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Chauvin Trial: Defense Cross-Examines Cardiologist. Aired 12:30-1p ET

Aired April 12, 2021 - 12:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

[12:30:00]

ERIC NELSON, DEFENSE ATTORNEY: A blocked right coronary artery that can contribute to a fatal arrhythmia?

DR. JONATHAN RICH, CARDIOLOGIST: Any -- anyone can have a fatal arrhythmia with or without coronary artery disease.

NELSON: And so if a blood vessel is blocked and blood is not getting through that vessel, what happens?

RICH: Well, it depends. But I'd like to answer that for you. So in the case of Mr. Floyd, what has most likely happened based on our understanding of coronary physiology is precisely because he had a narrowing of up to 90 percent and it had calcium in it.

We know that that developed gradually and the heart is fascinating in what it does. It develops what's called coronary collaterals, which means the body makes additional blood vessels so that if there's one artery that's narrow, it recruits and builds many more blood vessels to supply blood to the heart.

It's actually why you are more likely to die from a heart attack if you started with a lesser narrowed artery and it -- the plaque ruptured and blocked the vessel than if you started with a more severe narrowing because of all these unbelievable coronary collaterals and adaptive responses that the heart does when that happens.

NELSON: What is a safe dose of methamphetamine?

RICH: Prescribed?

NELSON: Illicit?

RICH: I would never consider any illicit drug to be off the street that's no prescribed by a physician to be safe.

NELSON: And methamphetamine is a vassal constrictor, correct?

RICH: It often can act as a vassal constrictor.

NELSON: That means it constricts the blood vessels more, correct?

RICH: Yes, that's what -- correct, that's what vassal correction means, it narrows them down more.

NELSON: You understand based on medical records that there's prior evidence of methamphetamine used by Mr. Floyd?

RICH: Yes, sir.

NELSON: And methamphetamine can cause some changes to the heart in and of itself, correct?

RICH: Correct.

NELSON: In fact, it sort of ages the heart more, right?

RICH: I've never used that terminology.

NELSON: OK. How would you -- what does it do to the heart over prolonged use?

RICH: Every case is different and it depends what we mean by prolonged use. So one day, one week, 25 years; like most things, if you use something for -- if you smoke cigarettes for 50 years you're going to have more problems than if you smoked a cigarette or a pack every once and a while.

NELSON: In terms of what does -- what does methamphetamine do to the heart itself?

RICH: So methamphetamine if used over a long period of time can sometimes contribute to the development of coronary artery disease, as we've been discussing. It can constrict blood vessels, as you mentioned.

It can have kind of a host of different effects on various parts of the body including the heart.

NELSON: And there's lots of things that can make the heart work harder and faster, right?

RICH: Sure.

NELSON: I mean methamphetamine being one of them.

RICH: Yes.

NELSON: Vigorous activity being one of them?

RICH: Sure.

NELSON: Adrenaline?

RICH: Yes. I mean we all, right now, have a lot of adrenaline flowing through our system. Adrenaline is needed for life, for sure.

NELSON: Increases in adrenaline can cause the heart to work harder and faster? RICH: Yes. I mean -- so adrenaline, which is the lay term for catecholamines, that's the purpose of adrenaline is to get it to pump more blood. When we go and exercise, the purpose of adrenaline is so we can run and we can jump and we ask the heart to allow us to do that, correct.

NELSON: And have you in your practice worked with someone who has a paraganglioma?

RICH: I have had a couple of patients who have had what we call pheochromocytomas, which is a type of paraganglioma, yes.

NELSON: In the -- in the hip area, generally?

RICH: No, generally it's actually near the adrenal gland, which is sort of just near the kidneys. But these paragangliomas can sometimes pop up in different places.

NELSON: And how are they typically identified?

RICH: Well, so it depends. If it was clinically pertinent, that's how I diagnosed the ones that I've had. The classic findings are the person who's saying I'm always finding headaches. What is with these headaches?

[12:35:00]

I'm always sweating, why am I always sweating?

And you start to say huh, I'm wondering if something is releasing a hormone that can be contributing to that. Other times, like in my opinion, the case here with Mr. Floyd, you pick them up incidentally, let's say an autopsy.

NELSON: There are also often identified because of person -- it contributes to high blood pressure.

RICH: It can, that is right.

NELSON: And you have agreed that you've reviewed the medical records of Mr. Floyd, correct?

RICH: Correct.

NELSON: And he has a pretty significant history of extremely elevated blood pressures, right?

RICH: Yes.

NELSON: I think the one that you referenced that the top number was over 200.

RICH: Yes, on more than one occasion.

NELSON: On more than one occasion. And the lower number of the blood pressure was likewise elevated, right. RICH: Yes.

NELSON: Did you observe that Mr. -- in the medical records that Mr. Floyd was taking prescribed medications to control his blood pressure?

RICH: I saw in the records during an emergency room visit that he was prescribed high blood pressure medication. What I could not see is whether he was taking them or not. But it did look like at one point there was a prescription given to him.

I think one of them was for amlodipine, which is a calcium channel blocker and one of them was for, I think, either hydrochlorothiazide or chlorthalidone.

NELSON: And you'd agree that the records that you had for Mr. Floyd were relatively limited, agreed? I mean they don't -- they weren't his entire life medical records.

RICH: I don't know when he started to see medical professionals. So I -- for all I know, the first instance in the records that I saw was the first time he started to see medical professionals, I'm not sure.

NELSON: So how many years of past medical records did you review?

RICH: I believe three or so. I think the beginning of 2018 is when I think they started.

NELSON: Are paragangliomas ever removed from a person?

RICH: Paragangliomas if they are causing those symptoms that I mentioned; the pulsatile headaches, the sweating, et cetera; a surgeon would sometimes remove them.

NELSON: Would you prescribe amphetamine for somebody who has a 90 percent blockage of the right coronary artery and a 75 percent blockage of the left interior descending artery?

RICH: So first of all, I don't typically prescribe amphetamines. I have many patients who have coronary arteries that are on stimulants, OK, for a variety of medical conditions. So I just don't prescribe them but I do have many patients with coronary disease who are on stimulants.

NELSON: Would you recommend to something that they use methamphetamines with that degree of coronary artery disease?

RICH: I would never recommend that anybody take methamphetamine off the street for any reason.

NELSON: You aware of the research showing that deaths where both methamphetamine and fentanyl are found, it occurs at a much higher incidents?

RICH: Can you repeat that question please?

NELSON: Sure. Are you aware that the research has demonstrated that deaths of those who are -- use methamphetamine and fentanyl have been notably higher than meth -- excuse me -- meth or fentanyl alone? A combination.

JERRY BLACKWELL, PROSECUTING ATTORNEY: Objection, Your Honor, for lack of foundation. Assuming facts.

PETER CAHILL, JUDGE IN CHAUVIN TRIAL: As to assume facts, that is overruled. Is assuming, is it the scope of his foundation because the state did ask him for toxicology opinions.

BLACKWELL: Sure (ph). But the reference to the medical articles, none of which anyone has seen, is simply counsel's reference, Your Honor.

CAHILL: Overruled. You may answer if you know.

RICH: OK. I -- I am not familiar with the breadth of the literature looking at all of the different combination of drugs and which combination worsens or improves survival.

NELSON: You testified that Mr. Floyd, based on your review of the video did start complaining of shortness of breath prior to being placed in the prone complaint -- prone position, right?

RICH: Yes, I heard on more than one occasion he'd -- he'd say the words, I can't breathe.

[12:40:00]

NELSON: And if Mr. Floyd had simply gotten in the back seat of a squad car do you think that he would have survived?

STEVEN SCHLEICHER, PROSECUTING ATTORNEY: Objection, Your Honor. That's not calling for medical testimony.

CAHILL: You may give -- if you have a medical opinion as to. Overruled to that extent.

RICH: So had he not been restrained in the way in which he was I think he would have survived that day. I think he would have gone home or wherever he was going to go had he not been subjected to the prone and positional restraint that he was.

NELSON: So in other words, if he had gotten into the squad car, he'd be alive?

RICH: I think my answer remains the same. Anything other than that scenario that he was subjected to, I have no reason to think from a medical perspective that he would not have survived that day, correct.

NELSON: And in terms of the prone position, you would agree that the prone position is not in and of itself inherently dangerous?

RICH: In an ordinary individual, if we were take away everything else that was going on and we -- and someone was just simply lying in their -- in the prone position, while there are many patients who that would be inherently dangerous, the average individual I would agree with you probably just lying flat in that situation generally wouldn't be dangerous.

NELSON: Even in the ICU there are circumstances were people have serious medical conditions where they're maintained in the prone position, agreed?

RICH: In the ICU when patients are put into the prone position it is when it is a desperate attempt to save someone's life where their lungs have actually developed what we call acute respiratory distress syndrome or ARDS.

They have a ventilator in to make sure that the amount of air that they get no matter their positioning will always be enough. And so it's a funny thing to think about putting someone in the prone positioning in the ICU on a respirator.

But because of the respiratory physiology, sometimes that will actually help open up certain segments of the lungs that are needed for oxygenation but it's really important to keep in mind that they are on a respirator every single time to open up those lung airways and they're usually on sedation as well to keep them comfortable.

NELSON: And my last question, Doctor, is after someone -- someone's heart stops, is it possible that they continue to respire?

RICH: It is -- well, I'm not sure I could answer that with certainty other than to say there are these things that are called agonal breaths. So when I'm in the intensive care unit with a patient who is dying and they go into cardiac arrest, once in a while you will see them take one or two extra breaths.

I'm not sure of the exact mechanism or the physiologic trigger for that so you could potentially see some extra breaths for a short period of time.

NELSON: By a short period of time, up to a minute?

RICH: In -- in my experience if the heart has completely stopped, I would not expect to see the breathing continue for up to a minute but I might expect it to be seen for several seconds.

NELSON: I have no further questions, Your Honor.

CAHILL: Any redirect?

BLACKWELL: Thank you, Your Honor.

Dr. Rich, you were asked several questions that -- that had to do -- at least had as premise the blockage of Mr. Floyd's arteries. Is blockage a proper medical term to you, as a cardiologist, to describe the narrowing in Mr. Floyd's arteries?

RICH: So when we tried to use terminology that is not medical terminology, right, to explain these phenomenon, the term blockage I tend to use when the blood vessel is completely blocked. It -- there's a blockage. I will usually describe, if I have a patient like Mr. Floyd who has coronary artery disease like this, I will usually use the term narrowings because the blood is still getting through.

In fact, the blood may be getting through just fine. There is no level of narrowing, in fact, even a totally blocked artery, this is what's fascinating, that develops overtime, the territory of blood that that blood vessel was supposed to supply can still be getting enough blood because of those collateral vessels that develop.

[12:45:10]

So I would use the term with Mr. Floyd as narrowings.

BLACKWELL: You were asked questions again about paragangliomas. And I think you told us that those are usually preceded by headaches of some kind?

RICH: Classically, correct.

BLACKWELL: One of the symptoms is headaches.

RICH: Yes, that is right.

BLACKWELL: Again, did you hear amongst the various complaints Mr. Floyd may have had about pain. Did you hear any of them being a headache?

RICH: No, in fact when I saw that there was a paraganglioma described as an incidental finding in the autopsy report, I actually -- when I went to the medical records I used that Control F button to put in headache and make sure that I never found headache in addition to scrolling through all the records. I didn't find headaches at any point.

BLACKWELL: When you referenced paraganglioma being an incidental finding on the autopsy, would you tell the jury what's meant by incidental?

RICH: Sure. So all of us have things in our bodies that aren't causing any medical problems but if they're discovered, let's say some gets a CAT scan for one reason, they might find that there's a cyst on the kidney or the liver, sometimes we'll even pick-up benign tumors.

So we refer to those as incidental findings. In fact, in the case of paraganglioma, the name you would actually call it is incidentaloma because we don't think it has clinical relevance but it was found and described in the imaging or in this case, the autopsy.

BLACKWELL: Are you familiar with any of the data as to how many people in the United States have ever died as a paraganglioma as the principle primary reason for death?

RICH: To be honest, I don't know the exact numbers. I just know that they are very low.

BLACKWELL: Now you were asked questions about high blood pressure, the role and impact of methamphetamine, paraganglioma, narrowing arteries; can any of those things in of and by themselves cause someone to die without first injuring the heart?

RICH: Can you repeat the question?

BLACKWELL: Yes, what I'm -- what I'm trying to get at, whether we talk about high blood pressure, methamphetamine, paraganglioma and the impact on the adrenals narrowing of the arteries, can any of those things by themselves cause a person to die without first impacting the stoppage of the heart?

RICH: Well, the reason I asked you to ask the question again is because I want to make sure that I'm precise and clear here. High blood pressure can cause death in manners outside of the heart. For example, it can contribute to a stroke, which we know Mr. Floyd didn't have.

And the other thing that occasionally happen is this thing called an aortic dissection where the aorta, the main tube that leads the heart can tear. That can cause death. So I want to make absolutely clear these conditions can cause death on occasion in areas not involving the heart but most of the time if death is going to occur by them it's going to be caused because of their impact on the heart.

BLACKWELL: And did Mr. Floyd had aortic section?

RICH: No. He absolutely did not based on the review of the autopsy.

BLACKWELL: He didn't have a stroke?

RICH: He also did not have stroke.

BLACKWELL: So again, just to be clear for the jury, with all the discussion about the narrowing of arteries, meth, et cetera; was there any damage at all observed to Mr. Floyd's heart muscle?

RICH: Based on my review of all the evidence, the EKGs, the autopsy report, I found absolutely no evidence at all of heart damage in Mr. Floyd's heart.

BLACKWELL: Thank you, Dr. Rich.

CAHILL: Any recross (ph).

NELSON: (Inaudible). On redirect you were asked a question about the various, the paraganglioma, the coronary heart disease, high blood pressure. If anyone of those can cause death independently and you answered relevant to the high blood pressure, right.

But you would agree that when you combined a lot of factors, you'd agree that the body is -- a lot of things are happening at the same time, right?

RICH: yes.

NELSON: And in combination if you have paraganglioma or you've got an increase in the fight or flight kind of response, you've got coronary heart disease you've got high blood pressure; all of those things combined could cause death even if there was not a physical restraint?

[12:50:10]

RICH: Well, there's -- his paraganglioma -- the likelihood that his paraganglioma was even releasing any hormone is highly unlikely.

NELSON: But in terms of the combination -- the drugs, every -- the high blood pressure, the -- take the paraganglioma out of it, right, the increase in adrenaline from a struggle with officers, all of those things combined together, even in the absents of prone restraints could have resulted in death, yes or no, sir?

RICH: Upon my review of the evidence and the facts of the case, I found no evidence to support that.

NELSON: Fair enough. Thank you.

CAHILL: All right. Thank you, Doctor.

RICH: Thank you.

CAHILL: You are excused.

RICH: Thank you.

CAHILL: And we have our next witnesses at 1:30 is that correct?

All right, we have two witnesses for this afternoon, members of the jury and counsel and I have to finish up some legal issues at 1:00. So we're going to break until 1:30. Have a good lunch.

JOHN KING, CNN HOST: See the judge calling a break there in the trial of the former Minneapolis police officer, Derek Chauvin. He is on trial, of course, in the death of George Floyd. You just heard Dr. Jonathan Rich, he's a cardiologist. He's the 36th prosecution witness. There's the defense cross examination and then a little redirect at the end there.

Let's bring in our legal analysts; CNN's Laura Coates, a formal federal prosecutor. And Chief Charles Ramsey, I believe, is also with us as well; former chief of the D.C. Police Department and commissioner of the Philadelphia Police Department.

Laura, you mentioned this a bit earlier during one of the breaks. The idea that as we start the third week of testimony on this Monday, very important for the prosecution not only to continue its case but in some ways to recap it's case.

LAURA COATES, CNN SENIOR LEGAL ANALYST: It's so important. You want to building off consistently. Remember the theories of primacy and recentcy. People remember the very first thing they heard, they remember the last thing they heard, they remember the last thing they heard. You might want to bury the bad facts in the middle for reason to the what is fresh in the jurors mind is what you think is most favorable to your case. And remember, this witness is meant to build off of the testimony of not just the -- the off duty fire fighter, a bystander who wanted to render aid and CPR. It built off the pulmonologist and the idea of a cardia pulmonary arrest meaning the heart and lungs stops.

It builds off of the forensic pathologist talking about why she would not have put asphyxia on there. It builds off of the medical examiner talk about why the size of George Floyd's heart would have had some impact or not at all compared to, of course, the restraint that was rendered by the police officers.

There was really a key moment here though that I think everyone paid attention to, it was the moment when the defense counsel asked the cardiologist that if said -- what was the question -- if -- just like what happened with the forensic pathologist last week, the idea of trying to pose a hypothetical response that took away all of the facts and made it more generic and not key to this one.

This time he asked, look, had George Floyd just gotten in the squad care, he'd still be alive today. And I had to cock my head at that moment and say are you telling the jury that but for the police officer's restraint and conduct, he would be alive.

That doesn't help your case at all, you realize. Also, it essentially shifts the focus on to George Floyd's purported noncompliance at a time when Derek Chauvin had not yet arrived on the scene and had not yet administered any force, yet alone, eventually deadly force.

So it's one of those moments where as a defense counsel you're trying to score points to try to undermine the testimony that's very, very good. At the same time you end up inviting the jurors to ask the question, well, isn't that while we're here because there was police encounter because they actually did the wrong thing, isn't that why we're here?

KING: That's an interesting point. And Chief, one of the things we know the defense counsel is trying to do is stir up some doubt here and Mr. Nelson tries to do that at every turn. It could have been this, it could have been that.

There was a crowd, George Floyd was on drugs. But one of the things I know you have been impressed with and I want you to walk me through whether that -- you share that in the case of Dr. Rich here. Yes, we're dealing with some pretty highly technical medical terms in many cases as they grow through the autopsy report as they talk about how the heart is constructed and the like.

And the prosecution has done, at least up to this point coming into this week by the account of both of you, a very good job of making it English, if you will. Making it presentable and acceptable in language the jury can understand. Are we still on that path?

CHARLES RAMSEY, CNN LAW ENFORCEMENT ANALYST: Yes, I think so. Mr. Blackwell has been very good at asking very clear questions that aren't complicated and eliciting the kind of response that he would need to have that's very understandable. He's done that throughout the interviews of the various technical witnesses. And -- and I've very impressed with it because I think it just adds to the strength of the case. This is incredibly powerful. And I didn't see anything in cross examination that really, you know, damaged any of the testimony that was given by Dr. Rich.

[12:55:00]

I mean I don't think the defense was able to poke any holes in it at all. So I really do think that the prosecution at this point is doing a very, very good job of presenting their case in a very understandable way, not only for the jury but for all of us that are watching.

KING: That is very important on this Monday as Laura noted.

COATES: And John, if I could --

KING: Go ahead, Laura.

COATES: -- I could say -- if I could say this part, you know, as if -- remember, before we were talking about heart stop, lung stop. As prosecutors, we never use a $10 word where a quarter word will do.

And when you have the jury start to have to write out things like paraganglioma and figure out how to spell, you're the defense and you're losing the case because up till now you've got very clear, as Charles was speaking about, very clear English words. They're short and to the point.

Once you launch into paraganglioma and think of that as a distraction, you are undermining the clarity that the jurors need to be able to understand this case.

KING: Laura Coates, Chief Ramsey; appreciate your time. We're standing by for another press conference in the neighboring suburb where there was a police shooting last night. A quick break. Ana Cabrera picks up our coverage in just a moment, stay with us.

(COMMERCIAL BREAK)

ANA CABRERA, CNN ANCHOR: Hello, I'm Ana Cabrera. Thank you for being with us. We are listening in live right now to a press conference out of Minneapolis, Minnesota. And this is in Minnesota where another person was involved in an officer involved shooting and car crash that turned deadly. Let's listen in to the mayor.

(JOINED IN PROGRESS)

UNKNOWN: -- several blocks before striking another vehicle. The Brooklyn Center police officers who present at the scene and who were attending to apprehend the driver did respond with an attempt at saving the -- the young man's life.

However, the young man died at the scene. Are Brooklyn Center officers do wear body cams and so there's body camera footage of the event. And we do plan on releasing the body camera footage today. In fact, we plan to do so here. But, you know, I want to say that our hearts are aching right now. We are in pain right now and we recognize that this couldn't have happened at a worse time. We recognize that this is happening at a time when our community, when all of America, indeed all of the world is watching our community that we are all collectively devastated and we have been for over a year now by the killing of George Floyd.

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