Medical examiners group steps away from 'excited delirium'

A leading group of medical experts says the term “excited delirium” should not be listed as a cause of death. Critics have said the term has been used to justify excessive force by police.

The National Association of Medical Examiners had been one of the last to take a stand against the commonly used but controversial term. In a statement posted on its site March 23, the association said “excited delirium” or “excited delirium syndrome” should not be used as a cause of death. The statement has no legal weight, but will be influential among medical examiners.

Critics have called the terms unscientific, rooted in racism — and a way to hide police officers' culpability in deaths. The American Medical Association and the American Psychiatric Association do not recognize excited delirium as a diagnosis. Yet some police training materials have described it as a potentially fatal collection of symptoms including elevated temperature, unexpected strength, hallucinations and extreme agitation.

“Excited delirium is often used when there’s a death associated with a physical altercation between a citizen and law enforcement," said Dr. Roger A. Mitchell Jr., who chairs the pathology department at Howard University in Washington, D.C., where he served as chief medical examiner from 2014 to 2021. “It’s not a real explanation for the death."

Medical examiners have ruled that excited delirium caused or contributed to police-related deaths including the 2020 case of Daniel Prude in New York, the 2019 death of Julius Graves in Missouri, and the 2017 death of Adam Trammell in Wisconsin. The term came up during the 2021 trial of former Minneapolis police officer Derek Chauvin, whom jurors convicted in the death of George Floyd.

Medical examiners investigate unexpected deaths, conduct autopsies and determine causes. Some already had been moving away from excited delirium in favor of listing the multiple causes that can contribute to such deaths, including police restraint, drug use and medical conditions.

Dr. Joyce deJong, president of the medical examiners' association, said the group’s statement stemmed from growing concerns that the phrase might be used to justify excessive force by police and might be used disproportionally when the deceased was Black.

“Anything we can do to avoid perpetuation of a phrase that might be causing harm,” said deJong, a medical examiner for 12 counties in Michigan.

For families mourning the loss of a loved one, an excited delirium ruling could cause confusion over a term they’d never heard, or anger about what they consider a way to cover up excessive force.

John Peters, president of the Institute for the Prevention of In-Custody Deaths, which provides training and litigation support for officers, said the group's statement could lead to more investigations of police officers.

He said that the behaviors associated with excited delirium are often triggered by the use of illicit drugs such as cocaine and methamphetamines and that they ”will continue regardless of what we call it."

In another notable move away from the term, the Minneapolis Police Department has agreed to bar its officers from directing paramedics to inject sedatives such as ketamine into individuals they believe are experiencing excited delirium. The move came in a court agreement announced Friday by the Minnesota Department of Human Rights, which alleged the practice had been part of a pattern of racially biased policing in the city in recent years.

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Johnson reported from Washington state; Foley reported from Iowa City, Iowa.

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