Death in custody from "excited delirium"?

Some coroners say suspects are dying not from police brutality but an obscure medical disorder.

Published September 29, 1999 4:00PM (EDT)

America's latest cultural export to the United Kingdom isn't some hot new software or a hip-hop single, it's a controversial medical theory that seeks to explain why so many people die in police custody. The concept, called "excited delirium" (ED) or "in-custody death syndrome," is being put forward by a small but vocal clique of big-city coroners. Proponents of excited delirium argue that most people who die in police custody are not the victims of police brutality, but rather victims of their own cocaine or amphetamine abuse, which can trigger this fatal condition.

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.

"Williams was a classic case of excited delirium. The police had nothing to do with his death," says Karch, who reviewed the autopsy report. The San Francisco medical examiner found evidence of numerous "blunt trauma" wounds to the head and abdomen, but came to the same conclusion as Karch. The city of San Francisco settled the case out of court for $98,000.

But Van Jones sees the Aaron Williams case as clear-cut police homicide. "The cops violated almost every one of their own rules -- from spraying him twice to beating him and leaving him unattended," says Jones.

Instead of excited delirium, Jones, the ACLU and other human rights activists say that pepper spray is the real killer. They argue that it was never proven to be safe. In fact, the one test that determined the weapon to be "less than lethal" was conducted by FBI agent Thomas Ward who later pled guilty to taking a $57,000 kickback from a pepper spray manufacturer. According to the ACLU, more than 100 people in the U.S. have died as a result of pepper spray since the early 1990s.

"These sorts of deaths are multi-factoral: obesity, heart trouble and amphetamine use are part of the problem. But excited delirium is not the cause of death," says D.J. Van Blaricom, an expert witness on in-custody death who was a police officer for 30 years, 11 of them as police chief of Bellevue, Wash.

Blaricom says that more than anything it is the combination of pepper-spraying and hogtying that is leading to in- custody deaths. "Many of these cases involve exhausted, overweight or injured prisoners who are left hogtied and face down. They simply suffocate, and die from "positional asphyxia," Blaricom says. "So it's really a combination of bad police practices that is causing in-custody death syndrome."

Karch disagrees. He maintains that hogtying is perfectly safe and dismisses positional asphyxia as a myth, pointing to a study in the Annals of Emergency Medicine. But that study used fit young men who exhausted themselves on exercise bikes before being hogtied. The International Association of Police Chiefs, a police professional organization, immediately dismissed the study as irrelevant because it failed to reproduce "field conditions."

The death of Mark Garcia, also from San Francisco, is another case that is contentious. Proponents of ED say his death was a classic case of the condition. Garcia, 41, was arrested wearing only a shirt as he was running and rolling in the street shouting for help; his family speculates that Garcia, who had a history of cocaine abuse, was high and had just been robbed and partially stripped by his assailants.

Police pepper-sprayed him four times, a violation of department policy, and failed to wash his face with water, which is also required by department procedure. Police then hogtied the 331-pound Garcia, according to press reports, and placed him face down in a paddy wagon. Garcia died of suffocation and positional asphyxia soon thereafter.

A 1995 study by the ACLU examined 26 known deaths of people who had been pepper-sprayed and found several common denominators: alcohol and drugs were involved in 24 of the 26 cases; two suffered from acute psychiatric disorders; and in 14 of the 26 cases, the victims had been hogtied by police. While acknowledging the contributing role of heart disease and drug abuse, the ACLU rejects the notion of ED as being separate from police brutality.

"If we want to avoid death in custody, police must not only declare a moratorium on life-threatening practices such as using pepper spray, [but] they have to [also] follow established rules," Jones says. And when the police violate their own rules willfully, Jones says they should be held accountable. "Police have to learn to de-escalate confrontations with agitated people; they have to practice verbal judo," she says. "If 5-foot-2 female social workers and nurses can do it, then I am sure the cops can too."

Whether these people are dying from police brutality or medical conditions such as excited delirium is still up in the air. But medical examiners like Karch are championing a new neurochemical test which, they say, will accurately determine if the person has died from excited delirium or another cause. "I'm not here to defend police brutality, but you'll never know if police
brutality occurred unless you gather all the facts," he says. He believes the test should be standard procedure in all suspected ED deaths. The test relies on taking fresh samples of brain tissue, and detecting changes in the brain chemistry. But the samples have to be taken within 12 hours of death -- and many autopsies aren't done until well after that time.

By Christian Parenti

Christian Parenti is the author of "Lockdown America: Police and Prisons in the Age of Crisis."

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