His scientific assessment that the Georgina’s death was caused by a massive amount of ketamine granted to her before suffered the fatal setbackthe Professor of Forensic Science and Toxicology, medical chemist and head of the toxicology laboratory of the Aristotle University, Nikolaos Raikos, testified before the Joint Jury, who performed the toxicological tests on samples of the child’s blood, urine and organs.

The professor testified at the trial of Roulas Pispirigou that the child a few minutes before suffering the suspension received a very large amount of ketamine all at once and ruled out any possibility that the substance was administered to the child by a mistake by the doctors, as the defense claims. He also pointed out that the ketamine was administered while Georgina was alive as the substance had time to metabolize before the child suffered a seizure.

“Intensivists are not random doctors, they had no indication to give ketamine, we are talking about experienced people who fight battles every day” said Mr. Raikos who then explained: “The child is just before death and there they give him Rucuronium for muscle wasting. They will never give a sedative like ketamine. If breathing and heart function do not return, we are talking about physical death.”

Describing the way, the methodology and the course of the investigations carried out, the professor analyzed in court the findings and the scientific explanations they gave for Georgina’s case:

“When we have a very rapid death because the redistribution throughout the body is not complete, the blood of the heart responds better to the pharmacological situation. We examined the blood of the heart. We in the laboratory knew nothing. Several drugs have been identified that are administered in medical therapy. I asked for the child’s hospitalization sheet. “There were really big peaks in ketamine,” he said.

Chairman: What do you mean;

Witness: A first analysis is performed. Ketamine does not appear anywhere in the hospital file. I asked to know if the medicine was administered in the hospital. There was no ketamine anywhere in the file, it didn’t appear to have been used anywhere.

Chairman: Did you also examine the urine?

Witness: Yes. Formalin was tested next. Formalin is the solution in which the child’s tissues and organs were preserved. In cases of poisoning, the diagnosis is made with the toxicological examination.

Chairman: Should the medical examiner accept the results of toxicology and histology?

Witness: Everything should match, but if you have reservations, you should write it down. For the report to be complete it should be documented, use the bibliography, if I don’t agree I should document it, everything should click.

Chairman: Can you tell us if the formalin in which the organs are located has any properties?

Witness: It dehydrates, we have shrinkage, we have the loss of water weight.

Chairman: When are instruments weighed?

Witness: When you open the body.

Chairman: Are they still weighed?

Witness: It is a matter for the pathologist.

Chairman: When was it weighed here?

Witness: After. We compare the weights of these tissues with corresponding tissues that were in formalin. We should take into account that he was a child with encephalopathy and has atrophy. But we cannot compare the weight of the heart after death with the heart in formalin.

Chairman: The forensic report says that there is a mild degree of swelling in the dermis…

Witness: I would not like to express a personal opinion. The point is that we should take into account what is written on the hospitalization sheet. Let’s take into account what happened in the hospital. Otherwise it is a philological discussion. We keep that the child has no pulse, no breathing, has mydriasis and cyanosis. So this kid was in trouble. There is the conventional or clinical death, when the functions gradually cease, with the heart being the last. But physical death does not mean that all tissues cease. There is also cell death. To sustain life even after the heart stops working, some cells are preserved. But for them to come back there has to be oxygen and blood to be sent, there has to be heart function. Tissues that die later have an animal response only they will not have an inflammatory response that we would have in a living organism.

Chairman: Did the child stop living at 15:50? Before he lived?

Witness: No, the child was physically dead.

In response to a question from the chairman of the Chair about ketamine, the professor said: “First of all, it is a safe drug when it is in the hands of a doctor. Administered under anesthesia. How much will be given depends on the patient and the route of administration. However, even at the minimum doses, oxygen will drop and this results from clinical studies. The most suitable person to administer it is the anesthesiologist. The dose should be given gradually, because if you give it all at once it will instantly make your brain concentrate too much and the drop in oxygen will be greater. Its action is not therapeutic, it is anesthetic. Ketamine helps the heart unlike other drugs. It drops the oxygen but keeps the heart in good condition. Among other things, it causes salivation, mydriasis, etc. It acts similar to heroin, it acts directly on the breathing center, like heroin, but it is a dangerous drug in non-medical hands. We don’t have many such incidents. Some deaths from users and one recent incident from ketamine. The doses used for psychedelic purposes are much smaller than what we give for medical purposes.”

Chairman: In relation to the child who was 25 kg, if we assume that a doctor gave him ketamine, what would be the appropriate dose and given his state of health?

Witness: .. In Georgina’s case, because she exceeds the clinical studies (the dose she received) of 6.5 milligrams, we have not encountered them. We must find even from the few incidents in the literature, similar deaths. Toxicity is determined by the rate at which the substance was administered.

Chairman: You say the ketamine concentration was 6.5 micrograms per ml of blood. So in total it was about 250?

Witness: Yes. Compared to the two other incidents we had.

Chairman: You say that the life time of ketamine in the blood is about two to four hours. Can you explain it to us a little bit?

Witness: We don’t have much information about the children. Compared to adults, however, children metabolize ketamine faster. It is detectable until seven o’clock. But it always depends on the dose, because in high dose the detection time is prolonged.

Chairman: When we have no pulse, breathing, the heart does not beat and the pacemaker gives current, when we have mydriasis, fixed gaze, perioral cyanosis and snoring and given that at 2:28 the doctors were informed and they were in the room at 2:33 and they started advanced CPR, at this time what exactly was working in the child’s body?

Witness: Every piece of information is important, every word. If we do not evaluate it, we are making a mistake. Ketamine if given all at once and quickly will make a big climax, because it acts on the respiratory center which is dormant. Saturation drops and when it drops below 60 within 3 to 5 minutes mydriasis occurs. It is a symptom that is constant. Adrenaline is then given which also causes mydriasis. But initially the child is not breathing, the heart has stopped. Then because adrenaline was given (12 doses) and there we have mydriasis. The appearance of mydriasis is constant in both. So we have a child that is dead, we have a physical death. Ketamine here was not given by gastrostromy. From the moment it will be given intravenously we have 1 to 3 minutes, and 3 to 5 minutes is the time for intramuscular administration. It can be given either intravenously or intramuscularly. After the hypoxia occurs, we want 3 to 5 minutes for the mydriasis to occur. When does the objection take place now? The so-called asphygmatic function should appear and until asystole manifests it can be 5 and ten minutes. Anyone who says exactly ten minutes is wrong. It always depends on the dose, the time the ketamine was administered, the child’s condition, and when other drugs are present. Encephalopathy is also a catalyst. So there are all these factors that even a smaller dose might have been fatal.

Chairman: Tell us about the metabolism of ketamine….

Witness: For metabolism to occur, the heart must send blood. There is no other way. There was no activity here. From 2:28 or 2:30 blood was not going to the child’s organs. Metabolism does not exist after cardiac arrest. At five minutes up without perfusion the brain is done and if it is saved for some reason it is clinically dead. CPR is not an easy process, you are running against time. Everything is done in parallel, everyone has to coordinate, and everything is recorded, and no one can do anything outside the protocol, even getting the doctor to the other side of the bed is critical.

Chairman: Do you find another cause of death?

Witness: No

Chairman: Are there any of the other findings that should raise concern about the cause of death?

Witness: No.

Mr. Raikos testified that the ketamine given corresponds to three bottles. He estimated that at 2:30 the child was in limbo and 5 minutes later he was not alive. “He was on a break that didn’t come back. So it was dead at that moment,” he stressed.

Dimitris Georgakopoulos (Class Support counsel): You told us that the cause of death is the administration of ketamine. If we had therapeutic administration of ketamine, at what concentration would it be found?

Witness: If it was intravenous 2 to 3 milligrams per kilogram of weight and if it was intramuscular it can reach 6-8 milligrams per kilogram of weight.

Dimitris Georgakopoulos (uses information from the hospitalization sheet): 14:35 do we agree that the child has passed away?

Witness: Of course, it is physical death.

Dimitris Georgakopoulos: Mr. Bouzianis detected swelling in the dermis, but on January 28, a day before the child’s death, he had been suctioned twice. Do these two go together as a possibility? So, was the swelling caused by suction?

Witness: Yes.

Dimitris Karabelas (Class Support counsel): Does the concentration of ketamine you found indicate a single or gradual administration?

Witness: It is most likely that it was given in one go.

The Defense side of the Class submitted at the start of the proceedings and in writing the request it made yesterday for a cross-examination of the seven doctors and nurses who performed resuscitation on Georgina with the medical examiner Sotiris Bouzianis

The court reserved its opinion on the request, but after a proposal by the district attorney, it unanimously decided to call the curator of the pediatric clinic of the Rio hospital, Ari Bertzouanis, to testify, regarding what the pediatric neurologist Polyxeni Pelekouda testified yesterday about the doctors’ suspicions against her Roulas Pispirigou.

Both the defense and the Class Support agreed with the decision.

Mr. Raikou’s testimony will continue at another meeting.