Bloomberg Law
March 23, 2021, 8:01 AM

Excited Delirium: The Connection Between George Floyd and Elijah McClain

Kathryn Quinlan
Kathryn Quinlan
University of St. Thomas School of Law
Jess Palyan
Jess Palyan
University of St. Thomas School of Law
Sarah Murtada
Sarah Murtada
University of St. Thomas School of Law
Christiane Dos Santos
Christiane Dos Santos
University of St. Thomas School of Law

There are numerous connections between the stories of Elijah McClain and George Floyd. They were both Black. They were both men. They were killed by police acting far below the cautionary standards imposed by their uniform.

But a more subtle, insidious thread will eternally link these two men with one another and countless victims of police brutality: excited delirium.

In Aurora, Colo., McClain suffered cardiac arrest in 2019 after police officers mounted approximately 700 pounds of force on his body. Subsequently, McClain received a dose of ketamine, that was well above the recommended limit for a man of his weight.

Paramedics administered ketamine, a medication used for anesthesia, after police suggested McClain was suffering from excited delirium, a controversial condition referenced in several high-profile deaths involving the police. Symptoms include hyperactivity, paranoia, violence, and “superhuman strength.” Perhaps the most troubling symptom is sudden, unexpected death.

Excited delirium is controversial because its diagnosis is not accepted by the World Health Organization, American Medical Association, or the American Psychiatric Association.

George Floyd Case

Despite this, excited delirium is mentioned in police training documentation across the U.S., including those distributed to the Minneapolis Police Department (MPD). Due to this training, officers know which “buzzwords” are closely associated with excited delirium. Once an officer uses at least one of these buzzwords, it can trigger action from EMS personnel.

In Floyd’s case, a transcript shows that Officer Thomas Lane referenced excited delirium by name while Floyd begged for air. In McClain’s case, officers restrained a five-foot-six-inch 140-pound man for an excess of 18 minutes due to his alleged display of superhuman strength. The use of buzzwords alert first responders of the potential danger a subject imposes on the public and on themselves, however, they are often used to justify police brutality.

Excited delirium is recognized by the National Association of Medical Examiners, allowing medical examiners to categorize the condition as a legitimate cause of death. This, in part, explains why no one was charged in McClain’s death: The cause of death was listed as “undetermined.”

However, excited delirium was discussed as a possible factor along with the administration of ketamine and McClain’s physical exertion. A similar defense is expected to be presented at Derek Chauvin’s trial for the murder of Floyd.

The majority of excited delirium diagnoses involve Black men. The consensus drawn from both anecdotal and statistical evidence by civil rights activists is this: Excited delirium is used as a get-out-of-jail-free card for police brutality

Problems in the Emergency Medicine Community

The problem extends past law enforcement and into the emergency medicine community. The American College of Emergency Physicians recognizes excited delirium, breaking with most of the general medical community. When excited delirium is identified, a subject is often restrained, either physically or chemically with a sedative such as ketamine. Many times, such as in the cases of Elijah McClain and George Floyd, these restraints were significant causes of harm or even death.

Ketamine, even when properly administered, can cause serious problems. In a series of controversial 2018 studies in Minneapolis, Hennepin Healthcare collected data on people who were “agitated” and were administered ketamine without informed consent in a pre-hospital setting. These studies revealed between 39% and 57% of people given ketamine ended up requiring endotracheal intubation to breathe. After public outcry, these studies were halted.

Physical restraint is also dangerous. In a study on the connection between excited delirium, physical restraint, and fatality, researchers examined as many identified cases of excited delirium (and a similar condition called “agitated delirium”) as they could find in scientific literature. Going case-by-case, theyfound a positive correlation between aggressive forms of restraint and death. They found no evidence of a link between excited delirium and death when there were no aggressive forms of restraint.

Avoiding Aggressive Restraint

While aggressive restraint may seem like the common-sense solution to the problem of hostile or agitated individuals, it must be avoided if possible. When restraint is necessary it must be done safely.

Cities like Eugene, Ore., and Denver have employed successful strategies to prevent police interaction with people in mental health crises. These cities provide successful models that are viable for the rest of the country. Their novel idea was a simple one: send a non-uniformed social worker and a non-uniformed safety liaison to mental-health calls, with a focus on preventing stress and agitation.

Excited Delirium Needs to Be Dropped From Protocols

Excited delirium is, at best, questioned by the medical community and, at worst, condemned by it. What we do know is once it is identified, the subject is usually restrained, either forcibly or chemically, and this restraint can put the victim in an unnecessarily dangerous situation.

Floyd died while being physically restrained, and McClain died after both physical and chemical restraint. Neither situation justified excessive use of restraint: Floyd was agitated during arrest and McClain was simply walking home.

Police were trained to recognize a non-medical diagnosis, and, in both cases, either the fear of excited delirium escalated their conduct, or the police justified their conduct with the excuse of excited delirium.

Until further study of the syndrome’s legitimacy and safety protocols for its treatment are developed, police departments and the National Association of Medical Examiners must drop excited delirium from their protocols and training, as it is a dangerous diagnosis, which has aided in the justification of the injury or death of several people.

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

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Author Information

The authors, Kathryn Quinlan, Jess Palyan, Sarah Murtada, and Christiane Dos Santos are student practitioners in the University of St. Thomas School of Law Community Justice Project.

The authors would like to thank the contributions of Professor Carl Warren, director, University of St. Thomas School of Law Community Justice Project, and Tori Kee, clinical law fellow and staff attorney, University of St. Thomas School of Law Community Justice Project.