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California bans 'excited delirium' term as a cause of death


Excited delirium is no longer an official cause of death in California. It's a controversial medical diagnosis that is sometimes used to explain the deaths of people while being subdued by police. But last week, Governor Gavin Newsom signed legislation making California the first state to ban the term on death certificates. NPR's law enforcement correspondent Martin Kaste explains why.

MARTIN KASTE, BYLINE: Jim Glennon was a cop for 30 years and then a police instructor for another 30 with a company called Calibre Press. And this is how he explains the concept of excited delirium.

JIM GLENNON: One of the things that we say is that it's a term that really doesn't have a specific definition.

KASTE: Glennon says over the years, the concept has mostly been used by trainers to prepare officers for people who might be extremely hard to handle, perhaps because of drugs or a psychological crisis.

GLENNON: People who are talking unintelligibly, extreme agitation, in many occasions, will start to rip their clothes off. You know, they'll often walk into traffic. So when you see it, don't try to handle a person by yourself, no matter how small they are or how big you are.

KASTE: But some say the danger in the term is that it might predispose police to use too much force or to call emergency medics in to sedate the person, which can also be risky. One of the officers on the scene when George Floyd was killed was heard raising the possibility that he had excited delirium. And in Aurora, Colo., in 2019, officials cited it as a possible reason that Elijah McClain died while he was being arrested. Only later did they charge officers and EMTs for his death. One officer was convicted last week.

MIKE GIPSON: This term, excited delirium, doesn't exist.

KASTE: That's California Assemblyman Mike Gipson. He wrote the legislation that just became law. He points to groups such as the American Medical Association, which have come out in recent years against the existence of this diagnosis. Gipson, who's also a former cop, thinks excited delirium is a fallback cause of death that just muddies the waters.

GIPSON: If a police officer has someone in custody, and a person dies from positional asphyxia, it should be placed on there that this person died from positional asphyxia, cutting off oxygen flow to someone's brain. It should conclude that. It should not be made up of a term to try to cover up something.

KASTE: This change in attitude goes beyond California. Police departments and trainers around the country are starting to accept that the science behind excited delirium is shaky. Last year, Lexipol, the biggest company that provides policy manuals for police departments, said the term should no longer be used. Ian Adams is an associate professor of criminology at the University of South Carolina, and he says, you have to keep in mind here that the police were not the ones who came up with excited delirium.

IAN ADAMS: The concept was sort of well-accepted and presented in training by doctors and lawyers who would fly in and present this as if it was simply accepted medical fact. There was really no consideration that this might be a controversial subject that medical professionals were quite divided on.

DETROW: And Adams thinks eliminating the term will mostly affect death certificates and court cases, not necessarily how much force the police use during the arrest itself.

ADAMS: Raising this issue as a cause of death is really a - something that happens after.

DETROW: Potential legal causes of death don't change the essence of good police training, says Jim Glennon. He doesn't think dropping this term, excited delirium, is going to be that big a deal.

GLENNON: I don't know if there is such a thing, medically. That's way above my pay grade. If a doctor came up to me and said, listen, I know this guy. He's a patient of mine. He's suffering from excited delirium - thanks a lot, but I'm still going to react to the human being in front of me.

KASTE: And a key part of that reaction, he says, should be to keep watching the person's condition, especially to watch whether he or she is able to breathe freely. That's more important, he says, than worrying about what the technical diagnosis might be.

Martin Kaste, NPR News.

(SOUNDBITE OF AGNES OBEL SONG, "THE CURSE") Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Martin Kaste
Martin Kaste is a correspondent on NPR's National Desk. He covers law enforcement and privacy. He has been focused on police and use of force since before the 2014 protests in Ferguson, and that coverage led to the creation of NPR's Criminal Justice Collaborative.
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