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Medical Examiner Who Examined George Floyd's Body Says He Had No Visible Or Microscopic Damage To His Heart Muscle. Aired 3-3:30p ET

Aired April 09, 2021 - 15:00   ET



ANDREW BAKER, MEDICAL EXAMINER, HENNEPIN COUNTY, MINNESOTA: 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 quickly. Sometimes you can even get hemorrhage into a plaque as it fractures.

And so the plaque can grow very quickly. 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 Mr. Floyd's coronary arteries. These looked to me to be, I guess you would call them stable plaques for lack of a better term.

JERRY BLACKWELL, PROSECUTING ATTORNEY: And if they had fractured in some way and created a clot of some kind, would that be observable on autopsy?

BAKER: Yes, and that's one of the reasons we dissect these arteries so carefully as you wouldn't want to miss an acute change or a thrombus because in most cases that would tell you a lot about how the person died.

BLACKWELL: And if there weren't a thrombus and it affected the heart muscle, what would that look like if you had such a defective heart muscle on autopsy?

BAKER: If we find a thrombus, which means an acute clot in a coronary artery, if the person dies 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, either under the microscope or with the naked eye.

So, again, if a person dies very quickly from a coronary artery event, we can only infer what happened based on the fact that they had bad coronaries and the circumstances of their death. We wouldn't expect the heart muscle to look abnormal.

BLACKWELL: And if the heart muscle does show damage from a clot, what does that look like? BAKER: So, that depends on how long the clot has been there and how

long the person has survived. There's a generally good progression of changes that we see very early. All you might see under the microscope is some of the heart cells start to look a little bit wavy and 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, then the heart cells start to die or necrose 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 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 a person survives, we'll see anything from those very early changes all the way out to a scar.

BLACKWELL: But with respect to Mr. Floyd, you didn't see any damage to the heart muscle?

BAKER: That's correct.

BLACKWELL: Let's talk about the brain. Did you note any injury or damage to his brain tissues?

BAKER: 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.

BLACKWELL: Did you note anything regarding Mr. Floyd's lungs?

BAKER: Mr. Floyd's lungs were quite edematous, meaning they had a lot of fluid and congestion in them. But other than that, they were generally normal postmortem lungs.

BLACKWELL: And is it possible to get fluid on the lungs or edematous lungs, I think you called it, from the efforts to resuscitate Mr. Floyd after he was taken from the scene?


BLACKWELL: And what kinds of fluids could cause that?

BAKER: Well, basically what we're seeing at autopsy is just called edema fluid, which is a lightly 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 CPR, who have been given lots of fluid, you know, as their hearts not working very well, perhaps not at all during the CPR, 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 fairly non-specific finding.

BLACKWELL: And so in this instance with respect to Mr. Floyd, you didn't or didn't need to take the time to try to understand what was the source of his pulmonary edema?

BAKER: I don't know that I could pin-point a source with any accuracy. Again, given that he got CPR, there's multiple potential explanations for his pulmonary edema.

BLACKWELL: What about the prospect of what's called a pulmonary embolism? What is a pulmonary embolism?

BAKER: 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 pulmonary 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 pulmonary emboli can go out into smaller branches of the lungs, sometimes they're completely asymptomatic and sometimes they're symptomatic, sometimes they can be life-threatening if the person has underlying conditions. We do always look for pulmonary emboli as part of a forensic autopsy.

BLACKWELL: Did you see any pulmonary emboli in the case of Mr. George Floyd?

BAKER: No, he did not have any pulmonary emboli.

BLACKWELL: Right. Dr. Baker, let's talk about the toxicology. Did you seek what's called a toxicology screen in this case?


BLACKWELL: Would you tell the jury what is a toxicology screen?

BAKER: So, 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 that 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, benzodiazepines, things in that class, barbiturates and so on.

And then 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 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.

BLACKWELL: And this is the lab you work with, NMS?

BAKER: Correct.

BLACKWELL: How long have you worked with NMS Labs?

BAKER: It's been about 13, 14 months now.

BLACKWELL: So, for the past 13 or 14 months, would that be the only lab that you would be sending out toxicology panels or screens to from the Hennepin County medical examiner's office?

BAKER: Yes. All of our postmortem toxicology is done by NMS.

BLACKWELL: Are you familiar with a toxicologist named Dr. Isenschmid?

BAKER: Yes, I know Dan.

BLACKWELL: Dr. Isenschmid testified here just a -- time flies, I don't know if it was yesterday or two days ago, but he testified here. Do you have a good opinion of him as a toxicologist?

BAKER: He has been great to work with so far. We have --





BLACKWELL: You know Dr. Isenschmid?

BAKER: I do.

BLACKWELL: Did you examine the contents of Mr. Floyd's stomach as part of your autopsy?

BAKER: I did.

BLACKWELL: What did you note regarding the contents?

BAKER: Counselor, can I refer to my report so that I don't --

BLACKWELL: Yes, if it helps refresh your recollection.

BAKER: I'm simply going to quote what I dictated as part of the postmortem exam. "The stomach contains approximately 450 milliliters of dark brown fluid with innumerable soft fragments of gray-white food particulate matter resembling bread."

BLACKWELL: Did you note anything resembling either a pill or pill fragments in the stomach contents?

BAKER: I did not.

BLACKWELL: Did you do any testing of the contents of Mr. Floyd's stomach as a part of the toxicology assessment for Mr. Floyd?

BAKER: So, I wouldn't do any testing of that. It is possible that we could send it to a lab like NMS for testing, but I did not request that.

BLACKWELL: So were you aware of whether or not Mr. Floyd have tested positive for COVID?

BAKER: Yes, I was aware of that, not at the time I did the autopsy, but I became aware of that later.

BLACKWELL: Was that significant to you in any way?

BAKER: That he had tested positive for COVID?

BLACKWELL: Yes, sir.

BAKER: 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's specific case, the fact that he had been COVID positive seven or eight weeks before he passed away, did not factor into my cause of death determination because I didn't see any signs of COVID at his autopsy and his lungs did not have any of the stigmata of COVID that I would expect to see under the microscope?


BLACKWELL: So, was he clinically asymptomatic from your point of view?

BAKER: 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 unaware that he was suffering from any acute COVID symptoms at that time.

BLACKWELL: You also note that Mr. Floyd had sickle cell trait. What can you tell us about that?

BAKER: 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 chain of hemoglobin 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 hemoglobin.

That's very different from 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 crisis, 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 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 tissues, the formaldehyde can cause cells to sickle as a postmortem artifact.

And so, when I saw that on Mr. Floyd's slides, I immediately called the hospital lab and I said, do you have a peripheral blood smear from Mr. Floyd, and it turned out they had made a blood smear during his CPR. And so I had a pathologist who specializes in blood disorders and look at the slide and confirm there was no evidence that Mr. Floyd was sickling on his peripheral smear during life.

I did also have our lab, them run a sickle cell quantitation, which means they actually quantified 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.

BLACKWELL: All right. What about paraganglioma, a kind of tumor? I'll just ask you about the paraganglioma as to whether you found or concluded that it had anything to do with Mr. Floyd's death?

BAKER: Simple, short answer is, I don't feel Mr. Floyd's paraganglioma had anything to do with his death. What we're talking about is an incidental tumor that I happened to find in his pelvis during the autopsy. I did look at them under the microscope, the most likely diagnosis is a paraganglioma, but I have no reason to believe that had anything to do with Mr. Floyd's death.

BLACKWELL: OK. So, Dr. Baker, I want to switch and talk about the death certificate.


BLACKWELL: So, if we could pull up exhibit 194. Well, first, I'd like to talk to you about the press release report.


BLACKWELL: And ask you first, Dr. Baker, if you would just identify what this is for the record.

BAKER: Yes, what you're 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.

BLACKWELL: OK. Can you explain to the jury what it means to certify a death.

BAKER: To certify a death as a physician means that you fill in the decedents cause of death and their manner of death, and if their manner of death is other than natural, then 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 the death certificate is actually filled in by family members and the funeral director. So, you know, what's the decedent's 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 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 unnatural causes. In practice, we should be the only people that certify deaths where the manner is ever anything other than natural.

BLACKWELL: So, doctor, if we could look at exhibit 193. First, would you for the record tell us what this is?

BAKER: Yes, this is -- looks to be an actual state of Minnesota death certificate for Mr. George Floyd. These death certificates are actually produced by the state, not by the medical examiners.


We simply fill in the parts we're responsible for. We push all of those data to the Minnesota Department of Health and then the death certificate is 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 and the manner, that's what I am responsible for and that's right in the middle of your display.

BLACKWELL: Yes, so I want to zoom in on that and show it to the jury. I think this is pre-admitted, your honor. So, if we look at the cause of death, immediate underlying, other contributing conditions, this would be the section that you fill out then?

BAKER: Correct.

BLACKWELL: So, if we see here, on the manner of death, it indicates homicide. Tell us, what does homicide mean to you as a medical examiner?

BAKER: So, as 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 five manners of death that we can choose from. The other four 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 a manner of death, and that would be 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 out of accidents in a given year in your state. And so it's a key piece of public health data, but we don't use it as a legal term.

UNIDENTIFIED MALE: So, we look at 918.

BLACKWELL: Dr. Baker, in front of you, exhibit 918 is a list of manners of death, the ones you just talked to us about. Natural, accidents, suicide, homicide, which I've highlighted because it's what you found in this instance and then undetermined. Would you tell us from your point of view as a medical examiner, what does natural mean?

BAKER: Natural means the person died exclusively of natural diseases.

BLACKWELL: Right, so an example of a natural disease might be a heart attack or a fatal arrhythmia as a primary cause of death?

BAKER: Those are actually pretty vague terms. We're much more specific. So to your point, counselor, atherosclerotic heart disease causing a heart attack would be a natural cause of death. A ruptured brain aneurysm from long-standing, untreated high blood pressure would be a natural cause of death. Metastatic lung cancer would be a natural cause of death. There's almost an infinite number of potential natural causes of death.

BLACKWELL: And if we look at accident as an accidental cause of death. Is a drug overdose an example of what could be an accidental cause of death?

BAKER: Most drug overdoses are accidental causes of 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.

BLACKWELL: And we know what suicide is. Doctor, what does undetermined mean?

BAKER: Undetermined means that despite the best efforts of law enforcements, the medical examiner, the medical examiner's investigators, we simply never could pin down the circumstances under which the individual died. And in any good medical examiner's office, you're going to have a small percentage of cases every year that go out undetermined in 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, 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 less common, but undetermined essentially means we never really did figure out the circumstances.

BLACKWELL: Now, in Mr. Floyd's case, you listed the immediate cause of death as cardio pulmonary arrest complicating law enforcement subdual, restraint and neck compression.

BAKER: Correct.

BLACKWELL: What does cardio pulmonary arrest mean?

BAKER: That's really just fancy medical lingo for the heart and the lung stopped. The heart -- no pulse, no breathing.

BLACKWELL: So, with respect to the term complicating, am I right in understanding that this term means occurring in the setting of?


BLACKWELL: Or in other words, cardio pulmonary arrest occurring in the setting of law enforcement, subdual, restraint and neck compression?

BAKER: Correct.

BLACKWELL: So, Dr. Baker, can you tell us how it is physiologically that the subdual, restraint and neck compression caused Mr. Floyd's death?


BAKER: 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 that you know -- you know he had very severe underlying heart disease. I don't know that we specifically got to it, 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 it's limited in its ability to step up to provide more oxygen when there's demand because of the narrowing of his coronary arteries. Now, in the context of an altercation 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 and abrasion on your shoulder, those events are going to cause stress hormones to pour out into your body, specifically things like adrenaline.

And what the 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 altercation. And, in my opinion, the law enforcement subdual, restraint and neck compression was just more than Mr. Floyd could take by virtue of that -- those heart conditions.

BLACKWELL: So, now, to make just a point of clarification I think occurs to me as you were talking. As a forensic pathologist, it is not part of what you do within the four corners of your job to try to calculate what Mr. Floyd's either lung volumes or oxygen reserves or that sort of thing would have been, is it?

BAKER: I think what you're getting at counselor is the sort of thing that I would defer to a pulmonologist. Those are obviously things we can't measure at postmortem. In living people, clearly, those things are the purview of pulmonologist.

BLACKWELL: Right, so Dr. Baker, we did find from the toxicology amounts of fentanyl and methamphetamines in the results from the lab?

BAKER: That is correct.

BLACKWELL: You didn't mention either fentanyl or meth in Mr. Floyd's system -- well, you mentioned those, but you don't list either of them on the top line as causes of death. Why is that?

BAKER: Well, the top line of the cause of death is really what you think is the most important thing that precipitated the death. 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 conditions are things that played a role in the death, but didn't directly cause the death. So, for example, you know, Mr. Floyd's use of fentanyl did not cause the subdual or neck restraint. His heart disease did not cause the subdual or the neck restraint.

BLACKWELL: So these are items that may have contributed but weren't the direct cause?

BAKER: Correct.

BLACKWELL: No further questions, Dr. Baker.

BROOKE BALDWIN, CNN HOST: The piece, that legal piece at the very end, this whole crescendo to, you know, to this chief medical examiner, heart disease or drugs, you know, none of that with regard to Mr. Floyd contributed to his death, so says the chief there.

Let's begin with Dr. Carter, forensic pathologist, former chief medical examiner yourself. What did you make of all that testimony discussing the heart, the lung -- forgive me, we don't have -- Elie Honig, just that final note, how did -- how did they do?

ELIE HONIG, CNN LEGAL ANALYST: Yes, Brooke, that was the key point at the end. That these other factors, the heart, the drugs, the lungs, they were only factors that contributed but not the main contributing factor. The main contributing factor, this doctor was very clear, the main causal factor here was the cardio pulmonary arrest caused by what the police officers did.

That's the heart of the causation case. In other words, what Derek Chauvin did to George Floyd was the cause of his death. These other factors may have played in, but only at the periphery. Legally, that is exactly what the prosecutors need to show here in order to get a conviction.

BALDWIN: OK, let me go to the MD, I'm told we have Dr. Jeremy Faust, an emergency physician, Brigham Women's Hospital. And so Dr. Faust, to you, just help us understand as you know, more lay people -- and I actually thought the chief medical examiner did a pretty excellent job, and I kept noting he was looking to the jury and did a pretty decent job of explaining some really highly technical medical stuff there. What did you think of the conclusion he came to?


JEREMY FAUST, EMERGENCY PHYSICIAN, BRIGHAM & WOMEN'S HOSPITAL: His conclusion seems to be the obvious one, which is that lots of people walk around with a variety of medical conditions, but those conditions don't inhibit them from living their regular life.

They walk into a situation with those conditions and they leave those situations. If you go shopping with heart disease, you leave shopping with heart disease. But what it sounds like they're getting at is that Mr. Floyd entered this interaction with a series of conditions that he should have walked away from and continued on with his life.

But then something intervened and obviously, we know what that was, that was inability for his body to get oxygen. So, what this line of questioning is really designed to show the jury is that he has lots of conditions, we all have lots of conditions, small and large, that don't really inhibit our daily life, but they might have a small impact on how we respond to a particular insult or injury.

BALDWIN: What about, Dr. Faust, so staying with you, the point when -- I remember, the lawyer was asking him, you know, did you find -- about George Floyd's stomach. And he said he found no pills, not even pill fragments in his stomach, and then ultimately, you know, had mentioned this toxicology testimony, how they had found fentanyl and meth in George Floyd's system, but that wasn't the top line of the death. What did you make of that and why is that significant?

FAUST: That's very significant because lots of people think that because there is evidence that there had been some kind of toxins on board, fentanyl, methamphetamine, that this could be sort of a scapegoat for this death. And so that's what the prosecution very much wants to get the jury to dismiss, to say no, that's not right.

And what I think is really important, and they didn't quite get there, but is very important for everyone to understand is that the drug tests that are done are actually, largely qualitative. So, they say yes or no, was there a drug in the system? Doesn't really tell you about level of impairment.

Some of the tests we do are quantitative, they give us numbers, but even that doesn't really tell you much because there are some people who can have one drink and have a blood alcohol level of 100 and they could be very sober appearing. Others, just that same amount of alcohol would make them very intoxicated. So, what I think that was being drawn here is, yes, they found some

evidence of some recent intoxication -- oh, sorry, recent ingestion of these substances, but really no implications that, that had any functional effect on what he was able to do in terms of walking around and walking into a store, for example.

BALDWIN: Elie, how does the defense come back and counter what the chief medical examiner said, that it wasn't heart disease or drugs, which is really what the defense has been coming at, that ultimately caused George Floyd's death? What does the defense do?

HONIG: It's going to be difficult particularly given, let's remember, this is now the third medical expert that we've heard essentially the same conclusion from. They have a serious uphill climb. What we've seen the defense lawyer Eric Nelson do with the prior two medical experts is try to sort of cherry pick out those facts that are consistent with his argument that, well, it could have been the drugs, it could have been the heart.

But one thing we saw the prosecution doing there really effectively is anticipating and rebutting those arguments. Remember the point when the prosecutor asked the medical examiner Dr. Baker just now, you didn't even photograph the heart. Why not?


HONIG: And Dr. Baker said, because there was nothing wrong with it. I wouldn't photograph something that was perfectly normal. That's a really effective tactic.

BALDWIN: Yes, I thought of you and your point about also taking -- your phrase, taking out the sting --

HONIG: Right --

BALDWIN: And you know, spotlighting specifically the corrosiveness in some of those, you know, heart -- the arteries. But yet, that wasn't the cause, so says the medical examiner. Gentlemen, quick break, we'll be right back.