True Intent
Page 20
“Got it. Luck.”
“Thanks.” I hung up. By the time I returned a couple of minutes later, Victoria was gone and Bre and Andrew Phillips were sitting in the hallway on a bench. Bre glared at me as I passed.
I smiled, went back into the courtroom, and planned on keeping Dr. Gerchuk on the stand for the rest of the afternoon.
33
“Mr. Shepherd, you may cross-examine the witness.”
“Thank you, Your Honor.” As I walked to the lectern with my trial book, Ray Gerchuk smiled. The coroner could be counted on to be cheerfully neutral so the key thing was to know where his opinions supported my case.
“Dr. Gerchuk, let's start with where you left off. You mentioned that a biologist might know about the interaction of St. John's wort with a beta blocker?”
“I did.”
“You don't have any evidence that Liselle Vila knew about that interaction, do you?”
“I do not.”
“So the jury is clear, you were speaking hypothetically, weren't you?”
“I was answering a general question, yes.”
“Right, generally, you wouldn't be surprised if a biologist knew about this St. John’s wort interaction, true?”
“True.”
“But you have no evidence, absolutely none, that Liselle Vila knew about this interaction, do you?”
“I do not.”
New topic.
“Dr. Gerchuk, Ms. Lance said that the chemical process that causes the interaction between St. John's wort and beta blocker blockers was complex, do you remember that?”
“I do.”
“I'd like to get into that a little bit.”
Dr. Gerchuck smiled. “Excellent.”
“Medications like beta blockers are metabolized by the liver, aren’t they?”
“They are.”
“And by metabolized we mean eliminated from the body, correct?”
“That's correct.”
“The liver does this with certain enzymes it creates, right?”
“That's right.”
“Some of those enzymes are out of the cytochrome P450 family, am I correct?”
Dr. Gerchuk’s smile broadened. “You are.”
“You and I are going to be rattling off some number and letter combinations. I'm going to have Danny put them up on the screen, is that okay?”
“That would be most helpful.”
Danny put two lines up on the screen:
CYP2D6-primary eliminator
CYP3A4-secondary eliminator
“Lopressor is primarily metabolized by the enzyme CYP2D6, isn’t it?”
“It is.”
“That means CYP2D6 is the enzyme produced by the liver that does most of the work eliminating Lopressor from the body, right?”
“That's right.”
“Now St. John's wort increases production of a different enzyme, right?”
“Yes.”
“The enzyme stimulated by St. John's wort is CYP3A4, true?”
Dr. Gerchuk nodded. “That's true.”
“And CYP3A4 is not the primary enzyme that eliminates Lopressor from the body, is it?”
“It is not.”
“Just because both enzymes start with CYP doesn't mean that they do the same thing, does it?”
“That's right. They're in the same family but they don't do exactly the same thing.”
“Danny,” I said. A new slide came up:
CYP2D6-primary-no effect
CYP3A4-secondary-stimulated
I pointed to the screen. “So the jury understands, Dr. Gerchuck, St. John's wort does not have any effect on the main enzyme that metabolizes Lopressor, right?”
“That's correct.”
“None whatsoever.”
“That’s right.”
“Instead, it stimulates one of the many enzymes that play a secondary role in that metabolization, true?”
“True.”
New topic.
“Dr. Gerchuk, I want to talk to you little bit about some of the health conditions that Mr. Phillips had.”
“Okay.”
“You mentioned that Mr. Phillips had a history of high blood pressure, correct?”
“He did.”
“Men with high blood pressure have an increased risk of cardiac death, don’t they?”
“There is certainly a statistical correlation, yes.”
“Liselle Vila did not give Mr. Phillips high blood pressure, did she?”
“She did not.”
“Mr. Phillips had a history of a heart arrhythmia as well, didn't he?”
“He did.”
“Men with a heart arrhythmia are at increased risk for cardiac death, aren't they?”
“They are.”
“I want you to assume Ms. Vila met Mr. Phillips six weeks before he died.”
“Okay.”
“If that’s true, Mr. Phillips had high blood pressure and a heart arrhythmia years before he met Ms. Vila, right?”
“That’s right.”
“Mr. Phillips was fifty-nine years old when he died, correct?”
“He was.”
“That is an age bracket that puts Mr. Phillips at an increased risk for sudden cardiac death, doesn't it?”
“It does.”
“And of course, Mr. Phillips’ age was not caused by Liselle Vila, was it?”
“Of course not.”
“The fact is, men in their fifties die of sudden cardiac death every day in this country, don't they?”
“They do.”
“Just because a man in his fifties dies of sudden cardiac death doesn't mean, by itself, that he was murdered, does it?”
“It does not.”
“We are all at an increased risk of death as we age, aren’t we?”
“We are.”
“That is the natural way things work, right?”
“It is.”
“In fact, your original autopsy stated that Mr. Phillips died of natural causes, didn’t it?”
“It did.”
“The autopsy was later amended though, wasn’t it?”
“It was.”
“Why?”
“Objection, Your Honor.” Victoria was standing.
“Basis?” said Judge French.
I saw Victoria make the same calculation that I was making and come to the same conclusion. “Withdrawn, Your Honor,” she said and sat down.
“Was your autopsy later amended, Dr. Gerchuk?” I asked.
“It was.”
“It was amended because the prosecutor's office came to you and asked you to assume that St. John's wort had been given to Mr. Phillips, right?”
“That’s right. I then verified the presence of St. John’s wort.”
“And even on your amended amended autopsy, you still stated that Mr. Phillips had a fatal heart arrhythmia, correct?”
“That's correct.”
“You just removed the line stating it was from natural causes, right?”
“That's true.”
“You did not however put anything in your report to say that the death was deliberately caused, did you?”
“That's true, I did not.”
“And that’s because you did not find any evidence in your personal examination of Mr. Phillips that his death was caused deliberately, did you?”
“That's also true.”
“Now Dr. Gerchuk, you testified a minute ago that men in their fifties die of sudden cardiac death every day in this country, do you remember that?”
“I do. And I'm suddenly feeling less optimistic about going home today.”
The jury chuckled.
I did too. “Dr. Gerchuk, St. John's wort is an herbal supplement, right?”
“It is.”
“It’s sold as a pill in grocery stores, drugstores, and health stores all across the country, right?”
“It is.”
“Millions of units of that herb are sold in this country every year, true?”
“It is not poison, is it?”
“It is not.”
“People take it for their health, don’t they?”
Dr. Gerchuk thought. “I believe that people think that it helps.”
“People typically take it for anxiety or to help themselves sleep, is that true?”
“It is.”
“For that reason, it's also a common ingredient in herbal teas, isn’t it?”
“It is.”
“St. John's wort is a yellow flower, right?”
“It is.”
“It's found naturally in the wild?”
“Yes.”
“People have been drinking tea with it for hundreds of years, haven't they?”
“I imagine so.”
“Dr. Gerchuk, you don't treat patients anymore, do you?”
“I do not.”
“You're familiar with the basics of treating patients in the medical community though, right?”
“I am.”
“Doctors tell patients about medication interactions all the time, don't they?”
“They do.”
“And it is ultimately the patient's responsibility to abide by those recommendations, isn’t it?”
“It is.”
“It's ultimately the patient's responsibility to control what goes into his body, isn’t it?”
“It is. So long as they know what they're ingesting.”
New topic.
“Dr. Gerchuk, you did a toxicology test on Mr. Phillips’ body, didn't you?
“I did.”
“You took a blood alcohol level, right?”
“I did.”
“You found that Mr. Phillips had a blood alcohol level of .18 when he died, didn't you?”
“I did.”
“That’s more than twice the legal limit for driving in this state, isn’t it?”
“It is. Although it’s my understanding that Mr. Phillips was not driving.”
“One last question, Dr. Gerchuk. You aren’t actually surprised that a fifty-nine-year-old man with a history of high blood pressure and a history of a heart arrhythmia who drank enough alcohol to have a level of .18 and who was exerting himself suffered from a cardiac event, are you?”
Dr. Gerchuk paused. Then he said, “I'm not.”
“That's all I have, Doctor. Thank you.”
“Ms. Lance?” said the Judge.
Victoria was already on her feet. “Dr. Gerchuk, Mr. Shepherd talked to you about the enzymes that are stimulated by St. John's wort. Do you remember that?”
“I do.”
“That was a very interesting scientific discussion but I'm going to ask you a simple question—do doctors recommend that patients refrain from taking St. John's wort when they are also taking a beta blocker?”
“They do.”
“And is that because it can be dangerous?”
“It is.”
“And do doctors recommend that patients avoid certain foods when they’re using St. John's wort?”
“They do.”
“And is that because it can be dangerous?”
“It is.”
“There's no question about that in the medical community, is there?”
“There is not.”
“It is dangerous to take St. John's wort with beta blockers.”
“That's right.”
“And if the person taking it doesn't know that he’s taking St. John’s wort, then he can't avoid taking it, right?”
Dr. Gerchuk cocked his head. “Can you say that again?”
Victoria smiled. “That was a bad question. Let’s try again. A person can only avoid taking St. John's wort if he knows that St. John's wort is in the thing he’s about to take, right?”
“That's right.”
“So if you give someone something with St. John's wort in it, like say tea, and don't tell the person that it has St. John’s wort in it, that can be dangerous, can't it?
“It can.”
“And if a patient is being cautious and vigilant about his health, he always read the label on the packaging and find out for himself what he’s taking, can’t he?”
“That’s the wisest course, yes.”
“Or in the case of tea, what he’s drinking?”
“Yes.”
Victoria went straight over to the evidence table and picked up a plain white box that I knew was filled with plain white tea bags.
Fuck.
She brought the box over to Dr. Gerchuck. “Dr. Gerchuck, what’s in this box?”
Dr. Gerchuck opened up the box and pulled out a teabag. “It looks like some teabags.”
“Will you please read the ingredients listed on the box?”
Dr. Gerchuck turned the box back and forth, showing the jury an expanse of blank whiteness. “There aren’t any.”
“Fine. Will you instead read the ingredients listed on the teabags themselves?”
He spun the bag like a rearview mirror ornament. “There aren’t any.”
“I see. So assuming this tea was homemade, how would someone find out the ingredients in it?”
Dr. Gerchuck shrugged. “I guess you’d have to ask the person who made it.”
“I guess you would.” Victoria took the box back and stood there with it, holding it in front of the jury. “Thank you, Dr. Gerchuck.”
Better hit this head on.
I stood. “Dr. Gerchuck, I want you to assume that the evidence is going to show that Ms. Vila made that tea you just examined, okay?”
“Sure.”
“You don’t know if Mr. Phillips asked Ms. Vila what was in the tea, do you?”
“I do not.”
“And you don’t know if he didn’t ask what was in it, right?”
“I do not.”
“He should have though, right?”
“Yes.”
“Especially if Ms. Vila didn’t know that Mr. Phillips was taking Lopressor, right?”
“Absolutely.”
“Thanks, Doctor.”
“You may step down, Dr. Gerchuk,” said Judge French and looked at the clock. “That is all we’re going to do for today. I will see you all tomorrow at eight a.m.” Then Judge French gave the jury some closing instructions about not discussing the case and not researching things they’d heard and excused them for the night.
As we gathered our things to go back to the office, Liselle leaned into me and whispered, “I never told him exactly what was in the tea.”
“I figured,” I said. “But you told him it was herbs and that it would help him rest, right?”
She nodded.
“And he never told you that he was taking a beta blocker, right?”
She nodded again.
“Then it's not your fault. There was no way you could've known. It was up to him to ask you about ingredients that mattered.”
Liselle looked unsure.
“Really,” I said. “It's okay.”
I hoped.
We finished gathered our things and headed back to the office. On the way out, I took some unprofessional pleasure in seeing Bre Phillips in the hallway stomp her foot—literally stomp her foot—because she wasn’t going to testify that day.
34
Danny and Liselle and I stood outside the courthouse waiting for Olivia to pick Liselle up and take her home. It was the week after Memorial Day, which meant we were just making the turn into more sunny days than not and had abandoned our overcoats with impunity. At Liselle’s suggestion, we waited under the great white oak tree on the courthouse lawn and there was a light breeze that rustled the leaves above us. I could see Liselle studying the oak as she said, “How did it go today?”
“How do you think it went?” I said.
“No way, Nate,” she said. “I'm paying you to be my lawyer. That includes giving your legal opinion about how my murder trial is going.”
I smiled. “Fair enough. I think the jury is as balanced as we’re going to get. I thought the
opening statements were fine, and by fine I mean there was nothing unexpected in them. I still think the prosecutor’s case is a stretch after listening to it.”
“I didn't know about the medicine he was taking,” Liselle said.
I nodded. “That's what I'm counting on. All this business about tea and food and dancing only matters if they can prove that you knew about his conditions.”
Liselle took an oak leaf in her hand and rubbed it between her thumb and forefinger. “She made me sound like a monster.”
“That's what she has to do to get you convicted of murder. They have to make the jury believe that you’d do it.” I thought for a moment. “Both sides got things out of Gerchuck.”
Danny bobbled a file and said, “I thought it sounded like Phillips was an old man who died of natural causes.” A stricken look crossed his face. “I mean not old, old, I’m sure he was fine. I meant—” He bobbled the file again.
Liselle smiled. “I know what you meant.”
“That's what we were going for, Danny,” I said.
Danny regained his grip on the file. “Who's up tomorrow?”
“Family members mostly.”
We moved to the curb as Olivia drove up in a bronze Chevy Tahoe. I opened the door for Liselle and she climbed in. Olivia motioned and I walked around to the driver side. “Do you have something?” I said.
Olivia handed me a folder. “Your instincts were right. We have a partial explanation for why our prosecutor might be bringing a thin case.”
“What's that?”
“Two things. First, right at the end of last year, a series of donations flooded into the Lance campaign.”
“She is up for reelection this year. Anything unusual?”
“There were a series of max donations, both individual and corporate. A super pac even got into the action. All St. Louis addresses.”
“Really? Interesting.”
“Ms. Lance is now sitting on a war chest that will destroy any local challenger. Looks to me more like an amount intended to propel someone to state office.”
“Can they do that?”
“You’re the lawyer. But yes, as long as their paperwork’s accurate and the people donating are really the ones who donated.”
“No shit.”
“One of the advantages of being a billionaire is that you don't even have to use your own money a lot of the time. You make a suggestion and money flows where you tell it to go. Guess that explains why she wasn’t willing to drop the case.”