As the foundation of the diagnosis of “excited delirium” cracks, the consequences spread.

By Renuka Raisam and Markian Hawryluk and Samantha Young, kff health news

When Angelo Quintos’ family learned that authorities attributed his 2020 death to excited delirium, a term they had never heard before, they couldn’t believe it. To them, it was clear that the science behind the diagnosis was not real.

Quintero, 30, was pinned to the ground by police in California for at least 90 seconds and his breathing stopped. He died three days later.

Now his relatives are asking a federal judge to exclude any testimony about agitated delirium in his wrongful death case against the city of Antioch. Their case may be stronger than ever.

His effort comes at the end of a significant year in a long-running nationwide effort to abandon the use of excited speech in official proceedings. Over the past 40 years, the discredited, racially biased theory has been used to deflect police culpability for numerous deaths in custody. But in October, the American College of Emergency Physicians rejected a key paper that would have given it scientific validity, and the College of American Pathologists said it should no longer be cited as a cause of death.

That same month, California’s Democratic Governor Gavin Newsom signed the nation’s first law to ban the term excited delirium as a diagnosis and cause of death on death certificates, autopsy reports and police reports. Legislators in other states are expected to consider similar bills next year, and some law enforcement agencies and training organizations have removed references to agitated delirium from their policy manuals and stopped training police on the debunked theory. Has pulled.

Despite this momentum, families, lawyers, police experts and doctors say much remains to be done to right past wrongs, ensure justice in ongoing trials, and prevent future avoidable deaths. But after years of fighting, they’re excited to see any kind of movement.

This whole thing is a nightmare, said Bella Collins, Angelo’s sister. But there are silver linings everywhere, and I feel very fortunate to be able to see change happening.

Ultimately, the campaign against excited delirium seeks to change the way police treat people experiencing a mental health crisis.

It’s really about saving lives, said Joanna Naples-Mitchell, an attorney who worked on the influential Physicians for Human Rights review of excited delirium.

Changing Law Enforcement Training

Use of the term excited delirium syndrome became widespread after the American College of Emergency Physicians published a white paper on it in 2009. It proposed that individuals in mental health crisis, often under the influence of drugs or alcohol, could exhibit supernatural powers. The police try to control them, and then they suddenly die, not from the police response, but from the condition.

He said the ACEP white paper was important in catalyzing police training and policy. mark krupansky, director of criminal justice and policing at Arnold Ventures, one of the largest nonprofit funders of criminal justice policy. The theory contributed to the deaths, he said, because it encouraged officers to use more force rather than calling medical professionals when they saw people in aggressive situations.

Following the 2020 death of George Floyd, which authorities attributed to excited delirium, the American Medical Association and the American Psychiatric Association formally rejected it as a medical condition. Then came rejection this year from the National Association of Medical Examiners and emergency physicians and pathologists groups.

Moves by medical societies to abandon the term have already had a concrete, albeit limited, impact. In November, Lexipol, a training organization used by thousands of public safety agencies in the U.S., reiterated its earlier move to move away from excited delirium, citing California law and a 2009 white paper by ACEP retracting it.

Lexipol now instructs officers to rely on what they can see, not guess at a person’s mental state or medical condition, said Mike Ranelli, an attorney and police instructor for the Texas-based group. If someone appears to be in distress, just get EMS, he said, referring to emergency medical services.

Patrick Caceres, a senior investigator with the Bay Area Rapid Transit Office of the Independent Police Auditor, successfully lobbied to remove agitated delirium from the BART Police Department’s policy manual in 2020 after learning of Quintero’s death and its rejection by the American Medical Association. Tried. Year.

Caceres fears the concept will take time to take root more widely in a country where law enforcement is spread across about 18,000 agencies ruled by independent police chiefs, or sheriffs.

The kind of training and conversation that is needed is still a long way away, Caceres said.

In Tacoma, Washington, where three police officers have been charged in the 2020 death of Manuel Ellis, The Seattle Times reported that local first responders testified as recently as October that they still accept the concept .

Paramedics Jeremy Cooper, left, and Peter Ciechuniak attend an arraignment at the Adams County Justice Center in Brighton, Colo., on January 20, 2023. Two paramedics prosecuted in the 2019 death of Elijah McClain told investigators in never-before-seen videotaped interviews the public said the 23-year-old Black man had “excited delirium,” a controversial condition that some say That it is unscientific and rooted in racism. (Andy Cross/The Denver Post via AP, file)

But in Colorado, the state Peace Officer Standards and Training Board ruled Dec. 1 to halt agitated delirium training for new law enforcement officers, KUSA-TV reported.

And two Colorado lawmakers, Democratic state Reps. Judy Amabile and Leslie Herrod, have drafted a bill for the 2024 legislative session that would ban excited delirium from other police and EMS training and bar coroners from citing it as the cause of death. Will be prevented from.

The idea that it gives you supernatural powers makes police think they should respond in a way that is often completely inappropriate for what’s actually happening, Amabile said. It seems clear that we should stop doing this.

She wants police to focus more on de-escalation tactics and ensure that 911 calls for people in mental health crisis are routed to behavioral health professionals who are part of crisis intervention teams.

Alexander Rios, 28, died in a jail in Richland County, Ohio, in 2019. (Don Mould)

Taking excited delirium out of the equation

As the Quintero family seeks justice in the death of the 30-year-old Navy veteran, they hope the new denial of agitated delirium will bolster their wrongful death lawsuit against the city of Antioch. On the other hand, defense attorneys have argued that jurors should hear testimony about the theory.

On October 26, when the family asked a U.S. District Court judge in California to exclude witness testimony and evidence related to excited delirium, he cited both California’s new law and ACEP’s rebuke that it should be considered scientific. cannot be considered formally valid. The diagnosis may have something to do with Quinto’s death.

Family attorney Ben Nissenbaum said a defense based on BS could succeed. It may succeed by giving jurors an alibi to give the police a way out of this.

Meanwhile, lawyers are demanding re-examination of autopsies of people who die in law enforcement custody, and families are fighting to change death certificates that blame excited delirium.

The Maryland Attorney General’s Office is auditing autopsies under the tenure of former Chief Medical Examiner David Fowler, who has blamed excited delirium in various deaths. But that’s just one state reviewing a subset of deaths in its custody.

The family of 28-year-old Alexander Rios reached a $4 million settlement with Richland County, Ohio, in 2021 after prison officials choked Rios and shocked him until he was blue and limping in September 2019 . This November, the pathologist who helped perform the Rios autopsy testified that her supervisor pressured her to list excited delirium as the cause of death, even though she did not agree. . Nevertheless, excited delirium remains the official cause of his death.

The county refused to update the records, so her relatives are suing to force a change in her official cause of death. A trial is scheduled for May.

Rio’s stepfather Don Mold, who is now helping raise one of Rio’s three children, said changing the death certificate would be a form of justice, but it would not undo the damage caused by her death .

He said, here’s a kid whose life is upside down. No one should be able to go to jail and not be able to come in or go out.

In some cases, refiling a death certificate may be difficult. The Quinteros family has asked a state judge to throw out the coroner’s findings about his 2020 death. But the California law, which takes effect in January and bans excited delirium on death certificates, cannot be applied retroactively, Contra Costa County attorney Thomas Geiger said in a court filing.

And, despite the 2023 rejection by chief medical examiners and pathologist groups, excited delirium or a similar explanation may still appear in future autopsy reports outside California. No single group has authority over thousands of individual medical examiners and coroners, some of whom work closely with law enforcement officials. The system for determining cause of death is highly disorganized and chronically underfunded.

One of the unfortunate things, at least within forensic pathology, is that a lot of things happen very piecemeal, said Anna Tartt, a member of the forensic pathology committee of the College of American Pathologists. He said CAP planned to educate members through conferences and webinars, but would not discipline members who continued to use the term.

Justin Feldman, principal research scientist at the Center for Policing Equity, said medical examiners need even more pressure and oversight to ensure that they prevent deaths caused by police restraint from being attributed to something else. Don’t look for ways.

He said only a minority of deaths in police custody now cite excited delirium. Instead, many deaths are being blamed on stimulants, even though fatal cocaine or methamphetamine overdoses are rare in the absence of opioids.

Yet advocates hope this year will mark such a turning point that alternative words will lose their appeal.

Julia Sherwin, a California civil rights attorney who co-authored the Physicians for Human Rights report, said the California law and the ACEP decision take a huge piece of junk science out of the equation.

Sherwin is representing the family of Mario Gonzalez, who died in police custody in 2021, in a lawsuit against the city of Alameda, California. Excited delirium does not appear on Gonzalez’s death certificate, but medical experts who testified for the officers who restrained him cited the theory in depositions.

She said she plans to file a motion to exclude testimony about excited delirium in that upcoming case and handles similar motions in all restraint-asphyxia cases.

And, in every case, lawyers across the country should do the same, Sherwin said.

KHN (Kaiser Health News) is a national newsroom producing in-depth journalism about health issues. Along with policy analysis and polling, KHN is one of the three major operating programs of KFF (Kaiser Family Foundation). KFF is a thriving non-profit organization that provides information on health issues to the nation.

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