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'Excited Delirium,' a term used to justify excessive force

Updated: Dec 15, 2023

Evidence taken and DA on the scene after police shooting
Law Enforcement after shooting

A review of California cases shows that law enforcement frequently publish highly misleading information about people they’ve killed "This means if someone dies while being restrained in custody ... law enforcement point to excited delirium as the reason." In some cases, police cited vague “medical emergencies” without disclosing that officers had caused the emergencies through their use of force. In others, departments falsely claimed that the civilians had been armed or had overdosed. In most instances, media outlets repeated the police version of events with little skepticism. With officers being held liable for their conduct, The American College of Emergency Physicians withdrew its approval of a 2009 paper on “excited delirium,” a document that critics say has been used to justify excessive force by police. “This means if someone dies while being restrained in custody ... people can’t point to excited delirium as the reason and can’t point to ACEP’s endorsement of the concept to bolster their case,” said Dr. Brooks Walsh, a Connecticut emergency doctor who pushed the organization to strengthen its stance. From 2009 until late 2023, ACEP reaffirmed several positions regarding the use of the terms “excited delirium" and "hyperactive delirium with severe agitation.” California became the first state to bar the use of excited delirium and related terms as a cause of death in autopsies. The legislation, signed Sunday by Gov. Gavin Newsom, also prohibits police officers from using it in reports to describe people’s behavior.

in the ambulance after murder
Body cam of George floyd

In March, the National Association of Medical Examiners took a stand against the term, saying it should not be listed as a cause of death. Other medical groups, including the American Medical Association, had previously rejected excited delirium as a diagnosis. Critics have called it unscientific and rooted in racism. The inaccuracies were exposed by body-camera footage, autopsy reports or litigation records, sometimes only years later. The widespread occurrence of police claims being disproven after the fact suggests that the problem is systemic, and that without public scrutiny or lawsuits, falsehoods are likely to go undetected. Fatal encounters that don’t involve shootings, such as stun gun deaths or asphyxiation, are often labeled as “medical” incidents or “in-custody deaths”, with news releases emphasizing alleged criminal actions by the individual but providing little or no information about police using force. “When you say ‘medical emergency’, nobody pays attention. The purpose is to prevent public outcry,” said Melissa Nold, a Bay Area civil rights lawyer who represents victims of police brutality, adding: “There are so many cases that would have caused national outrage, but it comes across as benign in the press release.” The emergency physicians’ 2009 report said excited delirium’s symptoms included unusual strength, pain tolerance and bizarre behavior and called the condition “potentially life-threatening.” The 14-year-old publication has shaped police training and still figures in police custody death cases, many involving Black men who died after being restrained by police. Attorneys defending officers have cited the paper to admit testimony on excited delirium, said Joanna Naples-Mitchell, an attorney and research adviser for Physicians for Human Rights, which produced a report last year on the diagnosis and deaths in police custody. In 2021, the emergency physicians’ paper was cited in the New York attorney general’s report on the investigation into the death of Daniel Prude, a 41-year-old Black man. A grand jury rejected charges against police officers in that case.

Understand the coding used in police procedure's
Included in Police Training

Press releases cited medical distress while downplaying or entirely excluding references to use of force have occurred in Hayward, where a man seeking mental health treatment shouted “I can’t breathe” while held on the ground; Antioch, where a man who had called police for help was restrained with his face in the dirt; Sacramento, where a man was shot by a Taser weapon and beaten into a coma, leading to the city’s largest police violence settlement; San Diego, where a man died with a police officer’s knee to his neck; and Alameda, in two separate deaths. Alameda police department pinned Mario Gonzalez to the ground for five minutes until he lost consciousness and died. The first press release described a “medical emergency”. Excited delirium came up during the 2021 trial of former Minneapolis police officer Derek Chauvin, who was later convicted in the death of George Floyd. This fall, the term resurfaced during the ongoing trials of police officers charged in the deaths of Elijah McClain in Colorado and Manuel Ellis in Washington state. Floyd, McClain and Ellis were Black men who died after being restrained by police. The emergency physicians group had distanced itself from the term previously, but it had stopped short of withdrawing its support for the 2009 paper.

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