Global Courant 2023-04-17 13:03:04
As a coroner’s jury enters the inquest into Myles Gray’s death Monday, they may hear arguments that his death was the result of something called excitable delirium, not the actions of Vancouver police officers.
Excited delirium has also been cited by Ottawa police officers in connection with the death of Abdirahman Abdi during a violent arrest, a coroner’s jury investigating a death at a New Brunswick jail, senior RCMP officers following the death of Robert Dziekanski at the airport of Vancouver, and defense attorneys the American officer who killed George Floyd.
The highly controversial term describes a state of agitation, aggression and fear generally related to drug use or mental illness, and is used to explain sudden, unexpected deaths during interactions with police.
It was one of several possible explanations given by a forensic pathologist for the death of Gray, an unarmed 33-year-old who died in 2015 after being handcuffed, limped, beaten, kneaded, kicked, pepper sprayed, and beaten with a baton by several Vancouver officers. He was making a delivery for his florist business at the time and the police had been called after suing a homeowner for watering her lawn during a prolonged drought.
But a major shift is underway, and medical examiners and coroners across Canada and the US are excitedly beginning to reject delirium as the cause of death. Both American Medical Association and the American Psychiatric Association completely rejected the diagnosis.
Excited delirium was listed as one of the possible causes of death for Myles Gray after a violent confrontation in 2015 with several Vancouver police officers. (Submitted by Margie Gray)
Dr. Michael Freeman’s take on excited delirium is blunt.
“(It) might as well be a wizard waving a wand and saying abracadabra for all the evidence we have for it,” he said.
Freeman is an associate professor of forensic medicine and epidemiology at Maastricht University in the Netherlands and clinical professor of forensic psychiatry at Oregon Health and Science University, and has analyzed the research on excited delirium.
“It’s an interesting theory that always takes the look at the cause of death away from the restraining staff, and so if you say it’s an excited delirium, it’s really the fault of the person who died,” he told CBC News.
“Then you don’t have to look any further. You don’t have to look at how the compulsion may have killed the person.”
Freeman said his review of cases described as excited delirium the scholarly literature suggests that the term is used almost exclusively when police restrain a person with handcuffs, bumps (leg shackles), or other forms of physical force, and death was most likely when the restraint was particularly aggressive.
LOOK | What the research of Dr. Michael Freeman suggests about excited delirium:
Dr. Michael Freeman discusses his research on excited delirium
Freeman, an expert in forensic medicine and epidemiology, shares what he’s learned from studying the literature on excited delirium.
‘Very inappropriate’ as a psychiatric diagnosis
Police officers are often trained to identify and respond to agitated delirium. A online description for one hour course on the subject offered through the Canadian Police Knowledge Network and designed by the Calgary Police Department, claims it is “responsible for the majority of custody-related deaths”.
The current Vancouver Police Regulations and Procedures Manual says officers should be aware of the signs of agitated delirium. Some officers on the scene when Myles Gray died said they believed he was suffering from agitated delirium, according to a report prepared for an investigation overseen by BC’s Office of the Police Complaint Commissioner.
But excited delirium is not a recognized diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the International Classification of Diseases, or the World Health Organization.
Dr. Gary Chaimowitz, president of the Canadian Psychiatric Association (CPA), said excited delirium is not a diagnosis he would use, describing it more as a set of behaviors than an actual condition.
“I think it’s kind of inappropriate to use that to convey what’s going on with the person until you’re really able to unpack exactly what’s going on,” he said.
Chaimowitz added that the research suggests racial and skill biases may be at play when the term is used.
“It’s often people with mental illness, people of color, other racial and ethnic groups who are … disproportionately affected,” he said.
Earlier this spring, the National Association of Medical Examiners made headlines in the US when they released a statement saying this no longer recognizes excited delirium as cause of death.
Coroners and medical examiners in a number of Canadian provinces say they no longer accept agitated delirium as a cause of death. (Dm_Cherry/Shutterstock)
Something similar is happening in Canada.
Of the county coroner’s offices and major medical investigation agencies that responded to questions from CBC News, only New Brunswick said agitated delirium could still be cited as a cause of death.
While there have been no public statements, the BC, Alberta, Manitoba and Newfoundland offices all told CBC News that they do not recognize agitated delirium as a cause of death.
“There was no point in time when this transition happened. It was in response to the evidence-based literature that changed over time,” Ryan Panton, a spokesperson for the BC Coroners Service, wrote in an email.
Dr. Nash Denic, chief medical examiner for Newfoundland, said he considers excited delirium a misnomer since delirious states caused by drug abuse, withdrawal or mental illness are inherently excited.
Both he and his Manitoba counterpart, Dr. John Younes, said excited delirium could be a mechanism of death, but not the cause. For example, the toxicity of cocaine that causes a person’s death can manifest as dangerous delirium.
Denic said excited delirium can also contribute to a death in custody.
“If you have someone who is under the influence of drugs and you have five people on top of him during the detention that are obstructing his breathing, obviously the excited delirium wouldn’t be the cause of that (death), but it may have contributed because he would do.” having trouble breathing anyway,” Denic said.
Freeman said he was strengthened by the move away from agitated delirium, but he wouldn’t be surprised if it were replaced by a new explanation for deaths in custody.
“There will still be interest in finding an exculpatory diagnosis when there’s a death that happens in restraint, because there are still people who believe you can’t die by restraint,” he said.
