A Medical Review of George Floyd’s Cause of Death in Chauvin’s Arrest Warrant
EDITED TO ADD UPDATE: This story was written prior to George Floyd’s final autopsy report was released by the Medical Examiner and an Independent Forensics Investigation. The below explanation is helpful in understanding the findings.
Over the past few months to years I have watched the slow desecration of medicine by others. As an Emergency Physician of over 10 years, I have become used to witnessing the misleading spin of nonmedical professionals on topics in our field of expertise. Despite my desensitization, I have found that some of the false interpretations of the summary of George Floyd’s preliminary autopsy in court documents are among the worst offenders. Within the charges filed against Derek Chauvin for Floyd’s death are listed preliminary findings from the Hennepin County Medical Examiner’s report that highlight Floyd had a past medical history and may have been under the influence of intoxicants. However, it is important that these are court documents, not the complete medical examiners report, and any insinuation that throws doubt on the fact that Floyd died because Minneapolis police officers kneeled on his neck and thorax for 9 minutes is dangerous and simply incorrect.
First, a full and thorough pathology report can take days to weeks to be completed, and is not the end all — other investigation surrounding the events must be taken into consideration. I suspect a full and independent autopsy to follow will provide the information we all know to be true.
When read carefully, this section of the court documents do not actually support any naysayer claims. The released excerpts say preliminary findings “revealed no physical findings that support a diagnosis of traumatic asphyxia or strangulation” and then allude that Floyd’s coronary vascular disease, hypertension and “potential intoxicants” were contributors. However, the same excerpt clearly states that the “combined effects of Mr. Floyd being restrained by the police” were what led to his death. At the end of the day it will be the job of a forensic pathologist to investigate and all I can do as a physician of the living is to explain why assumptions can not be made based off of this excerpt.
Allow me to further dissect.
The presence of intoxicants does not generally result in death except in the case of an overdose or in the setting of a complication. In the case of depressants (such as opiates), breathing slows, causing poor oxygenation, leading to somnolence, coma, and eventually cardiac death. Considering the alert, awake and oriented man we first see on video, an impending overdose was likely not the case.
To be sure, stimulant type drugs taken in excess can certainly cause cardiac complications, but trained professionals know for patients who are delirious from stimulant drugs and consequently need to be restrained, unexpected death is not infrequent so it’s imperative to be careful. Consideration should be made to first try de-escalation. Then, if necessary, restraint in a safe manner — which should absolutely never be in the prone position with added pressure on the thorax and neck for a prolonged period of time.
“Underlying Health Conditions”
The excerpt highlights that Mr. Floyd had underlying conditions such as coronary artery disease and hypertension. Any medical professional would concur that these conditions are contributors to mortality. In fact heart disease is the leading cause of death in the United States.
That being said, chronic medical issues are just that: chronic. They don’t cause death unless the patient is of advanced age, there is progression over years of the disease, or the underlying condition is triggered into an acute state by an outside factor.
Now imagine Mr. Floyd, his body filled with fear and adrenaline, causing his heart to race, his blood pressure to skyrocket. Then add in a lack of oxygen and blood flow caused by compression of his chest wall, and the chain of events becomes fatal. In other words, at best his medical problems may have put him at greater risk for death due to the acute event that was happening to him; however, they probably weren’t the primary cause of his death.
The Lack of Physical Findings
The excerpt being distributed across social media again highlights that there were “no physical findings that support a diagnosis of traumatic asphyxia or strangulation.” It is important to understand that phrase does not mean Floyd was not deprived of oxygen or blood supply. Outward signs of classic choking and strangulation may include soft tissue hemorrhage in the face and neck, skin vessel bleeding around the eyes (called petechiae), a broken hyoid or cervical bones in the neck (as may be seen with hangings), and bruising around the neck.
However, Floyd was not necessarily a victim of traditional choking. More plausible was that he was a victim of prone compressive asphyxia, when a person is forced into a breathing restricted position he can’t get out of. The position leads to decreased oxygenation and blood flow and return.
As a physician I have treated many violent patients, and at times we must restrain them with medication or a physical barrier for their own safety or to protect our staff. However, as mentioned previously, we are taught never to prone restrained individuals due to the danger of complications. This same learning is communicated to our EMS, military and police officers in their training. We know that prone positioning in itself, without confounding factors, can lead to asphyxiation and death. Add in the anxiety and stress Mr.Floyd’s body was enduring, his medical conditions, and the added compression of the knees and hands of the officers, and a fatal outcome became exponentially more plausible.
Outside of the pressure on his neck, Mr. Floyd had significant compression on his chest wall. The in-and-out of our chest wall as we breathe is imperative for multiple life sustaining actions we do automatically: breathing in oxygen, breathing out carbon dioxide, returning blood flow to the heart, pumping blood from the heart to the rest of the body. When the chest wall is compromised, these vital actions are compromised.
Signs of prone, positional and compressive asphyxia may not be obviously visible upon external physical examination or preliminary findings after death. In fact, one early study on positional asphyxia specifically highlights “limitations of interpretation of the anatomic changes at autopsy.”
No More Distortion
In their analysis of a partial reading of the summary of a draft report by non-medical professionals, some may surmise that Floyd would not have died if not for his heart problems and intoxicants. The effect of those factors has no bearing here. My guess is that death would not have occurred had George Floyd been upright without his chest wall and neck being compressed, frightened for his life.
I cannot watch the distortion of medicine for the sake of hiding an uncomfortable and tragic truth: George Floyd’s death was not natural, coincidental or accidental.