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Since the mid 1990s excited delirium has been floated as an explanation in several high-profile police custody deaths in the United States. But so far, the "excited delirium" debate has yet to begin in the U.K. Last week, the Royal Society of Medicine in London held a conference on "The Medical Aspects of Death in Custody" due to the record number of people (65) who died in custody last year in England and Wales.

While excited delirium was not proved as the cause of many of these deaths, in other countries, such as Canada, most of the people who died from excited delirium between 1988 and 1995 were in police custody at the time, according to one study. Medical examiners say this may just be the tip of the iceberg, but it's hard to say for sure since nobody tracks the number of ED-related deaths that occur each year.

"You can't prevent most of these deaths," says Dr. Boyd Stephens, chief medical examiner for the City and County of San Francisco. This view is shared by his colleague, assistant medical examiner Dr. Steve Karch, who has just returned from addressing the conference on drugs, restraint and postural asphyxia.

"Whether or not these people [who die in custody] see the police is irrelevant. They could be seeing a seven-headed monster. They're delirious, they get a surge of adrenaline and they die," Karch says. He and others contend that the real cause of death is long-term amphetamine abuse, which causes heart disease and increases neurotransmitters, called Kappa 2 receptors, in the part of the brain -- the lymbic amygdala -- that is responsible for fear. Translation: Speed and crack make you paranoid and prone to heart attacks.

Karch says that being high and paranoid leads to erratic behavior, delirium and a heightened heart rate, often accompanied by a rise in body temperature. All of this, plus a weakened heart, can kill a person, and the police have nothing to do with it, he says.

But not everyone is so impressed by the new theory. A bevy of critics, ranging from police accountability activists, to former cops, to toxicologists and coroners, think Karch and other proponents of excited delirium have turned the causal sequence upside down.

"Most of the people who die in police custody die not from drugs or some mysterious syndrome but from police abuse," says Van Jones, executive director of the Ella Baker Human Rights Center in San Francisco. "Officers choose to escalate confrontations and use force when dealing with disturbed and excited people." Jones points out that many of the cases cited as prime examples of excited delirium or sudden in-custody death syndrome involve gross police misconduct and extreme violence.

The in-custody death of Aaron Williams in San Francisco, which was later attributed to excited delirium, is one such example. In 1995, Williams was chased and beaten by 12 police officers. According to press reports, he was high on drugs and "acting crazy" at the time. Once he was captured, the police twice sprayed him with pepper spray -- a chemical agent that causes gagging and massive mucus production. The police then covered Williams' face with a surgical mask and hogtied him, which consists of manacling hands and feet together behind the back. They then repeatedly kicked him in the head, according to eyewitnesses quoted in press reports. (Although the San Francisco Police Department denies this part of the account.) He was then left untended in the back of a paddy wagon with his face down. Less than an hour later, the prisoner arrived dead at the local cop shop.

Next page | Should police be allowed to hogtie?