What were the differing medical opinions and autopsy findings in George Floyd’s death and how were they used at trial?
Executive summary
The Hennepin County autopsy, performed by Dr. Andrew Baker, listed cause of death as "cardiopulmonary arrest complicating law enforcement subdual, restraint, and neck compression" and classified the manner as homicide—findings Baker repeatedly defended in court [1] [2]. Defense experts countered that Floyd’s underlying heart disease, acute intoxication with fentanyl and methamphetamine, and other medical issues could have been the proximate cause of death, and those competing medical narratives were a central battleground in both the state and federal trials [3] [4].
1. The autopsy: what Baker found and wrote
Dr. Andrew Baker’s autopsy report documented an enlarged heart, coronary artery disease, evidence of drug use, pulmonary edema, and a positive postmortem nasal swab for COVID-19, but concluded that Floyd’s heart and lungs stopped while he was being restrained and compressed by police—a conclusion Baker termed homicide, a medicolegal classification that indicates death caused by another person, not a criminal verdict [1] [3].
2. Prosecution experts and the "low oxygen" narrative
Prosecutors relied on the autopsy and independent experts who testified the primary mechanism of death was hypoxia—an inability to get enough oxygen—caused by the restraint and positioning with Chauvin’s knee on Floyd’s neck and back, and that, absent the police interaction, Floyd would not have died that night [5] [2].
3. Defense experts and alternative medical theories
The defense advanced alternative explanations: that a fentanyl level described in some records as “pretty high” and the presence of heart disease and narrowed arteries could have precipitated a fatal arrhythmia or cardiopulmonary collapse, and thus that restraint was not the direct cause; defense lawyers raised these points to create reasonable doubt about causation [4] [3].
4. Disputed forensic details—fentanyl, pulmonary edema, and postmortem considerations
Experts disagreed over the role of drugs and lung findings: autopsy materials noted pulmonary edema and an elevated fentanyl measurement that some described as capable of causing pulmonary edema, but Baker and prosecution witnesses maintained that neither fentanyl nor heart disease directly caused the restraint or neck compression and thus were contributing but not primary causes [4] [2]. The defense emphasized postmortem redistribution and interpretation complexities around toxicology and tissue findings to challenge the weight of those measurements [4].
5. How the autopsy and opinions were used in court strategy
Prosecutors put Baker and supporting clinicians on the stand to anchor a timeline and a medical causation chain that linked the restraint to hypoxia and death, while defense counsel cross‑examined Baker aggressively—questioning methodology, potential pressure to list neck compression, and alternative mechanisms—to erode his exclusivity on causation and suggest other plausible causes such as preexisting cardiovascular disease or drug intoxication [6] [7] [8]. Jurors also heard pulmonology and critical‑care testimony that echoed the autopsy’s emphasis on oxygen deprivation, strengthening the prosecution’s causal narrative [5].
6. Weight, limits, and competing agendas in the medical testimony
Medical testimony in the trials showcased real forensic ambiguity: the autopsy report is definitive in its medicolegal classification but acknowledges contributing factors [1], defense experts stressed alternative physiologic pathways, and experts for the prosecution framed restraint as the trigger for irreversible hypoxia—each side had an incentive to elevate evidence favorable to its legal theory, and reporting of the autopsy at times simplified or conflated medicolegal terms with criminal culpability [6] [3].
7. Bottom line for causation at trial
Ultimately the trials turned on whether jurors accepted that the restraint-induced asphyxia was the proximate cause of death over competing causes; the prosecution’s use of the autopsy and corroborating expert testimony to make hypoxia the primary mechanism was decisive in the state conviction and in framing the federal civil‑rights cases, while defense medical testimony served to introduce doubt about fentanyl and cardiac disease as plausible, contributing causes [2] [5].