A Comprehensive Review
of Frequently
Restraint Research

Miller CD. A comprehensive review of frequently misinterpreted and
misrepresented restraint research; Part two. March, 2005.

NEW as of December, 2005:
A 39-page PDF FILE containing All 3 Parts & the References!

If you're going to PRINT any part of this 3-part Comprehensive Review, print from the PDF file. The webpages end up printing weird (text next to photos bumps the photos to another page). Plus, printing all these parts and the reference list from the webpages takes up a lot more than 39 pages.

Chan TC, Vilke GM, Neuman T.
Reexamination of custody restraint position and positional asphyxia

Am J Forensic Med Pathol
, September 1998;19(3):201-205.(17)

"... We review case reports of custody deaths in subjects placed in the hogtie position, as well as related medical literature regarding positional asphyxia. We also review the current research findings from human physiology studies that have investigated the effects of the hogtie position on respiratory and pulmonary function. We conclude that the hogtie restraint position by itself does not cause respiratory compromise to the point of asphyxiation and that other factors are responsible for the sudden deaths of individuals placed in this position."


"Based on these findings, factors other than body positioning appear to be more important determinants for sudden, unexpected deaths in individuals in the hogtie custody restraint position. Illicit drug use (including sympathomimetic, hallucinogenic, and psychomotor stimulant drugs), physiologic stress, hyperactivity, hyperthermia, catechol[amine] hyperstimulation, and trauma from struggle may be more important factors in the deaths of these individuals. Although restraints in general increase the psychological and physiologic stress on the individual, no evidence suggests that body position alone causes hypoventilation, respiratory compromise, or positional asphyxia in the hogtie custody restraint position."

In this 1998 article, Chan et al "reviewed" several previously-published case studies of deaths occurring between 1985 and 1995, wherein the victim died while being subjected to an asphyxial form of restraint (forceful-prone-restraint, with or without hogtie).(17) Chan et al painstakingly re-reported the myriad of different circumstances ("factors") additionally associated with each of these restraint-related deaths. Then, they did their best to cast doubt upon the cause-of-death conclusions drawn by forensic pathologists (individuals infinitely more qualified than Chan et al to draw conclusions regarding the cause of someone's death).
What was Chan et al's primary support for their argument that they knew better than forensic pathologists? Their November 1997 Annals-published report generated by the controlled clinical study they performed evaluating the effect of a pseudo-hogtie position on perfectly healthy volunteers.(1)

BASICALLY, the BIGGEST problem with Chan et al's
September 1998 "Reexamination" article is this:

The way they worded their review article's conclusions erroneously infers that "factors other than body positioning" were the REAL cause of these deaths (all of which occurred during the application of an asphyxial form of restraint). Chan et al neglected to discuss the fact that ALL the other factors they identified were ENTIRELY SURVIVABLE – IF the person suffering from one or more of them was NOT restrained in a manner that interfered with breathing!
In other words, NONE of these "factors other than body positioning" – all by themselves – were responsible for any of the restraint asphyxia deaths reviewed by Chan et al. Had any ONE of these "other factors" been evidenced at autopsy to have been a MORE-LIKELY-than-restraint-asphyxia "cause" of someone's death, that person would never have been considered a restraint asphyxia victim in the first place. That victim's death would immediately have been conclusively attributed to one or more of these "other factors."
And, although any of these other factors may have contributed to hastening death AFTER the person was restrained, since none of them were solely-responsible for any of the reviewed deaths, NONE of them can possibly be considered "more important" factors than the form of restraint that ultimately resulted in each death. They were simply "associated" factors.


The structure and wording of this review article strongly indicates that

  1. Chan et al remain primarily preoccupied with promoting the entirely FALSE idea
    that hogtie or forceful-prone-restraint "DOESN'T KILL"
  2. Chan et al remain primarily preoccupied with providing people like
    San Diego County Deputy Counsel, Ricky R. Sanchez
    a means to defend those who restrain someone to death.
If – by some bizarre circumstance – you arrived at this page without FIRST reading PART ONE of this 3-part Review, READ PART ONE NOW, and then come right back. Otherwise, you'll not recognize the legitimacy of those last two comments.

But, WHY would seemingly respectable and learned physicians
persist in promoting a FALSE interpretation of their research?!

What is Chan et al's motivation for doing this?
At this writing, I do not – yet – know the precise answer to those questions.
However, I am investigating several potential reasons.

Potential Reason #1; FOR THE MONEY:
Since their November 1997 Annals article was published, Chan, Neuman, and Vilke have been making a rather substantial amount of money working as "Expert Witnesses" for attorneys seeking to defend those who restrain someone to death.

Although I've worked at least one restraint asphyxia case wherein CHAN has testified in support of the individuals who restrained someone to death (maybe two or three cases – I forget), I've not yet managed to obtain CHAN's "FEE SCHEDULE." (A "Fee Schedule" is the document that identifies how much an "expert" charges to review case material and provide testimony.)
Either Chan has managed to protect his Fee Schedule from "discovery," or the attorney(s) I worked for didn't think to send it to me.
HOWEVER; on page 12 (lines 14-22) of the August, 2003 deposition testimony he provided in the case of Kapanak vs. City of Phoenix; Superior Court of the State of Arizona; County of Maricopa; No. CV 2001-012136; Chan made it very clear that 1998 was the first year that he ever began earning income by providing "Expert" testimony for legal cases. Consequently, Chan's "Expert Witness" career was non-existent prior to the November 1997 Annals article's publication.

I have obtained Neuman and Vilke's 2001 Fee Schedules. They were included within the materials I received to review for Stetter vs. Village of Hanover Park, et al. US District Court, Northern District of Illinois Eastern Division; CAUSE NO. 99 C 7084 in February, 2003.
If you'd like to see Neuman and Vilke's 2001 Fee Schedules, CLICK HERE, and then come right back!

HOWEVER. Even though Chan et al make a lot of money when they perform case material reviews and provide testimony for attorneys seeking to defend those who restrain someone to death, I cannot believe that their motivation for misrepresenting their work is purely monetary. After all ... they're Doctors! They already make a ton of money doing what they regularly do. Plus, "to make money" is not supposed to be a "motivation" for doctors doing the things they do!
Perhaps I'm na´ve – perhaps I'm wrong – but, until I obtain other information strongly identifying MONEY being their motivation, I elect to believe that Chan et al's desire to make more MONEY is NOT the motivation for their persistent promotion of a false interpretation of their research.

Potential Reason #2; TO "SAVE FACE":
Since their November 1997 Annals article's publication, Chan et al have received STRONG criticism from a number of Forensic Pathologists (including JD Howard and DT Reay), and a number of their "peers" (including DF Kupas and GC Wydro). Forensic and medical professionals who are unbiased and knowledgeable in this subject have strongly admonished Chan et al for citing the values they obtained (from studying healthy volunteers in a controlled setting) in a manner that encourages "misinterpretation of findings in deaths that occur outside the clinical setting."(12,13,14,16)

To re-read the small collection of published criticism regarding Chan et al's November 1997 Annals article that I provided in PART 1 of this Review, CLICK HERE, and then come RIGHT BACK!
When you read them, keep in mind that these are only the published letters and comments they received. Clearly, Chan et al probably received numerous other, unpublished, criticisms for the manner in which they misrepresented their study's findings.
Obviously, Chan et al would not want to admit that they misinterpreted (or ever misrepresented) their clinical study's findings. SO: When faced with all the criticism they've received, Chan et al may have decided to write their September 1998 "Reexamination" article in an attempt to suggest that there is further "support" for the conclusions they misrepresent as having been identified by their November 1997 Annals article.

Currently, THIS is the motivation I most-strongly believe led to Chan et al writing a review article that superficially seems to provide additional support for the entirely unsubstantiated and FALSE idea that they've "proven" that hogtie or forceful-prone-restraint "DOESN'T KILL."
Fortunately, anyone who is unbiased and knowledgeable in this subject easily recognizes that Chan et al's September 1998 "Reexamination" article's CONCLUSIONS are equally as flawed as their November 1997 Annals study article's CONCLUSIONS.
Unfortunately, anyone who is NOT unbiased and knowledgeable in this subject easily may adopt the erroneous belief that Chan et al's September 1998 "Reexamination" article provides additional support for the misinterpretations and misrepresentations of Chan et al's November 1997 Annals study article.

Potential Reason #3; TO AVOID LITIGATION???:
If more articles and/or review papers are published, containing suggestions that Chan et al's November 1997 Annals article provided "proof" that forceful-prone-restraint (with or without hogtie) "DOESN'T KILL" – even though that's not true – does that make Chan et al less susceptible to accusations of having "contributed" to the restraint asphyxia deaths that have occurred since their 1997 article's publication and their subsequent promotion of its misrepresentation?
I have no idea! I am not an attorney. (I don't play one on TV – I didn't stay in a Holiday Inn Express last night.) But, I'm working as hard as I can to imagine other potential motivations – apart from "for the MONEY" and "to SAVE FACE" – for Chan et al to act as they have. And, this is the ONLY other potential motivation that I can come up with.

However, if this IS their motivation, it's entirely INEFFECTIVE.
It has been my experience that; the more Chan et al (and others of their ilk) "muddy" the waters with misrepresentation of the November 1997 Annals article's study findings, the more time-consuming it becomes for unbiased and knowledgeable individuals to explain and expose such misrepresentation. But, no matter how muddy the water becomes, unbiased and knowledgeable individuals are NOT PREVENTED from providing explanation and exposure of these individuals' misrepresentation of the facts.
Thus, no matter how muddy the water becomes, IT IS A FACT THAT:

ANYONE who has argued that Chan et al's November 1997 Annals article
provided "PROOF" that asphyxial forms of restraint "DON'T KILL"
that has occurred SINCE THEN.

In the future, if I can contribute to a "Class Action" law suit being successfully brought against Chan et al (and others of their ilk), I will happily do so. It is my opinion that their persistent misrepresentation of the November 1997 Annals article's study findings has significantly contributed to ALL of the restraint asphyxia deaths that have occurred since it was published.
After all; had Chan et al (and others of their ilk) honestly represented the study's findings, NO ONE would have been able to use their study (or their subsequently-provided legal testimony) as an EXCUSE to CONTINUE USING the ASPHYXIAL FORMS OF RESTRAINT that are STILL KILLING PEOPLE TODAY!

A RELATED LETTER Published After Chan et al's REVIEW ARTICLE's Publication

An Excerpt From: Reay DT, Howard JD.
(Letter to the editor regarding) Restraint position and positional asphyxia.
Am J Forensic Med Pathol September 1999; 20(3):300-301.(18)

We still have concern regarding deaths that occur during restraint. From the work of Chan et al., we now know that the hog-tied position should not produce serious physiologic consequences. However, during street restraint maneuvers, the totality of events must be considered. In the process of rendering a person helpless to handcuff him or her in a prone position, the involved officers may be required to "pile on" the suspect, pinning the person to the ground with the partial or full weight of the officers and thus compressing and restricting ventilatory function. The physical condition of the person and the circumstances of restraint can make a difference, and each case must be evaluated with a careful reconstruction of events to identify respiratory interference during and after the "takedown" and before the person is restrained. One of us (D.T.R.) was witness to a take-down of an obese man whom the police were trying to control. While compressed on the ground, the man repeatedly complained that he was having difficulty breathing. He was handcuffed and sat upright and stopped complaining. We wonder what the outcome would have been if he had been held face down on the ground until he became quiet.

'Nuff said, I think.


Chan et al's September 1998 "Reexamination" article

NOW, Go To:

A Comprehensive Review of Frequently Misinterpreted and
Misrepresented Restraint Research; PART THREE

Chan TC; Neuman T; Clausen J; Eisele J; Vilke GM.
Weight force during prone restraint and respiratory function
Am J Forensic Med Pathol, September 2004;25(3):185-189.
Finally posted on August 1st, 2005!

A Comprehensive Review of Frequently Misinterpreted and
Misrepresented Restraint Research

SECOND DRAFT Posted on March 22, 2005.

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Misrepresented Restraint Research

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Email Charly at: c-d-miller@neb.rr.com
(Those are hyphens/dashes between the "c" and "d" and "miller")