tv Day 10 of Trial for Derek Chauvin Accused in Death of George Floyd CSPAN April 9, 2021 1:20pm-2:31pm EDT
our previous days coverage available for you at c-span.org. we expect them to return around 2:30 eastern, 1:30 central and i live coverage will resume a gavel back in until then to show you the testimony from earlier today from doctor thomas. >> call the next witness. >>. >> good morning your honor and counsel. state will call for our first witness, doctor lindsaythomas . >> you swear or affirm under penalty of perjury the testimony are about to get will be the truth and nothing but the truth . >>.
>> doctor thomas, if you feel comfortable doing so weask you to remove your mask and i will keep mine on . and let's begin by having you speak your full name,spelling interview names . >> lindsay carol, car hello thomas. ph ams. >>. >> morning doctor thomas. would you please tell us what kind after you are ? >> i am a forensic apologist. what is a forensicapologist ? >> ecology is that branch of ecology which is a branch of medicine where medicine and law overlap. so it could be anything with our medical and legal components, it could be toxicology, in some cases it may involve living patients but as i practice, and as
most forensic apologist practice it involves medical legal death investigations. >> does involve taking care of patients in the clinical sense ? >> not letting patients know. a forensic apologist may be consulted to help with the evaluation and interpretation of injury in a living patients. but not in a treatment or clinical sense. >> so most of your work is done then on deceased people. >> correct. >> any specific types of deaths? >> yes, the state tattooed with the types of debts that have to be reported to the medical examiner and recently, they can be unnatural deaths so accidents, suicide, besides. unexpected deaths potentially suspicious deaths. type of category of death. >> you get special training in how to determine the cause and manner of death?
>> yes. >> tell us something about the special trainingyou've received . >> i start back in medical school or just the end part. >> just be an art. >> i did a fellowship in forensic technology which is specified training program or doctors who want to be forensic apologists to learn how to do medical legal death investigations and certified cause and manner of death. >> would you tell us what technology is as a field of medicine. >> apologists are sometimes considered the doctor's doctor because we don't directly treat patients. but we provide information to doctors who then do treat patients so for example if you've ever been to allow and had blood drawn, that goes to a laboratory that is run by a apologist. a clinical apologist so blood count, chemistries, things
like that or if you've ever known someone that had a biopsy andwas diagnosed with cancer , that's the type of ecology that is done by an electronic pathologist so you look at tissue and under the microscope and make diagnoses . >> is a medical examiner a forensic psychologist? >> in minnesota a forensic examiner is a pathologist appointed by the county board of commissionersto be that these medical examiner . >> so it's public official. >> yes. >> you talk about the medical legal investigations, is that a fancy way of describing what forensic apologists do? >> yes, what it does is death investigations again where there's a medical component and may be illegal component.
>> say a death in a hospital. >> yes, so if someone dies in the hospital those are usually deaths due to natural causes. and they may have a medical death investigation in the sense that hospital apologist might do an autopsy but they wouldn't do the full scope of the medical legal death investigation because they are mostly due to natural disease. >> what does death investigation entail? >> the way a medical examiner's office performs death investigation, a lot of people assume it's all about the autopsy . the physical examination of the body . that's really just a tiny part of the death investigation . the investigation really starts at the very beginning when a gap is found. a person is found deceased or office is notified of a death .
we as medical examiners want to know all about that person . what's their past medical history, social history, family history so we will do whatever we need to do to get that kind of history. then we want to know well, what were their terminal events, what happened around thetime of their death . were they complaining of something or interacting with someone or driving. were they using you know, machinery, something like that. and then we will look at the physical examination and that part of the exam include x-rays, it could include getting specimens for toxicology. or cultures or all kinds of other laboratory tests. including looking at things under the microscope or sections of each organ under the microscope. sothat's the physical exam part . we look at the laboratory results that would be usually toxicology, but as i say it
could be blood cultures, or more recently it's probably been a lot of testing. that kind of thing and then look at the microscopic slides and then put all that together with the history, the terminal events. the physicalfindings, the laboratory findings . and then that's how the medical examiner reaches the conclusion about the cause and manner of death. >> all that goes into a death investigation. >> yes. >> you sometimes interview people also. >> the investigators go to the scene may talk to family members. we certainly will talk to medical providers. to get someone's past medical history. we also will interview or talk with law enforcement officers. they were the people who responded. it could beparamedics, ems , troopers area just depends on the case.
>> i want to ask about the phrase used terminal events. could you explain to the jury what those terminal events are? >> so when we are investigating a death, as medical examiners, as i mentioned we want to know as much as we can about this person leading up to their death cause that often is how they live will provide us information about how they died. when i'm talking about terminal events, i'm talking about what happened in the period of time around their death. bleeding shortly breathing to their death. so for example if he was out shoveling snow, he came in, clutched his chest andfell over . would be an example of a terminal event. for we know someone was driving a car, and went off the road. that would be what the terminal event was. >> so you're also relying on training and expertise on how
injuries occur. >> yes, as a forensic apologist, that's one of the things we look at is and learn about is when we see this type of injury, we associate that with this type of event. >> what does the medical examiner then do at the conclusion of a death investigation. >> the ultimate goal is to complete the information that's needed on the death certificate . specifically the cause and manner of death. >> is a report generated? >> yes. >> what's the nature of that report. >> one of the main reports generated would be considered the autopsy report and that's the report of the physical examination but ultimately the death certificate is kind of the final report. >> you told us as a forensic apologist you don't treat living patients . >> so if we wanted to have a
discussion for example about measuring non-body on the floor, air reserves , in someone that would not beyour bailiwick . >> that would not be me. by the time i see them, none of that applies. >> so doctor thomas, are you currently employed ? >> i'm kind of semiretired. i do consulting and then i work part-time at medical examiner's office is in reno nevada and salt lake city utah. >> reno and salt lake city. >> i really like the way the office runs. and i like still to be involved as a medical examiner. >> pretty good places to hide . >> and good places to hike. >> so where did you do your work before you were semiretired? >> right before i retired i was at that and up in county medical examiner's office as an assistant medical
examiner. and do you want me to go before that? >> yes, could you tell us your work experience as a medicalexaminer . >> initially i started after my training at the hennepin county medical examiner's office working as a deputy and assistant medical examiner and i was there for many years. then in 1997, i joined the minnesota regional medical examiner's office that was based in hastings. and then i was chief of that office for 13 years. we were the medical examiner's office for eight counties in minnesota, the largest of which weredakota and scott counties . and we also served as an autopsy referral service and medical examiner's office for many other counties in minnesota as well as wisconsin and even one in michigan area and then when
our office outgrew that space , dakota and scott counties merged with hennepin county and that's why then i came back to hennepin county. >> so over how many years did you perform work orservices of a forensic apologist ? >> let's see, 37 now. >> and in minnesota how many counties? >> oh god. well, i've been the direct medical examiner for eight counties . i've worked in offices that have been consultants to dozens of other counties. >> and have you also performed those services in wisconsin? >> yes. >> you stop working at the hennepin county medical examiner's office? >> it was early 2017 area and i retired from hennepin county. >> how many autopsies would
you estimate you have performed over your career? >> probably about 5000. and i myself did, and then hundreds, maybe thousands more where i assisted someone else or supervised or i participated in some way. >> so in 5000 or so cases, you determined the cause and manner of death? >> actually, way more than that because as medical examiner's, we don't just certify the cause and manner of death for the cases that we do autopsies on. there are numerous other cases that get reported by law to the medical examiner's office where we don't do a physical examination. so for example, an elderly persons falls in a nursing home and get a hip fracture and then dies the couple of months later. that does have to be reported
to the medical examiner's office. we will investigate that death and looking at the medical records and doing all of what i talked about. getting family inputs and medical provider input. but we generally will not do a physical examination but still by law we have to sign the death certificate. >> so you're still determining than the causeand manner of death . >> are just not using a physical examination as part of it. >> or using the medical records primarily. >> yes. >> doctor thomas, are you licensed? >> i'm licensed in minnesota, wisconsin, tennessee, nevada and utah. >> you also hold any board certifications? >> yes, i am board certified by the american board of apology and anatomic ecology, clinical apology and forensic apology. >> have you worked with any professional organizations
over the years related to forensic apology? >> yes, i've been on a number of different organizations, american medical association, college of american pathologists and american academy of forensic scientists and i've been on the board of the minnesota coroners and medical examiner's association. probably 30+ years. then i'm a member of the national association of medical examiners and i was on that board and a member of their executive committee for anumber of years . >> those by the acronym mame, and amd. >> what does maine do. >> there the professional organization of medical legal death investigators, specifically forensic apologist , medical examiners and as an organization, they
provide support to medical examiners. they provide information. theyprovide guidelines . and accreditation for them and inspection programs. lots of ways of assisting medical examiner offices. >> doctor thomas, have you done any teaching? >> yes. i have been a clinical instructor here at the university of minnesota apartment of ecology. i've done lots of law enforcement training through the bureau of criminal apprehension here inminnesota . as well as all my gosh, teaching everything from middle school science students through high school and college and all kinds of professional groups whether it's otherforensic apologist, other law enforcement . you name the organization that comes into contact with death investigation and i've
probably talked to some of them at some point. >> the you have any publication? >> that has been the main focus of my career but i have several early on was involved in an autopsy protocol that was ultimately published the united nations. that's still in use. >> let's switch topics and talk about your experience testifying in court. as you testified before in court? >> yes, probably over 100 times. >> is predominantly in your role as a medical examiner? >> it's mostly in my role as a medical examiner where i did the autopsy and prosecution would call me to testify as to my findings. i've also testified as an expert witness consultant in cases where i didn't do the autopsy but i was called by
maybe in a civil case either by the defendant or the plaintiff if they thought there was a wrongful death or some question about medical malpractice, something like that and i also have been consulted and testified in cases at the request of the defense. again, not where i did the autopsy where i refused someone else's work and i consulted with defense testified. >> and how you testified in minnesota court? >> minnesota, iowa, wisconsin , north dakota, south dakota, pennsylvania. i think those are the ones. >> so doctor thomas, are you being paid for your time and services ? >> no. >> could you tell us about that, how did it come about that you're not being paid foryour time and services ? >> well, i didn't ask to be
paid. >> did you reach out to the state board of the state reach out to you. >> it reached out to me and you know, i just knew this was going to be important. and i felt like i had something to offer and i wanted to do what i could to help explain what ithink happened . >> what were the last to do that in this case ? >> i was asked to review a lot of the materials and come to an independent conclusion about what i thought the cause and manner of death were the mechanism for that cause. >> could you give thejurors a general sense or overview of the kinds of materials you reviewed ? >> may i look at my notes. >> yes, if you need to. >> i looked at the hennepin county medical examiner
serials including the autopsy report and toxicology, microscopic slides, things like that. i looked at the hennepin county medical center records so mister floyd's past medical history from there as well as health partners, medical records. then i looked at a lot of interviews. many many videos including body worn camera videos, bystander videos, surveillance videos. some photographs, still photographs, timelines. then some medical literature andtextbooks . >> were you the medical examiner who investigated or did theautopsy around the death of george floyd ? >> no, that was doctor andrew baker, hennepin countymedical examiner . >> you know doctor baker?
>> i do, he was a pathology resident when i was on staff at an event county many years ago and then when he did his fellowship, i was one of the staff people there and then after our offices merged i worked again with him at hennepin county. >> would you been part of his training in his early formative years ? >> yes. >> you consider him a friend. >> yes. >> i did talk to him about this case. >> nonsense after it happened . >> did you review his report as well as misterfloyd's medical records ? >> yes. >> you review the history of terminal events from may 20 2020. >> yes. and what was kind of unique, absolutely unique in this case was the volume of materials i had to review . i've never had a case like this that had such thorough documentation of the terminal
events. >> by way of the thorough documentation, what makes it so thorough? >> the use of video is unique in this case. certainly as medical examiners, we use videos but there's never been a case that i've been involved with that had videos over such a long time frame from so many different perspectives. >> are you aware that doctor baker's conclusions onthe matter of death . >> yes. >> the honor, i'd like to show exhibit 193 that's stipulated to doctor baker's foundation for doctor thomas, what do wesee here on exhibit 13 ? >> this is a copy of the
certificate of death ofmister floyd . >> so if we could highlight just through the word underline. just to make it a little bigger to see. okay. based on your review of the evidence, and the death certificate, do you agree with doctorbaker's determination on the cause of death ? >> yes i do. >> is that the final word down here. >> yes, pulmonary law enforcement arrest, getting repression. >> and informed opinion about the mechanism of death? >> yes. >> would you tell us whatthat is ? >> in this case i believe the primary mechanism of death is asphyxia or low oxygen. >> we will come back tothe mechanism again in just a minute . can you explain to the jury
what this cause of death means and why you agree with it. >> it's kind of in two parts. there's the cardiopulmonary arrest which doesn't provide a lot of additional clarifying information because in a way everyone dies when your heart stops andyour loan stops . that's cardiopulmonary arrest . but as a forensic ecologist, i would use cardiopulmonary arrest when, to differentiate from a cardiac arrest. this is not a sudden cardiac death, a suddencardiac arrhythmia . this is a death where both the heart and lungs stopped working . and the point is that it's due to law enforcement some dual restraint and compression. that is kind of what ultimately is the immediate cause of death is the some dual restraint.
>> so it's clear for the juror, this audio pulmonary arrest means heart attack? >> no. >> does it mean fatal arrhythmia as a primary cause of death ? >> no. >> it simply means the heart stops area in other words is simply describing death itself. >> yes. >> can you explain what's referred to looking here at the term some dual restraint and neck compression. >> those were activities by the law enforcement agency officers involved. some dual is subduing someone , trying to restrain them is in mister floyd case involved handcuffing him. his positioning on the ground, the prone position, the people kneeling on him. and neck compression is the
knee on the neck specifically . additionally there was some back and other things being compressed by the officer. >> so if you put all this together, cardiopulmonary arrest , getting law enforcement some dual, restraint and neck compression, what does that mean? >> what it means to me is the activities of the law enforcement officers resulted in mister floyd's death and physically those activities were of so dual, restraint and neck compression. >> does this represent your own concluding a conclusion you have reached and holding a recent degree of medical certainty? >> yes. >> would you tell us what you reviewed to reach this conclusion. >> all those things i mentioned earlier. the again, what's unique
about this case is that often , i would just review the medical examiner case file and that would provide information about what the cause and manner of death is. but in this case the autopsy itself didn't tell me the cause and manner of death and it really required getting all of this other additional information, specifically the video evidence of the terminal event to conclude the cause of death. >> when you make reference to something called the mechanism of death, wouldyou tell us what mechanism of death means . >> so cause of death is what the thing, the disease or the injury or the process that caused someone's death. but the mechanism is kind of what was going on in the body at that time.
so for example, the cause of death might be a gunshotwound . but the mechanism of death might be blood loss or related to that gunshot wound or you know, an infection that complicated that gunshot wound down the road . thing like that. so it's more what was actually happening at the body level that resulted in the cause of death. >> so focusing in on the mechanism of death here, how is it that the officers some dual restraint and neck compression cause mister floyd's death ? >> as i mentioned i think the primary mechanism was asphyxia or low oxygen. and it's basically is mister floyd was in a position because of this of dual restraint and compression where he was unable to get enough oxygen in. to maintain his body function.
>> and what's required? >> what is required? there's kind of three components . you have to be able to get air in so you have to have a airway that could be nose, mouth, soft tissues of the neck. the larynx, trachea, larynx, trachea, bronchi, all of that have to be open areas at the level of the lungs itself, there has to be adequate air exchange between oxygen coming in, carbon dioxide going out. then finally, the way the loans work is it for a bellows. that when you suck in air, your diaphragm drops and pulls air in and then when you collapse, the diaphragm collapses which is air out. though all three of those things after the coaching in order to get adequate oxygen
in. so for example, if someone is smothered or strangled or the inhale piece of hotdog or they have pneumonia, such that their loans are completely filled, then there airway is constructed so that there isn't adequate air coming in oxygen coming in. or if someone is in an environment where there isn't enough oxygen, so and closed garage in which an old car has been running, there may be high carbon monoxide and in case you're perfectly to breathe in and out but there just isn't enough. and the third be there some restrictions such that your chest can't expand, your diaphragm can't stand so close to working. one of those components isn't working, then the result will
be this mechanism of inadequate oxygen. >> doctor, out of narrowing of the hypopharynx this. >> the example i would give you are probably most is sleep apnea are snoring. you yourself have a partner stores you know that especially in certain positions, the what happens is the hypopharynx which is sort of the soft tissues, the back of your throat, will. because there's inadequate air coming either forcing it out or forcing it in which is why a cpa speed machine works because it forces air through that sloppy area . and if that collapses, then it makes it difficult to get air in. >> doctor thomas, your lot what do you rely on to reach a conclusion low oxygen was
the mechanism of death? >> in this case it was primarily the evidence from the terminal event. the video evidence at show mister floyd in a position where he was unable to adequately breathe.>> out of the autopsy report itself assist you or not. >> so the way the autopsy helps is its great for ruling things that really so in this case, the autopsy ruled out for example underlying lung disease read mister floyd had history of hypopharynx but there was no evidence of it in his lungs that he had any lung disease that would impair his ability to breathe . and it ruled out injuries to the neck that suggests that his, that the bones in his neck and then broken for
example. and it ruled out a stroke. he didn't have a stroke so it wasn't like his blood pressure was so high that he ruptured a vessel in his brain. he didn't have an aneurysm. he didn't have, which is a ruptured blood vessel. he and will. he didn't ruptured his heart. he didn't have old heart and recent mile party so the autopsy is great forruling things out . >> doctor thomas, just to focus on one of those you said autopsy ruled out a recent martyr kyle inflection. how did he do that? >> when a forensic biologist examines the heart, one of the things they look at is the coronary arteries which are the vessels that supply blood and nutrients to the heart muscles . and then the apologist will examine the muscle of the heart. and if someone has had a
recent heart attack, there may be evidence in the heart muscle of damage. or if they've had a prior an older heart attack there will be starring in the heart muscle that shows that area as damaged. >> doctor period is it normal as a part of your death investigation then to speak out to look atthe video . >> oh yes. >> in this case, is there any particular video footage that struck you as more significant than others from what you saw? >> this case there were so many. they the body worn camera videos were very instructive because they started, well
and the cop foods video because they showed how mister floyd was behaving long before law-enforcement interaction. then a body worn camera showed the early interaction before there was any of this some dual restraint or repression. then they showed the interactions during the sub dual restraint. the bystander videos are really instructive. as well as the surveillance videos on the scene. showing kind of during the time of the restraint so there were lots. >> in terms of the video footage than either rolling in a call for ruling out the cause, how did it inform assessments about cause of death . >> it helped me rule in cause and also rule out causes i would say. >> so did it help you determine whether this was what i might refer to as a
lights out kind of death, sudden death . >> right. what i observed from all of these videos is this was not a sudden-death area mister floyd did not, it's when i told you when somebody. >> their chest and falls over, was nothing some about his death. so that's what i would have expected it was a cardiac arrhythmia or abnormal beating of the heart . typically those are someone really falls over pretty quickly. this was not that. likewise, it was not the type of death that has been reported in a fencing overdose for example where someone becomes very sleepy and gradually call a peacefully stopped breathing. this was not that kind of death so i felt comfortable ruling out those as causes of
death. and then on the flipside, you , i could clearly see from watching the video . what happens to mister floyd during this some dual restraint and compression. and what happens to his breathing. is it gradually becomes more difficult and then. >> doctors, tell us what is the bellows function. >> what your diaphragm does along with the muscles in between your ribs, so when you take in a deep breath, what's happening is your rib cage is expanding and that then forces the lungs to open up and that's what draws air in riyadh so when someone is anticipated in surgery, it's sort of the opposite because your diaphragm is paralyzed so somebody has to forced air
in riyadh but under normal breathing circumstances, you just, it's the bellows. it's pulling air in. >> what did the video tell you, what did you see in it that had to do with the bellows. >> he, mister floyd is in a position so first of all, he's prone for with his hips aside and he has his arms handcuffed behind his back. that's already a bit of a difficult position to be in. the prone and handcuffed. and then with at times at least three officers on top of him whether it's his neck or his back or his lower back or legs. it prevents him from moving his body into a position where he can adequately use
the bellows function. and his chest is sort of compressed in this position in such a way that he can't adequately expand and get enough oxygen. >> over what training time was this? >> nine minutes. >> what did you see in those nine minutes that led you to conclude at the mechanism of death was low oxygen or ecstasy. >> initially, he mister floyd is able to struggle pretty vigorously when he's in this position he recognizes as it's going to be hard for him to breathe in this position. >> the last part of the answer about mister floyd state of mind. is speculative. >> so initially when he's in the prone position, these breathing and speaking and it
might look like oh, these at that but getting enough air exchange. but over time, you can see that is breathing is getting more and more difficult. and he's saying less and less. and then about halfway through, the whole restraint some dual compression process he stops breathing, he first stopped speaking entirely. then, again after that there's a movement that i believe is what's been called an anoxic brain reaction which is, looks like kind of which. it's something that the body does when the brain no longer has enough oxygen. that's the point at which you
can tell by looking oh, that's where he no longer is getting enough oxygen to his brain. and then, the restraint some dual compression continue for many minutes more, even after someone checks and says oh, there's no calls. they maintain the position. so at that point, the heart has also stop. he stopped breathing and his heart has stopped. >> doctor, humans anoxic brain reaction. >> ..
>> people are who it witnessing someone die say they had a seizure and died. what happened is they've basically died. their brain doesn't have enough oxygen and they have a muscle twitch which may look like a seize sure. >> going back to exhibit 193 and i want to ask you -- that's right in front of you -- the other contributing conditions if we could highlight that. >> do you see where i'm referring to, the other contributing conditions? >> yes. >> and what are those? >> in this case, they are arterial score let trick and heart disease, fentanyl intoxication and recent meth -- methamphetamine use, we're what does it mean other, contributing conditions. >> so, the way forensic
pathologists and medical examiners use this is people often think of the death certificate is for that person, that specific person who died and their family, and that is true, it does serve a very useful purpose for life insurance, whatever. but forensic pathologists are using death certificates for public health data purposes, and so in any given case, we aren't just thinking about this particular person and their cause and manner of death. we're also thinking the state and the federal government collect data on why do people die? what is cause of death? it's how we know as a country that we have -- how many people die of covid, for example. it's because death certificates list. that one thing we use the other
contributing conditions for is to list disease processes or drugs that are present at the time of death but that we don't directly -- we don't believe directly contributed to the cause of death, but it's so that someone looking at da dat years from now can say, okay, we want to do an evaluation of all deaths during law enforcement subdual, and how many of those deathsed involve someone who also had drugs onboard? because that may be something that is relevant then in trying to prevent these sort of deaths in the future, for example. or the case where i use other contributing conditions probably the most is the hip fracture case that i talked about before, where someone dies of a hip fracture due to a fall, but they're 84 years old and also have hypercontinuesive heart
disease, asthma, diabetes, and so i will list those as other contributing conditions . now in no way did those things cause the fall and the hip fracture and the resulting whatever, pneumonia or whatever, but again, someone from a dat perspective might want to know, of the 84-year-old women who die of hip fractures, what percentage of them have underlying heart disease? because, again, from a data collection standpoint, does that provide useful public health information that can be used in the future to try and prevent these deaths? so, that is how i would view this, very long-winded, sorry. >> no, doctor thomas. in understanding this, further so other contributing conditions are conditions that may have contributed but were not the direct cause of the death. >> exactly. >> did you consider these other
contributing conditions and your assessment of the cause and mechanism of death for george floyd? >> yes. >> and how did you consider them, first of all? >> well, i wanted to look at each one as an -- and ask the question, is this the cause of his death? is heart disease the cause of his death? he has narrowing of his coronary arteries. in many cases that is the cause of someone's death. so, i looked at that, but, again, it comes down to what were the history of the terminal events. does this look like the type of death we see or is there -- i'm not a clinician so i don't see it but as a forensic pathologiologists from hundreds of families describing what happened at the time of death that this death does not fit what has been described in someone who dives cardiac
arrhythmia from arterio clearot rick hart disease and hypertensive heart disease. those tend to be cardiac arrhythmias, sudden cardiac death. this is not that death. likewise fentanyl intoxication -- i don't see living people, but what i know from family members who describe death, that then later turn out to be due to fentanyl, the death is slow, it's peaceful, they fall asleep, they may hear snoring or very heavy deep breathing. there's no struggle. they just often are found just kind of slumped over. it's a very slow death. so, again, totally different than what is seen in mr. floyd's death. methamphetamine as a cause of death generally is, again, much more of a sudden death, may
cause cardiac arrhythmia, may cause a seizure, and i don't just mean this sort of terminal noxic twitch but a full-blown seizure and looking from what i know about mr. floyd's death because it's so well-documented, that does not fit with this methamphetamine death. >> you see views the toxicology. >> oh, yes. >> how would you characterize the amount of meth in mr. floyd's system. >> it was there it's not particularly high. certainly in deaths that i have attributed to methamphetamine, it's been much higher. but it's not like there's any safe level of methamphetamine. but this was a very low level. >> so, was the methamphetamine significant in your assessment of the cause of death? >> no. >> so, then, based on your
review of the videoed video and an police indication of your experience and knowledge did you rule out drug overdose as a cause of death? >> yes. >> and that's an opinion you hold to a reasonable degree of medical certainty. , i. >> yes. now, i want to clarify this earlier and just forgot. to dogs the medical examiner complete the death certificate? >> yes. we don't issue it. that comes from the county or state. but as a medical examiner we fill out all of the cause and manner and how injury occurred and all that kind of stuff. >> how many death certificates have you filled out. >> oh, gosh. well, thousands and thousands. >> so if we look here again at the exhibit? front of you, 193, in the left margin we see a reference here to underlying.
>> yes. >> would you tell the jurors what that means. >> sure. so, let's go back to that hip fracture which is keep referring. to for example, someone who dies of a hip fracture, generally that's not a sudden death. what happens is someone gets a hip fracture, they get it surgically repaired, they may get pneumonia or something like that. so, then in that kind of case we would list the immediate cause of death as pneumonia, the underkyle cause of that is the hip fracture but the underlying cause of the hip fracture was the fall. they fell, they got hip fracture, they got pneumonia. so, it's something that is used when you have a death that has maybe multiple sequences of events, but in a case like this, you don't need an underlying because it's all included in the first line. it's all due to the law
enforcement subdual restraint and neck compression. >> now, the death certificate does not use the word "asphyxia" or any reference to low oxygen. >> no. >> which you have used the word "asphyxia" in this case. >> probably not. i tend not to use the word "as asphyxia" much because it requires a lot of explanation and doesn't offer much additional information unless you have a chance to have a discussion like we have had about what eye asphyxia "means. so i tend to just list -- inone dies of hanging that's a type of asphyxial death but i wouldn't say necessarily asphyxia due to hanging, probably just list hanging as the caught of death. >> so to refer to asphyxia or low oxygen, doesn't tell you anything about why there's asphyxia or low oxygen.
>> right. >> are there findings on autopsy that suggest low oxygen as a cause of death. >> no there's nothing on autopsy that shows low oxygen. >> there's no test task be done for low oxygen on autopsy. >> no. >> there are physical findings that sometimes may be found and may be consistent with low oxygen? >> so, there are no physical findings that show low oxygen, but there may be physical findings that are consistent with a cause of death that may result in low oxygen. so, for example, the hanging. let's use that hanging. if someone is partially hanged -- by that i mean they are only partially suspended so there's only some pressure on
their neck -- they may have what are called pecitia, because blood is going into their brain but can't drain out because of the pressure. be can see based on the scene investigation and the history, that finding is consistent with hanging which the mechanism for hanging is a type of asphyxia, or in manual strangulation we may see bruising or broken bones in the neck and the mechanism of death in strange lace layings is low objects -- strangulation is low oxygen but the findings we see are consistent with strangulation so it's a fine line between saying it isn't the low oxygen we see at autopsy, but sometimes -- not always but
sometimes in cases where the death is the result of low oxygen we see specific findings related to the cause. >> so if you then see peticia you could conclude it das beth low oxygen but if you don't see it, what can you conclude. >> nothing. it's one of those things that when it's present, if there's peticia or broken bones in the neck or bruising, that's very helpful in putting together a picture of what might have happened but if you don't have them, it doesn't help you one way or the other. >> by not help you one way or the other it means you can't conclude from that alone that a person did or did not die of low oxygen. >> exactly. >> you mentioned bruising in that context. >> right. again, sometimes -- i mean, for example, strangulation is a great example. sometimes in strangulation you
have all kind bruises you can see on the neck, but other times there's a strangulation case and they don't have a single mark on their neck, and there's all kinds of reasons that bruises may or may not occur, but it's, again, one of those things if it's there it's very helpful. if it's not, it's not helpful. >> where are there other findings in the death investigation that supported your conclusion on the cause or mechanism of george floyd's death. >> yes. >> would you tell us what those were. >> mr. floyd has superficial injuries, what would be described as superficial injuries specifically on his face, on his shoulders, on his wrists, and what that does is it supports what i saw in the videos, which is that he is being forcibly restrained and subdued, and he is trying to move into a position by rubbing
his face against the concrete cement of the ground, by pulling against his handcuffs. you can see the injury to his wrists from the handcuffs. and by pushing with his shoulder, and he also had some scrapes on his knuckles, on his right hand, and again, that was from him pushing to try and get into a position where he could breathe. >> dr. thomas there are photographs that depict what you're describing. >> yes, thank you. >> we stipulated by way of foundation to the photos and we have individual packets for the jurors. >> all right. members ofthe jury, there's some stipulated photographs that are going to be shown to you, or as we call, published to you, we're going to go old school and not going to put everything on he monitors, not going to broadcast it out. but everybody in the courtroom will have access to it,
including yourself, essentially a packet with these photographs. we resident collect them afterwards because these are for you to use the courtroom the actual visit will be available in deliberation, however. >> would either like the deputy or someone to contribute these or shy. >> you can go ahead. >> ike you can take them out but don't look at them until mr. blackwell resumes his
>> spectators should each get a copy of they want one. >> you'll have to give up one of your copies. mr. blackwell. >> if if may i think i'll give one to dr. thomas so she has it. >> she can have mine. >> oh. >> that way your honor won't have to use the camera at all. >> so dr. thomas, if we start with the exhibit that is marked 185. >> yes. >> -- i take that back.
i'd like to see it on my screen. dr. thomas, looking at exhibit 185, what is significant in this photograph that informs your conclusions pertaining to the restraint and subdual as a cause of mr. floyd's death. >> this is a photograph of mr. floyd's face and it shows some facial injuries, most notably the -- what are called abrasions which are describes, over his -- scrapes over his left eyebrow and left cheek. you can see there's littler scrapes or small cuts on his nose and lip, upper lip and then a little on the left side of his lower lip but the main thing this shows is that the left side of his face was obviously in contact with some rough surface.
>> dr. thomas if you look at exhibit 235, it may be a closeup of the same area. >> yes. yes. that is a closeup of the left cheek and the left forehead, and you can see, for example, above the left eyebrow, there's a dark area, that is a dried scrape, as well as there's at built of discoloration of the skin and there was a bruise there, and then on his left cheek, you can see the dark area as well as kind of a lighter orange pink area and those are again
scrapes. the dark area is where a scrape has dried. >> what does that tell you about the cause of mechanism of his death. >> it's consistent with the impression from watching the video that his face was on the ground and he was moving his face in an effort to get into a position where he could breathe. >> let look at exhibit 188. >> this is a photograph of mr. floyd's left shoulder. >> what do we see here? >> this, again, is an area of scrapes and indicates that there was some force between his shoulder and some rough surface, in this case the ground, and,
again, is consistent with what it looks like on the video, that he is struggling to push himself into a position where he can breathe. >> let's look at exhibit 187. >> this is a photograph of his right shoulder, and, again, you can see there's a little bit of discoloration and then the skin is scraped. so, there's less injury impact here and that fits with, again, what you see in the video of which side was down and which side had more contact with the ground. >> let's look at exhibit 189. >> this is a photograph of mr. floyd's left hand, and if
you look at the base of his hand, sort of right over his wrist, you can see there's some areas of red discoloration with kind of a pale area in between, and that is consistent with handcuff marks. you can also see on the sort of outer edge there's some white material that is dried skin, and that is an area where his skin has actually been rubbed up from the handcuffs. >> dr., exhibit 190. >> exhibit 190 is a photograph of his right hand and wrist, and, again, in this case, you can see more clearly the sort of double lined discoloration above his right wrist that is
consistent with the handcuff marks, and indicates pressure against handcuffs, and again, on the outer edge you can see there's a little bit where it's darker and then there's some white skin so that's an area where it's been scraped. this skin has been scraped by the handcuffs. also, on this photograph, you can see on the knuckles of his index finger and middle finger, there's some skin that is scraped off, and that is consistent with what you can see on the video where he is pushing against -- i think it's the rim of the car tire or something, to try to push his body into a position, again, where he can breathe. >> thank you, dr. thomas. the jurors may put the
conclusive. >> no. there are multiple ways that scrapes and bruises can happen. it's only useful in the context of what is seen in the video. >> was there any evidence to suggest that mr. floyd was suffering from a potentially fatal condition on the evening of may 25, 2020. >> no. >> do you have an opinion to a reasonable degree of medical certainty if mr. floyd would have died that night had he not been subject to the subdual and restraint of the police? >> there's no evidence to suggest he would have died that night except for the interactions with law enforcement. >> now, were there other mechanisms that you felt that contributed to mr. floyd's death?
>> yes. >> could you generally characterize what those were. >> sure. so, i think a secondary mechanism in this case is what i refer to as physiologic stress and i don't mean, like, the stress, somebody is a type a experiment have a deadline at work and they're just really stressed. i'm not talk about that kind of stress. i'm talking about the kind of physical stress you feel when you're driving along and all of a sudden a car swerves right in front of you and you slam on the brakes and realize, my gosh, if that -- hadn't reacted, if that happened a second earlier i would have been n a potentially fatal car crash and you can feel your heart race and you're in -- and then the car speeds on and you slow down and realize, i'm okay, everybody in the car is okay, and your heart rate then slows and -- or, i think even
worse, you're at the beach and you suddenly realize my toddler, i haven't seen my toddler in -- oh, my gosh, where is my toddler and that rush of adrenaline you get and you feel flushed and get goose bumps and your heart races and you feel short of breath, and then there they are, getting an ice cream cone and you go, oh, okay. few. but it takes you a few minutes for your heart to slow down and your blood pressure to slow down and you can take a deep breath and recover yourself. that's what i'm take 'but. and this goes on for a couple minutes but this goes on for nine minutes and you are terrified and you can't -- there's no recovery. so it's that kind of fear of life that i'm talking about, fir
physiologic stress. >> cue tell us what is going on in the body during that stress. >> the reactions are you get chemical release, you get adrenaline or ennever rein and they make your heart race, your blood pressure go up, you require more -- your muscles get ready to act , to good -- go run, do whatever you need to do slam on the brakes, and you start needing more oxygen in your muscles, your need to take more breaths, you need more oxygen for your heart rate because your heart is beating faster. there may be other chemicals that are released whether it's stress hormones or cortisal or things like that. there may be lack