Caused mr. Floyds death. Oxygen, mr. Floyd was in position, because of the subdual state, he was in position where he couldnt get enough oxygen. There is no evidence to suggest he would have died that night except for interactions with law enforcement. Joining me now is david henderson, eugene robinson, joyce vance and ben gupta. First, lets talk about the testimony today. Was she successful in rebutting we dont know what he will testify, but from the autopsy himself. He is determined to be gold. But its meaningful to hear witnesses like dr. Thomas donate their time for free for this case. I think she has done a remarkable job of clarifying what did not cause George Floyds death. The only complication is she is a sophisticated person and she expresses her opinion in sophisticated words. Like when she uses words like officers and not officer, singular. Overall, i think she did fantastic. Medical technical witnesses, yesterdays witness was extraordinary. Martin tobin. Lets talk about the jurys reaction. And, shaq, how are they reacting to todays witness dr. Thomas . Yesterday the jurors were following along as dr. Tobin was referencing the neck, they were following along with the instructions. They said they were thoroughly engaged. We also know how tough it was for the floyd family who was in the courtroom who walked out after a certain moment where they showed that george floyd lost his life. It seems like the jury is still engaged. We just got a note. If i can take it away from the jury, we do know for the first time we have seen someone occupy the seat held for a Family Member of derek chauvin. We dont know who she is, but it is a woman and the first time we have seen that. The seat was removed for much of the trial and someone is sitting in it now. There was a report explaining the delay in the trial proceedings. Apparently the judge brought in one of the jurors asking if she hadded media contact, had been offered a book deal. They said she looked surprised and didnt know what the judge was referring to. But this is the second time the judge has had to question the jury as a whole or an individual juror during the trial. The judge said he believed the jur or and would not take action based on the questioning this morning. This didnt happen on camera, but based on report, it did happen right before the first witness was called. Thats a big flag. Joyce vance is a former prosecutor. How concerned might you be that the judge did that . The big concern is that there are only two alternates. The judge needs to keep this jury as intact as people. He can afford to lose one or two people, but he cant lose more. You cant have people who is not impartial be involved in deliberation. If the judge misses that, that would be a good argument for defense to make on appeal if there is a conviction. Doctor, lets talk about the extraordinary testimony from dr. Tobin yesterday coupled with today hold on. Shaq. Did you want to correct one thing . Yes. This is a correction from the Pool Reporter. Just so you know the circumstances, they cant send these notes out in the pool so they are trying to send notes in between the break. One of the questions asked to the juror was whether or not her motherinlaw texted her and said it looked like a bad day for the defense. The juror confirmed she received that and didnt address whether she responded. That was just potential influence. This is once removed. You are getting this from a Pool Reporter who is permitted in the courtroom, but is there any indication that you juror reported that text to the judge or are they monitoring social media . Thats what is confusing. Sounds like court is back. Let me just what is left hanging out there is we dont know how the judge knew about that text confirmed by the juror. Just to clarify for the jurors what these various classifications are, you skusd discussed natural, which would be a heart attack. Yes. Accidental death. Where would Drug Overdose fit in general as a cause of death . Usually Drug Overdose would be accidental unless there was intent where it would be suicidal. Undetermined. If the medical examiner cant tell which it is, then its undetermined . Exactly. So if the manner of death has been determined to be homicide, does that in your opinion as a medical examiner, rule out death by accidental Drug Overdose . Yes. Lets go back to exhibit doctor, we are talking about the designation of homicide. Tell us what that is. Homicide is defined in a broad sense as death at the hands of another. It goes into more detail if we wanted to look at that. But this is guidance given from the National Association of medical examiners to medical examiners . Exactly. So perhaps if we could go to the next slide. Could you read this. Homicide occurs when a volitional act by another person to caught fear, harm or death. Intent is a Common Element but not required as classification for homicide. You agree with this . Absolutely. Its a guideline you have followed . Yes. Have you followed this guideline for the years you have been a medical examiner . Yes. Is there more guidance given from the guidelines on what constitutes yes. Could you read this for us . Thus, the manner may be classified as homicide because of the act, not because there was intent to kill. You agree with the conclusion reached by dr. Baker. Is this the definition of homicide you are applying that we saw in these two slides . Yes. Thank you, doctor. I want to ask you about a new subject. This has to do with certain studies that assess whether the prone restraint is dangerous from a breathing point of view. Id like to get your perspective as a forensic path ol gist and medical examiner . Yes. In certain laboratory safe settings, that may be true, but i do not agree with their applicability to real life situations. If you could characterize for the jurors, what is the punch line of these studies . 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. Do you find the study to be reliable or controversial . I think they are fine for laboratory purposes, but they bear no resemblance to real world situations so i would say they are irrelevant for purposes of what we are talking about here. So how do they then not relate to the real world . Whats artificial about them . I would say for starters, these are volunteers who have agreed to be put in this dangerous position of restraint. But they know if they feel scared or uncomfortable, all they have to do is say stop. And that has happened in some of these studies where volunteers say i cant tolerate being in this position. Its too scary. So to me that takes out the fis logic stress. These are young people, mostly healthy, who have agreed to be part of this study. So it doesnt relate to someone who may have other underlying factors. Thirdly, they are put on like a gymnastics mat faced down. Its different when you are squished between a person and hard ground versus having evenly distributed weight on your back and you are on a mat. Third or fourth i guess, and perhaps most significantly. None went on and on and onto the point where people stopped breathing and where their heart stopped. They were being monitored. If at any point they had had respiratory difficulties, the study would have stopped. And the person knew that. So to me it bears no resemblance to what mr. Floyd had. Did any of the studies involve a knee on the neck . No. Did any of them go on for 9 29 . No. Did it measure a decrease in lung volumes, a decrease in oxygen reserves . Not that i know of. Any relevance to george floyd at all . Not in my opinion, no. Dr. Thomas, have you done any work on your own to measure what the knee on the neck and back of mr. Floyd would have done to his oxygen reserves or lung capacity . No. I would defer to a pulmonary doctor to address. Are you able to tell the ladies and gentlemen of the jury, if you havent done that work, whether the forces that mr. Floyd was subjected to would have killed even a normal healthy person . In the way youve phrased that, not based on lung volume and that kind of study. I mean from watching the video, i certainly wouldnt want to be in that position, but thats a different answer. Thank you dr. Thomas. No further questions. Good morning, dr. Thomas. Good morning. You described being a forensic pathologist being a doctors doctor. General pathologist. And a general pathologist, you have to wear many hats in a Death Investigation . Yes. You have to have a broad familiarity with multiple medical conditions, right . Yes. And sometimes medical conditions may appear at autopsy that you have never seen before. Right. Some strange disease you have never seen. Yes. You will speak to other doctors, right . Right. You will gather that situation and they will share information with you to help you make conclusions in an autopsy, correct . Yes. You also described how being a medical examiner is more than just the autopsy, right . Yes. The autopsy is one small part of a Death Investigation, right . Yes. You described reviewing videotapes in certain circumstances, right . Yes. Past medical records . Yes. Interviews with friends, Family Members who knew the decedent. Yes. And the medical Examiners Office compiles a massive amount of information itself. Yes. You have had an opportunity to review a lot of that information in this case. Yes. Have you reviewed all of the interviews of witnesses . Probably not all of them, no. Have you, after you prepared your report, have you been provided additional materials that may be relevant to your considerations . Not that i can think of off the top of my head. You did have an opportunity to review dr. Bakers file. Yes. We will have an opportunity to hear from him, but i would like to follow up on some of your conclusion. There is a term used in dr. Bakers autopsy the cause of death, the term complicated. Can you define, medically speaking, what the term complicating means . 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 cardiopulp mon ri arrest cardiopulmonary arrest and Drug Overdose. Have you been provided anything about dr. Bakers opinion in this case . Not very specific. Just what he put in the autopsy report and his conclusions. In terms of the word complicating, its capable of different definitions based upon the forensic pathologist, correct . Yes. So you as a forensic pathologist may have a different interpretation of what complicating means compared to dr. Baker, for example . Yes. There is a reasonable degree of disagreement amongst any case generally. Its reasonable for doctors to disagree with each other, are there not . That sometimes happens. You did not perform the actual autopsy of mr. Floyd, correct . Correct. That was dr. Baker who did that. Yes. You know dr. Baker well . Yes. And you know him to be a competent medical examiner . Yes. He is the chief medical examiner for hinnepin county at this time . Yes. I would like to go through a few things with you. Lets talk about mr. Floyds heart first. What was the size of mr. Floyds heart as measured at autopsy . The weight was 540 grams. Would you describe that as an enlarged heart . I would say its slightly enlarged. There are different measures how to determine if a heart is enlarnld, right . Right. Some, by some categories, that would not be considered enlarged. There are two different primary measurements or primary ways of comparing mr. Floyds heart to determine if it is enlarged. The molina studies and northwestern studies . I see. There are probably multiple ways at looking at heart weights. Those are two of them. There is one in europe. There are lots. But ultimately, based on all of your information, you would agree that mr. Floyds heart was slightly enlarged . Yes. In terms of the standards, what would a normal male heart weight weigh for a person like in floyd . I dont know off the top of my head. Would you disagree if i said it was 383 grams . That could be. For the average. For the average, right. If that were the average heart size, heart weight, 383 grams, relevant to mr. Floyds heart, mr. Floyds heart would be considered profoundly enlarged. The thing about using averages especially in medicine, which is what i am most familiar with, weigh dont generally compare it to an average, we compare it to Standard Plus or minus two deviations. So i usually use 250 to 510 grams would be normal for someone of mr. Floyds height. I dont know in the demayomow molino study. You would say 510 grams is the high end of that . Right. And 540 exceeds that . Right. So in terms of whether it is a very enlarged heart or rather minimally enlarged heart, it causes a person to need more blood. Yes. What are some of the causes . High blood pressure. You understand from mr. Floyds records he had a history of high blood pressure. Yes. Can you describe the blood vessels of the heart . Several major coronary arteries that supply blood and nutrients to the heart muscle. There is the left and right and then the left branchs into the left anterior descending and left circumflex and there are some other branchs. How would you describe narrowing or stenosis . We look at an opening. So if an opening is fully open, that would be 0 narrowing. If its completely closed, it would be 100 occluded. We look at 50, 75, 90 . Its an eyeball estimation. We dont get out calipers and measure. Did they have coronary artery disease. Was it good, bad, that sort of thing. Can you describe the difference between promimal and distal . The main vessel takes blood from the heart to the rest of the body. In close to the aorta is called proximal. And further away is called distal. When you have proximal narrowing, how does that affect the heart . It can narrow the blood supply to more of the heart than if you have distal narrowing. Another way would be to say it decreases the amount of blood the heart is getting . Yes. It also affects how things are removed from the heart, like Carbon Dioxide . Well, thats different. That wouldnt happen from the blood vessels coming in i dont think. So i wouldnt include Carbon Dioxide in that. Is there a standard within forensic pathology where pathologists would consider there is enough of a narrowing to cause sudden death . So the way i would describe that is anything over more than 70 to 75 is in the view of a forensic pathologist something that in the absence of anything else, could be used to explain death. Its also true that people live with 100 occlusion and go on and live fine. This is my perspective as a forensic pathologist and everyone i see is dead so that is a different perspective. Can you explain what myocite necrosis is . Cyte means cell and myo means muscle. So when you have myocyte its muscle cell and necrosis means death. So that means there are dead heart muscle cells. Do you have to have myocyte necrosis to cause sudden death . No, you dont. Hypoxi a is hypoxia means low oxygen. Your question is can low oxygen to the heart cause sudden death, yes, through arrhythmia. How would you describe conduction. The way the heartbeats, lubdub, there are electrical currents that go through the heart muscle and normally there is a certain sequence heart muscles will fire. Thats called the conduction system through which the electrical impulses flow. Thats what keeps the heartbeating in a regular rhythm. Yeah, thats the conduction. So what happens if the conduction system is impaired . Then you can get whats called an arrhythmia or abnormal beating of the heart. That can result in sudden death . It can. Which artery supplies that pace maker of the heart . It probably is variable from person to person. I think the coronary artery we consider the most important is the left an anterior descending artery. What about the right coronary artery . It depends on the person, which part is supplied. In mr. Floyds autopsy, dr. Baker determined had a 90 occlusion, correct . 90 narrowing. Does that make the heart work harder . Yes. Does that mean that the heart needs more blood to function at that time . Yes. Its kind of like when we think about exerting anything, with jogging, running, the heart needs more blood and hence more oxygen to function properly . Yes. You also described fight or flight, the physiology of that in your consideration . Yes, the physiological stress. The physiological stress produces adrenaline, correct . Yes. That also causes the heart to work harder . Yes. And therefore need more blood and oxygen . Yes. Let me ask you this. In this particular case we have a heart that is at least above average, right, needing more blood. We have a heart with an occluded right coronary artery. Narrowed. We have a heart that the left anterior descending artery also had a 75 narrowing, right . Right. And then you have an exertion of stress producing adrenaline, right . Yes. So the heart has to work very, very hard in this case, fair to say . Yes. Lets take the police out of this and i am going to ask you a hypothetical. Lets assume you found mr. Floyd dead in his residence, no police involvement, no drugs, the only thing you found was these facts about his heart. What would you conclude to be the cause of death . In that very narrow set of circumstances i would probably conclude that the cause of death has his heart disease. So have you as a forensic pathologist ever certified a death due to artherosclerotic disease . Probably now thousands of times. Hyper card yeah vascular disease, absolutely. With a heart at this weight or smaller . Well, if it was in this setting where that was the only abnormal finding, then i would probably go with that, yes. So one of the things that has to be considered in this particular case is mr. Floyds heart, right . Yes. Even without any sort of exertion, again, take the exertion out of it the police out of it, the drugs out of it, that is a potential cause of death that needs to be considered. Yes. Now you discussed the abrasions that you saw and the jury saw pictures of. You would agree that the abrasions are on a left to right pattern. Meaning there are more on the left than the right . Right. On his face, yes, on his shoulder, yes, and then he had abrasions on his right hand. Even in terms of the pattern of abrasions, there are up and down aabrasion could go from the bottom of my body up or from left to right, right . Yes. I guess i didnt focus on what direction the abrasions were going in that sense. Thats fine. But you would agree that one possible way that at least some of the abrasions occurred would be when mr. Floyd was initially put down on the ground . I guess they could, yes. Not all of those abrasions necessarily occurred while mr. Floyd was in the prone position, right . Thats hard to answer. Its hard to answer when the abrasions were there and what caused the abrasions, right . Right. If someone was being held down with the weight of three people, would you expect those to be more punctile in their nature with the lines movements. Gosh, there are to many variables there. You ultimately determined that this was an asphyxiation . Yes. And asphyxiation is lack of oxygen to the brain. Inadequate oxygen. To the brain specifically. Yes. In terms of asphyxiation, you would agree there are multiple things that could cause asphyxiation. Yes. You referenced someone being strangled. Yes. If i strangled or put my hands around someones neck, there are certain things you would expect to see. Sometimes you do, yes. And when you do, thats great. Those would be things like a broken hyoid bone, the peticial hemorrhaging you discussed . Yes. It depends on the mechanism of asphyxia. You described hanging or strangling. Yes. You described positional or mechanical . Those are types. Positional being position of the body and mechanical using some sort of device to asphyxiate someone . We havent talked a lot about positional and mechanical. There are all kinds of things under both of those that can cause low oxygen. One of the things that can cause low oxygen to the brain is the use of controlled substance, correct . Well eventually, yes. Someone could ingest a particular substance and it could affect the diaphragm. Some affect the ability to breathe which then leads to low oxygen, yes. Thats essentially what you are saying. In this case, essentially what happens is there was some event that happened that resulted in a decrease of oxygen to the brain and that resulted in death . Yes. And thats essentially what asphyxia is generally . Inadequate oxygen. You were asked a series of questions about studies. I think they are out of san diego . Yes, dr. Chan. Dr. Chan. Are you familiar with the journal of forensic and legal medicine . Yes. Now you testified that some of the problems with the studies were that they were in laboratory settings, that they were controlled environments, healthy individuals, et cetera. Yes. Are you familiar with the work of dr. Christine hall and the outcome of prone positioning following police force on cohorts. Is that the one from canada . Yes. Yes. That was analysis of Actual Police encounters, correct . Yes, in canada. In canada, understood. But that study, they go through and look at the number of policecitizen interactions . Correct. And then they further go in to look at how many involved being placed in the prone position or nonprone position, correct . Correct. They consider actual various real life variables . Yes. Including whether drugs were on board, the length of time to a certain extent that someone was in a prone position . Yes. Ultimately they analyzed about 3,000 prone positional placements . Yes. Out of like 1. 1 Million Police interactions. Yes . So 1. 1 Million Police interactions resulting in 3,000 prone position arrests. These are real people, real incidents, right . Yes. And in those 3,000 or so interactions there were no deaths. Isnt that amazing . When you consider that virtually every forensic pathologist in the United States has probably had an officer involved death. It utterly baffles me. Thats why i kept emphasizing canada. I dont know whats different. So the let me ask you in terms of high pox yeah. Can you die fine that again . Low oxygen. Which is more sensitive to the lack of oxygen . The brain. The brain needs the most oxygen, right . Right. And thats because its doing millions of things simultaneously, right . Yes. Im sure there are lots of reasons. I think a previous witness testified that it takes about 20 20 of the bodys oxygen supply to function. That sounds about right. But you heart also needs oxygen. Yes. In terms of professional standards of determining an asphyxiated death, is it true that you have to first exclude all natural and nonnatural cases as cause of death . Well, you can have natural and nonnatural causes of low oxygen. I am sorry, i guess i dont understand. Sure. There is a criteria established for making positional asphyxia as a cause of death, right . Well i am not really sure. I am sorry, i just dont understand that. Fair enough. Is the prone position in and of itself inherently dangerous . Not if there are no other factors. So the prone position is examined and used in a lot of settings . Yes. Even in hospitals and in covid the prone position is used . Correct. And in those circumstances, being in a prone position is not inherently dangerous . Yes. Chiropractors put people in the prone position, right . Yes. Massage therapists . Yes. The prone position in and of itself is not dangerous. Right. Is the prone position on con concrete dangerous . By itself, no. I can lay on the concrete by the pool in the sun of florida and it is not inherently dangerous. Right. Did you take into consideration mr. Chauvins weight in your analysis . I am aware of his weight. I would say i took it into some consideration but it wasnt a major factor one way or the other. You reviewed all of the videos, right . Yes. Its fair to say that portions of his weight were placed on mr. Floyds body at a different distribution . Yes. And ultimately, in terms of the autopsy that dr. Baker conducted, in terms of the area in the shoulders, back and neck, no buoying was found, right . Right. In your experience as a forensic pathologist, if someone is placing a significant amount of weight on a persons area for a prolonged period of time, would you expect to see bruising . You might or might not. Its so variable. You would agree there are no abrasions or bruising described in the autopsy in the neck area of mr. Floyd . Correct. There is no bleeding into the muscles in his back . Correct. You would agree that the knee is sort of a pointy or a more protruberant part of the body . I guess so. When we talk about the shin bone, the shin bone itself, there is not a lot between the skin and the shin bone, right . That is true. It is sort of a triangular shape . Yes. And again, along mr. Floyds back there was no long bruise consistent with a shin bone, right . Thats right. And no circular bruise consistent with a kneecap . Right. You have reviewed a lot of strangulation cases in those in your career . Yes. Strangulation with the hands . Primary manual, but also ligature. The pressure thats exerted in that will frequently leave bruises, fingerprintsize bruises . Frequently but not always. And ultimately, what increases the likelihood of seeing a bruise is the amount of force thats applied, right . You know, i dont know what all the factors are. Whether its fragility of the vessels, the length of time, the force, location. I think there are lots of variables. Everyone bruises differently. What medications they may take . Right. Yesterday, there was an analogy to sitting on a church bench and you dont bruise your behind behind. That can feel long. Would it be different if you are on a church bench under with a baseball, for example, under your butt . I really couldnt say. In terms of dr. Bakers autopsy, you would agree that theres really no objective evidence showing any pressure to the back of mr. Floyd . Theres nothing at the autopsy, thats correct. Did you find did dr. Baker find hypoxic changes in his brain . He died too quickly for that to show up. Thats when we talk about the lack of ischemic hypoxia, correct . Dr. Baker noted a lack of ischemic hypoxia. You are describing lack of ischemic changes in the neurons . Correct. Because that has to happen over a period of time. When someone is experiencing that shortness of oxygen or that lack of oxygen to the brain, that will frequently lead to certain symptoms, right . Yes. Confusion is one . That could be, yes. Restlessness . Could be, yes. Shortness of breath . Could be. Visual changes . Could be. Incoherent speaking . Could be. To your knowledge, did mr. Floyd, in the videos that you observed, ever complain of these visual changes . No. Did he appear to be confused to you . What time i guess, what time period are we talking about . Sure. That helps. Maybe if we narrow down that the nine minutes during the nine minutes that mr. Floyd was restrained, did he appear confused to you . Gosh, how do you describe his behavior . Did he he was articulating that he was in pain, right . Yes. Then he couldnt breathe and he calls for his mother. He says he loves people. You might interpret that as confusion or you might interpret it a different way. Did he appear to be breathing during this time frame . Not effectively. Do you know how many breaths per minute . No. If one expert indicated it was at a rate of 22 breaths per minute, would you disagree . I would have no way of assessing that. When someone is hypoxic, they start breathing faster, right . That can be a mechanism of trying to balance. At least for the first five minutes or so, mr. Floyd was talking, right . Well, again talking, yes or no . He was talking . Yes. There were words, yes. He had an open airway . Yes. You would agree that would you agree that at some point he went limp . Yes. And would you describe what you saw as the progression of hypoxia in that instance at the point he goes limp . That is certainly a good explanation for it, yes. It was not a sudden hypoxic event, right . That is my interpretation, yes. You would agree that if he was progressively growing hypoxic, you would expect whole body hypoxia . I will rephrase my question. Yeah. Sorry. Im not a doctor. I have to rely on my notes. If he was progressively suffering whole body hypoxia, the brain would be the first thing that would have show signs of hypoxia . Oh, i see. The brain is the most sensitive. You would agree that that would not occur in a matter of seconds, but it would take a matter of minutes, right . Correct. Asphyxia due to position or compression, that prevents air from getting into the lungs, right . Yes. That leads to what we would call a global hypoxia . We havent really used that word global. Whole body. I mean, if theres inadequate oxygen, the blood flows everywhere. So i guess thats what you are talking about. The brain is the first thing to show symptoms of hypoxia . Right. Thats the most sensitive organ. In this particular case, where you have a 90 stenosis of the right coronary artery, thats going to be limiting oxygen to the heart, right . Yes. And he has a big heart, right . Yes. Needs more blood . Yes. Adrenaline speeds up the heart . Yes. Methamphetamine speeds up the heart . It can, yes. Methamphetamine and adrenaline caused the work the heart to work harder . Yes. And increases the hearts oxygen needs . Yes. At what point does the stenosis in the left and right coronary arteries become critical and cause the heart to stop . Generally. As are you asking that same question about as a forensic pathologist what degree of narrowing do we consider potentially fatal . Right. 70 , 75 and above. In terms of drug use, you obviously were aware based on the toxicology that mr. Floyd had certain drugs in his system, right . Yes. When we say on board, that means in the system . Yes. Would you describe the use as you know based on the information that you have as sort of a binge use of drugs . I guess i couldnt answer that. Are you familiar with drug use taken or used interrectally . I have heard of that. Thats speeds up the distribution of controlled substances in a person . It speeds up absorption. The effects would be felt faster . Yes, they could. In a case where you have a person who is experiencing cardiac arrest, right, and they are put in an ambulance and taken to the hospital for resuscitation, they are often theres i. V. S placed in a person, right . Yes. Those i. V. S contain saline . Yes. Saline can ultimately dilute or decrease, to some degree, the amount of controlled substances that would be as they would be measured . Thats a theoretical possibility. You would agree that fentanyl is a respiratory depressant, right . Yes. It slows breathing and lowers oxygen in the blood . Yes. Does the fact that theres norfentanyl in his blood mean he took it some time ago . Yes
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