Autism Induced "Excited Delirium Syndrome" ? Or Police Brutality?

A mom is suing police after her autistic son died following a struggle with police. Local police authorities, who apparently are also medical experts, stated that her son died from what they called "autism induced excited delirium syndrome" resulting in cardiac arrests. As the article indicates this purported "syndrome" is often used by police in explaining deaths of certain persons following confrontations with police. Interestingly, a 1999 Salon article on the subject points out that this medical theory was advanced by coroners. Recenlty excited delirium syndrom was cited by an official pathologist in a NB death of a man involved in a confrontation with police. A taser/excited delirium death also arose in Calgary and prompted a sudy of the connection between taser use and deaths from this purpoted syndrome. Apart from being regularly used by police coroners and pathologists to explain deaths of individuals in police custody or confrontations it is worthwile to note that "excited delirium syndrome" is not a diagnosis used in psychiatry:



"Excited delirium is not a diagnosis used in psychiatry,'' says Dr. Roumen Milev of the Mood Disorders Clinic at the Providence Continuing Care Centre in Kingston, Ont.

"It does not exist as such either in the American Psychiatric Association's diagnostic and statistical manual, or in the World Health Organization's international classification of diseases.''

Mom sues in death of autistic son

The Monterey County Herald

Article Last Updated: 05/29/2007 01:43:36 AM PDT

RIVERSIDE (AP) — The mother of an autistic man who died after struggling with Riverside County sheriff's deputies has filed a wrongful death lawsuit.

The suit, filed in federal court last month, accuses deputies of negligence and brutality and seeks unspecified damages in the death of Raymond Lee Mitchell, 21.

Mitchell died in a hospital last July following a struggle with deputies at his Perris home. Deputies responded to the residence after his mother called 911 saying she needed authorities to pick up her son.

Sheriff's officials contend Mitchell died from autism-induced "excited delirium syndrome," a condition that leads to sudden cardiac arrest.

His mother's attorney rejects that claim, saying it's a common defense among law enforcement agencies sued over in-custody deaths.

"That's what they always say," attorney Carl Douglas said.

Douglas believes Mitchell died of positional asphyxiation after several officers piled on top of him.

Sheriff's spokesman Jerry Franchville said deputies are trained for encounters with people with autism, mental illness and other special needs.

Besides what authorities claim is the cause of death, he refused to release results of an investigation into matter.

http://www.montereyherald.com/ci_6011038?source=most_viewed

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

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By Christian Parenti

Sept. 29, 1999 | 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.

http://www.salon.com/health/feature/1999/09/29/excited_delirium/index.html


Taser alone didn't kill Geldart: pathologist

Last Updated: Wednesday, February 28, 2007 | 5:14 PM AT
CBC News

A temporary condition, not an electronic stun gun used by Moncton police, was likely to blame for the death of a psychiatric patient, an inquest heard Wednesday.

Kevin Geldart, 34, who had walked away from the psychiatric unit at the Moncton Hospital, died in the Right Spot bar on May 5th, 2005, after police used a Taser in a bid to subdue him.

Ken Obenson, the pathologist who examined Geldart's body, told the inquest that in his opinion the primary cause of Geldart's death was "excited delirium," a condition in which a mentally ill person is acutely agitated, violent, sweating profusely and showing an insensitivity to pain.

Geldart showed many of those symptoms, according to previous testimony from four police officers who confronted him at the Right Spot Bar in Moncton. The officers used pepper spray and a Taser, an electronic stun gun, to try to subdue Geldart, who was six-feet-six inches tall, weighed more than 350 lbs., and suffered from asthma.

Obenson said that because an agitated Geldart was wrestling with police, his adrenaline level would have been high.

His potassium level would also have been high, Obsenson said, and that would have protected his heart. However, once restrained, his potassium level would have dropped, Obenson said, and that would have lead to arrthymia, an upset in the heart's normal rhythm.

Obenson said the Taser, pepper spray and Geldart's obesity might have been contributing factors in his death. But even if those factors had not been present, he said, the outcome still would have likely been death.

However, if the condition of excited delirium were removed, and every other factor left in place, Obenson said, Geldart likely wouldn't have died.



'Excited delirium' case raises taser questions

Updated Sun. Mar. 11 2007 5:16 PM ET

Canadian Press

FREDERICTON -- A New Brunswick man's death due to a mysterious malady called excited delirium has raised more questions about police arrest techniques and the growing use of stun guns.

Kevin Geldart, 34, of Moncton, N.B., died after he was repeatedly shocked with Taser weapons by RCMP officers in 2005.

It was another in a long series of deaths in North America following the use of police force and Taser guns to control people who are described as combative, irrational and extraordinarily strong.

In most of these cases, the cause of death is difficult to pinpoint and is often attributed to cardiac arrest, drug intoxication or a combination of the two.

But a New Brunswick coroner's inquest into Geldart's death earlier this month ruled that the large, mentally ill man died of excited delirium _ a condition that cannot be found in medical or psychiatric text books.

"Excited delirium is not a diagnosis used in psychiatry,'' says Dr. Roumen Milev of the Mood Disorders Clinic at the Providence Continuing Care Centre in Kingston, Ont.

"It does not exist as such either in the American Psychiatric Association's diagnostic and statistical manual, or in the World Health Organization's international classification of diseases.''

Critics say excited delirium exists purely in the imaginations of those who are anxious to defend the use of Taser weapons and excessive police force.

Eric Balaban, a staff attorney with the American Civil Liberties Union, says that blaming excited delirium for in-custody deaths could be a way of whitewashing inappropriate use of force by police.

"It's not recognized as a mental-health diagnosis,'' Balaban says.

"It is really used only by medical examiners to attribute the cause of death of an arrestee following a violent scuffle with police officers.''

Whatever excited delirium may be, it is characterized by extreme agitation, incoherence, bizarre behaviour, often superhuman strength and a high body temperature.

It is associated with drug abuse and mental illness, and occurs often in people who, like Geldart, are very large. Geldart was tall and weighed at least 350 pounds.

Family members and friends of people who die during police Taser arrests are almost always unsatisfied with descriptions of the cause of death and the fact that the police are exonerated.

One of Geldart's relatives has called for a moratorium on the use of Tasers until more is known about the effects of the weapon on people, especially on those with mental illness.

So far, 212 people in North America have died following custody struggles with Taser-wielding police officers _ at least 15 of them in Canada, where the weapon has been used since 2001.

In all cases, the stun gun has been cleared of any direct involvement in the deaths, even in cases like Geldart's, where there were eight Taser injuries to his body and head.

"I'm not aware of any case in the world where the conductive energy weapon has been found to be the factor that caused death,'' Sgt. Richard Groulx, an RCMP training and tactical weapons expert, told the New Brunswick inquest.

The Taser delivers a pulsating, 50,000-volt electrical current through the body, and police say it can pierce clothing four centimetres thick.

The shock, which lasts up to five seconds, locks muscles instantly and overrides the central nervous system.

Dr. Deborah Mash, professor of neurology at the University of Miami and a leading expert in North America on excited delirium, says the ultimate goal of her research is to establish a protocol so police know how to handle people exhibiting signs of the condition.

Mash says excited delirium is a real brain disorder.

"There are clearly neuro-chemical changes in the brain,'' she says. "There is a defect. The issue of police brutality is simply wrong. That's not to say it can't occur, but when the police are confronted by someone exhibiting superhuman strength like a Hulk Hogan ... what can they do?''

Mash says the phenomenon came to light in the 1980s, when crack cocaine first burst onto the Florida drug scene.

She says many victims have cocaine or drugs in their systems, although mentally ill people like Geldart, who was bipolar, are also susceptible.

"It doesn't have to be drug-related,'' she says. "There are a number of triggers that will pop the switch.''

Mash says no one knows the best intervention techniques for police when confronted by an individual in the throes of excited delirium.

She says she hopes a standard of practice can be developed.

She also says research may ultimately unlock a clear diagnosis of the disorder, so victims can be identified before they run into trouble.

"Thanks to advances in molecular biology, we have an opportunity to look for the first time for real diagnostic markers, and that's what we need,'' Mash says.


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"Link between excited delirium, Taser deaths to be studied


Calgary Herald


Saturday, January 14, 2006


CALGARY -- A Calgary physician is leading a national study to see whether a medical condition that causes violent behavior and superhuman strength can turn deadly when police Taser or pepper- spray suspects.

Dr. Christine Hall is undertaking a three-year analysis of subjects who die in police custody and what role the little-understood disorder, known as excited delirium, may play.

The condition, while not universally recognized by the medical establishment, has been linked to the deaths of several police suspects, including cases in which detainees died after being Tasered or pepper-sprayed.

"We think there's something systematically different from the people who die in custody than the people who don't," said Hall, an emergency room doctor and epidemiologist.

The study will also examine any association between police use of pepper spray or stun guns and custody deaths.

Hall's research, which must still be approved by an ethics review board, follows the Christmas Eve death of a man who was Tasered by Edmonton police after he went into a fit of rage at an intersection.

The Tasers can deliver a 50,000-volt shock to temporarily immobilize a suspect and have been the subject of heated debate in recent years.

While supporters argue they are less lethal than other weapons, groups like Amnesty International blame the stun guns for dozens of police custody deaths in North America.

Hall's research, which has received $1.5 million in funding from the Canadian Police Research Centre, could begin as early as this summer, pending approval from an ethics committee.

She hopes the study will unravel some of the mysteries surrounding excited delirium, a disorder that hasn't been studied extensively.

The condition appears to strike men who are mentally ill or high on drugs.

People suspected of having excited delirium are often agitated, violent, hot to the touch and don't feel pain at all, Hall said.

Hall will work with 11 police forces around the country to collect reports on all suspects who physically resist arrest, comparing the data to reports on suspects who die in custody.

The study will examine whether the suspects exhibited signs of excited delirium and what forms of restraint, such as Tasers, police used in the cases.

"We have to figure out if there's a way to know who the people at risk are," said Hall.

Since the devices came into use in Calgary last October, police officers there have used Tasers 37 times on suspects without any serious ill effects, according to Staff Sgt. Kevin de Villenfagne of the Calgary Police Service.

He said the move to study excited delirium and its relationship to Tasers is helpful for police.

"Anytime we can do research to determine the validity of the tools we're using to ensure we're doing the best with the tools we have, that's a good thing," he said.
__________________
Brian Hill
Training is not an expense, it is an investment. "

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