Saturday, April 7, 2012

The Case of Preston Hughes III: Eleven Twenty Five

Now that you understand how freely the blood flows when someone's carotid is severed, you are in a better position to understand that Shandra Charles did not live long after someone severed her carotid in that dark overgrown field. For those of you unfamiliar with the case, you can catch up quickly by reviewing summaries of the previous posts which I've collected at the Preston Hughes Table of Contents. The rest of you can buckle up now. Here we go.

Let's begin by establishing the nature of Shandra's wounds. For that, I'll turn to the testimony of a medical examiner who testified during the trial of Preston Hughes. I would prefer to say the medical examiner, meaning specifically the one who conducted the autopsy. Instead, I say a medical examiner, meaning the one who bothered to read the autopsy notes for the first time on the morning of his testimony, while in his car. I'll discuss this prosecution-friendly witness later. For now, I'll simply accept the description of the wounds provided by the person who performed the autopsy, as related by his autopsy report, as retold by a last minute fill-in medical examiner, as transcribed by a court reporter, as relayed to me by Barbara Lunsford of Mystery Crime Scene fame. It's straight from the horse's mouth, though its gastrointestinal tract, to your ears eyes.
Q. Doctor, moving along to the autopsy report, prepared on the body of the young woman in this case, Shandra Charles. having reviewed that report, do you have a medical opinion as to the cause of death of Shandra Charles? 
A. Yes, sir. 
Q. What is that? 
A. LaShandra Charles died as a result of a stab wound to the neck.
Q. Could you describe more specifically that stab wound to the neck? 
A. Yes, sir. There was a stab wound to the left side of the neck located 2 inches to the left of the midline and 1 inches below the top of the head. The instrument perforated the left jugular vein and the left common carotid artery, two of the large vessels in the neck. 
Q. Is this injury similar to the injury that the child, Marcell Taylor, received? 
A. That is correct. 
Q. In fact the arteries and veins were severed the same as on the child, Marcell Taylor? 
A, That is correct. 
Q. Did you note any other stabbing injuries or wounds on Shandra Chrarles? 
A. There was a stab wound to the chest. 
Q. Could you describe that more specifically to the jury? 
A. Yes, sir. The instrument penetrated the left side of the chest, 1 1/2 inches to the left of the midline and 4 inches below the external notch, which is where the collarbones come together, went into the chest and ended at approximately 4 inches below the entrance; in other words, the instrument penetrated to a depth of 4 inches. 
Q. Does the report indicate the approximate width of the stabbing wound? 
A. Yes, sir. 
Q. What was that? 
A. The wound gaped up to approximately 1/2 an inch in width. 
Q. Does the report indicate a length of the wound? 
A. Yes, sir. Wound measured 1 inch in length. 
Q. And when we say “gaped up to” I believe you said 1/2 inch? 
A. That is correct. 
Q. Does that mean the wound is an inch long but is open, sort of being pushed open an eighth of an inch? I'm sorry? Half an inch or eighth of an inch? 
A. Gaped 1/2 an inch. 
Q. 1/2 inch? 
A. When a sharp instrument enters the skin and subcutaneous tissues, the edges are pulled apart by the little muscular fibers and collagen fibers in the skin. So, it gapes open. 
Q. Did you note any other injuries on -- not you. Did your report note any other injuries on Shandra Charles? 
A. No sir.
As a juror, that is what you would get on this subject. You would hear it once, quickly, and you would be expected to remember the details, along with all the other details of days of testimony. Most jurisdictions do not allow you to take notes. They're afraid it will cause you not to pay attention to the testimony. You also could not, must not, research the subject yourself while acting as a juror. You must rely simply on the testimony, or that portion you can remember, or those portions you mis-remember.

This is one reason, a big reason, why jurors frequently rely heavily on gut feel. The details are too numerous, too convoluted in their delivery, too contradictory, and too far back in time. Screw the details; he's guilty.

I'll give you a much better chance than the Preston Hughes jurors had. I'll summarize the injuries and give you some additional insight from my research.

Shandra suffered two stab wounds: one to the left side of her neck and one to the left side of her chest. The stab wound to the neck severed both her common carotid artery and her jugular vein. The state's expert did not mention what damage the stab wound to the chest inflicted, but it sounds to me as if it must have punctured her left lung.

There are actually three carotid arteries in each side of the neck region. Most of the neck is transversed by the common carotid artery, and that is the one that was severed in Shandra's neck. A little higher up, the common carotid splits in two, into the internal and external carotids. If you recall, Richard Zednik had his external carotid severed by an ice skate.

A severed artery is much more serious than a severed vein. Arteries provide blood from the heart. Veins return blood to the heart. Arteries are on the supply side of the world's most amazing pump, and therefore operate under substantially higher pressure than do veins. When severed, arteries spurt and gush. We'll be talking about the significance of blood spurts in an upcoming post. I'm sure you can hardly wait.

Because the common carotid artery carries all the blood carried by both the internal and external carotid artery, a severed common carotid artery is going to spill at even a higher rate than a severed internal or external carotid. In other words, it is reasonable to expect that Shandra spilled her blood even faster than Richard Zednik spilled his.


On to the jugular. There are actually two jugular veins on each side of the neck: external and internal. The larger of the two is the external jugular vein. When people talk about the jugular, they are typically speaking of the external jugular. The external jugular vein and the common carotid artery travel pretty much alongside one another up the side of the neck. It is not unusual for someone suffering a severed carotid to suffer a severed jugular as well, and vice versa.  In Shandra's case, both her common carotid artery and her (probably external) jugular vein were severed, if we are to accept the testimony at face value.

Once again, by way of comparison, Richard Zednik had only his external carotid artery severed. As a reminder, here's the blood trail he left on the ice as he skated towards his trainer, as he skated for his life.

That blood poured out even thought Zednik was attempting to apply pressure with his own hands. That happened in just a few seconds. Because someone severed Shandra's common carotid artery and her external jugular, she would have been losing blood even more rapidly. She also had been stabbed in the chest.


Shandra Charles could not have lived very long without emergency care, and the first responders (as we are now apt to refer to them) offered her none. Let's see how long the prosecution-friendly fill-in medical examiner testified about how long Shandra might have lived.
Q. The injuries sustained by Shandra Charles, is it possible to determine, just from an autopsy report or from performing an autopsy at specifically what time that injury occurred? 
A. Within broad limits, yes. 
Q. Okay. Assuming that the deceased, Shandra Charles, was found at approximately between 11:00 and 11:30, let's say 11:15 in the evening, by the nature of the injuries she had sustained which you have reviewed in your autopsy report, can you make a determination as to approximately how far back from that time she had sustained those injuries if she was conscious at about 11:15 or 11:30 or died shortly thereafter? 
A. Within limits, yes sir. 
Q. Do you know what tine she died? 
A. No sir. The record states that she was pronounced dead. 
Q. Do you know what tine she was pronounced dead? 
A. At 12:58 a.m., on September 27, 1988. 
Q. Does the record indicate she had been transferred from another hospital to Ben Taub? 
A. According to the record, decedent was picked up by ambulance at the scene and taken to Ben Taub General Hospital. 
Q. Okay. Can you make any determination from the information you have available to you in your report and if you assume the facts that the deceased was seen alive at approximately 9:30 or 10:00 without any injuries and was found with the injuries at about, 11:15 or 11:30 and died at that time, is there any way you can determine where in there she was actually stabbed? 
A. No, sir. ... 
Q. Let me ask you this, Doctor. Would it have been possible, based on her injuries, to have been stabbed as early as 8:30 in the evening on September 26th of 1988, if she died of these injuries at 12:58, I believe you said, in the a.m. on the following day? … Can you tell? 
A. Not with any certainty. 
Q. Okay. Is it difficult to pinpoint times of injuries and times of death when cutting and stabbing injuries are involved? 
A.  Yes, sir. 
Q.  Is that because, why is that? 
A.  The determination of the time of death is difficult, at best. With cutting and stabbing injuries it is even more difficult because one has to consider the loss of blood and people bleed at different rates from different sharp trauma wounds. One cannot be sure either of the amount of medical support the decedent received in the interval from injury to death. 
Q.  Would it be possible to give an expert medical opinion in this particular case as to either the time the injury occurred without being there personally at the exact time of death? 
A.  No, sir.
Ladies and gentlemen of the jury, you have just been screwed by the people and state of Texas.

The prosecution wants the time of the attack to be as early as 8:30 PM, for reasons we'll discuss later. They  certainly don't want it to be soon before Shandra was found, for reasons we'll discuss later. So they hand-pick a compliant medical examiner to substitute for the person who actually performed the autopsy, because the proper witness happens to be conveniently out of town. (This is also a major issue to be discussed later.) The compliant medical examiner then, after a few leading questions, carefully phrases each answer such that it would be defensible later, but such that the jury is left to believe something that is not so. By the time the compliant, technically honest, but effectively dishonest doctor is done, the jury is left to believe that there is no way any medical expert could narrow the time of the attack any further than somewhere between 8:30 PM and 12:58 AM the next day. That's a 4 hour and 28 minute window.

I have found more than twenty medical experts who will state otherwise. Since I'm certainly not able to pay such experts $400 (or more) per hour, I'll take my chances with the free ones. I found then on Google Scholar. They weren't testifying about Shandra's case in particular. They were testifying about other cases in which a person's carotid had been severed. They were perfectly willing to give an expert medical opinion about how long someone might live after having a carotid severed. Some of them were also willing to give an expert medical opinion about how long someone might remain conscious after having a carotid severed.

Get ready for the money shot of this post.

I'm pretty proud of that plot. I spent 12 hours or so pouring through Google Scholar for the data, and another couple hours organizing the data into a hopefully understandable plot, and I'm several hours into writing this post before I get to insert the plot, so I'm pretty proud of that plot. Allow me to explain it a bit.

The red line plots time before death due to an untreated, severed carotid against the percentage of experts who testified that a person can live no longer. According to my summary of the data, eighty percent of the experts testified that such an injured person could survive sometime equal to or less than 14 minutes. Sixty  percent of of the experts gave a maximum survival time equal to or less than 6 minutes. Forty percent gave a time less than or equal 4 minutes.

In two cases, the victim somehow survived. I don't know if the carotid was barely nicked, or if they received some timely emergency care. There is simply insufficient information in the appellate decision to know. Nonetheless, I found two cases in which the victim survived for some unexplained reason. Those two cases cause the red line to extend all the way to the right rather than top out at 100% somewhere on the plot.

Frequently, but not always, the experts were somewhat vague in their time estimate. While some would say no more than 5 minutes, others would say "several minutes" or "within minutes."  I converted those clearly brief but generalized times into specific times so I could plot them. I plotted "couple minutes" as 2 minutes, and most other brief generalizations as 5 minutes. The single data point at 5 minutes actually represents 9 experts testifying to either 5 minutes explicitly or "several minutes" or something similar.

In summary, I found twenty cases in which an expert was willing to testify as to how long a victim might have lived after having one carotid artery cut. Only one of those was willing to testify that the person could live as long as forty minutes. One was willing to claim thirty minutes. One was willing to claim twenty minutes. The rest testified that a person could survive untreated for no more than 10 minutes, or for only several minutes, or for only a couple minutes.

Now we can estimate when Shandra Charles had her carotid severed. The paramedics arrived at 11:55 PM. I've found no medical expert willing to testify that she could have survived longer than 40 minutes without emergency treatment. That means the attack must have occurred no later than 11:15 PM, but much more likely later. The first police officers arrived sometime shortly after 11:30. The third police officer heard about their discovery at 11:40 and arrived at 11:43. Shandra must have been attacked sometime between 11:15 PM and 11:35 PM.

For convenience, I'll split the difference and call it eleven twenty five.

The End

But wait ... there's more.

My superduper plot also provides a curve of how long someone might remain conscious after having one carotid artery severed. Of the seven cases I found where experts testified to such times, none of them, I repeat NONE of them testified anyone could remain conscious longer than 5 minutes without medical intervention. None of them, I repeat NONE of them, ever mentioned that once someone passed into unconsciousness, they would awaken after bleeding out even more unless they received intensive medical intervention.

So the first two officers arrive sometime after 11:30 PM and find Shandra unconscious. No surprise there. Then the third officer arrives five or so minutes later, after Shandra has bled out even more, and he finds her not only conscious, but sufficiently alert to interview. And with what remains of her blood still flowing from within, she identifies Preston Hughes as her killer.

Houston, we have a problem!

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