A St. Mark's Hospital staff surgeon, who was in very critical condition Saturday, may have fallen or been the victim of a brutal assault, according to a Salt Lake County sheriff's office report.

Dr. John R. Ream, 52, Holladay, was discovered by a fellow doctor Friday about 7:30 a.m. draped over a railing in an east stairway between the second and third floor at St. Mark's, 1250 E. 39th South, the report says.Ream, an orthopedic surgeon, is known for his work in re-attaching severed limbs, particularly fingers and hands.

Investigators are looking into the possibility that Ream was assaulted and/or fell down the stairs. Emergency room personnel told investigators that due to the severe facial injuries and large amount of blood lost, an assault was more likely than a fall.

"His injuries were quite excessive for a fall," said Sheriff's Detective Barry Dalton.

"Nobody really knows what happened," Ione Knudson, a hospital nursing supervisor, said Saturday.

Evidence suggests that Ream fell down several stairs, lay possibly unconscious for a period of time on a landing, then regained consciousness and rolled down more stairs. At that point he steadied himself against the railing and passed out, according to the report.

Investigators are not sure how long Ream was there. He was treated in the emergency room and placed in the intensive care unit, where he remained Saturday.

A box of candy and a large pool of blood were found where Ream first fell. Marbles were found in the area. Some marbles were also found in the pockets of his clothing.

"He apparently had a habit of bringing candy and small toys to children and patients in the hospital," the report said.

Homicide detectives are investigating the incident.