A national physicians group is demanding an end to the use of the diagnosis “excited delirium,” calling it junk science that “cannot be disentangled from its racist and unscientific origins” in a report released last week.

“Excited delirium” is often used to describe a state of agitated confusion, often associated with drug use or mental illness, and sometimes with violent outbursts followed by an abrupt death.

But critics of the diagnosis say it has no clear or consistent definition, and the report’s authors note that it’s disproportionately applied to Black and brown men by law enforcement to explain sudden deaths in police custody.

The report, by Physicians for Human Rights, finds that, “When the diagnosis of ‘excited delirium’ has been advanced, it has almost always been by law enforcement and law-enforcement-affiliated organizations.”

Several medical professional groups, like the World Health Organization and the American Psychiatric Association, already don’t recognize the term.

Last year, the American Medical Association declared its opposition to the diagnosis. The association’s then-President-elect Gerald E. Harmon called it “a manifestation of systemic racism that has unnecessarily dangerous and deadly consequences for our Black and Brown patients.”

But its use remains prevalent nationwide. When Colorado police arrested Elijah McClain, they invoked “excited delirium,” both to justify injecting him with ketamine and later to explain his death. The defense team for Derek Chauvin — the Minnesota officer who murdered George Floyd — argued during Chauvin’s trial that Floyd was experiencing “excited delirium” and tried to use that to justify Chauvin pressing his knee to Floyd’s neck for more than nine minutes.

The diagnosis also has been used to explain deaths in police custody in the Bay Area.

Angelo Quinto’s family called the police to assist with a mental health crisis Quinto was experiencing in December 2020. Responding officers knelt on the Antioch man’s back, pinning him to the ground for what his family said was about five minutes. Quinto passed out, then died three days later.

Public outrage ensued, and community members called for justice for Quinto and for consequences for the responding officers. But in August 2021, a forensic pathologist hired by Contra Costa County named “excited delirium” as the cause of death, and the death was ruled an accident.

Dr. Vanja Douglas, a neurologist for UCSF, has worked for years with patients who experience delirium, mostly older people. He said he had never heard of the term “excited delirium” before reading the Physicians for Human Rights report.

Douglas said he was surprised to see delirium listed as a cause of death because it is a symptom of an underlying condition, not a condition in itself, and cannot be responsible for death. Instead, in a situation where a patient dies while delirious, the underlying condition would be the cause.

The Contra Costa County sheriff’s office, which houses the coroner’s office, directed questions from KQED about Angelo Quinto’s cause of death to the forensic pathologists involved who work as independent contractors for the county.

Dr. Ikechi Ogan, the pathologist who testified during a coroner’s inquest that “excited delirium” caused Quinto’s death, could not be reached for comment.

The Physicians for Human Rights report specifically names Quinto’s as one of the cases where “excited delirium” is used to explain away excessive force and minimize accountability of law enforcement.

“Angelo Quinto, a Filipino-American Navy veteran, is one of many people, disproportionately people of color, whose deaths at the hands of police have been attributed to ‘excited delirium’ rather than to the conduct of law enforcement officers,” the report states.

Julia Sherwin is a civil rights attorney based in Oakland who co-authored the report after spending years researching how the term is used among law enforcement. She said police departments must learn how to more safely handle people in distress rather than using “excited delirium” to explain away unnecessary deaths that are really caused by the actions of officers.

“What’s really important … is the human impact that this junk science has,” Sherwin said. “These are people who are suffering, who came into contact with law enforcement for one reason or another, and now they’ve been ripped from their families.”

Sherwin said restraints seemed to be one of the most common factors in deaths under police custody that were later ruled to be caused by “excited delirium,” and implored police departments to focus on deescalation training rather than resorting to force.

When encountering a person experiencing emotional distress, Sherwin said officers should make sure they are “not going hands-on with the person, not threatening them, they’re giving the person time to calm down … if they have to prone them out for handcuffing, good training would say turn them on their side or sit them up right away so they can breathe.”

Douglas, the UCSF neurologist, admitted that restraints are regularly used in cases where a patient is delirious and presents a danger to themselves or others, but said the use of restraints should be carefully monitored and deescalation tactics should always be used first.

“If you’ve got somebody who’s delirious, and you approach them with force, they may react in an unpredictable way and that situation could escalate … if they’re confused, restraining them will only make the confusion worse,” Douglas said.

Douglas also said it’s worth considering whether medical or mental health professionals would be better suited as the first responders to situations where a person is in crisis.

The report also calls on the Biden administration to establish a Department of Justice unit to investigate all in-custody deaths, and on the National Association of Medical Examiners to issue a statement recognizing that “excited delirium” is not a valid medical diagnosis and cannot be a cause of death.

In a statement to the authors of the report, NAME President Dr. Kathryn Pinneri said that although medical examiners will list “excited delirium” as a cause of death, the association doesn’t see it as a diagnosis.

“Though I suspect it is accepted among many NAME members, we have never issued any type of consensus statement on excited delirium,” Pinneri said. “And as an organization [we] have not formally ‘recognized the condition as a diagnosis.’”

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