CAMP VERDE - Dr. Ian Paul, an expert witness for the defense, said Wednesday that heat might not be entirely to blame for the October 2009 deaths of Kirby Brown, James Shore and Liz Neuman.
Those three died after a sweat lodge ceremony led by James Arthur Ray, a motivational speaker and author whose manslaughter trial has now lasted nearly four months.
Hired by the defense to review the medical records of the victims and several others who were hospitalized after the ceremony, Paul is a medical examiner from New Mexico, employed by the Office of the Medical Investigator and working out of the University of New Mexico at Albuquerque.
Unlike another medical expert, Dr. Matthew Dickson of Yuma, who previously testified for the state, Paul supported the defense view that organophosphate toxins may have been a factor in the three deaths.
Paul, who is earning $400 per hour for his work on the case, said that the symptoms of the victims not only lacked common prerequisites for heatstroke, they in fact were more consistent with a diagnosis of toxic poisoning.
"All the signs and symptoms definitely would include organophosphate toxicity in the differential diagnosis," he said, adding that he could not say for certain the compounds, which are present in many pesticides, played a part because doctors never tested for them.
"I probably would have described the death as undetermined in this case," Paul said. "The evidence is so compelling for another substance to have caused the deaths."
As for the sweat lodge participants who were hospitalized and released, Paul noted that many of their symptoms also pointed to toxins rather than heat. In particular, the fact that three patients, Steven Ray, Sidney Spencer and Tess Wong, recovered relatively quickly from the mental status changes they suffered.
"All three of these patients seem to have recovered to their normal states in six to 24 hours," he said. "That would be a very typical course for a toxin exposure. The toxin breaks down, it goes away and the patient wakes up."
Paul further pointed out that none of the victims showed signs of extreme dehydration he said is a hallmark of heatstroke, and that both Neuman and Shore also had underlying medical issues that included enlarged hearts and mild to moderate coronary artery disease.
The respiratory distress and pulmonary edema that some of the stricken suffered is another factor that Paul pointed to, saying that this would be a symptom of toxic exposure, which he said paralyzes the diaphragm and causes fluid buildup in the lungs, but came on as a symptom too early to be attributed to heatstroke.
"With heatstroke it is very unusual to see fluid buildup in the lungs early in the process," he said.
The victims could have been exposed to the toxins in the sweat lodge, he said, where the high temperatures would have made absorption easier through exposed skin or the mucus membranes of those who put their faces close to the ground where the air was cooler and easier to breathe.
Under cross-examination by Deputy County Attorney Bill Hughes, though, Paul admitted that in the hundreds of autopsies he has performed, he has never attributed a death to organophosphate poisoning, nor has he researched any of the many products that contain the compounds to determine how much would constitute a lethal dose.
When Hughes confronted him with the ongoing medical complaints of two of the participants, Paul allowed for the possibility of brain injury but stood by his opinion that toxins were a possible contributing factor.
And when asked if he could rule out heatstroke as a cause of the deaths, he said he could not.
"I think 'rule out' is not the appropriate term," he said.
A determination of the cause of death is important to the case because heatstroke, in the state's view, would be a malady entirely attributable to Ray, who has pleaded not guilty to the charges against him.
If toxic poisoning is a factor, the defense maintains, Ray could not have known of its presence in the sweat lodge, which was built on the property of the Angel Valley Spiritual Retreat Center near Sedona.