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The controversial autopsy at the heart of the Chauvin trial, explained

The defense hopes to raise doubts about how George Floyd died.

A sheriff holding notes in her hands. Brandon Bell/Getty Images

On May 25, 2020, the world witnessed the final moments leading up to George Floyd’s death: Police officer Derek Chauvin pinned a handcuffed Floyd to the ground with his knee for more than nine minutes until he became unresponsive. The bystander video of the incident, with Floyd muttering his last words, “I can’t breathe,” sparked racial justice protests around the globe. Now, nearly a year later, Chauvin is on trial facing charges of second-degree unintentional murder, third-degree murder, and second-degree manslaughter.

But despite what people saw, both virtually and in person last May, at the center of the trial is the question: What ultimately killed Floyd? The prosecution has argued that it was Chauvin’s knee, constricting Floyd’s neck and airway, that ultimately led to his death. Meanwhile, the defense has argued that it was Floyd’s history of drug use and underlying conditions that caused his death.

Two autopsy reports — one by a private medical examiner commissioned by Floyd’s family and another by the Hennepin County Medical Examiner — reached the same conclusion: that Floyd died of homicide, meaning death at the hands of someone else. But the medical examiner report also highlighted that Floyd suffered from other “significant conditions,” such as fentanyl intoxication and recent methamphetamine use. These latter conditions are what the defense is using to argue that Chauvin is not responsible for Floyd’s death.

On Friday, Hennepin County chief medical examiner Andrew Baker, who performed the county autopsy, took the stand. In documents last year, Baker described the “fatal level of fentanyl” in Floyd’s system and told federal investigators that if the victim was “found dead at home alone and no other apparent causes, this could be an acceptable overdose.” Baker also cautioned, “I am not saying this killed him.”

During cross examination, Baker clarified further. When the defense asked Baker whether fentanyl could have caused the abrasions on Floyd’s lung that were revealed during the autopsy, Baker said that underlying health conditions were “contributing” and not “direct causes” of Floyd’s death.

“In my opinion, the law enforcement, subdual restraint, and the neck compression was just more than Mr. Floyd could take by virtue of those heart conditions,” Baker said.

Floyd’s history of drug use is expected to be the most contentious part of the trial. So far, the prosecution had Floyd’s girlfriend take the stand to preemptively humanize his addiction. “Our story is a classic story of how many people get addicted to opioids,” Courtney Ross said during her testimony. “We both had prescriptions but ... we got addicted and tried really hard to break that addiction many times.”

The prosecution also brought in witnesses, such as the paramedics and the doctor who treated Floyd as well as a police surgeon and national breathing expert, who have said Floyd died due to a lack of oxygen. Even Minneapolis Police Chief Medaria Arradondo, the city’s first Black chief, testified that Chauvin pinned Floyd for too long and that restraints should have stopped “once Mr. Floyd stopped resisting.”

To get a conviction, prosecutors don’t have to prove that Chauvin’s actions were the sole cause of Floyd’s death, according to the state’s jury instruction guidelines. “The fact that other causes contribute to the death does not relieve the defendant of criminal liability,” the guidelines note. By emphasizing Floyd’s drug use, the defense is just trying to muddy the waters, john powell, a law professor at the University of California Berkeley and civil rights scholar, told Vox.

“The prosecutors shouldn’t have to make the case that Floyd didn’t have drugs in his body or that drugs were a contributing factor,” powell said. “All they have to do is make the case that Chauvin’s knee on the neck for nine minutes and 20 seconds substantially contributed to Floyd’s death.”

How the defense has used the medical examiner’s findings to shield Chauvin

Despite similar conclusions ruling Floyd’s death a homicide, there is a key difference in accounts of what caused it. The Hennepin County Medical Examiner’s Office states that the cause of death was a “cardiopulmonary arrest complicating law enforcement subdual, restraint, and neck compression” — which means physical restraint (handcuffs and Chauvin’s knee on Floyd’s neck) was a significant factor in Floyd’s cardiac arrest. But the private autopsy report found the cause was actually “mechanical asphyxia” that made Floyd’s heart stop, implying that there were no underlying conditions that may have played a role.

In their opening statement, prosecutors said they would make the case that Floyd died of asphyxia, or insufficient oxygen, which was not mentioned in the county report. On Monday, the prosecution brought to the stand Bradford Wankhede Langenfeld, a senior resident at the Hennepin County Medical Center who worked to recover Floyd but eventually pronounced him dead. Langenfeld said that based on the information he had, asphyxia was “more likely than other possibilities” to have caused Floyd’s cardiac arrest. But under cross-examination by the defense, Chauvin’s attorney Eric Nelson stuck with questioning Floyd’s use of drugs and asked if high levels of fentanyl and methamphetamine could also cause insufficient oxygen. The doctor agreed.

Martin J. Tobin, a pulmonologist and breathing expert, offered perhaps the most striking medical testimony in the prosecution’s case. On Thursday, Tobin took the stand and provided a detailed account of how Floyd died — including that Chauvin had placed more than 90 pounds on Floyd’s neck and that 85 percent of Floyd’s airways were restricted. Ultimately, Tobin said, Floyd died from “a low level of oxygen” caused by police restraint. “A healthy person subjected to what Mr. Floyd was subjected to would have died,” he said.

Tobin pushed back against Nelson’s questioning about Floyd’s drug use, saying he saw no evidence of an overdose in the footage, as Floyd seemed to be breathing fine before police restrained him. Seven medical experts who spoke to the Washington Post last month also warned against calling the situation an overdose, arguing that Floyd wouldn’t have had the same energy or behavior interacting with the police as he did if he were on his way to an overdose.

In his testimony Friday, Baker clarified why he ruled Floyd’s death a homicide. According to Baker, Floyd had severe underlying heart disease and hypertensive heart disease, meaning his heart weighed more than it should. But these conditions didn’t cause Floyd’s death. What caused Floyd’s death were conditions created by Chauvin and other officers that caused Floyd’s heart to work harder to provide oxygen during the encounter. He also explained the language he used on Floyd’s death certificate — “complicating” means “in the setting of.” In other words, Floyd’s heart stopped because of Chauvin’s neck restraint.

So far, the defense’s argument has relied largely on Floyd’s history of drug use and the result of the Hennepin County toxicology report. But Baker’s testimony — that drugs were “not a direct cause” — has hindered this argument.

The defense’s strategy of focusing on Floyd’s drug use has drawn parallels to a long history of painting Black men killed by police as criminals and drug addicts. “Part of the [defense’s] argument is really just saying Floyd is not worthy of our concern and respect, and you saw this on Fox News like ‘why are people so upset this guy has a criminal record, he was on drugs, he was trying to pass off a fake dollar bill, he’s not a hero,’” powell said. “It’s like immediately Floyd became on trial. It’s not the police on trial; it’s the person who has been killed who is on trial. It’s Michael Brown. It’s Eric Garner. … It’s Rodney King.”

While the prosecution has called a handful of medical experts to the stand so far, the defense has 15 medical experts queued up as potential witnesses when it presents its case next week — though it is unknown how many will testify. Multiple medical testimonies, notes powell, may confuse and overwhelm the jury.

“The defense has to prove that there’s reasonable or some doubt,” powell said. “Sometimes, what lawyers do is that if you have good facts, you try to confuse people, so any contradiction or anything to make the jury question like, ‘When you look at all these things are you sure this is what caused his death?’”

The trial’s outcome may hinge on whether the prosecution has built a strong enough case with medical and police testimony to erase doubt that Chauvin played “a substantial causal factor in causing” Floyd’s death. The proceedings are expected to last another two weeks.

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