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Doctors Abandon a Diagnosis Used to Justify Police Custody Deaths. It Might Live On, Anyway.
Verdell and William Haleck of Utah hold a photo of their son Sheldon, who died after an encounter with Honolulu police in 2015. They filed a civil lawsuit against the officers after his death, which they ultimately lost in large part due to an argument that he had died of 鈥渆xcited delirium.鈥 (Chris Hansen/9News)

Doctors Abandon a Diagnosis Used to Justify Police Custody Deaths. It Might Live On, Anyway.

Brooks Walsh hadn鈥檛 questioned whether 鈥渆xcited delirium syndrome鈥 was a legitimate medical diagnosis before the high-profile police killings of Elijah McClain in Colorado in 2019 and George Floyd in Minnesota in 2020.

The in Bridgeport, Connecticut, was familiar with the term from treating patients who were so severely agitated and combative that they needed medication just to be evaluated.

But it gave him pause when excited delirium 鈥 and not the restraint tactics used by arresting police officers 鈥 was mentioned as a possible factor in the deaths of those two Black men. That鈥檚 when Walsh took a closer look at the American College of Emergency Physicians鈥 , which he and other physicians had relied on to treat such patients, then decided something needed to be done.

鈥淚 was disappointed by a lot of stuff in that paper: the quality of the evidence that they cite and just, frankly, odd language,鈥 Walsh said.

Excited delirium is not listed in the standard reference book of mental health conditions, nor does it have its own diagnostic code under a system used by health professionals to identify diseases and disorders. No blood test or other diagnostic test can confirm the syndrome. Most major medical societies, including the and the , no longer recognize excited delirium as a legitimate medical condition. One of the last medical holdouts, the National Association of Medical Examiners, as a cause of death this year.

But the American College of Emergency Physicians, the medical society representing Walsh and more than 36,000 other doctors, still hadn鈥檛 disavowed its report that gave excited delirium much of its legitimacy 鈥 until this month. On Oct. 12, the group approved a resolution that Walsh co-authored to , removing the only remaining official medical pillar of support for a theory, which despite being based primarily on and racial biases, has played a key role in absolving police of culpability for in-custody deaths.

鈥淭his is the membership of ACEP saying we recognize that this was wrong,鈥 said , an emergency physician at Mount Sinai Hospital in New York City. 鈥淎nd now, as an organization, we need to reckon with our history and try to make up for some of the mistakes that were made and repair some of the damage that we did.鈥

The vote brought some vindication to Verdell and William Haleck, whose son Sheldon died in 2015 after being pepper-sprayed, shocked with a Taser, and restrained. The Utah family lost its civil case against Honolulu police officers, whose lawyers argued the 38-year-old former Hawaii Air National Guardsman had experienced excited delirium. Watching defense experts paint their son as responsible for his own death was excruciating, his parents said.

鈥淲e were right all along,鈥 Verdell Haleck said in response to the ACEP vote. 鈥淣ow our hopes are that the term can never be used again to cause pain and suffering for another family in their pursuit of justice.鈥

And momentum is building. Just before the vote, California became the first state to ban excited delirium as a diagnosis and cause of death on death certificates, autopsy reports, and police reports, as well as in civil court proceedings.

Backers of the emergency physicians鈥 resolution hope such disavowals of the term will lead to better training and greater accountability of paramedics and police when they interact with people in mental health crises.

But it is unlikely the doctors鈥 vote can affect past wrongful death and criminal cases against police. And it remains unclear whether renouncing the 2009 document will prevent defense lawyers in future cases from using similar victim-blaming concepts 鈥 just with alternative terminology.

鈥楾his Drastically Affected Our Lives鈥

Nearly 14 years ago, Patrick Burns, 50, died after sheriff鈥檚 deputies hogtied him and shocked him multiple times with Tasers in Sangamon County, Illinois, according to court documents. A medical examiner concluded the official cause of death was excited delirium.

Patrick Burns, pictured with his daughters Andrea (left) and Ally in an undated family photo, died in 2010 after sheriff鈥檚 deputies hogtied the 50-year-old and shocked him multiple times with Tasers in Sangamon County, Illinois. A medical examiner concluded the official cause of death was excited delirium. But this year, the county coroner changed the cause of death to homicide after the National Association of Medical Examiners decided that excited delirium should no longer be considered a cause of death.(Andrea Burns)

That diagnosis in Burns鈥 death stymied the family鈥檚 lawsuit against the county officers, which ended in a $40,000 settlement in 2015, said Richard Burns, one of Patrick鈥檚 brothers. The label also helped law enforcement create a picture of him as someone who was 鈥渙ut of control,鈥 which ruined his brother鈥檚 reputation, Richard said. 鈥淭hat picture is implanted on who my brother was, and that鈥檚 not the truth.鈥

The term 鈥渆xcited delirium鈥 dates back decades but has never been supported by rigorous scientific studies. Still, the term persisted as some of its early researchers earned money for testifying as expert witnesses in cases involving law enforcement and the company now called Axon Enterprises, which makes the Taser stun gun.

The theory suggested that agitated, delirious individuals were dying not because they had been shocked by stun guns, restrained with chokeholds, or held facedown so they couldn鈥檛 breathe, but because of this unexplained medical condition that could lead to sudden death.

Funding from Taser International, Axon鈥檚 former company name, sponsored some of the research forming the basis of ACEP鈥檚 white paper supporting the excited delirium theory, according to a . The 19-person task force that drafted the 2009 paper included three people who provided paid testimony or performed consulting work for Taser, that report found. KFF 国产精品视频 News called eight of the task force members but none agreed to interviews. Axon executives did not respond to calls or emails seeking comment on the white paper.

That ACEP paper described patients with excited delirium as having superhuman strength, being impervious to pain, exhibiting aggressive behavior, and making guttural sounds. To Walsh and other doctors behind the push to reject the diagnosis, those descriptions reflected age-old racist tropes of Black men as being stronger than white men or being animalistic. The persists in modern medicine and has led to disparities in pain treatment.

Indeed, excited delirium has been cited more often in cases involving people of color. According to , at least 56% of police custody deaths from 2010 to 2020 attributed to excited delirium involved Black and Latino victims. attributed to excited delirium also found they overwhelmingly occurred when people were being restrained.

Yet the authority of the esteemed doctors group and its position paper helped cement an alternative cause of death that defense attorneys for police argued in court. And now, it鈥檚 likely too late for families who lost cases based on an excited delirium defense. Even with ACEP鈥檚 disavowal, courts may be reluctant to reopen resolved cases, said Jim Davy, a civil rights lawyer in Philadelphia.

In June, just months after the National Association of Medical Examiners decided excited delirium should no longer be listed as a cause of death, the county coroner changed Patrick Burns鈥 official manner of death to homicide. The coroner concluded he had suffered brain damage due to a lack of oxygen after being restrained on his stomach, not from excited delirium.

But the Illinois state attorney declined to pursue new charges against the deputies in Burns鈥 death.

鈥淚t鈥檚 more than just an unfortunate story,鈥 Richard Burns said. 鈥淭his drastically affected our lives.鈥

Racial Reckoning Sparks Shift

At a 2020 American Medical Association policy conference, medical students spurred by the racial reckoning in the wake of the police-involved deaths of Floyd and many others introduced a series of resolutions around combating racism in medicine, including one against excited delirium. But emergency physicians, who also belong to that broader physician group, objected.

鈥淭hey’re regarded as the content experts on the issue, and so I think it was hard for us to combat some of those counterarguments at that time,鈥 said , a medical resident and a researcher with the at Harvard University.

Emergency physicians see patients with agitation and delirium more often than clinicians in other specialties do and oversee emergency medical technicians and paramedics who encounter such individuals outside of a hospital.

The AMA decided to study the issue. Its subsequent report firmly sided with the medical students and, in 2021, the AMA delegates issued a strong condemnation of excited delirium as a clinical diagnosis.

But ACEP, which represents a , dragged its feet in addressing its problematic paper. Instead, the group released a new policy statement in 2021 using the term 鈥渉yperactive delirium,鈥 saying the guidance was not meant as an update or refutation of the paper.

, an emergency physician in Tulsa, Oklahoma, and one of the authors of the 2021 policy statement, said ACEP didn鈥檛 want to issue a statement without providing a clinical document to help guide physicians. And since the task force wanted to focus on clinical considerations, he said, it avoided addressing 鈥渆xcited delirium,鈥 which had been under fire.

鈥淚t was being used in nonclinical ways, which no one ever really thought that it would be,鈥 he said. 鈥淚t was becoming at times a flashpoint between law enforcement and the community at large.鈥

This spring, the group issued a statement saying it no longer recognized excited delirium as a diagnosis but stopped short of retracting the 2009 white paper. And until this month鈥檚 vote, it hadn鈥檛 taken any steps to prevent its name and policy statement from being used by defense attorneys defending police in court cases involving in-custody deaths.

Goodloe, who now chairs the ACEP board, said it was hard for ACEP to track individual court cases and what expert witnesses were saying, especially if they were not ACEP members.

鈥淲e can鈥檛 ensure how nonmedical professionals use a document that is designed to inform and guide medical care,鈥 he said. 鈥淚 would hope that they would continue to recognize the primary intent of the paper and be very meticulous about avoiding misquoting or mischaracterizing what that paper is for.鈥

New Terms Arise

The remaining defenders of the term insist that excited delirium is a real condition that puts patients, physicians, and first responders at risk.

One of the 2009 white paper鈥檚 co-authors, Deborah Mash, a retired professor of neurology at the University of Miami, declined an interview but wrote in an email that the task force that penned the white paper included some of the most respected thought leaders in emergency medicine at the time, who sought to suggest best practices for treating patients with such symptoms.

Since then, she said, 鈥渂anning the use of the 鈥榯erm鈥 has caught on with the anti-police movement.鈥

Mash has for the defense in wrongful death claims filed against Axon over the use of its Tasers.

Some lawyers who bring in-custody death cases on behalf of families believe the ACEP reversal will help wipe out a major police defense tactic.

鈥淚t has a huge impact on cases going forward, because the white paper was the main vehicle for trying to legitimize excited delirium,鈥 said Julia Sherwin, a civil rights attorney who is representing the family of Mario Gonzalez, who died in police custody in California in 2021.

But eradicating the term “excited delirium” may not stop police from trying to use the theory behind it to justify the deaths of suspects in custody: The Minneapolis Star-Tribune that a training for the Minneapolis Police Department, which was involved in Floyd鈥檚 death, used PowerPoint slides with the words 鈥渆xcited delirium鈥 crossed out and replaced with the term 鈥渟evere agitation with confusion (delirium).鈥

Clinical documents from ACEP and other organizations have described the same cluster of symptoms at various times as hyperactive delirium, agitated delirium, or restraint-related cardiac arrest. Defense lawyers might argue the same concept using those terms or rely on other medical conditions to explain a death rather than law enforcement officials鈥 use of force.

鈥淚t’s so easy for them, once the excited delirium argument is dismissed, to use another kind of medical argument that鈥檚 quite similar,鈥 said , a social epidemiologist at Harvard University who studies patterns of in-custody deaths.

In April 2021, Gonzalez died after police officers in Alameda, California, restrained him on his stomach, handcuffed him, and placed their weight on him. The county coroner listed his death as a homicide. But ACEP member , one of the co-authors of the 2009 white paper, said in a September 2023 deposition he believed that Gonzalez died of cardiac dysrhythmia, an irregular heartbeat.

Vilke testified in the deposition that he could make up to $50,000 as a defense expert in the case, which is set to go to trial later this year, and that he has testified in restraint or law enforcement-related cases 58 times over the past four years. Vilke declined to comment to KFF 国产精品视频 News on the white paper.

颁补濒颈蹿辞谤苍颈补鈥檚 lists alternative terms 鈥 hyperactive delirium, agitated delirium, and exhaustive mania 鈥 that will be restricted along with excited delirium starting in January. Nothing in the law prevents defense experts from using other medical explanations, such as cardiac dysrhythmia, for the deaths.

鈥淧eople in agitated states due to cocaine, methamphetamine or untreated psychiatric illness still require help which is provided by police and first responders,鈥 Mash, who helped create the 2009 paper, wrote in an email. 鈥淭hese individuals are at increased risk of sudden death regardless of what you call it.鈥

Still, Richard Burns, the Halecks, and others whose loved ones died during police encounters hope the ACEP vote prevents future abuses, pushes more states to follow 颁补濒颈蹿辞谤苍颈补鈥檚 lead, and boosts police accountability.

鈥淲hat needs to happen is to focus on the why, the reason, the cause,鈥 said Burns. 鈥淭he cause is the police brutality, which gets minimized when it鈥檚 being able to be hidden behind these terms.鈥

Chris Vanderveen, KUSA-TV鈥檚 director of special projects, contributed to this report.