Abdirahman Abdi died because he had a “significant” and unknown underlying heart condition that put him at risk of cardiac arrest “at any time,” according to Dr. Christopher Milroy, the forensic pathologist who conducted Abdi’s post-mortem examination.
But the struggle, physical exertion and “extensive” facial injuries Abdi experienced and sustained during a confrontation with two Ottawa police officers on July 24, 2016, Milroy concluded, were all factors that could have contributed to the fatal heart attack he suffered at the scene.
Milroy took the stand on Tuesday in the criminal trial of Const. Daniel Montsion, who has pleaded not guilty to charges of manslaughter, assault and assault with a weapon in connection with the death of 37-year-old Abdi.
Abdi died in hospital on July 25, 2016. The heart attack starved his brain of oxygen and resulted in irreversible brain damage, according to Milroy. In the post-mortem report he prepared in Abdi’s case, Milroy determined the main cause of death as hypoxic brain damage.
The medical cause of Abdi’s heart attack, Milroy concluded, was “underlying coronary artery atheroma,” which he described as “a hardening of the coronary arteries.” But he determined there were several “mechanisms” that brought about the cardiac arrest, including the “physiological effects” of Abdi’s facial injuries.
Under questioning from the Crown, Milroy told the court he recorded 22 injuries in total when he examined Abdi’s body, but the main injuries were to Abdi’s head and face. CT scans showed Abdi’s nasal bone was fractured into multiple pieces, he said.
“In my experience from injuries, from blows, these were more extensive than I’ve often seen,” Milroy said.
“Typically when I’ve seen a punch, someone who’s been punched … I haven’t seen this extent of fracturing,” he continued when asked again about the nature of the injuries to Abdi’s nose.
When it came to determining Abdi’s manner of death, Milroy classified it as a ‘homicide.’ The pathologist explained both in his post-mortem examination report and in court that the term is a “medico-legal” determination, not a criminal one. In his report, Milroy made reference to “homicide by heart attack,” which he said is an entity recognized in in forensic medicine.
“… Death resulting from fear or fright that is caused by verbal assault, threats of physical harm, or via acts of aggression intended to instill fear may be classified as homicide, as long as there is a close temporal relationship between the incident and the death,” Milroy’s report read.
“In this case there was evidence of struggles with exertion. There were blows and impacts to the body.”
Court has heard Abdi ran away when a police officer tried to arrest him at a coffee shop in Hintonburg on July 24, 2016. The officer chased him on foot for about 250 metres to an apartment building at 55 Hilda St., where Abdi resided. The officer tried to arrest Abdi again in front of the building, but he didn’t comply, court has heard. It was then that Montsion arrived.
Surveillance video footage that has been released to the public — but not admitted as evidence in trial — appears to show Montsion and the other officer punching and kicking Abdi and bringing him to the ground to handcuff him.
Milroy said physical exertion, struggle, “good or bad” emotional stress and “noxious stimuli” like pepper spray are among the factors that can increase a person’s adrenaline, and can “aggravate” or “contribute to” someone going into cardiac arrest.
“The problem with the adrenaline rush is if you have a heart whose blood supply is compromised, you are at risk or at increased risk of it going into a abnormal rhythm,” Milroy told the court.
A forensic and cardiac pathologist examined Abdi’s heart “in detail” and determined he had “severe coronary artery atheroma.” Two of the main blood arteries were “significantly” blocked, according to that pathologist’s examination of Abdi’s heart.
Milroy cited coronary heart disease as “the most common reason people die suddenly in the Western world.” He said many people may not know they have it.
On Tuesday, Milroy also described in detail the injuries that he observed on Abdi’s body. In addition to the fractures on the left and right sides of Abdi’s nose, Milroy documented a swollen right eye, an “extensively bruised” upper lip, an abrasion along the right side of his face towards the jawline and bruising in multiple areas of his body, including the right side of his head. Milroy said some bruises were likely injuries caused by CPR.
Milroy said he did not attend the scene at 55 Hilda St. but saw photographs and videos from the scene provided by the Special Investigations Unit (SIU). Those videos included two copies of surveillance footage captured by a digital video recorder in the apartment building’s lobby. Milroy said he viewed the first video on July 26, 2016 and then a second video, which he described as “a slowed-down version” of the footage, at a meeting at the SIU headquarters on Nov. 15, 2016.
In his report, Milroy wrote that Abdi’s nose “does not appear to make contact with the pavement” when he is brought to the ground in that “slowed down version.”
Montsion’s defence team has yet to cross-examine Milroy. But on the second day of trial, in early February, the defence alleged Milroy had concluded in his draft report that Abdi’s manner of death was an ‘accident’ but then changed his opinion to ‘homicide’ after that meeting with the SIU.
Milroy told the court on Tuesday that he “modified” his report “a little” to produce his final report on Nov. 21, 2016.
Crown prosecutors are expected to continue questioning Milroy on Wednesday morning.
Abdi’s past medical history
On Tuesday, Milroy also noted two areas of Abdi’s past medical history which he said could be relevant to the case.
He said Abdi had hypertension, or high blood pressure, which could “promote the development of atheroma and other heart disease.” Abdi was also prescribed an antipsychotic medication but hadn’t been taking it, according to Milroy.
A toxicology analysis detected no drugs or alcohol in Abdi’s system. On top of that, the description Milroy was given of Abdi’s behaviour the day of his arrest “would support him not being compliant with his medication,” Milroy added.
He also told the court Abdi “may have been on the cusp of developing diabetes.”
“He was arguably right at the border … he may have become diabetic if he’d lived longer,” Milroy said.