A chief medical examiner and national expert on forensic pathology said Thursday that Elijah McClain’s manner of death is homicide.
As the only witness called to the stand, Dr. Roger Mitchell spent the entire day giving testimony at the trial of the two officers charged in McClain’s death in 2019.
Both Mitchell and Dr. Stephen Cina, the Adams County contracted pathologist who performed McClain’s autopsy and testified on Tuesday, agreed that the cause of McClain's death was “death by ketamine after forcible restraint.”
“I agree with Dr. Cena 100 percent in his cause of death,” Mitchell said.
But where Cina stopped short of determining the manner of death, Mitchell did not equivocate on Thursday. He was asked directly by a prosecution attorney what the proper classification of the manner of death of Elijah McClain’s death would be.
“Homicide,” Mitchell said.
Camera footage on repeat
The large part of the testimony today was Mitchell walking the jury through the footage from the body worn police cameras identifying points of potential hypoxia, which means someone isn’t taking in enough air, and aspiration, inhaling fluids such as vomit into the airway. He pointed out moments in the footage where he’s able to see McClain’s condition.
“He's having this dialogue and this heavy breathing is the residual hypoxia, the acidosis is building up and then later on you can see that he has a conversation,” Mitchell explained. “At that point he's trying to shift himself. He vomits again, aspirates again and at that point, that larger aspiration moment, he really starts going downhill from there.”
Mitchell details what he perceived as McClain’s worsening condition as the minutes tick by in the footage.
"At this point in his trajectory towards death, anything that's going to stop him from being able to gain breath, be able to clear his airway is not helping him. It is doing the opposite,” Mitchell said. “And so watching these videos or watching the hours that I've watched, I'm seeing this as this is really terminal. This is right before he gets the ketamine."
In addition to the repeated playing of body-worn camera footage, the prosecution also submitted photos from McClain’s autopsy. The attorney called them “graphic” — as he showed them to the jury and witness. The pictures showed the broken blood vessels in McClain’s eyes that Mitchell attributed to the carotid hold.
The pictures also showed scrapes and abrasions and what Mitchell called blunt trauma to McClain’s neck.
Using a laser pointer, Mitchell pointed out that black and purple spots on his lungs showed signs of aspiration. McClain had vomited into the ski mask he was wearing and aspirated.
“His lungs had what we call a leopard pattern of the lungs that showed that he aspirated both blood and fluid,” Mitchell explained. “And then, sections of that lung were looked at under the microscope and under the microscope we saw evidence of aspiration at the cellular level.”
‘Excited delirium'
The term “excited delirium” also came into play on Thursday. According to the National Library of Medicine, excited delirium is characterized by agitation, aggression, acute distress and sudden death, often in the pre-hospital care setting. But Mitchell disagreed.
“I don't believe that excited delirium exists as a cause and manner of death,” Mitchell told a defense lawyer.
He continually pointed out in the police footage instances where McClain doesn’t fit the condition of “excited delirium", and called attention to a part of the footage of McClain where he yelled "ow, ow."
“He's communicating with law enforcement. He's clear on what's going on with him. He's pleading in his case. But one of the big things is at the end where he says he responds to pain,” Mitchell said. “If we believe this notion of excited delirium, one of the things with excited delirium is that you're impervious to pain. And that response objectively tells us that he's not impervious to pain — he's responding to painful stimuli that's being placed upon him.”
Defense points to advocacy work
The defense, in many ways, tried to discredit both Mitchell and his testimony.
A defense attorney for Roedema compared Mitchell’s 2,000 performed autopsies to Cina’s 8,500. Mithcell was also questioned on being an advocate physician and referred to three questions he answered on cirticalvalues.org.
“You were asked specifically about you being an advocate physician, and isn't it true that you stated that you talked about coming to Howard University to teach a younger generation of Black doctors the importance of being an advocate physician and the importance of using our craft for the true liberation and freedom of our people,” Cisson asked.
Mitchell responded: “As a physician, we advocate for all of our patients, our individual patients, and then our collective patients.”
Cisson also mentioned the excerpts from Mitchell’s newly released book “Death In Custody,” in which Mitchell described Black people killed by police as a public health crisis. Mitchell also said that he had never spoken out on a white person dying in police custody.
Eventually, Cisson asked Mitchell if he agreed with one of the first witnesses, the expert pulmonologist Dr. David Beuther, that airway aspiration was evident and severe but ketamine was the primary cause of McClain’s death. The defense has continuously tried to make the case about the ketamine — not the officer’s actions.
Mitchell agreed to Cisson’s assertion: “Vomiting and subsequent airway aspiration likely led to significant impairment in lung function and decreased pulmonary reserve, which significantly increased the risk of respiratory depression and complications from administration of ketamine.”
But, he didn’t agree with Cina’s report that law enforcement were not responsible for McClain’s suffering from hypoxia, acidosis and aspiration that led to his death in 2019
What happens Friday
Mitchell is expected back in court to wrap up the cross-examination and redirect. Judge Mark Warner asked the jury to arrive at the courthouse by 8:30 a.m. Friday. The pathologist is the last witness for the prosecution, so they may rest their case tomorrow. The defense may call additional witnesses, like their own use-of-force expert, before they too rest.
Closing arguments are expected next week.
