Chief medical examiner: Arrest 'just more than’ Floyd could take

Hennepin County's chief medical examiner testified in Derek Chauvin's murder trial Friday that George Floyd's underlying heart disease was a contributor to his death at the hands of Minneapolis police officers, and that being held down on the street outside Cup Foods was "just more than Mr. Floyd could take."

Dr. Andrew Baker's testimony came in the afternoon, after three other medical experts had already testified in Chauvin's Hennepin County District Court trial on second-degree murder, third-degree murder and manslaughter charges in Floyd's death. The cause of death is a pivotal point for both prosecutors and the defense.

Baker's findings, based on his autopsy the day after Floyd died, determined that he died from "cardiopulmonary arrest complicating law enforcement subdual, restraint, and neck compression." He did not determine a lack of oxygen, or asphyxia, a cause cited by three prior prosecution experts, including Dr. Lindsey Thomas, a veteran medical examiner who worked on Baker's staff from 2013 to 2017.

"In this case, I believe the primary mechanism of death is asphyxia, or low oxygen," said Thomas, a medical examiner of 37 years who retired from Hennepin County, but still works part-time in Reno and Salt Lake City.

Questioned further by prosecutor Jerry Blackwell, she said, "There's no evidence to suggest he would have died that night except for the interactions with law enforcement."

The prosecution is trying to show that Floyd died from a lack of oxygen caused by police holding him prone and handcuffed on the pavement. Defense lawyer Eric Nelson is trying to sow reasonable doubt about that cause, raising the prospect that Floyd died by heart attack brought on by illicit drug use and underlying health problems.

Baker, who has been the county's chief medical examiner since 2004, said the 46-year-old Floyd had "very severe" 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," Baker said.

"Now in the context of an altercation with other people that involves things like physical restraint, it involves things like being held to the ground, it involves things like the pain that you would incur from having your cheek up against the asphalt and that abrasion on your shoulder, those events are gonna cause stress hormones to pour out of your body, specifically things like adrenaline, and what that adrenaline is going to do is it's going to ask your heart to beat faster," Baker testified. "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 the neck compression was just more than Mr. Floyd could take by virtue of those heart conditions."

While earlier medical testimony doubted that Floyd's physical condition or his drug use played a role in the death, Baker said under questioning by defense attorney Nelson that "in my opinion, yes," they were factors.

Baker testified that he believed Chauvin's knee was compressing the back or side of Floyd's neck.

Asked by Nelson whether Floyd died of asphyxiation, Baker said: "That's something we don't really see, pressure to the back of the neck resulting in strangulation."

Baker said it didn't appear to him that Chauvin was occluding Floyd's carotid artery, and "even if it were, normal people have two carotid arteries and an unoccluded artery would continue to supply blood to the brain."

Nelson also asked again about the amount of the powerful opioid fentanyl found in Floyd's body during the autopsy.

The lawyer had Baker disclose what he told prosecutors earlier about whether Floyd overdosed, and Baker replied, "I don't recall specifically what I told the county attorney, but it almost certainly went something like this: Had Mr. Floyd been home alone in his locked residence with no evidence of trauma, and the only autopsy finding was that fentanyl level, then yes, I would certify his death as due to fentanyl toxicity. But again, interpretation of drug concentration is very context-dependent."

Baker began his testimony by saying he was aware of little more than Floyd had died in police custody at the hospital, but he opted not to look at videos of Floyd's arrest and death until after the autopsy. "I don't want to go into autopsies with a preconceived notion about what already happened. It might cause me to skip something," Baker said.

Baker then was shown photos he took from the autopsy and also distributed to the jury, others in the courtroom but out of the view of the global audience watching the livestream.

The doctor said one photo showed bruises and scrapes to his left eyebrow area. He said he suffered those injuries while "being pinned against the asphalt the night before."

The prosecutor Blackwell asked, "In the prone position?" Baker responded, "Yes."

Before Baker, Blackwell questioned Thomas, the medical examiner's former assistant.

She said that although Floyd's heart stopped, he didn't die from a heart attack. She said she reviewed the numerous videos of Floyd's death to reach her conclusion that he died from subdual restraint and neck compression.

Thomas said she agreed with Baker's determination on the cause of death. However, Thomas's declaration runs counter to Baker's assessment in a meeting with the FBI that he could not say whether Floyd would have lived "but for" the officers' use of force, according to documents obtained in the case.

"Baker did not believe that the prone position was any more dangerous than other positions based on an article or journal he had read," said a summary of the meeting.

He also listed hardening and thickening of the artery walls, heart disease and illicit drug use as "other significant conditions." Fentanyl and methamphetamine were also found in Floyd's system, Baker's autopsy results noted.

Thomas, however, testified that the physical stress of being prone must be taken into account.

"Mr. Floyd was already in a position where he was experiencing difficulty breathing and getting enough oxygen in this body," she said. "On top of that, now there's the physiological stress that's putting increased demand on his heart, lungs and muscles. ... He's using his strength to get himself into a position where he can breathe."

In cross examination by Nelson, he said to Thomas, "Let's assume you found Mr. Floyd dead in his residence, no police involvement, no drugs, the only thing you found were these facts about his heart. What would you conclude is the cause of death?"

She responded, "In those very narrow circumstances, I would probably conclude that the cause of death was his heart disease."

When Blackwell questioned Thomas again, he took aim at Nelson's scenario that subtracted the police restraint.

"Aren't those questions a lot like asking, 'Mrs. Lincoln, if we take John Wilkes Booth out of this ...' " before Nelson interrupted with an objection and Judge Peter Cahill sustained, calling the incomplete question argumentative.

Thomas also revisited ground covered by previous medical experts concerning injuries on Floyd's body, saying they indicated his struggle to open his chest to breathe: scrapes on his knuckles, face and shoulders. The judge then had photos of the injuries distributed to the jurors, and Thomas explained what they depicted and why the images "are consistent that he is pushing himself so he can get in a position to breathe."

In the end, Baker stood firmly behind his initial ruling. "My opinion remains unchanged," Baker said as his testimony concluded. "That was my top line then, [and] it would remain my top line now."

Prosecution testimony continues Monday.