A Doctor’s Diagnosis for Murder Part II – Excited Delirium


Part I

Part II

Warning: This post will be graphic and discuss police violence in a very real way.

We left off after the first part of this excited delirium analysis with an account of Gregory Lloyd Edwards’ murder, how he was placed in a cell with tasers lodged in his back and a pepper spray covered hood over his head with his hands tied behind him. Unfortunately this tragedy is one of thousands that have been covered up with excited delirium as the cause of death.

Of course after police have killed someone from their own violent actions they won’t take responsibility. They are the ones that are supposed to protect us after all, right? Excited delirium provides the perfect scapegoat in instances where guns aren’t used, allowing police to intimately murder people with their own two hands and justify it as necessary against a “violent criminal.” Excited Delirium is diagnosed as a cause of death almost exclusively for individuals in police custody, and of these disproportionately occurring incidents, 62% have been directly preceded by use of force such as chokehold restraints or tasers. An additional 15% of ED fatalities have resulted from unclear circumstances, as they were erased from record or have suspect testimony. Most cases do involve illegal drugs too, but force is truly the definitive factor in these deaths as I’ve previously mentioned the levels of narcotics are nowhere near overdose thresholds. Of the excited delirium deaths that happen in police custody, 94% of them are men and nearly 40% are black men. African American men comprise only 6% of the population. 

Regardless of the disproportionate use of ED as a diagnosis for African American men dying, police use it to justify brutality on plenty of white folks too. Aaron Parker was found naked and bleeding on the highway by law enforcement when they showed up to arrest him. He began throwing punches and flailing when police approached him, in an obvious state of mental distress that didn’t pose a serious threat. He was tased repeatedly, physically restrained and given a dose of the sedative narcotic ketamine by paramedics. Aaron perished en route to the hospital, and upon autopsy his death was determined to be excited delirium from stimulants in his system. However the toxicology report only showed cannabinoids in his tissue despite the official report claiming he had levels of cocaine. This is indicative of many excited delirium cases; toxicology reports that show negative results for stimulants or reveal levels that are far lower than overdose thresholds. 

Only 7% of cases involving excited delirium are ruled as homicides and opened to further investigation, yet ED accounts for 10% or more of deaths in police custody. With over a thousand fatal incidents at the hands of the police per year, this is no small number of lives. In almost every case cops are able to use ED as a means to avoid homicide investigations being opened, which means there is no scrutiny on the behavior of police leading up to a victim’s death. 

The APA acknowledged in a formal statement during 2020 that medical examiners have insufficient basis for using excited delirium as a cause of death. ED isn’t recognized in the DSM 5 or by any reputable medical organization; including the APA, AMA, or European Society of Emergency Medicine. The only institution that has upheld it as a diagnosis is the American College of Emergency Physicians, specifically a doctor named Mark Debard who has been paid by Axon. Any reputable doctor, that is being truthful, will tell you excited delirium is a fabricated medical term used to cover up police actions that directly led to a patient’s death. As further proof that excited delirium is an absolutely made up medical term police and their examiners have conveniently co-opted; in every case that someone has died from “ED” with it being purely attributed to drug use, the levels of narcotics in their system have been consistent with outright overdoses (multiple degrees higher than the thousands of questionable deaths we are discussing). 

Dr. Deborah Mash, a medical researcher at the University of Miami, happens to be the most prominent advocate for excited delirium outside of Wetli and Debard. She has stated that people in a psychiatric state of mania (aka ED) usually have the police called on them in the first place, which necessitates the use of force. It is weird for a medical diagnosis to include cops being called on you, let alone justify their use of force due to a condition’s “psychiatric state.” Name me one other diagnosis that states death may occur because someone needs to be restrained from their own mania. She always chooses her words very carefully to avoid implicating the actions of law enforcement in any way. She never includes a statement about the tools or action that law enforcement used, rather just makes it seem that someone such as Edwards died because he didn’t get medical treatment in time for his excited delirium. This allows her to weasel around acknowledging that the cops actually caused his death, and many others, hiding behind the falsified medical term of ED. She is able to express sympathy for victims but she doesn’t blame police, or even acknowledge that their force was unjustified. Mash blames budgetary constraints and healthcare failures instead of the blatant brutality happening to these victims. The issue in her eyes is that jails don’t have enough nurses, so we need to give law enforcement more money that they can use to hire necessary staff. Police also totally won’t use that money on more weapons like tasers, they just need more medical personnel to take care of the people they shoot and strangle. 

Why else would police need a “special” term for overdoses unless they weren’t expecting that to actually be the cause of death, and perhaps knew that their actions were the true impetus? Police blatantly use excited delirium to avoid homicide cases being opened and having their behavior under scrutiny, like what they tried to do with George Floyd. When Floyd was on the ground dying, one of the responding officers that was casually watching the life being squeezed from a man asked his supervisor if they “should be worried about excited delirium or something.” The cause of death didn’t stick in Floyd’s case and an investigation was opened, but many others such as Elijah McClain have successfully had their murders covered up with an ED diagnosis. 

Elijah was walking home after stopping in a convenience store for iced tea. He had bowed to customers in the store and someone called 911 reporting suspicious behavior, so cops pulled up alongside him on the sidewalk. Bear in mind the following interaction is not abnormal in America, it is just one incident that caught attention.

Police: Hey, stop right there. Stop. Stop.  

Elijah McClain: I have a right to go where I’m going. 

Police: Stop. Stop. I have a right to stop you ’cause you’re being suspicious.  

McClain: Well, okay. 

Police: Turn around. Turn around. 

McClain: No actually … 

Police:  Stop tensing up. Listen to me, bro. 

McClain: Let go of me. No. Let go of me.  

Police: Stop tensing up. We’ll go away.  

McClain: No. I am an introvert.

Police: Stop tensing up.

McClain: Please respect the boundaries that I am speaking. 

Police: I’m trying to.

McClain: I’m so sorry. 

Police: He reached for your gun, dude.

Police: That’s why, that’s why I tried carotid … 

McClain: I don’t do that stuff. I don’t do any fighting.  

At this moment the original officers are joined by at least nine others, then they assist one of the first responders to grapple McClain and force his head into a neck hold. The officer takes Elijah to the ground in this hold, causing obvious pain and distress from the young man. 

McClain: I can’t breathe correctly ’cause …

Police: Dude, if you keep messing around I’ma bring my dog out, he’s going to dog bite you. You understand me? Keep messing around. 

Handcuffed, writhing under the full weight of another man, and struggling for air, Elijah vomits. Shortly after the threat of bringing out a dog he passes out. It’s important to keep in mind that after McClain vomits and passes out, he is still restrained in an awkward position. Paramedics then arrive and officers direct them to inject Elijah with Ketamine, with toxicology finding that the dosage was appropriate for someone over twice the young man’s size

Dr. Michael Baden, one of the leading Forensic Pathologists in the U.S., says if Charles Wetli was correct in his diagnosis then we would see other stressful occupations like marines and other combat personnel die from “overproduction of adrenaline.” Obviously this has never happened, and Baden states that he is “of the strong opinion it [excited delirium] is a boutique diagnosis created by my forensics pathologist colleagues specifically for persons dying when being restrained by law enforcement.” Dr. Russel Vega says that ED is a “behavioral state,” and that medical examiners should be determining the physical cause of death, not behavior that preceded death. A diagnosis of excited delirium would be like saying someone died from cardio respiratory arrest, which yeah, everyone dies because their heart and lungs stop working. The lead psychologist who oversees changes to the DSM V says that excited delirium is “bad science,” explaining that Wetli’s diagnosis was faulty due to biases surrounding the war on drugs and a misconceived, perhaps racist, drive to apply this to women that were strangled by a serial killer in the worst interpretation of Occam’s Razor.

The Axon Corporation (ironically also a provider of body cams for police departments), claims that their tasers have not caused any deaths; that they have in fact saved hundreds of thousands of lives and are 99.7% safe when used properly. Dr. Werner Spitz says quite bluntly that he’s seen numerous taser deaths, and the evidence is plentiful; there have been at least 1,005 documented fatalities in the U.S. since the early 2000’s after a victim was stunned by a taser, along with additional blunt force trauma from police in most cases. Additionally, coroners and medical examiners have listed tasers as a cause or contributing factor of death in at least 153 incidents where police deployed the weapon. Dr. Spitz notes that If you fire a taser into someone’s precordial area, either in their chest or back where the heart is, the current put out by the weapon is highly likely to affect the electrical impulses of the heart. Despite hundreds of case examples and overwhelming consensus that tasers can in fact induce death, Axon claims that only 24 incidents involving tasers have done so, and out of those the fatality was due to secondary factors such as a head trauma.

Israel Hernandez Llach, a recent highschool graduate, was caught spray painting tinted out McDonald’s windows by Miami Beach PD officers in 2017. After a brief pursuit the 18 year old aspiring art teacher was shot in the chest with a taser. Llach went into cardiac arrest instantly and at 6:18 am he was pronounced dead. 4 hours later the Miami Beach police department received an email; in their inbox, “Confidential” blared across the subject line. The message was from Taser’s manufacturer, and Axon had provided them with a detailed step by step guide for how to proceed with the case of Llach. It included everything from collecting hair and nail samples, recording body temperature at time of death, to documenting behavior before he was stunned. There was also a press release docket and a checklist for all the evidence that needed to be collected. The most heavily emphasized point in the letter was bold and underlined, urging the department to send Llach’s brain tissue to Deborah Mash at the University of Miami. It stated that the tissue would degrade quickly, warning them of the need for timely action as part of the “total package” that Axon provides to taser users. They send an entire fucking guide that goes through a detailed checklist for cops to mount a legal defense against the impending wrongful death suit. 

The kicker is, Mash’s relationship with taser was never disclosed in the email, and the Miami Beach medical examiner said he didn’t know about it when performing Llach’s autopsy. In a 4 year span she received at least $24,000 from Axon that Reuters could actually verify; she was most likely paid much, much more, explaining her fierce defense of cops and ED. It turns out her “mentor” is Wetli, and she has expressed admiration for his work on multiple occasions. She has been hired by Axon as an expert witness on his recommendation, being their most loyal employee and all, and in more than a dozen lawsuits she has reaffirmed the police’s defense of excited delirium. This is quite literally doctors taking money so that they will make up excuses for murder. The Miami-Dade examiner said that he was certain the taser charge was the cause of death for Llach, as it had directly induced cardiac arrest. Florida investigators included Mash’s testimony in their report, claiming they were unaware of her connection to Axon as well. In the end it was ruled that Israel died of excited delirium as a taser shot was determined to have no “reasonable expectation” of death. The doctors I’ve previously mentioned along with the former head of medical facilities at Rikers Island have all come out since and said ED isn’t real. Excited delirium doesn’t stop deadly behavior by the police, it only justifies it.

In order to continue making the claim that tasers have not caused any deaths and are safer than your 2 year old’s punches, Axon has gone to veritable war in the courtroom. Along with their team of medical professionals, they have dozens of lawyers to tackle the litigation from their guns actually (like seriously, factually) electrocuting people to death. Axon, like many companies, hands out a packet to its top investors every year that explains the company’s trajectory and justifies expenses. In Axon’s packet after hiring the big three, it said that the solution the company envisioned was to take top medical professionals and have them provide justification and support for the company. In essence, they wanted to defend the brand from bad PR by covering up deaths with phony medical diagnoses while ‘educating’ officials about the need for tasers in law enforcement. As a final remark, the investor packet said that it’s good to sue these people who have died from taser incidents, even if it means slandering their names and portraying them as criminal addicts, because it protects the company and ensures profit. This is everything that’s wrong with our current status quo.

Mark Kroll, another Axon backed medical examiner, has testified that tasers are like “therapy” for people suffering from excited delirium. “If you start exhibiting ED behavior and you are in the terminal throes of death, and you are so bizarre you can’t be controlled any place else, you will receive taser therapy. They need to be brought under control so their lives can be saved.” I would also recommend death if you suffer from depression. 

In 2004 David Glauzinsky, schizophrenic with substance abuse issues, was suffering a particularly severe mental health episode. His mom called 911 and said to the operator that he needed hospitalization, not law enforcement. He was standing in the middle of the street when officers arrived, holding a grateful dead book. He resisted arrest and cops took him to the ground while in the same instance stunning him 9 times with a taser. Glauzinsky was handcuffed, his legs ziptied, and a 270 pound officer sat on him while another bent down to mace him. David unfortunately died as a result of this abuse. His mother sued Axon and the cops for wrongful death, citing that she had specifically told the operator he was mentally ill. Axon somehow persuaded the judge that there was no certainty taser use or police force caused Glauzinsky’s death. Instead it was ruled that he died naturally from excited delirium. In litigation the defense referred to Suffolk County medical examiner, Dr. Charles Wetli, and his methodology of diagnosing ED. Samples of Glauzinsky’s brain tissue were sent to Dr. Deborah Mash, where she found evidence of “exhaustive mania.” This particular diagnosis is excited delirium that occurs specifically when no drugs are present, indicating the individual died of adrenaline overproduction.

I have dedicated so much space to detailing the history and outcome of excited delirium as a diagnosis because it is the most insidious method of police oppression. Hardly anyone is aware of its existence, yet it is used as a diagnosis for hundreds of deaths every year; entirely supported and propped up by corporate interests in capital growth while defending the white supremacist actions of the police that murder people with their stun guns or chokeholds. Were ED to be a true syndrome, we would be living in fear of taking any sort of stimulant. There is no evidence that excited delirium has any validity outside of justifying murders that authoritative, bullying, racists commit while they are supposed to be protecting the population. 

Further, ED is used to discredit the victims of police violence as the department can issue a statement claiming someone like George Floyd had traces of opiates in his system and half the country will automatically believe the police’s diagnosis of death as legitimate. In this way hundreds of victims are wrongfully portrayed as drug addled junkies that had their death coming after reckless behavior towards police. In reality, almost every victim of excited delirium has levels of narcotics far below the threshold of overdose, if any at all. Think about the cases of Elijah Mcclain, David Glauzinsky, or Gregory Edwards. Police attempted to slander their names by associating them with racist war on drug stereotypes or over exaggerated accounts of their actions that necessitated cops killing them. Corporations like Axon and the police who use their electrocution guns have sociopathically upheld a false medical diagnosis that allows a victim to be blamed for their own death despite mountains of counter evidence that would point towards law enforcement blatantly being at fault. 

Police commit atrocities that will kill regardless of drug use (especially at levels nowhere close to OD). Death or extreme pain is the intended outcome when police do this, but they are protected from accountability in every sense of the word, even by the medical field that is supposed to “do no harm.” Money trumps all morals in America.

America’s institutions are meant to protect the wealthy and their bullies for hire, with the standard of property (in this case tasers,) being more valuable to our society than human life. It hasn’t been until recently that anyone vocally challenged the police on this, and in one such example after a paramedic resisted the wishes of officers to inject a man in handcuffs with ketamine, he was harassed with an official statement claiming he was full of nonsense and couldn’t be trusted. Ketamine use is another aspect of the excited delirium chronicle I didn’t have a chance to detail but would suggest the reader look into my other writing for knowledge about. 

There is a Minnesota doctor (that is also a part time cop) named Jeffrey Ho, who co-authored an infamous study by the American College of Emergency Physicians that concluded Ketamine injection was sufficient to prevent death from excited delirium. As a result cops have begun ordering paramedics to inject patients with the substance, often with no need as they are restrained and calm, plus at levels several degrees higher than their body size requires (similar to McClain).  After the paper was published Axon began funding a study led by Ho, at his home hospital, which observes those police suspects injected with ketamine when they are in distress. Axon, Ho, and the hospital (which also received funding from Axon in their deal with Ho), have contributed to a huge rise in the number of people needlessly injected with Ketamine. This has resulted in more innocent deaths and a way for law enforcement to inject people with narcotics while claiming it was excited delirium all along. 

American police can murder someone for walking down the street then claim that it was due to a fake disorder only recognized by corporate doctors, ensuring no accountability is held to change their conduct because they are protected by corporate interest, medical practitioners, and most importantly, the government. Quite simply, we do not live in a free country. Our very existence could be ended by a thug wearing a blue uniform and there will be absolutely nothing done in response, letting him remain free to murder another innocent person.

“I know that it’s hard to believe that the people you look to for safety and security are the same people who are causing us so much harm. But I’m not lying and I’m not delusional. I am scared and I am hurting and we are dying. And I really, really need you to believe me. Our police force was not created to serve black Americans; it was created to police black Americans and serve white Americans.” -Ijeoma Oluo

I realize this two part series was a lot. While it is stomach churning and blood boiling material, it is necessary to understand the ways in which our individual rights are being impeded in our federalist system. Whether it be through corporate sponsorship or government directive the institutions in America serve to uphold a specific status quo, one that leaves the majority of us disenfranchised and trying to find where we will be least exploited.

Sources

  •  “How cops invented a disease” Behind the Bastards, Robert Evans.
  •  “Exploiting black labor after the abolition of slavery,” Forde, Kathy, Bowman, Bryan. 2017.
  •  Position statement on concerns about use of the term “Excited Delirium” and appropriate medical management in out of hospital contexts. APA board of trustees 2020.
  • “Excited Delirium: The controversial syndrome that can be used to protect police from misconduct charges,” Dickerson, John. 2020. 60 minutes.
  •  “Special Report: How Taser inserts itself into investigations involving its weapons,” Jason Szep, Tim Reid, Peter Eisler. 2017. Reuters.

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