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Soon, Day 10 of Chauvin Trial to Resume; Forensic Pathologist: Autopsy Ruled Out Any Recent Heart Attack in George Floyd; Prosecution Questions Chief Medical Examiner Who Performed Autopsy on George Floyd. Aired 2:30-3p ET
Aired April 09, 2021 - 14:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
[14:30:00]
ELIE HONIG, CNN LEGAL ANALYST: So when Dr. Baker gets up and gives the jury essentially the same conclusion, they won't be surprised. He is bolstered by the other two experts.
BROOKE BALDWIN, CNN HOST: Dr. Carter, this word "asphyxia," Dr. Thomas talked about the fact that the word "asphyxia" does not appear on the death certificate.
And she testified that she also avoids using that word because it requires too much explanation.
What do you make of the fact that the local medical examiner, Dr. Andrew Baker, didn't cite asphyxia in his autopsy report?
DR. JOYE CARTER, FORENSIC PATHOLOGIST: Well, in general, asphyxia is -- covers a very broad category of deaths that can range anywhere from natural to homicide and in between.
And what you generally want to do on every death certificate is make it clear to the person reading it what happened and what position that person was in or what condition the person was in.
So there are many things such as chokings, strangled, hanging, that are all part of having asphyxiation deaths.
BALDWIN: Dr. Carter, staying with you, you heard Chief Ramsey say it's going to be an uphill climb with the defense on these points. How do you see it? Do you agree?
CARTER: I actually do not engage in trial strategy. I'm a forensic pathologist. So I give neutral testimony. I don't engage in that.
BALDWIN: Let me ask it this way. What will you be listening for coming up?
CARTER: Well, I'll be listening for both sides, and testimony primarily from the forensic pathologist, and what both sides are asking the forensic pathologist.
A good forensic pathologist can produce answers for both sides. That would be my only point of listening. BALDWIN: Of course.
Chief Ramsey, I know you have seen hundreds, I don't know, thousands of autopsy photos. What do you make of the judge's decision not to make those photos public?
CHARLES RAMSEY, CNN LAW ENFORCEMENT ANALYST: It was the right decision. I mean, those are hard to look at. The people that needed to see them in the courtroom, the jury and others in the courtroom, actually had a chance to see them.
But to publish them publicly like that, just my personal opinion, and having seen thousands of photos like that, you know, I just don't see the point in that. I don't think it was really necessary.
I agree with that decision. I know there are some that probably don't.
But I think the video tells the story. People have seen the video. I don't think you need to see, you know, the autopsy photos.
BALDWIN: Thank you all. Stand by.
The trial has officially resumed.
PETER CAHILL, HENNEPIN COUNTY DISTRICT JUDGE: Do you swear or affirm, under penalty of perjury, that the testimony you're about to give will be the truth and nothing but the truth
DR. ANDREW MICHAEL BAKER, PATHOLOGIST & CHIEF MEDICAL EXAMINER, HENNEPIN COUNTY: I do.
CAHILL: Have a seat.
And if we could begin by having you state your full name spelling each of your names.
BAKER: My full name is Andrew Michael Baker. A-N-D-R-E-W. M-I-C-H-A-E- L. B-A-K-E-R.
CAHILL: Mr. Blackwell?
JERRY BLACKWELL, PROSECUTING ATTORNEY: Thank you, Your Honor.
Good afternoon, Dr. Baker.
BAKER: Good afternoon.
BLACKWELL: Before we -- well, first of all, you conducted the autopsy on Mr. George Floyd?
BAKER: I did.
BLACKWELL: Before we get into the specifics of the autopsy, why don't we explore your background a bit.
You're the chief Hennepin County medical examiner? BAKER: That's correct.
BLACKWELL: And would you tell us what it means to be the chief medical examiner in Hennepin County?
BAKER: I've been the chief medical examiner for Hennepin County since 2004. I'm actually the chief medical examiner for Hennepin, Dakota and Scott Counties.
My office provides service to all three counties, about 1.85 million Minnesotans. About a third of the state falls within our catchment areas.
The chief medical examiner means I supervise the rest of the staff, in particular, my other physicians. I have six other doctors as well as a doctor in training working under me.
BLACKWELL: So before becoming the chief, you were the assistant chief?
BAKER: Correct.
BLACKWELL: And that was in roughly 2002?
BAKER: Correct. I was the assistant chief medical examiner for two years.
BLACKWELL: All that has been going on 19 years as either assistant chief or the chief?
BAKER: Correct.
BLACKWELL: What did you do before joining the Hennepin County medical examiner's office?
BAKER: Are you asking me to go back to my educational background or just my post-graduate training?
BLACKWELL: Maybe to the Air Force.
BAKER: From the Air Force? Oh, prior to coming to Hennepin County, from 1998 to 2002, I was a major on active duty in the United States Air Force.
I served as a forensic pathologist for the Department of Defense. Our unit was known as the Armed Forces Medical Examiner. At that time, we were headquartered in the Washington, D.C., area.
[14:35:07]
BLACKWELL: Are you a board certified in any areas?
BAKER: I am.
BLACKWELL: Would you tell us which ones?
BAKER: I am board certified in anatomic and clinic pathology. And I hold subspeciality certification in forensic pathology.
BLACKWELL: Doctor, would you tell us what the National Association of Medical Examiners is?
BAKER: Yes. The National Association of Medical Examiners is the professional organization for people who do what I do for a living.
I want to say we have 800 or 900 members. Many of those are fellows like me, meaning they're fully board-certified forensic pathologists.
We do have a variety of other membership categories as well for investigators, for administrative personnel, and for other support personnel in the profession.
BLACKWELL: OK. Now, you are a former president of the National Association of Medical Examiners?
BAKER: Yes, I am.
BLACKWELL: In fact, at least as of to date, you are the youngest president -- or were the youngest president ever to hold that position with the NAME?
BAKER: I don't actually know that that's true. But I will take your word for it, Counsel. I did not know that.
BLACKWELL: Yes. I was just listening to you, Dr. Baker.
(LAUGHTER)
BLACKWELL: So you agree that you have been the president of NAME?
BAKER: Yes, I am.
BLACKWELL: Let's move to the specific autopsy of Mr. Floyd.
Could you give us some sense of what you knew about the circumstances surrounding his death before you started your work on Mr. Floyd.
BAKER: Yes. So I was made aware that Mr. Floyd had become unconscious while in police custody, that he had been transported to Hennepin health care, that that was where he was pronounced dead.
I believe, at the time I started the examination, my staff was probably still working to confirm Mr. Floyd's identity and properly notify his next of kin.
But that was basically the background information that I had.
BLACKWELL: Had you seen any of the videos at the time you started your work?
BAKER: I had not. I was aware at least one video had gone viral on the Internet. But I intentionally chose not to look at that until I had examined Mr. Floyd.
I did not want to bias my exam by going in with preconceived notions that might lead me down one pathway or another.
BLACKWELL: So it was within several days after you did your work on the autopsy that you saw the videos?
BAKER: One video I saw shortly after the autopsy. And that was the one that I think most of the public had seen through Facebook or other social media.
The other videos, such as the Cup surveillance video and the body worn camera videos, I did not see until three or four days after the autopsy.
BLACKWELL: Could you, Dr. Baker, give us of an overview of how you conduct autopsies? What is your approach to them?
BAKER: Sure. In a case that's believed to be a homicide or potential homicide, there's a few more steps involved than a typical natural death or an accidental death.
We start every exam with a very thorough external examination of the decedent's body in an as-in condition, meaning the medical devices are still in place.
If the decedent came in with clothing, that clothing would still be in place on their body.
All things potentially could be evidence to us, as the medical examiners.
In many cases, we will also collect trace evidence. For example, if the decedent's fingernails are long enough, we will collect fingernail clippings. We will collect some pulled head hairs as exemplars in case those are needed to match to anything.
It wouldn't apply in Floyd's case but, in some circumstances, we shoot a fair number of x-rays before the autopsy starts if we are looking for things like bullets or stab wounds, broken knife tips, that sort of thing.
Once all of those are done, we very carefully set clothing aside. We very carefully remove the medical devices. And then we examine the body again, from head to toe, front and back. We're documenting this with copious photographs as we go.
And then, the final step in the external examination is we clean the body very, very thoroughly. Because we don't want blood, any foreign material, any plant material, anything that might be on the body to obscure the injuries or diseases that we are looking for.
Then we again photograph the body, head to toe, front to back.
Once that part of the exam is done, then we proceed to the internal exam, which is, I think, what most lay people would think of when they hear the word autopsy.
We make a set of very careful incisions on the body that allow us to remove all of the organs one by one so we can look for evidence of natural disease, internal evidence of injury.
And while doing that, we're collecting specimens for toxicology. Typically, blood and urine are the ideal specimens.
We do remove all of the organs, from the tip of the tongue to the bladder. We also remove the brain. We also remove all of the structures from the front of the neck, looking for any injury or evidence of disease.
In a case like Mr. Floyd's, there are some additional steps we will take that wouldn't occur in most occupies.
So, for example, in Mr. Floyd's case, I did make incisions of his wrists and dissect around the skin underneath to look for evidence of what we would call subcutaneous bruising or bruising under the skin from the handcuffs that were applied.
[14:40:12]
ERIC NELSON, DEFENSE ATTORNEY: Objection.
CAHILL: Overruled.
BLACKWELL: Please continue.
BAKER: The last thing that I was going to say was, also in Mr. Floyd's case, I did make a special incision from the back of his head all the way down to his buttocks. And I dissected underneath his skin, all the way out to the side of his neck, all the way out to his shoulder and all the way out to his flanks.
You might ask why we would do something like that. And the answer is sometimes fresh bruises can be difficult to see in some people. And so we look underneath the skin to make sure that we haven't missed something.
Again, those last few steps wouldn't be part of a typical autopsy but, in circumstances like this, it's a generally accepted practice that we do that.
BLACKWELL: And, Dr. Baker, is the autopsy part of a broader death investigation?
BAKER: Yes. The autopsy is just one piece of the medical examiner's death investigation.
BLACKWELL: And could you generally characterize the -- the umbrella. What's the death investigation entail overall?
BAKER: So the medical examiner's ultimate mission, in addition to properly identifying people, is to ascertain their cause of death and their manner of death.
The autopsy is just one component of that. It obviously has a great deal to do to inform the cause of death and manner of death. But we also need to know the decedent's past medical history. We need
to get ahold of the decedent's next of kin to see, if the decedent could potentially be a donor, if there's any family history that we need to know about.
We will typically contact the decedent's primary care physicians as well as get hospital records. If an ambulance was dispatched and took them to the hospital, we'll get the ambulance run sheet as part of our investigation.
Because to get the cause and manner of death right, you need to assemble all those things for the whole picture.
BLACKWELL: So let's go back to the autopsy aspect of it. How important is it to have a detailed documentation of what you do?
BAKER: In terms of the autopsy?
BLACKWELL: Yes, sir.
BAKER: Well, it's critically important that the autopsy be very detailed, particularly if the death is potentially a homicide. Because obviously it could end up in the courts and the work you are doing would be evidence.
BLACKWELL: And do you create what we might refer to as a robust data set documenting what you do?
BAKER: Yes.
BLACKWELL: What's all included in that?
BAKER: When I use the term robust data set, what I really mean is I have dictated the most detailed autopsy report that I can, describing all the scars, all the tattoos, all the birthmarks, all the injuries.
In many cases, it's the pertinent negatives, meaning the lack of injury in places where you might expect to see injury but you don't.
All of those things are carefully dictated in a narrative autopsy report.
But that's not enough. You have to take copious photography as well.
My goal is to create a set of photos that's so robust that another pathologist could take my photos and almost feel like they'd been there for the autopsy.
That person has enough data that they could look at my work and reach their own conclusions. They don't have to take my word for it because it's in the photos.
BLACKWELL: And in the case of Mr. George Floyd, that's what you did?
BAKER: That was certainly my goal, yes. BLACKWELL: Your Honor, at this point, I'm going to ask Dr. Baker to
identify the photographs from the autopsy. I still have them here in hard copy.
May I approach, Dr. Baker, Your Honor?
CAHILL: (INAUDIBLE)
BLACKWELL: Dr. Baker, I've handed you a number of photographs that should have exhibit numbers 186, 235, 185, 236, 187, 188, 189, 190, 191 and 192. I'll represent to you, that's what you have.
BAKER: OK.
BLACKWELL: And if you could just look through the set and just confirm for the record that those are photographs that you took during your autopsy of Mr. George Floyd.
BAKER: So these are, in fact, autopsy photographs of Mr. Floyd. And they were taken by me.
BLACKWELL: Thank you, Dr. Baker.
I'd like to redistribute them to the jury, Your Honor.
[14:44:49]
CAHILL: (INAUDIBLE)
BLACKWELL: All right.
So, Dr. Baker, let me just ask generally first about documented injuries that you saw with respect to George Floyd. And I'll ask you about specific parts of the body.
BAKER: OK.
BLACKWELL: Did you note any injuries to Mr. Floyd's back?
BAKER: I did not.
BLACKWELL: Didn't see any bruises, scrapes, et cetera?
BAKER: Correct.
BLACKWELL: What about injuries to Mr. Floyd's face?
BAKER: Yes, Mr. Floyd had several injuries to his face.
BLACKWELL: And if you could, Dr. Baker, look at exhibit 186 and exhibit 235. And I'll represent to you that the jurors have seen these two photos.
But is the -- first, tell us, what do we see in these two photos?
BAKER: These are photographs of the left side of Mr. Floyd's face. This would be after I had removed or cut away any medical intervention. Had there been any blood or foreign material on his body, it was cleaned up before the photographs were taken as well.
And these were specifically taken to illustrate the injuries you see on the corner of his left eyebrow and on his left cheek. You can see the bruising and the abrasion.
That's fancy medical lingo for the big scrape on the left side of his forehead. And you can see the scrape or the abrasion on the left side of his cheek.
It's a very common for abrasions post-mortem to take on the dark black color. After death, the moisture that would me in the abrasion on you or me isn't there anymore and so they tend to dry out and look more like this, like what you see in the photo.
BLACKWELL: Do you have an opinion as to how Mr. Floyd would have incurred these abrasions?
BAKER: These would be entirely consistent with the left side of his face being pinned against the asphalt or the road surface he was on the night before.
BLACKWELL: In the prone position?
BAKER: Correct.
BLACKWELL: If you would, Dr. Baker, look at exhibit at exhibit 185.
BAKER: Got it.
BLACKWELL: What do we see in exhibit 185?
BAKER: This is an overall photo of Mr. Floyd's face taken early on in the post-mortem examination.
You can see the scale in the photograph. That's actually in the photos you have with the case number and the scale that allows you to gauge the sizes of what you're looking at.
This is a photograph I would take in any case so you can put a face with the decedent's name and the decedent's case number.
You can see the injuries that we illustrated in the previous two photos there on the left side of his head and on his left cheek.
You can also see a small abrasion on the left side of his forehead. It's kind of that pinpoint thing above the inch above the left eyebrow.
You can see the laceration, which is a tearing of the skin on the right side of the upper lip. There's also some subtle bruising of his nose and a couple of small abrasions on the right side of his nose.
And I think you can see a few small abrasions under the left corner of his mouth. BLACKWELL: Dr. Baker, what is the tube that we see in his mouth?
BAKER: The tube in Mr. Floyd's mouth is the endotracheal tube put in during the attempt to resuscitate him. We do leave those tubes in place and cut them off before we start the autopsy.
That's some quality control we do for the hospital and paramedics so we can confirm the tube was in the right place when we do our exams.
BLACKWELL: Dr. Baker, if you would go to the exhibit 187.
What do we see in exhibit 187?
BAKER: This is a close-up photograph of Mr. Floyd's right shoulder. Centered in the photograph just above the scale, you would see what I would call an abraded contusion, which is a fancy lingo for a bruise that has some scrapings superimposed on it.
[14:50:13]
BLACKWELL: And exhibit 188?
BAKER: Exhibit 188 is a close-up photograph of Mr. Floyd's left shoulder. You can see occupying most of the photograph there's an abrasion. The deep red, and slightly less red and pink injury that you see.
Again, it looks darker than you might envision this on yourself. Typically, these will dry out after death, and that's why it takes that darker appearance.
BLACKWELL: Is this an injury that is consistent with Mr. Floyd laying prone on asphalt?
BAKER: Yes.
BLACKWELL: Let's look at exhibits 189 and 190.
What are do you see in exhibits 189 and 190?
BAKER: Exhibit 189 is a photograph of the backside of Mr. Floyd's left hand. Exhibit number 190 is a photograph of the backside of Mr. Floyd's right hand.
In any case that we think has the potential to be a homicide, we do examine the hands very carefully and we photograph the hands very carefully.
Our hands are largely the way that we interact with the world around us, and so injuries on the hands or, sometimes lack thereof, can tell us something about what happened.
Specifically, in Mr. Floyd's case, you can see a number of scar-like areas on his knuckles on the left and some scattered across the back of his right hand.
I don't specifically know what those are from. Those obviously predate the events of his death. And I don't know where those came from.
The more acute injuries that you see in the photographs, right above the scale in each picture, you can see kind of a patterned bruise. It almost looks like a tram track, those parallel marks.
That's pretty typical for what handcuff marks look like when we see them at autopsy.
BLACKWELL: And, Dr. Baker, exhibit 191?
BAKER: Exhibit 191 is a close-up photograph of the back of the index and third fingers of Mr. Floyd's right hand. You can see he has injuries over his knuckles.
Just for orientation, if I were to use my own right hand, we're looking at an injury right here and an injury right here on the back of those two fingers.
BLACKWELL: Do you have an opinion as to what may be the cause of those two injuries?
BAKER: These are blunt force injuries. These are abrasions and lacerations. Again, that's damage to the skin from blunt trauma.
These would be entirely consistent with him having been in an altercation with another person. They certainly could be from the asphalt or just about anything his hand could have banged into.
BLACKWELL: Thank you, Dr. Baker.
And you can put the photos -- you can put the photos away.
I'd like to talk to you, for just a moment, about your examination of Mr. Floyd's heart.
BAKER: OK.
BLACKWELL: Did you take a photograph of Mr. Floyd's heart still intact?
BAKER: No, I did not.
BLACKWELL: Would you tell the jury why not?
BAKER: I don't normally photograph organs that appear to be perfectly normal unless there's some reason to. I don't have a photograph of Mr. Floyd's spleen or Mr. Floyd's liver either because those were also grossly normal.
His heart was enlarged by weight. But that wouldn't really be something you could capture in a photograph unless it was so excessively large that it would be obvious from the picture.
BLACKWELL: So, when we talk about the tissues of the heart, are you able to describe them generally, such as the endocardium, the myocardium, et cetera. BAKER: Sure.
BLACKWELL: Would you tell the jurors what those are that you would ordinarily look at?
BAKER: Yes, so, dissecting the heart is one of the most important things we do in every autopsy because the heart is involved in so many of the deaths we investigate.
The first thing we do is carefully remove the heart from the lungs. The next thing you do is you carefully make sure that there's no blood or clot left in the heart because you want to get a very accurate weight.
It turns out the weight of the heart is a very good predictor as to whether that heart is normal or not.
People who have high blood pressure for a long period of time, their heart will actually get heavier, just like any muscle that's worked hard. The heart will grow in response to that kind of stress.
So we do weigh the heart first.
The next thing you typically do is you very carefully dissect the coronary arteries. When I say carefully dissect, I mean you take a scalpel blade and you cut every two, three, four millimeters in very thin slices along every coronary artery.
[14:55:02]
A normal adult heart will generally be described as having two coronary arteries, the left and the right. The left immediately branches into the left anterior descending and the left circumflex. So we dissect those two very carefully.
And then we looked at the right coronary artery. Usually, we hear people describe three coronary arteries, the circumflex, the left anterior descending and the right.
We want to make sure those arteries are in the right place. We want to make sure they have normal openings where they connect to the aorta.
Then we go, tiny slice by tiny slice, making sure none have narrowings or blockages in them.
After we do that, then we typically will carefully slice the heart, meaning the whole organ where we're now cutting through the muscle.
And as you're making those slices, what you're looking for is evidence of previous heart damage. Is there a scar in the heart? Is there hemorrhage in the heart suggesting maybe a more recent heart attack, if you will?
There's many more rare conditions of the heart that we're also looking for while we do this. None of those apply in Mr. Floyd's case but those are always in the back of our minds as we do this. And the last thing we do is, once we've cut through the muscle of the
heart, we open all the valves of the heart, generally in the same direction the blood flows.
We make sure the valve leaflets are normal, make sure there's no infection, there's no calcification, there's the normal number of leaflets.
So, yes, now we've looked at the outside of the heart, the coronaries, the muscles of the heart and the valves.
BLACKWELL: Having done all of that, with respect to Mr. Floyd, did you find any previous damage to his heart muscle?
BAKER: No. Mr. Floyd had no visible or microscopic previous damage to his heart muscle.
BLACKWELL: No.
And I apologize to you, Dr. Baker, and the jury, but there's one other photograph I do want to look at.
BAKER: OK.
BLACKWELL: So, if we could pull out just number 192, which should be the heart valves.
Dr. Baker, would you tell us what we see in exhibit 192?
BAKER: Yes. Exhibit 192 is cross-sections of what I would describe as the worst or the narrowest lesions that I found in Mr. Floyd's coronary arteries.
So, above about the three mark on the ruler, you can see three pieces of coronary artery that are fairly close together.
The uppermost one in your photograph is what we would call the proximal left anterior descending coronary artery. That means that's close to the aorta. That's close to the origin of the artery.
In most adults, the left anterior descending is the largest of the three coronary arteries. So in this picture, you can see that Mr. Floyd's left anterior descending artery is quite narrowed. I would put that at 75 percent narrowing.
The cut that you see right below that, which is the middle of the three, that's another section through Mr. Floyd's left anterior descending coronary artery. You can see that area, a very tight narrowing is still there. Again, I would put that at about 75 percent.
And then the third one you see in that series of three, the one closest to the ruler, is the first branch off of his left anterior descending coronary artery.
That's called the first diagonal branch. That can be a big one in some people. It was pretty good sized in Mr. Floyd's case. But that one is also quite narrowed, as you can see in the photograph.
I should probably back up and explain that, when I say narrowed, I mean the yellow plaque that you see eccentrically lining those coronary arteries like a partially clogged plumbing pipe.
That's the cholesterol. That's the fibrous tissue. That's the scar that you don't want in your coronary arteries.
That's why your doctor checks your cholesterol and asks you not to smoke and tells you to watch your weight and your blood pressure. This is what he or she is trying to prevent is that plaque buildup.
That's the yellow discoloration you see in these arteries. They should be wide open. You should be seeing through, around and whole, of each of those. But they're pretty severely narrowed.
So getting back to the description of the photograph, the fourth cross-section you see, which is more closer to the one on the scale, that's Mr. Floyd's right coronary artery. In most adults, that would be the second largest of the three coronaries.
You can see that one is also significantly narrowed by atherosclerotic plaque as well.
BLACKWELL: So, Dr. Baker, are you kind of familiar with the concept of acute changes in plaque buildup?
BAKER: Yes.
BLACKWELL: Would you tell the jurors what that means?
BAKER: So, there are times at autopsy when we can tell that a plaque has suddenly changed because it has fractured. These plaques can actually be kind of hard. That's why this is known as hardening of the coronary arteries.
[14:59:55]
Sometimes these plaques will fracture and you can see clot or fibrin, 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 --
