Hi Dr Bernard here.
In my opinion, the things listed in George Floyd’s toxicology report by Hennepin
County, absolutely do not absolve the officers.
The reason I bring the toxicology report up right now in 2020, is because the report will
get brought up in the trial of the officers.
And, after digging deeper into the report, it confirms what the video shows- that George
Floyd died at the hands of the now former officers.
This is an educational video about not just the toxicology report, but also the things
that are listed on it.
On Memorial Day May 25th 2020
George Floyd bought a pack of cigarettes from Cup Foods.
East 38th and Chicago Avenue.
Minneapolis.
It was just before 8pm.
The employees of the store went to George’s vehicle after he made the purchase and asked
him to return the cigarettes because they believed the $20 bill he used to pay for it
was counterfeit.
He refused.
They called the police.
On the 911 call, they reported that George was “awfully drunk” and “not in control
of himself.”
That’s not out of the ordinary on a Memorial Day weekend.
On arrival of the police, George was in a vehicle with another person.
The police approached and confronted them.
An observer sitting behind the car, recorded the encounter.
It ended with George in handcuffs.
He was placed against a wall, sitting down.
He was then helped up, and brought to a police car, where on camera, he stumbles.
Police get him back up.
More police arrive.
As they struggle to get him into the police car, outside observers record 4 officers huddled
over George.
This culminated to the knee on neck image.
8 minutes 46 seconds, as George plead to the officer “I can’t breathe,” as his face
becomes purple, and he falls unresponsive.
This was in addition to a pressing down on George’s back, and multiple pleas from the
observers for the officers to let off.
On arrival of the ambulance, video records show an unresponsive George Floyd being put
onto a stretcher.
An hour later, George Floyd was pronounced dead in the emergency room.
An autopsy was done by Hennepin County the next day.
It’s good that the family requested a second independent autopsy.
But the second autopsy didn’t get a second toxicology report.
I’m not sure if they could do a repeat one because original samples can degrade over
time.
There’s also some misunderstanding circulating around about this report.
The medical examiner said straight up, Homicide.
He died at the hands of the officer.
So lets start from the top.
The title reads:
Cardiopulmonary arrest complicating law enforcement subdual, restraint, and neck compression.
Cardio means heart, pulmonary means lung.
Arrest meaning that the system of the heart and lungs has stopped functioning.
Cardiopulmonary arrest is not a heart attack.
Keep that distinction in mind.
Heart attacks are called myocardial infarction which means “heart muscle dead tissue from
blockage of blood supply.”
Cardiopulmonary arrest could be that the heart actually stops beating, or it could be something
like the heart shakes in place and doesn’t actually pump blood anywhere, because something
is wrong.
In George Floyd's case, something was wrong.
How did his Cardiopulmonary arrest happen?
Well, nothing traumatic on his neck and his back.
But "trauma" here, means something of a high impact, blunt force or something like a cut.
But we have video evidence of what happened.
Nothing hit him in a way that would cause a bruise there.
He wasn’t squeezed by hands as to cause contusions.
The officers laid weight on him.
They didn’t slam it on him, so yeah, you’re not going to see bruises.
Once the pressure is off, you might not see any marks.
And again, it wasn’t just his neck, there was someone also pressing down on his back.
And not back of his legs.
Back of his chest.
They didn’t find a bruise from what happened, they have someone who’s not alive anymore.
Both reports also say George Floyd had atherosclerosis.
This means that blood vessels that provide blood to his heart were narrowed.
A heart attack is when these blood vessels that supply oxygen to the heart, get clogged
and blocked.
This means oxygen can’t get to the heart muscle.
Muscles need a lot of energy so they can contract.
Oxygen helps help fuel that energy, and it provides a way to clear out waste products
when that energy is burned.
Circulating blood clears it all out.
Without oxygen and without blood flow, muscle tissue can’t function.
It will die.
That’s a heart attack.
The report says some of Floyd’s heart arteries were narrowed by 75% up to 90%.
The category for this is severe.
But he didn’t die from a heart attack.
He died from cardiopulmonary arrest.
Again, 2 different things.
George Floyd tested positive for coronavirus.
Once on April 3rd 2020.
And again post-mortem.
But, it looks like he was asymptomatic.
COVID can cause someone to stop breathing, but he didn’t have signs of being sick from
COVID.
You can have the virus and not be sick, so it doesnt look like that’s what caused the
cardiopulmonary arrest either.
So now we get to the toxicology part.
The report says they got the samples for testing about 30 minutes before time of death.
And what do the results say?
Theres 9 compounds that are listed.
This doesn’t mean that George Floyd took 9 different drugs.
Some of these are metabolites.
That is, you take something, and it gets broken down.
So in reality, there’s 5 unique drugs on this list.
Lets knock out the easy stuff.
Caffeine?
I had a cup of coffee this morning, I have caffeine in my blood.
Cotinine is a metabolite of nicotine.
The man just bought a pack of cigarettes.
Cigarettes have nicotine.
THC is from pot, along with breakdown products.
So then, fentanyl.
What is fentanyl?
It’s a synthetic opioid.
If you’ve heard about the American opioid epidemic, fentanyl is a big contributor.
An opioid interacts with the same structures in the body as morphine, which is from opium.
Fentanyl is 50-100 times more potent than morphine, meaning you only need 1/100th of
the same dose, to get the same effect.
I know the autopsy says 80-200 times.
The reality is, measuring opioid equivalence is hard, and depending on what endpoint you’re
going to base it off, the number is different.
And what effect do you get from an opioid?
They’re pain relievers, but at higher doses they cause the rush euphoria.
Just to give you a sense or proportion, heroin is 2 times more potent than morphine, because
these groups let it cross into the brain easier.
So fentanyl can be 50 times more potent than heroin.
All of this means you take a smaller dose, for the same effect.
The more potent a medicine, the higher chance it is to accidentally overdose.
This is why bad things happen when heroin is cut with fentanyl, because if the user
doesn’t know it’s been mixed, that’s an accidental overdose.
Going down the list, norfentanyl is not an additional drug.
It’s a metabolite of fentanyl, so it’s a breakdown product.
It’s not active.
Same with 4-ANPP.
Your body breaks drugs down so it can get rid of them.
Drugs don’t stay in the body forever.
And the presence of norfentanyl is really important.
We’ll get to this later.
And then methamphetamine.
Anyone who’s older than 25 right now, may have heard of term speedball.
This usually means cocaine and heroin together, but it can be any stimulant, also known as
an upper, combined with a sedative, called a downer.
Cocaine is usually the upper.
It’s a stimulant.
Heroin is usually the downer.
Famous people who accidentally died from overdose in the 70s through the 90s, often died from
speedballs.
And how does that work?
Well, this brings us to what an opioid overdose does.
Being a sedative, or downer, means that opioids cause respiratory depression.
It means in large doses, it affects the parts of the brain that control breathing rate.
Large enough dose, means you stop breathing altogether.
You stop breathing and heart stops beating, then it’s cardiopulmonary arrest.
Do you see how this will get brought up in the court case against the former officers?
Did George Floyd take enough of a dose to stop breathing?
I dont think so, because we see him responsive on camera.
If you’ve seen an opioid overdose, those people are chin to chest, nodding off, and
that wasn’t George as we saw it on video.
The way opioids distribute in the body usually peaks fairly quickly, and we have him on camera
for some time beforehand.
Speedballs in America aren’t as common as 30 years ago.
More common now is the combo of fentanyl and methamphetamine.
They’re called goofballs but there’s probably other names for it now.
Goof is because meth causes more cognitive changes than cocaine, despite them both being
stimulants.
So why is this more popular now?
Well, heroin is made from morphine.
To get morphine, you have to grow plants.
You don’t need to do any of that with fentanyl.
It’s lab made.
That lab is quicker and you don’t have to take time to grow anything.
Cheaper, quicker to make, and 50 times more potent.
The numbers show that fentanyl is more common now than 10 years ago, whether users like
it or not.
And meth really never went away.
We all heard about it in the mid 2000’s about it being cooked up in some farmhouse
in the midwest.
These underground cooks would use the cold medicine Sudafed, which has pseudoephedrine,
to help make it.
But once states started monitoring all pseudoephedrine sold at pharmacies, it kinda phased out production
in the midwest.
Now it gets shipped in.
So what does this have to do with George Floyd?
One of the points that’s been coming out about his autopsy is the 11 nanogram per milliliter
level in his blood.
Nanogram per milliliter is a concentration unit, so for any volume of blood that’s
pulled, find the mass of fentanyl in it.
There’s people saying this level is potentially lethal.
And they’re right, but remember opioid overdose causes one to stop breathing.
For the other drugs, nothing appears to be extraordinarily high.
How did George Floyd’s Cardiopulmonary arrest happen?
It’s because he couldn’t breathe.
So some might try to frame it that the fentanyl alone caused him to stop breathing, independent
of having a knee and someone’s bodyweight pushing down on his neck and back.
But no, that’s not right.
Again, the fentanyl ALONE didn’t cause him to stop breathing.
And here’s why.
George Floyd was a big guy.
The report says he was 6 feet, 4 inches tall, but other sources say 6 feet 6 inches.
He was 223 pounds.
Either way, he wasn’t obese by body mass index, and he was close to his ideal body
weight, which is calculated from his height.
So he likely didn’t have a lot of excess fat tissue on him.
This brings us to an idea called Lipophilicity.
Lipo meaning fat and phlilc meaning affinity for.
Fentanyl is lipophilic, meaning it dissolves in fat.
What does that mean?
Within 5 minutes of entering the bloodstream, 80% of the fentanyl dose leaves the blood
and enters the organs.
After this, the fentanyl will distribute from the organs, into fat tissue, where it slowly
releases back into the blood.
If George Floyd wasn’t obese, then he might not have as much fat tissue holding on to
the fentanyl.
This could mean he’d have a higher level in his blood compared to someone who has more
fat tissue.
One study that looks back at 500 fatal fentanyl overdoses in 2016 New Hampshire shows fentanyl
levels in the blood had a range from 0.75 to 113 ng / mL with an average of 10.
That’s a wide range.
Other studies have shown a higher average of around 18 ng / mL.
Keep in mind that’s the average.
I saw some people confuse mean, which is the average, with median.
They’re different values.
And also, you’re going to see ranges.
This is retrospective data.
It’s looking back in time.
You cant control for all variables, all other things equal.
So it’s subject to selection bias.
You’re not wrong if you say the level is elevated and within range of some of these
studies, but you’re also not looking at the video evidence— that George Floyd wasn’t
nodding off on fentanyl.
Someof these studies didn’t divide up the data to account for, body weight, obesity
which would affect how fentanyl is distributed in the body.
Remember, it’s lipophilic They didn’t account for male or female(*some did account for this but a reported mean in Results section of these studies are all-comers), men have more
water in their body as a percentage than women.
Elderly generally have higher bodyfat percent than the young on average.
Did the study divide the data based on kidney function, which decreases as you get older.
Kidneys are important for urinating out the breakdown products of drugs.
Liver function can also get worse if you have prior disease.
Patients who have opioid use disorder are at risk of hepatitis because of things like
needle sharing might happen.
And the liver is what breaks down fentanyl.
So without controlling for these, you may get a wide range of levels IN the study, and
BETWEEN studies.
Where did they pull the sample?
And when did they pull the sample?
If it was a long time after the overdose, and the person had a lot of fat tissue on
them, these are details that may change the measurements from one person to another.
So this brings us back to the original description.
On the 911 call, the store owners reported that George was “awfully drunk” and “not
in control of himself.”
He wasn’t unconscious.
He wasn’t nodding off on video, he didn’t have his chin to his chest and turn cold like
one would from an opioid overdose.
In medicine, you have to look at the patient after you read a lab number.
11 nanogram per milliliter is in the average reported in some these studies.
It may be high, but maybe not for George Floyd.
Again, he’s not knocked unconscious in the early parts of the video record before hes
on the ground.
Hard to see, but it doesn't look like he's asphyxiated before he’s on the ground.
He can respond to commands.
He can stand up.
He can talk and plead to the officer that he can’t breathe so he’s oriented and
knows hes on the ground in that case.
So yes, assuming the Hennepin County report is verifiable, George Floyd did have fentanyl
in his blood.
It was around the average level reported in retrospective overdose data.
But observing him, he was responsive.
He could follow commands.
He was oriented.
Had nothing additional happened to him after 8pm on Monday May 25th, the total amount of
fentanyl in his body wouldn’t have increased on its own.
The levels would only go down, because the body is breaking it down.
Norfentanyl's presence makes that known.
The report says the measurement was taken just after 9pm, which is more than an hour
after the encounter started.
Without an increase in fentanyl levels from taking another dose, which he couldn’t have
after the encounter started, it’s very unlikely he would have have died from fentanyl.
And speaking of norfentanyl, there’s one more reason is why its presence is important.
Fentanyl can cause something called Wooden Chest Syndrome.
Sometimes it’s called chest wall rigidity.
It’s important that people know about this because it’s one of the reasons why opioid
epidemic is so terrible.
Opioids cause respiratory depression.
But fentanyl is unique in that it doesn’t just cause respiratory depression, it also
tightens the respiratory muscles.
It can compromise the airway by tensing up the muscles, and it can do this at any dose.
We know this, because they use fentanyl in the operating room.
And sometimes fentanyl will cause someone to stop breathing.
Because the muscles are so tight and tense, doctors have trouble ventilating the patient.
They try to push pressure through the chest, but the muscles are so rigid, air has trouble
going in and the person suffocates.
How does wooden chest happen?
Well if it’s affecting the muscles, then it might be acting on the nerves, which send
signals to the muscles.
In the synapse where nerves connect to the muscles, chemicals are used send signals.
In this case, the chemical we’re focused on is called norepinephrine.
When the signal is done, that synapse needs to clear itself so that signals aren’t sent
nonstop.
This means those chemicals need to be pumped back in, or broken down.
It looks like fentanyl stops the synapse from getting cleared.
This means that signals are sent non-stop, continuously stimulating the nerve, and not
letting the respiratory muscles relax.
But, do you know what else causes the release of this norepinephrine?
Methamphetamine.
That’s exactly how meth works.
Meaning, taking both fentanyl AND methamphetamine together, could increase the chances that
someone can not only stop breathing, but they couldn’t even be ventilated even if they
wanted to be, which is why “goofball” needs it’s own distinction as specifically
fentanyl and meth, separate from the generic “speedball.”
But it’s important because Wooden Chest didn’t happen to George Floyd.
And here’s why.
When wooden chest happens, it looks like it appears so quickly after dosing, that many
times, the body didn’t even have time to break down fentanyl before the person dies.
Remember fentanyl leaves the blood quickly to go into the organs, then the fat and muscle.
The nerves are made of around 60% fat, so easy target for fentanyl.
This means if wooden chest happened to him, he might not have had norfentanyl in his blood.
But he did and that means that Wooden Chest likely didn’t happen.
SO why couldn’t George Floyd breathe?
It’s not because of Wooden Chest.
The fentanyl alone in my opinion, didn’t do it either.
The fentanyl and methamphetamine combo negated some effects of each another, as they’re
opposites.
But they elevated the toxicity of each other.
The lab numbers are in range, but remember, look at the patient.
The man was responsive, and oriented.
He was not nodding off.
Putting him in a compromising position on the floor.
Pressing bodyweight down on his back and neck, while he’s stressed due to a confrontational
situation, which would increase his need for oxygen, were the cause of death.
So again, I bring this up because I see some misunderstanding online about the report.
I had to step back and look deeper myself because the pivot of heroin to fentanyl has
happened so quickly in the United States over the last 5 years.
I put the references in the description below, but please keep in mind if you want to read
them, they sit inside a clinical and scientific conversation that needs some background context
to understand.
And clinical context, like looking at the patient after reading a lab number is not
something you “look up” online, as obvious as doing it sounds.
It’s one of the first things that students miss.
All of this is going to get brought up in the charges against the officer, so we have
to make sure the record is clear.
There might be more information to come out later, I dont know.
But the video from May 25th 2020, speaks for itself.
George Floyd shouldn’t have been put in that position to begin with and for that long,
regardless of whatever can be found in his blood by lab test.
None of this should have happened and I hope we never have to see anything like this ever
again.
And I think we should all work together to make sure that something like this never happens
again.
Take care of yourself.
Thank you so much for watching.
Be kind to one another.
And be well.