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"I think the honest truth is we don't know exactly why it is that Mr. Gray died," he told the public hearing into Gray's death.

"I think the only thing that we can say for sure is that he wouldn't have died on the day he did had it not been for his interaction with police," the pathologist said.

Orde testified that he found Gray's death was most likely explained by cardiopulmonary arrest, complicated by police actions to restrain the man, who had shown signs of "acute behavioural disturbance" before he died.

Orde said the police actions involved pepper spray, blunt-force injuries, neck compression and handcuffing behind the back in a forced, face-down positioning.

It's difficult to weigh which factors may have played a greater role, he said.

"In essence I'm saying that he, his heart stopped beating, that he stopped breathing, and I think that it came about as a complication of this scenario in which he found himself at the time he came to die," including his restraint by police, Orde said.

Still, Orde pointed specifically to neck injuries as potentially "operative" in having a significantly negative effect on the functioning of Gray's body. 

"All I can say here is that there were certainly signs of injury to the neck that could potentially reflect the application of lethal force, but they needn't necessarily be the cause of this individual's death," he said.

"The science behind how neck compression or blows to the neck brings about death is one that remains … to some extent unanswered," he said. "All we know is that people who have their necks compressed sometimes end up dead."

Orde also said that while some earlier studies were unclear about the potential significance of someone being held face down, later research has shown "quite persuasively" it can potentially have adverse effects on cardiorespiratory function.

"But I think the key takeaway message is it's probably the combination of extreme exertion and the prone positioning" that can ultimately lead to death, he told the hearing.

Orde said he had noted that Gray's strange behaviour that day may have been a factor in bringing about the situation in which he died.

Police had originally been called to respond to a complaint about a man who sprayed a woman with water from her garden hose.

The hearing has heard Gray had earlier abandoned his work vehicle, and witnesses described seeing him waving his arms, shouting and removing his clothing.

The hearing called by the Office of the Police Complaint Commissioner of B.C. is looking into the actions of seven Vancouver officers in Gray's death.

A police discipline authority cleared all the officers of misconduct in 2024.

However, police complaint commissioner Prabhu Rajan has said there was still "meaningful uncertainty as to what happened."

During Monday's hearing, Orde described the multiple injuries he saw during his examination of Gray's body.

The injuries included bruising apparently caused by strikes from a rigid object, a fractured eye socket and nose, and possible dislocation of Gray's jaw, Orde said.

There was also bleeding in Gray’s brain, Orde said. It was a small volume, "relatively minor," he said, but it likely reflected blunt-force injury to Gray’s head.

In 2023, a British Columbia coroner's inquest heard Gray was left with injuries that included a crushed voice box and ruptured testicles.

The inquest found Gray's death was a homicide, although coroner Larry Marzinzik told the jury the term is neutral and does not imply fault.

Several police officers told the inquest they believed Gray had been experiencing "excited delirium" at the time of the struggle, characterizing it as a life-threatening medical emergency.

Orde said Monday that the term "delirium" refers to disordered brain function and it could arguably be used in Gray's case, he said. 

"The problem with delirium, it implies a medical process that we understand, and in this case I don't think we do understand the things that might have been at play."

While excited delirium has been used in the past as a cause of death in its own right, the pathologist said recent studies have "shown pretty clearly that there's really minimal evidence" it can independently bring about death.

Orde also testified at the coroner's inquest, saying he believed Gray's body would have been working in overdrive in the struggle with police.

People who are forcibly restrained on their stomach are at greater risk of death, especially when their body has increased physiological demands, Orde said.

At Monday's hearing, Chris Considine, counsel for the police complaint commissioner, asked Orde what might be done to prevent such deaths and whether police should receive certain training on the use of neck restraints or prone positioning, or watching for signs of extreme exertion.

Orde said he isn't an expert in those areas, but added the less restraint that can be applied, the better, from a physiological perspective.

Under cross-examination by Glen Orris, counsel for one of the seven officers involved in the beating death, Orde agreed Gray's heart was "a little bit enlarged," but he didn't place much weight on it as a contributing factor in the death.

This report by ºÃÉ«tvwas first published March 9, 2026.