Excited Delirium was originally a descriptive phrase coined by medical researchers to describe the extreme end of a continuum of drug abuse effects. Currently, this is not a recognized medical or psychiatric condition. It is currently a very controversial subject often used in association with fatalities that occur to subjects in police custody where the force required to subdue the suspect is generally not sufficient to cause death. Generally, this condition is exacerbated by cocaine abuse and is related to a common cause of sudden death while in custody known as cocaine toxicity. It is also a cause of death listed by medical examiners where restrained subjects die in police custody. A coroner is the presiding officer of a special court to investigate deaths that occur under unusual circumstances where conventional criminal proceedings are not immediately called for. ... The Chicago Police Department arrests a man An arrest is the action of the police, or person acting under the law, to take a person into custody so that they may be forthcoming to answer for the commission of a crime. ...

This condition has also affected professional literature, departmental training bulletins and – in many cases – agencies’ general orders which have expanded this descriptive phrase to a symptom of “life-threatening” linkage, effectively changing the phrase from a descriptive to a prescriptive medical mandate. When disconnected from the precursive drug phrase (such as “cocaine induced excited delirium”), the term takes on the connotation of a recognized medical or psychiatric condition. This term is neither, but is used to describe the manifestations of extreme drug abuse.

Cocaine Toxicity Relation

This phenomenon was noted by Drs. Roger E. Mittleman and Charles V. Wetli in the late 1980s.^[1] Cocaine is an agent that stimulates both the central nervous and the cardiovascular systems. Pharmacologically, cocaine constricts blood vessels, elevates the heart rate, raises blood pressure and increases body temperature. Such effects have produced lethal physiologic catastrophes in individuals without underlying preexisting anatomic disease(s). Mittleman and Wetli noted that the medical literature clearly documents cocaine-induced vasoconstriction, vasospasm and hypertension that have resulted in spontaneous intracranial hemorrhage and infarcts of the cerebrum (i.e. strokes), kidney and intestinal tracts. Cocaine may also be the cause of death in cardiovascular incidents in which there is no anatomic abnormality. Likewise, these effects can substantially compromise an already diseased heart or vascular system, potentially resulting in fatalities. Cocaine toxicity leading to death can exist in the drug abuser regardless of the actions taken by police.

1996 Analysis

Researchers found that cocaine-related emergencies in California climbed from 3,688 in 1985 to 10,660 in 1988. Although such emergencies dropped to 7,545 in 1990, the decrease lasted only one year. Since then, the numbers have climbed annually, reaching a record high of 13,496 in 1994. Similarly, amphetamine morbidity has taken on epidemic proportions. In 10 years, amphetamine-related emergency admissions in California increased by 366 percent, from 1,466 in 1984 to 6,834 in 1993. This increase in drug-related emergencies means that there will be an increased need for the police to handle such incidents and probably an increase in custody deaths.

The News Media

There have been several cases of in-custody deaths which have been attributed to excited delirium. One such case occurred in Dallas, TX in 2006. Police say 23-year-old Jose Romero was found in his underwear, screaming gibberish and waving a large kitchen knife from his neighbor’s porch. Romero kept approaching with the knife and officers say they were required to subdue him with repeated shocks with a stun gun. Afterwards, Romero stopped breathing. His family blames police brutality for the incident, but the Dallas County medical examiner attributed it to excited delirium. At that time, three in-custody deaths within five months were linked to excited delirium, in what was typically a rare occurrence. ^[2]

Similar incidents have occurred in San Francisco, where two such incidents were documented within three days of each other. According to medical professionals, each of these subjects would have likely died due to drug toxicity, regardless of any actions taken by police or medical personnel. Mittleman and Wetli noted that it is impossible to ascertain an individual minimal lethal dose of cocaine since fatalities have been associated with a wide range of concentrations. The phenomenon is apparently the result of a kindling effect – a reverse tolerance whereby the brain’s sensitivity to cocaine is increased and its seizure threshold lowered, therefore implying that potentially lethal seizures may occur at any time.

Criticism

According to some medical experts, when the references to excited delirium contained in professional literature are disconnected from the precursive drug phrase, there are two significant ramifications: (1) the more frequently the term “excited delirium” appears outside of the drug context, the more often it will be cited as a recognized medical or psychiatric condition; and (2) this then could provide the basis for a case of legal negligence if a standard of care is not provided to a person who dies while in custody and who has exhibited one or more of the published symptoms attributed to “excited delirium”, such as bizarre and/or aggressive behavior, paranoia, violence, unexpected physical strength, and sudden tranquility. [1] However, these experts also claim that these symptoms are very similar to those displayed by subjects taken under arrest who may not show any life-threatening symptoms at all, yet are simply angry and do not wish to be arrested.

Civil rights groups also criticize “excited delirium”, claiming it is a term used by police departments in order to protect themselves from potential lawsuits in cases where alleged abuse occurred during the arrests. The city of Redwood, CA and the police department have been taken to court in regards to a in-custody death case from 2003 involving a man named Ricky Escobedo^[3], who required six officers to subdue before it was discovered he had stopped breathing. In his case, primary cause of death was listed as excited delirium, but autopsy results allegedly indicate that he had suffered two broken bones in his throat, eight broken ribs, and internal bleeding. “There’s a guy on his neck. There’s five or six cops on him. He’s screaming for help. There must be 1,200 pounds on top of this guy,” said Randy Daar, the prosecuting attorney in the case, who alleges that the police crushed the man to death when they restrained him.

It is typically accepted that this condition is generally the result of drug toxicity, but the criticism comes from whether or not the amount of force used when taking these subjects into custody exacerbated their deaths, or if it was inevitable.

Cases

• Nathaniel Jones

Nathaniel Jones died in December 2003 after being beaten by police while resisting their attempts to arrest him outside a White Castle hamburger shop in Cincinnati, Ohio. ...

Related Articles

Death by Excited Delirium: Diagnosis or Coverup? - NPR

Reference

1. ^ Pepper Spray/In-Custody Deaths. Zarc.com.
2. ^ ‘Excited Delirium’ Cited in Deaths. Newsday.
3. ^ Was It 'Excited Delirium' Or Police Brutality?. 60 Minutes (December 10, 2003). Retrieved on 2007-02-26.