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Forensic Pathologist: Floyd's Body Was In Position That Prevented Him From Getting Adequate Oxygen; Defense Cross-Examine Forensic Pathologist In Chauvin Trial; Forensic Pathologist: Floyd Had "Slightly Enlarged Heart". Aired 12p-12:30p ET
Aired April 09, 2021 - 12:00 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
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(COMMERCIAL BREAK)
JOHN KING, CNN HOST, INSIDE POLITICS: It's top of the hour, hello everybody and welcome to Inside Politics. I'm John King in Washington. Thank you for sharing a very consequential Friday with us. We are in a quick break just moments away from resuming the trial of Derek Chauvin in Minneapolis.
It is day 10 of testimony. And it began this morning with more expert medical perspective on exactly what killed George Floyd back in May. A Forensic Pathologist Dr. Lindsay Thomas ruling out suggestions by the defense that Mr. Floyd could have died from a heart attack or from a drug overdose. Dr. Tom is clear that the police on trial, the officer on trial in her view are the cause of Mr. Floyd's death.
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DR. LINDSEY THOMAS, FORENSIC PATHOLOGIST: What it means to me is that the activities of the law enforcement officers resulted in Mr. Floyd staff. And that specifically those activities were the sub duel of the restraint and the neck compression.
(END VIDEO CLIP)
KING: With me to discuss this important testimony are our CNN Senior Legal Analyst and the former Federal Prosecutor Laura Coates. Also our law Enforcement Analysts, former Philadelphia Police Commissioner and DC Police Chief, Charles Ramsey thanks to you both for being here.
Laura Coates, this medical testimony part of the prosecution build the medical examiner, we believe will come next, your perspective on how the prosecution is building its case.
LAURA COATES, CNN SENIOR LEGAL ANALYST: I'm doing a great job of it. Remember, they're building off and corroborating from prior testimony. You're seeing and hearing from the bystanders first talking about law enforcement. They pretty much covered the idea this was an unreasonable amount of force to use.
Now they're in that substantial causal factor. And they began with that dynamite testimony yesterday of the pulmonologist who described with great detail and a methodical way that George Floyd was struggling to the point that he tried to use his body, his finger, his knuckles, his face to lift himself to hoist himself the devolution of his respiratory abilities.
Now you've got this particular forensic pathologist whose job it is to determine and evaluate the cause and manner of death, corroborating showing through autopsy photos that were not published to the general public.
The way in which the pulmonologist viewing of that video was corroborated by different scrapes and skin peeling back and bruises on George Floyd's body and ultimately concluding that even with the underlying medical conditions, she says that he died as a result of the law enforcement actions against him not talking about anything about fentanyl or anything else honed in on what she saw through the video, which normally doesn't happen.
They usually only have the body before them and a process of elimination. They've got nine minutes and 29 seconds have looked at the actual death that occurred and they use that.
KING: And Chief Dr. Thomas was in the Hennepin County district medical examiner's office, excuse me, back when the next witness we believe the current medical examiner was in his training so the prosecution making a choice to bring in a more experienced person beforehand.
Dr. Tobin yesterday, Dr. Thomas today and I heard you talk about this earlier. And I think it's important. It is difficult for the prosecution and for these medical witnesses to present what can be highly complicated, highly scientific data and conclusions in a very conversational way. I want you to listen here.
This is part of the testimony where the prosecution trying to make the point they know what the defense is going to say, trying to get the expert witnesses say no, Mr. Floyd died because of what the police did. Listen.
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JERRY BLACKWELL, PROSECUTING ATTORNEY: Do you agree with Dr. Baker's determination on the cause of death?
DR. LINDSEY: Yes, I do. This is a death where both heart and lungs stopped working. And the point is that it's due to law enforcement, sub dual restraint and compression. The activities of the law enforcement officers resulted in Mr. Floyd staff and that specifically those activities were this sub dual restraint and the net compression.
(END VIDEO CLIP)
KING: In both the questioning and the answers sort of short, succinct English accessible testimony.
CHARLES RAMSEY, CNN LAW ENFORCEMENT ANALYST: Yes, you're right. I mean, this case has been building from the very first witness. It was largely emotional with the first few witnesses, you know, people that were actually on the scene started gradually getting more technical with the police experts, the trainers and the police chief and so forth.
Now you're getting into the medical aspect of it which gets, you know, very technical, can be very dry and can be very hard to understand. But the prosecutor, Mr. Blackwell in particular has done such a good job of walking us through it by asking the right questions and getting the responses in a very understandable way in bite sized chunks.
So that I mean everyone can understand it. I mean, yesterday I found myself feeling my neck and so forth when Dr. Tobin was going through his testimony, I think is very, very powerful.
[12:05:00]
RAMSEY: It's really building up. I don't think the prosecution could do much better, if at all than what they've done thus far.
KING: It's very compelling Laura from a storyline, a sad and tragic storyline, but compelling and how they are presenting it. But it's also very strategic in that they understand Mr. Nelson's defense arguments.
And the prosecution understands their driving right now in terms of theirs, determining the witnesses and Mr. Nelson will get his chance. So one of the key strategies is of course, try to - and get the jury to make up its mind about what they expect to hear from the defense.
We know the defense has argued other witness as well. Mr. Floyd was using drugs, Mr. Floyd had high fentanyl in assistance, high levels of drugs in his system. And that's what caused the co2 failure. That's what caused him to stop breathing. Again this witness this morning saying no, listen.
(BEGIN VIDEO CLIP)
BLACKWELL: You reviewed the toxicology.
DR. LINDSEY: Yes. Oh, yes.
BLACKWELL: How would you characterize the amount of meth in Mr. Floyd system?
DR. LINDSEY: Well, it was there. It's not particularly high. Certainly, in deaths that I have attributed to methamphetamine, it's been much higher. But it's not like there's any safe level of methamphetamine. But this was a very low level.
BLACKWELL: So were the methamphetamines significant in your assessment of the cause of death?
DR. LINDSEY: No.
(END VIDEO CLIP)
KING: Laura Coates just your take on how they have presented not only their case, but essentially tried to get out ahead of the defense case.
COATES: There again, very compelling here, but remember, they're not just up against the defense, his team and their ability to try to anticipate it. Remember, the idea of this pathology report, the toxicology report, the drugs in the system has been an issue for a very long time, even before the jurors were even sworn in before there was a jury questionnaire.
The idea of there being more than one autopsy report, one by the Hennepin County Medical Examiner's Office, one by the family had in the minds of a lot of people there was something wrong with the medical examiner report that somehow it was jaded, it was biased in some way.
And so they're also having to resolve a previous thought about this autopsy report and anticipated code.
KING: Laura Coates I'm sorry to interrupt the trial is resuming now. I need to take you back into the courtroom in Minneapolis. My apologies for.
(BEGIN VIDEO CLIP)
BLACKWELL: and then we're going to resume our discussion on homicide after that. Just to clarify for the jurors what these various classifications are. If we talk about natural you discuss that with us.
DR. LINDSEY: Yes.
BLACKWELL: As an example of a natural manner of death would be for example, a heart attack.
DR. LINDSEY: Yes.
BLACKWELL: If we talk about the - an accidental cause of death, where would the drug overdose fit in general as a cause of death?
DR. LINDSEY: Usually drug overdoses are accidental unless there's evidence of intent, in which case it would be suicidal.
BLACKWELL: So we know what suicide is.
DR. LINDSEY: Yes.
BLACKWELL: And undetermined if the medical examiner can't tell which of these it is or what it is, then and undetermined is what you would indicate.
DR. LINDSEY: Exactly.
BLACKWELL: So if the manner of death here has been determined to be homicide, does that in your opinion as a medical examiner rule out a death by accidental drug overdose?
DR. LINDSEY: Yes. BLACKWELL: Now Brett, let's go back to exhibit 952. That's committed
for demonstrative purposes. So doctor, we were talking about the designation of homicide.
DR. LINDSEY: Yes.
BLACKWELL: And tell us what this guide is as relates to how we define homicide as medical examiner.
DR. LINDSEY: Homicide is defined in its most broad sense as death at the hands of another. And it goes into more detail if we want to look at that.
BLACKWELL: Yes. So if - but this is a guidance given from the National Association of Medical Examiners to medical examiners.
DR. LINDSEY: Exactly.
BLACKWELL: And it provides guidance and guidelines on how to designate a matter of death as homicide.
DR. LINDSEY: Yes.
BLACKWELL: So Brett, if we could go to the next slide. So Dr. could you read this in for the record.
DR. LINDSEY: Homicide occurs when death results from a volitional act committed by another person to cause fear, harm or death. Intent to cause death is a common element, but is not required for classification as homicide more below.
It is to be emphasized that the classification of homicide for the purposes of death certification is a neutral term and neither indicates nor implies criminal intent, which remains a determination within the province of legal processes.
BLACKWELL: And you agree with this?
DR. LINDSEY: Absolutely.
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BLACKWELL: It's a guideline you follow?
DR. LINDSEY: Yes.
BLACKWELL: And have you followed that this kind of a guideline for the years, you've been a medical examiner?
DR. LINDSEY: Yes.
BLACKWELL: Is there more guidance given from the National Association of Medical Examiner guidelines on what constitutes voluntary acts?
DR. LINDSEY: Yes.
BLACKWELL: If you could click one more --. And so Dr. Thomas could be this voice.
DR. LINDSEY: In general, if a person's death results at the hands of another who committed a harmful volitional act directed at the victim, the death may be considered a homicide from the death investigation standpoint.
And then, although there may not have been intent to kill the victim, the victim died because of the harmful intentional volitional act committed by another person. Thus the manner of death may be classified as homicide because of the intentional or volitional act, not because there was intent to kill.
BLACKWELL: And when you agree with the conclusion that Dr. Baker reached up homicide, is this - the definition of homicide that you're applying that we saw in these two slides?
DR. LINDSEY: Yes.
BLACKWELL: Thank you, Dr. Thomas. Now I want to ask you about a new subject. And this has to do with certain studies that assess whether they're prone restraint is dangerous from a breathing point of view. And I'd like to get your perspective as a forensic pathologist and a medical examiner in this respect. Are you aware of any such studies?
DR. LINDSEY: Yes.
BLACKWELL: Do you agree generally with the research that comes to a conclusion that the prone restraint is not dangerous for respiration?
DR. LINDSEY: In certain laboratory safe settings that may be true, but I do not agree with their applicability to real life situations.
BLACKWELL: If you could generally characterize for the jurors, what's the punch line of these studies? What do they show?
DR. LINDSEY: Well they purport to show that putting someone in a prone position even with some restraint and with weight on their back is perfectly safe.
BLACKWELL: And that do you find these studies to be reliable? If you find them controversial?
DR. LINDSEY: Well, I think they are fine for laboratory purposes, but they bear no resemblance to real world situation. So I would say they're irrelevant for purposes of what we're talking about here.
BLACKWELL: And so how do they then not relate to the real world? What's artificial about it?
DR. LINDSEY: Well, I would say for starters, these are volunteers who have agreed to be put in this dangerous position of a prone restraint. But they know perfectly well at any point, if they feel scared or uncomfortable all they have to do is say, stop.
And that has happened in some of these studies that a couple of the volunteers have said, wait, no, I can't tolerate being in this position. It's too scary. So that to me immediately takes out that whole element that we were talking about, about the terror, the physiologic stress. So that's number one.
Number two is they're healthy volunteers. These are young people who have mostly young people, mostly healthy who have agreed to be part of this study. So it doesn't relate to someone who may have other underlying factors that may contribute.
Thirdly, there's - they're put on a like a gymnastics mat to be facedown. So it's completely different when you're squished between a person and the hard ground versus having evenly distributed weight on your back. And you're on a mat.
Third, none of our fourth I guess and perhaps most significantly here, none of them went on and on and on beyond the point where the person stopped breathing and where their heart stopped. So they were being monitored the whole time.
And if at any point they have had significant respiratory or cardiac difficulties, the study would have stopped and the person volunteering knew that so it to me it just it appears no resemblance to what Mr. Floyd experienced.
BLACKWELL: Did any of the studies involve a knee on the neck of any of the volunteers?
DR. LINDSEY: No.
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BLACKWELL: Any of them go on for as long as nine minutes and 29 seconds?
DR. LINDSEY: No.
BLACKWELL: Do you know if any of the studies actually measured the decrease in lung volumes, as part of the study that is decrease in oxygen reserves?
DR. LINDSEY: Nothing I know.
BLACKWELL: So any relevance to George Floyd at all.
DR. LINDSEY: Not in my opinion, no.
BLACKWELL: Dr. Thomas, have you done any calculations or kind of work of your own to measure what the subdued and the restraint with the knee on the neck and the back of George Floyd would have done to his oxygen reserves or lung capacity?
DR. LINDSEY: No, that would be something I would completely defer to a pulmonary doctor to address.
BLACKWELL: So then are you able to tell the ladies and gentlemen of the jury, if you haven't done that work. Whether the forces that Mr. Floyd was subjected to would have even killed a normal, healthy person?
DR. LINDSEY: In the way you phrase that not based on lung volume and that kind of study, I mean, from watching the video I certainly wouldn't want to be in that position. But that's a different answer.
BLACKWELL: Thank you, Dr. Thomas. No further questions.
UNIDENTIFIED MALE: Mr. Nelson?
ERIC NELSON, DEFENSE ATTORNEY: Morning, Dr. Thomas.
DR. LINDSEY: Good morning.
NELSON: How are you today?
DR. LINDSEY: Good. Thank you.
NELSON: Nice to see you. You describe being a forensic pathologist is sort of being the doctor's doctor, right.
DR. LINDSEY: General pathologist is considered that, yes.
NELSON: Right. And the forensic pathologist in terms of a death investigation, you kind of have to wear many hats, right?
DR. LINDSEY: Yes.
NELSON: You have to have a broad familiarity with the - with multiple medical conditions, right?
DR. LINDSEY: Yes.
NELSON: And sometimes medical conditions may appear at autopsy that you've never seen before.
DR. LINDSEY: Yes.
NELSON: Right. Some strange disease that you've never seen, right?
DR. LINDSEY: Yes.
NELSON: And you have to well, you will speak to other doctors, right?
DR. LINDSEY: Yes.
NELSON: You will gather information and share that they'll share information with you to help you conclude. Make conclusions and an autopsy, right?
DR. LINDSEY: Yes.
NELSON: And you also described how being a medical examiner is, is more than just the autopsy, right?
DR. LINDSEY: Yes.
NELSON: The autopsy is one small part of a death investigation, right?
DR. LINDSEY: Yes.
NELSON: You described reviewing videotapes in certain circumstances, right?
DR. LINDSEY: Yes.
NELSON: Past medical records, right?
DR. LINDSEY: Yes.
NELSON: Interviews with friends, family members, people who were who knew the decedent, right?
DR. LINDSEY: Yes.
NELSON: And ultimately the medical examiner's office compiles a massive amount of information itself about the cause and manner of death, right?
DR. LINDSEY: Yes.
NELSON: And you've had an opportunity to review a lot of that information in this case, correct?
DR. LINDSEY: Yes.
NELSON: Now, have you reviewed all of the interviews of witnesses?
DR. LINDSEY: Probably not all of them, no.
NELSON: OK. Have you - after you prepared your report, have you been provided with additional materials that may be relevant to your considerations?
DR. LINDSEY: Not that I can think of off the top of my head.
NELSON: OK. We'll come back to that. So I just kind of want to - but you did have an opportunity to review Dr. Baker's entire file, right?
DR. LINDSEY: Yes.
NELSON: And I believe we'll be hearing from Dr. Baker later this morning or this afternoon, but we'll have some questions for him. I would like to follow up on some of your conclusions. There is a term used in Dr. Baker's autopsy the cause of death, the term complicating.
DR. LINDSEY: Yes.
NELSON: Can you define medically speaking what the term complicating means?
[12:20:00]
DR. LINDSEY: Oh, I guess it could be used in lots of different ways. The way I would think of it in this setting is both things were present that there was a cardiopulmonary arrest and that it was due to law enforcement subdued restraint and compression. That's how I would consider it in this setting.
NELSON: Have you been provided with Dr. Baker's any information about Dr. Baker's opinions in this case?
DR. LINDSEY: Nothing very specific. I mean, just what he put in the autopsy report and all of his conclusions.
NELSON: Right. So in terms of the word complicating, it's capable of different definitions based upon the forensic pathologist, right?
DR. LINDSEY: Yes.
NELSON: Right. And so you, as a forensic pathologist may have a different interpretation of what complicating means compared to Dr. Baker, for example.
DR. LINDSEY: Yes.
NELSON: And there's a reasonable degree of disagreement amongst in any case generally, it's reasonable for doctors to disagree with each other, isn't not?
DR. LINDSEY: That sometimes happens. Yes.
NELSON: All right. You did not perform the actual autopsy of Mr. Floyd, correct?
DR. LINDSEY: Correct.
NELSON: And that was Dr. Baker who did that, right.
DR. LINDSEY: Yes.
NELSON: And you know Dr. Baker, well?
DR. LINDSEY: Yes.
NELSON: And you know him to be a competent medical examiner?
DR. LINDSEY: Yes.
NELSON: He's the Chief Medical Examiner for Hennepin County at this time?
DR. LINDSEY: Yes.
NELSON: Now, you were provided again with all of the information from his report and I would like to go through a few of the things with you. Let's talk about Mr. Floyd's heart first.
DR. LINDSEY: OK.
NELSON: What was the size of Mr. Floyd's heart as measured at autopsy? DR. LINDSEY: The weight of Mr. Floyd's heart was 540 grams.
NELSON: OK. And would you explain or would you describe that as an enlarged heart?
DR. LINDSEY: I would say it's a slightly enlarged heart. Yes.
NELSON: And there are some different measures of how to base an enlarged heart or how to determine if a heart is enlarged. Right?
DR. LINDSEY: Right. Some by some categories, that heart would not be considered enlarged.
NELSON: So there's two as I understand it, two different kinds of primary measurements are primary ways of comparing Mr. Floyd, it's hard to determine if it's enlarged, right? The Molina studies and the northwestern studies.
DR. LINDSEY: Oh, I see. Oh, there's probably multiple ways of looking at heart weights. I mean, those are two of them. There's the study from the mayo clinic. There's one in Europe. Yes, there's lots of ways of analyzing.
NELSON: But ultimately based on all of your information, you would agree that Mr. Floyd's heart was slightly enlarged?
DR. LINDSEY: Yes.
NELSON: In terms of the - and Molina standard, what would a normal male heart weigh - weigh for a person similar to Mr. Floyd?
DR. LINDSEY: Oh, I don't know off the top of my head.
NELSON: Would you disagree if I said it was 383 grams?
DR. LINDSEY: Well it could be - for the average.
NELSON: For the average, right?
DR. LINDSEY: Yes.
NELSON: So according to - if that were the average heart rate or heart size, excuse me, heart weight, 383 grams relevant to Mr. Floyd's heart, Mr. Floyd's heart would be considered profoundly enlarged.
DR. LINDSEY: Well, the thing about using averages in especially medicine which is of course, what I'm most familiar with is we don't generally say we don't generally just compare it to an average we usually compare to an average plus or minus two standard deviations.
So that's why the range that I usually use is, you know, from 253 to 510 grams would be the range of normal for someone with Mr. Floyd fight. And so I don't know in the - study what their two standard deviations would be.
NELSON: OK. DR. LINDSEY: But I wouldn't use just the average.
[12:25:00]
NELSON: OK. And so in terms of your - how you would assess the weight or size of the heart, you would say 510 is grams is the high 510 grams is the high end?
DR. LINDSEY: Right.
NELSON: Of that? And 540 exceed that, right?
DR. LINDSEY: Right.
NELSON: And so in terms of whether it's a much enlarged heart or even a relatively minimally enlarged heart, a larger heart requires more blood, right?
DR. LINDSEY: Yes, it has greater demand. Yes.
NELSON: What are some of the things that cause a person to have an enlarged heart?
DR. LINDSEY: Probably the primary cause is high blood pressure.
NELSON: And you understand based on Mr. Floyd's medical records that he did in fact have a history of high blood pressure, correct?
DR. LINDSEY: Yes.
NELSON: Can you describe the blood vessels of the heart?
DR. LINDSEY: There are several major coronary arteries that's, as I mentioned, supply blood and nutrients to the heart muscle. There's the left and right and then the left branches into the left anterior descending and the left circumflex. And then there are some other branches off that.
NELSON: And how would you describe narrowing or stenosis of the coronary arteries?
DR. LINDSEY: So the way we as forensic pathologists describe it is we look at the opening. So if an opening is fully open and that would be 0 percent narrowing, and if it's completely closed, then that would be 100 percent occluded. And so then we look at anything ranging from you know, 25, 50, 75, 90 percent.
Obviously it's just eyeball estimation, we don't actually get out calipers and measure because the actual percentage doesn't really matter more, did they have coronary artery disease? Was it pretty good, pretty bad, that sort of thing.
NELSON: Can you describe the difference between proximal and distal narrowing?
DR. LINDSEY: The way the coronary arteries supply blood to the heart, they come off of the aorta, which is the main vessel that takes blood from the heart to the rest of the body. And so in close to the aorta is called proximal to the aorta.
And then the further out it goes, distributing blood along the way to the heart muscle is called distal.
NELSON: And when you have proximal narrowing, how does that affect the heart?
DR. LINDSEY: It can narrow the blood supply to more of the heart than if you have distal narrowing.
NELSON: Another way of saying that would be a decreases the amount of blood the hardest getting, right?
DR. LINDSEY: Yes.
NELSON: And it also affects how things are removed from the heart like co2, carbon dioxide.
DR. LINDSEY: Well, that's different. That wouldn't happen from the blood vessels coming in, I don't think. So I wouldn't include carbon dioxide in that.
NELSON: OK. Is there a standard within forensic pathology where pathologists would consider being that there's enough of a narrowing to cause sudden death.
DR. LINDSEY: So the way I would describe that is anything over more than 70 to 75 percent is in the view of a forensic pathologist, something that in the absence of another cause of death could be used to explain death.
Now, it's also true that people live with 100 percent occlusion and go in and do fine. So you have to understand this is strictly my perspective as a forensic pathologist and everyone I see is dead. So that's kind of a different perspective.
NELSON: Can you just explain what myocyte necrosis is?
DR. LINDSEY: The myocyte is the name of the heart muscle cell, so cyte mean - C-Y-T-E and myo means muscle. So when you have a heart myocyte, it's the heart muscle cell and necrosis means death. So if you see myocyte necrosis, that means there are dead heart muscle cells.
NELSON: And do you have to have myocyte necrosis to cause sudden death?
DR. LINDSEY: No, you don't have to have myocyte necrosis.
NELSON: And would you say that hypoxia is the absence of oxygen? Agreed?
DR. LINDSEY: Yes.
NELSON: And can hypoxia of the heart cause sudden death. (END VIDEO CLIP)
