CITATION: Stewart J: "Excited Delirium"
A Dec. 10, 2003 news article found on the CBS NEWS.com Website:

To avoid having to spend time "writing" a "review," I'm going to put my comments in
blue text INSIDE the story's "body." I know this will likely irritate some folkz,
but – just get OVER IT!!! IF YOU WANT TO, you can copy and paste this whole
shebang into a word document file, and then DELETE my "editorial" notes!

Excited Delirium

Dec. 10, 2003

You may not find the diagnosis "excited delirium" in a medical dictionary, but it's popping up more and more around the country, especially when people die right after brawling with the police.
[They may be "pronounced" dead later, but they first die (loss of breathing and pulse) DURING police (and/or other emergency responders') control! This is an important distinction common to ALL restraint asphyxia deaths.]

Hardly anyone missed this videotape: Nathaniel Jones battling half-a-dozen Cincinnati police officers, who then wrestled him to the ground and beat him with nightsticks.

He died just minutes later, and some people in Cincinnati are calling it a clear-cut case of police brutality. The district attorney will decide whether to file criminal charges against the officers. But already, the coroner says the violent blows are not what killed him.

Correspondent Jim Stewart reports on a hotly disputed theory on why some people may die in police custody.

The coroner told 60 Minutes II that Nathaniel Jones was probably suffering from excited delirium, a controversial condition with a long history, but no single definition.

One of the first high-profile cases was in San Diego more than a decade ago, when a man named Toney Steele stepped off a cross-country bus, got into a fight with police, and ended up dead in the back seat of a patrol car.

It was his sudden death that helped sparked a debate about excited delirium, because it's a theory that usually lets cops off the hook – for what looks like police brutality.

"When they called me and told me that my son had died the way that he did, it was like someone had carved a hole in my heart and just threw it away. Took my heart out and threw it away," says Dorothy Nelson, who bid her oldest son, Toney Steele, goodbye at a bus station one night in Chicago. She was sending him westward to San Diego to begin a new life.

It was a parting she says she will never forget: "He got on the bus. I remember him and I will always remember him as having this beautiful smile on his face when he departed. And so, I told him when he made it there, to give me a call ... I said, 'Bye, and I love you. I love you.'"

Steele called along the way, and reported that everything was fine. A trained welder, he was expecting San Diego to have jobs. But he was also leaving behind a troubled past: run-ins with the law, time in prison, and a drug addiction that just wouldn't go away.

Sure enough, when he finally arrived at the bus station, something went terribly wrong. That's where he encountered Sgt. Dawn Summers.

"He's ranting. He's raving. He's talking about people that aren't there. He's sweating profusely. He had this wild look in his eyes. You know, a look I'll never forget," recalls Sgt. Summers, when she first tried talking to him.

When that didn't work, she tried to nudge him out of the street, Steele resisted and Summers called for backup. Within minutes, the fight was on – four officers wrestling with one man, right in the middle of traffic.

"I can hear cars whizzing by my head. And I was concerned about the cars running us over," says Summers, who said Steele had "super-human strength."

Summers said eventually she and her partners got Steele on his stomach, secured his hands to his feet, and bundled him into the back of a squad car for the short ride to a nearby psychiatric hospital. But when they got there, he was dead.
[Two "REAL-LIFE" possibilities for this situation: (A) Steele was dead when put in the squad car, but they didn't NOTICE it – or; (B) Steele was positioned PRONE in the squad car while hogtied, and died enroute. (See Figures 1 & 2 of the 1992 Positional Asphyxia During Law Enforcement Transport article.) Either way, Steele died WHILE in a position "controlled" by the police. NOT "after" the police were done with him.]

At 31, and in otherwise good physical health, Steele's demise was marked down as a case of excited delirium. It's a rare drug-induced condition, the theory goes, that often begins with hallucinations, requires excessive force by the police to control, and ends in sudden death. And while Steele's mother acknowledges her son's drug problem, she doesn't believe it's what killed him.
[Excited Delirium is NOT ONLY "drug-induced!" It can be caused by ANYTHING that produces an altered level of consciousness: alcohol, head injury, seizure, low blood sugar, acute psychotic episodes, fevers, etc! Additionally, by ITSELF, "excited delirium" does NOT kill people! So, Steele's mother was right. Excited delirium was NOT his "cause of death."]

"I call this police brutality," says Nelson. "I just wondered how did they come to that conclusion?"

Where did the theory of excited delirium come from? It's a term identified during the cocaine-wild 1980s in people who died mysteriously in police custody, says Dr. Deborah Mash, a brain researcher.

"These are individuals that are acting wildly incoherently, completely out of control. Exhibiting super-strength. Babbling incoherently. Some individuals jumping on top of police cars. Breaking through plate glass windows. Jumping off of second story buildings," says Mash. "Many of them exhibit behavior – behavior and unexpected strength that would be Hulk-like."

Dr. Mash has examined dozens of brains from so-called excited delirium victims, and found that nearly all of them were drug abusers, usually of cocaine or methamphetamine. The drug abuse can flood the brain with the natural chemical dopamine, the theory goes. Then the struggle with the police produces high levels of adrenaline. Together, she says, they make a deadly cocktail.
[Ah. "Nearly all of them." Yes, alcohol and drug-abuse is a more-frequently documented cause of excited delirium. But, it is not the ONLY cause of excited delirium. More importantly, what Dr. Mash didn't mention (or wasn't quoted as mentioning), is that: ALL victims documented as having DIED "due to excited delirium" were also RESTRAINED prior to their cardiopulmonary arrest, AND were restrained in a manner that interfered with their breathing. Again, excited delirium has NEVER – by itself – been legitimately demonstrated as being responsible for causing death.]

"What exactly kills the person when they have excited delirium? I think it's not completely understood," says Mash. "I think when your temperature's shooting up to 107, 108, you're in essence, cooking your brain."
[Febrile brain-cooking (caused by systemic infection or drug abuse) certainly CAN cause excited delirium. But, I know of NO case of febrile-induced excited delirium – by itself – being documented as having KILLED someone. Additionally, the "febrile" element associated with victims of excited delirium preceding a restraint asphyxia death is only a SURMISED contributing element – based solely upon the fact that so many excited delirium victims disrobe (get naked) prior to running amok and then being inappropriately restrained. No one has EVER factually documented an increased body temperature being association with a case of excited delirium restraint asphyxia death.]

By the time police arrive, they're confronted with a delirious victim burning with incredible power – the kind they say can only be tamed with overwhelming force.

That's what the coroner said the police were dealing with in Cincinnati last week. In Redwood City, Calif., District Attorney James Fox has a case of it right now. And he says he'd never heard of excited delirium until Ricky Escobedo caused a ruckus from the balcony of his ex-girlfriend's apartment and she called the police.

"He started talking about bugs biting him, although he had a jacket on. Talked about a dead cat that was on the balcony, which of course the officer could not see. Because there was no dead cat," says Fox.

It was quickly apparent that Ricky Escobedo was not going to leave. But when one of the two officers tried to frisk him for weapons, the fight was on.

"It ultimately ended up that there were six officers on one guy, before he was finally placed in leg restraints," says Fox.

Within minutes, the police discovered, Escobedo had stopped breathing.
[There you have it. Excited delirium PLUS restraint that interferes with breathing = DEATH. Had Escobedo NOT been restrained in a manner that interfered with his breathing, he MOST LIKELY would have SURVIVED whatever it was that caused his excited delirium in the first place.]

Escobedo suffered cardiac arrest, and, as with Toney Steele and Nathaniel Jones, blood tests revealed the presence of a stimulant in his system. In this case, it was methamphetamine.

But while all of that is true, it's the next line on the medical examiner's report that attorney Randy Daar takes strong exception to – the one listing a primary cause of death, as excited delirium.

"It is a blame-shifting phrase. It is a phrase that shifts the blame from the person exerting the force to the person that dies," says Daar. "Blame the victim. Blame the victim."
[Right on, Randy! You are entirely correct – especially these days. These days, ALL Medical Examiners KNOW about restraint asphyxia ... they all know that restraint asphyxia is "HOMICIDE," and NOT an "accidental" cause of death. But, many of them "MASK" their "cause of death" determination by wording it in a manner that avoids identifying emergency responders as being "at fault" for the death. This is an entirely inappropriate (probably illegal) practice. But, it happens again and again in these cases.]

Daar is taking the city of Redwood and the police to court on behalf of the Escobedo family, arguing that the real problem is that doctors are using foggy science to disguise police brutality.

"There's a guy on his neck. There's five or six cops on him. He's screaming for help. There must be 1,200 pounds on top of this guy," says Daar, who claims that the police killed Escobedo.

His proof, he says, comes from an autopsy that found a long list of injuries: including two broken bones around Escobedo's throat, eight broken ribs, and internal bleeding.

Daar says the cops simply crushed the man to death when they restrained him. But Fox launched an investigation, and then saw it a very different way: "In this case, the result of our investigation was, the officers were not guilty of anything."

Did the fact that the coroner found that excited delirium was a part of this death make his decision easier to make? Yes, it did, he says.

"He was the one who had broken the law by using the drugs. The effect of the drugs, I think, was the contributing factor to his death, the excited delirium," says Fox.

"The truth is usually what's right in front of your face, and not some long, convoluted explanation. And what you got right in front of your face is a man suffocated, with extensive injuries. Why are we looking somewhere else," asks Daar.

"Rather than dealing with it as a custody issue, they should have dealt with it as someone with a handicap. They certainly had enough force present that they could have protected themselves and the scene without engaging in a violent confrontation with someone they already knew was unstable."

So is it the violence that kills or is it the excited delirium? No one knows for sure, but in Cincinnati, the coroner ruled that the fight with police led to the death of Nathaniel Jones. And research shows that the struggle can ramp up the effects of excited delirium by pushing the heart rate beyond its limits, especially in someone who has abused drugs.

Nathaniel Jones was already suffering from heart disease. Ricky Escobedo's heart probably began to fail when he was restrained, the coroner found. And Toney Steele's autopsy found that his restraint may have been as much a factor in his death as the drug-induced excited delirium. But the police never faced any criminal charges.

The case, however, marked an important moment in the national debate over restraint that continues to this day. Excited delirium or not, the San Diego police decided, how you restrain someone could in fact mean the difference between life and death. So, it now trains its officers to deal with this situation: don't leave anyone facedown, and make sure you monitor him from the moment of arrest. For three years, not one person has died in police custody.

Summers believes that this training has helped save lives, but she says she doesn't think this would have saved Toney Steele: "I just feel that the narcotics had a hold of him, and I think it was slowly taking the life from him."

"I don't believe that. I don't believe that," says Steele's mother, Dorothy Nelson. "Hog-tying and suffocation. He suffocated. That's what I believe."

Nelson sued the San Diego police in civil court. But in the end, a jury decided that what happened after Sgt. Summers came face to face with Steele may have been tragic, but it was all in the line of duty.*

"I look back and I wish it would have been different. I wish he wouldn't have done those drugs. I wish he wouldn't have been a felon. I wish a lot of things," says Summers. "But I honestly don't know what I could have done different that day. I think he was dying basically, little bit by little bit, when I first met him in that intersection. That's how I look back at it."


(1) ANYone who's job description includes applying ANY form of restraint to another individual is RESPONSIBLE for performing restraint in a SAFE manner. Especially considering the amount of research and education available in the past ten years, "line of duty" responsibilities INCLUDE being properly trained to AVOID causing restraint asphyxia – and performing restraint techniques ONLY as properly trained to do so. These days, "I didn't know any better," is NO LONGER anything even vaguely resembling a legitimate "excuse" for restraining someone to death.

(2) Deaths associated with "Excited Delirium" ALWAYS have occurred AFTER a form of restraint that interferes with breathing was employed. Excited delirium – by itself – does NOT KILL people.

(3) Whether or not someone's excited delirium (altered level of consciousness) is caused by trauma, physical illness, mental illness, developmental disabilities, alcohol or drug abuse, there is NO JUSTIFICATION for KILLING them because of it. Especially since properly-trained restrainers can perform restraint SAFELY – for BOTH the restrainee and restrainers – there is no longer ANY EXCUSE for restraining someone to death.

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