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Prosecution Questions Doctor Who Tried to Save George Floyd. Aired 11-11:30a ET
Aired April 05, 2021 - 11:00 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
[11:00:01]
DR. BRANFORD WANKEHEDE LANGENFELD, ER PHYSICAIN WHO ATTENDED TO GEORGE FLOYD: Yes, sir. The Lucas CPR device which is a -- basically a mechanical device that sits across the body with something that almost looked like a plunger and pushes against the chest to provide CPR or chest compressions.
JERRY BLACKWELL, PROSECUTING ATTORNEY: So this Lucas device then was on Mr. Floyd when he arrived in at the hospital.
LANGENFELD: Correct.
BLACKWELL: Did you ever observe any point in time that his heart was beating on its own?
LANGENFELD: Not to a degree sufficient to sustain life.
BLACKWELL: Do you recall who brought Mr. Floyd into the emergency department?
LANGENFELD: I do -- I do recall two paramedics, and possibly one or two other people. But I don't remember exactly.
BLACKWELL: Do you recall whether there were any police officers there also?
LANGENFELD: I don't personally recall that, no.
BLACKWELL: Did the paramedic who's arrived at the registered department give you a report?
LANGENFELD: They did.
BLACKWELL: Do you recall what they said for purposes of treating Mr. Floyd?
LANGENFELD: I do. The report they gave us is that they were called to the scene of someone who was suffering from medical emergency. As I recall this is what I was told at the time, they were initially called for a lower type of acute event of facial trauma and then that was upgraded to individual in distress. They reported that on their arrival, the individual did not have a pulse. And CPR was started.
They place an I-gel which is a supraglottic airway device --
BLACKWELL: A super what?
LANGENFELD: A supraglottic airway device, a tube that goes down into the throat and can ventilate the lungs. And then they gave medications including epinephrine and sodium bicarbonate to try to resuscitate Mr. Floyd as CPR was ongoing.
BLACKWELL: Did they tell you that Mr. Floyd was in police custody?
LANGENFELD: They did mention that he was being detained at the time.
BLACKWELL: Now, did I recognize either one of the paramedics who came in?
LANGENFELD: I did. I recognized both of them. And I worked with one of them several times before.
BLACKWELL: Derek Smith? Did you know a Derek Smith?
LANGENFELD: I believe so, yes.
BLACKWELL: And do you recall having to work with a Derek Smith before?
LANGENFELD: I do.
BLACKWELL: How often?
LANGENFELD: Several times, throughout the course of my training.
BLACKWELL: When the paramedics bring a patient in to the emergency department, is it standard protocol for them to tell you why they are bringing the patient in? What's the emergency?
LANGENFELD: Yes.
BLACKWELL: In what the paramedics told you when they brought in Mr. Floyd, did they also give you information when they brought Mr. Floyd in?
LANGENFELD: They did. They essentially gave the report that I just told you, yes.
BLACKWELL: Did they say to you for purposes of caring or giving treatment to Mr. Floyd that they felt he had suffered a drug overdose?
LANGENFELD: Not in the information they gave, no.
BLACKWELL: Did they tell you information they gave that they felt that Mr. Floyd had had a heart attack?
LANGENFELD: No.
BLACKWELL: Did you receive any information or indication from the paramedics when they brought Mr. Floyd in that anyone attempted CPR on Mr. Floyd at the scene on May 25th, 2020?
UNIDENTIFIED MALE: Objection.
JUDGE PETER CAHILL, HENNEPIN COUNTY COURTHOUSE: Overruled.
LANGENFELD: I did not receive a report that Mr. Floyd had received bystander CPR, no.
BLACKWELL: Did you receive a report that he had received CPR from any of the officers who may have been on the scene on May 25th, 2020?
LANGENFELD: No.
BLACKWELL: Is the administration of CPR right away important for you to know when year dealing with a patient who suffered cardiac arrest?
[11:05:00]
Is it important for you to know about that?
LANGENFELD: It is in the sense that it informs the likelihood of survival.
BLACKWELL: And what do you mean by that, Dr. Langenfeld?
LANGENFELD: It's well known that any amount of time that a patient spends in cardiac arrest without immediate CPR markedly decreases the chance of a good outcome. Approximately 10 to 15 percent decrease in survival for every minute that CPR is not administered.
BLACKWELL: Did the paramedics then tell you anything about the care that they had administered to Mr. Floyd?
LANGENFELD: Yes.
BLACKWELL: Can you tell us what they told you?
LANGENFELD: That they had started CPR and placed that airway device and started bagging the patient as in providing breaths and administering the drugs. Yes.
BLACKWELL: So when you talk about bagging the patient, could you describe what that is?
LANGENFELD: Yes. It is called a BVM or a bag valve mask. It's essentially a device hooked up to oxygen on flow to simulate giving a breath or mouth-to-mouth as it might be more better understood, but, yeah.
BLACKWELL: Did the paramedics start something that is referred to as the ACLS algorithm?
LANGENFELD: Yes.
BLACKWELL: Would you tell the ladies and gentlemen of the jury what is the ACLS algorithm? LANGENFELD: So, ACLS stands for advance cardiac life support. It's
basically a standardized way of taking care of patients in cardiac arrest.
BLACKWELL: And so, these are protocols or sort of a checklist process you go through when somebody shows up in cardiac arrest?
LANGENFELD: Correct. It's a little broader than, but a big part is for folks in cardiac arrest, yes.
BLACKWELL: Is it to help you to determine why the person might be in cardiac arrest so you know how to treat them?
LANGENFELD: Yes.
BLACKWELL: Had the paramedics tried to resuscitate Mr. Floyd?
LANGENFELD: Yes.
BLACKWELL: Do you recall how long?
LANGENFELD: The report we received is for approximately 30 minutes.
BLACKWELL: Now you had mentioned to us just a moment ago that they had administered epinephrine and sodium bicarbonate. Would you tell the ladies and gentlemen of the jury what are those administered for?
LANGENFELD: Epinephrine is colloquially known as adrenaline. It's a drug that has been studied extensively and is part of the standard protocol for ACLS. The evidence on it is somewhat controversial. But it is part of the standard protocol.
Sodium bicarbonate is a medication that may provide buffering of the acidic environment in the blood that occurred during cardiac arrest and that is perhaps a more controversial medication than epinephrine.
BLACKWELL: Did the paramedics tell you whether they checked Mr. Floyd's heart function?
LANGENFELD: Yes.
BLACKWELL: Well, let me ask that a different way. I want to talk to you about two different heart functions and see if you can describe what they are to the jury and how or if they relate to Mr. Floyd. The first one we refer to as PEA. Do you know what PEA refers to?
LANGENFELD: Yes. So PEA refers to pulseless electrical activity. It's basically a situation where someone is in cardiac arrest. They do not have a pulse, as we previously discussed. And they do have some electrical activity on the monitor. And that suggests certain underlying causes that are known to be more common than most -- the most common cause of someone being in PEA arrest, the most common causes are hypovolemia either from typically bleeding or from hypoxia, or low oxygen.
BLACKWELL: So we'll talk about those in more detail. But was Mr. Floyd in PEA status, pulseless electrical activity when
you saw him on May 25th?
LANGENFELD: He was, yes.
BLACKWELL: And there is another term I would like to talk about and have you explain to the jury, asystole I think it's called.
[11:10:05]
Am I pronouncing that right, by the way?
LANGENFELD: Asystole, yeah.
BLACKWELL: Yes. Would you spell that for ladies and gentlemen of the jury?
LANGENFELD: A-S-Y-S-T-O-L-E.
BLACKWELL: And what is that, Dr. Langenfeld?
LANGENFELD: It's probably best known as flat lining where there is no cardiac activity on the cardiac monitor and patient is in cardiac arrest.
BLACKWELL: And so was Mr. Floyd in asystole status when his body was brought into the Hennepin County emergency department on May 25th?
LANGENFELD: At some point, yes. There was a report that at some point he was felt to be in asystole prior to arrival.
BLACKWELL: And was he -- asystole meaning flat line. Was there any point in time during your treatment on May 25th that Mr. Floyd was anything other than flat lined during your care and treatment of him?
LANGENFELD: There were times for the majority of his time in our emergency department, he was in PEA arrest. Ultimately that did devolve into asystole.
BLACKWELL: Is that pulseless electrical activity, PEA arrest, asystole, are those conditions of the heart where you can apply a shock?
LANGENFELD: No.
BLACKWELL: What are what we refer to as shockable rhythms? Is there a such thing, as a shockable rhythms?
LANGENFELD: So, typically, these are thought of as ventricular tachycardia or ventricular fibrillation, which are basically abnormal rhythms of the heart that are more commonly associated with cardiac arrest specifically from a heart attack. And they are rhythms that you can administer electricity to and shock a patient back into a normal rhythm.
BLACKWELL: But Mr. Floyd didn't have ventricular fibrillation or ventricular tachycardia --
LANGENFELD: Correct.
BLACKWELL: -- because his heart wasn't pumping?
LANGENFELD: Yes. Because he didn't -- yes. In both situations, it's a little more complicated than that. But, yes. He was no the in defib or VT as we have commonly called them.
BLACKWELL: Do you recall were there still handcuffs on Mr. Floyd when he was brought into the emergency department?
LANGENFELD: I don't specifically recall if they were on when he immediately arrived. But it would be unlikely because he had the Lucas CPR device on. And I recall his hands being at his sides.
BLACKWELL: Do you recall were his hands at his sides whether there were indentations or marks on his wrists?
LANGENFELD: At the end of the case, yes, after he was declared dead.
BLACKWELL: What did you observe in that regard?
LANGENFELD: What was -- I'm sorry? Can you --
BLACKWELL: In terms of any indentations on his wrists or markings on his wrist?
LANGENFELD: I inferred that it was from handcuffs.
BLACKWELL: So then let's talk about the care you then provided once the paramedics brought Mr. Floyd to the emergency department. What did you do?
LANGENFELD: So, immediately on arrival, we took a report from the paramedics. Mr. Floyd, as we knew him at the time, only unidentified individual was transferred over to the bed in the emergency department.
As I recall, multiple things typically will happen simultaneously in these cases. But we achieved additional access. I placed an interosseous line in his bone in his leg.
BLACKWELL: Would you tell the ladies and gentlemen of the jury what interosseous mean?
LANGENFELD: It's basically a type of IV that goes in through the bone and injects fluid or medications directly into the bone marrow essentially. It's a type of access that's easier to achieve in someone who is in cardiac arrest.
BLACKWELL: And did you also go through the advanced cardiac life support protocols?
LANGENFELD: Yes. Simultaneous to that and in obtaining blood draw and continuing chest compressions, et cetera, went through various different things that could be causing this. Commonly, in the ACLS protocol, these are thought of as the H's and T's specifically with regard to the PEA system we offer them.
[11:15:02]]
BLACKWELL: Well, let's -- if you could take a look at the H's and T's.
LANGENFELD: Sure.
BLACKWELL: So, Brett, if we could pull up I think 900.
I'm showing what you is marked at exhibit 900, for (INAUDIBLE) purpose.
(INAUDIBLE)
CAHILL: Sidebar.
KATE BOLDUAN, CNN ANCHOR: All right. Hello, everyone. I'm Kate Bolduan.
We're listening to week two as it is getting underway of the trial of Derek Chauvin.
Let me bring in with me right now, CNN senior legal analyst and former federal prosecutor Laura Coates on this, as well as Charles Ramsey, CNN law enforcement analyst and former Philadelphia police commissioner.
Laura, just your thoughts on what we learned so far from this witness.
LAURA COATES, CNN SENIOR LEGAL ANALYST: Well, you're seeing the prosecution try to establish that all points and all signs pointed towards not a heart attack. Defining this term we often think of as cardiac arrest and the presumptions that jurors have that that means that somebody has a heart attack as opposed to asphyxiation or other things.
They're unpacking this medically rich term for people to help them understand that paramedics essentially didn't -- weren't thinking about an overdose. They did not indicate that there was an overdose. They did not indicate it was a heart attack.
They were operating under the auspices, the belief this person did not have the oxygen. This is a huge turning point in terms of having disinterested medical bodies giving information hoping to treat and care for George Floyd. And providing none of the same statements that the Police Officer Derek Chauvin did about craziness or anything else. Instead, talking about this appeared to be not indicative of a heart attack.
BOLDUAN: And, Laura, also, the fact they go through -- this is the doctor that first treated and had them and offered majority of the care to George Floyd when he arrived at the hospital. He went into in great detail in the middle of it right now, kind of the protocols of what happened in the hospital in those moments, trying to offer lifesaving care to George Floyd.
You said EMS, when they arrived, they did not say anything about drugs. I suspect a drug overdose and didn't say anything about a suspected heart attack. And he said very clearly as you were mentioning that a cardiac arrest does not necessarily mean a heart attack. Why is this so critical in this moment?
COATES: Because it's going to come down to substantial causal factor of death. This is that legal term to keep in mind consistently throughout the trial. Remember, it's about whether the force was reasonable or excessive, but then prosecutors also have to prove that the asphyxiation, kneeling on the neck actually was substantial causal factor in the death.
The defense is going to try to weed out other things and talk about overdose, other complicating factors, perhaps to suggest the kneeling didn't have a causal link to the death.
By making these statements on the stand, this emergency physician whose job it was to try to save the life of somebody who already gotten upwards of 30 minutes plus of CPR to try to go through all of the duty of care they still performed to contrast that to what didn't happen on the scene, Kate, and the idea of how all of these life saving measures taking place but why? Why were these taking place but yet the officer that could have done the bare minimum, take the knee off the neck, checking a pulse, standing up perhaps, taking him out of the prone position, didn't do any of these things. This is a huge contrast.
BOLDUAN: Chief, your thoughts and your reaction from the law enforcement perspective of what we're hearing from this emergency room physician so far?
CHARLES RAMSEY, CNN LAW ENFORCEMENT ANALYST: Well, it's clear if CPR was administered on the scene, the outcome might have been different. I mean that's what I got from that. You know, 10 -- 10 percent to 15 percent lowering of positive outcome per minute I believe is what he said.
We know that the CPR did not begin until the paramedics arrived. Yet when you look at the video, there were minutes that passed when in Floyd was motionless on the ground. Don't know if he had succumbed at that point in time. But, certainly, it was a point where CPR would have been appropriate. He had no pulse when the paramedics arrived.
So, you know, time is of the essence. I mean, whether you're talking about a person who's suffering a gunshot wound that could literally bleed out while you're waiting for a ambulance and you try to get him to the hospital as quickly as possible or in this case a person who pretty much suffocated which caused his heart to stop probably. I mean that will come out in a medical examiner's testimony.
But if you got someone in that situation and there is training for police officers on CPR, that is the step that you take until paramedics arrive. BOLDUAN: Right now what is happening, we're standing by. It looks
like they're about to go to an exhibit. Exhibit 900 is what the prosecutor said and there seems to have been some -- having to be some conversation about this.
[05:20:09]
Right now, we're going to take a quick break. When we come back, the first witness of the second week of witness testimony and the trial of Derek Chauvin.
We'll be right back.
(COMMERCIAL BREAK)
LANGENFELD: -- through an ultrasound based approach, but I can go through all of this.
So, hypovolemia typically hemorrhage or bleeding. So, we would think of that more in a traumatic cardiac arrest.
Hypoxia, a low oxygen. Again, those being the two most common causes of PEA asystole arrest.
Hydrogen ions. Acidosis can be from any must remember of causes. Hypo/hyper-kalemia is low or high potassium, being a very important electrolyte for proper cardiac function and disturbances on the extreme can lead to cardiac arrest.
Hypothermia, very cold. Toxins. There's a lot of toxins that can cause cardiac arrests.
BLACKWELL: And that's from poisons to potentially drugs?
LANGENFELD: Correct.
Tamponade specifically are first fluid around the heart. They can prevent the heart from failing, and then lead to the heart stopping.
Tension pneumothorax is air around the lung, between the lung and chest wall that essentially expands to the point where it prevents blood flow from returning to the heart, and therefore, leading to cardiac arrest.
Cardiac thrombosis can refer to a heart attack or plaque in the arteries of the heart, and then pulmonary thrombosis or pulmonary embolism is a blood clot in the pulmonary arteries that prevents blood from flowing from one side of the other of the heart and therefore leading to heart no longer functioning.
BLACKWELL: You mentioned ultrasound. What is the role of ultrasound in studying or trying to assess the cause of cardiac arrest?
LANGENFELD: Ultrasound can be used to evaluate many of these different causes. I think people would be most familiar with ultrasound from movies where they look at the baby using an ultrasound device, or a small probe on the abdomen, but it's the same technology.
So, we can look at the heart directly and see if there's fluid around the heart, for example. We can evaluate for a large right ventricle that might be suggestive of a pulmonary thrombosis due to increased strain on that side of the heart. We can look for evidence of hemorrhage, hypovolemia by looking in the abdomen to see if there's any bleeding in the abdomen or bleeding elsewhere.
We can look for evidence of tension pneumothorax. For example, we can evaluate for what's called sliding signs on both sides of the chest, that would suggest that the lungs are up, and are -- there's no air between the lung and the chest wall. We can use it --
BLACKWELL: That the lungs are properly inflated in.
LANGENFELD: Exactly, yes. We can use it to evaluate for a large number of these etiologies.
BLACKWELL: So, you went through these protocols of the H's and the T's. Did you have any leading theories for treatment purposes as to what the most likely causes were for Mr. Floyd's cardiac arrest?
[11:25:02]
LANGENFELD: I -- I felt that I was able to determine that some etiologies or causes were less likely based on the information I had both from the paramedics and also the information I was able to obtain from my exam and ultrasound, et cetera.
At the time, based on the information I had I thought it was less likely that the patient had suffered from, for example, cardiac tamponade, there was no fluid around the heart, tension pneumothorax. We can discuss that briefly.
At one point in the case, I was concerned me may have developed a tension pneumothorax. I felt it was unlikely. We did in fact performed bilateral (INAUDIBLE) where we injured the chest --
(CROSSTALK)
CAHILL: Ask another question.
BLACKWELL: I'll ask another question.
You were explaining to the jury that you thought it was not likely a cardiac tamponade. Then you're explaining why you thought tension pneumothorax was not likely.
LANGENFELD: Correct.
BLACKWELL: And that could you, in plain English, help the jurors understand how you might have eliminated that?
LANGENFELD: We used a scalpel to cut into the chest and create a hole between the chest and the potential space where around the lungs. We did not appreciate any large gush of air that might suggest that there was air in that potential space.
BLACKWELL: Was there anything you looked at to determine whether or not the cardiac arrest was likely or unlikely to be related to Mr. Floyd having had heart attack?
LANGENFELD: A lot of that is based on the history that we received from paramedics. There was no report that, for example, the patient complained of chest pain or was clutching his chest or having any other symptoms to suggest a heart attack. That information was absent. Also the fact he was in PEA asystole as I was told on the initial rhythm check. Further decreases the likelihood of that possibility. At the time it was not completely possible to rule that out. I felt it was less likely based on the information that was available to us.
BLACKWELL: Did the ultrasound play any role in the question of whether or not he did or did not or was likely or not to have had heart attack?
LANGENFELD: No. Not especially in this case, no. It did not.
BLACKWELL: Did you consider the possibility of toxin, for example being responsible for Mr. Floyd's cardiac arrest, including potentially drugs?
LANGENFELD: In the sense that it might have informed our care, yes. I didn't -- there was, again, no report that this patient had, for example, over dosed on a specific medication such as calcium channel blocker or any other medication for there might be a very specific antidote. And so, in that sense, I didn't feel there was a specific toxin that we could give a medication for that would readily reverse his arrest.
BLACKWELL: What about then hypoxia?
LANGENFELD: So, hypoxia, again, being one of the most causes of PEA asystole just in general, I did then, as I mentioned use the ultrasound to look in the abdomen and did not see any evidence of hemorrhage. There was no obvious, significant external trauma that would have suggested that he suffered anything that could produce bleeding sufficient to lead to a cardiac arrest.
And so, based on the history that was available to me, I thought that hypoxia was one of the more likely possibilities.
BLACKWELL: And hypoxia, as an explanation for his cardiac arrest, meaning oxygen insufficiency?
LANGENFELD: Correct.
BLACKWELL: Did you have any other leading theories as to why Mr. Floyd's heart may have stopped other than oxygen deficiency?
LANGENFELD: Yes. I also considered an acidosis, in particular excited delirium which is a controversial diagnosis but it was in the differential in this case.
