'Excited delirium' theory used in Antioch death is racist and unscientific, new report concludes

OAKLAND, Calif. - A report released Wednesday by the Physician for Human Rights unequivocally states that "excited delirium" has racist and unscientific origins and points to a death in Antioch, Calif., as a recent example of just that.

This controversial term has already been declared "junk science" by several organizations. 

But its diagnosis still continues to be used today, including in the Contra Costa County Coroner's conclusion that Angelo Quinto, 30, died of "excited delirium" on Dec. 23, 2020, despite the fact that police knelt on his back for five minutes.

"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," write the authors of "Excited Delirum" and Deaths in Police Custody: The Deadly Impact of a Baseless Diagnosis." 

Quinto's family had called police for help when the former Navy sailor was suffering from a mental health crisis. Police restrained him soon after arriving at the family home. He stopped breathing and died three days afterward. 

One of the report's legal authors, Oakland-based civil rights attorney Julia Sherwin, said that this report is the first comprehensive one of its kind to review all the medical literature from when the term first was coined. 

She said using this term harms real people, such as the Quinto family, who watched police sit on their son's back and where the county is now allowing "the officers to get away with it." His family members have long contended he died of "restraint asphyxia." 

However, in August 2021, a 15-member jury in Contra Costa County ended up ruling the young man's death an accident. 

The Contra Costa County Sheriff's Office did not immediately respond for comment. Neither did the California State Coroners Association.

Kathryn Pinneri, president of the National Association of Medical Examiners, said her group does not promote the use of excited delirium as a cause of death.  If a person experiences an acute delirium prior to death,  she said the underlying cause of death is the process that caused the delirium, such as acute cocaine toxicity or alcohol withdrawal. 

"We agree that excited delirium is not a recognized diagnosis," she said.

Pinneri added that in-custody deaths are some of the most challenging that medical examiners and coroners investigate as they may involve combinations of external and internal factors including restraint, stress, drug intoxication, and underlying natural disease like heart disease.  

Deaths associated with an excited delirium component have also occurred in the absence of police involvement, Pinneri noted. 

"Forensic pathologists recognize that although a person may be experiencing a hyperactive or excited delirium, that does not mean they died from it," she said. "In fact, should a person die after experiencing acute delirium, the cause of death would be the underlying disease, injury or intoxication that caused the delirium."

Pinneri acknowledged that excited delirium may still be accepted among many of her organization's members but "as an organization have not formally recognized the condition as a diagnosis."  The NAME Position paper on the Certification of Cocaine-Related Deaths is no longer current, she said, and "therefore does not reflect our position at this time." 

The Physician for Human Rights' report was written by several doctors at the University of Michigan, Harvard, Massachusetts General Hospital as well as Sherwin, who served as a consultant after George Floyd's death, where the term was also brought up in court. 

The defense for former Officer Derek Chauvin argued during his murder trial last year that excited delirium is real, and that Chauvin acted reasonably when he pressed his knee to Floyd’s neck for about 9 1/2 minutes to restrain him, even as Floyd said he couldn’t breathe and eventually became limp.

Broadly, the term has been used to describe people who become agitated or distressed after using drugs or during a mental health episode. In some instances, those described as experiencing "excited delirium" are perceived to exhibit higher pain thresholds and unusual levels of strength.

Excited delirium is not recognized by the World Health Organization, the American Psychiatric Association or the American Medical Association. 

It's now become a disputed expression often used in fatal cases of police violence and there is no universally accepted definition of what it constitutes. 

As the Physician for Human Rights report outlines, the term was first coined in 1981 as two doctors tried to explain how many than 12 Black female sex workers died after consuming small amounts of cocaine. However, those two doctors were wrong, their supervisor concluded. They had actually been murdered, actually strangled. Investigators in Miami eventually came to learn a serial killer had murdered as many as 32 women in the 1980s. 

The authors conclude that excited delirium has since been misrepresented and distorted, and its diagnosis as a standalone cause of death was first brought about by subjective opinions and has since "taken on a meaning and life of its own with a deleterious impact." 

Since scientists can't agree on what the term means, the authors conclude that it's "therefore scientifically meaningless because of this lack of consensus of rigorous evidentiary basis." 

Bottom line: Excited delirium is a descriptive term of myriad symptoms and signs – not a medical diagnosis – and, as such, should ot be cited as a cause of death.

"It is essential to end the use of "excited delirium" as an officially determined cause of death," the authors wrote. "Particularly in cases of deaths in police custody."

The authors strongly recommend that emergency physicians and medical examiners immediately state that the term is not a valid medical diagnosis and cannot be a cause of death and governments mandate independent investigations of in-custody deaths.