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Monday, March 17, 2008

Ruling in cocaine-related taser deaths splits experts

March 17, 2008
By Mike Wereschagin, TRIBUNE-REVIEW

Traffic screeched to a halt on the Parkway West as Chad Cekas lay on his stomach in an inbound lane, disoriented and bleeding from his nose.

His legs didn't move. The 27-year-old Beechview man struggled weakly and unsuccessfully to rise on his elbows just outside the mouth of the Fort Pitt Tunnel. Headlights illuminated his wide and frightened eyes in the warmth of the late-summer night. A motorist knelt beside him, stroking his back and telling him the help he was pleading for was on its way.

Forty minutes later, at 9:23 p.m. Aug. 23, 2007, doctors at Mercy Hospital pronounced Cekas dead. Allegheny County Medical Examiner Dr. Karl Williams later would say a controversial syndrome and the cocaine in Cekas' blood -- not shocks delivered by a Pittsburgh police officer's Taser -- killed him.

"It says in the autopsy he was a healthy young man. All his organs were the right size. Everything was in good working condition," said Cekas' mother, Joanne Zekas, who uses the traditional Lithuanian spelling of their last name. "He shouldn't have died. There's no way he should have died," she said.

Controversial syndrome

Pathologists, police, stun-gun makers and civil liberties advocates differ on the merits and even the existence of Excited Delirium Syndrome, the cause of death listed for Cekas. Skeptics say the syndrome gets listed as a cause of death only when people die in the custody of police or medical personnel, and only when the person is forcibly restrained. Weapons such as stun guns or pepper spray frequently are involved.

Proponents list as proof the similarities in those who die from it -- erratic and violent behavior, cocaine or other stimulants in the person's blood, disorientation, surges of strength and a final period of calm before the person's heart stops beating.

As many as 1,000 people across the country die from it each year, said Michael Conner, a psychologist who serves as an expert witness in Excited Delirium cases. He added, however, that no one tracks all the deaths, so the number can only be estimated.

Neither the American Medical Association nor the American Psychiatric Association recognizes the syndrome. No physical evidence, such as lesions or microscopic tissue damage, exists to prove it as a cause of death, said former Allegheny County Coroner Dr. Cyril H. Wecht.

"There have got to be tens of thousands, hundreds of thousands (of cocaine users), who from time to time get excited or agitated when police aren't around," Wecht said. "How come there is not one case that I'm familiar with of anyone dying of Excited Delirium with cocaine toxicity in a situation that doesn't involve police?"

Using the word "delirium" causes further skepticism.

"You don't die of delirium. It's a symptom of what a person has," said Dr. William Narrow, director of research for the American Psychiatric Association.

Other cases

Three other deaths in the last year in Allegheny County could be attributed, at least partially, to Excited Delirium, said Williams, the Allegheny County medical examiner.

One involved a 39-year-old man with a history of seizures who died after a struggle with police in McKeesport. Police used a dog and pepper spray to subdue him, Williams said.

Another death involved a man who had a history of seizures and was taking psychiatric medicine. He died after being restrained in a psychiatric ward, Williams said. The third, a man who leaped out of a window and died of blunt-force trauma, might be partially attributable to the syndrome, he said.

Williams declined to release their names.

"I believe these are cases that represent some element of Excited Delirium, but I don't know right now whether that was listed as the immediate cause of death," Williams said. Cocaine intoxication or some other element of the syndrome sometimes is listed on death certificates instead of Excited Delirium, he said.

Williams said he understands criticism of the syndrome, especially in a death such as Cekas', where police used a stun gun. Still, he said, Excited Delirium is real.

"My gut reaction is you can't essentially electrocute somebody, even with low amperage and high voltage, without running the risk that you're going to have some adverse effects. But the case at hand is really different, (because of) the presence of really high levels of cocaine," Williams said. He declined to specify the amount of cocaine in Cekas' system.

Stun gun triggers?

No court, in the 66 lawsuits adjudicated so far, has ever found Scottsdale, Ariz.-based Taser International liable in a death or injury, said Steve Tuttle, the company's vice president of communications.

The electric current discharged from a Taser is designed specifically not to kill, Tuttle said. Measured in joules, the energy of a Taser shock is one five-thousandth as powerful as the defibrillators used to jump-start hearts, he said.

"If a shock were to kill somebody, does it kill them 20 minutes later? No," Tuttle said.

Medical researchers disagree whether stun guns can trigger heart problems. Tuttle said their safety has been "documented year after year in medical journals." But a study published in July, 2006, in the Journal of the American College of Cardiology, said the weapons "may have cardiac risks."

"I have not made up my mind on the Taser aspect of (Excited Delirium), to tell you the truth," Williams said. "I note the fact that (Cekas) has been Tasered."

Excited Delirium began gaining credence with medical examiners in the late 1980s, as cocaine use became more prevalent, said Dr. Jeffrey Jentzen, president of the National Association of Medical Examiners.

The condition wasn't invented to shield police, he said. Research suggests drugs such as cocaine prompt the brain to grow more of a certain kind of neuroreceptor -- the kind that responds to adrenaline. When cocaine users get into a fight, their more-sensitive brains soak up too much adrenaline. They become overstimulated, their body temperatures rise rapidly and their hearts give out, he said.

"The more you push them, the more belligerent and paranoid they become," Jentzen said.

Cekas had a history with police and drugs. He was serving a year of probation after pleading guilty to drug possession about one year before he died. He pleaded guilty to simple assault in 1999 and theft and harassment charges two years later, getting probation both times. When he died, he was awaiting trial on charges of simple assault and making terroristic threats.

In 2006, county courts awarded custody of his daughter, Zarah, then 5, to her mother. The mother, in a protection-from-abuse order she filed against Cekas, alleged he threatened violence against anyone she dated.

"I'm not saying cocaine may not play a contributing role, in terms of a person's behavior or placing a greater demand on the coronary system," Wecht said. "I'm not saying cocaine (levels) are a finding that is to be ignored.

"But to attribute all this to Excited Delirium because you find a little bit of cocaine, when you have someone who has been Tasered, has been beaten, has been physically subdued -- I think, frankly, that is a cop-out."

Cekas incident unclear

Paula Shubock, the motorist who knelt beside Cekas the night he died, said Cekas showed no signs of violence. Why Cekas was lying on the road remains unclear. His car was found on a nearby overpass, but police declined to talk about their investigation into Cekas' death -- even to his mother, who said she still wonders how her son ended up bleeding and frightened at the mouth of the Fort Pitt Tunnel.

Four cars were between Shubock and Cekas when traffic stopped that night. She left her car and walked to him.

"He just kept saying, 'Please help me. Please help me,' " said Shubock of Forest Hills. Three men stood nearby as she stroked his back and told him an ambulance was on the way.

After waiting several minutes, Shubock said she got frustrated and walked back to her car to again call 911. While she was on the phone, she saw a police officer arrive. He and the men who'd been standing near her lifted Cekas and moved him off the highway, out of her sight.

Other witnesses later told police and the Tribune-Review they saw Cekas shaking violently.

The ambulance had not yet arrived, Shubock said.

She ran back toward Cekas and saw him slumped over, being supported by a police officer who was holding a Taser against his back.

Tasers incapacitate people by sending 50,000-volt electrical currents through two small darts. The darts can be fired into a person from as far away as 35 feet, or delivered by touching the stun gun to the person. A typical cycle of short electrical pulses lasts five seconds, according to Taser International's Web site.

"I said, 'What are you doing?' " Shubock said. Another officer warned her to stand back. "The kid wasn't moving. He was never standing up, as far as I could see. He didn't appear to be able to stand up."

It was about 8:44 p.m.

Police said the day after the incident they shocked Cekas several times because he was combative and endangering other motorists.

Williams said he believes Cekas wasn't shocked more than twice, though the autopsy report lists eight puncture wounds that could have been caused by Taser darts.

Police and the District Attorney's Office reviewed the case and found no wrongdoing on the part of police, said Zekas' attorney, Paul Giuffre, with the Downtown firm Meyers Kenrick Giuffre & Evans. Police won't release their report, however, and Giuffre said he's considering asking a court to force them to turn it over.

"The decision not to prosecute is probably correct," Giuffre said. "But why are they forcing a family who just wants to find out what happened to get a subpoena from the court?"

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