How a person died. If there were a thrombus, what would that look like . If we find a thrombus, if the person dies quickly, we wont see anything in the heart muscle. People need to survive for hours from their acute cardiac event before we can see changes in their heart. Again, if a person dies very quickly from a coronary event, we can only infer what happened based on the fact that they have bad coronaries and the circumstances of their death. We wouldnt expect the heart muscle to look abnormal. If the heart muscle shows damage from a clot, what does that look like . That depends on how long the clot has been there and how long the person survived. Theres a generally good progression of changes we see very, very early. All you might see under the microscope is some of the heart cells look wavy and abnormal. They take on way more pigment after that. They look much brighter under the microscope. As the heart cells start to die, that necrosis brings in an inflammatory reaction from the body. You see inflammatory cells come in and clean up the dead heart cells. Then the body will bring in gran lags tissues. If the person survives, that dead area of the heart turns into a scar. Once they die, depending on how long a person survives, well see very early changes all the way up to a scar. With respect to mr. Floyd, you didnt see any damage to the heart muscle . Thats correct. Lets talk about the brain. Did you note any injury or damage to his brain tissues . I did not. I did not notice any acute injury to his brain in the sense of physical trauma, nor in the sense of it being deprived of blood or oxygen. Did you note anything regarding mr. Floyds lungs . Mr. Floyds lungs were they had a lot of fluid and congestion. Other than that they were normal. Is it possible to get fluid on the lungs from the efforts to resuscitate mr. Floyd after he was taken from the scene . Yes. What kinds of fluids could cause that . Basically what were seeing is edema fluid. Its a protein filled fluid that fills the lungs and the breathing spaces. We see that in people who have had protracted cpr. As their heart is not working very well, theyre still getting a lot of fluid put in them. We can see that pulmonary edema from that. Theres other circumstances as well. Its a fairly nonspecific finding. With respect to mr. Floyd, you didnt or didnt need to take the time to try to understand what was the source of his pulmonary edema . I dont know that i could pinpoint the source with accuracy. Given that he got cpr theres multiple explanations for his pulmonary edema. What about the prospect of whats called a pulmonary embolism . What is that . Its when you have a clot form in another part of your body, most commonly the lower legs. That clot breaks off and goes straight to the lungs because thats where all the heart pumps all the blood. A massive pulmonary embolism can be instantaneous fatal. Smaller pulmonary emboli can go into smaller branches of the lungs. Sometimes theyre asymptomatic. Sometimes they can be life threatening. We look for pulmonary emboli as part of the autopsy. Did you see any pulmonary emboli in the case of mr. George floyd . No, he didnt have any. Dr. Baker, lets talk about the toxicology. Did you seek whats called a toxicology screen in this case . Yes. Would you tell the jury what is a toxicology screen. So we actually use the term expanded panel because the laboratory we use, thats the terminology. In essence we send off one or more tubes of blood and some cases urine to the lab. They run a comprehensive panel looking for elicit drugs as well as scores and scores of prescription drugs. I expect you probably heard from the toxicologist. I wont go into the Laboratory Part of it. Thats not my expertise. They test for antibodies looking for drugs like morphine and related compounds, and so on. They have the potential to detect hundreds of different of medications. Thats what we call the expanded panel with the lab we work with. Thats what we ask for in most forensic autopsy. Is the lab you work with nms . Correct. How long have you worked with nms labs . About 13 or 14 months now. 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 office . Yes. All our toxicology is done by nms. Are you familiar with the toxicologist named yes, i know dan. He testified here just time flies. I dont know if it was yesterday or two days ago. He testified here. Do you have a good opinion of him as a toxicologist . Hes been great to work with so far. Hold on. The objection is . [ inaudible ] sustained. You know him . I do. Did you examine the contents of mr. Floyds stomach . I did. What did you note regarding contents . Counselor, can i refer to my report . Yes, if it helps refresh your recollection. I dictated as part of the exam, the stomach contains 450 milliliters of dark brown fluid and food matter resembling bread. Did you notice pills or pill fragments in his stomach . I did not. Did you do any testing of the contents of mr. Floyds stomach as part of the toxicology assessment for mr. Floyd . I wouldnt do any testing of that. Its possible that we could send it to a lab for testing, but i did not request that. Were you aware of whether or not mr. Floyd had tested positive for covid . Yes, i was aware of that. Not at the time i did the autopsy. I became aware later. Was that significant to you in any way . That he tested positive for covid . Yes, sir. This was very early in the pandemic. We were still scrambling to figure out autopsy safety protocols and what we should be wearing. In that sense it was significant. In mr. Floyds specific case, the fact he had been covid seven or eight weeks before he passed away did not factor into my cause of death. I didnt see any signs of covid at his autopsy and his lungs didnt have anything i would expect to see under the microscope. Was he symptomatic from your view . I cant assess that. I didnt know mr. Floyd when he was alive. To the best of my knowledge he was generally healthy. Im unaware he was suffering from acute covid symptoms at that time. Did you know that mr. Floyd had the sickle cell trait . What can you tell us about that . Its carried by about 8 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. If you have sickle cell trait, chances are you will go through life and never have symptoms. Thats different than Sickle Cell Disease. That means that both of the genes have that gene substitution. Then you have Sickle Cell Disease. People with Sickle Cell Disease can get anemia, theyre subject to a variety of infections. Mr. Floyd didnt have that. I wouldnt have known that except that it happens that people who have sickle cell trait, when you take a biopsy of tissue and put it in formal di hide, it can cause cells to sickle. When i saw that on mr. Floyds slides, i called the hospital lab and said do you have a blood smear for mr. Floyd. It turned out that had made one during cpr. I have a pathologist who specializes in blood disorder look at the slide. There was no evidence that mr. Floyd was sickling during life. I had the lack run a sickle cell kwant tags. It came back that mr. Floyd had the sickle cell trait. It was a fluke that it came back in autopsy. It doesnt have anything to do with how he died. What about the paraganglioma . I dont feel it had anything to do with his death. It was an incidental tumor i found in his pelvis. I looked at it under the microscope. I have no reason to believe it had anything to do with mr. Floyds death. Dr. Baker, i want to talk about the death certificate. Okay. If we could pull up exhibit 194. I would like to talk about the press release report. Dr. Baker, would you identify this for the record. What you are 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. Floyds death. Can you explain to the jury what it means to certify a death . To certify a death as a physician means you fill in the cause of death, manner of death. If their manner of death is other than natural, you have to fill in how the injury occurred box. Death certificates are standard in the united states. Most of whats on them is largely dictated by the centers of disease control. They vary a little bit in appearance, but the core elements are the same in every jurisdiction. Name, where they were born, parents names, did they serve in the armed forces. The medical examiners role is the cause of death, manner of death and how injury occurred. Most death certificates are filled out by clinicians, your primary care doctor you see. That person fills out death certificates for patients who die of routine natural conditions. Medical examiners get involved when the death is unNatural Causes. We should be the only people that certify deaths that are anything other than natural. Doctor, if we look at exhibit 193. First, would you for the record tell us what this is . This looks to be a state of minnesota death certificate for mr. George floyd. The death certificates are produced by the state, not by the medical examiner. We fill in the parts were responsible for. We push the data to the Minnesota Department of health. The death certificate is issued by the state. Thats why it says state of minnesota on the top. The cause of death, the contributing conditions and the manner, thats what im responsible for. Thats in the middle of your display. Can we zoom in on that and show it to the jury. I think this is preadmitted, your honor. If we look at the cause of death, immediate underlying, other contributing conditions, this is the section you fill out . Correct. If we see here under manner of death, it indicates homicide. Tell us what does homicide mean to you as a medical examiner. We apply the term homicide when the actions of other people were involved in the individuals death. Its one of five manners of death. Accident, suicide, natural or undetermined. Homicide in my world is a medical term. Its not a legal term. From a vital health and public statistic point of view its critical medical examiners fill that in. You want to know how many people committed suicide in your state. How many people died of accidents in your state. Its a key piece of Public Health data. We dont use it as a legal term. Exhibit 918 is a list of manners of death, the ones you talked about natural, accident, suicide, homicide which i highlighted because its what you found, then undetermined. Would you tell us from your point of view as a medical examiner, what does natural mean . The person dies exclusively of natural diseases. An example of a natural disease might be a heart attack or a fatal arrhythmia as a prior cause of death . Those are pretty vague terms. Were much more specific. To your point, Heart Disease, causing a heart attack would be a natural cause of death. A ruptured brain aneurysm would be a natural cause of death. Metastatic lung cancer would be a natural cause of death. Theres an infinite number of Natural Causes of death. If we look at accident, accidental cause of death, is a Drug Overdose an example of what could be an accidental cause of death . Most Drug Overdoses are accidental causes of death. Some are suicide. We dont believe the person intended to die. We regard those as accidents. We know what suicide is. Doctor, what does undetermined mean . It means despite the best efforts of Law Enforcement, the medical examiner, we never could pin down the circumstances under which the individual died. In any good medical Examiners Office youll have a small percentage of cases that go out undetermined. Most are people that died of drug toxicity and based on the persons known history we dont have enough data to know whether it was a suicide or accident. If we dont know their intent, its often undetermined. Slightly less common you find a skeleton out in the woods. You have no idea why the person was there, how long they were there. You dont really know what happened. A case like that might go out undetermined. It essentially means we never really figured out the circumstances. In mr. Floyds case you listed the immediate cause of death cardio pulmonary death complicated by sub dual neck compression. What does that mean . The heart and the lungs stopped. No pulse. No breathing. With respect to the term complicated, am i right in understanding this term means occurring in the setting of . Yes. In other words, cardio pulmonary arrest occurring in the setting of Law Enforcement restraint and neck compression . Correct. Dr. Baker, can you tell us how it is physiologically that the sub dual restraint and neck compression caused mr. Floyds death . In my opinion what was going on with mr. Floyd on the evening of may 25th, youve seen the photographs of his coronary arteries. He had severe underlying Heart Disease. I dont know we specifically got to it, but mr. Floyd had hyper tensive Heart Disease. He had a heart that already needs more oxygen than a normal heart by virtue of its size and it was limited in its ability to provide more oxygen because of the narrowing of his arteries. In the context of an altercation with other people that involved physical restraint, that involves like being held to the ground, involves things like the pain you would have with your cheek being held against the asphalt, those events cause stress hormones to pull out of your body. Specifically adrenaline. Its going to ask your heart to beat faster. Its going to ask your body for more oxygen to get through the altercation. In my opinion the Law Enforcement restraint and the neck compression was more than more floyd could take by virtue of those heart conditions. Dr. Baker, a point of clarification. As a forensic pathologist, its not part of what you do within the four corners of your job to try to calculate what mr. Floyds either lung volumes or oxygen reserves or that sort of thing would have been, is it . I think what youre getting at is what i would refer to a pulmonologist. Those are things we cant measure postmortem. In living people those are the purview of pulmonologist. Dr. Baker, we did find from the toxicology amounts of fentanyl and methamphetamine in the results from the lab . That is correct. You didnt mention either fentanyl or methamphetamine in mr. Floyds system. You mentioned those, but you dont list either of them on the top line as causes of death. Why is that . 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 not direct causes, get relegated to the other significant conditions part of the death certificate. The other significant conditions are things that played a role in the death, but didnt directly cause the death. For example, mr. Floyds use of fentanyl did not cause the neck restraint. His Heart Disease did not cause the neck restraint. So, these are items that may have contributed, but not the direct cause . Correct. No further questions, dr. Baker. Mr. Nelson . Im jeff bennett in for Ayman Mohyeldin covering ten day of testimony in the murder trial of derek chauvin. We have been hearing testimony from dr. Andrew baker who performed the initial autopsy of george floyd. To talk about what we just heard while the trial is inside bar we have dr. Were coming out of the side bar. Well go back to the trial. Were going to take a tenminute break. Theyre now taking a break. Well pick up with analysis here. We have dr. Benerji, shes the president of anchor forensic pathology. Paul henderson is with us. Hes a legal analyst. We have nbc news correspondent Megan Fitzgerald live in minneapolis. I would like to start with you, doctor. Dr. Baker said the Law Enforcements sub dual and restraint was more than mr. Floyds heart could take. That cuts to the heart of the case, does it not . Yes, 100 . When they were talking about cause and manner of death as we do in our practice, you know, he explained how he got to his cause of death. Its very descriptive, but then dr. Baker really said this is why he died. So what should we expect the hear from the defense team when they cross examine dr. Baker, do you think . You know, i think theyre still going to stick with trying to weaken his stance, if you will, on that cause of death. Why wasnt it fentanyl intoxication, methamphetamine use, hypertension as they went through the anatomic findings. You know, intoxication is the one thing that i question in the part too because usually i think that the person was having an adverse event from that. I dont know where dr. Baker will go with that. Whether hell say that, yes, the fentanyl could have contributed it or no, it didnt at all. Fentanyl use versus fentanyl intoxication, i think methamphetamine use is really it was a low level. They established that. It didnt really contribute to his death. Thats probably the only other avenue i see. Paul henderson, your take on what we heard so far from dr. Baker . I think this is really important and part of the bow that the prosecution is putting on their case. For the past week we were hearing the scientific analysis. Now were hearing the medical analysis, all about caution. This is what the defense needs to focus on. Theyre timing when theyre putting on their witnesses, especially the last witness, the medical examiner. I believe they wanted to time it to conclude their testimony at the end of the day so they can rest and have the jury contemplate all the evidence they presented so far without giving the defense time to cross examine and leave any doubt. Paul, dr. Baker is the 35th witness that the prosecution has called. Is there a risk of calling too many witnesses . I think there always is. At some point the jury stops paying attention and its too esoteric for them. One of the ways you can gauge that is by watching your jury to make sure they continue to be engaged or theyre taking notes or that its actually relevant either to what your theory of the case is in terms of how george floyd died, or issues that you know that the defense is going to raise up. Thats another reason to bring more witnesses just to close the door to make sure youre anticipating what defense is going to try and argue. In this case, like today, we saw the overextension of hypotheticals on both sides, but with two different results. When the d. A. Was making his hypotheticals that went too far like with the george booth analogy with lincoln, that was a good point. When the defense point was making his hypotheticals that were so strained they were misses that will come back to bite him in the end. In Closing Argument i would put up all the overreaching hypotheticals to remind the jury this was not this was george floyd and this is how he died, this knee from that defendant. Its been a lot of interesting things happening today. Well see how many witnesses the defense will put in and the question is if hes going to risk it all and put chauvin on that stand. I dont think he is, but well see. Megan, today we saw the jury was given physical exhibits of the autopsy photos of mr. Floyd. They werent shown on screen. We couldnt see it on tv. Based on the Court Reporter in the room, how were the photos received . Reporter these photos were presented to the jury during the testimony of dr. Lindsay thomas. They were looking at scratches on mr. Floyds hands, on his face when he was pressed against the pavement there. From the jury, from the Pool Reporter in the courtroom, we were told the jurors were engaged. They were flipping through the photos. Some were taking notes. George floyds family is also in the courtroom. They were doing the same. What stood out is there wasnt any noticeable reaction. No furrowing of the brow. We understand the jurors were attentive during the prosecutions questioning of dr. Thomas and not as attentive when the defense was cross exam. There was news out of the courtroom that one juror told the judge she turned on the tv yesterday and saw a glimpse of court and she turned the tv off. The juror also said she received a text message from her motherinlaw saying it was a bad day. The judge thought it was minor and believed this juror was not intentionally trying to find information about the case. He didnt do anything further. Didnt take any other steps further to reprimand this juror. Jeff . Paul, what do you make of that . I think its pretty significant for this case in particular because judge cahill made a conscious decision not to sequester this jury. Thats a big deal in a case like this because of the significance of this case and the notoriety of this case. What you run the risk of is having this information come to this jury when theyre on their phones or when theyre watching tv or when theyre speaking to anyone. Certainly theyve been admonished. This is a National Case that everyone is talking about and watching and he does not want that to influence this jury. What i appreciate is how meticulous and specific and intentional hes being safeguarding against outside influences affecting the jury with the conversations, the questions and the open conversations that hes having with both advocates about the process to make sure were not giving a chance for an appeal or jury tampering to come up from the defense or prosecution. Keep in mind, we dont have that many alternatives on this jury. Theres not a lot of jurors to go through if things start falling apart and we havent even gotten to the defenses case yet. This has been an emotional case and keep in mind, most jurors were not familiar with the tape at all. These jurors were chosen for their lack of familiarity. This has been traumatic for them already. Were all watching. Whenever theres a ripple in the jury about outside information, that has to be taken seriously by advocates and the judge. This is just another sign of that. Its affirming for everyone else to know this process is going on and the judge is being meticulous about the process. Good point. Paul henderson, doctor, megan, thanks to you. Youre sticking around as we wait for the trial to resume. Were watching another story closely. Thats florida congressman matt gaetz. Hes saying hes planning on fighting back as investigators allege he was involved in sex trafficking. Hes hired two attorneys to represent him. The team said matt has always been a fighter, a fighter for his constituents, a fighter for the country. Hes going to fight back against the unfounded allegations against him. That statement comes as hes set to headline an event at one of former president trumps golf clubs and as one of his republican colleagues is calling on him to resign. Joining us now is sahil gapour. Republicans have been radio silent about this. Where do you expect this to head next . Reporter we dont know the answer to that. Is congressman kinzinger a canary in the coal mine . Hes been more willing to buck his party and to specifically criticize the trump wing of his party. He was the first House Republican to come out in favor of impeaching the former president. At the end of the day there were only ten House Republicans in total who voted in favor of impeachment. He ended up being a minority there. We dont know where Republican Leadership is going to come down. Kevin mccarthy has said the allegations are serious. He intends to sit down and talk to him. He said a similar thing about Marjorie Taylor greene when there was criticism of her and let her go. The power within the Republican Party is still with that wing, the Marjorie Taylor greene wing, the matt gaetz wing, the trump wing. Weve got now with us nbc news Investigative Reporter tom winter. This was borne out of a probe into a florida Tax Collector named joel greenberg. We learned yesterday that he is likely going to take a plea in the case against him. Where do things stand on that front . What does it mean for matt gaetz . Reporter a couple people have reached out to me. There was a story and some reporting that he pleaded not guilty. He had to, jeff. Thats the process at this point. He was handed a superceding indictment and he had to enter a plea. Youre not going to say youre guilty without the benefits of a guilty plea agreement with it. Thats why today happened. As far as the discussions going forward, thats something they hope to wrap up. I would say by early may. They set a preliminary deadline of may 15th to come to a conclusion with an agreement or a trial. Thats where things stand as far as discussions. The attorney for greenberg made it very clear yesterday outside of court theyre hoping to limit his criminal exposure as much as possible, the most effective way of doing that is cooperating at this stage. Looks like thats the direction theyre headed towards at this time. It will be interesting to see what greenberg can offer in this ongoing investigation. Hes somebody that were looking at on the screen. Thats taken a lot of pictures with matt gaetz. We obtained his emails and he had a number of communications with gaetz office. Well keep you posted. Thanks to both of you. Lets go back to the trial. Mr. Nelson . Good afternoon, dr. Baker. Good afternoon, mr. Nelson. If i may have a moment, your honor. Dr. Baker, thank you for being here this afternoon. Just some followup questions. I want to break up into two different sections, one about the autopsy and then after the autopsy. Okay . Okay. Youve testified in many cases in Hennepin County . I have. Dakota and scott county as well . Not as much, but yes. In the process of exchanging information, the defense receives copies of everything, reports, meeting notes, things like that . Yes. Have you had opportunity to review that information prior to testimony today . To the best of my knowledge, yes. You testified in a Death Investigation its much more than an autopsy . Correct. In fact, if you pull your file, it ends up being a few inches thick . Were paperless, but if you printed it out, yes. Thats what i did and thats what it is. I guess i got to get with the times. Ultimately that file contains your autopsy report . Correct. The paperwork you fill out for the state of minnesota . Yes. We dont get a copy of the death certificate, but everything we put on there is in our file. You keep track of conversations with people . Generally, yes. Its my investigators talking to family, investigator. You keep a log today so and so spoke with x, right . I dont personally do that, but my investigators do. Its all a part of this file, right . Correct. In addition you obtain any known medical records that may factor into your analysis as well, right . Yes. Previous you received some hospital records from hcmc regarding mr. Floyd, correct . Correct. You dont go out and search perhaps you do try to search for every provider that he or any person may have seen, right . In most cases thats correct, counselor. There wouldnt be point in us trying to get every medical record ever generated. It would only be if i thought it would help me understand the cause and manner of death. Fair enough. I want to talk about the word complicating. How do you define the word complicating as you used it as to the cause of mr. Floyds death . I used the word complicating the way most physicians use the word complications. Most patient know what physicians mean by complications. It means something occurred and there was something that was untoward on the heels of that. If somebody goes into the hospital for hip surgery and they develop a blood clot, thats a complication. Its an untoward event that happened. Thats how i look at it as a physician. It could be during an incident or as a result of an incident, right . We dont use the word incident, but it could be an immediate complication or a delayed complication. There are certain circumstances that precede those complicates, agreed . Thats a little vague, counselor. In any Death Investigation youre trying to determine the cause and manner of death . Correct. In this particular case you took into consideration the police restraint, right . Correct. You also took into consideration the Heart Disease, correct . As well as the toxicology results, agreed . Yes. You factored those in in your cause theres the cause and manner of death and then theres the second thing that you left blank, right . Then theres the contributing causes or contributing factors . Yes. The term of art is other significant conditions is what youre getting at. Thats something you have to do for the cdc or did you take those in consideration as contributing to mr. Floyds cause of death . When you put those on a death certificate as a physician, what youre saying is i think these played some role in this death. Im unaware how the cdc would mandate what goes on there. Presumably you put things are there you think are relevant. You dont list trivial stuff that didnt play a role. If something was significant enough you put it on, but if its insignificant, you leave it off . Generally, yes. In your opinion both the Heart Disease as well as the history of hypertension and the drug the drugs that were in his system played a role in mr. Floyds death . In my opinion, yes. All right. Now, again in terms of your autopsy report, you dont generally note negative finding, right . If something is normal, you may just say its normal, but youre not going to take special note to say the heart is completely perfectly normal . Thats a really long question, counselor. I think i can give you a reasonable answer. For most normal organs we have a boiler plate description what that is. If a spleen is normal, ill give a normal description of the spleen with the weight of the spleen. Demanding on the nature of the case there are pertinent negatives, things that you think might be on the body based on the circumstances, so you specifically seek those things out. If theyre not there, you document them because their lack the fact theyre not present really means something. I dont know if that answered your question. There are somethings that are normal and we go on to the next step of the autopsy, theres some things the fact theyre not there, youre going to dwell on that and document that you looked for something that wasnt there. In that regard, if you note something, whether its odd or irregular or its the negative, you take special precaution to note those things in your autopsy . Ideally, yes. Not only do you document that, but you take a picture of things that are there and you document things that arent there that would be expected to be there. Its interesting to me you made a conscious decision not to watch any videos before you performed the autopsy, correct . Correct. That was to prevent bias you described . In general, yes. I dont want to go into an autopsy with a preconceived notion that i know what happened. That might lead you to skip certain steps or do certain things that could be relevant. Full disclosure, counsel, to fully answer the question, i saw the video that the entire world saw later that day after mr. Floyds autopsy. I didnt release his body until the following morning. Had i seen something on the video that triggered something else, i had a chance to act on it. I didnt want that in my mind when i physically performed his autopsy. Understood. You received some briefing from Law Enforcement to say heres generally what we know about what happened . It was pretty high level, but yes, i got a phone call that a man had gone unresponsive in Police Custody while restrained. He died at Hennepin County medical center. Thats what i knew. I believe i knew there was pressure applied to his neck. Beyond that, that was what i knew going into the autopsy. So you were you took special because you learned that there was potential pressure to the neck, you took special steps to look at the neck, neck area, shoulders, et cetera, right . Yes. Because of that, you did this unique incision or this specific incision to lift the skin off to look under the surface so to speak . Thats correct. All right. Well come back to that in a second. You did note i want to focus on the heart for a little bit. You noted that the heart was dilated . Yes. What causes that . Dilated is just fancy medical lingo for got a little bit bigger. When you blow up a balloon, it dilates. Mr. Floyds heart was can i refer to my report . Would it refresh your recollection . It would. I have described the ventricles as mildly dilated in mr. Floyds case. I would interpret that as being part and parcel of high Blood Pressure. Thats a manifestation of the heart getting bigger and heavier as it works against the high Blood Pressure over a period of time. You took note of the size of mr. Floyds heart . Its actually the weight, but yes, absolutely did take note. That was 540 grams . That is correct. Youre familiar with the papers on the normal heart size . I am familiar with the paper, although the one i usually use is the kitzman paper from the mayo clinic. Whats the maximum size . Its a function of your body height and weight. A larger person is going to have a bigger heart weight. Mr. Floyds case, the upper limit of normal for his body length according to the reference i use is 510 grams. The upper limit of normal for body weight would be 521 grams. He was 540 grams. Hes outside the upper limit of normal. On the bellshaped distribution for a man his size, hes on the heavy end. Okay. All of this various standards in terms of the wait of a heart, theyre Peer Reviewed . As far as i know, yes. The reference i use is from the going to assume is Peer Reviewed. Right. As would be say demio and other studies . Im not familiar with the other studies. I believe it was published in the american journal of forensic medicine which i know to be Peer Reviewed. Okay. You would agree that the larger the heart is the more blood it needs to provide adequate oxygen nation. As a general rule, yes. What kind of things cause a persons heart to be bigger than normal . Most common cause by far in adults in the developed world is high Blood Pressure. There are far less common causes. Aortic Heart Disease. Genetic causes of an enlarged heart. Typically we can tell by looking at the heart. Those are much further down the list than high Blood Pressure which again is the number one by a long shot. Based on the review of mr. Floyds medical records you determined that he has a history of high Blood Pressure. Yes . It was helpful to learn that from the medical record. He was known to be hyper tensive. Can you describe the narrowing of the arteries more . I can, counselor. If i may refer to my report again. Sure. So as i mentioned, when i was describing the photographs earlier, he had 75 proximal and 75 mid narrowing of the left descending coronary artery. He had 75 narrowing of the first diagonal branch of his left anterior ascending coronary and the right coronary he had 90 proximal narrowing. All right. What do Forensic Pathologists consider enough narrowing to cause a sudden death . We usually look to 75 greater as the as capable of causing sudden death. Are you familiar with myocyte necrosis . Yes. Do you have to have that to cause a sudden death . No, you do not. In arrhythmia there would be no necrosis, correct . Thats an electrical phenomenon and so i really can never diagnose an arrhythmia postmortem. We have to infer that from the circumstances and the condition of the coronaries. Apox yeah of the heart is the reduction of the oxygen to the heart, correct in. Correct. Can you can hypia to the heart cause death by other means or would it just be the arrhythmia . Well, theres many ways that a lack of oxygen to the heart could cause death. One would be a sudden disrim mia from a normal beat to a nor profusing beat and the person literally collapses in front of you. Depending on the nature of the disease the person should have a thrombis. Theres different ways the heart manifests that its not getting enough oxygen but one is sudden collapse and death. And sometimes people can survive that for a longer period of time. Survive the thrombis you described . Correct. I dont know the numbers but obviously people can and do survive in the coronary arteries and why we have clot busting drugs and urgent katherizations. Can you describe the conduction system of the heart . Only in the broadest terms because im not an expert. I have other people i rely on that but its the electrical part of the heart. Theres like the little watch in your heart that starts every heart beat. You would be able to see what it is doing on an ekg looking at an electrical tracing in a living person. Thats conducted to another node known as the av node. And then the impulses go from that to the ventricle that cause them to beat. You can see it under the microscope if you take it out and look for it. And theres on very rare occasions we do that. It wouldnt have been necessary in mr. Floyds case. If the conduction system is impaired what happens . Id have to defer to a cardiologist on that because theres so many different ways it can be impaired. Sometimes benign or night need a pacemaker or a defibrillator. Which of the arteries supplies the that first one, the sa node . The sino atrial node . Right. The right branch of the coronary in my people. I didnt dissect out the branch but the main right coronary artery was 90 narrowed. Youre aware also of the methamphetamine found in his system . Yes. Does methamphetamine further constrict the ventricle and arteries . I dont know. Im not an expert in the specific toxicology of methamphetamine. It is hard on the heart in the sense that it does things like drive up the heart rate and Blood Pressure. I dont know if its a vaso constrictor but either way as a general rule for forensic pathology it is not good for a damaged heart, a heart with coronary artery disease. Does the amount of or the level of the tox logical findings affect whether its good for the heart or bad for the heart . I dont know that theres a scientific answer to that, counselor, because im not aware theres a safe level of methamphetamine. Okay. And especially elicit methamphetamine, right . So safe level of the street drug versus the am met feigns sometimes prescribed. Yeah. Im very unfamiliar with any medical use for methamphetamine but amphetamine is used. Thats definitely not my area of expertise. My high level overview is all other things being equal, methamphetamine is not good with bad coronary arteries. And exertion also causes the heart to work harder . Correct. And therefore would require more oxygen . Correct. More blood has to pump through to oxygenate the heart . Correct. And send it to the rest of the body. And so, in this particular case, we have mr. Floyds heart is at least above average size. Right . Correct. He has a heart with narrowed coronary arteries, right . He does. There was evidence of a period of exertion prior to his being deceased . Yes. I mean, we are outside the autopsy now obviously but clear from the videotapes that, yes, there was a period of exertion prior to him becoming unconscious. In terms of your investigation, you ultimately did watch the videos . Correct. And including the body worn cameras of the officers . Yes. And did you also were you also provided with other videos in terms of surveillance videos, additional bystander videos, things of that nature . I was. Were you provided with investigative materials that what people said happened, et cetera . No. I did not have those. Okay. Have you ever certified a death due to hyper tensive me cardio. The answer to that is yes. The term is the heart is too big because of high Blood Pressure. We dont typically use that term but hyper tensive cardiovascular disease but i have used that or similar terminology. Have you ever certified a death due to art ro ske lotic disease . Yes. Compared to mr. Floyd . Yes. In terms of the injuries to mr. Floyd, the abrasions and things of that nature, obviously they appear to be fresher to you. Would you agree with that . I want to be careful in the answer. There is not any literature to date those kinds of injuries with any precision. Presumably theres contextual data to know that he didnt have the abrasions an hour before he died or whatever. Could i tell you how old they are as a pathologist . No. Not with any precision. In terms of abrasions on mr. Floyds body, they could have been from the period of time he was restrained on the ground. Agreed . Correct. Could have been consistent with the period of time where he was taken to the ground or brought to the ground. Right . Well, that would be true as long as theres something in the environment to explain the abrasions. Some would take a fairly rough surface to produce. A smooth