What's up, Doc? Taser deaths require inquiry

October 22, 2007
Ian Mulgrew, Vancouver Sun

Thank you, Ian Mulgrew - It's about time someone challenged Christine Hall on her flawed and biased "junk science". I've seen the good doctor in action on more than one occasion, including at the inquest into my brother's death. If we leave it up to her and Ontario's deputy chief coroner, Dr. James Cairns - Canada's so-called "experts" on excited delirium - every taser-related death in Canada will be the fault of the deceased.

I recently read this comment online which sums it up nicely: "It's difficult for me to understand the value of claiming a controversial and poorly understood phenomenon - death following Taser electroshock - can be explained away by another controversial and poorly understood phenomenon - "excited delirium".

Emergency room physician Christine Hall thinks focus should be on people who die in custody. I disagree. Two deaths in Canada from Taser incidents last week should have everyone concerned.

But Dr. Christine Hall, a Victoria emergency room physician who considers herself a specialist in such deaths, thinks we're wrong to blame the U.S.-made shock devices.

She says we should be focusing less on the instrument and more on the individuals who have died.

She thinks I'm "hysterical" and my call for an inquiry into the use of Tasers "a diatribe."

In her opinion, it's not the 50,000 volts of canned lightning that stops 'em dead -- it's something else.

Hall points to the similarities displayed by nearly everyone who has succumbed in these situations, which are categorized as "in-custody deaths" -- be they at the hands of prison guards, police or emergency personnel. The victims are all usually sweating, hyper-agitated and unresponsive to their environment and other people.

Today, as Hall says, the authorities try to restrain such people with a Taser and some die. It used to be they used physical restraint and some still died, she maintains -- in-custody deaths are nothing new.

Hall insists most people who die under such circumstances usually are under the influence of cocaine or methamphetamines, which I think is a huge issue.

Some also are suffering from mental health or other physical conditions that are aggravating elements that contribute to their death.

But, like the Polish immigrant killed at Vancouver International Airport last week, too many in my view suffer from nothing that would explain or point to a cause of death aside from the Taser or the restraint procedure.

And that's the problem Hall and law-enforcement agencies seems intent on overlooking.

Hall says she has been involved in these suspicious-death cases since 1999, when she was a senior medical resident in Calgary and dealt with an agitated, suicidal patient who unexpectedly died after being restrained.

Since then, she has wrestled with why these individual die, as well as protocols to deal with them.

She thinks that part of the problem is the research data captures only those who die in custody and that creates for researchers a kind of "publication bias."

"We don't know for instance whether people are dying in crack houses like this," Hall said. "The chemistry in the blood changes too much after death to allow us to determine that."

The phrase "excited delirium" has been used by medical examiners to describe these mysterious in-custody deaths. It sounds better than "we don't know what killed them," but it means pretty much the same. And that's why I think we need an inquiry.

I believe "excited delirium" is little more than bogus jargon.

Hall acknowledges "excited delirium" is not terminology that is particularly useful either for public debate or doctors -- it's not a diagnosis or a cause of death. It's nothing more than a description.

"I understand the criticism, I really do," Hall said. "Colloquial speech is difficult to control and people get up in arms because 'excited delirium' isn't in the CMA handbook."

But she argues that it can be a useful phrase for emergency personnel -- more specific than "running amok," I guess, although it means basically the same thing.

As Hall points out, it's impossible to know what is happening to individuals who are out of control and confronted by authorities because you can't conduct diagnostic tests while someone is in that condition.

True.

She says one researcher believes that people with such symptoms may be suffering from a chemical imbalance that can trigger arrhythmia and cause death.

I think that's a solid thesis and a great reason why police or anyone else should NOT zap such individuals with a Taser. The Taser may not "cause" death, but I suggest the evidence is mounting that it's a contributing factor.

Pathologists can tell if someone has had a heart attack; they cannot detect a death caused by arrhythmia, which may explain why these electrocuted individuals are dying without any identifiable cause.

In her attempt to explain why this isn't so weird as it might appear, Hall points out that there is a mortality rate for those suffering delirium tremens of about 25 per cent. Even with treatment, doctors still see a five per cent mortality rate -- why?

No one really knows.

Hall thinks the cause of death may be similar to what's happening with in-custody deaths they can't explain. The key theories involve the body's metabolism -- maybe these individuals are similar to marathoners who have gone through the wall; their metabolic system becomes so overloaded it collapses.

Hall insists focusing on Tasers as the problem is misguided -- 99 per cent of those who have received a Taser shock experience minimal injury, she said adamantly.

"I understand the concern about the Taser," she said. "We're always concerned when people don't survive. But 10 years ago, it was choke holds and pepper spray we were talking about. People still died. That's what should concern us."

Hall says she believes people are frightened because of the electricity involved and that it distracts us from the real problem.

"We're missing the boat," she said, "and we're scaring people in the process. We need to be wise."

Hall thinks the remarkably similar set of symptoms of in-custody deaths -- hyper-agitation, rapid heart rates, sweating ... that's what we should concentrate on.

"People have been dying in this state for decades, it's not new," Hall said. "Ten years ago, we would be talking about choke holds, now it's Tasers. But why are people dying?"

She thinks we're going to see more of these deaths: "The more people do coke and meth, the more we're going to see this."

Maybe.

The problem is cocaine and meth abuse are not involved. They do not seem to be implicated in the death last week of the Polish immigrant in Vancouver, nor in the case of the 34-year-old London, Ont., man who is recovering after he suffered a heart attack last week when he was Tasered.

Maybe Hall is right and it has nothing to do with the electro-pulse weapon.

But I don't think so.

I say we need an inquiry. Call me hysterical.