The trial of Derek Chauvin continued Wednesday with the defense’s medical expert testifying that the former officer did not play a critical role in George Floyd’s death by kneeling on his neck — but said that the 46-year-old might have survived if he got emergency help.

David Fowler, a former Maryland chief medical examiner, said that Floyd’s heart condition and drug use played a “significant” role in his death last May, clashing with other experts called by the prosecution who blamed police. Cross-examination grew tense at times as the prosecution pressed Fowler on the many contributing factors he suggested and on the delay in emergency care after Floyd went into cardiac arrest.

With closing arguments expected next week, it remains unclear whether Chauvin, a former Minneapolis police officer, will take the stand in his own defense.

Here’s what you need to know:

  • Fowler testified that other contributing factors to Floyd’s death included the traces of fentanyl and methamphetamine in his blood system, as well as possible “carbon monoxide poisoning” from the exhaust fumes of the police vehicle outside Cup Foods.
  • Fowler is being sued over a “chillingly similar” case in Maryland, where video footage showed officers struggling with Anton Black before pinning him down. Black died, Fowler deemed Black’s death an accident, and no officers were charged in his death.
  • Fowler’s testimony came after a motion for Chauvin’s acquittal was denied by Judge Peter Cahill, who heard attorney Eric J. Nelson’s argument that the prosecution has “failed to provide sufficient evidence.”

Prosecutor pushes back on factors that medical expert says contributed to George Floyd’s death

8:28 p.m.
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Blackwell pushed back on factors that medical expert David Fowler had assessed as contributing to Floyd’s death.

Under cross-examination, Fowler affirmed that Floyd did not show signs of overdose such as sleepiness — though Fowler testified this “does not exclude” a potential “depressive” effect from drugs.

The prosecutor also brought up Fowler’s earlier suggestion that a tumor called a paraganglioma could have secreted adrenaline that further compromised Floyd’s heart.

Blackwell asked: “90 percent of paragangliomas do not secrete adrenaline, is that right?”

Fowler said that was probably right.

“Now, you’re not telling the jury, are you, sir, that Mr. Floyd died from a paraganglioma, are you?” Blackwell said, and Fowler answered, “No.”

Defense medical expert concedes George Floyd should have received medical attention

8:23 p.m.
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George Floyd should have received immediate medical attention to reverse his cardiac arrest, conceded David Fowler, the defense medical expert.

During cross-examination, Fowler acknowledged that Floyd might have survived if he got emergency help after Jerry W. Blackwell, the prosecutor, inquired whether Floyd died suddenly. Unlike the prosecutor’s medical expert, Fowler said his death was not immediate, opening the door to a question from the prosecutor about whether it could have been prevented.

“Are you critical of the fact that he wasn’t given immediate emergency care when he went into cardiac arrest?” Blackwell asked.

“As a physician, I would agree,” Fowler responded.

The admission follows testimony from the prosecution’s witnesses that Chauvin did not respond to Floyd’s call that he could not breathe by halting his restraint and offering medical help.

One witness, Genevieve Hansen, an off-duty firefighter, testified in tears that she “pleaded” to be allowed to give Floyd medical aid.

“I would have been able to provide medical attention to the best of my abilities,” Hansen told the court during the first week of the trial. “And this human was denied that right.”

Paulina Villegas contributed to this report.

Prosecutor and medical expert for defense engage in tense exchange about substance in Floyd’s mouth

7:11 p.m.
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Prosecutor Jerry Blackwell engaged Fowler, a medical expert for the defense, in a testy back-and-forth about the witness’s earlier description of an object inside Floyd’s mouth while Floyd was in Cup Foods.

During cross-examination, Blackwell showed photographs of Floyd in the store with something white in his mouth. Then Blackwell referred to Fowler’s earlier mention of Floyd having a white object in his mouth when police approached him.

“So would it be fair to say, in order to say that the white substance in Mr. Floyd’s mouth was a pill, in light of what you’ve seen, that would be jumping to a conclusion, wouldn’t it?the prosecutor asked.

Fowler paused.

Specifically, when I testified, I said there was a white object in his mouth,” Fowler replied. “That’s all I could discern from that. And I remember saying that under direct.”

“So you were not, then, either telling or suggesting to the jury that the white substance was a pill, are you?” Blackwell asked.

“I never said it was a pill,” Fowler replied. “I carefully said that I could see a white structure in his mouth. I did not want to classify it, and I didn’t.”

The question of what was in Floyd’s mouth is relevant to the defense’s argument that Floyd’s death was caused in part by the presence of fentanyl and methamphetamine in his system.

Blackwell also challenged Fowler’s earlier characterization of a medical expert who had been critical of holding people in a prone position. The prosecutor reminded Fowler that he had said the expert had withdrawn his criticism. Then Blackwell showed a document in which the expert wrote that he had not changed his position.

Prosecution presses defense expert’s claim that Floyd was potentially exposed to carbon monoxide

6:52 p.m.
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Coming out of the lunch recess Wednesday afternoon, prosecutors pressed the defense’s medical expert witness on his claim that Floyd’s potential exposure to carbon monoxide played a role in his death.

Prosecutor Jerry W. Blackwell took issue with the defense’s argument in the morning that several factors contributed to Floyd’s death, including the man’s heart condition and history of drug use. But the prosecution focused on the suggestion from Fowler, the former Maryland chief medical examiner, that Floyd’s potential exposure to the exhaust fumes from the police car had a hand in him dying.

In questioning Fowler during cross-examination, Blackwell, who said he was “going right to the punch line on carbon monoxide,” referenced the autopsy report from Andrew Baker, the Hennepin County medical examiner.

Do you agree with me that there was no finding of carbon monoxide poisoning from Dr. Baker’s autopsy review?” Blackwell asked.

“I do,” Fowler replied.

The questions around carbon monoxide are the first to be brought up during testimony, and the term was mentioned dozens of times by the witness and Nelson.

When Blackwell asked him how he knew the police car outside Cup Foods was even on, Fowler said he “made an observation of water dripping from what appears to be a tailpipe.”

And you just simply assumed by seeing something dripping from a tailpipe that the car had to have been on?” Blackwell asked.

“It’s not an assumption,” Fowler replied. “It’s an evaluation, which in my mind indicates that the vehicle was running.”

Floyd died of cardiac arrhythmia, medical expert for defense testifies

5:51 p.m.
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Former Maryland chief medical examiner David Fowler testified on April 14 that he would classify George Floyd's death as "undetermined," rather than "homicide." (The Washington Post)

Fowler, a medical expert for the defense, said he concluded that Floyd died of a cardiac arrhythmia due to heart disease, with contributing factors.

Those factors included fentanyl and methamphetamine, possible carbon monoxide poisoning and a potential stomach tumor, testified Fowler, Maryland’s former chief medical examiner.

He said he would consider the manner of Floyd’s death undetermined because different potential factors correspond with different manners of death. Carbon monoxide poisoning, for example, would be classified as an accident, while Chauvin’s restraint would be considered a homicide.

“And you put all of those together, it’s very difficult to say which of those is the most accurate,” Fowler said. “So I would fall back to undetermined.”

Defense points to controlled substance that appears in Floyd’s mouth as police held him at gunpoint

5:31 p.m.
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When presented a video still of police approaching Floyd inside his car last May, Fowler testified Wednesday that it was evident the 46-year-old had ingested substances as Chauvin and the officers approached the vehicle.

Fowler, a former Maryland chief medical examiner and expert witness for the defense, said it was clear Floyd ingested a controlled substance as police held him at gunpoint when he was inside his car.

In court, a video still of Floyd with his mouth open and hands up was shown as guns are drawn on him.

In the back corner of Mr. Floyd’s mouth, you can see what appears to be a white object,” Fowler testified.

He said his video review of the body-cam footage and records of the case indicate fentanyl had been taken sometime before that allowed it to break down in Floyd’s system.

Chauvin’s knee did not injure Floyd’s neck, defense medical expert testifies

5:06 p.m.
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Former Maryland chief medical examiner David Fowler, an expert witness for former Minneapolis Police officer Derek Chauvin’s defense, testified on April 14. (The Washington Post)

Chauvin kneeling on Floyd’s neck did not injure him, a witness for the defense testified.

Is it your opinion that Mr. Chauvin’s knee in any way impacted the structures of Mr. Floyd’s neck?” Nelson, the defense attorney, asked.

“No, it did not,” replied Fowler, a former Maryland chief medical examiner. “None of the vital structures were in the area where the knee appeared to be from the videos.”

All of Floyd’s injuries were in areas that Chauvin’s knee did not press on, Fowler said. He said the injuries were on the front of Floyd’s body, including his face.

“The amount of force that was applied to Mr. Floyd was less than enough to bruise him,” Fowler said.

Defense’s medical expert claims ‘no evidence’ suggesting the prone position is an issue

4:55 p.m.
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The defense’s medical expert testified Wednesday that there’s “no evidence” in research suggesting that the prone position is an issue in restricting air.

Fowler, the former Maryland chief medical examiner, cited therapeutic maneuvers in which people are in the prone position, as well as people’s sleeping habits, as examples of why facing down is not dangerous.

There is no evidence right now that that is a significant issue,” Fowler testified.

During nearly two weeks of testimony, Nelson and Chauvin’s defense team have argued that the prone position, like the one in which Chauvin placed Floyd, is not inherently dangerous.

Experts called by the prosecution have argued the research supporting the case that the prone position is not dangerous does not apply in real-world situations — like the one outside Cup Foods last May.

Fowler testimony focuses on role of carbon monoxide in Floyd’s death

4:40 p.m.
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For the first time in the trial, a witness for the defense asserted that carbon monoxide poisoning from the police car near Floyd may have contributed to his death.

Fowler, a former Maryland chief medical examiner, testified that a certain amount of the odorless gas will kill even young, healthy people — not to mention someone with heart disease, as Fowler has characterized Floyd.

Fowler emphasized that he was not claiming carbon monoxide poisoning was Floyd’s primary cause of death.

“Now, again, you’re not suggesting to the jury that Mr. Floyd died of carbon monoxide poisoning?” asked Nelson, the defense attorney.

“Not exclusively, no,” Fowler replied.

Nelson and Fowler mentioned “carbon monoxide” about 50 times in the first 20 minutes of Fowler’s testimony after the morning break, suggesting that the defense is trying to draw attention to the theory that the gas may have played a role in Floyd’s death. Fowler had mentioned carbon monoxide earlier in the day when he listed factors that he believed may have contributed to the fatality.

Floyd’s hypertension was ‘out of control’ when restrained, Fowler testifies: ‘Much higher than I would expect’

4:03 p.m.
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When reviewing records of Floyd’s blood pressure when he was detained outside Cup Foods, Fowler told the defense that the 46-year-old’s hypertension spiked during his encounter with police.

Floyd’s blood pressure, 216 over 160, came as a surprising figure to Fowler, a former Maryland chief medical examiner, in analyzing the case, he told Nelson.

“A high blood pressure like that, and that’s markedly elevated, could be due to his hypertension being out of control,” Fowler said. “But this is much higher than I would expect.”

The medical expert said another possibility for Floyd’s increased blood pressure could have been his body’s stress reaction, which could have caused adrenaline to secrete and his heart rate to spike.

“There are multiple explanations for that, but certainly stress would be one of them,” he said before the morning break.

Fowler suggests Floyd’s enlarged heart showed high blood pressure

3:38 p.m.
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Floyd’s enlarged heart was “extremely good evidence” that the 46-year-old had high blood pressure that contributed to his death, Fowler testified Wednesday.

The former Maryland medical examiner told the defense that Floyd “had significant narrowing of all of his current arteries close to their origin,” meaning the blood supply was reduced throughout “not just a portion of his heart but the entire heart.”

Fowler testified how Floyd’s enlarged heart strongly indicated he had hypertension at the time of his death in May.

Bottom line is he has an enlarged heart,” Fowler said.

Designation of Floyd’s death as a homicide is meant to be a ‘neutral’ conclusion, medical expert testifies

3:29 p.m.
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Fowler, a former Maryland chief medical examiner, testified that the designation of Floyd’s death as a homicide on his death certificate is intended to be a neutral conclusion.

The label is a medical term that applies when death results from one or more intentional, volitional and potentially harmful acts, Fowler said in his testimony as a defense witness. He said intent to cause death is a common element of a homicide under this definition, but it is not required.

“It is to be emphasized that the classification of homicide for the purposes of death certification is a neutral term and neither indicates nor implies criminal intent, which remains the determination within the province of a legal process,” Fowler said, quoting from a guide produced by the National Association of Medical Examiners.

Homicide is one of five manners of death that medical examiners use to classify fatalities. The others are suicide, accident, natural or undetermined, Fowler said.

Floyd’s drug use and heart played ‘significant’ role in his death, defense’s medical expert says

3:18 p.m.
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A former Maryland chief medical examiner testified Wednesday that the condition of Floyd’s heart and his drug use played a “significant” role in his death.

David Fowler told Nelson that based on his review of the case, Floyd suffered a “a sudden cardiac arrhythmia” because of his heart disease.

“In my opinion, Mr. Floyd had a sudden cardiac arrhythmia … during his restraint and subdual by police,” he said.

The medical expert said other factors contributed to Floyd’s death, including the traces of fentanyl and methamphetamine in his blood and potential “carbon monoxide poisoning” from exhaust from the police vehicle.

“All of those combined to cause Mr. Floyd’s death,” said Fowler, a paid witness of the defense team.

The testimony of Fowler, who was described by some peers as “among the most respected forensic pathologists in America,” comes as he is being sued for his findings in the 2018 police-involved death of Anton Black in Maryland, The Washington Post’s Mark Berman and Ovetta Wiggins reported. The Maryland Attorney General’s Office, which is listed as the attorney for Fowler in the case, filed a motion last week asking the court to dismiss the counts against him.

Morries Hall, passenger in the car with Floyd, refuses to testify

2:14 p.m.
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Judge Peter Cahill quashed a subpoena against Morries Lester Hall, a passenger in the car with Floyd, after Hall invoked his Fifth Amendment right against self-incrimination to decline to testify.

“I’m fearful of criminal charges going forward,” Hall told the court. “I have open charges that’s not settled yet for my personal stuff.”

Chauvin’s defense had proposed asking Hall a limited set of questions about how Floyd looked in the SUV after leaving Cup Foods. Adrienne Cousins, an attorney for Hall, said her client could not answer those questions without opening himself up to potential charges, including a third-degree murder charge, arguing Hall was responsible for Floyd theoretically overdosing.

“Mr. Hall can’t put himself in that car with Mr. Floyd,” Cousins said. “Again, this is a car that was searched twice, and drugs were found twice.”

Hall had previously sought to quash the subpoena and said he planned to invoke his Fifth Amendment right.