SANTA ANA, Calif. — An expert in toxicology hired by the Los Angeles Angels testified on Friday that alcohol and oxycodone played a substantial factor in Tyler Skaggs’ death, and that fentanyl alone would not have killed the former pitcher.
However, on cross-examination by a Skaggs family attorney, the expert, Dr. Shaun Carstairs, admitted that he hadn’t reviewed evidence from Eric Kay’s criminal trial, in which numerous doctors involved in performing Skaggs’ autopsy gave opinions in direct contrast to Carstairs’.
Kay, the ex-Angels communications director, is serving a 22-year federal prison sentence for providing the fentanyl-laced pill that Skaggs ingested, leading to his death on July 1, 2019. The Skaggs family is suing the Angels for wrongful death.
Fentanyl was the “but for” cause of Skaggs’ death, as determined by a jury in Kay’s 2022 criminal trial — meaning that jury found Skaggs would have lived but for the fentanyl he ingested. The judge in this civil trial has ruled that lawyers cannot stray from that established fact, but is allowing the Angels to argue that other substances were “substantial factors” in Skaggs’ death.
It’s a critical issue in this trial, as the jury attempts to determine who is at fault in Skaggs’ death. Kay only provided the fentanyl-laced pill to Skaggs, while the oxycodone pills in Skaggs’ system were provided by teammate Matt Harvey. The alcohol, the Angels say, was consumed by Skaggs on the team’s flight from Long Beach, California to Dallas, Texas.
Under direct examination by Angels attorney Todd Theodora, Carstairs — an emergency medical physician and toxicologist — said that Skaggs had consumed between 11-13 alcoholic beverages, all on the team plane. Skaggs’ blood alcohol content was measured to be between .122 and .140 at the time of his death.
Carstairs also said that the 3.8 nanograms per milliliter of fentanyl Skaggs’ system was within the “therapeutic range” and would not have been enough to kill the Angels pitcher on its own.
“3.8 is not by any means, necessarily a fatal level,” Carstairs argued.
Using a demonstrative exhibit, Angels lawyers presented a graphic to jurors of Tyler Skaggs’ face next to 13 tall cans of Michelob Ultra. The judge ruled, before his testimony began, that the graphic had to be edited, since it claimed, “Without the alcohol…Tyler would not have died.”
The Angels also had a demonstrative exhibit they wanted to review with Carstairs, comparing Skaggs to the musical performer Prince, who died from a fentanyl overdose in 2016. The judge quickly ruled that it was inadmissible.
During testimony, Carstairs cited studies about how breathing slows considerably when opiates are combined with alcohol, for the purpose of showing how the alcohol Skaggs consumed played a substantial role in his death. He also cited a study showing how fentanyl deaths typically require double-digit, or even triple-digit nanogram-per-milliliter concentrations of fentanyl.
“Most people that take these pills don’t end up dying,” Carstairs said.
Notably, Carstairs also said Skaggs’ decision to snort the opioid, instead of swallowing it, was a major factor, and that he “may very well have woken up” had the pill been swallowed.
Lastly, Theodora presented a lengthy question about Skaggs — going through all of Skaggs’ actions, as alleged by the defense. Theodora eventually asked, “What role did he play in his own demise?” This is a critical question, as jurors ultimately have to determine the comparative fault of Skaggs, Kay and the Angels.
“That is an incredibly dangerous situation. That puts them at a risk of death,” Carstairs said, before comparing his conduct to a game of Russian Roulette, with five bullets occupying the six chambers of the gun.
Many of Carstairs’ determinations and assertions, however, came under scrutiny during questioning by Skaggs attorney Daniel Dutko.
Carstairs had said on direct examination that he agreed with the medical examiner’s findings, which list the cause of death as all three substances found in Skaggs system. The medical examiner’s report also notes that the findings were reviewed by other staff in the medical examiner’s office.
The Skaggs side’s toxicology expert, Dr. Stacey Hail, had testified in November that it is common practice to note all substances found in a decedent’s blood in an autopsy report — and that it does not mean they’re all significant contributing factors.
Dutko asked Carstairs if he was aware that two doctors charged with staff-reviewing the medical examiner’s findings both testified at the criminal trial. They said fentanyl was the cause of Skaggs’ death. Carstairs testified that he couldn’t recall if he reviewed that criminal trial testimony. Hail, who testified in both trials, also said fentanyl was the cause of death.
“You just disagree with everyone, don’t you” Dutko asked — a question which was sustained by the judge.
Dutko also investigated Carstairs’ claims that Skaggs had consumed between 11-13 drinks — all on the team plane. On a three-hour flight, Dutko calculated, that would require drinking one beer every 13 minutes.
The Skaggs lawyer pointed to a medical study related to the dangers of estimating the number of drinks consumed post-mortem, which stressed “the utter unreliability and inaccuracy of attempting back-calculations in either direction. Only gross approximates can be achieved and no (attempt) at accuracy must be offered.”
On a follow-up question from Dutko, Carstairs acknowledged that his estimation of 11-13 alcoholic beverages could be inaccurate.
Dutko asked about the potential for fentanyl to be lethal at even lower levels than the 3.8 ng/mL found in Skaggs’ blood. Citing a study, Dutko asked about an example where someone died with only 2.7 ng/mL of fentanyl found in their system.
Carstairs noted that the study also stated that the person in that example had what appeared to be a baggie of heroin, while Dutko said heroin wasn’t found in his system, and it was likely the fentanyl in the form of counterfeit heroin.
Lastly, Dutko pushed back on Carstairs’ assertion that Skaggs had died around 2 a.m. CST on July 1, when the medical experts at Kay’s criminal trial had said Skaggs died at 12:02 or 12:03 a.m. Carstairs had also admitted to not being an expert in determining time of death. Hail had testified that Skaggs likely died very soon after snorting the fentanyl, and that his death was quick.
Next week is the final week of the trial testimony after nearly two months of witnesses. The Angels will wrap by re-calling Skaggs’ widow, Carli Skaggs, and his mother, Debbie Hetman on Monday. They also intend to play video depositions of other ex-Angels who admitted to purchasing pills from Kay.
The Angels also plan to call several expert witnesses, including ex-MLB general manager Dan Duquette, to speak to Skaggs’ potential future earnings. Lastly, Theodora said the Angels will call team president John Carpino and chief financial officer Molly Jolly, if there’s time to do so.
Friday’s proceedings were only half of a normal court day, as the Theodora-Ohringer law firm needed to prepare for their annual holiday party. At the end of the day, Theodora reiterated his complaint that the Angels will not have enough time to put on their case.
The judge, who has remained unfazed by Theodora’s consistent timing complaints, indicated that Angels’ questioning has gone longer than that of the Skaggs side during the team’s defense, and that she will ensure Angels attorneys get twice as much time to question witnesses during the final week.