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Continuing Coverage of the Derek Chauvin Trial. Defense Cross- Examines Medical Examiner Who Did Floyd's Autopsy. Aired 3:30-4p ET

Aired April 9, 2021 - 15:30   ET




BROOKE BALDWIN, CNN HOST: All right, welcome back. You're watching CNN. I'm Brooke Baldwin.

That court there in Minneapolis taking a quick break in this murder trial here. And on this tenth day of testimony, the jury has now heard from this forensic pathologist and just now the questioning of this gentleman. This is the chief medical examiner for this area of Minneapolis, who actually was the one who performed the autopsy on George Floyd. And he concluded the cause of death was homicide.

And so far, he spent quite a bit of time talking about Mr. Floyd's heart. Said he found no significant damage there other than, you know, a regular person who lived a bit of life, which, you know, the defense has on many occasions argued he had a bit of heart trouble. And of course, the defense is also jumping all over previous drug use.

Sara Sidner has been covering this from the very beginning. She's right live outside that Minneapolis courthouse. And so Sara, it seems to me this Hennepin County Medical Examiner in his testimony, is pretty consistent with various other medical experts we have seen on the stand, yes?

SARA SIDNER, CNN CORRESPONDENT: All the other experts -- medical experts that we have seen on the stand. It is consistent with what they had said. And I would venture to say that to date, this is the most important witness, perhaps, in this trial for both the defense and the prosecution. Some of the others may have been more for the prosecution, but this is a really important point that this medical examiner is making.

One, he talked about the cause of death, which was restraint and neck compression and the manner of death, homicide. Why is that important? It's because we all know what a homicide means but he says, look, this is not in a legal manner, but a medical manner. And what it means is that basically other people were responsible or involved in another individual's death.


What does that tell you, who was there at the time? Well, who was there at the time was Derek Chauvin and several other officers who were there, and he says the cause is restraint and neck compression. Well who was causing that restraint and neck compression? That's the person on trial right now accused of the murder of George Floyd, former officer Derek Chauvin.

So, it is making the prosecution's point very, very clear. And the reason why this medical examiner is so incredibly important. You said, he is the person who actually did the autopsy on George Floyd's body after George Floyd died. He is very unequivocal, he's very clear, he wrote extensive notes on this.

Now we have not heard him cross-examined yet. That is coming. You'll hear Eric Nelson, Derek Chauvin's attorney, cross-examine him. He has been trying to get witnesses to talk about the drugs that were in George Floyd's system and his medical conditions before he ever came in contact with these officers. And those are the two things that we expect him to go down the line and really push this medical examiner, Dr. Baker on. Whether or not it is possible those drugs may have had an impact on his body and therefore, may have caused some of his issues, including the medical issues that stopped him from breathing.

But so far what we've heard from the medical examiner is clear. He basically determined that it was someone else who caused George Floyd's death and his death was caused by compressions to his neck and so -- and restraint. Those two things would not have happened, and he would not have died, Dr. Baker said, had it not been for those two things. And all you have to do is look at the video to see what caused those two things. One of the people involved in that was the defendant who is right now on trial for the murder of George Floyd.

BALDWIN: So appreciate you in all of that, and a bit of the foreshadowing, you're right on the money as far as what we're probably see in cross with regard to some of this drug use.

Chief Charles Ramsey to you, because I know you want to make a point -- we were just talking about how this chief medical examiner, he's on the stand, was testifying. He's asked about, you know, what was found in George Floyd's stomach. And you know, he was asked about pills. And he said, you know, he didn't find any pills. Didn't even find any pill fragments. We know we've talked before about previous testimony that some pills with George Floyd's DNA were found in that police squad car. I also remember, was it an eyewitness who was being asked about, you know, did you hear George Floyd as he was down on the ground saying, I ate too many pills, what did you want to say about that?

CHARLES RAMSEY, CNN LAW ENFORCEMENT ANALYST: Well that's exactly what I wanted to say. I mean, first of all, finding pills in a car is not the same as finding pills in his body, obviously. So -- but I do go back to a couple of days ago --

BALDWIN: Chief, forgive me. I promise we'll come back to this point. They just started again. Let's listen.

ERIC NELSON, DEFENSE ATTORNEY: So Dr. Baker, thank you for being here with us this afternoon. Just some follow-up questions. I kind of want to break up into two different sections. One about the autopsy and then some other questions about events after autopsy, OK? DR. ANDREW BAKER, HENNEPIN COUNTY, MINNESOTA MEDICAL EXAMINER: OK.

NELSON: All right. So you understand, Dr. Baker, that you've testified in many cases in Hennepin County before?

BAKER: Yes, I have.

NELSON: The Dakota, Scott County as well?

BAKER: Not nearly as much, but yes.

NELSON: You understand that as a part of the process of exchanging information, the defense receives copies of everything, your reports, meeting notes, prior statements you've given, things of that nature, right?


NELSON: OK. And have you had opportunities to review all of that information prior to your testimony today?

BAKER: To the best of my knowledge, yes.

NELSON: OK. And ultimately what you testified is in a death investigation, it's much more than just simply an autopsy, agreed?

BAKER: Correct.

NELSON: And in fact if, you know, you pull your file, it usually ends up being a few inches thick, right?

BAKER: We're actually paperless at the medical examiner's office, but if you printed it out, yes, I guess it would be a few inches thick.

NELSON: Well, that's what I mean, and that's what it is. I guess I've got to get with the times. But ultimately that file contains your autopsy report, correct?

BAKER: Correct.

NELSON: Death certificate, the paperwork that you fill out for the state of Minnesota?

BAKER: Yes. We don't actually get a copy of the death certificate from the state but everything we put on the death certificate is in our file.

NELSON: And then you also keep track of conversations that you had with people, right?


BAKER: Generally, yes. That's usually more my investigators who are talking to family, treating physicians, you know, hospital records department and stuff.

NELSON: So you keep a log, so to speak, of today investigator so and so spoke with X, right?

BAKER: Again, I don't personally do that so much but, yes, my investigators do.

NELSON: Right. And it's all a part of this file, right?

BAKER: Correct.

NELSON: And then in addition you obtain any known medical reports that may factor into your analysis as well, right?


NELSON: Previously you had received some hospital records from HCMC regarding Mr. Floyd, correct?

BAKER: Correct.

NELSON: But you don't go out and try to search -- or perhaps you do try to search for every provider that he or any person generally may have seen, right?

BAKER: In most cases, that's correct, counselor. There wouldn't be a point in us trying to get every medical record ever generated for a particular -- so we are given only the -- if I thought it would help me understand the cause and manner of death better.

NELSON: OK, fair enough. Now I want to talk to you first about the word complicating. How do you define the word complicating as you used it as to the cause of Mr. Floyd's death?

BAKER: I use the word complicating the way I think most physicians use the word complications. And I'm guessing that most people who have been a patient or had a loved one who's a patient know what physicians mean by the word complications. It means an intervention occurred and there was an outcome that was untoward on the heels of that intervention.

So for example, somebody goes into the hospital for hip surgery, and they develop a blood clot in their leg, that's a complication. You get started on a new medication for a heart condition and you have an allergic reaction to it, that's a complication. So it's an untoward event on the heels of an intervention that happened. That's how I look at it as a physician.

NELSON: And it could be during an incident or as a result of an incident, right?

BAKER: Again, we don't usually use the word incident in medical practice, but, yes, it could be an immediate complication as a result of a medical intervention or therapy, or to could be what we call a delayed complication.

NELSON: And there are certain circumstances that precede those complications, agreed?

NELSON: That's a little vague, counselor. I wonder if you could --

NELSON: I mean, in any death investigation, you're trying to determine the cause and manner of death, right?

BAKER: Correct.

NELSON: And in this particular case, you obviously took into consideration the police restraint, right?

BAKER: Correct.

NELSON: But you also took into consideration the heart disease, correct?


NELSON: As well as the toxicology results, agreed?


NELSON: And you factored those in in your -- there's the cause and manner of death and then there's the second thing that you left blank, right, and then there's the contributing causes or contributing factor?

BAKER: Yes. The term of art is other significant conditions is what you're getting at, counselor.

NELSON: And that's simply something just something you have to do for the CDC, or did you take those into consideration as contributing to Mr. Floyd's cause of death?

BAKER: So, when you put those on a death certificate as a physician, what you're saying is, I think these played some role in this death. They had a contributing condition. I'm unaware of how the CDC would mandate what goes on there. Presumably, the goal is, you put things on there you think are relevant. You don't list trivial stuff on there that didn't play a role.

NELSON: So if something was significant enough, you put it on, but if it's insignificant and didn't contribute, you leave it off?

BAKER: Generally, yes.

NELSON: OK. And so, 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. Floyd's death?

BAKER: In my opinion, yes.

NELSON: All right. Now, again, in terms of your autopsy report, you don't generally note negative findings, right? If something is normal, you may just say it's normal, but you wouldn't yet have to take special note to say the heart is completely perfectly normal?

BAKER: That's a really long question, counselor, but I think I can give you a reasonable answer to that. For most normal organs, we have a boilerplate description for what that organ is. So if a spleen is normal, I'm going to give a normal description of the spleen with the weight of that spleen, the same for a liver.

Depending on the nature of a particular case, there are -- I used this term earlier -- pertinent negatives. Things that you think might be on the body based on the circumstances, so you specifically seek those things out. And if they're not there, you document them because they're lack -- the fact that they're not present really means something.


So I don't know if that answered your question. There are some things that are normal, but they're almost always normal and we go to the next step of the autopsy. There's sometimes that depending on the complexity of the case, the fact that's it's not there, you're going to dwell on that. You're going to do special dissection. You're going to take a picture, whatever you need to do to document that you specifically looked for something and it wasn't there.

NELSON: OK. And so in that regard, if you note something, whether it's odd or irregular or it's the negative, right, you take special precaution to note those things in your autopsy?

BAKER: Ideally, yes. You -- not only do you document that in your narrative report, but you take a picture of things that are there, and you document things that aren't there that people might have expected to be there.

NELSON: OK. And it was -- it's interesting to me that you made a conscious decision not to watch any videos before you performed the autopsy, correct?

BAKER: Correct.

NELSON: And that was to prevent bias, you described?

BAKER: In general, yes. I don't want to go into an autopsy with a preconceived notion that I already know what happened. Because that might tempt you to skip certain steps or not do certain things that could turn out to be relevant. And just -- full disclosure, counsel, to fully answer the question, I did see the video that the entire world saw later that day after Mr. Floyd's autopsy.

I did not release his body until the following morning, so had I seen something on the video that triggered yet another thought in my mind, I still had the chance to act on it. I did not want that to be in my mind when I physically performed his autopsy on the morning of the 26th.

NELSON: Understood. But you had received some briefing from law enforcement or somebody to say, here's generally what we know about what happened.

BAKER: It was pretty high level but, yes, I got a call from the BCA that a man had gone unresponsive in police custody while he was being restrained. He had died at Hennepin County Medical Center and that was largely what I knew going into the autopsy. I believe I was aware there had been pressure applied to his neck. But beyond that, that's what I knew going into the autopsy.

NELSON: So you were -- you took special -- because you had learned that there was potential pressure to the neck, you took special steps to look at the neck -- neck area, shoulders, et cetera, right?


NELSON: And because of that, you did this unique incision or this specific incision to lift the skin off to look under the circumstance, so to speak?

BAKER: That's correct.

NELSON: All right. And we'll come back to that in a second. You did note -- I want to focus on the heart for a little. You noted that the heart was dilated.


NELSON: What causes that?

BAKER: So dilated is fancy medical lingo for has gotten a little bigger than it used to be. Like when you blow up a balloon it dilates, for lack of a better lay description. Mr. Floyd's heart was, if I can refer to my report, counselor.

NELSON: Would that refresh your recollection?

BAKER: It would.

NELSON: So I described the ventricles, which are the two main pumping chambers of the heart, the right and left, as mildly dilated in Mr. Floyd's case. I would interpret that as being part and parcel of his high blood pressure. That's a manifestation of the heart getting bigger and heavier as it works against that continued high blood pressure over a period of time.

NELSON: You also took note of the size of Mr. Floyd's heart, right?

BAKER: It's actually the weight, counselor, but, yes, I absolutely did take note of the weight, yes.

NELSON: All right, and that was 540 grams?

BAKER: That is correct.

NELSON: And you're familiar with the papers of DiMaio and Molina on the normal heart size?

BAKER: I am familiar with the DiMaio and Molina paper, although the one I usually use it the Kitzman paper from the Mayo Clinic.

NELSON: OK. And what's the maximum size of a heart under that standard?

BAKER: So the Kitzman paper normalizes heart rates as a function of your body length and your body weight. Because if you think about it, a very large person is going to have a larger heart than a very small person. So you don't to want penalize people for being too big or too small. That's why you normalize their heart rate.

So Mr. Floyd's case, the upper limit of normal for his body length, according to the reference that I use, is 510 grams. The upper limit of normal for his body weight would be 521 grams. Again, he was 540 grams, so he is outside the upper limit of normal. That means on the bell shaped distribution of heart weights for a man his size, he's way out on the tail ends, the heavy end.

NELSON: OK. And all of these various standards in terms of the weight of a heart, they're peer-reviewed?


BAKER: As far as I know, yes. The reference I use is from the Mayo Clinic proceedings, which I'm going to assume is peer-reviewed.

NELSON: Right. And as would be, say, DiMaio and Molina's or the Northwestern studies, or any of these other studies.

BAKER: I'm unfamiliar with the other studies your referencing, counselor, the DiMaio and Molina paper, I believe was published in the American Journal of Forensic Medicine and Pathology, which I know to be peer reviewed.

NELSON: OK. And you would agree that the larger the heart is, the more blood it needs to provide adequate oxygenation, agreed?

BAKER: As a general rule, I would say that is true, yes.

NELSON: What types of things cause a person's heart to be bigger than normal?

BAKER: The most common cause by far in adults in the developed world would be high blood pressure. There are a number of far less common causes, aortic valve disease could do it if the heart is pumping against the defective valve. There are genetic causes of an enlarged heart, typically we can tell those by looking at the heart grossly and microscopically. Those are much farther down the list than high blood pressure. Which again, is the number one by a long shot.

NELSON: Based on your review of Mr. Floyd's records, you determined that he has a history of high blood pressure, correct?

BAKER: Yes, it was very helpful to learn that from his medical record, he was known to be hypertension.

NELSON: Can you describe the narrowing or the stenosis of the coronary arteries in a little bit more detail?

BAKER: I can, counselor, if I may refer to my report again. So as I mentioned, when I was describing the photographs earlier, he had 75 percent proximal and 75 percent mid-narrowing of his left anterior descending coronary artery. Again, in most people, that would be the largest of the three coronary arteries. He had 75 percent narrowing of the first diagonal branch of his left anterior descending coronary artery. And then in his right coronary artery, which in most people is the second largest of the three, he had 90 percent proximal narrowing.

NELSON: All right. And what do forensic pathologists generally consider to be enough narrowing of the arteries to cause a sudden death?

BAKER: We usually look to 75 percent greater as capable of causing sudden death.

NELSON: Are you familiar with myocyte necrosis?


NELSON: And do you have to have myocyte necrosis to cause a sudden death?

BAKER: No you do not.

NELSON: In arrhythmia there would be no necrosis, correct?

BAKER: So an arrhythmia is an electrical phenomena, not an anatomic one. And so, I really can never diagnose an arrhythmia post-mortem. We just have to infer that from the circumstances and from the condition of the coronaries.

NELSON: And when we describe hypoxia of the heart, that's reduction of oxygen to the heart, correct?

BAKER: Correct.

NELSON: And can you -- can hypoxia to the heart cause sudden death by other means or would it just the arrhythmia?

BAKER: Well there's many ways that a lack of oxygen to the heart could cause death. One could be a sudden dysrhythmia. Where the person's heart goes from a normal beat to a non-perfusing beat, and the person would literally just collapse right in front of you. Depending on the nature of the coronary artery disease, the person could have a thrombus they could present to the emergency, with crushing chest pain and sweating and difficulty breathing. That would be a different mechanism of death. So there's different ways the heart manifests that is not getting enough oxygen but one of them is sudden collapse and death.

NELSON: And sometimes people can survive that for a longer period of time?

BAKER: Survive?

NELSON: The thrombus you just described. BAKER: Correct. I don't know the numbers but obviously, people can and

do survive thrombi in their coronary arteries. That's why we have clog busting drugs and cardiologists on call for emergency rooms, for urgent catheterizations and stuff like that.

NELSON: Got you. Now can you generally describe the conduction system of the heart?

BAKER: Only in the broadest terms because I'm not an expert in the conduction system of the heart. I have other people I rely on for that. But it's basically the electrical system of the heart. There's a part of your heart called the sinoatrial node, and that's like the little watch in your heart that starts every heartbeat. You would be able to see what it's doing on an EKG if you were doing electrical tracing on a living person, that's conducted to another node that's known as the AV node -- the atrial ventricular node, and then the atrial impulses go out from that to the ventricles that cause them to beat.

You can see the conduction system under the microscope if you take it out and look for it.


There's on very rare occasions that we do that. It wouldn't have been necessary in Mr. Floyd's case but that's basically what the conduction system does.

NELSON: If the conduction system is impaired, what happens?

BAKER: I'd have to defer to a cardiologist on that because there's so many different ways it can be impaired. Sometimes it's completely benign. Sometimes the person might need a pacemaker or even a defibrillator. It totally depends on the nature of the derangement.

NELSON: Which of the artery supplies, that first one, the sino --

BAKER: The sinoatrial node?

NELSON: Right.

BAKER: I believe it's a small branch of the right coronary artery in most people.

NELSON: And is that the one that was 90 percent narrowed.

BAKER: Not the branch? I didn't dissect out the branch. But yes, the main right coronary artery was 90 percent narrowed.

NELSON: You're aware also of the methamphetamine that was found in Mr. Floyd's system?


NELSON: Does methamphetamine further constrict the vessels and ventricles in the Arteries? BAKER: I don't know. I'm not an expert in this specific toxicology of

the methamphetamine. It is certainly hard on your heart in sense that it does things like drive up the heart rate and drive up blood pressure. I don't know if it's a vasoconstrictor but in either way, as a general rule for forensic pathology, methamphetamine is not good for a damaged heart -- a heart at the point of artery disease.

NELSON: Does the amount of or level of the toxicological findings affect whether it's good for the heart or bad for the heart?

BAKER: I don't know if there's a scientific answer to that, counselor, because I'm not aware that there's a quote unquote safe level of methamphetamine.

NELSON: And especially illicit methamphetamine, right?

No safe level of a street drug versus the amphetamines that are sometimes prescribed.

BAKER: Yes, so I'm very unfamiliar with any medical use for methamphetamine in approved circumstances. I'm aware that amphetamine is used in some circumstances. That's definitely not my area of expertise. Again, my high level overview as a forensic pathologist is all other things being equal, methamphetamine is not good if you have bad coronary arteries.

NELSON: And exertion also causes the heart to work harder.

BAKER: Correct.

NELSON: And therefore would require more oxygen?

BAKER: Correct.

NELSON: More blood has to pump through to oxygenate the heart and send it to the rest of the body, right?

BAKER: Correct.

NELSON: And so in this particular case, we have Mr. Floyd's heart is at least above average size, right?

BAKER: Correct.

NELSON: He has a heart with narrowed coronary arteries, right?

BAKER: He does.

NELSON: There was evidence of a period of exertion prior to his being deceased?

BAKER: Yes, I mean, we're getting outside the autopsy now obviously, but it's clear from the videotapes that yes, there was a period of exertion prior to him becoming unconscious.

NELSON: So in terms of -- in terms of your investigation, you ultimately did watch the videos.

BAKER: Correct.

NELSON: Including the body worn cameras of the officers.


NELSON: And did you also -- were you also provided with other videos in terms of surveillance videos, additional bystander videos, things of that nature?

BAKER: I was.

NELSON: And were you provided with investigative materials with what people said happened, et cetera?

BAKER: No, I did not have those.


NELSON: Have you ever certified a death due to hypertensive cardiomegaly? I don't know how to M-E-cardio-M-E-G-A-L-Y

BAKER: So the answer to that, counselor, is yes. The term you're going for is hypertensive cardiomegaly. Which is fancy medical lingo for the heart is too big because of high blood pressure. We don't typically use that term. We just use the term hypertensive vascular disease because it's more precise. But yes, I have used that or similar terminology.

NELSON: Have you ever certified a death due to atherosclerotic cardiovascular disease?


NELSON: And with similar narrowing of the arteries compared to Mr. Floyd?


NELSON: 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?

BAKER: They do appear to be fresh. But I want to be very careful in my answer. There's not any literature that allows to date those kinds of injuries with any precision.