by Kenneth Eade
“Yes, sir.”
“To do this, you have to pass this area, the upper esophageal sphincter, is that correct?”
“Yes, sir.”
“Is that what gives the un-anaesthetized patient the choking sensation?”
“Yes, sir.”
“It is the sphincter that keeps food from entering the trachea, or breathing tube, is that correct?”
“Yes, sir.”
“Nurse Benson, do you know what aspiration is?”
Benson was building up a sweat, as if he was running a marathon. It was running from his hairline down his forehead and cheeks.
“Yes, sir.”
“Have you ever seen a patient aspirate fluid during an enteral feeding procedure?”
“Yes, sir.”
“Aspiration is a common complication during enteral feeding, is it not?”
“Yes, sir, it is.”
“Do you have any monitoring devices in place for enteral feedings at Guantanamo Bay that show whether the feeding tube is properly positioned?”
Benson pulled at his collar, as if it was choking him. “No, sir.”
“Nurse Benson, how many times had you performed the enteral feeding procedure on Mr. Khury?”
“About ten times.”
“And at every feeding, Corporal Reeding was present, isn’t that correct?”
“Yes, sir.”
“And Mr. Khury gagged every time the tube was inserted, isn’t that correct?”
“Yes, sir.” A drop of sweat hit Benson’s eye. He blinked from the sting of it and wiped his brow.
“Isn’t it also correct that you and Corporal Reeding had already seen Mr. Khury cough up his feeding tube before the last feeding?”
“Yes, sir.”
“More than once?”
“Yes, sir.”
“Nurse Benson, during the last feeding, when Corporal Reeding yelled at you to stop the procedure, did you worry that the feeding tube may have been malpositioned?”
“Yes, sir.”
“And did you stop the procedure?”
“Yes, sir.”
“And you removed the feeding tube?”
“Yes, sir.”
“At that point, Mr. Khury was unconscious, wasn’t he, Nurse Benson?”
Benson hesitated, and took a measured breath. “He didn’t appear to be feeling well.”
“Move to strike as non-responsive, Your Honor.”
“Granted.”
“He was unconscious, wasn’t he?”
“N-no, sir,” Benson stammered.
“When Sergeant Brown came in and cleared the room, you didn’t see him at first, did you Nurse Benson?”
“No, sir, I was occupied with Mr. Khury.”
“Trying to save his life, is that correct?”
“No, no, sir. He was alive,” Benson stammered.
“You didn’t give him CPR?”
“No, sir.”
“You and Sergeant Brown took Mr. Khury by gurney back to his cell, is that correct?”
“Yes, sir.”
“We have to move quickly, Benson!” said Brown, as they entered Ahmed’s cell and closed the door.
“Take off his jumpsuit?”
“Why?”
“Because it’s a special one, Benson. God damn it, don’t you squids learn how to obey orders? Just do it, man!”
Brown ran out, slamming the door behind him. He returned in a couple of minutes with another jump suit. Tying the leg into a noose, he slipped it around Ahmed’s limp neck and pulled tight.
“Okay Benson, climb up on the sink. You have to tie the other end to the ceiling.”
Benson got up on the steel sink/toilet combination and tied the end of the sleeve of the jumpsuit to the wire mesh ceiling as Brown held up the body. Vomit dripped out of Ahmed’s mouth and onto his chest.
“Don’t fuck it up! Is it done?”
“I’m trying,” said Benson.
“Pull hard on it. We want to make sure it doesn’t break.”
Benson pulled hard on the sleeve. “It’s in.”
Brown gently let go of the body, which swung back and forth slightly like a pendulum, Ahmed’s lifeless feet dangling about six inches above the ground.
“This never happened, Benson.”
CHAPTER FORTY-THREE
Timothy Nagel’s task of rehabilitating Nurse Benson was a tough one. He couldn’t make Benson to appear any less nervous, but he could emphasize the weak points in Brent’s case. After all, Brent had not established that there was anything wrong with Ahmed, other than he “didn’t feel well during the feeding,” which would be what the jury would expect after seeing the videotape. There were no facts elicited about Ahmed’s death, or the cover up, as Brent had expected there would be, at least from Reeding.
“Nurse Benson, on the last enteral feeding of Mr. Khury, you followed the enteral feeding procedures to the letter, isn’t that correct?”
“Yes, sir.”
“And you had followed the same procedures with every feeding of every detainee, is that correct?”
“Yes, sir.”
“It happened many times, didn’t it, that a detainee would complain about discomfort?”
“Objection, irrelevant,” Brent interjected.
“Overruled. You may answer.”
“Yes, almost every time.”
“And it also happened that detainees coughed up their feeding tubes from time to time?”
“Objection, relevance.”
“Overruled.”
“Yes, sir.”
“So, was there anything unusual about this feeding with Mr. Khury, other than Corporal Reeding’s overreaction?”
“Objection, lack of foundation, assumes facts not in evidence, argumentative.”
“Sustained. The jury will disregard the question. Counsel, please rephrase.”
“What was unusual, if anything, during the last feeding of Mr. Khury?”
“The way that Corporal Reeding reacted to Mr. Khury coughing up his feeding tube.”
“Other than that, the feeding procedure was normal?”
“Yes, sir.”
“It was also not unusual to take Mr. Khury back to his cell by gurney, was it?”
“No, sir.”
“Why not?”
“When detainees experience discomfort, we always take them back to their cells by gurney.”
“Thank you, Nurse Benson, I have no further questions.”
CHAPTER FORTY-FOUR
Dr. Orozco waddled up to the stand, wiggled into the witness chair, faced the jury, and smiled. Despite his obesity, he had a pleasant manner about him and he made good eye contact with the members of the jury.
“Dr. Orozco, you are a medical examiner, is that correct?”
“Yes.”
“Can you please summarize for the jury, your background, education and experience?”
“Certainly. I have over 30 years’ experience as a pathologist and medical examiner. I hold an MD, a PhD, and a medical license in the state of California, where I am board certified in clinical, anatomic and forensic pathology. I also have a JD from Southwestern University School of Law and am a licensed attorney in California and New York. I am a Diplomate of the American Board of Pathology. I worked as a Chief Medical Examiner for the County of Los Angeles for ten years and another 10 years for the Federal Bureau of Investigation. I have testified as an expert witness in hundreds of trials.”
“Could you just give us a brief description of what forensic pathology is?”
“I can. Pathology, the larger field, is one of the medical specialties, and it has basically two subcategories; anatomic pathology and clinical pathology. Anatomic pathology deals with the study of disease, that's really what the word means, from actual anatomic inspection. So it involves areas such as performing autopsies, looking at surgical specimens under a microscope, those sorts of things where there is an actual naked eye or microscopic examination for the most part.
“Clinic
al pathology is the laboratory area, and clinical pathologists usually head a hospital laboratory and serve as consultant to hospital physicians in ordering and interpretation of tests. Forensic pathology is a special area in pathology. The word “forensic” comes from the Latin word “forum”, which was the Roman courtroom. The term is applied because forensic pathologists are often involved in clarifying medical or scientific questions that come up in the courtroom. Most forensic pathologists work in a coroner's office or medical examiner's office and investigate sudden or unexpected deaths.”
“How many autopsies have you done in your career, doctor?”
“Too many to count. I would say many hundreds, maybe in the thousands.”
To eliminate questions of bias, Brent asked Dr. Orozco to point out that he, like any medical expert, worked for money, what his hourly rate was, and the fact that he had worked on both criminal and civil cases, for both the plaintiff and the defendant.
“Dr. Orozco, please tell the jury what materials and reports you viewed in preparation for today’s testimony.”
“I reviewed the autopsy report of the Naval Criminal Investigation Service, the medical records of the decedent, Ahmed Khury, from his regular medical doctor, the medical records of the decedent from the Guantanamo Bay Detention Camp, my own report, which was based on my own autopsy of the decedent, and, of course, I listened to the testimony of all the witnesses up to this point.”
Dr. Orozco was very comfortable with a jury. He had done this many times, and knew how to put the story to them in layman’s terms. Brent identified all of the exhibits that Dr. Orozco had mentioned.
“Dr. Orozco, as a result of your review, and your examination of the body, do you have an opinion within a reasonable degree of medical certainty what caused Ahmed’s death?
“Yes, I do.”
“Would you please tell the jury your opinion?”
“As a result of my autopsy, which concurred with the NCIS autopsy report, there were traces of olive oil in his nostrils and lungs. The use of olive oil in enteral feeding is, in my opinion, gross negligent medical care in reckless disregard of standard medical practices.”
“Why, Doctor?”
“Since olive oil is not water soluble, once this fatty type oil gets into the lungs, it can cause a serious disease called lipoid pneumonia. I ran a check on his pulmonary tissues and confirmed that he had this pathology.”
“Was that the cause of Ahmed’s death?”
“No. His lungs were weakened by the lipoid pneumonia, which made him more susceptible to further injury, but, in this case, the cause of Mr. Khury’s death was aspiration of the liquid nutrients. This is supported by the findings of the nutrients in his lungs. He simply drowned due to an improper insertion of the feeding tube.”
Brent put up some graphic photographs from Orozco’s autopsy, and the doctor used them to illustrate his testimony further, using a pointer.
I also examined Mr. Khury’s neck and head to eliminate asphyxiation by hanging as a cause of death. I found lack of ligature marks consistent with death by hanging. In other words, I found no abrasions or hemorrhages in the skin and indeed no hemorrhages in the eyes that one would expect to occur if he had been alive when he was hanged.”
“Are you saying that Mr. Khury was hanged after he was already dead?”
“That’s how it appears from the forensic evidence. When I do an autopsy, the body “talks” to me. It leaves physical signs, which communicate the cause of death. In this case, I examined the tissue around the ligature, and there was no traces of any reaction to the hanging that you would expect from a live subject.”
“Doctor, do you have an opinion within a reasonable medical certainty what injuries Mr. Khury suffered as a result of his aspirating the liquid nutrients?”
“Yes. As I stated, Mr. Khury literally drowned from the presence of fluid in his lungs. This drowning occurred slowly, as he was able to speak and even cough while it was in process. Aside from the obvious pain that this procedure – done without anesthesia – caused before he aspirated the fluid, after the fluid had been completely assumed by the lungs, I would say that he suffered great pain for approximately 8 minutes before losing consciousness.”
“Do you have an opinion within a reasonable degree of medical certainty as to whether the pain and suffering endured by Mr. Khury was a result of his aspirating the liquid nutrients?”
“Mr. Khury’s pain and suffering was, in fact, from the enteral feeding procedure and aspirating the liquid nutrients.”
“As a result of your examination and all of the evidence you observed doctor, do you have an opinion as to the standard of care exercised in this enteral feeding procedure?”
“Yes. It is my opinion that Mr. Khury’s death was caused by gross negligent medical care in reckless disregard of standard medical practices by an improper insertion of the enteral feeding tube, and the failure to make adjustments to the position of the tube after he complained, which adjustments would have most certainly saved his life.”
“No further questions, Your Honor.”
“Cross?”
“Thank you, Your Honor,” said Nagel.
“Dr. Orozco, you testified that the autopsy you performed on Mr. Khury was a second autopsy, correct?”
“Yes.”
“And when you examined the body, the internal organs had already been dissected and examined, correct?”
“Yes, but there were tissue samples preserved in paraffin blocks.”
“Nevertheless, there were limitations on the second autopsy, isn’t that true?”
“Yes, but often a second autopsy looks at things that the pathologist in the first did not and it, along with the findings of the first autopsy, presents a more complete picture of the cause of death.”
“Move to strike after “Yes,” Your Honor.”
“Granted. The jury will disregard everything after ‘yes’.”
“The stomach had been removed and dissected already, isn’t that correct?”
“Yes.”
“And the intestines were dissected already, correct?”
“That is correct.”
“And the lungs had been dissected and examined already?”
“Yes.”
“And body fluids that you would have liked to examine were already examined and removed, isn’t that correct?”
“That is correct.”
“So, Doctor, wouldn’t you have been able to make a better evaluation of the cause of death if you had been the pathologist who performed the first autopsy?”
“Objection,” interrupted Brent. “Calls for speculation.”
“Overruled.”
“I suppose so.”
“Thank you, Doctor. No further questions, Your Honor.”
“Nagel, pleased with himself, took his seat at the counsel table, his lips curling into a smile that Brent wanted to slap right off his face.
“Redirect?”
“Thank you, Your Honor.” Brent stood up.
“Doctor Orozco, your opinion is not based solely on your autopsy, is it?”
“No, it is not.”
“What else is it based on?”
“I based my opinion on the observations during the autopsy I performed, and the report of the autopsy performed by the NCIS pathologist.”
“But you disagree with their conclusion?”
“Yes.”
“Why?”
“Because of the traces of enteral feeding liquid in the lungs in the NCIS report as well as my examination, as well as the lack of physical evidence of death by asphyxiation.”
“And this evidence was apparent from your examination of the body?”
“Absolutely.”
CHAPTER FORTY-FIVE
Brent found Rick sitting at a corner table at Sonny’s, in front of a heaping pile of some kind of Chinese style appetizer. When he walked in, Rick held up a mug of beer in a toasting motion and smiled. Brent was not in a smiling mood.
“
So what did you find out?” Brent asked.
“It’s good to see you too, buddy.”
“Come on!”
“I’ve got a surprise for you.”
“Tell me about Reeding first.”
“Okay, but my surprise is better. It seems that after our meeting with Reeding in Miami he went out and got drunk, and, well, some other things, and as he was staggering out of the strip club-slash-whorehouse, he was paid a visit by some masked men.”
“Like me.”
“Yes, amazingly similar. Anyway, they beat the living crap out of him. Put him in the hospital.”
“Let me guess, he didn’t press charges?”
“You got that right.”
“You have to find those guys, Rick.”
“And make gold from mercury: Okay boss, no problem.”
“Seriously, we need them and we need them now.”
“Okay, I’m on it. Can I finish my Chinese ‘whatever-the-fuck-this-is’ first?”
“Of course. Now, what’s the surprise?”
“Ah, I see curiosity has finally conquered the ‘too serious’ beast.”
“Are you going to tell me?”
“First you have to guess what number I’m thinking of.”
“Fuck, man, do you ever take anything seriously?”
“Not during happy hour I don’t.”
“Okay, give it up.”
“What number?”
“What? Five.”
Rick smirked like a gambler who had just won a bet.
“It’s not five.”
“Oh, it’s five,” Brent said, brandishing his fist. “Because if you don’t tell me now I’m gonna plant these five knuckles right between your eyes.”
“You’re really no fun today. Alright, are you ready for this?”
Brent regarded Rick with childish impatience, like he had just swallowed a bug. Rick grinned through it.
“The good Colonel Masters had a very interesting tour of duty before his assignment to Gitmo. Remember the Abu Ghraib scandal?”
“Yeah. With the pictures of naked prisoners being tortured by soldiers.”