Archive for November, 2012
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Tags: ASCLD/LAB, clonazepam, crime lab analyst false testimony, Kentucky State Police Forensics Laboratory, KSP Lab, lab analyst posing as expert witness, liquid liquid extraction, non-DNA toxicology testimony, organic chemistry, Paul Coverdell grant program, toxicology
Despite an exculpatory crime lab toxicology result, I was convicted of a DUI (and other crimes dependent on the DUI) and sentenced to a lengthy prison term. This is the executive summary of a complaint that I will be filing with ASCLD/LAB (American Society of Crime Laboratory Directors/Laboratory Accreditation Board) and the National Institute of Justice (A branch of US DOJ that funds these laboratories through Paul Coverdell grants), with copies to other authorities. The reference list is extensive, as is the body of the complaint. This complaint has to do with improper testimony of a crime lab analyst, in a non-DNA toxicology case that resulted in conviction and sentence. I will share the link to the full body of the complaint, once it is completed.
This is a formal complaint, regarding the trial testimony of a Kentucky lab analyst, during a jury trial on January 22, 2008. The analyst was, and still is, employed at a lab that was at the time of the testimony, and still is, under your purview. The analyst’s name is Ryan Johnson. He works in the Toxicology section of the Central Forensic Laboratory, a division of the Kentucky State Police (KSP), in Frankfort, KY. The Kentucky State Police and its labs are a division of the Kentucky government known as the Justice and Public Safety Department. Mr. Johnson is the current supervisor for the Toxicology division of this lab, although in 2008 when he testified, I do not believe he was a supervisor. The lab Director is Ms.Laura Sudkamp.
Posing as a clinical and pharmacology ‘expert witness,’ Mr. Johnson based his under-oath statements on, in some cases, information that did not exist, regarding the prescription benzodiazepine, clonazepam. In other instances he took a drastic departure from the FDA-regulated package insert and delivered exactly the opposite information to the jury, or delivered information and represented it as accepted fact, when such information did not exist. He misled the jury by claiming by inference that this product, since it happens to be a benzodiazepine, causes nystagmus, for example. In truth, clonazepam can be and has been, according to the peer-reviewed literature (more than a few sources), used to treat and alleviate pathological nystagmus and other problems related to vision. I will provide more detail in the body of this complaint. (References will be provided in the body of the complaint).
In addition, Mr. Johnson reported that he was “familiar with this drug” and that he had “read the literature” for this drug. His extensive review of the peer-reviewed clinical literature consisted of two articles, each written at least six years prior to the drug being marketed, available and regulated in the United States, and each published in countries outside the United States. On one article he presented information that was diametrically opposed to the article summary (related to eye movements). The other article discussed only ten volunteer healthy human subjects, only four of whom were women, none of them within ten years of my age. Mr. Johnson expanded the ten-volunteer-subject findings (again, done in a laboratory setting and not a clinical one) to include all humans taking therapeutic doses of the drug.
One resource he described relying on is called Courtroom Toxicology, which is not peer-reviewed by the clinical world, and is authored by a lawyer (likely a prosecutor). I will discuss the problematic clinical bibliography for this publication in the body of the complaint. The DRE (Drug Recognition Expert) non-peer-reviewed literature that he discusses relies, in pertinent part, on a study done on primates, in 1968, on a different drug, ten years before clonazepam was invented, 27 years before the drug was available, marketed and regulated in the United States, and 37 years before Mr. Johnson represented the information in the study as accepted scientific fact for all humans taking the drug at therapeutic doses. When I attempted to contact the author of the ape study, I learned that he is retired. That study is: 9 David A. Robinson, Eye Movement Control in Primates, 161 Science 1219 (Sept. 1968). The reference document is here.
Mr. Johnson gave a technically misleading description of the chemical structure of this drug, describing it as having a unique characteristic (an attached chlorine atom) that is, in fact common to most of the drugs in this class, and misrepresented an extraction and separation process of organic chemistry as a diagnostic quantification tool. He wrongly stated that “liquid-liquid extraction is incapable of pulling clonazepam out of the blood,” when, in fact, liquid-liquid extraction has been the gold standard for extracting this drug (and about 6,000 others) from the plasma into a pH-adjusted organic layer for years. He stated,
Basically, it’s a, it’s a drug like diazepam but they put a chlor, a chlor, a chlorine atom on it, and that ends up, um, making it so that the test that we run, it’s called a liquid-liquid extraction, um, that test is incapable of pulling clonazepam out of the blood.
The chemical name for clonazepam is 5-(2-chlorophenyl)-7-nitro-2,3-dihydro-1,4-benzodiazepin-2-one, and the chemical name for diazepam is 7-chloro-1,3-dihydro-1-methyl-5-phenyl-1,4-benzodiazepin-2(3H)-one. Both structures have chlorine atoms. Clonazepam is not utterly unique for having the chlorine atom attached to the phenyl group (a group attached to the diazepine ring that is closely related to benzene) of the benzodiazepine skeleton. Ativan (lorazepam), another common benzodiazepine, is also a chlorophenyl benzodiazepine, named, (RS)-9-chloro-6-(2-chlorophenyl)-4-hydroxy-2,5-diazabicyclo[5.4.0]undeca-5,8,10,12-tetraen-3-one.
Mr. Johnson misstated the drug’s time-span of therapeutic activity as well as its’ half-life (he did not bother to explain half-life to the jury), and compared it, wrongly, in milligram-to-milligram equivalency that he termed “potency” to another drug, valium.
He misrepresented rare adverse, uncommon adverse and in some cases, non-existent adverse events as common every-day effects that are part of the well-known therapeutic profile for the drug and commonly experienced by everyone who is taking the drug as prescribed. He lied about the ‘generally accepted’ purpose of the drug, agreeing with the prosecutor that clonazepam is “specifically designed to get the user high.” Ironically, clonazepam is listed in the Bureau of Prisons formulary. As the only benzodiazepine allowed in the prison system, one of its ten off-formulary approved uses is “**04. Detoxification for substance abuse**.” In some cases, Mr. Johnson represented rare adverse events associated with extreme serum toxicity of a different benzodiazepine as common effects related to intended therapy and prescription of clonazepam.
Mr. Johnson lied by deliberate omission about not having a specific request to test for the drug by name in my case, when in fact he did have a request, to ‘test for’ clonazepam, by name. That request was verified to me by Laura Sudkamp on the telephone last month. He failed to explain to the jury that forensic lab toxicology testing takes the unknown to the known in a two-pronged approach that involves presumptive screening followed by quantification if the screen is positive and a report of “no drugs detected” if the presumptive screen is negative. He failed to explain the limits of detection for his testing purposes. He failed to explain that, generally speaking, for all of the classes of drugs that they screen for, drugs that fall below the limits of detection are not reported because they represent no issue of toxicological or therapeutic interest.
Mr. Johnson left the jury with the impression that (1) the drug was present in my blood and (2) no matter how high the level of this drug may have been, ie., even if the blood he presumptively screened had contained blood from a deceased person who had died from a toxic overdose of clonazepam and clonazepam alone, he simply would have had no way in the world to figure that out, with the equipment he had, in his toxicology laboratory at the time.
Mr. Johnson’s written lab report is unambiguous and exculpatory, and without a single notation or even asterisk explaining, “We have no idea what this drug is,” or “We can’t test for this drug because we can’t extract it in our lab,” or “not tested- clonazepam,” or “Please give us a call if you have a problem with the fact that we cannot meet your explicit request,” or “Shall we save this blood until the day when we have the right machine, and that could be years from now?” or “The principles of Organic Chemistry do not work in our lab,” or “We don’t have any money, but if you send us some, we’ll get this tested at NMS Labs in Willow Grove, PA, a third party contract lab that we typically send mysterious blood samples to.”
Mr. Johnson, when confronted with his own exculpatory lab result that lacked an asterisked notation regarding clonazepam, misrepresented the same report as inculpatory, leaving the jury with the impression that there was not only clonazepam present in the blood, but the level was likely in the higher range for prescription therapy. He discussed, as would a licensed physician or clinical pharmacologist, the “normal dosages” at “normal dosage times” for this drug, even though he has, by his own admission, never seen it before in his life.
In addition to this discussion being outside the scope of Mr. Johnson’s practice as a lab tech, Mr. Johnson’s discussion contained a dearth of information that was not bogus. He gave his name. I will assume, for the sake of argument that he told the truth about that. I was not able to verify his stated course of education, however.
Mr. Johnson’s testimony has far-reaching potential impact on the citizens of Kentucky. I was convicted of a DUI (among other things that depended on the DUI conviction) with no drugs or alcohol in my blood, and without exhibiting any unlawful driving whatsoever. I appealed and my conviction was affirmed by the Kentucky Court of Appeals in a unanimous, 26-page published opinion. The opinion has ‘facts’ in it that are based on this man’s trial testimony. In other words, there is a published and binding affirming opinion in Kentucky that not only contains science fiction, but actually obviates the need for any lab testing at all. The Kentucky published opinion affirming is based on findings of fact that are not founded in any sort of clinical reality whatsoever, and are a direct result of Mr. Johnson’s testimony. The published opinion could potentially affect any and all drivers in Kentucky who are ever pulled over for any reason. Mr. Johnson’s problematic testimony can and likely will lead to future unfortunate litigation around future no-drugs-no-alcohol-no-improper-driving DUI convictions.
Mr. Johnson appears to enjoy his deliberate, false testimony, as he smiles and giggles throughout. Part one of his testimony follows. Since he was recorded on videotape, I will include an official court-reporter transcript, for ease of review. Mr. Johnson is unsafe and unfit to work in a laboratory and make decisions about what to do with the blood samples that he receives.
Tags: chemistry, clonazepam, clonazepam structure and pharmacology, crime lab analyst false testimony, crime lab toxicology, forensic chemistry, FROG GRAVY, Frog Gravy Legal Case, Kentucky crime lab, liquid liquid extraction, organic chemistry, toxicology, toxicology screening blood, wrongful conviction
This is related to the Frog Gravy legal case.
This is part one of Kentucky crime lab analyst Ryan Johnson falsely testifying at trial by posing as a clinical expert and delivering information about this prescription drug that is false, misleading, totally unsupported anywhere in any literature on the planet, or a combination of all.
In the next few days, I will upload the rest, and then I will use this testimony as a the basis of a detailed complaint that I plan to file with the accreditation board and other authorities. At that time, I will go into gruesome detail, sentence by sentence beginning with the chemistry and going into information in the clinical literature. I will back each and every claim with the FDA-regulated package insert, the peer-reviewed literature, or a combination of both. I will provide detailed background based in known fact where appropriate, particularly regarding the organic chemistry as well as the clinical ‘effects’ of this drug.
He claims during the testimony (just to provide a teaser), that the lab had no idea it was supposed to look for this commonly prescribed benzodiazepine, and even if it did, the lab had no way of detecting the very presence of it. Problem is, and this is just one of his many problems here, he DID have that request, and he DID at least screen for the presence of benzodiazepines. Even though the lab can and does use outside competent labs for quantification, he did not send the blood to an outside lab, and that is likely because he did not detect the presence of a benzodiazepine in the blood in the first place, so there was no need for the second prong of the test, which would include quantification.
His clinical claims are false and bizarre.
As a result of this man’s false testimony, I was convicted of some crimes that I did not commit, and that includes a DUI with no drugs or alcohol in my blood, and without any bad driving or traffic violations. As a result of his false testimony, there is now a published opinion affirming in the Kentucky Court of Appeals, that contains a great deal of false information and science fiction. If you wish to lose IQ points, give it a read. Here is that opinion.
I will share the entire complaint with every appropriate related link, once I get the whole thing uploaded.
UPDATE: Here is the follow-along transcript for this portion. Second portion is being uploaded to YouTube and a transcript will be available for the whole testimony within a day or so. I will then share with my readers a sentence-by-sentence analysis of the false statements with backing literature.
Ryan Johnson (JOHNSON) is on the stand, under oath.
Chris McNeill (DEFENSE) is the defense attorney.
James A. Harris (COMMONWEALTH) is the prosecutor.
Hon. Judge Craig Z. Clymer (COURT) is the presiding trial court judge.
The testimony occurred on 1-22-2008, and was recorded on videotape. Here is that testimony.
COMMONWEALTH: (unintelligible)… Please, sir.
JOHNSON: Uh, my name is Ryan Johnson.
COMMONWEALTH: And how are you employed, Mr. Johnson?
JOHNSON: Um, I am a Forensic Science Specialist with the Kentucky State Police, um, Central Forensic Laboratory.
COMMONWEALTH: That’s in Frankfort.
JOHNSON: Yes, sir.
COMMONWEALTH: So you’ve got a four-hour drive to go home, lookin’ at you.
JOHNSON: (chuckles) Yes, sir.
COMMONWEALTH: Um. And, just summarize for our jury your training, and your education that qualifies you to practice in our lab.
JOHNSON: Um, I have a Biology and a Chemistry Bachelor of Science from (sounds like Pikeville College), (unintelligible) testing at the Kentucky State Police in Central Forensic Laboratory and I’ve had ongoing education approved for studying drug effects on human behavior, um and, the Society of Forensic Toxicology annual conferences (unintelligible).
COMMONWEALTH: You understand there are two subjects I want to ask you about (unintelligible) right to the blood sample that was sent to you, you can stipulate that there was a blood sample taken from Rachel Leatherman on the night of June 28, ’06, you did a blood test to see if there was any drugs in her blood, is that right?
JOHNSON: That’s correct, yes.
COMMONWEALTH: And your, what you test for came back “no drugs in her blood,” is that right?
JOHNSON: That’s correct, yes.
COMMONWEALTH: Okay. Now. This test that you run for drugs in her blood, does that test for clonazepam?
JOHNSON: No sir, it does not.
COMMONWEALTH: Why is that?
JOHNSON: Uh, clonazepam is a chloro-derivative benzodiazepine. Basically, it’s a, it’s a drug like diazepam but they put a chlor, a chlor, a chlorine atom on it, and that ends up, um, making it so that the test that we run, it’s called a liquid-liquid extraction, um, that test is incapable of pulling clonazepam out of the blood. So, it’s a, it’s a issue of, we need, um, the drug actually is, needs to be ran, to test for that drug, needs to be ran on, uh, what’s called liquid chromatography and with the budget the way it is right now we don’t have that instrument.
COMMONWEALTH: Um. (clears throat) Your test would have tested for heroin?
JOHNSON: Uh, we would have detected opiates.
COMMONWEALTH: You would have, would have, your test would have determined whether there was either rock or powder cocaine or its derivatives and (unintelligible) derivatives in the blood…
JOHNSON: Yes, sir.
COMMONWEALTH: And it came back negative on that.
JOHNSON: It was negative for cocaine and opia…
COMMONWEALTH: (interrupting) No heroin, no opiates, no forms of cocaine.
JOHNSON: That’s correct.
COMMONWEALTH: Can’t tell us about clonazepam.
JOHNSON: I couldn’t tell you if it had clonazepam in it.
COMMONWEALTH: As to her blood.
JOHNSON: As to her blood, yes.
COMMONWEALTH: Okay. Now I’m going to ask you about clonazepam. Are you familiar with it?
JOHNSON: Yes sir, I am.
COMMONWEALTH: Have you read the literature on it?
JOHNSON: Yes, sir, I have.
COMMONWEALTH: Including not only the, the uh, manufacturer’s um, data sheet, um, but also the other, uh, PDR-type references that describe clonazepam and its effects?
JOHNSON: Yes, sir, the general textbooks that we use are the PDR, which is the Physician’s Desk Reference, um, the Courtroom Toxicology, which is a database of drugs and their effects, um and how, how they can be detected, uh, ranges, and then another book, it’s called, um Drug Effects on Human Behavior, um, it’s just another book to tell us if there is any driving effects…
COMMONWEALTH: (interrupting) And since you don’t have a clonazepam test that you did on her blood, you can’t tell us about any clonazepam levels in her blood.
JOHNSON: That’s correct.
COMMONWEALTH: So I’m going to ask you to answer my questions based on normal dosages, okay?
JOHNSON: Yes, sir.
COMMONWEALTH: Uh, within a normal dosage time, okay?
JOHNSON: Yes, sir.
COMMONWEALTH: Um. First of all, taken in normal dosages, can you tell our jury whether clonazepam is generally what we would refer to as intoxicating?
JOHNSON: Um, for the most part, it’s considered a potent sedative, which would be intoxicating, yes, sir.
COMMONWEALTH: Potent, does that mean very intoxicating?
JOHNSON: Uh, yes, sir, it’s considered about, uh, according to the recent literature I’ve read, about twenty times more potent than valium.
COMMONWEALTH: Twenty times more potent than valium.
JOHNSON: Yeah, on a milligram-per-milligram basis.
COMMONWEALTH: And, what are the chemically, scientifically, pharmacologically recognized effects on vision of someone who is taking normal dosages of clonazepam?
JOHNSON: It can cause double vision, blurred vision.
COMMONWEALTH: Um, do you know anything about the HGN test?
JOHNSON: Um, according to what I’ve read, uh, the DRE, which is the Drug Recognition Expert, um, they recommend that benzodiazepines does cause HGN. I wasn’t for sure…
COMMONWEALTH: Causes the signs of HGN.
JOHNSON: Yes, um, after reading the literature that we have, it does say that nystagmus, either vertical or horizontal, are present, as a side effect.
COMMONWEALTH: A person taking clonazepam is likely to flunk the HGN test.
JOHNSON: That’s correct, yes.
COMMONWEALTH: And it would also be very intoxicating.
JOHNSON: It is possible, yes, sir.
COMMONWEALTH: Um, you say “possible.” Again, at normal dosages, based on all the literature that you’ve read, thought you said it was a potent, twenty times stronger than valium.
JOHNSON: Yes, sir. Um, the only reason I say possible, is that drugs do tend to have different effects on different people. A certain dosage for a person who is used to taking them might not actually be as potent as a drug, as, one that not been taken…
COMMONWEALTH: That’s not gonna, that’s not very scientific, Mr. Johnson, let me ask you this.
COMMONWEALTH: Uh, given what you know about clonazepam, uh, if a person were taking clonazepam, would it be unusual if that person were to describe themselves as so whacked out they couldn’t remember?
JOHNSON: Uh, it could be, that would be consistent…
COMMONWEALTH: That would be consistent.
JOHNSON: That would be consistent with um, the things I’ve read about clonazepam, yes.
COMMONWEALTH: In terms of impairment, in terms of motor skills, and particularly those motor skills that we usually associate with being able to drive an automobile, would a person taking clonazepam in normal dosages be impaired?
JOHNSON: According to the pharmacy companies that produce clonazepam they do recommend that, um not driving a motor vehicle while taking the drug until you know exactly how it affects you, um, and from the studies that I’ve read it causes uh, degradation in mental ability to concentrate, uh, the fine motor skills, um, confusion, dizziness are all symptoms of clonazepam…
COMMONWEALTH: (unintelligible and interrupting)…about glassy eyes, is that something (unintelligible) recognized signs of use of clonazepam?
JOHNSON: I don’t recall (unintelligible)
COMMONWEALTH: That’s all I have. Thank you.
COURT: (unintelligible) defense?
DEFENSE: Uh, yes, Judge. (papers shuffling) Um. Mr. Johnson, even if you had found that there was clonazepam in her blood, that still wouldn’t be an indicator that she was quote under the influence of it, would it?
JOHNSON: I couldn’t testify to impairment based on (unintelligible)
DEFENSE: Right. Clonazepam can actually stay in your system for some period of time even after the effect of it wears off, right?
JOHNSON: The effects are usually given at six to eight hours and the half-life of the drug can be up to nineteen, twenty hours, twenty-seven hours.
DEFENSE: So, um, you can’t offer any testimony today about whether or not she was under the influence of clonazepam and/or impaired by the effects of clonazepam, can you.
JOHNSON: I couldn’t say, no, sir.
DEFENSE: Um. Now, you say that you all didn’t have the uh, the equipment to test for the presence of clonazepam in the blood. Uh, but, the Kentucky State Police Lab that you work for, sometimes they do send off materials for testing at other labs.
JOHNSON: Uh, we do use private labs for some things, yes, sir.
DEFENSE: Like, DNA, for example, sometimes, is that correct?
JOHNSON: Um, I’m not familiar with exactly DNA, but I know the toxicology section does do it, sometimes.
DEFENSE: Well, but, again, you’re familiar with some tests that the KSP Lab either doesn’t do or doesn’t have enough staff to do, they do contract out with labs who do do those tests, right?
JOHNSON: (giggling) It has been done, yes.
DEFENSE: Um, so certainly that would have been possible to test for clonazepam.
Tape ends here. Last part of tape is being uploaded, and will also be transcribed for follow-along convenience.
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Tags: CHARITY HOSPITAL NEW ORLEANS, EARL LONG, HUEY LONG, HURRICANE KATRINA, INTERNSHIP NEW ORLEANS 1958, Letty Owings, MEDICAL HISTORY IN THE US, PEDIATRICS AT CHARITY IN NEW ORLEANS, PUBLIC HEALTH HOSPITAL NEW ORLEANS, RAY OWINGS MD
This is a true story of internship at the Public Health Hospital and at Charity Hospital in New Orleans in 1958, as told by Ray Owings, MD, age 89, and his wife Letty Owings, age 87. This essay represents just one year of a long and interesting history for Ray Owings, and it is part of a series. After this, we will go back and review the history of how he got to this point, and then will share more details about the medicine at that time.
Charity Hospital in New Orleans was specifically founded by grant in 1736 to serve the indigent population in New Orleans, and it was a teaching hospital affiliated with the LSU Health Sciences Center in New Orleans (LSUHSC-NO) for more than 250 years until its close after Hurricane Katrina. The hospital was notable for being the second largest hospital in America in 1939 with 2680 beds and it has been featured in a TLC series called Code Blue, which was a documentary series featuring the ER that was one of the busiest in America. Here is one part of that series about Chavez Jackson, a 9-year-old boy who was accidentally shot by his brother, who was playing with a gun. If you take a moment to watch this, you can begin to get a feel for the intensity and emotion that was a constant given in this ER:
Public Health Hospital and Charity Hospital New Orleans Internship of 1958
The first thing Ray said to me was, “Maybe you shouldn’t have come down here.” Ray was never, ever able to come home and the place was just a madhouse. It was a weird, weird, weird year. Everything was crooked in the politics, and we had the likes of Earl Long getting out of his car and peeing by the side of the road. It was just bizarre. Somebody shot Huey Long right there in the Capitol because you had to get dramatic in New Orleans. Earl, at thirty-six, called Huey “the yellowest physical coward that God had ever let live.” Huey Long said of Earl: “Earl is my brother but he’s crooked. If you live long enough he’ll double cross you.” Source.
We had the shrimp people who paid for their baby delivery in shrimp because they thought the doctor ought to get a little something for his services and they were very grateful, so they brought shrimp. There just weren’t enough people to man the place, so I was home with the kids a lot and the first thing I did was slip and fall on some concrete slabs because everything was so wet your shoes turned green. It was truly a bizarre year but for all of its utter craziness, New Orleans had such a haunting and deep beauty about it. The weeping trees were gorgeous, and the flowers were so pungent it was like putting your face into a jar of perfume. We had four small children at the time.
During the internship at Public Health Hospital in New Orleans that year, the interns could go to Charity Hospital right near the Mississippi River as well, so that’s what I did. I reported for duty July 1, 1958 and at first I just rented a room. It was hotter than the damn hinges of Hell, so I bought me a little old fan and had the thing directly on me during the night. Letty moved down there but I wasn’t so sure she should have even come.
The training was very good. At the Public Health Hospital we treated merchant seamen and their families as well as fishermen and their families. Charity was quite interesting because if you wanted to see a disease, you could find it in that hospital. For example, there were very few cases of diptheria in the US, and a physician may go through an entire career without seeing it, but on the Pediatrics ward we had 25 cases of diptheria at one time.
At Charity I worked with a resident named Clarence MacIntile from Idaho. He went back, and we kept in touch. Interns had free run to do what they wanted, so we ran the Pediatrics Deartment by ourselves. The place was always jammed, and I mean there were hundreds of them. But there just weren’t enough hours in the day, and you were lucky to get to a little bed across the street and get a few hours of sleep.
Emory had been a good school because during the clinical years, students got to do a lot of things and this was not true of some medical schools. I felt that my training was much better than others, so I was happy about that.
What took place over my lifetime to get to that point might have been called the ‘American Dream’ just a little while ago. You hear that term, but no one ever talks about the nitty gritty of how this was obtained. It will be important to begin at the beginning in the next few essays, but my philosophy has always been that no matter what it is one chooses do do in life, it is essential to do the very best you can do at it.
End Note: I do not usually put more than one video in, but here is a second Charity ER video from TLC. A 9-year-old girl was involved in an accident where the frame of a swing set fell onto her skull. She has a severe head injury with bleeding and her brain is swelling. The brain has few places to swell to inside the rigid skull except through the foramen magnum at the base of the skull, and this is called herniation. Doctors will monitor the pressure, as they explain. They will also likely induce a coma to rest the brain and decrease oxygen demand. Posturing is an indication of severe head injury, where the arms become rigid and either turn out and away from the body or move inward toward the core of the body. This video is called Kernisha.