The CHAIRMAN. All right, Dr. Carrico, you know the reason why we are
here, what we are investigating.
If you will raise your right hand, please, and be sworn, sir.
You solemnly swear the testimony you give before this Commission shall
be the truth, the whole truth and nothing but the truth, so help you
God?
Dr. CARRICO. I do.
The CHAIRMAN. Mr. Specter will conduct the examination.
Mr. SPECTER. Dr. Carrico, will you state your full name for the record
please?
Dr. CARRICO. Charles James Carrico.
Mr. SPECTER. And what is your address, Dr. Carrico?
Dr. CARRICO. Home address?
Mr. SPECTER. Please.
Dr. CARRICO. It is 2605 Ridgwood in Irving.
Mr. SPECTER. What is your professional address?
Dr. CARRICO. Parkland Memorial Hospital in Dallas, Tex.
Mr. SPECTER. How old are you, sir?
Dr. CARRICO. 28.
Mr. SPECTER. Will you outline briefly your educational background?
Dr. CARRICO. I attended grade school and high school in Denton, Tex.;
received a Bachelor of Science in Chemistry from North Texas State
University in 1947; received my M.D. from the University of Texas
Southwestern Medical School in 1961; served an internship at Parkland
Memorial Hospital from 1961 to 1962; and then did a year of fellowship
at the surgery department at Southwestern Medical School, followed by
my surgery residency at Parkland Hospital.
Mr. SPECTER. Are you duly licensed to practice medicine in the State of
Texas, Dr. Carrico?
Dr. CARRICO. Yes; I am.
Mr. SPECTER. Are you board certified at the present time or are you
working toward the board certification in surgery?
Dr. CARRICO. I am engaged in surgery residency which will qualify me
for board certification.
Mr. SPECTER. What experience have you had, if any, with gunshot wounds?
Dr. CARRICO. In the emergency room at Parkland, during my residence
school and internship and residency, we have seen a fair number of
gunshot wounds.
Mr. SPECTER. Could you approximate the number of gunshot wounds you
have treated in the course of those duties?
Dr. CARRICO. In all probably 150, 200, something in that range.
Mr. SPECTER. What were your duties at Parkland Memorial Hospital on
November 22, 1963?
Dr. CARRICO. At that time I was assigned to the elective surgery
service, which is the general surgery service treating the usual
surgical cases. I was in the emergency room evaluating some patient for
admission.
Mr. SPECTER. What were you doing specifically in the neighborhood of
12:30 p.m. on that day?
Dr. CARRICO. At that time I had been called to the emergency room to
evaluate a patient for admission to the hospital.
Mr. SPECTER. Were you notified that an emergency case involving
President Kennedy was en route to the hospital?
Dr. CARRICO. Yes, sir.
Mr. SPECTER. What is your best estimate as to the time that you were
notified that President Kennedy was en route to the hospital?
Dr. CARRICO. Shortly after 12:30 is the best I can do.
Mr. SPECTER. How long thereafter was it that he actually did arrive at
Parkland, to the best of your recollection?
Dr. CARRICO. Within 2 minutes approximately.
Mr. SPECTER. And precisely where were you at Parkland when you first
observed him?
Dr. CARRICO. When I first observed him I was in the emergency room,
seeing--actually Governor Connally had been brought in first, as you
know, Dr. Dulany and I had gone to care for Governor Connally and when
the President was brought in I left Governor Connally and went to care
for the President.
Mr. SPECTER. Will you describe briefly the physical layout of Parkland
with respect to the point where emergency cases are brought up to the
building and the general layout of the building into the emergency room.
Dr. CARRICO. The emergency entrance is at the back of the building.
There is an ambulance ramp. Then immediately adjacent to the ambulance
ramp are, of course, double doors, swinging doors and a corridor which
is approximately 30 feet long and empties directly into the emergency
room.
Then inside the emergency room are several areas, the surgical area
consists of about eight booths for treating, examination and treatment
of patients, and four large emergency operating rooms.
Two of these are specifically set aside for acutely ill, severely ill,
patients and these are referred to as trauma rooms.
Mr. SPECTER. And were these trauma rooms used in connection with the
treatment of President Kennedy and Governor Connally?
Dr. CARRICO. Yes, sir.
Mr. SPECTER. What precisely was the point where you met at his arrival?
Dr. CARRICO. The President was being wheeled into trauma room one when
I saw him.
Mr. SPECTER. Who else, if anyone, was present at that time?
Dr. CARRICO. At that time, Dr. Don Curtis, Martin White.
The CHAIRMAN. Was he a doctor, too?
Dr. CARRICO. Yes, sir; Miss Bowron.
Mr. SPECTER. Who is Miss Bowron?
Dr. CARRICO. She is one of the nurses on duty at the emergency room.
Mr. SPECTER. Who was the first doctor to actually see the President?
Dr. CARRICO. I was.
Mr. SPECTER. Now, what did you observe as to the condition of President
Kennedy when you first saw him?
Dr. CARRICO. He was on an ambulance cart, emergency cart, rather. His
color was blue white, ashen. He had slow agonal respiration, spasmodic
respirations without any coordination. He was making no voluntary
movements. His eyes were open, pupils were seen to be dilated and later
were seen not to react to light. This was the initial impression.
Mr. SPECTER. What was the status of his pulse at the time of arrival?
Dr. CARRICO. He had no palpable pulse.
Mr. SPECTER. And was he making any movements at the time of arrival?
Dr. CARRICO. No voluntary movements, only the spasmodic respirations.
Mr. SPECTER. Was any heartbeat noted at his arrival?
Dr. CARRICO. After these initial observations we opened his shirt,
coat, listened very briefly to his chest, heard a few sounds which we
felt to be heartbeats and then proceeded with the remainder of the
examination.
Mr. SPECTER. In your opinion was President Kennedy alive or dead on his
arrival at Parkland.
Dr. CARRICO. From a medical standpoint I suppose he was still alive in
that he did still have a heartbeat?
Mr. SPECTER. What action, if any, was taken with respect to the removal
of President Kennedy's clothing?
Dr. CARRICO. As I said after I had opened his shirt and coat, I
proceeded with the examination and the nurses removed his clothing as
is the usual procedure.
Mr. SPECTER. Was President Kennedy wearing a back brace?
Dr. CARRICO. Yes; he was.
Mr. SPECTER. Would you describe as precisely as you can that back brace?
Dr. CARRICO. As I recall, this was a white cotton or some sort of fiber
standard brace with stays and corset, in a corset-type arrangement and
buckles.
Mr. SPECTER. How far up on his body did it come?
Dr. CARRICO. Just below his umbilicus, as I recall.
Mr. SPECTER. How far down on his body did it go?
Dr. CARRICO. I did not examine below his belt at that time.
Mr. SPECTER. Did you at any time examine below his belt?
Dr. CARRICO. I did not; no, sir.
Mr. SPECTER. Do you know if anyone else did?
Dr. CARRICO. Not in a formal manner.
Mr. SPECTER. What action did you take by way of treating President
Kennedy on his arrival?
Dr. CARRICO. After what we have described we completed an initial
emergency examination, which consisted of, as we have already said,
his color, his pulse, we felt his back, determined there were no
large wounds which would be an immediate threat to life there. Looked
very briefly at the head wound and then because of his inadequate
respirations inserted an endotracheal tube to attempt to support these
respirations.
Mr. SPECTER. Specifically what did you do with respect to the back, Dr.
Carrico?
Dr. CARRICO. This is a routine examination of critically ill patients
where you haven't got time to examine him fully. I just placed my hands
just above the belt, but in this case just above the brace, and ran my
hands up his back.
Mr. SPECTER. To what point on his body?
Dr. CARRICO. All the way up to his neck very briefly.
Mr. SPECTER. What did you feel by that?
Dr. CARRICO. I felt nothing other than the blood and debris. There was
no large wound there.
Mr. SPECTER. What source did you attribute the blood to at that time?
Dr. CARRICO. As it could have come from the head wound, and it
certainly could have been a back wound, but there was no way to tell
whether this blood would have come from a back wound and not from his
head.
Mr. SPECTER. What action did you next take then?
Dr. CARRICO. At that time the endotracheal tube was inserted, using a
curved laryngoscopic blade, inserting an endotracheal tube, it was seen
there were some contusions, hematoma to the right of the larynx, with
a minimal deviation of the larynx to the left, and ragged tissue below
indicating tracheal injury.
The tube was inserted past this injury, and the cuff inflater was
connected to a Bennett machine which is a respiratory assistor using
positive pressure.
Mr. SPECTER. Will you describe briefly what you mean in lay terms by a
cuffed endotracheal tube?
Dr. CARRICO. This is a plastic tube which is inserted into the trachea,
into the windpipe, to allow an adequate airway, adequate breathing. The
cuff is a small latex cuff which should prevent leakage of air around
the tube, thus insuring an adequate airway.
Mr. SPECTER. Will you continue, then, to describe what efforts you made
to revive the President.
Dr. CARRICO. After the endotracheal tube was inserted and connected,
I listened briefly to his chest, respirations were better but still
inadequate.
Dr. Perry arrived, and because of the inadequate respirations the
presence of a tracheal injury, advised that the chest tube was to be
inserted, this was done by some of the other physicians in the room.
At the same time we had been getting the airway inserted Dr. Curtis
and Dr. White were doing a cutdown, venous section using polyethylene
catheters through which fluid, medicine and blood could be administered.
Mr. SPECTER. Will you describe in lay language what you mean by a
cutdown in relationship to what they did in this case?
Dr. CARRICO. This was a small incision over his ankle and a tube was
inserted into one of his veins through which blood could be given,
fluid.
Mr. SPECTER. Is the general purpose of that to maintain a circulatory
system?
Dr. CARRICO. Right.
Mr. SPECTER. In wounded parties?
Dr. CARRICO. Yes.
(At this point, Representative Ford entered the hearing room.)
Mr. SPECTER. Would you now proceed again to describe what else was done
for the President in an effort to save his life?
Dr. CARRICO. Sure. Dr. Perry then took over supervision and treatment,
and the chest tubes were inserted, another cutdown was done by Dr.
Jones on the President's arm.
Fluid, as I said, was given, blood was given, hydrocortisone was given.
Dr. Clark, the chief neurosurgeon, Dr. Bashour, cardiologist, was there
or arrived, and a cardiac monitor was attached and although I never saw
any electro-activity, Dr. Clark said there was some electrical activity
of the heart which means he was still trying to----
Mr. SPECTER. What is Dr. Clark's position in the hospital?
Dr. CARRICO. He is chief of the neurosurgery department and professor
of the neurosurgery.
Mr. SPECTER. Dr. Carrico, will you continue to tell us then what
treatment you rendered the President?
Dr. CARRICO. When this electrocardiac activity ceased, close cardiac
massage was begun. Using this, and fluids and airway we were able
to maintain fairly good color, apparently fairly good peripheral
circulation as monitored by carotid and radial pulses for a period of
time. These efforts were abandoned when it was determined by Dr. Clark
that there was no continued cardiac response. There was no cerebral
response, that is the pupils remained dilated and fixed; there was
evidence of anoxia.
Mr. SPECTER. Will you describe in lay language what anoxia means?
Dr. CARRICO. No oxygen.
Mr. SPECTER. Was cardiac massage applied in this situation?
Dr. CARRICO. Yes, sir; it was, excellent cardiac massage.
Mr. SPECTER. Were bloods administered to the President?
Dr. CARRICO. Yes, sir.
(At this point, Mr. Dulles entered the hearing room.)
Mr. SPECTER. Dr. Carrico, was any action taken with respect to the
adrenalin insufficiency of President Kennedy?
Dr. CARRICO. Yes, sir; he was given 300 milligrams of hydrocortisone
which is an adrenal hormone.
Mr. SPECTER. And what was the reason for the administration of that
drug?
Dr. CARRICO. It was recalled that the President had been said to have
adrenal insufficiency.
Mr. SPECTER. Now, at what time was the death of the President
pronounced, Doctor?
Dr. CARRICO. At 1 o'clock.
Mr. SPECTER. Who pronounced the death of the President?
Dr. CARRICO. Dr. Clark, I believe.
Mr. SPECTER. Was that a precise time fixed or a general time fixed for
the point of death?
Dr. CARRICO. This was a general time, sir.
Mr. SPECTER. What, in your opinion, was the cause of death?
Dr. CARRICO. The head wound, the head injury.
Mr. SPECTER. Will you describe as specifically as you can the head
wound which you have already mentioned briefly?
Dr. CARRICO. Sure.
This was a 5- by 71-cm defect in the posterior skull, the occipital
region. There was an absence of the calvarium or skull in this area,
with shredded tissue, brain tissue present and initially considerable
slow oozing. Then after we established some circulation there was more
profuse bleeding from this wound.
Mr. SPECTER. Was any other wound observed on the head in addition to
this large opening where the skull was absent?
Dr. CARRICO. No other wound on the head.
Mr. SPECTER. Did you have any opportunity specifically to look for a
small wound which was below the large opening of the skull on the right
side of the head?
Dr. CARRICO. No, sir; at least initially there was no time to examine
the patient completely for all small wounds. As we said before, this
was an acutely ill patient and all we had time to do was to determine
what things were life-threatening right then and attempt to resuscitate
him and after which a more complete examination would be carried out
and we didn't have time to examine for other wounds.
Mr. SPECTER. Was such a more complete examination ever carried out by
the doctors in Parkland?
Dr. CARRICO. No, sir; not in my presence.
Mr. SPECTER. Why not?
Dr. CARRICO. As we said initially this was an acute emergency situation
and there was not time initially and when the cardiac massage was done
this prevented any further examination during this time this was being
done. After the President was pronounced dead his wife was there, he
was the President, and we felt certainly that complete examination
would be carried out and no one had the heart, I believe, to examine
him then.
Mr. SPECTER. Will you describe, as specifically as you can then, the
neck wounds which you heretofore mentioned briefly?
Dr. CARRICO. There was a small wound, 5- to 8-mm. in size, located in
the lower third of the neck, below the thyroid cartilage, the Adams
apple.
Mr. DULLES. Will you show us about where it was?
Dr. CARRICO. Just about where your tie would be.
Mr. DULLES. Where did it enter?
Dr. CARRICO. It entered?
Mr. DULLES. Yes.