Dr Robert Geffner – Testimony on Gunshot Wound

Dr. Robert Geffner, Defence Sur-Rebuttal Witness Day 54 Part 3 12 minutes 45 seconds in.

Foundation Questions

Willmott: We talked a little bit earlier about you having a diplomate in neuropsychology, is that right?

Geffner: Yes, ma’am.

Willmott: What is neuropsychology?

Geffner: Neuropsychology is the bridge between psychology and medicine, so, in psychology it’s a science of the study of human behaviour and all the things that go into that. In medicine, neurology is the study of the nervous system, the central nervous system, and the brain from a medical standpoint. Neuropsychology bridges those two and it is basically the study of how the brain affects behaviour and how those are interacting. That’s the realm of neuropsychologists.

Willmott: And so a neuropsychologist then would specialize in what, what does a neuropsychologist do?

Geffner: They would do usually one of three things. Actually what we would call neuropsychological tests … so if somebody wanted to know whether or not they had some type of impairment in some part of their brain, a neuropsychologist … assuming we’re not talking about a fracture …. would be the one to do that. So evaluation of the different ways the brain affects behaviour and functioning would be up to a neuropsychologist. So, evaluation is one part. Treatment would be another. So if we discovered that somebody had particular parts of their brain that weren’t functioning quite right, due to an injury, a stroke, an illness or closed head injury, then the neuropsychologist and the people they work with would structure what would be called the cognitive rehabilitation. It would be the program in treating that person to help them regain functioning, either outpatient , outside the hospital in your own clinic, or in some kind of clinical setting. It would be developing the program to do that, and perhaps, actually doing it. We can’t change the brain itself, but what neuropsychologists do is figure out how to use parts of your brain that are working right to help compensate for whatever isn’t working right. And the third would be training, education about what neuropsychology is , what we know about the brain. That would be another component of that.

Willmott: So based on that then, are neuropsychologists taught and trained specifically about what the brain functions do, what parts of the brain do what?

Geffner: Yes, and how to evaluate the different parts of the brain to look for impairment in the different areas of the brain, and how that would impact the person him or herself. So what part of the brain might be impacted that would affect certain behaviours. That would all come under the purview of a neuropsychologist.

Willmott: Alright, can you tell me since you have a diplomate, and we discussed it earlier, tell me what kind of specialized training that you have then with neuropsychology?

Geffner: Neuropsychology is actually one of my earlier specializations. I was trained in my pre-doctorate years in dealing with learning disabilities in children, mostly, or adolescents, attention deficit disorder, etc. and had done some research on that. And then after I received my doctorate and became an assistant professor at the University of Texas at Tyler, I was the one in the department charged with developing our assessment protocols. So I ended up going to quite a few trainings, some were one week long, some two, in different parts of the country. In fact, one was here in Arizona, and the other was in Nebraska to learn the different techniques in assessment, so that I could bring it back and develop those at the University. And then ended up going to quite a few workshops on the brain, on neuropsychology, what the research was, etc. And so it was probably about the mid 1980’s after having done this for over five years that I applied for that first board certification; the first diplomate, which I believe, was awarded sometime in the mid 1980s and then I have continued that ever since, so..

Willmott: How do you continue that?

Geffner: Well two ways. One is, as I mentioned before, I set up the courses at the University in Texas to train our graduate students in how to do these assessments, how do you actually assess for brain functioning, and how do you find out how that’s impacted on the person. So one was there. The other is I had a large private practice mental health clinic that I, one of three that I had created and built that I oversaw. And we actually did the work in that clinic. We had a clinical staff of about thirteen; psychiatrists, psychologists, social workers, MFTs. So we actually had a whole part of our operation that conducted neuropsychological evaluations for the local hospitals, and clinics and others. So if somebody either had or was suspected of having a learning disability or a head injury or concussion, or a stroke or anything that impacted the brain; then often the referral would come to us. We would evaluate that person and then make recommendations about treatment, rehabilitation. And then we also had part of our clinic that actually did the outpatient rehab. So that’s started then and it’s continued so we still train people even though I am here now, in neuropsychological evaluations, how that connects to trauma, what happens in the brain, how to do those assessments, and from time to time, we are still asked to do those types of evaluations.

Willmott: Okay and have you ever…. and we talked earlier peer review and publishing. Have you ever had any publications with regard to neuropsychology?

Geffner: Yes.

Willmott: Could you tell us what those are, or do you need to look at your vitae?

Geffner: One was … some were dealing with learning disabilities, and looking at that in school children, which was early on. Another one was focused on neuropsychological assessment, and another one was on research we had actually conducted. We had actually conducted neuropsychological and what’s called quantitative EEGs. It’s a way to measure how the brain responds to different things going on in a person’s life. So we actually had a research study comparing domestic violence offenders to people who referred for head injuries to people who didn’t have either. And that was published in ’97. And then we are currently now putting together the entire data base of all the capital cases where we did neuropsychological assessments over about a fifteen year period.

Willmott: What does that involve?

Geffner: Well, it meant that we went in and actually conducted full neuropsych evals of capital offenders in eight states.

Martinez: Objection, relevance.

Stephens: Sustained.

Willmott: Judge, may we approach.

Stephens: Sustained.


Willmott: So, besides becoming a diplomate in neuropsychology a long time ago, are you currently involved in neuropsychology?

Geffner: Yes.

Willmott: Okay, and are you currently involved in studies with regard to neuropsychology?

Geffner: Yes.

Willmott: Okay, so does that keep you up to date then?

Geffner: Yes.

Willmott: Okay, and so based on that information, do you have a very good understanding of the different parts of the brain and how it works?

Geffner: I would say yes. There are probably very specific things that I probably don’t remember anymore, but in general yes, we still do the training to people on how that is connected to other things even now.

Willmott: Okay, and you are obviously familiar with the physiology of the brain, right?

Geffner: Yes, ma’am.

Willmott: And in your practice, have you specifically dealt with brain injuries?

Geffner: Yes, I have.

Willmott: Have you evaluated .. well, you have told us you have evaluated people with injuries, have you ever had an occasion to have people with frontal lobe injuries?

Geffner: Yes.

Willmott: And have you treated people with frontal lobe injuries?

Geffner: Yes.

Willmott: And specifically, do you recall about how many?

Geffner: Well, frontal lobe injuries, in the broad perspective, there would be quite a few because often closed head injuries or concussions cause damage to the frontal areas of the brain. So, we have worked with that quite often. The different types, we’ve had occasional times where, I couldn’t tell you how many, but where somebody had a stroke or a hemorrhage or something that also affect frontal lobe, temporal lobe, other areas of the brain. And we had a few cases that are called projectile, where something penetrated the brain, and a few others, where the skull penetrated the brain. So, over time, we have had quite a few different types of cases.

Willmott: Okay. Let’s talk about the projectile penetrating the brain, not the skull itself, but a projectile. Have you had specific cases that you have worked on with regard to that?

Geffner: Yes, Ma’am.

Willmott: And about … when we are talking about projectiles, and not being knocked out by a skull fracture, so we are talking about specifically projectiles, do you remember the projectiles that you worked with?

Geffner: There were two that I can recall.

Willmott: Okay.

Geffner: One was … or two cases were bullets, and one was a nail from a nail gun.

Willmott: From a nail gun, okay. And in these three particular cases, are we talking specifically about the frontal lobe?

Geffner: Yes.

Willmott: Okay, I am showing what’s been already in evidence as exhibit 529. From this picture can you tell us where the frontal lobe is?

Geffner: Yes, from this one it would be, let me just look for a second … I can’t tell if we are looking at the front or the side view. Yes, it would be on the left side of the picture, so it would be over this area. The frontal lobe would be this area in here… would be the frontal lobe of this person’s brain. I can’t tell if it is right or left side, but that would be the frontal lobe.

Willmott: Okay, alright and when we are talking about frontal lobe, does it matter whether it is right or left side?

Geffner: Yes.

Willmott: Okay. How does it matter?

Geffner: Well, if it is the right side of the brain, especially if you are talking about, say motor skills, or sensory skills which would occur more in this area, ah, the right side of the brain controls the left side of the body. So, the left side of the brain controls the right side of the body. So that’s why if you hear of somebody, who, for example, had a stroke in the left side of the brain in the parietal or motor area, then they may become paralyzed; their right arm or their right leg or both. Or if it is on the left side, similar. Or if they have had a stroke, say, right in this area, which is sort of on the lower side of the frontal, approaching the temporal region, you can see this particular diagram talks about the Broca’s area. The Broca’s area there is speech. So, if somebody who has damage to that area of the brain, on the left side, would mean they might have significant difficulty in speech. It could be anywhere from not being able to talk, to saying the wrong things, or not being able to literally form the words. If it was below that on the left side, it could mean that they could speak but they may not understand language or words. If it is on the right side, it wouldn’t affect speech. It would affect some other function. So each part of the brain affects different things we do, from the way we perceive, hear, see, touch, motor skills, thinking, reasoning, everything we do comes from basically the brain except for breathing or what we call autonomic things, breathing, sleeping, things like that, are controlled more with other parts of the brain.

Willmott: Okay, and so we’re clear, what you’re telling us then, is that on the left side of the brain is where we talk about speech, is what controls speech?

Geffner: Well, the left side of the brain in a particular area correct.

Willmott: Right, and so that particular area, can you … this picture isn’t particularly good to show us, but generally speaking, where, if you’re looking at your own head, where on the left hand side of the brain are we talking about speech?

Geffner: Well, I will do both. In this particular diagram, it would be right in here.

Willmott: Okay.

Geffner: And what that does on the actual brain, would be sort of inside the brain, sort of behind the eye, about in that area, but inside, so this is inside the brain. It’s not on the outside of that area… it’s inside. Depending on the size of head, skull, and brain … it would be at least a few inches inside.

Willmott: Okay, so inside the brain on the left hand side?

Geffner: Yes.

Willmott: Okay, and that’s where speech is?

Geffner: That’s correct.

Willmott: Okay. And what about ….

Geffner: Well, I need to clarify a little bit.

Willmott: Sure.

Geffner: I mean, that’s generally where speech is, but theoretically, certain damage to the motor skills could mean that you might be able to speak but you can’t actually control, say the muscles or the motor parts of speaking. But you would know how to do it, but you couldn’t do it. This actually means that you can’t speak, not because there’s a problem with your motor skills. It’s really more of a problem with the way the brain is.

Willmott: Okay, so motor skills. Let’s talk about motor skills. Where do we get those from in the brain?

Geffner: In this particular drawing, it would be in this region in here, it is called the frontal parietal lobe. It has particular names, because toward the frontal side here is the motor skills, behind it is more the sensory. So everybody listening to me now, that would be here this… perceiving what I am saying is more in the sensory region. Me actually talking, and moving, would come more from the motor skills. So, and then again, the right and left side. But that’s sort of when you’re looking at the brain, sort of in the centre of the brain, inside is probably the best way I can describe it. So you can see if this is the front of the skull, if this is the front of the head, you talking about pretty well up and in.

Willmott: So up and inside the brain?

Geffner: Correct.

Willmott: Anything to do with the frontal lobe?

Geffner: Pardon?

Willmott: Does it have anything to do with the frontal lobe?

Geffner: Well, all the brain is interconnected, so it’s not like everything works in isolation. So yes, the frontal lobe is involved, but it’s not really… the frontal lobe doesn’t focus on motor skills. But let’s say, you want to do a very complex motor skill, like a sport event or something that required skills. That would likely involve both the frontal lobes and the sensory motor cortex. So the motor skills part would come out of the motor cortex, but being able to plan and develop those skills would come out of the frontal lobe as well. So they work together. The brain is a very impressive, unique thing in the way everything does interconnect. There are millions of neural pathways that go all the way through the brain and connect all sorts of different things, which is why the neuropsychologist tries to figure out what’s going on … where in the brain it is, and then what can we do.

Willmott: Okay. Is there anything .. When we look inside a skull, okay, and you’re looking at a brain. Is there anything in between the skull and the brain?

Geffner: Yes.

Willmott: What’s in between?

Geffner: There are membranes, three actually. One is called the dura mater, which is on the outside here. So the skull would essentially be all around here on the outside, and then in between that and the brain itself are membranes. The dura mater is one of the ones that is inside there, and it surrounds the brain. So in some respects, it protects the brain, because, essentially the brain is not rigidly in your head. It sort of floats and does other things, so these all sort of protect it.

Willmott: So one of the membranes is the dura mater, you said?

Geffner: Yes.

Willmott: And is that something that completely surrounds the brain?

Geffner: Yes.

Willmott: And in particular, is it something that is surrounding the frontal lobe of the brain?

Geffner: Yes, so in this drawing here, I mean, it would go all around here.

Willmott: Okay, and as a part of this case, did you have a chance to review the medical examiner’s report?

Geffner: Yes, ma’am.

Willmott: And that was Dr. Horn?

Geffner: I believe so.

Willmott: Okay, and in reviewing his report, he talks about Mr. Alexander’s brain that he is examining, right?

Geffner: Yes.

Willmott: Alright, and so when you’re talking about peoples’ brains, I want to go back to the people that you have specifically worked with, your two gunshot wounds and the nail gun.

Geffner: Yes.

Willmott: Okay. The two gunshot wounds, can we talk about … do you remember where those gunshots went into those particular patients?

Geffner: More or less. I don’t think I can tell you exact, but I can tell you more or less.

Willmott: Well, which part of the brain?

Geffner: It was frontal lobe. One was from down up, a suicide attempt and the bullet went this way. The other was, I believe, an accidental shooting or something and the brain went, oh, this doesn’t show, from the side through.

Willmott: Do you know which side?

Geffner: No, I couldn’t tell you if it went from left to right, or right to left, but I think it went completely through.

Willmott: Okay, so in and then out?

Geffner: Yes.

Willmott: Okay, and in both of those cases, did you have a chance to see those patients at some point?

Geffner: Yes.

Willmott: And were you familiar with their cases, familiar with their medical history from the gunshot wound?

Geffner: Yes.

Willmott: And in those particular cases, were those people incapacitated because of a gunshot wound to their frontal lobe?

Geffner: No.

Willmott: What can you tell us about incapacitation with regard to gunshot wounds or injuries to the frontal lobe, projectile injuries?

Geffner: Well, first incapacitation, in the technical sense, is usually referred to as somebody who has an inability to move arms and legs. They may or may not be conscious, but even if they are conscious, they couldn’t do that. That’s generally what we mean by incapacitation.

Willmott: Okay, and so with these patients that you specifically worked on, with frontal lobe projectile injuries, were they incapacitated to a point that they could not move their arms and legs?

Geffner: No. In fact neither of those two actually lost consciousness.

Willmott: Okay. And, in fact, you said one of them the bullet actually went through and through, right? In and out?

Geffner: I believe both actually did, but from different angles.

Willmott: Oh, both

Geffner: but from different angles. Yeah, neither one had the fragment left in the brain.

Willmott: Okay, oh so the bullet went in and came out on both of them?

Geffner: Correct.

Willmott: And neither one of those people were incapacitated?

Geffner: That is correct.

Willmott: Then, in reviewing this medical examiner’s report, Dr. Horn’s report , I am looking, did he talk about the gunshot to the head?

Geffner: Yes.

Willmott: And did he talk about where the bullet … the wound track perforated?

Geffner: Yes.

Willmott: And was that the anterior frontal skull?

Geffner: Yes, right side.

Willmott: Near the superior orbital bone?

Geffner: Yes.

Willmott: Can you tell us what that means?

Geffner: That means that the bullet went in essentially above the eyebrow on the right side, and it actually tells you where and it shows you a picture, but it went in through the skull here. The orbital is the bone behind where your eye is, and the skull is in there. So it went in above the right eyebrow. That’s what the medical examiner’s report showed.

Willmott: Okay, and then does he talk about how it traverses the right anterior fossa?

Geffner: Yes.

Willmott: What is that?

Geffner: That’s ah, that’s the area below here, sort of the crater area that the brain frontal lobe sits in and it’s behind the nose, essentially.

Willmott: Okay, what do you mean crater area?

Geffner: Well, you can see like right here, this doesn’t go all the way down to your chin or others, so there are spaces in here and other areas of the brain that’s called for, lack of a better word, let’s call it a crater area.

Willmott: Okay, and are you aware that Dr. Horn’s own report said that there is no gross evidence of significant intracranial hemorrhage?

Geffner: Yes.

Willmott: And what does that mean to you?

Geffner: It means that there doesn’t appear to actual damage to the brain itself.

Willmott: And what about when he says or apparent cerebral injury?

Geffner: That’s again saying that there’s not apparent injury to the brain itself from the bullet.

Willmott: Okay, and does he qualify this with talking about the fact that the brain was somewhat decomposed?

Geffner: Yes, he says that as well.

Willmott: Okay, regardless of the decomposition, based on the report reading, was there any injuries noted inside the brain?

Geffner: No.

Martinez: Objection. Lack of foundation, rule 703.

Stephens: Approach.

Willmott: So, Dr. Geffner, again with regard to Dr. Horn’s report ..

Geffner: Yes

Willmott: Okay, based on his own report, does it … do we see that even Dr. Horn said there is no apparent injury to the brain?

Geffner: Yes, that’s one of the statements he made.

Willmott: Alright. When we talk about this dura mater..

Geffner: Yes.

Willmott: Okay, so this membrane that surrounds our brains, right?

Geffner: Yes, ma’am.

Willmott: Does Dr. Horn talk about the dura mater?

Geffner: Yes.

Willmott: And what does he say about the dura mater?

Geffner: He says it was intact.

Willmott: What does that mean to you?

Geffner: It means that this membrane around the brain here was not penetrated or damaged in general.

Willmott: And is there any possible way that you can see a projectile piercing the brain without piercing the dura mater?

Geffner: Not to my knowledge.

Willmott: And so is the dura mater such that it surrounds our brains that if something is going to get into our brain, it’s has to pierce through the dura mater first?

Geffner: And the other two membranes there as well.

Willmott: Okay, but Dr. Horn’s own report notes that the dura mater was intact, is that right?

Geffner: Correct.

Willmott: Assuming for a second that that’s a mistake and the dura mater was not intact and he made a mistake.

Geffner: Yes ma’am.

Willmott: If the bullet did pierce through the frontal lobe and then out into the left cheek,

Geffner: Yes.

Willmott: We know from his report, did it go through the right side?

Geffner: Right side and then downward, yes.

Willmott: Downward into the left cheek, is that right?

Geffner: Correct.

Willmott: Okay, so the right frontal lobe, what is that you would expect to see if there was damage to the brain to the right frontal lobe?

Geffner: Difficulty with spacial relations, in other words, being able to perhaps have depth perception or see how things fit together non-verbally. It doesn’t deal with verbal issues. The right frontal lobe talks about planning, reasoning, things like that, but mostly regarding nonverbal types of interactions. So, some of the movements might be uncoordinated. You might have some disorientation, things like that, are all aspects of the right frontal. You could see some issues in behaviour, depending on how long we wait, you could see personality changes, you can

Willmott: Personality changes … are we talking like down the road?

Geffner: Usually, I mean, you don’t usually get an immediate personality change. It usually takes more time, but if you did have something in there, that’s one of the things we do see, is personality changes. Those would be types of things that would come from right frontal lobe, depending again, where in the lobe it is too.

Willmott: Okay, if Dr. Horn told this jury that he believed it would be immediately incapacitating, meaning that the person would not be able to purposely lift their arm or move their leg, would you agree with that, based on what you know about the brain?

Martinez: Objection, lack of foundation.

Stephens: Approach. You may continue.

Willmott: Let me try that one again. If Dr. Horn were to tell this jury that because a bullet somehow made it past the dura without piercing it and leaving it intact, and made it through the brain and out into the left cheek, the frontal lobe. If he told this jury that that would have caused immediate incapacitation, where the person could not move, would you agree with that, based on what you know about the brain?

Geffner: Not unless it produced some type of huge explosion or something in the brain that would affect all these other areas in the motor strip. It could disorient the person; it could cause some other things; but there is substantial documentation in the research about frontal lobe injuries, some even more severe than that, that do not cause incapacitation.

Willmott: What kind of research are you referring to?

Geffner: There’s been research in both the … especially in the neuropathology area in the journals that deal with medicine and legal and neuropsych that have studies going back into the 1990’s, the effects of projectile wounds like gunshots on different parts of the brain. There have been actual journal articles on what types of things lead to incapacitation, what do not, and numerous case studies reported where somebody either shot themselves or was shot by somebody else, and then how they acted afterwards. So that has been documented going back 20 years.

Willmott: Okay, and based on that research, do you have an understanding then with the frontal lobe injury, what … if the projectile … you talked about if there was a big explosion, so what is your understanding what would qualify as a big explosion?

Martinez: Objection, lack of foundation.

Stephens: Overruled.

Geffner: A bullet, like a hollow point or something like that, that shatters or some other kind of thing that actually literally shatters and goes everywhere, or somehow blows up the brain, explodes inside the brain, something like that could cause widespread damage, but a bullet that goes through, even if it did go through say the frontal area here and out the other side, it would likely cause some things happening, but nothing in that part of the brain would incapacitate a person. That’s not the area of the brain that does that. So there is no evidence from a report that that would cause that effect, unless something else happened that we don’t know about.

Willmott: Alright, and are you aware, based on the reading of Dr. Horn’s report that he didn’t find any fragments, so there is no evidence that the bullet or anything shattered into all these pieces. Are you aware of that?

Geffner: Yes, I am.

Willmott: And, what if Dr. Horn were to talk about some kind of a shock wave that occurs. Do you know anything about that?

Geffner: No, I mean the type of shock waves that are generally dealt with in this area are something from outside like an explosion, like now coming back from Mid East you have all these people with IED explosions, that produces a huge shock wave but that causes the whole brain to be impacted and that’s how you get concussions, closed head injuries. But to incapacitate somebody, most of the time we’re talking about neurogenic shock, is to the spinal cord or in this area because that’s also movement. If you severe the spinal cord here by a bullet or anything else then a person is essentially immediately is incapacitated and/or dies. So something that went all the way through the head and severed back here, that could do it. Or you would need something to go up here, but a bullet going through one particular time, I mean, side and coming out, I am not aware of how that would impact all the way into the motor strips and other areas to quote “incapacitate”. Now it is conceivable that there is some other type of thing that happened because of this, but it wouldn’t be immediate. I mean over time if there is something else ruptured, like you know, an artery in here and then it started hemorrhaging and eventually hit all these other areas, a) you would probably see it on your medical examination report, but then that is a possibility.

Willmott: Okay, and did you see any evidence of that in reviewing his report?

Geffner: No ma’am.

Willmott: And you said something that would happen later?

Geffner: Well, yeah, you could have long-term effects if damage is there and you have further hemorrhaging or other things, but again, not likely an incapacitation.

Willmott: Okay. Is there anything that you have said today that in any way has attempted to diagnose Ms. Arias?

Geffner: No ma’am.

Willmott: Anything that you have said that has attempted to diagnose her as a battered woman?

Geffner: No ma’am.

Willmott: Anything that you have said that has attempted to diagnose her as an abused woman?

Geffner: No ma’am.

Willmott: PTSD?

Geffner: No.

Willmott: Why not?

Geffner: Because I focused on the records that I was asked. That was my role. I tried to explain those records. I have not evaluated her. I have not met her. I have not reviewed her case. I have not seen the testimony. I don’t know the interviews of her or others. I haven’t met with her myself. Those would all be necessary to do that.

Willmott: To make an actual diagnosis?

Geffner: That’s correct.


Day 54 Part 4 – 47:47

Martinez: One of the other things that you talked to us about today was this issue about the frontal lobe, right? Do you remember talking to us about that?

Geffner: Yes, sir.

Martinez: How many autopsies have you conducted, sir? If you could just give me …..I know that it may be a lot so just … just give me a ballpark figure.

Willmott: Objection, argumentative.

Stephens: Overruled.

Geffner: No, I have not. That is not my area of expertise.

Martinez: So the answer is how many?

Geffner: Zero.

Martinez: You’ve never gone inside the brain and taken it out and looked at it, have you?

Geffner: No, sir.

Martinez: Have you taken a look … do you know what the difference is between a brain that has not decomposed and one that has decomposed. Have you ever done an autopsy to look at that?

Geffner: I have never done an autopsy.

Martinez: Have you ever even been at an autopsy where there was a brain that was decomposed?

Geffner: I don’t believe so.

Martinez: And have you ever even been at an autopsy?

Geffner: No, I think it was afterwards. I don’t think I was at it when they were actually opening up the person.

Martinez: You said something and I didn’t hear what you said.

Geffner: I said I don’t think I have actually been at one where they are opening. I have been at one where it was afterward, but not when they were doing it, no, sir.

Martinez: And even though you have never been even to an autopsy, you feel confident in offering an opinion as to what was inside Travis Alexander’s brain, right?

Geffner: No, I wouldn’t word it that way. I am comfortable in talking about the different brain functions do and what kind of damage needs to occur, in order to make different statements. I’m not comfortable …. I’m relying on the medical examiner’s report to say what went on in the brain.

Martinez: So you’re saying that what is written there … you’re basically critiquing what he wrote there, right?

Geffner: No, I’m assuming that everything he wrote in his report is accurate.

Martinez: So when he says apparent in terms of the track, because the brain was the consistency of tapioca, you’re saying that you will agree with that then, right?

Geffner: Yes, sir.

Martinez: So, if apparent, or the word that you used was …. apparent brain injury, apparent means that there has to be some skill that is applied in determining that brain injury, doesn’t it?

Geffner: I would assume so.

Martinez: And especially because the brain was decomposed, correct?

Geffner: Yes, sir.


Day 54 Part 5 – 0:59:52 & continues 1:03

Willmott: And you were asked questions about the medical examiner’s report, right?

Geffner: Yes, ma’am.

Willmott: And you are relying on what the medical examiner says in his own report, right?

Geffner: Definitely.

Willmott: And, you’re not trying to say that you are a medical examiner or a medical doctor, right?

Geffner: Both of those are correct. I’m not trying to say either.

Willmott: Okay, but in your expertise with neuropsychology, do you understand how the brain works?

Geffner: Yes, ma’am.

Willmott: And do understand brain injuries?

Geffner : Yes, ma’am.

Willmott: And, in if this report, you asked were asked questions about the word apparent.

Geffner: Yes.

Willmott: Prior to seeing that though, don’t we see that Dr. Horn actually writes when he is talking about the brain that it is without gross evidence of significant intracranial hemorrhage?

Geffner: Yes.

Willmott: And then he says or apparent cerebral injury, right?

Geffner: Yes.

Willmott: Okay. Regardless of whether or not you can examine a brain because it is decomposed or anything like that, in Dr. Horn’s own report, does he say that this membrane, the dura mater is intact?

Geffner: Yes.

Willmott: Is there any possible way for the dura mater to remain intact if something pierced through it into the brain?

Geffner: Not that I am aware of.

Willmott: And so you are relying on the fact that Dr. Horn wrote a valid report, right?

Geffner: Yes, I am assuming that all the information is accurate because I would have no way of knowing otherwise.

(gunshot cont’d at 1:03:15)

Willmott: And with regard to the medical examiner, again. You are not … the trajectory of the bullet, you are relying on what is in his report, right?

Geffner: Yes, well, and knowing what he said is where the bullet ended up and where it went in, and knowing the brain.

Willmott: Okay, so based on what you know about the brain and what Dr. Horn says in his own report, can you tell us …. give us an idea where the bullet went?

Geffner: Yes.

Willmott: Okay, what is that?

Geffner: It looks like it went in on as I said, or as he said, at a downward angle in the forehead and ended up behind the cheek. Actually, he tells you how many inches from the nose and back, behind the cheek and went through the nasal cavity, is what he said, which is essentially, either bypassing the brain or maybe going in part of the frontal lobe. But again, if it is going in the frontal lobe, it should have gone through the dura mater, so … but the trajectory is going down and ending up here and going in here. So that’s really not going through major parts of the brain. I mean, I don’t want to say it that way. All parts of the brain are major and important, but if anything it’s going through part of the frontal lobe, and I am not sure exactly how it made it in, with the dura mater intact, but that’s essentially what he is saying.

Willmott: Okay, and so based on what Dr. Horn actually says in his own report is it possible that the bullet didn’t even go through the brain?

Geffner: It is possible.

Willmott: And you talked about the sinus cavity?

Geffner: Yes.

Willmott: And does that tell you, then where the bullet is going behind the eye, over the mouth ..

Geffner: And behind the nose.

Willmott: And behind the nose. And that’s not near the brain?

Geffner: Well, it’s in front of ..

Willmott: In front of the brain, okay. That, plus the fact that the dura mater was intact at the time that Dr. Horn examined …. does that also give you a conclusion or are you able to make a conclusion about the brain because of that?

Martinez: Objection,

Stephens: Sustained.

Willmott: And with regard to the brain, if it did go through a part of the brain somehow, that Dr. Horn’s report is incorrect about the dura mater, then it would be through the right frontal lobe, is that right?

Geffner: Yes.

Willmott: And based on your experience and knowledge with regard to the brain, does that cause any type of problems that would make the person immediately incapacitated?

Geffner: No.

Willmott: And is that based on just your experience with the previous patients you’ve had or ..

Geffner: No.

Willmott: Okay, what can you give us that answer based on?

Geffner: There are books written on what is called neuropathology. There are both medical, legal and neuropsychology books. There are research articles. Quite a bit actually done in Europe, that have actually traced projectors in the brain, that actually studied with cases people who have had different types of injuries to the brain from bullets and others, and what did and what did not incapacitate. They’ve actually laid out pretty clear criteria of the types of injuries you would need to incapacitate somebody.

Willmott: And based on those studies, a .25 calibre bullet going through the right frontal lobe, can you tell us anything about whether or not that would cause immediate incapacitation?

Geffner: Well, depending on if it went into the brain, it would have to…. well, no. Actually, a bullet, especially going through the frontal lobe here, in order to cause incapacitation, would have to essentially go through the motor strip that we showed on the diagram, which is back here, on the right side which would then incapacitate the left side of the body; somehow, turn and go through and cause damage to the left side which would then incapacitate the right side, and then somehow end up in the cheek. It’s almost like a u-turn. And you’d have to see usually damage too, but you would have to somehow impact the motor strip area or the brain stem to incapacitate a person, especially immediately.

Willmott: Okay, and that motor strip, is that located in the frontal lobe at all?

Geffner: No, not at all. Well, it’s frontal parietal. It’s at the back of the frontal, and in sort of the centre in the parietal area.

Willmott: Okay, but is it located anywhere near where you can tell, based on the ME’s report, where the bullet went in?

Geffner: No, it is not.

Willmott: Alright. Nothing further, judge.

Juror Questions

Day 54 Part 5 1:16

Stephens: You stated that a lack of apparent hemorrhage from the gunshot wound to the brain indicates lack of significant injury to the brain. Could it also mean that it occurred after death, therefore, no active bleeding?

Geffner: Can the oh . . I don’t .. can the hemorrhage ….can you read that last part again?

Stephens: Can it also mean it occurred after death, therefore, no active bleeding?

Geffner: I am going to have to assume that means the gunshot occurred after death.

Stephens: Yes.

Geffner: It depends on how far after, because there is still blood in the brain and in the body, so you may not get as much hemorrhaging, but even after death if something is going through tissue, then it’s leaving a path or destroying tissue or something. You just may not have lots of hemorrhaging, but there is usually some type of damage, whether it is before or after … unless it’s so far after that essentially there’s, I mean, there’s no blood left in the brain, then you wouldn’t see hemorrhaging, but you would still likely see damage.

Stephens: Is it your belief that a gunshot to the front of the head, specifically the brain, at a very short distance, would not be able to immediately drop a person?

Geffner: To the front side, it depends on the calibre. I mean, some of those studies I mentioned, they had shotguns, or large calibre guns that essentially went in and just really wiped out the brain. Those cases did incapacitate. But even with large calibre or shotguns that were at a distance, it didn’t incapacitate. So, really to incapacitate, more of those go through the side, because then they go through both the motor strips, and that’s what incapacitates. Assuming again, we haven’t hit the spinal cord, or the brain stem back here, which is a separate issue, cause that will do it. But just the brain itself, something coming in, it would have to be a pretty major damage in the brain that would spread to the motor strips to incapacitate somebody. Again, using the incapacitate meaning could not move arms or legs.

Additional Juror Questions

Day 54 Part 5 – 1:28

Stephens: Do bullets always travel in a straight line when going through a human body, or is there the possibility that a bullet can change its trajectory by deflection?

Geffner: Yes, if it hits something, it can.

Stephens: If there is a possibility of change of trajectory, can you give us with one-hundred percent certainty, what the exact path of the bullet was?

Geffner: I could not.

Followup Juror Questions

Day 54 Part 5 – 1:40:32

Willmott: And you were asked a question about bullets and the path of travel, if it hits something can it change direction because of deflection?

Geffner: Yes.

Willmott: Is this your particular speciality?

Geffner: No.

Willmott: Okay, but can tell us, with your speciality as far as your knowledge of what the centres … different centres of the brain do, if in this case, we have a bullet that is going in on the right hand side, just over the eyebrow and eventually being lodged into the left cheek, okay. And we know that the medical examiner said that it went through his sinuses, right?

Geffner: Yes.

Willmott: Based on that information, can you tell us where the bullet would have had to have travelled, maybe it’s been deflected, to make this person incapacitated?

Geffner: It would have to somehow, well, two things, one is it would have to have been deflected through both the right and the left motor strips to incapacitate them. If there is any other thing like couldn’t speak, couldn’t talk, couldn’t others, there would be other areas of the brain. Whatever you’re saying that the person could not do, then those are the areas of the brain that would need to have been impaired, damaged or injured to then cause that kind of incapacitation or reaction.

Willmott: And the motor strips are located more in the centre of the brain?

Geffner: Yes, technically it’s called frontal parietal. It’s sort of in the centre, but inside also on both sides that I was showing on that diagram that we had up.

Willmott: Okay, and if we were going to have an arrow pointing from where the bullet entered to where the bullet eventually was lodged, would that arrow in any way touch those motor sensory areas … those motor areas?

Geffner: Not to my knowledge.

Willmott: And this is all assuming that then, that Dr. Horn’s medical examination report was incorrect when he stated that the dura mater was intact, right?

Geffner: Yes.

Willmott: If we were to assume that a bullet went through the brain, we would have to also assume that Dr. Horn was incorrect and wrong when he said that the dura mater was intact?

Geffner: It would have to have gone through it to get into the brain. If you are coming from the outside and you get into the inside you got to through the stuff in the middle, which is the dura mater. So, yes, one of those two things are inconsistent.

Willmott: Alright, thank you. Nothing further.

Followup Prosecution

Day 54 Part 6 – 11:44

Martinez: One of the other things that you talked about, was that in terms of the trajectory, that you could never be one-hundred percent sure as to what the trajectory could be, right?

Geffner: Yes, sir.

Martinez: And in part, the reason that is because you are not an expert in that area, right?

Geffner: Yes, correct.

Martinez: And in fact, you have never opened up a cranium to go in … do you know that they stick rods from one end to the other, correct?

Geffner: They do a variety of things..

Martinez: Pardon

Geffner: They do a variety of things, yes.

Martinez: And are you aware that to do trajectory, they actually have rods that go in, what is perceived as the entrance wound, to where it actually, they believe, the bullet may have come to rest, right?

Geffner: Yes, I have seen that.

Martinez: But you don’t do that sort of work, right?

Geffner: No sir.

Martinez: You were also asked, well in terms of the bleeding that was associated with this particular case, you indicated that in terms of the bleeding, couldn’t it also be in your experience that the reason that there wasn’t any bleeding along the track or where the shot to the head was, was because Mr. Alexander was already dead at the time he was shot, right?

Geffner: That’s what was asked.

Martinez: And the answer is he could have, given your experience, he could have been dead at the time he was shot and that would explain the lack of blood, right?

Geffner: Yes, sir.

(gunshot cont’d 17:22)

Martinez: One of the things that you were telling us about was that you were familiar with people who get shot in the head, correct?

Geffner: Somewhat.

Martinez: And you were also telling us that with regard to these individuals, you were telling us, that unless they get shot in a very specific way, they are still able to ambulate, correct?

Geffner: In general.

Martinez: And sir, all of this information that you were giving to us involved you reading some articles, right?

Geffner: Plus the few cases I’ve had, plus the training, and the workshops that I’ve gone to.

Martinez: And workshops you attended didn’t have any cadavers, correct?

Martinez: Correct?

Geffner: That’s correct.

Martinez: So really what you have here, in terms of your knowledge of what you have here, would you agree, that in terms of experience, your experience is lesser than an individual who actually conducts the autopsies and actually sees the effects of the gunshot wounds?

Willmott: Objection foundation as to experience.

Stephens: Overruled.

Geffner: Yes, I would agree with that.

Martinez: Thank you.