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September 18, 2020 

Karen Stillwell 

O’Connor & Dyet 

7955 South Priest Drive 

Tempe, AZ 85284 

RE: Estate of Muhammad Abdul Muhaymin v. City of Phoenix et al

 United States District Court, District of Arizona 

 Case No. CV-17-04565-PHX-SMB

Dear Ms. Stillwell, 

You have asked me to review provided material and offer rebuttal opinions regarding the 

potential causes that may have contributed to the cardiac arrest of Mr. Muhammad 

Muhaymin and subsequent death in the hospital, specifically the impact of 

methamphetamines. 

As you are aware, I am a physician actively practicing at the University of California San 

Diego (UCSD) Health System since 1999. As a physician specializing in the fields of 

medical toxicology and emergency medicine, I routinely evaluate and treat patients with 

illnesses or injuries resulting from acute or chronic exposure to drugs or chemicals and 

the complications of these exposures. My primary academic appointment is as a 

Professor of Emergency Medicine at the UCSD School of Medicine. The Emergency 

Department at UCSD Medical Center is a level 1 trauma center, regional burn center, and 

tertiary care center in a major metropolitan city that receives patients from the 

southernmost region of California including most of the detention centers in the County 

of San Diego. 

Currently, I am the Vice Chair of Education in the Department of Emergency Medicine. I 

was also formerly the Director of the Medical Toxicology Fellowship and Emergency 

Medicine Residency training programs at UCSD. In addition to my duties at UCSD, I 

serve as a staff medical toxicologist at the San Diego Division of the California Poison 

Control System (CPCS), which provides poisoning treatment advice to the general public 

and medical community in the State of California as well as law enforcement and fire 

department personnel. Additional details of my qualifications are included in my 

curriculum vita, which is attached. 

My opinions for this matter were formulated after review of the following material 

provided by your office: 

1. Plaintiff’s First Amended Complaint 

2. Defendants’ Motion to Dismiss 

Ly Expert File 005929 CONFIDENTIAL COP 015777

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3. Plaintiff’s Response to Motion to Dismiss 

4. Defendants’ Reply in support of Motion to Dismiss 

5. Order granting Motion to Dismiss in part 

6. Defendants’ Answer to First Amended Complaint 

7. Plaintiff’s Motion for Leave to File Second Amended Complaint (currently 

pending before the Court) 

8. Defendants’ response to Motion for Leave to File Second Amended Complaint 

9. Plaintiff’s Reply in support of Motion for Leave to File Second Amended 

Complaint 

10. Phoenix Police Department Incident Report (COP 14-238) 

11. Audio of 911 call (COP 239) 

12. Body Camera Video from Officer Grenier (COP 1) 

13. Body Camera Video from Officer Hobel (COP 2) 

14. Body Camera Video from Officer Hobel (COP 3) 

15. Body Camera Video from Officer Canilao (COP 4) 

16. Body Camera Video from Officer Head (COP 5) 

17. Body Camera Video from Officer Head (COP 6) 

18. Body Camera Video from Officer McGowan (COP 7) 

19. Body Camera Video from Officer Nielsen (COP 8) 

20. Body Camera Video from Officer Nielsen (COP 9) 

21. Body Camera Video from Officer Nielsen (COP 10) 

22. Body Camera Video from Officer Aker (COP 11) 

23. Body Camera Video from Officer Clark (COP 12) 

24. Body Camera Video from Officer Miller (COP 13) 

25. Audio of recorded interview of Antonio Tarango (COP 251) 

26. Audio of recorded interview of Anthony Williamson (COP 252) 

27. Audio of recorded interview of Arizona Smith (COP 253) 

28. Audio of recorded interview of David Head (COP 254) 

29. Audio of recorded interview of Dennis Leroux (COP 255) 

30. Audio of recorded interview of Dennis Leroux (COP 256) 

31. Audio of recorded interview of Everett Baeza (COP 257) 

32. Audio of recorded interview of Hannah Glemba (COP 258) 

33. Audio of recorded interview of Jason Hobel (COP 259) 

34. Audio of recorded interview of Jimmy Yee (COP 260) 

35. Audio of recorded interview of Juan Lara (COP 261) 

36. Audio of recorded interview of James Clark (COP 262) 

37. Audio of recorded interview of Kevin McGowan (COP 263) 

38. Audio of recorded interview of Mark Aker (COP 264) 

39. Audio of recorded interview of Murray Williamson (COP 265) 

40. Audio of recorded interview of Oswald Grenier (COP 266) 

41. Audio of recorded interview of Ronaldo Canilao (COP 267) 

42. Audio of recorded interview of Ryan Nielsen (COP 268) 

43. Audio of recorded interview of Steven Wong (COP 269) 

44. Audio of recorded interview of Susan Heimbigner (COP 270) 

45. Audio of recorded interview of Tonya Davis (COP 271) 

46. Audio of recorded interview of Tonya Davis (COP 272) 

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47. Audio of recorded interview of Tonya Davis (COP 273) 

48. Transcript of recorded interview of Anthony Williamson (COP 12054-12076) 

49. Transcript of recorded interview of Antonio Tarango (COP 12077-012156) 

50. Transcript of recorded interview of Arizona Smith (COP 12157-12183) 

51. Transcript of recorded interview of David Head (COP 12184-12206) 

52. Transcript of recorded interview of Dennis Leroux (COP 12272-12278) 

53. Transcript of recorded interview of Dennis Leroux (COP 12279-12295) 

54. Transcript of recorded interview of Everett Beaza (COP 12335-12350) 

55. Transcript of recorded interview of Hannah Glemba (COP 12351-12387) 

56. Transcript of recorded interview of James Clark (COP 12388-12407) 

57. Transcript of recorded interview of Jason Hobel (COP 12445-12481) 

58. Transcript of recorded interview of Jimmy Yee (COP 12541-12572) 

59. Transcript of recorded interview of Juan Lara (COP 12573-12603) 

60. Transcript of recorded interview of Kevin McGowan (COP 12604-12622) 

61. Transcript of recorded interview of Mark Aker (COP 12671-12695) 

62. Transcript of recorded interview of Matt Murray (COP 12696-12709) 

63. Transcript of recorded interview of Oswald Grenier (COP 12710-12751) 

64. Transcript of recorded interview of Ronaldo Canilao (COP 12817-12872) 

65. Transcript of recorded interview of Ryan Nielsen (COP 12951-12967) 

66. Transcript of recorded interview of Steven Wong (COP 13025-13065) 

67. Transcript of recorded interview of Susan Heimbigner (COP 13115-13131) 

68. Transcript of recorded interview of Tonya Davis (COP 13189-13219) 

69. Transcript of recorded interview of Tonya Davis (COP 13220-13225) 

70. Transcript of recorded interview of Tonya Davis (COP 13226-13236) 

71. 50 photos taken at scene (COP 278-327) 

72. 394 photos taken at scene (COP 328-721) 

73. 164 photos taken of officers (COP 722-885) 

74. Photos taken of items received at autopsy (COP 886-926) 

75. Photos of autopsy and scene (COP 927-1274) 

76. Videos from library player (w/ Pelco Player software) 

77. X-rays taken by medical examiner 

78. Medical Examiner Report and Toxicology Report (COP 3356-3370) 

79. Medical records from Phoenix Fire Department (COP 13882-13892) 

80. Medical records from Abrazo Community Health Network (COP 14724-15221) 

81. Medical records from Terros (COP 15222-15398 

82. Medical records from Community Bridges (COP 13893-13918) 

83. Medical records from Maricopa County Correctional Health (COP 11932-12022) 

84. Audio of recorded interview of Dennis Leroux (COP 10809) 

85. Audio of recorded interview of David Head (COP 10810) 

86. Audio of recorded interview of James Clark (COP 10811) 

87. Audio of recorded interview of Jason Hobel (COP 10812) 

88. Audio of recorded interview of Kevin McGowan (COP 10813 

89. Audio of recorded interview of Oswald Grenier (COP 10814) 

90. Audio of recorded interview of Ronaldo Canilao (COP 10815) 

91. Audio of recorded interview of Ryan Nielsen (COP 10816) 

92. Audio of recorded interview of Susan Heimbigner (COP 10817) 

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93. Audio of recorded interview of Steven Wong (COP 10818) 

94. Investigation File (COP 10819-11008) 

95. Use of Force Results (COP 11009 and COP 10501.1) 

96. COR Affidavit and Summary (COP 11010-11021) 

97. Transcript of David Head’s recorded interview (COP 012207-012271) 

98. Transcript of Dennis Leroux’ recorded interview (COP 012296-012334) 

99. Transcript of James Clark’s recorded interview (COP 012408-012444) 

100.Transcript of Jason Hobel’s recorded interview (COP 012482-012540) 

101.Transcript of Kevin McGowan’s recorded interview (COP 012623-012670) 

102.Transcript of Oswald Grenier’s recorded interview (COP 012752-012816) 

103.Transcript of Ronaldo Canilao’s recorded interview (COP 012873-012950 

104.Transcript of Ryan Nielsen’s recorded interview (COP 012968-013024) 

105.Transcript of Steven Wong’s recorded interview (COP 013066-013114) 

106.Transcript of Susan Heimbigner’s recorded interview (COP 013132-013188) 

107.Deposition of Defendant Antonio Tarango 

108.Deposition of Defendant Officer Oswald Grenier 

109.Deposition of Defendant Officer Jason Hobel 

110.Deposition of Defendant Officer Ronaldo Canilao 

111.Deposition of Defendant Officer David Head 

112.Deposition of Defendant Officer Susan Heimbigner 

113.Deposition of Defendant Officer Ryan Nielsen 

114.Deposition of Defendant Officer James Clark 

115.Deposition of Defendant Sgt. Steven Wong 

116.Deposition of Witness Andy Damiano 

117.Deposition of Witness Jimmy Yee 

118.Deposition of Witness Arizona Smith 

119.Deposition of Mussalina Muhaymin (sister) 

120.Deposition of Muhammad Muhaymin (son) 

121.Deposition of Muhaymin (daughter) 

122.Deposition of Sgt. James Ward (30b6 witness from Phoenix Police Department 

re: training) 

123.Deposition of Det. Jemima Schmidt (30b6 witness from Phoenix Police 

Department re: 

animals) 

124.Deposition of Amanda Maskovyak, MD (medical examiner) 

125.Plaintiff’s Fourth Mandatory Disclosure 

126.Defendants’ Tenth Mandatory Disclosure 

127.Plaintiff’s response to Non-Uniform Interrogatories 

128.Plaintiff’s response to Request for Production 

129.Defendant City of Phoenix’ response to Request for Production 

130.Defendant Canilao’s response to Non-Uniform Interrogatories 

131.Defendant Clark’s response to Non-Uniform Interrogatories 

132.Defendant Grenier’s response to Non-Uniform Interrogatories 

133.Defendant Head’s response to Non-Uniform Interrogatories 

134.Defendant Heimbigner’s response to Non-Uniform Interrogatories 

135.Defendant Hobel’s response to Non-Uniform Interrogatories 

Ly Expert File 005932 CONFIDENTIAL COP 015780

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136.Defendant Leroux’ response to Non-Uniform Interrogatories 

137.Defendant McGowan’s response to Non-Uniform Interrogatories 

138.Defendant Nielsen’s response to Non-Uniform Interrogatories 

139.Defendant Tarango’s response to Non-Uniform Interrogatories 

140.Defendant Tarango’s amended response to Non-Uniform Interrogatories 

141.Defendant Wong’s responses to Non-Uniform Interrogatories 

142.Expert Report of Bennet Omalu, MD 

143.Expert Report of Scott DeFoe 

144.Expert Report of Greg Meyer (COP 15599-15675) 

145.Expert Report of Gary Vilke, MD (COP 15475-15598) 

146.Letter from Maricopa County Attorney (COP 3371) 

147.Plaintiff’s Notice of Claim (COP 3372-3376) 

148.Incident Report prepared by Antonio Tarango (COP 11239-11246) 

149.Memo sent to Antonio Tarango (COP 11509) 

150.Notice of Inquiry to Antonio Tarango January 2017 (COP 11510-11513) 

151.Notice of Inquiry to Antonio Tarango February 2017 (COP 11514-11517) 

152.Brochure on Disability Issues (COP 11518-11519) 

153.Statement prepared by Hannah Glemba re Sept 2016 (COP 11520) 

154.Statement prepared by Hannah Glemba re Jan. 2017 (COP 11521) 

155.Notice of Inquiry/Interview to Hannah Glemba (COP 11522-11523) 

156.Phoenix Police Department’s Operations Order re Use of Force 2019 (COP 

13919-13942) 

157.Mesa Police Department Report (COP 15399-15407) 

158.Phoenix Police Department’s Operations Order re Purpose Statement (COP 

15676-15677) 

159.Abrazo Maryvale Hospital Incident Report (COP 15680-15683) 

160.Maricopa County Animal Care & Control Report (COP15684-15687) 

161.Phoenix Police Department Operations Orders (COP 011449-011508) 

162.Statements from MCC Employees (COP 015694-015701) 

163.Laboratory and Toxicology Data (COP 015702-015757) 

164.Statements from Joshua Govan and Isabel Silvas (COP 015688-015693) 

The following summary of facts is provided for convenience and is not intended to 

itemize every fact that I relied upon in formulating my opinions in this matter. The 

relevant facts of the case pertaining to my analysis are summarized as follows: 

1. On 3/9/2013, Muhaymin presented to Maryvale Hospital by EMS after being 

found by police with an altered level of consciousness. His initial vital signs in the 

emergency department were unremarkable (COP 015194). Muhaymin was 

diagnosed with the following (COP 015091-015221): 

a. Toxic encephalopathy with severe agitation 

b. Methamphetamine toxicity with urine drug screen was positive for 

amphetamine and negative for barbiturates, benzodiazepines, cocaine, 

methadone, opiates, cannabinoids, phencyclidine. 

c. Rhabdomyolysis with elevated creatinine kinase at 1310 U/L 

Ly Expert File 005933 CONFIDENTIAL COP 015781

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2. Muhaymin was incarcerated and assessed on multiple occasions at Maricopa 

County Correctional Health Services 

a. 3/27/2016 

i. Vital signs are normal (COP 011951) 

ii. Bipolar, paranoid “no medications” (COP 011954) 

iii. Muhaymin denied currently using any drugs or alcohol (COP 

01156) 

iv. Muhaymin was overactive, euphoric, not oriented and had 

impaired judgment and insight (COP 011959-011960) 

b. 6/23/2016 

i. Vital signs are normal (COP 011965) 

ii. Muhaymin reported that he gets treatment for an unknown mental 

health condition. (COP 011971) 

iii. Muhaymin denied currently using any drugs or alcohol (COP 

011973) 

iv. Muyhamin did not exhibit any signs of substance 

intoxication/withdrawal (COP 011979) 

c. 9/5/2016 

i. Vital signs are normal (COP 011983) 

ii. Muhaymin reports he has schizophrenia but is on “no current 

meds” (COP 011990) 

iii. Muhaymin denied currently using any drugs or alcohol (COP 

011991) 

d. 9/6/2016 

i. Vitals signs are normal (COP 012005) 

ii. Muyhamin denied alcohol or drug use. He appeared paranoid or 

intoxicated on a psychostimulant (COP 012017) 

3. Muhaymin was evaluated on multiple occasions at Terros, Inc 

a. On 10/25/2016, Muhaymin and his sister met with Dr. Villalobos and case 

manager Shaheed (COP 015346-015353) 

i. When asked, Muhaymin did not state what drugs he uses aside 

from marijuana 

ii. Sister, Mussalina, reported Muhaymin “has been using drugs: 

cannabis, questionable meth” 

iii. He reported “aud[itory] and visual hallucinations, some paranoia” 

iv. Dr. Villalobos makes a diagnosis of “schizophrenia, 

undifferentiated type” 

b. On 11/14/2016, Muhaymin was evaluated by Dr. Villalobos (COP 

015324-015326) 

i. He reports drug use history, drug of choice is cannabis. 

c. On 12/5/2016, Muhaymin was evaluated by Dr. Villalobos in the presence 

of his stepmother and sister (COP 015368-015370) 

i. Symptoms started after his father passed away in 2006 

ii. Muhaymin was arrested multiple times for different reasons 

iii. Muhaymin was previously treated with Risperdal, Wellbutrin SR, 

Seroquel 

Ly Expert File 005934 CONFIDENTIAL COP 015782

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iv. Behaviors worsen with drug use. Did not specify drug use. 

v. Admitted to smoking cannabis 

vi. Dr. Villalobos diagnosed Muhaymin with “schizophrenia” and 

“cannabis use disorder, mild.” 

d. On 12/12/2016, provider Bryant meets with Muhaymin (COP 015243-

015247) 

i. Drug of choice is meth 

ii. Also “used all types of substances and is not ready to say what he 

has used” 

iii. Reports longest sobriety was 2 months 

iv. Diagnosed with psychiatric condition at age 33 

v. Muhaymin’s “nutrition is not good due to his homelessness” 

4. In the morning of 1/4/2017, police were summoned to Maryvale Community 

Center where they encountered Muhaymin and his dog. 

a. Officers speak briefly with Muhaymin and allow him to use the restroom. 

b. While Muhaymin is in the bathroom, officers discover that Muhaymin has 

a warrant for his arrest. 

c. After walking Muhaymin out of the community center, officers advise him 

that he is under arrest and requested that he put the dog down but 

Muhaymin does not comply. Officers attempt to place him in custody but 

Muhaymin resists and is taken to the ground by the officers and eventually 

cuffed behind his back. 

d. Officers then walk Muhaymin to one of the police vehicles. During this 

time Muhaymin continues to resist. 

e. Muhaymin is somehow able to bring his hands to the front of his body and 

able to escalate his efforts to resist multiple officers trying to once again 

place him securely in custody. 

f. Eventually officers are able to restrain Muhaymin on the ground when he 

suddenly stops moving and vomits. 

g. Officers recognize that Muhaymin is unresponsive and not breathing. 

They request medical aid and initiate CPR. 

5. Phoenix Fire Department medical crew arrived at the scene around 10:08 AM and 

assumed care of Muhaymin. They found him to be pulseless, apneic with vomit in 

his airway. CPR was continued and Muhaymin was transported to Abrazo 

Maryvale Hospital and arrived at 10:21 AM. 

6. Despite additional advanced resuscitative measures employed at the hospital, 

Muhaymin remained pulseless and apneic. He was pronounced dead at 10:39 AM 

7. An autopsy was performed 1/5/2017 at 10:12 AM, approximately 24 hours after 

death. Significant findings include the following: 

a. Height 67 inches, weight 164 pounds 

b. Coronary artery disease with 40-50% stenosis of the left anterior 

descending artery 

c. Acute methamphetamine intoxication 

i. 0.81 mg/L methamphetamine in iliac blood 

ii. 0.24 mg/L amphetamine in iliac blood 

d. Multiple blunt force injuries 

Ly Expert File 005935 CONFIDENTIAL COP 015783

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8. Statements obtained in investigations, inquiries, interviews or depositions: 

a. Anthony Williamson thought that Muhaymin was “definitely lit up on 

something...that dude was pretty strong...or he was on 

something...because those four guys...they were all pretty big...and this 

guy wasn’t that big, and they were having a hard time...it was a major 

struggle” (COP 012068-012070) 

b. Juan Lara stated “so then, I saw another police officer running towards 

that area, and basically they just -- they were struggling with him.··He was 

really resisting...It looked like the gentleman was Superman, man, he was 

strong...He looked like he was strong...They were having a hard time 

with him. (COP 012575) 

c. Ofc. Leroux stated Ofc. Hobel informed him “hey, this guy is real strong” 

(COP 012311) 

d. Ofc. Hobel stated “and once on the ground, we're still struggling to get his 

arms up, and I'm absolutely shocked that he was putting up as much of a 

fight as he is because I'm a bit bigger than he is, and I'm fairly strong, and 

it was everything that I could do to get his hand behind his back” (COP 

01249) 

e. Ofc. Grenier 

i. “In 18 years, I've never had anything like that in my life...That guy 

has been the strongest guy I've ever had in my life or my police 

career...I've never had anybody that strong.” (COP 012734) 

ii. “the strength in 20 years is probably one of the most strong guys 

I've ever had to deal with. And I've dealt with people that are on 

PCP. And his strength was astronomical...it seems like he didn't 

have any pain receptors.” (Deposition p. 121) 

f. Ofc. Nielsen stated “for somebody to get that like super human strength, 

my first thought was there’s got to be some sort of drugs on board.” (COP 

013009) 

g. Ofc. Canilao stated “I was thinking the baton was going to bend -- the 

baton was going to bend because this guy’s hold was strong...Man, this 

guy is strong as a mule...He’s just very strong. I’m just surprised by how 

strong he is.” (COP 012884, 012902, 012917) 

h. Ofc. Heimbigner – “I just know that he was extremely strong...I mean, he 

was causing people to lift up, he was still moving.” (COP 013123) 

i. Sgt. Wong – “I ran across it in my career before, but very, very, few 

times...And, yeah, this is one of those where I -- he was -- he was 

definitely a lot stronger than what he should have been.” (COP 013104) 

j. Andy Damiano (Damzano) - Mr. Muhaymin was "fighting hard" and must 

have been on something extreme. Mr. Damzano added, "I've heard about 

men being as strong as a bull, but I'd never seen it." Mr. Damzano said Mr. 

Muhaymin was kicking, twisting and contorting his body to get away and 

the officers could not control him (COP 010826). 

k. Tony Tarango – “It took me by surprise when he bumped me on this 

day...Muhaymin showed signs of unpredictable behavior and was 

physically aggressive towards me” (COP 011512). 

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l. Isabel Silvas – “The guy was getting loud and rude...he got mad and 

pushed Tony...The guy was yelling screaming...then the guy said his dog 

was a cat.” (COP 015691) 

My opinions are as follows: 

1. Muhaymin was a homeless, poorly nourished, schizophrenic man with coronary 

artery disease that also used illicit drugs notably marijuana, methamphetamine, 

and possibly others. On 3/9/2013, he was hospitalized for complications of 

methamphetamine intoxication. On 1/4/2017, he was also acutely intoxicated with 

methamphetamine. 

2. Despite a purported history of schizophrenia, Muhaymin did not appear to be 

consistently engaged in treatment for schizophrenia or any medical condition 

prior to his death. 

3. Muhaymin used marijuana. It is used both as an intoxicant and for medicinal 

purposes. Users describe typical intoxicating effects to include relaxation, 

alteration in sensory awareness, alteration in time perception, euphoria, among 

others. There is no evidence that Muhaymin was prescribed marijuana for any 

medical condition by a qualified healthcare provider. 

4. Muhaymin used methamphetamine. The mechanism of action of 

methamphetamines is to cause the body to release chemical messengers called 

neurotransmitters (i.e. adrenaline, noradrenalin) that prepare the body to rapidly 

flee or stay and vigorously fend off a perceived threat. This response is commonly 

referred to as the “fight or flight” response and happens naturally when people 

and other mammals are faced with threatening situations. As a result, heart rate 

and blood pressure increase to provide the body with sufficient alertness, energy, 

and oxygenation of tissues to respond to the perceived threat. For these reasons, 

methamphetamine is also used by athletes to enhance performance by increasing 

speed, strength, and endurance while reducing the perception of fatigue. When 

used as an intoxicant, methamphetamine causes the body to release these 

neurotransmitters absent a threat causing the individual to misperceive reality and 

confuse typical experiences in society as potential threats to life and react in 

aggressive and bizarre ways that individuals not acutely intoxicated with 

methamphetamines would typically behave. Methamphetamine is used as 

medication but there is no evidence that Muhaymin was prescribed 

methamphetamine for any approved medical indication. 

5. Methamphetamine is also capable of producing psychosis in the absence of 

schizophrenia and this psychosis is indistinguishable from paranoid 

schizophrenia. In the presence of schizophrenia, methamphetamine may 

exacerbate psychosis. 

6. Muhaymin’s aggressive and unpredictable behavior seemed to escalate after using 

the bathroom. He may have consumed some additional methamphetamine in an 

effort to conceal the drug while using the bathroom and not under direct 

observation of the officers. This is known in as “body stuffing” and may have 

contributed to additional toxicity. 

Ly Expert File 005937 CONFIDENTIAL COP 015785

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7. Amphetamine was also detected in Muhaymin’s blood. Its presence is most likely 

a result of his body metabolizing methamphetamine to amphetamine rather than 

independent use of amphetamines. Nevertheless, the effects of amphetamine on 

the body is very similar to methamphetamine both physiologically and 

psychologically and its effects on the body is at least additive when 

methamphetamine is also present. Like methamphetamine, amphetamine also has 

accepted medical uses but there is no evidence that Muhaymin was prescribed 

amphetamine for any approved medical indication. 

8. Methamphetamine concentrations detected in Muhaymin is well within a range of 

postmortem levels reported in the medical literature to result in death absent other 

causes. Muhaymin used methamphetamine as an intoxicant in the several hours 

prior to his death and was acutely intoxicated with methamphetamine. Acute 

methamphetamine intoxication also augmented his body’s physiology allowing 

him to summon the strength to resist multiple officers. Because Muhaymin was 

acutely intoxicated with methamphetamine, he likely did not perceive the 

discomfort of fatigue which allowed him to continue to resist in a prolonged 

manner four officers trying to cuff him. The officers were audibly breathing hard 

during and following the encounter with Muhaymin. The strenuous exertion in 

resisting officers led Muhaymin to develop severe lactic acidosis which is 

commonly accompanied by hyperkalemia (high blood potassium). Hyperkalemia 

may also result from muscle injury (rhabdomyolysis) associated with extreme 

exertion. Both lactic acidosis and hyperkalemia may independently precipitate 

cardiac dysrhythmia resulting in sudden death and is the most likely cause of 

death in this case. 

9. If Muhaymin was not intoxicated with methamphetamine he would not have 

resisted in the manner and extent that he did and would have survived the 

encounter with police on 1/4/17 like he did in past encounters 

You also asked that I comment on Dr. Bennet Omalu’s opinion as they migrate into my 

areas of expertise in medical toxicology: 

1. Omalu opines that Muhaymin was alive and well on 1/4/2017. Muhaymin was a 

homeless, poorly nourished, schizophrenic man with coronary artery disease that 

was acutely intoxicated with methamphetamine. Muhaymin was alive but he was 

not well. 

2. Omalu opines that Muhaymin “did not die of methamphetamine toxicity.” 

a. Omalu acknowledges that Muhaymin consumed methamphetamine within 

hours of his death. I agree with this opinion. 

b. Omalu states that Muhaymin “was a chronic drug user, and people who 

use Methamphetamine chronically develop drug tolerance and habituation 

and as time passes would use and need higher levels of drugs to achieve 

the same effects.” While Muhaymin may be a chronic drug user, it is not 

clear from the materials available to me that he used methamphetamines in 

a manner to suggest that he is tolerant to the effects of the drug. Tolerance 

and habituation occur with long-term, regular use of a drug but invoking 

tolerance in Muhaymin requires knowledge of the drug types, routine drug 

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dose, and escalation of drug dose over time to achieve the same effect. 

Omalu’s opinion that Muhaymin was tolerant to the effects of 

methamphetamine is not based on the evidence as none of the critical 

information to suggest tolerance was present in the material I reviewed. 

Additionally, tolerance is not a durable effect across time. Individuals who 

have well documented tolerance to drugs will lose that tolerance during 

periods of abstinence. Muhaymin was abstinent from drug use for at least 

a 2-month period according to jail records and he was presumably 

abstinent while in jail as well. The medical records from Terros, Inc is 

vague and imprecise in detailing type, quantity, and pattern of 

Muhaymin’s drug use in the weeks to months prior to his death. In fact, 

Dr. Villalobos who evaluated Muhaymin during that period only 

diagnosed him with schizophrenia and cannabis abuse. Notably absent 

from the list of diagnoses is methamphetamine abuse or dependence 

because there was insufficient information for Dr. Villalobos to 

responsibly make such conclusions, so it is unclear to me how Omalu 

concludes that Muhaymin was a chronic user of and had achieved 

tolerance to methamphetamine and amphetamines. While Muhaymin’s 

behavior may be due to methamphetamine intoxication alone or 

methamphetamine intoxication in a person with schizophrenia, the 

strength and endurance he exhibited in resisting law enforcement officers 

is attributable to acute methamphetamine intoxication not schizophrenia. 

c. Omalu also discusses postmortem redistribution of drugs which is a very 

real phenomenon that can result in higher or lower levels of drugs 

measured from postmortem samples. It is also well accepted that samples 

obtained from more peripheral sites (distant from the heart), like the iliac 

vessels in this case, are less likely to be distorted by postmortem 

redistribution than those obtained centrally (from or near the heart). 

Omalu also points out that individuals with higher methamphetamine 

concentrations than found in Muhaymin have survived but ignores 

numerous reports in peer-reviewed medical literature that individuals with 

lower methamphetamine concentrations have also died. 

d. I believe that Muhaymin used a sufficient amount of methamphetamine in 

the hours prior to his death to cause acute intoxication leading him to 

exhibit the extraordinary strength and endurance to resist multiple officers 

trying to place him in custody and this is irrespective of tolerance and 

postmortem redistribution. 

3. Lastly, Omalu opines that Muhaymin “experienced conscious pain and suffering 

for a total composite median duration of less than 15 minutes before he became 

unconscious on January 4, 2017 and died.” He further states that 

“Methamphetamine did not prevent or preclude Muhammad from experiencing 

conscious pain and suffering.” At no time during any video did I hear Muhaymin 

verbally expressing pain to anyone. If he did experience pain, he did not modify 

his behavior and actions in a manner that most other humans would do to stop the 

pain from continuing. In fact, Ofc. Grenier thought that Muhaymin seemed as if 

he was not feeling any pain. Methamphetamine may independently cause 

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intoxicated individuals to become disconnected from reality and has the ability to 

exacerbate the psychosis in individuals with schizophrenia. It is not scientifically 

based that Omalu offers an opinion that suggests he knows the content and 

manner in which Muhaymin was experiencing reality 15 minutes prior to his 

death. There are no animal or human models that reasonably approximates the 

mind of a schizophrenic man that is also highly intoxicated with 

methamphetamine. 

These opinions are based on review of the material noted above and provided to a 

reasonable degree of medical certainty. 

Sincerely yours, 

Binh T. Ly, MD, FACMT 

Professor of Emergency Medicine 

Vice Chair, Education 

Assistant Medical Director 

California Poison Control System – San Diego Division 

Ly Expert File 005940 CONFIDENTIAL COP 015788

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