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 hypothetical