Camp Verde - As an emergency room physician in Yuma, Dr. Matthew Dickson has plenty of experience with heat-related illness. And because of the proximity of a great deal of agriculture, he also has encountered instances of organophosphate poisoning.
Testifying Tuesday in the manslaughter trial of James Arthur Ray, Dickson said he personally sees dozens of patients each year who are suffering from symptoms caused by excess heat, making him all too familiar with the continuum of distress that leads to heatstroke.
It is his firm belief that Kirby Brown, James Shore and Liz Neuman, whose October 2009 deaths led to the manslaughter charges against Ray, died from heatstroke, and heatstroke alone.
"I would say 99 percent," when asked by defense attorney Truc Do how certain he was of his conclusion.
During his direct examination, carried out by prosecutor Bill Hughes, Dickson explained his view of the continuum of heat-related illness, a concept the state has repeatedly referred to during the trial. On that continuum, he said, is a point where simple, treatable heat exhaustion crosses the line to life-threatening heatstroke.
"When you go to heatstroke," Dickson said, "one of the cardinal signs is you get a change in mental status. That's tough because if you're the one who's having the change in mental status, you won't recognize the signs."
Several participants in the ill-fated sweat lodge ceremony that was the culminating event of Ray's Spiritual Warrior seminar at the Angel Valley Spiritual Retreat Center near Sedona have testified to the altered mental states they experienced during the event. Indeed, an altered mental state was a large part of what Ray promised they would attain in the lodge.
"Once you cross that line into heatstroke from heat exhaustion," Dickson said, there is an 80 percent chance that death will follow.
As have other doctors, including two medical examiners and two doctors who treated the patients involved, Dickson allowed that some symptoms, specifically red skin, vomiting and pinpoint pupils, could be signs of toxic poisoning as well as of heat-related illness.
Unlike those other doctors, though, he would not bend from his opinion that heatstroke caused the three deaths.
"There are overlapping symptoms between them," he said, later adding, "I'm just saying (other doctors) may not have had all the information. I've now got the luxury of having the bigger picture."
Hired by the state as an expert witness at the cost of $400 per hour, Dickson repeatedly referred to "the big picture," one he said was not available to Dr. Brent Cutshall, who treated Liz Neuman in Flagstaff. During his testimony, Cutshall, who originally attributed Neuman's death to heatstroke, allowed for the possibility that toxicity from organophosphates was a possible contributing factor.
Likewise, Maricopa County Medical Examiner Dr. Robert Lyon, albeit grudgingly, allowed for the possibility that toxins could have been a factor in the deaths of Brown and Shore, whom he autopsied under contract from Yavapai County. And last week, Coconino County Medical Examiner Dr. A.L Mosley altered his initial conclusion of heatstroke to include the possibility of hypercapnia as a result of excess carbon dioxide.
Lyon and Mosley veered from their certainty about heatstroke after reviewing the report of defense witness Dr. Ian Paul of New Mexico, who has yet to testify. Paul's report allegedly cites organophosphate poisoning as a contributing factor.
Dickson's testimony is important because the prosecution seeks the clarity that heatstroke as the cause of death would provide. As leader of the sweat lodge ceremony, Ray was solely responsible for the heat in the lodge, as he called in the number of rocks and determined the length of time each round lasted, as well as how long the door flap remained open between rounds.
If toxicity or carbon dioxide are contributing factors, though, the defense can point to others as being behind their presence, either through the use of organophosphate-based pesticides or by the construction of the vinyl-clad sweat lodge itself.
But when Do repeatedly pressed him on the 99 percent certainty of his conclusion, Dickson could only lament that he wasn't even more sure.
"I wish everything was 100 percent in medicine," Dickson said. "It would make my life a lot easier. But you have to take the big picture. The big picture is heatstroke."
Dickson's testimony is to continue today, May 11.