Kern County pathologist Debra Hanks spent nearly three hours on the stand last April outlining a graphic list of bruises, cuts, abrasions, fractures and internal injuries that inmate James Moore suffered last year at the hands of Kern County jail deputies.

Hanks told the court the cause of Moore's death was "multifactorial." The 30-year-old prisoner, she said, died as a result of a combination of several injuries to his head and neck, including fractures and other damage to the cartilage around Moore's Adam's apple.

As a result of Hanks' testimony -- and the testimony of several eyewitnesses who said Moore was chained hand and foot when he was beaten -- detention deputies Daniel Thomas Lindini, Ralph Contreras and Roxanne Fowler were ordered to stand trial in Moore's slaying.

But a new twist in the case is calling attention to injuries the defense contends were not caused by the punches, kicks and baton strikes that left Moore with bone fractures around his eyes, blood in the sinuses and swelling of the brain.

It was a department-approved choke hold that killed Moore, according to a pathologist hired by defense attorneys. Dr. Paul Herrmann of San Rafael asserted in a letter released by defense attorneys earlier this month that Moore died as a result of a carotid artery hold placed on him at the jail. The controversial neck hold, which chokes off blood to the brain, is allowed by Kern County Sheriff's Department policy.

One defense attorney said that, based on Herrmann's findings, he would file a motion to dismiss the case on Monday.

Kern County detention Sgt. Randy Holtz applied a carotid hold on Moore during one of the earlier altercations between the prisoner and detention deputies, according to court testimony. Holtz was not charged in Moore's death.

Prosecutors disagreed with Herrmann's findings, calling the release of the information an attempt to sway public opinion and influence potential jurors.

'A terrible idea'

The carotid artery hold and choke holds in general have a checkered history.

In San Diego, controversy erupted during the 1990s when at least four people died, including a 16-year-old boy, after San Diego police used the carotid artery hold to restrain them, according to a 2000 story in the San Diego Union-Tribune


And, between 1975 and 1982, 16 men died after the application of choke holds by officers with the Los Angeles Police Department. According to the LAPD's reports, five of the men had bar-arm holds placed on them, which cuts off air passage.

Nine of the deaths occurred after officers used the carotid artery hold, and in two of the cases, there was some uncertainty about which hold was used.

"The carotid hold -- it's a terrible idea, physically and medically," said Los Angeles civil rights attorney Michael R. Mitchell, who sought an injunction against the city of Los Angeles to bar the use of the control holds in the 1970s and 1980s.

Mitchell argued the case when it went before the U.S. Supreme Court in 1983. One count alleged that police officers "regularly and routinely" applied choke holds in situations where they are not threatened by the use of deadly force, and that numerous persons had been injured or killed as a result of the application of the carotid hold and other choke holds.

While the court did not side with Mitchell, the LAPD saw fit to raise the threshold for use, allowing the carotid hold only when there is an immediate threat of serious bodily injury or death.

The policies of the Kern County Sheriff's Department and the Bakersfield Police Department are not as strict. Though the Sheriff's Department prohibits the bar-arm hold "except in circumstances which would support the use of deadly force," it sanctions the use of the carotid hold "when it reasonably appears necessary to the officer at the time of the event to bring the subject under control."

The BPD's policy similarly leaves the use of the hold to the discretion of officers.

Proponents say the carotid hold, when correctly applied, chokes off the arteries that supply the brain with blood, resulting in a short period of unconsciousness but no permanent damage.

But that's not a realistic viewpoint, Mitchell said.

"You can't apply the carotid hold correctly," he said. "It can't be done."

Mitchell cited medical testimony in the Supreme Court case asserting that the application of choke holds result in nerve messages sent to the brain signalling an acute danger of death. Those signals cause the body to react with an involuntary "fight or flight" response to save itself.

Even proponents of the hold acknowledge that a violent struggle by the subject makes the correct application of the hold more difficult.

In medical testimony in the Supreme Court case, pathologist A. Griswold asserted that the carotid control hold "is extremely dangerous in a manner that is at least as equally unpredictable as the bar arm control."

When applied with sufficient pressure, the restraint hold will crush the carotid sheath against the bony structure of the neck, shutting down the supply of oxygenated blood to the brain and leading to unconsciousness in approximately 10 to 15 seconds.

"However, pressure on both carotid sheaths also results in pressure ... on both of the vagus nerves," Griswold testified. "The vagus nerves (right and left) arise in the brain and are composed of both sensory and motor fibers. ... Stimulation of these nerves by pressure can activate reflexes within the vagus system that can result in immediate heart stoppage."

Dr. Herrmann, the pathologist hired by the defense in the Moore case, said he believes the carotid hold was improperly placed and caused internal bleeding, which eventually constricted Moore's airway and caused his death.

'In the midst of combat

Kern County sheriff's Sgt. Steve Hansen has been training cadets and sworn law enforcement officers in defensive techniques for more than 18 years.

The carotid hold has its limits, he said, but it remains an important tool when deputies are faced with controlling or apprehending violent subjects.

"I've seen it done," he said. "I've done it myself."

Although he has no firm statistics, Hansen estimated the carotid restraint is used relatively rarely within the department. But like a police baton, hand- and arm-control holds or pepper sprays, it should remain in the nonlethal arsenal of peace officers, he said, for the safety of officers and the public.

"What Los Angeles has done is they have taken the carotid hold and said it is a deadly force option," he said. "That makes the firearm and the carotid hold equal."

That's a dangerous precedent, Hansen said. And the result of Los Angeles bowing to political pressure and the fear of lawsuits.

"Under those circumstances, it would be silly to even try a carotid hold," he said. "There's no reason to put a deadly force hold on someone if I have a firearm and can do it from a distance."

Hansen said he goes to great lengths to train deputies what to do and what not to do when using a carotid restraint. But when subjects become combative, the safety of officers is immediately at risk.

That's when split-second decisions may become necessary.

"Even to consider applying it, you'd have to be in the midst of some struggle," he said. "You will probably be in the midst of combat."