State of 20 Florida they use depositions for absolutely 21 everything. 22 Q Before we go further, I assume that 23 I could dispense with the typical admonitions 24 that are given at the outset of a deposition, 25 yes? 0006 1 Wetli 2 A Yes. 3 Q I just want to remind you that the 4 oath that was given by the court reporter is the 5 same oath that you would be given in a court of 6 law. 7 Do you understand that you are 8 testifying under penalty of perjury? 9 A Correct. 10 Q Prior to the outset of the 11 deposition, I asked you for a copy of your CV, 12 and you indicated that you didn't have one, but 13 that you would e-mail one to the reporter. 14 A Yes. 15 MR. WILLIAMSON: We'll attach 16 the CV of Dr. Wetli as Plaintiff's 17 No. 1 for identification. 18 (Curriculum vitae of Charles 19 V. Wetli, M.D., was deemed marked as 20 Plaintiff's Exhibit No. 1 for 21 identification, as of this date.) 22 BY MR. WILLIAMSON: 23 Q Going back to your medical-legal 24 experience, have you ever given, for example, 25 deposition testimony on behalf of TASER 0007 1 Wetli 2 International? 3 A I believe I have, yes. 4 Q Do you recall when that was? 5 A I do know that I've dealt with 6 cases for TASER International, that I was for 7 the defendant, and those cases may or may not 8 have been retained by TASER, but I know that 9 there were cases that involved TASER. 10 I can't recall offhand, but I have 11 a list of court testimony, and I might be able 12 to glean something from that. 13 Q I did bring that, and let me have 14 you look at it just briefly (handing). 15 A (Perusing document.) 16 Nothing is jumping out at me as far 17 as TASER is concerned on these. I know TASER is 18 not listed as the defendant on this, but that 19 doesn't mean anything. 20 Q I will represent that I reviewed 21 that list and I didn't see TASER's name 22 appearing anywhere on the list. 23 A Right. Well, TASER's name may not 24 appear, because, like in this case, for example, 25 in my records, the way I have it captioned is 0008 1 Wetli 2 Heston v. City of Salinas, but I know I've 3 testified in cases before, at least by 4 deposition, where TASER I know was a defendant. 5 Q Let me ask you this, and it leads 6 me to my next question: Have you ever been 7 retained by TASER International as an expert 8 prior to this case? 9 A I don't believe so. 10 Q Since we have the list out, I just 11 want to ask you a couple of brief questions 12 about a couple of the cases that were listed 13 here. 14 One of the cases that you have 15 listed from 2004 is a case called Turner v. City 16 of Long Beach. 17 Off the top of your head, do you 18 recall that case at all? 19 A No. 20 Q So if I asked you the substance of 21 your testimony in that case, you wouldn't know 22 it as you sit here today? 23 A No. It would take me about two 24 seconds for it to come back if I saw something 25 about the case, but I don't remember any of 0009 1 Wetli 2 those cases. 3 Q Let me ask you the same question 4 about one other case. 5 A Sure. 6 Q There's a case from 2006, last 7 year, entitled Lawrence v. City of San 8 Bernardino. 9 Does that case name ring a bell at 10 all? 11 A I can't recall any of the details 12 of the case. I remember the caption, I remember 13 San Bernardino, because I know a pathologist in 14 that area. 15 Q Who is that? 16 A Dr. Sheraton. 17 Q Do you know if the Laurence v. City 18 of San Bernardino case involved police 19 misconduct of some kind? 20 A I can't recall. 21 Q There's one other case, and it 22 actually goes back a little further, but it has 23 some notoriety in California, and that is the 24 case of Drummond v. City of Anaheim. 25 Do you remember that case at all? 0010 1 Wetli 2 A Vaguely, because I testified in 3 that case, and then it came back on appeal for a 4 retrial. I remember he subsequently died -- by 5 the time I testified he had subsequently died, 6 and as I recall it was an excited delirium case. 7 Q Do you remember any of the 8 specifics of your testimony in that case at all? 9 A No. I still have the file, because 10 it's coming up in trial next year. 11 Q So as far as you know, this case, 12 the Heston case, is the first case that you've 13 ever been retained by TASER International 14 specifically? 15 A As far as I know, that's correct. 16 Q When were you first contacted by 17 TASER or their attorneys in regard to your 18 expert opinion in this case? 19 A November of last year. 20 Q And do you recall what you were 21 specifically asked to do as far as this case is 22 concerned? 23 A Yes. I was specifically asked to 24 address the issues of hyperthermia, 25 rhabdomyolysis and excited delirium. 0011 1 Wetli 2 Q Before we get into the specifics of 3 the case, do you currently serve on any boards 4 that relate to TASER at all? 5 A That relate to TASER, no. 6 Q You are aware that they have a 7 Science and Medical Advisory Board, or are you 8 aware? 9 A Yes, I've heard that. 10 Q You don't sit on that board? 11 A No, I do not. 12 Q Do you receive any direct 13 compensation, other than testifying, do you 14 receive any direct compensation from TASER 15 International? 16 A No, I do not. 17 Q Now, the firm that is defending 18 this case on behalf of TASER International is 19 Manning & Marder, have you ever worked for that 20 firm before, to your knowledge? 21 A No, I have not. 22 Q Prior to this case, have you ever 23 been retained by Mr. Brave? 24 A No, I have not. 25 Just to clarify one thing, there is 0012 1 Wetli 2 one case, I believe it's Gates v. The State of 3 California, I believe was the name of it, I was 4 retained actually by the Department of Justice, 5 but apparently Manning & Marder are also 6 attorneys working on that case also representing 7 somebody else. 8 Q So you weren't specifically 9 retained by them? 10 A Exactly. They are involved on 11 another case that I'm involved with. 12 Q Now, prior to the start of the 13 deposition, you were kind enough to show me the 14 contents of your file in this case. 15 Let me just ask you, first of all, 16 in terms of your first contact by Manning & 17 Marder, who contacted you, do you recall? 18 A Mildred O'Linn. 19 Q When she first contacted you, did 20 you have a discussion about this case? 21 A Very briefly. 22 Q Do you recall the substance of that 23 conversation? 24 A Basically she just said that she 25 had a case involving excited delirium and TASER, 0013 1 Wetli 2 the use of a TASER electronic control device, 3 and she wanted to retain me as a witness on the 4 case. 5 Q Did she use the term "excited 6 delirium," or did you? 7 A I believe she did. I know she did. 8 Q Did she discuss with you the facts 9 of the case? 10 A No. 11 Q How did you learn about the facts 12 of this case? 13 A Materials that were sent to me 14 subsequently. 15 Q Did Ms. O'Linn tell you the names 16 of any other experts that have been retained in 17 this case? 18 A I don't believe so. 19 Q At the present time, are you aware 20 of any other experts that have been retained in 21 this case? 22 A Yes. I received a packet of expert 23 reports on this case. Not all of them, but a 24 good many of them. 25 Q Were those reports that you 0014 1 Wetli 2 requested, or were those that were voluntarily 3 supplied to you? 4 A They were voluntarily supplied to 5 me. 6 Q And do you know how many additional 7 expert reports are out there that you have not 8 reviewed, have you ever been told that by 9 anyone? 10 A I've never been told that. I know 11 that there's a Dr. Meyers, a Dr. Spitz and a Dr. 12 -- I forgot the name. He was deposed last week, 13 I think. 14 Q Dr. Luceri? 15 A I think so, yes. 16 Q Do you know a Dr. Vincent Di Maio? 17 A Yes. 18 Q Were you aware that he was one of 19 the experts in this case? 20 And the reason I specifically ask 21 you that, Doctor, is because I didn't see his 22 name on the list of expert reports that you 23 have. 24 A I did not know he is an expert in 25 this case. 0015 1 Wetli 2 Q So, therefore, I can conclude that 3 you never had any conversations with him about 4 this particular case? 5 A That's correct. 6 Q Now, in terms of depositions that 7 you received, I noticed in your group of 8 documents only one deposition, and I believe 9 that was of Dr. Hain. 10 A Correct -- well, that's not true. 11 Q Okay. Which additional ones did I 12 miss there? 13 A I have the deposition of Dr. Terri 14 Haddix, Dr. John Hain, and Dr. Steven Karch. 15 Q Those are the only three 16 depositions that you've reviewed in this case so 17 far? 18 A Correct. 19 Q And were you aware that the 20 officers that were involved in this case were 21 deposed? 22 A I was not specifically aware of 23 that, but I'm not surprised that they were 24 deposed. I presume they also have given 25 statements, and I have not seen those statements 0016 1 Wetli 2 or those depositions. 3 Q Have you asked for either of those 4 statements or those depositions? 5 A I haven't asked for them yet. 6 Q Do you plan to? 7 A Yes. 8 Q You realize that this is my 9 opportunity to question you about your expert 10 opinions in this case? 11 A Correct. 12 Q It sounds to me -- well, I'm not 13 presuming that your opinions will be changed by 14 anything you read, but would it be fair to say 15 that you might have some additional thoughts 16 after you read those depositions? 17 A I would imagine that after reading 18 the statements -- I'm more interested in the 19 statements than the depositions, because they 20 are usually more accurate, to tell you the 21 truth, at least in my experience they are. 22 Q Statements not under oath are more 23 accurate than statements taken under oath? 24 A Yes, in my experience. 25 But either way, I would imagine 0017 1 Wetli 2 that they would reinforce my opinions more than 3 anything else. 4 MR. WILLIAMSON: Mr. Brave, I 5 just want to reserve the right in 6 the event that the doctor does read 7 those reports and issues some 8 supplemental report, that we'll be 9 able to take his deposition again. 10 A Also, by the way, I would also like 11 to review the microscopic sections that were 12 taken at the time of the autopsy and the 13 photographs of the autopsy. 14 Q Have you requested those? 15 A I have not specifically requested 16 those yet. 17 MR. BRAVE: In answer to your 18 statement, yes. 19 MR. WILLIAMSON: Okay. Thank 20 you. 21 BY MR. WILLIAMSON: 22 Q Were you also aware that the 23 plaintiffs in this case, specifically the 24 parents of Mr. Heston and some other relatives 25 were deposed in the case? 0018 1 Wetli 2 A I'm not aware of that, but I'm not 3 surprised. That's usually the course of events. 4 Q And, again, let me ask you one 5 final question: Were you made aware of the fact 6 that there were witness depos taken in this 7 case? 8 A I'm sure there were. I was not 9 made aware of that, though, and they were not 10 sent to me. 11 Q Now, when you are doing analysis of 12 the cause of death, do you agree that it's 13 important, in fact, critical, that you review 14 all information that is available in order to 15 arrive at a cause of death? 16 A You don't necessarily have to 17 review all the information that's available, but 18 you have to review a certain amount of critical 19 information; that's true. 20 In this particular case, I was 21 asked to get a report out relatively soon, 22 because I was brought into the case relatively 23 late, and, therefore, I had relatively not the 24 luxury of having months and months to review 25 materials before I had to render my expert 0019 1 Wetli 2 opinion. 3 Q Let me go back for a second and ask 4 you specifically what are the factors that go 5 into establishing a cause of death, what are the 6 things that you consider? 7 A You consider the history of the 8 individual, you consider the terminal events, 9 the autopsy findings, the toxicology findings, 10 and then any ancillary studies which may be 11 pertinent; such as some chemistry studies might 12 be important on a case, microscopic studies 13 could be important on a particular case, among 14 other things that could be done, hemoglobin 15 electrophoresis, for example, not on this case, 16 but on other cases. 17 Q As I understand your testimony, one 18 of the important factors to consider is the 19 circumstances which give rise to the death, 20 correct? 21 A Correct. 22 Q And it would be important for you 23 to gather as much information as you could 24 regarding those circumstances; is that true? 25 A True. 0020 1 Wetli 2 Q And as part of understanding the 3 circumstances of the events in this case, would 4 you agree that it would be critical to review 5 the depositions or the statements of police 6 officers who were involved in terms of what 7 their specific activities were in relation to 8 the decedent, Mr. Heston? 9 A I would say it would be helpful, 10 but not necessarily critical. 11 Q Now, before you were involved in 12 this case, had you received any kind of training 13 at all in the application of a TASER? 14 A Specific training, no. 15 Q Have you reviewed any scientific 16 literature specifically concerning the TASER 17 prior to your involvement in this case? 18 A Yes. 19 Q What would that be, or what would 20 it consist of? 21 A Quite a bit of material, actually. 22 We had TASER cases before when I was chief 23 medical examiner, and the TASER Corporation 24 fired a tremendous amount of material from the 25 scientific literature concerning the application 0021 1 Wetli 2 of TASER, not only their articles consisted of 3 those, but those independent agencies, as well. 4 I was also aware of electronic 5 control device studies that appeared in the 6 forensic literature prior to all of these 7 things. 8 I've examined TASERs, I've done 9 applications of TASERs to dead animals and 10 things like that, and I've seen TASER cases 11 myself at the time of the autopsy and in 12 consultation. 13 Q Approximately how many cases 14 regarding TASER applications had you seen in 15 autopsy prior to becoming involved in this case? 16 A I don't really know, perhaps maybe 17 a dozen. 18 Q And over what period of time do you 19 recall? 20 A About ten years I think. 21 Q And I assume that was when you were 22 employed by Suffolk County? 23 A Yes. 24 Q Have you ever seen any cases while 25 you were employed by Dade County? 0022 1 Wetli 2 A Not with TASER. I was asked one 3 time to evaluate the Nova stun gun, but not 4 TASER. 5 Q Do you recall the last time you did 6 an autopsy involving an individual that had been 7 subjected to a TASER discharge? 8 A I'm not sure I ever personally did 9 an autopsy of somebody who was subjected to a 10 TASER discharge, because in Suffolk County I did 11 a few autopsies, but I was aware of the 12 autopsies because I was reviewing them or I was 13 there while the autopsies were being done. 14 Q Just so I understand, your 15 responsibilities in Suffolk County, I assume, 16 were more administrative? 17 A Yes. I still did autopsies, but 18 far fewer than my colleagues did. I did about 19 75 a year, my colleagues would do about 175. 20 Q Were you involved in any of the 21 autopsies regarding the crash of the flight -- I 22 don't remember the number? 23 A TW800. I was involved in all of 24 them. 25 Q Now, subsequent to you being 0023 1 Wetli 2 retained in this case and reviewing various 3 materials that were provided to you -- actually, 4 you know what, for the record, can you just list 5 them briefly, so we have that? 6 A Sure. 7 Monterey County Sheriff-Coroner 8 Investigative Report by Detective Davidson. 9 Autopsy report of Dr. Haddix. 10 The toxicology report. 11 Stanford University cardiac 12 pathology and neuropathology reports. 13 Medical records of Mr. Heston, 14 including his admissions of April 1, 2000, June 15 8, 2002, September 30, 2003, and, of course, the 16 February 19, 2005. 17 The Ambulance Call Report and 18 hospital admission of February 19, 2005. 19 Opinion statements of Dr. John Hain 20 and Steven Karch. 21 The depositions and attached 22 exhibits of Drs. Haddix, Hain, and Karch. 23 And the expert reports of Patrick 24 Smith, Michael Evans, Adam Aleksander, Richard 25 Clark, Raymond Ideker, Mark Lehto, Richard 0024 1 Wetli 2 Luceri, that's Dr. Richard Luceri, Dr. Dawn 3 Tanescu, Dr. Debra Mash and Dr. Michael Gram. 4 Q Dr. Wetli, did you receive the 5 expert reports subsequent to your drafting of 6 your Rule 26 Report? 7 A Yes. 8 Q When did you receive the expert 9 reports that you just referred to? 10 A Probably February of 2007. 11 Q And I assume, because you did not 12 prepare a Supplemental Rule 26 Report, that 13 nothing in the expert reports that you reviewed 14 altered any of your opinions; is that a correct 15 statement? 16 A No, that basically supported my 17 opinions. 18 Q But you are agreeing that they 19 didn't change any of your opinions? 20 A No, not at all. I don't 21 necessarily agree with everything that's in 22 those opinions, some I disagree with, for 23 example, but in general, they support my 24 opinions. 25 Q Now, subsequent to your review of 0025 1 Wetli 2 the initial documents that were provided, you 3 prepared a three-page Rule 26 Report, correct? 4 A Correct. 5 Q And that was dated December 4, 6 2006? 7 A Correct. 8 Q Do you have a copy of that in front 9 of you? 10 A Yes, I do. 11 MR. WILLIAMSON: We're going 12 to make a copy of this document, the 13 Rule 26 Report of Dr. Wetli and 14 attach that as Plaintiff No. 2 for 15 identification. 16 THE WITNESS: I actually have 17 an extra copy with me for some 18 reason. Should I just give that to 19 the court reporter? 20 MR. WILLIAMSON: Absolutely, 21 that would be great. Thank you. 22 (A four-page document, 23 consisting of a three-page report of 24 Charles V. Wetli, M.D., dated 4 25 December 2006, to Ms. Mildred K. 0026 1 Wetli 2 O'Linn, Esq., Re: Heston v. City of 3 Salinas, et al., was marked as 4 Plaintiff's Exhibit No. 2 for 5 identification, as of this date.) 6 BY MR. WILLIAMSON: 7 Q Now, let me just clarify one thing 8 before we actually get into the report, and that 9 is the source of the factual information. 10 In other words, when I say "factual 11 information," I'm specifically talking about how 12 this incident occurred, was derived from what 13 sources specifically? 14 A The materials I just listed on my 15 report. 16 Q Let me ask the question again. 17 And I'm not talking about all the 18 subsequent findings on autopsy and things like 19 that, I'm talking about the incident itself. 20 I want to know what the source of 21 the factual information is regarding how the 22 incident occurred. 23 A That would be the Monterey County 24 Sheriff-Coroner Investigative Report by 25 Detective Davidson. 0027 1 Wetli 2 Q Let me ask you some specifics about 3 your report. 4 In the first full paragraph on page 5 1 of your report, there's a sentence that begins 6 with the word, "However, since no crime was 7 being committed," do you see that? 8 A Yes. 9 Q And then about a line or two below 10 that you say that the police returned to the 11 home a second time for "violent assaultive 12 behavior." 13 What violent assaultive behavior 14 are you referring to? 15 A I don't know, because I did not get 16 a chance to review the actual statements of the 17 police officers. I was only reviewing, and I 18 only had available at the time was the 19 Investigative Report by Detective Davidson. 20 Q So you basically were relying on 21 the statements that were made by Detective 22 Davidson in his report specifically insofar as 23 the term, "violent assaultive behavior"? 24 A Yes, exactly. I would obviously 25 want to know more specifically what that violent 0028 1 Wetli 2 assaultive behavior was and that type of thing, 3 but that was all I had, that's all I had to rely 4 on at the time. 5 Q At this point, as you sit here 6 today, you have no independent information about 7 what that was? 8 A Correct. 9 Q And I assume the answers to my next 10 several questions are going to be the same, but 11 let me ask them anyway, just to be clear. 12 A Sure. 13 Q Skipping down a couple of lines, it 14 says, "The police responded with multiple 15 deployments of a TASER which had no apparent 16 effect." 17 Again, the basis for that was 18 Detective Davidson's report, correct? 19 A Correct. 20 Q And the rest of that sentence, "Mr. 21 Heston was able to remove a number of the 22 darts." 23 That again was from Detective 24 Davidson's report, correct? 25 A Correct. 0029 1 Wetli 2 Q Now, in terms of sequence of events 3 that occurred, and, again, you may not be able 4 to answer this question, but I'll ask it anyway, 5 was it your understanding that Mr. Heston hit 6 his head on the piece of furniture before the 7 second TASER deployment? 8 A Yes. I know he hit his head, I 9 don't know before the second TASER deployment or 10 not, but I know he hit his head and then 11 received a second TASER application again after 12 that. 13 Q Is it your understanding that there 14 were two very distinct TASER deployment 15 sequences in this case, is that your 16 understanding? 17 A Basically, yes. He had apparently 18 several or about the same time, he pulled some 19 of the darts out and then he went inside and hit 20 his head and then he received another TASER 21 deployment, yes. 22 Q And in terms of the TASER 23 deployments themselves, would it be a fair 24 statement to say that at the time that you wrote 25 your report, you had no specific information 0030 1 Wetli 2 about the number of TASER deployments and the 3 duration of each one? 4 A Actually, I believe there was some 5 information about that in the Sheriff-Coroner 6 Report. 7 (Perusing document.) 8 Page 5 of 15 of the Monterey County 9 Sheriff-Coroner, office of the Coroner Report, 10 two trigger pulls, one trigger pull, two more 11 trigger pulls, it says three trigger pulls and 12 two cartridges and three trigger pulls through a 13 single cartridge. That's all the information I 14 have. 15 Q What about the duration of each 16 trigger pull, does it reflect that? 17 A No, it does not. 18 Q So, again, absent any information 19 you subsequently reviewed in the other Rule 26 20 Report, at the time you wrote this report, would 21 it be fair to say that you were unaware of the 22 duration of the TASER discharge? 23 A Correct. 24 Q And did you feel that that was 25 information that was significant or important 0031 1 Wetli 2 for you to know at the time you wrote your Rule 3 26 Report? 4 A No. 5 Q So it wouldn't matter to you how 6 long -- in other words, let's say the duration 7 was ten minutes long, that wouldn't matter to 8 you? 9 A Well, I know that didn't happen, 10 because I know that he was hit with the TASERs 11 and he pulled darts out and he was moving around 12 and so forth, so that ends it right there. And 13 then he got one more TASER application after 14 that. 15 It's my understanding that the way 16 this electronic control device works is that 17 it's a pulsatile action of a limited duration, 18 so these things don't really mean very much. 19 Besides that, the electricity is going to blow 20 between the two darts, between the two 21 electrodes, so it doesn't really matter. 22 Q I'm not quite sure I understand -- 23 A In other words, you don't get a 24 continuous electrical charge when you pull the 25 trigger of the TASER. It's a pulsatile-type 0032 1 Wetli 2 thing of a very limited duration. 3 Q When you read the report of Dr. 4 Alexander, that you received subsequent to your 5 Rule 26 Report, do you recall reviewing his 6 analysis of the data report information that was 7 downloaded from the specific TASERs used in this 8 incident? 9 A I remember glancing at it, I don't 10 remember specifically very much about it. In 11 other words, there is a lot of data that was 12 attached to his report. 13 Q Let me ask you foundationally, as 14 you sit here today, do you have any reason to 15 believe that the TASERs used in this particular 16 incident were not functioning properly at the 17 time? 18 A As far as I can tell from Dr. 19 Alexander's report, they were functioning 20 properly. 21 Q Do you see in Dr. Alexander's 22 report where he indicates that Officer 23 Livingston specifically depressed his TASER 24 continuously for 74 seconds? 25 A I don't recall that, no. 0033 1 Wetli 2 Q Would you take a look at that, 3 please? 4 A I don't have that. 5 When I go through these reports, I 6 only keep the parts that I think are important. 7 Q So you didn't feel that the fact 8 that Dr. Alexander was reporting based on the 9 data report download that Officer Livingston 10 depressed his trigger on the TASER for 74 11 consecutive seconds, you didn't find that 12 significant? 13 A No, not at all. 14 Q Let me ask you about what your 15 knowledge of the TASER is, can you tell how it 16 works, if you know? 17 A All I know is that basically it's a 18 device that relies on some batteries and it 19 involves step up transformers inside the 20 cartridge itself to get a maximum of 50,000 21 volts of electricity to overcome impediments, 22 such as air gaps or clothing, and then it 23 delivers an electrical charge of ultimately high 24 voltage and extremely low amperage. 25 Q Do you know what the amperage is? 0034 1 Wetli 2 A It's measured in milliamperes. 3 That's all I remember offhand. 4 Q Do you know how long the device is 5 activated after the trigger is pulled? 6 A I don't recall offhand. I know 7 it's a matter of seconds. 8 Q Do you know what the physiological 9 effects of a TASER are? 10 A I think it depends upon the model 11 of TASER. Some result in merely pain compliance 12 or just creating pain, others can cause muscle 13 spasm. 14 Q Are you familiar with any 15 scientific literature that addresses the 16 question of the amount of pain that's inflicted 17 by the TASER? 18 A I don't know how you measure pain. 19 Q Well, for example, Dr. Ho, who has 20 done a lot of research in this case and is a 21 retained expert by TASER, testified in his 22 deposition that on a scale of one to ten, ten 23 being the most severe pain, and one being a 24 pinprick, let's say, he estimated it was an 25 eight or a nine. 0035 1 Wetli 2 Does that have any significance to 3 you? 4 A Well, it's a very rough estimate. 5 This is the type of thing that is used in 6 hospital emergency rooms for patients to 7 subjectively tell you how much pain they have. 8 It is a subjective measurement. 9 The only objective measurements 10 that I know of that appear in a laboratory are 11 pharmaceutical companies that are testing 12 algesic-type drugs. They will put, for example, 13 the tail of a rat that's been medicated on a hot 14 wire and see how long it takes the rat to remove 15 its tail. 16 Again, I'm not sure how accurate 17 that is either, because part of the pain is very 18 subjective, number one. 19 Number two, when you have a person 20 with excited delirium, it's totally meaningless 21 because these people feel absolutely no pain, so 22 it doesn't really matter. 23 Q But at least in your mind, there's 24 no doubt that TASER inflicts pain on someone? 25 Is there any doubt in your mind 0036 1 Wetli 2 about that? 3 A No. There's no doubt in my mind 4 about that. 5 Q Let me again go back to your report 6 for a moment, because we kind of meandered off 7 there for a second. 8 Towards the bottom of the first 9 paragraph, it says, "Apparently, another TASER 10 deployment occurred at that time and moments 11 later he was handcuffed. At that point the 12 police realized he was becoming cyanotic and was 13 not breathing." 14 What do you understand the gap of 15 time to be, if any, between the process of 16 handcuffing Mr. Heston and when they observed 17 him becoming cyanotic? 18 A Again, I don't have a good answer 19 for that, because I have not seen the actual 20 statements of the police officers. My 21 impression from reading Detective Davidson's 22 report and in my experience with other cases, it 23 occurs almost spontaneously. 24 Usually the situation is that the 25 person is TASERed or they are handcuffed and 0037 1 Wetli 2 they turn them over and they are blue and 3 cyanotic and pulseless. 4 Q Define for me cyanotic. 5 A Blue. 6 Q Just the skin color turning blue? 7 A Exactly. 8 Q What is the cause of that? 9 A The heart stops. 10 Q So you would agree that in this 11 case Mr. Heston had a total collapse, cardiac 12 collapse, prior to him being observed to be 13 cyanotic? 14 A Exactly. In a sudden cardiac 15 death, it develops very rapidly, probably 16 because the right heart stops a little before 17 the left side of the heart, so blood is 18 continually being pumped into the facial area 19 and can't get out, so, therefore, the person 20 becomes a very dark blue, purple very, very 21 rapidly. 22 Q Can you give me an estimation, if 23 it's possible, in terms of how long it takes a 24 person to become cyanotic after a total cardiac 25 collapse? 0038 1 Wetli 2 A Seconds. I've seen it. 3 Q Do you have an opinion with any 4 degree of medical certainty as to whether Mr. 5 Heston suffered his cardiac collapse in 6 relationship to the time he was handcuffed? 7 A As I have said before, these events 8 are usually all occurring at about the same 9 time. The usual scenario is that -- I'm sure it 10 happened in this case, too -- is that the person 11 is finally handcuffed or restrained, they move 12 the individual either to the side or on their 13 back and they look and they say, oh my god, he's 14 not breathing and he's blue; that's usually in 15 that timeframe. Sometimes it can occur several 16 minutes later, but usually it occurs very, very 17 quickly. 18 Q In this case could it have occurred 19 minutes before he was handcuffed? 20 A Of course not. 21 Q Why is that? 22 A Because once your heart stops, you 23 have about 13 seconds of consciousness 24 remaining. 25 Q I'm not sure I follow that. 0039 1 Wetli 2 What would have prevented it from 3 occurring minutes before, before he was 4 handcuffed? 5 A Because as far as I know he was 6 still struggling and so forth, which is why he 7 got TASERed the second time, and they had to 8 pull his hands out, as I understand it, from 9 underneath him to handcuff him. All these 10 things require active participation on Mr. 11 Heston's part. 12 Q Was he still resisting while he was 13 being TASEed, if you know? 14 A I don't know that for a fact. I 15 did not see the individual statements, but I 16 would imagine that that is why he was TASERed 17 again; because he was still resisting. 18 Q Was it your understanding that Mr. 19 Heston's arms were underneath his body? In 20 other words, he was faced to the ground and his 21 arms were underneath him at the time? 22 A That's my understanding, yes. 23 Q Do you have an opinion as to 24 whether Mr. Heston physically could have 25 released his arms during the process of being 0040 1 Wetli 2 TASEed? 3 A I don't see why not. 4 Q What do you understand the TASER 5 does to a person? 6 What are the physiological effects 7 of the TASER? 8 A Again, it depends on the TASER, but 9 the more modern ones can actually cause tetnea 10 or spasm of the muscles between the two 11 electrodes. 12 Q Is tetnea tightening of the 13 muscles? 14 A Yes. 15 Q A contraction of the muscles? 16 A Yes. 17 Q And it's your testimony that during 18 the process of this contraction of the muscles 19 that Mr. Heston could have voluntarily released 20 his arms from underneath his body? 21 A It's my understanding the TASER 22 went into his back, so it doesn't have anything 23 to do with his arm muscles. 24 Q When you looked at the autopsy 25 report of Dr. Haddix, did you determine the 0041 1 Wetli 2 location of the various dart marks on his body? 3 A Not really, no. I know that they 4 were on there, but I didn't particularly pay 5 attention to where they were. 6 Q So you felt there was no 7 significance to the fact that one of the TASER 8 dart marks was on his anterior chest? 9 A No. 10 Q Is the location of the TASER darts 11 relevant to the heart significant, in your 12 opinion? 13 A No. 14 Q And is there any scientific basis 15 that you are aware of, any peer-reviewed 16 scientific literature that supports that 17 opinion? 18 A I'm sure if I went back and looked 19 at my files I could find it, but it's my 20 understanding that -- well, yes, as a matter of 21 fact there is. It goes back a couple of 22 centuries, actually. Electricity has to go 23 between the two electrodes. The electrodes are 24 not in the heart. 25 Q So, for example, if one dart was on 0042 1 Wetli 2 one side of the chest and one was by the other, 3 and the electricity had to traverse the chest, 4 that wouldn't be significant in your opinion? 5 A It doesn't traverse the chest. It 6 traverses the skin and subcutaneous tissue. 7 Q Well, I was referring to that as a 8 location rather than as an anatomic explanation. 9 If one dart was on one side of the 10 chest and the other dart was on the other side 11 of the chest, wouldn't the electricity have to 12 traverse the area across the chest? 13 A Yes. 14 Q And, in your opinion, is that 15 significant or relevant to -- 16 A Not with TASER. No with the TASER 17 electrode, it's not. It would be, for example, 18 a household electrical current, that's 19 different. 20 Q Now, do you know what Mr. Heston's 21 downtime was from the time he stopped breathing 22 until the paramedics arrived and restored the 23 pulse? 24 A I don't know offhand, but I can 25 look it up. 0043 1 Wetli 2 Give me a minute. (Perusing 3 documents.) 4 The paramedics arrived at the scene 5 at 1429 hours. I believe the incident occurred 6 at about 1420 hours and as of I think 1449 hours 7 they were still not able to get a pulse, but I 8 don't see any evidence when they say a pulse was 9 actually established or reestablished. 10 Q Can we agree that it was in excess 11 of ten minutes? 12 A I wouldn't be surprised. 13 Q And you wouldn't be surprised 14 because of the brain injury that occurred in 15 this case? 16 A No. The brain injury wouldn't 17 necessarily have anything to do with starting 18 the heart. 19 Q He was found to be in asystole at 20 the time that the paramedics arrived, correct? 21 A Correct. 22 Q What is asystole? 23 A The heart stops. When the term 24 "asystole," is used, it literally means the 25 heart is stopped, it's just standing at a 0044 1 Wetli 2 standstill. 3 In the context of EMS and Emergency 4 Medicine, it would mean there's no electrical 5 activity. If there's electrical activity and no 6 response to that electrical activity, then it's 7 called PEA or pulseless electrical activity. 8 In this case the heart was in 9 asystole, so there's no electrical activity and 10 no mechanical activity. 11 Q Is there any way for you to 12 determine whether at the time of Mr. Heston's 13 collapse that he went into ventricular 14 fibrillation and then asystole, or did he go 15 directly into asystole, if you have an opinion? 16 A My opinion is he went directly into 17 asystole. He could have gone into pulseless 18 electrical activity first, but in cases of 19 excited delirium, the initial rhythm is almost 20 invariably asystole, then pulseless electrical 21 activity, even when the paramedics are standing 22 there when that happens. 23 Q So it's your opinion that he went 24 directly into asystole? 25 A Correct. 0045 1 Wetli 2 Q At the very bottom of page 1 of 3 your report, you indicate that upon admission 4 into the hospital he was severely acidotic. 5 Can acidosis trigger arrhythmia? 6 A I suppose it can if it's severe 7 enough, yes. 8 Q Well, you said he was severely 9 acidotic; 6.83 was his pH. 10 A In cases of excited delirium that's 11 not unusual to have extremely low pH when they 12 are admitted into the hospital. 13 Q What causes someone to become 14 severely acidotic? 15 A Usually it's the intense physical 16 activity that they had prior which lead up to 17 their cardiac arrest basically and built up 18 lactic acid as a result of that. 19 Q Does the application of the TASER 20 -- strike that. 21 You agree that the application of 22 the TASER affects muscles, correct? 23 A Yes. 24 Q And it stimulates the muscles and 25 contracts the muscles, correct? 0046 1 Wetli 2 A Correct. 3 Q And does that stimulation of the 4 muscles produce lactic acid, if you know? 5 A Locally, yes. I would imagine it 6 would locally. I don't know if that's ever been 7 measured, but it would make sense that it would 8 create a localized increase of lactic acid in 9 the muscle itself, not in the blood. 10 Q Where does the lactic acid go once 11 it's released from the muscle, doesn't it go 12 directly into the bloodstream? 13 A Yes. 14 Q And, in fact, the measurement that 15 was taken in the hospital was from blood, 16 correct? 17 A Of course. 18 Q Are you aware of any peer-reviewed 19 scientific studies that have been done 20 specifically relating to the production of 21 lactic acid subsequent to a TASER discharge? 22 A No. 23 Q You also indicated elevations of 24 sodium, potassium, urea nitrogen, creatinine, 25 and creatine phosphokinase. 0047 1 Wetli 2 What's the significance of the 3 increase of those things? 4 A The sodium, urea nitrogen and 5 creatinine may well be just a reflection of some 6 degree of dehydration. 7 The potassium is interesting, 8 because one of the proposed mechanisms of sudden 9 death and the asystole seen in cases of excited 10 delirium are fluctuations in potassium, because 11 they can be very high or very low. 12 Q Or hypokalemia? 13 A Or hyperkalemia. And in this case 14 hyperkalemia, and in conjunction with a very low 15 pH could be very lethal. 16 The creatine phosphokinase is a 17 measure of skeletal muscle breakdown, and that 18 was extremely high in this case. 19 Q And that would explain the 20 subsequent rhabdomyolysis? 21 A Correct. 22 Q So basically -- 23 A No. The rhabdomyolysis explains 24 the evaluated creatine phosphokinase. 25 Q I was going to ask you to define 0048 1 Wetli 2 rhabdomyolysis. 3 A Rhabdomyolysis is defined as the 4 chemical breakdown of skeletal muscle. 5 Q So what I meant to say is that that 6 caused this very high reading where you see the 7 skeletal muscle in the blood, correct? 8 A Well, you don't see the skeletal 9 muscle in the blood, you see the products of 10 skeletal muscle in the blood. 11 Q I meant to say the breakdown of the 12 skeletal muscle; is that correct? 13 A Correct. 14 Q Do you have an opinion to any 15 degree of medical certainty as to what would 16 cause the elevated potassium? 17 A Probably the breakdown of skeletal 18 muscle. 19 Q Is there any other possibility for 20 that? 21 A Yes. With exercise, intense 22 physical exertion, can also elevate potassium. 23 Again, it's probably related to breakdown of 24 skeletal muscle, but you can also get drops of 25 potassium levels, and I don't know precisely why 0049 1 Wetli 2 that happens with exercise. I read it does 3 happen, but I don't know the reasons for it. 4 Q And just to clarify one point: 5 Potassium affects the electrolytes in the body? 6 A Potassium is an electrolyte. 7 Q And it affects the electrical 8 system in the body, for lack of a better word? 9 A Part, anyway. 10 Q Hyperkalemia can result in a fatal 11 cardiac arrhythmia, correct? 12 A Correct. 13 Q Do you have an opinion in this case 14 whether, in fact, that was the mechanism of 15 death in this case? 16 A No. You can't really identify that 17 specifically as a mechanism of death, because in 18 order to do that you would have to have a 19 potassium measurement at the time he became 20 cyanotic, and you don't have that. 21 Q Let me ask you this specifically: 22 What do you believe to be the mechanism of death 23 in this case? 24 A The mechanism of death in cases of 25 excited delirium is thought to be an 0050 1 Wetli 2 exaggeration of normal exercise in physiology. 3 It's a combination of the mass of increase in 4 catecholamines that you received coupled with 5 the presence of stimulant drugs, such as 6 methamphetamine. These will go on to affect the 7 heart, and the heart in this case is also 8 enlarged, which makes a person more susceptible 9 to the effects of these catecholamines and 10 stimulant drugs. There is the consideration of 11 the fluctuation in potassium, which we can only 12 speculate about. 13 However, also, once the intense 14 physical activity is over with, the body 15 responds to that with a surge of a hormone 16 called norepinephrine. This hormone constricts 17 blood vessels and skeletal muscle and skin and 18 forces the blood back to the central part of the 19 body. 20 The physiologic rationale for that, 21 if you want to call it that, is that if you stop 22 exercising suddenly and all your blood is in a 23 pool of the skeletal muscle, you'll pass out. 24 So this prevents that from happening. But the 25 bad news is that it can also cause the heart to 0051 1 Wetli 2 stop. 3 So right now the current thinking 4 is that the combination of all these factors 5 that lead to sudden death, or the death occurs 6 actually at the scene. If they get 7 resuscitated, as what happened with Mr. Heston, 8 they invariably go into rhabdomyolysis, acute 9 renal failure, multiorgan failure, and die 10 within a matter of anywhere from one to four or 11 five days later, usually within four days. 12 Q You just covered quite a bit of 13 information, and I want to see if I can kind of 14 break it down in more lay terms. 15 The exercise that you are talking 16 about, do you agree that the constriction of 17 muscles contributes to that exercise? 18 A Of course. 19 Q And you agree that TASER constricts 20 the muscles? 21 A Yes. 22 Q So, therefore, is TASER a 23 contributing factor in terms of the amount or 24 level of exercise that a person experiences 25 while he or she is being TASEed? 0052 1 Wetli 2 A No. Any amount of lactic acid of 3 skeletal muscle breakdown by TASER is going to 4 be miniscule compared to the intense physical 5 exertion that goes on in these individuals. 6 That is a miniscule amount, it is not 7 contributory. 8 Q And what is the basis of that 9 opinion? 10 A The basis of that opinion is that 11 the electrical discharge is going to be only 12 between the two electrodes, number one. 13 Number two, it's a very brief 14 duration. 15 And number three, actual scientific 16 studies looking at rhabdomyolysis related to 17 TASER revealed that at the most, it's a one 18 percent increase, which I think that is even 19 high, personally. But that's what the 20 peer-reviewed article says, so it's a miniscule 21 amount of contribution. 22 Q Are you familiar with the research 23 that's been done by Jauchem and his colleagues? 24 A I don't recall it offhand. I may 25 have heard of it. If you tell me what the 0053 1 Wetli 2 experiment is about. 3 Q He specifically measured in pigs 4 the increase in acid subsequent to repeated 5 TASEing application. 6 MR. BRAVE: Objection; form. 7 It misstates the research. 8 Q That's one of the number of things 9 that he tested, but he specifically was testing 10 acidosis in response to a repeated TASEing 11 application. 12 Does that refresh your recollection 13 at all? 14 MR. BRAVE: Same objection. 15 A Yes. 16 Q Do you know what Jauchem's findings 17 were in that study? 18 A I don't really recall offhand, but 19 as far as I know, it's not really applicable to 20 human beings. 21 Q Why would that be? 22 A Because it's a pig. You'd have to 23 show that -- if you want to establish an animal 24 model, you would have to show that the same 25 thing is going to happen in a human that would 0054 1 Wetli 2 happen to a pig. Then if you can establish 3 something like that in a human being, which 4 would support the validity of the pig 5 experiments, then subsequently you can do pig 6 experiments and extrapolate that to a human 7 being. But to TASER a number of pigs and say 8 that is what's happening in a human, you can't 9 say that. 10 For example, when lightning strikes 11 on pigs, it's an entirely different pathology 12 than when lightning strikes on humans. 13 Q There is a lot of research done on 14 pigs specifically as they relate to 15 defibrillators and things like that, correct? 16 A I don't know. I'm not familiar 17 with that literature. 18 Q Do you have any idea why pigs are 19 used to do that type of research? 20 A Well, like I said before, when you 21 are going to pick an animal model, you'll pick 22 the animal that closely resembles the human 23 being. 24 First of all, you'll start off by 25 guessing and then you'll see which is going to 0055 1 Wetli 2 react to the human being most likely by whatever 3 methods you choose to do it. So in some 4 instances, the dog might be a better model, 5 sometimes a rat, sometimes a pig, sometimes a 6 monkey. 7 Q You testified earlier that you've 8 reviewed scientific peer-reviewed literature 9 regarding the physiological effects of TASER 10 application, correct? 11 A Correct. 12 Q In those studies that you've 13 reviewed that are peer-reviewed, what's the 14 longest duration of the TASER application in any 15 of those studies? 16 A I don't recall offhand. 17 Q Do you agree that the predominant 18 duration in 90 percent, 95 percent of the 19 studies is one five-second discharge? 20 A As I recall, five seconds is about 21 right, as I recall, yes. 22 Q Are you aware of any peer-reviewed 23 scientific studies that have analyzed the 24 physiological effects on a human being of 25 someone that has been TASEed for 74 consecutive 0056 1 Wetli 2 seconds? 3 A No. 4 Q By the way, I neglected to ask you 5 a question earlier in this particular case, do 6 you have any understanding as to whether there 7 was one or more than one TASER application at 8 the same time? 9 A It's my understanding that he was 10 initially TASERed from two or three different 11 electronic control devices at one time. He 12 removed some of those, pulled some of those out, 13 it had no affect, and then he was TASERed once 14 more. That's my understanding. 15 Q Just once more? 16 A Yes. 17 Q For how long? 18 A I don't know. 19 MR. WILLIAMSON: Let's take a 20 break. 21 (Whereupon, at 11:05 a.m., a 22 recess was taken to 11:14 a.m.) 23 (The deposition resumed with 24 all parties present.) 25 C H A R L E S V. W E T L I, M.D., resumed 0057 1 Wetli 2 and testified further as follows: 3 BY MR. WILLIAMSON: 4 Q You just testified to a number of 5 things that I want to get back to in a little 6 bit, but let's move on to your report. 7 Do you remember how many different 8 pairs of TASER dart marks were noted by Dr. 9 Haddix in her autopsy report? 10 A I don't recall that offhand, no. 11 Q By the way, I should have asked you 12 this earlier: You've had a chance to review Dr. 13 Karch's report, correct? 14 A Correct. 15 Q And do you agree with Dr. Karch 16 that Dr. Haddix -- he made the comment in his 17 report at the very outset, he said this was the 18 most thorough autopsy report he had ever seen in 19 this type of investigation. 20 Do you agree that it was a very 21 thorough report by Dr. Haddix? 22 A Yes. 23 Q So you don't remember how many 24 marks were noted in the report? 25 A No. That doesn't really mean much 0058 1 Wetli 2 to me. 3 Q Now, let's talk about hypertrophy 4 of the heart. 5 Do you remember the weight of the 6 heart on autopsy? 7 A I believe it was 478 grams. 8 Q And in a male, a normal male, if 9 there is such a thing, of 40 years old or 10 thereabouts, what would you typically expect the 11 weight of the heart to be? Is there a range, in 12 other words? 13 A The predicted weight for his heart 14 for his height should be 328 grams, and his 15 heart weighted 485 grams. 16 Q And would you classify the 17 hypertrophy of his heart to be mild, moderate or 18 severe? 19 A Moderate. 20 Q Do you believe that independent of 21 any involvement by the police officers in this 22 case that Mr. Heston would have died as a result 23 of the enlargement of his heart? I mean at the 24 time of the incident. 25 A No. The enlarged heart predisposes 0059 1 Wetli 2 one to die from excited delirium, but the 3 enlarged heart in and of itself, I would not 4 expect him to have died at that time and place 5 just from the enlarged heart. 6 Q Can a male who has a moderately 7 enlarged heart lead a normal life span? 8 A He can yes, and many actually do. 9 Obviously if you have any type of heart 10 abnormality, your odds of that happening are 11 somewhat diminished, because it's an abnormal 12 heart, unless you are an athlete. But assuming 13 he is not an athlete, then you have to look at 14 why that heart is enlarged. 15 Q Well, let's talk about that. 16 I think you said in your report 17 that the etiology of that was uncertain to you; 18 is that correct? 19 A Correct. 20 Q And the etiology of that enlarged 21 heart could be due to, for example, high blood 22 pressure, correct? 23 A Correct. 24 Q Do you have any knowledge as to 25 whether Mr. Heston had a history of high blood 0060 1 Wetli 2 pressure? 3 A No, that's why it's uncertain. 4 Q And obviously one of the other 5 potential causes of that would be misuse of 6 illicit drugs, correct? 7 A Specifically stimulant drugs such 8 as methamphetamines, they are known to enlarge 9 the heart. And that's one factor we have that 10 we can identify, but I don't know from his 11 medical records whether he has a history of 12 hypertension and so forth that has been 13 untreated. 14 Q Would one of the reasons you would 15 want to look at the microscopic slides relative 16 to the heart could be to see the thickness of 17 the walls of the heart? 18 A No. I believe Dr. Haddix probably 19 measured those at the time she did the autopsy. 20 You would not measure the thickness of the heart 21 wall by the microscopic slides. She did not 22 measure the thickness. 23 Q So do you recall if you've reviewed 24 any -- 25 A I'm sorry. I take it back. She 0061 1 Wetli 2 referred the heart to Stanford Medical Center. 3 Q Dr. Berry, I believe. 4 A So at any rate, it was looked at by 5 a cardiac pathologist at the University. 6 Q And what would be the reason why 7 you would want to look at the thickness of the 8 walls of the heart? 9 A Because when you have an enlarged 10 heart and the walls are thin, it usually means 11 that you have a dilated chamber, which could 12 mean various other types of heart disease could 13 be present. 14 Q Valve disease? 15 A Not valve disease, but it would be 16 what's called a dilated cardiomyopathy, or you 17 can have asymmetric hypertrophy of the heart, 18 which is another form of the disease of the 19 heart, another type of cardiomyopathy and so 20 forth. 21 So there are various reasons as to 22 why you want to measure the thickness of the 23 heart, the thickness of the walls, the thickness 24 of the heart valves and that type of thing. 25 And I know it was measured -- I 0062 1 Wetli 2 know it was looked at by a cardiac pathologist, 3 but I can't find it, though. 4 (Perusing documents.) 5 Q I think actually there's some 6 reference to it in Dr. Karch's report, if you 7 have that in front of you? 8 A Yes, there is. 9 (Perusing documents.) 10 Q Let me just share with you while 11 you are looking for that, in Dr. Karch's report 12 he does refer to Dr. Berry from Stanford 13 University, his microscopic analysis, and he 14 says it confirmed biventricular, quote/unquote, 15 mild myocyte hypertrophy. What is that? 16 A The muscles of the heart are 17 enlarged. It's just a fancy way of saying it. 18 Q And Dr. Berry who is I guess -- so 19 he refers to the hypertrophy as mild, or is he 20 specifically talking about something else or is 21 he generally talking about the hypertrophy? 22 A He's talking about the hypertrophy. 23 Q And you agree that based on your 24 review of Dr. Haddix's report that there were no 25 injuries to account for Mr. Heston's death, no 0063 1 Wetli 2 outward manifestation of injury? 3 A Correct. 4 Q You also note in your report -- I'm 5 sorry. There was one other thing that I wanted 6 to ask you about, and that was the chamber 7 dilatation. What does that refer to? 8 A In this case, probably the 9 mechanism of death. 10 Q Okay, but specifically. What is 11 that, can you define that for me? 12 A The heart begins to fail and it 13 just doesn't contract very much anymore and it 14 dilates. 15 Q Let's talk about the level of 16 methamphetamine that was detected in his blood. 17 Do you remember what that was? 18 A I believe it was .64 milligrams per 19 liter. 20 Q Now, again, I asked you kind of a 21 variation on this question, but let me put it a 22 different way: Do you believe absent or 23 independent of the police involvement in this 24 case that Mr. Heston would have died at the time 25 he did from a methamphetamine overdose? 0064 1 Wetli 2 Is there any way for you to offer 3 that opinion one way or the other? 4 A No, I can't. Drugs are too 5 variable for that and it involves issues of 6 tolerance and things like that, so you can't 7 really predict it. 8 I could say if he was found dead, 9 for example, and I had his blood level on that, 10 I wouldn't have any problem attributing that as 11 the cause of death. So that's kind of what we 12 would need. Drug levels have to be interpreted 13 like everything else in the line of events. 14 Q So you would agree that it's 15 difficult, if not impossible, to say one way or 16 the other whether Mr. Heston would have died 17 strictly from a methamphetamine overdose? 18 A Exactly right. If the police had 19 never responded, it's entirely possible he could 20 have died from methamphetamine by itself. 21 Q Or not? 22 A Exactly. 23 Q You are aware that Mr. Heston had a 24 history of methamphetamine use, correct? 25 A Correct. 0065 1 Wetli 2 Q Were you made aware of the fact 3 that Mr. Heston had had prior altercations with 4 police during which time he was under the 5 influence of methamphetamine? 6 A I would not be surprised. I don't 7 know if that's reflected in the medical records 8 or not. I did not see a rap sheet on him or an 9 arrest record on him. I know he has at least 10 three prior hospital admissions because of 11 methamphetamine overdose. 12 Q You have no way of knowing, for 13 example, whether Mr. Heston had ever experienced 14 excited delirium prior to this particular 15 incident; is that correct? 16 A I can check for you. (Perusing 17 documents.) 18 April 1st of 2000 he had a 19 psychotic reaction related to problems of 20 presumed methamphetamine, but it wasn't 21 apparently excited delirium. 22 Q What would be the difference 23 between a psychotic episode and excited 24 delirium? 25 A A psychotic episode would just mean 0066 1 Wetli 2 things like seeing little green men running 3 around the window sill and being paranoid, but 4 you could be aware of where you are and who you 5 are and your surroundings and so forth and you 6 wouldn't have delirium. 7 And June 8th of '02 he's brought in 8 handcuffs and shackles presumably by the Salinas 9 Police Department, presumably under the 10 influence of crack. They used maximum 11 restraints on him, so it's a good chance that 12 he, in fact, had an episode of excited delirium 13 at that time, but it's not absolutely 14 substantiated. 15 And on August 30th of '03, probably 16 the same thing, he has an episode where he's 17 naked, bloody, draped in a sheet, he's put in 18 restraints, and these are all features of 19 excited delirium. His creatinase is a little 20 elevated, but he came close to it, if he doesn't 21 have it at that point. 22 Q In those two instances that you 23 just referred to, is there any indication in the 24 records as to whether Mr. Heston was TASERed? 25 A No, there's no evidence of that. 0067 1 Wetli 2 Q So we know that at least on two 3 prior occasions there's suggestion that he 4 suffered from excited delirium, but he did not 5 die, correct? 6 A That's possible, correct. 7 Q Do you agree, by the way, that most 8 people -- let's put it this way, the vast 9 majority of people who suffer from excited 10 delirium do not die? 11 A We don't know that. It's a study 12 that has been waiting to be done for years. 13 What you would have to do would be to look at 14 emergency room records over a period of, say, a 15 year or two, and compare those to medical 16 examiner records, and they have very strict 17 criteria. The studies just haven't been done. 18 I do know that it's not unusual for 19 me to review records of people who have died of 20 excited delirium, to see prior evidence of very 21 well documented excited delirium when they did 22 not die. 23 Q Would you agree that people that 24 are in mental institutions suffer from excited 25 delirium all the time and don't die? 0068 1 Wetli 2 A All the time, no, not today. 3 Q Is that because of Thorazine and 4 other similar drugs that are used? 5 A Right. The initial descriptions of 6 excited delirium were referred to as Bell's 7 Mania. It was first reported in 1849 and 8 repeatedly reported throughout the phychiatric 9 literature predominantly. Then the syndrome 10 seemed to have disappeared in the late 1950s, 11 late 1940s, rather, and then reemerged in the 12 1960s as the neuroleptic malignant syndrome, 13 which is kind of like excited delirium in slow 14 motion, and that's thought to be essentially 15 related to basically the same type of thing, 16 without being drug induced, except for the 17 neuroleptic drugs. 18 Q I'm going to get into excited 19 delirium in more detail in a few moments. 20 Let me just kind of get through the 21 rest of your report. We kind of got ahead of 22 ourselves a little bit, but that's okay. 23 Let me ask you about hyperthermia 24 in this case. 25 Do you agree that hyperthermia is a 0069 1 Wetli 2 common characteristic of excited delirium? 3 A It's frequently seen in excited 4 delirium, particularly due to cocaine. 5 Q What about methamphetamine? 6 A I don't know. You sometimes see 7 it, you sometimes don't. Part of the problem 8 with hyperthermia is that it's too often not 9 looked at by either medical examiners, coroners 10 or hospital personnel. 11 Q Is there a certain threshold 12 temperature that qualifies one with having 13 hyperthermia? 14 A I believe the clinicians have it as 15 100.8. Anything above 100.8 means you have a 16 fever. 17 Q Which by their definition is 18 hyperthermia? 19 A But usually when you refer to 20 hyperthermia, you are referring to temperatures 21 closer to 105. 22 Q In this case, you noted in your 23 report that an initial temperature was noted to 24 be 97 degrees? 25 A Correct. 0070 1 Wetli 2 Q But do you know how that 3 temperature was taken? 4 A Absolutely no idea. I don't know 5 how it was taken, where it was taken, who took 6 it, if it was one of these strips that you put 7 on the skin, or you measure it in the ear, it's 8 totally irrelevant. 9 Q But you don't know if it might have 10 been taken rectally, for example? 11 A It could have been. 12 Q Or orally? 13 A I'd be very surprised if they took 14 it orally in a person that is unconscious with a 15 tracheal tube in them. 16 Q 97 degrees is far below 17 hyperthermia, correct? 18 A Correct. 19 Q When was the temperature taken, if 20 you know? 21 A I have no idea. 22 Q So you don't know how it was taken, 23 you don't know when it was taken? 24 A Correct. 25 Q Now, there is another notation in 0071 1 Wetli 2 the records of a rectal temperature of 101 3 degrees. 4 A Correct. 5 Q Now, would you agree that's just 6 about the threshold of hyperthermia? 7 A Right. 8 Q And how long after Mr. Heston's 9 admission was that taken, if you know? 10 A I don't know. I remember seeing it 11 somewhere. And then there's another notation 12 that -- because I was looking for that -- and 13 then there's another notation that in the 14 doctor's orders that says if the temperature is 15 above 101, to go ahead and apply a cooling 16 blanket. 17 But that whole thing about the 101 18 temperature to me is kind of vague and not very 19 well documented as to when it actually occurred, 20 when it was taken. 21 Q What would be some other 22 explanations as to why Mr. Heston's temperature 23 had jumped three or four degrees? 24 A Well, I think just the intense 25 running around, the intense physical exertion is 0072 1 Wetli 2 going to elevate the body temperature. 3 Q But he had not done that for quite 4 a while at the point when these tests were 5 taken. 6 A Right. 7 Q So he wasn't running around when 8 the temperature was taken. So I'm asking in the 9 hospital what would have been some of the 10 reasons why his temperature might have elevated? 11 A Because it might be coming down 12 from an episode of hyperthermia. 13 Q So if that were true, then you 14 would have to discount the 97 degree 15 temperature, correct? 16 A Correct. These body temperatures 17 are only valid if they are core temperatures, 18 number one. 19 Number two, the only significance 20 it has is that if there is, in fact, documented 21 hyperthermia, it helps support the diagnosis of 22 excited delirium. That's it. 23 Q Let me just kind of summarize this, 24 if I could. 25 Do you agree, Dr. Wetli, that there 0073 1 Wetli 2 is no way of knowing one way or the other 3 whether Mr. Heston was hyperthermic subsequent 4 to this incident with the police? 5 A Correct. 6 Q I think I asked you earlier, and I 7 apologize if I'm repeating myself, but 8 hyperthermia is one of the key aspects of 9 excited delirium, correct? 10 A Wrong. 11 Q So, in other words, someone may be 12 in excited delirium, but not be hyperthermic? 13 A Correct. 14 Q And under what circumstances would 15 a person be in excited delirium, but not have a 16 high core temperature? 17 A That's never been studied. As I 18 said, it's my experience that if a person is 19 under cocaine induced excited delirium, you 20 expect to find them hyperthermic. It's still 21 not invariable, but it's most frequent. 22 Aside from that, I just don't know 23 of any studies that have been done that really 24 looked at that. 25 In Miami, when I was there, we were 0074 1 Wetli 2 very much aware of cocaine induced excited 3 delirium, and so were the emergency room 4 physicians. And so medical examiners, police 5 and emergency room physicians would very readily 6 take these core temperatures, either in the 7 hospital or at the scene. So we had a pretty 8 good idea of it. 9 In cases that I've subsequently 10 looked at involving other things, other than 11 cocaine, you may or may not have hyperthermia. 12 You find it in cases of excited delirium not due 13 to drugs and you can find it -- but, again, it's 14 not invariable. 15 Q Is methamphetamine in the same 16 stimulant family, general family as cocaine? 17 A Only in the family of its 18 physiological effects. Chemically they are 19 totally different. 20 Q Physiological effects include 21 elevated blood pressure, for example, correct? 22 A Yes, it can. 23 Q Explain to me, if you could, the 24 physiological mechanics of why someone that's 25 under the influence of cocaine has an elevated 0075 1 Wetli 2 temperature? 3 A I don't know. 4 Q So you are not aware of any 5 medically peer-reviewed studies that indicate 6 the basis for elevated temperature as a result 7 of cocaine use? 8 A Yes, there are. Dr. Mash has done 9 those studies. What she found is that the areas 10 of the brain that are affected by cocaine are 11 the same areas of the brain that are involved in 12 schizophrenia, the same areas of the brain that 13 are involved in regulation of body temperatures. 14 Now, I don't know if those studies have been 15 done with methamphetamines. At least cocaine it 16 has. 17 Q So that explains the reason why the 18 temperature increases, because the same part of 19 the brain is being affected? 20 A Exactly. 21 Q And you don't have an opinion one 22 way or the other whether the same mechanics are 23 true of amphetamine? 24 A Correct. And I don't think we know 25 why some people get hyperthermia and some people 0076 1 Wetli 2 don't. 3 Q Let me move down to the third full 4 paragraph on page 2. In the middle of that 5 paragraph there's a sentence that begins with, 6 "Therefore, listing the struggle and the proper 7 application of less-than-lethal force." 8 Do you see that? 9 A Yes. 10 Q Now, I take it from the words that 11 you chose to use in your report, "the proper 12 application of less-than-lethal force," that you 13 are offering an opinion in this case that the 14 use of the TASER was proper. Am I misreading 15 your opinion? 16 A No. As far as I can tell, it was 17 used properly. 18 Q Are you a use of force expert? 19 A No. 20 Q Are you going to be testifying as a 21 use of force expert in this case? 22 A No. 23 Q Do you have any police training? 24 A Some. 25 Q What's the nature of your police 0077 1 Wetli 2 training? 3 A Fire arms. 4 Q So you've been taught how to fire a 5 gun? 6 A Essentially. 7 Q Have you ever received any formal 8 instruction on police tactics? 9 A No. 10 Q Have you ever received any formal 11 training on the proper use of force by police? 12 A No. 13 Q And have you received any formal 14 instruction on less lethal options available to 15 police officers in restraining individuals? 16 A Formal training in that aspect, no. 17 Q What is the basis of your opinion 18 in this case that the application of the TASER 19 was proper? 20 A It's just based upon the report 21 that I read. 22 Q So, again, it's based on what 23 Detective Davidson said in his report? 24 A Correct. 25 Q And if you were to receive 0078 1 Wetli 2 information that would be contrary to Detective 3 Davidson's report, would you consider changing 4 your opinion in this regard? 5 A I'll always consider changing my 6 opinion upon the addition of bona fide 7 legitimate information. 8 Q So, in other words, if you were 9 provided with legitimate scientific information, 10 peer-reviewed research that was contrary to any 11 of the opinions you offered in your report, you 12 would change your opinion? 13 A No. I said I would consider it. 14 Q Consider it. I'm sorry. I didn't 15 mean to leave out that word. 16 So you would consider changing your 17 opinion? 18 A Well, it goes for not only 19 scientific publications, but it also goes for 20 witness statements. If the factual basis 21 changes, then obviously my report is going to 22 have to change. 23 Q Were you aware that TASER 24 International had issued a warning in regard to 25 the repeated and prolonged application of a 0079 1 Wetli 2 TASER on an individual? 3 A I heard that. 4 Q How did you hear that? 5 A I think somebody told me. 6 Q Do you know who it was? 7 A No. 8 Q Do you know what the nature of the 9 warning was? 10 A No, just that the -- basically, the 11 bottom line is that the misuse of the TASER 12 could possibly be dangerous. 13 Q And you didn't feel in this case 14 that the use of the TASER for 74 consecutive 15 seconds was a misuse of that device; is that 16 correct? 17 MR. BRAVE: Objection to 18 form; assumes facts not in evidence. 19 A One thing I don't know that it was 20 applied for a continuous 74 seconds. 21 Secondly, it's my understanding 22 that you could not apply it for a continuous 74 23 seconds. It's five minute bursts and these are 24 microsecond pulses. 25 Q Five minute bursts? 0080 1 Wetli 2 A Five second bursts. I'm sorry 3 about that. 4 So five second bursts and these are 5 microsecond pulses to begin with, so I don't 6 even know if that's possible, and if it was, so 7 what; he was standing there, he was shot with a 8 TASER, apparently several of them, he ripped the 9 darts out, he went inside the house, he was 10 finally prone and he was TASERed once more. 11 Q Let me ask you this question, 12 Doctor, and I want you to assume the following 13 facts: 14 I want you to assume that Mr. 15 Heston was taken down by a TASER, and subsequent 16 to being on the ground on his face with his arms 17 underneath him, that the TASER was discharged 18 over 50 seconds, is that, in your opinion, a 19 misuse of the TASER? 20 MR. BRAVE: Objection; form. 21 A Not being a police tactics expert, 22 I would say I have no opinion about that. I can 23 tell you medically. I'm not a police tactics 24 expert, so if that's a misapplication or not, 25 that's not for me to judge. 0081 1 Wetli 2 Q The reason I'm asking these 3 questions is because you have offered an opinion 4 that does go to the application of a less lethal 5 option, this is not a medical opinion. It seems 6 to me it's something beyond that. That's why 7 I'm asking these questions. 8 A The reason why I worded it in that 9 particular fashion is that if any of these 10 things can, in fact, become lethal under certain 11 circumstances, if, for example, the TASER was 12 defective and issued a continuous stream of 13 electricity, and that was going on for a period 14 of three minutes, and that could paralyze 15 somebody's chest, I would have to take that into 16 consideration. 17 In this particular case, none of 18 the TASERs seem to be defective, therefore, a 19 50-second burst might be technically against 20 police rules, but medically it's not going to 21 have any affect. 22 Q So you don't think that there would 23 be any duration of the TASER application that 24 would have any adverse affect on a human being? 25 A No. It's not going to stop his 0082 1 Wetli 2 respiration or his heart. 3 Q And I just want to ask one last 4 question and then we'll move on: Is it your 5 understanding as you sit here today that a TASER 6 cannot be discharged continuously, let's say, 7 for a minute straight? 8 A I don't know if it can or not, but 9 it's my understanding the way a TASER works is 10 you have to keep pulling the trigger on it. 11 Q Let's assume that someone either 12 continues to pull the trigger or depresses the 13 trigger without releasing it, is it your 14 understanding that a TASER can continue to cycle 15 and discharge for as long as the battery will 16 last on the device? 17 A I don't know that. 18 Q Now, I take it that you disagree 19 with Drs. Haddix, Karch and Hain in the sense 20 that they list the application of the TASER as a 21 contributing factor to the cause of death in 22 this case? 23 A Correct. 24 Q Let's now move on to talk more 25 specifically about excited delirium. 0083 1 Wetli 2 Did you ever receive any formal 3 medical training in -- I'm sorry. Let me 4 withdraw that for a second. 5 Is there a distinction in your mind 6 between excited delirium and excited delirium 7 syndrome? 8 A No. Excited delirium syndrome is 9 probably a more accurate title, but they are the 10 same thing. It's a syndrome. 11 Q Do you consider Dr. Di Maio to be 12 one of the experts in this country on excited 13 delirium? 14 A If you mean has he had enough 15 experience with the syndrome and done research 16 on it and so forth, I would say yes. 17 Q Are you familiar with his book that 18 he's written with his wife on the subject? 19 A Yes. 20 Q Dr. Di Maio has testified in this 21 case that at least in his mind there's a 22 distinction between excited delirium and excited 23 delirium syndrome, and that excited delirium 24 refers to the manifestation; where a syndrome 25 refers to the death. Someone who dies from 0084 1 Wetli 2 excited delirium has excited delirium syndrome. 3 Do you agree or disagree with that 4 analysis? 5 A I mildly disagree. 6 Q Why? 7 A Because I think you can have cases 8 in which excited delirium occurs when it's not 9 fatal and it can be fatal. To me they are the 10 same syndrome. Like a heroin overdose, you can 11 have a heroin overdose that's not fatal or you 12 can have a heroin overdose that's fatal. They 13 are both heroin overdoses. 14 Q So should we use the term "excited 15 delirium" or "excited delirium syndrome" as we 16 move on in this case? 17 A To me they are the same. It 18 doesn't matter what you use. 19 Q So let me begin and ask you if you 20 have ever received any formal medical training 21 in excited delirium? 22 A I think I would say yes. 23 Q And where was that? 24 A University of Miami School of 25 Medicine. 0085 1 Wetli 2 Q And what do you recall being taught 3 about excited delirium syndrome? 4 A I'd given a lecture on deaths 5 related to cocaine, and one of the cases I've 6 described would be now called excited 7 delirium -- 8 Q I'm sorry, Doctor. I didn't mean 9 to interrupt you, but maybe you misunderstood my 10 question. 11 I was asking what formal education 12 you received, not what you've given others. 13 A That's what I'm getting at. 14 A psychiatrist after the lecture 15 told me that one of the cases I described is 16 what in psychiatry they call excited delirium. 17 He then introduced me to the term and made me 18 familiar with the syndrome, and we reported that 19 case in the Annals of Emergency Medicine. 20 A few years later I went back to 21 the same psychiatrist, a Dr. David Fishbain, and 22 said I think I have about a half a dozen more 23 cases this time occurring in all recreational 24 cocaine users and he confirmed that they were 25 all, in fact, excited delirium cases. We 0086 1 Wetli 2 reported that as a series of cases of excited 3 delirium induced by cocaine. And I've been 4 doing research and observation on these ever 5 since. So in that sense, I've had formal 6 education and training in excited delirium. 7 Q When was that lecture at the 8 University of Miami? 9 A 1980. 10 Q When did you first publish any 11 articles relating to the diagnosis of excited 12 delirium? 13 A Probably that occurred in 1982. 14 That's the publication date. You can check my 15 CV, it's in there. Dr. Fishbain is the senior 16 author on that particular report. 17 Q And he's a psychiatrist? 18 A Yes. 19 Q Now, is excited delirium or excited 20 delirium syndrome a recognized diagnosis by the 21 American Medical Association? 22 A I have no idea and I could care 23 less. 24 Q Is it a recognized diagnosis by the 25 American Psychiatric Association, if you know? 0087 1 Wetli 2 A I don't know what the association 3 says, but I do know that it's in textbooks of 4 psychiatry. I do know that it's described in 5 the diagnostic manual of psychiatry. But it's 6 not listed as a specific diagnosis in the 7 diagnostic manual, but it is described there. 8 Q Do you agree that there is some 9 dispute about the validity of excited delirium 10 syndrome as a cause of death? 11 MR. BRAVE: Objection; form. 12 A No, I don't believe there is. 13 There are some people who disagree about the 14 mechanism of death, but excited delirium is 15 pretty well established. 16 Q Those people that disagree with the 17 mechanism of death, what is the basis of their 18 disagreement, if you know? 19 A Basically it's -- in Latin it would 20 be "post hoc ergo propter hoc," because of this, 21 therefore, this. 22 In other words, it occurred in 23 police custody, therefore, the police must have 24 done something or they contributed in some way. 25 And depending upon what the police did, that's 0088 1 Wetli 2 the mechanism you are going to invoke. So if it 3 was pepper spray, if it was TASER, if it was an 4 upper control body hold, if it was hogtying. 5 That's what they would invoke. 6 Q In Dr. Di Maio's book, he 7 chronicles a number of cases, and in each one of 8 those cases, do you agree that they involved 9 police restraint, if you are familiar with his 10 book? 11 A I believe all his cases were, 12 that's true. 13 Q And in this case Dr. Di Maio 14 testified that the vast majority of people who 15 suffer from excited delirium do not die absent 16 police restraint. 17 Do you agree or disagree with that 18 opinion? 19 A I don't fully agree with it. I 20 have seen people die from excited delirium where 21 they were not restrained, they've jumped off 22 buildings, they have been hit by cars, they 23 drowned, they've died from smoke inhalation, 24 they've died from jumping down stairs, they've 25 died from massive lacerations and bleeding to 0089 1 Wetli 2 death. There's all kinds of ways these people 3 die if you don't restrain them. 4 Q What edited medical textbooks have 5 you read on excited delirium syndrome? 6 A There's one by Wendkos, there's a 7 chapter in that book published I believe in 8 1979, and the title of that book, as I recall, 9 is "Sudden Death in Psychiatric Patients." He 10 did not use the term "excited delirium," but 11 it's described in there. 12 Dr. Di Maio's book, rather 13 obviously. 14 A book edited by Drs. Ross and Chan 15 called "Death in Police Custody." That's 16 devoted entirely to excited delirium. 17 Those are the only actual books I 18 know that have been devoted to excited delirium. 19 There have been a number of papers, but entire 20 books, those are the only two that I'm aware of; 21 the one by Di Maio, and the one by Ross and 22 Chan. 23 Q What are the diagnostic criteria 24 for excited delirium syndrome? 25 A Basically the initial criteria, 0090 1 Wetli 2 which I think has been pretty well 3 substantiated, is when the person has a disorder 4 or thought process where they are basically 5 unaware of their surroundings. 6 Q Would that be the delirium aspect 7 of it? 8 A Exactly. And at that point it's 9 either excited delirium or it's the more 10 usual -- well, I guess ordinary delirium, for 11 example, alcohol withdrawal. But with excited 12 delirium, that is now laced with things like 13 paranoia, apparent increase in strength and 14 bizarre behavior. The bizarre behavior includes 15 things such as inappropriate disrobing, smashing 16 of glass, that type of activity taking place. 17 One of the other characters is continued 18 thrashing after being restrained, and then 19 according to Dr. Di Maio, sudden death. 20 According to me, you may or may not survive it 21 at that point. 22 It's not so much a diagnostic 23 criteria, it's more of a descriptive thing, but 24 the main features are that you have the 25 fulfilled criteria for delirium and bizarre 0091 1 Wetli 2 agitated behavior and continued thrashing after 3 being restrained. Those are the main features 4 of it. 5 Q So forced restraint is common to 6 deaths that involve excited delirium syndrome, 7 correct? 8 A Well, it's common to excited 9 delirium whether you die or not. In fact, in 10 this case he's brought in I believe on two 11 occasions where he's been bought in by the 12 police restrained. 13 Q But those cases didn't involve the 14 use of a TASER? 15 A I don't know whether they did or 16 not, it doesn't say in the medical records. 17 Q Are you familiar with the term 18 "post-exercise peril"? 19 A Yes. 20 Q What does that refer to? 21 A That refers to the surge of 22 norepinephrine, and that means that for the 23 first several seconds, like usually 30 seconds, 24 40 seconds, something like that, after you cease 25 intense physical exertion, you have that period 0092 1 Wetli 2 in there where you have that surge of 3 norepinephrine when the heart can stop. 4 Q And Dr. Di Maio reported that 5 oftentimes in these case of excited delirium 6 death you would see this period of post-exercise 7 peril? 8 A Exactly. Because they almost 9 invariably die after they have been restrained, 10 not while the fight is going on. 11 Q Now, in this case Mr. Heston died 12 with -- if not while the restraint was taking 13 place or within seconds thereafter, correct? 14 A Correct. 15 Q So at least in this case, the 16 Heston case, there was no post-exercise period 17 of peril, correct? 18 A I don't know that. He was lying 19 prone. As I understand it, he was lying prone, 20 his arms were under him, he had been TASERed, 21 and that's a sudden cessation of violent 22 physical activity, and that's where the 23 post-exercise peril begins; the clock starts 24 ticking. 25 Q Well, I don't know if this was in 0093 1 Wetli 2 Detective Davidson's report, but do you recall 3 reading that within seconds of the last TASER 4 discharge, he was handcuffed and immediately 5 seemed to be cyanotic? 6 A Right. 7 Q So there was no gap in time, and if 8 there was, it was no more than a few seconds? 9 A A few seconds, several seconds, 10 yes. 11 Q But that period doesn't describe 12 this more exaggerated timeframe of post-exercise 13 peril, correct? 14 A No, not at all, it does. It occurs 15 within seconds up to maybe 30 or 40 seconds 16 after the cessation of intense physical 17 activity. 18 Q But would you agree in this case 19 that we don't know when there was cessation of 20 breathing, do you agree with that? 21 A No. As far as I know, there were 22 no observations of that. But, again, I have not 23 read the individual police reports. Sometimes 24 when you have this type of situation, a police 25 officer will check and say, yes, I feel a pulse, 0094 1 Wetli 2 but he's still breathing, and then a few minutes 3 later, or a few seconds later, even, and they 4 say now he's not breathing anymore and he still 5 has a pulse. I've seen that numerous times. 6 Q If we assume that it took a few 7 seconds -- at least at the minimum it took a few 8 seconds for Mr. Heston to become cyanotic and we 9 back that up, we're at around the time when he's 10 being handcuffed or he's -- I'm sorry. Strike 11 that. That's not what I meant to say. 12 If we back that up a few seconds, 13 that's when the last TASER application ends. 14 A Okay. 15 Q So would you agree, then, that 16 there is no period of post-exercise peril in 17 this case shown? 18 A No, because he was TASERed, they 19 turned him and he's cyanotic. There's several 20 seconds after the TASERing was done. 21 Q Do you know if any medical 22 specialty societies recognize excited delirium 23 syndrome as a valid diagnosis? 24 A I don't know of any societies that 25 particularly address the issue. 0095 1 Wetli 2 Q What about the American Psychiatric 3 Association, wouldn't that deal with issues of 4 delirium? 5 A I don't know what the American 6 Psychiatric Association does. I mean, the 7 American Psychiatric Association maybe sets up 8 criteria for diagnoses and so forth, but I have 9 no idea if that's what they do, or if they have 10 a committee that does that, or if they hold 11 seminars. I have no idea what they do. 12 Q But can you name one specialty 13 society that recognizes excited delirium as a 14 proper diagnosis? 15 A I don't know if they recognize it 16 or don't recognize it. I don't think it's in 17 the proper sphere of a society, of a 18 professional society, to recognize it or not 19 recognize it. 20 Q Are you aware of any specific 21 scientific research that validates the accuracy, 22 sensitivity or specificity of the diagnosis? 23 A Could you repeat that, please? 24 Q Sure. Are you aware of any 25 specific scientific research that validates the 0096 1 Wetli 2 accuracy, sensitivity of specificity of the 3 diagnosis? 4 A I don't think it's an appropriate 5 question for something like excited delirium. 6 It's based upon the behavior of the individual. 7 Q So I take it your answer is no, you 8 don't know any research that does that? 9 A I just don't think it's a valid 10 question to begin with. I don't think that it's 11 valid to say about the accuracy and so forth 12 about it. It's based upon the individual's case 13 and individual's behavior. 14 If you are asking whether a survey 15 has been done amongst medical examiners or 16 psychiatrists, giving them a number of cases and 17 say which diagnoses would you apply, I don't 18 think that's ever been done. 19 Q I think I asked you earlier about 20 medical textbooks, but are you aware of any 21 edited medical textbooks that recognize and 22 provide the diagnostic criteria for excited 23 delirium? 24 A By edited, do you mean -- all 25 textbooks are edited, do you mean peer-reviewed? 0097 1 Wetli 2 Q Peer-reviewed, right. 3 A Besides the ones we've already 4 mentioned, no. 5 Q Now, apart from Dr. Di Maio's book, 6 which does purport to provide the criteria for 7 the mechanism of death, are you aware of any 8 other peer-reviewed medical textbooks that do 9 that? 10 A The one by Ross and Chan. 11 Q And are you familiar with that 12 book? 13 A Yes. 14 Q What do they state to be the 15 diagnostic criteria for excited delirium? 16 A I'd have to have the book in hand. 17 I don't know what their criteria are offhand, if 18 they even list the criteria. I know they give a 19 general description of it, of the syndrome, just 20 like Di Maio does. 21 By the way, if I can go back and 22 answer your other question before for fatal 23 excited delirium, one other diagnostic criteria 24 is essentially a negative autopsy. 25 Q So upon autopsy you are looking for 0098 1 Wetli 2 some objective signs that would point in the 3 direction of a cause of death, and there are 4 none, correct? 5 A What I'm saying is that if you want 6 to attribute the death due to excited delirium, 7 you cannot have a lethal injury, you cannot have 8 evidence of strangulation, for example. 9 Q Or heart attack or gunshot or 10 anything like that? 11 A Yes, exactly. 12 Q I want to refer to you Dr. Di 13 Maio's book and ask your opinion about something 14 that he says. 15 On page 59 in his book, and I'll 16 read you the quote and ask you to comment on it. 17 He says, "In the author's opinion, myocardial 18 ischemia is due to the action of catecholamines 19 in association with hypokalemia is the 20 precipitating cause of death in individuals with 21 excited delirium due to methamphetamines?" 22 First of all, do you agree with 23 that statement? 24 A I don't have enough basis to agree 25 or disagree. 0099 1 Wetli 2 Q First of all, what's myocardial 3 ischemia? 4 A Lack of oxygen to the heart muscle. 5 Q And you mentioned earlier 6 catecholamines, but we didn't really talk about 7 that very much. 8 What are catecholamines? 9 A They are a class of drugs that 10 basically are adrenaline and related-type 11 hormones. 12 Q So what he is saying, as I 13 understand it, in lay terms, is that there is a 14 sudden rush of adrenaline into the bloodstream, 15 and that basically stops the heart; is that 16 correct? 17 A Well, you have the mass stimulant 18 effect of the heart based on the catecholamines 19 and the methamphetamine, which in turn may well 20 be dropping potassium levels and constricting 21 blood vessels. When you have the cessation of 22 the intense physical activity, now you get in 23 addition to that the surge of norepinephrine, 24 which is responsible for this so-called 25 post-exercise peril period, and that can also 0100 1 Wetli 2 stop the heart. Now the exact mechanism by 3 which that happens, I don't know. 4 I think others would opine that you 5 have shifts in electrolytes and iron channels 6 and so forth and things like that, and all these 7 may, in fact, be operative in any particular 8 individual. 9 I think Dr. Di Maio's opinion is a 10 good one. But, again, it's an opinion. I don't 11 think it's anything that has been scientifically 12 studied, and you can't scientifically study it. 13 Q Now, the adrenaline that you 14 previously mentioned, pain stimulates the 15 production of adrenaline in the body, does it 16 not? 17 A It can, yes. 18 Q And you've already testified that 19 the application of a TASER discharge results in 20 pain? 21 A To a normal individual. 22 Q And you are saying that in this 23 case Mr. Heston wasn't a normal individual, 24 right? 25 A Exactly. These people typically do 0101 1 Wetli 2 not respond to pain. 3 Q In this case, a TASER application 4 or a TASER discharge was applied to Mr. Heston. 5 Is it your understanding that he 6 went to the ground? 7 A The initial TASER application? 8 Q Well, any TASER application in this 9 case. 10 A It's my understanding that he did 11 not go to ground as a result of a TASER 12 application. It's my understanding that he fell 13 and hit his head and then while he was on the 14 ground the TASER was applied, but I don't think 15 the TASER actually took him to the ground. 16 Q If you were to read the testimony 17 of Officer Goodwin, and when he applied TASER 18 prior to the time -- strike that. 19 Actually, why don't we -- let's 20 just leave out names. Let's assume that you 21 were to review testimony in this case that one 22 or more officers applied a TASER prior to Mr. 23 Heston going to the ground. Would it then be 24 your opinion that the TASER did have some 25 affect, in other words, there was some pain 0102 1 Wetli 2 component which resulted in Mr. Heston being on 3 the ground? 4 MR. BRAVE: Object to form. 5 A Not pain component, there would 6 have been muscular contraction component 7 perhaps, but not pain. These people do not feel 8 pain. 9 Q But they are susceptible to the 10 muscle contractions that would result them going 11 to the ground, correct? 12 A If the right muscles are 13 contracted, it might make them go to ground, 14 correct. 15 Q Have you ever watched TASER videos? 16 A Yes. 17 Q And typically the subject that is 18 subjected to TASER discharge begins to go to the 19 ground, sometimes they are held up by other 20 people, but if not held up, typically they go to 21 the ground? 22 A Right. But those people I have 23 seen did not have excited delirium. 24 Q And there's no studies -- it would 25 be impossible to study a human being who is in 0103 1 Wetli 2 the throws of excited delirium and then subject 3 them to TASER discharge, do you agree with that? 4 A Well, yes, I don't think you would 5 find any committee that would allow you to do 6 that kind of work. 7 First of all, to induce excited 8 delirium is in and of itself lethal or 9 potentially lethal, and then on top of that do 10 your experiments, that is not ethical. 11 Q And, likewise, it would be fairly 12 -- not fairly, it would be unethical to subject 13 a human being to a prolonged TASER discharge, 14 let's say, over a minute, that would be equally 15 unethical, correct? 16 MR. BRAVE: Objection; form. 17 A I don't know if that could be 18 unethical or not if you can find a volunteer. 19 Q Do you know in looking at any of 20 the autopsy report or any of the hospital 21 records actually whether there was any evidence 22 of myocardial ischemia on EKG? 23 A I have no idea. 24 Q Have you seen any EKG strips at all 25 in this case that were taken at the hospital 0104 1 Wetli 2 subsequent to Mr. Heston's admission? 3 A Not that I recall. 4 Q Is myocardial ischemia something 5 that would show up on EKG? 6 A It might. If it's true myocardial 7 infarction it probably would, but aside from 8 that, if you have a global ischemia you probably 9 wouldn't see anything. In cases of excited 10 delirium, if we go with Di Maio's opinion, it is 11 caused by the contraction of the intramyocardial 12 arteries causing global ischemia, you would 13 probably not see anything. 14 Q Was a troponin blood test taken in 15 the ER after Mr. Heston was admitted, if you 16 know? 17 A I don't know offhand. I could find 18 out for you. (Perusing document.) 19 Q While you are looking, let me just 20 ask you, would evidence of myocardial ischemia 21 show up in a troponin blood test? 22 A Yes. That is supposed to be one of 23 the better tests to determine whether or not 24 there's actual myocardial ischemia. In cases of 25 excited delirium, I've seen it where they have 0105 1 Wetli 2 had some mild elevations of the troponin level, 3 which has subjected global ischemia. 4 (Perusing document.) 5 It was done on the 19th and it was 6 normal; 0.17. The normal troponin level in the 7 reference manual is less than 1.5. 8 Q So is it your opinion that at least 9 as to global myocardial ischemia there was none, 10 based on that troponin blood test? 11 A Based on that one single test, 12 that's correct. 13 MR. WILLIAMSON: Let's take a 14 break. 15 (Whereupon, at 12:07 p.m., a 16 recess was taken to 12:16 p.m.) 17 (The deposition resumed with 18 all parties present.) 19 C H A R L E S V. W E T L I, M.D., resumed 20 and testified further as follows: 21 EXAMINATION 22 BY MR. WILLIAMSON: 23 Q I want to go back to something you 24 said a few minutes ago regarding typically on an 25 autopsy where there are no objective signs of 0106 1 Wetli 2 the cause of death, that's when you would start 3 to consider excited delirium. 4 In that regard, do you agree that 5 excited delirium syndrome is a diagnosis of 6 exclusion? 7 A No, not at all. 8 Q Do you have an opinion to any 9 degree of medical certainty that assuming there 10 had been no encounter with the police on the 11 date of this incident that Mr. Heston 12 nonetheless would have suffered a cardiac 13 arrest? 14 A I don't know whether or not he 15 would have suffered a cardiac arrest. If so, it 16 would have been due to the methamphetamine 17 toxicity. More than likely since he was in 18 excited delirium he would have died from trauma. 19 Q What trauma? 20 A These people are intensely paranoid 21 and violent. They smash glass and inflict 22 lethal sized wounds to their upper extremities, 23 they jump into pools of water and drown, they 24 run into traffic and get hit by cars, they jump 25 from one building to another, they jump down 0107 1 Wetli 2 stairs and rupture spleens. There's all kinds 3 of things that can happen to these people. 4 Q I understand that there are a lot 5 of different possibilities. My question was 6 really case specific as to Mr. Heston, because 7 in this case there was no evidence of any of 8 that, no evidence of trauma in this case up to 9 the point where he died. 10 A That's because the police were 11 involved. 12 Q But my question is -- I think you 13 answered it, but just to be clear, my question 14 was specific as to Mr. Heston: Absent police 15 involvement, whether you have an opinion to a 16 degree of medical certainty that Mr. Heston 17 would have died due to cardiac arrest? 18 A No. 19 Q Did you ever consider TASER 20 applications in this case to be a contributing 21 factor towards death? 22 A Any time you have a death in police 23 custody, you look at the actions of the police 24 and always take those into account as to whether 25 or not they could have been contributory, 0108 1 Wetli 2 regardless of the method that's used, whether 3 it's pepper spray or hogtie or whatever it is. 4 Q But in this case, having considered 5 the TASER applications, you discounted that as a 6 contributing factor to the cause of death? 7 A Correct. 8 Q By the way, do TASER applications, 9 the darts themselves, cause skin burns, if you 10 know? 11 A Well, the darts themselves do not 12 cause skin burns, but if you have the dart and 13 then you have the electrical charge, then you 14 can get electrothermal burns. 15 Q It cauterizes the skin, 16 essentially, correct? 17 A Yes. It's a burn, an electrical 18 burn. It looks like a very typical electrical 19 burn under the microscope. 20 Q And based on your review of Dr. 21 Haddix's autopsy in this case, do you recall how 22 many different electrical burns she noted in her 23 autopsy report? 24 A No, I didn't pay any attention to 25 that. I think she noted them, but I didn't 0109 1 Wetli 2 really pay attention to that. I expect them to 3 be there. 4 Q Would the number of electrical 5 burns be evidence of the number of TASER darts 6 that struck Mr. Heston? 7 A No. 8 Q In this particular case what would 9 be the other reasons why Mr. Heston would have 10 electrical burns? 11 A He would have electrical burns as a 12 result of the TASER darts, but some darts could 13 have landed on his clothing and not caused the 14 burning of the skin. 15 Q I understand that. 16 A Maybe I'm misunderstanding your 17 question. 18 Q Maybe my question wasn't very good. 19 Assuming TASER darts actually 20 struck his skin, do you agree that the 21 electrical burns on his body would evidence 22 those strikes? 23 A Yes. 24 Q Have you done any research yourself 25 in regard to the potential adverse physiological 0110 1 Wetli 2 consequences of both prolonged and multiple 3 TASER applications? 4 A No. 5 Q Do you know anybody that has? 6 A Not offhand. Dr. Jeffrey Ho may 7 have, but I don't know that for sure. 8 Q Do you know Dr. Ho personally? 9 A I've met him, yes. 10 Q Have you talked to him in 11 connection with this case? 12 A No. 13 Q Are you aware that he's been 14 designated as an expert in the case? 15 A Yes, you told me. 16 Q He told you? 17 A You told me. 18 Q I understand you are going to be 19 lecturing in an upcoming in custody desk 20 seminar, correct? 21 A Correct. 22 Q And that's in Los Angeles? 23 A Correct. 24 Q Do you know what you are going to 25 be speaking on specifically? 0111 1 Wetli 2 A Basically proposing an algorithm 3 for approaching death in police custody; things 4 to do, not to do. 5 Q What are some of the things to do? 6 A Give as much information as 7 possible, take lots of photographs, both 8 pertinent negatives, as well as positive 9 findings, document everything extremely 10 thoroughly, very thorough toxicological testing, 11 including tissue distribution studies, in cases 12 of African-American males to do an analysis of 13 blood to determine the types of hemoglobin that 14 are present, because some of these can be 15 dangerous. 16 It's basically that type of 17 information. A lot of housekeeping type of 18 things, for example, after the creation of 19 clarification diagrams, to have the proofreading 20 done by somebody who has little knowledge of the 21 case, that type of thing. 22 Q Will you be offering any opinions 23 at all during your lecture about the need to 24 have medical personnel present while, if 25 possible, when restraining someone who is 0112 1 Wetli 2 suffering from excited delirium? 3 A No. There's no reason to have 4 medical personnel present for that. 5 Q There's none? 6 A No. 7 Q Who is sponsoring that seminar, by 8 the way, do you know? 9 A I'm not sure. The institute for 10 death -- I can't remember the acronym for it. 11 It's something for institute of prevention of 12 deaths in police custody, I think is the name of 13 the organization. 14 Q And is that an organization that's 15 lead by Dr. John Peters? 16 A Yes. 17 Q Have you worked with Dr. Peters 18 before? 19 A Only in the seminar that occurred 20 last year in Los Angeles. 21 Q The same seminar that's now being 22 repeated in a couple of months? 23 A No. It's a different topic. At 24 that seminar last time, my topic was the history 25 of excited delirium. This time it's death in 0113 1 Wetli 2 police custody. 3 Q Do you know what Dr. Peters' 4 connection is with TASER International? 5 A No, I don't. I know they have some 6 kind of relationship, but I don't know exactly 7 what it is. 8 Q And you are aware that, for 9 example, the defense attorney in this case, Ms. 10 O'Linn, is also going to be lecturing at that 11 conference? 12 A Yes. I believe she lectured last 13 time. 14 Q And what about Dr. Di Maio, do you 15 know if he's going to be lecturing at that same 16 conference? 17 A I will presume he is. I don't know 18 for sure. I haven't seen the list of speakers 19 yet. 20 Q So you don't know whether any of 21 the other experts that have been designated in 22 this case will also be speaking at that 23 conference? 24 A I'm sure many, if not all of them. 25 Q We talked much earlier today about 0114 1 Wetli 2 acidosis, and forgive me if I asked you this 3 question: In this particular case, what do you 4 believe to be the cause of the severe acidosis 5 that was found in Mr. Heston? 6 A Lactic acid. 7 Q What produced the lactic acid? 8 A Prolonged and intense physical 9 exertion. 10 Q There is a difference between 11 metabolic acidosis and respiratory acidosis, 12 correct? 13 A Correct. 14 Q Can you tell me what -- so the 15 lactic acid refers to metabolic acidosis, 16 correct? 17 A Correct. 18 Q What is respiratory acidosis? 19 A Respiratory acidosis is when you 20 have impairment of respirations and you build up 21 carbon dioxide in your blood and carbonic acid 22 and you get the increasing oxygen saturation, 23 dropping pH because of the carbonic acid and 24 carbon dioxide build up. 25 Q Now, do you believe in this case 0115 1 Wetli 2 that Mr. Heston was suffering from -- strike 3 that. 4 You agree he was suffering from 5 metabolic acidosis? 6 A Correct. 7 Q Was he also, in your opinion, 8 suffering from respiratory acidosis? 9 A Probably. An internist can answer 10 that better for you because they work with these 11 things all the time. He had a downtime for 12 several minutes, so, therefore, he probably had 13 a component of respiratory acidosis in there, as 14 well. 15 Q Respiratory acidosis compounds the 16 problem in two ways, as I understand it; it 17 creates, as you said, carbonic acid, but there's 18 also a mechanism whereby as you blow out carbon 19 dioxide it decreases metabolic acidosis, 20 correct? 21 A Sure. Because as you start 22 exhaling, you start getting rid of the lactic 23 acid and the carbonic acid and so forth, and 24 that's going to increase your blood pH, 25 therefore, it's going to help correct the 0116 1 Wetli 2 metabolic acidosis, as well. 3 Q So the fact that there is a 4 cessation of breathing results not only in 5 perhaps an exacerbation of the metabolic 6 acidosis, but it also causes respiratory 7 acidosis, correct? 8 A Correct. Only if you start 9 breathing again, though. 10 Q Well, did Mr. Heston start 11 breathing again in this case? 12 A Right. I was just being complete. 13 The concept has no validity if the person is 14 ever breathing again, either artificially or on 15 his own. 16 Q Would you expect that someone who 17 after cessation of breathing would begin to 18 breathe again and is blowing off the CO2, that 19 the metabolic acidosis would decrease over time? 20 A Well, getting rid of the acid 21 products in the blood by exhaling is going to 22 increase the pH and, therefore, help alleviate 23 the metabolic acidosis, as well. 24 Q Do you know in relationship to the 25 drawing of blood from Mr. Heston when he began 0117 1 Wetli 2 to breathe artificially or whatever? 3 A There's no way to tell that, as far 4 as I know. 5 Q We had talked about the pH of 6.83. 6 Are you aware that Mr. Heston had a blood CO2 of 7 42? 8 A I don't recall that offhand. 9 Q What's the significance, if you 10 know, of that number? 11 A To me it doesn't mean anything, 12 because he had this downtime, so I imagine his 13 CO2 would be pretty high. 14 Q And what's CO3? 15 A That is HCO3, bicarbonate. 16 Q And that number was 7. Is there 17 any significance to that number? 18 A It's very low, I think. 19 Q What does that mean? 20 A It means he had ten minutes of 21 downtime. 22 Q Do those numbers in combination 23 subject both respiratory and metabolic acidosis? 24 A To me they do, but, again, an 25 internist like Dr. Karch would be better able to 0118 1 Wetli 2 answer those questions. 3 Q But at least to you they suggest 4 that? 5 A Yes. But it also suggests to me 6 that the respiratory acidosis is pretty much 7 artifactual. 8 Q Would you agree that during steady 9 rate exercise, aerobic metabolism matches the 10 requirements of the muscles? 11 A No. You are going to -- well, I 12 think it is a matter of degree for a 13 neurologist, but you eventually are going to 14 confer over to anaerobic metabolism. 15 Q But before you do that, we'll get 16 to that in a second, but rapid exercise causes 17 the muscles to respond to the need for -- 18 A Sure. It initially starts off as 19 aerobic exercise. 20 Q And at some point after intense 21 stimulation in the muscles, aerobic exercise 22 turns into anaerobic exercise, correct? 23 A Well, it's not like switching it on 24 and off. The anaerobic exercise will supplement 25 the aerobic. The anaerobic metabolism begins to 0119 1 Wetli 2 supplement the aerobic metabolism. Let's put it 3 that way. You don't stop the aerobic 4 metabolism, it continues. You continue to 5 breathe. 6 Q I guess I should have asked you to 7 define the terms. 8 What is the difference between 9 aerobic and anaerobic? 10 A Aerobic metabolism basically means 11 that you are taking an oxygen and utilizing the 12 oxygen that's present in the hemoglobin. 13 Anaerobic metabolism means that the 14 expenditure of energy exceeds the amount that 15 can be taken in by just simply breathing alone, 16 even with a rapid heart rate and rapid breathing 17 rate, and then you switch over to anaerobic 18 metabolism, which means you are breaking down 19 other nutrients and converting that into energy 20 to maintain the activity of muscles. And that 21 is as much biochemistry as I recall. 22 Q I'm sorry for getting out of your 23 field. 24 A It's not exactly out of my field, 25 but there was a time in my life when I'd be able 0120 1 Wetli 2 to tell you all the chemicals involved, but that 3 was too long ago. 4 Q But you realize, Dr. Wetli, that 5 I'm here to keep you on your toes, right? 6 A It keeps me up, thank you. 7 Q Is the onset of anaerobic 8 metabolism associated with the accumulation of 9 lactic acid? 10 A It's my understanding that is 11 correct. 12 Q Does it also indicate a shift in pH 13 to an acidotic condition? 14 A Eventually yes, but the blood has 15 numerous buffers, and the anaerobic metabolism 16 does not exceed those buffers for pH to stay 17 pretty normal. When it becomes more intense and 18 exceeds that, then that's when lactic acidosis 19 occurs. For example, a person who is normally 20 running on a treadmill will not be getting 21 lactic acidosis or dropping pH. It's when it's 22 exceeding is when you start getting that drop. 23 Q Let's apply those principals to 24 this specific case. We know that Mr. Heston was 25 acidotic caused by the influx of lactic acid 0121 1 Wetli 2 from muscle stimulation, correct? 3 A Muscle exertion. 4 Q Okay. So can we conclude from that 5 that his metabolism went from aerobic to 6 anaerobic in this case? 7 A Correct. But he still has an 8 anaerobic metabolism taking place. You just 9 don't stop aerobic metabolism, it continues. 10 Q I take it from your previous 11 testimony that you do not believe that the 12 increasing numbers of simultaneous discharges of 13 the TASER will have any physiological affect on 14 a human being? 15 A As far as I know, it will not. 16 Q What about the same question with 17 duration. 18 A From a properly functioning TASER, 19 it would not have any affect either. 20 Q So you would not expect there to be 21 human injury to a human being from an extended 22 duration TASER application? 23 A If the TASER is properly 24 functioning, that's correct, I would expect to 25 find only the TASER burn marks. 0122 1 Wetli 2 Q What is a vasovagal reaction? 3 A A vasovagal reaction is where you 4 stimulate the vagus nerve generally because of 5 compression of certain arteries, stimulating the 6 vagus nerve receptors which then sends a signal 7 to the brain to slow down or stop the heart. 8 Then the vagus nerve then sends the signal to 9 the heart to stop or slow down. 10 Q So I take it based on your answer 11 that it can cause -- let me withdraw that 12 question. 13 What are some of the factors that 14 precipitate a vasovagal reaction? 15 A Pulmonary embolism, direct 16 compression of the carotid sinus in the neck. 17 Those are some of the ones. 18 Q Anything else that comes to mind? 19 A No. I'm sure there are others, 20 certainly gastric reflexes and things like that. 21 Q What about pain? 22 A I've never heard of that causing a 23 vasovagal reflex. If that was the case, then 24 there'd be a lot of people dying on the street 25 from pain, football players included. 0123 1 Wetli 2 Q What about something like emotional 3 trauma or phobias and things like that, can that 4 trigger that type of reaction? 5 A There is such a thing called voodoo 6 death in which that is an invoked mechanism. 7 Q What is that? 8 A When a person strongly holds a 9 certain belief system, then they can literally 10 be scared to death, literally. The example 11 given by a research anthropologist named Ken is 12 that the victim that he described knew that a 13 curse is going to be placed on him, and one day 14 the shaman literally held a doll or a depiction 15 in front of him and caused him to drop dead. 16 That type of thing has been apparently 17 documented, although it's pretty rare. 18 Q And that presumably is the 19 vasovagal reflex? 20 A That's the only circumstance that 21 anybody really knows. 22 Q Do you think that the vasovagal 23 reaction plays a part in this particular case? 24 A No. 25 Q Why is that? 0124 1 Wetli 2 A There's no reason to invoke it. We 3 do know that he's acidotic, we do know that he 4 has a high potassium, we do know all these other 5 various things about him, so to throw in 6 vasovagal reflex with no consideration if this 7 actually played a role is purely speculative. 8 If, for example, there had been an application 9 of a prolonged lateral vascular neck restraint, 10 then that might be a consideration, but that's 11 not the case here. 12 Q Is there a distinction between 13 toxic and lethal doses of a drug? 14 A Yes. 15 Q What's the distinction? 16 A Toxic levels of a drug means you 17 are having adverse reactions to the drug itself, 18 not allergic or idiosyncratic reactions, but 19 basically too much of the drug is causing too 20 much of the desired effect. That's the toxic 21 reaction. A lethal reaction is when you drop 22 dead from it. 23 Q So would you agree in this case 24 that Mr. Heston had a toxic level of 25 methamphetamine, but not necessarily a lethal 0125 1 Wetli 2 level? 3 A You could say that, yes. 4 Q Do you agree generally that the 5 level of methamphetamine in a person does not 6 necessarily correlate with excited delirium? 7 A True, and the same goes for 8 cocaine. 9 Q I think I asked you this question 10 and, again, I apologize if I'm repeating myself, 11 because I've got notes all over the place here: 12 Do you agree that it's possible for blood to 13 become so sufficiently acidotic that it would 14 trigger a cardiac arrest? 15 A Well, essentially, yes. If you 16 become acidotic enough, you will die. 17 Q And the reason for that is that it 18 creates an arrythmia, correct? 19 A Yes. Basically it interferes with 20 the metabolic machinery of the entire body, so 21 everything shuts down. 22 Q So it's not just the heart, but 23 it's a global shut down, essentially? 24 A Yes, exactly right. People who 25 have metabolic problems like diabetes, for 0126 1 Wetli 2 example, can suffer headaches as a result of 3 diabetes because their blood sugar drops too 4 much and they become acidotic and that type of 5 thing. Even normal individuals can go into 6 what's called a starvation ketosis, where the 7 same thing is happening. Those are mild 8 examples, take it to the extreme and you're 9 dead. 10 Q And do you believe that the 11 acidosis in this case, the severe acidosis that 12 you described, was, in fact, what triggered Mr. 13 Heston's cardiac collapse? 14 A I think it's a combination of a 15 variety of things, like the surges of 16 norepinephrine, the catecholamines, the 17 metabolic acidosis. All of these things 18 interacting together is what caused it. 19 Q And you attribute the surge of 20 catecholamines to his struggle with the police, 21 correct? 22 A Well, it began before the struggles 23 with the police. It began with whatever demons 24 he was recognizing that was causing him to have 25 excited delirium to begin with. I'm sure the 0127 1 Wetli 2 struggle with the police may or may not have 3 added to it. He may have already been at the 4 maximum level of catecholamines by the time the 5 police interacted with him. There's no way of 6 knowing. 7 Q But he hadn't dropped dead before 8 the police arrived? 9 A Correct. 10 Q Exactly. Let me just understand 11 one last concept about this; the production of 12 catecholamines, or maybe I should say the 13 overproduction of catecholamines, is triggered 14 by entering into this excited delirium phase. 15 Is that a correct statement? 16 A Yes, exactly. Once you get into 17 the stage of excited delirium, then you start 18 having this flow of catecholamines in addition 19 to the amphetamines which were present. 20 Q If someone has a cardiac arrest due 21 to acidosis, there are not going to be any 22 findings on the autopsy, correct? 23 A Correct. 24 Q I don't think I asked this, but 25 hypokalemia is not a necessary criteria for -- 0128 1 Wetli 2 or is it a necessary criteria for finding of 3 excited delirium? 4 A No. The diagnosis of excited 5 delirium is based upon behavior. 6 Q I earlier asked you whether based 7 on the autopsy findings if it was possible to 8 determine if Mr. Heston went into ventricle 9 fibrillation, and I think your answer was there 10 was no way to tell; is that correct? 11 A Correct. 12 Q Do you agree that if someone in 13 this case were to opine that electrical 14 stimulation did not trigger ventricular 15 fibrillation, would it be impossible to prove 16 that opinion? 17 MR. BRAVE: Objection; form. 18 Q Dr. Wetli, do you understand my 19 question? 20 A No. 21 Q Let me rephrase it. 22 If someone were to opine in this 23 case that direct electrical stimulation of the 24 heart could not have caused ventricular 25 fibrillation, there would be no way to prove 0129 1 Wetli 2 that theory or that opinion, correct, because 3 there's no evidence of ventricular fibrillation? 4 A Not only that, you not only have no 5 evidence for it, but I don't know the timeframe 6 from when he was cyanotic and the paramedics 7 actually put the EKG monitor on him. If more 8 than several minutes has gone by, then the 9 asystole means nothing. 10 Usually we look at the initial 11 heart rhythm to determine within the first 12 minute after the person collapses, then you can 13 be sure of what the electrical rhythm was that 14 terminated their life. 15 Q In this case there's no evidence of 16 that, correct? 17 A Exactly. I'm not sure of the 18 timeframe that's going on at that particular 19 time, but usually in these cases the paramedics 20 are already on the scene. They are not called 21 to the scene after the person turns cyanotic, 22 they are already on the scene. And within 30 to 23 60 seconds you know what the rhythm is. 24 In that case -- I don't think you 25 have that in this case, therefore, it's 0130 1 Wetli 2 impossible to be definitive about it. As I said 3 before, in cases of excited delirium, almost 4 invariably it's either PDA or asystole, but, 5 again, in this particular case we don't know for 6 sure. 7 Q Is it more difficult to gain a 8 sinus rhythm from someone who is in asystole 9 versus ventricular fibrillation? 10 A Generally speaking, it's easier 11 from ventriclar fibrillation if it's a healthy 12 individual to begin with. The asystole -- when 13 people die with asystole or PDA, it's my 14 understanding that their chances of survival are 15 very, very slim, unless it's in an operating 16 room, for example. But skipping all that, 17 ventricular fibrillation is better because you 18 can defibrillate them and cause the heart to 19 come to a stand still and then start it again. 20 That's usually what happens. 21 In fact, CPR was begun, the whole 22 concept came about because of young men who were 23 getting electrocuted and dying, and the idea was 24 to defibrillate them and start their hearts 25 again. 0131 1 Wetli 2 Q When a person has ventricular 3 fibrillation, there is some electrical activity 4 of the heart, correct? 5 A There's lots of electrical 6 activity, it's just uncoordinated. 7 Q Right. It's bouncing and beating 8 all over the place. 9 A Each individual muscle fiber beats 10 independently of every other one. 11 Q Does the mere contraction of muscle 12 cause a release of adrenaline? 13 A There is an answer to that, but I 14 don't know what it is. I think that locally, 15 yes. In other words, you just contract your 16 muscle like I did now by flexing my arm. I 17 believe locally there is a release of 18 epinephrine, but I'm not positive about that. I 19 would have to look at a physiology book. 20 Q To kind of summarize all this, 21 would it be fair to say that in excited delirium 22 you are essentially OD'ing on adrenaline; is 23 that a very basic way to put it? 24 A I would say that's part of it, yes. 25 Q I'm just about done, but I just 0132 1 Wetli 2 want to ask you to comment, if you would, on the 3 autopsy reports of Dr. Haddix and Karch. 4 Do you have any specific criticisms 5 that you intend to testify to at the time of 6 trial in this case of Dr. Haddix's autopsy 7 report? 8 A No. I've reviewed a number of her 9 reports, she's very, very thorough, she very, 10 very good. I have no criticism whatsoever. 11 Q And obviously you disagree with her 12 conclusions? 13 A Right. 14 Q Only to the extent I assume as to 15 the contributing factor of the TASER? 16 A Correct. 17 Q Otherwise you agree with her 18 conclusions? 19 A Exactly. 20 Q And you also disagree -- strike 21 that. 22 In terms of Dr. Hain's overview or 23 summary of the report that was done by Dr. 24 Haddix, do you have any criticisms of that 25 overview? 0133 1 Wetli 2 A No, again, just the conclusion. 3 Q Do you know Dr. Hain at all? 4 A No, I do not. 5 Q Have you ever spoken to him in 6 relation to this case? 7 A No. 8 Q Have you ever spoken to Dr. Haddix? 9 A Not in relation to this case, no. 10 Q Have you talked to her at other 11 times? 12 A Yes. 13 Q Was it in regard to autopsies that 14 she performed? 15 A No. 16 Q Can you recall what the context of 17 your conversations with Dr. Haddix were? 18 A Black tar heroin. 19 Q Dr. Haddix had been involved in 20 some research regarding overdose deaths in San 21 Francisco, as I understand it? 22 A She may well have, I don't recall. 23 Q So your conversation wasn't in 24 regard to research that she was doing? 25 A No. It was basically a case of 0134 1 Wetli 2 black tar heroin and had no legal implications 3 whatsoever in that case. 4 Q Were you consulting with her 5 regarding her opinion, or was she consulting you 6 regarding your opinion? 7 A We were having a chat and she says 8 I have a great picture of black tar heroin, 9 would you like a copy. That was it. 10 Q Was that at a medical conference or 11 something? 12 A Yes. 13 Q Now, finally Dr. Karch, do you have 14 any criticisms of his overview or summary of Dr. 15 Haddix's report? 16 A The only thing I disagree with Dr. 17 Karch is that he's attributing a rhabdomyolysis 18 as due to the TASER, which I think is totally 19 absurd. There's no evidence of that. These 20 people with excited delirium get sky high levels 21 of CPK and get severe rhabdomyolysis with or 22 without the application of TASER, pepper sprays 23 or anything else. 24 Q Do you know Dr. Karch, by the way? 25 A Yes. 0135 1 Wetli 2 Q As I understand it, he has a 3 reputation of some note, as do you; is that 4 true? 5 A Yes. 6 Q And are you familiar with Dr. 7 Karch's study regarding overdose deaths? 8 A I don't know what study you are 9 referring to. He's written a number of papers 10 on drug abuse, drug overdose deaths. He's 11 published a number of books on those subjects. 12 So I'm not sure which one you are referring to. 13 Q I just meant in general. 14 (Perusing document.) He refers on 15 page -- I don't think it even has a page number 16 on it -- it's page number 5, subsection 7 of the 17 toxicology interpretation. 18 Do you have that in front of you, 19 Doctor? 20 A Yes. 21 Q He talks about a study of 413 22 methamphetamine related deaths in San Francisco 23 that he was involved in where the mean 24 methamphetamine level was 2.08 milligrams per 25 milliliter. Do you see that? 0136 1 Wetli 2 A Yes. 3 Q So you agree that the level that 4 Mr. Heston had was substantially lower than 5 that? 6 A Yes. 7 Q Now, I guess Dr. Haddix had 8 reported a study that she did of 92 9 methamphetamine deaths where the mean was 0.42. 10 Do you see that? 11 A Correct. 12 Q And in Mr. Heston's case, he was 13 slightly above that? 14 A Correct. 15 Q Do you agree with Dr. Karch that 16 the metabolized version of methamphetamine is 17 amphetamine, correct? 18 A Of course. 19 Q And is there any particular 20 significance, or did you find any specific 21 significance to the numbers, the correlation of 22 the numbers between methamphetamine and 23 amphetamine that were found in Mr. Heston? 24 A Both were cocaine and with 25 methamphetamine -- I'll take it back. 0137 1 Wetli 2 The cocaine usually has very low 3 levels of cocaine and very high levels of 4 cocaine metabolized. 5 With methamphetamine cases, it's 6 usually the reverse. You have higher levels 7 methamphetamine than you do with amphetamine. 8 Why that is, I don't know. 9 Q What I was kind of driving at 10 was -- first of all, do the numbers suggest to 11 you over what period of time Mr. Heston ingested 12 methamphetamine in relationship to the incident 13 that resulted in his death? 14 A No. 15 Q Do those numbers in any way suggest 16 to you over what period of time Mr. Heston had 17 been ingesting the methamphetamine prior to the 18 incident that resulted in his death? 19 A No. The only thing I can say is 20 that excited delirium does not occur in novice 21 users, and that they are frequently bingeing on 22 the drug before they go into that state of 23 excited delirium, but you can't say that it 24 would take him three days or five days or two 25 days; you can't say that. 0138 1 Wetli 2 Q Or when he took it? 3 A Correct. 4 Q Do the numbers suggest in any way 5 to you that Mr. Heston was bingeing on 6 methamphetamine prior to this incident with the 7 police? 8 A You can't tell. 9 Q Now, in the third paragraph under 10 toxicology interpretations, he refers to the 11 research that Dr. Mash is doing in Florida, and 12 I want to make sure at least that your 13 understanding is the same as Dr. Karch's. 14 To your knowledge, has Dr. Mash 15 done any measurements to validate brain-dead 16 excited delirium patients? 17 A I don't think she specifically 18 looked at it like that. I know she has examined 19 a number of cases where people were declared 20 brain dead and died and went to the medical 21 examiner's office, but whether she specifically 22 looked at it, let's say, fresh dead people 23 versus people who died of a subsequent time and 24 were declared brain dead, I don't know if that's 25 happened. 0139 1 Wetli 2 Q I'm referring specifically to the 3 middle of that paragraph where Dr. Karch says, 4 "However, as Dr. Haddix rightly observed these 5 measurements, they have never been validated in 6 brain dead ED victims supported on a ventilator 7 for 30 hours." Is that your understanding, as 8 well? 9 A I don't know. You'd have to ask 10 Dr. Mash that. 11 Q Are you aware of measurements of 12 dopamine transporters in the brain dead ever 13 having been reported that you've seen? 14 A I want to say yes to that. I know 15 it occurred at least once in San Francisco and I 16 think it occurred at least once in Suffolk 17 County, that I recall. It would not be unusual 18 -- I mean, I know she's looked at people that 19 have been declared brain dead and they survive 20 for a period of time on respirator and then 21 died. And I know samples of brain have been 22 sent to her for analysis, so I know that's been 23 done. 24 Dr. Haddix carefully worded it by 25 saying has it ever been validated, and that 0140 1 Wetli 2 means you have controlled studies and so forth. 3 But that's something you'd have to ask Dr. Mash 4 about. 5 Q Are you aware of any studies that 6 have been published, any peer-reviewed studies, 7 regarding the effects that TASER has on someone 8 who has, for example, heart disease? 9 A No. 10 Q Are you aware of any studies, 11 peer-reviewed studies, that have been done on 12 the physiological effects of TASER and people 13 who are under the influence of methamphetamines? 14 A No. You cannot do these studies. 15 Q Do you agree with Dr. Karch's 16 statement in section 8 under the TASER paragraph 17 D where he states, quote, "The darts diverge 18 when fired and the wider the distance between 19 them, when they land, the greater the effect." 20 Do you have any basis for knowing 21 whether that's true one way or the other? 22 A No, I don't know if that's true or 23 not. 24 Q Do you know what the spread pattern 25 is of the TASER dart, of the two darts? 0141 1 Wetli 2 A I've read it. It's almost at a 3 constant rate of so many inches per feet of 4 discharge or something like that. 5 Q Do you agree that the further you 6 are from the subject when you discharge the 7 TASER darts, the wider the spread? 8 A That's my understanding, yes. 9 Q Because of the hypertrophy of the 10 heart, would the surface of both ventricles be 11 closer to the anterior chest wall? 12 A No. 13 Q What is the difference between 14 cardiomegaly and hypertrophy? 15 A Hypertrophy is more specific. It 16 means there's actually thickening of the heart 17 muscle. 18 Cardiomegaly just means the heart 19 is enlarged. It could be dilated and enlarged, 20 for example, due to deposits of abnormal 21 proteins likes amyloid, for example. 22 Q Dr. Karch says in his report again, 23 and I quote, "There is no question that 24 electrical current can disrupt muscle tissue." 25 Do you agree with that? 0142 1 Wetli 2 A The way it's stated there, yes. 3 Q I think I asked you this, but I'm 4 sorry, I just want to be clear about something. 5 Was the rhabdomyolysis secondary to 6 hypoxia? 7 A No. 8 Q And why not? 9 A I don't know that hypoxia causes 10 rhabdomyolysis; excited delirium does, alcohol 11 withdrawal does, but as far as I know, hypoxia 12 does not. 13 Q I know we've covered a lot, Dr. 14 Wetli, and I appreciate your patience. Is there 15 anything in the way of an opinion that you 16 intend to offer at the time of trial that we 17 have not covered today? 18 A No. 19 Q Good. That means I did a good job. 20 You indicated that you may consider 21 additional materials as they are supplied to 22 you. 23 What I would ask is that through 24 counsel that I be notified if you do have any, 25 either new opinions or changed opinions other 0143 1 Wetli 2 than what's been articulated in your Rule 26 3 Report, and at that time myself and my 4 co-counsel, we'll make an assessment whether we 5 need to talk to you again. 6 MR. WILLIAMSON: As long as 7 that's agreeable with Mr. Brave. 8 MR. BRAVE: Yes. 9 MR. WILLIAMSON: Then I think 10 we're done. 11 MR. BRAVE: I just have a 12 couple of questions. 13 EXAMINATION 14 BY MR. BRAVE: 15 Q Doctor, as far as which cardiac 16 rhythm Mr. Heston was in, you've already stated 17 that excited delirium can put someone in 18 asystole, correct? 19 A Correct. 20 Q And if someone is going to go into 21 a heart rhythm caused by electricity, that will 22 be ventricular fibrillation, correct? 23 A If it's alternating current 24 electricity, the answer is yes. 25 Q And your understanding is that Mr. 0144 1 Wetli 2 Heston was down for approximately ten minutes? 3 MR. WILLIAMSON: I'm going to 4 object. It misstates his testimony. 5 I think he testified he didn't know. 6 Q If I present to you that Mr. Heston 7 was down for approximately ten minutes, that 8 would be reasonable to you? 9 A Yes. I believe it was stated in 10 the medical records, but I don't have -- what I 11 really need is the time when he became cyanotic, 12 and compare that to the time when the paramedics 13 actually got to the scene. 14 Q But it was at least several 15 minutes? 16 A Yes, that's my understanding. 17 Q Dr. Luceri testified that in his 18 experience that people pay a heavy price for 19 deteriorating through ventricular fibrillation 20 into asystole. By having price, what he said 21 was if they do go first into ventricular 22 fibrillation and it does deteriorate to 23 asystole, they cannot be brought back. Is that 24 your understanding, as well? 25 A Yes. 0145 1 Wetli 2 Q So, therefore, based on some of the 3 questions that were asked earlier, that would 4 also in this case be proof that Mr. Heston was 5 never in ventricular fibrillation? 6 A Correct. That would support that 7 contention, that's correct. 8 Q Also, you've mentioned a couple of 9 times if there was a TASER defect, it would put 10 out substantially greater energy. 11 Are you aware that the TASER 12 normally functioning is at one hundred percent 13 capacity? 14 A I believe it is not one hundred 15 percent capacity, because you get some loss of 16 heat, things like that, so it's less than the 17 calculated -- the actual amount of energy 18 delivered is less than the amount calculated. 19 Q Let me rephrase the question. 20 If a TASER were to have a defect, 21 it would go less to deliver a charge as opposed 22 to a dramatic increase. 23 MR. WILLIAMSON: I'm going to 24 object. 25 This calls for an expert 0146 1 Wetli 2 opinion this witness is not 3 qualified to give. 4 Q If you know. 5 A I don't know the answer to that. 6 When I was referring to it earlier, I was 7 referring more to duration of time. And it 8 should be from a pulsating delivery of 9 electricity to continuous delivery of 10 electricity. 11 Q And also you mentioned some of the 12 studies that you've seen regarding TASER 13 devices, have you seen that there have been some 14 studies performed now with up to 45 seconds of 15 continuous TASER device discharges? 16 A I'm not aware of that. I hope they 17 paid that volunteer very well. 18 Q Now, there was some discussion 19 regarding the April 1, 2000, the June 8, 2002 20 and the August 30, 2003 psychotic episodes or 21 events regarding Mr. Heston. 22 Do you recall those? 23 A Yes. 24 Q Dr. Mash, in her testimony referred 25 to the term "flicker moments," do you know what 0147 1 Wetli 2 she meant by that? 3 A Not really. I think that what she 4 means by that is that these are episodes that 5 are almost excited delirium or even excited 6 delirium, but they are nonfatal, and it is 7 apparently up to the full blown syndrome. 8 Q Dr. Mash also testified that in her 9 opinion the excited delirium was actually caused 10 by the brain disorder of the maladapted dopamine 11 transporter system. Are you familiar with that, 12 do you agree with that? 13 A Yes. 14 Q I'm sorry. That was a compound 15 question. 16 Are you familiar with it and do you 17 agree? 18 A Yes and yes. 19 MR. BRAVE: That's it. 20 MR. WILLIAMSON: I just want 21 to cover something Michael brought 22 up. 23 EXAMINATION 24 BY MR. WILLIAMSON: 25 Q I thought you had testified earlier 0148 1 Wetli 2 that in terms of someone who is in asystole, 3 that it is -- let me ask you again. 4 If someone is in asystole, is it 5 more difficult to get a sinus rhythm from them 6 as opposed to someone who is in ventricular 7 fibrillation? 8 A Generally speaking, it's easier 9 with ventricular fibrillation. In cases of 10 excited delirium it may be done, but they'll 11 still die within one to three days. You can 12 induce it, but that doesn't mean they are going 13 to live. 14 When you look at people, for 15 example, that go into asystole as a result of 16 infection, your chances of survival are less 17 than one percent, I've been told by clinicians. 18 In ventricular fibrillation, your chances of 19 survival are much better. 20 Q But in this case, a sinus rhythm 21 was obtained ultimately? 22 A Right. 23 MR. WILLIAMSON: That's it 24 for me. 25 I have nothing further. 0149 1 Wetli 2 We're going to put on the 3 record, because we do this under 4 California law, we're going to do a 5 stipulation and that is to relieve 6 the court reporter of her custodial 7 duties under the Federal Rules of 8 Civil Procedure. 9 The original transcript will 10 be sent to Ms. O'Linn at Manning & 11 Marder and we'll see to it that Dr. 12 Wetli is provided with the 13 transcript and that he reviews his 14 testimony and signs it under penalty 15 of perjury, that I be notified 16 within 45 days of receipt of the 17 transcript by Ms. O'Linn that Dr. 18 Wetli has both signed it and whether 19 he has made any changes to his 20 testimony, and if not, so to notify 21 or in the event of a transcript 22 being lost or misplaced for any 23 reason that a certified transcript 24 can be used for all purposes 25 including trial, that Ms. O'Linn 0150 1 Wetli 2 will maintain custody of the 3 original transcript and produce it 4 upon reasonable request including 5 trial. 6 MR. BRAVE: Agreed. 7 (Whereupon, at 1:11 p.m., the 8 deposition was concluded.) 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 0151 1 2 C A P T I O N 3 4 The Deposition of CHARLES V. WETLI, 5 M.D., taken in the matter, on the 6 date, and at the time and place set 7 out on the title page hereof. 8 9 It was requested that the deposition 10 be taken by the reporter and that same 11 be reduced to typewritten form. 12 13 14 The Deponent will read and sign the 15 transcript of said deposition. 16 17 18 19 20 21 22 23 24 25 0152 1 2 C E R T I F I C A T E 3 4 STATE OF___________________________________: 5 COUNTY/CITY OF________________________________: 6 7 Before me, this day, personally appeared 8 CHARLES V. WETLI, M.D., who, being duly sworn, states 9 that the foregoing transcript of his/her deposition, 10 taken in the matter, on this date, and at the time 11 and place set out on the title page hereof, 12 constitutes a true and accurate transcript of said 13 deposition. 14 15 __________________________ 16 CHARLES V. WETLI, M.D. 17 18 SUBSCRIBED and SWORN to before me this __________ 19 20 Day of ______________, 2007, in the 21 Jurisdiction aforesaid. 22 23 _________________________ __________________ 24 My Commission Expires Notary Public 25 0153 1 2 DEPOSITION ERRATA SHEET 3 RE: FILE NO. 4 CASE CAPTION: HESTON, et al. vs. 5 CITY OF SALINAS, et al. 6 DEPONENT: CHARLES V. WETLI, M.D. DEPOSITION DATE: AUGUST 20, 2007 7 To the reporter: 8 I have read the entire transcript of my Deposition taken in the captioned matter or the same has been 9 read to me. I request for the following changes be entered upon the record for the reasons indicated. 10 I have signed my name to the Errata Sheet and the appropriate Certificate and authorize you to attach 11 both to the original transcript. ___________________________________________________ 12 ___________________________________________________ ___________________________________________________ 13 ___________________________________________________ ___________________________________________________ 14 ___________________________________________________ ___________________________________________________ 15 ___________________________________________________ ___________________________________________________ 16 ___________________________________________________ ___________________________________________________ 17 ___________________________________________________ ___________________________________________________ 18 ___________________________________________________ ___________________________________________________ 19 ___________________________________________________ ___________________________________________________ 20 ___________________________________________________ ___________________________________________________ 21 ___________________________________________________ ___________________________________________________ 22 23 SIGNATURE:__________________________ DATE:_________ 24 CHARLES V. WETLI, M.D. 25 0154 1 2 I N D E X 3 Witness: CHARLES V. WETLI, M.D. Page 4 EXAMINATION BY MR. WILLIAMSON 3, 147 5 EXAMINATION BY MR. BRAVE 143 6 7 8 E X H I B I T S 9 Plaintiff's Description Page For Ident. 10 1 Curriculum vitae of Charles V. 6 11 Wetli, M.D. (deemed marked) 12 2 A four-page document, consisting 25 of a three-page report of Charles 13 V. Wetli, M.D., dated 4 December 2006, to Ms. Mildred K. O'Linn, Esq., 14 Re: Heston v. City of Salinas, et al. 15 16 17 18 19 20 21 22 23 24 25 0155 1 2 C E R T I F I C A T E 3 STATE OF NEW YORK ) 4 ) ss. 5 COUNTY OF KINGS ) 6 I, JULIA MOKSIN, a Shorthand 7 (Stenotype) Reporter and Notary Public 8 for the State of New York, do hereby 9 certify that the foregoing Deposition, 10 of the witness, CHARLES V. WETLI, 11 M.D., taken at the time and place 12 aforesaid, is a true and correct 13 transcription of said Deposition. 14 I further certify that I am 15 neither counsel for nor related to any 16 party to said action, nor in any wise 17 interested in the result or outcome 18 thereof. 19 IN WITNESS WHEREOF, I have 20 hereunto set my hand this 31st day of 21 August, 2007. 22 23 24 ____________________________ 25 JULIA MOKSIN