Homicide. At no point did the m. E. Talk or mention or write anything about asphyxiation. And we know the prosecution has been hammering Asphyxiation Point saying that Floyds Ability to breathe was cut offer when shoef Ychauvins Knee was neck and heard him pleaiding saying he couldnt breathe. Well see how they lay out the theory and stitch together as Fix Asphyxiation when the m. E. Never mentioned it. The first day, the prosecution said they will prove that asphyxiation is the cause of death and they also said they will show evidence to prove that asphyxiation is difficult to detect. Jim . Adrian, Open Question still as to whether the man who was in the car with George Floyd, when he was initially confronted by police, will testify. His lourz saying he does not want to. That it may incriminate him. The judge was considering this. Do we know whats going to happen and when . Were still waiting to hear what will happen. There was that hearing on tuesday. After the hearing, judge ordered them to prevent questions for review. The judge wants to review the questions. The defense had until today to get those questions in. But there is nothing on the schedule right now that calls for another hearing to take up that matter. It could happen today. But, yes, as you mentioned, Maurice Hall who was in the suv with floyd, has said if he is called to testify, he will invoke his fifth amendment rights. Now its up to the judge. Adrian, thank you very much. Joining us now to talk about all this, cnn senior legal Anl Alys Laura Coates and charles ramsey. Laura, you describe the Prosecution Case as income three acts. First is to show what happened. Second, get to the question of excessive force. They largely concluded at this point and then the third being cause in death. How have they done in the first two acts and what is The Hill to climb in this final act . The prosecutions first two acts are very, very strong. They had compelling emotional testimony from not only bystanders, they had the journey with the jurors here and the court of public opinion, of course, watching through the Vantage Point of so many people including Law Enforcement officials who have essentially confirmed that what shoechauvin was not only a reasonable use of force, excessive amount of force, but going towards criminal assault and the prolonged, unnecessary application of deadly force that was not proportional because there is no resisting arrest at the point were looking at. Now the challenge is to say, okay, now what actually caused the death . And, remember this is where it gets a little mercury and the defense is going to try to muddy the waters. The prosecution is going to say, look, Cardiac Arrest by virtue of the prior er Doctor Testimony is not sinynonymous with a hear attack. Its the sudden us is sags of the heart. The defense will say its underlying conditions, perhaps, drug overdose. The prosecution has to be very focused in front of this jury that when they say the substantial causal factor, they mean the action of derek chauvin, not only kneeling but also the withholding of aid when there was a Duty Of Care owed. Yeah. Charles ramsey, this is the testimony that you have been saying all the way through. This is going to really be key. Im wondering what you think the most important question is that the m. E. Will have to answer. What would you ask, i suppose, if you were on the Prosecution Team . Well, i mean, Manner And Cause is going to come down to that. It always does in a Homicide Trial anyway. So thats going to be very, very important. As far as what i think the prosecutions going to have to do, if asphyxiation was not mentioned in the m. E. s report, a lot of the focus on part of the defense is going to be on drugs. Theyre already doing it. Thats Thats Nothing new. Theyre going to have to focus on issues like tolerance, for example. Fentanyl is a very powerful drug, 50 to 100 times more powerful than morphine. It caused a lot of Overdose Death officials time. This he have to deal with that issue. Because thats going to be, i think, the pount that the defense is going to really try to drive home. Is that he had a lethal amount in his bloodstream or in his body and thats what actually caused the death. So theyre going to have to really, really fight that. Now they may have a second Medical Examiner to come in to really, you know, take a second look at this as far as the Asphyxiation Part of it goes. But when you look at Shchauvin Knee and where it, is its not a question of asphyxiation, he is shutting off the Blood Flow to the brain depending on where his knee is located. There are a couple areas in which it could have caused the death to occur. And all that is going to be discussed today when the Medical Examiner testifies. Laura, so many questions. But on that the legal standard as you described it for cause of death is you just have to prove that the choking, choke hold, the knee on the neck was a substantial cause. What is the legal definition of that . The jury is considering it. Is there a percentage . More than 50 . How do they assess what is substantial . They dont have that idea of a percentage base. The Jd Wheidea is whether it is substantial causal factor. There is Flexibility And Nuance in. That but ultimately speaking, they have to show it is one of the contributing factors here. Of again, even if the autopsy revealed that George Floyd, say, had heart disease, this was not the direct causal why he died in that particular moment. And so even if there was an underlying commission that could have eventually led to this persons death, the jury is not to consider that as one of the substantial causal factors of why he died at that particular moment. And you know what is interesting about this case is normally if you got a competing medical expert and a competing autopsy, it usually is the defense who wants to raise that. The prosecution are often in sync with the Medical Examiners. Here what is different is the state and the opening statements mentioned there is other Medical Examiners, other pathologists called and references the Medical Examiner in an aside. And so its youre going to see how a Prosecution Team who normally is in tandem with not always lock step but in tandem with the medical xexaminer is going to be dismissive. Theyre going say, look, when you said Cardiac Arrest, did you mean Heart Attack . Is there only one way for the heart to cease . Everybody essentially dies of Cardiac Arrest when the human heart stops. Thats how Human Beings die. So what are the potential causes for that in that moment . Thats the heart of the question for them. Forgive the pun. Thats so interesting, laura. Because its different than what you would normally see as you argue. If youre in the jurors position, what of the multiple examiners do you give most credence to . It sounds like youre saying there was another at least one other autopsy done. There was. Remember the family also had some questions about the Medical Examiners report. There is a bit of a Trust Gap that is inherent. We know thats why George Floyd case is so George Floyds death and the Derrick Shoef Yun Trial has been so illustrative of other cases because of the Trust Gap between the members of communities across this Country And Police officers in the Inability Or Reductance to secure a conviction against now former officers involved in the death of a civilian. And so this Trust Gap is played out when you see you sometimes will get an additional second opinion to say well what do you think it is . Because theres a tendency to believe that the Medical Examiner is going to extend a benefit of the doubt to officers the way we think juries do. You have to address this very notion. But youre right, the jury is going to have to decide who is most credible among competing experts, not competing laymen. Thats why the Prosecution Cant take the route of saying forget the Medical Examiner. They have to attack in a way that they say, i know what you said, what did you mean . So good to have you both. This trial resumes in moments. Well take you lufive in the courtroom. Plus, hours after another Mass Shooting in america, Prize Bid Eni President Biden is going to announce some ghost guns. Well take you luf live to the e house. Can America Vaccinate enough americans to curb a current spike . Dr. Faucis warnings just ahead. But when you bring a friend, you get a month for 5. So im bringing everyone within 12 degrees of me. Bam, 12 months of 5 wireless. Visible. 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These are all great. And when you get a big deal. You feel like a big deal. Priceline. Every trip is a big deal. At philadelphia, we know what makes the perfect schmear of cream cheese. You need only the freshest milk and cream. That one and the worlds best, and possibly only, schmelier. Philadelphia. Schmear perfection. This next story will sound familiar. Five people are dead, a sixth person wounded following another Mass Shooting in york county, south carolina. The victims include a doctor, well known in the community, his wife, and two children. Their two grandchildren who were just 5 and 9 years old. The family was very prominent, very well known, and its a close knit community. The doctor had been practicing in that area since 1981. Authorities say they found the suspect in a house near the crime and apparently the suspect lives nearby. Well update with you more when we have it. The news of this shooting comes hours before President Biden is set to announce a slate of Executive Actions on Gun Control. Jeremy diamond joins us from the white house. Tell us how far hes going to go with these measures, how far can he go via Executive Action . Its days after he said to take action in gun legislation. Today well see President Biden unveil the first of the steps with a trio of Executive Actions taking action limited action to be sure to address some specific provisions as it relates to guns in america. The first of those actions is going to be to try and tighten the restrictions around these socalled ghost guns. Then they dont have any serial numbers and regulated as firearms. Senior Official Yesterday told us that, you know, declined to provide specific details as to whether they will be regulated as firearms but merely the efforts are auimed at trying to stop the proliferation of the weapons. There are going to be efforts to tighten restrictions around the pistol braces including the one that was used by the shooter in boulder, colorado, to essentially convert a pistol into something more akin to a short barrel rifle. Youll see the action theres. Will youll hear president bide Tone Day nominate the new head of the alcohol, tobacco, and firearms bureau. And that will be david chipman. He is a Gun Control advocate who serves as a senior Policy Adviser to former congresswoman gabby giffords Gun Control advocacy group. She was a congresswoman shot back in 2011 and has been a real leader in the Gun Control movement. So she and other Gun Control advocates are really hailing the steps that President Biden is taking today. But to be clear, these are very limited actions. Jeremy, apologize for interrupting, we have to get to the courthouse in minneapolis where the Murder Trial of never mind. This is what happens. Its about to begin. Jeremy, finish your thought. This is first of several steps they floon take on gun reform. They want to see Congress Act here. But whether or not that happens, really is leaning towards the side of not happening, especially because democrats so far not going away, doing away with the filibuster. Jeremy diamond, there is a camera in the courtroom. And there did look like there was movement there. They said theyre going to call the next witness, the Medical Examiner. But it does appear that is a few moments away. The moment it comes, well bring it to you. Thanks so much. As we wait for that, dr. Anthony fauci saying new covid19 cases plateaued at what he thinks is a pretty disturbing level as the u. S. Is primed for potentially another surge. This comes as the Uk Variant is the dominant Coronavirus Strain across america. Im joined now by cnn medical analyst and former baltimore health commissioner. Good morning, doctor. Lets get your reaction to what we heard from dr. Fauci and the control room. If we have that sound. Do we . Lets play it and then we can get your reaction. The way were looking at it now, it is almost a race between getting people vaccinated and this surge that seems to want to increase and do what is going on, for example, in europe. Theyre having surge thats are quite alarming. What is your reaction to this clearly a warning from dr. Fauci . I agree that it is a race. I actually think that were in the middle of a fourth surge right now. It is just that the surge looks different from previous surges because many of the most vulnerable, those who are older, for example, are already vaccinated. So whereas before we would have seen a steeper rise in the number of cases followed by a steep rise in hospitalizations and deaths. This time thats blunted a lot because the most vulnerable are vaccinated. But at the same time, we are seeing a higher proportion of younger people who are getting ill and unfortunately getting hospitalized. Dr. En wen, i do apologize. Theyre swearing in the first witness today. I have to get to that. Here you go. And, doctor, if you would mind removing your mask for your testimony. Yes. And also to make sure the microphone is properly placed, were going to have you state your full name, spelling each of your names. Martin tobin. Good morning, doctor tobain. Good morning. What is your current employment . Im a physician in pulmonary and Critical Care medicine. And where abouts . In chicago at heinz Va Hospital and Loyola University Medical School. And is heinz Va Hospital a large facility . It used to be the largest Va Hospital in the country. I think its now superseded by one or two others. And you specialize in Pull Mondayology . I specialize in Pull Minutology and Critical Care merchandise. Will you tell the jury what pulmonology is . Its the study of the lungs. It zeeldeals with all diseases affect the Respiratory System, the lungs, Chest Wall. So what are the various elements, components of the Respiratory System other than the lung ands Chest Wall . The Respiratory Systems begins at the nose and mouth. It goes down through the back of the throat. Down through the Wind Pipe out through the Bronxal Tubes and then the Air Sacks, these are the small grape like structures at the bottom where all the Gas Exchange takes place, where oxygen gets in and Carbon Dioxide is removed. So this is system for getting oxygen into the body . Correct. That is the prime purpose for Get Oxygen in. Now at heinz hospital, do you Work In intensive Care Unit . Yes, i Work In the medical intensive Care Unit. And thats considered Critical Care . Same as Critical Care. These words all have the same meaning. Is Critical Care different from Emergency Medicine . Yes, its very differentmedi. Emergency medicine is kind of the front door of the hospital that is at a Triage Area where you separate out where people need to go, whereas the Critical Care is where you take the very, very sickest people. What kind of patients do you see in the icu . In the icu, probably more than half are patients requiring medi medical ventilator to help them with breathing and a Number Wont be on less pier t respirator. That makes up 70 or. So the remaining patients will have drug overdoses, alcohol withdrawal, diabetic coma, sepsis, things like that. Do you only see the patients in need of Respiratory Care . No. Once they come into the icu, theyre our patients. Im the primary Care Physician for everybody who comes into the icu. And how long you have been a physician, sir . Ive been a physician for three months short of 46 years, over 45 years. And where did you go to school . I went to Medical School in dublin, ireland. And i took my degree there. Not that anybody noticed the accent. But are from You Dublin . No, im not from dublin. Im from a small village called freshford in rural ireland. What degrees do you hold . Im sorry . What degrees . The degree i hold is the mb degree, the Ire Ish Equivalent The American md and subsequently i got an md through research. Are you currently licensed . Yes, im licensed in the state of illinois. In the past, i was licensed in ireland and in england and a number of u. S. States. But i let them all lapse because the only place im practicing is in illinois. Are you board certified . Yes, im board certified in internal medicine, Pulmonary Merchan medicine and Critical Care medicine. So youre still actively taking care of patients . Yes, i was taking care of patients last week and monday i go straight back into the icu again. How long you have held positions at Loyola University School Of Medicine . Ive been at Loyola And Heinz for 32 years almost. Before going to loyola, were you practicing medicine somewhere else . Yep. I spent seven years at the university of texas at houston. Did you also set up a Sleep Clinic houston . Yes, i did. That would have been in the early 80s. I set up one of the very first Sleep Labs in the united states for evaluating patients with obstructive Sleep Apnea. How do Sleep Disorders fit within your expertise . Because this is related again to breathing. And the problems with sleep, particularly people who snore and the people that snore during the night time, they cloese the Up Airway and the level of oxygen in the blood will go very low. And the basic problem in Sleep Apnea is because the Soft Palate, i mean, the roof of your mouth is your hard palate. And then just if you look in the mirror, its that little piece that is hanging down at the back and thats your Soft Palate and that jams in against the back of your throat and it gets it blocked. 500 times a night in somebody who has Sleep Apnea. And does that kind of Research Or Science or medicine relate to your Work In this case . Yes, its extremely pertinent to the case of mr. Floyd because obviously in Sleep Apnea, the problem is that the back of the throat and as we will see in mr. Floyd, the problem of where the obstruction is occurring is in the back of the throat. There is a lot of overlap to patients with Sleep Apnea. Well come back to that in a little bit. Are you also engaged in Medical Research . Im sorry . Are you also engaged in Medical Research . Im yes. Ive been doing Medical Research since the early 80s, since about 1981. What kind of research you have been doing . All of my research is related basically to breathing. So it is kind of looking at Breathing In patients with Lung Disease, people who have Lung Disease that walk in the door to the clinic. And also patient was are in the icu and particularly patient whos are requiring Mechanical Ventilation. But then i do a lot of research that has absolutely nothing to do with clinical medicine, just to know how people breathe. Have you authored a textbook . Yes. I authored a large textbook on Mechanical Ventilation that is called the principles and practice of Mechanical Ventilation. Is this the book youre referring to . Thats correct. 1500 pages . Correct. 1500 pages. Yeah. Are you familiar with the lancet medical journal . Yes. And does the lancet medical journal refer to this book as the bible on Mechanical Ventilation . Yes, it has called it that. Have you authored other books also . Yes, i have. Roughly how many . I think ive published eight or nine other books. And all related to less pieration or Respiratory Failure . Yes. Theyre all on different aspects of the lungs. Have you published articles and abstracts also . Yes, i have. Approximately how many of those . I lost count. I think i published more than 750. You have published in the new England Journal of medicine . Yes. The journal of The American medication association. Yes, likewise. Rez r. Those two of the most sprekted medical journals in the world . They are for clinical work, yes. Have you also held Editor Positions at medical journals . Yes. I was editor in chief of the journal called The American journal of respiratory Critical Care merchandise. That medicine. It is the Premier Journal in the world for intensive care medicine. And its the officially journal of The American thoracic society. Have you taught and lectured outside of illinois and or texas . Yes. Generally where . I lectured all around the world. I mean, i lectured in more than 30 different countries around the world. And probably the vast majority of states within the united states. Minnesota is one of the states in the united states. How about minnesota . Ive lectured in minnesota. Ive been in the Mayo Clinic several times as a lecturer. Were you given an award from the Mayo Clinic . Yes, i was given an award in the Mayo Clinic and they give it out to one doctor every ten years. And its only to one doctor. It doesnt matter what specialty. So it could be around neu neurosurgery, gynecology, whatever. Was there anything in particular you were recognized by the mayo clun snik. No, just for my Work In as a researcher in clinical medicine. Have you also published in basic science journals as the journal of Applied Fizzphysiolo . Yes. I published in a lot of things that would not be directly medicine in the journal of applied physiology. The jurors may not be aware of what physiology is as a science. Can you generally explain it . Physiology is basically how the body works. You want to know the science of how it works. You want a deeper understanding of what a really the mechanisms that make the body does what it does. Within the field of physiology, is there a particular Focus Or Interest you have . Im primarily interested in Breathing In the bigger area. And so with breathing, that would mean how the brain regulates your breathing, how the brain sends signals down to the muscles that control your breathing, diaphragm, Rib Cage, and then how you expand your chest and how you overcome forces within your chest like resistance within your chest and all the rest of it to get air moving in and out of your lungs. And then the particular forces that you generate in terms of the pressures within your chest that will enable breathing to occur with the ultimate purpose of getting oxygen in and getting rid of Carbon Dioxide. You consider this a part of the study of snmedicine . Its really quite separate. Tsz more the basic physiology. So its more in the realm of math and psychics. But then its applied over because to be guy doctor, you need to have a good knowledge of science. But the Science Part is really separate from the medical part. How long have you been working in Respiratory Physiology . Since 1981. So 40 years. And what exactly drew you to the physiology of breathing . Because i was going into pulmonary i knew i was directed, i spent five years doing Lung Disease. And i just wanted to really know how you breathe. And i wanted to come up with new knowledge. Everybody thought everybody knew everything about breathing. I found out a lot of new stuff. So, doctor, do you know of Others Kind of in your Fweield O have been studying Respiratory Physiology for 40 years. No. I know them along the way. I would know no more than a handful or less of people who are still doing physiology at the patients bedside. No. After 46 years. Doctor, lets change subjects and talk about your Experience Work serving as an expert. Had you served as an Expert Witness before . Yes, i have. What types of cases . Practically all of them have been in medical malpractice. So they have done it for the plaintiff, for the Patient Side and have done it for the defense for the physician side. Have you ever been involved in a Krunl Case before . No, i have never been involved in a criminal case. Have you testified in court before . Ive testified in court. I dont keep track of the numbers. But i suspect ive been in court about 50 times. Would you tell the Ladies And Gentlemen if you are getting paid for your time in this case . No, i am not getting paid. And why is that . Well, when i was asked to do the case, i thought i might have some knowledge that will be helpful to explain how mr. Floyd died. Since i never done this type of Work In this nature before, i decided i didnt wish to be paid for it. So did you volunteer to the state of minnesota or did the state of minnesota call you . The state of minnesota contacted me. What were you asked to do . I was asked to review the medical records related to the case. These were medical records from the county. Then there were a number of interviews of people that were interviewed. I was given a long list of these. And primarily it was related to looking at a large number of different videos. The big part was that i needed to read on the scientific background of all the various aspects related to it. So lets talk about your opinions with respect to this case. Have you formed an opinion to reasonable degree of medical certainty on the cause of mr. Floyds death . Yes, i have. Would you please tell the jury what that opinion or opinions are . Yes. Yes. Mr. Floyd died from a low level of oxygen. And this caused damage to his brain that we see and it also caused a p. E. A. Arrythmia that caused his heart to stop. And by p. E. A. , you mean Pulseless Electrical Activity . Correct. Its a particular form of abnormal beat of the heart, arrythmia. A particular form of it. Is this what some persons might refer to as asphyxia . Yes. It has been called asphyxia. To me, it is not terribly helpful. What were really talking about is a low level of oxygen. Other people talk about hypoxia. That is just a latin term meaning a low level of oxygen. So all of this is just really other words for a phenomenon that is a low level of oxygen. Have you formed an opinion to a reasonable degree of medical certainty as to what the cause is or was for the low level of oxygen in mr. Floyd . Yes. I have. Would you tell us what that is . The cause of the low level of oxygen was Shallow Breathing. Small breaths. Small tidal volumes, shallow breaths that werent automobile to carry the air through his lungs down to the essential areas of the lungs that Get Oxygen into the blood and get rid of the Carbon Die dioxide. Dr. Tobin, using a short video that you prepared help you explain to the jurors how oxygen gets into the lungs and the body . How we take in oxygen . Yep. Im going to show you what is marked as exhibit 950. Can you describe what that is . Here were looking at the lungs inside the body. The Wind Pipe at the top. And then that splits into the Bronchial Tubes and the diaphragm at the bottom. When the Diaphragm Contracts the Jurors Cant see it yet. So im just having you describe it. I apologize. Im going to offer it, your honor. Consistent 950. No objection. 950 is received. Yeah. Please proceed. Well display it so the jurors can see it. Cow. Okay. So now were looking, you can see the contraction of the diaphragm. We see air going down through the Wind Pipe and then proceeding to the Bronchial Tubes and then continue down the tube on to the Air Sacks which will be the area here. Were moving down here and these are like the grape like structures down at the bottom. This is where all the action occurs. The oxygen goes across the those Air Sacks and also the co2 goes across and then it expelled back out. So Thats Everything in a very rapid video. So then what are you what happened in the case of mr. Floyd that relates to the Shallow Breathing that resulted in his low oxygen . So there are a number of forces that led to that is the size of his breath became so small and so series of forces higher up that are leading to that. And the main force is that are going to lead to the shallow breath are going to be that hes turned prone on The Street. That he has the Hand Cuffs in place combined with The Street and then that he has a knee on his neck and then that he has a knee on his back and down his side. All of these four forces are ultimately going to result in the low tidal volume which gives you the shallow breaths that we saw here. And so the air will not be able to reach those Air Sacks we just saw on the video where the oxygen is exchanged and the Carbon Dioxide is removed. Doctor, is in a concept that in the respiratory Medicine Field known as Dead Space . Yes, there is. How does that relate to mr. Floyd . If you think of the video back all the way until you saw those clusters of grapes where you saw the Blood Vessels surrounding this area, everything up to there is that space. So as youre Breathing In, youre breathing through your nose, your mouth goes down through your wund pipe, down through the tubes, radiating out on until it reaches the Air Sacks, up until you get to the Air Sacks, its all Dead Space. The reason we call it is because no oxygen can get across those Bronchial Tubes. No Carbon Dioxide can get across it. The oxygen, Carbon Dioxide, the only place that gets across is those little grape like structures. So everything in the lungs before that is Dead Space. So you mentioned several reasons for mr. Floyds low oxygen. And i just want to capture those for the jury. And then well talk about them. You mentioned one handcuffs and The Street . Right . Correct. You mentioned knee on the neck . Yep. Sore sorry for my writing. The prone position . Yep. And then the knee on the back, arm inside. Were those the four . Yep, these are the four. Okay. So we want to talk about each of these. But before we do that, might it be helpful for explaining your testimony to the jury for them to see the relative positioning of the various officers on mr. Floyds body when he was subdued on the ground . Yes, i think that will be very helpful. Did you assist in preparing an illustration to show the relative position of the officers on the ground . Yes, i did. And let me show you what is marked as exhibit 949. Can you just tell us, just describe generally for the record what it is. I mean, i watched the videos and certain segments of the Vud Yoez hundreds of times. Its very difficult to get an overall view of where everybody is positioned because youre seeing different videos from different angles. And so the artist has taken all the different videos here and hes combined them into One Moment In Time and you can see here. And also he will remove the Police Vehicle so youre going to get a better view. So youre looking amount a Birdseye View of where mr. Floyd is lying and where the officers are positioned in relationship to mr. Floyd. All right. So the purpose of this is to show the relative positions of the officers . Correct. Your honor, we offer exhibit 949. Any objection . No, your honor. 949 is received. So at what point in time if, you told us this is at Player Point in time . Its a particular point in time. I dont remember the exact minutes, second at the top of my head. But it is like does 8 21 44 . Yes. Okay. It appears okay. There we go. Okay. So lets walk through exhibit 949 if you can advance. And doctor, tell us what were seeing. Okay. Now you can see the cash is being rotated. Youre able to see Officer Chauvin. Youre able to see Officer King and then Officer Lane down at his feet. You see Underneath Mr. Floyd and now the car is being rotated. Now the car has been removed. And so youre able to see how theyre positioned at different points in terms of with Officer Chauvin with his left knee on the neck. His right knee on mr. Floyds arm and chest, and then you can see here Officer Lane holding his legs and then you can see Officer King with his knee on his torso. So this represents a snapshot in time as you told us. Did the officers positions change over time as they were there on the ground . Yes. The officers positions changed over time. And also the position of mr. Floyd himself changed over time. And these become relevant in how we evaluate everything. And was it something you factored into your analysis then . Yes. Did you consider where mr. Chauvins left knee was during the encounter . Yes. For Officer Chauvins left knee is virtually on the neck for the vast majority of the time. And when you say vast ma jord, you are able to its more than 90 of the time in my calculations. There are certain times where it becomes difficult because you dont get a good view of where for example, i know that an Officer Chauvins right knee is on his back 57 of the time. The reason im not able to say for the 43 is that i dont get a good view. Other times dont have a good view of exactly where it is. So did you focus on the first five minutes and few seconds . Yes. I focused on the first 5 minutes, 3 seconds because that is up to the time that we see evidence of brain injury. So if mr. Chauvins right knee was on his back from time to time, and other times it was placed where . In your observation . It was placed on his Arm Or and then rammed into mr. Floyds left chest. So really whether youre making it the determination whether the knee is on the chest Per Se or whether its on the left arm and rammed in against the left chest. From the Point Of View of breathing, the effects are extremely similar. So lets turn to the Number One on the [ inaudible ] oh, yes. So i want to turn back to the notes that the Number One here that written down for the reasons you told us for floyds low oxygen, mr. Floyds low oxygen, handcuffs and The Street to talk about the first four . Yes. Can you first, dr. T ooobin the four forces, street, handcuffs, knee on the neck, back, knee on the back, arm and side, how do those mechanisms fall into your work of either Respiratory Physiology or clinical medicine . They dont have an awful lot in clinical medicine but related in my Work In physiology in understanding the forces that the body has to cope with. These become these are crucial in terms of the various forces that involved in physiology. So then, turning to the first one handcuffs and The Street, the very first one, what is the effect of the Hand Cuffs and the context of what happened to mr. Floyd . The handcuffs are extremely important to mr. Floyd. But the handcuffs on their own just handcuffs Per Se are not that important. It must be the handcuffs combined with The Street. And its because of the positioning of the handcuffs at the back, then how he is manipulated with the handcuffs by both Oufficer Shoef Chauvin theyre pushing the handcuffs into his back and pushing them high. Then on the other side, you have The Street. So The Street is playing a crucial part because hes against the hard asphalt street. So the way theyre pushing down on these handcuffs combined with The Street, his left side, and its particularly the left side we see that. Its like the left side is in a vice. Its totally being pushed in, squeezed in from each side from The Street, at the bottom, and then from the way that the handcuffs are manipulated. Its not just the handcuffs. Its how the handcuffs are being held, how theyre being pushed, where theyre being pushed that totally interfere with central features of how we breathe. So mr. Floyd then is pancaked between the pavement under him and then force on top of him . Precisely. Could you help us explain how this mechanism, the handcuffs and The Street, how does that explain the Shallow Breathing that you described . Yep. So this gets back to how we breathe. And this is fairly simple. So the way we breathe, we have two big muscles that help us with breathing. We have the diaphragm and we have the Rib Cage muscles. The diaphragm does about 70 of what we need for breathing. And about 30 of it comes from the Rib Cage. And theres when the Diaphragm Contracts or the Rib Cage contract, they expand the chest. And when he expand the chest, then air flows in from outside and its coming in. And thats all that happened on the inspiration. But to expand the chest, there are two crucial actions that have to happen. And we referred to these you about the terms pump Handle And Bucket handle. If Bucket Handle so if you have a regular bucket that you carry water with and you lift up the handle of the bucket, the handle comes up like this. And so when you contract your diaphragm, you are performing a Bucket Handle movement of your on the Rib Cage. So you contract your diaphragm like that. And each time as you inspire, you can see it yourself. You inspire each of you in the jury. You inspire, you see the Rib Cage is going out wards like that. That say Bucket Handle movement. The second movement that you have is called the Pump Handle. And this reflects to an old Water Pump that will be in the yard, pumping out water. And so you have the handle at the top of the pump. You lift up the handle at the pump each time. And the water comes out the spout at the bottom. So youre filling up getting the container of water. So with that action, youre lifting up here. This refers to the front to back movement of the Chest Wall. So with the Pump Handle, your chest goes out with each breath. And so you can do it yourself. As you take a deep breath, can you feel that front to back youre expanding your chest. The front to back expansion of your chest is your Pump Handle. At the same time, youre doing both of them at the same time. At the same time, youre doing that, your chest is expanding from side to side. And thats with your Bucket Handle. So both of these are occurring. And these are vital. Without these, you cant breathe. If you dont have the Bucket Handle working and the Pump Handle working, there is nothing happening. There is no air going to get in there. Doctor, do you have a photograph that you brought that would help better understand the pump Handle And Bucket handle . Yes. Let me show you whats been marked as states exhibit 951. Do you recognize what this photograph depicts . Yes. Is it an accurate portrayal of a certain incident . Yes. Would it help to explain the testimony . Yes. This is an event that happened in england. One moment. I apologize. I need to offer sooner, your honor. We offer exhibit 951. Any objection . Yeah. I have an objection to this. May we have sidebar . All right. Sidebar. This is a Sidebar Question has been raised by a slide that the doctor was going to use to help explain the breathing process. Judge asked the defense if they had an objection. They said they did. So theyre having what is called a sidebar now to discuss the decision on this. Laura, these nhappen in trials. You heard the objection there. Why would the defense have an objection to this kind of slide . Objection sustained. Because it is effective. The idea of having the jurors have an actual understand ago way from the technical aspects of the pulminology and this is precisely what is happening. Its a composite. Its not in real time like the videos we have seen. They can be problematic for the defense to say youre reinventing and creating a narrative here. Okay, lets go back. Yeah, the judge sustained that objection. That is notable. Lets list in. That is. The police and the handcuffs, particularly on the left side. So they were forcing his left wrist up into his chest, forcing it in tight against his chest, forcing it high up and you have to keep in mind that the opposite side of this is The Street. So he was being squashed between the two sides. I mean The Street totally blocked his Pump Handle. There is no way he could do any front to back movement. And, again, the way they were pressing in on the back, there was absolutely no way that he could do any front to back movement. Then in addition, because of the knee that was rammed in against the left side of his chest, sometimes the knee was down on the Arm Or and against the chest. So this would have the same effect. So basically, on the left side of his lung, it was almost like a surgical humanectomy. Almost as if a surgeon had gone in and removed the lung. No the quite, but along those lines. So there was virtually very little opportunity for him to be able to get any air to move in to the left side of his chest. So he was going to be totally dependent on what he would be able to do with the right side. You have selected any footage from the body worn cameras that you feel depicts mr. Floyds struggles to breathe . Yes. Im going to show you what has been marked as states exhibit 944. And first, would you describe what it is . What youre seeing here is on the dr. Tobin, the jurors are not seeing it. Just tell us what it is. They will not see this. Im describing what im seeing. For now. Okay. Thats fine. What im seeing is that his left hand is being grabbed by the police officers. So thats a handcuffed left hand. And its being pushed into his chest. So hes just not able to expand that. In addition, youll what im seeing foundation i apologize. So lets hold off and turn it my misunderstanding. Your honor, we offer states 944. Any objection . No objection. Admitted. What is the significance . Now youre able to see here with the yellow arrow. You are able to see that the officer is holding mr. Floyds left hand. Hes holding it very firmly. There is a very firm grasp on it. And then mr. Floyds left hand is being pushed in against his chest. Also were able to see just on the side that Officer Chauvins knee is coming in and thats compressing in against his side as well. So the ability to expand his left side here is enormously impaired. And also, youre seeing that the size of the chain between the two the right side and the left side is very short. So he his whole left arm is also being pulled over. And so its preventing him also from expanding the right side. Ive been focusing on the Bucket Handle and the Pump Handle on the left. But you can also see here that these are impaired. His ability to expand his chest and, of course, the key factor you must keep that is in kind of a sense seen here in one sense is The Street. The street is what is having a huge effect because hes jammed down against The Street. And so The Street is playing