Thread by @AnaViLastra

Day 9 of testimony continues this morning. We've heard folks testifying on use of force, MPD policy and now shifting to more technical/medical topics.

Here's a quick look at everyone who has testified so far in the #DerekChauvinTrial

kstp.com/news/who-has-t…

Court is now in session.

Eric Nelson is making a note about the state's intent to start calling their medical experts. Jerry Blackwell confirms they intend to call Dr. Andrew Baker who performed the autopsy on George Floyd. #DerekChauvinTrial

Live:

The state's first witness this morning is Dr. Martin Tobin.

Dr. Tobin is a physician who specialize in pulmonology and critical care. #DerekChauvinTrial

Dr. Tobin works in the medical intensive care unit at the Edward Hines, Jr. VA Hospital in Chicago. #DerekChauvinTrial

Dr. Tobin is from Ireland, in case you didn't notice the accent. #DerekChauvinTrial

Dr. Tobin is explaining his research, which he says is primarily focused on breathing. #DerekChauvinTrial

Blackwell is holding up Dr. Tobin's book on mechanical ventilation which has been called the "Bible on mechanical ventilation" by the Lancet Medical Journal. #DerekChauvinTrial

Blackwell: Minnesota is one of the states in the United States, how about Minnesota?
Dr. Tobin: I've lectured in Minnesota. I have been in the Mayo Clinic several times as a lecturer. #DerekChauvinTrial

Dr. Tobin: I'm primarily interested in breathing...how the brain sends signals down to the muscles that control your breathing...then how you expand your chest & how you overcome forces w/in your chest like resistance w/in your chest...to get air moving in and out of your lungs.

Jerry Blackwell asks if Dr. Tobin has served as an expert witness before. He confirms he has, but never in a criminal case. Dr. Tobin says he is not getting paid, "I thought I might have some knowledge that would be helpful to explain how Mr. Floyd died. #DerekChauvinTrial

Dr. Tobin: Mr. Floyd died of a low level of oxygen. And this caused damage to his brain that we see and it also caused an arrhythmia that caused his heart to stop. #DerekChauvinTrial

Dr. Tobin: The cause of the low level of oxygen was shallow breathing, small breaths. Small tidal volumes, shallow breaths that weren't able to carry the air through his lungs, down to the essential areas of the lungs, they get oxygen into the blood and get rid of the CO2.

Dr. Tobin is explaining how breathing works using this graphic. "That's everything in a very rapid video." #DerekChauvinTrial

Dr. Tobin says there are four forces that combined to cause Floyd to have shallow breathes. Prone on the street, handcuffed, knee on his neck and knee on his back. #DerekChauvinTrial

Dr. Tobin helped create an illustration to help show the positioning of the officers on George Floyd. He says an artist reviewed all of the videos to essentially combine them all into one illustration to clearly show those positions. #DerekChauvinTrial

Dr. Tobin explained the graphic. The squad was removed at one point to better see the positions of the officers. Again, Dr. Tobin says the illustration is based off of the videos. #DerekChauvinTrial

Dr. Tobin says Derek Chauvin's left knee is on George Floyd's neck for 90% of the time, according to his calculations. He says Chauvin's right knee was on Floyd's back for 57% of the time. #DerekChauvinTrial

Dr. Tobin says he saw Chauvin's right knee was on Floyd's arm or rammed in to his left chest. And says the two positions, "from the point of view of breathing, the effects are extremely similar." #DerekChauvinTrial

Dr. Tobin: The handcuffs on their own...are not that important is must be the handcuffs combined with the street."

He says the position of the handcuffs on Floyd's back, against the hard street and how they're being held/pushed and where they're pushed. #DerekChauvinTrial

Dr. Tobin is explaining how the body moves and the forces it uses to physically breathe.

"We have the ribcage muscles, the diaphragm does about 70% of what we need for breathing and about 30% of it comes from the rib cage." #DerekChauvinTrial

Blackwell offers up an exhibit that Dr. Tobin brought to explain the mechanics of breathing. Nelson says he has an objection to it. Now in a sidebar. #DerekChauvinTrial

The objection is sustained.

Blackwell moves on.

Dr. Tobin: What I observed is particular is in terms of the hands of the police and the handcuffs...they were forcing his left wrist up into his chest, forcing it in tight against his chest forcing it high up, & you have to keep in mind the opposite side of this is the street.

Dr. Tobin: It was almost to the effect as if a surgeon had gone in and removed the lungs...Along those lines, so there was virtually, very little opportunity for him to be able to get any air to move into the left side of his chest. #DerekChauvinTrial

Dr. Tobin is now using images from body camera video to explain why he believes Floyd's breathing was "enormously impaired" by the position of the handcuffs, etc. #DerekChauvinTrial

Dr. Tobin: The key factor you must keep...is the street. The street is what is having a huge effect because he's jammed down against the street. And so the street is playing a major role in preventing him from expanding his chest. #DerekChauvinTrial

I think because it's Dr. Tobin's first criminal case, he's not clear on the procedure of introducing evidence and when it's being shown to jurors, etc. #DerekChauvinTrial

Dr. Tobin notes Floyd's knuckles in R pic.

"To most people, this doesn't look terribly significant, but to a physiologist, this is extraordinarily significant, b/c this tells you he has used up his resources & he is now literally trying to breathe w/ his fingers and knuckles."

Dr. Tobin is now explaining these images that he selected to continue his explanation.

"It's what you have to do when everything else is failing...you will call on the use of the shoulder to try and breathe." #DerekChauvinTrial

Dr. Tobin asks jurors to examine their own necks and describes what they feel and its significance. #DerekChauvinTrial

Dr. Tobin: The hypopharynx...because it's so vulnerable...it has no cartilage around it, it's going to be an area that is compressed. It's extremely small to breathe through, and it becomes very important for being able to continue to breathe through. #DerekChauvinTrial

Dr. Tobin: That's the tongue there & then above it is an empty space & then above that is the top of the hard palate...the critical structure, in this case because the act of speech in Mr. Floyd becomes very important how he was able to speak and all these different things.

Blackwell: Then what if it had become totally occluded? Dr. Tobin: Within seconds, you're going to drop the level of O2 to a level that will be produce O2 deprivation in the body resulting in either a seizure or a heart attack, one or the other. #DerekChauvinTrial

Dr. Tobin asks jurors to look at him demonstrate first on his face and their own necks/skulls to understand the images shown.

They stop him and call for a sidebar as he's asking jurors to hold the back of their skulls.
#DerekChauvinTrial

Judge Cahill comes back and says "the witness has asked you to do certain things. These are not required. You may do them and he should phrase it more in terms of, if you were to do that. And if you wish to do it. That is your choice." #DerekChauvinTrial

Dr. Tobin continues his explanation.

Dr. Tobin says in the L image that Floyd is "actually using his forehead and his nose and his chin as a way of trying to help him get air into the right side of his chest..." #DerekChauvinTrial

Dr. Tobin is now explaining this graphic. He told Blackwell that this formula is used to understand the impact on everyone, not just specific to George Floyd.
#DerekChauvinTrial

(I'm not going to attempt to follow and condense for Twitter on this right now.)

Blackwell: In the case of Mr. Floyd, the narrowing was of his hypopharynx?
Dr. Tobin: It was in the hypopharynx. Yes.
Blackwell: Did the Mr. Chauvin's knee on the neck then cause the narrowing of the hypopharynx?
Dr. Tobin: Yes it did. #DerekChauvinTrial

Dr. Tobin notes that Chauvin's left foot is no longer touching the ground.

"So here, we're taking half his body weight, plus the weight of these half the gear weight, and all of that is coming directly down on Mr. Floyd's neck." #DerekChauvinTrial

This graphic is a little clearer of an explanation of my last tweet. #DerekChauvinTrial

Dr. Tobin: We know that his oxygen levels were enough to keep his brain alive and the reason we know that is because he continued to speak. Over that time we know that he made various focal sounds...from the time that the knee is placed on the neck.

Now in their first morning break.

Pool reporter notes that jurors were taking notes during Dr. Tobin's testimony this morning. Those that weren't "still appear to be listening intently." #DerekChauvinTrial

When Dr. Tobin asked jurors to examine their necks, the pool reporter notes that "most do it" and that they seemed "attentive and engaged by the visual aids." #DerekChauvinTrial

They're now back from break with Dr. Tobin. #DerekChauvinTrial

Watch live:

Dr. Tobin describes a movement made by George Floyd at one point during the incident. "...it means that he has kicked out his leg in an extension form...And that is something we see as clinicians in patients when they suffer brain injury as a result of a lower level of O2."

Dr. Tobin: For the first five minutes, the left knee is on the neck, virtually all of the time. The right knee, by my calculation...is on his back 57% of the time. The reason I can't say that it's on 100% is for the most of that other time I don't get a good view. #ChauvinTrial

New graphic up showing "tidal volume." Dr. Tobin says there is a standard size of breathe for everyone: young, old, male, female. #DerekChauvinTrial

Dr. Tobin calculated George Floyd's lung volume while sitting on the sidewalk. #DerekChauvinTrial

Blackwell asks if the EELV is commonly referred to as oxygen reserves. Dr. Tobin confirms and that some of the residual oxygen can be used by the body. #DerekChauvinTrial

Dr. Tobin based his calculation based off of Floyd's age, sex and height.

"The level of oxygen varies with age and this is exactly the level of oxygen you expect in a 46 year old man."

#DerekChauvinTrial

Dr. Tobin: You're seeing a drop in his end expiratory lung volume it's smaller when you're placed face down...so in anybody who is turned prone you see that the lung volumes will on average go down by about 24% by simply turning them prone. #DerekChauvinTrial

Dr. Tobin says the oxygen storage would also accordingly go down by 24%. That's not the absolute percentage, but that's the average change. #DerekChauvinTrial

Dr. Tobin: And in addition, when you're turned prone like this your work of breathing goes up because the stiffness of your lungs changes and the stiffness of your chest wall changes. So the person has to do more effort to breathe in that position. #DerekChauvinTrial

Dr. Tobin is now explaining why COVID-19 patients are treated in the prone position.

He says that a substantial number of people w/pneumonia can see better "matching" between blood vessels and the air sacs. "This does not apply to people w/normal lungs.

#DerekChauvinTrial

Blackwell: A lot of people sleep in the prone position.
Dr. Tobin: Yes.
Blackwell: Is that dangerous.
Dr. Tobin: No, b/c again for the average person you have so much reserves, so I mean, for a drop of 24% for you, it's not going to have any impact. #ChauvinTrial

Dr. Tobin says being prone w/the addition of the knee on the back reduces the EELV by 43%, which reduces oxygen reserves by 43% and says there's a "huge reduction" of the size of hyphopharynx. #DerekChauvinTrial

Dr. Tobin: So there's a huge increase in the work that Mr. Floyd was performing just to try and cope with what was happening below the neck, leaving aside what is happening above the neck. #DerekChauvinTrial

Blackwell offers up a new exhibit. You can see Eric Nelson & Derek Chauvin reviewing it, before saying "no objection." #DerekChauvinTrial

This graphic is expanding on the feed to mimic breathing. Dr. Tobin is explaining what these graphics show. One seated, the other prone, and the other adding compression. He says as you breathe in, the Hypopharynx expands with it. #DerekChauvinTrial

Dr. Tobin says the Hypopharynx expansion is reduced from the positions of sitting, prone and prone w/compression. #DerekChauvinTrial

Dr. Tobin says he's able to tell the precise time of where George Floyd lost consciousness.

He also notes "as an ICU doctor...we're always looking at facial features to be able to tell consciousness." #DerekChauvinTrial

Dr. Tobin: We're looking at the effects on Mr. Floyd's oxygen as a result of all the various maneuvers that are being done."

He says Floyd's level of oxygen dropped down to 36 mm Hg at the moment he lost consciousness.
#DerekChauvinTrial

Dr. Tobin says 20:24:53 or 8:24:53 p.m. was the moment George Floyd lost consciousness.

He says at 20:25:41 or 8:25:41 p.m. is when "he wouldn't have an ounce of oxygen left in his entire body." #DerekChauvinTrial

*deleted previous to correct time

Blackwell asks Dr. Tobin about studies suggesting that someone in the prone position with weight on the back is not dangerous.

Dr. Tobin: "The bottom line is they're highly misleading." #DerekChauvinTrial

Dr. Tobin: ...first of all, they take perfectly healthy volunteers to bring in to the physiology lab...oxygen is the exact wrong yardstick to be using in a study like this..." #DerekChauvinTrial

Dr. Tobin is now explaining this graphic which shows the study he called "highly misleading." #DerekChauvinTrial

Blackwell: So the pressure then being exerted by a knee is 10 times greater, is what you're saying?
Dr. Tobin: Is 10 times greater than what is going to be affected by the bell here that's showing from out of the gym. #DerekChauvinTrial

JB: Do any of these studies, involve a knee on the neck? DT: Nobody has done any studies involving the knee on the neck, I suspect, you'd have major trouble getting that through the ethics committee in any medical school. #DerekChauvinTrial

JB: Do you have an opinion to a reasonable degree of medical certainty as to whether...a healthy person would have died of the same circumstances as Mr. Floyd?
DT: Yes, a healthy person subjected to what Mr. Floyd was subjected to would have died as a result...

JB: ...If you can speak you can breathe. Is that a true statement.
DT: Yes. It's a true statement, but it gives you an enormous false sense of security, certainly at the moment you're speaking, you're breathing, but it doesn't tell you you're going to be breathing 5 secs later.

Dr. Tobin notes George Floyd continued to speak for 4 min & 51 secs from the time the knee is placed on his neck.

"It tells us that there could not have been complete compression could not have been total occlusion of the neck." #DerekChauvinTrial

Dr. Tobin: If you stop the flow of oxygen to the brain you lose consciousness in eight seconds.

#DerekChauvinTrial

Dr. Tobin: It tells you how dangerous is the concept of..."if you can speak, you can breathe." Yes, that is true on the surface, but highly misleading...a very dangerous mantra to have out there. #DerekChauvinTrial

They just played a short clip from a body worn camera showing Floyd's leg lift up backwards while in the prone position. Dr. Tobin says "that is something we see when somebody suffers major brain lack of oxygen...fatal injury to the brain from a lack of oxygen." #ChauvinTrial

Dr. Tobin: When you have a lower level of oxygen that's going to show up in the brain, and it's also going to show up in the heart, and when it shows up in the heart, it's going to cause their heart to beat abnormally. #DerekChauvinTrial

Dr. Tobin reinforces that "the leg is crucial here, because this is...the first time you're seeing there is major league oxygen damage." #DerekChauvinTrial

Dr. Tobin is now explaining how people speak. He says the average dimensions of a trachea are between a dime and a quarter, as pictured below. #DerekChauvinTrial

DT: I've shrunk the size of the coins...it tells you how dangerous it is to think well if he can speak he's doing okay...if there is a small increase in the amount of narrowing here not only will you not be able to speak, you won't be able to breathe, you won't be able to live.

Dr. Tobin: A major part of my work as a lung specialist is looking at people's breathing. You get an awful lot of information...the respiratory rate, it's one of the signs that tells us and it gives us a lot of clues as to what is happening inside the body. #DerekChauvinTrial

TW: They're going to play a video that Dr. Tobin used to review George Floyd's breathing. There's no audio.

Dr. Tobin is counting out the respiratory rates that he sees in the video. He counts 7-8 breathes in a roughly 17 second clip. #DerekChauvinTrial

Dr. Tobin's calculated a respiratory rate of 22. He says it's significant to this case because of the "question of fentanyl."

"So with fentanyl his respiratory rate should be down at around 10. Instead of that, it's right in the middle of normal at 22." #DerekChauvinTrial

Dr. Tobin says the normal respiratory rate is between 12 and 22. He says Fentanyl would have lowered it. #DerekChauvinTrial

Dr. Tobin says George Floyd took his last breathe or last attempt to breathe at 20:25:16 or 8:25:16.

#DerekChauvinTrial

Dr. Tobin says nine minutes and 50 seconds from when Floyd took his last breath is when paramedics were able to insert a device into his throat.

He says that's significant because CO2 increases at a predictable rate when someone is not breathing. So it would build up.

JB: So doctor, what's the punch line with respect to that?
DT: It's a second reason why you know fentanyl is not causing the depression of his respiration. #DerekChauvinTrial

Dr. Tobin says someone w/heart disease that's causing shortness of breath "are going to have very high respiratory rates." Floyd's rate was normal at 22. #DerekChauvinTrial

Dr. Tobin: ...I work in an ICU where 40% of our patients die so I'm extremely familiar with seeing people who die unfortunately...when you see these changes you see the changes in the face. #DerekChauvinTrial

They're playing video and Dr. Tobin points out the moment when Floyd's eyes flicker in consciousness...and then when he is no longer consciousness. He then marks a point & says "That's the moment the life goes out of his body." #DerekChauvinTrial

^no longer conscious

Dr. Tobin leaves the jurors w/ this: Chauvin's knee stayed on Floyd's neck for another 3 min and 27 secs after his last breath, remains after there's no pulse, and continues for 2 min and 44 secs after the officers have found no pulse. It stays for another two mins 44 secs.

They are now on lunch break. Back at 1:30 p.m.
#DerekChauvinTrial

Pool reporter wrote this: "I'm struck by how engaged jurors were through this whole testimony. Despite technical nature they took notes and remained attentive throughout." #DerekChauvinTrial

Pool reporter also notes that "jurors lean in toward monitors" while video played and Dr. Tobin notes when Floyd lost consciousness.

They also noted that Floyd's family member "doesn't appear to look at a screen" during that video. #DerekChauvinTrial

Eric Nelson starts his cross examination of Dr. Tobin.

Some laughs in the courtroom as Nelson says, "I'll take a sip. Cheers, like they say in Ireland." #DerekChauvinTrial

Live:

Nelson is now asking Dr. Tobin about his decision to be an expert witness for the state for free, his fees for being expert witnesses, etc.

Nelson establishes that Dr. Tobin is not a Minneapolis Police officer. He says, correct. #DerekChauvinTrial

Nelson: It's fair to say that the training that is provided by the Minneapolis Police Department in terms of medical care comes nowhere close to your level of expertise.
Dr. Tobin: Correct. #DerekChauvinTrial

N: I think you testified that you've watched these videos, hundreds of times...and you've watched them all from different angles...and you've had the luxury of slowing things down, moving it into slow motion, still framing various times. Right?
DT: Correct.

N: You've also been able to spend a substantial period of time preparing the exhibits...Right?
DT: Correct.
N: You provided those to the prosecution, in advance of today's testimony?
DT: Correct.
N: You understand those were provided to me last night?
DT: I have no idea when.

Nelson: You've taken this case, and you've literally boiled it down into a nanosecond.
Dr. Tobin: Well I wouldn't say that...

#DerekChauvinTrial

N: You would agree with me that as this incident was occurring there was nobody measuring the units of force that were placed on any particular position of any particular person...there was nobody there measuring them at the time.
DT: I agree that, but they're all calculable.

Nelson: They're looking at things beyond a nanosecond. Right?
Dr. Tobin: No, I mean, I think, in terms of a pathologist, they're looking at a nanosecond, they're looking at the nanosecond of death. #DerekChauvinTrial

Nelson: They're making an inference based on a pathological time point considering a multitude of biological factors that are involved in the death of a person, right?
Dr. Tobin: I mean it's the same as any physician is looking at it multitude of factors. #DerekChauvinTrial

DT: ...the low level of oxygen caused the damage to the brain, the low level of oxygen separately cause the pulseless electrical arrhythmia.
N: So it's an example of how multiple processes are occurring simultaneously...
DT: It's a low level of oxygen that's doing both...

Nelson asks about the "if you can speak, you can breathe" analysis. "You describe this as a very dangerous proposition...causing a false sense of security to people." #DerekChauvinTrial

Nelson points to something in Dr. Tobin's report about how physicians can confuse a diagnosis when a patient comes in expressing a difficulty to breathe.

Dr. Tobin says he was writing to hyperventilating, says it's "very different than the difficulty with speech."

N: You would agree that your calculations are generally theoretical, correct?
DT: No, they're not theoretical. I mean they're based on direct measurements. #DerekChauvinTrial

Nelson: You're making certain assumptions in the application of that science...
Dr. Tobin: Very few assumptions.

Nelson goes on to list Chauvin's weight, gear weight, etc. #DerekChauvinTrial

Nelson struggles to say respiratory rate, laughs and says, "I can't say it. I'm taken by your accent."

Laughter in the courtroom.

Nelson eventually says it the way Dr. Tobin says it. #DerekChauvinTrial

N: You would not describe him as hyperventilating.
DT: The word hyperventilation is open to an awful lot of misinterpretation. That is most certainly not hyperventilation. #DerekChauvinTrial

N: Mr. Floyd was a smoker, and smoking, changes the lung function...I'm not suggesting that people who smoke have lung problems, right?
DT: Less than 10% do. 90% don't have any. #DerekChauvinTrial

Nelson says "the end result of fentanyl can include respiratory depression."

Dr. Tobin says yes, but through neural receptors. #DerekChauvinTrial

Nelson asks Dr. Tobin to explain what wooden chest syndrome is...

"Some patients with fentanyl, you'd get an increase in chest was thickness..." #DerekChauvinTrial

Nelson asked a question related to evidence introduced yesterday showing pills in a squad car. Blackwell objected. Cahill overruled, but then changed his decision telling Nelson to ask in the form of a hypothetical. #DerekChauvinTrial

Nelson ask if partially ingested pills contain both fentanyl and methamphetamine had the DNA of the decedent, "is it fair to say that you would expect a peak fentanyl, respiratory depression, within about five minutes?"

Dr. Tobin: I mean obviously it will depend on how much of it was ingested a minute, just finding the pills won't tell you anything about whether any of it was ingested or some of it or anything.

He does confirm that if any is ingested, the peak would be in about 5 min.

Nelson is now asking Dr. Tobin about the moment George Floyd kicked. Earlier called that moment "key" in showing injury. #DerekChauvinTrial

Nelson: Would it be reasonable for a police officer to interpret that same behavior as resistance?

State objects and it's sustained. #DerekChauvinTrial

JB: You just asked a lot of questions about science and medicine, changing, constantly changing, evolving by the nanosecond by the millisecond, you hear all that...
DT: *chuckles slightly* yes I did. #DerekChauvinTrial

JB: Did you see him get off of the back of Mr. Floyd by the nanosecond...in the 9 min and 29 sec that you saw him on.

DT: No.

#DerekChauvinTrial

JB: There was also a reference made to the absence of bruising on the neck...Does that make any difference to you whatsoever?
DT: No, because obviously...whenever I go to church I sit on a hard bench. I don't get bruising of my buttocks when I leave. #DerekChauvinTrial

JB: If somebody has suffers, or dies from low oxygen. Does that show up on autopsy?
DT: No it does not...because low O2 is a functional thing just like an arrhythmia is a functional thing it doesn't, it doesn't leave a fingerprint on the autopsy. It's just there. #ChauvinTrial

JB: I think you were asked questions about nicotine, remember that?
DT: Yes.
JB: He didn't die from nicotine?
DT: *chuckles slightly* No he did not. #DerekChauvinTrial

Nelson asked twice if fentanyl could cause death as a result of low O2. Both times, Dr. Tobin attempted to say yes, but...

#ChauvinTrial

Blackwell asked the final Q before Dr. Tobin was excused.

JB: You're familiar with the way people die from fentanyl. Do they, or do they not go into a coma, before they die from a fentanyl overdose.
DT: Yes.
JB: Was Mr. Floyd ever in a coma?
DT: No.

There now taking a quick break before bringing in the next witness. #DerekChauvinTrial

Dr. Daniel Isenschmid is a forensic toxicologist with NMS Labs in Pennsylvania.

They're going over his educational background. #DerekChauvinTrial

Dr. Isenschmid tells Erin Eldridge he reviews 7,000-8,000 cases/year and receives 12-1,300 requests for testing/day.

#DerekChauvinTrial

Dr. Isenschmid says the most notable finding in the hospital blood was the presence of fentanyl (11 nanograms/milliliter. Methamphetamine was found at 19 nanograms/milliliter. #DerekChauvinTrial

Dr. Isenschmid says the level of methamphetamine "is actually approximately the amount that you would find in the blood and with somebody that was given a single dose of methamphetamine, as prescribed." #DerekChauvinTrial

Eldridge: asks if Fentanyl levels can vary widely depending on an individual. Dr. Isenschmid says yes, because of tolerance. #DerekChauvinTrial

Dr. Isenschmid tested both blood and urine samples. He found morphine in the urine, but not in the blood.

Eldridge: And again, is that because it shows up in in urine longer than than blood?
Dr. Isenschmid: Yes. #DerekChauvinTrial

Dr. Isenschmid is explaining this graphic. It shows Fentanyl metabolizing into Norfentanyl. #DerekChauvinTrial

He's now explaining this graphic of data from NMS Labs from 2020. #DerekChauvinTrial

Nelson is now cross examining Dr. Isenschmid.

N: There's no way to determine at what point any particular amount of fentanyl was ingested, agreed?
DI: I would agree with that.

#DerekChauvinTrial

N: When we're talking about the illicit street drugs that involve or include fentanyl, you have really no way of knowing what the particular fentanyl concentration is literally from pill to pill.
DI: Yes. #DerekChauvinTrial

In 2020, @ryanraiche reported on counterfeit pills and the difficulty in knowing how much fentanyl are in them. In 5 INVESTIGATES learned federal agents seized about four times as many counterfeit pills compared to all of last year.

kstp.com/news/dea-lsquo…

Eldridge calls for a sidebar. It seems like there's confusion about a report Nelson is citing. Dr. Isenschmid said it wasn't correct and he corrected it the other day. #DerekChauvinTrial

They're now going to take a 20 minute break while they figure it out. #DerekChauvinTrial

Nelson: It's my fault, because apparently the second version on April 6, I must have looked and just assumed it was a second copy of the same thing. #DerekChauvinTrial

Nelson is back cross examining. Apologizes to Dr. Isenschmid saying "I was working from a previous copy of your presentation" before moving on to questions. #DerekChauvinTrial

Here's Derek Chauvin as his attorney pauses and flips through some papers after questioning Dr. Isenschmid about fentanyl deaths. #DerekChauvinTrial

Nelson's voice seems to be fading and rougher as he continues to talk than before the break. #DerekChauvinTrial

Nelson asks if Dr. Isenschmid has heard the terms "goofball" or "speedball."

Isenschmid has not heard the term goofball as it relates to drugs.

Nelson wraps. Eldridge is back to redirect.

Eldridge: You were asked some questions about your lab, NMS and the testing that was performed in conjunction with accreditation standards...& did NMS follow all the standard operating procedures when it came to that testing?
DI: We did.

N: How can you answer that question. When we don't know the context of how people actually died?
DI: Because we still looked at a large number of data within, within that population. #DerekChauvinTrial

N: So, you have no frame of reference in terms of the what did the person actually die from I mean...what if of the 19,185 post mortem cases 19,184 of them were gunshots.
DI: That's not really the possibility
N: Nothing further. #DerekChauvinTrial

Now Dr. Bill Smock is on the stand. He's an emergency medicine physician w/specialized training in forensic medicine. #DerekChauvinTrial

Jerry Blackwell is holding up one of four books that Dr. Smock edited. #DerekChauvinTrial

Dr. Smock confirms he is being paid to be a state expert witness. "Yes, sir I am. and I hope so otherwise my wife will be very [un]happy with me."

His hourly government rate is $300. #DerekChauvinTrial

Dr. Smock says George Floyd died of positional asphyxia.

Blackwell asks Dr. Smock to walk jurors through the signs of excited delirium. #DerekChauvinTrial

Blackwell is now asking Dr. Smock about the fentanyl and methamphetamine found in Floyd's blood.

On methamphetamine: "It's really a nothing level. It's a level you expect to see with a recreational use of methamphetamine and clinically, saying, extremely low level."

Dr. Smock: You can be fatally strangled, die of asphyxia and have no bruising. #DerekChauvinTrial

DS: The example that I like to use is, you can have someone put their bicep and forearm on either side of your neck & squeeze render you unconscious, even kill you & you will never ever see a bruise on the neck...you're applying a broad surface area...to a broad surface area

TW: THey're playing Keung's body camera video w/audio. #DerekChauvinTrial

JB: Why is this relevant to your assessment?
DS: This first section that we're looking at, listen to Mr. Floyd's voice. He's speaking w/ full volume...as we go through these different segments, compare what we're hearing now to what we hear later. How his voice changes.

Dr. Smock also tells jurors to watch for Floyd's right arm. He says it's important because it shows what Floyd is doing to try and breathe.

Dr. Tobin also marked that as a significant sign. #DerekChauvinTrial

The video is still playing. #DerekChauvinTrial

JB: At what point should CPR have been commenced?
DS: Way before it was. As soon as Mr. Floyd is unconscious. He should have been rolled over.
We have documentation on the video that the officer says, I can't find a pulse. #DerekChauvinTrial

Eric Nelson is now cross examining Dr. Smock.

Nelson: Fair to say you're not a pathologist.
Dr. Smock: That's correct. #DerekChauvinTrial

Nelson: So there are variables, but essentially methamphetamine and fentanyl combined is different than the reaction to fentanyl.
Dr. Smock: That is correct, sir. #DerekChauvinTrial

Nelson: But in terms of street level, street purchased methamphetamine there would be no valid medical basis to have that in your system?
Dr. Smock That is correct for methamphetamine. #DerekChauvinTrial

Nelson: Did you see any medical autopsy or physical, excuse me, any physical evidence from the autopsy that can point to Mr. Floyd's airway being obstructed?
Dr. Smock: No sir, not in the autopsy. #DerekChauvinTrial

Nelson: People who have their respiration suppressed, as a result of fentanyl, don't necessarily all the time die, right?
Dr. Smock: That is correct...hopefully they don't. #DerekChauvinTrial

N: You are aware that people who are in the ICU with COVID are oftentimes held in the prone position...that actually assists them...they don't necessarily suffer a sudden death, right?
DS: Yes.
#DerekChauvinTrial

N: You've reviewed the videos many times.
DS: I have spent a lot of time studying and analyzing the videos. Yes sir.
N: How many hours would you estimate that you had spent?
DS: Analyzing the videos...10 #DerekChauvinTrial

N: Based on your experience and training police officers...you've observed police officers use a prone handcuffing technique.
DS: Yes I have for short periods of times.
N: You've observed them place their knee...on the base of the neck?
DS: Yes again for short periods of times.

N: Brain damage can occur from low O2...When Mr. Floyd was speaking to the police officers, as he was in the prone position, do you see any evidence that his brain was injured at that point?
DS: Which part b/c he speaks in full sentences...but later on, his speech is weaker...

N: Can people suffer brain injuries while they're conscious?
DS: Depending upon the mechanism. Stroke, would be an example. Hit in the head would be another example. #DerekChauvinTrial

N: So if someone's not using a controlled substance for several months, let's say two to three months, and then they're going to lose that tolerance...
DS: Some part of it, they may, depending upon the substance. #DerekChauvinTrial

N: A person at a greater risk for cardio respiratory effects if they're under the influence of methamphetamine?
DS: It would depend upon the level.
N: How about a combination of methamphetamine and fentanyl?
DS: Again, it's going to depend upon the level.

Blackwell: Was there any evidence that you saw that George Floyd had a heart attack?
Dr. Smock: There was absolutely no evidence at autopsy of anything that suggested Mr. Floyd had heart attack. #DerekChauvinTrial

Blackwell says "can you think of from any stretch of the imagination you could refer to being subdued and restrained on the ground for nine minutes and 29 seconds until you until the pulse was gone, as a stress test..."

Nelson objects, Cahill sustains.

B: Did you see any evidence that Mr. Floyd died of a meth overdose.
DS: No sir, he did not.
B: Did you see any evidence that he died of a fentanyl overdose.
DS: No sir, he did not.
B: ...any evidence putting them together he died from that kind of an overdose.
DS: No sir...

Nelson: So, the more someone is used to taking a particular drug, the fewer signs of impairment, they may exhibit?
Dr. Smock: That's correct, sir. #DerekChauvinTrial

Adjourned until 9:15 a.m. tomorrow. #DerekChauvinTrial