by Renuka Rayasam and Markian Hawryluk and samantha young, KFF Health News
Angelo Quinto's family couldn't believe what they had never heard before when they learned authorities were blaming his death in 2020 on “excited delirium.” It was clear to them that the science behind the diagnosis was not true.
Quinto, 30, was pinned to the ground by California police for at least 90 seconds until he stopped breathing. He died three days later.
Now, his relatives are asking a federal judge to exclude testimony about “excited delirium” in a wrongful death case against the city of Antioch. Their case may be stronger than ever.
Their push comes at the end of a pivotal year for a years-long national effort to abolish the use of excited delirium in official proceedings. Over the past four decades, discredited and racially biased theories have been used to explain police responsibility for many in-custody deaths. But in October, the American College of Emergency Physicians rejected the key paper it looks scientific at first glance rightfulnessand the College of American Pathologists says: Should not be quoted anymore As for the cause of death.
That same month, California's Democratic Governor Gavin Newsom announced that the nation's First law to ban this term The death certificate, autopsy report, and police report list “excited delirium'' as the diagnosis and cause of death. Lawmakers in other states are expected to consider similar bills next year, with some law enforcement agencies and training organizations removing references to excited delirium from policy manuals and training police on the debunked theory. There are some places that have withdrawn from the
Despite this momentum, families, lawyers, law enforcement experts and doctors say more must be done to right past wrongs, ensure justice in ongoing cases and prevent avoidable deaths in the future. He says there are still many left. But after years of fighting, they're encouraged to see some movement.
“This whole thing is a nightmare,” said Vera Collins, Angelo's sister. “But there are silver linings everywhere and I feel very lucky to see change happening.”
Ultimately, the Campaign Against Excited Delirium aims to change the way police deal with people facing mental health crises.
“This is really about saving lives,” he said. joanna naples mitchella lawyer who worked on influential cases. Doctors who defend human rights reviews A state of excited delirium.
Changing law enforcement training
Use of the term “excited delirium syndrome” became widespread after the founding of the American College of Emergency Physicians. We published a white paper The report found that individuals in mental health crises are often under the influence of drugs or alcohol, exhibit superhuman strength when police try to control them, and then respond to their conditions rather than police response. He suggested that this could lead to sudden death.
He said the ACEP White Paper was important in promoting police training and policy. Mark Krupanski, director of criminal justice and policing at Arnold Ventures, one of the largest nonprofit funders of criminal justice policy. This theory contributed to his death because it encouraged police officers to use more force when they saw people in an aggressive state rather than call medical professionals. he said.
After George Floyd's death in 2020, police officers claimed excited delirium was the cause, but the American Medical Association and American Psychiatric Association have officially rejected this as a medical condition. And this year, the American College of Medical Examiners and groups for emergency physicians and pathologists issued a statement of denial.
The medical community's efforts to abolish the term have already had a measurable, albeit limited, effect. In November, Lexipol, a training organization used by thousands of public safety agencies in the United States, reiterated its previous efforts to move away from excited delirium, citing California law and ACEP's 2009 white paper revocation.
Mike Ranalli, an attorney and police trainer for the Texas-based group, said Lexipol currently teaches officers to rely on what they can observe and not make assumptions about a person's mental state or medical condition. He is said to be instructing. “If someone appears to be in distress, please get EMS,” he said, referring to emergency medical services.
Patrick Caceres, Senior Researcher, Bay Area Rapid Transit Independent Police Auditor’s Officelearned of Quinto's death in 2020 and successfully pushed to have excited delirium removed from the BART Police Department's policy manual after the American Medical Association rejected it the following year.
Caceres said it takes time to eradicate not just the term, but the concept more broadly, in a country where law enforcement is spread across some 18,000 agencies under the jurisdiction of independent police chiefs and sheriffs. I am concerned that it may cost me a lot of money.
“We still have a long way to go in terms of what training we need to do and what conversations we need to have,” Caceres said.
In Tacoma, Washington, three police officers have been charged in the 2020 death of Manuel Ellis. seattle times reported that local first responders testified in October that they were still “embracing” the concept.
However, in Colorado, the state's Peace Police Standards and Training Commission decided on December 1 to discontinue excited delirium training for new police officers. KUSA-TV reported.
and two Colorado congressmen, Democratic state House members. Judy Amabile and leslie herrodhas drafted a bill for the 2024 session that would ban excited delirium from other police and EMT training and prohibit medical examiners from listing it as a cause of death.
“This idea that you can have superhuman powers has led you to believe that police should respond in a completely inappropriate way to what is actually going on,” Amabile said. “It's clear that we need to stop doing that.”
She said police should put more emphasis on de-escalation strategies and ensure that 911 calls from people in mental health crises are routed to behavioral health professionals who are part of the police force. I think I want it. crisis intervention team.
Remove “excited delirium” from the equation
The Quinto family is seeking justice in the 30-year-old Navy veteran's death and hopes a new defense of excited delirium will strengthen their wrongful death lawsuit against the city of Antioch. Meanwhile, the defense argued that jurors should hear testimony regarding this theory.
On October 26, the family asked a California district court judge to exclude eyewitness testimony and evidence related to excited delirium, citing both California's new law and ACEP's rebuke of the diagnosis. It is unacceptable,” he said. It's a valid diagnosis that has something to do with Quint's death. ”
“A defense based on BS can be successful,” said family attorney Ben Niesenbaum. “It could be successful by giving the jury an excuse to get the police out of this situation.”
Meanwhile, advocates are calling for reexaminations of autopsies of people who died in law enforcement custody, and families are fighting to change death certificates that say excited delirium was the cause.
The Maryland Attorney General's Office conduct an audit A review of autopsies performed during the tenure of former chief medical examiner David Fowler has attributed various deaths to excited delirium. But this is just one of the states that investigates some deaths in custody.
The family of Alexander Rios, 28, was arrested in 2021 in Richland County, Ohio, after jail staff stacked his body on him in September 2019, shocking him and leaving him blue and limp. reached a $4 million settlement. The trial ended in a mistrial in November, but the pathologist who assisted in Rios' autopsy testified that her supervisor said: pressured her to cite “excited delirium” as the cause of death, even though she did not consent to it. Still, excited delirium remains the official cause of his death.
The county has refused to update its records, so his relatives are suing to force the official cause of death to be changed. A trial is scheduled for May.
Changing the death certificate is a form of justice, but it can't undo the damage his death caused, said Don, Rios' stepfather and now helping raise one of Rios' three children.・Mr. Mold said.
“There are kids whose lives have been turned upside down,” he said. “No one should go to prison and be stuck in it and never get out.”
In some cases, it may be difficult to resubmit a death certificate. Quinto's family asked a state judge to throw out the coroner's findings in his 2020 death. But Contra Costa County Attorney Thomas Geiger said in a court filing that a California law that went into effect in January that prohibits listing excited delirium on death certificates cannot be applied retroactively.
And despite the denial by a group of leading medical examiners and pathologists in 2023, excited delirium, or a similar explanation, could still appear in future autopsy reports outside of California. No single group has authority over the thousands of individual coroners and medical examiners, some of whom work closely with law enforcement authorities. The system for determining the cause of death is Severely fragmented and chronically underfunded.
“One of the unfortunate things, at least in forensic pathology, is that a lot of things are very fragmented,” says Anna Tartt, a member of the College of American Pathologists' Committee on Forensic Pathology. She said CAP plans to educate its members through conferences and webinars, but does not intend to discipline members who continue to use the term.
Justin FeldmanThe Center for Police Integrity's lead researcher said coroner's authorities need more pressure and oversight to ensure they don't find other ways to attribute deaths in police custody to other causes.
Currently, only a minority of deaths in police custody are caused by excited delirium, he said. Instead, many deaths are blamed on methamphetamines, even though fatal cocaine and methamphetamine overdoses are rare in the absence of opioids.
But advocates are hopeful that this year will be enough of a turning point that the alternative terminology will lose momentum.
California law and ACEP's decision “takes a huge amount of junk science out of the picture,” said Julia Sherwin, a California civil rights attorney who co-authored the Physicians for Human Rights report. Ta.
Sherwin is representing the family of Mario Gonzalez, who died in police custody in 2021, in a lawsuit against the city of Alameda, California. Gonzalez's death certificate does not list excited delirium, but medical experts who testified against the officers who detained Gonzalez cited this theory in their depositions.
She said she plans to file a motion to exclude testimony about excited delirium in future cases and will file similar motions in all restraint-asphyxia cases she handles.
“And in any case, lawyers across the country should do that,” Sherwin said.
KHN (Kaiser Health News) is a national news station that produces in-depth journalism about health issues. KHN, along with policy analysis and polling, is one of three major operational programs in the United States. KFF (Kaiser Family Foundation). KFF is a nonprofit nonprofit organization that provides information about health issues to the public.
