held that a plaque has suddenly changed because it has fractured these plaques can actually be kind of hard to that's why this is known as hardening of the coronary arteries sometimes these plaques will fracture and you can see clot or fiber which is protein from the blood suddenly filling that plaque and so the plaque went from being smaller than it used to be to being bigger than it used to be very very quickly sometimes you can even get hemorrhage into a plaque as it fractures and so the plaque can grow very quickly we can we can see that with the naked eye at autopsy sometimes we can see that under the microscope as well to get to the heart of your question counselor i did not see those changes in the stroke floyds coronary arteries these looked to me to be i guess you would call them stable plaques for lack of a better term and if they had fractured in some way and created a clot of some kind would that be observable on autopsy yes and that's one of the reasons we decided to these arteries so carefully as you wouldn't want to miss an acute change or a from us because in most cases that would tell you a lot about how the person died in if there were any thrombosis and it affected the

heart muscle what would that look like if you had such a defective heart muscle autopsy if we find a from us which means an acute clot in the coronary artery if the person dies a very very quickly which is entirely possible we won't see anything abnormal in the heart muscle that depends on that coronary artery for its survival people typically need to survive for hours from their acute cardiac event before we can see any changes in the heart he's there under the microscope or with the naked eye so if a person dies very very quickly from a coronary artery events we can only infer what happened based on the fact that they have that coronaries and the circumstances of their death we wouldn't expect the heart muscle to look abnormal. and the if the heart muscle does show damage from a clot what does that look like so that depends on how long the clot has been there and how long the person that survived there's a generally good progression of changes that we see very very early all you might

see under the microscope is some of the heart cells start to look a little bit wavy an abnormal shortly after that they start to take on way more pigment under the microscope than the surrounding heart cells do they look much brighter to us under the microscope than those the heart cells start to die or necros as we say in pathology that necrosis then brings in an inflammatory reaction from the body and so you see inflammatory cells come and start to clean up those dead heart cells and then eventually the body will bring in what we call granulation tissue which is new blood vessels and early scar tissue and if the person survives long enough that that dead area of heart will just turn into a scar dead heart cells unfortunately don't grow back and so once they die depending on how long the person survives will see anything from those very early changes all the way out to a scar but what the spectrum is sort of missed a floyd you'd see any damage to the hartmans that's correct let's talk about the

the brain did you notice the injury damage to his brain tissue i did not i did not notice any acute injury to his brain in the sense of physical trauma nor did i note any injury to his brain in the sense of it being deprived of blood or oxygen. did you know anything regarding this before his lungs. mr floyd's lungs were quite a demo this meaning they had a lot of fluid in congestion in them but other than that they were generally normal post-mortem lungs and is it possible to get fluid on the lawns way democrats lungs i think you call that from the efforts to resuscitate mr floyd. after he was taken from the scene yes and what kinds of fluids could cause that. well basically what we're seeing at autopsy is just called a demon fluid which is

a lately protein filled fluid that seeps out of the blood into the lungs and fills up the breathing spaces we see that in people who have had protracted c.p.r. been given lots of fluid you know as their heart's not working very well perhaps not at all during the c.p.r. they're still getting a lot of fluid put in them in the emergency room and so we can see that pulmonary edema from that there's other circumstances in which we see pulmonary edema as well it's a it's a fairly nonspecific finding and so in this instance with this directive mr floyd. you you didn't or didn't need to take the time to try to understand what was the source of his pulmonary edema i don't know that i could pin point a source with any accuracy again given that he got c.p.r. there's multiple potential explanations for his pulmonary edema. what about the prospect of what's called a pulmonary embolism. what is a pulmonary embolism

a pulmonary embolism is when you have a clot form in another part of your body most commonly it's in the lower legs or the pelvis although it can form in other places and that clot breaks off and it goes straight to the lungs because that's where your heart pumps all the blood as it returns from your body a massive public embolism can be almost instantaneously fatal and by massive i mean it blocks the artery coming off the top of the heart that goes to the lungs smaller pomona or pulmonary emboli can go out into smaller branches of the lungs sometimes they're completely asymptomatic sometimes they're symptomatic sometimes they can be life threatening if the person has underlying conditions we do always look for pulmonary as part of the forensic autopsy did you see any point where you can buy in the case of mr george for you know he did not have any homeowner employing. dr baker let's talk about the toxicology did you seek was called the toxicology screen in this case. yes would you tell the jury what is

a toxicology screen. so we actually we actually use the term expanded panel simply because the laboratory that we use that's the terminology but in essence what we do is we send off one or more tubes of blood in some cases urine to our toxicology lab and they run a very comprehensive panel looking for a variety of illicit drugs as well as scores and scores of prescription drugs. i expect you've probably already heard from a toxicologist so i won't go into the laboratory part of it because that's not my area of expertise but part of the testing they do is antibodies looking for specific categories of drugs like morphine and related compounds benzo days of penes things in that class barbiturates and so on in the lab can do a variety of other techniques that are often go under names like gas chromatography liquid chromatography mass spectrometry things like that and there they have the potential to detect hundreds of different medications that way that's what we call

the expanded panel with the lab that we work with that's typically what we ask for in most forensic autopsies and is the lab you work with him that's correct how long have you worked with m.s. labs it's been about 13 or 14 months now. so put the past 13 or 14 months with that be the only lab that you would be sending out the toxicology panels with screens to from the county medical examiner's office yes all of our post-mortem toxicology is done by analysts. are you familiar with the toxicologist named dr yes i know dan. dr oz testified here just. time flies of his yesterday or 2 days ago

but he testified here do you have a. good opinion of the toxicology of him he's been great to work with so far and we have we. will defend is. this day and. well you know dr isaacson i do. did you examine the contents of mr void stomach as part of your autopsy i did. what did you know regarding the contents. and i refer to my reports of that yes if it helps refresh your recollection. i'm simply going to quote what i dictated as part of the post-mortem exam the stomach contains approximately 450 millimeters of dark brown fluid with innumerable soft fragments of gray white food particulates matter resembling bread. did you know anything resembling either

a pill or pill fragments in the stomach contents i did not. did you do any testing of the contents of the floyd stomach as a part of the toxicology assessment for mr floyd so i wouldn't do any testing of that it is possible that we could send it to a lab like m.s. for testing but i did not request that. so were you aware of whether or not miss the floyd had tested positive for. yes i was aware of that not at the time i did the autopsy but i became aware of that later it was a significant to you in any way that he had tested positive for kobe. i guess it kind of depends on what you mean by significant this was very early in the pandemic and we were still scrambling to figure out things like autopsy safety protocols and what we should be wearing so in that sense it was significant in mr floyd specific case the fact that he had been coded positive 7 or 8 weeks before he passed away

did not factor into my cause of death determination because i didn't see any signs of kobe that his autopsy and his lungs did not have any of the stigmata coated that i would expect to see under the microscope. so he was clinically symptomatic from your point of view. i can't assess that because i didn't i didn't know mr floyd when he was alive to the best of my knowledge he was generally healthy on may 25th before the events of that evening i'm i'm unaware that he was suffering from any acute symptoms at that time. and you also know that misapplied had sickle cell trait what can you tell us about that sickle cell trait is carried by about 8 percent of americans of african heritage what it means is that one of the genes that codes for the beta gene chain of human globin has an abnormal substitution in it if you just have sickle cell trait chances are you will go through life and

never have any symptoms from it because you make plenty of normal human globin that's very different than sickle cell disease which means that both of the genes have that gene substitution and then you have sickle cell disease people with sickle cell disease can get very severe anemia they can have sickle cell crises they're subject to a variety of infections and other complications but mr floyd didn't have that he just had the one gene for sickle cell trait i wouldn't even have known that except that it's happens that people who have sickle cell trait. when you take a biopsy of one of their tissues and put it in formaldehyde which is what pathologists do with all tissue the formaldehyde can cause cells to sickle as a post-mortem artifact and so when i saw that on mr floyd slides i immediately called the hospital lab and i said you have a peripheral blood smear for mr floyd and it turned out they had made a blood smeared during his c.p.r. and so i had a pathologist who specializes in blood disorders look at the slide and confirm there was no evidence that mr floyd was sick or laying on his peripheral smear

during life i did also have our lab then run a sickle cell quantitate which means they actually quantify the abnormal hemoglobin in the blood and sure enough that came back with the exact number that would be consistent with mr floyd having sickle cell trait so it's really just a fluke that it got picked up at autopsy in my opinion it doesn't have anything to do with why he died all right. what about the period being glioma a kind of tumor i'll just ask you about the period being glioma as to whether you found concluded that it had anything to do with this is that. the short answer is i don't feel mr floyd's pair again glioma had anything to do with his death what we're talking about is an incidental tumor that i happen to find in his pelvis during the autopsy i did look at it under the microscope most likely diagnosis is a pair again glioma but i have no reason to believe that had anything to do with mr floyd stuff. so that could make you want to switch and talk about the best to

figure out if we could pull up exhibit one. first i'd like to talk about the press release report ok and ask you 1st the doctor bigger if you just identify what this is for the record. yes what you are looking at is the final press release my office put out once i had reached my conclusion as to the cause and manner of mr floyd's death. he explained to the jury what it means to certified death. to certify death as a physician means that you feel in the decision is cause of death and their manner of death and if their manner of death is other than natural than you also have to fill in the how injury occurred box on the death certificate. death certificates are relatively standard in the united states most of what's on them is largely dictated by the centers for disease control they vary

a little bit in appearance from state to state but the core elements are pretty much the same in every jurisdiction most of what's on a death certificate is actually filled in by family members in the funeral director so you know what's the dizziness full name where were they born what are the names of their parents did they ever serve in the armed forces there's all kinds of things that are captured. the medical examiner's primary role again as i mentioned is the cause of death the manner of death and the how injury occurred most death certificates in the united states are actually filled out by clinicians meaning your primary care doctor that you see that person fills out death certificates for their patients who die of routine natural conditions medical examiners get involved when the death appears to be from natural causes in practice we should be the only people that certify deaths or the man or is ever anything other than natural. so doctors we can look at exhibit 193. first

which is for the record tell us what this is you know this is looks to be a actual state of minnesota death certificate for mr george floyd these the death certificates are actually produced by the state not by the medical examiners we simply fill in the parts were responsible for we push all of those data to the minnesota department of health and then the death certificates issued by the state and so that's why what you see here says state of minnesota on the top but the cause of death the other contributing conditions in the manner that's what i'm responsible for that's right in the middle of your display you've been on that short to the jury i think this is prevented john. so if we look at the cause of death media underlying other contributing conditions this would be the section that you feel correct. so if we see here on the manner of death is indicates homicide. tell us what does

homicide mean to you is a medical exam so is a medical examiner we apply the term homicide when the actions of other people were involved in an individual's death it's one of 5 manners of death that we can choose from the other for being accident suicide natural. or undetermined homicide in my world is a medical term it's not a legal term from a vital health and public statistics point of view it's critical that medical examiners fill in the manner of death and out of a death certificate because from a public health point of view you want to know how many people committed suicide in your state how many people died of accidents in a given year in your state and so it's a it's a key piece of public health data but we don't use it as a legal term so. dr baker in front of the exhibit 19 is a list of man is a bit the ones you just talked to us about natural accidents suicide homicide which

have highlighted because is what you found in this instance and then hunted term. would you tell us from your point of view as a medical examiner what does naturally natural means the person died exclusively of natural diseases right so an example of a natural disease might be a heart attack or a fatal arrhythmia as a primary cause of death. those are actually pretty vague terms were much more specific so to your point counselor erratic heart disease causing a heart attack would be a natural cause of death a ruptured brain aneurism from long standing untreated high blood pressure would be a natural cause of death metal static a lung cancer would be a natural cause of death there's almost an infinite number of potential natural causes of death and it looked at accident as an accidental cause. is a drug overdose an example of what could be an accidental cause of. most drug overdoses

are accidental causes death some are suicides but yes we do regard most drug overdoses because we don't believe the person intended to die we do regard those as accidents. and we know what suicide is dr what does undetermined mean undeterred. means that despite the best efforts of law enforcement the medical examiner the medical examiners investigators we simply never could pin down the circumstances under which the individual died in any good medical examiner's office you are going to have a small percentage of cases every year that go out undetermined and manner most of those as it happens are people who died of drug toxicity and based on the drug levels based on the person's known history we just don't have enough data to know whether this was a suicide or an accident and so if we don't know their intent it's often undetermined more dramatic but slightly less common example you know you find a skeletonized body out in the woods you have no idea why the person was there or

how long they were there there's very little left to work with so you don't really know what happened a case like that might go out undetermined as well again much much less common but undetermined essentially means we never really did figure out the circumstances. now in the midst of pleas case elicit the immediate cause of death as cardiopulmonary arrest complicating law enforcement restraint and the compression correct what does cardiopulmonary arrest. that's really just fancy medical lingo for the heart in the long stopped the heart no pulse no breathing. so with respect to the term complicating am i right in the understanding that this term. means occurring in the setting of yes or no the worst part of cardiopulmonary arrest occurring in the setting was. restraint and that compression. correct.

so dr baker can you tell us how it is physiologically that the subdual restraint and the compression cause mr floyd's that. in my opinion the physiology of what was going on with mr floyd on the evening of may 25th is you've already seen the photographs of his coronary arteries so the inno you. you know he had a very severe underlying heart disease i don't know that we specifically got to a counselor but mr floyd also had what we call hypertensive heart disease meaning his heart weighed more than it should. so he has a heart that already needs more oxygen than a normal heart by virtue of its size and its limited in its ability to step up to provide more oxygen when there is demand because of the narrowing of his coronary arteries now in the context of an alter cation with other people that involves things like physical restraint that involves things like being held to the ground that involves things like the pain that you would incur from having your you know your cheek up against the asphalt abrasion on your shoulder those events are going

to cause stress hormones to pour out of your body specifically things like adrenaline and what that adrenaline is going to do is it's going to ask your heart to beat faster it's going to ask your body for more oxygen so that you can get through that alter cation and in my opinion the law enforcement subdual restraint in the neck compression was just more than mr floyd could take by virtue of those heart conditions. you're just a point of clarification that i think we could use you were talking as a forensic pathologist it's not part of what you do within the 4 corners of your job to try to calculate what missed a few ways either lung volume's or oxygen reserves that sort of thing would have been is. i think what you're getting at council as the sort of thing without that i would defer to a poll monologist those are obviously things we can't measure post-mortem in living

people clearly those things are the purview of politics. so dr baker. we did find from the toxicology amounts offense and all that methamphetamine in the results from the way that is correct. you didn't mention the other friend or meth in mr floyd's system. you mention those but you don't list the them either of them on the top line is causes of this. why is that. well the top one of the cause of death is really what you think is the most important thing that precipitated the death of other things that you think played a role in the death but were not direct causes get relegated to what's known as the other significant conditions part of the death certificate so the other significant good engineers are things that played a role in death but didn't directly cause the death so for example you know mr fellates use of fenton ill did not cause the sub duel or neck restraint his heart

disease did not cause the the subdual or the neck restraint. so these are. items that may have contributed want to direct cause her. over the question. right so we've just been watching testimony here from dr andrew baker who is hennepin county chief medical examiner he was expected to testify today and it was

certainly one witness test me that we were all eagerly awaiting because baker perform the initial autopsy or i should say the only autopsy of george floyd of course this these are proceedings in the trial of derek show the now entering the 10th day show than standing trial for murder in the death of 46 year old george floyd has entered a plea of not guilty to those charges and now prosecutors have shifted from discussing the use of reasonable force on the use of force to focusing on the specific cause of death. george floyd and they've now repeatedly we've heard witnesses for the prosecution repeatedly argue that george floyd died from a lack of oxygen and that narcotics did not cause his death or we this goes very much to the heart of the strategy in the arguments from the defense. lawyer.

eric nelson arguing that continuing to argue of course that floyd died because of fentanyl and methamphetamine use but we've heard some very significant testimony today not least from forensic pathologist dr lindsay thomas who is a veteran medical examiner saying that she essentially joined other expert witnesses in saying that illicit drug use did not kill george floyd now actually alan fisher is life 1st now in minneapolis and so alan every day is has dr baker's test me now concluded. no here no piece questions from the defense will always leave a few things that we want to ask him about recently during his evidence there was a couple of points but essentially undermined what the defense has been seeing people talking about the fact that tablets were found in the patrol car with george floyd's d.n.d. the have been suggesting that george floyd me have taken tablets either orally or.

through other measures. what the medical examiner it was seeing was that there was no trace of drugs found trace of tablets phone in george 'd floyd's stomach which would suggest that if he'd taken drugs he taken some time before the altar kitchen with the police and also that the final point when he'd been talking about. how george floyd had a great deal of pluck around his arteries which as we know it could cause serious harm. problems he said that it wasn't that that killed george floyd it was his heart might not be in a great state it might not have been able to sustain the pressure that was put on by the police but he said the it would that may have contributed but was not the direct cause he's suggesting the direct cause was the pressure that was exerted by

the police it was interesting that doctor because said that he did not want any of the videos before the autopsy and the cause of death in the manner of death was what he was investigating and the autopsy is just one part of the death investigation so taking in to account the videos and what happened on the ground would be another part of the investigation and there was an interesting part as well where he was asked if he'd taken photos of the organs he said he didn't take any pictures of the heart because it seemed like a normal organ although later on he did find the plot in those arteries which could cause not knowing which of course is a key moment a key thing key factor is the war does looking for in heart attacks when the plot gets so much that duis arteries are actually not all enclosed so interesting testimony from dr baker building on what we heard earlier today from lindsay. thomas who is essentially the woman who trained dr baker and harve you she said it

was very clear that the death of george floyd was caused because he couldn't get oxygen into his system and that was because the police was it that we're exerting so much pressure on his body while on the ground thank you so much alan fischer following proceedings there in minneapolis and at ronald sullivan as a no professor and director of criminal justice and change to harvard law school joins us now from his massachusetts massachusetts via skype so course the defense strategy is to argue the existing health issues and not the actions of the police cause the death of george floyd is the prosecution and this witness testimony succeeding in countering that bar of reasonable doubt. absolutely this was great i mean great testimony for the prosecution people were worried because this report the report that dr baker filed at the time of the incident just didn't mention the expect as as

a cause of the death so people were worried about the extent to which the defense would be able to score a lot of points with this witness but. this witness clearly and unequivocally said at the end of his testimony that heart disease that not was not the major cause of death and that fit not was not the major cause of death they may have contributed he said but the major cause of death was the lack of oxygen so i mean this is precisely what the prosecution wants the jury to hear let me also add very briefly that in trial advocacy work lawyers know about 2 concepts primacy and recency jurors remember best what they hear 1st and what they hear and last it was brilliant that they ended with the question about going to know and then the question about heart disease that's the last thing the jury heard from

this witness and it's going to sink in a bit so both in terms of form and structure the prosecution did an excellent job with this witness right now there's a 10 minute break happening but what do we like what is the defense going to focus on the end that questioning when it trial resumes. well the defense has done a great job in being consistent with its theory so the defense is going to ask questions very narrowly such that dr baker will have to say yes yes yes they're going to ask is it possible that the death occurred because of fintan oh and yes of course it's possible so they're going to ask a series of questions that lead up to their final question is it possible that this was a cause of death and they just need one juror one juror to believe that well.