tv Day 9 of Trial for Derek Chauvin Accused in Death of George Floyd CSPAN April 8, 2021 4:41pm-5:30pm EDT
>> we are talking about speaking and breathing simultaneously from a different consideration a minneapolis police lieutenant who trains police happens to have testified that it a common statement in the course of treatment or course of training, minneapolis police, you might take exception with that? >> i didn't follow your question, it is very hard to hear. >> and i'm losing my voice. >> if a minneapolis police officer -- minneapolis police lieutenant, a trained minneapolis police officer testified that is frequently said, trained to police, a person can talk, it means they can breathe, he would have a problem with that? >> they are able to breathe at that moment in time --
>> thank you, judge. i apologize, i was working from a previous copy of your presentation but nevertheless, i want to show you, ask some follow-up questions on this presentation in terms of the postmortem internal concentrations that your lab looked at in 2020, you looked at a total of 19185 cases, correct? >> a lot more than that but i specifically show a subgroup peripheral blood, cardiac blood, to do something that represents both accurate what might be found and the subject. >> so you are focused specifically on the concentrations in the most equivalent type of blood sample
taken? >> to the extent you can do that, yes. >> in those 19185 cases than, not all of them represent a fatal overdose? fema correct. >> so of the 19185 cases, do you know the number of cases attributed to overdose typically? >> unfortunately we don't because we don't get the history of the cases or the outcome or even the context. >> so you can't determine which cases included something like a heart attack or something else that would cause the death? >> correct. >> these are simply blood samples? >> correct. >> when you look at the blood samples, you say the mean level was 16.8 nanograms a milliliter? >> yes. >> when we say meanwhile, you're talking average?
so if you take up all 19185 cases, add up there levels and divide by the number of cases, that is the average? >> correct. >> the median being ten nanograms a milliliter, right. >> right. >> 50% of the cases have higher levels and 50% have lower. >> yes. >> we can't differentiate the cause or manner or death in any one of these cases? >> correct. >> in terms of the 19185 cases, when you look at the inclusion of nora fentanyl versus exclusion, the vast majority included the fentanyl? >> it did.
>> now when you look at the dui concentrations, obviously people, this is a little bit of a different type of situation, right? people are alive, driving a motor vehicle. >> yes. >> presumably. >> here again, 2345 dui cases. >> yes. >> the average level was nine-point 59. >> yes. >> the median level was 5.3, 50% above and 50% below. >> correct. >> they were all arrested for dui? >> well as mentioned, other drugs may be present so is just looking at fentanyl. >> what we are really doing is trying to isolate and create a
>> in terms of when we look at the ratio of fentanyl levels between nine and 13 nanograms, of the 19185 postmortem cases, 3088 of those cases had again a similar fentanyl concentration to mr. floyd? again up the 3088 cases, within that range, we have no frame of reference, no contact as to what percentage of those people died from fentanyl overdose versus another cause or manner of death. >> that is true. >> all right so statistically, it is fair to say some of these 3088 people in that category
died of fentanyl overdose? >> yes. >> some died of another cause. >> yes. >> in terms of amphetamine, methamphetamine and amphetamine, methamphetamine and fentanyl, do you find that to be an unusual mixture of controlled substances? >> i'm not familiar what accommodations are being seen with street drugs, we see a variety of controlled substances, we see reginald more with cocaine but that is just what i see but i can't speak to what is being observed.
>> have you heard of the phrase speedball? >> i have heard of speedball. >> usually being like conventional and opiate and cocaine? >> yes, heroin and cocaine. >> but you have never heard of the term -- ball? >> no. >> in this particular case, your lab tested the pills that were found in the squad car as well as mercedes-benz? >> yes. >> you reviewed those? >> yes. >> similar to fentanyl, you've got methamphetamines, the active ingredient. >> yes. >> and amphetamine. >> in the tablet are you saying? >> no, in mr. blood -- mr. floyd blood sample.
>> yes. >> generally speaking, methamphetamine is the active drug and amphetamine is a metabolite of the drug? >> it's also active. >> okay, meaning -- what you mean it's active? >> it's an active metabolite. >> so a person would have an effect from both substances? >> yes. >> an intoxicating effect? >> not necessarily. >> but some affect? >> some effect. >> in relevant to the dui population, mr. floyd's amphetamine and methamphetamine ratio was on the low side? >> we didn't look at the ratio of methamphetamine to
amphetamine because of the reporting limit, it is not on the report, we didn't report it. >> so you can't compare the ratio but is methamphetamine on the low side? >> compared to dui, yes. >> so in comparison again, there may have been other drugs on board? >> yes. >> i have no further questions. >> were asked questions about your lab and the testing performed in conduction with accreditation? >> yes. >> you are asked by the medical
examiner's office, is that right? >> correct. >> performed what was requested? >> yes. >> did they follow standard operation? >> we did. >> you didn't report anything in your final report that was below your reporting limit? >> no. >> but you maintained the data in connection with standard procedures? >> yes, the data shows what we found. >> why do you do that? >> excuse me? >> why do you keep the data? >> we keep that in normal course of business. >> it's important to have record of the testing you did and things you went through to achieve results? >> absolutely. >> you are also asked about methamphetamine levels mr. floyd had in his system, he indicated it was lower level, 19th nanograms a live milliliter? >> yes. >> so low you wouldn't expect to
have an intoxicating effect? >> i would not. >> as part of your lab procedures, he ruled out that's a contaminant, that's how low it was? >> i would say that, it's real, it there and confirmed. >> it was confirmed in the confirmation process, amphetamine said it was john not just a contaminant? >> true. >> but either way, mr. floyd had levels that were lower than 94% of driving under the influence when it comes to methamphetamine? >> yes. >> you are also asked about fentanyl levels in this case, obviously depending on an individual's tolerance level of 11 nanograms a milliliter, a different effect on a different person depending on their level of tolerance? >> yes. >> in your experience, recent or
acute, there are a number of cases you'd expect to see none of the fentanyl? >> yes, we do observe that in cases where we know somebody dies with a syringe in their arm or something like that. >> and if they do, you'd expect there to be little to no nor fentanyl? why is that? >> it's a very acute amount, it doesn't mean who could never find it because there could be previous used but that is not our general observation. >> in that way, the ratio becomes important? >> correct. >> why is the ratio important? >> that basically documents how acute the fentanyl was relative to being broken down. >> so mr. floyd's ratio, 1.96, 11 nanograms of fentanyl, 5.6 nor fentanyl, suppose there was
survival time after ingestion of fentanyl, is that right? what does the ratio so you. >> two things, there was survival time in an earlier post could be an additional goes on top of previous doses. >> and again, the ratio is consistent and lower than average ratio you see for driving under the influence of fentanyl? [inaudible] >> what does that show you compared to the population? >> the difference between a population where vegetal is more likely to be acute and the population words more likely to be chronic. >> in terms of ratio, was mr. floyd's ratio more similar to the driving population, people alive or the modem population?
>> the dui population. >> nothing further. >> how can you answer that question we don't know the context of how people actually died. >> because we still looked at the large number of data within that population. >> so you have no frame of reference in terms of what a person actually died from what if of the 19195 postmortem cases, 19184 of them were gunshots? >> that's not really a possibility. >> i have nothing further. >> thank you. >> you may step down. >> next witness, we are going to
present, i appreciate you, she has a flight out tonight so we are trying to finish today. >> thank you, your honor. the state will call doctor williams. [background noises] >> do you swear or affirm -- [inaudible] [background noises] >> if you could remove your mask -- >> thank you. >> start off with having you state your full name. >> doctor bill smock.
>> proceed. >> good afternoon. can we start with you telling us your specialization. >> emergency medicine physician in forensic medicine. >> would you tell us, what is forensic medicine? >> legal medicine taking medicine usually practiced by forensic but in that case, practice on living patient and applying it legal situations. >> could you give us a brief overview of your educational background in medicine? >> yes, i obtained masters degree in anatomy from the university of the school of medicine. entered medical school, graduated in 1990 from the university. then completed a three year residency in emergency medicine at the university and completed a one-year fellowship in
clinical forensic medicine with the kentucky medical examiner's office. >> have you ever worked in an emergency room? emergency medicine? >> many times, many years. >> how many years? >> twenty-one years at the level one trauma center at the university of laurel and smaller he is. >> what is a level one trauma center? >> the american college of surgeons criteria saying this is the place you want to go when you have major trauma, gunshot wounds, car wrecks, stab wounds, strokes, heart attacks, this is where we have positions on duty in the er 24/7 ready to take care of you. >> are there any level one trauma centers in minnesota. >> one right here in minneapolis. >> the county medical center? >> it is. >> do you also teach the area of
emergency medicine? >> yes, sir, i do. >> what you teach and where? >> emergency medicine residents, medical students, paramedics, police officers, not only at the university of the global police academy, i trained the paramedics for the jefferson town emergency medical service, i also trained and teach all over the country in areas relating to strangulation, gunshot wounds and medicine, forensic medicine. ... i have edited for textbooks.
>> one domestic violence and nonfatal strangulation. >> that is 11 sir. >> is as a teaching book? >> it is. it is designed as a work look where you work through case studies looking at injuries, understanding the injuries and how the injuries occur or don't occur in nonfatal strangulation. >> another and called for in sick merkozy medicine. >> that is correct sir. the second issue of the book. >> and our third larger one forensic medicine clinic lamp have the logical. >> that is correct sir. >> what is this for? >> i'm looking i clinical forensic medicine which is medicine applied to the patient that is still alive in most cases. >> have you also, do you also
have your background any work as an assistant medical examiner? >> yes sir co i i do. >> what is that sir? >> in louisville kentucky we started the kentucky medical examiner's office providing living forensic medicine consultations. that is providing the same level of the valuation on someone who may have been shot, stabbed or didn't die in the emergency department and the icu compared to someone that they have died with that same level of care and so that pro grandma started at the kentucky medical examiner's office back in 1990 and from 1991 through 1997 i was an assistant radical examiner at the kentucky medical examiner's office providing all sorts of evaluations and consultations. >> so you have a background in clinical forensic medicine? >> yes sir company i do.
>> would you tell the jury what that is? >> clinical forensic is applying the same training that the pro rent to apologists get from autopsies to medicine but applying it to the person who is in front of you that is still alive and so what is the difference between someone who has sustained a gunshot went to his dead as opposed to sustained a gunshot wound to is live in did they get to the operating room on time but the frantic as the same. how do you determine entrance from accident how far was the gun away from the body when the person was shot? at the same science applied to the moving patient >> how are you currently employed? >> i'm the police urgent for the global metro police department as well as the medical director for the training institute for strangulation prevention. i'm also the medical director for the jefferson tom emmer is a service and the unical professor
of emergency medicine at the university of louisville. >> could you give the jury some sense of how large the louisville police department is in comparison to minneapolis? >> the louisville police department has space for 1200 sworn officers and we are down to less than 1100 officers right now. at think anyapolis may have seven or 800 or them not sure. i think we have a little larger department. >> would it be fair to describe you as a police surgeon? >> that is my role and that is my job. >> would the her duties? >> it's the doctor that goes with the s.w.a.t. team to make sure if somebody gets hurt a suspect hostage officer that there is a doctor there to kate -- take care of them. i advised the police chief on health care policy. i do occupational medicine looking at the officers who may
get hurt, duty and can they go back to work and i write descriptions and a body aches -- most of the time is doing forensic consultation which means when they detective calls and says document the shooting and internal affairs calls and says we have an officer-involved shooting i would then go to the scene, the hospital or wherever and that examination needs to be done and they do the assessment head to toe like a pathologist would do on someone who is to cease but doing it on someone who is still alive. do you actually do police training? >> i do sir. >> what kind of training? >> each recruit class i get four hours of training two hours to spend on forensics of valuation of then shot once in two hours is spent on strangulation next
fix the elder abuse and child abuse. >> i be treated her since with cardiac emergencies? >> cardiac oh yes three hospitals -- [inaudible] >> what about those who struggle with methamphetamine abuse? >> very frequently either on the scene or in the emergency department. >> are you familiar with the symptoms of overdose by either fentanyl or methamphetamine? >> i am very familiar sir read. >> can you tell us what narcaine is? >> narcan is an antagonist that will block the effects of opioid receptors in the brain so if you overdose and you have taken too much narcotic and you are not breathing or you are close to the going unconscious if you give narcan intranasally that
reverses it and displaces the narcotic that is in the brain and you wake up. >> have you had to make decisions about administering narcan for methamphetamine or fentanyl? >> nothing for fentanyl because it's an opiate and yes i have administered narcan hundreds of times. >> one of the things i'd like to talk with you about with respect to this employee is drug tolerance. is the subject of opioid tolerant something you're familiar with? [inaudible] >> can you help us understand the concept of your intolerance? >> tolerance is what does the body repeatedly said in a certain drug and most commonly we think about alcohol. somebody builds up a tolerance meaning at one time you are a
naïve drinker and you take one sip for one bottle whatever but if you are an alcoholic you feel nothing because that is tolerance. the same as chair of four amphetamines as well as for hopefully i'd fentanyl whether you are talking about her cassette or other opiates means it takes more about drug for your brain to perceive the feeling, the high whatever it is that you get when you take that. >> someone who doesn't rank doesn't feel a bit -- feels a to what an alcoholic who knows? when the jury when you made reference to it explain what you mean by that. >> it means somebody that doesn't drink or do any sort of drug. naïve means totally new.
>> doctor you've been retained by the state of minnesota as an expert in this case. are you being compensated for your time? >> yes sir co i am and i hope so otherwise my wife will be very unhappy with me. >> can you tell as we are hourly rate is? >> the government rate is $300 per hour. >> to charge for your time is a government rate? >> that is correct sir. is part of your work when you're asked to render an opinion regarding this -- >> yes sir i was. >> before we get into your payment can you tell us what it is you reviewed to give you the at commendations to formulate? >> i reviewed videotapes, body camera video dash cam video's police videos medical records. hospital records statements,
witnesses, the autopsy report autopsy photographs thousands of pages of documents. >> they are forward get to that there's one thing i meant to ask you as a police surgeon are you required to make board certifications? >> no sir i'm not. >> are you currently board-certified? >> i'm currently board eligible. i take the boards on two occasions but i'm not at the emergency department anymore so i'm no longer board-certified. >> you have been in the past? >> yes sir co. >> let's talk about your opinions regarding the cause of mr. floyd's death. you formulated an opinion. >> yes sir i did. >> lead tell us what your opinion or opinions are? >> mr. floyd died from
positional asphyxia which is a fancy way of saying he died because he had no occidental left in his body. >> so what we've been referring to his low oxygen. >> low oxygen is one-way, low oxygen within the body deprived of oxygen and in this case from his chest, pressure on his chest and back. he gradually succumbed to lower and lower levels of oxygen until he was gone and he died. >> did you consider other possibilities as causes when you have. he waited its? >> absolutely. >> was one of those excited delirium? >> yes sir co it was. >> would you tell the ladies and gentlemen of the jury what excited delirium is? >> excited delirium is a physical and psychiatric state
where because of an imbalance in the brain a patient will exhibit multiple symptoms. basically they are hot, their body is revved up the heart rate is up, respiration is up superhuman strength. they are out of control. their speech is garbled. they can't answer questions or that's what they call the delirium someone who is delirious. someone very familiar with not only. hospital but in the hospital the symptoms of excited delirium. >> doctor what they show you exhibit 921 for identification purposes. i want to show it to you and them i want to ask you a couple of questions. >> is this a demonstrative view
created showing 10 sides of excited delirium? >> yes sir it's from the american college of emergency physicians white paper. >> into that way we show this to the jury or at least to offer it is excited delirium considered a controversial diagnosis? >> yes sir it is. >> why is that? >> because there are varying opinions as to what causes it and what is it. per in sick -- a forensic pathologist or emergency physicians or other positions, there is an 100% agreement on what excited delirium is. but i can tell you my opinion. i think it is real. >> on a reputable medical organization may not wreck it nice that? >> that is correct or the american medical association
doesn't recognize it in the american psychiatric association doesn't recognize it. >> i offer exhibit 921 for demonstrative purposes. demonstrative or press is only. purpose is all mighty. all my. >> if your honor could -- thank you. so if we could walk through each of these and go through them one by one and i would like for each one to explain what it is and then explain how it applies to george floyd. let's start with number one inappropriate clothing naked or partially closed. what is the significance of this this one and how does it manifest? >> when we get a call of a naked man in the street the first thing we are thinking is excited
delirium. why? why would somebody take off their clothing? their body is hot so in the case of mr. floyd was he appropriately dressed or inappropriately dressed for the weather and in the case of mr. floyd i believe the temperature was in the 70s and he was appropriately dressed. therefore this does not apply to mr. floyd. >> what about the second one, attraction to glasper destruction of last mirrors lights on vehicles. >> this is another sign that someone with excited delirium, they are attracted to glass and light and mirrors. sometimes they will kick, lunch try to break the glass, brick the mirrors because for some reason there brain says that as a threat to them. when you watch the video of mr. floyd in the store, there is
glass all around him. was he attracted to the glass on the counter, the windows? and no, so in mr. floyd's case it doesn't apply here. >> so you eliminated the second one? >> yes sir i did. >> what about the failure to respond to police presence? what does that mean? >> when an officer gives you a command to do something you don't even hear it. you are going on. when we watch the video of the officer asking mr. floyd to go to the sidewalk and sit down does he comply? absolutely he complies. it does not apply to mr. floyd. >> because you saw him being responsive to the police. >> u.s. responses answer appropriate questions and giving appropriate answers. >> number four constant or near cannes and physical activity. what does that mean?
>> that means these individuals are sped up. their bodies are going 90 miles an hour and in this case what do we see mr. floyd to? he sits. he tabled the sit down. he is not going 90 miles an hour. hit the tip any level isn't so you can cross that one off. you saw no evidence of back? >> number five not tiring -- these people can run a marathon. a police officers chasing them they are out running the police. they can go in go and go why? because they are sped up. in this case did we see mr. floyd tyer? absolutely we saw him get tired. he got tired to the point where he stopped breathing. doesn't apply in this case? no, it does not.
>> number six unexpected or unusual strength. >> these people are described as having superhuman strength. they are throwing police officers awful right and left and someone my size throwing people off right and left. what do we see in this case? is mr. floyd able to throw those police officers who have them on the ground? no he is not so in this case that does not apply. >> number seven on affected by pain. >> when we listen to the tapes did we hear mr. floyd complained of main? >> absolutely we do in his neck his face pain in his back. he has complaining of pain so does this apply to mr. floyd? absolutely not. mr. floyd did not complain of pain would get added into the list but in this case he complained of pain from the time he gets on the ground.
it does not apply. >> number very rapid breathing. >> these individuals will have the breathing rate 30 to 40 times a minute. very rapid breathing. when i watched the videotape and counted mr. floyd's respirations at different points at one point it was zero and other times its fifth teen to 20, 22, 23 in that range and by breathing criteria he does not meet the criteria. >> what about number nine? >> a couple of ways to assess this. you can see evidence of excessive sweating. what did the er docs describe with mr. floyd presenting to the er? he was cool to the touch. when these patients come into the er their temperature if you
touch them they are hot. they could be 104, 106 even 107 degrees. on temperature mr. floyd was cool to touch. that does not apply. >> excessive sweating number 10. >> when your body gets hot when your temperature goes up what is your body want to do what it wants to sweat to cool you down so when i watched the video do i see evidence of sweating on mr. floyd? no, it's not there. again it does not apply. >> .org smock we have to have a minimum of six of these items for excited delirium. how many dgc? >> with that. >> i want to talk with you about another potential cause which is drug overdose. are you familiar with the
toxicology results of the case? >> yes sir i am. >> just a reminder what were the levels of venza know when methamphetamine in mr. floyd's floods and you can check your report. >> the fentanyl level was 11 and the metabolites of fentanyl called nor fentanyl was 5.6 and the methamphetamine level was nana grams per. >> focusing on fentanyl you have lots of experience treating patients suffering from opioid overdose. >> yes sir i do. >> can you explain with fentanyl intoxication how that might differ from fentanyl overdose? >> the fentanyl, i will work backwards. with fentanyl overdose excessive amounts can kill you because it
will cause your respiratory rate to go to none in that's how you die with the narcotic overdose. you ceased to breathe. with fentanyl toxicity you are looking at somebody who is high, they are awake but they are high so there's a big difference so you have to temper it said fentanyl intoxication versus fentanyl overdose? what is that patient doing in front of your eyes? are they awake talking and breathing normally or are they getting weak and are their respirations getting less or are they not reading at all? that's how you'd differentiated, just by looking even without a laboratory. look at what that patient is doing. >> in the case of the fentanyl overdose are there certain telltale signs? >> yes. they are people can be constricted and they are
snoring, their respirations are decreasing or they are not perspiring at all. >> bringing this home to george floyd, when they came to the scene on may 25, the paramedics do you recall whether he hit -- were restricted or not? >> i believe they were dilated. >> do you know what the concept of air hunger is? >> yes sir i do. >> can you tell a is? >> air hunger is you are wanting to breathe and for some reason one example would be if you are drowning and you're going to do every thing you can to surface from the water because you want to breathe. another application that i frequently deal with this someone who has been strangled. when their airway has been cut off and they camp read their
body is telling them to breathe but they can't because of the pressure on their airway that is the human desire to live and to breathe. >> so when george floyd is saying please come i can't read, i can't read is that an example of air hunger? >> it's absolutely an example of air hunger. >> can you tell the jury whether fentanyl causes air hunger? >> no it does not pay the only time it could is if you have overdosed but it's not air hunger because you are going to sleep. you are not hungry at all. you are asleep. there's a difference between air hunger that drive to bring in that air versus. >> with an overdose if it's not air hunger that of fentanyl overdose causes does it -- the drive to breathe at all?
>> therapeutically no, at an overdose level, yes. he can decrease the drive to breathe if you have too much. >> but you are not starving for air. >> you are not starving for air. >> doctor the case of the fentanyl overdose to talk about the person going to sleep or snoring. therefore death from overdose is a coma state. >> someone who is asleep you could say they look like they are in it, state. they are not moving so that's what you would see in an overdose. >> you watch the various videos of george floyd's encounter with the police on may 25. can you tell the jury from having looked at those videos can you tell by looking at that
weather george floyd was suffering from a fentanyl overdose? >> when you watch those videos into go through them, what is his respiration? he is breathing. he is talking. he is not snoring. he is saying please, please get off of me. i want to breathe. i can't breathe. that is not a until all overdose. that is somebody who needs to breathe. >> and so if a person is suffering from a fentanyl overdose would you describe that person as alert? >> no sir. they are going to be alert. they are going to be sleepy. >> would you describe them is oriented? >> no, their brain is going to be in sleep mode or not breathing mode. >> was george floyd oriented? >> oh, he was. he gave her responses, name, date of birth.
>> he knew where he was and what was happening. >> in exactly where he was and what he was doing and responding apart really to the questions that were asked of him. >> have never encountered situation of a fentanyl overdose where a person was in to overdose displaying air hunger and essentially crying out for life and crying out in pain? >> yes. >> now from your review of the medical records and other data in the case did you get some sense of mr. floyd's history was with respect to opioid use? >> yes sir i did. when you look at the medical record mr. floyd was a chronic user meaning what i saw was four years. >> and how it does correlate to the notion that tolerance we talked about at first?
>> the more you use any drug comment i'll call in this case fentanyl you build up that tolerant so it takes more drug to give you that hide, to affect your brain. and in this case we actually had a visit to the emergency department where he took seven or eight narcotic hills. they watched him and let him go. >> was there any use of oxycodone or percocet that might be relevant to the discussion? >> yes. when he presented to the emergency department he said he may have taken percocet or oxycodone. >> what does that have to do with tolerance for fentanyl? >> both fentanyl and oxycontin and percocet, oxycodone work on the same receptors in the brain. it's called bait -- receptor so
they both attached to that and stimulate that receptor so it's what we call cross tolerance. if they both work on the same receptor either one is going to give you an effect attending on the quantity that the brain takes. >> and concerned with a issues are you able to generally characterize with the range of opioid level has been? >> yes i have sir. >> what can you tell us about that? >> we are going to break away from our live coverage of the derek chauvin trial. our 40 plus year commitment to covering congress. we'll return or you can watch it on line at c-span.org or this schedule to meet at the pro forma