Debate is quietly raging within the medical and law enforcement communities about a diagnosis first identified more than 160 years ago which more recently has become associated with the deaths of people in police custody, many of whom were involved in physical altercations with officers or shocked with Tasers before they died.
The diagnosis of “excited delirium syndrome” was initially linked to psychiatric patients during the late 1840s, but was little heard of until the 1980s when authorities in Miami began using it to explain deaths linked to cocaine use, mental illness and confrontations involving the police. Officials claim the syndrome, a rare neurological condition, turns normally peaceful individuals into raging, violent attackers.
Since 2002, according to records from the Miami-Dade Medical Examiner’s Office, 29 people have died in the South Florida city due to excited delirium; of those, nine were Tased and two others, who were also stunned with Tasers, were found to have had contributing causes – cocaine intoxication or “psychosis.”
Critics contend that excited delirium syndrome is not grounded in science, but instead based on shaky medical research that is used to cover up aggressive police tactics.
“The data supporting it is tenuous,” said Indiana University cardiologist Dr. Douglas Zipes, who testifies in court on behalf of clients suing Taser International. “I think excited delirium is often used as a catch-all to explain in-custody deaths.”
The American Civil Liberties Union suggests that excited delirium is cited as a cause of death mainly to cover up the use of excessive force by law enforcement. Police and medical examiners “are using ‘excited delirium’ as a means of whitewashing what may be excessive use of force and inappropriate use of control techniques by officers during an arrest,” Eric Balaban, senior counsel with the ACLU’s National Prison Project, told NPR during a 2007 interview.
San Francisco cardiac pathologist Dr. Steven Karch, who has extensively studied the syndrome, disagrees. “It’s utterly real. It’s a not a made-up disease at all,” he said. “It is a first-class medical emergency.” Karch explained that most cases of excited delirium involve the police because those who suffer from the syndrome exhibit violent outbursts.
“They’ve come up with the concept that the individual is so excited they bring on their own death,” countered Dr. Zipes. “That you can be excited is without question. That you can be delirious is without question. But the concept of this being a syndrome causing death is incorrect and false.”
Excited delirium has been described as a genetic abnormality of the brain that might never reveal itself were it not for triggers such as stress, mental illness or chronic abuse of hardcore drugs, according to neurology professor Deborah Mash with the University of Miami’s Brain Endowment Bank. Mash directs a project on excited delirium that maintains it “is a medical emergency that presents itself as a law enforcement problem,” and claims people who suffer from the syndrome “exhibit superhuman strength and are impervious to pain.” Mash said an overheated body is a telltale sign among people who have died due to excited delirium.
“Hyperthermia is often a harbinger of death in these cases,” she stated. “You get hot, you reset your core body temperature, you’re going to die. It means you’re going to collapse. That’s why the body temperature is an important bio marker of the condition.”
Dr. Vincent Di Maio, the former chief medical examiner for San Antonio, Texas and author of a book on excited delirium, said the brain sends pulses to nerves which cause the heart, often weakened by years of drug abuse, to beat irregularly. Next, the victim often begins shouting and becomes aggressive, acting panicked and paranoid and exhibiting extreme strength. Dr. Di Maio added that when police are invariably called to restrain the victim, the flood of chemicals in their body becomes greater due to increased stress, and the person collapses and dies.
“Essentially, to put it simply, they’re dying of an overdose of adrenaline,” he said.
The ACLU’s Balaban doesn’t buy that explanation. “I know of no reputable medical organization – certainly not the AMA (American Medical Association) or the APA (American Psychological Association) – that recognizes excited delirium as a medical or mental health condition,” he noted.
“[The] APA has no official position on the notion of ‘excited delirium’ as a mental health diagnosis,” APA spokesman Michael Shulman told PLN in a March 9, 2016 email. “We are, however, aware of an ongoing debate within the professional literature about such a diagnosis. Licensed practicing psychologists rely on peer-reviewed research and diagnostic manuals such as the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, to diagnose mental conditions. To the best of our knowledge, ‘excited delirium’ is not included in the DSM-5, the latest edition of the aforementioned manual. Ultimately, more research on the concept of ‘excited delirium’ needs to be undertaken.”
Mash has defended her position on the syndrome. “It’s definitely real,” she insisted, “and while we don’t know precisely what causes this, we do know it is the result of a neural chemical imbalance in the brain.”
Fueling the controversy further, excited delirium syndrome is accepted by the National Association of Medical Examiners and the American College of Emergency Physicians. The syndrome is listed as the cause of death for about 250 people each year in the United States, though some experts say that number could be as high as 800 annually.
Another issue involves the role that Taser stun devices play in excited delirium deaths that involve law enforcement officers. Amnesty International, a long-standing critic of Tasers, has reported that since 2001 at least 550 people died after being Tased by police. [See: PLN, Oct. 2006, p.1; June 2005, p.1]. The company that manufactures the stun devices, Taser International, has been at the forefront of educating police about excited delirium as a medical condition.
“We’re not telling departments [that] excited delirium is always the cause of death following a Taser application,” said company spokesman Steve Tuttle. “We’re simply pointing out the facts: that excited delirium is an issue out there, and they need to treat this as a medical emergency if they see these signs.” Each year, he said Taser International “sends hundreds of pamphlets to medical examiners explaining how to detect excited delirium. Taser also holds seminars across the country, which hundreds of law enforcement officials attend.”
Such tactics infuriate the ACLU’s Balaban. “If police officers are being trained about this condition known as excited delirium, and are being told the people suffering from it have superhuman strength, and [these people] are being treated as if they are somehow not human, it can lead officers to escalate situations.”
In February 2015, Fairfax County, Virginia jail prisoner Natasha McKenna, 37, died several days after she was Tased four times while handcuffed by deputies. Even though she weighed just 130 pounds, it took six guards to restrain her. Three months later the medical examiner ruled the official cause of death was “excited delirium associated with physical restraint including use of conducted energy device.” Bipolar disorder and schizophrenia were listed as contributing factors.
Police in Miami initially claimed Rudy Eugene had used a designer drug known as “bath salts” before he removed his clothes, ripped up a Bible, and pounced on a sleeping homeless man and began to eat his face in a widely-publicized 2012 incident. An official with the Fraternal Order of Police said Eugene exhibited symptoms of excited delirium, though the cause of his death was not in doubt – he was shot dead by a responding police officer. A toxicology report later determined that he only had marijuana in his system.
Another alleged Miami drug abuser, Camilo Guzman, 28, took off his clothes and climbed on the roof of a nursing home in 2013 before attacking officers. One shot him with a Taser and Guzman died a short time later. His mother, Delia Nuñez, disagreed that her son’s death was caused by excited delirium.
“I don’t think he died of that,” she said. “If they hadn’t Tased him, he wouldn’t have died. But how can I dispute it?”
Some critics simply don’t subscribe to the notion that excited delirium is a neurological condition exacerbated by drug use and psychosis.
“It’s junk science to a lot of board-certified cardiologists,” observed attorney David Gold. “Some people might buy it, especially with cocaine use. But when the toxicology comes back clean?”
“They want the victim to be looked at as the cause of his or her own death,” added Dawn Edwards with the Ella Baker Center for Human Rights, a non-profit criminal justice watchdog organization based in California. “The bottom line is that these people are dying at the hands of, or in the custody of, police officers.”
The ultimate paradox of the controversy might be that some police departments have started training officers in how to diffuse volatile situations. For example, police in Dallas, Texas are trained to summon an ambulance when they come across someone displaying symptoms of excited delirium, and to defuse situations involving people suspected of being mentally ill.
Whether or not excited delirium syndrome is a legitimate medical condition, such tactics are more likely to result in fewer deaths when people with mental health problems, or who are under the influence of drugs, have confrontations with law enforcement officers.
Sources: Miami Herald, www.npr.org, www.miamiherald.com, www.washingtonpost.com, www.slate.com, www.exiteddelirium.org
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