Derek Chauvin trial live Doctor testifying for prosecution says what Mr. Floyd was subjected to would kill healthy person

MINNEAPOLIS — A medical expert in the physiology of breathing testified in the murder trial of Derek Chauvin that the way George Floyd was restrained — handcuffed behind his back, face-down on the ground, with a knee on his neck — prevented him from breathing properly.

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Dr. Martin Tobin, called as an expert witness by the prosecution, said the cause of Floyd's death was hypoxia, or a low level of oxygen that led to asphyxia, or suffocation. The overall effect of the restraint was almost "as if a surgeon had gone in and removed the lung," he said, referring to Floyd's left lung.

"A healthy person subjected to what Mr. Floyd was subjected to would have died as a result of what he was subjected to," Tobin said.

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Chauvin is charged with second-degree murder, third-degree murder and second-degree manslaughter in Floyd's death. The defense argues Floyd died as a result of the drugs in his system and underlying medical issues, but prosecutors say Floyd was killed by Chauvin's knee on his neck for more than nine minutes.

Stay updated on the Derek Chauvin trial: Sign up for text messages of key updates, follow USA TODAY Network reporters on Twitter, or subscribe to the Daily Briefing newsletter.

Latest updates:

• Court was expected to resume at 9:15 a.m. CST Friday.
• Dr. Bill Smock, a police surgeon with a specialty in forensics who reviewed "thousands of pages of documents" in Floyd's case, told jurors he concluded Floyd died of positional asphyxia, "which is a fancy way of saying he had no oxygen in his body."
• Daniel Isenschmid, a forensic toxicologist who analyzed George Floyd's blood and urine, told jurors the amount of meth in Floyd's system was consistent with a prescribed dose – a "very low" amount.
• Jurors have heard from 33 witnesses so far – all called by the prosecution.
• Attorney questioning returned to the topic of Floyd's drug use on Wednesday. Two forensic scientists said pills found in the SUV and police squad car Floyd had been in that day contained methamphetamine, a stimulant, and fentanyl, a synthetic opioid. A toxicology report found both drugs in Floyd's system after his death.

Prosecutors say Derek Chauvin, other officers betrayed policy by not giving aid to George FloydEmotional eyewitness accounts, lots of video: Here's what we learned in the first week of testimonyLegal experts: What to do if you see police using excessive forceStill grieving, Minneapolis residents wonder how city will move forward after trialGuilt, regret, helplessness: Floyd's death had 'profound' impact on witnesses

Expert witness Dr. Bill Smock: Floyd was not in 'excited delirium,' didn't overdose or have a heart attack

Dr. Bill Smock, called by the prosecution as an expert witness on drug tolerance who reviewed "thousands of pages of documents" in Floyd's case, took the witness stand Thursday afternoon.

Smock spent more than 20 years at a Level 1 trauma center in Louisville and teaches emergency medicine to paramedics, medical students and others in Louisville. He's edited four textbooks and has worked as an assistant medical examiner. He also is the police surgeon for the Louisville Police Department. Smock said he specializes in forensic analysis on people who have suffered major injuries but have not died.

Questioned by prosecutor Jerry Blackwell, Smock said he concluded that Floyd had died of positional asphyxia, "which is a fancy way of saying he had no oxygen in his body."

Smock said he also  researched other potential causes of death, including excited delirium, a state where someone's respiration and breathing rate is up, and they're "out of control." Smock said excited delirium is a controversial diagnosis because "there isn't 100% agreement on what excited delirium is." However, Smock added, "in my opinion, it is real."

Responding to questions from Blackwell, Smock said Floyd showed none of the symptoms of excited delirium, including failing to respond to instructions from law enforcement officers, excessive sweating and far higher than normal strength.

Smock also said he ruled out a Fentanyl overdose as a potential cause of death. Symptoms of an overdose of the synthetic drug can be slower respiration rates, "or they're not respiring at all."  Such an overdose would normally cause eye pupils to constrict said Smock. Instead, Floyd's respiration rate was normal and his pupil's were dilated, Smock testified.

The level of methamphetamine found in Floyd's system was "an extremely low level," Smock said, not suggestive of an overdose from  that drug.

Smock also addressed the lack of bruising on Floyd’s body. He added that "you can be fatally strangled, die of asphyxia, and have absolutely no bruising." Bruising depends on where, how much and how long pressure has been applied, he said.

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Trying to underscore Smock’s medical opinion on the cause of death, Blackwell played part of a police body camera video and audio of the struggle with Floyd. "Listen to Mr. Floyd's voice, he's speaking with full volume," Smock said, adding, "You will hear his voice get weaker and weaker."

As the court played video of Floyd crying out "Mama," his niece, Tiffany Hall, put her hand on her head and avoided watching the video. She breathed heavily and appeared to cry, dabbing her eyes with tissues as Floyd could be heard saying "I can’t move."

At one point in the video, Smock highlighted Floyd pushing against the tire of the police patrol car in an attempt to breathe. "He's trying to get his right chest off the pavement so he can breathe," Smock said. That echoed earlier testimony from Tobin, the expert in the physiology of breathing.

Blackwell also focused Smock on the police officers’ duty to provide medical care to Floyd. Smock said the officers should have started CPR "way before" paramedics arrived and began to administer it – a point several Minneapolis police officers have made in recent days. "As soon as Mr. Floyd was unconscious, he should have been rolled over," Smock added.

During cross-examination, lead defense attorney Eric Nelson got Smock to acknowledge that he's not certified as a pathologist. Asked by Nelson, Smock acknowledged there's no evidence from Floyd's autopsy that his airway had been obstructed. "The evidence is not from the autopsy, it is on the videotape, sir," Smock replied.

Smock said the autopsy showed Floyd had evidence of heart disease. Nelson asked whether Floyd's struggle with police officers could be likened to a cardiac stress test, when someone is placed on a treadmill with electrodes that record heart response as the treadmill's speed and difficulty level increases. Smock disagreed.

Asked by Blackwell, Smock said: "Th