Suspects' deaths blamed on ‘excited delirium’

September 25, 2006
Associated Press

DALLAS - Police found 23-year-old Jose Romero in his underwear, screaming gibberish and waving a large kitchen knife from his neighbor's porch.

Romero kept approaching with the knife, so officers shocked him repeatedly with a stun gun. Then he stopped breathing. His family blames police brutality for the death, but the Dallas County medical examiner attributed it to a disputed condition known as "excited delirium."

Excited delirium is defined as a condition in which the heart races wildly — often because of drug use or mental illness — and finally gives out.

Medical examiners nationwide are increasingly citing the condition when suspects die in police custody. But some doctors say the rare syndrome is being overdiagnosed, and some civil rights groups question whether it exists at all.

"For psychiatrists, this is a rare condition that occurs once in a blue moon," said Warren Spitz, a former chief medical examiner in Michigan. "Now suddenly you are seeing it all the time among medical examiners. And always, police and police restraint are involved."

Excited delirium came to doctors' attention in the 1980s as cocaine use soared, said Vincent DiMaio, chief medical examiner in Bexar County, Texas, and a proponent of the diagnosis. No reliable national figures exist on how many suspects die from excited delirium because county medical examiners make the ruling, and some use different terminology.

In Dallas, at least three in-custody deaths in the past five months have been linked to excited delirium. This prompted the police department to start offering mental health assessment training they say will stem the sudden deaths.

Other police departments, including San Diego, have done the same to try to prevent community protests and costly lawsuits. In Phoenix, a jury awarded $9 million in April to the parents of a suspect whose death was attributed to excited delirium.

Adrenaline overdose
The condition, described as an overdose of adrenaline, largely affects men with histories of drug use or mental illness, DiMaio said. He said most cases are triggered by drugs such as cocaine and methamphetamine.

The drugs elevate blood pressure and heart rate, and the increase is pronounced if a person is experiencing paranoia, hallucinations and violent impulses, DiMaio said.

Police often respond to calls of sufferers stripping off clothes to cope with a soaring body temperature, breaking glass and threatening others. The officers and the suspect struggle, and the excitement stresses the suspect's heart until it fails, DiMaio said.

"You are gunning your motor more and more and more, and it is like you blow out your motor," said DiMaio, who estimates that the condition kills as many as 800 people nationwide each year. "You are just overexciting your heart from the drugs and from the struggle."