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Doctor: "Highly Misleading" to Think Someone Can Breathe if They're Talking; Defense Cross-Examines Pulmonologist in Chauvin Trial. Aired 2:30-3p ET
Aired April 08, 2021 - 14:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
[14:30:00]
BROOKE BALDWIN, CNN HOST: Eli Honig and Cedric Alexander are back with me.
Elie, earlier, you described this expert witness testimony as devastating for the defense, impeccable, crystal clear. How does the defense cross-examine this gentleman?
ELIE HONIG, CNN LEGAL ANALYST: They have their work cut out. But, Brooke, this was not a restful lunch hour, I guarantee you.
Here's what I think we should look for. I think the defense is going to try to question this witness and say, some of what you observed, those symptoms that George Floyd was exhibiting, wouldn't they also be consistent with a drug overdose?
But here's the problem with that. And it's so important that our viewers remember this. All the prosecution has to do is show that Derek Chauvin's actions were, one, even one of several, one, substantial contributing factor to the death.
And just as an intuitive factor, it's hard to imagine that the jury's going to buy that all that pressure that the doctor just walked us through had nothing to do with the death. It just happened to be an overdose happening at that exact moment.
BALDWIN: I hear you. And you're not totally buying it. You made that point yesterday and I hear you again.
Tough lunch hour. We'll listen for the defense coming up.
Cedric, I'm curious, like are police officers trained, is there some notion that, all right, if my suspect, you know, is talking, he or she is breathing, so not concerned? Is that not a concern for many officers?
CEDRIC ALEXANDER, CNN LAW ENFORCEMENT ANALYST: You know, oftentimes, we hear people say that. We hear people say that in spite. We just hear them say it because they want to be smart about something.
But the reality of it is, and as you've heard from the pulmonologist, you have to have air in order for your brain to function. But that does not mean, a few seconds later, as you continue to lose oxygen -- you can go into a coma, which subsequently leads to death.
So, I think this whole notion about -- that many people have, well, if someone can talk, they're breathing.
As we heard the pulmonologist, the expert, say, yes, that is true, but it is a false notion, and we should not assume when someone has a compressed airway or compressed lungs that somehow merely because they're able to say, I need help, I can't breathe.
We need to take that as a serious warning and be able to help them, make sure that they can breathe, whether we believe it or not. So, we can't operate under that notion any longer.
And that's why I said, in the last segment, it is so important for police agencies across the country today to be watching this testimony and get ahead of this.
Because this is going to change. This is going to be a game changer in terms of how we subdue, secure, and even handcuff --
(CROSSTALK)
BALDWIN: Understand.
(CROSSTALK)
BALDWIN: Let's jump back into the trial. Dr. Tobin is back on the stand. And here is the defense.
DR. MARTIN TOBIN, PULMONOLOGIST: I'll take a sip.
(LAUGHTER)
TOBIN: Cheers.
ERIC NELSON, DEFENSE ATTORNEY: Like they do in Ireland, right?
TOBIN: Yes.
NELSON: All right. So, I just want to kind of review a few things with you, sir.
TOBIN: All right.
NELSON: I don't think we'll take too long, but.
So you were ultimately approached by the state of Minnesota to assist them in the review of the medical issues in this case, correct?
TOBIN: Correct.
NELSON: And you have volunteered to do this work at no cost, correct?
TOBIN: Correct.
NELSON: And that's -- you're not normally involved in criminal cases of this nature, correct?
TOBIN: Correct.
NELSON: And this is the first time you've ever been involved in a critical case, correct.
TOBIN: Correct.
NELSON: And it was that reason that you decided not to charge a fee, correct?
TOBIN: Correct.
NELSON: Now, when you are in other cases, what type of fee do you normally charge?
TOBIN: I charge per hour. So it's --
NELSON: What's your hourly rate?
TOBIN: My hourly rate is $500 an hour.
NELSON: OK. But you agreed to waive your hourly rate for this?
TOBIN: Correct.
NELSON: You felt it was an important case, right?
TOBIN: Yes.
NELSON: All right. Now, in preparation for your testimony today, you met with the state numerous times, correct?
TOBIN: Correct.
NELSON: You have had the opportunity to review all of the medical information that was obtained in this case, correct?
TOBIN: Yes.
NELSON: That would include Mr. Floyd's previous medical history, correct?
TOBIN: Correct.
NELSON: The autopsy and attending toxicology reports that were prepared in this case?
TOBIN: Yes.
NELSON: As well as some investigative materials, police reports, things of that nature, correct?
TOBIN: Correct.
NELSON: And just correct me if I'm wrong, but you are not a pathologist, correct?
TOBIN: Correct. I am not a pathologist.
NELSON: Your specialty is in pulmonology, critical care, things of that nature?
TOBIN: Correct.
NELSON: And then you have an interest in and -- of an impressive resume relevant to applied physiology as well?
TOBIN: Correct.
NELSON: And you have been honored quite extensively for your work in that regard, right?
TOBIN: Correct.
NELSON: You're not a Minneapolis police officer?
TOBIN: Correct.
[14:35:00]
NELSON: It's fair to say that the training that is provided by the Minneapolis Police Department, in terms of medical care, comes nowhere close to your level of expertise?
TOBIN: Correct.
NELSON: You understand that Minneapolis police officers are not even EMTs?
TOBIN: Correct.
NELSON: They have a basic life-saving certificate dealing with gunshots, chest seals, tourniquets, and CPR, right?
TOBIN: Yes.
NELSON: So, you are -- you've also had the opportunity to review a lot of the body camera footage, correct?
TOBIN: Yes.
NELSON: You've done -- I think you testified that you have watched these videos hundreds of times.
TOBIN: Correct.
NELSON: And you have watched them all from all different angles, correct?
TOBIN: Correct.
NELSON: And you have had the luxury of slowing things down, moving it into slow motion, still framing various times, right?
TOBIN: Correct.
NELSON: And so, your analysis of this case comes after hundreds, if not thousands, of hours of time spent looking at this information.
TOBIN: I don't know the total amount of time that I have spent but it's substantial.
NELSON: Right. So, then, you ultimately, based on the review of all that, you prepared a report.
TOBIN: Correct.
NELSON: And you provided that to the state of Minnesota in late January of this year, right?
TOBIN: January 27th, yes.
NELSON: And after that, you have had numerous meetings with the prosecution team in this case?
TOBIN: By phone or by Zoom, yes.
NELSON: Right. Including January 30th of this year?
TOBIN: I don't know the dates but, I mean, that sounds correct.
NELSON: Right. So, if I were to tell you the dates were January 30th, March 3rd, March 9th, March 17th, March 21st, April 6th, and April 7th, you would not have any reason to dispute me?
TOBIN: I have no reason to be concerned.
NELSON: All right. And you understand that notes are made of those meetings and provided to the defense in this case?
TOBIN: I understood that.
NELSON: And then you've also been able to spend a substantial period of time preparing the exhibits that the jury was able to see earlier today, right?
TOBIN: Correct.
NELSON: And those were all prepared by you or someone within your team, right?
TOBIN: They're prepared by me.
NELSON: And you provided those to the prosecution in advance of today's testimony?
TOBIN: Correct.
NELSON: And do you understand those were provided to me last night? TOBIN: I have no idea when.
NELSON: OK. All right.
So you have had a lot of time to prepare both yourself as well as the prosecution team in connection with this case, fair to say?
TOBIN: Correct.
NELSON: Now, you talked quite a bit about physics in your direct testimony, agreed?
TOBIN: Yes.
NELSON: And you would agree that physics or the application of physical forces is a constantly changing set of circumstances?
TOBIN: I didn't understand what you said.
NELSON: You would agree with me, would you not, that when you look at the concepts of physics, these things are constantly changing, right?
TOBIN: Yes. All science is constantly changing.
NELSON: Constant.
TOBIN: Yes.
NELSON: In milliseconds and nanoseconds, right?
TOBIN: Yes.
NELSON: So if I put this much weight or this much weight, all of the formulas and variations will change from second to second, millisecond to millisecond, nanoseconds to nanoseconds, agree?
TOBIN: I agree.
NELSON: Similarly, biology sort of works the same way, right?
TOBIN: Yes.
NELSON: My heart beats, my lungs breathe, my brain is sending millions of signals to my body at all times.
TOBIN: Correct.
NELSON: Again, even -- I mean, faster than the speed of light, right?
TOBIN: Correct.
NELSON: Millions of signals every nanosecond, right?
TOBIN: Yes.
NELSON: And I think, in your report, you even kind of discuss that when you're talking about these instances, when you're talking about the physics or the biology, what you're really talking about is a single kind of nanosecond.
But all of these processes are working in concert at all times, right?
TOBIN: Right. I mean, the way we calculate it is the mean value, but I mean, it's then into one instant.
NELSON: Right. You've taken this case and you have literally boiled it down into a nanosecond.
TOBIN: Well, I wouldn't say that, no. Because it's obviously in my report, as you see, it's sequentially. There's a whole chronology. I begin from the time the knee is placed on the neck and then all the time until what's happening in Hennepin County E.R.
NELSON: And so you talked -- your report talks about the sequential nature of things. But when we talk about the biology and the physics of this case, these things are working simultaneously, contemporaneously, all together, right?
TOBIN: That's correct.
NELSON: In an incredibly rapid fashion?
[14:40:01]
TOBIN: Yes.
NELSON: And you would agree with me that, as this incident was occurring, there was nobody measuring the units of force that were placed on any particular position of any particular person at any particular moment, right?
TOBIN: I mean, there was nobody there measuring them at the time, I agree with that, but they're all calculable.
NELSON: Understood. And that's when you calculate them. And what you have to do is you have to boil it down into what you would call the mean or the average, right?
TOBIN: Correct.
NELSON: So whenever we look at the concept of an average, there are things that are happening moments before, moments after, right?
TOBIN: Yes.
NELSON: And forces will increase or decrease relative to the nanosecond of time, agreed?
TOBIN: Correct. Yes.
NELSON: And ultimately, when we talk about kind of the biology of things, a pathologist tries to look at all the intersection of all of the things that occur to a particular -- in a particular death investigation, correct?
TOBIN: I mean, they're not looking at anything to do physiology.
NELSON: Understood. But they're also looking at how other factors may contribute to the death of an individual, right?
TOBIN: I mean, they're basically looking --
(CROSSTALK)
NELSON: Yes or no, sir?
TOBIN: Sorry?
NELSON: It's a yes or no, sir. I'm objecting.
TOBIN: Yes, partly.
NELSON: They're looking at things beyond a nanoseconds, agreed?
TOBIN: No, I mean, I think in terms of a pathologist, they're looking at a nanosecond. They're looking at the nanoseconds of death.
NELSON: Right. But they're taking into consideration things simply that extend beyond physiology, right?
TOBIN: I mean, they're looking primarily at pathology.
NELSON: Right. So, what causes the heart to stop, what causes the lungs to cease to function, et cetera, right?
TOBIN: I mean, they're making an inference based on a pathological time point.
NELSON: Right. Considering a multitude of biological factors that are involved in the death of a person, right?
TOBIN: I mean, it's the same as any physician is looking at a multitude of factors.
NELSON: Right.
TOBIN: So, in terms, again, of your review, you would agree that the amount of time that you have spent looking at videos, analyzing these videos from different perspectives and angles, is far greater than the length of this incident?
TOBIN: Yes.
NELSON: Probably to the times a thousand?
TOBIN: I can't -- I really don't know. But it's substantially longer than the incident.
NELSON: All right. And ultimately, you conclude that Mr. Floyd died as a -- well, what we would call a hypoxic death? TOBIN: He died of a low level of oxygen.
NELSON: Right. There was a low level of oxygen that caused damage to the brain, which resulted in a pulseless electrical activity, correct?
TOBIN: Not quite.
NELSON: How did you phrase it?
TOBIN: He had a low level of oxygen that caused damage to the brain. The brain didn't cause the pulses of electrical alternance.
(CROSSTALK)
TOBIN: The low level of oxygen caused both. The low level of oxygen caused the damage to the brain. The low level of oxygen separately caused the pulse's electrical alternance.
NELSON: So it's an example of how multiple processes are occurring simultaneously?
TOBIN: Not really. It's just one process. It's a low level of oxygen that's doing both.
NELSON: That's having an effect on multiple -- the heart and the brain and the lungs, right?
TOBIN: Not really. It's just two, the brain and the heart.
NELSON: The brain and the heart. All right.
Now, you talked about -- I think, you called it the -- is it the Nuchal ligament?
TOBIN: Yes.
NELSON: Am I saying that correct?
TOBIN: Correct.
NELSON: All right. That's that space at the back of the neck that's very, very hard, right?
TOBIN: It's not so much a space. I mean, it's a long bit. But it's roughly the palm of your hand. You stick the palm of your hand at the back of your neck.
NELSON: Right.
TOBIN: And you're right over the Nuchal ligament.
NELSON: Right. And that's, you said, a very hard surface?
TOBIN: Yes.
NELSON: Can withstand a great amount of pressure, right? TOBIN: Correct.
NELSON: And so, when we talk about the placement of the knee, there would be periods of time where Mr. Chauvin's knee was placed at that Nuchal ligament --
TOBIN: Yes.
NELSON: -- based on your observation of the videos?
TOBIN: Yes.
PETER CAHILL, HENNEPIN COUNTY DISTRICT JUDGE: (INAUDIBLE)
TOBIN: I'm sorry.
That goes both ways.
[14:45:00]
NELSON: And you have had an opportunity to review the autopsy, correct?
TOBIN: I did, yes.
NELSON: All right. And you understand that there was no bruising either atop the skin or under the skin surfaces that were noted by Dr. Baker?
TOBIN: Yes, I'm aware.
NELSON: And you also are aware -- you talked quite a bit about the hypopharynx, right?
TOBIN: Yes.
NELSON: You're aware that the hypopharynx was photographed at autopsy and no injury was noted?
TOBIN: I'm aware.
NELSON: Now, I found it very interesting ,in your testimony and your report, when you were kind of talking about this notion of, if you can't speak -- or if you can speak, it doesn't mean you can -- sorry. I have to say it. If you can speak, you can breathe, right?
TOBIN: Yes.
NELSON: And you described this as a very dangerous proposition, right?
TOBIN: Yes.
NELSON: You described this as causing a false sense of security to people, right? That's how you --
(CROSSTALK) TOBIN: Correct.
NELSON: And in fact, in your report, you actually write a paragraph about how physicians oftentimes have trouble with this, right?
TOBIN: Yes.
NELSON: And so, people who have, similar to yourself, attended medical school?
TOBIN: Mm-mmm.
NELSON: Right?
TOBIN: Right.
NELSON: Sorry, you have to say "yes."
TOBIN: Yes. I'm sorry. Terribly sorry.
NELSON: No problem.
TOBIN: Yes.
NELSON: So, you know, intelligent men and women who have graduated from college, gone on to medical school, and are engaged in the practice of medicine, sometimes have problems with this notion, right?
TOBIN: Yes.
NELSON: A patient comes in and says they're having trouble breathing, and oftentimes, the physician will not believe them, essentially?
TOBIN: It's important, Mr. Nelson, I think to make sure we're talking about speech or difficulty in breathing. Because they're different.
NELSON: Right. Well, you -- you write in your report that some doctors incorrectly consider patients to be hysterical.
UNIDENTIFIED DEFENSE ATTORNEY: Objection, Your Honor. May we approach?
CAHILL: (INAUDIBLE)
UNIDENTIFIED DEFENSE ATTORNEY: Your Honor, the report is not in evidence -- (INAUDIBLE).
CAHILL: Overruled.
NELSON: You wrote in your report that "some doctors incorrectly consider patients hysterical and the symptoms imaginary in nature, which further aggregates patient distress," right?
TOBIN: Yes. Yes, I recall.
NELSON: And you wrote that "this view represents a physician's failure to understand the fundamental cause of a clinical disorder." TOBIN: Right, but I'm talking about a different thing there. That's
hyperventilation syndrome.
NELSON: So, somebody comes in --
(CROSSTALK)
TOBIN: It's very different than the difficulty with speech. They're really apples and oranges.
NELSON: OK. But if physicians, right, someone comes in --
TOBIN: Yes.
NELSON: -- and they're hyperventilating and they articulate to their physician --
TOBIN: Yes.
NELSON: -- I can't breathe, right?
TOBIN: Yes.
NELSON: And it's hyperventilation syndrome, right?
TOBIN: Yes.
NELSON: And physicians, oftentimes, as you indicate --
TOBIN: Yes.
NELSON: -- confuse this issue?
TOBIN: Correct.
NELSON: They blame the patient, right?
TOBIN: I don't know if they blame the patient but, I mean, they certainly miss the diagnosis.
NELSON: And it's kind of -- when we're talking about speaking and breathing simultaneously --
TOBIN: Yes.
NELSON: -- which is a different consideration, if a Minneapolis police lieutenant, who trains police officers, happened to have testified that that's a common statement in the course of treatment -- or in the course of training of Minneapolis police officers, you might take exception with that statement?
TOBIN: I didn't follow your question.
NELSON: I'm sorry.
TOBIN: It's very hard to hear through that plexiglass. NELSON: And I'm losing my voice, I think. Excuse me.
If a Minneapolis police officer --
TOBIN: Yes.
NELSON: I'll try to talk closer to the mic.
If a Minneapolis police lieutenant, who trains Minneapolis police officers, testified that it is frequently said and trained to police officers that a person can talk, it means they can breathe, you would have a problem with that?
TOBIN: Yes. I mean, they're able to breathe at that moment in time, but 10 seconds later, they may be dead.
NELSON: Right. And because dealing with any person is a rapidly evolving situation that can change from second to second?
TOBIN: Yes.
NELSON: Now, in terms of the calculations that you have made, you would agree that your calculations are generally theoretical, correct?
TOBIN: No, they're not theoretical. I mean, they're based on direct measurements. They're based on extensive research.
NELSON: But you're making certain assumptions in the application of that science, are you?
TOBIN: Very few assumptions.
NELSON: You are assuming the weight of Mr. Chauvin?
[14:50:01]
TOBIN: Right, I'm aware. So I mean -- obviously, I'm aware that there are two different weights that are given.
NELSON: Right. And you are assuming the weight of the equipment that the officer wears?
TOBIN: Yes.
NELSON: And you've not actually ever physically measured the weight of the equipment a police officer carries, correct?
TOBIN: No. I mean, I took the measurements that are reported.
NELSON: And you are not actually weighing what Mr. Chauvin weighed on May 25th of 2020?
TOBIN: No.
NELSON: In your measurements, you appear to be, at least from my understanding, which is going to be limited, from my understanding, is that your measurements assumed an equal weight distribution between the right and left legs?
TOBIN: Yes, that's correct.
NELSON: All right. So, again, as we know, as things change and evolve and flow, weight is pretty frequently redistributed, right?
TOBIN: That is correct.
NELSON: And, again, in terms of the EELV -- am I saying that right?
TOBIN: Yes.
NELSON: The EELV, that's the --
TOBIN: End-expiratory lung volume.
NELSON: You are also basing that -- those calculations on the presumption that a person is a healthy individual, right?
TOBIN: For the EELV, it's not going to change, really.
NELSON: But in terms of the normal respiratory rate -- excuse me, some of the other factors that you've put into your analysis, it's all premised upon a healthy individual, right?
TOBIN: Right. It's based on a 46-year-old person of a particular height and sex, yes.
NELSON: Who is healthy?
TOBIN: Correct.
NELSON: Right. So you would agree if biology can change rapidly that the biological -- the specific biological conditions of Mr. Chauvin and/or Mr. Floyd come into play, right?
TOBIN: Correct.
NELSON: And those volumes or those figures that you assessed in connection with this case, they are conditioned upon him being a healthy individual?
TOBIN: Right. I mean, it varies in terms of the lungs. I mean, say, for example, compliance would vary but expandable lung volume is pretty robust. It will not vary.
NELSON: OK. So someone -- but other factors, like you said -- what was the first thing?
TOBIN: Compliance would vary from one person to the next person. But it varies, different segments within the lung. They are not all monolithic.
NELSON: OK. Now, you talked about one thing in terms of -- and this is a little bit of an aside -- but in terms of the prone position and the pushing of the stomach into the lungs, right? TOBIN: Yes.
NELSON: The size of a person's stomach has some baring on that, right?
TOBIN: It does.
NELSON: A person like myself, who has a few extra inches, if I am prone, it's going to perhaps push further or harder up into my lungs, right?
TOBIN: Yes.
NELSON: A person who is healthy, physical, muscular, it's going to have less of an impact?
TOBIN: That is correct.
NELSON: All right. But, again, in terms of what we have learned about Mr. Floyd from his autopsy and his medical records is that we understand that Mr. Floyd had heart disease, right?
TOBIN: That is correct.
NELSON: And in fact, I believe that he had somewhere, in his arteries, somewhere between a 75 percent and 90 percent occlusion of his ventricular arteries, right?
TOBIN: Correct.
NELSON: And that's going to affect blood flow in a person, right? It's going to make a body work harder to get the blood through the body?
TOBIN: No, not really. It's not going to do that.
NELSON: OK. How does that affect a person's respiratory?
TOBIN: The coronary artery?
NELSON: Yes, mm-mmm.
TOBIN: If the coronary artery is affecting it and if the coronary artery was contributing to shortness of breath, you would expect that he would be complaining of chest pain. And you would expect that he would be demonstrating a very rapid respiratory rate. And we don't see either.
NELSON: OK. We will come back to the respiration -- I can't say it right. I am taken by your accent. The respiratory rate.
TOBIN: I am trying to compensate for this.
(LAUGHTER)
NELSON: Appreciate it.
I will say it like you, his respiratory rate. [14:55:00]
TOBIN: There you go.
NELSON: All right.
We also -- we also understand that Mr. Floyd, based on his medical records, has a history of hypertension or high blood pressure?
TOBIN: Yes, that's correct.
NELSON: Now, in terms of -- what we also understand that Mr. Floyd had previously been diagnosed with COVID-19, right?
TOBIN: Correct.
NELSON: And he may not have been symptomatic on March 25th, but it's fair to say that a lot is unknown about the effects of COVID-19 on a person's lungs, long term?
TOBIN: I mean, not as much as it would appear to be the case. I mean, because, obviously, it's a viral. And we have a huge amount of information about the long-term effects of viral illnesses?
NELSON: And those can affect the elasticity of the lungs, right?
TOBIN: Not the elasticity. It would be -- if it's having an effect, it would be within the sensory receptors within the tracheal/bronchial tube. So it really wouldn't have anything to do with the elasticity.
NELSON: OK. Now, but we also learned quite a bit about the toxicology as -- excuse me. On the COVID-19, you testified that treatment of people with COVID-19 includes leaving them in the prone position, right?
TOBIN: Correct.
NELSON: And so those people who would be treated for COVID-19 in the prone position, based on your calculations, you would have a 24 percent decrease in the EELV?
TOBIN: Right. This is people with COVID, where they're -- during the time that they have COVID.
NELSON: Right.
(CROSSTALK)
NELSON: But that's what you would expect, that same decrease in the EELV?
TOBIN: No. It's going to be very different in somebody who has, say, pneumonia. What is going to happen in the prone position will be very variable from one person to another as a result of the pneumonia. It's different than normal lungs.
NELSON: OK. So in essence, every person is different?
TOBIN: Oh, for certain.
NELSON: Now, you calculated his respiratory rate to be 22, right?
TOBIN: Correct.
NELSON: And you said that that was within the normal respiratory rate?
TOBIN: Yes.
NELSON: And you would not describe him as hyperventilating?
TOBIN: The word "hyperventilation" is open to an awful lot of misinterpretation. That is most certainly not hyperventilation, no.
NELSON: And hyperventilation assists in the removal carbon dioxide from the body.
TOBIN: It's confusing. It's not that simple.
NELSON: In its simplest terms?
TOBIN: In the simplest terms, yes, it does. It gets rid of carbon dioxide.
NELSON: All right.
TOBIN: But it can be frequently misleading.
NELSON: OK.
Now, in terms of the toxicology of Mr. Floyd, we did learn that there were some controlled substances in his system, right?
TOBIN: Yes.
NELSON: We know that there was, for example, nicotine, right?
TOBIN: Yes.
NELSON: Mr. Floyd was a smoker.
TOBIN: Correct.
NELSON: And smoking changes the lung function, agreed?
TOBIN: In some people.
NELSON: Now, we also learned more -- and I'm not suggesting that all people who smoke have lung problems, right?
TOBIN: Less than 10 percent do. Ninety percent don't have any.
CAHILL: (INAUDIBLE)
NELSON: I need you to back up a little bit from the microphone.
TOBIN: I'm sorry. I'm sorry.
NELSON: No problem.
So we focused, in your direct examination, quite a bit in terms of Fentanyl and the Fentanyl's effect on the respiration rate?
TOBIN: Yes.
NELSON: And you would agree, generally, that Fentanyl is a respiratory depressant?
TOBIN: It can be.
NELSON: It's used in operating rooms, right?
TOBIN: Yes, frequently.
NELSON: And it's also used in the management of chronic pain, right?
TOBIN: That is correct.
NELSON: And medically speaking, those are the only two reasons that Fentanyl would be prescribed?
TOBIN: Yes, probably.
NELSON: All right. And, but you understand that Fentanyl has become far more prolific in street drugs, right?
TOBIN: Yes, I am aware.
NELSON: And there's a -- you would agree, generally, that there's a significant difference between Fentanyl that is manufactured according to the United States -- you know, their whatever rules apply, right? The pharmaceutical companies make it much differently than the street dealers do, right?
TOBIN: I imagine so.
NELSON: Right. And so when you are -- when a person is ingesting elicit street-purchased Fentanyl, it's -- every time they take a Fentanyl dose, it's a different experience for that person?
[15:00:00]
TOBIN: Right. But if it's affecting the respiratory center, it's going to actually be affecting receptors in the medulla oblongata. There's no other way around that.
NELSON: Right.
