that, and that is markedly elevated could be due to his hypertension being out of control. but this is much higher than i would expect. second, it could be part of the stress reaction where adrenaline is being secreted and it is pushing his heart rate up and that will increase your blood pressure. the adrenaline secreted is causing restriction so there is more blood staying within the central vascular and therefore that would also increase your blood pressure. >> there are multiple explanations for that. stress would be one. >> i believe right now would be a good time for the midmorning break. >> we will reconvene at 11:10. >> more from day 13 of the trial

of former minneapolis policeman derek chauvin, accused in the death of george floyd on may 25. following a lunch break, the prosecution cross-examined dr. david fowler, a retired marilyn chief medical examiner. >> you are still under oath.

counsel, ladies and gentlemen. doctor fowler, good afternoon. >> good afternoon, sir. i would like to say that i have a few questions for you but i have more than a few. let me start with some basic questions by way of background. as an expert witness. do you agree that as an expert witness, you should be objective, fair and impartial as best you can? >> yes, i would agree.

>> do you agree that in the background research you do to testify that you should be thorough? >> yes. and maybe you should do your homework before you arrive at your opinions, fair enough? >> yes. i asked that question in part because you were asked a question about mr. chauvin's weight and you understand the relevance of his weight to this case is how much weight he was putting onto the body of george floyd. you understand that, don't you? you told the jury his weight was 140 pounds, didn't you? >> that is the information i was provided. >> where did you get this information provided? >> from council. a. >> and the information provided to you, were you not told that mr. chauvin was wearing

equipment? >> that wasn't considered a part of the process. [inaudible] >> so you know he is wearing equipment though, as a police officer at the time. >> absolutely. >> so you didn't factor in the weight of the equipment that was also on the body. >> that is true. >> now, you agree that as an expert witness, you shouldn't jump to conclusions, that is you should reach fair conclusions based upon a careful, considered analysis. a. >> do you agree that you shouldn't come at this in a way that is biased, you agree with that, right? >> absolutely. >> you shouldn't try to confuse the jury. >> correct. >> the reason i ask about that, because you spent quite a bit of time talking about carbon monoxide. you remember that discussion, don't you?

>> i do indeed. >> now going to the punch line of carbon monoxide that you talked about at some length, you haven't seen any data or test results that showed he had a single injury from carbon monoxide is that true? >> that is correct b6. >> i asked if it was true, yes or no. >> it is true. >> as you were talking about carbon monoxide, you were referring to the squad car that mr. floyd was mere, weren't you? >> yes. >> had you ever laid eyes -- i don't need pictures physically on the squad car that you were referring to. >> i had not. >> do you know if it had a single exhaust were double exhaust? >> the information i was provided, it has a double exhaust with twin exhaust pipes on each side, so for exhausts. >> did you know the make and

model of the car? >> it is a ford explorer interceptor. >> is it a hybrid? >> yes it is. >> did you see any monitoring data that would give you any information as to what amount of carbon monoxide if any would have been in mr. floyd's breathing zone? >> no, because it wasn't tested. >> it was a yes or no question. you haven't seen any? >> i haven't seen any data. >> and you didn't go herself to monitor the air sampling to simulate what mr. floyd might have been exposed to in proximity of a similar vehicle. you didn't do that, did you? >> your honor [inaudible] >> [sidebar]

[sidebar]

thank you, your honor. >> do you agree with me that there was no finding of carbon monoxide poisoning from doctor baker's autopsy review? >> i do. >> you mentioned in epa standard of nine parts per million on and in our basis as the exposure limit for carbon monoxide. do you remember that discussion? >> yes. >> you mentioned 35 parts per million in the exposure for a one hour time period. >> that is correct. >> now you not now or ever have been an industrial hygienist. >> that is true i have not.

>> now the fact that osha or i'm sorry, the epa has a standard of nine parts per million on an eight hour basis. that is a time weighted average, isn't it? >> yes, that is the maximum exposure over that period and you are allowed to do that once in one year. >> so it is an average over eight hours. are you able to tell this jury whether or not mr. floyd, at the time that may 205th was being exposed to carbon monoxide above the level set by the epa of nine parts per million? >> no, no testing was done. betting even more to the chase, how do you know the car was even

on? >> it's a question that i specifically asked and made the observation of what is dripping from what appears to be the tailpipe. >> so if i ask directly do you know if in fact the car was on or not -- you didn't see any information or data from anybody that said i turned of the car on or i'm the one that turned on, you didn't see that information? >> correct. >> you assumed by seeing something dripping from the tailpipe that the car had to be on? >> it's not an assumption, it is an evaluation in my mind that indicates the vehicle was running. >> you mentioned in carbon monoxide studies these are outside studies you are

referring to. remember those outdoor studies? >> they are referring to outdoor air, yes. >> you referenced a total of two studies, true? >> the carbon monoxide -- which studies are you referring to? >> the san antonio study, i'm sorry, three. san antonio study, the demaio and then the poland study. >> so, the demaio and san antonio are one of the same. doctor maye was the chief medical examiner the san antonio medical examiner's article. >> so if we have the san antonio and demaio study, that involves three people, didn't it? >> correct. >> and then we have the study you told us about, the polish study that involved one person. >> correct. >> you can you tell the ladies and gentlemen of the jury how long were the subjects in those

studies exposed to carbon monoxide, do you know? >> it is unknown. >> now, i had another issue that i wanted to raise again under this heading of the jury not being confused and this relates to the white substance that you were referring to in the mouth of mr. floyd, remember that discussion? >> yes. >> so it started with a white substance in his mouth and i think it ended with talking about a partially digested pill in the car. remember that? >> yes, i do. >> i'd like to show you and discuss with you a couple of exhibits. you told us you looked at surveillance video from the stores in discussing the

materials that you review. remember that? >> yes sir. >> and the store here is cub foods. >> that was one of them, yes. you recall looking at the surveillance video. i want to review part of that video with you if i could. and if we pull up exhibit 29.

showing you an excerpt on exhibit 29 inside of cup foods and i want us together observe george floyd. 7:41:02. >> go ahead and play that. >> could you zoom in on george floyd.

>> were you able to see that portion of the club, doctor fowler? >> yes. >> were you able to see mr. george floyd was chewing? >> overruled. if you have an opinion. >> i saw his mouth open and close briefly. he could have been chewing. i don't know. >> let's play it again because i would like for you to know. it was fast, your honor. >> do you need to see it again to render your opinion? >> from what i saw, your honor it was brief.

>> i want to show you a couple of stills, your honor. i've made a couple of stills from this segment of the footage that i want to enter separately as exhibit 12 and 813. >> any objection. >> 812 and 815 are received. >> can we put up eight to 12, and could you zoom in again on george floyd. >> now doctor fowler, can you see a white substance in his mouth there? >> i can. >> it doesn't it look remarkably similar to the white substance that you were talking about when you were discussing the photograph with a gun pointed at him in the car when he was first approached by the police? >> yes, it looks very similar. >> is it your understanding that when mr. floyd left cup foods,

he went out across the street to sit in the vehicle? >> yes. >> and next, he was then approached by the police sitting in the vehicle? >> i believe he was first approached by the clerks in the store and then the police subsequently. >> so, would it be fair to say in order to save the white substance and mr. floyd's mouth was a pill, in light of what you've seen, that would be jumping to a conclusion, wouldn't it? >> specifically when i testified, i said there was a white object in his mouth. that's all i could discern and i remember that saying -- >> so you were not either telling or suggesting to the jury that the white substance was a pill, or you? >> i never said it was a pill. i carefully said i could see a white substance -- [inaudible] >> i didn't want to classify and

i didn't. >> could you answer the question, you are neither telling or suggesting to the jury that the white substance was a pill, are you? >> no, i never did. >> one other thing, under the heading of not wanting to confuse the jury, you had a discussion with mr. nelson about a scientist, doctor reay said a stick see a bit later retracted that. do you remember discussing that? >> yes. the statement that doctor rea

had about the dangers related to asphyxia, that statement in fact was never withdrawn by mr. rea. isn't that the truth? >> he withdrew it and said that it was more of a risk to individuals that were obese is my recollection [inaudible] your honor, i want to show exhibit 818 simply for identification purposes to discuss with the witness. >> so, let me show you first this is an affidavit from doctor rea, and if you look at the second page, do you see where he has signed and dated?

>> yes. >> that's the person you are referring to? >> yes. >> let's go back to the first page and see if he retracted this. let's see the first paragraph just so we see what this is about. the statement about donald ray in june and in november issue, published a paper entitled restraint physicians and positional asphyxia. this is one of the studies that you were referencing earlier today, isn't it? >> yes. >> if we go down to paragraphs to the i readily acknowledge. here, doctor rea is saying i readily acknowledge the value of the studies in the san diego case of price versus san diego

we have many others besides hog tying and restraint measures to control victims. this has been presented to law enforcement publications as my retraction of positional asphyxia as a cause of death with particular reference to blog tying. and let's look at the next paragraph. here's the punchline, doctor fowler. such is not the case. i still maintain that there are risks [inaudible] >> objective. i'm reading it what it says. >> what's the question. >> the question simply what is it that doctor rea said on the issue of whether he retracted the statement? [inaudible] make sure there's a question after each portion [inaudible] mr. blackwell, could you join us for a sidebar.

[sidebar] if you could re- ask the question. >> sorry, your honor. so, i would like to explore with you doctor rea's response on the question of whether he retracted his statements of concerns about the positional asphyxia as related to the prone position.

did he say here that such is not the case? >> yes. >> do you see where he says there are risks and the case must be evaluated to assess the presence or absence of respiratory restriction in light of methods of restraint? >> do you see that? >> yes, that is written in the affidavit. >> and then one more if we can see just to paragraphs down. he said here the point is straight deaths are different than controlled investigations. do you see that? >> yes. >> and if so, doctor fowler, after seeing this affidavit of doctor rea does this change your opinion since he retracted his

opinion of concerns about positional, the prone position with positional asphyxia? >> it appears he hasn't completely withdrawn his position. but he does go into some additional description which is the paragraph above [inaudible] after fowler, you answered my question. if there are other things mr. nelson would like to bring. thank you, your honor. now, let's talk for just a moment about your areas of expertise. you know that you are a pathologist, sir. but you are not a toxicologist, or you don't have a degree in toxicology. >> that is correct i am not a

toxicologist. >> and to be clear for the jury, as a forensics pathologist, you do not treat patients. >> correct. >> we've heard from a pulmonologist that is also a respiratory physiologist. you are not a pulmonologist or respiratory physiologist. >> that is true. >> so, you never measured anybody's respiration, that is there breathing as a part of your work as a forensics pathologist? >> no, i have not. >> you are not a cardiologist. >> no. just by way of a couple of background things you told us. what year was it that you were recognized? >> i believe it was 1991. >> and what year did you retire?

>> december 301st, 2019. >> you told us quite a bit there about the forensics panel and you are employed as a consultant by the forensics panel. is that a fair description? >> yes,. >> to be clear for the jury so they are not confused, the forensics panel is not a nonprofit, is it? >> it is not a nonprofit. at least to my ability i don't know what it is classified as frankly. >> so, for the panel you earn a livelihood so it isn't volunteer work is it? >> no i get compensated by the hour. >> and the panel we have is not a governmental body. correct, it is an independent organization.

>> it is a medical forensic science practice which practices on businesses, yes. >> it is a business. >> so, i want to talk with you a bit about asphyxia. it's been what we have referred to as death caused by low oxygen. do you agree, doctor fowler, that positional asphyxia is placing a person into a position that restricts their ability to ventilate their lungs or a position where their hand may be in such a position that you cannot keep their airway open? >> that is correct, yes. >> and then at the end of the day, in positional asphyxia, what gives restricted is a

person's ability to oxygenate their blood because of the position that they are in, correct? >> that is correct, yes. >> doctor, there are two component methods to ventilating the lungs. one is to move ribs and the other is to be able to move your back. is that a true? >> that is true, yes. >> but the key thing for breathing is that you are able to expand your chest. if you cannot expand your chest, you cannot breathe. >> you need to expand the capacity so the lungs draw air in as a part of the process. >> i would like to focus with you for a moment on the first roughly five minutes that mr. floyd was on the ground under mr. chauvin. can you analyze where his knees

were relative to the positioning in that first five minutes? >> i did review the positioning, yes. >> would you agree over half of that time period his left knee was on the neck and his right knee at times is on the back and other times on his left arm or pushed him against his left side? >> the positions that i observed during that period of time. >> so he's sandwiched in between with mr. chauvin on top and the asphalt pavement beneath, right?

>> yes if you -- >> it's a yes or no question. >> yes. i want to ask a question about putting pressure on someone's neck. that is if you are on a person's back and applying pressure to the neck, do you agree that if pressure is applied to somebody's neck in the prone position and a person is squeezed until they become unresponsive and if the pressure is maintained for a minimum of four minutes, that can cause irreversible brain damage because the brain may be starved of oxygen, is that true? >> once oxygen stops -- >> my question was is it true? >> could you please restate the question. >> yes sir.

>> if you apply pressure to someone's neck and squeeze until the person becomes unresponsive and you maintain that pressure for at least four minutes, you will cause irreversible brain damage because you will have starved the brain of oxygen, is that true? >> correct it takes four minutes to cause irreversible brain damage. >> now, if somebody dies as a result of the consequences of insufficient oxygen or low oxygen, we know that when that person dies they are going to die of cardiopulmonary arrest because everybody dies of cardiopulmonary arrest, fair enough? >> yes. >> if a person dies as a result of low oxygen, that person is also going to die ultimately of a fatal arrhythmia, right? >> correct. every one of us in this room will have a fatal arrhythmia at some point. >> because that is kind of how we go.

>> yes. >> so i want to talk about the role of the physical activity, the struggle if you will on the oxygen stores, the reserves when somebody may be in the prone position. do you agree when somebody is involved in a pretty vigorous physical confrontation, they would certainly have what is referred to as an oxygen deficit? >> yes. any kind of exertion you build up a degree of lactic acid and other metabolites that need to be removed from the body and return oxygen data [inaudible] you have makeup to do. >> can you use your oxygen reserves then?

>> somewhat, but it's also more generation of the metabolic byproduct from the actual activity as well. >> would you agree a somebody with an oxygen deficit who is involved in a vigorous physical confrontation would be more susceptible to positional asphyxia than would otherwise be the case? do you agree with that? >> yes. >> would it be more difficult for them to get rid of the metabolic byproduct of the activity. >> and would you agree then that a person with an oxygen deficit or debt is more prone to any type of asphyxia than a person completely at rest, do you agree with that? >> a fully oxygenated person would certainly be at low risk, or a substantially lower level of risk of an arrhythmia compared to somebody [inaudible]

>> doctor fowler, are you familiar with a text known as smith and bishop? >> yes. [inaudible] this is a standard test for medical examiners, isn't it? >> it's certainly one of the recommended books that pathology will review as a part of the training, yes. >> in the past you referred to it as a reliable test. >> yes. >> is handed out to all forensics pathologists and training is a standard text. >> again it is recommended that they use it as one of the references. >> and you are aware that this has text on medical, legal investigation of death? it contains sections on death by is fixed via? >> yes. >> and do you agree that death

by positional asphyxia that his isdeath caused by low or insufficient oxygen that the cause for that may be what is referred to as endless? >> yes hence the complexity of these particular cases. >> so, you spoke with mr. nelson about the fact that on the autopsy when somebody dies of asphyxia or insufficient oxygen, you might see injuries to the ribs or their vertebrae that indicates the type of restraint or at least how the asphyxia came about, you might see that right? >> yes. >> you might see what is referred to as traumatic manifestation, things like bruises, evidence of injury. you might see those, right?

>> absolutely. >> do you agree, doctor fowler, that the majority of cases where somebody dies of asphyxia are very subtle and in fact no traumatic manifestations are visible at all? >> that is correct, depending on the circumstances. >> and what, i mean, by that is there isn't necessarily any evidence on autopsy of what it is that causes the low oxygen in the majority of cases, right? >> in a substantial number of the cases. i'm not sure that it's absolutely the majority. >> [inaudible]

can you see here from the representative for identification purposes your honor it is exhibit 814 for the record. am i reading here majority of cases are subtle in fact often with no traumatic manifestations at all, i read that accurately? >> [inaudible] are you familiar with a publication called forensic pathology? >> that is another reliable authority for the pathologists. >> correct. >> did you know that the forensics pathology also has a chapter on suffocation? >> that doesn't surprise you,

doesn't? >> it doesn't surprise me. >> and that is exhibit 815 for identification purposes and i want to show you page 354. >> this is taken from night. there are no truly distinctive autopsy signs of hypoxia and most of the criteria are caused by factors other than a lack of oxygen. the did i read that accurately? >> yes i'm just reading it, trying to process it, i apologize. >> sorry, please know, take your time. >> yes, that is what it says. >> you had some discussions with mr. nelson about strangulation.

you do understand in this case no one is contending that mr. floyd was manually strangled by anyone. you understand that, right? >> absolutely. >> there was no discussion of manual strangulation. >> do you agree with respect to positional asphyxia the diagnosis of positional asphyxia is one that is made by an investigation because you won't find in autopsy finding that necessarily specifically tells you why the person was asphyxiated. >> correct. >> the information becomes very important. >> you spent quite a bit of time

talking about the prone position study, and i've referenced that just a few minutes ago. let me ask you a couple of other questions just about those studies and try to correlate them to this case. is it true, doctor fowler, that none of the prone restraint studies that you've referred to studied subjects that had somebody's knee and their neck in the prone position. >> that is true. >> none of the studies went for as long as nine minutes and 29 seconds, is that true? >> that is true.

>> so do you agree that if the weight of several officers or police officer is put on the torso and abdominal areas of a person, the person in police custody, that can cause confessional or positional asphyxia, would you agree with that? >> if it exceeds the limits of 225 pounds as done by multiple studies, then yes, your argument is correct. >> could i show exhibit 808. >> for identification purposes

sorry, judge. let me ask you first you did gave a deposition in a case called curtis versus prince georges county a few years back. do you remember giving a deposition of the case? >> yes. >> and you've been involved in any number of depositions over your career as a forensics pathologists, haven't you? >> yes sir. >> and everyone of them you took an oath you would to tell the truth in the deposition. >> yes. >> so, with that said, let's look at your questions and answers from this deposition. question, what would it take a police officer to do in that situation to cause confessional or positional asphyxia. well, the compressional specifically would require the

weight of several officers on the torso and abdominal area, something that is documented in the medical literature which is a method of killing people that was made popular back in england in the middle ages when they were looking for bodies to teach medical students. the did i read that accurately? >> yes. >> you can we agree when you gave the answer to this question, you didn't say anything about an excess of 200 pounds or 220 pounds, is that true? >> all i said is it would take the weight of several officers on the torso and abdominal area. that's exactly what i said. >> i'm asking if you made reference to having a weight that exceeds 200 or 220 pounds. did you make a reference? >> i didn't give a specific weight. i said several officers. >> so, we know here in this case

when mr. chauvin was on mr. floyd's back and neck, from time to time he was pressing down forcefully with his me also on the left arm. you saw his knee on the left arm from time to time didn't you? >> yes, i did. >> i want to ask you in that framework about another quote from fisher, exhibit 814 for identification purposes on page 833. >> what page? >> 833. >> contrary to the belief of some, it is our opinion pinning down the shoulders or forcefully pushing the arms is equivalent to loading the back. an agitated individual breathes

faster, has a faster heartbeat, elevated blood pressure and high metabolism. such individual requires more air and more oxygen. immobilization of the chest even if only partially reducing the ability to maintain vital functions can cause cardiac arrhythmia. do you agree with the statement? >> no specifically i do not. they said it is their opinion. again this is a to medical opinions expressed by those authors and not a scientific fact. >> thank you. doctor fowler, do you agree that with mr. floyd in a prone stomach down position with

mr. chauvin applying some pressure to the neck and pressure to the torso in a downward position that these forces would be symbiotic, they would add together, is that true? >> yes. i agree as i quoted earlier on. >> doctor fowler, i just asked if it was true. >> yes [inaudible] and all those things together would make somebody more likely than if those factors were not present it would make it more likely for them to succumb to asphyxia, correct? >> if the weight is sufficient, yes. >> you told us you had been able to catch some of the testimony of the trial from some of the

other medical persons who testified. you didn't see all of them but you sell some of it. >> that is correct. >> are you then aware that a number of medical experts and others have testified that mr. floyd died primarily due to the effect of low oxygen? that arose out of mr. chauvin's sub dual restraint and neck position. are you aware a number of persons have testified about that? >> yes, i am. >> i would like to talk with you about what specifically you have done to assess what mr. floyd's actual oxygen reserves would have been during the sub dual restraint and compression on mas underneath the body of mr. chauvin. you wrote a report containing

your opinions in the case and then february 202nd, 2021. >> yes. >> i will assume for purposes of my questions that in the del be in the amount of air that remains in your chest between your breath, would you accept that as a premise for my questions? >> the and respiratory lung volume is that what you are referring to? >> yes. >> i will refer to that commonly as the body of oxygen reserves as a common way to refer to it. >> it is the air that is left in your lungs it isn't an oxygen an reserve. your major oxygen reserve -- >> we will call it to the eelv. >> do you agree that as it

decreases that it takes more work to breathe? >> i believe so, yes. >> incidentally, you are having were havinga discussion or had n with mr. nelson about the hypo- pharynx, do you recall that discussion? >> yes. >> now the report that you prepared for the case was 31 pages or thereabouts. fair enough? >> yes. >> can we agree that the word hypopharynx doesn't appear in your report in any of the 31 pages expressing your opinions? >> that is correct. >> now, you had made some comments earlier that you couldn't find anything in the literature about whether the hypopharynx may be impeded by restraints on the back.

do you recall that discussion? >> and i take it you went to look at pathology forensics? >> i went to the resources, yes. >> did you look and physiology terms, sir? >> that i would consider to be part of the general medical literature. >> so you did look at the literature. >> i searched broadly for it. i don't know whether it's -- i did not specifically focus on the physiology journals. >> [inaudible] >> do you -- i'm sorry, judge. sidebar, please. [sidebar]

>> thank you, your honor. >> i was simply trying to get a clear answer if you could give one. do you have a specific recollection of looking at physiology terms on the question of the relationship between the hypopharynx and the ability to breathe? >> i specifically [inaudible] that includes physiology, journals and nothing came up on my search so therefore i didn't read any physiology journals on this because nothing came up in the search. >> so, doctor fowler, did you

calculate quantitatively and include in your report what mr. floyd's eelv was while he was sitting on the sidewalk? >> no i don't believe i did. >> did you calculate the amount of air you took in with each breath? did you determine whether his breathing and eelv was normal or abnormal? incidentally, his eelv was 89 millimeters of mercury would

you agree that would have been normal then before the time of the restraint on the ground? it's not something i keep in my head so i don't know, counsel. >> when mr. floyd then was laid prone on the street, when he is face down, did you do any calculations of what any reduction may have been in his eelv due to him being placed in a prone position? >> no. when he had his knees on mr. floyd's back and arm and side did you do any calculations

quantitatively for how that weight on the back would have had any impact on his eelv? >> no i did not. >> would you agree then that is the eelv goes down, do you agree it takes more work to breathe? >> that is my understanding, but i am not a pulmonary physician. >> fair enough, but you would refer to a pulmonary physician. >> yes. let me ask you this and you will tell me if i'm asking the wrong person, doctor fowler, would you agree that pressure on the soft side of the neck also narrows the size of the upper airway, the hypopharynx?

>> i've not seen any literature that indicates it wasn't something i ever heard of my literature search was not [inaudible] >> thank you, doctor fowler. if we might show in exhibit 941 is already in evidence. >> what has been entered in as exhibit 941 if we look at the left picture we can see here mr. chauvin is on top of mr. floyd,

you can see his knee is on the back part of his neck. can you see that? >> yes. >> and then on the right picture, you can see that his knee is on the soft side of the neck. can you see that also? >> yes, on the back of the right side of the neck. >> i think you referred to mr. floyd's death [inaudible] is that the word you used? >> yes, more sudden than prolonged. >> you focus on the first five minutes that mr. floyd is restrained on the ground.

you were able to see and that five minutes he was struggling to breathe, right? >> you could see in the first five minutes that he was first calling out he can't breathe. >> correct. he verbalized i can't breathe multiple times. >> and you then later heard him call out for his mother. >> yes. as time passes and that first five minutes, you can hear that his voice got thicker and quieter, you could hear that, couldn't you? >> i didn't see that, but anybody can make up their own with regards to that. >> but you didn't hear any

change in his voice. is that what you are saying? >> not that i noticed. >> did you notice during the five minutes his words got further apart? yes they did. >> did you notice after that he went unconscious? >> yes. >> did you notice sometime after five minutes he was found not to have a pulse? >> correct. >> you refer to this as a sudden-death event that in your reported findings you don't record a time, do you, for when the sudden-death supposedly occurred. >> i don't specifically remember doing that. looking at the continuum from hearing george floyd calling out

that he can't breathe to the point that he doesn't have a pulse, over that time period is it fair to say that is what you were referring to as a sudden-death? >> no. >> i asked a question about when the sudden-death occurs. where then, and it's okay if you don't know the specific, but where from the time that he's on the ground saying he can't breathe to the point in time he's found not to have a pulse are you able to characterize where the sudden-death took place? >> so, what you are referring to is a sudden-death, and i may have misinterpreted but i refer to it as a sudden cardiac, there's a difference between death and cardiac arrest, cardiac arrest isn't irreversible and isn't

synonymous. there will be a period of time between his cardiac arrest, for instance in this particular case. the official pronouncement was done in the hospital. frankly, he was dead long before that. but the moment of death isn't something that you can easily document. >> so, when we are in this space, when there is a space between cardiac arrest and actual death, are you contesting though he may have been in cardiac arrest, there was a time when he may have been revived because he wasn't dead get? >> immediate medical attention for a person that had gone into cardiac arrest may well reverse that process, yes. >> do you feel that mr. floyd should have been given emergency attention to try to diverse the

cardiac arrest? >> is a position i would agree. >> observing the footage after he has gone unconscious there's a point in time that you see his legs raise up. do you recall seeing this when he was unconscious on the ground? >> yes. >> was that consistent with what is known as an anoxic seizure? >> that is what we would typically call it, yes.

>> and an anoxic seizure represents that there is damage to the brainstem due to insufficient oxygen. >> true. >> in some cases we would call it a hypoxic seizure. the muscular movement at the higher portion of the brain isn't functioning properly so typically people with seizure disorders that have had seizure activities in this from the cortex and not the brainstem. if you damage the brainstem in that particular stage it is effectively going to be. >> so it's fair to say what we see in the anoxic seizure at the very least we know that the brain is suffering from

insufficient oxygen. >> yes. do you agree low oxygen can cause brain injury, can't it? >> absolutely. a. >> and it can also result in pulseless electro activity. >> true. >> mr. floyd had a pulseless electrical activity arrhythmia when his body was taken away from the scene on may 25, 2020, didn't he? >> correct. >> is it true that the most common cause of a pea is low oxygen, insufficient oxygen? >> to the brain? >> yes sir. >> yes but it can also be caused by cardiac from either mechanism it could cause.

>> i have a number of questions. i will ask you this i have a number of questions that have to do with whether we did any sort of quantitative measurements about mr. floyd's oxygen levels, he is eelv at different points in time including at what point in time do you think that his oxygen stores were completely depleted? if there's any questions about the quantitative measurements about mr. floyd's eelv, those were not a good measurement that you would have undertaken for any reason? >> correct. and to the extent we are looking for such measurements, better to ask either pulmonologist,

respiratory physiologists but not necessarily doctor fowler as a forensics pathologist. fair enough? >> fair enough. they do not typically look at living people who are breathing. >> by the same token, if i have a series of questions about the mentioning of the carbon dioxide levels in his body after he's ceased to breathe, between the time he ceased to breathe and before the time he was given oxygen when he was picked up and given medical care and then taken to the hennepin county medical center you didn't do any quantitative analysis did you, as to the carbon dioxide levels in mr. floyd's body in between the time he ceased to breathe and he would have received assisted oxygen? >> no, not specific quantitative

analysis. >> there was quite a discussion about the terror again glioma [inaudible] remember we had witness testimony that refers to it as an incidental. have you heard that expression before? >> yes. >> you talked about the pair again glioma potentially being an issue if it were secreting adrenaline. >> correct. >> 90% of [aragamg;op,a do not -- >> i have no reason to disbelieve that. >> you are not telling the jury that mr. floyd died of a

paraganglioma. >> no. and although baker did identify paraganglioma on the autopsy, he didn't perform any test to determine if it was a secreting tumor, did he? >> correct. the only way to test those particular tumors, there's two methods. one is to do a blood test and if the paraganglioma is one that is constantly secreting you would pick it up on a blood test. for the paraganglioma that tend to [inaudible] if you do a blood test and at the bottom of the cycle it won't show so in some cases they do a test and if it is positive you've got your answer. if the blood test is negative you then go on to do a 24 hour urine screening which would pick up the surges and the depths and

that is the second test that would be done but neither of them were done. >> just for clarification, is it pronounced paraganglioma? i often add extra vowels. >> now is it true that in all of the world literature there've only been six reported cases of people who've died from a sudden heart event from adrenaline release from a paraganglioma, is that true? >> that's what the literature says because in many cases it may go -- >> i'm just asking if it is true. >> yes if it is in the literature. >> one of the signature hallmarks is a headache, right? >> if it is one that does secretion and surge, dip and surge, so if it is one that

constantly secretes a small amount, it will not cause any symptoms at all. >> but to the extent -- well, we know that among the various complaints mr. floyd had about pain he never complained about a headache, did he? >> i seem to remember one admission where he complained of a headache but i'm going from memory now and i'm not sure. >> here in referring to may 25 of last year if you have a recollection that he complained of a headache? >> i know he complained of pain but i cannot be sure he didn't complain of a headache i do not have a clear recollection.

>> so, you are asked some questions about mr. floyd saying i can't breathe before he was put on the ground during the subdural restraint. do you recall that discussion? >> yes. were you able to see what was happening with mr. floyd as they were trying to get him into what is referred to as squad 320? >> yes. were you aware of whether or not mr. floyd was experiencing being choked as he was being put into the back of the squad? >> i didn't see anything around

his neck. from my recollection that i noticed. >> your honor and counsel i have a couple of stills from exhibit 43. these are 281 and 282 and i would offer those from what is already in evidence. >> any objection? >> mae i, your honor? >> received. >> thank you, your honor. >> if we could show 282.

>> can you see in 282 can you see where i've circled, doctor fowler you see this arm that is around mr. floyd's neck? >> yes. >> do you recognize this person? >> it appears to be, yes. >> and if i could show you 281. >> and then there is a hand here. >> yes. these were not images or things

you had paid special attention before as you looked at what was going on in squad 320 you didn't see arms or anything around his neck? >> i had seen these particular pictures. sorry if i misinterpreted the question, you said before squad 320. i apologize if i misinterpreted your question. >> so do you know whether when he was in the back of squad 320 and before he was pulled out whether he complained about being choked? did he say i'm getting choked? >> i believe he did, yes. >> and it doesn't take a medical doctor such as yourself to know that if somebody feels that they are getting choked that would be a good reason they would say they can't breathe. >> yes.

i want to see if you can clear up a couple of things for me just in the timeline of what happened with respect to the restraint on the ground. with the leg extension, the anoxic seizure as it is referred to, is that before he lost consciousness or after? >> after. >> and did you make a note of when mr. floyd's -- what was his last vocal sound? do you remember? >> somewhere between a minute [inaudible] i have the information somewhere. before he went unconscious is

about the last time. if we focus on the period of the subdural restraint, was there ever a time during the nine minutes and 29 seconds where you saw mr. floyd either sleeping, not arousal or anything that is akin to being in a coma? >> so, from the period after he has this hypoxic seizure -- >> from the time he is first put on the ground, put out of the car, subdued and restrained on the ground mr. chauvin is on his neck and back. did you ever see mr. floyd at any time manifest either sleepiness, lack of awareness

that he wasn't arousal or that sort of thing? >> no, not until he lost consciousness. >> and particularly when somebody passes away from a fentanyl or opioid overdose, one of the hallmarks of that is that they are very sleepy, and they will tend to be on arousal and pass away essentially of a coma. >> correct if they are passing away from a fentanyl overdose that is what happens. >> and mr. floyd was not expressing any of those outward symptoms? >> it doesn't exclude the fact that it's still having a depressive affect on his respiratory system. >> before he lost consciousness, his respiration rate i think you told us that you agree with doctor tobin was somewhere in the ballpark of 22 breaths per minute. >> correct. >> that is normal, isn't it?

>> yes. >> if fentanyl was affecting his respiration, then you would have expected a respiratory rate that would have been less than 22 breaths per minute if it is depressing his respiratory system, right? >> unless he should have been breathing at that particular stage because of his exertion and other stressors. >> and you have no basis to suggest he should have been breathing at 30 instead of the normal 22. >> a person getting short oxygen to their brain would often increase were usually increased to more than 30.

>> i want to talk with you a bit about methamphetamine. first, let me clear out if i can, this issue of pills again in the car on may 25. when doctor baker performed the autopsy, isn't it true there were not any pills found in mr. floyd's stomach? >> correct, doctor baker did not identify any pill, call it what you want, residue within the stomach. >> and obviously any pill found in the car, it isn't in his body. >> correct whatever the residual amount and the tablet was was

not in his body. >> i think you made a statement with respect to the methamphetamine that it wasn't accompanied by a metabolite commonly seen if it had been in his system for an appreciable period of time. >> yes. and i want to be clear on this. have you, since making the statement in your report learned that in fact the metabolite of methamphetamine, that is as a metabolite was present in

mr. floyd's bloodstream from the toxicology results. >> i have heard a statement to that effect, yes. >> did you investigate the statement or determine whether or not it was true? >> yes. >> and did you find contrary to what you had written in the report you in fact found that the metabolite of methamphetamine was present from the toxicology results from mr. floyd. >> and very low levels, though it didn't change my opinion. >> the methamphetamine itself is only present [inaudible] >> that is true. >> so then there won't be a lot of the metabolite either if that makes sense. >> correct, and or again, a substantial amount hasn't yet been metabolized. >> so what was the level of methamphetamine that was found in the next toxicology results do you recall? >> how about 19 grams per

milliliter does that sound right? >> that sounds right but i didn't want to say because i didn't want to be inaccurate. >> 19 nanograms of methamphetamine is within range of what you would see in a patient whose dr. prescribed a therapeutic dose of methamphetamine, true? >> that is true if it is used in a therapeutic environment. >> your honor, can i have just one second?

>> so, last question, doctor fowler and then i will sit down for now. i wanted to again address the timeline from your report, and i will read it to you and my question will be whether or not this is the time you stand by, if i may. at 8:24:09 the last sound identifiable by mr. floyd were heard soon or after bystanders tell police he wasn't breathing. he exhibits movements from the

right lower extremity from 8:24:01 and movement at 8:24:23. at 8:16 he appears to have passed out. so, from your report is that your best knowledge and information, sir? >> you stand by that at this time? >> i have no reason not to. >> break? okay we will take a 20 minute break. let's try to think about ten >> monday, the closing arguments in the derek chauvin trial.

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