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. (808) 524-PRSU 2491 1 separate and apart from the treatment he got from 2 Dr. Roberts and Dr. Neal, he had depressive illness? 3 A. As long as the jury understands that it's not 4 independent of treatment. 5 Q. How about I put separate from treatment? 6 A. Pre-existing to treatment. 7 Q. Okay. Pre-existing to treatment, okay? 8 A. Yes. 9 Q. Now, your second factor you told us was a 10 substance abuse, alcoholism or drug use, right? 11 A. Alcoholism or drug use, yes, sir. 12 Q. Now, when Mr. Vickery was asking you the 13 questions, you said you were really talking about 14 current substance problems, if I heard you right? 15 A. Yes, and I'm really hamstrung throughout my 16 testimony because I can't talk about current drug use. 17 Q. Now, the fact that Mr. Forsyth had a history of 18 alcoholism, even though it was in remission, gives him 19 that risk factor; isn't that right? 20 A. It depends on who you talk to. I think he 21 hadn't had a drink in 26 years, or was not certainly 22 an alcoholic for 26 years, so that's not the same 23 thing as being an alcoholic. On the other hand, AA 24 says once an alcoholic always an alcoholic. So it 25 depends on what source you would use. I would think PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2492 1 he was not an alcoholic at the time of his death. 2 Q. You know, I was not suggesting that he was, but 3 my question, which I will direct to Ron Maris -- 4 A. Yes, sir. 5 Q. -- if I may, isn't it correct that 6 Mr. Forsyth's prior history of alcoholism, even though 7 he was in remission, gives him that risk factor for 8 suicide? 9 A. It's a weak positive, yes, sir. 10 Q. Okay. 11 A. It is not a strong positive because he's coped 12 with it, but it is -- certainly he did have a history 13 of alcoholism. 14 Q. And that was pre-existing to the treatment of 15 Dr. Roberts and Dr. Neal? 16 A. Yes, sir. 17 Q. So we'll put a weak positive, okay? 18 A. Right. 19 Q. Now, the next that you have is suicidal 20 thinking and the way you have it down here, suicidal 21 ideation, talk preparation, and religious ideas? 22 A. Yes, sir. 23 Q. Okay. Suicidal ideation, talk, preparation, 24 religious ideas. Let me first go over the suicidal 25 ideation part. That means thinking about suicide? PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2493 1 A. Yes, thinking about it. 2 Q. And Mr. Forsyth had that? 3 A. Yes, sir. 4 Q. And he had it prior to February 22, 1993; isn't 5 that right? 6 A. I am not completely clear on that. The thing 7 that I was specifically referring to was one month 8 before his death, is that exactly one month before his 9 death? 10 Q. No, it's way more than a month before his 11 death. 12 A. I was referring to Dr. Neal. 13 Q. Let me ask it that way, then. That's a better 14 way to do it. Mr. Forsyth had suicidal ideation one 15 month before his death? 16 A. Yes, sir, at least one month before his death. 17 Q. Now, there's also this religious ideas item 18 that you listed. Is it the case that the religious 19 conflicts, if you will, between Mr. Forsyth and his 20 family, would also be one of the predictors in this 21 item? 22 A. That's a confusing indicator. What I meant 23 there is when I interview people, I always ask them 24 what their religion is and what their concept of death 25 is. For example, are you a member of the Jones Town PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2494 1 Sect because clearly their religious ideas could make 2 a big difference on whether or not you were going to 3 act out. 4 What do you think happens to you after you die, 5 particularly if you kill yourself? Do you get 6 punished for it? Is there some retribution that you 7 have to pay? That's just a general question. I think 8 in this case, the fact that they were a religious 9 family, that that was not present. 10 Q. Let me ask you about that one. Did I give you 11 a copy of your deposition in this case? 12 A. Yes, you did. 13 Q. Could you take a look at Page 158, please? 14 THE CLERK: Mr. See, could you wait a minute? 15 MR. SEE: I certainly will. I'm going to ask 16 at Page 158, Your Honor, that starts at Line 19. 17 Q. And, Dr. Maris, my question for you is, you 18 remember I took your deposition? 19 A. Yes, sir. 20 Q. And you were sworn to tell the truth and there 21 was a court reporter there and that's the transcript 22 there in front of you? 23 A. Yes. 24 Q. Let me ask, were you asked this question and 25 did you give this: PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2495 1 "QUESTION: Would the history of Mr. Forsyth's 2 feelings about the religious conflict between himself 3 and the other members of his family, would that be one 4 of your predictors or -- one of the factors or 5 predictors of suicide? 6 "ANSWER: Yeah, I think so. Because I think in 7 my judgment that it had never been satisfactorily 8 resolved. His family, except him, were much more 9 religious, much more conservative, and he was back in 10 that environment now, so, yes." 11 Did you give that answer? 12 A. I don't have a copy of that. You gave me 13 something else. 14 Q. Oh, I beg your pardon. I apologize, I thought 15 you had it. So if you would look at 158 then, please. 16 You have that there, sir? 17 A. Yes, I do. 18 Q. Just looking at it, did you get the question 19 and give the answer that I just read? 20 A. Yes, I did. Yeah. I heard you say it, yes. 21 Q. Okay. Maybe I'm being confusing and I 22 apologize. At the time you were deposed in this case, 23 did you have that question posed to you and did you 24 give that answer? 25 A. I think I said, yes, I think so. I indicated PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2496 1 some confusion even at that time about the role of 2 religion. 3 Q. And then going onto the end of your answer 4 there on the next page. 5 MR. VICKERY: I'm sorry, what page, Mr. See? 6 MR. SEE: It starts out on Page 158. 7 Q. And the last part of your answer goes over on 8 159, where you say, "So, yes." You see that? 9 A. I'm not exactly sure where you are now. 10 Q. Okay. If you look at Page 158, it starts at 11 Line 19. That's the question. Maybe I'll just read 12 it again. "Would the history of Mr. Forsyth's 13 feelings" -- do you see that -- "about the religious 14 conflict between himself and the other members of his 15 family, would that be one of your factors or 16 predictors for suicide?" 17 And the answer, "Yeah, I think so. Because I 18 think in my judgment, that it had never been 19 satisfactorily resolved. His family, except him, were 20 much more religious, much more conservative, and he 21 was back in that environment now, so yes." 22 A. Yes, I did say that, and I stand by that. 23 Q. So actually, the religious ideas of this third 24 factor, that would have been present in Mr. Forsyth? 25 A. Yes. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2497 1 Q. And that was pre-existing his treatment? 2 A. Yes. 3 Q. Now, the fourth factor is prior suicide 4 attempt, right? 5 A. Correct. 6 Q. Now, I think you testified earlier that in this 7 category of people, older white men, we just don't -- 8 in analyzing a completed suicide, we just don't have 9 this; isn't that right? 10 A. Typically, we do, but it is fairly rare. 11 Q. When you say typically we do? 12 A. Eighty-eight percent of the Chicago suicides in 13 my epidemiological study made one fatal suicide 14 attempt, so 12 had prior. 15 Q. The only time they acted out suicidality was 16 the time they actually completed their own suicide? 17 A. That's correct. 18 Q. That was 88 percent in your study? 19 A. Yes, in one study that I did. 20 Q. And that would be in the category of older 21 white men? 22 A. Yes. 23 THE COURT: Let's break for lunch now. Please 24 be back at one. I want to meet with counsel. 25 (Whereupon, the following proceedings were had PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2498 1 in open court out of the presence of the jury.) 2 THE COURT: I wanted to go over the Beasley 3 deposition, and the pages that the Court will allow, 4 these are the ones that have been marked in yellow, 5 and I assume that Mr. See has been given those pages; 6 is that right? 7 MR. VICKERY: Yes, he has, Your Honor. I gave 8 them the page and line of everything we were offering. 9 THE COURT: That would be pages -- the Court 10 will allow as proper rebuttal, Pages 12 and 13. 11 MR. VICKERY: I'm sorry, Your Honor. Are you 12 looking at the pages on the miniscript or the 13 deposition pages themselves? 14 THE COURT: I'm looking at what I was given, 15 which is, I guess, the miniscript. 16 MR. VICKERY: Okay. I see what you're doing, 17 so 12 and 13 is where he states his name and his 18 background there? 19 THE COURT: Right. 20 MR. VICKERY: Okay, sir. I'm with you. 21 THE COURT: Then Pages 127 through 130, and 22 Pages 190 through 197, but omitting one, Page 195. 23 MR. VICKERY: I'm sorry, Your Honor, 190 24 through 195? 25 THE COURT: 190 through 197, omitting 195. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2499 1 MR. VICKERY: Okay, sir. Gotcha. 2 THE COURT: Pages 209 through 211, and I take 3 it this would require an instruction that this is only 4 for -- the jury may only consider it for the purpose 5 of whether Lilly was on notice of this material. 6 MR. VICKERY: Right. 7 THE COURT: And then Pages 359 through 372. 8 MS. MANGRUM: Your Honor? 9 THE COURT: Yes, ma'am. 10 MS. MANGRUM: If I may briefly be heard 11 regarding Pages 359 through 372? In the portions that 12 were designated on the last page, 372, and we 13 specifically discussed this with Dr. Tollefson before 14 he testified that, in fact, the Court had ruled that 15 the findings of the psychopharmacologic drugs advisory 16 committee -- 17 THE COURT: Well, wait. Let me turn to that 18 page. Just a minute. You're referring to Page 372? 19 MS. MANGRUM: The part that is not highlighted 20 between 371 and 372. That would be 371 Line 11 21 through 372 Line 7. 22 MR. VICKERY: I'm with her. We'll withdraw the 23 part on Page 372. It's just one question and answer. 24 We'll just stop on 371 on Line 10, Judge. 25 MS. MANGRUM: No, I don't think does. I don't PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2500 1 think that takes care of my concern. My concern is 2 this, Your Honor, on this rechallenge study when 3 Dr. Tollefson testified, we specifically instructed 4 him that he could not list, among the reasons that 5 that rechallenge was not done, the fact that the 6 psychopharmacologic drugs advisory committee had 7 unanimously concluded that this is no evidence -- no 8 credible scientific evidence that this drug causes 9 suicide and, in fact, that was one of the factors that 10 went into the company's decision. Not only all of the 11 problems inherent in the studies that he discussed, 12 but also the fact that volumes of materials had been 13 reviewed by this independent committee set up by the 14 FDA and their conclusion had been, as indicated in our 15 Exhibit 1068, that there was no evidence that this 16 drug caused the problem. That is one of the reasons, 17 though not the only reason -- 18 THE COURT: Wasn't that in the talking paper of 19 the FDA? 20 MR. SEE: Yes, which the Court excluded as a 21 non-final determination and that's why our witness -- 22 THE COURT: I thought the talking paper had 23 been introduced. 24 MS. MANGRUM: Not this talk paper, Your Honor. 25 There are several. This is the one about the PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2501 1 Psychopharmacologic Drug Advisory Committee. It is 2 what occurred -- 3 THE COURT: I thought there was a talking paper 4 of the FDA, if my memory serves me correctly, that was 5 introduced that stated that the FDA had studied the 6 results of the Teicher paper and had concluded that 7 there was no relationship between Prozac and suicide. 8 MS. MANGRUM: There are several that say that, 9 but the timing and sequence of this rechallenge that 10 are in the questions Mr. Vickery has highlighted deal 11 with why it was not done and why it was not discussed 12 after September of 1991, and the reason is, the 13 Psychopharmacologic Drug Advisory Committee, and their 14 conclusion that there was no evidence of causation 15 based upon everything that they reviewed. 16 THE COURT: Well, why wasn't the talking paper 17 that I just referred to the answer? 18 MS. MANGRUM: The talk paper, I mean, doesn't 19 put anything in context. There are several talk 20 papers because the FDA has concluded the same thing 21 time after time, but as to why the discussions went on 22 that Mr. Vickery had highlighted here and what was 23 going on to put it in context. The context is the 24 psychopharmacologic drugs advisory committee and their 25 conclusion in September of 1991. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2502 1 THE COURT: Well, I guess I still don't 2 understand why the FDA talking paper was not the 3 response of Dr. Tollefson. 4 MS. MANGRUM: It's just that it's misleading 5 because of the time. The Court is correct, that there 6 have been several talk papers and several conclusions 7 by the FDA that the drug does not cause suicide or 8 homicide. 9 THE COURT: But I think that Mr. Vickery or 10 perhaps Mr. See asked -- well, I guess Mr. Vickery 11 asked Dr. Tollefson whether the rechallenge study had 12 ever been done, and I think Dr. Tollefson's testimony 13 was that there was a meeting and it was decided not to 14 do it, but I think Mr. Vickery's question was rather 15 open-ended as to why hasn't it been done even as of 16 today and certainly that talking paper came out before 17 today. 18 MS. MANGRUM: Exactly. But the Court excluded 19 it and that's why we would not allow Dr. Tollefson to 20 talk about -- 21 THE COURT: Wait a minute. I thought you just 22 admitted that there was a talk paper as I described. 23 MS. MANGRUM: Not about this issue of the 24 Psychopharmacologic Drug Advisory Committee, which is 25 the time that's concerned with the decision on not to PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2503 1 go forward with the rechallenge. Now, what I'm saying 2 is, what he has said along, that this opens the door. 3 We have kept it shut on the Court's order and haven't 4 brought up this talk paper and this committee's 5 decision. 6 THE COURT: What does the other talk paper say 7 that came into evidence? I mean, I thought you nodded 8 that I was correct as I described it. 9 MR. SEE: I think -- I believe you are correct, 10 Your Honor. The ones that have come into evidence are 11 FDA talk papers about citizen's petitions, the Church 12 of Scientology says take Prozac off the market and the 13 FDA responds to it and says, we've studied all the 14 evidence and we conclude that Prozac does not cause 15 suicide or violent behavior. That has come in. 16 THE COURT: I don't see why Dr. Tollefson 17 didn't refer to that then. 18 MR. SEE: Well, if I may, Your Honor, you 19 really have to go back in time. The designation by 20 Mr. Vickery specifically asks, why did you not do the 21 challenge, rechallenge? 22 THE COURT: Or why haven't you? Which is 23 rather open-ended. 24 MR. SEE: Well, except the Court had ruled that 25 no witness could talk about the advisory committee PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2504 1 because it was not a final agency decision, and so we 2 instructed Dr. Tollefson not to do it. 3 THE COURT: But the talking paper did come in. 4 MR. SEE: Sir? 5 THE COURT: I said, the talking paper did come 6 in, the one that I described that you acknowledged. 7 MR. SEE: Correct. Yes, sir. 8 THE COURT: Why couldn't he refer to that? 9 MR. SEE: I think he did. I believe he did. 10 The problem is, the way Mr. Vickery has designated 11 Dr. Beasley's testimony, if nothing is mentioned about 12 the advisory committee, then it looks like there was 13 no reason in Dr. Beasley's transcript, so that's our 14 objection to it. Either Mr. Vickery ought to withdraw 15 it, because Beasley gives that as the reason, there 16 was an advisory committee. That's the real problem, 17 Dr. Beasley said -- 18 THE COURT: What pages are you referring? Are 19 you just referring to Page 371 and 2 or what? 20 MR. SEE: Yes, sir. 21 THE COURT: Mr. Vickery. Seems to me that 22 Mr. See has a valid point. 23 MR. VICKERY: Well, I'll be glad to read all of 24 371 and 372 through Line 10, Your Honor. I need to 25 alert the Court, if he's going to say now the door's PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2505 1 open to bring in this other item, I need to alert you 2 what will come in with it, because the advisory 3 committee that he's talking about, the one that the 4 Court excluded, was packed with a bunch of people who 5 were paid a lot of money by Eli Lilly and I've got 6 interrogatories from them to that effect. So I just 7 want to alert you, if that document is going to come 8 in -- 9 THE COURT: I'm not saying that document comes 10 in. 11 MR. VICKERY: I will certainly read the 12 portions on 371, all of 371 and down to Line 10 of 13 372, and I think that puts in to context everything 14 that this witness, Charles Beasley, knows about that 15 matter. 16 MR. SEE: And that will be agreeable, Your 17 Honor, if there's also an agreement that that doesn't 18 open the door to anything? 19 MR. VICKERY: That's fine. I agree to that. 20 THE COURT: Well, if you're in agreement, I 21 guess there's nothing more for me to do. 22 MR. VICKERY: It's the second time this trial 23 that's happened, Your Honor. 24 THE COURT: Well, while we're here, in the 25 event we go into a -- well, first off, have you agreed PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2506 1 on a form of verdict? 2 MR. VICKERY: Yes, we have. 3 MR. SEE: Yes, we have. 4 THE COURT: That's going to be basically -- 5 MR. VICKERY: A general verdict. 6 THE COURT: And if we go into a punitive 7 damages session, how long do you anticipate that's 8 going to last? 9 MR. VICKERY: I would think, Your Honor, from 10 our perspective, probably a day, day and a half of 11 testimony at most. 12 THE COURT: And what do you predict, Mr. See? 13 MR. SEE: The same, although I will say there 14 will be some significant legal questions about what 15 evidence ought to come in in the event we get there. 16 THE COURT: So a couple of days going over the 17 legal issues? 18 MR. SEE: I don't know that it will take a 19 couple of days. 20 THE COURT: Are you saying a day in addition to 21 what Mr. Vickery said? 22 MR. SEE: If I had to estimate right now, I 23 would say, on putting on evidence, we would take that 24 day and a half that he talked about or less. 25 THE COURT: And have you agreed as to a form of PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2507 1 verdict in that? 2 MR. VICKERY: I gave you the question number 3 five, is that agreeable? 4 MR. SEE: The only problem with what 5 Mr. Vickery submitted was, he just asked the jury 6 about how much. He doesn't ask them if. So we do 7 need to work on that. It's missing an element, but I 8 suspect we can agree. 9 THE COURT: All right. Anything else we should 10 take up at this time? 11 MR. SEE: I think that's all right now, Your 12 Honor. 13 THE COURT: All right. Let's break for lunch. 14 (Whereupon, a lunch recess was taken from 15 12:15 p.m. to 1:25 p.m.) 16 THE COURT: Mr. See. 17 MR. SEE: Thank you, sir. 18 Q. Dr. Maris, let's run through the rest of your 19 factors. Now, factor number five was use of a lethal 20 method? 21 A. Yes. Shouldn't you put a zero or a minus after 22 four so we indicate that that was not positive? 23 Q. Absolutely. But with an older white man, we 24 would expect it to be positive, wouldn't we? 25 A. That's a qualification. Thank you. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2508 1 Q. Now, number five is using a lethal method. Is 2 it correct that this use of a lethal method is what 3 you used to analyze whether a prior suicide attempt 4 really demonstrated a higher risk of later attempts? 5 A. Well, you could, but these were all independent 6 right now. In other words, if you use a gun, you're 7 going to have a lethal outcome. There's a scale by 8 Card which rates the method in terms of the 9 probability of the outcome being death. That's what I 10 use. 11 Q. Oh, okay. So Mr. Forsyth had a lethal method? 12 A. He had a -- it was a moderately lethal method. 13 It was a stabbing which is more lethal than cutting, 14 but it's not as lethal as a gun. 15 Q. Right. But with respect to Mr. Forsyth, where 16 there was no prior attempt, he was one of these older 17 white men, the lethality of method really doesn't 18 apply, does it, because there's no prior attempt to 19 look at? 20 A. Well, that's -- I'm not sure what you mean by 21 that. 22 Q. Let me ask the question so you do know what I 23 mean. In going over these factors to see if they are 24 predictive of suicide in Mr. Forsyth, because we 25 really don't have a prior attempt, then the lethality PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2509 1 of the method really doesn't apply, does it, because 2 it couldn't be predictive for him because there really 3 wasn't a prior attempt to look at? 4 A. No, that doesn't follow. It's quite possible 5 that he could have survived. His method was not that 6 lethal. If it had been a gun, it would have been a 7 totally different situation. 8 Q. Okay. So moderately lethal on the method? 9 A. Yes. 10 Q. Now, number six was isolation, living alone, or 11 loss of support? 12 A. That's correct. 13 Q. And for Mr. Forsyth, you noted, I think, in 14 your report that he wasn't isolated, but he had some 15 estrangement from his wife? 16 A. Well, he also had some recent closeness. I 17 gave that a zero. What I actually said in the report 18 was "Mr. Forsyth was married had two loving children, 19 just received treatment and had several professional 20 therapy sessions." 21 Q. You gave that a zero in your report. Let me 22 ask you this question: If there was testimony that 23 Mr. Forsyth had become increasingly withdrawn in the 24 last two months of his life, would that satisfy the 25 isolation aspect of the risk factor? PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2510 1 A. It's a judgment call. I think these other 2 factors would have to be weighed in as well. I mean, 3 for example, I saw some testimony about lying in bed 4 with covers pulled up over his head. If that's all he 5 did, I think that might indicate that he was certainly 6 isolated, but that wasn't all that he did. 7 Q. Okay. So the lying in bed in the afternoon, I 8 think the testimony was, with the covers pulled up, 9 that would be evidence of isolation? 10 A. It would be some partial evidence, but you have 11 to consider all his social relations. 12 Q. I want to make sure I understand. I may just 13 not have caught your answer, and if I didn't, that was 14 my fault. Isn't it the case, based upon the evidence 15 that you reviewed and what you heard in court, that, 16 in fact, Mr. Forsyth had become increasingly 17 withdrawn, such that he was staying home and not going 18 out and about as he had in the last two months of his 19 life? 20 A. There was some changes in his social 21 interaction, yes. 22 Q. And there were changes toward the increasingly 23 withdrawn and staying at home more and, if you will, 24 isolated? 25 A. That doesn't negate the contacts that he had, PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2511 1 though. You know, typically, what we see is an older 2 white male who's divorced, who's living alone in a 3 one-room flat downtown someplace. It's a very 4 different situation. 5 Q. I understand that, but I'm asking specifically 6 about Mr. Forsyth. The testimony you've heard and all 7 the materials you've reviewed in this case about him 8 becoming increasingly withdrawn in the last two months 9 of his life, staying at home more, not going out, 10 would that fit under the isolation category? 11 A. It would be certainly a consideration in that 12 category. It would also fit under depression. 13 Q. Okay. So would it be fair to say we have some 14 consideration of isolation? 15 A. There's some, yes. 16 Q. And that would certainly be before it got -- 17 A. But, you know, this isn't an all or nothing 18 kind of judgment, and I think, on balance, what I 19 decided was it was a zero. I didn't give it a 20 partial. I gave it a zero. 21 Q. No, I understand. What I'm asking you about is 22 your testimony here today. And would it be fair to 23 say that there was some consideration of isolation? 24 A. There was some changes, but I don't see him as 25 isolated, no. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2512 1 Q. Okay. Some changes? 2 A. Yeah. 3 Q. Item number seven is the hopelessness and 4 cognitive rigidity; is that correct, sir? 5 A. That's correct. 6 Q. And on the hopelessness side of things, we 7 certainly had that before Mr. Forsyth treated with 8 Dr. Roberts or Dr. Neal? 9 A. I'm not sure about the levels of that. I 10 noticed it in referenced it in terms of his report to 11 Dr. Neal. That was my citation. 12 Q. All right. Isn't it correct that at one of the 13 first visits with Dr. Roberts, Dr. Roberts noted 14 that -- 15 A. That's also true, yes. 16 Q. So we can say that was before treatment? 17 A. Yes, or during. 18 Q. Now, we talked about cognitive rigidity, and 19 you said, I think if I heard you right, you used the 20 term, the person would be thinking as if they were 21 boxed in? 22 A. Boxed in, no alternative, yes. 23 Q. Would trapped fit in there? 24 A. That's not my word. 25 Q. I'm just asking if it would fit in there. Your PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2513 1 use of the term boxed in to talk about cognitive 2 rigidity, would feeling as if you were trapped, does 3 that not -- 4 A. It would certainly be in the same family, but 5 it has to do with, you know, no good enough future, no 6 way -- no good enough future kind of thing. 7 Q. I'll just put down boxed in. Trapped would not 8 be the same concept? 9 A. I don't think so. I think -- you know, part of 10 the problem with this one is I indicated evidence on 11 both sides. In other words, I indicated some evidence 12 that he was not hopeless. 13 Q. But you ended up giving it, in your own 14 analysis -- 15 A. Yes, I gave it a plus. 16 Q. -- a positive for suicide risk for Mr. Forsyth? 17 A. That's correct. 18 Q. Now, number eight is pretty straightforward, 19 that's the older white male, correct? 20 A. Correct. 21 Q. And that, of course, existed before his 22 treatment with Dr. Roberts or Dr. Neal, right? 23 A. Yes. 24 Q. Number nine was the modeling or the suicide in 25 the family, and we just don't have that here? PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2514 1 A. It's a zero. 2 Q. Not as far as we know we don't have that? 3 A. We have a zero for that. 4 Q. Now, ten was the work problems, and I think 5 part of your analysis was a consideration that 6 Mr. Forsyth was a workaholic by his own description, 7 and in fact, had not made a good adjustment to his 8 retirement, therefore, you gave that one a positive 9 risk of suicide mark for him? 10 A. In my report, all of these are qualified on the 11 next page where I did -- yes. The short answer is 12 yes, I did give it that. 13 Q. And that's one that existed before the 14 treatment with Dr. Roberts and Dr. Neal? 15 A. Yes. 16 Q. And then 11 was the marital problems, and I 17 think you noted in your report that, you noted two 18 separations and a divorce had been considered, so you 19 gave a positive for that factor? 20 A. I did. 21 Q. And that existed before treatment with 22 Dr. Roberts and Dr. Neal. 23 A. Yes. 24 Q. Number 12 was stress and life events, and you 25 listed under that one post-retirement, stressful, PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2515 1 nothing to do, and domestic arguments, so that would 2 be a positive risk factor for suicide for Mr. Forsyth? 3 A. Yes, except the nothing to do I have sense 4 learned is probably not as strong as that. I mean, he 5 did have things he was doing, but he did have some 6 trouble with retirement in my judgment. 7 Q. Isn't it correct, as we know from looking at 8 his -- what he told Dr. Neal and what he told 9 Dr. Roberts, that, in fact, in his perception that he 10 was inactive and not productive and had nothing to do 11 was, in fact, a significant stressor for him in the 12 last month or two of his life? 13 A. And I admitted that, yes, sir. 14 Q. And the number 12 stress and life events 15 existed before his treatment with Drs. Roberts and 16 Neal? 17 A. Yes. 18 Q. We're almost done with these here. Thirteen is 19 anger, aggression, and irritability, correct? 20 A. Correct. 21 Q. Now, you noted in your report, anger towards 22 wife -- 23 A. Yes, sir. 24 Q. -- is that right? 25 A. Yes. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2516 1 Q. In fact, from your review of all the materials 2 in the case, you noted that Mr. Forsyth became 3 irritated with his wife almost like her very person 4 irritated him; is that right? 5 A. Yes, I think that's been testified to today, 6 the God talk and so on. 7 Q. So that would be a positive factor for risk of 8 suicide for Mr. Forsyth, correct? 9 A. Yes, it would. 10 Q. And before his treatment with Drs. Roberts or 11 Neal? 12 A. Yes. 13 Q. Now, 14 is physical illness, and I take it we 14 don't have that here? 15 A. We do not. It's a zero. 16 Q. And the last of the 15 factors is what you call 17 repetition and co-morbidity? 18 A. Yes, sir. 19 Q. And is what that means is these things were 20 happening over and over, and they were -- some of them 21 were happening at the same time? 22 A. Yes, it is a suicidal career's notion. 23 Q. This one actually relates to the suicidal 24 career? 25 A. Yes, because it's the interaction and the PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2517 1 repetition over time. 2 Q. Okay. And that one you said you give a plus, 3 but a weak plus? 4 A. Yes, sir. 5 Q. And that factor would have existed before his 6 treatment with Dr. Roberts and Dr. Neal? 7 A. My report says at least since 11/91. 8 Q. Okay. Let me go back to the hopeless one for 9 just a second and ask you a question about that. When 10 Mr. Forsyth was discharged from the Castle Medical 11 Center after his inpatient treatment for depression, 12 that's the kind of event, isn't it, that someone like 13 Mr. Forsyth could see as a treatment failure; that is, 14 he hadn't gotten any better? 15 A. It depends. I mean, you don't expect to get 16 better for a while. I mean, most of the medications 17 and the treatment takes several weeks to get better, 18 and as long as you have proper therapeutic 19 reassurances, it probably shouldn't upset you that 20 much. I mean, you continue to be treated even though 21 you're not in the hospital. 22 Q. Well, wouldn't it be accurate to say that from 23 what we know in reading the Castle Hospital record, 24 that from Mr. Forsyth's own perception, the way he 25 felt, at least we can learn about it from what he said PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2518 1 or told other people, is that he felt his stay at 2 Castle really hadn't made him better? 3 A. Well, I'm not sure. He went there -- if you 4 read the record carefully, he said, I went there to be 5 weaned from my Xanax. I have a lot of Xanax 6 dependency, and that was something that was 7 accomplished. You would almost have to give me a 8 specific reference for me to know what you're -- 9 Q. Well, how about this reference, when he said in 10 Castle, after he had been there, I don't know, maybe 11 it was the second day he was there, he said "I really 12 need to get help with my depression. I get so 13 depressed." Didn't you take that to indicate that he 14 was perceiving that he just wasn't getting any better? 15 A. I don't think it had anything to do with his 16 treatment. I think he's saying, that's why I'm here. 17 I'm here because I want to get that treated. 18 Q. Now, finally, I think you testified that one of 19 the basis for your opinion that these factors, as it 20 applies to Mr. Forsyth, did not show that his 21 depression was responsible for his acts, I think I 22 heard you say, that he had been a successful 23 businessman all his life, and he was used to dealing 24 with stress, and had dealt with stress successfully, 25 you recall that? PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2519 1 A. Yes. Most of us have different coping 2 thresholds, and I think he had been an accomplished, 3 coping, successful man. 4 Q. Now, my question for you is this: Don't we 5 know from reading the medical records in the case and 6 from reading Mr. Forsyth's own notes and from knowing 7 his own interactions with Dr. Roberts, his 8 psychiatrist, don't we know that in the last two 9 months of his life, Mr. Forsyth couldn't handle 10 stress? 11 A. What we know is that he had, in fact, handled 12 stress up to a certain point, which I'm precluded 13 talking about. 14 Q. My question for you is, don't we know even from 15 reading Mr. Forsyth's own notes, that in the last two 16 months of his life, he had become so that he couldn't 17 handle stress? 18 A. Yes, sir, that's part of what it means to be 19 depressed. It affects your coping ability. 20 Q. Depression affects your coping ability? 21 A. Sure. It slows you down. You think of the 22 nine symptoms we talked about. It slows you down. 23 You lose your energy. You lose your ability to take 24 pleasure in life. I mean, these are all a part of the 25 disease. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2520 1 Q. And by affecting your coping ability, do you 2 mean, depression impairs your ability to cope with 3 stress? 4 A. Generally, yes. 5 MR. SEE: All right. Dr. Maris, thank you very 6 much. I pass the witness. 7 THE COURT: Mr. Vickery. 8 MR. VICKERY: Yes. Thank you, Your Honor. 9 I'll give Mr. See a minute to clear off the podium 10 there. 11 REDIRECT EXAMINATION 12 BY MR. VICKERY: 13 Q. I want to follow up on a few things that 14 Mr. See had asked and put it in time context. Are all 15 of things that he had -- he had just gone over with 16 you all the things that would put him potentially at 17 risk, things that predated February 22, 1993? 18 A. That's correct. 19 Q. And you know that's the date that he first got 20 Prozac, right? 21 A. Yes, I understand that. 22 Q. So all of the risk factors and even the trigger 23 factors he mentioned preceded that by some long period 24 of time? 25 A. Yes, sir. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2521 1 Q. And had he ever attempted to take his life? 2 A. No, he never made an attempt. 3 Q. Had he ever threatened or harmed his wife? 4 A. No. Bobbi Comstock testified that she never 5 saw him violent towards June. 6 Q. Now, is there anything that happens that is a 7 possible acute trigger for lethality after 8 February 22, 1993, except Prozac? 9 A. Not in my reading of the record. 10 MR. SEE: Your Honor, I object to the question 11 because it is contrary to your prior ruling, and I 12 move that the question and the answer be stricken. 13 THE COURT: I'll sustain the objection and 14 strike the answer. 15 Q (By Mr. Vickery) Okay. Let me rephrase my 16 question. Was there any trigger of any of these other 17 types after February 22 of 1993? Was there any acute 18 trigger of lethality of any of the other types that 19 Mr. See has discussed with you? 20 A. I don't think so. I didn't see any new 21 triggers. 22 Q. Why is it -- 23 THE COURT: What have you written down there? 24 MR. VICKERY: What I've written down is "No 25 acute triggers of similar type," the type that Mr. See PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2522 1 was discussing with him, Your Honor. 2 THE COURT: Thank you. I can't see that. 3 Q (By Mr. Vickery) Now, I want to ask you about 4 a few of the specific things that Mr. See asked you 5 about. He asked you about anger. Is there, in your 6 field, a rule of thumb in looking at a stabbing death, 7 in particular, as to when it was prompted by anger or 8 rage? 9 A. There's a kind of rule of thumb that the FBI 10 uses, which counts the number of stab wounds, and the 11 number is 20. 12 Q. Twenty or more -- 13 A. Twenty or more indicates rage and anger. 14 Q. Okay. And you're familiar from the autopsy 15 that Ms. Forsyth had 15? 16 A. Yes, sir. 17 Q. Now, in the chart that you -- you still have 18 your chart up there with you? 19 A. The general model that was given to me? 20 Q. Yes, sir. Maybe we should show this on the 21 screen, Ms. Barth. 22 While she's getting this up, Dr. Maris, I'm not 23 going to ask you to go through this chart. That's the 24 reason why we did it in the simplified form, but if 25 you would just kind of give us an idea of the PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2523 1 complexity of the analysis that you've done. 2 A. Shall I wait until it's displayed? 3 Q. Yes, let's wait until it's up for the jury. 4 You talked about the primary factors, secondary 5 factors, tertiary or third-level factors and then 6 trigger factors? 7 A. Yes, sir. 8 Q. And this is all I want to ask you about this, 9 so it is a very specific and narrow question. There's 10 one over here about low 5HII -- HIAA -- say it for me. 11 A. HIAA. 12 Q. Thank you. Does that have something to do with 13 the serotonin system? 14 A. Yes, it's a metabolite of serotonin, which is 15 5-HT. 16 MR. VICKERY: Ms. Barth, thank you very much. 17 Q. Do any of the risk factors for suicide that 18 Mr. See has discussed at some length with you, as have 19 I, account for June's death? 20 A. No, of course not. 21 Q. Now, I want to ask you about this witness 22 school. Have either I or anyone who's helped you with 23 what kind of neck tie to wear, told you to ignore the 24 lawyer's questions and try to make your own points? 25 A. No, sir, they haven't. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2524 1 Q. What have you been instructed insofar as how to 2 respond to questions from Mr. See, the other lawyer? 3 A. Listen carefully, wait for objections, and 4 answer the question. 5 MR. VICKERY: Okay. Fine. I have one more 6 thing I would like to ask him, Your Honor, but it is 7 something that I need to apprise the Court of at side 8 bar first. 9 THE COURT: All right. 10 (Whereupon, the following proceedings were had 11 at side bar out of the hearing of the jury.) 12 MR. VICKERY: Your Honor, Mr. See asked him, in 13 his cross, about impulsivity and the role of 14 impulsivity. I want to ask him his opinion about the 15 role of Prozac with respect to impulse control. This 16 was the matter that Mr. See did cover with him in the 17 deposition. I've got the quotes from 142 and 43, and 18 that's the one thing I want to ask in response to 19 Mr. See's -- 20 THE COURT: That's improper with the Prozac? 21 MR. VICKERY: Impair his impulse control and 22 his opinion. This was covered by the deposition and 23 then Mr. See chose to cross-examine. 24 THE COURT: He didn't talk about causation. 25 MR. VICKERY: Only in a very narrow way and PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2525 1 only because, A, Mr. See covered it in the deposition, 2 and B, Mr. See cross-examined him about impulsivity. 3 MR. SEE: Your Honor will recall the topic of 4 impulsivity came up on the direct examination -- 5 THE COURT: That's true. 6 MR. SEE: -- not from me. I simply followed up 7 and ask if Mr. Forsyth was impulsive and that was it. 8 Not from me. 9 THE COURT: I won't allow it. 10 (Whereupon, the following proceedings were had 11 in open court in the presence of the jury.) 12 THE COURT: Please proceed, Mr. Vickery. 13 MR. VICKERY: Thank you, Your Honor. 14 Q. When you, in the context of doing analyses of 15 suicides, either things that have happened or fear 16 might happen outside of a courtroom context when you 17 look at those, do you consider the risk factors -- do 18 you consider them in your proper historical context, 19 in other words, how long has this risk factor been 20 there, how this person copes with it, and that sort of 21 thing? 22 A. Sure. By definition, there is a time line down 23 at the bottom of the chart and we try to specify the 24 dates, of course. 25 Q. And when you are looking for things that PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2526 1 precipitate violent or self-destructive behavior and 2 looking at the acute phase, can you tell us what 3 period you principally focus on? 4 A. Of course, by definition, acute means 5 proximate, close to, continuous, shortly thereafter. 6 Q. A week, two weeks, how close to the event 7 itself do you typically hone in and focus on? 8 A. It's relative. Chronic is a long time. Acute 9 is a short time. We typically look in terms of weeks. 10 MR. VICKERY: Okay. That's all I have. I'll 11 pass the witness. 12 RECROSS-EXAMINATION 13 BY MR. SEE: 14 Q. I just have two questions, Dr. Maris. When 15 Mr. Vickery asked you about this 5-HIAA on your -- 16 A. Yes, sir. 17 Q. -- chart and you said it had to do with the 18 serotonin system, the entry on your chart says low 19 5-HIAA. If I may, that means, by your entry on the 20 chart, low serotonin, right? 21 A. Yes, sir. 22 Q. Now, just one last thing. The trigger factors 23 that we discussed earlier -- you still have your chart 24 in front of you? 25 A. Yes, I do. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2527 1 Q. Yeah. Now, these trigger factors that we 2 listed, you've got that listed right down at the 3 bottom of that far right-hand column, and it says 4 there, and the same column applies to these factors 5 and it says, suicide zone, right? 6 A. Yes, sir. 7 MR. SEE: Thank you, sir. 8 REDIRECT EXAMINATION 9 BY MR. VICKERY: 10 Q. Why doesn't it say homicide zone? 11 A. These are predictors of suicide, and I should 12 say that for every hundred people in a suicide zone, 13 only one will kill himself. We need additional 14 factors. 15 MR. VICKERY: Thank you. 16 MR. SEE: Nothing further, Your Honor. 17 THE COURT: Thank you. You're excused. 18 MS. BARTH: Your Honor, at this time plaintiffs 19 would like to present the deposition of Charles 20 Beasley. 21 THE COURT: Very well. 22 MS. BARTH: Mr. Chang is engaged in another 23 matter in court, so we have asked Mr. Mergatroid from 24 my office to read the deposition. 25 THE COURT: All right. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2528 1 (Whereupon, the following is a reading from the 2 deposition of Dr. Charles Beasley.) 3 MS. BARTH: "Dr. Charles Beasley called by the 4 plaintiffs and after first being duly sworn, was 5 deposed and testified as follows: 6 Q. "Would you state your name, please? 7 A. "Charles Merit Beasley, Jr. 8 Q. "Are you a medical doctor? 9 A. "Yes, I am a medical doctor. 10 Q. "Would you give for us, please, your 11 educational background, starting with when and where 12 you graduated from high school? 13 A. "Yes. I graduated from high school in 14 Lexington, Kentucky in 1968. I received my BA degree 15 from Yale in 1977. I completed my medical education 16 at the University of Kentucky 1983. I did one year of 17 psychiatric residency at Yale in 1983, 1984, and did 18 my psychiatric residency at the University of 19 Cincinnati in 1987. Was board certified in general 20 adult psychiatry in 1988, and I have been working for 21 Eli Lilly and Company since July of 1987 when I 22 completed the residency. 23 Q. "Do you not believe that Prozac can cause a 24 worsening of akathisia or can cause akathisia? 25 A. "I don't know whether it can or can't. My PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2529 1 answer here is actually rather complex and I would be 2 happy to -- 3 Q. "The question simply is, do you consider 4 akathisia as an event that is significant, has a 5 significant association between Prozac and the event? 6 A. "I'm not sure that akathisia, with all that it 7 connotes, is an appropriate term for what is 8 associated with Prozac and that's reflected in a 9 lengthy response of mine to an article published by a 10 group at Columbia discussing akathisia with Prozac. 11 Q. "Do you consider yourself an expert in 12 akathisia, Doctor? 13 A. "I'm sitting here thinking. I have never 14 thought -- it's never occurred to me as a question -- 15 Q. "I guess maybe -- go ahead. 16 A. "I'm not an eminently recognized authority by 17 my peers. 18 Q. "All right. But you feel in your own mind that 19 you have some superior knowledge of akathisia over and 20 above that of the ordinary psychiatrist? 21 A. "Possibly. 22 Q. "All right. Even though you've never treated 23 anyone for akathisia since you graduated from your 24 studies? 25 A. "That's correct. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2530 1 Q. "Have you ever seen a patient who has 2 complained of akathisia since you graduated from your 3 training? 4 A. "No. 5 Q. "Have you ever prescribed any medication for an 6 individual complaining of akathisia since you 7 completed your training? 8 A. "No. 9 Q. "And the fact is, is the analysis that you made 10 is an analysis of the minority of the patients who 11 have been involved in clinical trials on Prozac? 12 A. "That's correct. 13 Q. "And is a minority of the number of clinical 14 trials done using Prozac by Lilly? 15 A. "I would not be -- again, I would not be 16 surprised if that was the case. 17 Q. "Clinical trials that are analyzed are only 18 United States clinical trials, aren't they? 19 A. "That's correct. 20 Q. "There was no analysis made of the outside 21 United States clinical trials that were in existence 22 at the time to this paper? 23 A. "In this paper, no. 24 Q. "There were double-blind clinical trials using 25 Fluoxetine for depression controlled against placebo PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2531 1 or tricyclic antidepressants done outside the United 2 States that weren't included in this analysis, weren't 3 there? 4 A. "Yes. 5 Q. "You only -- in other words, you limited to -- 6 you limited the analysis to double-blind randomized 7 trials of Fluoxetine and depression controlled 8 against placebo or tricyclic antidepressant in the 9 United States? 10 A. "In this report, that's correct. 11 Q. "Even though there were exactly studies 12 comparing these substances in the same manner being 13 done outside the United States? 14 A. "In this report, that's correct. 15 Q. "It's true, isn't it, in fact, Dr. Beasley, 16 that the clinical trials were not meant to assess 17 suicidality, were they? 18 A. "No. They were intended to assess the efficacy 19 and overall safety of Fluoxetine, a component of that 20 would be suicidality, but they did not have that as 21 the specific goal. 22 Q. "So the answer to my question of the goal of 23 the clinical trials analyzed was not to analyze 24 suicidality would be yes, wouldn't it, Doctor? 25 A. "You're correct. Yes. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2532 1 Q. "The only measure of suicidality in the 2 clinical trials, was the Hamilton Depression Scale, 3 was it not? 4 A. "Along with adverse event reports. 5 Q. "All right. But the only scale used in the 6 clinical trials to assess suicidality was the Hamilton 7 Depression Scale? 8 A. "That's correct. 9 Q. "And the only part of that Hamilton Depression 10 Scale that focuses in any way on suicidality is Item 11 3, is it not? 12 A. "That's correct. 13 Q. "Item 3 is simply a zero to four analysis of 14 suicidal ideation and acts, is it not? 15 A. "That's correct. 16 Q. "Are you telling us, Dr. Beasley, that you 17 think the Ham-D Item 3 was adequate to measure the 18 suicidality in individuals participating in the 19 clinical trials of Prozac for depression? 20 A. "I'm telling you it's an item with significant 21 scientific support. I'm telling you that in my 22 personal opinion, it's sufficient to detect large 23 changes in suicidal ideation. 24 "I'm also telling you that I believe it's less 25 sensitive than the other instruments that you've PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2533 1 mentioned to detect relatively smaller changes in 2 suicidal ideation." 3 MS. BARTH: At this point, Your Honor, the 4 proffer goes to notice. 5 THE COURT: Pardon me? 6 MS. BARTH: At this point the proffer goes to 7 notice. Did you want to make an instruction on that? 8 THE COURT: Yes. As far as this next section 9 that will be read, you should only consider that as to 10 whether Defendant Lilly had notice of the matters 11 discussed in that. 12 BY MS. BARTH: 13 Q. "And you had information that through 14 December 14, 1990, that you had had 198 suicide deaths 15 in the United States, hadn't you? 16 A. "Yes. May I ask a question? Well, well 17 that -- well, let's this is -- 18 Q. "It also indicates that you had data in your 19 DEN reporting system which included clinical trial and 20 spontaneous post-marketing reports that there were 94 21 deaths outside the United States? 22 A. "That's correct. 23 Q. "So you had actually almost 300 deaths that had 24 been reported by suicide by individuals taking Prozac 25 ten months earlier than this article was written, PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2534 1 didn't you? 2 A. "Yes. 3 Q. "And that's not anywhere reflected by -- in any 4 way reflected in your paper, is it? 5 A. "No. 6 Q. "Now, equally important, Dr. Beasley, there's 7 no discussion in your paper, is there, about the fact 8 that patients that participated in these trials may 9 well have received concomitant medications, such as 10 sleeping medicines and sedatives? 11 A. "That's not mentioned in the paper, no. 12 Q. "But in those 17 trials, patients were 13 receiving agents for sleep and agents for anxiety, 14 were they not? 15 A. "They could have been, yes. 16 Q. "But, in fact, were, weren't they? 17 A. "A percentage of patients were, yes. 18 Q. "You didn't feel it was relevant to report 19 that? 20 A. "No, I did not." 21 MS. BARTH: That concludes the deposition 22 proffer, Your Honor. 23 MR. VICKERY: Your Honor, I have one other 24 thing to do and then we will close. Here it is right 25 here. I would reoffer in the rebuttal phase of our PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2535 1 case Exhibit 101, Plaintiffs Exhibit 101. 2 MR. SEE: Just give me a minute. 3 MR. VICKERY: Here, Mr. See, you can have this 4 one. This one was previously excluded, Your Honor, 5 under 403 grounds, but I submit it's appropriate 6 rebuttal. 7 THE COURT: I have no idea what you're talking 8 about. 9 MR. VICKERY: May I simply hand it to your 10 clerk, Your Honor? It's a one-page document. 11 MR. SEE: I think Your Honor has already ruled 12 on this. 13 THE COURT: My notes -- well, let's take a 14 15-minute break at this time. Please be back at 2:15. 15 (Whereupon, a recess was taken at 2:00 p.m.) 16 (Whereupon, the following proceedings were had 17 in open court out of the presence of the jury.) 18 THE COURT: Okay. Mr. Vickery, why should I 19 change my earlier ruling? 20 MR. VICKERY: Because your earlier ruling, Your 21 Honor, was based not on the relevancy of the document, 22 but on the 403 analysis. 23 THE COURT: No, it was based on both. 24 MR. VICKERY: I'm sorry, then. I thought your 25 earlier ruling was based on a 403 analysis. This PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2536 1 document is relevant, I think, to show that Lilly, in 2 the very critical period of time following the Teicher 3 and Cole article was exerting improper influence 4 within the FDA and this is something, if you will 5 recall, that Dr. Tollefson talked about their 6 relationship and how closely they worked with the FDA 7 as if it was a real arm's-length regulatory process, 8 and I think the fact that Lilly was able to 9 orchestrate the destruction of documents within a 10 federal agency, at this particular time about this 11 particular issue, is extremely probative and it's 12 rebuttal of his testimony. 13 THE COURT: Thank you. Mr. See. 14 MR. SEE: In addition to the prior objections, 15 I want to add one for foundation. The reason 16 Mr. Vickery wants to put this in is this typewritten 17 note on this piece of paper that says, "At the request 18 of Lilly." However, there is no evidence from anybody 19 anywhere who put that on there or more importantly, 20 although, let me say, equally importantly, what it 21 means. So there's also a foundation objection to it. 22 MR. VICKERY: Well, I can lay the foundation 23 with a Lilly interrogatory answer, Your Honor. I 24 asked them in an interrogatory in another case about 25 that note and they said -- well, I can't remember PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2537 1 exactly what they said, but it's a Lilly document with 2 a Lilly PZ number, and I said would you please explain 3 the circumstances? And they gave an answer about, 4 well, this was -- they never did answer the part about 5 who ordered it destroyed at Lilly and why. They just 6 said, well, the FDA didn't really want to meet with 7 us. But I mean, there was no suggestion in the 8 interrogatory that it was not a genuine Lilly 9 document. It has the Lilly PZ on it -- 10 THE COURT: I think Mr. See's objection as to 11 foundation is to this typed in note; is that right? 12 MR. SEE: Yes. 13 THE COURT: About the destruction? 14 MR. SEE: Yes. 15 MR. VICKERY: Well, that's what I'm saying. I 16 can lay that foundation with an interrogatory if 17 that's the new objection. It would just take me a few 18 minutes to get that. Because I asked them in an 19 interrogatory to please explain this note, this 20 typewritten note that's stuck on it, and they did. 21 They never said, oh, it wasn't us that did it. Oh, 22 this isn't a genuine document. They never said that 23 at all. They just said the FDA didn't really want to 24 meet, but they never fairly answered the entire 25 interrogatory, but the answer clearly indicates that PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2538 1 it's a genuine Lilly document and that the 2 destruction, indeed, was most probably at Lilly's 3 request. 4 THE COURT: So if they had written -- instead 5 of calling up and saying, hey, we want to withdraw our 6 request, if they had written a note, a letter saying 7 we want to withdraw our request, then you'd have the 8 same concern? 9 MR. VICKERY: No, I wouldn't have the same 10 concern at all because it would all be a matter of 11 public record. What I have a concern about is a 12 company like Lilly, basically, arranging for shredding 13 of documents. 14 THE COURT: Well, we don't know whether -- what 15 Lilly asked them to do, whether they said we want to 16 withdraw our request, so the person who typed in this 17 note translated that into meaning destroy all the 18 copies instead of saying withdraw all the copies, 19 we're sending another memo out to counteract the 20 request to meet. 21 MR. VICKERY: To me, Your Honor, when somebody 22 says at the request of Lilly, we were able to pull and 23 destroy documents within a government agency, the 24 logical inference is that something improper is going 25 on. That's completely different than a note or a PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2539 1 telephone call saying we want to cancel our request 2 for the meeting. This is destroy the document. 3 MR. SEE: I will add a little more to my 4 foundation objection. What's it about? There isn't 5 any information from any witness anywhere what this is 6 about. Mr. Vickery will want to argue this is some 7 heinous act when, in fact, it's a request to have a 8 meeting and then, we withdraw our request, can we have 9 our letter back. 10 There's no witness to say this means something 11 horrible or this means nothing, and so he wants to 12 argue it means something horrible. There's no 13 foundation for the typewritten note at all. 14 MR. VICKERY: Let me read to you, if I may, 15 Your Honor, the interrogatory about this note. It was 16 Interrogatory No. 26. I'll hold it so Mr. See can 17 read it with me. "Please explain fully the background 18 and consequences of the note attached to Lilly's 19 March 26, 1990 letter to the FDA, PZ 76026155, which 20 reads as follows: Quote, at the request of Mr. -- of 21 Lilly Mr. A. W. Decicco was able to pull and destroy 22 all copies of this submission except Dr. T. P. 23 Lauren's desk copy. Your explanation should, at 24 minimum, cover the following issues: Who at Lilly 25 authorized the request to destroy, who communicated PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2540 1 this request to Decicco at FDA, why was this document 2 destroyed, and was the requested meeting ever 3 conducted, and if so, when and with what results?" 4 Now, the only answer I got to that was the 5 following: "Lilly states that the note on the 6 referenced document refers to Lilly's withdrawal" -- 7 THE COURT: Wait. Wait. It says what? 8 MR. VICKERY: "Lilly says that the note -- 9 states that the note" -- 10 THE COURT: Thinks? 11 MR. VICKERY: States. 12 THE COURT: States. 13 MR. VICKERY: "Lilly states that the, quote, 14 note on the reference document refers to Lilly's 15 withdrawal of its formal request for a meeting with 16 the FDA as set out in the March 26, 1990 letter. 17 "What the FDA wanted at this time was the 18 analysis of data and not a specific meeting to address 19 the issues raised by Dr. Teicher's article which 20 appeared in the February 1990 edition of the American 21 Journal of Psychiatry." 22 So that tells us what the meeting was about. 23 It was about the Teicher article. "A group from Lilly 24 did meet with representatives of the FDA on 25 September 25, 1990 and later on May 13, 1991," which PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2541 1 obviously is way past -- both of these are way past 2 this date, Your Honor, "to discuss this issue, methods 3 of analysis, and possible study designs to address the 4 issue. 5 "On September 20, 1996, the FDA called a 6 meeting of its psychopharmacologic drug advisory 7 committee" -- this is the very one that Ms. Mangrum 8 was talking to you about today -- "to address the 9 issues raised by Dr. Teicher's article. The advisory 10 committee unanimously concluded that there's no 11 credible evidence of a causal link between the use of 12 the antidepressant drugs, including Prozac, and 13 suicidality or violent behavior. 14 "Lilly is continuing to investigate subparts A 15 and B and will then answer if additional information 16 becomes available." 17 They never supplemented it. So all I know 18 about the substance and background of this document is 19 what Lilly said in this interrogatory answer, but it's 20 clear from this interrogatory answer that the meeting 21 was about suicide and Dr. Tiecher's article, to the 22 note -- 23 THE COURT: Wait a minute. The meeting was -- 24 when did the article come out? 25 MR. VICKERY: In February of '90. And this PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2542 1 letter asking for the meeting is March 26 of 1990. 2 THE COURT: To discuss the past two years of 3 safety experience. 4 MR. VICKERY: Well, what Lilly says in the 5 interrogatory, Judge, is what the FDA wanted at this 6 time was an analysis of data and not a specific 7 meeting to address the issues raised by Dr. Teicher's 8 article. 9 MR. SEE: And not the meeting. So the meeting 10 wasn't had and the request was withdrawn, period. 11 MR. VICKERY: But you see, that's what they say 12 the FDA wanted. The request from Lilly -- what Lilly 13 had requested was a meeting to discuss the Teicher 14 article. So I can lay the foundation with this 15 interrogatory. It was about the issues at suit here, 16 and to me, the thing that has probative value is not 17 whether they wanted a meeting or didn't want a 18 meeting, it's the fact that Lilly was able to persuade 19 a government employee to shred government documents 20 within a government agency. That's the probative -- 21 THE COURT: All Lilly has said is that they 22 request to withdraw their -- that they withdrew their 23 request to meet. There's nothing about telling the 24 FDA to destroy all their copies, right? 25 MR. VICKERY: Well, that's all they said in the PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2543 1 interrogatory answer, Your Honor. 2 THE COURT: Right. 3 MR. VICKERY: But don't you think that if they 4 hadn't done that, given the interrogatory I read you, 5 that the fair answer would have been, oh, we never 6 asked them to destroy a document? We never did. I 7 asked them that question, they simply dodged it. 8 THE COURT: Well, the Court's not going to 9 reverse its ruling. The Court finds, again, under 402 10 and 403 that exhibit -- Plaintiffs Exhibit 101 should 11 not be admitted. There's a lot of confusion over this 12 note that was typed in as to who -- whether Lilly made 13 a request to withdraw its request to meet and who 14 interjected the word "destroy all copies," whether 15 that was requested by Lilly. 16 The Court finds that this is a very limited and 17 questionable probative value and significantly 18 outweighed by unfair prejudice to Lilly, as well as 19 possible causing of confusion to the jury. 20 Here's your exhibit back. 21 MR. VICKERY: Thank you, Your Honor. I want to 22 thank you for the patience of considering that request 23 this late in the trial. 24 THE COURT: I guess we should take a short 25 recess to allow the jury to come back in. As far as PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2544 1 the jury instructions, let's meet at ten o'clock on 2 Monday morning to finalize them. 3 MR. VICKERY: Very well. 4 THE COURT: How long do you think you're going 5 to be in your -- maybe I should say how short do you 6 think you'll be in your final arguments? 7 MR. VICKERY: Can we confer with one another 8 for a minute? 9 THE COURT: Bear in mind that out here we have 10 very short attention spans. 11 MR. SEE: Well, I suggested each side no more 12 than an hour and Mr. Vickery just said he wanted an 13 hour and a half, so we'll leave it in your hands. 14 THE COURT: I'm not going to limit it, so an 15 hour and a half for each of you? 16 MR. VICKERY: Yes, sir. 17 MR. SEE: Mr. Vickery would then split his 18 between opening and rebuttal? 19 MR. VICKERY: Of course. 20 THE COURT: See you shortly. 21 (Whereupon, a recess was taken at 2:25 p.m.) 22 (Whereupon, the following proceedings were had 23 in open court in the presence of the jury.) 24 THE COURT: Mr. Vickery. 25 MR. VICKERY: Your Honor, at this time the PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2545 1 plaintiffs rest and close. 2 THE COURT: Well, that concludes the 3 presentation of evidence. So we'll adjourn at this 4 time. And as I mentioned to you last week, tomorrow 5 is Prince Kuhio's Day, and the courts will not be 6 opened. We will not have trial. So our next day will 7 be next Tuesday. You'll hear final arguments at that 8 time and then you'll start your deliberations. So 9 please be back at nine o'clock this coming Tuesday. 10 Have a nice weekend. 11 (Whereupon, the proceedings were adjourned at 12 2:40 p.m. to be reconvened on Tuesday, 13 March 30, 1999 at 9:00 a.m.) 14 15 16 17 18 19 20 21 22 23 24 25 PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 2546 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 25, 1999, before the Honorable Alan C. Kay, 10 United States District Judge. 11 DATED: December 29, 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. (808) 524-PRSU