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8 Apr, 256 tweets, 37 min read
Judge Cahill tells jurors they don’t have to follow along with Dr. Tobin’s suggested exercises to feel their neck anatomy, but they are “welcome” to do so if they wish. Tobin’s testimony has resumed after the sidebar.
Dr. Tobin says that in the image on the right, it’s visible how Chauvin has increased the pressure leading to more severe compression of the hypotharanx. Compares trying to breathe like this to “breathing to a drinking straw...except it gets way worse than that”
Tobin describes how it is possible to calculate the degree of force Chauvin is pressing into Floyd based on his weight and boots etc
Another sidebar requested
Tobin is walking the court through this graphic explaining “the effort required to breathe”
“This is much more narrow than breathing through a straw”
Effort required to breathe increases significantly as the hypotharanx is narrowed
Tobin presents the court a physics equation that informs scientific understanding of the effort required to breathe
“At some stage...[narrowing of the hypotharanx] becomes unsustainable, you’re not going to be able to do it.”

Tobin tells Blackwell that the knee on the neck did in fact place significant pressure on the hypotharanx
“What you’re seeing is the orientation of Officer Chauvin, his body build is quite erect here, but what you’re seeing is that his toe is not touching the ground. This means that all his body weight is being directed down at Mr. Floyd’s neck...”

-Dr. Tobin
“Half of his body weight...is coming down directly on Mr. Floyd’s neck...the toe is off the ground and there’s no body weight sitting back, hunkering back, so all the weight is being directed down to the knee...”
“We know that his oxygen levels were enough to keep his brain alive, and the reason we know that is he continued to speak, he made various vocal sounds for 4m 51 secs from the time the knee is on his neck...you can’t speak without a brain being active...”
Another sidebar, seems to have been called by Judge Cahill
Sidebar done
Judge Cahill asks for a good time for mid morning break, Blackwell says “now would be a good time”. Court is now in recess.

Thanks for choosing UR as your source for coverage of the #DerekChauvinTrial, we will keep doing our best to bring you updates here as fast as we can.
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We apologize for giving incorrect instructions about muting trauma content previously in this thread, in a tweet which has been deleted.
Court is back
Dr Tobin says that “when he has suffered brain injury...we can tell from the movement in his leg...that he has kicked out his leg in an extension form...that is something we see as clinicians in patients when they suffer brain damage from a low level of oxygen...”
“For the first five minutes, the left knee is on the neck virtually all the time...by my calculation the right knee is on his neck 57 percent of the time...I say that because...the cameras were moving around [and I couldn’t see everything that happened” -Dr. Tobin
Blackwell enters exhibit 129 - an illustration of "lung function and tidal volume” created by Dr. Tobin
“About 400 ccs is the normal tidal volume” for adults, “including teenagers and grandparents”.
Tobin says he calculated George Floyd’s tidal volume and explains in extremely fine grain technical detail how those volume levels interact with the conditions that led to his death
EELV or End-Expiratory Lung Volume is “where your oxygen reserves are stored..:the volume that’s in your lung between each breath...in between your in and out, what’s remaining in your lung is your EELV”
Dr Tobin calculated the reduction in George Floyd's EELV on may 25, 2020 due to "prone lung position"

“It’s smaller when you’re face down...your lungs are going to get smaller...you’re going to have greater difficulty...as you lay down your belly is going into your chest...”
“Lung volume will go down by 24 percent simply by turning them prone...the oxygen stores will go down by 24 percent as well...once you have less volume in your lungs your oxygen levels are going to go down proportionally...” -Dr. Tobin says there’s a 2-4 percent variation in this
Blackwell asks if someone suffering from COVID may be treated in the prone position
Tobin says “Any patients w pneumonia, particularly w COVID, you can turn them over...if you flip those patients prone some of them will show no improvement but some will get better” “due to matching improving between blood vessels and air sacs” this doesn’t apply w healthy lungs
Tobin tells Blackwell that it’s fine for people to sleep face down bc of the oxygen reserves in their lungs
Asked if it matters if a knee was on Floyd’s back, neck or side, Tobin says “the effect is the same...it’s going to impair your ability to move your chest...you need to keep in mind this is happening on the street...[which] is totally preventing anything coming in from the front”
“What you’re seeing here is that it’s not just prone, you also have knee on neck or back...this is going to “squash down” the EELV...you’re seeing a 43 percent reduction...which also means a huge reduction in the hypotharanx...
an additional effect is your work of breathing goes up...with each breath he has to try to fight against the street...he has to try to lift the officers knee of his neck/back” also says how the other officer twisting his arm up is another severe restricting factor
“You’re looking at a more than threefold increase in the work of breathing...and that’s leaving out the knee on the neck...just trying to cope with what is happening below the neck...”
“Weee looking at the effect of the lungs on the hypotharanx beginning w Mr Floyd sitting on the sidewalk...as you inspire, the size of the hypopharynx is also increased”
“Now we can see that Mr. Floyd has been turned prone and his lungs and hypopharanyx are smaller”
Correction: it’s spelled hypopharynx, we were misspelling it for a lot of this thread
Tobin describes being able to tell if a patient is conscious or unconscious by “inspecting” via looking at their eyes and face
“We know that the moment people lose consciousness, the level of oxygen in your blood will be 36...very hard scientific data telling us that...in a 46 year old man you expect the normal level is 49, the moment at which you would have a loss of consciousness is 36...”
"We’re looking at the effect on Mr. Floyd’s oxygen levels of the various maneuvers that are being done to him...you can calculate based on very rigorous science when the level of oxygen will go to zero...”
“Once he stopped breathing at 20:25:16, it would take another 25 seconds for tbe oxygen level to go down to zero...at that point there wouldn’t be an ounce of oxygen left in his body”
"We’re seeing that the level of oxygen has gone down to zero, at that point there's not an ounce of oxygen left in his body, this is based on very precise science...we see here that he reaches a level of zero of oxygen at 20:25:41..."
"the knee remained on the neck for another 3 mins and 2 seonds after we reach the point when there's not an ounce of oxygen left in the body"
Tobin is asked about studies that claim to show neck on back maneuvers are safe. Tobin names the authors of the study by name, says they are out of San Diego and that he considers the studies “misleading in nature” due to things like using soft mats instead of pavement
With very fast recitation of clinical and academic terminology, Tobin is basically saying he does not consider these studies to be at all relevant to examining what was done to George Floyd’s body.
These studies don’t concern EELV, Tobin tells the court
Exhibit 948: "If you look at the subject's back you can see 4 gym weights placed on the back... trouble is when officers knell on the back of a suspect they dont place an olympic weight on their back, they place their knee...pressure is force over area"
"the pressure being exerted on the back is ten times more than what the San Diego people are claiming...they are off by a doctor of ten"

"theyre all very brief studies" none of which go on for 9 mins 29 secs, Dr. Tobin says
Asked "if you can speak you can breathe" is a true statement, Tobin says "its a true statement but it gives you an enormous amount of false security...certainly when you can speak you are breathing but it doesn't mean you are breathing five seconds later"
“You cannot blow air out if you didn’t take air in beforehand...you cannot speak if you didn’t take a breath...also...if someone speaks you know...there is oxygen going into their brain at the time they are speaking”
"the brain is the most sensitive area to needing oxygen"..."the brain is relatively small, it's only 2 percent of our body weight but it takes in 20 percent of all the oxygen that we take in...the brain eats up oxyugen at 10 times the normal level..it nees a huge level of oxygen”
"If you stop the flow of oygen to the brain you lose consciousness in 8 seconds” Tobin

“If you can speak you can breathe, yes that is technically true but it’s highly misleading... a very dangerous mantra”
Blackwell pulls up exhibit 27 at 20:24 - a clip from body cam footage.
Tobin tells the jury he sees "a key finding..when you see his leg going up...you have to keep in mind he's prone...so this is his leg coming up backwards, what we call as clinicians an extension movement of the leg...that is what we see when someone suffers major lack of oxygen”
“The bottom line is the leg jumps up like that as a result of a fatally low level of oxygen going to the brain” -Dr. Tobin
Blackwell now asking Dr. Tobin about the physical signs of PEA or pulseless electrical activity, Tobin describes PEA as “where were seeing there’s electricity in the heart but it’s not resulting in any mechanical force...”
“This is the first time where you’re seeing that there is major league oxygen damage”
Blackwell shows other exhibits - Dr. Tobin says "this is the same MRI that you saw before but what your attention is drawn to by the yellow arrow is the vocal cord...to speak you must take air into your vocal chords and vibrate...that's what makes the sound of speech"
Tobin also discusses dimensions of trachea and talks about how much scarring in windpipe can "prevent you from speaking"
size of a normal trachea is between a quarter and a dime
"even when the trachea has been narrowed down to 15 percent you are still able to speak...as shown here, so it tells you how dangerous it is to think if he can speak, he's doing okay... at this point you won't only be able to speak, you won't be able to live...
... so it's a very dangerous thing to think that if you're able to speak you're able to breathe...."
Blackwell just pivoted to asking Tobin to go into some detail about his physiological research into breathing. Talks about the importance of monitoring the pace of breathing to know “what is going on inside the body”.
Tobin says he’s done this “millions of times” and trained students, doctor and nurses in it.
Blackwell plays the court body cam video of Floyd being held down prone on the ground as Tobin watches his breathing and counts each breath out loud.
The pace is “extremely significant”, Tobin says, bc “one of the questions in this case is the effect of fentanyl and if fentanyl is effecting...it’s going to show...a 49 percent reduction in the respiratory rate...instead it’s right in the normal at 22...”
Floyd’s respiratory rate was normal just before he lost consciousness, Tobin tells the court
"he's reported to have a carbon dioxide level in the arterial blood in the emergency room of 89...thats a very high level of carbon dioxide...so you have to take into account what factors may have led to that...”
normal CO2 levels is 35-45, says Tobin
"important factrrs to know are that he made his own spontaneous effort to breathe...after that you can see he makes no effort...then we know after that he stayed on the street for another 3 mins or so, then we know in the ambulance they attempted to make an airway...
... you can see that on Officer Kueng's bodycamera, and you can see the time at which they actually inserted the airway and gave him his first breath...that is a gap of 9 mins and 50 secons from when he took his least breath."
*last breath
This can be calculated via carbon dioxide levels - "if someone doesnt take a breath carbon dioxide increases at a preditcable rate"
"its a second reason why you know fentanyl is not responsible for the depression in breathing...it's what you expect to happen to anyone who doesn't have any ventilation given to them for 9 mins and 50 secs...it's completely predictable"
Asked for his observation of the last mins of George Floyd's life, Dr. Tobin says "we're observing..the change in his facial appearance [due to the] effects of low oxygen...43 percent of our patients die so i'm very familiar w watching people die..you see the changes in the face"
Blackwell is showing the court and asking Tobin to narrate a slowed-down video which shows the change in George Floyd’s face as “you see in his eyes that he is conscious, and then you see that he isn’t. That’s the moment you see the life goes out of his body”
Tobin is now rapidly narrating over clips of body camera of officers restraining Floyd. Too fast to catch it all so here’s a sample of the start of his narration:
"you can see in his hip how he is rocking the right side of his body to try to breathe... you can see how is pressing on the street to try to get air in...keep in mind the left-side is nonfunctional from the way they have manipulated him..."
The state just ended its direct examination of Dr. Tobin (“no further questions”). Judge Cahill invites Nelson to cross, Nelson asks for a sidebar. Sidebar ends suddenly just now, Cahill tells jurors that lunch break is starting NOW & will go “til 1:30” (that’s central USA time)
Court is resuming now (new stream link): twitter.com/i/broadcasts/1…
Nelson is cross-examining Dr. Tobin - asks him about waiving his fee for his testimony in this trial, how he hasn't testified in a criminal trial before, what he reviewed with the prosecution in his preparation w prosecutors for his testimony, toxicology reports, police reports
Nelson solicits Tobin's agreement with the fact that Minneapolis police officers have nowhere near his level of medical knowledge and in fact only generally have somewhat low-level medical certifications
Nelson asking about the date of various phone convos, including January 30, 2021, that Dr. Tobin had with the state during preparations for his testimony
Nelson asks if Tobin has had a substantial amount of time to prepare his exhibits which he gave the prosecution before today, Tobin says yes. Asked by Nelson if he "knew that these were just provided to me last night" Tobin says no.
Nelson asks Tobin about his citation of a physics equation in his explanation of breath, Nelson says "when you talk about the science of physics, its constantly changing right?...the formulas and variations will change. Tobin responds to say yes, science is always changing
Nelson: you've taken this case and literally boiled it down to a nanosecond

Dr. Tobin: "i wouldn't say that, no, if you look in my report you see a whole chronology. I start with the knee on the neck and it ends at the Hennepin County ER"
Nelson characterizes Tobin's presentations and testimony as presenting facts in a rapid and oversimplified manner, Tobin disagrees
Nelson again tries to get Tobin with a "nanosecond" comment when asking if pathologists should "look beyond a nanosecond' -

Tobin: "in terms of pathologist they are looking at a nanosecond, the nanosecond of death...they're making an inference about a pathological time point"
Nelson: you concude Mr. Foyd died as a, we'll call it a hypoxic death

Tobin: he died of a low level of oxygen which caused damage to the brain
Nelson: its an example of many processed simultaneously

Tobin: not really its one process affecting the others

Nelson: and the others are all being affected together

Tobin: no it's really just two, the brain and the heart
Nelson asking Tobin if he saw Chauvin kneeling on a particular ligament on the neck, Tobin agrees
Nelson now asking about the hypopharynx "being photographed...[with] no injury noted", Tobin says yes
Nelson: intelligent men and women who graduate college and go into the field of medical school sometimes have trouble with... a patient comes in and says they're having trouble breathing and a physician will not believe them necessarily
Tobin: we're talking about speech, and having trouble breathing, they're not the same
Nelson asking Tobin about a quote in his report about "hyperventilation syndrome" of patients saying "I can't breathe" when they actually can. Prosecution objects on hearsay, Judge Cahill overrules the objection. Tobin says that some docs sometimes "miss the diagnosis"
Nelson smiles and says "i'm losing my voice" as he takes a swig of bottled water
Nelson asks Tobin that "if a Minneapolis police officer tells a person, if you can talk you can breathe, you'd have a problem with that?"

Tobin: yes because they could die in ten seconds
Nelson: your weight measurements assumed equal measurement distribution between the right and left legs

Tobin: yes

Nelson: but we know weight is often readjusting

Tobin: yes

Nelson: you're basing that on assumptions of a normal healthy person

Tobin: for EELV it doesnt matter
Nelson: other factors like you said...

Tobin: lung compliance will vary...different segments in the lung...they're not monolithic
Nelson: in terms of the prone position, the pushing the stomach into the lungs, the size of the stomach has some bearing on that, someone like me who has a few extra inches, its not going to help to have that pressing up...?

Tobin: yes?
Nelson: we understand from his medical records, Mr. Floyd had heart disease...that's gonna affect blood flow in a person right?
Tobin: no...if the coronary is affecting it and if the coronary artery was contributing to shortness of breath you can expect complaints of chest pain
Nelson now asking about some of the finer statistical point of the earlier discussion of treating covid patients while face down and what that has to do with pulmonary physiology
Nelson: in essence, every person is different

Dr Tobin: for certain
Nelson: in terms of the toxicology of Mr. Floyd we learned there were controlled substances ...such as nicotine, we know he was a smoker. Nicotine changes the lung function?

Dr Tobin: in some people
Nelson: I don't mean to say that all people who smoke have lung problems

Dr Tobin: less than ten percent have any
Nelson asks about depressant effects of fentanyl - asks about the different makeups of street and pharmaceutical products, asks that isn't it true that every time they take a fentanyl dose its a different experience
Tobin: if it acts through the nervous system its going to act on the medulla oblongata , not some other mechanism, if its going to effect the respiratory system
Nelson asking Tobin about known properties of methamphetamine, mentions it can be prescribed for ADHD
Nelson asks about use of fentanyl in a hospitals, what "wooden chest syndrome" is

Tobin: "some patients w fentanyl you get an increase in chest stiffness"

Nelson: that would decrease the performance of the lungs?

Tobin: it would impact the ability of the lungs to expand
Nelson asking about the "substances found in the back of squad 320"

Tobin: i've heard reports to that effect, i don't know what the status of it is ... I've been provided with a lot of info, i don't necessarily keep it all at the front of my brain
Nelson asks again about the pills found in the squad car

prosecution objects, judge overrules objection
Nelson: yesterday a person from a chemistry forensics lab testified in this case

Judge Cahill interrupts to say he will consider the objection after all. Sidebar now w court audio muted
Sidebar done
Nelson: let me ask a hypothetical, if partially ingested pills. thatwere determined to contain both fentanyl and methamphetamine were found partially ingested in the back seat of the squad car, and if those pills had the DNA of the deceased individual on them...
, meaning that they took them, and that those pills would have been in his mouth at about 20:18, is it fair. tosay you would expect a peak fentanyl respiratory depression in five minutes?
Tobin: it would depend on how much you took what the effect would be, but at any amount the effect would peak then yes...you're trying to really confuse me Mr. Nelson
Nelson asking about George Floyd's alleged "kick of the legs" he says is shown in the body camera footage

Tobin: there's additional information in the hand but the leg was the key

Nelson: wouldn't it be reasonable to say that a police officer could interpret that as resistance
State objects to Nelson's last question/implication, Judge Cahill sustains the objection. But the jurors heard it.
Nelson asking about the time gap between paramedic arrival and the first application of air, almost 9 mins, Dr. Tobin says yeah. Drive to the hospital was above 5 mins, Tobin says he wasn't aware of that but has no reason to dispute it.
Nelson's cross examination just ended. Jerry Blackwell from the MN state prosecution team starting his re-direct now "just a few questions, for clarifications sake. you were just asked about science and medicine evollving, changing, by the millisecond...
Blackwell....go to the period of time when Mr. Chauvin was on the back & neck of Mr. Floyd ...did you see him get off of him by the millisecond, the nanosecond, at all?

Tobin: N

Blackwell: he was there most of that time?

Tobin: Y

Blackwell: not constantly changing?

Tobin: N
Tobin says injuries on the hypopharynx are not extremely visible after the death. Says effects of low oxygen are not always easy to see after the fact, gives the example of suffocating someone with a pillow
Tobin laughs and says "no" when asked Floyd died from the nicotine Nelson asked about. Answers "no" in a more sober tone when also asked if Floyd died from effects associated with methamphatine or fentanyl. No signs of depressed breathing due to fentanyl, Tobin says
Blackwell's re-direct just finished. Nelson on re-cross now
Nelson: you testified his carbon dioxide was at an 86?

Tobin: I think it was 92

Nelson: generally speaking fentanyl could also cause death from low oxygen?

Tobin: it would have to go through the {inaudible]

Nelson interrupts and repeats the Q

Tobin: yes but only in part
Re-redirect from Blackwell:

Blackwell: don't people go into a coma before they die due to fentanyl?

Dr. Tobin: yes

Blackwell: any evidence of a coma in this case?

Tobin: no
Dr. Martin Tobin is done testifying. Court is on a brief break
Court is back from a slightly overtime 5 min break - next witness getting sworn in is Daniel Isenschmid, a forensic toxicologist at MMS labs in Horsham, PA since 2011, was chief toxicologist for Wayne County Medical Examiner etc and from 1982-1991 was at Maryland Medical Labs
Prompted by prosecution, Dr. Isenschmid is going over more of the extensive details of his career, training, education, and certification for his specialized career in forensic toxiciology
Asked to describe his day to day job duties at MMS - "I do case review...when toxicology reports are performed at MMS labs, particularly ones requiring many different types of tests, they wind up being reviewed...by analysts...but the final review comes to a toxiciologist"
Dr Isenschmid signs off on stuff - says he has reviewed up to 7,000 reports
"thousands of tests a day" involved in the general work at the lab, high volume activity. MMS is a licensed and accredited lab nationally in the USA
MMS received samples sent for testing from Hennepin County, taken from the scene of the killing of George Floyd - blood and urine
"most noticeable findings in the hospital was 11 nanomilligrams/ml of fentanyl... found meth at 19 nanomilligrams/ml"
"methamphetamine is a central nervous system stimulant...it can be prescribed for ADHD and also obesity, was experimented w use for treatment of narcolepsy...between 2016-2019 about 10,000 prescriptions written for it in the USA" - Dr. Daniel Isenschmid
Dr. Isenschmid says the methamphetamine levels in the blood sample would be consistent with a low level of a daily dose of prescribed use of methampetamine.
Dr. Daniel Isenschmid asked to describe fentanyl, says it is a powerful opioid ("opioids include natural, semisynthetic, and synthetic drugs... opiates are from [the poppy plant]... all opiates are opioids but not all opioids are opiates") compares it to morphine
Dr. Isenschmid is asked to describe the effects of tolerant - says if someone gets used to a drug you need more and more to get the desired effect

Prosecution attorney Erin Eldridge's Q: it would have a weaker effect w repeated use?

A: yes
Isenschmid asked about norfentanyl, a metabolite of fentanyl, being found in blood. He says its rare to find it in cases where fentanyl just caused a death because it is the product of a longer-term breaking down of fentanyl by the body's systems
Isenschmid says the urine sample was positive for cannabinoids, methamphetamine and fentanyl, opiates (morphine at 86 nanograms per milliliter). This level "can be indicative of prior use before the time of death"- shows up in urine longer than in blood
Dr. Isenschmid talks about finding caffeine, and a chemical thats a metabolite of nicotine, and THC at 2.9 nanograms per ML as well as a THC metabolite
Asked about impact of cannabinoids, Isenschmid says its hard to interpret w cannabinoids bc "they go into the fat" and can be released over time, says "anything with CPR would release them from the fat"
Eldridge asks Isenschmid about other substances found, the Dr. says they did find other levels of substances that came up but not in levels that merit mention in the report. However, these details were retained and provided as part of a "litigation package"
Eldridge asks about the presence of methamphetamine and amphetamine as well as saboxone, getting into the finer details of saboxone ("generic narcan") now
Asked "whats significant about using hospital blood for testing", Dr. Isenschmid says "after death there are changes that occur w blood concentrations especially with blood taken from the heart...drugs go from areas of higher concentration to areas of lower concentration"
"post-mortem redistribution" can make drug levels show higher in blood than was present at the time of death
Dr. Isenschmid asked about data MMS has drawn from its many methamphetamine and fentanyl cases - (Judge asks if "any objection for demonstrative purposes" - means jury won't take it into deliberations, doesn't seem to be any)
Correction: *NMS not MMS labs
George Floyd’s fentanyl levels were under the median level for blood samples tested by NMS Labs that were associated with DUIs.
Same report kind of thing happening now for the methamphetamine levels
Low levels around on the meth and fentanyl stuff, based on Dr. Isenschmid’s testimony. Direct from the state just ended. Nelson beginning cross exam for Chauvin defense now
Nelson asks Dr. Isenschmid if he was aware this was a significant case, he says yes. Asks about the accreditation for laboratories and why labs have thresholds "to be consistent in how toxicology is reported in various individuals...
one of those accreditation standards is that if a...substance...is below a threshold, you'd be told to not report it...
Eric Nelson: it's not common practice to report chemical components below the threshold, bc its contrary to the accreditation standards, agreed?

Dr. Isenschmid: it could depend but when it goes below those its not something we typically would do
Nelson asking about how analysts will decide to classify levels and thresholds in samples, the state objects ("overruled" -Judge Cahill)

Nelson: they could be told to disregard things based on the threshold rules?

Isenschmid: i don't work in lab, my scope limited to toxicology
Isenschmid: "the thresholds are not set bc of any standard", says labs make their own SOP (Standard Operating Procedures)
Nelson asks about various dates Isenschmid has met w prosecutors to prepare his testimony, clearly he is trying to get the idea across to the jury that Isenschmid and the state are in cahoots
Nelson asking about fentanyl and norfentanyl levels found in the sample - "one scenario is a person took a certain amount...and enough time passed to eliminate that...to break it down and have that metabolite present...
the other is...someone took some...that initial does began to break down and the other person took more so the active ingredient is there so id hadn't yet broken down...you describe it as an acute ingestion or a non-acute ingestion..." - Nelson
Nelson asking about the body processing drugs or alcohol while also still consuming drugs or alcohol - thats similar w all substances?

Dr. Daniel Isenschmid: in general yes, w some drugs it can be different
Nelson: there's no way to determine when any particular fentanyl was ingested right?

Dr. Isenschmid: yes

Nelson: its a controlled substance, yes?

Isenschmid: it can be prescribed in a patch, used in surgery
Nelson: thats a controlled manner...street drugs, you have no way of knowing what the concentration is from pill to pill...each time is unique

Isenschmid: true

Nelson: so any single incident could cause adverse reaction
Isenschmid: well if you suddenly had a pill that was 10x stronger than the other, yes
Nelson asks Isenschmid about the pills in the squad car, state objects, Judge Cahill sustains the objection. Nelson clears his throat and moves on. Asks "are you familiar with the term hooping?" state objects, Judge Cahill tells Isenschmid to answyer yes or no.
Isenschmid says he doesn't know.
Nelson now getting into some of the overdose data analysis from NMS Labs that was promoted during Isenschmid's direct examination testimony
Nelson says “it’s misleading to me bc it says a fatal overdose case”

Isenschmid: if it says that, that’s something I corrected that the other day, that’s not correct

Nelson starts to ask another Q when Eldridge (state) asks for a sidebar
Court is talking w the jury gone now
Nelson is complaining about "receiving an updated copy of a presentation...updated 17 pages later...this was all last night"

Eldridge: this would have all been provided, not sure if its the same batch that went out, the updated slides were shown to the jury
Nelson shuffling papers extremely close to the microphone
Judge Cahill asks the state about dates of when the state sent stuff to the defense. "Let's take our break and nail it down specifically, but we can hardly, there's a lot of moving parts... [Nelson] received an earlier version that's been updated"
Nelson complains about PDF format

Cahill calls it this a "good faith passing in the night of different versions", says noone at fault

Then Nelson seems to have just discovered he had the proper new copy the whole time and had it mixed up(?)
Court is now on a break til ~3:40 PM central USA time. The jury already left on break a few mins ago but the Judge and both parties wanted to discuss these sorts of evidence complaints outside the presence of the jury (any potential impression made on jurors is so high-stakes)
Court resumes - Nelson back on cross of NMS Labs forensic toxicologist Dr. Daniel Isenschmid
Nelson asking Isenschmid about the high number of cases processed by the lab. Solicits Isenschmid's agreement with his statement that by looking at a blood sample, he can't determine whether a person died from a gunshot, from a car crash, from whatever
Nelson trolling for implications in basic questions about the DUI drug levels blood sample data analysis presented earlier on direct
"All we know is that they are deceased" - Isenschmid when asked about by Nelson what factual determinations about cause of death can be reached with blood samples alone
Nelson getting into the NMS Labs fentanyl concentration analysis data now - generally he is getting Isenschmid to just answer in the negative or the affirmative w short replies. This sort of cross is arguably a glorified dance to tell the jury "what about this, what about that"
Isenschmid says he can't speak to the concentrations of regional street doses. Asked if he's heard the phrases "goofball or speedball" he says he has heard of a "speedball".
Nelson's verbal trolling for things he may want to suggest to the jury has now proceeded into the area of the methamphetamine statistics
Back to the DUI data again w Nelson, to this observer it sure does seem like Nelson is eager to repeat the names of these fear factor drugs in front of the jury as much as he can (speculation).
Nelson's cross just finished Erin Eldridge from the state is doing re-direct now.

Eldridge asks about Qs Dr. Isenschmid was asked about NMS testing, whether they followed all proper certified procedures (he says that, yes they did.)
Asked if they keept data they didn't use in the actual report, he says "yes we [NMS] keep all that data...it's important"
Eldridge solicits Dr. Isenschmid's agreement w saying that Floyd's methamphetamine levels were "lower than 94 percent of the DUI population" (the Doc agrees)

Judge Cahill keeps sustaining Nelson's repeated objections to similar Qs re the fentanyl to norfentanyl ration level
without objection, Eldridge is able to get Dr. Isenschmid to answer in the affirmative that Floyd's fentanyl levels were lower than the fatal data group levels and within DUI survival average levels
Nelson: how can you answer that Q without actually knowing how those ppl died?

Isenschmid: no but i mean we look at the data very closely (paraphrasing here)
That's it for Doc Isenschmid

next state witness, Dr. Bill Smock, getting sworn in now.
Dr. Bill Smock is an emergency physician specializing in forensic medicine or "legal medicine...practiced on legal patients and applying that to legal situations "

Smock has a masters in anatomy, has done residencies and fellowships
Dr. Smock has worked in emergency centers for many years including a Level 1 Trauma Center
Smock also teaches emergency medicine and trains paramedics around the USA on things like strangulation, gunshot wounds, specializes in looking at asphyxial death
Smock has edited 4 textbooks, he tells the court upon questioning by Jerry Blackwell, including:

-Domestic Violence and Non-Fatal Strangulation Assessment

-Forensic Emergency Medicine (2nd ed)

-Forensic Medicine, Clinical and Pathological Aspects
Blackwell getting some more quite extensive details from Dr. Smock about his career history, our scribe resting fingeys for 5 secs
"clinical forensics is applying the same training that the forensic pathologist gets but applying it to the patient in front of you that is still alive" says that forensics on gun wounds, for example, is the same science whether the gunshot patient is alive or dead
Dr. Smock asks about his previous work with the Louisville Metro Police Department and compare it in size to Minneapolis which he thinks is a little smaller

Blackwell asks "is it fair to call you a police surgeon?"

Smock says yes, says he is doctor deployed with the SWAT team
Smock says he writes prescriptions for officers including antibiotics and viagra
Asked what kind of police trainings he does, Smock says he does 4 hours of training with each recruit class - 2 hours on forensic evaluation of gun shot wounds, 2 hours for strangulation, asphyxia, elder abuse and child abuse
Dr. Smock asked by Blackwell to describe the administration and effects of Narcan, which inhibits the effects of opiate drugs. Says he's administered narcan "hundreds of times"
Blackwell is asking Smock about "the concept of drug tolerance" which he defines as "the body repeatedly sees a drug, the most common we think about is alcohol...
...does someone have a tolerance - you're a naive drinker, you have one.. you feel it. but if you're an acoholic you won't feel it....opiates...needing more of the drug for your brain to perceive the feeling, the high, whatever it is you get when you take that drug"
Dr. Smock, the Louisville police surgeon and SWAT team affiliate, says he was paid $300/hr, the "government rate", for his work on this case
Blackwell asks Smock if he is required to maintain board certification - he is not required to have certification and currently has none "because it's not required for the police surgeon" (but has been certified in the past "on two occasions")
Asked his opinion of how George Floyd died, Dr. Smock says he "died of positional asphyxia, which is a fancy way of saying he ran out of oxygen til he died"
Blackwell asks Smock if he reviewed and considered, then rejected as unlikely, alternative explanations for Floyd's death. Smock says yes. He describes the controversial concept of"excited delirium" and how he doesn't believe its accurate here.
Blackwell is walking Smock through this list of the signs of “excited delirium” (which according to some experts doesn’t even exist as a real thing anyway) and showing how the excited delirium concept does not apply to George Floyd.
Smock being asked to define the difference between fentanyl toxicity (aka being high on fentanyl) and a fentanyl overdose. He emphasizes the primary role of observing the person to tell - “look what that patient is doing”
Smock asked to define the term “air hunger” -

“You are wanting to breathe. One example would be if you are drowning, you are going to do whatever you can to reach the surface of the water to breathe....the human desire to live”
Asked whether “fentanyl overdose causes air hunger” Dr. Smock says “no it does not.” Says no “air hunger” invoiced in a fentanyl OD because “you’re going to sleep.” “It can decrease the drive to breathe if you’ve had too much...but you’re not ‘starving’ for air”
Asked about watching the videos of George Floyd’s death, Smock says he can tell Floyd was not having a fentanyl overdose. He wasn’t snoring, he was talking, “he was begging to breathe”. Says “they’re not going to be alert” or “oriented” if a fentanyl OD.
“Their brain would be in sleep mode”

“He knew exactly where he was, who he was, and what he was doing”
Blackwell now asking Smock about Floyd’s history of “chronic” use (this is probably a prosecution attempt to simply get ahead of the state dragging this in to in to try to cover for Chauvin)
More talk now from Smock about how “fentanyl and oxycodone... both work on the same receptor” and therefore have a cross-tolerance
Smock says that with repeated users, the data can show drugs are present but that doesn’t mean they have any significant effect due to high tolerance. “It’s a level you’d expect to see with a recreational use...and clinically, that’s an extremely low level”
Blackwell asks Smock about myths about indicators for death by low oxygen, asks him to describe the myths around strangulation and asphyxia.

Dr. Smock: “you can be fatally strangled, die of asphyxia, and have no bruising” says variables such as pressure determine a lot
Blackwell is playing Smock some video clips and gonna ask him how they informed his decision making around determining how George Floyd died.
This is one of the longer clips of officers’ body camera videos to be played in court in a while. Shows Floyd repeatedly crying out for his mother and saying he can’t breathe.
Dr. Smock speaks directly to the jury, saying “this first section, what we’re looking at, is listen to Mr. Floyd’s voice, it’s at full volume...listen how later...how his voice changes...I want you to also look at Mr Floyd, where is he, where do we see pressure being applied...”
Smock tells jurors to look at Floyd’s hand, arm and elbow “pushing against the tire”... asked why it’s significant he says “this is what Mr. Floyd is trying to do to breathe, to bring the right side of his chest off the pavement so that he can bring in air”
A longer composite video clip of some of the hardest parts of the scene to watch has been rolling for a few mins now, without commentary from the witness
Asked what was significant that video portion, Smock says “his voice is getting gradually weaker...he’s telling officers that he’s dying, “I’m through”...

“...we also have him using his elbow to try and leverage his chest up...”
Asked if he thinks George Floyd is shown “dying of...asphyxia” Smock says he thinks it’s in the next video portion where “you can see his facial expression..sounds of him getting closer..then he loses consciousness” describes the physical seizure symptoms from fatal oxygen loss
Smock: His left shoulder was bruised from being pushed into the pavement, his face was bruised from being pushed into the pavement
Asked about timing re CPR, Smock says “the sooner we start..the higher our chance of success...as soon as Mr. Floyd was unconscious he should have been rolled over...we have an officer on the video saying “we can’t find a pulse”...when you can’t find pulse CPR should start ASAP
State’s direct done on Smock, Nelson starting to cross. Solicits his agreement w the fact that he isn’t a pathologist and isn’t trained in forensic pathology
Smock says he is actually trained in forensic pathology “as it applies to the living patient” “forensics for the living”
Nelson asked if he subscribes to the Journal of Forensic Medicine (he does). Nelson asks how many autopsies he’s done, Smock says maybe 100 but says he has observed thousands
Nelson asks if reaction to methamphetamine and fentanyl is different than fentanyl alone, Dr Smock says yes
Asked “there is no safe level of methamphetamine?” Smock says “no, well there is a safe level of amphetamine, for people with ADD”
Asked by Nelson about likelihood of death from fentanyl, Smock says it depends on how much fentanyl was taken, how soon medical aid is rendered, “lots of factors”. Nelson takes the chance to make a point of repeating “lots of factors” before his next Q.
Asked for evidence in the autopsy of significant force, Smock answers no, the evidence of that is in the video
Nelson asks Smock if he knows about the “partially ingested pills in the back of squad car 320”, he says yes
Nelson asks about Smock’s experience treating cardiac diseases, asks if methamphetamine and fentanyl can be a factor, Smock says yes
Nelson asks “methamphetamine has an effect on the heart”, Smock replies “it can”
Nelson asks Smock about his analysis of the videos, asks him to estimate how many hours he spent (“10”)
Nelson asking Smock about “going to tactical SWAT” situations and “arrests”. Asks about witnessing officers using control techniques - state objects, Judge Cahill tells Nelson to “ask non-leading questions”
Asked if there was bruising on Floyd’s neck or back, Smock agrees no. Asked if it’s known that Floyd had some heart disease, Smock agrees
Nelson asks if “physical struggle against officers” would be equivalent to a heart “stress test”. Smock says no it’s not the same
Asked if there would be brain injury while Floyd was “speaking with officers”, Smock tells Nelson no, not at the time he was still speaking
Nelson is asking about drug tolerance, seems eager to once again repeatedly put drug keywords out into the jury-aether
Nelson asks Smock about any history of lung disease in Floyd’s records, Smock says he has healthy lungs other than a brush with Covid
Nelson has asked a few reaching Qs about the possibility of a heart attack, the state has objected twice, Judge Cahill overruled twice
Nelson asked one more w about meth use and heart disease before ending his cross. Blackwell doing re direct w Doctor Smock now: going over the heart disease Qs Nelson just asked
Blackwell: was there any evidence you saw that George Floyd had a heart attack?

Dr. Smock: no evidence that Mr. Floyd had a heart attack

Blackwell: did the autopsy say he had a heart attack?

Smock: no
Blackwell dispels Nelson’s implication that Floyd had an arrhythmia by asking Smock if Floyd experienced the “sudden death” associated with the onset of arrhythmia
(He didn’t, Smock says)
Asked how George Floyd could both be intoxicated and “alert and making sense”, Smock says “he can’t”
Asked he Floyd died from any sort of drug overdose, Smock says “no he did not”. End of redirect, Nelson on re cross now. Asks if any evidence shows Floyd was choked from the front, Smock says no.

Asked if fighting with officers can put stress on the heart, Smock says yes.
Nelson getting into the tolerance stuff, saying someone can be on drugs with “fewer signs of impairment”, Smock tentatively agrees. Nelson’s re cross is done, Judge Cahill clearly was eager to end the day of court so court was declared over pretty much instantly.
More important testimony is expected in the #DerekChauvinTrial as it's slated to continue tomorrow morning at 9:15 a.m. CDT.

It's likely that Medical Examiner Dr. Andrew Baker will take the stand on Friday.

For our coverage and live streams of the trial: unicornriot.ninja/derek-chauvin-…

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