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The Lead with Jake Tapper

Defense Cross-Examines Medical Examiner Who Did Floyd's Autopsy. Aired 4-4:30p ET

Aired April 09, 2021 - 16:00   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

DR. ANDREW BAKER, HENNEPIN COUNTY, MN MEDICAL EXAMINER: -- those kinds of injuries with any precision, you know, presumably, there's contextual data that would allow us to know that Mr. Floyd have those abrasions, you know, an hour before he died or whatever.

[16:00:13]

If you just showed me those abrasions blindly, could I tell you how old they are as a pathologist, and the answer is no, not with any precision.

ERIC NELSON, DEFENSE ATTORNEY: Right. And in terms of the abrasions that we looked at on Mr. Floyd's body, they could have been from the period of time he was retrained on the ground, agreed?

BAKER: Correct.

NELSON: They could have also been consistent with the period of time where he was taken to the ground or brought to the ground, right?

BAKER: Well, that would be true as long as there's something in thinks environment that explain those abrasions. Some of those would take a fairly rough surface to produce. A smooth surface wouldn't -- you really don't expect that to cause those.

NELSON: Understood, but if you were -- if you were in the midst of a struggle with police officers and police officers brought Mr. Floyd to the ground, the moment of impact with the ground could have result in some of those abrasions.

UNIDENTIFIED MALE: Objection, Your Honor, beyond the whole thing called speculation.

JUDGE PETER CAHILL, HENNEPIN COUNTY COURTHOUSE: Overruled.

Would you mind repeating the question, Counsel?

NELSON: Sure.

The abrasions we looked at, it would likewise be consistent with Mr. Floyd being taken out of a police car and be put on to the ground?

UNIDENTIFIED MALE: Same objection, beyond the scope of the autopsy.

CAHILL: Overruled. NELSON: Yes, depending how he made contact with the ground, if the

direction of motion is correct and there's enough abrasive force, yes, that contact could explain those abrasions.

NELSON: Okay.

Would you agree with the general proposition that the prone position is not inherently dangerous?

BAKER: As far as I know, based on my understanding of the medical literature, that is true.

NELSON: Now, in term of your autopsy reports, there is no -- you dissected Mr. Floyd's shoulder and neck area, right?

BAKER: That's correct.

NELSON: And you found no bleeding into the subcutaneous tissues of the neck and back, right?

BAKER: That is correct.

NELSON: And there's no bleeding into the muscles of back, correct?

BAKER: That's correct.

NELSON: And you don't have any section in your autopsy report to describe any injuries whatsoever to Mr. Floyd's neck and back like you do other areas of the report.

BAKER: That's not true, Counselor. There's a special paragraph that specifically describes me dissecting his back and not finding anything.

NELSON: Okay. And you took pictures of that as well.

BAKER: Correct.

NELSON: And all of those procedures were documented in the normal course of how you -- when you conduct an autopsy, right?

BAKER: Yes, all of those things were photographed.

NELSON: And you did that so that other people would have an opportunity to review your work, correct?

BAKER: Correct.

NELSON: And you understand that people have done that, right?

BAKER: Yes.

NELSON: Now, you have, I'm assuming, conducted many autopsies in your career.

BAKER: I have. NELSON: How -- if you had to venture a guess, how many autopsies have

you conducted?

BAKER: I've never kept a spread sheet, but I would say it's probably in the neighborhood of 2,900 to 3,000.

NELSON: OK. You've done other autopsies where asphyxiation was the suspected cause of death?

BAKER: Yes, asphyxia is a very common cause of death in my line of work.

NELSON: Right. You see it manifest itself in many ways, right?

BAKER: That's correct.

NELSON: And there's certain things you look for in the course of your autopsy to determine whether or not this death would be consistent with asphyxiation, agreed?

BAKER: Yes and no. It depends on the type after asphyxia you're talking about. There are many ways human beings die of asphyxia. So, as pathologists, we want to make sure we know the type of asphyxia that we're talking about because the signs that you would see are going to vary from one type to the other.

NELSON: And including -- you look at the brain for signs of lack of oxygen, right?

BAKER: We do, but to be fair, the brain -- the person has to survive the anoxic brain injury for a considerable period of time before we can see anything. In most of the asphyxias that we investigate, we're not going to see any acute changes in the brain.

NELSON: You look for musculoskeletal changes to the body, right?

BAKER: Again, depending on the nature of the asphyxia, yes.

NELSON: So, you may look for, perhaps, if the asphyxia was from the front to the back, broken hyoid bones, for example?

BAKER: Correct. We're specifically looking at things like the muscles of the neck, the thyroid cartilage and hyoid bone, and things like strangulations and hangings where there's pressure on the neck.

[16:05:02]

NELSON: Okay. And you formed some opinions ultimately about the amount of pressure and whether the pressure was applied to the neck, right?

BAKER: Could you be more specific, counselor?

NELSON: Well, ultimately, you have your -- you have described your cause of death, right?

BAKER: Correct.

NELSON: And part of your cause of death includes neck restraints?

BAKER: I believe I actually used the term neck compression, but yes, that is the top line of my cause of death statement.

NELSON: And in the course of your many conversations that you've had with various prosecutors and law enforcement officers, you, after watching the video, you made some statements about where you thought Mr. Chauvin's knee was placed, would you agree with that?

BAKER: Yes.

NELSON: And did you feel that Mr. Chauvin's knee was compressing his neck?

BAKER: Yes.

NELSON: Did you describe it as being more on the back or in this lower part, base part of the neck?

BAKER: So in my impression from the video, and I want to be very clear, I have no special expertise in looking at videos. I'm just looking at them as another person trying to figure out what happened. In my opinion, it would appear that Mr. Chauvin's knee was primarily on the back or the side or the area in between on Mr. Floyd's neck.

NELSON: Did you see any evidence that he was occluded the carotid artery?

BAKER: Did not appear his knee was able to occlude the carotid artery. Even if it were, normal people have two carotid arteries and the un-occluded carotid artery would continue to supply blood to the brain.

NELSON: OK.

And when you look at deaths by manual strangulation, for example, are you also looking for bruising?

BAKER: Yes.

NELSON: You're looking for bruising. Do you consider, do you see the bruising in the majority of your cases or not in the majority of your cases?

BAKER: Well, keep in mind that my decedents, my patients are all deceased. And so, if my patients were strangled, it was so significant that they died. And I say that because if you were to ask an ER doc for her experience in living strangulation victims, you might get a different answer.

In my world, we typically see bruises on the outside of the neck, we see abrasions on the neck, we see bruises to the small muscles of the neck. Depending on the type of strangulation and how old the decedent was, we could see fractures in the thyroid cartilage and hyoid bone. We often even see petechiae as well, which are tiny blood spots on the lining of the eyes, sometimes you could see them on the face, on the inside of the lips, even the inside of the mouth.

NELSON: And did you observe any of those signs in this case?

BAKER: No, I did not.

NELSON: And in terms of when you think about just kind of the classic strangulation, taking my fingers and my hands and I'm applying pressure to your neck, even those small fingers, you would expect to see bruises consistent with the size of my fingers, right?

BAKER: Again, in my line of work, we more often than not see bruises. You did say consistent with the size of your fingers, that might be true on television shows, but in the real world, there's not a lot of correlation between the size of bruises we see and the size of assailants hands, but we are looking for those telltale bruises.

NELSON: All right. And in terms in this particular case, the knee, the placement of the knee being a bony round hard object, right?

BAKER: Yeah. I mean, it's pretty concentrated under the kneecap, the force.

NELSON: Of course, the shinbone is just below the skin, right?

BAKER: Yes.

NELSON: And it's sort of triangular in it nature, right?

BAKER: On cross section, yes.

NELSON: So if a substantial amount of force was being used by the knee or the shinbone on the neck or back area in your line of work and if that force was sufficient to asphyxiate him, would that, would you expect to see bruising?

BAKER: I would expect to see bruising but I don't know that the lack of bruising excludes that. You and I kind of just pivoted from strangulation, which was pressure to the front of the neck to pressure at the back of the neck and that's not something I think we see as medical examiners, pressure to the back of the neck explaining a strangulation.

NELSON: Or an asphyxiation.

BAKER: Correct.

NELSON: So is there any objective medical finding in your autopsy that shows a sufficient or significant amount of pressure to the back?

BAKER: Again, I think we've covered this. I did not find any injuries to Mr. Floyd's back. Not on the outside of his body. Not looking at the soft tissue under his skin to make sure I didn't miss any occult bruises.

[16:10:02]

I didn't find any bruises on his back.

NELSON: Thank you.

Did you find any hypoxic changes to Mr. Floyd's brain?

BAKER: I did not but again, a person has to survive for many hours before we would be able to see those as pathologists.

NELSON: You're generally familiar with a hypoxic death and how that occurs?

BAKER: Again, Counselor, it depends on the nature of the asphyxia. Keeping in mind, in my world, asphyxia is hangings, it's strangulations, it's carbon monoxide poisoning, it's drownings. There's all different ways people can be asphyxiated. It really depends under which mechanism you're talking about.

NELSON: Well, generally, regardless of the mechanism, would you generally see symptoms consistent with hypoxia? Would a person exhibit certain symptoms?

BAKER: So, symptoms is a little outside my bailiwick because we're talking about living people, and I don't treat living people who are suffering from hypoxia of any cause.

NELSON: So, I mean, Dr. Thomas who just testified would testify that you may see confusion when someone is going into a hypoxic state.

UNIDENTIFIED MALE: Objection, Your Honor, the characterization of Dr. Thomas's testimony.

CAHILL: Rephrase.

NELSON: So your role as a medical examiner, right, you take into consideration information from lots of different sources, right?

BAKER: That is true.

NELSON: And there may be cases where you -- where you just don't know what's going on, right? You can't figure something out.

BAKER: Could you be more specific?

NELSON: Well, you have a decedent in your medical examining table and appears to be some sort of tropical disease, right? I'm assuming you're not a tropical disease or an infectious disease expert, right?

BAKER: I'm certainly not an expert in tropical diseases. We do diagnose a lot of infectious diseases at the M.E. office.

NELSON: But if there's some sort of infectious or tropical disease, you may go to another person and ask that person, hey, are you familiar with this?

UNIDENTIFIED MALE: Object to the question in terms of relevance and beyond the scope.

CAHILL: Beyond the scope of overruled. Relevance at this point is sustained.

NELSON: Sure. Do you rely on the expertise of other physicians when you conduct an autopsy?

BAKER: Not always. But I am never above reaching out to clinical colleagues or other pathologists if they have an area of expertise that would help me.

NELSON: And part of your job as a pathologist is to attempt to determine whether there is asphyxia in a particular case, right?

BAKER: Again, it's completely dependent on the nature of the case, Counselor, but if it appears to be an asphyxial death, we're always trying to get at the root of how did this occur? Why did this person asphyxiate?

NELSON: And as a physician, you're fa -- physician and forensics pathologist, you're familiar with what happens to the human body when someone asphyxiates, right?

BAKER: In general, yes. Again, I don't actually see living people asphyxiate, I don't treat living victims of different types of asphyxia in a clinical setting.

NELSON: In the context of your research or education, you may go to a conference and they're saying, this -- here's an asphyxia death. Let's talk about it, right? Here's a picture of someone hanging from all the way fully suspended, versus someone who's on their knees and suspended forward with a belt or something.

UNIDENTIFIED MALE: Object to the question --

CAHILL: Sustained with relevance.

NELSON: Are you familiar with the symptoms of hypoxia?

BAKER: Again, they would be very general symptoms and I don't know what the differential diagnosis for those symptoms would be.

NELSON: What would the general symptoms be?

BAKER: Of hypoxia?

NELSON: Right.

BAKER: Probably some sort of mental status change in the form of confusion or disorientation.

NELSON: Incoherent speech?

BAKER: Again, the differential diagnosis for something like that is so long. Could asphyxia explain? Yes. But there are many other things that could as well. NELSON: When someone is hypoxic, does that cause someone to breathe

faster?

BAKER: I honestly don't know again. It probably depends on the nature of the asphyxia. I would defer any further questions to an pulmonologist because they're the experts in breathing.

NELSON: OK.

Would you, based on your understanding, you reviewed the toxicology of Mr. Floyd, right?

BAKER: Yes.

NELSON: You'd agree the fentanyl is a respiratory depressant.

BAKER: That's my understanding, yes.

NELSON: And it slows breathing resulting in lower oxygen levels.

BAKER: It can, yes.

[16:15:02]

NELSON: And similarly increasing the carbon dioxide, correct?

BAKER: What it would do to carbon dioxide is outside the scope of my expertise. I would defer back to a pulmonologist or maybe a toxicologist.

NELSON: Methamphetamine is a stimulant, correct?

BAKER: Correct.

NELSON: Meaning, again, it causes the heart to beat faster.

BAKER: Correct.

NELSON: It causes the heart to work harder.

BAKER: Yes.

NELSON: Causes constriction of the arteries.

BAKER: I believe you already asked me that, Counselor, and my answer was I don't recall if that's a specific mechanism of methamphetamine, but I would acknowledge that it increases your heart rate and the work of the heart.

NELSON: So, have you certified deaths by overdose?

BAKER: Hundreds of times a year.

NELSON: Have you certified deaths as an overdose where the level of fentanyl was similar to the level of fentanyl in Mr. Floyd?

BAKER: Yes.

NELSON: Have you done so where levels were lower?

BAKER: Yes.

NELSON: Or higher.

BAKER: Yes.

NELSON: What's the lowest level of death by fentanyl overdose that you have certified?

BAKER: Without doing a search of my office's records, I'm not prepared to give you an answer on that. I know I've seen levels low as 3 nanograms per ML and possibly lower. Like all death investigations that we do, if it involves a drug overdose, you also want to try to piece together the person's history of how much they've been using it, how long they've been using it, if they're tolerant to it at all.

There's a lot of variables that go into it, but I have seen levels low as three. In some cases, even lower if there's other intoxicants on board such as alcohol, or benzodiazepines.

NELSON: So the combination of drugs in any person's system is a relevant situation?

BAKER: I'm sorry? Did you say irrelevant or relevant?

NELSON: Relevant, a relevant consideration.

BAKER: Yes, combinations of drugs and interactions of drugs can be relevant.

NELSON: And that's why you included both the heart condition of Mr. Floyd as well as his toxicology findings as other contributing issues into his death, correct?

BAKER: That's correct.

NELSON: All right. I just want to kind of review with you the history of your involvement in this case, if that's okay.

BAKER: Okay.

NELSON: You -- obviously, Mr. Floyd was deceased on February, or excuse me, May 25th of 2020, correct?

BAKER: Correct.

NELSON: You performed the autopsy on the 26th?

BAKER: Yes.

NELSON: And after the autopsy, you had a meeting with some Hennepin County attorneys, correct?

BAKER: Correct.

NELSON: On May 26th, correct?

BAKER: Yes.

NELSON: And do you recall telling them that the autopsy revealed no physical evidence that Mr. Floyd died of asphyxiation?

BAKER: I don't know that -- I don't know what my specific language is but, yes, that is what I conveyed to them was the lack of anatomical findings that would support that conclusion.

NELSON: All right. And you told them that you had avoided watching the videos at that point, right?

BAKER: Until after I performed the autopsy, yes.

NELSON: All right.

Do you recall telling them certain factors that you thought contributed to the death?

UNIDENTIFIED MALE: Objection, your honor, hearsay --

CAHILL: Consider any statements made outside of court as possible impeachment of the witness's testimony and not what is actually being asserted. Mr. Nelson, you may ask that question.

NELSON: Thank you.

Do you recall telling the Hennepin County Attorney's Office on May 26th after you conducted your autopsy what you thought the contributing factors were to his death?

BAKER: I don't recall the specifics of that conversation. As far as I know, the only narrative record of that conversation would be what they wrote down. I would be shocked if I did not tell them about Mr. Floyd's heart condition because obviously I knew that the moment the autopsy was done. I couldn't have known the toxicology results the afternoon the autopsy because I wouldn't have those back for several more days.

NELSON: So you found initially his heart condition was pretty significant, right?

BAKER: Yes, you would know that walking out of the autopsy suite.

NELSON: You received the toxicology on June 1st of 2020.

BAKER: Can I refer to my record and see if that's correct?

NELSON: Yes. On or about June 1st.

BAKER: That is correct. And I'm going off the toxicology report itself. It appears it was issued on the morning of June 1st at 7:04.

NELSON: OK. Do you recall having a conversation with Hennepin County prosecutors about the significance of the toxicology findings?

[16:20:05]

BAKER: I recall having the conversation. I don't recall the specifics of it but I'm certain that I would have relayed the toxicology findings to them.

NELSON: Do you recall describing the level of fentanyl as a fatal level of fentanyl?

BAKER: I recall describing it in other circumstances. It would be a fatal level, yes, in other circumstances.

NELSON: Would you agree that one of the causes of the pulmonary edema that you communicated to the county attorney was also fentanyl?

BAKER: Fentanyl can certainly be a cause of pulmonary edema as I indicated earlier in previous questioning. It's confounded by the fact he had a bit of CPR, and so, I find the pulmonary edema much less specific, given that he survived and made it to the hospital for a period of time.

NELSON: Do you recall telling the county attorney's office that had you found Mr. Floyd under different circumstances, you would have determined this to be a fentanyl overdose?

BAKER: So I don't recall specifically what I told the county attorney but it almost certainly went something like this. Had Mr. Floyd been home alone in his locked resident with no evidence of trauma and the only autopsy finding was that fentanyl level, then yes. I would certify his death due to fentanyl toxicity. Again, interpretation of drug concentrations is very context dependent.

NELSON: You then were also interviewed by the Federal Bureau of Investigation on or about July 8th of 2020?

BAKER: I believe it was the Federal Bureau of Investigation and/or the U.S. attorney. A lot of these took place over video calls and I wasn't entirely sure who was who at all times but I believe it was those two groups, yes.

NELSON: And that occurred on July 8th of 2020, correct?

BAKER: To the best of my recollection, yes.

NELSON: All right. Were you asked but-for type questions?

BAKER: I was.

NELSON: Were you able to form an opinion on but for the involvement of law officers whether Mr. Floyd would have died under these circumstances?

UNIDENTIFIED MALE: Objection, your honor, the state (INAUDIBLE)

CAHILL: Overruled. This is not the legal standard, simply his diagnosis. You can go forward on that basically.

BAKER: So, I'll answer the question, Counselor. As I mentioned earlier, there were multiple people on these video call and at some point, there was more than one person asking questions at a time. I don't normally think of things in the but-for paradigm. Perhaps that's a legal think but it's not normally how I think as a forensic pathologist.

So, what I clarified for the U.S. attorney and the Federal Bureau of Investigation was what happened to Mr. Floyd and that is he experienced a cardiopulmonary arrest in the context of law enforcement subdual restraint and neck compression. It was the stress of that interaction that tipped him over the edge given his underlying heart disease and his toxicological status.

That was also clarified in a letter from the Hennepin County attorney to the U.S. attorney, I want to say, within a few days of that meeting because of the confusion around how that meeting was run and the way those questions were asked.

NELSON: Fair enough. Thank you.

Again, the labeling this death as a homicide, that is a medical determination that you made, correct?

BAKER: Correct.

NELSON: It is not the same standard as the legal standard, agreed?

BAKER: Ii don't even know what the legal standard is but there are two different worlds.

NELSON: OK.

Now in terms of your, again, involvement in this case, you have actually testified twice in connection with other proceedings, right?

BAKER: Yes.

NELSON: Regarding the death of Mr. Floyd, right?

BAKER: Yes.

NELSON: And the first of those testimonies occurred 20th of August 2020.

BAKER: Yes.

NELSON: You understand those were transcribed and under oath, correct?

BAKER: Correct.

NELSON: You have had an opportunity to review those transcripts?

BAKER: I have. NELSON: The first time you testified in connection with the death of

Mr. Floyd, at any point do you recall saying I have to defer to some other specialty?

BAKER: I believe I said that multiple times.

NELSON: The first time you testified or the second time you testified?

BAKER: I recall it was much more frequent the second time. I don't -- I don't recall how often it happened the first time, if at all.

[16:25:04]

NELSON: In terms of the placement of Mr. Chauvin's knee, would that explain anatomically why Mr. Floyd, would that anatomically cut off Mr. Floyd's airway?

BAKER: In my opinion, it would not.

NELSON: Did you testify extensively about the significance of the coronary arteries and the heart disease?

BAKER: I'm not sure what you mean by the word extensively, Counselor. I -- if we need to pull up the transcript, we can, I'm not sure what it means in this context.

NELSON: OK. You talked about the issues surrounding Mr. Floyd's death involving his coronary arteries, right?

BAKER: Again, I have no -- I can't quote you the grand jury transcript. If you'd like to pull it out, I'd be happy to refresh my memory. I almost certain it would have had to come up.

NELSON: May I approach the witness, Your Honor?

CAHILL: For what purpose?

NELSON: To refresh his recollection as he requested.

CAHILL: (INAUDIBLE) refreshing first.

NELSON: In this proceeding, did you testify about, do you recall testifying about how the coronary arteries work relevant to providing the heart with blood?

BAKER: I'm almost certain I would have. I can't imagine I didn't, but I don't recall how extensively that took place without looking at the transcript again.

NELSON: Would looking at the transcript refresh your recollection about your testimony in that connect -- in connection with that?

BAKER: Yes.

NELSON: May I approach? (INAUDIBLE)

NELSON: Does it refresh your recollection?

BAKER: It does.

NELSON: What was the problem with the coronary arteries in this context?

BAKER: I believe it's essentially the same answer I gave the jury earlier, which is because of the degree of narrowing in Mr. Floyd's coronary arteries, they have a limited ability to supply extra blood in muscle -- and oxygen to his heart muscle when he needs it. On top of that, he's got a larger heart than a man his stature would normally have because he's hypertensive and so, that heart is going to need more oxygen which this coronaries have a limited ability to deliver.

NELSON: And how do you think the introduction of methamphetamine to that scenario impacts?

BAKER: Again, I could only give that a high level answer as a forensic pathologist. I don't treat living people who have methamphetamine toxicity, but my understanding is methamphetamine is hard on the heart. It is going to increase heart rate. It's going to increase the work of the heart because it's a stimulant.

NELSON: And in the circumstances of this particular case in terms of a person with an enlarged heart, narrowing of the arteries, right, and how does the introduction of methamphetamine affect that?

BAKER: And as I just said, it increases the heart rate. It increases the work of the heart. It's not something that I as a forensic pathologist would want to see in the blood of someone that has heart disease.

NELSON: Did you describe it as a multifactorial process, the death of Mr. Floyd?

BAKER: That certainly sounds like something I would have said, yes.

NELSON: OK.

And then you testified a second time, correct?

BAKER: To the federal grand jury?

NELSON: Yes.

BAKER: Yes, I did.

NELSON: And that was in February of 2021?

BAKER: Yes.

NELSON: And ultimately, you deferred to experts far more extensively in that second testimony than the first, correct? BAKER: So, the short answer to that is yes. The long answer is, I

believe I deferred to a pulmonologist repeatedly because there were so many questions about --