681



1 MR. FELOS: Your Honor, I'd review my

2 objection as to relevancy. What does the

3 Supreme Court of California's opinion in the

4 Wendland case and opinions about that have

5 to do with this case?

6 THE COURT: Well, the opinion of

7 California Supreme Court is not relevant to

8 our proceedings here, but if Dr. Cranford

9 was critical of it, I think that may be

10 something that Ms. Anderson may explore.

11 MS. ANDERSON: Yes, I'm exploring bias

12 of this witness, Judge.

13 BY MS. ANDERSON:

14 Q. Dr. Cranford, did you see Robert

15 Wendland on more than one occasions to examine

16 him and to observe him?

17 A. I saw Robert Wendland on more than one

18 occasion, yes, to examine him. Basically for the

19 purposes of the upcoming trials I examined him

20 once for that.

21 Q. Now you have only examined Terri

22 Schiavo once here, correct?

23 A. That's right.

24 Q. It lasted about 45, 35 to 45 minutes?

25 A. Yes.




682



1 Q. Did we catch the entire exam on

2 videotape?

3 A. I think you probably did, yes.

4 Q. All right. Do you always try to

5 prevent contractures in these types of patients?

6 A. Yes. Did you say prevent?

7 Q. Prevent?

8 A. Yes.

9 Q. Contractures?

10 A. Yes.

11 Q. And you prevent them through the use of

12 physical therapy?

13 A. Yes, basically through physical

14 therapy.

15 Q. Now, you said you --

16 A. I'm sorry, physical therapy and good

17 nursing care, yes.

18 Q. Right. Now, you said you had reviewed

19 some selected records of Terri Schiavo; is that

20 right?

21 A. Yes.

22 Q. Did the records that you review reflect

23 the fact that she has not received any physical

24 therapy?

25 A. Well, I didn't look over them for that




683



1 purpose, but I'm almost certain that it would

2 reflect that she didn't have physical therapy

3 recently, yes.

4 Q. Did you know that her teeth had not

5 been cleaned in a number of years?

6 A. I didn't --

7 MR. FELOS: Your Honor, I object. I

8 don't believe that's been part of the record

9 and a fair question.

10 MS. ANDERSON: Dr. Gambone testified

11 about that.

12 THE COURT: I wouldn't know at this

13 stage what is or what is not in the record,

14 Mr. Felos. We will have to sort it out at

15 the end. If it gets real egregious and I

16 have a specific recollection I'll rule on

17 that, but.

18 MS. ANDERSON: Dr. Gambone talked about

19 it.

20 THE COURT: If Ms. Anderson says it's

21 in the record I will accept her

22 representation.

23 THE WITNESS: No, I didn't remember it.

24 Somebody brought that to my attention in the

25 records. I didn't review it for that




684



1 purpose, no.

2 BY MS. ANDERSON:

3 Q. Now, you have consulted with Mr. Felos

4 about this case?

5 A. Yes.

6 Q. About how many conversations have you

7 had with him?

8 A. I would venture to guess in terms of

9 five to 10 times on the phone. That would just

10 be a guess.

11 Q. When was the most recent before today?

12 A. In terms of telephone or interaction?

13 Q. Either one.

14 A. This morning.

15 Q. Okay and --

16 A. Last night when I came in.

17 Q. Okay. Did he go over the other

18 physician's testimony with you?

19 MR. FELOS: Your Honor, I object on the

20 same basis of the questioning of the other

21 witness. My conversations with Petitioner's

22 expert witness involve work product and

23 trial preparation, strategy. It is not --

24 it is not a proper subject of

25 cross-examination.




685



1 THE COURT: Miss Anderson, it's clearly

2 part of Mr. Felos's work. Why is it

3 admissible?

4 MS. ANDERSON: Why is it admissible?

5 THE COURT: Yes.

6 MS. ANDERSON: Because he has

7 undertaken to comment on other physicians'

8 testimony. He must have been told what the

9 testimony was and I think that he's tailored

10 his testimony accordingly. So I'm entitled

11 to get that into the record.

12 THE COURT: Well, explore first where

13 he obtained that information and if it does

14 tie up I will listen to it.

15 MS. ANDERSON: Explore first where he

16 got the information on the other physicians'

17 testimony you mean? Is that what you said?

18 THE COURT: Well, I mean --

19 MS. ANDERSON: I mean, I'll do that. I

20 just couldn't hear you.

21 THE COURT: That's what I'm -- if he

22 got this information last night from

23 Mr. Felos or this morning then you could

24 explore it. If he got it from collateral

25 source i.e. A report or TV or a newspaper or




686



1 whatever, then I think we have kind of a

2 work product privilege at least for that

3 area.

4 BY MS. ANDERSON:

5 Q. Dr. Cranford, have you received any

6 information from any source about the other

7 physicians' testimony in this case?

8 A. Yes.

9 Q. From who?

10 A. Mr. Felos.

11 Q. Did he summarize that testimony for

12 you?

13 MR. FELOS: Well, Your Honor, the fact

14 that there are conversations with your own

15 expert witness about other witnesses'

16 testimony does not operate to invalidate the

17 work product privilege. And --

18 THE COURT: Mr. Felos, I think you got

19 that door wide opened on direct examination

20 when he uses that information to underscore

21 what the information is.

22 MR. FELOS: On direct examination he

23 testified as to the reports of --

24 THE COURT: Mr. Felos, you didn't tell

25 us what he testified from. He said he




687



1 disagreed with Dr. Bambakidis and Dr. Greer

2 on this area. He agreed with them in this

3 other area.

4 There was extensive testimony that you

5 brought forward about at least two of the

6 other witnesses. I don't remember your two

7 witnesses being part of that.

8 MS. ANDERSON: No, he avoided my two

9 witnesses.

10 THE COURT: But I could be wrong. I

11 think the door is ajar on that issue and I'm

12 going to allow Ms. Anderson to inquire.

13 BY MS. ANDERSON:

14 Q. Did Mr. Felos summarize the testimony

15 of the other physicians in this case for you?

16 A. No, he didn't summarize them.

17 Q. He did not summarize them?

18 A. No.

19 Q. Did he cover some points that he wanted

20 you to make and tell you how the other physicians

21 had testified on those points?

22 A. He sent me the original stuff. He

23 didn't summarize it.

24 Q. What original stuff?

25 A. He sent me the written reports. He




688



1 sent me the tapes.

2 Q. Just now you said that he talked to you

3 about the testimony of the other physicians?

4 A. Well, we talked about the testimony,

5 but --

6 Q. What did he tell you?

7 A. Oh, what did he tell me?

8 Q. Yes, what did he tell you?

9 A. Well, we had a disagreement on the

10 tapes because I said that Dr. Maxfield was so

11 unqualified to do the neurological exam that I

12 wasn't going to see the tape.

13 And Mr. Felos thought it would be a

14 good idea for me to see the tape. And so I went

15 along with what he said and watched the tape last

16 night.

17 Q. Where were you when you watched the

18 tape?

19 A. Holiday Inn Express.

20 Q. And did he bring the tape to you last

21 night?

22 A. No, I was sent the tapes. I was sent

23 five tapes, three of Dr. Hammesfahr, one of

24 Dr. Maxfield and one, I don't know what the other

25 one is. And I was sent those tapes to look at.




689



1 Q. Did you look at them when you got them?

2 A. I looked at the ones with Hammesfahr.

3 I really felt I was not going to look at

4 Maxfield's. And the other one I don't know what

5 it is. He also sent me the written reports from

6 Hammesfahr and Maxfield as well as the written

7 reports from Bambakidis and Greer.

8 Q. Now, when you said that Dr. Maxfield is

9 not qualified, are you speaking in terms of his

10 qualifications as a neuroradiologist?

11 A. No.

12 Q. You would agree that he's qualified

13 there?

14 A. As a neurologist or anybody to do a

15 neurologic exam.

16 Q. Did anyone tell you that he holds

17 himself out as a neurologist?

18 A. Well, he -- yes, I guess you did

19 because it was supposed to be a neurological exam

20 from him and Dr. Hammesfahr. That was my

21 understanding that they had five experts to

22 perform a neurologic exam of the patient. That

23 was my understanding of what the Court

24 proceedings were about.

25 Q. How did you draw that conclusion, sir?




690



1 A. From my understanding of this trial and

2 what we are here for.

3 Q. Okay. Now, I notice that you used the

4 word grainy?

5 A. Pardon?

6 Q. You used the word grainy?

7 A. Yes. Yes.

8 Q. To describe this blowup of the '96 CT

9 scan?

10 A. Yes.

11 Q. Would it aid in your comparison to look

12 at the film of the '96 scan and the film of the

13 '02 scan?

14 A. Would it help?

15 Q. Would it alleviate any concern you had

16 about the graininess?

17 A. I don't have any concern about the

18 graininess because -- with a high degree of

19 medical certainty I don't think there's any

20 change, so I don't think seeing the original

21 would make any difference to me because they're

22 clearly, in my opinion, similar. There's no

23 change. It wouldn't do any good to see the

24 original one, no.

25 Q. So what was the comment about




691



1 graininess? What did that go to?

2 A. The graininess was related to lack of

3 resolution of whether you can see gray matter

4 versus white matter, whether you can see

5 increased white matter that had regenerated or

6 something like that to see if there was any way

7 this scan shows improvement and this scan does

8 not show improvement.

9 Q. Would you normally defer to a

10 neuroradiologist who said it does?

11 A. A neuroradiologist?

12 Q. Yes.

13 A. I would generally -- not necessarily,

14 but generally when I work with a

15 neuroradiologist, the neuroradiologist always

16 knows more than I do.

17 So it's -- I usually will defer to the

18 neuroradiologist, but in this scan -- I wouldn't

19 necessarily defer to a neuroradiologist on this

20 one. This is so easy that I would not defer to a

21 neuroradiologist on that, no.

22 Q. You are comparing Cell Number 15 on

23 the -- or Image Number 13 on the '02 scan with

24 Image Number 7 of the '96 scan?

25 A. I was using all of them. I was just




692



1 commenting on certain ones that illustrated

2 certain points.

3 Q. Okay. Now, did I understand you

4 correctly to say that she has brain tissue in the

5 thalamus area?

6 A. Yes, she does.

7 Q. Does she also have brain tissue in the

8 other structures of the brain?

9 A. Well, the brain tissue means glial

10 tissue and neurons. Yes, she has brain tissue.

11 Q. Now, what shows up on the CT scan is

12 what the radiological tracer agent, the isotope,

13 if you will -- not the isotope on the CT scan,

14 but you get the localization of the agent that

15 shows up the structures, correct?

16 A. No. You're switching from a CAT scan

17 to some type of diagnostic imaging. I'm not sure

18 what you're switching to there.

19 Could you explain the question better

20 and I'll answer your question.

21 Q. Okay. Does scar tissue localize on a

22 CT scan?

23 A. Does heart tissue --

24 Q. Scar tissue?

25 A. Oh, yeah, you could see scar tissue




693



1 very well, yes.

2 Q. It does localize?

3 A. Localize?

4 Q. Yes.

5 A. What do you mean by localize?

6 Q. With a radioactive isotope?

7 A. That's not the proper terminology.

8 You're not using medical terminology --

9 Q. I'm not talking about the CT scan now.

10 A. You're not talking about anything

11 because that's not the right word. Localized is

12 not the right word.

13 Q. Localize is not the term --

14 A. No.

15 Q. Oh, okay. Is the -- is your

16 observation of the CT scan on the thalamus tissue

17 inconsistent with your clinical observations?

18 A. Is the what?

19 Q. Your observation on the CT scan of her

20 thalamus area in her brain inconsistent with your

21 clinical observations?

22 A. No. No. They are consistent.

23 Q. Nothing surprised you about that?

24 A. The CT scanning or?

25 Q. Either one.




694



1 A. No. No.

2 Q. Now, does she has tissue in her frontal

3 lobes?

4 A. She has glial tissue.

5 Q. She has no brain tissue at all?

6 A. She has glial tissue.

7 Q. She has no brain tissue? No neurons at

8 all?

9 A. You've got to use these words properly.

10 I don't know what you're talking about. You mean

11 neurons? No.

12 Q. She has no neurons at all?

13 A. I don't think she has any neurons, no.

14 I think it's all severe glial tissue.

15 Q. Does she have any neurons in her

16 occipital lobes?

17 A. I think probably not. Looking at this

18 and looking at her examination I think the

19 chances that she has any viable neurons in this

20 cerebral cortex anywhere is extremely on the --

21 unlikely. There could be pockets of viable

22 neurons as a remote possibility, but I think if

23 you put it all together the chances are

24 overwhelming that this is all essentially glial

25 tissue in the neocortex, yes. I don't think she




695



1 has neurons in those areas.

2 Q. Okay. Did you write an article

3 entitled Withdrawing Artificial Feeding From

4 Children with Brain Damage, that was published in

5 the British Medical Journal in August of 1995?

6 A. Yes, I did, I think. Yes.

7 Q. Do you recall that at that time you

8 said there was overwhelming consensus in the

9 medical profession that there are no substantial

10 moral or legal distinctions between artificial

11 feeding and other medical treatments?

12 A. No, that wouldn't make sense to say

13 that. A substantial -- what did you say?

14 Q. I'll read this sentence to you and ask

15 you if you remember writing this. Artificial

16 nutrition and hydration are medical treatments.

17 It may be much more psychologically difficult to

18 withdraw artificial feeding than other forms of

19 medical treatment, but an overwhelming consensus

20 has developed in recent years that there are no

21 substantial moral or legal distinctions between

22 artificial feeding and other medical treatments.

23 A. That's a bit strong to say an

24 overwhelming consensus. I would say a strong

25 consensus. When I said an overwhelming consensus




696



1 that's a bit strong, if I said it back then. If

2 I said a strong consensus, yeah, I would stand by

3 that. Yes.

4 Q. Do you recall the piece that you wrote

5 for your University quarterly newspaper, I guess,

6 called the Bioethics Examiner four years later in

7 the winter of 1999 in which you said that you had

8 expected a consensus to develop and none had?

9 A. On what?

10 Q. On the right to die debate?

11 A. On the generic right to die?

12 Q. Do you recall writing that?

13 A. I don't recall specifically writing

14 that. It sounds -- I probably wouldn't make a

15 generic statement, but I could have. But there

16 hadn't been a consensus on the issue in the

17 medical journal on right to die.

18 Q. Do you recall writing this sentence in

19 the winter of 1999 issue of the Bioethics

20 Examiner, Prior to the 1990s I thought there

21 would probably be a high order of social

22 consensus on many aspects of the right to die

23 debate either in terms of actual practice, case

24 law or legislation. How wrong I was?

25 A. Yeah, I wrote that. Yes.




697



1 Q. In fact, you write the lead piece on

2 these quarterly newspapers every quarter, don't

3 you? These newsletters?

4 A. In the Bioethics Examiner?

5 Q. Yes.

6 A. No. I write it once every 12 to 16

7 months. Everybody in the department of

8 bioethics -- in the department of bioethics is

9 the lead author on that -- for the University of

10 Minnesota Bioethics Center you mean?

11 No. I write that once -- I rotate with

12 everybody else. We all rotate once every 12 or

13 16 months depending on how many faculty members

14 there are. I'm lead author like everybody else

15 who wrote things.

16 Q. That newsletter comes out of your

17 institution every quarter; does it not?

18 A. Yes, every quarter.

19 Q. Did you likewise write or coauthor a

20 law review article published in the American

21 Journal of Law and Medicine in 1987, an article

22 with someone named David Smith?

23 A. Yes, I did.

24 Q. Entitled Consciousness the Most

25 Critical Moral Constitutional Standard for Human




698



1 Personhood?

2 A. Yes, I did.

3 Q. Do you remember writing that?

4 A. Yes, I do.

5 Q. Do you recall that you took the

6 position in that paper that unconscious patients

7 are not persons?

8 A. From a constitutional standpoint, yes,

9 that's the position we took.

10 Q. Is that a position that you still

11 adhere to?

12 A. Well, nobody ever has agreed with that.

13 The courts haven't agreed with it. The efficacy,

14 no one has really agreed with that position

15 except for a few people. So in actual reality, I

16 still stand by what we said in our article.

17 The reality is it seems no one has

18 taken that position so it's not fair to say that

19 people who are unconscious lost personhood. So I

20 would agree now with saying that I would agree

21 with the article. I would agree with our

22 conclusion. I would agree with the way we came

23 to our conclusion --

24 Q. But you're saying that today your view

25 is different?




699



1 A. It's different in the sense that no one

2 has agreed with me at this point.

3 Q. Why would that matter?

4 A. Well, I think it would matter because

5 if there were U.S. Supreme Court decisions on

6 constitutional law and the Court had addressed

7 this issue directly it might make a big

8 difference.

9 As you see in that article, do you

10 remember the last paragraph it says, it's an

11 academic article or poisonous food for thought,

12 et cetera?

13 That's the way it was done in 1987. It

14 never went anywhere from a constitutional or

15 legal standpoint, but that was clearly an

16 academic article that's phrased that way --

17 Q. And you were advocating that position

18 that unconscious people lack personhood, correct?

19 A. Meaning lack therefore constitutional

20 rights, yes.

21 Q. Or any other kinds of rights, correct?

22 A. No, we didn't talk about all rights.

23 We talked about constitutional rights. David

24 Smith was a constitutional lawyer, as I believe.

25 Q. Now, you also said that you were one of




700



1 five or six key people with regard to drafting

2 the termination -- Uniform Termination of Death

3 Act back in the late '70s, correct?

4 A. Uniform Definition of Death Act?

5 Q. The Termination, the Uniform

6 Termination of Death Act.

7 A. That's the Uniform Determination of

8 Death Act. It's not the Uniform Termination --

9 Q. Definition --

10 A. It's called the UDDA --

11 Q. I misheard you then.

12 A. It's the UDDA.

13 Q. Okay. You were one of the five or six

14 key people?

15 A. No. I advised the four to five or six

16 key people because there are three organizations

17 bringing together at that time the Presidents

18 Commission for the Study of Ethical Problems in

19 Medicine and Biomedical Behavioral Research, the

20 American Bar Association and the National

21 Conference of Commissioners on Uniform State Law.

22 And there was five or six key people

23 involved in those three organizations that I

24 worked with closely. I was not a party to the

25 actual drafting of the UDDA, but what they did




701



1 was they called me frequently because they wanted

2 to know when they drafted the Uniform

3 Determination of Death Act whether this language

4 was consistent with the medical criteria for

5 brain death.

6 Q. And when they called you did you tell

7 them that unconscious patients are not persons?

8 A. It had no bearing on the Uniform

9 Determination of Death Act. That was on brain

10 death.

11 Q. Now, you also said that you were one of

12 10 people on the Multi-Society Task Force that

13 came out and ultimately published the two-part

14 paper in the New England Journal of Medicine

15 about persistent vegetative state, correct?

16 A. Yes, I was.

17 Q. And that was in 1996, I believe?

18 A. 1994.

19 Q. '94?

20 A. '94, yes.

21 Q. Now. Unless, I misheard heard you you

22 said that you working in this group of 10 people,

23 that you developed this doctrine for uniform

24 diagnosis standard, correct?

25 A. Well, not just diagnosis, but




702



1 prognosis --

2 Q. Right.

3 A. -- of relevant medical features that

4 would go into the legal and ethical decisions

5 that would be used for all sorts of other

6 decisions. Yes, we selected what we thought were

7 relevant medical views on the vegetative state,

8 that's right.

9 Q. Then you advocated a specific position;

10 did you not?

11 A. No, I did not.

12 Q. What did you say that you were

13 advocating a specific position in your testimony

14 on direct? What were you referring to?

15 A. I have no idea what you're talking

16 about. I did not -- I'm not sure what you're

17 talking about. I advocated a view of what?

18 Q. Advocated a specific position is what

19 you said. Can you tell me --

20 A. Oh, I don't know --

21 Q. -- about that?

22 A. No. We developed a consensus on all

23 those different areas. I'm not sure what I said

24 about that. We did not develop legal or ethical

25 views in this area.




703



1 Q. Now, would you agree that a patient in

2 a persistent vegetative state is completely

3 unconscious?

4 A. Yes.

5 Q. Shows no sign of any voluntary

6 interaction with the environment?

7 A. Yes.

8 Q. No awareness of self?

9 A. I'm sorry?

10 Q. No awareness of self?

11 A. That's right.

12 Q. No purposeful interaction with the

13 environment?

14 A. That's the standard definition, that's

15 right.

16 Q. Zero?

17 A. Zero. Nil.

18 Q. But you acknowledge, do you not, that

19 the adjective persistent is now being used in a

20 lot of different ways?

21 A. It always has -- there was confusion

22 before, there's been confusion since. The word

23 persistent is not nearly as relevant as the word

24 permanent. That's the critical word. That means

25 irreversibility. That's what we said in the task




704



1 force report. We tried very hard to deemphasize

2 the word persistent in the fact we have two or

3 three or four paragraphs in there discussing the

4 confusion over the word persistent.

5 Q. Now, how many PVS patients are you

6 currently right now the attending physician for?

7 A. The attending physician? Probably none

8 because the patients in long-term care facilities

9 I'm not the attending physician in long-term care

10 facilities. I would be the attending physician

11 on the ward at Hennepin --

12 Q. On the what, acute care?

13 A. Yeah, acute care, but I'm not on the

14 ward right now. So how many am I following? You

15 didn't ask that question, you asked how many I'm

16 attending. I'm not the primary attending on

17 these patients.

18 Q. Because once they get out of the acute

19 phase they go to some other physician for the

20 attendee, right?

21 A. No, the patient, they usually go to the

22 long-term care facilities or they go home and

23 then they have a primary care physician, either

24 an internist or a general practitioner or someone

25 similar to that, yes.




705



1 Q. Now, the visual-orienting reflex is

2 what Pavlov called the what is it reflex,

3 correct? It is --

4 A. Oh, I didn't know that. What did

5 Pavlov --

6 Q. You never heard that before?

7 A. No.

8 Q. Pavlov called it the what is it reflex.

9 A. No, I never knew the word, what is it.

10 Q. And basically what that is is the

11 patient would see something in the peripheral

12 vision and would turn quickly and check, is it a

13 source of danger? Is it a threat?

14 A. I'm not familiar with what Pavlov said

15 in that respect. It could be, but I'm not

16 familiar with that.

17 Q. And once that reflex occurs, the

18 organism, whether it's a human patient or, you

19 know, some other animal, has to make a decision

20 and assess the threat, correct?

21 A. Well, you're talking about two

22 different things, because the visual-orienting

23 reflex to me you can't make an assessment because

24 that's a brain stem mediated reflex.

25 Q. Once it occurs in the next instance --




706



1 A. Are you talking about Pavlov?

2 Q. No, I'm talking about generally.

3 A. Well, you can't talk generally. You've

4 got to talk either visually-oriented reflex or

5 what I'm talking about or Pavlov, but you can't

6 talk about something that I'm not talking about.

7 If -- you need to be more specific.

8 Q. If a patient exhibits the

9 visual-orienting reflex, that is she glances to

10 the side and continues to glance to the side for

11 five minutes, could you say the entire five

12 minutes was a reflexive action?

13 A. No, it would be unusual for that kind

14 of reflex to last for five minutes.

15 Q. In fact, it is a little like a startled

16 response in that it's sort of a fleeting

17 instantaneous response; is it not?

18 A. Yes, it's like the startling response.

19 The startling response is a brain stem mediated

20 response secondary to auditory stimuli. And the

21 visual response -- the visual-orienting reflex is

22 similar to the visual oriented for a few seconds

23 except -- and the analogy was the brain stem

24 auditory-oriented reflex versus the brain stem

25 visual-oriented reflex.




707



1 Those two are analogous in terms of one

2 is auditory, one is visual, where they follow for

3 a few seconds or they look, inherently look

4 towards something for a few seconds. Those are

5 analogous. The startling is not quite as

6 analogous as the other two.

7 Q. Do you have neuropsychologists --

8 A. Yes.

9 Q. -- on service?

10 A. Yes.

11 Q. At Hennepin?

12 A. Yes.

13 Q. Do you have a neuropsychiatrist as

14 well?

15 A. I don't know specifically if we have --

16 people call themselves neuropsychiatrists. There

17 is two meanings for neuropsychiatrist, the old

18 meaning and the newer meaning.

19 Q. Now the neuropsychologist, which,

20 again, you're more familiar with since you know

21 you do have one on staff, correct?

22 A. Yes.

23 Q. You have at least one or more than one?

24 A. We've always had at least one,

25 sometimes more than one.




708



1 Q. And a neuropsychologist helps a patient

2 learn new methods of communication, correct?

3 A. Yes, but usually the speech -- it

4 depends on what the problem is, but usually the

5 speech therapist with a patient is more of value

6 than the neuropsychologist.

7 The neuropsychologist could be of value

8 in that area, but the speech therapist or speech

9 pathologist is of more value in developing

10 communication systems, yes.

11 Q. Now, did I understand you correctly

12 when you said that if a patient said ouch, stop

13 that, in response to a pain stimulus that that

14 would not indicate any sort of cortical-mediated

15 behavior? That that would be a brain stem

16 reflex?

17 A. No, you misunderstood me. I may have

18 been talking too fast.

19 Q. Yes, you talk fast.

20 A. We discussed it in the report of the

21 minimally conscious state. If they really said,

22 ouch, stop that, rather than just saying, no,

23 that would indicate a cortical response. So you

24 may have misunderstood what I was saying at that

25 point. I wasn't saying that. That's not true.




709



1 Q. PVS patients can speak, can't they?

2 A. Speak in what sense?

3 Q. Words? Language?

4 A. They are reports from Nicco Shief and

5 others about the one patient that's reported

6 extensively in the literature about saying words

7 who they think is in a vegetative state. But

8 speaking is extraordinary rare. And the case

9 reported by Nicco Shief and others is a

10 phenomenonly rare case.

11 So they don't normally speak, no. But

12 his patient did in his one reportable case it's

13 well-documented of words being expressed by

14 someone in a vegetative state.

15 Q. Now, regardless of linguistic --

16 A. The who? Who?

17 Q. The linguistic ability, regardless of

18 that, the patient can be taught to communicate in

19 other ways, correct?

20 A. Which patient?

21 Q. A patient say in a minimally conscious

22 state?

23 A. Yes. You try to -- well, not minimally

24 conscious because it's very hard to communicate

25 with them, but if they're conscious there are




710



1 certainly other ways to try to communicate with

2 them besides verbally. Yes, very much so.

3 Q. Now, in looking at your videotape

4 examination again, is it your belief that she

5 exhibited no sustained visual pursuit?

6 A. Yes.

7 Q. And that is because she didn't do it

8 three times?

9 A. She didn't do it at all. There was no

10 sustained visual pursuit in the way that was

11 meant in the task force report. There was not a

12 shred of anything suggesting sustained visual

13 pursuit.

14 There's a visual-orienting reflex, but

15 there's no sustained visual pursuit. When people

16 come out of a vegetative state you see almost 100

17 percent of the time they follow you all the time.

18 They don't follow you 5 percent or 2 percent or 3

19 percent or 10 percent or even 20 percent. These

20 are followed 100 percent of the time.

21 Q. So if on Dr. Hammesfahr's tape we can

22 clearly see her eyes following Dr. Hammesfahr

23 around the room, would you count that as

24 sustained visual pursuit?

25 A. Dr. Hammesfahr's report and what he




711



1 sees is totally bogus. He's not seeing visual

2 pursuit.

3 MS. ANDERSON: Move to strike that,

4 Your Honor.

5 THE COURT: Strike the word bogus.

6 BY MS. ANDERSON:

7 Q. My question to you is: If on the

8 videotape which you say that you have reviewed,

9 correct?

10 A. Yes, I have.

11 Q. If it is clearly visible that she

12 follows him with her eyes around the room would

13 that be an example of sustained visual pursuit?

14 MR. FELOS: Your Honor, I object to

15 that question. First of all, it doesn't

16 correspond with the record.

17 And second of all, the witness has said

18 that the tape doesn't show that. So the

19 question is objectionable on both grounds.

20 THE COURT: Well, it's a hypothetical

21 question. I think I heard the word if in

22 there. He's at least perfectly competent to

23 answer a hypothetical question.

24 THE WITNESS: Over what period of time?

25 BY MS. ANDERSON:




712



1 Q. Say 90 seconds, two minutes?

2 A. No.

3 Q. How long would it take?

4 A. Well, the task force never came up to

5 any conclusion on that and if you look at the

6 task force report the vegetative state, if you

7 look at the minimally conscious report when we

8 talked about the words consistent and sustained

9 and reproducible we can't quantify that.

10 Q. That is subjective, correct?

11 A. No, it's not subjective. It's not

12 subjective since -- that's not quantifiable. So

13 I can't give you a time frame of three minutes or

14 five minutes.

15 I can say beyond any doubt what

16 Hammesfahr saw is -- I don't know the word to

17 describe Hammesfahr's examination that I can use

18 in court, but it doesn't show sustained visual

19 pursuit.

20 And his report, when you look at the

21 film you're certainly welcome to show me that.

22 It doesn't show sustained visual pursuit.

23 Q. Now you said that your examination was

24 incomplete, correct?

25 A. Well, yeah, it was incomplete in the




713



1 sense that you could always go further and spend

2 hours at the bedside trying to produce voluntary

3 responses.

4 Q. Did Terri --

5 A. It was not incomplete for the purpose

6 of making a diagnosis of a permanent vegetative

7 state, no. Was it incomplete in that I could

8 have done other things?

9 I certainly could have done the tape

10 better, Ms. Anderson, in terms of the microphone

11 and showing what I was doing because if I saw

12 that tape myself and it was some other doctor I

13 would really criticize them for not being more in

14 depth at showing what they were doing and

15 explaining better what they were doing into the

16 microphone because at several points you can't

17 tell what I'm doing and I don't think that's

18 right.

19 I didn't realize the microphone did not

20 pick it up. I was sort of intent on the face, so

21 I'm being critical of my own tape in terms of not

22 illustrating as best I could on the videotape

23 what I should have done in terms of my

24 explanation, what I was doing in the background

25 and how she is responding.




714



1 Q. In fact, you instructed the

2 videographer to get a close-up of her face,

3 didn't you?

4 A. Well, that was because the visual

5 pursuit was so important. I focused on the face

6 and it clearly showed no visual pursuit at all.

7 And in my attempt to look at the face I wasn't

8 careful enough on the videotape to say clearly in

9 the background what I was doing and/or to

10 illustrate what I was doing.

11 So you can't put together what you see

12 on the tape with what I see in the background.

13 So I should have done a better job of

14 videotaping.

15 Q. So you can't put the visual image that

16 is shown on the videotape with the sound track;

17 is that what you're saying?

18 A. You can't tell --

19 Q. Is that fair?

20 A. In some parts you can't tell exactly

21 what I said to the patient to do and what I was

22 doing in going from one side of the bed to the

23 other. When I was taping to get a visual

24 pursuit, which she has none, she has no

25 consistent visual pursuit, visual tracking, but




715



1 you can't tell at some points when I said that

2 what I was doing.

3 So you can't infer what I was doing in

4 terms of a stimulus, so that was in error in the

5 way I videotaped.

6 Q. Now, Dr. Cranford, is it not a fact

7 that on that videotape you said to Terri, oh, you

8 can track that a little bit, can't you?

9 A. Oh, yes.

10 Q. In talking about the balloon?

11 A. Yes.

12 Q. So it's not really accurate to say that

13 she showed no pursuit?

14 A. It's absolutely accurate because when I

15 talk to a patient I'll say all sorts of things to

16 a patient. When you're talking about persistent

17 visual pursuit, what I was saying to the patient

18 and I was trying to encourage the patient to say

19 it and what I say to the patient to say in

20 tracking through a visual-orienting reflex versus

21 what I call a consistent sustained visual

22 pursuits are two entirely different things.

23 Q. So when you said to Terri, You can

24 tract that, you didn't really mean that; is that

25 what you're saying?




716



1 A. To who? To Terri Schiavo?

2 Q. Yes, during the examination.

3 A. At that point in time she was following

4 with her eyes. That was not seeing visual

5 pursuit, but she was following the multicolored

6 balloon more than I thought she would have.

7 Q. Now, Dr. Cranford, did you ever ask

8 Terri to look at you on this exam and she turned

9 her head towards you and then you said, No, over

10 here?

11 A. Try that one again.

12 Q. Did there ever come a point in that

13 exam where you said to Terri, Look at me, she

14 turned her head to the sound of your voice where

15 you were and you said then, No, over here?

16 A. Yes.

17 Q. And you did that to confuse her?

18 A. No, I was trying to get her to look at

19 me. I was trying to get her to respond verbally

20 to me so that she could track in my direction.

21 Q. Now, with a brain-damaged patient since

22 we're talking about life or death and you're very

23 well aware of that, aren't you?

24 A. Yes.

25 Q. With a brain-damaged patient you would




717



1 want to give that patient time to respond; would

2 you not?

3 A. You always do a neurologic exam over an

4 adequate period of time to observe them to know

5 what their basic neurologic condition is and

6 whether there's any chance for reversibility.

7 So, I'm sorry, that's a long way of saying yes.

8 Q. So it would be unfair to step on her

9 response time; would it not, by changing the

10 command?

11 A. Sure.

12 (CHAR CHECK ** ) ** 86787682-18&(

13 Q. Now, would you also agree that Terri

14 Schiavo has some vision problem?

15 A. No, she doesn't have a vision problem.

16 She's blind.

17 Q. She's totally blind?

18 A. She is totally blind in the sense that

19 she can't see at the cortical level. She is not

20 blind in the sense that she has a

21 visual-orienting-reflex and that is mediated

22 through the brain stem and through parts of the

23 thalamus just like she can't hear in a cortical

24 level, but she have stimuli there on an auditory

25 level.




718



1 Q. In fact, didn't we see her repeatedly

2 turning her face towards sound?

3 A. You could have been partially --

4 Terri's interesting because she doesn't have the

5 brain stem auditory-orienting reflex very much.

6 So it's possible that her head could turn at

7 times which, again, would be part of the brain

8 stem auditory-orienting reflex, yes.

9 Q. Now your concept of minimally conscious

10 state has not been embraced; has it?

11 A. My concept or the task force report's

12 concept?

13 Q. Are they not one in the same?

14 A. Oh, no, they're not. Ms. Anderson,

15 you're way off on that one. You better rethink

16 that one.

17 Q. When neurology, the term --

18 A. Yes.

19 Q. -- earlier this year published the

20 paper on the minimally conscious state there was

21 some post-publication review of that article; was

22 there not?

23 A. Post publication? There was an

24 editorial by Jim Bernet in his letters to the

25 editor that came in later, yes.




719



1 Q. Do you --

2 A. Do you mean the letter --

3 Q. Do you recall some very strong

4 criticism --

5 A. I would have expected that from those

6 people, yes. We always get those.

7 Q. Do you know Dr. William J. Burke at

8 St. Louis University in Missouri?

9 A. I've never met Dr. Burke, but I know of

10 him, yes, very much so.

11 Q. Tell me if you agree or disagree with

12 the following two sentences: The definition of

13 yet another dubious diagnosis the minimally

14 conscious state makes it apparent that a few

15 members are hijacking the academy to promote

16 their own eugenic social agenda.

17 Do you agree or disagree with that?

18 A. Do I disagree with -- that that

19 statement was made or the substance of that

20 statement?

21 Q. The substance. Do you agree or

22 disagree with the substance of that statement?

23 A. I think it's comical because it's

24 ludicrous. It sounds like I have a lot of power

25 within the American Academy of Neurology. If you




720



1 read that statement to the American Academy of

2 Neurology they would find that so unreal they

3 would laugh you out of court because I don't have

4 that much power to hijack the American Academy of

5 Neurology.

6 And when I saw that statement I said to

7 my colleagues, Oh, I wish that I had as much

8 power to hijack the American Academy of

9 Neurology.

10 I can assure you that minimally

11 conscious report was not my making. I wish I was

12 more of a power that that -- there was a

13 significant disagreement in that report among the

14 people that did that report. And you'll recall

15 that several rehabilitationist and four

16 neurologists and neurosurgeons and we disagreed

17 on some points which would be discussed with you,

18 but I can assure you that report was not

19 dominated by me.

20 And if you don't think so, you can ask

21 anybody on that report. It was not dominated by

22 me. I did not hijack the Academy. I wish I had

23 that much power, but I don't.

24 Q. Of course I'm not asking about you, am

25 I, Dr. Cranford, I'm asking about the idea?




721



1 A. No, you're not, because you know that

2 means me when Dr. Burke said that. Everybody

3 knew that meant me. It didn't mean Steve Ashwal.

4 It didn't mean Bryan Gennette. It didn't mean

5 Joe Jiacino. That meant me, so that among us on

6 the minimally conscious report that's a big, big

7 joke.

8 Q. And do you recall that Dr. Burke went

9 further in his letter which was published after

10 the minimally conscious report was published and

11 quoted from Dr. Leo Alexander who served on the

12 staff at the office of chief counsel for war

13 crimes at Nuremberg and pointed out that Hitler's

14 eugenic program succeeded because they had a

15 subtle shift in physicians -- that physicians

16 came to believe in Nazi, Germany that there was

17 such a thing as a life not worth living.

18 A. Dr. Burke usually, most everything he

19 writes, often will quote from Leo Alexander.

20 That's a standard quote from Leo Alexander, which

21 is a very good report by Leo Alexander.

22 Q. Isn't Dr. Alexander's observation worth

23 remembering again and again?

24 A. I think Leo Alexander's observation is

25 extremely valuable as it applies to Nazi,




722



1 Germany. It's absolutely true and it's very

2 scary to see what happened among the medical

3 profession in Nazi, Germany.

4 I've written on that subject, by the

5 way, of Nazi, Germany, so I think he's absolutely

6 right and I think he's a very acute observer. I

7 think it's taken out of context, but I think it

8 should be heeded very closely what Leo Alexander

9 meant.

10 I think his article should be read by

11 everyone.

12 Q. Well, in fact, you yourself had piloted

13 the notion that profoundly disabled people

14 perhaps are living a life that is worse than

15 death? That is worse than death?

16 A. Yes.

17 Q. Do you recall that you advanced that

18 notion in a guest editorial to be published in

19 the British Medical Journal in response to

20 Professor Andrew's study about misdiagnosis?

21 A. Yes.

22 Q. Do you recall your specific words?

23 A. No, not that many years ago. No.

24 Q. Let me read this sentence to you and

25 ask you if you recall this: Reasonable people




723



1 may differ in their view of the quality of life

2 of these conscious individuals, but I would

3 speculate that most people would find this

4 condition far more horrifying than the vegetative

5 state itself. And some might think it's an even

6 stronger reason for stopping treatment than

7 complete unconsciousness.

8 A. Yes.

9 Q. Do you still hold to that view?

10 A. I've said it even more strongly in an

11 article which I had reviewed recently by

12 Dr. Hashton (phonetic) which was much more

13 specific in an article by Dr. Hashton and myself,

14 yes.

15 Q. When Mr. Felos asked you on direct

16 examination to define the uses and the functions

17 of a SPECT scan you started your answer by saying

18 my understanding is and then went on.

19 Do you recall that testimony?

20 A. Yes, I do.

21 Q. Do you use the SPECT scans in your

22 practice?

23 A. No.

24 Q. Now the University of Minnesota Medical

25 School has a hyperbaric chamber; does it not?




724



1 A. Well, no, we have a hyperbaric chamber

2 at Hennepin County Medical Center. I don't know

3 if the University does. Our hyperbaric chamber

4 is at our institute and --

5 Q. At your facility?

6 A. At our facility, yes.

7 Q. Have you ever ordered a SPECT scan for

8 one of your patients?

9 A. Have I? No.

10 Q. So you're not really all that familiar

11 with it?

12 A. I don't use it very much because

13 they're not very much help. They're kind of

14 worthless in most situations.

15 Q. In your opinion?

16 A. In my opinion, that's right.

17 Q. And other professionals might find them

18 quite useful; would you not agree?

19 A. I think the consensus would be they're

20 not of much value. You will not find a lot of

21 worth on SPECT scans compared to the others --

22 MS. ANDERSON: Move to strike that

23 answer as non-responsive, Your Honor.

24 THE COURT: What was the question?

25 MS. ANDERSON: The question was, other




725



1 professional physicians might find them very

2 useful.

3 THE COURT: I thought the answer was

4 responsive to that question.

5 MS. ANDERSON: Well he's talking about

6 was the consensus. What I want him to do is

7 tell me if there are other physicians who

8 find SPECT scans useful.

9 THE COURT: Well, we had two of them

10 testify in this courtroom. Now what does

11 the word "other" mean? Two or less? Two or

12 more? I think the answer was responsive.

13 It may not have been what you wanted him to

14 say, but I'll overrule that objection.

15 BY MS. ANDERSON:

16 Q. Dr. Cranford, would you agree that

17 clinical observation of these kinds of profoundly

18 brain-injured patients would be the most

19 significant part of the examination, aside from

20 taking the history and a review of the records?

21 A. Clinical observation in terms of the

22 clinical exam over a period of time?

23 Q. Yes.

24 A. Like 12 years, yes.

25 Q. No, like your diagnosis because you




726



1 have not dealt with her for 12 years, have you?

2 A. No, that's not true. That is totally a

3 fallacious way of looking at it. When you make a

4 diagnosis of a vegetative state my exam was in

5 the context of reviewing records over 12 years

6 and knowing what the test showed and knowing what

7 the CAT scans show and knowing what numerous

8 neurologists had said before about this patient

9 and knowing what the attending physician had said

10 about this case.

11 So you don't go in and examine the

12 patient like I do for 25 or 35 minutes and make a

13 diagnosis on that exam alone. That's ludicrous.

14 You go on for 12 years of repeated observations.

15 You go on what the records show. You go on your

16 interpretation of that. You go on the fact that

17 she's had numerous neurologists examine her that

18 have all said the same diagnosis.

19 Q. So --

20 A. I'm not finished yet.

21 Q. Okay.

22 A. You look at the overall medical

23 records. You take a history and you look at the

24 original insult, was it hypoxic ischemia? Was it

25 a traumatic injury?




727



1 Then you look at the CAT scans and then

2 you gain the relevant material like an EEG or

3 other studies. And then when you see the patient

4 20 -- 30 to 45 minutes is not an adequate exam to

5 see a patient to know that you've never seen

6 before.

7 Is it adequate in this context?

8 Absolutely, because you're going on all of the

9 other records that have been accumulated for over

10 12 years. There's never been a serious dispute

11 about the diagnosis in this case until recently

12 and your experts in this area are not qualified

13 to Object --

14 MS. ANDERSON: Objection and move to

15 strike that, Your Honor.

16 THE COURT: Sustained.

17 BY MS. ANDERSON:

18 Q. Dr. Cranford, please confine yourself

19 to answering the question that I've asked. Don't

20 bad mouth your fellow physicians, please.

21 A. I don't --

22 Q. Can you do that?

23 A. No, I will not do that. This is a

24 fraud with these people --

25 MS. ANDERSON: Your Honor, I move to




728



1 strike this and will you please instruct

2 this witness not --

3 THE COURT: Doctor, the Rules of

4 Evidence do not allow one expert to comment

5 on the diagnosis of prognosis of a fellow

6 expert in the case. They may only comment

7 on methodology. And then only in response

8 to a question. So if you would please

9 try --

10 THE WITNESS: But I can comment on

11 methodology then --

12 THE COURT: If you would please try to

13 confine yourself within those parameters

14 we'll get out at a decent hour today and

15 we'll have record that's what it should be.

16 BY MS. ANDERSON:

17 Q. From 1992 to the end of 2001, can you

18 tell me what neurologists examined Terri Schiavo?

19 A. Oh, there were three or four or five.

20 I know Dr. Barnhill did.

21 Q. Do you know how long he spent with

22 Terri examining her?

23 A. Of course I don't know that,

24 Ms. Anderson.

25 Q. Because he didn't make a note in the




729



1 record, did he?

2 A. I don't know what he did. I know he

3 examined the patient. I know he made a

4 diagnosis. I know --

5 Q. Did you make any notations in her

6 records, by the way?

7 A. No.

8 Q. When you reviewed them, did you see any

9 notations by Dr. Bambakidis?

10 A. I wasn't looking for any notations. I

11 didn't look in the records -- in the records at

12 the current hospital? No, I didn't look at

13 those.

14 Q. At Hospice?

15 A. Why would Dr. Bambakidis put something

16 in the records?

17 Q. I'm just asking you if you saw anything

18 that Dr. Bambakidis entered into the records?

19 A. Why would I look at something that

20 shouldn't be there?

21 Q. I'm simply asking you if you saw it.

22 A. No, I did not. No.

23 Q. Did you likewise see anything put into

24 her records by Dr. Melvin Greer?

25 A. I didn't look for that. I didn't look




730



1 at the records to see if Dr. Greer put anything

2 in the records.

3 Q. What's the most recent record of

4 Theresa Schiavo that you've examined?

5 A. I think probably the report by the

6 attending physician. I don't remember the exact

7 date --

8 Q. Is that the one that checks off --

9 A. No. No. I have it right here. I will

10 tell you --

11 Q. Are you talking about Dr. Gambone's

12 report?

13 A. Yes, I am.

14 Q. The one that you went over with

15 Mr. Felos?

16 A. Pardon?

17 Q. The one that you went over with

18 Mr. Felos?

19 A. No, I didn't go over that with

20 Mr. Felos. He gave me the records. I didn't go

21 over that with Mr. Felos.

22 Q. I should say the one that you mentioned

23 on direct examination?

24 A. Oh, I mentioned a lot of things in

25 direct examination and that was one of the things




731



1 probably, yes. That was the most recent record

2 that I have seen was the report by the doctor,

3 yes.

4 Q. Now, I think I heard you testify that

5 Terri has a right gaze preference; is that

6 correct?

7 A. Her head and her eyes are often turned

8 to the right and so at that point in time I would

9 call that what appears to be a right gaze

10 preference, yes.

11 Q. So to the extent that during an

12 examination her head is turned to the left and

13 her eyes appear to be fixated to the left?

14 A. You mean to the right?

15 Q. To the left.

16 A. Yes.

17 Q. She's looking to the left. Her head is

18 turned to the left. Would you expect that to be

19 in response to some sort of stimulus?

20 A. Oh, no. No. No.

21 Q. No?

22 A. That's not what you meant by the term

23 gaze preference. It's a preference. A gaze is a

24 preference and at times her head is more to the

25 right and her eyes are more to the right, but a




732



1 preference doesn't mean they can't go to the

2 left.

3 They can go to the left spontaneously.

4 They can go to the left in terms of a response to

5 stimuli. We saw that in the tape that her head

6 and eyes went to the left. You can't draw that

7 conclusion from what I said there, no.

8 Q. Now, when you touched Terri's neck --

9 A. Yes.

10 Q. -- and she smiled?

11 A. Yes.

12 Q. Was that the same way her mother

13 touches her neck?

14 A. Oh, I don't know exactly how her mother

15 touches her neck.

16 Q. You didn't observe that?

17 A. I observed touching, but I don't know

18 what the touching was. I didn't --

19 Q. Don't you think it's likely that your

20 touching her neck on the right side evokes a

21 learned response from Terri of, Mom is that you?

22 A. No, that's ridiculous.

23 Q. Now, on which side of Terri's bed is

24 the window in her room?

25 A. Oh, I don't recall. As I recall it's




733



1 on the right-hand side.

2 Q. But you said she's totally blind and

3 would not be able to see out?

4 A. She is blind from a cortical

5 standpoint. She cannot see at all -- she can see

6 if you want to use the word see. She possesses

7 eyesight, I think, on a visual-oriented reflex at

8 a midbrain hypothalamic. So it depends on how --

9 can she see the way we think of seeing? The way

10 you and I associate it? No, she can't.

11 Q. And you also testified that it's a

12 total waste of time to examine her arms and legs

13 because of her contractures?

14 A. If I said "total" I think it's a major

15 waste of time because you can spend hours and

16 hours at the bedside and not see any movements.

17 So, she had severe contractures.

18 She had paralysis before that. Yes,

19 since she's in a vegetative state it would be a

20 waste of time to do that. You could try that for

21 hours and hours, but what would be the point of

22 that?

23 Q. Were you able to straighten out either

24 one of her arms?

25 A. To some extent the left arm I could




734



1 straighten it out a bit, yes.

2 Q. How many degrees?

3 A. I don't remember because that wasn't

4 significant to me, 10, 20, 30 degrees. The left

5 arm was clearly less contracted than the right

6 arm. So the right arm was very difficult to

7 stretch out in any way. The left arm I could

8 stretch out more, so the 10, 20, 30 degrees

9 really wasn't that important.

10 Q. Now, I want to be sure that I

11 understand your testimony about visual pursuit

12 and the balloon. She followed the balloon, I

13 think you said, up and down, left and right --

14 A. I think --

15 Q. -- on one of the trials, correct?

16 A. Yes, at least one of the trials she

17 did, that's right.

18 Q. Then she got sleepy, correct?

19 A. Well, if she got sleepy I wouldn't do

20 the test. No, that's wrong, but any time you get

21 fatigued they can do that.

22 Q. No, I mean after you did that first

23 trial she began to go to sleep, right?

24 A. She might have. I don't remember that

25 specifically, but I'll take your word about that.




735



1 Q. And you woke her up by pinching her?

2 A. By pinching her or stimulating the

3 forehead or something. I tried not to pinch her,

4 but I tried to stimulate her by Terri, wake up.

5 I prefer not to pinch them. If you don't keep

6 them away you have to stop your examination.

7 Q. Did she have a cold that day?

8 A. I wasn't aware if she had a cold one

9 way or the other.

10 Q. Would a cold make her more sluggish?

11 A. More what?

12 Q. Sluggish?

13 A. Yeah --

14 Q. Less responsive --

15 A. It would in terms of sleepiness. Any

16 time a patient may have an infection her eyes

17 closed, but their response when their eyes are

18 open wouldn't change that much.

19 But any time you have any kind of flu

20 or something you use the word sluggish, I would

21 say more sleepy. So you would look for an

22 infection, yes, but once her eyes are open it

23 would be very unlikely that a cold would affect

24 her wakeful performance as opposed to her

25 sleeping performance.




736



1 Q. When you have a cold don't you feel a

2 little more sluggish?

3 A. Yes, I do.

4 Q. Why would Terri be any different?

5 A. Well, because that's a totally

6 different thing because sluggish to me is totally

7 different from her.

8 Q. I see.

9 A. Being sluggish wouldn't -- for her she

10 could be more sleepy, which would be much more

11 profound for me. I don't think --

12 Q. Now, let me -- in between the first

13 balloon trial where she tracked and the second

14 balloon trial where you said she did not track

15 you pinched her; did you not?

16 A. You know I don't remember the details.

17 I know I did three trials with the balloon. I

18 did three trials with the teddy bear. And on the

19 one trial with the balloon, I don't remember the

20 exact order, Ms. Anderson, but I thought she did

21 follow for a few seconds. I think you can see in

22 the video.

23 By the way, you can see when the father

24 does it on September 4th he had her follow the

25 lights, so it's obvious that she does have




737



1 some -- whether you want to call it tracking or

2 visual-orienting reflex it's obvious at some

3 point she follows for a few seconds a light or a

4 bright balloon. And I saw in one of three trials

5 these observations were with the balloon, but not

6 with the teddy bear.

7 Q. What's the answer to my question,

8 Dr. Cranford? And you may need to have your

9 memory refreshed on this. Did you pinch Terri

10 between the first balloon trial where she tracked

11 and the second one where you said she didn't?

12 A. My answer is I don't remember.

13 Q. Thank you. Thank you. Now, was that a

14 teddy bear, some stuffed animal that was being

15 displayed to her?

16 A. Yes.

17 Q. And you're saying she did not look at

18 it?

19 A. She did not follow it like she did with

20 the one of three of the trial balloon. She did

21 not appear to follow it with her eyes up and down

22 and both sides for a few seconds like she did

23 with that balloon that one time with the

24 multicolored balloon. She did not appear to do

25 that, no.




738



1 Q. Now, did you say that stem cell

2 research will never ever be of any assistance to

3 brain injuries?

4 A. No, I didn't say that at all. I said

5 in severely brain damaged -- permanently brain

6 damaged people where the brain does not

7 regenerate stem cell research cannot replace

8 permanent brain damage. That's what I said. Not

9 brain injury, because injury is a non-specific

10 term.

11 Q. Did you check the research before you

12 flew to Florida?

13 A. Did I check the research?

14 Q. Did you do a Medline research or a

15 Pubmed research --

16 A. I will stand on my statement, as I said

17 it.

18 Q. Have you read Dr. Hammesfahr's papers?

19 A. He doesn't have any papers.

20 Q. Have you read --

21 A. I've read what -- he apparently

22 published, but those are not peer reviewed

23 publications, but I've read them.

24 Q. Have you -- does it provoke your

25 curiosity at all in terms of treating your own




739



1 patients --

2 A. To see what Dr. Hammesfahr wrote?

3 Q. Yes.

4 A. No, it makes me ashamed for the medical

5 profession.

6 MS. ANDERSON: You move to strike, Your

7 Honor.

8 THE COURT: You asked him what he felt

9 and he told you.

10 BY MS. ANDERSON:

11 Q. Dr. Cranford, have you read anything on

12 hyperbaric oxygen therapy?

13 A. Yes, I have.

14 Q. And have you ever ordered it for your

15 patients?

16 A. Oh, yes.

17 Q. For wound healing?

18 A. No, I wouldn't order it for wound

19 healing. I wouldn't be involved with that. So

20 that wouldn't be a fair statement to make, no.

21 Q. Have you ordered it for children with

22 cerebral palsy?

23 A. No.

24 Q. Are you -- do you consider yourself an

25 expert in hyperbaric oxygen therapy?




740



1 A. No.

2 Q. Do you consider yourself an expert in

3 vasodilation therapy?

4 A. No.

5 Q. Do you know if your institution treats

6 migraine headaches with vasodilators?

7 A. Oh, sure I do.

8 Q. Now, if you coauthored --

9 A. I'm sorry, you said vasodilators?

10 Q. Vasodilators.

11 A. Did you mean vasoconstrictor?

12 Q. No, I meant vasodilators.

13 A. No, the pathophysiology of migraines

14 where the pain is is vasodilation, so the

15 treatment is vasoconstriction, not vasodilators.

16 Q. Would it surprise you to know that

17 Dr. Kunkle at the Cleveland Clinic uses

18 vasodilators?

19 A. I don't know who Dr. Kunkle is and I

20 don't know the answer to that question.

21 Q. Would you agree that the line between

22 the vegetative state and the minimally conscious

23 state, if you conceive those two states, may not

24 be distinct?

25 A. In some cases, yes, I would definitely




741



1 concede that, yes.

2 Q. Do you think Terri Schiavo is

3 suffering?

4 A. No, I do not think she is suffering in

5 a cortical level.

6 Q. Do you think she is unconscious?

7 A. Yes, I do.

8 Q. Do you think she's a person?

9 A. Yes, I do.

10 Q. Have you written that you must question

11 the assumption of the distinction between PVS and

12 the minimally conscious state?

13 A. I'm sure I have probably on several

14 occasions. That's been one of the hallmarks of

15 my work in this area to be careful of false

16 positive, false negative diagnoses of both the

17 vegetative state and the minimally conscious.

18 So, in the last five years of my life

19 or 10 years have been questioning to some degree

20 the vegetative state and the minimally conscious

21 and the percent of false diagnoses. So I've

22 probably written on that on several occasions.

23 Q. Do you recall a piece that you

24 coauthored with Dr. Nancy Childs of the rehab

25 center out in Austin, Texas, that was published




742



1 in the Journal of Head Trauma and Rehabilitation

2 entitled Termination of Nutrition and Hydration

3 in the Minimally Conscious State Contrasting

4 Clinical Views.

5 Do you recall that it was published in

6 1997?

7 A. Yes, it wouldn't be fair to call it

8 coauthored, because this was a context and view.

9 Q. Right.

10 A. So she wrote one side and I wrote the

11 other.

12 Q. Right.

13 A. So, yes, I remember that and we did --

14 jointly authored it together, but we're not

15 coauthors. We had different viewpoints on that,

16 obviously.

17 Q. Do you recall the following sentence in

18 your part of that article quote: If people

19 really understood what it meant to be in a

20 minimally conscious state and how this condition

21 differs from the vegetative state it is my view

22 that the vast majority find it more abhorrent to

23 be minimally conscious than completely

24 unconscious?

25 A. Yes.




743



1 Q. Do you remember writing that?

2 A. Yes.

3 Q. Is that your present view?

4 A. Yes.

5 Q. And in both instances minimally

6 conscious or in a persistent vegetative state,

7 those are lives that are not worth living?

8 A. No, I don't believe that. I don't use

9 the term life is not worth living.

10 Q. You agree that the PVS patient exhibits

11 no behavioral response whatsoever?

12 A. Yes.

13 MR. FELOS: Asked and answered, Your

14 Honor.

15 THE COURT: It's been answered again.

16 BY MS. ANDERSON:

17 Q. Do you believe that physician-assisted

18 suicide could be justified?

19 MR. FELOS: Your Honor, I object. This

20 isn't a case about physician-assisted

21 suicide. This is a case regarding

22 withdrawal of unwanted medical treatment.

23 MS. ANDERSON: This is a case about

24 bias, Judge. The bias of this witness.

25 THE COURT: But if he's biased about




744



1 short people what does that got to do with

2 this case?

3 MS. ANDERSON: It has everything in the

4 world to do with this case.

5 THE COURT: Well, physician-assisted

6 suicide the Courts had made a real

7 difference between withdrawing of life

8 support and physician assisted suicide,

9 so --

10 MS. ANDERSON: Yes, and he's for all of

11 it. He's for death in whatever form it

12 takes.

13 MR. FELOS: Well, Your Honor, this is

14 going far beyond any bounds of relevancy.

15 MS. ANDERSON: Oh, I don't think so. I

16 also think it's relevant where an expert

17 witness is called upon to opine upon the

18 ultimate question and who has himself delved

19 into the legal issues, not confining himself

20 to the medical issues.

21 THE COURT: Well, is the next area of

22 inquiry capital punishment?

23 MS. ANDERSON: No.

24 THE COURT: Well, why are you stopping

25 at physician-assisted suicide?




745



1 MS. ANDERSON: I guess because

2 Dr. Cranford knows that he can't influence

3 capital punishment statutes or --

4 THE COURT: Well --

5 MS. ANDERSON: -- there are --

6 THE COURT: -- his belief on that is

7 equally the same as a physician-assisted

8 suicide which is contrary to the law.

9 MS. ANDERSON: We'll move along, Your

10 Honor.

11 THE COURT: Thank you.

12 BY MS. ANDERSON:

13 Q. Now, you mentioned Sergeant David Mac,

14 a patient of yours, who came out of PVS?

15 A. Yes, sir.

16 Q. How long was he in PVS?

17 A. Well, we discovered he was no longer in

18 a vegetative state at 22 months out, but in going

19 back and reviewing the records and actually

20 talking to the patient, it was like detective

21 work, actually.

22 We went back at least two months. So

23 he probably became aware at 20 months after being

24 in a vegetative state.

25 Q. Do --




746



1 A. I'm not finished. It may have been

2 further back then. I spent a lot of time with

3 Sergeant Mac trying to decide when he really

4 could start thinking again and when he was aware

5 of memories.

6 So I would say at 20 months for sure

7 and maybe he could have recovered before that,

8 maybe four to six months, but we weren't able to

9 verify some of the stories that he told us.

10 So we really tried hard to see how long

11 he was unconscious versus when he became

12 conscious.

13 Q. In fact, those misdiagnosis cases I

14 think you said give you some pause as a

15 physician, don't they?

16 A. Yes, you do.

17 Q. Because you're never dealing with

18 certainties in this area?

19 A. Well, you're dealing with almost

20 absolute certainties in cases like this one, yes.

21 Q. Now, do you recall back in 1989 a very

22 dramatic case in New York in which a woman for

23 whom a Court had ordered the nutrition tube to be

24 withdrawn suddenly woke up?

25 A. Yes, I'm familiar with that case.




747



1 Q. Do you remember what you told the New

2 York Times on that occasion?

3 A. I don't remember what I said at that

4 time. You can refresh my memory.

5 Q. It's a dramatic case. It shows you

6 that you're basically never dealing with

7 certainties here, said Dr. Ronald E. Cranford.

8 Do you recall that?

9 A. That sounds like something that I would

10 say, but that certainly doesn't apply here

11 because you're dealing with absolute certainties

12 here.

13 Q. Do you remember that woman's name in

14 New York?

15 A. Kerry Coons. I have all her medical

16 records in my office.

17 Q. And have you reviewed Dr. Childs' case

18 report published in the New England Journal of

19 Medicine in 1996 entitled, Brief Report Late

20 Improvement in Consciousness After Post-Traumatic

21 Vegetative State?

22 A. I believe that was the -- Nancy has

23 written several articles. Dr. Childs has. I

24 believe that was the one that started recovery

25 after 15 months in a vegetative state from head




748



1 injury, if that's the report that you're talking

2 about.

3 She had a couple of other reports so

4 I'm not sure, Ms. Anderson, which one you're

5 talking about. If it's the one at 15 months out

6 from a head injury, yes, I'm familiar with that

7 one.

8 Q. This is the one that she sent the

9 patient home 5.2 years after the injury.

10 A. Sent the patient home?

11 Q. Yes.

12 A. Well, that has nothing to do with when

13 they came out of a vegetative state -- when they

14 regained consciousness.

15 Q. You're not familiar with this report?

16 A. No, I think you misread the article.

17 It's not 5.2 years. The one that she talked

18 about, Ms. Anderson, as I recall, was a head

19 injury patient who came out at 15 months

20 post-injury.

21 And I don't know when the patient went

22 home, but the critical factor is not when the

23 patient went home, the critical factor is when

24 the patient discovered or came out of the

25 unconsciousness and that case report, I believe,




749



1 was 15 months, not 5.2 years. You totally

2 misread it, if you think that's what it says.

3 Q. Would you say that if a patient

4 responds twice to commands they're coming out of

5 a PVS state?

6 A. No, it depends on what responding twice

7 to a command means. And we discussed that a lot

8 in the minimally conscious report. Respond to

9 what command?

10 If it's a complicated command or it's

11 unequivocal at a high level of cognitive

12 functioning then once is enough. If it's

13 something that is easily confused with voluntary

14 activities then multiple observations are

15 necessary.

16 So, it depends on what the response

17 was --

18 Q. Let me read you this sentence and ask

19 you if this is what you are referring to from

20 Dr. Childs' case study, 15 months after patient's

21 injury the staff members reported possible leg

22 flexion and eye closure on two separate occasions

23 in response to command, but the responses were

24 rare and inconsistent during the next two months.

25 A. Yes, that's the report --




750



1 Q. Is that what you were thinking of?

2 A. That's the report that I was thinking

3 of, not 5.2 years.

4 Q. In fact, in the last six months there's

5 now another report of a patient coming out of a

6 persistent vegetative state, I believe, in

7 Holland; did you pick that up?

8 A. No, I know about -- there is -- we

9 tried to track the one down in Hawaii at seven

10 years. We tried to track the one down in New

11 Mexico that we talked about at the last trial,

12 but we've not been able to verify that.

13 I haven't heard about the one in

14 Holland, but, you know, we're talking about five

15 years, seven years. I don't think we're talking

16 about 12 years.

17 Q. Now, Dr. Cranford, is it your

18 contention that there is no treatment regimen

19 whatsoever that shows any hope at all for Terri

20 Schiavo?

21 A. Absolutely unequivocally to the

22 highest --

23 Q. Are you --

24 A. -- to the highest -- let me finish. To

25 the highest degree of medical certainty, using




751



1 the word absolute, to the highest degree of 99.99

2 percent I am certain there is no treatment that

3 will help Terri Schiavo, yes.

4 Q. Now, you base that opinion not on your

5 experience, correct, because you don't try to

6 help these patients get better since they're not

7 your patients --

8 A. No, that's not correct. I base it on

9 my experience among other reasons.

10 Q. Have you ever been the attending

11 physician for a patient this far out?

12 A. No. No.

13 Q. Now, in fact, you testified earlier

14 that after the acute phase a neurologist is no

15 longer the attending, correct?

16 A. That's exactly -- well, sometimes they

17 are, but most of the time the attending

18 physicians of patients with severe brain damage

19 are the internist or the general practitioner or

20 the long-term care facility at home.

21 So usually the neurologist or the nurse

22 or the person that's doing the physical

23 rehabilitation are not the primary attending

24 physician, that's right.

25 Q. So the person who is in charge of the




752



1 rehab of a patient like this, like Dr. Childs'

2 would really be the better person to address that

3 issue; isn't that correct?

4 A. Address which issue?

5 Q. What regimen will work to bring these

6 patients out?

7 A. Oh, no, not after the point of

8 uncertainty. She is no more qualified to address

9 that than I am. She is certainly a

10 rehabilitationist. In some areas I think she's

11 more qualified to decide what kind of

12 rehabilitation, but she's not more qualified when

13 you get this far out.

14 When you pass the point of

15 irreversibility by this many years or half of

16 this much or three quarters of this much she is

17 definitely not any more qualified to make that

18 statement. And anyone who is a neurologist or

19 neurosurgeon or in physical medicine or even

20 rehabilitationists or others who have experience

21 dealing with patients with severe brain damage.

22 Absolutely not.

23 Q. Let me ask you this question: Do you

24 keep up with rehabilitation literature?

25 A. No.




753



1 Q. Are you familiar with a study that was

2 published in March of 2001 in Archives of

3 Physical Medicine and Rehabilitation entitled

4 Positive Outcomes in Traumatic Brain Injury

5 Vegetative State Patients Treated With

6 Bromocriptine?

7 A. No.

8 Q. Have you ever heard of treating

9 patients with bromocriptine?

10 A. Yes.

11 Q. Who are in PVS?

12 A. Yes.

13 Q. Have you done that?

14 A. No.

15 Q. Are you familiar with the outcome of

16 this trial involving it looks like about 70

17 patients?

18 A. Well, if I haven't read it, I'm

19 probably not familiar with the outcome.

20 Q. So you haven't spoken with anybody

21 about it?

22 A. If I hadn't read the article I probably

23 hadn't spoken to anybody about it, that's true,

24 too.

25 Q. No one called you up and said,




754



1 Dr. Cranford, you ought to take a look at this

2 study?

3 A. Not that I'm aware of on that study. I

4 don't remember that, no.

5 Q. Let me ask you this: Would you agree

6 with this statement: There are no tests which

7 can confirm whether the patient has any inner

8 awareness?

9 A. Yes and no. I would confirm it from

10 the standpoint that what the person is trying to

11 say is you can't measure inner awareness. So you

12 can't test for inner awareness.

13 From a medical standpoint, no, I think

14 you can determine inner awareness when you do

15 medical tests to confirm your clinical diagnosis.

16 And I think the PET scan can do that, yes.

17 But I think the best basic argument

18 there is one of epistemological argument and I

19 would agree with epistemology, but I would not

20 agree with the clinical determination of that

21 statement.

22 Q. Would you agree that the great British

23 physicist Stephen Hawking has inner awareness?

24 A. He's locked in. That's a wonderful

25 example of being locked in. He's not only aware,




755



1 but his IQ is out of sight and probably double

2 mine.

3 He's the perfect example of somebody

4 that is locked in who has written books, as you

5 know, it goes on and on and on. So he's the

6 perfect example of an unusual case of primary

7 motor neuron disease that has become

8 progressively locked in over the years.

9 He has a fantastic communication system

10 that he's absolutely profound. I've read all his

11 books. I read quite a few of his books.

12 Q. Dr. Hawking cannot feed himself, can

13 he?

14 A. I don't know the circumstance, but I

15 think he's locked in. I don't know how he feeds

16 himself, but he's essentially locked in. Whether

17 there's a tube or not I don't know that, but --

18 Q. But he certainly can't bring a spoon to

19 his mouth?

20 A. I think he's locked in. When you see

21 pictures of him he's in that wheelchair and he's

22 locked in. There's no doubt about that. So when

23 you use the phrase locked in you mean they can't

24 do any activities of daily living because of

25 paralysis.




756



1 Q. Do you think his is a life worth

2 living?

3 A. Yes.

4 Q. And that's because of his social

5 contributions, correct?

6 A. No. First of all, I don't use the term

7 life worth living, but he's a man who has a

8 severe disability that has done profound things

9 and wants to live. I think people with

10 disabilities should have the right to decide for

11 themselves.

12 Q. Do you agree with this statement: The

13 diagnosis of the cognitive state is

14 time-dependent and cannot be made in a short

15 single assessment even by competent and

16 experienced clinicians?

17 A. Yes.

18 Q. Do you agree with this statement:

19 Assessments are best based on a series of

20 behavioral patterns?

21 A. I'm sorry, I didn't quite catch that.

22 Q. Do you agree with this statement:

23 Assessments are best based on a series of

24 behavioral patterns?

25 A. Behavioral patterns?




757



1 Q. Patterns, correct?

2 A. I don't know who wrote that, but, yes,

3 I guess in a generic sense. Yes, I would agree

4 with that.

5 Q. Do you agree with this statement: The

6 ability to generate a behavioral response

7 fluctuates from day-to-day and hour-to-hour and

8 even minute-to-minute?

9 A. Yes, generally, but not major

10 behavioral changes. I wouldn't agree with that

11 if you're talking about major. If you're talking

12 about minor changes in behavior I think that's

13 probably true of all of us each day. So I think

14 that's a common statement.

15 Q. And, in fact, during the course of your

16 exam with Terri she went to sleep, didn't she?

17 A. I would say she was dozing. Her eyes

18 were closing, so she went to sleep for a few

19 minutes a couple of times, yes.

20 Q. So your testimony is that her response

21 to her mother was reflexive, correct?

22 A. Only in the context of the overall

23 evaluation, not in terms of one individual

24 examination. I wouldn't say that. I'm putting

25 the whole case together in terms of my




758



1 evaluation, the whole case in terms of all of the

2 reports, in terms of everything that happened

3 beforehand in those reports, in terms of the

4 laboratory data, in terms of the doctors who

5 examined her that I felt credible, in terms of

6 these other doctors, in terms of my examination,

7 yes, it was definitely reflex of some type with

8 subcortical -- it was involuntary, but I wouldn't

9 take an individual response and just say, no,

10 that is just reflex, no.

11 Q. And when she failed to respond in the

12 same fashion later on during your exam to her

13 mother, is that a failure of the reflex action?

14 A. Oh, it varies. You can see the father

15 and mother tried many times to get a response and

16 they got nothing. Is that a failure to respond?

17 Sure. It means that the reflex response didn't

18 occur at that time so, that's right. That's

19 right.

20 Q. Isn't it more likely that she

21 recognized her mother initially and then didn't

22 feel the need to recognize her as dramatically on

23 a subsequent context?

24 A. Are you talking about now at 12 years

25 out?




759



1 Q. Yeah.

2 A. No. No. No way.

3 Q. Let me show you something. Do you

4 recognize this image of Terri and her mother,

5 Dr. Cranford?

6 A. I've never seen the still, but in terms

7 from the videotape I reviewed I'm sure, yes.

8 Q. Do you believe that the expression on

9 her face is a reflex?

10 A. Yes.

11 Q. Do you believe that she does not

12 recognize her mother?

13 A. Yes, to the highest degree of medical

14 certainty I believe that you can't take one

15 picture and call that a real response. If you'll

16 notice she's not even looking at her mother,

17 she's looking besides her mother. Do you see the

18 eyes?

19 Q. Well, isn't she blind, according to

20 your testimony?

21 A. Well, if you think she can smile when

22 she's looking at her mother and you think she has

23 visual pursuit -- she's not even looking at her

24 mother.

25 Q. You don't think this picture




760



1 demonstrates unconsciousness, do you?

2 A. That's just cheap sensationalism. I

3 don't think so at all.

4 Q. This is cheap sensationalism?

5 A. You know, you could take any patient in

6 a vegetative state, and I've done this before,

7 you can take any patient and produce a picture

8 like that, it shows one picture. I've seen it

9 over and over and over again.

10 MS. ANDERSON: I am done with this

11 witness, Your Honor.

12 THE COURT: Thank you. Is there

13 redirect, Mr. Felos?

14 MR. FELOS: I do, Your Honor, and it

15 may be a little while so perhaps we can take

16 a short break.

17 THE COURT: Let's take a 15-minute

18 break and then we'll start with redirect.

19 (Thereupon, there was a 15-minute break.)

20 MR. FELOS: Thank you, Your Honor.

21 REDIRECT EXAMINATION

22 BY MR. FELOS:

23 Q. Dr. Cranford, would you believe that

24 the subject of withdrawing artificial life

25 support from a patient evokes very strong




761



1 opinions?

2 A. Yes.

3 Q. The fact that you may have opinions of

4 this subject, has that affected in any way your

5 neurological exam of Terri Schiavo and your

6 opinion as to her condition?

7 A. No.

8 Q. Has it affected your opinion as to the

9 issue of treatment or lack thereof?

10 A. No, I think mine was a very objective

11 neurologic examination.

12 Q. You were asked about the Wendland case.

13 Had Mr. Wendland been diagnosed to be in a

14 persistent vegetative state, would it have been

15 more likely that his life support would have been

16 removed?

17 A. As a general statement, it would have

18 been much more likely that had Robert Wendland **

19 had been in a vegetative state it is more likely,

20 yes, that the treatment would have been

21 discontinued with permission of the courts.

22 Q. Now, did you testify that Mr. Wendland

23 was in a vegetative condition?

24 A. No, I testified that he was in the

25 condition that he was in. Whether it was




762



1 minimally conscious or not he clearly had

2 cognitive conscious interaction with the

3 environment.

4 Q. And you testified as such?

5 A. Yes.

6 Q. Have you testified in any other cases

7 in which you have rendered a diagnosis of a

8 patient that's not in a persistent vegetative

9 state?

10 A. Yes, quite a few.

11 Q. And those were cases regarding the

12 question of the removal of artificial life

13 support?

14 A. Both related to a question of removal

15 of life support and also malpractice litigation

16 cases where I was called in just as a medical

17 expert on the neurologic condition of the

18 patient, him or herself. It had nothing to do

19 with the liability or causation, just on the

20 damages related to neurologic condition.

21 Q. I want to limit that question to cases

22 in which you've testified that involve the

23 question of removal of artificial life support.

24 Are there other cases besides Wendland

25 in which you have testified that the patient is




763



1 not in a vegetative state?

2 A. Yes.

3 Q. You were asked about, referring to the

4 comparison of the CAT scans, whether you would

5 defer to the opinion of a neuroradiologist.

6 Would you defer to the opinion of

7 Dr. Maxfield?

8 A. Absolutely not.

9 Q. There was also some discussion about

10 difference between persistent and permanent

11 vegetative states. I'm going to ask you a

12 question on redirect examination slightly

13 different.

14 Do you have an opinion, within a

15 reasonable degree of medical certainty, as to

16 whether or not Theresa Schiavo is in a permanent

17 vegetative state?

18 A. Yes, I do.

19 Q. What is that?

20 A. She is in a persistent vegetative

21 state.

22 Q. You were asked whether you were the

23 attending physician currently for any vegetative

24 patients and I believe you answered no; is that

25 correct?




764



1 A. That's correct.

2 Q. Are you following any vegetative

3 patients at this time?

4 A. Quite a few, 10, 20 mainly in

5 Minnesota, but around the country, yes.

6 Q. Are you aware of whether any of those

7 patients are receiving hyperbaric oxygen therapy?

8 A. Yes, I am aware of that.

9 Q. Are any?

10 A. Yes.

11 Q. For how long?

12 A. One case for two to four years. That's

13 in Florida here, so...

14 Q. And has there been any change in the

15 patient's condition?

16 A. Absolutely not, no.

17 Q. Can a neuropsychologist teach Theresa

18 Schiavo a nonverbal communication system?

19 A. No.

20 Q. Do you believe, Dr. Cranford, that

21 there are fates worse than death?

22 A. Yes.

23 Q. You were asked about cerebral treatment

24 of cerebral palsy children with hyperbaric

25 oxygen.




765



1 Do you have any information for or

2 against as to whether that works?

3 A. Yes.

4 Q. What is that?

5 A. There was a study done recently, I

6 don't remember all the details, of comparing

7 hyperbaric oxygen to compressed air and following

8 over a long period of time.

9 This study which was done in Canada

10 showed no difference between hyperbaric oxygen

11 and compressed air over a period of whatever

12 time. That was a large-scale study.

13 Q. You were asked whether you considered

14 yourself an expert on various subjects, I

15 believe, vasodilators and hyperbaric oxygen.

16 Do you consider yourself an expert on

17 the vegetative state?

18 A. Yes, I do.

19 Q. You were asked about the Comes case in

20 New York?

21 A. Coons, C-O-O-N-S.

22 Q. Coon's case?

23 A. Yes.

24 Q. This, I gather, was a case of someone

25 on a feeding tube who woke up?




766



1 A. Yes.

2 Q. Was the patient in that case in a

3 vegetative state?

4 A. I'm not sure, as I recall the case.

5 The patient was severely brain damaged. I think

6 she carried a diagnosis of vegetative state --

7 the critical issue that I can't remember right

8 now is how far along she was in terms of the time

9 frame --

10 Q. That was my next question.

11 A. I can't remember the time frame, but

12 the dramatic aspect of the case while it was

13 under litigation and there were attempts to stop

14 treatment on her and let her die. And during

15 that period normally if you let someone die from

16 stopping treatment who is severely brain damaged

17 you establish permanency or irreversibility to a

18 high degree of certainty.

19 It was obvious in that case that had

20 not been established because during the

21 litigation, and I can't remember all the details,

22 but it was fairly dramatic because she woke up

23 and she woke up enough that they asked her

24 something about stopping treatment and she said

25 something, well, that's a pretty serious decision




767



1 or something to that effect. I can't remember

2 the exact words, but it was a pretty dramatic

3 case in the New York courts. That's basically

4 what I remember.

5 Q. But you don't remember how long she had

6 been in that condition?

7 A. No, I really don't and I think that's

8 very critical to the whole thing. I really right

9 now don't remember how long she had been in this

10 presumed diagnosis of vegetative state.

11 Q. Now, what's the longest verifiable case

12 in which a non-traumatic vegetative patient has

13 shown signs of neurological recovery?

14 A. Of good recovery is -- started from

15 David Mac from Minnesota, my case.

16 Q. Which was how long?

17 A. That was -- 1979 was the original

18 injury, December of '79 and he started waking up

19 in December of 1981. We learned something very

20 important from that case and that was that the

21 CAT scan didn't show any atrophy.

22 And we weren't used to following the

23 patients with CAT scans. And after that case

24 when we looked back we recognized that his CAT

25 scan in retrospect had not shown any atrophy.




768



1 So subsequently, CAT scans have been

2 very available not to establish the diagnosis of

3 a vegetative state, but to establish

4 irreversibility.

5 Q. There was some question on

6 cross-examination about, Well, did you hear about

7 the case in Holland or allegedly cases where

8 people have come out of vegetative states after

9 five or seven years. Have those cases been

10 verified?

11 A. No. No. We tried to -- we meaning

12 some of us in this area, tried to verify these.

13 There was a police officer in Kentucky or

14 Tennessee that came out of a persistent

15 vegetative state very dramatically after seven

16 years and we tried to verify those cases and

17 follow up with those cases.

18 We need to speak to the attending

19 physician or the consulting neurologist or

20 examine the patient ourselves or in a certain

21 case we actually got the PET scans on that

22 individual.

23 Q. Was that good science?

24 A. Pardon?

25 Q. Was that good science to follow up?




769



1 A. I'm sorry?

2 Q. Was that good science to follow up?

3 A. Yes. He wasn't in a vegetative state,

4 by the way, but he did dramatically improve over

5 a very short period of time. So it was an

6 unexplained and very dramatic recovery from a

7 prolonged state of diminished responsiveness or

8 seven, seven-and-a-half years. So it was a very

9 dramatic case.

10 Q. But that patient wasn't in a vegetative

11 state?

12 A. No. When we went back there was no

13 doubt that he was never in a vegetative state,

14 but he did have a markedly decreased

15 consciousness for seven to seven-and-a-half years

16 and he did, for some reason, show an unusual

17 dramatic improvement over a period of -- well,

18 over a period of six to eight hours, actually.

19 Q. There were questions about Terri

20 becoming drowsy or falling asleep on your exam.

21 Did you notice whether Terri became drowsy or

22 fell asleep during Dr. Hammesfahr's exam?

23 A. Sure. She'll always do that, yeah.

24 Q. Does Terri Schiavo have a locked-in

25 syndrome?




770



1 A. No.

2 Q. Why not?

3 A. Well, she's vegetative. And with the

4 locked-in syndrome you wouldn't see the atrophy

5 of the cortex. It's just the opposite here. You

6 see atrophy of the cortex and preservation --

7 preservation of the brain stem.

8 In a locked-in syndrome you would see

9 just the opposite, you would see massive damage

10 of the brain stem and preservation of the cortex.

11 The cortex will have to be preserved from the

12 locked-in syndrome because they're nearing normal

13 or near normal consciousness.

14 Q. What is bromocriptine?

15 A. Bromocriptine is a medicine that's a

16 neurostimulant that's been used in a wide variety

17 of circumstances. It could be used in

18 Parkinson's and some other diseases. And it's

19 basically a neurostimulant that's been used

20 without -- my understanding without major success

21 in the field of patients with brain damage.

22 Q. Why wouldn't you use it regarding --

23 why wouldn't you use it for a permanent

24 vegetative patient?

25 A. I might have never used it for a