By Catherine Hamilton and Natalia Ruvalcaba
RIVERSIDE, CA – The quadruple homicide trial of Jose Larin-Garcia proceeded here in Riverside County Superior Court Tuesday with testimony from a registered nurse at Desert Regional Medical Center and a forensic pathologist at Bio-Tox Laboratories.
Larin-Garcia is on trial for the murder of four people the night of Feb. 3, 2019 in Palm Springs. The prosecution is pursuing the death penalty.
Deputy District Attorney Samantha Paixao called Rachel Johns to the stand, a trauma nurse that assisted with the medical attention of Larin-Garcia the night of murders when he was brought to Desert Regional Medical Center.
Johns said that Larin-Garcia was coming in as a gunshot victim, but they could only find skin abrasions as wounds. 
Private Defense Attorney John Dolan attempted to show Johns the pictures of Larin-Garcia’s abrasions to see if she remembered the injuries specifically, but DDA Paixao objected on the grounds of foundation.
Johns had said the pictures “appeared to be in her trauma room, but she doesn’t recall that man,” and therefore had no independent recollection of Larin-Garcia and his treatment.
DDA Paixao said that the pictures could come into evidence at some point during the trial, but not through this specific witness, adding the medical records additionally have instances of hearsay, an objection sustained by Judge Anthony Villabolos.
One of the medical records said Larin-Garcia was discharged in stable condition, but DDA Paixao kept reiterating that video footage from the medical center showed him running out of the center.
The biggest question of debate was whether or not, since the medical records show conflicting evidence as to Larin-Garcia’s discharge, a doctor said Larin-Garcia was discharged, and if so, who that doctor was.
The point DDA Paixao continued to return to was that it doesn’t matter if Larin-Garcia was discharged, it matters if he knew he was discharged.
Johns returned to the witness stand, with the jury still absent for the previous debate about evidence, so that the court could figure out if she had independent recollection of Larin-Garcia’s injuries.
Attorney Dolan asked her whether the pictures of the injuries are consistent with what was recorded on the trauma flow sheet. She said they were, though absent was a picture of a skin tear to his left calf, but said she’s seen a lot of patients since Feb. 2019, and can’t say with certainty that these pictures are of Larin-Garcia.
She also said that normally the medical center doesn’t take pictures of injuries, so it was likely that the pictures were from law enforcement.
Johns left the courtroom again so that Judge Villabolos could discuss with the attorneys the evidence permitted to the jury, still out of the courtroom.
Judge Villabolos decided that since Johns didn’t have independent recollection of Larin-Garcia, and since the pictures were from law enforcement and therefore cannot be considered her past recorded recollection, the pictures “appear[ing] to reflect” his injuries is not a sufficient statement for foundation.
However, he did allow the attorneys to ask about the pictures’ consistency with recorded injuries, a medical record reflecting his blood work, and the trauma flow sheet noting his discharge.
Johns and the jury returned to the courtroom.
Johns agreed with attorney Dolan that the pictures of the injuries were consistent with the reported injuries. She also verified the officiality of Larin-Garcia’s blood work showing a blood alcohol level of 0.165, a relatively high level, double the legally allowed limit of .08 when driving
She did not recall Larin-Garcia’s discharge information on the trauma flow chart.
However, DDA Paixao asked her to read over the discharge information even though someone else had written it.
According to the document, Larin-Garcia “eloped,” meaning that he did not wait for his discharge papers, he did not stop upon request from medical staff as he left with a “steady gait,” and left his belongings behind.
There were conflicting statements, though, on Larin-Garcia’s medical records. According to another page, medical staff verbalized instructions to Larin-Garcia about his discharge, but DDA Paixao objected on the grounds of speculation since Johns did not write the information. Judge Villabolos sustained the objection.
The timeline of the medical records continued to further complicate the question about whether Larin-Garcia was officially discharged. The flow sheet included that he was given instructions for discharge, and that he verbalized understanding, though another part says that he was discharged to law enforcement.
However, the timeline presented in court did appear to show he left before instructions were given, and yet another record showed that he was no longer to be taken into custody by law enforcement, and could leave after the MTF (metabolized to freedom) process, also known as “sober to go.”
Johns is subject to recall by the defense as a precautionary measure, though attorney Dolan said it was unlikely she would be called back.
Erin Crabtrey, a forensic toxicologist at Bio-Tox Laboratories in Riverside, took the stand and examined the blood reports done on the deceased victims as well as Larin-Garcia.
When asked about alcohol and its effect on individuals, Crabtrey identified that alcohol is a depressant with varying effects from mental to physical impairments—sleepiness, loss of concentration, and slurred speech—depending on the amount consumed by the individual.
Following the questioning of alcohol, DDA Paixao then inquired about the expert’s knowledge of Fentanyl.
Crabtrey noted that Fentanyl maintains its own drug category—narcotic analgesic—which is classified as an opioid, adding that Fentanyl is a prescription drug intended for pain relief, yet it has side effects similar to that of alcohol.
When DDA Paixao questioned Crabtrey about the results of the alcohol and drug tests, in respect to the 17-year-old victim Yuliana Garcia, Crabtrey stated that there were no findings of alcohol and no presence of any drugs within the 10-panel screening.
Regarding victim 19-year-old Jacob Montgomery, Crabtrey said the results discovered zero presence of alcohol but did it detect Fentanyl. And that it could have been used within hours of being killed.
The prosecution then moved to the blood sample of 18-year-old Juan Duarte Raya, another victim.
Crabtrey reported, “No alcohol was detected, so zero percent alcohol. We do have cannabinoids detected similar to Mr. Montgomery’s sample,” in addition she noted, “We did also detect Fentanyl.”
Carlos Campos Rivera, 25 years old, was the final victim which Crabtrey reviewed. The testing, as Crabtrey communicated, found zero alcohol but did detect cannabinoids, cocaine, and Fentanyl.
After stating these findings Crabtrey testified that the levels of drugs found within the three male victims were quite equivalent. When questioned about the significance of this by DDA Paixao, Crabtrey asserted that the time of use may have been consistent between the men and that they had similar dosages.
The blood specimen of Jose Larin-Garcia was then examined by the court, and Crabtrey said her company only received Larin-Garcia’s sample in Sept. 7, 2021, more than two years from when the sample was originally taken, noting, “It is a possibility that the longer a sample is stored that you may lose some of the drug or alcohol that may have been present.”
The blood analysis and drug screening of Larin-Garcia revealed the presence of cannabinoids at 3.8 nanograms per milliliter. Given this information, Crabtrey claimed that “the use would have been in the past few hours, or several hours,” based on the fact that after three hours of use levels of cannabinoids often drop below 2.5 nanograms per milliliter.
Crabtrey added alcohol in the Larin-Garcia’s blood sample was 0.117 percent. Though, she noted that there could have been some amount of decrease in the alcohol levels due to the time in which the test was conducted.
The hospital’s original collection of blood reported a 0.13 percent, which accounts for the potential loss of alcohol levels that Crabtrey observed.
Private Defense Attorney Dolan cross-examined the expert, asking her to confirm her previous testimony, and she did.
In the case of Jose Larin-Garcia, Dolan asked, “Would these results indicate that the cannabinoids would be affecting the central nervous system of the person from whom this sample was taken?” Crabtrey noted that she would need more information to confidently answer.
Defense Exhibit “ZZ” was then presented to the court and labeled, “Physical Impairment” and “Mental Impairment.” Dolan gave Crabtrey a range of blood alcohol levels to which he wanted her to indicate whether or not mental or physical impairments were detected at each given level.
In a hypothetical, Dolan asked, “If you had an event that took place at 11:40 p.m.” and “and the blood alcohol was drawn at 12:37 a.m. about an hour later…what you could opine the blood alcohol could have been at 11:40 if it was fully absorbed?”
Crabtrey told the court that she was being asked by Attorney Dolan to do retrograde extrapolation, which examines how alcohol is eliminated from the body and the rate of calculation of how much can be lost in a given amount of time and what the initial amount could be.
After writing down her calculations, Crabtrey reported that the person’s blood-alcohol level, “if fully absorbed at 11:40 p.m. that they could have been from a .147 to a .157.” Slurred speech, delayed response time, and confusion were detailed by Crabtrey as being possible effects of this blood-alcohol range.
Based on Larin-Garcia’s report, taking into consideration the extrapolation by Crabtrey, Defense Attorney Dolan scrutinized the effects of cannabinoids with alcohol. Crabtrey insisted that there could be an additive effect but could not speak to a synergistic effect.
Crabtrey, speaking to the effects of this combination of drugs and alcohol on the gross motor skills, stated that effects depend on the individual and that she does not know about the tolerance of Larin-Garcia
Defense Attorney Dolan emphasized to the jury that mental impairments come before physical impairments, to which Crabtrey agreed. He then made recognition that some people can be mentally impaired but not look physically impaired, which was also agreed upon by the expert testimony.
Using the blood alcohol level of 0.147-0.157 defense Attorney Dolan questioned the physical and mental impairments of an individual. In response, Crabtrey noted that an individual would not be able to drive safely but physical impairment will not always be the case as tolerance affects a person’s abilities.
The jury trial will reconvene Thursday.
