2414 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 2,414 - 2,546 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 Thursday, March 25, 1999 at 9:15 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. (808) 524-PRSU 2415 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 For Defendant: ANDREW SEE, ESQ. 9 MICHELLE R. MANGRUM, ESQ. Shook, Hardy & Bacon L.L.P. 10 One Kansas City Place 1200 Main Street 11 Kansas City, Missouri 64105 12 EDMUND BURKE, ESQ. Burke Sakai McPheeters Bordner 13 Iwanaga & Estes 737 Bishop Street 14 Suite 3100 - Mauka Tower Honolulu, Hawaii 96813 15 16 17 18 19 20 21 22 23 24 25 PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2416 1 I N D E X 2 WITNESSES ON BEHALF OF PLAINTIFFS 3 WILLIAM DAVID FORSYTH PAGE 4 Direct Examination by Mr. Vickery 2423 5 RONALD W. MARIS, Ph.D. 6 Direct Examination by Mr. Vickery 2425 Cross-Examination by Mr. See 2474 7 Redirect Examination by Mr. Vickery 2520 Recross-Examination by Mr. See 2526 8 Redirect Examination by Mr. Vickery 2527 9 CHARLES BEASLEY, M.D. 10 Reading of his deposition testimony 2528 11 EXHIBITS ADMITTED INTO EVIDENCE: PAGE 12 Defendant's Exhibit 1008 - Thomas F. 2421 Brady, Ph.D. records regarding William 13 Forsyth, Sr. and June Forsyth 14 Defendant's Exhibit 1009 - Castle Medical 2421 Center medical records regarding William 15 Forsyth, Sr. 16 Defendant's Exhibit 1010 - Howard Cohen 2421 M.D./Westside Cardiology Consultants 17 medical records regarding William Forsyth, Sr. 18 Defendant's Exhibit 1011 - Richard Hawley 2421 19 M.D. medical records regarding William Forsyth, Sr. 20 Defendant's Exhibit 1012 - Maui Medical 2421 21 Group Lahiana medical records regarding William Forsyth, Sr. and June Forsyth 22 Defendant's Exhibit 1013 - Randolph Neal 2421 23 M.D. medical records regarding William Forsyth, Sr. 24 Defendant's Exhibit 1016 - Riggs Roberts 2421 25 M.D. medical records regarding William Forsyth, Sr. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2417 1 Defendant's Exhibit 1020 - Trascey Lee 2421 Jennings, M.A. counseling records 2 regarding June Forsyth 3 Defendant's Exhibit 1021 - Maui Medical 2421 Group Wailuku medical records regarding 4 June Forsyth 5 Defendant's Exhibit 1022 - Alfred 2421 Pasternak, M.D. medical records 6 regarding June Forsyth 7 Defendant's Exhibit 1023 - Joseph 2421 Raymond, M.D. medical records regarding 8 June Forsyth 9 Defendant's Exhibit 1024 - David A. 2421 Reisbord, M.D. medical records regarding 10 June Forsyth 11 Defendant's Exhibit 1025 - St. John's 2421 Hospital and Health Center medical 12 records regarding June Forsyth 13 Defendant's Exhibit 1029 - William 2421 Forsyth, Sr.'s handwritten notes 14 Defendant's Exhibit 1030 - William 2421 15 Forsyth, Sr.'s handwritten journal 16 Defendant's Exhibit 1031 - William 2421 Forsyth, Sr.'s handwritten notes in 17 Mead Company notebook 18 Defendant's Exhibit 1032 - June 2421 Forsyth's handwritten notes in Mead 19 Composition notebook 20 Defendant's Exhibit 1033 - June 2421 Forsyth's handwritten notes in Mead 21 Spell-write Steno Book 22 Defendant's Exhibit 1034 - June 2421 Forsyth's handwritten notes in Mead 23 Spell-write Steno Book 24 Defendant's Exhibit 1035 - June 2421 Forsyth's Rosalie R. Prussing 1993 25 Collectors Edition Calendar PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2418 1 Defendant's Exhibit 1036 - June 2421 Forsyth's Longmeadow Press Bound Theme 2 Book 3 Defendant's Exhibit 1037 - William 2421 Forsyth, Sr.'s handwritten notes on 4 Precision Auto Body notepad 5 Defendant's Exhibit 1038 - William 2421 Forsyth, Sr.'s handwritten notes 6 Defendant's Exhibit 1039 - William 2421 7 Forsyth, Sr.'s handwritten notes 8 Defendant's Exhibit 1040 - Dr. 2421 Ianitello's handwritten notes dated 9 6/24/91 and 8/29/91 regarding June Forsyth 10 Defendant's Exhibit 1041 - Prozac 2421 Package Insert dated 3/23/92 11 Defendant's Exhibit 1042 - Dear Doctor 2421 12 Letter dated 8/31/90 13 Defendant's Exhibit 1046 - Maui County 2421 Police Department Property Report 14 Defendant's Exhibit 1049 - Letter dated 2421 15 6/3/92 from Carl Peck, M.D. to Ida Hellendar, M.D. and Sidney Wolfe, M.D. 16 Defendant's Exhibit 1061 - Letter dated 2421 17 7/26/91 from Carl Peck, M.D. to Sanford Block 18 Defendant's Exhibit 1067 - FDA Talk Paper 2421 19 dated 8/1/91 and illustrative chart 20 Defendant's Exhibit 1116 - Benefit/Risk 2421 Considerations According to the State of 21 Knowledge of 5/21/85 concerning the Antidepressant Drug Fluoxetine 22 Defendant's Exhibit 1124 - 11/4/90 2421 23 memorandum from C. Bouchy to L. Thompson, Dr. Weinstein, and Dr. Zerbe regarding 24 changing event terms 25 Defendant's Exhibit 1138 - FDA Talk Paper 2421 dated 7/31/90 and illustrative chart PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2419 1 Defendant's Exhibit 1141 2421 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2420 1 THE CLERK: Civil No. 95-00185 ACK, Susan K. 2 Forsyth, et al. versus Eli Lilly and Company, et al.. 3 MR. VICKERY: Andy Vickery and Karen Barth for 4 the Forsyths. Mr. Chang had a conflicting court 5 engagement this morning. 6 THE COURT: Good morning. 7 MR. SEE: Good morning, Your Honor. Andy See 8 with Michelle Mangrum and Ed Burke for Eli Lilly and 9 Company. 10 THE COURT: Good morning. Good morning, ladies 11 and gentlemen of the jury. Please proceed. 12 MR. SEE: Your Honor, at this time we'll read 13 from the deposition of Ms. Celestine Star. And if it 14 please the Court, I'll ask Ms. Mangrum to take the 15 witness chair so she can read from Ms. Star's 16 testimony. 17 THE COURT: Very well. 18 MR. SEE: We'll start on Page 4. 19 (Whereupon, the deposition of Celestine Star 20 was read.) 21 MR. SEE: That concludes the deposition of 22 Celestine Star. 23 Your Honor, we now have the remaining of formal 24 offer of the exhibits that we spoke of before. 25 THE COURT: Please proceed. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2421 1 MS. MANGRUM: Your Honor, Eli Lilly and Company 2 would offer the following exhibits: 1008 to 1013, 3 1016, 1020 to 1025, 1029 to 1042, 1046, 1049, 1061, 4 1067, 1116, 1124, 1138, and 1141. 5 THE COURT: Any objection? 6 MR. VICKERY: I'm sorry, Your Honor. No 7 objection at all. 8 THE COURT: Those exhibits are admitted. 9 MR. SEE: Your Honor, with that, Eli Lilly and 10 Company rests its case. 11 THE COURT: Mr. Vickery. 12 MR. VICKERY: Thank you, Your Honor. First 13 very briefly, Your Honor, I want to recall Bill 14 Forsyth, Jr. 15 MR. SEE: Your Honor -- 16 THE COURT: You're reminded you're still under 17 oath. 18 THE WITNESS: Yes. 19 MR. SEE: Your Honor, may we approach the side 20 bar? 21 THE COURT: Yes. 22 (Whereupon, the following proceedings were had 23 at side bar out of the hearing of the jury.) 24 MR. SEE: This is the first I learned that 25 Mr. Vickery desired to call Mr. Forsyth. He didn't PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2422 1 tell us in advance that he was going to do this. 2 MR. VICKERY: I made up my mind to do it when 3 they were reading Celestine Star. She met with him in 4 November, but she couldn't remember what year. This 5 is November '91; and B, I want him to address 6 financial needs of the church, that's all. And I 7 decided when I listened to this testimony. 8 MR. SEE: Your Honor, this deposition was taken 9 about two years ago and he's had it all along. We've 10 always designated we were going to read it. All of 11 this could have been done in the case in chief. 12 We had no idea he was going to call 13 Mr. Forsyth. He didn't tell us he was going to. He 14 didn't advise us as to the rebuttal witness. I object 15 to his giving testimony. I simply haven't prepared 16 to -- 17 THE COURT: Just ask him those two questions, 18 the church's needs, financials needs, and the date of 19 when the deposition was. 20 MR. SEE: The date of the deposition? 21 MR. VICKERY: No, not the date of the 22 deposition. The date that this man and woman met. 23 THE COURT: I'm sorry, I meant the date of the 24 meeting. 25 MR. SEE: Well, I've never asked him what he PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2423 1 knows about that. I have no idea what he'll say. He 2 was deposed long before she was. She was a witness we 3 found after his deposition. 4 THE COURT: Well, I'm going to allow it. 5 (Whereupon, the following proceedings were had 6 in open court in the presence of the jury.) 7 WILLIAM DAVID FORSYTH, 8 the Plaintiff, called as a rebuttal witness, after 9 having previously been first duly sworn to tell the 10 truth, was examined and testified as follows: 11 DIRECT EXAMINATION 12 BY MR. VICKERY: 13 Q. Mr. Forsyth, just two questions. We just heard 14 a deposition of a lady, a hypnotherapist, that your 15 father met for three hours in November. Can you tell 16 us, was that November of '91 or November of '92? 17 A. It was 1991. I never heard that deposition 18 until today, but even within the deposition it said 19 that my dad would call my mom to tell her he might 20 possibly not be coming back, and in November of '92 my 21 mom was already living with my father and counseling 22 with Tom Brady twice a week for double sessions. So 23 it's just totally inconsistent with the thought that 24 it was even '92. 25 Q. Okay. Secondly, did your church have, like, a PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2424 1 big building campaign or some big need for a lot of 2 money? 3 A. No. Our church was started in 1981 and ever 4 since that time, we've met in the same location, which 5 is an old golf cart barn in a resort area that they 6 let us use for virtually no rent. So we don't have 7 big expenses or any big financial need like that. We 8 never had a financial problem in 18 years that our 9 church has met. 10 MR. VICKERY: Thank you. That's all I have. 11 MR. SEE: No questions, sir. 12 THE COURT: You may step down. 13 MR. VICKERY: Your Honor, we would now call 14 Dr. Ron Maris. 15 THE CLERK: Please raise your right hand. 16 RONALD W. MARIS, Ph.D., 17 called as a witness on behalf of the Plaintiffs, after 18 having been first duly sworn to tell the truth, the 19 whole truth, and nothing but the truth, was examined 20 and testified as follows: 21 THE CLERK: Please be seated. Please state 22 your name and spell your last name. 23 THE WITNESS: Ronald W. Maris, M-A-R-I-S. 24 25 PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2425 1 DIRECT EXAMINATION 2 BY MR. VICKERY: 3 Q. Good morning, Dr. Maris. 4 A. Good morning. 5 Q. You have been here throughout the defendant's 6 case, have you not, sir? 7 A. That's correct. 8 Q. Has that been at my request? 9 A. Yes. You asked me as a rebuttal witness to 10 hear the defense experts' testimony. 11 Q. And have I agreed to compensate you for your 12 time in doing all of that? 13 A. You have. 14 Q. At what rate? 15 A. My rate to read and investigate is 250 an hour 16 and for court testimony it's 350 an hour. 17 Q. Okay. Now -- and approximately how much time 18 has been involved in this project or how many dollars, 19 if you can translate that? 20 A. Up until I came here, over two years' time, I 21 think I spent 68 hours or about $17,000. 22 Q. Okay, sir. Now, let's get your background, if 23 we may. How old of a gentleman are you? 24 A. Sixty-two. 25 Q. And where did you grow up, Dr. Maris? PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2426 1 A. I grew up in Illinois, Champagne or Bent, 2 Illinois. 3 Q. Where did you go to college? 4 A. I have three degrees from the University of 5 Illinois, Urbana. 6 Q. And what are those degrees in? 7 A. My undergraduate work, I started out as a 8 chemical engineer for the first year, and I actually 9 graduated in 1958 in English and philosophy. 10 Q. And then what course of graduate studies did 11 you pursue? 12 A. After that, I went to Harvard University in 13 Cambridge, Massachusetts and had a year's worth of 14 study in religion and philosophy. 15 Q. Okay, sir. Then what? 16 A. I came back to Illinois and I did a masters 17 degree in philosophy with a specialty in the history 18 of science and linguistic philosophy, so I got a 19 masters in philosophy, and then I stayed on to finish 20 my Ph.D. My Ph.D. was in medical sociology and in the 21 epidemiology of social psychology of suicide in 22 Chicago. 23 Q. Give us an idea, if you would, what you did in 24 terms of primary research for your Ph.D. dissertation. 25 A. My Ph.D. dissertation involved looking at the PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2427 1 coroner's records and the death records of 2,153 2 completed suicides over a five-year time span in Cook 3 County, mainly the City of Chicago. 4 Q. Did that Ph.D. dissertation end up getting 5 published? 6 A. Yes, it did. 7 Q. In what format? 8 A. In a book format called, "Social Forces in 9 Urban Suicide" in 1969. 10 Q. Dr. Maris, what year did you get your Ph.D.? 11 A. 1965. 12 Q. And have you continuously, from that time to 13 today, been involved in the study of suicide? 14 A. Yes. I would describe myself, primarily, today 15 as a suicidologist. 16 Q. And is suicidology something that's sort of a 17 recognized academic discipline in this country, and if 18 so, for how long? 19 A. It started in 1969. It was founded by someone 20 named Edmond Shneidman, with no C, at the University 21 of California, Los Angeles, so it's relatively recent. 22 It probably sounds strange because it is relatively 23 new, but I assume that psychology or sociology, when 24 the first used those words, sounded somewhat strange 25 because of the novelty. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2428 1 Q. Now, altogether in the course of your career, 2 how many different books have you published on the 3 subject of suicide or suicidology? 4 A. Well, not every one was on suicide, but I have 5 a total of 16, and then two right now that I'm 6 finishing up, so after next year, 18 books. 7 Q. Are -- I brought three of them with me this 8 morning. Is one of them called "Pathways to Suicide"? 9 A. Yes, sir. 10 Q. And is that a concept that you have used 11 throughout your study of this phenomenon? 12 A. Right. One of the things that I have 13 associated with my own work is the notion of what I 14 call a suicidal career, that people tend to become 15 suicidal over a lifespan from birth to death, 16 including background factors, and that actually was a 17 study funded by the National Institutes of Mental 18 Health to go back to Chicago and follow up in depth a 19 case control study looking at non-fatal attempters and 20 natural deaths and seeing how they differed from 21 completed suicides. So that was a follow-up to my 22 dissertation. 23 Q. When you did that, did you actually interview 24 the families and do that kind of a primary research? 25 A. Yes. We had a research team in which I stayed PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2429 1 in Chicago myself and we actually went door to door, 2 and for the most part, since most suicides are older 3 white males, this was primarily interviewing the wife 4 or the next of kin, and not just one person, but over 5 two or three people per family, with about a two-hour 6 interview and we've talked some about the 7 psychological autopsy. Basically, that was a 8 psychological autopsy study. 9 Q. Is another one of your books called "The 10 Biology of Suicide"? 11 A. Yes, it is. That's an edited book, however. I 12 was the senior editor, and I, basically, in that, 13 reviewed all the biological markers that indicated 14 suicide outcomes and commissioned people to write 15 papers, including people like Marie Osburg, who wrote 16 a paper on the serotonin aspects of suicide, so yes, I 17 did do that collection of articles. 18 Q. Is another of your books called "The Assessment 19 and Prediction of Suicide"? 20 A. Yes, sir. That's a 1992 book and it's just 21 what it says. It looks at how we try to assess 22 individuals who are suicidal, including patients, and 23 also can suicide be predicted was another major issue 24 in that book. 25 Q. And is one of the issues that you addressed in PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2430 1 a chapter of this book different measuring scales, 2 like we've heard about the Beck or the Ham-D as means 3 to measure the prediction of suicides? 4 A. Yes. There's a chapter in the book about what 5 are the best tools that we know, state-of-the-art 6 tools to try to measure suicide ideation, to try to 7 predict suicide as an outcome, yes, sir. 8 Q. Now, Dr. Maris, in addition to the books that 9 you have authored, have you also authored a number of 10 published articles in peer-reviewed literature on the 11 subject? 12 A. Yes, I have. 13 Q. Approximately how many? 14 A. It's hard to know. I think I've mentioned 75 15 to this point. I haven't kept it completely current, 16 but about 75 total. 17 Q. Okay, sir. In addition to that, have you been 18 the editor of a journal that's devoted to this 19 subject? 20 A. Yes. For 15 years I was the editor in chief of 21 a journal called Suicide and Life-Threatening 22 Behavior, which is the only scientific peer-reviewed 23 journal in the United States on suicide studies. 24 Q. And I brought a copy of that with me. This 25 says, Volume 28, and it's the fall '98. How long has PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2431 1 this publication been going on? 2 A. Twenty-eight years. 3 Q. Okay. What did you do once you got your Ph.D.? 4 A. I had two or three years, I taught a year at 5 Arizona State at Tempe, taught statistics and suicide 6 studies, and then I went to Dartmouth College and 7 taught there for two years, basically doing, deviate 8 behavior, medical sociology, and after two or three 9 year after working in sociology, from 1968 to the 10 present day, for the last, what, 31 years, I have been 11 continuously employed in medical schools. And in 12 order to become qualified to work in that area, I've 13 had four or five, almost six, now post-doctoral 14 fellowships helping me to become familiar with 15 psychiatry, psychology, and the study of suicide. 16 Q. Tell us what a post-doctoral fellowship is. 17 A. Basically, after you finish your Ph.D., it's 18 customary, particularly in the physical sciences, to 19 go on to do additional research, funded research at 20 another university to become more specialized. It's 21 similar to what the doctors have been talking about of 22 board certification. Although, I should point out 23 that in suicidology, there is no board certification 24 at this point in time. But it's an effort to become 25 more specialized in a particular field, and for me, PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2432 1 that was suicide studies. 2 Q. Have you actually gone through part of the 3 residency training in psychiatry? 4 A. Yes, I did. Well, when I left Dartmouth and 5 came down to Baltimore, Maryland, which was my next 6 job, I came down as a NIMH post-doctoral fellow in 7 psychiatry at the Johns Hopkins University Medical 8 School. So from '68 to '69 I went through a version 9 of a residency training program in suicide studies 10 with the other psychiatric residents. 11 I also, later on in 1993, took a formal 12 psychiatric residency as an auditor. I was not signed 13 up. I took one year at the University of South 14 Carolina and studied things like psychopharmacology, 15 forensic psychiatry, and mental diagnosis and other 16 aspects, but I've never completed -- of course, I'm 17 not an M.D. I want to make that clear right up front. 18 I don't pretend to be an M.D. 19 Q. What is your Ph.D. in? 20 A. My Ph.D., the actual topic, is in social 21 psychology and the thesis or dissertation was called 22 "Suicide in Chicago" and I just described the 2,153. 23 Q. Have you taught psychiatrists? 24 A. Yes. Currently, I teach at the University of 25 South Carolina. I direct a center for the study of PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2433 1 suicide, which is a semi-autonomous independent state 2 agency that is part of the university, but it's also 3 separate. 4 I do courses in psychiatric diagnosis, 5 introduction -- I teach introduction to psychiatry. I 6 teach a course on suicide prevention. I teach 7 suicidology, which I've just explained before. I 8 teach courses in death investigation. I should point 9 out that when I was in Baltimore for five years, I was 10 a deputy medical examiner for Russell Fisher, who was 11 the medical examiner, which I investigated all the 12 deaths in which he wasn't sure whether it was a 13 suicide or a homicide or an accident. So I've done 14 that hands-on kind of experience in the medical 15 examiner's office. And I also teach social 16 psychology, but I teach them to pre-medical students, 17 I teach them to medical students, I teach them to 18 psychiatric residents, and I teach them to physicians, 19 particularly in the form of continuing education 20 workshops. 21 Q. Okay. Now, have you had occasion to either 22 visit other portions of the world as part of your 23 studies, either as lecturer or to live there and study 24 the phenomenon of suicide? 25 A. Yes. I'm not sure about the wisdom of it, but PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2434 1 I decided to do some total emersion. If you look at 2 the study of suicide, you see certain parts of the 3 world where it's very high and other parts of the 4 world where it's virtually absent. And one of the 5 things I did consciously was to go live in West 6 Berlin, which is very high, to go live in Finland. I 7 took a year's fellowship to go live in Vienna, 8 Austria, which is a very high rate, and basically 9 tried to immerse myself in the culture and the 10 geography and the way of life of communities that are 11 known to have really high suicide rates. So yes, I 12 did that partly as Sabbatical, partly as research. 13 The one in West Berlin was as a World Health 14 Organization fellow. 15 Q. Okay, sir. I think I'm going to stop right now 16 and tender you. 17 MR. VICKERY: Your Honor, I tender Dr. Ron 18 Maris as an expert in the field of social psychology 19 and suicidology. 20 MR. SEE: Your Honor, I believe that Dr. Maris' 21 credentials in those areas satisfy the rule. 22 THE COURT: Okay. The Court finds Dr. Maris 23 qualified as an expert to testify in suicidology and 24 social psychology. 25 Q (By Mr. Vickery) Dr. Maris, I want you to PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2435 1 help us try to understand this phenomenon of suicide, 2 but before we do that, let me ask you straight up, how 3 closely related is the phenomenon of suicide with 4 homicide or homicide then suicide? 5 MR. SEE: Your Honor, I object. It's beyond 6 the scope of the report. I believe it's also beyond 7 the scope of the Court's ruling yesterday. 8 MR. VICKERY: I don't believe it's beyond the 9 scope of the Court's ruling, Your Honor. This is in 10 direct rebuttal to the testimony that he sat here and 11 listened to. 12 THE COURT: I don't think it's beyond the scope 13 of the Court's order as far as what I presume you're 14 going to be questioning him on. As far as the report, 15 I haven't -- well, I'd have to take some time to 16 review that. 17 MR. VICKERY: Well, Your Honor, that's one of 18 the reasons I asked him here to listen to the 19 testimony, because there's many things that have come 20 out that weren't contained in their reports, which he 21 couldn't put in his report, so that's the reason I 22 invited him here to listen to the testimony. 23 THE COURT: Well, I want you to go on to some 24 other topic at this point and I'll review it at a 25 break. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2436 1 MR. VICKERY: Very well. 2 Q. Can you help us get an understanding on the 3 phenomenon of suicide? I mean, is there some way that 4 you can sort of, in a short period of time, give us 5 the short course and help us understand this 6 phenomenon? 7 A. It's a tall order, but I'll do the best I can 8 understand the circumstances. There's certain ways of 9 approaching this. One is to look at the so-called 10 risk factors that tend to be associated with a suicide 11 outcome and then compare them to populations, usually, 12 that are not suicidal. 13 So, for example, if I'm working in the medical 14 examiner's office, every one of us in this room 15 eventually is going to have a death certificate filled 16 out on us, and there's a box there that says natural, 17 accident, suicide, homicide. One of the ways to 18 answer that question is to say, how is it -- if I 19 checked the box that this death was a suicide, that 20 would mean it's not an accident, that it's not a 21 homicide, and it's not natural, so that's a definition 22 by exclusion, which is not sufficient, but it gets us 23 started. 24 And the other thing we have to do is to realize 25 that within suicide there are many different PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2437 1 dimensions. Suicide really is on a continuum. So, 2 for example, a completed suicide is very different 3 than somebody who just thinks about suicide. If we 4 went to a shopping mall near by, there have been 5 studies by Marsha Linahan in Washington doing this 6 showing that 20 percent of the people you stop 7 randomly in a shopping center have seriously thought 8 about suicide at sometime in their life. So suicide 9 ideation is very common, and that's not the same thing 10 as suicide completion. 11 So we have to -- once we get within the realm 12 of trying to predict self-destructive behaviors, we 13 have to be sure, are we talking about somebody who's 14 just thinking about it, are we talking about somebody 15 who actually is dead from something they intentionally 16 did to themselves, and there are other dimensions 17 along those lines. For example, all this talk about 18 Beck's suicide ideation scale is interesting, but at 19 best, that measures suicide ideation. It does not 20 measure suicide completion. 21 So, for example, 15 percent of the people who 22 think about suicide will eventually go on to kill 23 themselves, but 85 percent will never kill themselves. 24 So suicide ideation has a relationship, but it's not a 25 perfect relationship, and we need a lot more than just PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2438 1 that to predict a suicide outcome. 2 Q. You mentioned something called the pathways to 3 Suicide or the suicidal career. Can you help us 4 understand what you're talking about when you talk 5 about a suicidal career? 6 A. Yes. Basically, what I mean is that you have a 7 combination of factors and you may or may not want to 8 put this on the paper board. 9 Q. Why don't I do that. It might help us. Should 10 I put suicidal career at the top? 11 A. You may. 12 Q. Now, where do we start in getting a handle on 13 the suicidal career of the human being? 14 A. Well, where I start is I start with what I call 15 background factors. These are things like, have there 16 ever been any history of suicide among first degree 17 relatives. So if I were interviewing people in this 18 room, one of the questions I would ask them is, has 19 anybody in your family, your immediate family, ever 20 completed suicide? So background, and that includes 21 things like possible biological influences. We're not 22 saying whether they're biological or whether they're 23 modeling. 24 Let me just give you a quick case in point 25 Ernest Hemingway, the author Ernest Hemingway, his PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2439 1 father, his brother, his sister, and his 2 granddaughter, Margo recently, all committed suicide. 3 That's much greater than chance in a particular 4 family, and so we want to know is there, for example, 5 a gene for depression? Is there a gene for suicide? 6 Is there something going on in the biology or the 7 modeling in the family? So I always look at the 8 background factors to start with. 9 Q. And is there anything in the background factors 10 of Mr. William Forsyth that would indicate that he was 11 on the pathway of a suicidal career? 12 A. Not of the nature that I just mentioned. Of 13 course, later on, we're going to notice that he's 14 obviously a white male, and that's one of the risk 15 factors. I don't know if you want to count that. 16 That's obviously been there for a long time, but as 17 far as suicide in the family, I saw nothing. 18 Q. After background, then what do you look at? 19 A. Well, I hate to admit it, there's really a 20 complex table, that I would ask, maybe, to prepare as 21 a chart, but I think my feeling is that that would be 22 too confusing to the jury to say that, but it's much 23 more complicated than I'm ever going to be able to 24 describe right now. But there are, over a period -- 25 you know, basically, you go from zero to about a PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2440 1 hundred, that is for the number of years there are in 2 the human lifespan, and there are these risk factors, 3 so we need to look next at risk factors. 4 Q. Okay. Let me write that down. Now, is this 5 something that you have written and published about? 6 A. Yes, it is. For example, in the assessment and 7 prediction '92 book in chapter one, Table 1.1, there's 8 actually a list of risk 15 risk factors, which I don't 9 say are the only ones, but they are ones in which 10 there seems to be some consensus among suicidologists 11 and psychiatrists as being common risk factors in 12 suicide. 13 Q. Okay. And have you specifically looked at 14 those risk factors with respect to William Forsyth to 15 determine whether those risk factors -- and one of 16 them is depression, right? 17 A. Depression is the first one on my list. 18 Q. Whether those risk factors, in your opinion, 19 would have caused him to take his own life in and of 20 themselves? 21 A. The short answer to that question is no. One 22 of the things you have to remember -- 23 Q. No, that you haven't looked or no -- 24 A. I have looked -- I guess that's the trouble 25 with short answers, isn't it? PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2441 1 Q. The question was, have you looked at it? 2 A. I have looked, yes. 3 Q. And do you believe that those risk factors, all 4 things taken into account, would have caused him to 5 end his own life in and of themselves? 6 A. No. 7 Q. All right. We're going to come back and talk 8 about the risk factors, but is there something else in 9 addition to the background and risk factors that you, 10 as a suicidologist, look at? 11 A. Yes. I know you want to come back to this, but 12 let me just say one thing. The problem with all these 13 risk factors is they tend to give us false positives. 14 What I mean by that is if we use them, you think you 15 have a suicide, but, in fact, when they die, you have 16 ordinarily a natural death. So it is predicted to be 17 a suicide, but it, in fact, isn't. So you tend to -- 18 for example, in a study done by Pokorny in Houston, he 19 followed 4800 psychiatric inpatients over five years 20 using things like the 15 risk factors and he found 21 that he had a 30 percent false positive rate. That 22 30 percent of the people he said are going to be 23 suicides, in point of fact, were not suicides. 24 So the problem with these, even though they are 25 risk factors and they're greater than zero association PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2442 1 with a suicide outcome, they don't take us far enough 2 to predict suicide. For example, depression. We've 3 heard a lot of talk in this trial about 15 percent of 4 depressed psychiatric inpatients, the Guze, G-U-Z-E, 5 and Robbins 70 paper, will eventually die by suicide. 6 But just think about the other side of the coin, 7 85 percent of depressed individuals never kill 8 themselves, so obviously depression, most of the time, 9 is insufficient to predict or to lead to a suicide 10 outcome. So we need something else. 11 Q. Okay. And what is that something else? What 12 do you look at -- before I ask you that, are the risk 13 factors something that you sometimes also label 14 chronic lethality? 15 A. Yes. It's a subtlety that's important. When 16 we're predicting on a pathway to suicide whether 17 there's going to be a suicide or an accident or a 18 homicide or a natural death, we're talking about 19 things that operate over a long time. Mr. Forsyth, 20 the gentleman, was 63 years old. He wasn't 3 years 21 old. He wasn't 14 years old. He's operated over a 22 long period of time, and those are, therefore, 23 chronic. They accumulate gradually. Also, they 24 interact. What I mean by that -- we've tended to talk 25 about factors as if they were separate, like PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2443 1 depression causes suicide, but as I suggested by 2 listing 15 of them, there's a bunch of them 3 interacting together. So we have to -- and that's 4 statistically very often difficult to tease out, you 5 know, what's the percentage of, let's say, suicide 6 ideation? What's the percentage of having a history 7 of suicide in your family? They interact as well, so 8 it is a chronic lethality over usually about 50 or 60 9 years, first 50 or 60 years of our life. 10 Q. Okay. 11 A. One other thing, excuse me. Lethality means 12 the medical certainty of death; that is, what's the 13 probability, the medical probability of death. 14 Q. All right. Now, what's the third step in your 15 analysis of a suicidal career? 16 A. In my model, and again, I stress that this is 17 my model in assessment prediction of suicide Chapter 18 32, if you want to look at a picture of it, I think 19 there also have to be, what I call, trigger factors. 20 Q. Okay. What is a trigger factor? 21 A. The question is, why now? Why this weekend? 22 Why today? Why this particular point in our life? Is 23 there something -- you might -- an analogy to think of 24 this would be that the predictors in the background 25 get you to the end of the caseum, of the suicide PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2444 1 cliff, but they don't push you off usually. Most of 2 the time we can live with depression. Most of the 3 time we can -- 20 percent of us think about suicide, 4 but most of us don't do it. 5 What is there in addition in anyone's life, and 6 there's both individual and social forces that make 7 them go that next step from thinking about it, maybe 8 from making a series of non-fatal attempts to actually 9 completing it, and these are what I call trigger 10 factors. 11 Q. Now, you mentioned non-fatal attempts and we 12 heard some testimony yesterday by a Lilly expert about 13 attempts as predictors. In a white male in their 14 sixties, as Bill Forsyth was, is an attempt a good 15 predictor of suicide? 16 A. It's as good as most, but one of the things you 17 have to remember -- I'll give you one specific 18 statistic, which I think is stark. In my Chicago 19 studies, I looked at older white males, people like 20 Mr. Forsyth. I found that fully, 88 percent of white 21 males, make one suicide attempt, so obviously you 22 can't use suicide attempt to prevent suicide because 23 they're already dead. So it's a predictor, but it's 24 not a very helpful predictor because the person has 25 already done the violent act and there's no possible PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2445 1 rescue. 2 So yes, it predicts for some people, for 3 younger people. Typically, for women there are 4 multiple attempts and that's a pretty good way to 5 predict and to intervene, but if almost 90 percent of 6 your population that we're concerned about makes an 7 attempt and dies, obviously, it may predict, but it 8 doesn't allow you to intervene. 9 Q. I didn't mention this in terms of establishing 10 your credentials, but is part of what you do on an 11 ongoing basis to have a clinical practice and try to 12 intercede and save people's lives? 13 A. The answer is yes and no. Like Dr. Matthews, 14 in the last several years, I have done less direct 15 clinical services. I do more forensic, after the 16 fact, this kind of stuff. But for many, many years, 17 and indeed, continuing until today, I'm a director of 18 a suicide center at the University of South Carolina, 19 so that if students walk in my door and say, I'm 20 feeling sad, I'm feeling depressed, I'm worried about 21 hurting myself, I actually sit down with them and do 22 therapy, and more often than not, I'll do an 23 evaluation and refer them to one of the other twelve 24 people in the suicide center who's a psychiatrist or a 25 nurse or a social worker. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2446 1 But yes, when I was at Johns Hopkins for five 2 years, I was on the psychiatric inpatient facility. I 3 did therapy for five years. I've continued to do 4 that, but it certainly is part of my background and 5 part of my current practice. 6 Q. Okay. Now, what kinds of things have you seen 7 typically, if you can just give us a checklist, of the 8 most common trigger factors for self-destructive 9 behavior? 10 A. Certainly one would be drugs, in general, and 11 particularly, alcohol. 12 Q. All right. 13 A. Another would be psychosis. 14 Q. All right. I'll write a couple of these down; 15 drugs and alcohol. Psychosis, what's that? 16 A. That's where you can't distinguish reality from 17 your own private subjective world, which is typical, 18 for example, in schizophrenic suicides, where you may, 19 for example, have a so-called command hallucination 20 where you hear voices and the voices are telling you 21 that you're worthless and that you need to kill 22 yourself. That's a very common pattern. 23 Q. Okay. Any others that are particularly strong 24 or recurring factors? 25 A. There's another third set, which I think are PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2447 1 very important, which are impulse control disorders, 2 whatever causes that, that impulsivity is a trigger 3 factor. So anything that affects our impulse control 4 can trigger these risk factors into a lethal outcome. 5 And incidentally, these last ones I call acute 6 lethality. 7 Q. Acute lethality? 8 A. Roman III would be acute lethality, that is the 9 long term versus the short term. And notice that in 10 suicide prevention, we're clearly interested in what 11 is the acute lethality, is it going to happen now, 12 this weekend if we don't put somebody in the hospital? 13 Q. Let me ask you about this impulsivity or 14 impulsive control. When you say an impulse disorder, 15 are you talking about the pattern of behavior that we 16 seen that Mr. Forsyth exhibited when he left and went 17 to L.A. for a while or are you talking about something 18 that's different? 19 A. I hadn't thought about that. I think one of 20 the things that's interesting about Mr. Forsyth is 21 that my own study in Chicago found that 70 percent of 22 all completed suicides were escape, and In psychiatry 23 we call it fugue behavior, F-U-G-U-E. So that in a 24 sense, what suicide is, in a nutshell, is it's a 25 solution to the problem of life, and it solves the PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2448 1 problem of life by taking leave of life; that is, the 2 suicide says my life is no longer viable. Now, they 3 may be wrong, and we try to treat them and talk them 4 out of it, but they believe they have to leave. So 5 it's not uncommon to see people who are suicidal 6 fleeing, but then the interesting thing is fleeing 7 from life is another caliber of taking leave. 8 So yes, you do see this a lot in suicidal 9 patients. Sometimes there's a combination of the 10 three where they may be taking medications that reduce 11 their control, they may be intoxicated. For example, 12 alcohol is a classic disinhibitor, and you may have 13 these chronic lethality factors and you're like Mel 14 Gibson in one of his movies, where he's sitting there 15 in his trailer on the beach with a gun drinking a 16 bottle of Jim Beam. The fact that you have that Jim 17 Beam there is an impulse deregulator. Alcohol is a 18 very common one. 19 Q. Do you believe from all the studies that you've 20 done, that it was impulsivity that triggered 21 Mr. Forsyth's behavior? 22 A. I certainly think that that was a part of it. 23 I'm not sure. I would think it was a substantial 24 factor in his outcome, yes. 25 Q. Okay. Now, we've talked about the background PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2449 1 factors, the risk factors, and the trigger factors. 2 Let me follow up on that last one for a minute. Do 3 you think that impulse alone would have done it, 4 depression and impulse alone would have done it in 5 Mr. Forsyth? 6 A. Certainly not. In fact, if you go back and 7 read my writings on this, I believe that the thing 8 that we tend to forget is the chronic lethality. You 9 have to have the chronic lethality first before the 10 impulse is deadly. So it's certainly not sufficient. 11 Q. Okay. Well, let's talk about the risk factors. 12 We talked about his background, now let's talk about 13 the 15 risk factors and how they figure in. Now, 14 you've already told us that depression is number one. 15 Dr. Maris, does depression in and of itself cause 16 people to kill themselves? 17 A. Usually not. Almost never. Just to repeat 18 myself, 85 percent of the people who are depressed 19 never kill themselves. 20 Q. Well, that leaves 15 percent. Are 15 percent 21 of the people who are depressed killing themselves 22 every year? 23 A. No. In fact, that's a misleading statistic. 24 Suppose you get depressed when you're 40 years old and 25 have your first depressive episode, at 15 percent is PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2450 1 over the whole rest of your life. So it's a lifetime 2 prevalence which means that it's only about 1 percent 3 in any given year for the rest of your life. 4 So it's like if you had been depressed, you 5 have an additional one percent risk for suicide per 6 year, a little bit more in the first year if you had 7 been hospitalized, maybe as much as 2 percent, but it 8 totals that. It doesn't -- certainly that's not 9 15 percent in one year. It's one percent a year for 10 about 15 years is what it amounts to. 11 Q. Well, we have seen, though, that one of the 12 nine diagnostic criteria for depression is suicidal 13 thoughts or acts. Are you familiar with those 14 diagnostic criteria? 15 A. Yes, I am. I teach them every year to my 16 students. 17 Q. Can you just recite them for us off the top of 18 your head? 19 A. Well, I cheat a little bit. I have a pneumonic 20 device and I take the first letter of every word I'm 21 now going to mention and then give you one of the 22 diagnostic criteria. Depression is worth studiously 23 memorizing extremely grueling criteria sorry. 24 Q. What do those nine things stand for in that 25 pneumonic. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2451 1 A. Take the first letter depression. Depression, 2 of course, means depressed mood. 3 I, is, means interest. We've seen some 4 testimony here that people who are depressed have 5 anhedonia, they are unable to take pleasure. They 6 lose interest in their life. 7 W is weight loss. We've heard testimony that 8 Mr. Forsyth had a significant weight loss. 9 S is sleep. People who are depressed tend to 10 have sleep disorders, and they particularly tend to 11 have what we call terminal insomnia. That is, if you 12 divide the sleep cycle into three stages they tend to 13 wake up at four or five in the morning and not be able 14 to go back to sleep. Let me write all these down. I 15 can't keep all nine in my mind. So that's sleep. 16 M is motor or psychomotor activity, and usually 17 its -- their psychomotor activity is slowed down. 18 People who are depressed, are lethargic, they move 19 slowly, they have trouble getting out of bed. We all 20 do, but more so in that may not get out of bed at all. 21 They can be agitated, but usually their psychomotor 22 behavior is slowed down. 23 E is energy. People who are depressed tend to 24 lack energy and particularly they lack libido. It's 25 kind of a technical term that Freud used. They don't PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2452 1 have any interest in sexuality for the most part 2 because of their depressive disorder. 3 G is guilt. People that are depressed tend to 4 feel guilty, tend to feel worthless. 5 C is concentration. People who are depressed 6 have difficulty concentrating, difficulty paying 7 attention, short attention spans. 8 And finally S is suicide or death thoughts. 9 It's not just suicide incidentally. The ninth 10 diagnostic criterion it says, suicide thoughts or 11 death thoughts, not just suicide thoughts. You have 12 to have -- you have to have five of nine of these -- 13 incidentally, this is the criteria for major 14 depressive episode in the DSM-III IV, that's a 296 15 code. You have to five of these. You have to one of 16 the first two, and Mr. See actually corrected me in my 17 deposition that I had left off the fact that 18 obviously, Mr. Forsyth also had a depressed mood as 19 well as anhedonia, so he had both of the first two, 20 and any four others and they have to be continuously 21 over a two-week period, and they have to represent a 22 change from your previous functioning. And if you 23 meet those conditions, then the American Psychiatric 24 Association would say, ruling out other possible 25 differential diagnoses, that you were suffering from a PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2453 1 major depression. 2 Q. Now, I got a couple things to ask you to follow 3 up on that one, but first of all, what do you make of 4 the fact that none of the three trained psychologists 5 or psychiatrists that saw him, either Tom Brady or 6 Riggs Roberts or Randolph Neal, ever found that ninth 7 one, suicidal thoughts? 8 A. What I make of it? Usually, what you do is you 9 ask people, you say, have you ever thought about 10 hurting yourself? We often worry about people who are 11 depressed hurting themselves and he may have denied 12 it, and most typically, patients will deny it. That's 13 one of the problems with some of these self reports, 14 is that if they deny it, you can probe, but if they 15 keep denying it, you have to kind of take their word 16 for it unless you do it. That's one of the reasons 17 why you do an indirect test for suicide and suicide 18 ideation because they don't know what you're asking. 19 If you ask them, are you feeling suicidal? It's 20 pretty obvious what you're asking and if they don't 21 want you to know that -- I suspect he denied it. 22 Q. Dr. Maris, those nine criteria that you just 23 cited for us all sound pretty bad. Why is it, then, 24 that you don't believe that they in and of themselves 25 lead to suicide without some trigger? Can you explain PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2454 1 it? 2 A. Well, I believe that actuarially. I mean, if 3 you look at the data, depression is very, very common. 4 Many people in this room are, as we sit here today, 5 depressed or have been at some time in their life, as 6 many as 10 percent of the general population. This is 7 very, very pervasive mental disorder, but yet, most of 8 us stumble and stagger through life and don't do it. 9 So actuarially speaking, the data show us that most 10 people who have serious thoughts about depression do 11 not commit suicide. 12 Remember, we've seen testimony that suicide is 13 one in 10,000 in the general population. It's a very 14 rare phenomenon, yet 10 percent of the population, ten 15 out of hundred have depression at sometime in their 16 life. So actuarially speaking, I don't believe it. 17 Q. Let me see if I followed that through. If it's 18 10 percent that's 1,000 out of 10,000 would have 19 depression, but only one out of that 1,000 would 20 actually do it? 21 A. I think that's right. I would have to check 22 your math. 23 Q. Okay. We have talked about depression. Is 24 there anything else you need to add for us to 25 understand that as a risk factor in the context of PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2455 1 Bill Forsyth? 2 A. Well, you know, one thing I want to stress 3 here, bottom line, this is a very complex behavior. 4 It's not simple, so even within depression, there's 5 many different kinds of depression. There's bipolar 6 or manic dysthymia, psychothymia, bipolar one, bipolar 7 two, all of these have different dynamics and 8 different medications and somewhat different 9 psychotherapy. So within that category, there are 10 lots of subtleties, and the medication you give and 11 treatment you give is different, so yes, plus that 12 there are all these other factors that we have to 13 consider which interact with depression. 14 Q. Okay, sir. And what are the other risk factors 15 that we should discuss in the context of this case? 16 THE COURT: Well, let's break at this point. 17 Please be back a quarter of. I want to meet with 18 counsel for a minute. 19 (Whereupon, the following proceedings were had 20 in open court out of the presence of the jury.) 21 THE COURT: How much longer do you think you'll 22 be with this witness? 23 MR. VICKERY: Not that much longer, Your Honor. 24 Probably less than 30 minutes. I think I told the 25 Court yesterday I thought I would be an hour or less PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2456 1 with him. I believe I got him at -- I didn't notice 2 exactly the time, but I think it was about 9:45, so 3 I've had him about 45 minutes. 4 THE COURT: And how long do you think you'll 5 be, Mr. See? 6 MR. SEE: I suspect the cross will be longer 7 than the direct, but probably not much longer. 8 THE COURT: Well, that will probably take up 9 the rest of the morning. 10 MR. SEE: I would expect. I think that's 11 reasonable. 12 THE COURT: All right. Mr. See, do you want 13 more time to cross-examine Mr. Forsyth, Jr. on that 14 point -- those two points that he made? 15 MR. SEE: I do not, Your Honor. 16 THE COURT: All right. I don't see that there 17 was any prejudice in allowing him to testify to those 18 two points. I must say, I am surprised that that 19 deposition had not been brought to his attention. 20 Although I still see he was listed as a witness, and I 21 don't see any prejudice in those two points. 22 Actually, they -- particularly, the timing of it, I 23 think, was quite logical from the timing sequence 24 being there in late November. Obviously, the 25 testimony in evidence has already been that PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2457 1 Mrs. Forsyth was with Mr. Forsyth in marital 2 counseling with Dr. Brady at that time, from October 3 on in '92. 4 Now, I guess as far as the deposition testimony 5 of Dr. Beasley, we can go over that after lunch. I 6 did want to be sure, as far as the report that you're 7 referring to of Dr. Maris, it's this paper that's 8 entitled expert opinion? 9 MR. SEE: Yes, it is dated July 28, 1997. 10 THE COURT: Correct. Okay. I'll take a look 11 at that. 12 MR. SEE: If I could offer the Court one 13 further item on that, at his deposition when, in 14 reviewing his opinions in his report and so on, and 15 eliciting his testimony about them, noticing that he 16 really didn't give any testimony or opinions about 17 homicide/suicide as a different kind of event. I 18 asked him specifically, you know, whether he knew that 19 there was a homicide/suicide literature, and he said 20 yes, he did know about that. And then I asked him, 21 well, did you review -- did you cite any of it in your 22 report, and he says no. No, I didn't. So that's 23 where I left it. 24 I think the Court will see, although the word 25 homicide is contained in his report in several places, PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2458 1 in no place does he talk about homicide/suicide as a 2 single conjoined event, and what's the literature 3 about that and what his opinions about that are. He 4 never addresses that at all and that's really the 5 basis for my objection. I don't think he ought to be 6 able to talk about it because he didn't disclose any 7 opinions about it. 8 Although the word homicide appears in here, his 9 opinions really went to his analysis of his suicide 10 predictors which is what he's talking about here 11 today, and not about the science or study of the topic 12 that Dr. Tardiff talked about, which is studying a 13 specific kind of event, a killing followed by an 14 immediate suicide. 15 THE COURT: Or any relationship between suicide 16 and homicide? 17 MR. SEE: Exactly. And he didn't talk about 18 that. There's no opinion in the report, anyway, about 19 that at all. 20 THE COURT: Do you want to add anything about 21 that Mr. Vickery? 22 MR. VICKERY: I was just looking for that, Your 23 Honor. Right up front he says that he reviewed the 24 report of Dr. Tardiff, and he says the main arguments 25 of the defense experts are and number two is, PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2459 1 depressive disorder including hopelessness did call 2 the Forsyth homicide/suicide. 3 THE COURT: Where are you? 4 MR. VICKERY: I'm right in the second paragraph 5 on Page 1 where they start "The main arguments of the 6 defense experts are," and then number two under that 7 that the depressive order -- or I'm sorry, depressive 8 disorder, including hopelessness, did call the Forsyth 9 homicide/suicide. And then I was going to look back 10 to see -- 11 THE COURT: Well, that's simply reciting what 12 one of the main arguments of the defense experts is. 13 MR. VICKERY: Yes, it is, Your Honor. 14 Throughout the report -- if you look, for example, on 15 Page 10 in the middle paragraph where he says, 16 "Lilly's defense experts tend to state dogmatic, 17 rigid, unscientific absolute opinions, for example, 18 Dr. Eliashof states that none of the thousands ever 19 became suicidal or homicidal, and there's no 20 scientific evidence that it causes suicide or 21 homicide," and I understand that we're not getting 22 into a causation opinion with him, but then he says, 23 "Dr. Matthews believes there's not evidence that 24 Prozac causes homicide or suicide." 25 You see, the part of the problem that, I guess, PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2460 1 we had is, on the one hand, Lilly's expert said they 2 don't think that Prozac does cause it, and we 3 understand the Court has said that's out of bounds 4 with Dr. Maris and we're being very careful not to 5 slip in to out-of-bounds territory. On the other, 6 there is the evidence not only in their reports, but 7 the evidence that's been introduced here by this 8 trial, which is what I asked him to rebut, that this 9 is a classic homicide suicide, as if there were such a 10 thing, and that depression is the thing that causes a 11 classic homicide/suicide, and so those are the issues 12 consistent with the Court's order yesterday that I 13 want to ask him about because there is an 14 interrelationship between these kinds of acts of 15 violence. 16 I could show you, for example, the very first 17 document when Lilly read about the Teicher article, 18 the very first thing they wrote is that experts think 19 that there is, I think, a similar biological 20 substrates is what Dr. Beasley wrote, between the 21 phenomenon of suicide and homicide. So kind of from 22 the get-go that's something we wanted to address with 23 him, this double phenomenon. 24 MR. SEE: And with respect, from the get-go all 25 of those reports were disclosed and then we were PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2461 1 supposed to have a disclosure of the rebuttal expert 2 who was going to talk about that, and as the Court, I 3 think, has noticed, there's nothing in his report 4 about it, so I didn't depose him on it. No 5 murder/homicide, no homicide/suicide literature in 6 here at all. 7 THE COURT: And again, you initially questioned 8 him on that and he said he hadn't looked into it? 9 MR. SEE: I asked him, do you know -- I mean, 10 after reading his report, I noticed there's nothing in 11 there about the event homicide/suicide, so I asked 12 him, do you know that there is such a literature? And 13 he said, yeah. I said, well, is there anything in 14 this report about that literature? And he said, no. 15 So I just left it. 16 MR. VICKERY: You see, that's what I think, 17 with all do respect to Mr. See, we could put in the 18 category of what he was talking about yesterday as 19 sandbagging. Instead of saying, well, your report 20 mentions homicide/suicide on ten different pages, so 21 let me ask you -- I know you didn't cite this 22 literature, but let me ask you what your opinion is on 23 it. Instead of doing that, he sort of leaves it 24 because there's nothing cited in the report, and then 25 comes into court and says, but now, because I chose PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2462 1 not to ask the questions about it in the deposition, 2 then he shouldn't be allowed to testify about it here. 3 MR. SEE: Well, when I disclose an expert 4 specifically on the topic, it's this man's life work 5 to study homicide/suicide, and he's fully disclosed, 6 and then they give us a rebuttal expert that doesn't 7 talk about it, sandbag doesn't apply to that exactly. 8 THE COURT: All right. I'll take a look at it. 9 Let's take a break. 10 (Whereupon, a recess was taken from 10:40 a.m. 11 to 11:00 a.m.) 12 THE COURT: I need to meet with counsel at side 13 bar a minute. 14 (Whereupon, the following proceedings were had 15 at side bar out of the hearing of the jury.) 16 THE COURT: During the break, Mr. Vickery 17 provided my clerk with this deposition and I 18 understand there's an agreement. 19 MR. SEE: Yes, he told me about it. 20 THE COURT: And I quote, this is at Page 143 of 21 the deposition. The top question says. 22 "QUESTION: Do you consider yourself to be an 23 expert in the medical literature regarding 24 suicide/homicide as a conjoined-associated event? 25 "ANSWER: Yes, I do. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2463 1 "QUESTION: And you've made a review of that 2 literature? 3 "ANSWER: Yes." 4 THE COURT: And then on Page 142. 5 MR. SEE: I'm sorry, Your Honor? 6 THE COURT: Page 142, there's a question: 7 "What are the facts that support that statement; that 8 is, specifically ten days after ingesting Prozac 9 Mr. Forsyth's impulse control was lowered? 10 "ANSWER: Well, the obvious one is the 11 homicide/suicide which I take he would not have done 12 if his impulse control had been better." And he goes 13 on. 14 In the order that was filed on October 16 on 15 the motion in limine, the Court specifically ruled, as 16 it did yesterday, that Dr. Maris' proposed testimony 17 addresses that Mr. Forsyth, absent Prozac, would not 18 have led to his suicide and homicide. And I notice on 19 Page 5, in addition to other pages that the Court 20 cited, that he says fluoxetine was the proximate cause 21 for the homicide/suicide, and then he has a 22 subheading, the other non-drug life event itself and 23 stressors; e.g., marital problems over time, 24 difficulties, by themselves are insufficient to cause 25 the Forsyth homicide/suicide. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2464 1 The Court finds that he can testify on the 2 relationship of homicide and suicide. I'll return 3 this deposition to Mr. Vickery. 4 MR. VICKERY: Thank you, Your Honor. 5 THE COURT: And I just wanted to ask the 6 question also, as I had exerted my surprise that his 7 son had never read or heard of that deposition. 8 MR. VICKERY: He hadn't even read his 9 deposition. 10 THE COURT: Pardon me? 11 MR. VICKERY: Bill never read his own 12 deposition. 13 THE COURT: What I'm surprised is he was 14 ignorant of what his father had reported to a 15 spiritualist as to what the circumstances were 16 involving his own father's condition. I wonder also 17 had he read his father's notes in January and February 18 of 1993? 19 MR. VICKERY: Is he aware of them? 20 MR. SEE: His testimony was he never read them. 21 MR. VICKERY: I think Mr. See asked him if he 22 read both of his parents journals during his 23 deposition, but I don't think he ever independently 24 read their private journals. 25 MR. SEE: I asked him if he read them, and he PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2465 1 said no. 2 THE COURT: Oh, he had not? 3 MR. SEE: He had not. 4 THE COURT: Well, I think it would have had 5 some impact on settlement negotiations if he had been 6 aware of that information. Anyway, let's go. 7 (Whereupon, the following proceedings were had 8 in open court in the presence of the jury.) 9 THE COURT: Let's proceed, Mr. Vickery. 10 MR. VICKERY: Thank you, Your Honor. 11 Q. Dr. Maris, we were running through these 15 12 risk factors and we're going to do it fairly quickly 13 and get through. One more area to ask you about. 14 There's depression, and what's number two? 15 A. Number two is drug use, particularly 16 alcoholism. 17 Q. And we know that Mr. Forsyth had a history of a 18 problem with alcohol many, many years before. Are you 19 talking about past history, agent history like that, 20 or current alcoholism problems? 21 A. I'm talking about current drug use, but you 22 could, of course, apply to the chronic, but I'm 23 talking primarily about current drug use. 24 Q. Okay. There's no indication that he had any 25 drugs, other than the prescription drugs that were PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2466 1 given to him by Dr. Neal? 2 A. As far as I know, that's correct. 3 Q. And you understand that as a rebuttal witness, 4 I'm not going to ask you about the drug use? 5 A. That's correct. 6 Q. Okay. Number three, what is that? 7 A. Suicide ideation. 8 Q. And what's number four? 9 A. Prior suicide attempts. 10 Q. And five? 11 A. Lethal methods. 12 Q. And what do you mean by lethal methods? 13 A. A method that you employed is likely to lead to 14 your death. 15 Q. And what's number six? 16 A. Social isolation. 17 Q. Any indication that in February and March of 18 1993 that Mr. Forsyth had social isolation? 19 A. I don't think it rose to the kind of a clinical 20 level. I mean, he clearly was depressed and was 21 slowed down a little bit, but he was surrounded by a 22 loving family. 23 Q. What's number seven? 24 A. Seven is hopelessness, including cognitive 25 rigidity, and you may want me to explain that. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2467 1 Q. Yeah, I sure do. Let me write it down first. 2 What is cognitive rigidity? 3 A. Typically, what we mean by that is people -- we 4 like to say the only four letter word in suicidology 5 is only. Like as in, it was the only thing I could 6 do, and that's a constrictive train of thought where 7 people feel boxed in, where they feel like they have 8 no choice but to take their life, kind of a tunnel 9 vision, if you will. 10 Q. Okay, sir. What's number eight? 11 A. Being an older white male. 12 Q. Just by being one? 13 A. Right. Make you nervous? 14 Q. A little bit. What's number nine? 15 A. Suicide in the family, sir. 16 THE COURT: What was that? 17 THE WITNESS: Suicide in the family. You might 18 also put there modeling, because I don't want to 19 suggest it's just modeling, like copying, so it may be 20 biological. It may be modeling. 21 Q (By Mr. Vickery) Okay. Modeling just means 22 that you model your behavior of your father's or your 23 aunt's or someone else? 24 A. Right, you copy someone else in your family. 25 Q. What's number ten? PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2468 1 A. Work problems. 2 Q. And 11? 3 A. Marital problems. 4 Q. Let me stop on that one for a minute. When you 5 talk about risk factors for suicide and you talk about 6 marital problems, can you tell us what you're looking 7 for? Are you looking for something that's an acute 8 problem in the marriage or chronic problem or whether 9 they are seeking help for it or I mean, what sorts of 10 things do you look at in connection with marital 11 problems? 12 A. First of all, you look at marital status. We 13 know that people who are divorced or separated are 14 widows, so that marital status is a predictor in 15 itself. So if you're married, happily married, 16 getting counseling, that would be not an indication so 17 much as having failed and getting divorced. 18 Q. Okay. And, I guess, the flip side, having gone 19 through the therapy sessions that Bill and June did 20 and being where they were, as we've heard from the 21 various witnesses in this trial, is that a risk 22 factor, a protective factor, or neither? 23 A. It's a little complicated, but I think I would 24 say overall it's a protective factor. And we probably 25 should tell the jury, that in addition to 15 risk PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2469 1 factors, there are also protective factors, like 2 getting treatment, so that there are other factors 3 that protect you from suicide. 4 Q. I made a note on here to ask you about 5 protective factors when we're through with the risks. 6 All right. Marital problems is 11, what's 12? 7 A. Stress or negative life events. 8 Q. Thirteen? 9 A. Anger or aggression. 10 Q. How important is, in the category of 11 aggression, having past history of aggression or 12 violence? 13 A. I think it's important. It's very important. 14 You have to remember, most people when you think about 15 suicide, they think of somebody who's depressed and 16 hopeless, but those kind of people tend to lie around 17 in bed. They don't even have the energy to kill 18 themselves, so you need a catalyst. You need an 19 aggressive energizing to carry out your -- act out on 20 your depression, so it's very important that you have 21 that component as a catalyst in the mix. 22 Q. Okay. What's number 14? 23 A. Physical illness. 24 Q. And 15? 25 A. Is repetition of the above 14, what is PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2470 1 sometimes referred to as co-morbidity. Co-morbidity, 2 that just means that you have multiple factors. 3 Q. Now, were some of these, in addition to being 4 an older white gentleman, were some of these other 5 factors present in greater or lesser degrees in 6 Mr. Forsyth? 7 A. By my reading of the records, sir, I counted 11 8 out of 15. 9 Q. Present in some degree or the other? 10 A. Yes. 11 Q. Bottom line, considering all those that were 12 present in analyzing, as you have done, do you believe 13 that the depression and the other risk factors would 14 have caused him to take his own life in and of 15 themselves without some triggering event? 16 A. Definitely because for one thing, he had most 17 of these for sometime and he had coped with them. 18 Q. Okay. Now, what are the protective factors? 19 A. In a sense, the protective factors would be the 20 opposite of the 15, so you could run right down the 21 list. If you're a young female, married with 22 children, and so on, the opposite of all of those. 23 But categorically, it would be things like getting 24 treatment. If you had been sick, getting treatment; 25 being in the hospital would be a protective factor; PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2471 1 having people around you that care about you, social 2 support; of course never, ever having any mental 3 diagnosis would be a protective factor, being healthy 4 psychologically, so no depression, no schizophrenia. 5 But the short answer is, if you take the 6 opposite of all of the 15, those are all considered 7 protective factors. 8 Q. And what -- in the case of Mr. Forsyth, what do 9 you think insofar as protective factors with respect 10 to his family situation, his marital therapy and his 11 getting treatment? 12 A. Well, I'm on record in my report as saying that 13 I thought he had a very close, supportive, loving 14 family, which was very protective. June Forsyth, as 15 we've seen, did not abandon him. In fact, he didn't 16 abandon her. So they were fighting hard to salvage 17 their marriage and they were working on it. He was 18 close to his two children, to Susan and Bill. His 19 grandchildren were a very important part of his life, 20 that's a protective factor. He was well educated. He 21 was a successful businessman who was used to dealing 22 with stress, which helped him to cope. He had money, 23 which meant that he could afford treatment and could 24 afford to take care of his problems when other people 25 maybe couldn't. So I think those are all protective PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2472 1 factors. 2 Q. Okay, sir. Now, Dr. Maris, let me ask you 3 this: I want to talk to you now -- we've been talking 4 about suicide. Now I want to talk about homicide 5 followed by suicide. You've told us that suicide, in 6 the general population, is a one in 10,000 event. How 7 about homicide followed by suicide? 8 A. Very, very rare. There's a classic book, which 9 may have not been cited in the literature, which I 10 think I mentioned to Mr. See when he deposed me, the 11 book by West called "Simply Murder Followed By 12 Suicide." It's a Harvard University Press. West 13 claims that murder suicides never amount to more than 14 1 or 2 percent of all suicides. So we start of with 15 suicides being one in 10,000 in the general 16 population, murder/suicides are probably, let's say, 17 one percent of that, so we're talking about a very 18 small group. 19 For example, in Chicago, when I did the 2153, I 20 had 20 to 40, I forget exactly the number, 20 to 40 21 murder suicides that I looked at in some detail. So 22 out of 2,000 I had 20, so it was a very small number. 23 Q. That's about one percent. What, from that 24 study, were you able to determine about any patterns 25 of behavior or factors that caused that kind of PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2473 1 behavior? 2 A. Well, let me just add before I answer that, 3 that as a journal editor for the suicide journal, 4 since it was understudied and a rare phenomenon, I 5 actually commissioned two papers for my journal, one 6 by Nancy Allen at the University of Southern 7 California, and one by Alan Burman in Washington, D.C. 8 to kind of look at that. 9 When I looked at those papers and thought about 10 my own data, one of the things that was obvious to me 11 was that typically, if there is a typical and with a 12 small group it's hard to say what's typical, if there 13 is a typical murder/suicide, it's usually a younger 14 man, maybe in his twenties or thirties who has some 15 sort of domestic dispute with his wife or lover, could 16 be a gay relationship, and usually the man kills his 17 spouse. That is the, if there is a classic 18 murder/suicide, that's it. 19 Q. Okay. Are there enough of them in the context 20 of the older population, the Bill and June Forsyth 21 vintage people, to even get any kind of 22 epidemiological feel for whether there is a classic? 23 A. Sure. I have an answer. It's not sure, there 24 is. I think the answer is no, there is not. If we're 25 going to play by the scientific method, we have to PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2474 1 follow where it leads us and this is an extremely 2 rare, extremely understudied population. I think if 3 you think back to Dr. Tardiff's testimony, he had a 4 very small number of cases. 5 I don't think it makes sense to talk about 6 people like Bill and June as being in a classic older 7 homicide/suicide. I don't think we have enough cases 8 to make that scientific conclusion, and furthermore, I 9 think they tend to be younger. 10 MR. VICKERY: Okay. Very well. Thank you, 11 sir. I pass the witness. 12 THE COURT: Mr. See. 13 MR. SEE: Yes, sir. 14 CROSS-EXAMINATION 15 BY MR. SEE: 16 Q. Good morning, Dr. Maris. 17 A. Good morning. 18 Q. Mr. Vickery has been asking all the expert 19 witnesses questions about compensation -- 20 A. Yes. 21 Q. -- or testifying, and so I guess I just need to 22 round that out with you. You said that up to the time 23 you came out here, your time in the case had been 24 about $17,000? 25 A. That's correct. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2475 1 Q. And then how long have you been here in the 2 courtroom? 3 A. Like one day over a week and I charge 350 an 4 hour. 5 Q. And how many hours a change? 6 A. One per diem, which is ten hours. 7 Q. I beg your pardon? 8 A. One per diem is ten hours. 9 Q. Okay. So that would be ten hours times $350, 10 so that would be $3,500 a day? 11 A. That's correct. 12 Q. And have you charged that every day you've been 13 in Hawaii? 14 A. Yes, I've been working every day. 15 Q. So what would that come out to be? Is that 16 seven days, eight days? 17 A. About, yes. 18 Q. Okay. So $3500 times eight days, would be 19 another $28,000? 20 A. I'll take your word for it. I haven't 21 calculated it. 22 Q. So altogether the 28 and the 17 would be about 23 $50,000? 24 A. Twenty-eight an seventeen are fifty? 25 Q. Maybe my math is real bad. Let me try again, PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2476 1 how about 45? 2 A. I'll live with that. 3 Q. Okay. Thanks. I'd like to just ask you with 4 respect to your providing testimony, you have paid 5 money to have yourself listed in directories 6 advertising your availability? 7 A. Yes, I think I have one listing, and it's 8 basically it's called the National Directory of Expert 9 Witnesses, and it is just a one-page listing, yes. 10 Q. And you've also paid to have yourself listed on 11 the Internet? 12 A. I've always been on the Internet. The suicide 13 center has a web page and so on, so I've always been 14 on the Internet. 15 Q. Well, that's not what I'm asking about. Have 16 you paid to have -- 17 A. There may be one other -- 18 Q. -- advertising put on the Internet? 19 A. There may be one other, yes, sir. 20 Q. To let lawyers know that you're available? 21 A. Yes, I believe that's true. 22 Q. Now, Mr. Vickery asked some questions of some 23 other witnesses, so I guess to round it out, I'll ask 24 you, is there some expert witness school or training 25 that you've gone through at the request of PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2477 1 Mr. Vickery's or Ms. Barth's firm? 2 A. There was one time, in 35 years, when they told 3 me not to wear these kind of ties. Actually, they 4 told me to wear this tie. It was a very profound 5 experience, and to look at the jury, which I've 6 noticed everybody's done. Yes, I did go to that for 7 one day in 35 years. 8 Q. You went to -- Mr. Vickery's office now is in 9 Houston? 10 A. I went to something called the Whelming 11 Institute and it wasn't really just for me. That was 12 a spin-off. There was a trial prep that was going on 13 and I just spent a little bit of time going through 14 that. 15 Q. That was in Houston, Texas? 16 A. Yes, it was. 17 Q. And they told you how to dress and how to act 18 in court and that sort of thing? 19 A. Yes, sir. 20 Q. Actually, somebody had built a courtroom, so 21 you could get up on the witness stand and ask 22 questions and sort of go over what you were going to 23 say? 24 A. Which I have done many years before in real 25 life. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2478 1 Q. They even had a psychologist interview you, 2 sort of help on that aspect of it? 3 A. That's what an expert witness school is. 4 Q. Now, I do want to ask you about your 15 5 predictors for suicide. 6 A. Yes, sir. 7 Q. And these 15 predictors or factors, you've 8 published this in your writings on suicide? 9 A. That's correct. 10 Q. And, in fact, the factors that you have 11 published have shown to be highly statistically 12 significant in relation to an eventual suicide; isn't 13 that right? 14 A. You'll have to ask me a more precise question, 15 because in the book where I list them, I don't do any 16 validation of the scale. 17 MR. SEE: Just one moment, Your Honor. I'll 18 get some transcripts out. 19 If I may approach, Your Honor? 20 THE COURT: Yes. 21 Q (By Mr. See) Doctor, let me hand you a 22 transcript and this is very short. 23 When your deposition was taken in June of 1997, 24 I'm looking at Page 69, and I want to specifically 25 refer you to the answer you gave really at Lines 13, PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2479 1 14, 15. Do you see that? 2 A. Yes, I do. 3 Q. Do you recall now testifying that the 15 4 factors, actually, you said had been shown to be 5 related at highly statistically significant levels 6 with suicide outcome? 7 A. Yes, but I didn't necessarily always do that. 8 I thought you were asking me if I had done that. 9 Q. No. I was just asking if they had been found 10 to be -- 11 A. Yes. For example, in the Pathways to Suicide 12 book, I use many of them. There are many tables with 13 significance tests, and they tend to be statistically 14 significant at a fairly high level. Not always, but 15 they tend to be. 16 Q. But the testimony you gave there in '97 was 17 that these factors had been found to be highly 18 statistically significant with suicide outcome? 19 A. That's correct. 20 Q. Now, before we get to the factors, just a few 21 general questions. With respect to suicide, do you 22 believe that personality of the individual can be an 23 important factor in considering suicidal risk? 24 A. Sure. When we do a diagnosis, we always look 25 at what's called Axis II, so in addition to looking at PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2480 1 the major depressive episode, the Axis II would be 2 things like borderline personality disorder, 3 anti-social personality, so yes, I think that's 4 important. 5 Q. And even short of having an actual personality 6 disorder that's diagnosable, would you agree that a 7 person who has a controlling personality, who may have 8 a hard time coping with changes in life, that that 9 person is at an elevated risk because of the 10 personality? 11 A. I think they may be. I would reserve judgment 12 to look in detail at the case. 13 Q. But that's a factor that you would consider as 14 being -- if that was present, that may indicate an 15 elevated risk for suicidality? 16 A. It strikes me that that may be relevant to the 17 cognitive rigidity criterion that I use. 18 Q. You just testified earlier about a term that 19 you call escape suicide? 20 A. That's correct. 21 Q. And that is involved with an individual who 22 simply comes to a conclusion that life is acutely 23 painful and they just want to get away from it? 24 A. Well, they've tried everything usually within 25 life, treatment, and often treatment failures, often PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2481 1 they've been hospitalized several times and they 2 perceive, whether they're right or wrong, that the 3 only solution to their suffering, is to stop living. 4 Q. And I think you've written, and maybe you 5 testified also earlier today, that 75 percent of all 6 suicides are of what you have termed escape suicides? 7 A. That's about right, yes. 8 Q. Now, there's -- you've already testified a 9 little bit about Mr. Forsyth simply because he was an 10 older white male, was at an elevated risk for suicide 11 just because of that factor? 12 A. Yes, that alone. 13 Q. And would you agree that in people of that 14 description, that a common feature of suicide in older 15 white males is surprise by those around them that they 16 would actually commit suicide? 17 A. Well, I'm not sure I would go that far. I may 18 have to ask you to refine your question. I think I 19 will. 20 Q. With respect to the older white male who 21 commits suicide, would you agree that one of the 22 common reactions with regard to that kind of an 23 individual is the people around them, the friends and 24 family and people that knew him and so on, say, gosh, 25 I thought he was getting better. I can't believe he PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2482 1 actually did this. In other words, a feeling of 2 surprise, I can't believe this happened. Isn't that a 3 common reaction in that kind of a suicide? 4 A. It can be. I mean, we're talking about older 5 white men who are usually in control, who usually 6 don't seek therapy that easily, who may be the head of 7 the family, who are not typically given to being sick 8 or accepting a sick role, and it may come as a 9 surprise to some family members, sure. 10 Q. In fact, it's because most older white males, 11 who actually commit suicide, keep those thoughts 12 themselves; isn't that right? 13 A. They don't always. 14 Q. I didn't ask always. My question was, isn't it 15 correct that most white older males who commit suicide 16 keep their thoughts about that to themselves? 17 A. I would say that -- I'm not sure exactly how 18 to -- I suspect that you're quoting from my 19 deposition, so I'll say yes. 20 Q. That saves us a minute, so thank you. And 21 isn't it true, just to follow up one more specific 22 step on that thought, that in the case of suicide of 23 older white males, it is common that even the spouse 24 is surprised that this happened, they think that their 25 husbands are getting better, they can't believe that PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2483 1 they would do something like this; isn't that right? 2 A. Yes, it certainly may be, but often people do 3 suicide because they're getting better. May I 4 elaborate that answer because you asked me a question 5 I feel like I didn't finish it? 6 Q. The question about the spouse of the older 7 white male being surprised? 8 A. About people being surprised, and I started to 9 talk to you and I didn't really finish my thought. 10 Q. Sure, if you have on the question, that would 11 be fine. 12 A. I think it is directly relevant to the 13 question. What I want to say here is that as people, 14 for example, with depression are treated, they tend to 15 get better, and this doesn't mean that they're out of 16 risk because I think their suicide ideation persists, 17 so sometimes people are surprised because they look 18 like they're getting better, but that's just what we 19 call their biological or vegetative symptoms, getting 20 better. They're more active, but they still have 21 suicide ideations. So you can look like you're better 22 and still kill yourself and actually be getting 23 better. 24 Q. All right. Thank you. Doctor, I'd like to ask 25 you a question or two about a chart that came out of PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2484 1 one your books. 2 MR. SEE: If I might approach the witness, Your 3 Honor? 4 THE COURT: You may. 5 Q (By Mr. See) Is that a copy of one of the 6 charts that you have in your book called "The General 7 Model of Suicide Behaviors"? 8 A. Yes. In fact, that was the long version of the 9 short version that Mr. Vickery put on the poster 10 board. 11 Q. Okay. I just wanted to ask you some questions 12 about some of the factors on that chart before we get 13 into a listing of your 15 risk factors or predictors. 14 I guess one of the first things I want to ask you 15 about is you indicate first that with respect to 16 suicide, there are some primary predisposing factors, 17 correct? 18 A. There are primary, secondary, and tertiary 19 factors, yes. 20 Q. Okay. Now, the primary predisposing factors, 21 are they items that simply put people at risk for 22 suicide? 23 A. They are kind of what we were talking about in 24 terms of background factors, often they tend to be 25 biological, often they tend to be before birth, like PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2485 1 history of suicide in the family. 2 Q. Now, one of them is the history of depression, 3 right? 4 A. That's correct. 5 Q. And we can agree Mr. Forsyth had that? 6 A. It doesn't mean Mr. Forsyth. It means the 7 history before him. 8 Q. So that one doesn't apply to him? 9 A. It does, but I'm saying he had it, but in order 10 for this to be a positive here, it would have to be 11 like Hemingway, where the whole family had it. 12 Q. Oh, I see. So the depression that Mr. Forsyth 13 had comes down the line in your chart? 14 A. I think it doesn't really start early on. You 15 notice down at the bottom of the chart, it says birth 16 to death. I mean, he didn't -- when he was born, he 17 obviously wasn't depressed. 18 Q. Okay. I misunderstood your chart. Let's start 19 at another place then. You have some -- after primary 20 column, you have secondary and you say prediction risk 21 factors, right? 22 A. Right. 23 Q. And now, under that, there's a section about 24 personality and psychology? 25 A. Yes. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2486 1 Q. Now, under there, there is impulsivity, right? 2 A. Yes. 3 Q. Okay. And you said we did see some impulsivity 4 in Mr. Forsyth? 5 A. Yes. 6 Q. And then we also see there cognitive rigidity? 7 A. Yes. 8 Q. And we also saw that in Mr. Forsyth, didn't we? 9 A. I think there's some, yes. 10 Q. And is cognitive rigidity just the way some 11 people can't see a full range of options, they just 12 see, maybe, this is the only thing I can do because of 13 their -- I think it's referred to as sort of tunnel 14 vision? 15 A. Sure. Either I have to be miserable or I've 16 got to kill myself, two options. Dichotomous logic. 17 Q. We also had anger under this one, correct? 18 A. That's correct. 19 Q. And there's evidence in the materials in this 20 case that Mr. Forsyth had some anger; isn't that 21 right? 22 A. There's certainly in the record there is 23 mention of anger. 24 Q. And suicide ideas. I think you said there is 25 evidence in the case that Mr. Forsyth was having some PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2487 1 suicidal thinking? 2 A. Per Dr. Neal. 3 Q. I'm just going to put a little check here just 4 to make sure we've understood those are the ones that 5 Mr. Forsyth has. Then you go down and talk about 6 sociology and economics and culture and you also have 7 one there that says work problems? 8 A. Yeah, some of this I'm having trouble reading. 9 Q. They are bad copies. 10 A. I see that, yes, sir. 11 Q. Now, as a result, at least during the Maui 12 phase of his life, Mr. Forsyth was exhibiting problems 13 in adjusting to his perception that he just didn't 14 have anything to do. Would that fall under that 15 category? 16 A. I think there's been conflicting testimony on 17 that and I'm wanting to see how I recorded it on my -- 18 I gave it a plus on my report. 19 Q. Which means it's present? 20 A. Yes. 21 Q. And now let's go over to the column that you've 22 called the trigger factors. It's the column on the 23 right-hand side of that? 24 A. Yes, I see it. 25 Q. Now, the first one that's listed there is PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2488 1 hospitalization, correct? 2 A. Yes. 3 Q. And, of course, Mr. Forsyth was in a mental 4 hospital, right? 5 A. I noticed that there's a feedback loop up at 6 the top. If you get treatment and medication, it 7 actually becomes a protective factor, if you get 8 adequate treatment and medication, that becomes a 9 protective factor. 10 Q. We've had testimony that Mr. Forsyth was, 11 perhaps, prematurely discharged from Castle Medical 12 Center, and he still was suffering from his major 13 depression, so would you put hospitalization as one of 14 the trigger factors as indicated on your chart for 15 him? 16 A. I'm not sure how I feel about that. The fact 17 that he was getting treated, that he was on 18 psychiatric medication would be a plus. If Daryl 19 Matthews is right and he was let out early, that would 20 be a minus. I'm not sure what the sum total would be. 21 Q. Well, Dr. Ron Shlensky, who was one of your 22 colleagues in testifying for the plaintiffs said that 23 he probably was discharged prematurely, would you 24 agree with that? 25 A. I think he probably was let out a little early, PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2489 1 Yes. 2 Q. So would hospitalization be one of trigger 3 factors for Mr. Forsyth? 4 A. I think so, yes. 5 Q. Then we have depressive episode and this is 6 where Mr. Forsyth's own depression would come in? 7 A. He had a major depressive episode, yes, sir. 8 Q. And then also in your trigger factor column, if 9 we could go down to the personality psychology line, 10 the first item there is listed as hopelessness. Do 11 you see that? 12 A. Yes. 13 Q. Now, would you agree that Mr. Forsyth, in fact, 14 had that state; that is, he had the state of 15 hopelessness? 16 A. I gave it a plus on the basis of Dr. Roberts' 17 records of 12/21. 18 Q. That means it is present in Mr. Forsyth? 19 A. I believe so, but on the other hand, if you 20 read my verbal comment, I say, if I may be allowed, 21 there was some hopelessness noted in Dr. Roberts' 22 records. I can't talk about some of that. 23 Q. We're really just trying to see if that factor 24 is present, and I think in your report, you indicate 25 it was? PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2490 1 A. It was. 2 Q. Okay. Now, those preliminaries out of the way, 3 I, like, Mr. Vickery want to go on to your 15 points, 4 and I can't write on his chart. I don't mean to 5 repeat things, but I want to make a notation or two so 6 let me just ask you if we can go through them. The 7 first you had is depressive illness? 8 A. Yes, and that should be a subset of mental 9 disorder. 10 Q. How about if I just put mental disorder? 11 A. That's fine. We want to cover the fact that 12 you could be schizophrenic. 13 Q. But we don't have any evidence that he was 14 schizophrenic? 15 A. That's why I didn't mention it. 16 Q. So we do have evidence that Mr. Forsyth had a 17 depressive illness. Now, the question I want to ask 18 you is, Mr. Forsyth had this depressive illness 19 independent of any treatment he received from 20 Dr. Roberts or Dr. Neal; isn't that right? 21 A. He had -- it pre-existed the treatment, yes. 22 Q. Okay. 23 A. But may I just say, it is not independent. It 24 pre-existed, but it's not independent. 25 Q. I understand, but what I'm asking you is, PACIFIC REPORTING SERVICES UNLIMITED, INC.