it decrease in lung appeal ability up around 35 percent that's a substantial decrease in your lung volumes that you're finding and then they conclude in virtually all of their studies that that level of decrease in lung volume doesn't matter because there is no change in the level of oxygen and so therefore it's not clinically relevant the problem is in doing a study like that oxygen is the exact wrong yardstick to be using in a study like this what they needed to do is continue to measure out the changes in lung volume like the. showing what happens to this oxygen will only fall at the very end it's an extremely insensitive measure it's very important but it's very insensitive to know if stuff is going bad inside the body it's going to be a very late event and so for there concluding this.

question. there are. so so to help us to better understand doctor told. are these studies measuring the demolition or decrease in the actions or accidental reserve of the no they're not. i want to show you what's marked as exhibit 948. and it does that exhibit 148.21 of the studies that you were referring to yes it does would it be helpful to use this live to explain your testimony yes into it . we would offer. any objection that put it is busy.

so looking here at this live dr dr tolan. what does this tell us in terms of for example the surface area that's involved of the weight on the back so if you look at the subject's back you can see here that there are 4 weights out of it jim that are placed on the back of the subject and the be. out at the the plate out of it an olympic plate is going to have a diameter of 17 and a half inches and so you can measure the cross-section of the area if that is going to be 2 $140.00 square inches the trouble is that when officers need on the back of a suspect they don't place in the olympic wheel on their back the place they're neat and so the cross-sectional area of the knee is $24.00 square inches which is 110th of the area of the beat bellows that you're looking at here and so we know from

simple physics that pressure is force over area so that it's too far to be divided by 24 that tells you that the pressure being exerted on the back is 10 times more than what the sent the people are claiming they're off by a factor of 10 so pressure then been exerted by me is 10 times greater is what you're saying is 10 times greater than the it's going to be affected by the bell here that show in from out of the gym that bar that you're doing in place. do any of the studies dr involving the neck nobody has done any studies involving the need on the neck i suspect you'd have major trouble getting that through the ethics committee in any medical school do any of these studies go on for 9 minutes and 29 seconds no they're all very brief studies. so dr that we now covered the 4 mechanisms that result of the missive which shallow

breathing in the production of a high full fare yes we have. now dr toben where you were are you aware that mr floyd had some preexisting health conditions yes i am. and how you were that i mean i read them in the records from him in county and obviously saw also saw them mentioned in the autopsy do you have an opinion to a reasonable degree of medical certainty as to whether a person who had none of those preexisting health conditions a healthy person would have died of the same circumstances as mr floyd yes healthy person subjected to what mr floyd was subjected to would have died as a result of what he was subjected to. are you also aware that mr floyd was found to have a type of tumor known as a parent ganglion yes i am and for the ladies and gentlemen of the jury what is

apparent ganglion perry going to be omitted that type of each rumor that is found in the parikh and the ends kind of sometimes in the pelvis and. is the finding of apparent ganglion significant to you as relates to this to floyd is that no because one of the key things about perry is that it's called the 10 percent schumer which means that 10 percent of people who have a parrot ganglion been secreted drennan well that could be important but 90 percent of them don't sue preet it's random so you don't in 9 out of 10 at the times that you have a pair of ganglion may you have no increase in the amount. so if somebody were to die from a tumor. from some effect of peri ganglion would it be a sudden death yes there's been 6 reported cases of people who have had peri gangly omens who have died suddenly but that's the total in the literature 6 and those

people who died have headaches and mr floyd complained of a lot of pain in lots of different regions why he's down on the street but he did not complain of hetty. so in terms of reported cases where people have died from. apparent dangly almost over the entire world you know of 6 reported cases yes and all of those are sudden deaths occurred they missed a floyd die a sudden death no. one to talk to you about a different subject but the jurors may have heard one of the officers say if you can speak you can breathe yes it is that a true statement. it's a true statement but it gives you an enormous fault senses security certainly at the moment your speech that you are speaking you are greedy but it doesn't tell you that you're going to be breathing 5 seconds later. so let's

talk about kind of why this is significant. so could you tell us about something that has an obvious audience was required for speaking. so i mean for speaking you only speak when your ex hayley you have to blow air out and then you 5 break the vocal chords and that's all there is to speech so it's air going across the vocal cords they vibrate and you speak but to speak there is 2 things important one is you can a little air out if you didn't he could take a breath in before and so you must have had an inspiration in to speak to the 2nd thing is you cannot speak if your brain is not alert ok so. when you see somebody speaking you know they have had an inspiration

momentarily before they're speaking and that there is oxygen going to the brain at the time that they are speak and i aspiration even that have to take in a breath in directly rather speak. what's the timing of missile floyd speech during the restraint important to your analysis yes it was why why so because it is at far the time that he's speaking and he's continues to speak for 4 minutes 51 seconds from the time the knee is placed on the snake it tells us that there could not have been complete compression could not have been totally through jand of the neck at that time for at that time because he's continuing to speak for our 4 minutes 51 seconds dr toben is the brain sensitive to oxygen deprivation the brain is the most sensitive area to needing oxygen. so what percentage of the

brain of body weight and how much oxygen does it consumes the brain is 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 so the brain eats up oxygen at 10 times the normal there but it needs a huge amount of oxygen because it's sending out millions of nerve signals every 2nd so it needs very high supply box then how long can the brain go without oxygen and that's where i worked out if you stop the flow of oxygen to the brain you lose consciousness in 8 seconds. so if you might recall mr floyd's last words you know i can't breathe. are those who are significant to us upon an ologist yes that i mean obviously they're

important different ways one his complaining to you of difficulty with breathing but they're also telling me that at that time he's saying please i can't breathe this we know at that point he has oxygen in his brain but and again it's a perfect example of how it gives you a huge false sense of security because very shortly after that we're going to see that he has a major loss of oxygen in the way that he moves his leg and so it tells you how dangerous is the concept of if you can breathe or if you can speak you can breathe yes that is through the surface but highly misleading very a very dangerous. mantra there. so that from hearing you correctly when he says i can't breathe that shows his brain is alert yes but then immediately

thereafter his brain was correct. and did you see or is there anything in the video that you can shoulder jurors that they can see also that would point to the fact those brain was no longer alert yes. let me pull up exhibit a 47 already in it in evidence. at 2024. some want to play a clip for you dr told when and then tell the jurors what what they see as you know . so there's the key finding that you see here and that is when you see his

leg going up and you have to keep in mind he's prole so he's facing down so this is his leg coming up backwards and so that's what we call as finish ans that's an extension movement of the lake and that is something we see when somebody suffers major brain lack of oxygen and it tells us at that point he's having what are sometimes called a my pill and sometimes called a hypoxic seizure there's different terms that are used but really they all amount to saying that you're see here faith injury to the brain from a lack of oxygen. it's sometimes also called an anoxic seizure has all of these different words there's a lot of different words that are used but they all come down to the same thing that it is that at that point the brain is responding to the drastically low level of oxygen that's present and does the fact of an anoxic sees your

reflect damage to the brain it indicates appear damage to the brain. and the the reflex that we saw with the legs coming up is that of involuntary reaction it's a it's an involuntary reaction i mean there's a lot of different medical terms that we apply to it but the bottom line is that you see that the leg jumps up like that as a result of a faithfully low level of going to the brain. so dr we talked about the brain injury. we also told us earlier about low levels of oxygen potentially causing pulseless electrical activity yes and is that also then evidence of loss of rights i mean there when you have a low 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 at normandy and the particular way that it happened to mr floyd was he developed a particular arrhythmia called the p. e. a which is that pulse us electrical activity where we're seeing those electric city in the heart but it's not resulting in any mechanical force and so that's why it has that name and so it's the low level of oxygen is producing both we don't see the p. e. a the pulses that i through could activity arrhythmia until that's shown up on the e.k.g. in the ambulance so it's much later that we see the evidence of it in terms of display but here we're seeing huge evidence in terms of the leg the leg is crucial here because this is this is the time that you're the 1st time you're

seeing there is majorly oxygen damage so if we reach a point where mr floyd couldn't speak due to low oxygen was there any correlation also to a narrowing of the airways that prevented his being able to speak yes as well. i want to show you what's marked as exhibit 13493633. and just tell us. one of these images the general so we're seeing a gannett the same m.r.i. but it did at a different view of it that we looked at before you are all for exhibits 93493633. $34.00 and there he thinks the length are 3 areas that you've.

so that to tell us what we see here starting with the 1st so this is the same m.r.i. that you saw before but what's for much or being your attention is drawn to by the low arrow is the vocal cords and the vocal cords is simply how you speak so to speak you must inhale you must take air into your lungs and then when you let the air ote you're going to vibrate those little vocal chords there and that's what makes the sound of speech. and so here we see the size of the windpipe the trachea and this becomes important in terms of speech because our knowledge about the influence of this is at the size of the trachea of the windpipe for speech is from patients who it had an end to through q. shubin place and then that the ballot scarring after that and so as

a result of the scarring we know what is the point at how much scarring in your windpipe will prevent you from so and so these are just that then mentioned so as you know what is the size of the normal trachea it's between a corker and a dime as you can see here in terms of the diameters. that file and here is when the those coins have been shrunk to 15 percent and even when. the trachea has narrowed all the way down to 15 percent you are still able to speak even when they hold through your windpipe is just the size as i've shown here where i've shrunk the size of the coins you are still able to speak so it tells you how dangerous it is to think well if he can speak he's he's doing ok because at this point you will be able to speak but again

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 and so it's a very dangerous. thing to think that because you're able to speak you're doing ok and so dr you night able to speak breathe or live once the airway merrill's to below 15 percent correct once you i mean a true you go from the 1515 percent you're still be able to speak and then as it gets lower from that initially be struggling and then at some stage you just won't be able to do any. better if we could show exhibit mad 40 sarti they have so again this is exactly because this is the same experiment i showed you before and it just so happens this is pure coincidence it's at 85 percent you're

looking at that top curve and that's the same number that we should showed you on the day m.r.i. this is pure coincidence but you can see here once you're up at 85 percent that the work of breathing is enormous at 7 and a half old increase and then as that. narrowing would get further and further then they work would become unbearable. so it again it just emphasizes at the point where you can't speak and you are in deep trouble. talked of like to transition now from talking about the physiology of breathing to talk about your work as a clinician taking care of a patients with respiratory troubles. does that experience factor into your opinion so they also yes. did you do anything to try to understand mr floyd's actual

rate of breathing yes i did. why was that important to do because a major part of my work is a long specialist is look is looking at people you get an awful lot of information by looking at how they breed by looking at how the use their chest all of this is extremely informative and at the lowest level one of the simplest things to do that is especially informative is simply to count how many breaths somebody takes in it's one of the fighting signs like with blood pressure pulse rate temperature is the risk for a rate it's one of the signs that gives it's a lot it clues as to what is happening inside the body is this something you've done before. of millions of times do you train others in how to say nurses respond therapist medical students doctors in how to do it. and so you're accounting to

bres do you observe the muscles and things also separately from counting the breath you going to look at the different muscles they're using whether they're using their sternum asked that the type of bucket hand lakshman they have what type of pump and you're looking at all that this unit lance i mean with somebody as old as me how can see all of this very rapidly. so did you take this clinical experience and apply it to your observations of this avoids breathing in this case on the videos yes i did. was there video video evidence from which you could take measurements yes there is. want to show exhibit 43 that already happens. so i want to play this doctor and afterward tell us what we're seeing.

so a moment it will start. so if you focus down here on where he is the hand of his and where he's arm is toast to his black shirt is the best place to see and you can count out his response rate so you're seeing that he's making a response rate here then another. and so we need to play it back so i needed to tell you 1st where to focus if you focus down there you will see be able to count out the rates we will. play at that once more so that you can count the rates of error see what you refer to. 1. 2. 34567

. 8. so that was a reckless 17 2nd clip right and you count to 7 and said between 7 and 8 and did you use this to calculate a rate of respiration yes because i mean it's simple once you have 1000 seconds and you can count out the number of threats you have here. and if you say 7 breaths that we come out at a risk for the rate of $22.00 is that number the respiratory rate of $22.00 significant to this case it's extremely significant why is that because one of the things in this case is the question of fent in them and if ent in early is having an effect and it's causing depression of the response centers the centers that control breathing that's going to result in

a decrease in the response rate and it's shown that with fent you expect a 40 percent reduction in their isp rate so with fent to know his response rate should be down at around 10 instead at that it's right in the middle of normal at $22.00. so you didn't see a depressed rate of respiration or breathing rate in this to florrie no it's normal and so what does it tell you bottom line with respect to. fettle as relates to mr exactly in terms of fent to them the major one of the major changes you see in phantom is a slowing of the response rate slow and they get an we would be expecting a 4 p. percent reduction in there is a rate with fentanyl the normal response rate is 17 breaths per minute plus or minus 5 so that would mean

a normal response rate of between $12.22 that's the normal range of respect for free rate and so if it was with fenton expecting a response rate of 10 instead it that you counted here yourself and you can see when you counted yourself that there is perfectly rate is $22.00 so basically it tells you that his there isn't fenton on board and that is affecting his response to spur free centers it's not having an effect on his wrist recent years some of the floyd's respiratory rate was normal at $22.00 just before he lost consciousness correct. so that your jury may have heard some other information in the case. about the the fentanyl related to an elevated carbon dioxide level in the supplies body in the emergency room was that significant yes that's very significant as well also because he's reported to have a p.c.

or 2 sorry i take it back he's reported to have a carbon dioxide level in the arc here eod blood in the emergency room of 809 that's a very high level of carbon dioxide and so you have to take into account what are the factors that might have led to that and there's particularly important factors in mr floyd to explain why he's carbon dioxide was found at 89 in the emergency room so dr would you 1st tell us what would normal have been for carbon dioxide levels the normally carbon level in you or me is $35.00 to $45.00 millimeter mercury that's the norm you don't need the middle images of mercury stuff but there are the units that are given in the hospital chart. so you said that there were significant factors in the case of mr floyd would you help the jury

understand what those were yes the important factors that we know that he made his own last spontaneous effort to breed at 202568 after that you can look at the videos and you see he makes no effort there is he makes no breath at last breath he took. was it 202560 then we know after that he stayed on the street for another 3 minutes or so then he's placed into the ambulance and we know that in the ambulance the attempted to put in an airway and nigella and you can see that on officer lane's body cam you can see all of that happening and then you concede the time at which they actually successfully inserted the airway and when they gave him the 1st breath and that is a gap of 9 minutes and 50 seconds from when he last took

a breath and why is that significant that's very significant because we can calculate what is the rate of increase in the carbon dioxide in somebody who doesn't breathe if somebody doesn't take a breath kerpen. up to $4.00 millimeters a mercury per minute that it increases and so he has not taken a breath for 9 minutes and 50 seconds so you would expect that the plates are larger than life people would go up by 49 so you add. $49.00 to the normal values of $35.00 to $45.00 and then you add that and you're going to get a value of. between $89.00 and

above and so it comes out eggs for the identical to the value that they found in the emergency room of $89.00 so so dr what's the punch line with respect to that what does it tell us the significance of all of that is it's a 2nd reason why you know fenton the is not causing that the pression of his respiration what you're seeing is that the increase in his carbon dioxide that is found in the emergency room is solely explained by what you expect to happen in somebody who doesn't have any ventilation given to him for 9 minutes and 50 seconds is completely explained but that so when a person that is not breathing then carbon dioxide would naturally continue to go up in the body yes and that's that's what matches what was seen in there are for mr forth precisely.

and you said that there were other things that were significant that were related to the rate of respiration and we talked about that know. was there anything else yes the other things there's 2 other things that are very important to the response because you saw it with your own eyes exactly his response rate and the 1st thing is that if you have somebody who has underlying heart. yes and there aren't diseases so severe that it's been said that it's causing sharpness of breath that it's causing you difficulty with breathing if somebody has heart disease that's causing shortness of breath for chile all of those patients are going to have very high risk rates they're going to have respond very rates of 3530 over 30 even over 40 when you have heart disease that will give you shortness of breath instead of that we find that he's.