Bloomberg Law
Dec. 17, 2021, 9:00 AM

‘Excited Delirium’ Endures in Probes Into Deaths in Custody

Jess Palyan
Jess Palyan
University of St. Thomas School of Law

During the Derek Chauvin trial, I was part of a team that published a Bloomberg Law Insight linking the deaths of George Floyd and Elijah McClain through claims of excited delirium. Since then, more has come out about this spurious diagnosis and the injustices associated with it.

Excited delirium as a cause of death has delayed or denied justice for thousands of victims of police violence. George Floyd and Elijah McClain are the most famous—Floyd’s family did get to see his murderer convicted, whereas McClain’s case has resulted in the indictments of his alleged killers about three years after his death. McClain’s story mirrors another we are just learning about: Antonio May.

According to a civil lawsuit filed in May 2019 by May’s family against the Fulton County, Georgia, sheriff’s office and others, May was suicidal and high on methamphetamine when he was encountered by police. All parties agree that May was throwing rocks at a building in Atlanta when they arrived, and he peacefully surrendered himself into their custody.

They brought him to a hospital. There he was diagnosed with substance abuse psychotic disorder, however, the hospital cleared him to leave. He was brought to Fulton County Jail in Atlanta: It was a Tuesday; the guards are alleged to have been overheard declaring it “Taser Tuesday.” In his cell, May undressed and exposed himself, according to the complaint. Guards noticed, entered his cell, and allegedly tasered him without warning.

In all, six guards allegedly tasered, beat, and maced May. They also strapped him to a restraint chair and sprayed water in his face to get the mace off, the complaint said. May ended up dead, strapped to the chair, in a pool of his own blood. The Fulton County Medical Examiner’s report determined that the cause of death was “probable excited delirium.”

Blaming this (made-up) disease for May’s death is one of the reasons why it took three years to indict the jail officers on charges of murder—they were indicted in November.

Excited Delirium Defined

Excited delirium is a re-branding of a panic attack, or of a bad high. It is partially characterized by hyperaggression, superhuman strength, non-responsiveness to authority figures, and high body temperature.

The symptoms, however, are flexible, and have been criticized for being so vague that they are diagnostically unusable. Dr. Lesley Brooks, a physician on a State of Colorado Health Department panel that was set up to investigate excited delirium told Denver 7 News: “It has subjective and non-medical criteria such as hyper-aggression, increased strength and police noncompliance—all of which are very subjective and inherently biased.”

The panel also concluded, in its December report, that excited delirium has, perhaps unsurprisingly, “been associated with racial bias against African-American men.” The most dangerous claimed symptom, and the one with the least scientific evidence, is that excited delirium can cause sudden and otherwise unexplained death.

The claim of death is scientifically baseless. The only major, tier-one evidence study of excited delirium as a cause of death came to the following conclusion:
“There is no evidence to support [excited delirium] as a cause of death in the absence of restraint. These findings are at odds with previously published theories indicating that [excited delirium]-related death is due to an occult pathophysiologic process. When death has occurred in an aggressively restrained individual who fits the profile of [excited delirium], restraint-related asphyxia must be considered a likely cause of the death.”

In cases documented as excited delirium, aggressive restraint was the much likelier cause of death. That restraint can come in many ways, with three being most prominent. For George Floyd, it was physical restraint, being kept in the highly dangerous “prone restraint” position.

For Elijah McClain, it was chemical and physical restraint, as he was given an overdose level of the powerful anesthetic ketamine while in prone physical restraint. And for Antonio May, it was electrical restraint, being repeatedly tasered, along with physical restraint.

Excited Delirium Denounced as a Diagnosis

These and other findings led the American Medical Association in June of 2021 to officially denounce the use of excited delirium as a clinical diagnosis in the absence of scientific proof. The American Psychiatric Association came to a similar conclusion, stating that the vagueness and adaptability of the symptoms of excited delirium make the term diagnostically useless.

Neither organization had ever recognized the condition prior to these statements, though they had not condemned it, either. Still, excited delirium is defended by the National Association of Medical Examiners and the American College of Emergency Physicians.

Even if the behavioral state described by excited delirium were valid, excited delirium’s acceptance as a cause of death is an acceptance of convenience. It is a quick case closer, a way to shrug and say “there is nothing we could do” even when a patient has been beaten and tortured by police. It is a way to justify murders, obscure accountability, and delay justice.

In Antonio May’s and Elijah McClain’s case, the excited delirium smoke screen only delayed the arrests of their alleged killers. But there are many more cases of excited delirium, though there is no reliable tracking system for those deaths. A Reuters investigation found at least 276 cases of excited delirium being cited in taser-related deaths since 2000, and that count excludes deaths unrelated to tasers or before 2000.

Not every death blamed on excited delirium represents a wrongful death, but all deaths blamed on excited delirium represent a failure to properly and completely investigate the true cause of death.

No institution should be accepting this unscientific diagnosis as a cause of death unless or until someone can explain in detail what excited delirium is and how it kills people. No person supposedly killed by excited delirium should have their case swept away by a coroner.

This column does not necessarily reflect the opinion of The Bureau of National Affairs, Inc. or its owners.

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Jess Palyan is a certified law student practitioner at the University of St. Thomas School of Law Community Justice Project, a legal clinic focused on achieving social justice through policy. He wants to thank co-clinicians Kathryn Quinlan, Sarah Murtada, and Christiane Portugal Dos Santos for their research and leadership.