It’s impossible to say with certainty exactly what triggered the fatal heart attack Abdirahman Abdi suffered on July 24, 2016, but Abdi’s strained body could have reached that “point of no return” before his interaction with two Ottawa police officers outside his home, a top forensic pathologist testified on Thursday in Const. Daniel Montsion’s criminal trial.

Abdi experienced multiple physical stressors before and during the violent struggle with police outside 55 Hilda St. three years ago, and any one of those stressors, on their own, could have been enough to aggravate his seriously diseased heart and set off a cardiac arrest, according to Dr. Christopher Milroy, who examined Abdi’s body.

And court heard on Thursday that Milroy told the police watchdog that investigated the Ottawa man’s death that proving causation in Abdi’s case was complex, months before charges were laid against Montsion.

Abdi’s heart was already in critical condition due to severe and undiagnosed blockages of two main arteries that supplied blood to his heart, according to Milroy.

“He could have dropped dead at any time,” Milroy said under cross-examination by the defence on Thursday.

Montsion, one of the two constables involved in Abdi’s arrest nearly three years ago, has pleaded not guilty to charges of manslaughter, assault and assault with a weapon in Abdi’s death. At the outset of the trial, the Crown said it intended to prove that Montsion’s “unjustified assault” on Abdi contributed to his death.

Thursday marked Milroy’s third day on the stand in Montsion’s trial. During his daylong cross-examination on Thursday, defence lawyer Michael Edelson built on testimony Milroy had given over the previous two days.

Milroy has explained that factors like physical exertion, struggle, pain and emotional stress like fear can increase chemicals in the body called catecholamines, including adrenaline. Increased adrenaline in the body – or an adrenaline rush – can put a person with a compromised heart at an increased risk of suffering cardiac arrest, he said.

A cardiac arrest triggered in this context may not occur until up to 10 minutes after the height of the adrenaline rush, Milroy told the court, citing evidence from scientific studies.

The morning of July 24, 2016, Abdi was involved in a physical struggle at a Hintonburg coffee shop after he allegedly committed several sexual assaults, and then Abdi ran away from Const. Dave Weir, who tried to arrest him outside the cafe.

About four minutes later, the struggle at Hilda Street began, during which Montsion and Weir dealt a number of blows to Abdi’s face and body. Abdi stopped moving about two minutes after Montsion threw his first “distraction blow,” Edelson suggested.

All of those factors – the struggle, the running and the punches – would have contributed to a surge in Abdi’s adrenaline, according to Milroy. But Milroy said he can’t “separate them out” and definitively say which factors specifically precipitated his heart attack or not.

“It’s possible there was a sufficiency of the stress effects on his heart … that can occur just from physical exertion. It doesn’t require a struggle, nor does it require injuries,” Milroy said on Thursday. “But the fact that there are all of these elements means that’s it’s not possible with any certainty to include or exclude them.”

Edelson raised that Milroy initially told the Special Investigations Unit (SIU) it had “a causation issue” back in mid-November 2016. The defence then played a recording of a follow-up phone interview with Milroy that an SIU lawyer conducted on Jan. 17, 2017.

“Can you say when the cardiac arrest was going to become inevitable? And the answer is no, you can’t, in my opinion,” Milroy is heard saying in the audio of the phone call.

“If you’ve reached the point where you’re on the cusp of a heart attack, additional blows aren’t going to make a difference. Is it possible that you haven’t quite reached it and the blows just add a bit more? Yes, it is. That’s why I’ve put them in the cause of death. But equally, I recognize there is a causation issue in the sense of what parts of those were necessary, as opposed to were just potential contributors.”

The SIU charged Montsion in March 2017.

After playing the audio, Edelson proffered that Abdi could have reached “the point of no return” physiologically before Montsion arrived on scene at 55 Hilda St.

“That’s possible,” Milroy answered.

“The effects of the catecholamines and the other exertions could have occurred before we see the police officers – and I use that plural deliberately – before we see the police officers in the video at 55 Hilda. And that was what I was alluding to,” the pathologist continued minutes later.

Following Edelson’s cross-examination, Crown prosecutor Roger Shallow asked Milroy whether Abdi’s facial injuries alone, excluding any other preceding factors, could have been sufficient to trigger a cardiac arrest.

“I have seen cases with people with existing heart disease who have been struck in this way … that has been a sufficiency to lead them into cardiac arrest,” Milroy responded.

Abdi died in hospital on July 25, 2016. Milroy determined that Abdi’s primary cause of death was hypoxic brain damage, as a consequence of his cardio-respiratory arrest.

Milroy’s post-mortem examination report said the medical cause of Abdi’s cardiac arrest was his underlying heart disorder, and listed “physical exertion, struggle and facial injuries” as contributing factors.

Proceedings will resume the week of June 17.

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