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THE LEAD WITH JAKE TAPPER
Watching The Zimmerman Trial; Physician's Assistant on Stand in Zimmerman Trial
Aired June 28, 2013 - 16:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
JAKE TAPPER, CNN HOST: Welcome back to THE LEAD. We are keeping an eye on the trial of George Zimmerman. Testimony is about to resume. We're about to hear from Lindsay Folgate. She is a physician's assistant. George Zimmerman was her patient after August 19th, 2011. And what was going on in the side bar just now with lawyers talking to the judge.
I want to bring in Martin Savidge and Diane Dimond to talk about this until the testimony resume, is they were talking about what medical testimony can be admitted in terms of the record of George Zimmerman. Martin, what can you tell us about that?
MARTIN SAVIDGE, CNN CORRESPONDENT: Well, yes, that is in fact what the discussion has been about. They wanted to -- Mark O'Mara is trying to restrict how much information from the medical records of George Zimmerman would get in. The RIONDA is trying to portray or they will try to portray that he was not as badly injured as he has tried to describe and so that's why this testimony is key and that's why that evidence is needed.
TAPPER: The testimony is resuming. We're going to listen in to the testimony of Lindzee Folgate, a physician assistant who had George Zimmerman as a patient. We'll continue to monitor and bring you other news. But for now let's listen to the testimony.
BERNIE DE LA RIONDA, LEAD PROSECUTOR: And do you recognize that exhibit as part of the medical records that are kept at your family practice?
LINDZEE FOLGATE, PHYSICIAN'S ASSISTANT: Yes.
RIONDA: I've highlighted certain parts that I want to ask you specifically about. So if you can just make reference to those.
RIONDA: That record would indicate he was a patient of yours and he's got his name George M. Zimmerman, 27 years old, male, race white, is that correct?
RIONDA: And the encounter date August 19, 2011 at 1:29 p.m. FOLGATE: Correct.
RIONDA: In terms of the highlighted parts only, can you read the first part -- the first sentence of the highlighted part?
FOLGATE: Of the history of present illness?
RIONDA: Yes, just the highlighted part only.
FOLGATE: Seen in the office to establish care, referred through insurance provider.
RIONDA: In that same paragraph it has a highlighted part towards the bottom of that paragraph. Do you see that?
FOLGATE: Yes, difficulty falling and maintaining sleep, started to exercise intensely with MMA but that has not helped.
RIONDA: I'm sorry, can you repeat that last sentence started to --
FOLGATE: Difficulty with falling and maintaining sleep, started to exercise intensely with MMA but this has not helped.
RIONDA: And were you able to determine MMA as being mixed martial arts?
RIONDA: On the notes I believe there are two sentences that are highlighted, is that correct, in yellow?
RIONDA: Could you read those two sentences?
FOLGATE: Patient here to establish care. Patient was referred by his insurance list of providers.
RIONDA: Ma'am, I'm going to now provide to you, if I could, with the court's permission may I approach the witness, your honor?
JUDGE DEBRA NELSON: Yes, you may.
RIONDA: You saw him subsequent to that. I want to refer specifically to a date, which is September 23rd of 2012 and I'm going to show you RIONDA's exhibit 196.
JUDGE DEBRA NELSON: It's 2011.
RIONDA: I apologize, 2011. Thank you, your honor. Do you see that exhibit before you, ma'am?
FOLGATE: I do.
RIONDA: I'm sorry. You had contact with the defendant again on that date? FOLGATE: Correct.
RIONDA: And when you say, you yourself had contact with the defendant?
RIONDA: OK. On that day also when you saw him, you gathered just -- that exhibit's got the regular information, George M. Zimmerman, 27 years old, male, white, and the date, September 23rd, 2011 at 1:52 p.m. Is that correct?
RIONDA: I believe there's a highlighted part in that page where you've got in terms of social history exercise, is that correct?
RIONDA: And what did you notate there in terms of social history, exercises to the defendant George Zimmerman?
FOLGATE: That he was involved in mixed martial arts three days per week.
RIONDA: May I approach the witness, your honor?
JUDGE DEBRA NELSON: Yes, you may.
RIONDA: Let me get that document back from you, if I could, and let me show you State's exhibit 194. You would have seen him on --
TAPPER: We're listening to the testimony of Lindzee Folgate, a physician assistant who had George Zimmerman as a patient. I want to bring in Diane Dimond and Martin Savidge during this slightly slow part of the testimony. Diane, what is the state trying to accomplish here?
DIANE DIMOND, INVESTIGATIVE JOURNALIST: Well, I think Martin had it exact right. They're trying to show that weeks after the event he went to the doctor and didn't complain about anything other than I can't sleep very well, I can't go to sleep, I can't maintain my sleep. There's been a lot of testimony about his condition, especially right after the event.
And I was interested earlier today to hear one of the responding paramedics say, well, he didn't ask for an x-ray on his head so we usually leave that up to the patient and we didn't give him one. I think it's probably working in the defense's benefit here that he didn't have that x-ray because I'm not sure that he sustained any serious or permanent damage from that fight.
TAPPER: Diane, I am not an attorney.
DIMOND: Nor am I. TAPPER: I don't know how difficult a fight has to be before it becomes legally understandable for a jury to say, well, he needed to use his gun because his life was under serious threat. Are people allowed to just shoot people if they're involved in bar brawls? Is that an acceptable defense?
DIMOND: You know, that's such a good question and it such a good point you bring up, Jake. In the state of Florida, they have this stand your ground law. If you feel that your life is in danger, you have the right it defend yourself. It doesn't matter if you started the fight. It doesn't matter if you got out of your car and you followed someone to see what they were doing in your housing complex.
If at any time you feel that your life is in danger, you have the right to defend yourself. And with George Zimmerman almost immediately after this incident telling a neighbor of his who responded to the scene I shot him, I had to do it for self-defense. I mean, I think if I'm a juror, that's ringing in my ears for the whole trial.
TAPPER: We're going to take a very quick break and come back with more on the George Zimmerman trial including live coverage from testimony inside the courtroom. Back after this.
TAPPER: Welcome back to THE LEAD. We're keeping an eye right and we're going to go back to the courtroom where George Zimmerman is being tried for the murder of Trayvon Martin. We're listening to the testimony of Lindzee Folgate, a physician assistant, who testified that she treated George Zimmerman for a broken nose. Let's listen in.
FOLGATE: -- and associated with that any abdominal pain. I then go through and look at the review of systems, as well as this is a drop down box menu in our electronic medical record system and review any other symptoms that would have been involved.
RIONDA: So this goes one by one.
RIONDA: In terms of you asking denied H.A. What does H.A. mean?
FOLGATE: H.A. means headache.
RIONDA: So he denies having any headache?
RIONDA: Change in V.A. What does that mean?
FOLGATE: V.A. means visual acuity so no change in vision.
RIONDA: He denies any slurred speech. What does that mean?
FOLGATE: That would mean exactly what it says. Sometimes I'll rephrase that to patients as are you talking any more abnormally than you would have normally.
RIONDA: He denies dizziness. That's an obvious one, but let's make sure for the record what that means.
FOLGATE: Clarifying to see if he had any dizziness meaning he felt off balance for any reason.
RIONDA: And gait normality, meaning he's able to walk fine? No problems walking?
FOLGATE: Exactly and sometimes I'll clarify that as are you walking as if you are drunk or staggering?
RIONDA: Then notate on the history of present illness he admits to occasional nausea when thinking about the violence last night but denies abdominal pain. Can you elaborate a little bit about that?
FOLGATE: He was telling me when he was reflecting on what happened that night that he was having nauseous feelings. I would then further ask are you having abdominal pain to clarify whether the nausea was coming from an abdominal pain symptom or from a psychological factor?
RIONDA: And what was your determinations to that?
FOLGATE: That it was not from his abdominal system. That it was more from a psychological factor.
RIONDA: You notated complaints of left S.I. joint tenderness since the event. What does that means?
FOLGATE: The S.I. joint is the sacroiliac joint. He has mentioned that he was having some tenderness on the left side since the altercation that night.
RIONDA: You also notated the numbness or tingling or incontinence, tell us about that.
FOLGATE: These are follow-up questions I would ask on anyone who would complain of back pain or S.I. joint tenderness to make sure that there was nothing more severe going on. So was he having any numbness or tingling to his extremities or was he having any bladder or bowel incontinence.
RIONDA: When you do the drop on your computer, I guess, when you say drop down or you're going through in terms of constitutional symptoms, right. He denies fevers or chills.
RIONDA: His eye, doesn't have blurred vision --
FOLGATE: That means double vision.
RIONDA: Ears, nose, mouth and throat. Tell us about that.
FOLGATE: He admits to nose pain, but has no hearing loss or tinnitus which is ringing in the ears.
RIONDA: What is the significance of that?
FOLGATE: The significance of the tinnitus?
FOLGATE: Just making sure what the trauma that he is telling me has sustained. Would there be any significant side effects from that and one of the results could be hearing loss or ringing in the ears.
RIONDA: So he has no hearing loss or ringing in the ears?
FOLGATE: No complaints of that.
RIONDA: I'm sorry no complaints.
RIONDA: Cardiovascular, tell us about that.
FOLGATE: He denies palpitations, meaning any abnormal or irregular heartbeats and he denies any chest pain or chest pressure.
FOLGATE: Respiratory, denies any shortness of breath.
RIONDA: OK, tell us about the next few other ones.
FOLGATE: The gastrointestinal, denies abdominal pain, nausea and/or vomiting related to the gastrointestinal system.
FOLGATE: The integumentary, that's the skin, so I put in there, admit scalp lacerations because that is one of his concerns. Neurological would be next, admits to head trauma as he's telling me that he sustained a head trauma that night based on the story that he's telling me but denies tingling, numbness, weakness, headache, dizziness, speech difficulty, gait disturbance or loss of consciousness. The last part would be psychiatric. He admits distress surrounding the events, but denies suicidal thoughts or attempts.
RIONDA: Go back to neurological in terms of admits head trauma, why are you concerned about whether he has difficulty with space, has headaches or lost consciousness. What's the significance of that?
FOLGATE: The significance of those review of systems or symptoms would be more concerning or lead me to down another line of questioning and that would further potentate the certain treatment that I would --
RIONDA: So you have no concerns in terms of he says he's not losing consciousness. He is able to write, able to function fine. He has no problems in terms of concentration in terms of weakness or headaches or anything like that?
RIONDA: If he had complained of those, what steps would you have taken in treating those if those existed?
FOLGATE: It would also be based off my physical exam. I would take those symptoms into consideration while I'm doing the physical exams and tending some of those who are tense and you would rank those uncertain severities then you would proceed with possible imaging meaning a picture of the brain.
RIONDA: So at this point, you had no concern about -- we're going to get to the physical, but based on just this, you have no concern regarding --
FOLGATE: Based on what he's telling me, there is less concern.
RIONDA: Am I skipping a step or are you going now to physical exam?
FOLGATE: I would go next to the physical exam.
RIONDA: If you could just cover that, please. Thank you.
FOLGATE: No problem. So the first part of the physical exam would be his general appearance. It says he's in no acute distress. Most of the time that means is there any physical shortness of breath or a significant pain at the time. He is obese based off his body mass index, which takes into account his height and weight.
RIONDA: Is his height and weight on here?
FOLGATE: His height and weight would be on the first page.
RIONDA: I neglected to ask but that, sorry.
FOLGATE: In the vital signs saying he's 5'7.5" and weighs 204 pounds.
RIONDA: It's 5'7" and how much?
FOLGATE: It's 7.5.
RIONDA: OK, and then what else? What was his weight?
FOLGATE: It's 204 pounds.
RIONDA: You stated also he is obese and that you base on what now?
FOLGATE: That's based off his body mass index, which takes into account your height and weight. A BMI greater than 31 falls into a category of obesity.
RIONDA: What's the next sentence you've got there under general appearance?
FOLGATE: He is alert and oriented and appears his stated age. RIONDA: Anything significant with that?
FOLGATE: I would take that into account given the history of the head trauma to make sure that he's alert and is understanding the questions that I'm asking him.
RIONDA: Go ahead.
FOLGATE: Next would be head, he normocephalic, atraumatic. The face is symmetric, two scalp lacerations to the occiput, which is the back part of the head approximately 2 centimeters and 0.5 centimeters respectively.
RIONDA: Tell me the significance of that.
FOLGATE: The significance of the measurement itself?
RIONDA: Tell me the measurements and in terms of you used some big words there, tell me what you mean by those big words.
FOLGATE: The significance would be two lacerations meaning two cuts to the back of his head and the occiput again is the back part of the head. I measure them given his concerns and his complaints to have that documented to make sure that we know should these not heal appropriately these were the original size that he came in to be seen for.
RIONDA: You said 2 centimeters and 0.5 centimeters. How big would that be? Estimate using your finger, I guess, or using your (inaudible).
FOLGATE: OK, 2 centimeters would approximately be about this big and 0.5 is much smaller.
RIONDA: And based on your observations and review of those lacerations, did you feel there was anything additional that need to be done regarding those, like any kind of stitches or anything like that?
FOLGATE: That determination is based on how well the skin edges are what we call approximated, which means how well are they together to begin with and how deep is the laceration itself? Based of the approximation of the skin margins and depth of the lacerations, I did not feel that sutures were necessary.
RIONDA: And a laceration, tell us what that means when you say a laceration versus a cut or something like that.
FOLGATE: A laceration is basically a more proper term for a cut.
RIONDA: And you said it wasn't deep enough to require, in your opinion, any stitches or anything, is that correct?
RIONDA: And you said the skin edges were approximated well. Have I got that right?
RIONDA: Tell me about the eyes.
FOLGATE: Eyes that says PERRLA, which means pupils are equal, round and reactive to light and the extraocular movements are intact. So I'm checking his pupils to make they are responding to light appropriately and then we check the -- extraocular movements meaning how well are his eyes moving in each direction and that was normal. And then it says conjunctiva and sclarae are clear. The conjunctive and sclarae for lack of better words the white parts of his eyes, making sure there's no injection into that part. But I did note that he had bilateral black eyes.
RIONDA: What does mean to you?
FOLGATE: That would mean skin discoloration to the inferior orbit meaning to the bottom part of the eyes.
RIONDA: Going back to the head, did you notice those lacerations? Did you notice any other trauma to the head?
FOLGATE: I did not at the time. I don't recall.
RIONDA: Let's talk about the ears, nose, mouth and throat.
FOLGATE: Bruising noted to the nasolabial folds bilateral was welling. The nasolabial folds would be the folds between the nose and the mouth. And there was some swelling noted there and some bruising, so darkening of the skin. No evidence of septal deviation on visual inspection meaning the septum, which is the center part of your nose appeared to be straight and in alignment. No bleeding noted in the nares, which means there is no blood in the nose itself. No hemotempanums of the bilateral ears, which means there's no blood behind the eardrums and no evidence of tonsilar stones, which was a complaint that he had outside of the current reason that he was there.
RIONDA: So let talk about the nose itself, no evidence of septal deviation. What does that mean?
FOLGATE: Septal deviation again would mean is the alignment of the nose correct?
RIONDA: So his nose is straight in other words?
RIONDA: It is not crooked or in any way damage to that extent?
FOLGATE: Not on visual inspection, no.
RIONDA: I think you've already covered the chest and his heart you said seemed normal?
FOLGATE: Correct. RIONDA: You talked about a tender left S.I., correct?
RIONDA: Tell me a little bit about that again.
FOLGATE: The S.I. again is the sacroiliac joint, which is the space located, for lack of a better word, in the center of your buttocks.
RIONDA: You gave him some medicine for the complaint he had, is that correct?
FOLGATE: For the S.I. joint pain, correct.
RIONDA: Yes, and what did you give him?
FOLGATE: We gave him Lodine, which is an anti-inflammatory.
RIONDA: By the way, when you saw him regarding those lacerations, did he have any band-aids covering them?
FOLGATE: He did have one large band-aid covering them.
RIONDA: Did you remove the band-aid to look at them?
RIONDA: You mentioned that he said, Mr. Zimmerman told you that he had told you that the nose was either broken or possibly broken. Is that correct?
FOLGATE: That's what I was told, correct.
RIONDA: Based on your examination of his nose, can you say the nose was broken?
FOLGATE: I would say likely broken. It's hard to say definitively based of -- the fact that there were no x-rays to show the break itself. However most of the time a broken nose can be made clinically as well and that's based off of the black eyes that we saw, the nasolabial swelling, and the bruising.
RIONDA: So you can say, it is or isn't or you don't know or --
FOLGATE: I couldn't say definitively one way or the other because I have no direct x-ray saying this is exactly where the fractured occurred, but clinically appearing, it appeared to be, yes.
RIONDA: But it was still perfectly straight?
FOLGATE: It was still straight. There was no septal deviation.
RIONDA: I think you've got in terms of the plan decision making progress, is that what you move on to next?
FOLGATE: After the physical exam, yes, I would move to the plan and decision making process.
RIONDA: You talked about the scalp lacerations that there was no sutures need. In other words, he didn't need any sewing up at all, right?
FOLGATE: No stitches, correct.
RIONDA: And you stated in terms of broken nose that we discussed it is likely broken, but does not appear to have septal deviation, swelling and black eyes are typical of this injury.
RIONDA: Now, you're there. Did you then recommend something to him in terms of making a definitive determination of whether his nose was broken?
FOLGATE: My recommendation was that he see an ENT, which is an ears, nose and throat specialist.
RIONDA: What did he say regarding that?
FOLGATE: He told me at the time that he was not going to be seen by the ENT.
RIONDA: Regarding the S.I. joint pain, did you give him any suggestions?
FOLGATE: We discussed using Lodine, which the anti-inflammatory to help with the inflammation and then we discussed heat, ice and massage.
RIONDA: He had complained on a prior occasion of having some back pain of some kind. Do you recall that?
FOLGATE: I do.
RIONDA: And had you treated him for that before?
FOLGATE: I had. It was related to constipation.
RIONDA: So it was not related to an injury, a physical injury?
RIONDA: I apologize. In terms of laceration to the head, you mentioned two of them.
RIONDA: I have a bald head so I know what it is to get cut and have a laceration. How do those bleed in distinguishing those from a cut somewhere else on the body? Is there something about the head where it bleeds more profusely?
FOLGATE: The scalp is very vascular meaning there are many blood vessels there. So a scalp laceration can bleed perhaps a lot more than somewhere else on the body.
RIONDA: How about somebody who doesn't have any hair?
FOLGATE: It doesn't mean it will be less but it may be less noticeable.
RIONDA: So if there was hair, there could be a cushion or you may not notice it?
FOLGATE: Possibly both. It may be getting mixed up with the hair itself. I guess it would depend on the thickness of your hair to determine the amount of cushion that would be.
RIONDA: I have no further questions at this time.