2025 1 IN THE UNITED STATES DISTRICT COURT 2 FOR THE DISTRICT OF HAWAII 3 4 SUSAN K. FORSYTH, ) Civil No. 95-00185ACK Individually and as ) 5 Personal Representative ) Pages 2,025 - 2,239 of the Estates of June M. ) 6 Forsyth and William D. ) Forsyth, and WILLIAM F. ) 7 FORSYTH, JR., ) ) 8 Plaintiffs, ) ) 9 vs. ) ) 10 ELI LILLY AND COMPANY, ) an Indiana corporation, ) 11 et al., ) ) 12 Defendants. ) __________________________) 13 14 TRANSCRIPT OF PROCEEDINGS 15 The above-entitled matter came on for trial on 16 Tuesday, March 23, 1999 at 9:10 a.m. at Honolulu, 17 Hawaii. 18 BEFORE: THE HONORABLE ALAN C. KAY 19 United States District Judge District of Hawaii 20 21 REPORTED BY: TINA M. STUHR, RPR, CSR #360 Notary Public, State of Hawaii 22 PACIFIC REPORTING SERVICES UNLIMITED, INC. 23 733 Bishop Street Suite 2090, Makai Tower 24 Honolulu, Hawaii 96813 (808) 524-PRSU 25 PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2026 1 APPEARANCES: 2 For Plaintiffs: ANDY VICKERY, ESQ. Vickery & Waldner 3 2929 Allen Parkway Suite 2410 4 Houston, Texas 77019 5 KAREN BARTH, ESQ. Baum, Hedlund, Aristei, Guilford 6 & Downey 12100 Wilshire Boulevard 7 Suite 950 Los Angeles, California 90025 8 ROY K.S. CHANG, ESQ. 9 Shim & Chang 333 Queen Street 10 Suite 900 Honolulu, Hawaii 96813 11 For Defendant: ANDREW SEE, ESQ. 12 MICHELLE R. MANGRUM, ESQ. Shook, Hardy & Bacon L.L.P. 13 One Kansas City Place 1200 Main Street 14 Kansas City, Missouri 64105 15 EDMUND BURKE, ESQ. Burke Sakai McPheeters Bordner 16 Iwanaga & Estes 737 Bishop Street 17 Suite 3100 - Mauka Tower Honolulu, Hawaii 96813 18 Also Present: Catherine Itai 19 20 21 22 23 24 25 PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2027 1 I N D E X 2 WITNESSES ON BEHALF OF DEFENDANT 3 DARYL BRUCE MATTHEWS, Ph.D. PAGE 4 Direct Examination by Mr. See 2029 Cross-Examination by Mr. Vickery 2099 5 VICTOR I. REUS, Ph.D., M.D. 6 Direct Examination by Mr. See 2179 7 Cross-Examination by Mr. Vickery 2215 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2028 1 (Whereupon, the following proceedings were had 2 in open court in the presence of the jury.) 3 THE CLERK: Civil No. 95-00185ACK, Susan K. 4 Forsyth, et al. versus Eli Lilly and Company, et al. 5 MR. VICKERY: Good morning, Your Honor. Andy 6 Vickery, Karen Barth, and Roy Chang for Susan and Bill 7 Forsyth. 8 THE COURT: Good morning. 9 MR. SEE: Good morning, Your Honor. Andy See, 10 Michelle Mangrum, and Ed Burke for Defendant Eli Lilly 11 and Company. 12 THE COURT: Good morning. Good morning, ladies 13 and gentlemen of the jury. Please proceed. 14 MR. SEE: Thank you, Your Honor. Your Honor, 15 for its next witness, Eli Lilly and Company calls 16 Dr. Daryl Matthews. Dr. Matthews, will you come up 17 and take the witness stand, please, sir? 18 THE CLERK: Please raise your right hand. 19 DARYL MATTHEWS, Ph.D., 20 called as a witness at the instance of Defendants, 21 being first duly sworn or affirmed to tell the truth, 22 the whole truth, and nothing but the truth, was 23 examined and testified as follows: 24 THE CLERK: Please be seated. Please state 25 your name and spell your last name. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2029 1 THE WITNESS: Daryl Bruce Matthews, 2 M-A-T-T-H-E-W-S. 3 DIRECT EXAMINATION 4 BY MR. SEE: 5 Q. Good morning, Dr. Matthews. 6 A. Good morning, sir. 7 Q. You're a medical doctor? 8 A. Yes, I am. 9 Q. Do you have a particular specialty? 10 A. Yes, I do. 11 Q. Would you tell us what it is, please? 12 A. My specialty is psychiatry with a subspecialty 13 in forensic psychiatry. 14 Q. And where do you live, sir? 15 A. I live in Honolulu. 16 Q. Now, before we start, could you tell us, what 17 is forensic psychiatry? 18 A. Forensic psychiatry is -- well, psychiatry is 19 the study or the diagnosis and treatment of mental 20 illnesses, and forensic psychiatry is using psychiatry 21 to answer questions that the legal system asks, and so 22 that's forensic psychiatry. 23 Q. What are some examples of the kinds of 24 questions the legal system asks about psychiatry? 25 A. One of the very common questions that the legal PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2030 1 system asks is, what was a person's mental condition 2 at the time they might have done a violent crime? 3 That's a question that I get asked a lot and, in fact, 4 the major portion of my work is looking at that as a 5 question and helping the legal system answer that 6 question. 7 Q. Now, let's just cover your educational 8 background, Doctor. Where did you attend college? 9 A. I went to Dartmouth College and Johns Hopkins 10 University. 11 Q. And where is Johns Hopkins? 12 A. That's in Baltimore, Maryland. 13 Q. During your time in college, what was your 14 field of study? 15 A. It was human biology as my major, and also 16 studied psychology. 17 Q. Did you then go on to medical school? 18 A. I did. 19 Q. Would you tell us where you went and when you 20 received your medical degree? 21 A. I went to medical school at John Hopkins 22 University, also in Baltimore, and received my medical 23 degree in 1973. 24 Q. Now, after you became an M.D., did you then go 25 on for specialized training in psychiatry? PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2031 1 A. I did. 2 Q. Would you tell us about that? 3 A. I trained in psychiatry, specialized training 4 to become a psychiatrist, also at Johns Hopkins 5 Hospital through the years 1973 to 1976. 6 Q. Is that what's called the psychiatric 7 residency? 8 A. Yes, that is. 9 Q. And that's a three-year training period? 10 A. It was three years then. It's now actually 11 four years. 12 Q. Now, Dr. Matthews, during the time that you 13 were involved in your psychiatric residency, did you 14 also work on another academic degree? 15 A. I did, yes. 16 Q. Tell us about that, please. 17 A. I worked on a degree in sociology and took 18 courses in sociology while I was at medical school and 19 as a resident, and then got a doctoral degree in 20 sociology in 1977 also from Johns Hopkins. 21 Q. That was a Ph.D.? 22 A. That was a Ph.D. in sociology, yes. 23 Q. What was your particular field of study when 24 you got your Ph.D. in sociology? 25 A. It was the sociology of deviant behavior, PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2032 1 medical sociology, those areas. 2 Q. And did that include the study of violent 3 behavior? 4 A. It included some study of violent behavior. My 5 actual research was in the emergency room setting, and 6 that was the only emergency room in Baltimore that 7 had -- was open 24 hours a day, so if the police had 8 anybody that needed a psychiatric evaluation who had 9 been violent, that was the emergency room that that 10 person was brought to. 11 Q. Now, after the completion of your training as a 12 psychiatrist and the completion of your Ph.D. in 13 sociology, did you go for more training in the 14 particular area of forensic psychiatry? 15 A. I did, yes. 16 Q. Could you tell us where you went and what that 17 study was? 18 A. I went to the University of Virginia. Had a 19 program that was jointly run by the law school and the 20 medical school at the University of Virginia in 21 Charlottesville, and I was involved in a hospital 22 that, much like the forensic unit at Hawaii State 23 Hospital, that is where all the criminal justice 24 defendants, who would need an evaluation, would go. 25 And I was the doctor on the inpatient evaluation unit PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2033 1 for a year, so the various violent offenders that were 2 brought in, who needed evaluations before they went to 3 court, I was the doctor who did those evaluations, and 4 I had supervisors who watched over me as I did that. 5 Q. Did you also teach during the years you spent 6 at the University of Virginia? 7 A. Yes. I taught in the psychiatry department and 8 taught psychiatry and legal issues to the psychiatry 9 residents there. 10 Q. Now, we've heard testimony today about what it 11 means to become board certified. Have you become 12 board certified in psychiatry? 13 A. Yes. 14 Q. And is there also a certification for your 15 particular specialty, that is, forensic psychiatry? 16 A. Yes. There is a certification in psychiatry, 17 and then there's a subspecialty certification in 18 forensic psychiatry, and I got that certificate as 19 well. 20 Q. All right. What years were those? 21 A. Psychiatry, I have to look at my CV to tell you 22 that. Psychiatry was in 1984, and forensic 23 psychiatry, this way that I've just mentioned, as a 24 subspecialty, was in 1994. 25 Q. Now, you finished at the University of Virginia PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2034 1 what year? 2 A. In 1982. 3 Q. What did you do then? Did you go out and get a 4 job? 5 A. I got out and got a job, although, in all 6 fairness, I had a job earlier, before I did my 7 fellowship. 8 Q. What did you do in 1982? 9 A. In 1982, I took a job with the State of Hawaii 10 and I moved to Kauai and became the chief of mental 11 health, chief at the Kauai Community Mental Health 12 Center in 1982. Lived on Kauai. 13 Q. And what kind of work did you do at the Kauai 14 Mental Health Center? 15 A. I was the -- it's a small mental health center. 16 I was the director of it. I did a lot of the 17 psychiatric care there and supervised the nursing 18 staff, supervised the other psychiatrists who worked 19 there, supervised the social workers, and was involved 20 in all of the criminal justice cases that went through 21 the mental health system on Kauai, I was pretty much 22 involved in. 23 Q. Other than doing evaluations for individuals 24 who had been charged with violent crimes, did you also 25 see and treat patients in the mental health center PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2035 1 that just had psychiatric problems? 2 A. I did. I treated outpatients at the community 3 mental health center, and was on the staff at Mahalona 4 Hospital and on the staff at Wilcox Hospital and 5 treated patients at both of those places, and then 6 ultimately had a private office and a private practice 7 in Lihue and treated patients there as well. 8 Q. During the time that you lived on Kauai, what 9 kind of patients did you see and what kind of mental 10 illnesses did you treat? 11 A. There weren't that many psychiatrists on Kauai 12 back then, there still are not that many psychiatrists 13 on Kauai now, and so it wasn't really possible to 14 focus on a specific kind of patient, so I really saw 15 every kind of patient. I saw people who had very 16 serious mental illnesses and people who had more like 17 problems in living, and saw people for the family 18 court, I saw adolescents. I saw really every social 19 group, every kind of patient that presents to a 20 psychiatrist, I think. 21 Q. Now, during the time you were living on Kauai, 22 did you also teach? 23 A. Yes. As time went on, as I lived on Kauai, I 24 became more involved with the UH, the University of 25 Hawaii Department of Psychiatry, and ultimately became PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2036 1 a part-time faculty member at the University of Hawaii 2 and would come to Honolulu about once a week and did 3 teaching of the psychiatry residents at UH. 4 Q. During this time, were you also involved with 5 the State of Hawaii regarding psychiatric issues 6 affecting professional licensing? 7 A. I was a consultant to the group that looked at 8 impaired doctors, doctors who were maybe mentally ill 9 or drug addicted, and if they needed a psychiatrist to 10 look at their situation, I was involved in that. 11 Q. How long did you live on Kauai during this 12 period of time we're talking about? 13 A. During this period of time, I lived on Kauai 14 for eight years between 1982 and 1990. 15 Q. Did you raise your family there? 16 A. My two children were born there and I did, yes. 17 Q. Did an opportunity present itself that caused 18 you to leave Kauai for a time? 19 A. Yes, it did. 20 Q. Tell us what you did. 21 A. For someone who was doing what I was doing at 22 the time, which was practicing psychiatry mostly in a 23 rural setting, I had a pretty unusual and exciting 24 opportunity, which was to move to a university, 25 full-time setting, and I was offered the chance to PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2037 1 become a tenured full professor and to teach 2 psychiatry and to direct a residency program in 3 psychiatry, and that was at the University of 4 Arkansas, in Little Rock, so I moved to Little Rock in 5 1990. 6 Q. And how long did you stay in Little Rock, at 7 the University of Arkansas? 8 A. I was there for five years. 9 Q. And during that time, did you become involved 10 with the Arkansas Psychiatric Society? 11 A. Yes, I did. 12 Q. Did you hold any office? 13 A. I held a couple of offices and became president 14 ultimately of the Arkansas Psychiatric Society. 15 Q. Now, you left Little Rock when? 16 A. In 1995. 17 Q. All right. And what was going on that caused 18 you to leave Little Rock? 19 A. I had a very excellent job and I enjoyed it 20 very much, but the truth is that Hawaii was home for 21 us and my family and I missed Hawaii very much, and so 22 we went back to Kauai, went home. 23 Q. And that was what year? 24 A. 1995. 25 Q. Now, you say you live in Honolulu now? PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2038 1 A. Yes. 2 Q. When did you move over here? 3 A. We moved to Honolulu in August of 1998. 4 Q. Just this last year? 5 A. Just this last year, yeah. 6 Q. Now, let me ask, since the time you came back 7 to Hawaii in, did you say it was '95? 8 A. Yes. 9 Q. Have you continued to teach? 10 A. Yes. I've been very involved in teaching both 11 at the University of Hawaii and, also, something that 12 I started doing, actually started doing it when I was 13 in Arkansas, but I've kept it up, is I teach for part 14 of one day every week, I teach the residents at 15 Tripler, at the Army psychiatry training program here, 16 so I go there once a week and teach the residents 17 forensic psychiatry, community psychiatry, and 18 psychiatric interviewing. 19 Q. And have you been or become involved in the 20 examination process given to psychiatric residents who 21 complete their program and want to become a 22 full-fledged psychiatrist? 23 A. Yes. I've been involved in that in a couple of 24 different ways. 25 Q. Could you tell us about that, please? PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2039 1 A. I've been, for over ten years now, an examiner 2 for the American Board of Psychiatry in neurology. 3 When you finish your psychiatry training, as Mr. See 4 said before, you can become certified in psychiatry, 5 and part of the process is that you have to 6 interview -- if you want to become certified, you have 7 to interview a patient while a senior doctor looks on 8 and criticizes you and says whether you've done it 9 right or not, and that was my job, to -- that is my 10 job, to go and watch the young psychiatrists do the 11 examination of the patients and decide whether they 12 should pass and become board certified or not, and so 13 that's one of the ways. 14 Q. What are the other ways? 15 A. The other way, there's an examination that 16 every psychiatry resident takes every year. Every 17 person who's training in psychiatry in the United 18 States takes this examination every year. It's called 19 the psychiatry resident and training examination, and 20 it's a written examination that changes every year. 21 And I'm on the editorial board for that exam and so I 22 write the questions that every psychiatrist has to -- 23 every trainee has to take every year. 24 Q. Now, since you returned to Hawaii, have you 25 also been involved in a state task force on PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2040 1 individuals with mental illness in the criminal 2 justice system? 3 A. Yes. 4 Q. Could you tell us what that involves? 5 A. There has been a lot of concern over -- for 6 many years now, how mentally ill individuals who were 7 charged with criminal offenses, how that system works 8 in the state of Hawaii. And I was appointed to a 9 committee that the Mental Health Association and the 10 Department of Health and the Office of Protection and 11 Advocacy had formed to try and come up with solutions 12 to what's going on with mentally ill individuals in 13 the criminal justice system. 14 Q. Have you been called upon to give speeches and 15 presentations, and so on, to medical and psychiatric 16 and other professional groups? 17 A. Yes. 18 Q. And, in general, what kind of topics do you 19 cover when you give such presentations? 20 A. They are mostly topics about psychiatry and the 21 law in some way, and very, very often, something 22 involving some kind of violent behavior. 23 MR. SEE: Your Honor, at this point, I would 24 tender Dr. Matthews as an expert witness in the areas 25 of psychiatry and forensic psychiatry. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2041 1 MR. VICKERY: I accept his qualifications. 2 THE COURT: Very well. The Court finds 3 Dr. Matthews qualified as an expert to testify in the 4 areas of psychiatry and forensic psychiatry. 5 Q. (By Mr. See) Now, Dr. Matthews, let's talk 6 about this case. I contacted you about three years 7 ago? 8 A. I think you contacted me, yes, about three 9 years ago. 10 Q. And what were you asked to do by me? 11 A. I was asked to conduct an evaluation of the 12 circumstances of the deaths of William and June 13 Forsyth, and to look at a variety of materials, to 14 research the areas that might be important medically 15 and psychiatrically in the situation leading up to 16 their deaths, and to develop an opinion about what 17 might have been responsible. 18 Q. And is that a process or procedure that you had 19 gone through before in other matters? 20 A. Yes. 21 Q. And did you and do you have sort of a 22 standardized methodology of how you go about doing 23 that kind of evaluation? 24 A. Yes. 25 Q. Could you tell us what that is? PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2042 1 A. It involves a review of all the medical records 2 that might have been generated by the person or 3 persons involved, a review of any kind of evidence 4 that can be gathered through reading depositions of 5 people who knew the individuals involved. It involves 6 looking at police reports, witness statements, autopsy 7 reports. It involves -- sometimes, if it's 8 appropriate, many of my exams are done on people who 9 are in custody. It involves doing interviews of those 10 individuals. It involves -- if people wrote letters 11 or had journals or diaries, it involves looking at 12 that material. It, basically, involves looking at 13 everything you can find about a person to try and find 14 what when into producing whatever mental condition was 15 operating at the time. It is very, very detailed 16 oriented and takes a long time to do. 17 Q. Were you provided materials, such as you have 18 just described, that have to do with the deaths of 19 William and June Forsyth? 20 A. Yes, I was. 21 Q. Okay. Could you just tell the jury generally 22 what kinds of materials you looked at? 23 A. Generally, what I looked at was medical and 24 psychiatric and other kinds of professional records of 25 William and June Forsyth. I looked at hospital PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2043 1 records. I looked at pharmacy records. I looked at 2 counseling records that they'd received. I looked at 3 a variety of depositions of people who knew them, the 4 family members' depositions that were taken earlier in 5 the case, depositions of the various doctors that 6 treated them, and read some of the legal documents in 7 the case, looked at the police reports and the witness 8 statements, read the autopsy reports, read some of the 9 expert reports and then some of the depositions of the 10 experts that the plaintiffs' side had retained. 11 And then I looked at some of the medical 12 literature having to do with the problem of homicide 13 followed by suicide, and also looked at some of the 14 professional literature on the question of whether 15 Prozac and other similar kinds of drugs are 16 responsible for producing suicide or any kind of 17 violent behavior. 18 Q. And over what period of time did you conduct 19 this review of the materials you just described? 20 A. This was over several years starting in the 21 beginning of 1996. 22 Q. And did you then set down your analysis and 23 your conclusions in a report? 24 A. Yes, I did. 25 Q. How long is your report? PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2044 1 A. The report is 40 pages long. 2 Q. Dr. Matthews, based upon your training and your 3 experience and upon your review of all the materials 4 you have reviewed in this case, do you have an 5 opinion, to a reasonable degree of medical certainty, 6 on what the probable cause was of the deaths of 7 William and June Forsyth? 8 A. Yes, I do. 9 Q. What is that opinion, please? 10 A. My opinion is that the probable causes of the 11 deaths were Mr. Forsyth's major depression, which is a 12 serious psychiatric illness that he had, along with an 13 anxiety disorder that he had, and those conditions 14 combined with certain risk factors that he had for 15 committing suicide, committing homicide followed by 16 suicide. 17 On top of that, there were stresses in his life 18 that were serious and were part of the contributing 19 causes, which included his retirement, his marital 20 problems, family problems otherwise that he was 21 having, his hopelessness, his recent discharge from a 22 psychiatric hospital without having really improved, 23 the loss of a former medication that he had been 24 taking, Xanax, to help calm him down, he no longer was 25 able to take that and, in general, a situation where PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2045 1 he had been quite angry at his wife for many, many 2 years, had kept the anger very, very bottled up inside 3 except to run away. 4 When he got so angry that he couldn't stand it, 5 he would run away, but his depression had paralyzed 6 him to such a degree, his depression had prevented him 7 from -- sometimes from even getting out of bed, but 8 certainly it prevented him from running away from his 9 wife the way he had on a couple of occasions earlier, 10 and yet at the same time, he was so angry and 11 dependent on his wife, that he felt that he had to get 12 away, and yet couldn't, and so a combination of all of 13 those factors erupted in what happened. 14 Q. Now, I want to ask you some questions, 15 Dr. Matthews, about some of the materials you've 16 reviewed. The jury has seen some of them and we don't 17 need to go over all of those again, but first, I'd 18 like to look at the records of Riggs Roberts and ask 19 you a question or two about these. 20 MR. SEE: And, Your Honor, these blowups are at 21 1016. 22 Q. Dr. Matthews, it's hard to see at these angles, 23 so for your convenience, I put a notebook up there 24 that has small copies of these. That should be just 25 under tab one. Do you have it there? PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2046 1 A. Yes, sir. Thank you. 2 Q. This a blowup of the first visit with Dr. Riggs 3 Roberts, and the question I want to ask you about is 4 this, there's been testimony in the case that I want 5 to ask you about. The first visit, which is 1216, do 6 you have that? 7 A. Yes, I do. 8 Q. I want to ask you this: There's been testimony 9 in the case that Mr. and Mrs. Forsyth had undergone 10 some marital counseling with Dr. Tom Brady in Los 11 Angeles prior to their return to Maui in early 12 December of '92. Are you familiar with that? 13 A. Yes. 14 Q. So would the first visit with Dr. Roberts, 15 which is dated December 16 of '92, have been after the 16 counseling with Dr. Brady had ended? 17 A. Yes, very shortly after it ended. 18 Q. Now, what I want to specifically ask you about 19 is, there's an entry that we've seen before on 20 December 16 of '92, after the conclusion of the 21 marriage counseling with Dr. Brady, where Mr. Forsyth 22 was telling his psychiatrist that loneliness was his 23 biggest problem. Do you see that? 24 A. Yes, I do. 25 Q. Can you explain what significance, if any, PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2047 1 Mr. Forsyth's statement about loneliness has for your 2 opinions? 3 A. It suggests that -- it's one of the things that 4 suggest that despite the fact that there had been this 5 marriage counseling that the couple had had, the 6 couple of sessions, six sessions or several months' 7 worth of sessions that the couple had had together, 8 that, perhaps not surprisingly, in a couple that had 9 had serious marriage problems for many, many years, 10 that this didn't simply fix and transform the marriage 11 so that everything was quite wonderful now; that 12 despite having gone through this counseling, that 13 Mr. Forsyth was still not close enough to his wife 14 that he did not express the sense of loneliness, and 15 so that is what I take from that. 16 Q. Let me ask you to turn to the next blowup which 17 reflects a visit of January the 4th of 1993. Do you 18 have that one? 19 A. Yes. 20 Q. And here we are at January 4 of '93, and I 21 specifically want to ask you about the entry down at 22 the bottom of that blowup which reads, "Co-dependent 23 on my wife, new feeling." Could you explain for the 24 jury what significance, if any, that entry had on your 25 opinion about the status of the relationship as it was PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2048 1 entered in 1993? 2 A. Yes. I think, first, you can take the word 3 co-dependent and just say dependent, that that's 4 really what it means in this connection. And 5 Mr. Forsyth, for many, many years, had been a very 6 independent, outgoing man, and he was dependent mostly 7 on himself over the years and he prided himself on 8 that, and the depression that he suffered beginning in 9 1992, that that depression and anxiety symptoms had 10 left him pretty immobilized and pretty fearful, and he 11 got to the point where he no longer could be 12 functionally independent and he became dependent on 13 his wife, which was totally new to him and something 14 that I believe he had a great deal of difficulty 15 tolerating. 16 Q. Let's move now to the blowup that covers the 17 entry of January 18, and I want to look at the second 18 page of that particular one, the one that starts out 19 at the top, "Out of control, disorganization." Do you 20 see that one? 21 A. Yes. 22 Q. And I particularly want to ask you about the 23 entry that is listed that says, "Anger at her." Do 24 you see that? 25 A. Yes. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2049 1 Q. Could you tell us what significance, if any, 2 does that entry have regarding your opinion about the 3 status of the relationship between Mr. and 4 Mrs. Forsyth as of this time, January 18, 1993? 5 A. It seems, and it seems, particularly in 6 connection with the other things on that page, that he 7 still feels angry at his wife. That anger has been a 8 problem in the marriage for a long time. It was 9 expressed in a very indirect kind of way and some of 10 the ways that that has been expressed, I've mentioned 11 before, but he still maintains that sense of anger. 12 Q. Now, Dr. Matthews, let me ask you to turn to 13 the entry for February 9 of 1993. Do you see that 14 one? 15 A. Yes. 16 Q. Now, I want to ask you about the entry that 17 reads, "Now attached to wife, bonded, fearful." Could 18 you tell the jury what significance, if any, that 19 entry has on your opinion on the status of the 20 relationship as of the 9th of February of '93, and in 21 particular, whether it tells you anything about stress 22 in the relationship? 23 A. This is a man who had been very angry at his 24 wife for many years who, now, because of his mental 25 illness, is afraid of being away from her and is PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2050 1 totally attached because of his sickness, and he is 2 bonded to her in this repellant kind of way to him and 3 he's so frightened, that he can't get away from her. 4 So I think that this is a major stress on him is the 5 fact that a, formerly, man who is totally independent 6 is now fearfully bonded to his wife whom he's been 7 angry at for so many years. 8 Q. All right. Thank you. Now, I'd like to turn 9 to Exhibit -- 10 MR. SEE: If I could just have one second, Your 11 Honor. 12 Q. I'd like to turn to Exhibit 1037, and that will 13 be in your book there, Doctor, at tab two. Do you 14 have that there? It's the handwritten notes of 15 William Forsyth, and this one says, up at the top, 16 "Thursday 12/3." Do you have that one? 17 A. Yes. 18 Q. Now, this is also materials that you reviewed 19 in forming your opinions in this case? 20 A. Yes. 21 MR. VICKERY: Excuse me, Mr. See. Your Honor, 22 may we have clarification whether that's 12/3/91 or 23 '92? 24 MR. SEE: Yeah, we're going to do that right 25 now. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2051 1 MR. VICKERY: Okay. Great. 2 Q. (By Mr. See) The first thing I do want to ask 3 you, Doctor, is looking at Thursday 12/3, can you tell 4 what year that was? 5 A. I believe so, yes. 6 Q. How do you tell that? 7 A. By looking at a calendar and seeing 12/3 is a 8 Thursday in '92. 9 Q. Now, we had testimony that in their marital 10 counseling with Dr. Brady in Los Angeles, their last 11 visit was on December 4, 1992, so would that put this 12 Exhibit 1037 one day before that last visit? 13 A. Yes, that's correct, I believe. 14 Q. And it's your understanding that Exhibit 1037 15 is simply a blowup and so it's easier to read the 16 writing of a handwritten note by Mr. William Forsyth? 17 A. Yes, that's right. 18 Q. Now, I want to ask you some questions about the 19 significance, if any, of some of these entries for 20 your opinions. The first entry reads, "June, walk, 21 Bill Dornblazer, back with determined bitter attitude, 22 issues, Susan's life, and feeling I would not be there 23 if she were sick. History, must sit down and 24 discuss," and then there's a parenthetical, "June 25 upset, Bill pain." Would you tell us what PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2052 1 significance, if any, that has on your opinion on the 2 relationship as of December 3rd of 1992? 3 A. It appears that despite the fact that the 4 couple had been going through marriage counseling, 5 that the day before the marriage counseling concluded 6 before the last session, that there was still a lot of 7 bad feeling and trouble in the marriage. 8 Q. Would that be the "bitter attitude"? 9 A. Yes, and "June upset, Bill pain." 10 Q. The second entry says, "Phantom of the Opera, 11 drove to get tickets, how I handled purchase hurtful, 12 June upset, Bill pain." What significance does that 13 have, if any? 14 A. That a pattern, I think, that had been present 15 earlier in the marriage, which was small things that 16 would happen between the couple would be occasion of 17 great conflict and trouble or great pain, in any case, 18 that how he purchased the tickets was perceived as 19 hurtful and that June was upset, that it caused Bill 20 pain, again evidence that not all is well, that 21 there's serious problems in the marriage still at this 22 point. 23 Q. Okay. Now, let's look at the next item that's 24 here on the blowup. It says, "Dinner out, special 25 restaurant, parking car. Move to more secure parking. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2053 1 June very upset. Bill paranoid. Ruining dining out. 2 Bill needs to know reasons for anxious and 3 unreasonable fears. June upset. Bill pain." Does 4 that entry have significance for your opinion? 5 A. Yes, it does. 6 Q. Tell us what it is. 7 A. I would say it is exactly the same thing. This 8 is a very troubled couple that is suffering a lot in 9 terms of marital problems at this point in time, that 10 they're still upset and there's pain, and that I think 11 that June is thinking of Bill as being paranoid, which 12 is a pretty strong word to use about your husband, and 13 I think there's a lot of trouble in that relationship. 14 Q. Going down, it says, "Drove to Malibu house to 15 get clothes for June and pick up mail. Much clutter 16 and disarray not pleasant for June, Bill. No 17 conversation on ride back. June, Bill mentally 18 tired." Does that have significance for your views? 19 A. Yes. 20 Q. What is it, please? 21 A. Again, the same thing, that there is 22 considerable disharmony; that they were not talking to 23 each other, not communicating with each other, and 24 that the marriage counseling, up to that point in 25 time, had not cured, in any meaningful sense, the PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2054 1 difficulties that they'd had together. 2 Q. Then we have the last entry here. It's a 3 blowup of this part written on the back of this page 4 and it says, "Out of control, not secure, out of 5 place, anxious." Does that have significance for your 6 opinions? 7 A. Yes. 8 Q. Would you tell us what that is, please? 9 A. Well, at this point in time, by this point in 10 time, Bill is becoming depressed and he has an anxiety 11 disorder and he is beginning to feel like he's out of 12 control, which is a terrible way to feel, and insecure 13 and out of place and anxious, and that these are 14 symptoms of his mental illness that he is experiencing 15 at this time. 16 Q. Let me ask this question: The entry that 17 Mr. Forsyth writes down, "Out of control," does that 18 have any particular meaning for him as it relates to 19 the way that he had lived his life up to this time? 20 A. Yes, I think so. 21 Q. Would you tell us what that is? 22 A. As I think I said before, Mr. Forsyth is a man 23 for whom control is very important and control had 24 always been important to him and he had always kept 25 his life in good control and been controlling of PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2055 1 himself, and to some extent, I think controlling of 2 other people perhaps, and that when control is very 3 important to you as a person, when you feel you're 4 losing control, so much the worse for you. That is a 5 bigger stress on someone for whom control is such an 6 issue, as it was for him. 7 Q. I want to turn, Dr. Matthews, to Exhibit 1031 8 which is at tab three of your book. And is 1031 also 9 one of the handwritten notes of William Forsyth that 10 you reviewed in your analysis and materials in this 11 case? 12 A. Yes. 13 Q. Now, I do want to ask you about what we know 14 about when this was written, Doctor. And I 15 particularly want to refer you to the notation up in 16 the upper right-hand corner which reads, "13 day on 17 75." Now, does that have any significance to you? 18 A. Yes, I think so. 19 Q. What is it, please? 20 A. One of the medications that Dr. Roberts had 21 been prescribing for Mr. Forsyth was Pamelor, and at 22 one point in time, the dosage was increased, I think, 23 from 60 milligrams a day of Pamelor to 75 milligrams a 24 day of Pamelor, and so this can be dated in that he 25 had been taking Pamelor, 75 milligrams a day for 13 PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2056 1 days. 2 Q. Let's look back at Dr. Roberts' chart, this is 3 the blowup that covers February 9th of 1993, just for 4 one second. And can I ask you to refer to the entry 5 which is the second line, which says, "13 days of 6 Pamelor, nortriptyline, 75-milligrams." Would that 7 correspond to the 13 days on 75 that Mr. Forsyth 8 himself wrote on this handwritten note? 9 A. Yes. That's the method I'd use for dating the 10 note. 11 Q. So we know that Exhibit 1031 would be dated the 12 same date as the Roberts chart that is February 9th of 13 1993? 14 A. Yes, that's right. 15 Q. Now, I want to ask you about, first, the top 16 entry of the blowup section where it first says, 17 "Loose cannon." Does that have significance to you as 18 a psychiatrist in your evaluation of Mr. Forsyth? 19 A. Possibly, yes. 20 Q. Tell us what that is. 21 A. Well, I gather that what this means is he's 22 seeing himself as a loose cannon, which is not a very 23 good thing to be; that he is somebody who's out of 24 control. He mentions it in this note. He mentions it 25 in the other note we talked about, he feels out of PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2057 1 control, and that this is just another dimension of 2 that. 3 Q. And then we have listed, "business," and in the 4 second listing is a word that appears to be 5 E-S-T-R-A-N, "Estran," and then "marriage." What do 6 you take that entry to be? 7 A. Probably estranged marriage. 8 Q. Now, Doctor, there is an entry right after 9 that. It's a little bit hard to read. Have you 10 examined that particular entry? 11 A. I have. 12 Q. And are you able to make out what it says? 13 A. Not with certainty, no. 14 Q. Do you have any judgment at all about what it 15 might say? 16 A. It possibly says, "Okay plus," but I'm not sure 17 about that. I don't know for sure. 18 Q. Well, let's talk about that. Suppose it does 19 say, "Okay plus," I'm going to circle that and put a 20 question mark by it because we're not quite sure 21 whether it says that or not, at least you're not. 22 A. I'm not sure. 23 Q. Okay. Now, suppose it does say, "Okay plus," 24 beside the estranged marriage listing, does that have 25 significance for your opinion, particularly about the PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2058 1 status of the relationship between Mr. and 2 Mrs. Forsyth as of February 9, 1993? 3 A. Yes. 4 Q. Could you tell us what that is? 5 A. I don't know exactly what that means. It's 6 tough when you get these telegraphic kind of notes. 7 It could mean that the marriage has improved some over 8 the time that's passed. It could mean that he's 9 gotten comfortable with the idea that his marriage is 10 not improved, that he's accepting of the idea that his 11 marriage hasn't changed. It could mean that his 12 marriage has been having some ups and downs and 13 sometimes it's better than others. It's hard to know 14 exactly what that means. 15 Q. Let me ask you to turn back to Dr. Roberts' 16 chart for just one moment. On his entry for 17 February 9, which is the day that we're talking about, 18 do you have that one there? 19 A. Yes. 20 Q. And now, I want to revisit, just for a brief 21 moment, the entry on the very same day where it is 22 recorded, "Now attached to wife, bonded, fearful." 23 Now, here's my question, if Mr. Forsyth has recorded 24 estranged marriage okay, how does that fit and what 25 significance does it have, if any, to his report to PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2059 1 his psychiatrist on the very same day that he is now 2 attached to his wife, bonded and fearful? 3 A. I think the difficulty in the marriage is 4 taking a new form and that he's talking about it to 5 the psychiatrist, that instead of being estranged and 6 separated, that now what's happening is that he is 7 bonded to her because of the fear and inability to 8 really be independent that his depression has forced 9 on him, and so I think it's showing another aspect of 10 the difficulty between them. 11 Q. Now, if we could go down the rest of this one, 12 if you have it back there, we see the entry, "Thinking 13 busy, busy and out of control." Does that have 14 significance to your opinion? 15 A. Yes. 16 Q. Could you tell us about it? 17 A. I think that part of the problem that 18 Mr. Forsyth experienced when he was so ill was that he 19 had -- couldn't stop his thoughts from thinking, that 20 he was constantly thinking and working over things, 21 that that was maybe part of the anxiety symptoms that 22 he was having, but associated with that was the 23 feeling of being totally out of control. And it's a 24 theme that he brings up over and over, that he feels 25 out of control, and that's part of his depression and PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2060 1 part of a man who is very used to being in control, 2 losing it, and saying that his life is falling apart. 3 Q. And then there's an entry over here that says, 4 "Denial, anger." What significance does that have, if 5 any? 6 A. There's anger. He's a man who's angry at his 7 wife, who has been angry at his wife for many years 8 and the anger has been for many years, and I think he 9 has to deny the anger because he's so attached to her 10 right now, he can't get away from her because his 11 dependency is because of his sickness, so he has to 12 deny the anger, but it's still there. 13 Q. And the last part we have blown up here, "Bad 14 edge. Will I get back emotional strength?" Would you 15 tell us what significant strength that has, if any? 16 A. I think he's become concerned about, is he ever 17 going to recover, and there's material throughout his 18 notes that express hopelessness and despair, which are 19 very, very serious risk factors for suicide, and I 20 think that's part of that, that he's fearful that he 21 won't ever recover. That's what people who are 22 depressed sometimes think. 23 Q. Then going on down to the next page, the entry, 24 "Can't take stress." How is that significant, if it 25 is? PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2061 1 A. I think that it means that his former ability 2 to tolerate stress that he had when he was well, kind 3 of rolled with the punches and functioned under 4 stressful situations, has been impaired by his illness 5 and that he isn't able to tolerate stress anymore. 6 Q. Again, we see an entry down at the bottom, 7 "Co-dependent on June." Let me ask you about this 8 one, "Into my problems, can't enjoy," what 9 significance does that have, if any? 10 A. "Can't enjoy" is, I take that to mean that he 11 doesn't get enjoyment out of life anymore. That's one 12 of the criteria for major depression. It's a common 13 sign of serious depression is the inability to take 14 pleasure from life, and it's a sign of his illness. 15 Q. I want you to help us come to a date for this 16 second page on the blowup, Doctor, and I want to refer 17 you specifically to the entry here that says, "21 18 times five and a half." Do you see that? 19 A. Yes. 20 Q. What did you take that to signify? 21 A. I take that to signify that he was, at that 22 point in time, taking another medication that he had 23 been taking, which was Xanax; that he had taken 24 five-and-a-half Xanax a day for 21 days. 25 Q. Let me show you briefly the blowup for PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2062 1 Dr. Roberts' chart that has the entry for February the 2 1st of 1993. It's got February 1st, '93, down at the 3 bottom of the blowup there. I'm sorry. Up at the 4 top, it says January 25 of '93. 5 A. One may be missing from my book. 6 Q. I'll read it to you. It says, "Xanax, five and 7 a half times 19 days." 8 A. Yes. 9 Q. And what would that signify? 10 A. That he had been taking, I think, 11 five-and-a-half Xanax tablets for 19 days at that 12 point. 13 Q. On February 1st? 14 A. On February 1st. 15 Q. If you add two days to make it 21, would you 16 get to February the 3rd? 17 A. Yes. 18 Q. So can we date this bottom note to be February 19 the 3rd of 1993? 20 A. Yes, that's what I would believe. 21 Q. Now, we're still looking at Exhibit -- no, now 22 we're looking at Exhibit 1031, which should be at tab 23 three of your book. It is the second page. You see 24 that, the one that has "Fearful of time" up at the 25 top? PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2063 1 A. Yes. 2 Q. Now, we also want to date this, and I want to 3 refer you specifically to the note here by Mr. Forsyth 4 that says, "75 okay." Do you see that? 5 A. Yes. 6 Q. And what did you take that to represent? 7 A. I think above the "75 okay," it says, "Three 8 bad hours," also, and I think that may be part of it. 9 I think he's questioning whether 75 milligrams is an 10 all right dose of Pamelor for him, whether he's able 11 to tolerate that. People often get increased side 12 effects when the dose of an antidepressant is raised, 13 and I think he's wondering whether he can tolerate 14 that, so I think it may be early on in the time that 15 he was taking 75 milligrams of Pamelor. 16 Q. If I could just refer you back quickly to 17 Dr. Roberts' chart, the entry for February the 1st of 18 '93, which says "nortriptyline." Is that Pamelor? 19 A. Yes. 20 Q. "Nortriptyline, 75 milligrams," so how would 21 you put those two entries together, that is, the 75 22 milligrams of Pamelor on February the 1st, and then 23 Mr. Forsyth's note, "75 okay" with a question mark? 24 A. That Mr. Forsyth's note appears to have been 25 written shortly after Dr. Roberts' note was written. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2064 1 Q. So for dating this particular note, we would 2 say about February the 1st? 3 A. About February the 1st or 2nd or 3rd, within a 4 few days after would be my surmise. 5 Q. Now, let me ask you about the significance of 6 these entries. The entry here in Mr. Forsyth's hand 7 is, "Fearful of time, filling time." Does that have 8 significance for your opinion? 9 A. Yes. 10 Q. Would you tell us what it is? 11 A. The -- Mr. Forsyth is a fearful -- is becoming 12 fearful in the course of his illness, and he is 13 somehow, at this point, fearful of time passing or 14 fearful that he won't be able to fill his time. I 15 think it may be associated with the fact that he has 16 retired in a very, very unsatisfactory way to him. 17 His business was essentially taken away from him and 18 he had not adjusted well to his retirement and boredom 19 has been a big problem for him, and I think it may 20 well refer to that. 21 Q. Let's go down here. He has some ditto marks, 22 so with the ditto marks, it would be, "Fearful of 23 being on my own." Does that have significance for 24 your opinion? 25 A. Yes. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2065 1 Q. Would you tell us what that is? 2 A. I think, at this point, it very likely relates 3 to what I referred to before, which is his fear of 4 being alone, fear of being away from his wife, that he 5 was so intensely dependent on her at this point, that 6 he couldn't be by himself, which is a very 7 uncomfortable state. 8 Q. And we have the entries here, "Co-dependent and 9 can't handle stress," would those have the same 10 significance that you already testified about? 11 A. Yes, they would. 12 Q. And then, "Lack of interest and employment," 13 would that be the same sort of reference to 14 Mr. Forsyth's unhappiness of having no productive work 15 to do? 16 A. Yes. 17 Q. Then there's an entry over on the one side that 18 says, "My personality change." Does that have 19 significance for your opinion? 20 A. Yes. 21 Q. Tell us what that is, please. 22 A. I think that as he has become ill, he has seen 23 his personality change and other people have seen his 24 personality change, but he's seeing it as well and 25 perceiving it and it's a frightening thing for him to PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2066 1 see yourself go from an outgoing, independent, capable 2 person to being somebody who is -- can't sleep, 3 doesn't eat, losing weight, can't -- takes no pleasure 4 from life, doesn't interact with people, is totally 5 fearful and dependent and all those things. It's a 6 marked personality change and I believe that's what he 7 would be referring to. 8 Q. And then there's an entry, "Son." Does that 9 have significance for your opinion? 10 A. Yes. 11 Q. Tell us what that is, please. 12 A. Well, I think, at times during his depression, 13 Mr. Forsyth perceived there were problems in his 14 relationship with his son and that he didn't trust his 15 son's business dealings or that he felt his son was 16 trying to take over running his business or running 17 his business interests or manage his affairs, and I 18 think that that's what that would refer to. 19 Q. There is an entry that says, "Into myself, 20 problems." Is that significant? 21 A. Yes. 22 Q. If it is, would you tell us about that, please? 23 A. I think that he's totally preoccupied with 24 himself and his inner life and his problems, and that 25 he is a tormented man at this point in time, that PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2067 1 that's what all these notes show is considerable 2 mental torment. 3 Q. I'd like to go over to the next chart on 4 Mr. Forsyth's note which is 1038, which is under tab 5 four of your book, Doctor. Do you see this one? 6 A. Yes. 7 Q. Now, in trying to date this, let me refer you 8 to the one entry that says, "Worry, an addiction to 9 drugs." Does that help date this note at all? 10 A. To some extent, I think it may. 11 Q. All right. Would you tell us how it does? 12 A. My understanding is that Mr. Forsyth did not 13 start becoming concerned that the Xanax that he had 14 been taking was potentially addictive until after he 15 started seeing Dr. Roberts, so that this is sometime 16 after he began seeing Dr. Roberts in December of '92. 17 Q. Okay. Now, let me ask you some questions about 18 the entry. He has, "Sad, withdrawn, can't talk," and 19 "stress." Would you explain the significance of that, 20 if any? 21 A. I think those are signs of his depression, that 22 at the time he's writing this, that he has a depressed 23 mood, he's withdrawn from others. Those are signs of 24 major depression; can't talk, doesn't want to relate 25 to people, feels stress, the sign of anxiety or PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2068 1 stress. 2 Q. And we've seen many entries that talk about 3 co-dependent, and I presume your testimony about that 4 would be the same? 5 A. Yes. 6 Q. Now, let's specifically ask about the entry 7 that says, "Fear, loss of control," and then in 8 parentheses, it says, "Me," and then, "Not on top of 9 respond." 10 What significance does that have, if any? 11 A. He's fearing loss of control, which is an issue 12 that has been on his mind in these other notes that we 13 looked at; and loss of control meaning that he can't 14 control himself and that he's not on top of his 15 responsibilities, that he's failing, that he sees 16 himself as deteriorating and can't handle his 17 responsibilities. 18 Q. Now, Mr. Forsyth has written here two sections, 19 one that is entitled "Now" and one entitled "Before." 20 Is that something that you also reviewed? 21 A. Yes. 22 Q. Okay. Now, let me ask you about the "Before" 23 first. The entries there are, "Always on the go, 24 running here, there, busy, busy, never settle down, 25 and mental fine." What significance does that have, PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2069 1 if any, to your opinions; that is, Mr. Forsyth's notes 2 that he has labeled "Before"? 3 A. I think that he is seeing an illness develop in 4 himself, that he has become ill, and that he doesn't 5 have a history of that illness earlier, that he was 6 mentally fine before that, and that he describes in 7 what ways mentally fine, that he's on the go and 8 running and an active outgoing person, and that it's a 9 before and after kind of picture. 10 Q. Okay. Now, let's look at the item marked 11 "Now," and there, we have, "Anxious, Type A 12 personality, unrealistic with other people," and then 13 "Want to isolate myself and read books, afraid to be 14 alone," and then, "Fears," with a parentheses, "alone, 15 won't be able to function." Let me ask you 16 specifically about that entry, "Afraid to be alone, 17 fears alone, won't be able to function." What 18 significance does that have, if any? 19 A. Well, I think that part of his illness, which 20 included anxiety and depression, that part of that is 21 his fear of being alone and that he's expressing that 22 here, and that it was responsible for his refusal to 23 let go of his wife during that later period of time, 24 and that he won't be able to function on his own. 25 That, again, fearing that he's going to fail, that he PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2070 1 can't function without someone standing right there, 2 that's a terrible state of affairs. 3 Q. Now, Dr. Matthews, this blowup covered up a 4 little entry that I want to ask you specifically 5 about, and that entry on this exhibit, it comes down 6 after the, "Mental fine," and it's an entry that 7 simply says, "B again." You looked at that? 8 A. Yes, I think so. 9 Q. Yeah. What significance does that have, if 10 any? 11 MR. SEE: It's covered up. It's right under 12 here. 13 MR. VICKERY: Oh, okay. 14 THE WITNESS: And this is the one that says -- 15 I'm sorry? 16 Q. (By Mr. See) It says "B again," the letter B. 17 A. That could mean born again. 18 Q. And what significance would that have to your 19 opinion, if any? 20 A. It's hard to know what that means. It could 21 refer to his wife's born-again experience, which has 22 caused him some difficulty. It could refer to his own 23 desire to be born again, which is something that he 24 had hoped for because he was in a lot of despair and 25 looking very, very widely for some comfort, and it PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2071 1 could mean that he felt that he was born again. It's 2 difficult to know for sure. 3 Q. Let me ask you now, for the last one in this 4 series, which is Exhibit 1029, that should be under 5 tab five of your book. That's the one that has at the 6 top, "Automatic negative thoughts." Do you see that 7 one? 8 A. Yes. 9 Q. Now, again, in dating this particular note, I 10 want to refer you to the entry that says, "I fear 11 addiction," and then it says "Xanax." Do you see 12 that? 13 A. Yes. 14 Q. What does that tell you, if anything, about 15 when this particular note was written? 16 A. It suggests what the other one did, that it was 17 written sometime after he began seeing Dr. Roberts and 18 was concerned about addiction as an issue, ultimately 19 obsessed with addiction as an issue, maybe. 20 Q. Okay. Let's ask you about whether this has any 21 significance for your views regarding Mr. Forsyth. 22 First, Mr. Forsyth has written, number one, "Automatic 23 negative thoughts." Does that have significance for 24 your view? 25 A. Yes. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2072 1 Q. Would you tell us what that is? 2 A. That is a very characteristic kind of way of 3 thinking in depression; that everything that you look 4 at is negative, that it automatically turns negative, 5 that you're not optimistic or positive or feel good 6 about anything, it automatically turns negative, and 7 that's something that he's experiencing. 8 Q. Okay. And let's go down to the entry that says 9 this, "I am lesser than I was," and that has three 10 entries by it, "In control, outgoing, positive." What 11 significance do you take from those entries, if any? 12 A. I take it to mean that he formerly was in 13 control and he was formerly outgoing and formerly 14 positive, but that now, he's not, that he sees himself 15 as lesser, which is part of a feeling of worthlessness 16 and low self-esteem, and that the ways that he sees 17 himself as lesser are those ways, that he's lost his 18 former functioning in that way. 19 Q. Now, the next entry reads, "I feel that I will 20 not be able to manage my assets and keep up with 21 challenges and requirements for someone else. No pain 22 accepted." If that has significance for your view, 23 would you tell us what it is? 24 A. I think that it shows a man who is fearful that 25 he's failing, fearful that he's losing his ability to PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2073 1 function, and seeing himself not able to take care of 2 himself the way that he has throughout his whole life. 3 Q. And what, if anything, does that kind of 4 attitude or that kind of thought, what, if any, effect 5 does that kind of thought have on risk of suicide? 6 A. This is a risk factor for suicide, this kind of 7 hopelessness that he's expressing is a serious risk 8 factor for suicide. 9 Q. Then he also enters here, it says, "Fear of 10 losing physical stamina." How is that significant, if 11 it is? 12 A. It is -- all of these things fit together as 13 part of the disease of depression, and at this point, 14 he's now fearful of his physical decline and he's very 15 fearful -- sometimes people who are depressed are 16 depressed to the point where they're concerned about 17 health concerns that are unrealistic. He doesn't 18 really have any medical problems that we know of, but 19 yet he's fearful of this, and I think it's part of his 20 depression. 21 Q. Now, I want to ask you about the next entry, 22 but -- it says, "Not in control, just reacting to 23 needs," but my question goes to every entry that has 24 to do with the subject of control on this exhibit, and 25 I count at least four. What significance, if any, PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2074 1 regarding Mr. Forsyth's mental state would the 2 repetitive reference to control and loss of control 3 have, if any? 4 A. It's a man who has been able to control himself 5 very well throughout his life and for whom control has 6 been an important issue and who now sees himself very 7 frighteningly as being out of control and unable to 8 control himself, very fearful, frightening. 9 Q. Now, Doctor, let me ask you to turn to the last 10 entry on the blowup, which is a blowup of a word 11 written by Mr. Forsyth, and it says "paranoia." Does 12 that have significance for your views? 13 A. Yes. 14 Q. Would you tell us what that is? 15 A. Paranoia is a sign of serious mental illness. 16 It's unreasonable fears that someone is trying to harm 17 you. I don't know if he sees himself as that or he's 18 reflecting the fact that his wife has felt that he has 19 been that. I think there's some, maybe, evidence of 20 him having symptoms of paranoia in his final months, 21 but, obviously, it's on his mind. He wrote it in big 22 letters. Perhaps the fact that it's in quotes refers 23 to the fact that that's what his wife has been saying 24 about him, and what he thinks about that is a little 25 bit hard to know, but it is on his mind. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2075 1 MR. SEE: Your Honor, I'm about to turn to a 2 separate and final topic. It might be appropriate to 3 break, if that was convenient for the Court. 4 THE COURT: All right. Let's take a 15-minute 5 break. Please be back at 20 minutes of. I want to 6 meet with counsel. 7 (Whereupon, the following proceedings were had 8 in open court out of the presence of the jury.) 9 THE COURT: First, I simply want to put in the 10 record the preliminary draft jury instructions that I 11 distributed to counsel at the end of last week. 12 Secondly, I understand that you wanted to introduce 13 some exhibits, Mr. See? 14 MR. SEE: Yes, sir. I think Ms. Mangrum will 15 take care of that, if she can. 16 MS. MANGRUM: Your Honor, at this time, we'd 17 like to offer Defendant Eli Lilly and Company's -- 18 THE COURT: Well, I don't want you to offer 19 them right now, but I simply want to know if there's 20 any objection to them. 21 MR. VICKERY: The list Ms. Mangrum has given 22 me, she assures me are things that the Court's already 23 ruled are coming in, so I don't have any objection to 24 them being offered. 25 THE COURT: Anything else we should discuss PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2076 1 now? 2 MR. VICKERY: I don't think so right now. We 3 probably all want breaks. 4 MR. SEE: We do have a written paper 5 essentially addressing the Court's draft jury 6 instructions. If that will be helpful, we could hand 7 that up. 8 MR. VICKERY: I do, too, Judge, but I didn't 9 think it would be helpful at this break. 10 THE COURT: Well, I have nothing else to do 11 during my breaks. Let's take a break. 12 (Whereupon, a recess was taken from 10:25 a.m. 13 to 10:50 a.m.) 14 THE COURT: Please proceed, Mr. See. 15 MR. SEE: Thank you, Your Honor. 16 Q. Dr. Matthews, have you also reviewed the notes 17 and journals and diaries written by June Forsyth? 18 A. Yes, I did. 19 Q. Now, there has been testimony in the case 20 already that Mr. Forsyth may have had a personal 21 religious experience himself at some time during the 22 last month or months of his life. You're familiar 23 with that issue? 24 A. Yes. 25 Q. What I'd like to ask you to do is turn to PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2077 1 Exhibit 172, which is at tab six of your book, and 2 specifically turn to the dated entry in June Forsyth's 3 journal dated January the 12th, 1993. It should be 4 marked there. 5 A. Yes. 6 Q. Do you see that? 7 A. Yes. 8 Q. All right. Would you just read the jury just 9 the first highlighted section there in Mrs. Forsyth's 10 journal under the date January 12, 1993? 11 A. "January 12th, 1993, Bill told me he kneeled 12 down in the hall and asked you into his heart. Oh 13 Lord, thank you. Please honor that little baby step 14 as he crosses into his walk with you for all eternity. 15 I praise you for the work you've done in his life. If 16 your word is true, and it is, he is now born again." 17 Q. Now, Dr. Matthews, I want to refer you back to 18 Dr. Roberts' chart for the January 18, 1993 entry. 19 Now, the portion of Mrs. Forsyth's journal that you 20 just read, that described an experience that her 21 husband related to you, was January the 12th, 1993, 22 right? 23 A. Yes, that's correct. 24 Q. Now, let's look at Mr. Forsyth then coming to 25 see his psychiatrist, Dr. Roberts, on January the 18th PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2078 1 of 1993, and I want to direct you specifically to an 2 entry that says, "Too much religion," and then there's 3 an arrow pointing to "stress." Do you see that? 4 A. Yes. 5 Q. Now, I want to also go to the next page, which 6 is also January the 18th, 1993, specifically to the 7 entries down at the bottom which read, "Wife and kids 8 so totally into spirituality, fighting God back." Now, 9 those were entries that you reviewed in your analysis 10 of these materials? 11 A. Yes. 12 Q. Can you tell us the relationship, if any, and 13 the significance, if any, to your opinions about 14 whether religious life or religious activity was a 15 stressor in Mr. Forsyth's life using the entry in 16 Mrs. Forsyth's diary you just read dated January the 17 12th, '93, and the information in Dr. Roberts' charts 18 about the religious issue dated six days later on 19 January the 18th of 1993? 20 A. Yes. 21 Q. Would you do that, please? 22 A. I think that, at this time, as we've seen, 23 Mr. Forsyth is extremely depressed, and he has been 24 turning to psychiatry for help and he's still 25 depressed. He's been taking medications, he's been PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2079 1 getting therapy, and he's still depressed. He has, 2 for some time, not been, I think, very accepting of 3 his wife's religious views, but I think he's a man 4 who's, as we've seen, is becoming kind of desperate, 5 looking for help in every way, and he is, I think, 6 trying to get some help even from there. But I think 7 that it has not worked and that he still is not -- 8 does not have that religious perspective; that he 9 finds that his wife is excessive in that regard, and 10 that, basically, all of the religious activities that 11 she's involved in are stressful on him and he has 12 not -- it has not offered him the kind of comfort 13 which he might have liked. 14 Q. Now, let me ask you a general question, 15 Dr. Matthews. You said that you had reviewed the 16 writings that we have from Mrs. Forsyth? 17 A. Yes, I have. 18 Q. And you've also reviewed Mrs. Forsyth's records 19 regarding her own psychiatric conditions and 20 treatment? 21 A. Yes, I have. 22 Q. Now, before we look at those things, would you 23 tell us what significance, if any, the existence of a 24 psychiatric condition or emotional problems in one 25 spouse has on the relationship and has on the PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2080 1 emotional condition of the other spouse? 2 A. It is very hard to live with someone who is 3 seriously depressed, and the mental condition, 4 emotional condition, of one of a spouse pair affects 5 the other very seriously; that you know some of the 6 symptoms of depression and those symptoms of 7 depression, when you're living with a person who is 8 experiencing those symptoms and acting in those ways 9 that a depressed person experiences and gives off, 10 that for the spouse, it's very difficult. 11 So, not surprisingly, we know that when one 12 member of a spouse pair is depressed, there's a great 13 risk of depression in the other member. And we know 14 when one member of a spouse pair is depressed, that 15 that very commonly produces a lot of marital 16 difficulties for many reasons. So that's the 17 relationship between the two. 18 Q. Now, I'm going to ask you to explain for the 19 jury the significance of your views regarding 20 Mrs. Forsyth's writings, and these are all in 21 Exhibit 172, but the copies of the blowups, for the 22 Court's convenience, would be located at 1033. 23 THE COURT: Thank you. 24 Q. (By Mr. See) Now, Dr. Matthews, we've already 25 had testimony that Exhibit 1033 is a book of PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2081 1 Mrs. Forsyth's writings, a journal if you will, and 2 that book carries dates from April to May of 1991, and 3 that's also your understanding from your review of the 4 materials? 5 A. Yes. 6 Q. I'm sorry. These should be at tab seven of 7 your book there for your convenience. 8 A. Yes. 9 Q. Do you have the first one there that starts 10 out, "The end of my world"? 11 A. Yes. 12 Q. Now, I just want to read this for the jury and 13 then ask you the significance of Mrs. Forsyth's 14 writings, and this is now sometime around April, May, 15 or the middle of 1991. "The end of my world, peace, 16 life, joy, control, thrown to the wolves. No place of 17 safety. Totally unable to deal with future security 18 and with peace. Losing all support, like a death, in 19 a sense, in knowing that nothing will ever be there 20 for me, my needs will never be maritally filled. Lost 21 in space. No rope to grab onto. Just unlimited 22 nothingness. Avoid. Everything is gone that I need 23 to survive. I want to survive. The pain, the pain 24 grabs hold of me." 25 Does this have significance for your views PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2082 1 regarding Mrs. Forsyth's condition as it may have 2 affected Mr. Forsyth? 3 A. Yes. 4 Q. Tell us what it is, please. 5 A. Mrs. Forsyth, at this point in time, is 6 expressing some depressive symptoms, that Mrs. Forsyth 7 has the same condition that Mr. Forsyth had, the same 8 diagnosis, major depression, and the emotional pain 9 that she's experiencing is expressed here. The sense 10 of purposelessness, the pessimism, the thoughts of 11 death, they're all associated with depression and all 12 can predictably have a bad impact on the marriage and 13 on the spouse. 14 Q. And this next one is from the very same 15 exhibit. This one reads, "I'm stabbed to my inner 16 core. The horror is so great, I want to die, but I 17 can't. That, too, is the horror, knowing I must go 18 on. Wanting to cry and run away, but knowing there is 19 no way out. No place to run that is safe and having 20 to stay in that terrible pain forever, so alone, so 21 alienated, so unable to connect to anyone or anything. 22 Hell. Nothing comforting or safe and warm and secure, 23 just fear and a terrible painful emptiness. No way 24 out forever." 25 What significance would this writing have to PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2083 1 your opinions in this case, Dr. Matthews? 2 A. I think this writing is expressive of terrible 3 emotional pain and serious depression, including 4 thoughts of death, wanting to die, but the -- not 5 feeling that she can end her life. The -- it 6 illustrates how, when one feels so bad as a result of 7 being depressed, when one experiences this terrible 8 emotional pain that she's experiencing, that one 9 thinks about dying and that death is preferable to 10 experiencing that pain. It shows the pessimism and 11 the emptiness that is associated with depression. 12 Depression is a terribly painful condition when it's 13 serious, and this is obviously quite serious. 14 Q. And the next is also from the same exhibit, 15 again, the notes of Mrs. Forsyth in the April-May time 16 frame in 1991. "TV movie about a man who kills wife 17 and unborn child. He walked into home they lived in 18 nighttime, carries flashlight, opens closets and 19 cupboards, knowing he's the killer, but no one else 20 knows. He's living a lie. It struck a cord. 21 Overwhelmed me. He was living a lie. Was that me, 22 just faking who I am? Walking through darkness, 23 pretending I'm good and real when inside, I'm flawed 24 and a destroyer. It was my first glimpse into 25 something. I did identify some reality in that short PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2084 1 scene. Very deep stuff. I couldn't take it all in or 2 understand it. It didn't come clear, but I realize it 3 had some great significance." 4 Would you tell us the significance, if any, 5 about that entry by Mrs. Forsyth in 1991? 6 A. Mrs. Forsyth had expressed a concern that she 7 was living a lie that she had put on for many years in 8 front of her kids and in front of the rest of the 9 world, a big facade about how she felt about the 10 marriage and how she felt about herself, and did not 11 let on, even to her family, how depressed she was or 12 how horrible her marriage was from her point of view. 13 And so the living the lie, seeing that in her, I 14 think, refers to that. Pretending she's good, seeing 15 herself as flawed, is a sign of depression for sure. 16 I think this is, once again, evidence of her 17 depression. 18 Q. And, again, from the same exhibit, again from 19 the notes of Mrs. Forsyth, "My recurring dream, the 20 bedroom, me in bed under comfy soft blanket, a 21 crooning sound in the music. How I did remember that 22 music for years, like I know the melody so well, there 23 was no song I've ever heard or ever did hear or even 24 close to any melody, just a song, music, from where? 25 The crooning, soothing, comforting. The black figure PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2085 1 in the corner, who or what was it? It never moved, 2 and maybe if I didn't move, it wouldn't hurt me. 3 Maybe if I did move, it would hurt me. I didn't move 4 or even look over there. What was I looking at? 5 Maybe I had my eyes closed. Who is crooning? Where 6 was the melody coming from?" 7 What is the significance of that entry by 8 Mrs. Forsyth to your views of the case, Doctor? 9 A. I think the association of a black figure 10 possibly hurting her is, you know, a depressed thought 11 about death, that that's more evidence of depression. 12 Q. From the same exhibit. Again, from 13 Mrs. Forsyth's notes, "When I first started feeling, 14 the thing I felt most often was I was lost in a dense 15 fog or I would be overwhelmed by things like boredom, 16 confusion, desperation, hopelessness or anxiety. What 17 I gradually learned was these were not actually 18 emotions, but lids I kept on my emotions. As soon as 19 I had a glimmer of raw feeling, I would throw a big 20 thick blanket over it to cover it up. If I scratched 21 beneath the boredom, there was usually anger. Anxiety 22 covered up terror. Hopelessness and depression were 23 rage turned inward." 24 Could you tell us the significance, if any, of 25 that to your view? PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2086 1 A. She's expressing a lot of emotions that are 2 associated with depression; mental confusion, 3 desperation, hopelessness. Anxiety is very commonly 4 associated, in a greater or lesser degree, with 5 depression. She's got a sense of how she handles her 6 feelings and how she covers up one with another here. 7 The idea of hopelessness and depression being rage 8 turned inward, that's a common psychological 9 explanation that is sometimes given for depression. 10 The anger, I have to assume that's anger at 11 Mr. Forsyth because of the difficulties that they had 12 over the years. 13 Q. From the same exhibit, the next blowup. "Just 14 a nothing floating around. No mind of my own. Ugly, 15 low self-esteem, no self-reliance or motivation, a 16 total zero. Still much anxiety. I have no abilities. 17 An inability to set a goal and carry out to 18 fulfillment. I am fearful. I don't have any faith in 19 my abilities. I feel like a complete zero." 20 Now, Doctor, can you tell us what significance 21 this entry has, if any, upon Mrs. Forsyth's own self 22 image on her relationship with her husband? 23 A. This is an extremely low self image and is 24 suggestive of feeling totally worthless, and that's 25 characteristic of feeling depression. And it's very PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2087 1 hard to participate well in a relationship when you 2 feel totally worthless. I think that, you know, it's 3 sometimes said you can't love someone else until you 4 love yourself, but it is very hard to participate 5 constructively in a marriage when you feel like a 6 complete zero and think yourself ugly and having no 7 self-esteem. 8 Q. From the same exhibit, Mrs. Forsyth's note that 9 reads, "All the years he was drinking and wasn't there 10 for me or the kids, I tried to let him know of the 11 pain and stress I was suffering, but as soon as I got 12 below the surface, he left the room or left the 13 house." Let me just stop right there. I want to 14 specifically ask you about Mrs. Forsyth's description, 15 "As soon as I got below the surface, he left the room 16 or left the house." What significance, if any, does 17 that particular entry by Mrs. Forsyth have regarding 18 what you've already testified about as Mr. Forsyth's 19 mechanism or way he coped with stress or conflict? 20 A. This is Mrs. Forsyth telling us that, that this 21 was the way that her husband handled stresses in the 22 marriage and handled her own expressing of her 23 emotions and her difficult feelings and her bad 24 feelings, which he couldn't handle it, he would flee, 25 and he would do that during the period of time he was PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2088 1 capable of doing that. 2 Q. Now, the entry goes on, "One day in the desert, 3 some of these issues came up and for the first time, 4 he heard part of what I was saying or crying about and 5 he went into total denial, turned on me, accused me of 6 changing and making him unhappy. Things have gone 7 downhill ever since." 8 Doctor, we've heard testimony in the case about 9 a catalog of grievances, a meeting that Mr. and 10 Mrs. Forsyth had. Is that an entry that relates to 11 that? 12 A. That's my belief, yes. 13 Q. If it has significance to your views, would you 14 tell us what those are? 15 A. Well, I think this entry really speaks of very 16 serious long-standing marital problems that go back 17 quite long in the marriage, and that Mrs. Forsyth, in 18 terms of her own distress in the marriage, was not 19 able to really effectively express to her husband for 20 many years, and finally, on this one day, she did 21 express it, and that that expressing, he finally had 22 to hear her in some way, and that expressing of it was 23 a stressor for him; and that their marriage, which was 24 facade good, but really very troubled beneath the 25 surface, particularly from her point of view, that PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2089 1 even deteriorated further, and that's what she's 2 saying. 3 Q. The next is from the same exhibit. "I realize 4 I was extremely co-dependent and I was an enabler in 5 his alcoholism and lived a lie for so many years. I 6 was his everything. His actions sucked me dry of who 7 I am. My life was lived like a juggler. My sole 8 purpose 24 hours a day was to keep our family like the 9 all-American family, no faults or flaws. I never told 10 one person our secrets. I lived a lie and it did much 11 destruction to me. I lost who I was. He gets so 12 angry if I say something needs fixing around the 13 house." 14 Now, does this entry have significance for your 15 opinions in this case? 16 A. Yes. 17 Q. Tell us about that, please. 18 A. Mrs. Forsyth was very involved in putting on a 19 good front for the rest of the world and for her 20 family. Her children really didn't understand what 21 she was going through and that is -- that is done at a 22 cost to one's self, that if you aren't genuine, that 23 if you can't express your true self to anyone and 24 totally keep your feelings bottled up inside, that 25 that comes out in a number of years, and I think the PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2090 1 first paragraph is reflective of that. The second 2 paragraph, I guess it sort of speaks for itself. It 3 speaks of her husband's anger and I guess other small 4 things. 5 Q. The next is from the same exhibit as well. "I 6 managed apartments for 20 years and he didn't want 7 anything to do with it. Now he's doing the same thing 8 with our daughter. She's an engineer, works long 9 hours, one hour's drive each way to work. He's got 10 her living in our house and managing all our rental 11 units. I feel this is wrong. When I tell him, he 12 becomes so angry. I thought I was being a good wife. 13 I mistakenly translated submissive to doormat. I 14 thought unconditional love meant if you act lovingly, 15 your partner will treat you lovingly. Wrong." 16 Again, Doctor, if this has significance, would 17 you explain to us, please? 18 A. I think this indicates one of the areas of 19 conflict between the couple and one of the things that 20 was a bone of contention between them. Also, it shows 21 that Mrs. Forsyth really tried and, I guess, went very 22 far in submerging herself in being deferential to her 23 husband in order to get him to act lovingly, and that 24 did not ever really work. 25 Q. Now, this is the last blowup from Exhibit 172, PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2091 1 again, from Mrs. Forsyth's handwriting. "I was 2 co-dependent in my marriage and every time I tried to 3 break out and be who I was created to be, Bill reacted 4 badly or else walked away." 5 Tell us what significance that has on your 6 opinion, Dr. Matthews. 7 A. I think that this, once again, refers to 8 Mr. Forsyth's tendency to flee conflict in the 9 marriage. When there's difficulty, when his wife 10 tried to express herself or change in any way, as she 11 later did, that he would -- he couldn't handle it, and 12 when he wasn't depressed, he would flee. And I think 13 that this supports the notion that that's his usual 14 reaction style which was frustrated by his depression 15 at the end. 16 Q. Now, Dr. Matthews, you have also reviewed the 17 records regarding Mrs. Forsyth's treatment by 18 Dr. Catherine Iannitello, a psychiatrist on Maui? 19 A. Yes. 20 Q. You'll see Dr. Iannitello's records at tab 21 eight in your book and it's Exhibit 1021. Did you 22 find the blowup of that one in your book, Doctor? 23 A. Yes. 24 Q. Now, I want to ask you about the entries for 25 Dr. Iannitello. The first entry is dated June 24, PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2092 1 1991, and says, "Self-referred for evaluation for 2 depressive syndrome, recurrent after three to four 3 years remission." 4 First of all, there has been some testimony in 5 the case and it is your understanding that Mr. Forsyth 6 had a problem with recurring major depression; that 7 is, it came back? 8 A. Yes. 9 Q. It goes on, "Current symptoms include sleep 10 disturbance with early a.m. awakening, poor 11 concentration, worthlessness, helplessness, 12 anhedonia." Would you tell us what that is? 13 A. Anhedonia is the inability to experience 14 pleasure in life, enjoyment in life. 15 Q. "Withdrawal and passive thoughts of death." 16 That entry goes on, "Patient confuses loyalty with 17 fear. Don't make waves attitude prevails. 18 Self-sacrificing behavior erodes her self-esteem. 19 Feels she's wasted her life being a stifled nobody," 20 and then again, "passive wish for death." 21 The August 16, '91, entry indicates, Patient's 22 husband has separated from her last week." 23 Now, Doctor, I'd like to ask you what 24 significance to your opinion, if any, does the notes 25 of Dr. Iannitello have with regard to her evaluation PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2093 1 and treatment of Mrs. Forsyth for depression? 2 A. Well, this note certainly confirms the 3 diagnosis of depression in Mrs. Forsyth, and there's a 4 listing of the various symptoms that she had which are 5 the symptoms of major depression. It talks about some 6 of the troubles in the marriage and also shows the 7 fact that thoughts of death, passive thoughts of 8 death, which is the thought that you may be better off 9 dead, and Mr. Forsyth had a passive thought of death 10 shortly before he did what he did, that these are 11 evidence of the kind of pain that people experience in 12 depression. 13 Q. Now, have you also reviewed, Dr. Matthews, the 14 notes of Traci Jennings, a therapist that Mrs. Forsyth 15 went to see? 16 A. Yes. 17 Q. That's at tab nine of your book. 18 MR. SEE: And this, Your Honor, will be at 19 Exhibit 1020. 20 Q. Do you have that, Doctor? 21 A. Yes. 22 Q. Now, we're referring here again to this 23 July-August 1991 period. It indicates, "The client 24 telephoned on July 4, '91, in a crisis. She presented 25 and relayed a history of social isolation, decreased PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2094 1 self-esteem, anxiety, fear of her father, and no 2 memory at all prior to age 17." 3 The next entry, August 3rd, "The client 4 telephoned for our scheduled session. She was in 5 tears and relayed how she had been feeling such 6 sadness, loneliness, anxiety and depression." And the 7 last entry on the blowup is August 10 of '91. "The 8 client telephoned at her scheduled time. She is 9 experiencing increased anger, sadness, and depression, 10 and stated she is contemplating returning to the 11 Mainland because her husband refuses to discuss any 12 plans of when they will return there to live. 13 She is becoming increasingly aware of the 14 problems and conflict in their marriage, part of -- 15 part, in their inability to communicate and her 16 husband's ignoring of her needs, concerns, feelings, 17 et cetera." 18 What significance, if any, do the entries of 19 the notes of Mrs. Forsyth's psychotherapy sessions 20 with Traci Jennings have to your opinion? 21 A. I think this is further evidence of her 22 depression and further evidence of her marital 23 problems. 24 Q. Now, I'd like to turn also to another part of 25 Exhibit 172, the notes of Mrs. Forsyth. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2095 1 MR. SEE: But this blowup, Your Honor, will be 2 at 1032. 3 Q. And, Doctor, it should be at tab ten in the 4 book there you have in front of you. Now, these 5 notes, that are on the blowup marked 1032, are in a 6 different book than Mrs. Forsyth kept; is that 7 consistent with your review, Dr. Matthews? 8 A. Yes, I believe so. 9 Q. And are there particular dates contained in 10 that book to help us date these particular loose pages 11 that were just stuck in the book? Do you have a 12 recollection of that? 13 A. I believe so. Yes. 14 Q. Can you recall what the dates are in this 15 particular book, just for reference? 16 A. I think that this was a '92 into '93 book. 17 Early '93 was the last entry. 18 Q. And these particular pages that were blown up 19 were loose pages simply stuck in the book? 20 A. Yes, that's my understanding. 21 Q. Now, I'd like you to refer, please, to an 22 exhibit that you have a copy of in your book, which is 23 from Exhibit 165, the Maui police records. If you'd 24 turn over to tab 11 in your book, there will be two 25 photographs there. Do you see those? PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2096 1 A. Yes. 2 Q. Do you have those in front of you, Doctor? 3 A. Yes, I do. 4 Q. And are the loose pages that are blown up here, 5 Exhibit 1032, those pages were actually stuck into the 6 book that's pictured in Exhibit 165? 7 A. That's my understanding, yes. 8 Q. The first of those photos just shows the cover 9 of the book. If you look at the second one of those, 10 again, all part of 165, this shows the desk; do you 11 see that one? 12 A. Yes. 13 Q. And does that photograph show that the book, 14 that is, Ms. Forsyth's journal or diary from which 15 1032 was obtained, is sitting on the edge of 16 Mrs. Forsyth's desk in their home? 17 A. Yes. 18 Q. And it is your understanding, Doctor, that the 19 police photographs that are Exhibit 165 were, in fact, 20 taken at the time of the investigation immediately 21 after Mr. and Mrs. Forsyth were found deceased? 22 A. That's my understanding, yes. 23 Q. Now, I'll read Ms. Forsyth's notes. Let me 24 just ask you this: Is it possible to get an exact 25 date on these loose pieces of paper that were stuck in PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2097 1 that date -- 2 A. No. 3 Q. -- found on her desk? 4 A. No, it's not. 5 Q. Okay. Now, the first says, "My needs will 6 never be known or fulfilled. Lost in space. No ropes 7 to grab onto. Just unlimited space, just unlimited 8 nothingness. Avoid. Everything is gone that I need 9 to survive. How will I survive? The pain, the pain 10 grabs hold of me. I'm stabbed to my inner core. The 11 horror is so great, I want to die, but I can't." 12 And the second one reads, "Bill hates me, 13 resents me, because I am the one person who shows him 14 his weaknesses. He doesn't want to be accountable and 15 living with me brings him up against his weaknesses. 16 Also, he has presented himself as strong and 17 righteous, and I bought into that so deeply, that I 18 had been reacting to him for a long time as a very 19 strong, powerful man when, in realty, he isn't at all. 20 So I must change my mind about that and react and 21 think differently about him." 22 Could you tell us the significance that these 23 entries have for your opinions, Dr. Matthews? 24 A. The first portion is obviously suggestive of 25 just terrible, terrible emotional pain and wanting to PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2098 1 die and just serious depression, and shows how the 2 thoughts of death, you know, come up in response to 3 such serious kind of pain when someone suffers from 4 major depression. 5 The second portion, it shows her perception of 6 what her husband thinks of her and why, and it is that 7 she shows up his weaknesses, and I think that -- I 8 don't know that this was written near the end, but I 9 think that that's part of what the psychological 10 dynamics were when we talk about his dependency and 11 weaknesses and being very, very close to her, the way 12 he felt forced to be at the end, made him angry and 13 made him hate her or resent her in some way. That is 14 part of the dynamic of the relationship that she 15 perceives that I take away from this. 16 Q. Doctor, now let me go back and ask you one more 17 question about the entry at the top, and particularly, 18 the entry, "The horror is so great, I want to die." 19 And the question I'd like to ask you is this: Using 20 that as an example, can you tell us the place of 21 suicide as a part of the disease of major depression? 22 A. I'm sorry. The place of -- 23 Q. Sure. How suicide is involved in the disease 24 of major depression. 25 A. Major depression involves tremendous suffering, PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2099 1 and I think that Mrs. Forsyth has done a very graphic 2 job of expressing her suffering in her writings, and I 3 think that Mr. Forsyth has done so as well. When one 4 is suffering so much, one just feels one needs to put 5 an end to the suffering. That's a response to just 6 extreme emotional pain, and that's what suicide is in 7 a depressed person. 8 MR. SEE: All right. Thank you. Your Honor, I 9 would pass the witness and, at this time, ask the 10 Court for permission to publish to the jury the two 11 photographs of Mrs. Forsyth's journal from 12 Exhibit 165. 13 THE COURT: Well, I've already seen them there, 14 haven't they? 15 MR. SEE: The photographs are of the location 16 of the book where this came from. 17 THE COURT: Oh, very well. 18 MR. SEE: Thank you, sir. 19 THE COURT: Mr. Vickery. 20 MR. VICKERY: Thank you, Your Honor. 21 CROSS-EXAMINATION 22 BY MR. VICKERY: 23 Q. These big blowups, did you choose which ones to 24 blow up or did Mr. See? 25 A. I'm not sure. I referred to a lot of this PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2100 1 material in my report and, ultimately, the decision 2 was made by Mr. See or his colleagues. 3 Q. Can you explain for us, sir, why didn't you 4 blow up any of the entries from 1992 or 1993 from 5 June's journals? 6 A. Again, I didn't blow up these entries. These 7 were prepared by Mr. See or his office. 8 Q. Did you look carefully at the 1992 and 1993 9 materials? 10 A. Yes. 11 Q. And they're completely different in character, 12 are they not, sir? 13 A. Yes, they largely are. 14 Q. Now, Dr. Matthews, you have seen June Forsyth's 15 innermost thoughts and fears, have you not, sir? 16 A. I believe so. 17 Q. I mean, you've seen her journals from 1991 that 18 we've just gone through, correct? 19 A. Yes. 20 Q. You've seen the notes of her work with Traci 21 Jennings in 1991, when she was trying to get some 22 help, haven't you? 23 A. Yes. 24 Q. You saw her notes of Dr. Iannitello, who she 25 sought out help for in August -- or from, in August of PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2101 1 '91, correct? 2 A. Yes. 3 Q. And did you read the sworn testimony of both of 4 those ladies? 5 A. Yes. 6 Q. Tell us this: Was her problem in 1991 a 7 problem with her husband or with her father? 8 A. I think her problem was with an illness called 9 major depression, and that some of those issues 10 involved -- some of the difficulties involved her 11 father or her thoughts about the relationship with her 12 father, and some involved her relationship with her 13 husband. 14 Q. Now, considering that this entry back here in 15 Traci Jennings, this is a social worker kind of a 16 person, right? 17 A. It's a Master's level psychotherapist, I think. 18 Q. All right. When she says fear of her father 19 and no memory at all prior to age 17, does that 20 suggest to you that this lady, at this time in her 21 life, was dealing with some very, very old problems 22 relating to her father? 23 A. Yes, I believe so, and that those continued to 24 probably manifest themselves in her relationship with 25 her husband. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2102 1 Q. And do you believe -- I understand fully well 2 that these three pages were stuck in the '92-'93 3 journal, but do you really believe, sir, from 4 everything else in that journal, that these pages are 5 from '92-'93? 6 A. No, I don't believe that. I said we can't date 7 those pages. I don't know is the answer. 8 Q. There is nothing else in the journal in '92-'93 9 that reflects the kind of emotional pain that this 10 lady went through in '91, is there? 11 A. That's right. That's what I think. 12 Q. Here's the original. You've seen this, haven't 13 you? 14 A. Yes. 15 Q. And the '92 journal, it's on lined paper, isn't 16 it? 17 A. Yes. 18 Q. And these three pages are not the only three 19 pages that were stuck in that journal, there's a whole 20 bunch of other stuff, isn't there? 21 A. Yes, there is. 22 Q. We don't know if the police stuck that in or 23 she stuck it in or who stuck it in that journal, do 24 we? 25 A. We don't know if she did or if her husband did PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2103 1 or who might have. We just don't know. 2 Q. But you will agree with me, will you not, sir, 3 that the bound things, that we know come from 1992 and 4 '93, have nothing of this tenor? 5 A. The bound material does not have material of 6 that tenor, that's correct. 7 Q. Okay. I mean, is this just put up here and 8 blown up because it says, "I am stabbed to my inner 9 core"? Is that the long and the short of it, 10 Dr. Matthews? 11 A. Once again, I didn't make those blowups, so I 12 can't speak to the motivation of who made what 13 blowups. 14 Q. I mean, you will agree with me that that sort 15 of -- that sounds like it has something to do with 16 what happened two years later? 17 A. It does sound like it does. 18 Q. Because she says, "I am stabbed to my inner 19 core"? 20 A. It's eerie. 21 Q. Anyone you know ever said something like that? 22 Has your wife or someone else ever said, boy, that 23 stabbed me to my inner core? 24 A. I'm a psychiatrist, sir, so I've heard people 25 say things like that before, let me just leave it at PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2104 1 that. Hearing about serious depression and the 2 tremendous pain that seriously depressed people feel, 3 I am not a stranger to that. 4 Q. Let me follow up on that with you, 5 Dr. Matthews. You are trained in traditional 6 psychotherapy, aren't you? 7 A. I was trained in traditional psychotherapy many 8 years ago, yes. 9 Q. And have you done traditional therapy from time 10 to time throughout the years? 11 A. I have, yes. 12 Q. And have you trained the new generation of 13 psychiatrists in those techniques? 14 A. Yes, I have. 15 Q. And is one of the things that you do, when you 16 work with someone in psychotherapy, really encourage 17 them that what you're saying to them is confidential 18 and it's private just between the two of you? 19 A. Well, I think nowadays, what we do is say, with 20 certain legal exceptions, yes, that what we're saying 21 is confidential; that if we think that you're 22 dangerous to yourself or someone else, then material 23 may be released, but basically, this is a 24 confidential, private relationship. 25 Q. And do you encourage them to sort of dredge PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2105 1 back to their earliest childhood memories and bring 2 out things that bother them or anger them? 3 A. Sometimes. Sometimes we encourage them to not 4 do that and to try and get on with life and to cope 5 better with their current situation. There are 6 different schools of psychotherapy and there are 7 different approaches to psychotherapy, so what you say 8 is sometimes true and sometimes not. 9 Q. Do you encourage them sometimes, as they dredge 10 up old feelings, to express them very bluntly? 11 A. I suppose, if you're encouraging them to 12 express them, then the answer is yes. 13 Q. And do you, as part of that process, frequently 14 encourage people to write them down themselves in 15 their own personal journal? 16 A. I have very rarely done that and I have never 17 recommended that anybody do that. 18 Q. Do you find that sometimes people, particularly 19 well-educated people like the Forsyths, when they are 20 going through that process, it's typical for them to 21 keep very private personal journals in which they 22 write down things that have bothered them either 23 present or past? Do you agree with me that a lot of 24 folks do that? 25 A. That people do that? PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2106 1 Q. Yes. 2 A. Yes, people do that. 3 Q. Now, what is the very first step that a 4 psychiatrist takes when someone comes to them for the 5 first time? 6 A. I think, normally, you say, tell me about what 7 the circumstances are that bring you here. 8 Q. Is that called a history? 9 A. Well, okay, that's part of the history, yes. 10 The first thing you do is take a history. 11 Q. Not just psychiatrists, but that's something 12 that every doctor is trained to do, is it not, to take 13 a history? 14 A. Yes, that's correct. 15 Q. And we expect, when we look at medical records, 16 that the very first medical record will chronicle the 17 history, do we not? 18 A. That's often true, yes. 19 Q. And history is things that happens in the past; 20 correct, sir? 21 A. Past up to the present, yes. 22 Q. So I want to ask you about the history that was 23 given to Dr. Roberts. In this blowup, this is his 24 first visit on -- I'm sorry, I don't have all the Q 25 and A's here for what your tab number is. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2107 1 A. That's okay. 2 Q. Can you see it? 3 A. I'll do the best I can here. 4 Q. Let me move these '91 materials out of the way 5 here. 6 A. I have that one. 7 Q. Okay, sir. I want to ask you, sir, whether 8 this thing, "Loneliness is biggest problem," do you 9 see how that's blown up over here on the side? 10 A. Yes. 11 Q. We see it right here in the handwriting, but 12 what's not blown up? What is not blown up and typed 13 up by Mr. See that occurs in the handwriting right 14 after that? 15 A. "No alcohol or" -- "no alcohol, no running 16 around." 17 Q. "No alcohol, no running around," okay, sir. 18 And then, after that, what does it say? 19 A. "Saw counselor in L.A, unbelievable." 20 Q. "Unbelievable." What's that "unbelievable" 21 relate to? 22 A. I don't know for sure. I can say what I think 23 it might relate to. 24 Q. Well, do you think it might relate to the 25 unbelievably good session that -- or sessions that PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2108 1 Bill and June had with Tom Brady over the course of 2 six weeks in L.A.? 3 A. It may relate to that, or to the fact that he 4 found the nature of what Dr. Brady was saying was not 5 believable. It's hard to know. 6 Q. Do you think -- you've read Tom Brady's 7 testimony, haven't you? 8 A. Yes. 9 Q. And you've read the testimony of other people 10 that describe how they were after visiting with Tom 11 Brady, haven't you? 12 A. Yes. 13 Q. And do you really believe that they were saying 14 that Tom Brady, the experience with Tom Brady was not 15 believable, or do you think they were saying it was 16 unbelievable? 17 A. Well, in the sense that he would be saying 18 "unbelievable" because, hey, this has fixed my 19 marriage and now, I'm fine, no, I don't think that's 20 what he's saying. 21 Q. Well, let me ask you this, Dr. Matthews: Have 22 you been updated with the testimony that's come out in 23 this trial? 24 A. Not really, sir. If there's something you'd 25 like me to refer to, I think you probably should tell PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2109 1 me. 2 Q. Well, for example, Mr. Capelouto, who had known 3 this man for 50 years and who had saw him regularly 4 when he was going through this experience, testified 5 right from the chair you're sitting in that Bill 6 Forsyth told him, at the end of the experience with 7 Tom Brady, his relationship was better than ever, it 8 was really good, even the sex. Now, were you aware of 9 that? 10 A. Well, I know he's used the word "better than 11 ever." I also know that it was never very good, so 12 it's hard to know what "better than ever" means. I 13 know he said that in the hospital, I think at a time 14 that he was really trying to cover up and put a 15 wishful thinking perspective on what his situation is, 16 so I believe there was that testimony. I don't think 17 that defines or really alters my opinion. 18 Q. Okay, we'll come back and get that in context. 19 Let's back up for a minute, if we may. Mr. See has 20 brought out the fact that you reviewed voluminous 21 materials and you wrote a 40-page report, correct? 22 A. Yes, sir. 23 Q. Now, that must have taken you a lot of time? 24 A. The whole process has been very time-consuming. 25 Q. Approximately how long do you think, how many PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2110 1 hundreds of hours? 2 A. To produce the report? 3 Q. Well, including everything, including getting 4 ready for testifying today and coming up here. From 5 start to today, how many hundreds of hours have you 6 got invested in this? 7 A. Not hundreds of hours. That's wrong. I think 8 about 135 hours. I asked my secretary to tally up the 9 time. 10 Q. A hundred and thirty-five hours? 11 A. Hundred thirty-five hours. 12 Q. Okay. Now, back when you did your report two 13 years ago, your hourly rate was $400. Is that still 14 the rate you're charging? 15 A. Yes. 16 Q. So if my math is good, at 135 hours at $400 is 17 what, about fifty something thousand dollars, 50, 18 $60,000? 19 A. Yes, sir. I think that's right. 20 Q. Okay, sir. Now, the very last sentence in your 21 report said, let me read it so I don't misquote it, 22 "In keeping with standards of practice, I will be 23 considering other information as it becomes 24 available." Now, did you mean that when you wrote it? 25 A. Certainly. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2111 1 Q. Are you willing to consider information that we 2 might bring to your attention to see how that might 3 alter your opinion? 4 A. Yes. 5 Q. Okay, sir. Now, the report was June 23rd, '97. 6 Have you received information since that time that you 7 have considered to see if it affects your opinion one 8 way or the other? 9 A. Yes. 10 Q. What information have you received since then? 11 A. Sir, I want to apologize. I'm deficient in not 12 having brought an entire list with me of -- 13 Q. I don't expect it to be comprehensive. Just 14 give us the gist. 15 A. I think it, very largely, was depositions and 16 material by experts on the plaintiffs' side of the 17 case; and also, I've continued to look at the 18 literature on murder/suicide and on side effects of 19 Prozac and other SSRIs as it's become available. 20 Q. Well, has it become available by virtue of your 21 going out and finding it, or has it become available 22 because Mr. See selected things for you to look at? 23 A. It has become available by both ways. Mr. See 24 has sent me material, but in no way would I ever let 25 that suffice. I constantly look up material on my PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2112 1 own. I'm constantly researching areas into the causes 2 of violence on my own and am involved regularly in 3 teaching in this area and make it my business to keep 4 up to date, at least to follow the literature to know 5 what's out there. So I would not let one side in a 6 lawsuit provide me with literature and let it rest at 7 that. I just wouldn't do it. 8 Q. Now, you do agree that we have never provided 9 you with anything, right? We've never given you our 10 side of it, never asked you how this would change your 11 opinion or that? 12 A. You've never spoken to me, but I've read 13 material that I believe your side of the case has 14 provided others about the negative effects of Prozac 15 purportedly, and things like that, but no, you haven't 16 contacted me and said, here, take a look at this. 17 Q. Well, how about the documents, the internal 18 documents, that give us some clue to what Lilly knew, 19 but which is not available in the published 20 literature, has Mr. See shared that information with 21 you? 22 A. Mr. See did not share that material with me or 23 ask me opinions about any internal matters at Lilly. 24 Q. Okay. One that jumps to mind is Plaintiffs' 25 Exhibit 58, which was a study according to the state PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2113 1 of the knowledge in March of 1985, in which they found 2 that the risk of suicide attempts, if you looked at it 3 mathematically, was 5.6 times higher on Prozac than on 4 Imipramine. Did you ever see that? 5 MR. SEE: Object. The question is beyond the 6 scope of direct and there's no foundation. 7 THE COURT: Sustained. 8 Q. (By Mr. Vickery) If you had been provided with 9 information, and the jury has this information, okay, 10 but if you had been provided with other information 11 like that, that I'm not going to ask you about in 12 light of this objection, would that have maybe caused 13 you to crank that into the equation and factor it into 14 your opinion? 15 A. I would take into account the information in 16 any study that I read, but would look at the methods 17 involved and try to -- at least as far as my skill 18 goes, and see -- taking it all put together if I 19 thought that it was correct, the results were correct. 20 Q. Okay. Now, I wrote down here a host of things 21 that you listed as being those things that you thought 22 contributed to the deaths of Bill and June Forsyth. 23 Remember early in your testimony, you gave a list? 24 A. Yes, I did, and it's in my report. 25 Q. And are each and every one of those things, in PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2114 1 your opinion, substantial factors in the deaths of 2 Bill and June Forsyth? 3 A. Is there a legal meaning to the term 4 "substantial factors"? I'm sorry, I don't -- 5 Q. It just means something that contributes in a 6 substantial way. 7 A. I think they're all important. They're all 8 important. 9 Q. All right. I want to list each one of them. 10 Before I do that, you understand this is a complex 11 phenomenon, that there are many different things that 12 go into human behavior as bizarre and violent as what 13 Mr. Forsyth did; you agree with that, don't you? 14 A. I agree with that. I think I understand that. 15 Q. Now, your memory may be better than mine, so 16 I've written them down, but would you sort of tick off 17 that list again for me? 18 A. The best way I can do it is to read from my 19 report. Would that -- 20 Q. No, I don't want you to read from your report. 21 Let me just ask you, because I think I made pretty 22 good notes about them, depression, his depression. 23 A. Yes. 24 Q. Was that a substantial factor? 25 A. Yeah. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2115 1 Q. You mentioned an anxiety disorder. Was that a 2 substantial factor? 3 A. Yes. 4 Q. Number three, you mentioned some risk factors 5 for suicide. 6 A. Yes. 7 Q. Now, you all didn't really discuss that in your 8 direct examination, but I may want to ask you what you 9 meant by "risk factors for suicide." Let me ask you 10 this now, sir: Are you a suicidologist? 11 A. I am not a suicidologist. 12 Q. Do you know what those people are? 13 A. It's a kind of broad term, but it refers to 14 people who specialize in studying suicide. 15 Q. Do you know any of them? 16 A. I do. 17 Q. Do you know one in this courtroom? 18 A. I do know one in this courtroom. 19 Q. Who is that? 20 A. That's Professor Ronald Maris. 21 Q. And was Professor Maris one of your professors 22 when you were at Johns Hopkins? 23 A. He was one of my professors at Johns Hopkins. 24 Q. Did he teach you about suicide? 25 A. He did. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2116 1 Q. Are you familiar with the numerous books and 2 articles he's written on this subject over the course 3 of a lifetime of study? 4 A. I'm familiar with some of them. I try to keep 5 up with what Professor Maris writes. 6 Q. Okay. Now, number four you mentioned was 7 stressors, and you mentioned several and I want to get 8 them each down. The first one you said was 9 retirement? 10 A. Yes. 11 Q. When did he retire? 12 A. It was several years ago. I'd need to look at 13 my notes to see the date. 14 Q. Would you buy '86? 15 A. It sounds early to me, but if you represent 16 that that's true, I accept it. 17 Q. I think somebody said it. 18 A. Again, it sounds early to me. I don't have it 19 written down. I don't know. 20 Q. Now, if his friend of 50 years, who also worked 21 with him in the business, Mr. Dave Capelouto, has 22 testified that the man loved retirement, that he did 23 fine with retirement for four years in California 24 before he even moved out here, how would that impact 25 your belief that that stressor, retirement, played a PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2117 1 part in what he did on March the 3rd of 1993? 2 A. Well, I was a psychiatrist on a neighbor island 3 and I treated people who had moved from the Mainland 4 to a neighbor island and retired, other people. 5 Living in Los Angeles is real different from living in 6 Maui and he had lived in Los Angeles for many, many 7 years, had a whole network of connections, and so 8 adding to the stress of retirement is the fair bit of 9 difficulty that people often have in adjustment when 10 they move from the Mainland to Hawaii late in their 11 life. 12 And also, when they move and all the supports 13 and all the purpose and connections that they have in 14 life are in some other place, and my sense is that his 15 retirement was not desired, and my reading of the 16 evidence is that his retirement was not desired, and 17 that that portion of his retirement that occurred in 18 Hawaii was unsatisfactory. I think that there's 19 really little doubt about that. 20 Q. Do you want to add island fever instead of 21 retirement? 22 A. I said it the way I said it. I think it's very 23 difficult to be far from home and very difficult to 24 adjust to new life, not only on an island, but a 25 different culture. You know, Hawaii is different from PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2118 1 living in L.A. 2 Q. Should we put move to Maui? 3 A. Sure. Put it. That's a stressor. 4 Q. Why did he move to Maui? 5 A. I think his wife was more eager to move than he 6 was. That's the impression I have. 7 Q. For what source? 8 A. Would you like me to go through and find the 9 source? 10 Q. Yes, sir. If you've got something where 11 somebody says that June wanted to move here more than 12 Bill, I want to know about it because we've heard 13 exactly opposite in the trial of this case. 14 MR. SEE: Your Honor, I object to the 15 commentary of counsel and move that it be stricken. 16 THE COURT: Sustained. It will be stricken. 17 THE WITNESS: I've found it. 18 Q. (By Mr. Vickery) Who said it? 19 A. This is from the deposition of Randolph D. 20 Neal, M.D. He said that his wife was primarily the 21 one who wanted to live in Maui and that was partly to 22 be closer to their son, and he was not real happy 23 about being in Maui. He really would have preferred 24 to be back in L.A. where his friends and contacts 25 were. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2119 1 Q. So we have to rely on Dr. Neal on that one? 2 A. Dr. Neal is a psychiatrist who -- 3 MR. SEE: Your Honor, I object to the question 4 as being argumentative. 5 THE COURT: Sustained. Are you going to be 6 much longer with this witness? 7 MR. VICKERY: Considerably. 8 THE COURT: Let's break for lunch now. Please 9 be back at one o'clock. 10 (Whereupon, a lunch recess was taken from 11 12:00 p.m. to 1:15 p.m.) 12 THE COURT: Please proceed, Mr. Vickery. 13 MR. VICKERY: Thank you, Your Honor. 14 Q. Dr. Matthews, before the lunch hour, we were 15 listening to the factors that you had opined are 16 substantial factors in the deaths of June and Bill 17 Forsyth. We talked about depression and anxiety 18 disorder and risk factors for suicide, and now we're 19 talking about stressors, retirement and move to Maui. 20 Now, you gave us some other stressors. What other 21 stressors? 22 A. I think he perceived his relationship with his 23 son as being troublesome. 24 Q. Do you have any evidence for that other than, 25 other than the statements by Dr. Randolph Neal? PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2120 1 A. I need to look and see. 2 Q. Okay. 3 A. Yes. 4 Q. Who else? 5 A. Dr. Brady. 6 Q. Dr. Brady? 7 A. Yes. 8 Q. Okay. What do you have Dr. Brady saying about 9 his relationship with his son Billy? 10 A. Billy was not as worker-oriented as Mr. Forsyth 11 and that there was friction about that. He might take 12 off for a two or three-week fishing trip. This was a 13 reason for having to do with friction, about how he 14 worked and how he took care of his family. He would 15 go off on these fishing trips, and he had little 16 children. I believe at the time, his wife might have 17 been pregnant. 18 "QUESTION: Bill didn't think that was the 19 right way for a father to behave? 20 "A, ANSWER: Yeah, that would be my 21 interpretation." That's from Dr. Brady's deposition. 22 Q. History or current problems, isn't Dr. Brady, 23 in all fairness, Dr. Matthews, recounting problems 24 that Bill, Sr., had had with Bill, Jr., in years past? 25 A. Well, I think this was including the time his PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2121 1 wife was pregnant, so I think that that dates it. So 2 I think these are concerns and it is consistent 3 between doctors, so I take it seriously. 4 Q. And is it your belief that the stress that 5 Mr. Forsyth had from his son going fishing caused him 6 to murder his wife and then himself? 7 A. I don't think any one of these things. As you 8 said before, this is a complex piece of human behavior 9 and all these factors work together, not any one. So 10 I think it would be inappropriate to take any one and 11 say that that did it. That's not an accurate 12 reflection of what I think or what my testimony was. 13 Q. What other stressors? Well, I nearly slipped 14 and gave you the biggy. How about his marital 15 relationship? 16 A. Well, I was going to ask had that been listed 17 under stressors since you've turned the page; marital 18 problems and recent discharge from a psychiatric 19 hospital without doing well and returning to a marital 20 situation that had been stressful. 21 Q. Okay. Now, I want to represent to you that we 22 have heard testimony in this trial from his long-time 23 friend, Dave Capelouto, the marriage was better than 24 ever; from her closest friend, Bobbi Comstock, that on 25 the day that they died, she sort of shunned her PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2122 1 friends, if you will, and said "I'm going to go get my 2 Bill, eat Mexican food and get my Bill; from Susan 3 saying, in December of '92, that her parents called 4 from a trip that they were taking while they were 5 going through therapy with Dr. Brady and said it's the 6 second honeymoon; from Dr. Brady himself who said that 7 they had gained lots of tools to deal with one another 8 and made lots of progress; from Dr. Neal himself who 9 said their relationship was better than ever as 10 confirmed by both of them. 11 So if all of that is true, do you really 12 believe that the marital problems, that they certainly 13 had had in the past, were a problem to them in 1993? 14 MR. SEE: My objection is to the form, Your 15 Honor. It's an incomplete hypothetical question. 16 THE COURT: Well, I think we all have to 17 recognize that it's hardly complete, but -- 18 MR. VICKERY: I was just trying to think how I 19 could complete it, Judge. I can go on and on about 20 other evidence that indicates that there's a good 21 relationship. 22 THE COURT: Maybe you better rephrase your 23 question. 24 Q (By Mr. Vickery) If there is an abundance of 25 evidence from the facts, from people that knew them, PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2123 1 that indicates that their marriage had been through 2 dark times, but was in good times in 1993, if the jury 3 chooses to believe, from the evidence they have heard 4 that that's the case, do you, sir, believe that on 5 March 3, 1993, that anything about their marital 6 relationship caused their deaths? 7 MR. SEE: Objection to the form. It's an 8 incomplete and an improper hypothetical. 9 THE COURT: I'll have to sustain that 10 objection. 11 Q (By Mr. Vickery) Have you considered all of 12 the evidence that indicates that their relationship 13 was good in 1993? 14 A. I don't know that I've considered all the 15 evidence because I haven't been sitting here and 16 watching the trial, but I've -- of all the evidence 17 I've considered, I think that their marital problems 18 were different in February of '93/March of '93, that 19 they took a different form, in some regard, 20 particularly with regard to this kind of dependency 21 that we've been talking about, but I think that they 22 were still there and I think that -- the fact that the 23 Forsyths had kept their marital problems hidden and 24 she worked to put such a positive spin on her 25 marriage, to some extent, takes away from the weight PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2124 1 that you can give to testimony, certainly testimony by 2 the children as to what the marital situation is. 3 I think the marital problems were completely 4 hidden from the children, and that all the evidence 5 shows that over the years, so for them to have that 6 opinion now, I can't give that very much weight. 7 Q. Dr. Matthews, I agree with you entirely from 8 1988, '89, '90, '91, their marital problems were 9 private, hidden from the children. Do you believe, 10 sir, that when they separated, when he flew from here 11 to the Mainland and went into intense psychotherapy 12 with Tom Brady and then asked June to join, were they 13 hiding that from anyone? 14 A. I don't think the separation was hidden, but I 15 think the extent and the nature of their marital 16 problems were quite hidden, and I think that's 17 revealed throughout the depositions of the children. 18 I think there were serious marital problems 19 right through up until the end. I don't think a brief 20 course of marital therapy is an effective tool, you 21 know. With all respect to my profession and the 22 profession of marriage counselors, I don't think it 23 transformed it overnight that way. I just don't think 24 it happens, particularly in the face of the husband 25 having a serious major depression. I just think that PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2125 1 that's not plausible. 2 Q. When did his major depression start? 3 A. It started in late '92, and certainly was 4 present by December of '92. 5 Q. By the start of December? 6 A. I believe there's evidence, in the start of 7 December, of depression. 8 Q. Well, that's not what Dr. Riggs Roberts' notes 9 say, is it? Don't his notes say that the depression 10 started -- right here. Look at this. Depression 11 started 12/20/92. Can we just toss out what Dr. Riggs 12 Roberts has to say? 13 A. I think there is -- it's unlikely for 14 depression that is of this nature to begin on a 15 particular day, and I think there is other evidence in 16 the documents that I looked at just this morning that 17 there was depressive symptoms earlier than that. 18 Q. So we're going to reject, then, what 19 Dr. Roberts says right here, this part that Mr. See 20 blew up, depression started 12/20/92? 21 MR. SEE: I object to the mischaracterization 22 of the testimony. The testimony was that that's what 23 Mr. Forsyth said. 24 THE WITNESS: I need to look at the actual -- 25 I'm sorry. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2126 1 THE COURT: Just a minute. What's the 2 objection? 3 MR. SEE: My objection is to the 4 mischaracterization of the testimony. I believe 5 Dr. Roberts said that's what Mr. Forsyth told him, not 6 what he noted as a physician. 7 THE COURT: He wasn't even treating Mr. Forsyth 8 at that time. 9 MR. VICKERY: Yes, sir, he was. 10 THE COURT: 12/20? 11 MR. VICKERY: December 22. He started on 12 December 16th was his first visit, and his note of 13 December 22nd says, depression started 12/20/92. 14 Q. So my question is, can we simply discard what 15 Dr. -- 16 THE COURT: As far as whether that was 17 Dr. Roberts' conclusion or whether that was something 18 that Mr. Forsyth told Dr. Roberts, I'll leave that to 19 the jury to recall the testimony of Dr. Roberts as 20 well as the exhibit itself. 21 Q (By Mr. Vickery) Are you willing -- 22 MR. VICKERY: I'm sorry, Your Honor. I stepped 23 on your words. 24 Q. Are you willing to simply discard what 25 Dr. Roberts wrote down? PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2127 1 A. I believe it contradicts the other evidence and 2 I think that it's implausible, so I don't accept that 3 his depression is two days old. I think that's not 4 true. 5 Q. Is that the only thing that Dr. Roberts wrote 6 down that you want to discard or is there other stuff 7 that he wrote down that you would like to discard? 8 MR. SEE: I object to the form of the question 9 as being argumentative, Your Honor. 10 MR. VICKERY: It's cross-examination, Your 11 Honor. 12 THE COURT: I'll allow the question, although 13 we've heard his testimony all morning on that. 14 THE WITNESS: Nothing comes to mind right now, 15 but if you'd like to give me his records to review, 16 I'll do that and see if there's something else that I 17 disagree with. 18 Q (By Mr. Vickery) Okay. We're still going 19 through these stressors and one that you didn't 20 mention at first when Mr. See asked you about, so I 21 need to. What about religious differences? 22 A. I think there were serious religious 23 differences and that was a stressor. 24 Q. And do you think those religious differences 25 existed up to the time of their deaths? PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2128 1 A. I think they probably did. 2 Q. Well, Mr. See took great pangs to point out to 3 you that on January the 12th, 1993 there was an entry, 4 remember he read aloud, "If your word is true, then 5 Bill is born again;" do you remember that? 6 A. I do. 7 Q. And then he showed you, on January the 18th, 8 where Dr. Roberts writes that Bill was fighting God 9 back; you remember that one? 10 A. Yes. 11 Q. Now, is there any entry anywhere, in any 12 medical record after January the 18th, that indicates 13 that Bill was either fighting God back or fighting 14 June over religion or that there was any religious 15 strife between the two of them? 16 A. There is not, but there is also not any entry 17 that suggests that he accepted religion or that it had 18 become an important part of his life or that it had 19 been of any help to him or that he felt that he was 20 saved, so I think that there's not. 21 Q. Did you not, sir, see in that very same 22 exhibit, June's 1993 calendar, where she wrote on 23 January the 26th, eight days after the entry about 24 fighting God back, quote, Bill's spiritual birthday. 25 Thank you, God. All things work together for good for PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2129 1 those who love the Lord and who are called according 2 to his purpose? Did you not see that or did you 3 simply not rely on that? 4 A. I relied on that. Again, I think people were 5 really looking around for something to be helpful 6 here. This is a terribly depressed man in a very bad 7 situation and, naturally, this is something that his 8 wife would have loved to have happened and loved to 9 have seen, that religion would come into his life and 10 take away this horrible depression and provide him 11 some comfort and some strength, but I don't see that 12 it happened. 13 I'm not an expert on religion, but I think that 14 if one thinks that spiritual matters are often helpful 15 to people in comforting them and relieving their 16 depression, as it truly is, I think that just didn't 17 happen with Mr. Forsyth. 18 Q. Well, did Mr. See tell you that June's best and 19 closest friend, Bobbi Comstock, this lovely lady 20 sitting right out here, testified that in January of 21 '93, that Bill Forsyth started reading the very books 22 that he had previously told her to get out of my face? 23 Did he not tell you that? 24 A. He did tell me that. 25 Q. And how does that strike you? Does that PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2130 1 indicate a man that's got religious resentment? 2 A. It strikes me exactly the same as I just said. 3 It strikes me as here's a man who is reaching out for 4 something to be helpful, that people who are under the 5 worst circumstance in their life, they turn to the 6 Bible, whether they're believers or not, they 7 naturally will if they're of that background, and 8 that's how I take it, not that he was faithful or that 9 the religious differences had been erased, but rather 10 that he was looking about desperately to treat his 11 serious depression and that it didn't work. 12 Q. So what you're saying, if I hear you correctly, 13 is that you question the sincerity of his religious 14 conversion experience; is that true? 15 MR. SEE: I object to the form of the question 16 because it misstates what the doctor just said. 17 MR. VICKERY: That's the reason why I asked him 18 if that's true. That's the way I interpret it, Your 19 Honor. I want to hear what he says. 20 THE COURT: I'll allow the question. 21 THE WITNESS: Sincerity is probably the wrong 22 word, and I don't think that's a word I used. I think 23 it's a word you used. I question whether his reading 24 the Bible, any turning toward religion that happened 25 at that time, I deeply question whether it had a PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2131 1 beneficial effect upon his psychiatric condition. I 2 see no evidence that it did. I'm not here to talk 3 about sincerity of people's faith and I didn't testify 4 in those terms, but I think that there's no suggestion 5 that I can draw from the record that this altered his 6 psychiatric condition any. 7 Q (By Mr. Vickery) Okay. Dr. Matthews, 8 incidentally, in your 135 hours working on this case, 9 has that included any kind of media training or 10 coaching or practice runs of your testimony? 11 A. No. 12 Q. Okay. I just wondered if maybe someone had 13 instructed you to speak directly to the jury instead 14 of to me. 15 A. My understanding is that the jury is going to 16 decide the outcome of this case and it's important 17 that the jury understand what I'm saying and that's 18 why I'm speaking to the jury, and it's not because of 19 media training. 20 Q. Okay. Well, that's true. They are going to 21 decide the outcome. Hopelessness, you listed before. 22 Is that on your list of stressors that were a 23 significant factor? 24 A. I believe hopelessness was present and is a 25 significant factor, and if you'd like to list it among PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2132 1 stressors, I think that's fine. 2 Q. I just wrote it down because you said it 3 earlier. 4 A. It's present. It's certainly present. 5 Q. Now, we have heard testimony that Mr. Forsyth's 6 fourth grandchild was going to be born two weeks after 7 this happened, that Mr. Forsyth had planned a trip to 8 Greece with a very delightful lady who had testified 9 here that he had taken many trips with before, and 10 that in December, he had rented an office for himself 11 down in Lahaina. Do those things sound like the 12 activities of a hopeless man? 13 A. Taken in isolation, apart from everything else 14 that we know about Mr. Forsyth, no, they don't, but I 15 think if you look at everything that we know about 16 Mr. Forsyth, that there was considerable hopelessness 17 and it was everywhere throughout his life. So I think 18 that you can't just look at those isolated facts. 19 Q. Okay, sir. Next factor -- I think we've gone 20 through all the stressors that I wrote down. Can you 21 think of any other stressors? 22 A. I mentioned -- I'm not sure whether you're 23 listing every factor that I considered in calling it a 24 stressor. There are other factors that I named and I 25 can bring those up now if you like. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2133 1 Q. If there are other factors that you considered 2 to be substantial factors in these deaths, then I want 3 to talk about them and list them. 4 A. Okay. 5 Q. Are there others? 6 A. Yes. 7 Q. What are they? 8 A. I think that you listed the fact that he 9 recently had been discharged from the hospital, I 10 think -- 11 Q. Well, I'm getting to that in a minute, but I 12 thought we were talking about life stressors right 13 now. Those are other factors. 14 A. We're splitting hairs a little bit. 15 Q. Let's go to that one, okay? 16 A. Okay. 17 Q. In your report, you say it was a premature 18 release from the hospital, right? 19 A. I think it may well have been, yeah. 20 Q. Now, is that a medical term or can we just take 21 it at its face value? 22 A. I think you can take it at face value. 23 Q. What is it, Dr. Matthews, that leads you to 24 conclude that Mr. Forsyth was prematurely released 25 from the hospital? PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2134 1 A. I need to turn to my reports to be exhaustive 2 about that. I want to look first at the comment that 3 he had thought that his son was trying to gain control 4 of his assets and that's why he left. That's found in 5 the police reports. I think it's later testified to 6 by Dr. Neal, but the cite that I have was to the 7 police reports. Dr. Neal told the police that. 8 Q. So we're clear on that, it's not something the 9 police wrote down, it's what Dr. Neal told the police? 10 A. Told the police right then at the time that 11 they were interviewing him. 12 Q. Okay. Is that not -- let's see. How do I ask 13 this? Are you critical of Dr. Neal for discharging 14 the man because he said, I'm worried about my son 15 taking over my business? 16 A. You interrupted my answer so I hadn't had a 17 chance to finish it. It's quite a long answer. 18 Q. Okay. Well, I don't want to interrupt your 19 answers at all. I want to give you all the time you 20 want. 21 A. Okay. I don't know whether the son was trying 22 to gain control of his assets or not, but I know there 23 are three possibilities that I can think of; one is 24 that he was trying to get control of his assets and 25 that's a genuine concern on Mr. Forsyth's part, and I PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2135 1 think, if that's true, that suggests there's trouble 2 in the relationship. 3 The second possibility is that it's totally 4 baseless and that the son was not trying to get 5 control of his assets. If that's true, then 6 Mr. Forsyth was suffering, possibly, what's known as a 7 psychotic depression, that he lost touch with reality, 8 and that he was making -- he was delusional. He was 9 making up, for mentally ill reasons, the thought that 10 his son was trying to get control of his assets. 11 The third possibility is that he was using that 12 as a way to get out of the hospital, that he wanted 13 out of the hospital and he wanted to convince his 14 doctors and the other people at the hospital that it 15 was time to leave the hospital, and that he needed to, 16 and so he said that as a way of getting out of the 17 hospital. 18 I think no matter how you look at it, it's not 19 a good thing, and if he was, in fact, psychotic, out 20 of touch with realty about the situation or if he was 21 making it up, then that's suggestive of the release 22 being premature. 23 Q. So who do we blame for that? Do we blame 24 Dr. Neal? 25 A. I didn't bring this up in the context of blame, PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2136 1 sir. You asked if that was a stressor on him, and I 2 said it was. I think that, in the best possible 3 world, Mr. Forsyth would have remained in the hospital 4 longer, so it was premature in that sense. I'm not 5 really here to criticize Dr. Neal in any way. 6 Q. Do you believe that if he had been kept in the 7 hospital longer, that he would be alive today? 8 A. That's beyond the scope of my kin. I think a 9 lot would have depended on how he was treated and what 10 happened in the course of his depression. He was 11 suffering from a severe depression. He was discharged 12 still severely depressed, and I think if his 13 depression had been in remission, had been gone, that 14 this would not have occurred. That's the most I can 15 really say. 16 Q. I don't want to write something down unless 17 this is the gist of your testimony. Are you saying 18 that your concern about the premature release from the 19 hospital is that based on your review of the records, 20 it's likely that he was psychotic? 21 A. No, not at all. I said that was one of the 22 possibilities, and I think there's other suggestions 23 that it's possible that he was psychotic. I think on 24 balance, the evidence is that he probably wasn't 25 psychotic, but I don't know for sure. And I think PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2137 1 there's evidence on both sides. 2 Q. Incidentally, this just popped into my head, so 3 let's back up to it. When you talk about the marital 4 problems and the family problems, relationship with 5 his son, and earlier you talked about the anger, if, 6 indeed, this was what this man was experiencing, he 7 was mad at his son, mad at his wife, how do you 8 explain the entries in the Castle medical records, 9 where on one day when his son and wife come to visit 10 him, he's so happy and the people record that he's so 11 happy that they visited him, and the next day when 12 they're not there, he's so sad that they're not there? 13 How do you jibe those two things? 14 A. I need to look at those records to see if 15 you're actually representing them as one causes the 16 other in exactly that way, but I can tell you that 17 being in a psychiatric hospital, even if you are 18 seriously depressed, maybe particularly if you're 19 seriously depressed, is no fun, and you're lonely. 20 He's now away from home on a different island, doesn't 21 know anyone in the hospital, doesn't know his doctor, 22 brand new doctor that he's getting, doesn't know any 23 other patients, doesn't know any of the staff. And I 24 didn't say he was angry at his son. I said there were 25 problems in the relationship, arguably, possibly, but PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2138 1 I think to see any close person, family member, would 2 possibly cheer you up under that circumstance. 3 Q. So even if, even if you're just boiling up with 4 anger at your wife, it's still perfectly reasonable to 5 be so happy to see her one day and the next day be so 6 sad that she's just not there? 7 A. Again, I don't know if that accurately 8 characterizes what happened in the hospital, but I 9 think you also have to keep in mind that in the months 10 leading up to the hospitalization, Mr. Forsyth had 11 become very dependent on his wife, as we've said, and 12 couldn't tolerate separation from her and so her 13 showing up at the hospital, sure, that may well have 14 relieved some of his anxiety. 15 Q. Let me just read to you from the hospital 16 records, which are in evidence, and I'm reading, 17 actually, from a copy that says, "Records of Daryl 18 Matthews" right at the bottom, Page 2,087 of those 19 records. 20 MR. SEE: What page is this on? 21 MR. VICKERY: It's Page 28 of that exhibit. 22 Q. And I can show this to you if you want me to, 23 but what is written in one handwriting on February the 24 27th, "Stated his wife and son's visit went well. 25 Requesting to receive his visitors in the morning." PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2139 1 And then later, "Gave permission for them to visit. 2 Thanks." And then on the next page, in what appears 3 to me, and I'm no handwriting expert, to be a 4 different handwriting, February 28, 1993, "Very 5 pleasant, soft spoken, may be missing visitors, 6 question mark." 7 So if your testimony, sir, is that is 8 consistent with somebody who was so angry at his wife 9 that he stabbed her 15 times a week later, then just 10 say so and we'll move on to something else? 11 A. I think that, yes, it's consistent, and that 12 your saying that he was happy to have his visitors 13 there is not reflected in the record, as you suggested 14 it was. And that to say a visit went well by the 15 report of a patient, particularly a patient, who -- I 16 think Mr. Forsyth minimized his problems when he was 17 in the hospital, and that was part of his premature 18 release, that he didn't tell everybody really what was 19 going on with him and that was over and over shown in 20 the record. And when someone comes up and says, how 21 did your visit with your wife go? 22 Well, just fine, thank you. 23 And I think that that was more likely what 24 happened than that he was made happy, unless the 25 record reflects something different. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2140 1 Q. So do you think that he basically hoodwinked 2 his doctor into letting him out of the hospital too 3 early? 4 A. I think that may be what's going on. I think 5 there's a lot of suggestions that that's true. 6 Q. And that is precisely the phenomenon that 7 Theodore Van Putten reports as being consistent with 8 akathisia, isn't it? 9 A. As far as I understand akathisia, that has 10 nothing to do with akathisia. That akathisia is 11 something totally different than that. 12 Q. Have you read the works of Dr. Van Putten, "The 13 Many Faces of Akathisia"? 14 A. No. 15 Q. Do you recognize him as the leading authority 16 in akathisia? 17 A. No. 18 Q. Well, others have described this article, and 19 so I just want to read to you from it. Let me make 20 sure Mr. See has a copy. 21 I'm just reading from the conclusion of this. 22 Would you like a copy? Would that help you? 23 A. Would it help me do what? 24 Q. Help you read along with me. 25 A. Sure. I'm happy to do that if you like. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2141 1 MR. SEE: Your Honor, before he reads that, I 2 think I object to the reading of this. I don't think 3 the foundation has been established under 803.18. 4 MR. VICKERY: The foundation for Dr. Van 5 Putten's article were laid with Dr. Healy under 6 803.18, Your Honor. It referenced this very specific 7 article and discussed that Dr. Van Putten was the 8 leading authority on akathisia in the world until his 9 death. That's all that's -- 10 THE COURT: Who relied on it? Yes, Dr. Healy 11 did. 12 MR. VICKERY: Right, that's the foundation. 13 MR. SEE: I could be wrong, but I don't think 14 anybody read from that article or talked about it or 15 saw this was authoritative about Dr. Van Putten. 16 MR. VICKERY: Your Honor, all I can tell the 17 Court now, without checking with Ms. Stuhr on exactly 18 the words he used, Dr. Healy said Theodore Van Putten 19 was the authority on akathisia in the world prior to 20 his death, and he discussed several of his writings on 21 this subject of akathisia, and I believe he mentioned 22 this article by name, but certainly he established the 23 foundation under 803.18 to cross-examine any other 24 experts on the basis of Dr. Van Putten. 25 THE COURT: I'll allow it. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2142 1 MR. VICKERY: Thank you, sir. 2 Q (By Mr. Vickery) Let's look under 3 consequences of akathisia. "The inner agitation of 4 akathisia is always subjectively stressful, cause 5 nausea; states that akathisia could be, quote, more 6 difficult to endure than any other of the symptoms for 7 which the patient was originally treated," and he 8 cautions that "It may be mistaken for an agitated 9 depression." 10 Now, agitated depression are the first two 11 things that you said were substantial factors in 12 depression with an anxiety disorder; isn't that true, 13 sir? 14 A. Yes, but I don't think it's an agitated 15 depression. I didn't use the word agitated at all. 16 That's your word. 17 Q. Is anxiety not agitation? 18 A. No, sir. 19 Q. All right. Next paragraph, "Akathisia is 20 tolerated very poorly by hostile paranoid patients in 21 that they tend to misinterpret the inner agitation of 22 akathisia as further proof that they are being 23 poisoned or controlled by outside malevolent forces." 24 Now, Mr. Forsyth thought he was becoming 25 addicted to a drug, Xanax, didn't he? PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2143 1 A. Yes. 2 Q. And he also, according to Dr. Neal, even at 3 this point in time, thought that his son was trying to 4 control his business, didn't he? 5 A. Yes. That's in evidence, yes. 6 Q. So let's read on. "Consequently they often 7 refuse to take their medications or run away from the 8 hospital." You see that? And do you see in the 9 fourth line of the conclusion where he says, "Failure 10 to treat the patient with akathisia may lead to a 11 refusal to continue with prescribed neuroleptic drugs, 12 sudden elopements from the hospital, paradoxical 13 responses to phenothiazines, and at times 14 exacerbations of psychosis." 15 So I guess my question is, having seen this, if 16 this guy really is the world authority on akathisia, 17 would you not agree with me that Mr. Forsyth's desire 18 to elope from the hospital or dupe his doctor to 19 release him from the hospital is perfectly consistent 20 with someone who is experiencing akathisia? 21 A. You threw me with the word consistent. While 22 it may be consistent, Mr. Forsyth in no way had 23 akathisia. There's no evidence that he had akathisia, 24 and to take leaving a psychiatric hospital by itself, 25 alone, without any other evidence of akathisia as PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2144 1 being evidence of akathisia, strikes me as being 2 something that I've never heard anybody do, and I 3 don't think that that's really what the article is 4 getting at. More importantly, though, what akathisia 5 is, I think, is defined best in the Diagnostic and 6 Statistical Manual, which was -- of mental disorders, 7 which is the standard diagnostic manual for 8 psychiatrists. It was written about 20 years after 9 this article was written and it's much more up to 10 date -- I'm sorry, 25 years, and it's much more up to 11 date. 12 Q. And does it -- 13 A. I don't see leaving a psychiatric hospital as 14 evidence of akathisia. That's ridiculous. 15 Q. Let's look then. Since you sort of challenged 16 Dr. Van Putten, let's look at the first paragraph of 17 his article on "The Many Faces of Akathisia. 18 Akathisia, a common side effect of neuroleptic therapy 19 is an emotional state and, quote, refers to any type 20 of pattern of movement" -- I'm sorry, "refers not to 21 any type of pattern of movement, but rather to a 22 subjective need or desire to move. Akathisia, in 23 contrast to the other drug-induced extrapyramidal 24 reactions, is subjective, and for this reason, it may 25 be difficult to diagnose." PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2145 1 Do you agree with Dr. Van Putten on that? 2 A. No, sir. Prior to his death in 1975, Dr. Van 3 Putten may have believed that to be true, but that's 4 not what's believed nowadays about akathisia, and if 5 you look in the Diagnostic and Statistical Manual of 6 the American Psychiatric Association, akathisia has 7 both a subjective component, the desire to keep 8 moving, the sensation to keep moving, which is what, I 9 guess, Dr. Van Putten is referring to, but also refers 10 to movements, to specific movements, and if you have a 11 copy of the DSM, I can say exactly what they are, but 12 that's what I believe akathisia to be. I disagree 13 with this article. 14 Q. We've seen it or we've heard it discussed. It 15 deals with neuroleptic-induced akathisia, doesn't it? 16 A. No. 17 Q. The DSM-IV? 18 A. It says -- the criteria deal with 19 neuroleptic-induced akathisia, but it also says in the 20 text, if you look at the text that comes before the 21 criteria, it says that the SSRI type drugs, which is 22 the kind of drug that Mr. Forsyth was taking, that 23 they produce identical kinds of akathisia to 24 neuroleptic akathisia. So I believe that akathisia is 25 akathisia, and that the DSM describes it as it would PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2146 1 exist in any of the drugs. 2 Q. And the DSM-IV, the Diagnostic and Statistic 3 Manual, the fourth edition, that's kind of the bible 4 of psychiatrists' diagnosis, right? 5 A. Well, it -- I don't like to use that word, but 6 it's something that is very widely used and very well 7 recognized by psychiatrists. It's the way I make 8 psychiatric diagnoses and that's the way most 9 psychiatrists do. 10 Q. And are you telling us, sir, this authoritative 11 book says that the SSRI drugs, the selective serotonin 12 reuptake inhibitor, drugs like Prozac, cause 13 akathisia? 14 A. May cause. 15 Q. Do you believe they do? 16 A. I know it's been reported in those drugs. I 17 don't know that a causal relationship has been 18 demonstrated, but I know that it's in the product 19 literature. It's a concern. Something to be 20 concerned about. 21 Q. Incidentally, have you been involved in a 22 clinical practice since you moved back here in '95? 23 A. Very little. Very little. 24 Q. Have you prescribed Prozac for anybody since 25 '95? PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2147 1 A. No. 2 Q. How about before that, what was your experience 3 personally in prescribing Prozac? 4 A. I prescribed Prozac in the course of my 5 practice prior to that. 6 Q. And did you have to -- ever have to discontinue 7 someone because of side effects? 8 A. I believe so. 9 Q. Did you ever have patients develop akathisia on 10 Prozac? 11 A. No, not that I was aware of. 12 Q. Did you give concomitant benzodiazepines to 13 keep that from happening? 14 A. I didn't give concomitant benzodiazepines to 15 keep that from happening. I'm sure I gave concomitant 16 benzodiazepines for other reasons. 17 Q. Now, Xanax is a benzodiazepine, isn't it? 18 A. It is, yes. 19 Q. It's anxiety medicine? 20 A. Yes. It's helpful for anxiety and maybe other 21 things, too. 22 Q. And that kind of brings us to the very next 23 factor that you mentioned, of the many substantial 24 factors contributing to this death, and that is 25 somebody took this man off his Xanax. How do you want PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2148 1 me to phrase that, no more Xanax? 2 A. You can phrase it like that if you like. 3 Q. Why is it, Dr. Matthews, that you believe that 4 the absence of Xanax, which I think, if I'm correct, 5 was discontinued on the, maybe, 27th or 28th? 6 A. Yeah, you're incorrect. 7 Q. When was it discontinued, the 26th? 8 A. He received it in the hospital. 9 Q. Not every day. Want to see the log? 10 A. My understanding is he received it in the 11 hospital. 12 Q. No, sir. We'll dig it out and show you. He 13 didn't get it the last three or four days he was in 14 the hospital. 15 A. I think my records are that he got it up to the 16 last day in the hospital and he got his last dose of 17 Xanax. 18 Q. When one wants to look at that -- and we're 19 going to dig it out, believe me. They're looking for 20 it right now. Do you have the hospital records up 21 there? 22 A. No, sir. 23 Q. When one wants to know what somebody got in the 24 hospital or didn't get in the hospital, do you look at 25 the charts that the nurses keep where they write down PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2149 1 what medication a person gets and when? 2 A. Yes, normally. 3 Q. That's the most reliable source for what 4 someone gets in the hospital medication wise, isn't 5 it? 6 A. Probably, yes. 7 MR. VICKERY: May I approach the witness, Your 8 Honor? 9 THE COURT: You may. 10 MR. VICKERY: This is on Page 43 of the Castle 11 records, Mr. See. 12 Q. Just look at that chart, if you would, which is 13 the medication record and tell us when is the last day 14 this man got Xanax. 15 A. It's a little hard to know. It's not on the 16 page that you pointed to. It's on the next page, and 17 that shows that he received Xanax on the 1st and then 18 it's a little hard to make sense of what happened on 19 the 2nd, but the note after Xanax, 0.25 milligrams, 20 P.O., Xanax 0.25, by mouth that means, it's listed as 21 being given on the 2nd. There is a notation in 22 contrast to what you suggested, it was given on the 23 2nd, and then it says, "Discontinue Xanax," on the 24 3rd, so it was really only a couple of days before 25 that his Xanax was discontinued. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2150 1 Q. Okay. I'll look at it more carefully because I 2 just may have made a mistake on that. 3 A. You may have, sir. 4 Q. But in any event, one of the things that you 5 listed as a factor, that you thought was a substantial 6 factor, contributing to their deaths was the fact that 7 he got no more Xanax. Why? 8 A. There's a number of reasons. First of all, he 9 got no more Xanax. This is a medication that is an 10 anti-anxiety medication. It hadn't helped him 11 powerfully, but it may have helped him some, that he 12 took it for quite some time. 13 He was taking it in a dosage range that 14 addiction, per se, is not a real concern, and -- but 15 still there may have been what's called rebound 16 anxiety, when he went off it, which means you get more 17 anxious when you stop an anti-anxiety drug briefly. 18 It may have been that it was treating some of the 19 anxiety and that came out when it was discontinued, 20 and some of it may have been that he just, in his 21 mind, had the notion that, I can take this medicine. 22 I have this anti-anxiety medicine to take, and that he 23 felt, his perception was, that it helped him even if 24 it really wasn't, and all of a sudden, when he left 25 the hospital for the first time in quite sometime, he PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2151 1 didn't have that to turn to. It was something that he 2 turned to for quite a while. So I think reasonably 3 that is something in one of those modes or other would 4 be a factor. 5 Q. Now, the same question there about the 6 premature release, is that something that you -- makes 7 you critical of Dr. Neal for discontinuing the Xanax? 8 A. Once, again, sir, I have not been asked for my 9 opinion about Dr. Neal's care. I'm not here to 10 criticize Dr. Neal or talk about that in any way. 11 Q. Excuse me, Dr. Matthews. Let me be real clear. 12 I'm asking you if you're critical of Dr. Neal's care 13 in this regard for discontinuing his Xanax? 14 A. I've never formulated an opinion. I don't have 15 an opinion about Dr. Neal's care. I think that I 16 don't have an opinion about that. 17 Q. You mean after 135 hours in studying this case 18 and after telling us that you think two of the 19 substantial factors are premature release and no more 20 Xanax, you don't have any opinion at all about whether 21 Dr. Neal blew it on that? 22 MR. SEE: Objection to the form, argumentative. 23 THE COURT: I'll allow the question. 24 THE WITNESS: I've spent a lot of time, as you 25 said, looking at this material, but I have never been PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2152 1 asked, before you asked it right now, did Dr. Neal do 2 something wrong, and I take certainly that question 3 very, very seriously, and I would want to look at all 4 the material, all the records once again, and really 5 try to think about it from Dr. Neal's point of view 6 before I would give an opinion that Dr. Neal did 7 something wrong. So I honestly don't have an opinion 8 about that even though I think I'm somewhat familiar 9 with the case. 10 Q (By Mr. Vickery) Let's just say -- see these 11 two things right here. Let's just say, what if 12 Dr. Neal had gotten a warning about keeping a patient 13 in and observing him long enough, or about giving him 14 a concomitant benzodiazepine, what if Eli Lilly had 15 warned him that that was necessary in the early period 16 of time on Prozac, and then what would you have 17 expected him to heed those warnings and to do one of 18 these two things that you said might have saved the 19 life of the Forsyths? 20 MR. SEE: Objection, foundation. Calls for 21 speculation. 22 THE COURT: I'll allow the question. 23 THE WITNESS: I'm sorry, sir. I don't really 24 understand it. 25 Q (By Mr. Vickery) Let me make it real simple. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2153 1 A. Okay. 2 Q. What if Eli Lilly had said to him in the 3 published literature or with a visit from a detail 4 person or with a Dear Doctor letter, Doctor, warning, 5 risk of suicide in the early period of time when a 6 patient is taking Prozac, you need to -- if you think 7 they're at all at risk for suicide, you need to take 8 precautionary measures. You need to make sure that 9 you keep them in the hospital if they're in the 10 hospital, and observe them. You need to make sure 11 that you give them a concomitant sedative, another 12 pill to counteract some problems. If that had 13 happened, do you think that the treating doctor would 14 have said, whoa, the drug company warned me about this 15 and I better do it? 16 MR. SEE: Your Honor, again, I object. It 17 calls for speculation. 18 THE COURT: I'll sustain the objection. That's 19 speculation. 20 Q (By Mr. Vickery) Do you follow those drug 21 company warnings about their medications? 22 A. I try to, sir. 23 Q. Okay. And if you got such a warning, would 24 you, as a psychiatrist, tend to heed that warning? 25 MR. SEE: Your Honor, I object. It is an PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2154 1 incomplete hypothetical. It's also way beyond the 2 scope of any direct examination. 3 THE COURT: Sustained. 4 MR. VICKERY: Well, if I may be heard on that, 5 Your Honor, under Rule 611(b), the scope of 6 cross-examination goes to matters of credibility. 7 THE COURT: This is not the treating physician 8 here. 9 MR. VICKERY: Okay. May I see this sheet? 10 Q. You're right. I made a mistake on the Xanax. 11 He got it right up to the time he left, didn't he? 12 A. Yeah. 13 Q. And then they took it away. And they took it 14 away from him. Did they take away a pill from him 15 that could have saved his life? 16 A. Well, you know, I think that's not what I said, 17 and I don't think that's a good way of looking at the 18 situation. He was withdrawn gradually from the Xanax. 19 That's the right way to discontinue Xanax, not to stop 20 taking it after taking five or seven of them suddenly. 21 Nobody did that to him, and that would have clearly 22 been the wrong thing to do. They discontinued it 23 gradually and tapered it. 24 I think this is one factor, among the many, 25 that we've talked about. That there were many, many PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2155 1 factors that were involved, and so to say that could 2 have saved his life, that isn't really the way I would 3 have called it. 4 Q. Well, let me just read to you from your report, 5 okay. You've got it in front of you? 6 A. Yes. 7 Q. Page 30. You see there -- before we talk about 8 lack of therapeutic, the lines about four or five 9 lines up, "Finally, it is noteworthy that Mr. Forsyth 10 was discharged without Xanax as described above. He 11 disliked the idea of taking Xanax. It may have well 12 been helpful in reducing his symptoms." Do you stand 13 by that report? 14 A. I do. 15 Q. Do you stand by your testimony this morning 16 that no more Xanax is one of the substantial factors 17 that contributed to the deaths of Bill and June 18 Forsyth? 19 A. I think it's probably true, yes. 20 Q. Okay, sir. Now, you mentioned anger as another 21 factor. And I want to ask you about that. Is anger 22 something that makes someone likely to commit an act 23 of violence? 24 A. Sure. 25 Q. Tell me, if you would, Dr. Matthews, what is PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2156 1 the single best predictor of violence? 2 A. The best predictor of violence is probably past 3 violence. 4 Q. All Right. And you know that there is not a 5 shred of evidence anywhere that this man had ever been 6 violent, don't you? 7 A. There is no evidence that he had been violent, 8 but I don't think that I said that this act could have 9 been predicted. That is not what I've said. 10 Q. Okay. Finally, we get to number eight. You 11 said -- I'm sorry. I asked them to do that, but it's 12 distracting, isn't it? 13 You said that all of these things just erupted. 14 There's a word that you psychiatrists use to describe 15 what Bill Forsyth did and it's a word you used in your 16 report, isn't it? What is that word? 17 A. I'm not sure I know what you're referring to, 18 sir. 19 Q. I'm talking about psychosis. 20 A. No. 21 Q. Did Bill Forsyth have a psychotic break? 22 A. I don't think he did. On balance, I think that 23 there's not evidence that he was psychotic. I think 24 there's some hints and suggestions. It's a 25 hypothesis. I don't think that he did. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2157 1 Q. Let me show you your report and see if you 2 still stick with that. You may find it quicker than 3 me, Dr. Matthews. If you do, just sing it out. Okay, 4 on Page 23, are you there with me? 5 A. Yes. 6 Q. "Psychotic features may have been present. 7 Although Dr. Neal did not believe that Mr. Forsyth's 8 depression included them, there's other evidence that 9 Mr. Forsyth's fearfulness may have been of psychotic 10 proportions. Dr. Roberts, indeed, detected elements 11 of psychosis." 12 Now, are you sticking with that portion of your 13 report? Oh, and then on the next page, on 24, you 14 talk about him being unrealistically concerned about 15 the cost of care and such baseless financial worries 16 are common of psychosis. Are you sticking by your 17 report there or are you saying now, no, I didn't 18 really mean that, he didn't have any psychosis? 19 A. Oh, I'm not changing my mind at all, I want to 20 make that quite clear, that I think he may have been 21 psychotic. That's what I said in the report. 22 Psychotic features may have been present, and I think 23 there's some evidence, and I cite in the report, and 24 you have just, sir, referred to some of the things I 25 said. But I think, on balance, if I have to choose PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2158 1 one or the other, was he or wasn't he, that the better 2 evidence is that he wasn't; that while it may be true 3 that he was psychotic, had psychotic features, that he 4 probably wasn't. 5 Q. Dr. Matthews, does Prozac cause psychosis? 6 MR. SEE: Your Honor, let me object. Beyond 7 the scope of direct. 8 MR. VICKERY: This is very important insofar as 9 the credibility of this witness and the case Lilly has 10 sought to produce through him, Your Honor. Under 11 611(b), I would suggest that this is extremely 12 germane. 13 THE COURT: I'll allow it. 14 Q. (By Mr. Vickery) Does Prozac cause psychosis? 15 A. There are reports that it's caused psychosis, 16 and it would not surprise me, in some instances, if 17 people became psychotic on Prozac, but I think there's 18 no evidence that Mr. Forsyth was psychotic because of 19 the Prozac. 20 Q. Well, let's look, if we may, at Exhibit 5. 21 We're going to put it on the screen for you here. 22 This is not other people talking about Prozac 23 psychosis. This is Eli Lilly. 24 And what I'm showing you, Doctor, is a 1985 -- 25 I'm sorry, 1986 draft warning for Prozac, and you see PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2159 1 here where it says, "Mania or psychosis may be 2 precipitated in susceptible patients by antidepressant 3 therapy." 4 Were you aware that anyone at Eli Lilly ever 5 drafted a warning to warn patients about psychosis 6 being precipitated by antidepressant therapy? 7 A. No. 8 Q. Sir? 9 A. No. 10 Q. You're real familiar with the product label 11 though, aren't you? 12 A. I've looked through it a few times. 13 Q. And you've never seen, ever, this draft make it 14 into final print? You've never seen this drug company 15 warn that psychosis may be precipitated in susceptible 16 patients by antidepressant therapy, have you, sir? 17 A. I don't recall that wording, no. 18 Q. Okay. One of the factors you mentioned, and we 19 haven't talked about, and we've talked about all the 20 others, I think, is the risk factors for suicide. 21 Now, what did you mean when you said that was a 22 substantial factor in the deaths of June and Bill 23 Forsyth? 24 A. Some of this may be repetitive because they may 25 have already been considered elsewhere on your list, PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2160 1 but the factors that I considered, certainly, his 2 major depression; his, I think, many of the major 3 depression criteria, which I can go through for you, 4 but I think that the jury has probably heard. 5 Q. Yes, they have. 6 A. Those are predictive of suicide, and major 7 depression is predictive of suicide. Recently being 8 discharged from a psychiatric hospital; I think that 9 there's some evidence that there was a lack of 10 therapeutic alliance, in other words, that he did not 11 have somebody he really felt he could turn to at the 12 worst moment of his life, in a time of crisis, to 13 reach out to. I think -- 14 Q. Let me stop you there, Dr. Matthews. Are you 15 saying he had a bad relationship with Dr. Riggs 16 Roberts? 17 A. I'm not saying that. No, I didn't say that. 18 What I said was that there may not have been, at that 19 point in time, a very strong therapeutic alliance. 20 One of the things is that there is some evidence that 21 Mr. Forsyth felt that Dr. Roberts wouldn't accept him 22 back in treatment because Dr. Roberts didn't want him 23 to go into the hospital. There's evidence about that, 24 so I think just that he felt that he could not turn to 25 Dr. Roberts, and I don't know that there were other PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2161 1 relationships that he felt would be appropriate to 2 reach out to in that way. 3 I think that the difficulty in his 4 interpersonal relationships is a risk factor. I think 5 that hopelessness is a risk factor. I think that 6 impulsivity, I think that Mr. Forsyth, while he has 7 not behaved violently in the past, has behaved very 8 impulsively in the past, and that being impulsive is a 9 risk factor to suicide. And I think that -- let's 10 see. 11 Q. It's really multi-faceted, isn't it? I mean, 12 what you're doing is you're taking factors that have 13 been written about at some length, many numerous risk 14 factors that affect whether a person is likely to 15 commit suicide or not, that have been written by 16 people like Beck and by Dr. Maris and others in 17 helping to analyze whether a person would or would not 18 commit suicide. That's what you're doing, isn't it? 19 A. I'm looking at things that clinicians consider 20 risk factors for suicide, things that are, from the 21 point of view of a psychiatrist, associated with 22 suicide. 23 Q. From the point of view of a psychiatrist 24 associated with a risk of suicide, would you ever, 25 ever just look at Item 3 of the Ham-D, the Hamilton PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2162 1 Depression Scale, and say, oh, that answers it for me? 2 Would you ever do that? 3 MR. SEE: I object to the question as an 4 improper, incomplete hypothetical. 5 THE COURT: I think you better revise the 6 question. 7 Q. (By Mr. Vickery) You know what the Hamilton 8 Depression Scale is? 9 A. Yes. 10 Q. You know what Item 3 is, where you measure from 11 zero to four whether you're thinking about killing 12 yourself or not? 13 A. I've seen it. I think I know what it is. 14 Q. And would you ever base -- in a clinical 15 practice with a real live human being, would you ever 16 rely on that to determine whether they were at risk 17 for suicide or not? 18 A. I think suicide is a risk every time somebody 19 has a major depression. I don't think anyone would 20 rely solely on that or I would not rely solely on 21 that. It's a complex clinical judgment about whether 22 someone's going to be likely to have a suicide attempt 23 or not. It's not just one thing. 24 Q. What would you say to somebody who tried to 25 sell you on the idea that the Ham-D Item 3 was the PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2163 1 gold standard for assessing suicidality? 2 MR. SEE: Objection. Incomplete hypothetical. 3 Or you talking about clinical practice or clinical 4 trials? It's not specified in the question. 5 MR. VICKERY: I'm talking about the real world, 6 Your Honor. I'm not talking about the real world that 7 this man lives in. 8 THE COURT: Real world? 9 MR. VICKERY: Yes, sir. Real world, real 10 patients, real risk of suicide. 11 THE COURT: In the clinic or otherwise? 12 MR. VICKERY: In a clinical setting dealing 13 with human beings. 14 THE COURT: Why don't you rephrase your 15 question. 16 Q. (By Mr. Vickery) In the real world setting of 17 dealing with human beings and life and death matters, 18 what would you say if somebody said, here, rely on the 19 Ham-D Item 3, it's the gold standard? 20 A. It's not the way I would think about it. I 21 don't think there is a gold standard in clinical 22 practice. I think it's a difficult clinical judgment. 23 I think it's something that clinicians don't always do 24 very well, which is predict suicide or predict any 25 kind of behavior, so that's not terminology that I PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2164 1 would choose. 2 Q. You're a generous and gentile man, 3 Dr. Matthews. The truth of the matter is, if somebody 4 tried to sell that bill of goods to you, you'd tell 5 them that's a complete crock, wouldn't you? 6 MR. SEE: Objection to the form. 7 Argumentative. 8 THE COURT: Sustained. 9 MR. VICKERY: Okay. Bear with me. If I could 10 have a minute, Your Honor, I'm going to start checking 11 some notes here? 12 Q. Okay. You've talked to psychiatrists in the 13 State of Hawaii, right? 14 A. Yes. 15 Q. In the State of Hawaii, if a psychiatrist has 16 any reason whatsoever to believe that a patient that 17 they're treating, even a patient they're treating in 18 confidence, might kill someone else, what are they 19 supposed to do? 20 MR. SEE: Objection. Relevance. 21 MR. VICKERY: I'll be glad to tell the Court 22 the relevance. Let me lay the foundation for 23 relevance. 24 THE COURT: All right. 25 Q. (By Mr. Vickery) You have gone back through PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2165 1 the records of Dr. Riggs Roberts and Dr. Randolph 2 Neal, and sort of interpreted their words or 3 Mr. Forsyth's words there to suggest that it's just 4 apparent what happened, that the risk is just obvious 5 from their records, haven't you? 6 A. No. 7 Q. Do you think it is obvious from their records? 8 A. From a prediction point of view, from the point 9 of view of the doctor that's taken care, no, I think 10 it's not obvious. I think this is an event that 11 occurs uncommonly and that it's hard to predict. I 12 think that there are things that caused it and it's 13 understandable when you do what I did, which is look, 14 I think, carefully at all the material, but I don't 15 believe that this is something that could have or 16 should have been predicted. 17 Q. Okay. Do you think that's fair to us to do, 18 then, to go back after the fact and sort of say, well, 19 there it is. It's right there in Riggs Roberts' 20 records? My goodness. 21 MR. SEE: I object to the form of the question. 22 THE COURT: I think he just answered it. 23 MR. VICKERY: Okay. 24 Q. Let me ask you this. I want to follow with 25 your train of thought for a minute, that Bill Forsyth PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2166 1 was in such despair, that he had decided to end his 2 life, okay, this hopelessness, this despair. How does 3 that reconcile or how do you reconcile that opinion of 4 yours with the fact that this man was doing absolutely 5 everything he could to get the best professional help 6 possible? 7 A. I think that, unfortunately, we can't 8 successfully -- when I say we, I mean we as a 9 profession, psychiatrists and mental health people, we 10 cannot successfully treat every case of major 11 depression. I just don't think that psychiatry is 12 that good. 13 I mean, we're successful many times. Often the 14 medications are often helpful, but they're not helpful 15 in every instance, and that there are treatment 16 failures and I think that, despite the best efforts of 17 all the caregivers involved, that this happens 18 sometimes, that people don't recover. 19 Q. Okay. In my notes, I made a big star about 20 this, so I guess I have to ask you maybe. There was a 21 reference in 1991, in all these blowups from '91 that 22 you and Mr. See went over, to her having anger, and 23 you said, oh, yeah, that must have been towards her 24 husband. Do you really think that's fair in view of 25 the fact that in 1991, she was seeking professional PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2167 1 help because of the relationship with her father? Is 2 that fair, Dr. Matthews? 3 A. I think she was probably angry at her husband, 4 and I think that the reason she sought help, in some 5 stated way, may have been because of the relationship 6 with her father, but basically, she had a major 7 depression herself, that that was the nature of her 8 psychiatric problem. 9 Q. And she -- it's already come out, cat's out of 10 the bag, she was treated with Prozac for it, wasn't 11 she? 12 A. Yes. 13 Q. And that's when she had this dream about this 14 dark figure in the corner, was when she was under the 15 influence of Prozac, wasn't it? 16 A. I'm sorry, I haven't dated it, so I don't have 17 an answer to that. 18 Q. Okay. I was struck by one of the things you 19 said when you were establishing your credentials, that 20 you teach young psychiatrists and you have to actually 21 sit in there with them when they're talking to folks. 22 Can you explain kind of the importance of that? 23 A. Explain the importance of what? 24 Q. Of them getting that kind of teaching, them 25 getting the sort of hands-on teaching of -- I hope I'm PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2168 1 teaching her something by being here with me. 2 Somebody that's got some gray hair or no hair at all 3 teaching someone younger in their profession, why is 4 that important? 5 A. Forgive me, sir. I'm sorry. I don't want to 6 answer something you haven't asked. Why is it 7 important to teach or why -- 8 Q. Why is it important for someone experienced, 9 such as yourself, to give hands-on training to teach 10 younger psychiatrists how to be psychiatrists? 11 A. It's important because that's how people learn 12 to be psychiatrists. You do more than just read about 13 it in books or listen to lectures or something like 14 that, but you actually watch people interview patients 15 and treat patients and have somebody experienced sit 16 in when you interview patients and comment on it and 17 criticize it. 18 Q. Dr. Matthews, the reason I ask you that is 19 because right after that, you said that when you're 20 teaching young psychiatrists, you train them to focus 21 on current problems. That was your testimony, wasn't 22 it, sir? 23 A. Train them... 24 Q. That you train these young psychiatrists, when 25 their dealing with patients, to get a handle on what's PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2169 1 currently the situation with a patient. 2 A. I think I said sometimes, and certainly, in 3 clinical psychiatry and in the practice of treating 4 patients, yes, I think that's pretty important, that 5 psychiatrists know what's going on with their patient 6 right then. 7 Q. What would you do to one of your residents if 8 they were trying to analyze a patient who was in 9 clinical depression, and you said, okay, let's -- tell 10 me now, Doctor, what have you learned about this 11 patient? And if, instead of talking to you about the 12 current problems with Bill, we'll call him Bill, if, 13 instead of doing that, your resident brought you 13 14 blowups of ancient history two years old about June, 15 his wife? What would you say to that resident? 16 MR. SEE: Objection to the form. 17 Argumentative. 18 THE COURT: Why don't you just rephrase your 19 question, Mr. Vickery. 20 Q. (By Mr. Vickery) What would you say to a 21 resident who ignored the husband's current problems 22 and focused on the wife's two-year-old problems, sir? 23 Would you flunk them? 24 MR. SEE: I object to the form of the question. 25 It's argumentative. It's not relevant. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2170 1 THE COURT: Well, I'll allow the question. 2 THE WITNESS: There's a difference between 3 clinical psychiatry and forensic psychiatry. The 4 residents that I teach in the way that Mr. Vickery is 5 referring to, are people who are interviewing a 6 patient and have the benefit of being able to talk to 7 a patient and saying, what's going on with you, how 8 are you feeling today, what's your situation, and 9 asking all kinds of questions. 10 When I conducted this examination, this is an 11 examination of an individual who was not available to 12 be interviewed in that way, and the techniques of 13 doing forensic psychiatry, what I have done, I 14 believe, are totally different from the techniques of 15 clinical psychiatry. So I teach the residents two 16 different kinds of things. I teach them, how do you 17 treat a patient, how do you evaluate a patient when 18 they're there, and I also teach them how do you 19 analyze a case when the patient isn't there, and 20 that's really different. 21 Q (By Mr. Vickery) When you -- let's follow up 22 on that. When you do, as you have done in this court, 23 and you base your testimony on the written words of 24 dead people, then there's no danger at all of them 25 setting the record straight or putting it in context, PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2171 1 is there? 2 MR. SEE: Objection to the form of the 3 question. It's argumentative. 4 MR. VICKERY: Your Honor, this is 5 cross-examination. 6 THE COURT: I'll allow the question. 7 THE WITNESS: That's the reason I've relied on 8 so many sources of evidence besides just the words of 9 people who aren't available. I relied on medical 10 records that were kept by other physicians, medical 11 records that were kept by other caregivers. I relied 12 on police reports. I relied on depositions of friends 13 and depositions -- I tried to look at every kind of 14 evidence that I could and not just rely on one thing. 15 Q (By Mr. Vickery) And let's follow up on that. 16 One of the things you cite repeatedly in your report 17 as a basis for your opinions about what happened in 18 this case is the testimony of Annie Blanchard, isn't 19 it? 20 A. Yes. I have cited Annie Blanchard's testimony 21 in my report. 22 Q. Now, who is Annie Blanchard and what was her 23 relationship to Bill and Susan's parents? 24 A. I believe she was a friend and housekeeper. 25 Q. She was their maid, their housekeeper, wasn't PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2172 1 she? 2 A. Yes. 3 Q. And did she see them at all from the time they 4 left in the fall of '92 until their deaths? 5 A. Not that I recall. 6 Q. Well, there's one instance maybe you didn't 7 recall, see if I can help you. June ran into Annie at 8 Longs Drugstore in December of '92, when they got back 9 and told her, you know, they had been to the Mainland 10 and had -- their relationship was wonderful and they 11 were doing good? 12 MR. SEE: Your Honor -- I'm sorry, Mr. Vickery, 13 but I object to Mr. Vickery testifying. 14 THE COURT: Sustained. 15 Q. (By Mr. Vickery) Do you remember reading, in 16 Annie Blanchard's deposition, sir, about the 17 conversation that she had with June in December of 18 '92? 19 A. Honestly, right now, I don't remember that. I 20 don't dispute it, but I don't remember it. 21 Q. Okay. Well, if it's true she had no 22 conversation with them, with Bill, and only one chance 23 meeting with June, then why would you, in basing your 24 report about what happened in March of '93, talk about 25 what this lady said way back in November -- I'm sorry, PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2173 1 in the summer of '92? 2 A. I think this couple's marital problems were 3 profound and serious and deep and had been going on 4 for a long time, and that's the -- if her testimony is 5 cited in my report, that's the connection that it's 6 cited, and it's not cited for anything other than what 7 it's cited for. 8 Q. One of the -- you talk about relying on the 9 medical records. One of the medical records you 10 relied on is the records from Castle Medical Center, 11 right? 12 A. Yes. 13 Q. And throughout that period of time, Mr. Bill 14 Forsyth was under the influence of Prozac, wasn't he? 15 A. Under the influence of Prozac is not a term 16 that I would use. He was being treated with Prozac, 17 but it was started there first on February 26th. 18 That's my understanding. 19 Q. And it had -- 20 A. He was admitted on the 24th and it was started 21 on the 26th. 22 Q. And he had had Prozac by prescription from 23 Dr. Riggs Roberts a couple of days before he went in, 24 didn't he, sir? 25 A. Yes, that's correct. He had been treated. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2174 1 Q. And you know what a half life is, don't you? 2 A. Yes. 3 Q. That's how long it takes for half the medicine 4 to go away? 5 A. Yes. 6 Q. And does Prozac have a long half life? 7 A. Yes. 8 Q. And once it goes away, it turns into something 9 else called norfluoxetine, doesn't it, sir? 10 A. Probably, but I'm not a pharmacologist or an 11 expert on the metabolism of Prozac, so that's not -- 12 Q. But it metabolizes, it changes into something 13 else, a different substance, doesn't it? 14 A. It does, into a different substance. 15 Q. And in the case of Prozac, that metabolite that 16 also remains in the body is psychoactive, isn't it? 17 It affects the mind? 18 A. It may be. Many active medications have active 19 metabolites, but which ones do and which ones don't, 20 I'm not up to date on that right now. 21 MR. VICKERY: Okay, sir, I think I just have a 22 few things and we will be done here. May I check with 23 my brain trust, Your Honor? 24 (Whereupon, a discussion was had off the 25 record.) PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2175 1 Q (By Mr. Vickery) I'd like to end with this 2 with you, Doctor. If we take everything you say that 3 put Bill Forsyth at risk for suicide, okay, he was 4 depressed, he was having a tough time, he had the risk 5 factors, he was an older white male, and there are 6 other risk factors that put him there, he had some 7 anxiety. I disagree with you about the stressors, but 8 let's just, for the sake of argument, toss them in. 9 He was prematurely released. He didn't get his Xanax. 10 If we took all of that, all of that said, and said, 11 okay, we'll give you that just for the sake of 12 argument, would you please just look these folks in 13 the eye and explain to them why he killed his wife? 14 A. I think human behavior, as Mr. Vickery has 15 said, and he said very early and very correctly and 16 very well, is extremely complex, and why anybody kills 17 anybody or why anybody does any piece of violence or 18 why anybody kills themselves is complicated. It is 19 not one thing that causes it. It's a complex 20 interrelationship of a number of different factors. 21 And the best I can do is what I've done. 22 I wish there were a simple answer to say that 23 this is -- that there's a simple way of saying why 24 this was done. Mr. Forsyth had all those things that 25 Mr. Vickery just conceded, I believe. I think that PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2176 1 those are accurate. I think that he was forced into a 2 position, by his depression, of being terribly, 3 terribly dependent on his wife and totally unable to 4 tolerate that because of his former personality and 5 his own style, and that the way he would normally deal 6 with marital problems, the way he had dealt with it 7 over the years was by running, and running in a 8 dramatic remarkable way, things that are quite 9 dramatic and remarkable, leaving the house, going to 10 the airport, getting on an airplane and flying to the 11 Mainland. You know, that's not the usual kind of 12 marital separation, but that's what happened. It was 13 extremely impulsive. And I think that, very likely, 14 if Mr. Forsyth had not been immobilized by his 15 depression, that whatever kinds of anger and emotion 16 and the issues between them that came to the fore at 17 the last moment, that if he'd been able to run, that 18 he would have run. 19 He's not, by history -- as Mr. Vickery has 20 noted, he's not a violent man, but the major coping 21 mechanism in his relationship, which he had done over 22 and over and over again, is to flee, and he couldn't 23 do it. 24 You've heard my testimony about this. I think 25 that the best I can do is to say that it's PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2177 1 understandable that he could do this. It's not 2 predictable in advance. It's too uncommon an event to 3 predict in advance, but it's not something that's 4 beyond the kin of psychiatry or that you need to 5 invoke that the drug caused that. 6 Q. Well, what you're willing to do, sir, with all 7 due respect, first let me set the record straight, 8 Mr. Vickery did not concede that there was marital 9 problems or religious problems. I just said, for 10 purposes of that question, let me just give that to 11 you. 12 A. I understand. I'm sorry. I mean, concede for 13 purposes of the answer. 14 Q. But what you are willing to do for substantial 15 compensation is to say that all of these things were 16 substantial factors, they all contributed, except one, 17 the drug that you know is a psychoactive drug that 18 affects the brain chemistry, that's designed to affect 19 human behavior. That's the one thing of all of these 20 that you're not willing to admit was a significant 21 contributor; isn't that so? 22 A. I think there are many things that you could 23 name that were not significant contributors. I think 24 that he was taking other medications at the time. I 25 don't think those were significant contributors. I PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2178 1 don't think that the phase of the moon contributed to 2 it. I think that there's no evidence that -- no 3 scientifically credible evidence that Prozac causes 4 this kind of thing. It does affect brain chemistry. 5 All kinds of things affect brain chemistry. He was -- 6 chocolate affects brain chemistry, running affects 7 brain chemistry. To say that this is something that 8 affects brain chemistry is not saying very much. 9 Q. Dr. Matthews, you're willing to blame his son, 10 you're willing to blame his wife's two-year-old 11 depression, you're willing to blame him, but you just 12 simply aren't willing to blame either the doctors or 13 the big drug companies; isn't that true, sir? 14 MR. SEE: Object to the form. Argumentative. 15 THE COURT: Sustained. 16 MR. VICKERY: I'll pass this witness. 17 THE COURT: Let's take a 15-minute break. 18 Please be back at ten of. 19 (Whereupon, a recess was taken from 2:35 p.m. 20 to 2:55 p.m.) 21 THE COURT: Please proceed, Mr. See. 22 MR. SEE: Thank you, Your Honor. Your Honor, I 23 have no more questions for Dr. Matthews and ask that 24 he be excused. 25 THE COURT: Thank you. You may step down. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2179 1 MR. SEE: The next witness, Your Honor, for Eli 2 Lilly and Company, is Dr. Victor Reus. 3 THE CLERK: Please raise your right hand. 4 VICTOR I. REUS, M.D., Ph.D., 5 called as a witness at the instance of the Defendant, 6 being first duly sworn or affirmed to tell the truth, 7 the whole truth, and nothing but the truth, was 8 examined and testified as follows: 9 THE CLERK: Please be seated. Please state 10 your name and spell your last name. 11 THE WITNESS: Victor I. Reus, M.D., R-E-U-S. 12 DIRECT EXAMINATION 13 BY MR. SEE: 14 Q. Afternoon, Dr. Reus. 15 A. Good afternoon. 16 Q. You're a medical doctor? 17 A. Yes, I am. 18 Q. Do you have a specialized practice? 19 A. Well, I'm a psychiatrist. 20 Q. Where do you live, sir? 21 A. San Francisco. 22 Q. And tell us where you work. 23 A. I'm a professor at the University of 24 California, San Francisco, School of Medicine. 25 Q. Now, we first would like to go over your PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2180 1 educational background. Would you start by telling 2 the jury where you went to college and what you 3 studied? 4 A. I went to college at Cornel University in 5 Ithica, New York, and majored in psychology and 6 neuroscience, behavioral neuroscience. After that, I 7 went to the University of Maryland School of Medicine, 8 got my Doctorate of Medicine there. And then after 9 that, I did a combined internship and residency in 10 psychiatry at the University of Wisconsin in Madison, 11 Wisconsin. And following that, I went to the National 12 Institute of Health for several years as what's called 13 a clinical associate there, in the National Institute 14 of Medical Health section. And then after that, I 15 took my first academic job at the University of 16 California, San Francisco, as an assistant professor, 17 and that was back in 1978, and I've progressed up to a 18 full professor and that's my position currently. 19 Q. How is it that you became interested in 20 psychiatry, Dr. Reus? 21 A. That can take longer time than we have 22 available. I'm a fifth generation of physicians in my 23 family, and my mother was an internist and we grew 24 up -- actually, she was in internal medicine, but we 25 had a house on the grounds of a very large PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2181 1 neuropsychiatric hospital, and I sort of, from the age 2 of seven actually, sort of grew up in close proximity 3 to individuals who had psychiatric problems. And we 4 also had a lot of family friends who were physicians 5 in the hospital and so somehow, from that and also 6 from being interested in behavior in animals, I found 7 myself sort of gravitating towards medical school 8 every time. 9 Q. And your position is now at the Langley Porter 10 Neuropsychiatric Institute? 11 A. That's correct. 12 Q. Would you tell us what that is? 13 A. That's a -- the University of California, back 14 in the mid forties, decided that mental health had 15 been neglected from the standpoint of research and 16 training, and was unique -- well, together with New 17 York State, actually, set up -- each of those states 18 set up institutes in a couple of locations. 19 California set one up in San Francisco, the Langley 20 Porter Institute, and another one down in Los Angeles, 21 the Neuropsychiatric Institute at UCLA. And those 22 were sort of state-supported mandated institutes to 23 learn more about mental illness, do research on the 24 illness, and teach medical practitioners about how to 25 diagnose and treat mental illness. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2182 1 Q. What had been your general responsibilities at 2 the Langley Porter Institute? 3 A. When I first got there, I ran what was called 4 the Behavioral Neuroscience Service, which was the 5 largest adult inpatient unit there, and I did that for 6 six, seven years, something like that. 7 After that, or actually, coincident with the 8 last couple years of that, I also became medical 9 director in charge of all the inpatient units, so that 10 involved sort of overview of the original unit I had 11 been on, plus another adult crisis unit, plus an 12 adolescent unit, plus a child unit. 13 Then in the last couple of years, our 14 institution, like most others, have seen a sort of 15 gradual downsizing of inpatient beds, and then since 16 then, I shifted more to an outpatient setting and I'm 17 currently in the process of setting out a mood 18 disorder center that we're in the process of putting 19 together. 20 Q. When you use the term mood disorders, does that 21 include the disease, major depression? 22 A. Yes, it does. 23 Q. Now, along with your responsibilities at the 24 Langley Porter Institute, have you also had teaching 25 responsibilities at the medical school? PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2183 1 A. Yes. That comes with the territory. 2 Q. Tell us what you teach and what have been your 3 responsibilities there? 4 A. I am most commonly called upon to teach about 5 mood disorders, how to diagnose them, recognize them, 6 and also the sort of pathophysiology, the biological 7 mechanisms underlying what we know about mood 8 disorders, and then the psychopharmacology, the drug 9 treatment, of mood disorders. So those are the topics 10 I most commonly talk about. 11 Q. Now, have you also done research in 12 psychopharmacology? 13 A. Yes, I have. 14 Q. Could you tell us what that involves? 15 A. Well, it's taken several different pathways. 16 There have been a number of studies looking at new and 17 innovative treatments in mood disorders, trying to 18 figure out if there are additional new compounds that 19 can be effective in the treatment of depression. 20 There have been other studies that try to take a look 21 at specifically memory, which can oftentimes be 22 impaired in depression. We've also looked at memory 23 in Alzheimer's disease and medications that might 24 specifically improve that particular problem. And 25 more recently, I've done a lot of work in the genetics PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2184 1 of mood disorders. 2 Q. As a part of that research work, have you been 3 involved in the design and the planning and the 4 execution of controlled clinical trials? 5 A. Yes, I have. 6 Q. Can you give us an idea of about how many? 7 A. Well, I would say that all the trials that we 8 try to do, that we try to shoot towards a controlled 9 clinical trial, so even with compounds that are not 10 sponsored yet by third parties, we still try to create 11 designs that involve placebo control and what's called 12 random assignment where we try to control for 13 possibility of bias either on the part of -- on 14 ourselves in terms of finding answers that we expect 15 to find, or bias on the part of individuals' 16 expectancies, you know, the idea that when you're 17 given a new drug, a lot of people think that something 18 that's new is necessarily better. So part of trying 19 to do a double-blind control trial is trying to deal 20 with those different sets of expectancies. 21 Q. Can you give us an idea, over the years that 22 you've been involved in this kind of research, how 23 many controlled clinical trials have you actually been 24 involved with and conducted yourself? 25 A. Well, I don't know that I have an exact number PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2185 1 offhand. 2 Q. Do you have a best judgment? 3 A. I mean, our clinical trials can go several 4 years in length, so I would say, you know, a dozen, 5 maybe something like that. 6 Q. Now, have you also had publications in 7 peer-reviewed scientific journals? 8 A. Yes, I have. 9 Q. On what topics generally? 10 A. Well, again, psychopharmacology, drug 11 treatment, articles on basic mechanisms involved in 12 different psychiatric conditions, most commonly, mood 13 disorders, depression, manic-depressive illness, and 14 recently a series of articles on genetics and mood 15 disorders. 16 Q. Other than being an author, have you played a 17 role in the peer-review process for medical and 18 scientific journals? 19 A. Yes. 20 Q. Could you tell us about that? 21 A. I am called upon to review articles for a great 22 number of psychiatric and medical journals, so I serve 23 as an editorial reviewer there. It's on the CV. I 24 don't know that I could list all the different 25 journals. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2186 1 And then, in addition, I've served on a series 2 of what are called review sections. These are groups 3 of individuals put together by the National Institute 4 of Health to review grant applications for research in 5 these areas as well. 6 Q. Are you called upon from time to time to give 7 speeches and presentations in these areas of research 8 into psychoactive drugs and psychopharmacology? 9 A. Yes, I am. 10 Q. Can you give us just a general idea what kinds 11 of programs and topics you present on and in what 12 kinds of places? 13 A. Well, the kinds of places can be anywhere from 14 grand rounds at specific medical centers or university 15 centers to what are called continuing medical 16 education seminars. Every doctor has to record a 17 certain amount of hours of educational participation 18 per year and in a very direct sort of personal 19 attendance way, and so I'm called upon to give 20 lectures that have CME credit so that physicians can 21 maintain their medical licenses as a result. And most 22 of those talks have to do with diagnosis and treatment 23 of depression. 24 Q. Do you belong to scientific organizations that 25 specifically look at psychopharmacology drugs used to PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2187 1 treat psychiatric illness? 2 A. Yes, I do. 3 Q. Could you tell just about that generally? 4 A. Well, there are a number of organizations. 5 There's the American Society of Clinical 6 Psychopharmacology that I'm a member on, and I serve 7 also on the membership committee of that organization. 8 I'm a fellow of the International College of 9 Neuropsychopharmacology, which is a worldwide 10 organization. I'm also in the organization of Society 11 of Biological Psychiatry, and I have served on a lot 12 of different committees in that organization, and also 13 I've been president of the West Coast Biological 14 Psychiatry, which is an organization of individuals on 15 the West Coast of the United States that have been 16 involved in psychopharmacology and biologic aspects of 17 psychiatric. 18 Q. Have you become board certified in psychiatry? 19 A. Yes, I've been board certified since 1977 and 20 have served as an examiner for the American Board of 21 Psychiatry and Neurology since actually a year after I 22 was certified, and I've been a senior examiner for the 23 American Board for the last four years. 24 Q. What does it mean to be a senior examiner for 25 the board? PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2188 1 A. Well, there are, I think, six teams that 2 examine all the candidates for people who want to 3 become certified in the specialty of psychiatry. Each 4 of those six teams has three or four senior 5 individuals, so that's a total of 18 to 20 some 6 people, and we're responsible, basically, for 7 overseeing the examination process of all physicians 8 who have gone through a residency in psychiatry and 9 who want to be certified as a psychiatrist, and it 10 requires flying around the country three or four times 11 a year to help conduct the live examinations. These 12 are examinations that involve candidates actually 13 interviewing live patients and being observed while 14 they do that. 15 Q. Have you heard of this book called, "The Best 16 Doctors in America"? 17 A. Yes. 18 Q. Tell the jury how the individuals in this book 19 are chosen. 20 A. Well, what happens is that the people who put 21 out that book, had put out other books like best 22 lawyers in America. This is a book that they did 23 this -- followed the same process on for best doctors, 24 and what they basically do is call physicians at -- in 25 a sort of a generalized sampling procedure across the PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2189 1 whole country, starting with physicians at major 2 medical centers, but then going on and sort of asking 3 people at those centers who they would most want to 4 refer a family patient to or who they would most want 5 to go to for their own care and treatment, and so 6 after sort of creating a whole sort of sampling and 7 matrix out of all of those responses, they end up with 8 a group of individuals that represents about one 9 percent of the doctors in the United States. 10 Q. And are you, Dr. Victor Reus, listed in this 11 book, "The Best Doctors In America"? 12 A. Yes, I am. 13 Q. Do you recall what section you're listed in? 14 A. Mood disorders. 15 Q. And that includes major depression? 16 A. That's correct. 17 MR. SEE: May I approach the witness, Your 18 Honor? 19 THE COURT: You may. 20 Q (By Mr. See) May I ask you to look at Page 21 448 of "The Best Doctors In America," and the question 22 I want to ask you is, is Dr. Kenneth Tardiff also 23 listed in that book? 24 A. Yes, he is. 25 Q. And what section is he listed under? PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2190 1 A. Under violence. 2 Q. Now, Dr. Reus, I want to ask you about this -- 3 MR. SEE: First, Your Honor, I should tender 4 Dr. Reus to the Court as an expert in psychiatry and 5 in psychopharmacology. 6 MR. VICKERY: His experience and credentials 7 meet the requirements of Rule 702, Your Honor. 8 THE COURT: Thank you. The Court finds 9 Dr. Reus qualified as an expert to testify in 10 psychiatry -- in the fields of psychiatry and 11 psychopharmacology. 12 Q (By Mr. See) Now, Dr. Reus, I would like to 13 ask you about your own experience with using the 14 antidepressant medication Prozac. Have you used 15 Prozac? 16 A. Yes, I have. 17 Q. Now, I first want to ask you, you were around 18 practicing psychiatry at the time Prozac became 19 available for use in the United States in early 1988? 20 A. Yes, I was. 21 Q. So you were familiar with the treatment of 22 major depression before Prozac was available and after 23 Prozac was available; is that right? 24 A. That's correct. 25 Q. Can you tell the jury, please, what impact did PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2191 1 the availability of Prozac have on the treatment of 2 major depression? 3 MR. VICKERY: Objection, this is cumulative of 4 Dr. Tollefson, Your Honor. 5 THE COURT: Pardon me? 6 MR. VICKERY: This is cumulative of 7 Dr. Tollefson. We've already heard one witness tell 8 us the impact. 9 THE COURT: I'll allow it. 10 THE WITNESS: Well, it was really a tremendous 11 impact on the field. We had, previous to that, a 12 series of drugs called tricyclic antidepressants and 13 also another class called monoamine oxidase 14 inhibitors, both of which were very effective in the 15 treatment of depression, but which also carried a 16 number of significant side effects that made it hard 17 for patients to be able to take the medications over 18 time. 19 And the medications, also, one of the real 20 serious drawbacks to their usage was that if you took 21 them in an overdose -- and we know that suicide is a 22 very serious risk in the treatment of depression, you 23 wanted to give these medications so that people would 24 feel better, but it took, actually, several weeks, 25 usually, maybe sometimes as long as four to six weeks PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2192 1 before people would feel better. And we knew that 2 these medications were also very toxic if taken in 3 overdose and it was not all that difficult to kill 4 yourself with them, so it was sort of paradoxical. 5 You wanted to give the medication to the person to 6 feel better, but you also knew that you were giving 7 them something that made it easier to kill themselves 8 if they chose to do so. 9 So when Prozac came out, it was the first in 10 the class of compounds called selective serotonin 11 reuptake inhibitors, and what that meant, practically 12 speaking, was that it was a drug that was just as 13 effective as the previous drugs we had in the 14 treatment of depression, but its side effect profile 15 was much better tolerated by people, so they found it 16 easier to stick with the trial until they got to the 17 point where they felt better. 18 And in addition, if they were to take that drug 19 in overdose, it was very, very hard to kill yourself 20 in overdose with that drug. And that's also proven 21 true for the subsequent drugs that have come out in 22 that class. So that was really a very dramatic 23 difference in how we approached outpatient treatment 24 of depression. 25 Q (By Mr. See) Let me ask you, Dr. Reus, do you PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2193 1 have an opinion to a reasonable degree of medical 2 certainty whether Prozac causes people to commit 3 suicide and/or commit violent, assaultive, or 4 homicidal behavior? 5 A. Yes, I do. 6 Q. What's your opinion? 7 A. It's my opinion that there is no credible 8 evidence that Prozac is associated with causing people 9 to kill themselves or causing them to kill other 10 people. 11 Q. Now, did you, at my request, review the medical 12 records of William Forsyth? 13 A. Yes, I did. 14 Q. And do you have an opinion whether taking 15 Prozac caused Mr. Forsyth either to kill himself or to 16 kill his wife? 17 A. Yes, I do. 18 Q. And what's that opinion, please? 19 A. From my review of all of the material that was 20 given to me, I did not find any credible cause to 21 suggest that Mr. Forsyth killed himself or killed his 22 wife due to his having received Prozac. 23 Q. Now, Dr. Reus, we have heard testimony in this 24 case about a certain article, a case report by 25 Dr. Martin Teicher that came out in February of 1990 PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2194 1 that reported that Dr. Teicher had six patients whom 2 he had or he or another physician had given Prozac and 3 then observed those patients to have experienced 4 suicidal thinking. Did you see that article when it 5 came out? 6 A. Yes, I did. It was widely disseminated and it 7 came out in the American Journal of Psychiatry which 8 is a journal that everyone who's a member of the 9 American Psychiatric Association receives. 10 Q. Now, Dr. Reus, when that Teicher article came 11 out, did you believe that it proved and established 12 that Prozac causes people to kill themselves? 13 A. No. It was far from that. It did nothing of 14 the sort. 15 Q. Why didn't you think that? 16 A. It was a series of case reports of six 17 individuals, and the six individuals were presented as 18 possibly showing what Mr. See just said, but if you 19 actually looked at the cases, they were, how should I 20 say, there was no logical way that you could deduce 21 that the drug resulted in the person thinking about 22 suicide. 23 The title suggested that suicide occurred sort 24 of out of the blue in individuals. When you took a 25 look at these individuals, all six of these PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2195 1 individuals had had active suicidal thoughts prior to 2 them ever having received Prozac. In addition, the 3 way in which Prozac was given to these people, it was 4 given in a manner that was totally out of keeping with 5 all of the medical recommendations for how to 6 administer it. The dose was rapidly escalated to a 7 very high dose in a very short period of time, and in 8 addition, was given with many other medications on 9 board in at least four of the six individuals. In 10 fact, there's a fifth one also who had an additional 11 medication on board, so it was very confusing and 12 there's no way that anyone could, first of all, say 13 that the suicide ideation was new, or two, relate it 14 to one out of all of the medications that these 15 individuals were receiving. 16 And to just make an added point about that, the 17 drug cocktails that were being given by Teicher were 18 exceedingly unusual cocktails and cocktails that many 19 clinicians would not advocate giving in any 20 circumstance. They involved giving stimulate drugs, 21 for example, Ritalin in addition to lithium, in 22 addition to the Prozac, in addition to other 23 antidepressants like Trazodone, so each cocktail for 24 the patients that were described was different also, 25 so this was sort of an arbitrary collection of six PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2196 1 cases and I don't know how he happened to, you know, 2 collect these six cases, but there was really no 3 bottom line that you could deduce from looking at 4 these cases. 5 Q. Now, I want to ask you, Dr. Reus, about 6 research methodology. Is there a generally accepted 7 view in the medical and scientific community, of which 8 you're a part of, whether case reports, such as 9 Dr. Teicher's article, can be used to come to a 10 conclusion that the drug caused a certain effect or 11 adverse event? 12 A. There's no way you can come to a causal 13 conclusion on the basis of a case report. A case 14 report is an anecdote basically. It's someone saying 15 I had this patient. I saw this happen under this 16 circumstance. And any person can, basically, tell a 17 story, and that's really all it is. Every 18 psychiatrist or every doctor can basically write a 19 case report and they're not without use. You know, 20 sometimes those stories lead to something, but on the 21 basis of a single case report or a series of cases, 22 you cannot deduce causal relationships. Their only 23 use is to lead towards controlled clinical trials 24 which actually control for the confounding variables, 25 trying to account for the other things that might PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2197 1 create the outcome that is being observed. 2 Q. Now, I want to ask you about controlled 3 clinical trials. Is that a research methodology that 4 is generally accepted in the medical and scientific 5 community as being scientifically valid to use to 6 determine causation? 7 A. It's been the basis of all the scientific 8 advances and biomedical science for most of the 9 century. 10 Q. Now, we've heard some testimony about 11 controlled clinical trials, but I'm not sure we really 12 have heard evidence in this case that tells us exactly 13 what that is, so I'd like for you to explain how you 14 go about, in lay person's language, conducting a 15 controlled clinical trial. First of all, how many 16 groups are involved in a controlled clinical trial? 17 A. Well, at least two groups, but it can be more. 18 Q. And why do you have at least two groups? 19 A. Well, because in a clinical trial, you're going 20 to manipulate something, you're going to do something. 21 In a drug trial, what you're going to do is give a 22 drug to these individuals. So one of the things that 23 you want you -- and you want to find out what the drug 24 does to that individual over a certain period of time. 25 We know that a lot of things can happen when PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2198 1 you work with people, and one of the things that can 2 happen is that the drug can have no effect or it can 3 have a beneficial effect or it can have adverse 4 effects. We also know that even if you don't give an 5 active drug, if you just give what people think is a 6 drug, sometimes you can have changes as well because 7 people, when they have expectancies that they're going 8 to feel better or in some cases, they might feel that 9 they're going to be worse, that they can have that as 10 well, and so one of the important things in a clinical 11 trial is to have a placebo, to have a drug that is 12 basically inactive. 13 Q. Okay. We have out two groups now. 14 A. So you give an active drug to one. 15 Q. And you give a drug you're studying to one 16 group? 17 A. Right, and a placebo to the other group. 18 Q. And placebo is just the sugar pill? 19 A. That's right. 20 Q. So you've given drug to one group and placebo 21 to the other group? 22 A. Right. So you have a population of people that 23 you want to give this drug to. Let's say it's people 24 with depression, but you know that people with 25 depression are different from one another. Even PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2199 1 though there's a group of people with depression, you 2 know that within that grouping there could be many 3 different kinds of depression. Some people can be 4 very severely depressed, some people can be mildly 5 depressed, some people can have agitated depression, 6 some people can have a more retarded depression. 7 So one of the things you want to do is, first, 8 specify, as best you can, what the inclusion criteria 9 are, what are the characteristics of the people that 10 you want to study in as many ways you can do, so to 11 make it as homogenous a group as you can, and you also 12 want to specify what the exclusion criteria are, what 13 sort of characteristics you would rather not have in 14 individuals who are undergoing this trial, because if 15 they were included, the results would be perhaps more 16 variant. So you're trying to, basically, make it as 17 similar a group that's being exposed to both the drug 18 and the placebo group as you can. 19 Q. Let me ask you this: The concept of having the 20 comparison group with the placebo, is that the part 21 that is called the control? 22 A. Well, that's one part of it. The other part of 23 the control is -- once you've defined who you want to 24 study and they've gone through the inclusion and 25 exclusion criteria, the other thing you want to do is PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2200 1 you want to make sure you don't, on your own, make a 2 decision as to who's going to get the active drug and 3 who's going to get the sugar pill. So what you do is 4 you randomize it. You take it out of the realm of 5 your choice, and you do it, basically, like flipping a 6 coin. 7 So you take the population and you don't 8 know -- in the classic double-blind control trial, you 9 don't know who's going to get the drug or the sugar 10 pill, and also the patient doesn't know what they're 11 going to get, so your expectancies are controlled for 12 and also the patients expectancies are controlled for. 13 Q. Now, first let's talk about randomized. Now, 14 why is it important to randomize the assignment of the 15 patients in these two groups? 16 A. Well, that's because of what we call bias, that 17 if I want the results to turn out a certain way and I 18 didn't randomize, I might preferentially assign people 19 that I thought were going to do better to the active 20 drug and assigned the worst people or the people that 21 had a more treatment resistant illness, for example, 22 to the placebo. 23 Q. So the randomization is to ensure that you 24 don't put all of the real sick people all in one 25 group, and the people that are not so sick in another? PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2201 1 A. That's correct. 2 Q. Now, you talked about the concept of double 3 blind. First, what's the double part of that mean? 4 A. Well, the double is neither you nor the person 5 who's receiving the drug know which is which. You 6 don't know which is the active drug, which is the 7 placebo, and they don't either. 8 Q. And why is that important? 9 A. Well, again, if you know which is active, then 10 when you try to measure how people are changing, you 11 may evaluate them as getting better or getting worse 12 depending upon how you expect things to turn out, how 13 you want them to turn out, and in the same sense, the 14 patient would do the same thing. We know that 15 psychological factors are very important, and 16 sometimes we're aware of these psychological factors 17 within ourselves, sometimes we're not. Sometimes 18 they're unconscious. 19 Q. Now, these case reports, like Dr. Teicher's 20 that we've been hearing about, are they double blind? 21 A. No, they're not. 22 Q. Are they randomized? 23 A. No, they're not. 24 Q. Do they have a control group? 25 A. No, they don't. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2202 1 Q. Now, one other concept that I would like you to 2 talk to the jury about, in lay person's language if 3 possible, is the concept of statistical significance. 4 You're familiar with that? 5 A. Yes, I am. 6 Q. Could you tell the jury, in as plain language 7 as possible, what that means and why it's important? 8 A. Sure. Let's say you do the study and you get a 9 certain set of results. The question is that even 10 after you've gone through all of these controls and 11 done the best job as you can to try to control all 12 sorts of random variables that might affect the 13 results, even after you do all of that, there are 14 still going to be things that you didn't think about, 15 that you may not even know about that could affect the 16 results, and we also know that some things occur just 17 by chance alone. 18 So if you flip a coin, we know that if you flip 19 a coin a million, million times, it will come up 20 50 percent heads, 50 percent tails. But we also know 21 that you could flip a coin and have it come up heads 22 ten times in a row, so that means that a certain set 23 of results can occur just by chance alone. 24 So what statistics are designed for are to set 25 sort of guidelines for when do we accept data as being PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2203 1 really meaningful and truthful, and there are 2 arbitrary guidelines, but they're guidelines that 3 everyone in the field has basically agreed to, and the 4 sort of gold standard guideline is what's called the 5 .05 significance level, and what that means, 6 basically, is that when you get a certain set of data, 7 when you get your results, to accept those results as 8 real and significant. They have to meet a point of 9 odd significance level, which means that you would not 10 get results like this greater than five times out of a 11 hundred by chance alone. 12 So, again, that's the sort of -- that's an 13 arbitrary. You can still get it by chance alone, but 14 no greater than five times out of a hundred would you 15 get a data set that looks like what you're looking at 16 greater than that. 17 Q. And that significant standard you just 18 described is the one that's generally acceptable in 19 the medical and scientific community? 20 A. That's correct. That's really what all the 21 journals look for. That's what -- when you're doing a 22 study, that's what you're always looking for. I mean, 23 if you can get a .01 significance level, that's even 24 better, you know, less than one time in a hundred 25 would you see data like this, by chance alone, but .05 PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2204 1 is the minimal standard. If it's less than .05, it's 2 considered not significant. 3 Q. Let me specifically ask about that. If you get 4 a result in a study that is not significant after 5 you've done a statistical test, is that result a 6 result that you can use to come to a causal 7 conclusion? 8 A. Absolutely not. And, in fact, it's an all or 9 none thing. You can't say, for example, something is 10 close to significance or nearly significant. That is 11 really improper to do, and no journal would accept you 12 saying something like that. You have to meet that 13 standard. 14 Q. Now, are there other types of studies that 15 involved larger groups of people in controlled 16 clinical trials? 17 A. Yes, those are epidemiologic studies. 18 Q. Epidemiology studies, tell us what that is, 19 please, briefly. 20 A. Well, epidemiologic studies are not controlled 21 clinical trials in that you're not manipulating 22 something, you're not changing a scientific condition, 23 administering a drug, you're just observing a 24 population, and the benefit of epidemiologic studies 25 are that you're working with very large numbers and so PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2205 1 it allows you to look at relationships between things 2 that might be very subtle and might be quite rare, and 3 when you have large numbers, you're allowed 4 statistically to look at things in a much more 5 sensitive fashion, so epidemiologic studies try to 6 look at the relationships between variables in a given 7 subject that is drawn from a specific population, and 8 the key things to look at in epidemiologic studies are 9 how do you define the population that you're looking 10 at, how do you sample individuals from that 11 population, how do you select who you're going to look 12 at, and then what are the variables that you're most 13 interested in to look at. 14 Q. Let me ask this question: You discussed the 15 concept of statistical significance when we talked 16 about controlled clinical trials? 17 A. Yes. 18 Q. Does that also apply to the underlying results 19 from epidemiology studies? 20 A. Yes, absolutely. 21 Q. And does the same concept apply; that is, if 22 the result is not statistically significant, can it be 23 used to come to a causal conclusion? 24 A. Absolutely not. 25 Q. Now, sometime back during our trial, we had the PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2206 1 testimony of Dr. Healy who testified about a 2 particular epidemiology study performed by Dr. Hershel 3 Jick. The jury heard testimony about that. First, 4 are you familiar with that study? 5 A. Yes, I am. 6 Q. Now, the question I want to ask you is, does 7 the Jick study, the epidemiology study, show that 8 Prozac has a statistically significant increase in 9 risk for suicide? 10 A. No, it does not. 11 Q. And, in fact, what is the conclusion of the 12 authors of the Jick study about whether their data 13 that they gathered shows whether Prozac has an 14 increased risk for suicide compared to other 15 antidepressants? 16 A. Well, the conclusion of the author is, but I 17 should also say the conclusion of anyone who's 18 familiar with the interpretation of scientific 19 methodology is that there is no difference in the risk 20 of suicide amongst the antidepressant medications that 21 were looked at, including Prozac. So there is no 22 greater risk for Prozac or any of the other 23 medications than any other target or comparative 24 antidepressant medication. 25 Q. Dr. Reus, have you, in your experience as a PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2207 1 psychiatrist and a physician, had occasion to treat or 2 diagnose patients with a condition called akathisia? 3 A. Yes. 4 Q. Can you tell the jury what akathisia is? 5 A. Akathisia is a condition that involves both 6 subjective sense of discomfort, in most cases, a very 7 severe and significant sense of anxiety, restlessness, 8 internal distress, sort of like bugs are crawling out 9 of your skin, sort of like you feel like you're sort 10 of antsy inside, really -- it's a very uncomfortable 11 and distressing internal sensation of anxiety. That's 12 one requirement for akathisia. 13 The other requirement is that you actually have 14 a motor disturbance. And it usually involves the 15 lower extremities, your legs, and it can take several 16 different forms. It can take sort of swinging of your 17 legs on a regular and repetitive basis. It can take 18 pacing actively. It can take the form of not being 19 able to sit still for minutes at a time -- 20 Q. Can I interrupt you there? What does someone 21 actually look like if they have akathisia? 22 A. Well, my legs are sort of covered here on the 23 stand. 24 MR. SEE: May the witness step down to 25 demonstrate, Your Honor? PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2208 1 THE COURT: Very well. 2 Q (By Mr. See) Would it be helpful to sit in a 3 chair, Doctor? 4 A. Well, I can show you sitting down certainly. 5 (Demonstrating.) 6 Q. Now, you're showing a movement of your legs? 7 A. Um-hum. 8 Q. And then you show a crossing and uncrossing of 9 your legs? 10 A. Yeah. It's basically a restlessness of the 11 lower legs. In fact, there's another syndrome that's 12 very similar to it in neurology. It's called restless 13 legs syndrome, and it is caused by different factors, 14 but it's very similar to the way it looks. 15 Q. Now, you also -- 16 A. It could also be sort of like when a person is 17 standing up, they are sort of wanting to pace like 18 this, and sometimes it can actually be pacing in 19 broader steps. 20 Q. All right. Thank you, sir. Now, the jury has 21 heard the testimony of Dr. Randolph Neal, who was the 22 psychiatrist who cared for Mr. Forsyth during the time 23 he was in Castle Medical Center, and Dr. Neal's 24 testimony was that Mr. Forsyth did not have the 25 condition akathisia during the time he was in Castle. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2209 1 What I want to ask you is, you have reviewed the 2 Castle Medical Center records? 3 A. Yes, I have. 4 Q. And from those records, did you see whether 5 Mr. Forsyth was taking Prozac during the time he was 6 in Castle Medical Center? 7 A. Yes, he was. 8 Q. And from your review of those records, do you 9 have an opinion whether, in fact, Mr. Forsyth had the 10 condition of akathisia during the time he was in 11 Castle Medical Center? 12 A. Yes. I mean, I saw absolutely no evidence in 13 the hospital record that he was suffering any of the 14 symptoms of akathisia, either the subjective symptoms, 15 which is, as I said, are very uncomfortable and 16 symptoms that the individual complains about. 17 Mr. Forsyth was reported during the course, and there 18 are a number of observations on a daily basis, as 19 being comfortable, as his anxiety decreasing over the 20 course of his week-long hospitalization. He was 21 reported as sleeping well, as being cooperative and 22 pleasant. He was going to groups. He was stating 23 that he was feeling better, and, you know, he was not 24 getting up and leaving groups. He was not observed to 25 be pacing or rapidly engaging in leg movements and he PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2210 1 was not complaining of anything that had to do with an 2 internal sense of distress. He was actually saying, I 3 was feeling better over the course of the week, and 4 the last view we have of him is actually the family 5 meeting that he had and the reports by his son, and 6 his son, the last person to see him alive, said that 7 he was also calm and collected during the course of 8 that meeting. Again, this is incompatible with the 9 diagnosis of akathisia. 10 MR. SEE: Your Honor, if I may just have one 11 second? I'm looking for one blowup. 12 Q. Dr. Reus, are you familiar with the package 13 insert for Prozac? 14 A. Yes, I am. 15 Q. And how did you acquire that familiarity? 16 A. Well, I mean, every medication that you 17 prescribe comes with a package insert and I have, you 18 know, been familiar with the patient package insert 19 with Prozac since it first came out. 20 Q. And did you, at my request, specifically look 21 and review the package insert for Prozac that was in 22 effect in 1992? 23 A. Yes, I did. 24 Q. I'm going to put up a blowup which is 25 Exhibit 1041, which is a blowup of that package PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2211 1 insert. Now, first, Dr. Reus, I want to ask you a 2 general question, and I'm asking you, as an expert in 3 psychopharmacology, with that expertise, do you have 4 an opinion whether the Prozac package insert provided 5 to prescribing doctors in 1992, provided adequate 6 information so that those doctors could safely and 7 effectively prescribe the drug? 8 A. Yes. I mean, based on everything that I knew 9 of the drug at the time and also everything I've 10 learned about the drug in the year since leads me to 11 say yes. 12 Q. Now, I want to specifically ask you about a 13 couple of points. In the section of the insert that 14 is under the section "Other events observed during 15 premarketing evaluation of Prozac," there are listed 16 the events, "agitation and akathisia." You're 17 familiar with that? 18 A. Yes, I am. 19 Q. Now, my question is, did the listing of these 20 events, agitation and akathisia, as events that were 21 observed during the premarketing evaluation of Prozac, 22 did that provide the prescribing physicians in 1992 23 adequate warning that there could be a risk of 24 patients having agitation or akathisia when they took 25 Prozac? PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2212 1 A. Yes. I mean, there's a set format for how 2 these data are presented. The first table that you 3 see there reflects observations of symptoms and side 4 effects that may or may not be related to the drug, 5 but had been observed in placebo controlled trials. 6 Then under the premarketing, what they basically do is 7 list additional symptoms that had been observed not in 8 placebo controlled trials, but in all the other 9 trials, some trials that are open trials, again, where 10 there haven't been, you know, controlled conditions or 11 other comparative drugs. 12 And so when you see a new drug, I mean, you 13 never -- when a new drug comes to market, I think 14 every responsible clinician spends a lot of time 15 looking in detail at the patient package insert, 16 because at that point, you haven't had any experience 17 using the drug and nor has there been all that much 18 experience out in the field, so you look at the whole 19 long list because it's possible that additional things 20 will be discovered over time that weren't evident in 21 the original trials, so yeah, that's exactly in the 22 list of things that you would look at and read and 23 take into consideration. 24 Q. Okay. Doctor, I want to take you down to the 25 section a little further down in the insert, the one PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2213 1 that is entitled, "Post-introduction reports" and that 2 one reads, "Voluntary reports of adverse events 3 temporally associated" -- what that does temporally 4 associated mean? 5 A. It means, associated in time, that occurred in 6 some close time proximity. 7 Q. "...with Prozac that had been received since 8 market introduction and which may have no causal 9 relationship with the drug, include the following: 10 Suicidal ideation and violent behaviors." Now, my 11 question for you is this: Did the inclusion of the 12 term "suicidal ideation" and "violent behaviors" in 13 the post-introduction reports section of the Prozac 14 insert provide adequate warning to the prescribing 15 physicians that these risks had been reported and that 16 they were information that the doctor ought to be 17 aware of? 18 A. Yes. I think it was the most prudent and 19 appropriate way in which to present that information 20 at that time. There wasn't any causal relationship 21 associated, and as I've said already, in my opinion, 22 in the year since, and all the additional 23 investigations that have been done on this issue, 24 there is no causal relationship, but still at that 25 point in time, it was prudent to list that as PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2214 1 something that a clinician should be aware of, but 2 that really, you know, is one of the things that's 3 being looked at and reported on in the literature. 4 Q. Dr. Reus, let me ask you one final question. 5 With respect to the question whether Prozac causes 6 suicide, this jury has heard testimony from Dr. Ronald 7 Shlensky, and during his testimony, about that issue, 8 that is, whether Prozac causes suicide, Dr. Shlensky 9 said, there's no controversy anymore. Do you agree 10 with that? 11 A. Yeah, I would agree there's no controversy. 12 Q. And what is there controversy about? 13 A. There's no controversy about Prozac being 14 associated with an increased suicidal or violence 15 risk. This is an issue that, as I mentioned, was 16 precipitated by the Teicher article in 1990. There 17 were a large number of case reports, collected series, 18 controlled trials that looked at the issue. A number 19 of the best and the brightest in the field in the 20 various organizations, in the FDA, in the American 21 College of Neuropsychopharmacology, which is probably 22 the most prestigious psychopharmacologic organization 23 we have, looked at this issue, reviewed all the 24 articles, and the consistent conclusion has been that 25 there is no associated risk over and above what PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2215 1 normally occurs in the treatment of depressive 2 illness. 3 MR. SEE: All right. Thank you very much, 4 Doctor. I pass the witness. 5 THE COURT: Mr. Vickery. 6 MR. VICKERY: Thank you, Your Honor. 7 CROSS-EXAMINATION 8 BY MR. VICKERY: 9 Q. Dr. Reus, it sounds to me like there's some 10 controversy between you and Dr. Shlensky. He says 11 it's obvious it does cause it and you say it's obvious 12 it doesn't. How are we to decide that? 13 A. Well, I didn't -- I'm not here -- I mean, 14 Dr. Shlensky is not here for him and me to discuss it, 15 but as I said, I feel I'm pretty well connected to all 16 the major groups and the majority of the credible 17 practitioners in the country and the world in 18 psychopharmacology, and that's my reading of the 19 situation. I don't know why Dr. Shlensky made a 20 statement like that. 21 Q. How about Dr. Healy, you've seen his 22 credentials, haven't you? 23 A. Yes, I have. 24 Q. May I see this book you've got here? 25 MR. VICKERY: If I may approach the witness, PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2216 1 Your Honor? 2 THE COURT: You may. 3 Q (By Mr. Vickery) This book is nice, but has 4 the Harvard Press published a book by you on the 5 antidepressant era? 6 A. I haven't submitted anything for Harvard Press 7 to publish. 8 Q. Have you done a Ph.D. dissertation on the 9 serotonin system? 10 A. No. 11 Q. If there's no controversy, if it's just a dead 12 issue, how can a guy with the credentials of a David 13 Healy, who's never testified in his life before, say 14 that this drug causes this behavior generally and 15 caused it in this man? 16 A. It is bewildering to me how he could say 17 something like that. I have no clue as to how he 18 could make a statement like that. 19 Q. You think that maybe one of the things that 20 might be helpful for us to do is to look at the 21 biases? That's one of the things you do in the 22 epidemiological study, right, you control for bias? 23 A. Yes. 24 Q. You think that maybe that's the process that we 25 should do, is to look for bias to see if that would PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2217 1 help us resolve this controversy? 2 A. Sure. 3 Q. Well, let me talk to you about your biases. 4 Approximately what percentage of your income is 5 derived from working for the pharmaceutical industry, 6 either doing clinical trials or doing speeches or 7 doing consulting or doing testifying? What percent? 8 A. I would say -- well, first of all, one of the 9 things you have to understand about my testifying 10 income, as an employee of the University of 11 California, San Francisco, I have to turn over all my 12 external income to the University of California, San 13 Francisco. So if you're suggesting that someone 14 benefits from that, it's the regents of the University 15 of California, so they may be biased in having me go 16 out to examine such issues, but I'm not aware that it 17 significantly affects me. 18 In terms of the amount of money, I would say 19 that it's, I don't know, 15, 20 percent of my income. 20 Q. I'm confused. Either you turn it all over to 21 the University of California or you get to keep -- 22 A. As a percentage of my salary -- I do turn it 23 over, but that's the percentage that is equivalent to 24 what my salary is based on. 25 Q. You turn over all of your external income from PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2218 1 whatever source to the University of California? 2 A. We are allowed, at last count, to keep 3 individual CME lectures that we've received honoraria 4 for. If we do forensic testimony, we have to turn 5 that over. If we do consultation, we have to turn 6 that over. 7 Q. How about outside consulting fees? 8 A. We have to turn that over. 9 Q. Like do you have income from the Mendel group? 10 A. Sorry? 11 Q. The Mendel group. 12 A. Yes. 13 Q. Do you have income from the Mendel group? 14 A. Yes, I do. 15 Q. And do you have to turn that over to them or do 16 you get to keep that? 17 A. That wasn't a consulting. That was an 18 honoraria for a direct product that I produced. 19 Q. So you get to keep that money? 20 A. That's correct. 21 Q. Now, the Mendel group is a group of consultants 22 that try to help drug companies like Eli Lilly for 23 sort of strategic marketing planning; isn't that true, 24 sir? 25 A. I have no idea what they do. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2219 1 Q. Let me read you something about them and see if 2 you agree. Is it a strategic management consulting 3 firm for the pharmaceutical industry with a practice 4 dedicated to assisting client companies in making 5 optimal decisions in business development, marketing, 6 and public strategy? 7 A. Again, I don't have a clear understanding of 8 what it is they do. My relationship with them is, 9 basically, to evaluate certain work products that they 10 created. This is a one-time event, and what they did 11 was produce certain descriptions of certain new drugs 12 that are considered to be developed or in the process 13 of early stages of development and then they asked me 14 whether I thought that what they had said about the 15 drug was accurate from a medical point of view or a 16 neuroscience point of view, and that's all my 17 relationship is with them. 18 Q. Aren't you on their editorial board? 19 A. That's what that means, having done that type 20 of activity. 21 Q. That's sort of like a one-shot time? 22 A. As far as I know, yeah. 23 Q. Incidentally you're also on the review board of 24 the Harvard Review of Psychiatry, are you not? 25 A. Not on the review board. I'm one of the PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2220 1 editorial reviewers for that journal. 2 Q. A peer reviewer? 3 A. Sorry? Yes, that's correct. 4 Q. You're what they call a peer reviewer? 5 A. That's correct. 6 Q. And that's a peer-reviewed journal? 7 A. Yes. 8 Q. Are you familiar also with something called the 9 Harvard Mental Health Newsletter? 10 A. I don't believe so, no. 11 Q. How can you be on the board at the Harvard 12 Review of Psychiatry and not know about this important 13 publication, the Harvard Mental Health Newsletter? 14 MR. SEE: Objection to form, it's 15 argumentative. 16 THE COURT: Sustained. 17 Q (By Mr. Vickery) Would you put -- do you 18 believe the Harvard Medical -- Mental Health 19 Newsletter is a peer-reviewed journal? 20 A. I don't know if it is or isn't. 21 Q. Would you put any credence at all in a 22 statement in a newsletter where they didn't even list 23 who the author was? 24 A. I'm sorry? 25 Q. Let me be real clear. Would you, as a PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2221 1 scientist, as a university professor, look at a 2 newsletter where they said something about what a drug 3 did or did not cause and they didn't even list who the 4 author was? 5 MR. SEE: Objection to the form. I'm sorry, I 6 thought you were finished. 7 Q (By Mr. Vickery) Would you put any credence 8 in that or would you toss it in the trash? 9 MR. SEE: Objection to the form, incomplete 10 hypothetical. 11 THE COURT: What was the objection? 12 MR. SEE: To the form, it's an incomplete 13 hypothetical. 14 MR. VICKERY: Your Honor, I don't know how to 15 complete that hypothetical. 16 THE COURT: I'll allow the question. 17 THE WITNESS: I don't know how to respond to 18 you. I get newsletters all the time from various 19 different organizations, and without seeing a specific 20 item and without being able to evaluate it and know 21 more about what the item was alleging, the context, 22 the background information on it, I don't know how I 23 can make a statement about whether it was credible or 24 not. 25 Q (By Mr. Vickery) Well, the reason I asked PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2222 1 this is that we've heard -- we've seen one and we've 2 heard that we're supposed to put credence in it. Now, 3 you don't put credence in the statements of two very 4 senior clinicians in your field, Jonathan Cole and 5 Martin Teicher, in a peer-reviewed journal, do you? 6 A. Well, I separate out a specific product from 7 the individuals involved in the product. I don't 8 think there's any cause or need to engage in ad 9 hominem descriptions of individuals. What I can tell 10 you is that I do have significant and serious 11 criticisms of that particular paper and I'm not alone 12 in that. 13 Q. Well, ad hominem means personal attacks? 14 A. That's correct. 15 Q. I'm talking about Dr. Jonathan Cole. Is there 16 any man in this country that is more revered as a 17 pharmacologist, as a psychopharmacologist, as an 18 early-on guy as Jonathan Cole? 19 A. Well, I don't know how you judge rankings among 20 psychopharmacologists. 21 Q. Well, let me ask you it this way then: What is 22 your opinion about the reputation and the integrity of 23 Dr. Jonathan Cole? 24 A. I think he has -- enjoys a good reputation and 25 I have no reason to suspect his integrity. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2223 1 Q. Now, and Dr. Martin Teicher also has a good 2 reputation and credentials, does he not? 3 A. That's correct. 4 Q. So when not one, but both of those fellows 5 report on a phenomenon and it's peer reviewed and 6 published, can we just discount it? 7 A. Well, I think you have to look at each 8 individual item and object, and all I can tell you is 9 that in my own life, I'm well aware of the fact that 10 even smart people can do stupid things at times, and 11 this particular paper, I don't think, should have been 12 published. I don't think it underwent significant 13 enough editorial scrutiny. 14 Q. If you had been the reviewer, it wouldn't have 15 gotten published? 16 A. That's correct. 17 Q. Well, let me ask you, I was asking about your 18 alliance with the pharmaceutical company. When you do 19 clinical trials like Mr. See has described, do you 20 keep that money or does that go to the University of 21 California? 22 MR. SEE: I object to the question on the basis 23 of form, on the basis of counsel's first statement 24 regarding alliance with the pharmaceutical industry. 25 THE COURT: I'll sustain the objection on that. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2224 1 You may ask the question otherwise. 2 Q (By Mr. Vickery) When you do clinical trials, 3 there's a fee paid, is there not? 4 A. For conducting the trial. I mean, it has to 5 pay for the trial, you have to hire nurses and 6 research assistants, yes. 7 Q. And we've heard from Dr. Tollefson that it's 4, 8 $5,000 per patient. Is that consistent with your 9 experience? 10 A. Well, that's a pretty lucrative project, but it 11 can be as high as that. 12 Q. Okay. And when that 4 or $5,000 per patient is 13 paid, is a portion of it paid to the physician who is 14 the clinical investigator? 15 A. Well, if you're in the private sector, you can 16 construct a budget however you wish. If it is myself 17 doing the budget, then again, the entire budget is 18 turned over to the University of California. 19 Q. Okay. 20 A. I don't personally -- 21 Q. You don't personally profit from it? 22 A. That's correct. 23 Q. Why do you do it? 24 A. Why do I do it? 25 Q. Yes, sir. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2225 1 A. Because I'm interested in the generation of new 2 knowledge. 3 Q. Okay. In terms of your own interest and own 4 attitude towards pharmacology and SSRI drugs, in 5 particular, can you tell us what it is? 6 A. I'm afraid you'd have to be more specific. 7 Psychopharmacology in general? 8 Q. Well, let me ask it to you this way: Do you 9 consider yourself a psychopharmacologist? 10 A. Well, I consider myself knowledgeable about the 11 usage of drugs. I think drugs are just tools. A drug 12 is not good or bad. It's a tool for helping you treat 13 a certain condition. 14 Q. I'm sorry, Dr. Reus, I need to be real specific 15 on this. Are you a pharmacologist? 16 A. Well, again, I don't know how you apply that 17 term. 18 Q. I don't apply it at all. 19 A. There is no specialty certification in 20 psychopharmacology, so I have an interest in 21 psychopharmacology. I consider myself knowledgeable 22 in psychopharmacology. I belong to organizations that 23 are interested in psychopharmacology, but do I do 24 other things, do I believe in psychosocial 25 interventions and treatments? Yes. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2226 1 Q. Let's try it this way -- 2 A. So I don't know how you bracket the term. 3 Q. I'm not interested in how I bracket it, but how 4 you do. 5 A. Well, I just told you. 6 Q. We need to talk at different times, okay. If I 7 were to meet you at a party or something, said hi, 8 what do you do? Is one of the things you would say 9 is, I'm a pharmacologist or a psychopharmacologist or 10 a neuropsychopharmacologist? Would you apply any of 11 those labels to yourself? 12 A. I'd say I'm a psychiatrist. 13 Q. Are you a member of the prestigious American 14 College of Neuropsychopharmacology? 15 A. No, I'm not. 16 Q. Do you believe in cosmetic psychopharmacology? 17 A. What is that? 18 Q. That's giving a psychoactive drug, like Prozac, 19 to perfectly healthy people to see what it will do to 20 them. 21 A. To see what it will do to them? 22 Q. See if perfectly healthy people, just like all 23 of us here in the room, will have a reaction. You've 24 done that, haven't you? 25 A. No, I've not given Prozac to perfectly healthy PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2227 1 people. 2 Q. You've given Paxil, haven't you? 3 A. In a context of a research study, I gave 4 paroxetine to normal individuals to evaluate whether, 5 in fact, it does influence the normal. 6 Q. And paroxetine is an SSRI that's Paxil, isn't 7 it? 8 A. That's correct. 9 Q. Paroxetine is Paxil just like fluoxetine is 10 Prozac? 11 A. That's correct. 12 Q. And you have, sir, as part of research, given 13 this drug, it's also an SSRI, isn't it, selective 14 serotonin reuptake inhibitor? 15 A. That's correct. 16 Q. And you've given this drug to perfectly healthy 17 people, have you not, sir? 18 A. Under informed consent in the context of a 19 double-blind controlled, placebo controlled trial, 20 that's correct. 21 Q. Tell us, if you would, please, Doctor, why you 22 gave a mind-altering chemical to perfectly healthy 23 people? 24 A. Well, first of all, it's important to 25 understand that the term mind-altering chemical PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2228 1 applies to a lot of things that we take into our 2 bodies on a daily basis, such as coffee. I don't know 3 what you're drinking -- 4 Q. It's water. All it does is make me go to the 5 bathroom. 6 A. Coke has caffeine, chocolate has caffeine and 7 will alter your mind, nicotine is a mind-altering 8 substance. We studied mind-altering substances in 9 normal individuals for many, many years and we're 10 interested in the ways in which substances can affect 11 the minds and the same substances can affect the 12 heart, the liver, the kidneys. 13 So the fact that we have drugs that we 14 prescribe to individuals who have mental disorders, in 15 some way changes their mood, one of the questions that 16 has arisen has been, and particularly now where the 17 drugs are relatively easily tolerated, the question 18 has been, in fact, do normal individuals respond in 19 any way or is it something that, again, is something 20 that is just subject to people's expectancy about a 21 given drug? 22 With the issue as to whether a drug should be 23 given, I think that's a very serious and legitimate 24 issue. I don't have an answer for that. That wasn't 25 the purpose of this study. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2229 1 Q. We're going to need to leave, but before I 2 leave today, I want to ask you this. I'm not talking 3 about caffeine or coffee or drugs, I'm talking about a 4 drug that is intended to alter the chemistry of this 5 very important neurotransmitter called serotonin in 6 the brain, and I would like for you, rather than 7 talking about coffee and everything else, tell us, 8 before we leave, why you have lent your credentials 9 and your expertise and your name as one of the best 10 doctors in America to give that kind of psychoactive 11 drug to perfectly normal human beings? 12 A. Again, that's a serious mistake to separate out 13 a drug like paroxetine, or one of the drugs that we 14 currently have, from other mind-altering substances 15 that aren't prescribed, that one is less serious as to 16 the other. As to why, I actually was interested, 17 along with my colleagues, in exploring the effects of 18 paroxetine. We know that it can result in improved 19 mood and social ability in individuals who are 20 depressed. 21 More recently, it has been used by individuals 22 in more minor and mild depressions that you can see 23 similar benefits, and there is a popular book by Peter 24 Kramer about "Listening to Prozac" which suggested 25 that maybe this is, in fact, a continuum that, in PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2230 1 fact, alterations of neurotransmitters can, in fact, 2 maybe result in improved mood and social ability even 3 in normal individuals. 4 Q. Dr. Reus, just to follow up on that with 5 Dr. Kramer's book, which I'm well familiar, what Peter 6 Kramer was saying about Prozac and what you were doing 7 about Paxil in this study was helping the drug 8 companies look for additional markets, for additional 9 people to buy this? 10 A. No. Absolutely not. 11 MR. SEE: Just hold on one second. My 12 objection is to the form of the question as 13 argumentative, and counsel is raising his voice to the 14 witness. 15 THE COURT: I'll sustain the objection. It's 16 after four. Let's break now. I want to meet with 17 counsel, please. Be back at nine o'clock tomorrow 18 morning. 19 (Whereupon, the following proceedings were had 20 in open court out of the presence of the jury.) 21 THE COURT: Where are we schedule wise? 22 MR. VICKERY: I'm sorry, Your Honor? 23 THE COURT: Where are we schedule wise? 24 MR. SEE: We have one more live witness which 25 we'll bring tomorrow, however long Mr. Vickery takes PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2231 1 to continue with Dr. Reus, and then we have, I think, 2 two deposition transcripts, all designations are 3 pretty short to read, and that would conclude the -- 4 that would probably conclude the evidence, so I think 5 certainly the end of the day tomorrow is a very good 6 estimate and maybe -- 7 THE COURT: How much longer do you think you're 8 going to be on Dr. Reus? 9 MR. VICKERY: Probably not over an hour, Your 10 Honor. And I've told Mr. See in terms of rebuttal, we 11 filed this morning a proffer of about 25 minutes worth 12 of deposition excerpts from Dr. Charles Beasley, which 13 I would like to offer in rebuttal, and then I shared 14 with him I would like to call Dr. Ron Maris, 15 consistent with your order, Your Honor, and Dr. Jean 16 Hoepfel, who is a clinical epidemiologist to address 17 these so-called epidemiology studies that Mr. See has 18 pulled out of his briefcase during the case of these 19 trials. 20 MR. SEE: Your Honor, we have a very serious 21 issue about putting any kind of deposition 22 designations in. It is totally outside of the 23 scheduling order. We have very serious issues about 24 the, I'm sorry, Jean -- 25 MR. VICKERY: Dr. Hoepfel. PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2232 1 MR. SEE: Sorry, Dr. Hoepfel, who has never 2 been designated as an expert, never written a report, 3 never disclosed anything about what she may say. I 4 have no idea what she might say. It's totally outside 5 the Court's scheduling order and we also take issue 6 with Dr. Maris' testimony and would like to take that 7 up with the Court before he testifies. 8 We litigated this in front of Magistrate 9 Yamashita, and the question was, was this really 10 rebuttal. The Court may recall, if the Court has 11 looked at it recently and may not have because there 12 is a lot of paper in the case, the plaintiffs engaged 13 Dr. Maris at the time they engaged their experts in 14 chief, and he wrote his report before the expert 15 disclosure date, and then the plaintiffs said, oh, 16 just hang onto it for a little bit. And they waited 17 until after we had disclosed our experts and then took 18 the very same report and filed it and said he's a 19 rebuttal expert. 20 Well, we would like to address that with the 21 Court and address the opinions that are expressed in 22 Dr. Maris' reports and we strongly feel that none of 23 them are in rebuttal and Dr. Maris ought not testify. 24 The first two are pretty clear, the Court provided a 25 time to designate deposition testimony and this was PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2233 1 it. I have never seen it. Mr. Vickery said he filed 2 something this morning and certainly was never 3 designated within the Court's scheduling time whenever 4 everybody was supposed to do it, which was when we did 5 it. And with respect to an undisclosed expert, I 6 think that's a pretty clear issue about totally 7 outside the scheduling or termed completely 8 undisclosed, no report, no discovery, but anyway, I 9 think the only one that it's really talking about is 10 Dr. Maris and we'd like to address with the Court 11 tomorrow, and I have his report here, issue by issue 12 to see whether he truly is in rebuttal and our 13 position is he is not. 14 THE COURT: Mr. Vickery. 15 MR. VICKERY: Your Honor, I'd be glad to 16 address all three of those matters with you in the 17 morning or tonight. 18 THE COURT: Give me a summary now. 19 MR. VICKERY: Okay. The summary, quite simply, 20 is that rebuttal testimony -- because we bear the 21 burden of proof, we are entitled to put on rebuttal 22 evidence to rebut what the defendants put on in their 23 case and that's what we're doing. Mr. See says you 24 can't put Dr. Maris on because you told us early about 25 him so that can't be rebuttal, and then you can't call PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2234 1 Dr. Hoepfel because you didn't tell us early. Well, 2 it seems like, with all due respect to Mr. See, that 3 he's saying two things that are mutually 4 contradictory. Mr. See, with respect to Dr. Hoepfel, 5 even when the Court asked him at the Daubert hearing 6 about epidemiological studies, he said I've got some 7 epidemiological studies, Judge, and the Court said 8 what are they? He said, well, I don't want to share 9 them with you right now because I'm going to use them 10 in the cross-examination with Dr. Healy. So he 11 wouldn't share them with the Court in camera in an ex 12 parte basis, which the Court was willing to do. 13 Dr. Hoepfel is being called to respond to those 14 studies which they characterize dispositive 15 epidemiological studies that he just pulled out of his 16 briefcase in the middle of this trial. 17 Dr. Maris is consistent with your order, Your 18 Honor. That's the reason that we brought him down 19 here at considerable expense and reliance on the 20 Court's order to respond to this notion that it is a 21 classic murder/suicide caused by depression. That's 22 not our case. 23 Our case was that these deaths were caused by 24 Prozac. It's their case that it was caused by 25 depression or it was caused by religion or something PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2235 1 else. That's why we asked him to come down to rebut 2 that. And as far as Dr. Beasley goes, I thought, as 3 did the Court, quite frankly, that Dr. Beasley would 4 be here to testify live. He was on my list as he was 5 on Mr. See's. The Court ordered him to bring him. 6 They persuaded the Court and changed your mind, but I 7 don't think you can penalize my clients because 8 Mr. See prevailed on the Court to change your mind 9 during the course of it. And what happened is I'm 10 designating from Dr. Beasley, this witness they 11 absolutely refuse to bring, his testimony which rebuts 12 the testimony of Dr. Tollefson in this case. 13 So all three things that I'm bringing respond 14 specifically to defense matters initiated in their 15 case. That is the very function of rebuttal 16 testimony, and I would address, Your Honor, that even 17 at that -- even with Dr. Hoepfel and Dr. Maris whose 18 scope of examination is more limited, I've still only 19 got four. Because, you know, Mr. See and I have 20 talked about it and he's assured me that he's not 21 going to get accumulative with things, his five expert 22 witnesses to the two in our case in chief, and I don't 23 think it's unreasonable or unfair when we have the 24 burden of proof for us to be able to put on expert 25 opinion evidence to respond to their case. That's the PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2236 1 summary. 2 THE COURT: And you filed something this 3 morning? 4 MR. VICKERY: I'm sorry, we didn't prepare -- 5 THE COURT: This is another non-filing? 6 MR. VICKERY: Excuse me? 7 THE COURT: This is another non-filing? 8 MR. VICKERY: It is filed, Your Honor. 9 Everybody has been busy. He's been busy. I've been 10 busy. I was going to discuss -- I think I did tell 11 him this morning that we were going to make deposition 12 excerpts from Dr. Beasley. What I filed was a proffer 13 of pages and lines we intend to read from, line such 14 and such to line such and such in the deposition of 15 Dr. Charles Beasley in rebuttal. We read it out loud 16 and it takes 25 minutes to read it out loud. It would 17 take the Court a lot less to read quietly. 18 THE COURT: When do you want me to read it? 19 MR. VICKERY: Your Honor, my view is that the 20 Court doesn't have to read it. I think we are 21 entitled, as a matter of law, bearing the burden of 22 proof, to put on deposition testimony from Eli Lilly 23 witnesses in rebuttal in our case to rebut the 24 testimony of live Eli Lilly witnesses. However, if 25 the Court's feeling obliged in light of Mr. See's PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2237 1 objection, I would like you to read it at your 2 convenience so that you can read it -- I guess reading 3 it to yourself would take probably 15 minutes. 4 THE COURT: All right. We'll -- and, Mr. See, 5 you filed something on this? 6 MR. SEE: I have not filed anything on it. 7 THE COURT: No, on these objections that you 8 had to these three witnesses? 9 MR. SEE: Oh, I will file something. I'll file 10 something tomorrow. I hadn't. Mr. Vickery is making 11 announcements that he wants to put in Charles Beasley. 12 He called me on the phone or I called him on the phone 13 yesterday and he told me that he had a woman, a 14 doctor. That's it. Nothing was disclosed. I have no 15 idea who she is. I do intend to file something. I 16 haven't done it yet, but I will. 17 THE COURT: Well, based on your representations 18 last week, the Court has something scheduled for 19 April 6th right now. I'm not sure we're going to be 20 through by then. 21 MR. SEE: I don't think that's a problem. 22 We'll be through before tomorrow is over and with 23 respect, that ought to be the end of the evidence. 24 THE COURT: Well, you know, we have to make 25 time for -- we'll have final arguments hopefully on PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2238 1 Tuesday of next week. 2 MR. SEE: Yes, sir. 3 THE COURT: It may take the jury some time to 4 deliberate. 5 MR. SEE: Understood. 6 THE COURT: And then there's the punitive 7 damages phase. 8 MR. SEE: I appreciate that. 9 THE COURT: That's why I'm telling you, I 10 scheduled something for April 6th, which is the 11 following Tuesday, but we'll meet at nine tomorrow 12 then. 13 (Whereupon, the proceedings were adjourned at 14 4:17 p.m. to be reconvened on Wednesday, 15 March 24, 1999 at 9:00 a.m.) 16 17 18 19 20 21 22 23 24 25 PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU 2239 1 C E R T I F I C A T E 2 --ooOOoo-- 3 I, TINA M. STUHR, Official Court Reporter, 4 United States District Court, District of Hawaii, 5 Honolulu, Hawaii, do hereby certify that the foregoing 6 is a correct partial transcript of proceedings in 7 Civil No. 95-00185ACK, Susan K. Forsyth, et al. vs. 8 Eli Lilly and Company, et al., at Honolulu, Hawaii, on 9 March 23, 1999, before the Honorable Alan C. Kay, 10 United States District Judge. 11 DATED: December 28, 1999. 12 13 ______________________________________ TINA M. STUHR, RPR, CSR #360 14 15 16 17 18 19 20 21 22 23 24 25 PACIFIC REPORTING SERVICES UNLIMITED, INC. (80) 524-PRSU