Judge called for early lunch. Be back at 1:15 p.m.
Stephens: There's no way of being able to tell if this is a fresh bleed or not. There is a breakdown of blood, hemocydrin (sp?) containing macrophages, which means it's about 24-48 hour old injury.
Stephens: He only saw limited slides. There wasn't stains or samples for each slide, which was a small sample and it was incomplete.
Stephens: It has iron in the macrophages but it's not significant to being inside or outside the arachnoid tissue. There's no way to tell if it came from the dura or arachnoid of the brain. It could be a 48-72 hours old injury.
Stephens: It's impossible to know if there are two different bleeds. The evacuation of blood during surgery interferes with that. There's no way to age a bleeding as less than 24 hours. It's a sub acute dural hematoma. There could have been a re-bleeding, which is part of an original bleed.
Stephens: Just seeing red blood cells doesn't mean it's a fresh bleed. Nothing in Baumbach's report to refute that it could be within 24-48 hours.
Stephens: He doesn't agree with Baumbach's opinion of 12-24 hour window as a result of the change in a cell because of lack of oxygen. Between 12-24 is when it starts, not a window.
Maybanks on cross: You haven't done an autopsy since 2008?
Stephens: That's right.
Maybanks: You haven't done any studies on timing of brain injuries?
Maybanks: You have published any study on intervals between symptoms and injuries?
Maybanks: You didn't review any of the radiological reports?
Stephens: No, I'm not a radiologist.
Maybanks: You're saying the injury happened 2 or 3 days before Kamryn came to hospital?
Stephens: Yes. Based on iron in the macrophages.
Maybanks: When you looked at sample, you saw a more recent event? You said within 2-3 or 5 hours?
Stephens: Yes. There is evidence of blood that could be recent.
Maybanks: That's what Baumbach testified to that there could have been an older bleed and recent one?
Stephens: Potentially. He can't tell difference in red blood cells. There's no way to be certain. Can't say it's not more recent or that there can't be two events. The recent one could have been from "surgical intervention."
Stephens: In deposition, he said there is mixture of two events. He should have said there "could be."
Stephens: He can't say recent bleed caused Kamryn's collapse.
Maybanks: In deposition, he said recent bleed caused her collapse?
Stephens: Yes, it's a possibility. It may be more likely than not. The re-bleeding could have been from a slow bleed.
Maybanks: In order to consider possibility of re-bleed, wouldn't sub dural injury be chronic?
Stephens: If it's an acute sub dural hematoma , the body can heal it and then it re-bleeds. Then it goes into chronic phase.
Maybanks: Isn't there more a tendency for re-bleed to occur in elderly?
Maybanks: Isn't re-bleeding rare in sub dural hematoma?
Stephens: Doesn't think he can say that.
Maybanks: In order for re-bleeding, wouldn't blood have to come from blood vessels?
Stephens: Yes, from blood vessels or small capillary of blood vessels.
Maybanks: No doctor has been able to say there is blood vessels for a re-bleed?
Maybanks: You're saying there's a re-bleed but there's no evidence of how it happened?
Stephens: That's correct.
Johnston: The red blood cells in the clot are consistent with 0 to what?
Stephens: 2 to 5 days old injury. He would go with 2 to 3 days. There's no way to determine if there is one episode or two or more.