Taser's Delirium Defense

By Bernice Yeung
Mother Jones - March/April 2009

By all accounts, Patrick Lee was having too good a time at the Mercy Lounge, a Nashville rock club. He'd commenced the September 2005 evening by dropping a few hits of acid. Before long, the 21-year-old was tripping and determined to climb onstage. A bouncer eighty-sixed him and called the cops, who, according to witnesses, found Lee outside the club, babbling incoherently. Things went downhill fast. Lee made a move toward an officer and was hit with pepper spray. He ran a few feet and stripped off his clothes. The cops deployed their Tasers­, jolting Lee 19 times in all. By the time paramedics arrived, witnesses say, he was unresponsive. He died 39 hours later. The cause, a county medical examiner concluded, was "excited delirium."

For the past five years, this has been a common conclusion in deadly incidents involving Tasers, and the nation's top seller of electric stun guns prefers it that way; Taser International Inc. has twice sued medical examiners who cited its products as a contributing factor in a subject's death. At the same time, the company aggressively promotes awareness of excited delirium, an ill-defined condition that helps it fend off lawsuits. Thanks partly to testimony from a cast of ED proponents, several with financial ties to the company, Taser has lost just one wrongful-death case at trial out of 33 filed against it since 2001. (Dozens more lawsuits are pending.)

Taser's lone courtroom defeat, which it may appeal, involves Robert Heston, a California meth user who died after 25 jolts. Last June, the family's lawyers convinced a jury that Heston most likely died not of ED, but rather of cardiac arrest due to metabolic acidosis—a temporary state in agitated individuals that may be exacerbated by excessive Tasering, recent animal studies indicate. But in January, a suit by Patrick Lee's parents was dismissed after Taser argued that excited delirium was the culprit. "We look at excited delirium as a responsibility-shifting mechanism," says Peter Williamson, an attorney for the Hestons. "It's a way for the police department, the officer, and Taser to shift responsibility to the victim."

The company insists its devices never kill, but Amnesty International, the only organization to have compiled data on the issue, says there have been 334 fatalities following Taser jolts since 2001. In 69 of these cases, autopsy reports specifically cited ED as a cause of death.

"Of all in-custody deaths [not involving firearms], excited delirium syndrome is the most common form," notes Vincent Di Maio, a Taser expert witness, retired Texas medical examiner, and coauthor of the 2005 book Excited Delirium Syndrome: Cause of Death and Prevention.

But as a medical condition, the term is meaningless. "We have no idea what any of the causes are, what the biology behind it might be, what underlies it, how being in this state leads to death with supposedly some intervention with a Taser or other force," says Matthew Stanbrook, a faculty member at the University of Toronto medical school.

Purported ED signs range from "bizarre" behavior to sweating and high body temperature, attraction to shiny objects or glass, foaming at the mouth, a penchant for disrobing, aggression, and superhuman strength. Such symptoms could result from "alcohol withdrawal, acute schizophrenia, bipolar disease, stimulant drug intoxication, psychological illness plus stimulant drugs, hypoglycemia, an infection of the brain. I could go on," says Christine Hall, a Canadian ER physician who researches in-custody deaths.

"The bottom line is this," says Andrew Dennis, a Chicago surgeon, part-time police officer, and medical researcher who coauthored three studies of Taser's effects on swine. "You have a lot of people who are acting psychotic, and often law enforcement is asked to deal with them. Some subgroup of this population is going to die, and we don't know why. This potential at-risk group is the quote-unquote excited delirium group. But there are no common threads to identify this at-risk group. As far as I'm concerned, everything discussed about excited delirium is conjecture."

None of these concerns have stopped Taser from talking up ED in training sessions, literature, and court filings. The company attends conferences for police chiefs and medical examiners, where it distributes ED-related literature, and has doled out free copies of Di Maio's book. It also sends unsolicited materials to medical examiners when an in-custody death occurs in their jurisdiction. In 2002, Taser released a statement for police to use if someone died in a Taser-related incident. "We regret the unfortunate loss of life," it begins. "There are many cases where excited delirium caused by various mental disorders or medical conditions, that may or may not include drug use, can lead to a fatal conclusion."

The expression first appeared in medical documents in the 1800s, and for a time it was associated with deaths in asylums. It fell into disuse during the 1950s and was revived in the 1980s, essentially to describe the agitated state of cocaine addicts. Since then, ED has been the subject of dozens of articles aimed at law enforcement. (Among the authors are Jeffrey Ho, an ER doctor whom Taser pays to conduct studies and testify—he got $70,000 during a recent 12-month stretch—and Mark Kroll, a member of Taser's science advisory board who has cashed in at least $2.5 million in company stock options.)

The term has also gained traction among medical examiners and coroners. "People are looking for an explanation for some of these deaths," notes Stanbrook, "and this syndrome provides an answer that's convenient." (In an unpublished survey last year by a national medical examiners group, 67 of 187 MEs said Taser's litigi­ousness would affect their conclusions in cases involving stun guns.) Last October, prompted by the term's growing popularity in law enforcement, the American College of Emergency Physicians resolved to study whether ED should be considered as a diagnosis.

Several people I spoke with credit Taser for helping popularize excited delirium. Dennis, the surgeon-cop, first heard the term, he says, at a company training session five years ago; Shao-Hua Lu, a psychiatrist who treats addicts at Vancouver General Hospital, hadn't heard of ED before 2007, when he began working on a Canadian government probe of Taser safety. "No [practicing] medical doctor would write down 'delirium' on a death certificate as a cause of death," says Lu, who trains Canadian Mounties to identify mental health problems, including various forms of delirium, in their subjects. "I don't understand why MEs would write that."

Taser insists that any corporate outreach involving ED relates to safe use of its products. "We don't teach anything about excited delirium," says spokesman Steve Tuttle. "We let law enforcement agencies know that they need to be aware of it."

But the company is remarkably tight with America's foremost ED training and advocacy business. The Institute for the Prevention of In-Custody Deaths (ipicd) was cofounded by police trainer John Peters and an old acquaintance, Michael Brave, Taser's national litigation counsel.

At the time, Peters later stated in a deposition, he was reworking his firm's training regimen after hearing from other stun-gun merchants. "Some of the manufacturers said, you know, '[Police departments] are paying out lots of money in these lawsuits, and it's hurting us because they don't have money left over to buy our product.'"

In 2005, Peters filed corporate papers for the ipicd listing himself and Brave as the founding directors. Within six months, the institute was leading eight-hour sessions at Taser's Scottsdale, Arizona, compound, teaching cops to recognize ED and often touting Tasers as the most effective tool for subduing agitated individuals. In the first two years, Brave estimated in a deposition, Taser paid $70,000 to $80,000 for the sessions. To date, Peters says, the ipicd has certified some 10,000 officers worldwide as in-custody death prevention instructors.

Taser also pays the way for Peters and ipicd instructor David Berman to speak at outside conferences, directs business Peters' way, and helps plug the ipicd's annual conference in Las Vegas, where past presenters have included Taser-backed researchers and employees. A flyer for last October's three-day shindig, which drew 250 attendees, promised the "historic" opportunity to help form a "general consensus about excited delirium that will then be published in leading medical, legal, and law enforcement journals." As an expert witness for Taser, Peters charges $5,000 plus $2,750 per day; in 2007, he was paid about $42,000.

Peters sees nothing inappropriate about his Taser connections. "We are not aligned with them at all," he says, although "we did not distinguish ourselves enough" at the start. (Brave, now listed as an inactive director, says he remains a legal adviser at ipicd.) In any case, the institute will continue in its quest to entrench ED as a medical and psychological diagnosis, Peters says, "to quiet these folks" who don't believe it exists.

These folks include Heston attorney John Burton, who, not surprisingly, finds the ipicd/Taser bond problematic. "These guys want to help the police stop killing people, and they're trying to build a liability defense for when they do," he says. "The two things are in direct conflict."

Brave, for his part, has nothing but contempt for the company's critics. "How much more damage are we going to do to police officers by continuing to put forth this ignorant rhetoric?" he asks. "A druggie's mommy hires a plaintiff's attorney, and now we need to blame someone. Do we blame the person who sold them the drugs or the mommy who let them take the drugs or the kid who actually took the drugs? No. We blame the police and Taser, because they were present at the time of death."

U.S. study raises more questions about stun gun safety

January 25, 2009
CBC News

The Taser stun gun has been advertised and sold as a police tool that can decrease the number of suspect shooting deaths and officer injuries, but a new study suggests its use does not reduce the number of people who die in custody.

The study was conducted by researchers at the University of California San Francisco. They surveyed U.S. city police departments for cases of in-custody sudden deaths in the absence of lethal force in the five years before they started using Taser stun guns and the same period after deployment began. Fifty of the 84 departments approached were able to provide data.

The research group found a sharp increase in the rate of in-custody sudden death in the first full year of Taser deployment compared with the average rate in the five years before the stun guns were used.

"A little bit to our surprise we found a statistically significant six-fold increase in the in-custody sudden death rate in the first full year of Taser deployment, and that rate then declined down near baseline in years two to five," said one of the researchers, cardiologist Zian Tseng.

Tseng testified last May at the Braidwood inquiry, which is looking into the death of a Polish immigrant Robert Dziekanski at Vancouver International Airport in October 2007.

Over the entire reporting period, researchers found the average rate of 1.57 sudden deaths per 100,000 arrests in the 50 cities. In the first full year after stun guns were deployed, the rate was 5.96 per 100,000 arrests, a 6.4-fold increase over the predeployment period.

The study showed that in the first complete year after deployment, the rate of deaths caused by officers using firearms remained high at 15.1 per 100,000 arrests, a 2.3-fold increase over the predeployment period. In years two to five after deployment, the rate of lethal force deaths decreased to 9.1 per 100,000 arrests.

Officers adjusted use, researcher believes

Tseng said his team concluded that police likely changed the way they used the Taser after the first year and that accounted for the drop in sudden in-custody deaths. He thinks the findings point to the importance of stringent policies for Taser use.

Tseng told Vancouver's Braidwood inquiry that a normal healthy person could die after a jolt from the stun gun if the shock went into the chest during a vulnerable point in the heart beat.

The U.S. researchers acknowledge their study is "purely observational" and has limitations because they did not ask police for details about the reported in-custody deaths and did not ask whether the Taser had actually been applied in those incidents, meaning the weapon was used only in a subset of these deaths.

However, they said, other investigators have suggested that stun guns may cause sudden death by increasing the risk of excited delirium, a much-debated condition in which sudden death occurs after a violent struggle.

Canadian physicians concerned

The Canadian Medical Association has raised concerns in the past about police departments relying on the manufacturer's claims of safety, and has called on police departments to open their databases to researchers.

Dr. Matthew Stanbrook, deputy editor for science at the CMA's Journal, thinks the U.S. study is a good first step toward building a body of work about real-life stun gun use.

"Greater societal pressure needs to be put on agencies on this to release that information for the public good because people are asking serious questions about this," he said.

Taser International, which is based on Scottsdale, Ariz., has been selling the most popular brand of stun gun to police departments in North America since 2001. The company has data on its website that it says shows the number of injuries to police officers has dropped dramatically since the introduction of the stun gun.

The San Francisco study found no change in the injury rate to officers. However, researchers noted in their report that the 10 largest U.S cities where stun guns are used most frequently refused to release their Taser data for the study.

Officials defend Tasering

October 31, 2008
By JIM MACDONALD The Canadian Press

EDMONTON — Alberta’s premier and solicitor general are downplaying the role a stun gun may have played in the death of an Edmonton man who was zapped twice by police.

Trevor Grimolfson died after he was confronted by police armed with Tasers as he ran amok in an Edmonton pawn shop Wednesday.

His death is being investigated by the Alberta Serious Incident Response Team, an independent organization that reviews fatalities involving police forces in Alberta. But Grimolfson’s family is already questioning the use of a stun gun on him.

Solicitor General Fred Lindsay said Thursday there’s no proof Tasers have caused any deaths. He said there’s plenty of evidence, however, to suggest that they have prevented people from being killed.

"What I will say is the Taser is an effective tool and it’s an alternate tool to lethal force," said Lindsay. "In over 2,000 cases where it’s been used in this country, it’s actually saved people’s lives."

More than 20 people have died in Canada after being stunned by Tasers.

The U.S. company that makes the devices points out they have never been directly blamed for a death. Steve Tuttle, the vice-president of communications for Taser International, said the family’s assertion that the device may have played apart in Grimolfson’s death isn’t based on the facts. "Until all the facts surrounding this tragic incident are known, it’s extremely inappropriate to jump to conclusions on the cause of death," he said from the company’s offices in Scottsdale, Ariz.

There is already a long list of independent research that has verified the safety of the devices, Tuttle said. More than 130 studies have been done on Taser technology and 80 per cent of them have been independent, Tuttle said. "We have yet to see a human study come back and give us an indication that these devices are unsafe," Tuttle said.

Lindsay said a condition known as excited delirium may be responsible for the deaths rather than the Taser itself. "How many of those deaths have been confirmed to be because of the use of the Taser? I haven’t seen a lot of evidence come forward yet that confirms at the end of the investigation that it was caused by the voltage that was put into the person’s body by the Taser."

Premier Ed Stelmach noted that Lindsay himself was jolted with a Taser during a demonstration earlier this year. "This minister is standing. He got Tasered and he’s alive."

Dr. Matthew Stanbrook, a deputy editor of the Canadian Medical Association Journal who has been critical of the lack of studies on conducted energy weapons, said there’s a great need to know more about the potential health effects of the devices.

Stanbrook, who is an associate professor at the University of Toronto, said it’s in the public’s interest to know whether they are potentially harmful.

"We need independent, public analysis of a robust, broad data set of all the times this has been used, by experts who are capable of doing it, so we can get an answer as to whether this device causes harm," he said.

He said such research may answer whether the devices may be contributing to in-custody deaths, especially for people who are highly agitated — either due to mental-health issues or drugs and alcohol.

"The truth is right now, we simply don’t know. We’ve got a lot of concerns, but no answers," Stanbrook said.

Stanbrook dismissed excited delirium as an explanation for such deaths, saying there’s no agreement in the medical community about whether it’s a real syndrome.

CANADIAN MEDICAL ASSOCIATION JOURNAL - Tasers in medicine: an irreverent call for proposals

EDITORIAL
Canadian Medical Association Journal
Early release, published at www.cmaj.ca on May 1, 2008 – subject to revisions

In this issue, we call your attention to an emerging and increasingly popular medical device: the taser. It may strike you as odd to hear tasers described as medical devices. Tasers are probably more familiar to you, depending on your point of view, as a valuable tool for subduing criminals and safeguarding the lives of law enforcement personnel(1) or, alternatively, as a potentially lethal weapon being deployed with wanton disregard for public safety.(2) The latter perspective has possibly been inflicted on society by the media, which has an annoying habit of publicizing when someone dies after being exposed to a taser discharge. In fact, media reports to date have documented over 300 such deaths, 20 in Canada.(3,4) Critics charge that tasers are too dangerous, that independent studies evaluating their safety are urgently needed and that a moratorium should be placed on their use.(2-4)

Fortunately, comforting words can be found if you're looking for reassurance that tasers really are the greatest invention since pepper spray - another weapon that medicine has appropriated, now that capsaicin cream is used as a topical analgesic. You see, despite what scientific demonstration of potentially lethal effects in animals and humans (as reviewed by Nanthakumar and colleagues in this issue(5)), overwhelming circumstantial evidence and a certain notorious airport video might lead you to believe, tasers are perfectly safe and have never, ever killed anyone. We know this because TASER International, manufacturer of the market¬leading device, says so, claiming "the TASER ECD cannot stop the heart".(6) And TASER International is an honourable, and for most of its existence very profitable, company.

So honourable, in fact, that they have sponsored research to prove the taser's safety. Just about all the research, as it turns out.(7) Moreover, they pay for experts to travel across North America and spread the good news about how safe tasers are and correct any misconceptions that might arise from events like deaths of suspects in police custody or immigrants in Vancouver's airport.(8) They even set up demonstration booths where, like some bizarre extreme sport, people line up voluntarily to experience a taser shock for themselves.(9) Notably, volunteers are almost always shocked in the back and not in the chest, where the electrodes might cross the heart, nor do volunteers experience the repeated and sustained shocks that are often used in the field, a feature that has led the United Nations to classify the taser as a form of torture.(10)

TASER International appears to attract loyalty. The scientific literature bears witness to a small group of dedicated researchers who diligently write letters to journals pointing out flaws in studies reporting harm from tasers. Unfortunately, some of these researchers occasionally neglect to mention their participation on TASER International's medical advisory board or board of directors.(11,12) TASER International itself sometimes goes further, to the extent of suing a researcher for publishing scientific results critical oftasers in a peer-reviewed journal and a medical examiner for the "error" of listing taser exposure on a death certificate as the cause of death.(13) Obviously, no one is better suited to instruct a qualified physician, coroner or specialist in forensic pathology on how to determine the cause of death than advisors to a corporation with a vested interest in the device being critiqued. This bold step ushers in a new medico-legal era: physicians can now be sued not only for delivering bad care but also for holding bad opinions.

Owing to these diligent efforts, the taser's good reputation has been maintained. Law enforcement agencies worldwide are increasingly adopting its use. In the United States, the general public can also exercise their second-amendment right to bear tasers, with the latest consumer models sporting stylish leopard print or camouflage motifs.

And now, apparently, it is medicine's turn. You see, the company and its hired experts have managed to explain why so many people seem to die after being zapped by a taser without this being in any way the fault of the device. They have taught us about an emerging disorder called "excited delirium." As reported recently in CMAJ,(14) this disorder, which does not officially exist as a recognized clinical condition in the DSM-N classification, enjoys lively discussion whenever tasers are involved. The message to remember is that tasers do not kill people: excited delirium does. Only cynics would observe that tasers nevertheless appear to be the leading risk factor associated with sudden death due to excited delirium, suggesting a potential cure for this increasingly prevalent and fatal condition if society could accept the drastic measure of withdrawing tasers from use.

Despite this, some law enforcement training materials actually discuss excited delirium as an indication for taser use(15) which is a position endorsed by the manufacturer. As it seems from this that tasers are being recommended as a treatment for a medical condition, we infer that they are in effect being construed as a medical device. Now, we have some bad news for the manufacturer. To be approved for use, medical devices must satisfy rigourous scientific standards and be subjected to clinical trials. This is to protect the public from unsafe medical devices. Fortunately for TASER International, there are no similarly rigourous scientific standards mandated to protect the public from potentially unsafe law enforcement devices. Tasers can thus be used freely on any member of the population, albeit safeguarded by the sound judgment of law enforcement personnel and, in the United States, by the sound judgment of most any adult who has money to purchase one.

To keep health care professionals from being excluded from this exciting treatment option, perhaps the Canadian Institutes of Health Research should issue a call for proposals for taser research. A randomized trial of tasers for excited delirium would seem a logical place to start, but given the lack of an accepted case definition for this condition, a study in ordinary delirium might have to do. For those who might have ethical concerns with such a trial, we point out that a management strategy currently popular in this context, the off-label use of antipsychotics, is already known to increase the risk of death,(16) thus one could argue that clinical equipoise exists as to whether tasers would be a safer and more effective intervention. The emergency department may be a safer environment to study taser use because, curiously, patients rarely seem to die of excited delirium in an emergency department and physicians' hearts are comforted by the presence of a defibrillator.

On the other hand, perhaps the CIHR should issue a different kind of call. The CIHR could start by recognizing that deaths occurring in association with taser use make the safety of these devices a public health issue. New and independent research, both epidemiologic and biological, into whether tasers can kill is essential to settle this issue. Also, law enforcement agencies could be made to open up their databases on taser use for independent analysis, on the principle that the assertion that tasers have saved lives of police and suspects alike, while plausible, should be proven, not merely asserted as fact. We imagine that, to TASER lnternational, this type of research may seem unnecessary and pedantic. We're sorry, but in the end, we are used to thinking like physicians and scientists concerned about health, preferring to gather and analyze the facts rather than succumbing to the bald assertions of a large corporate entity that has demonstrated a willingness to squelch any messages that could hurt its bottom line.

Matthew B. Stanbrook MD PhD Deputy Editor, Scientific, CMAJ
With the Editorial-Writing Team (Paul C. Hebert MD MHSc,
Rajendra Kale MD, Barbara Sibbald BJ, Ken Flegel MDCM MSc and Noni MacDonald MD MSc)

REFERENCES

1. Klint DE. TASER device liability and litigation risk. Scottsdale (AZ): TASER International, 2007. Available here. (accessed 2008, Apr 15).

2. Amnesty International's concerns about Tasers. Ottawa: Amnesty International Canada, 2007. Available here. (accessed 2008 Apr 15).

3. Amnesty International reiterates call to suspend police use of tasers following airport death [news release]. Ottawa (ON): Amnesty International Canada, 2007. Available here. (accessed 2008 Apr 15).

4. TNT - TRUTH...not TASERS [blog]. Available: http://truthnottasers.blogspot.com/ (accessed 2008 Apr 15).

5. Nanthakumar K, Masse S, Umapathy K, et al, Cardiac stimulation with high voltage discharge from stun guns CMAJ 2008;1781:1451-7.

6. Kroll MW. Cardiac safety. Scottsdale (AZ): TASER International: 2007 Mar 25. Available here. (accessed 2008 Apr 15).

7. Anglen R. Taser tied to "independenr' study that backs stun gun. Arizona Republic 2005 May 21. Available here. (accessed 2008 Apr 14).

8. S. Alphonso C, Leeder J, EI Akkad O. Taser firms picked up coroner's tab to give lectures. The Globe and Mail 2007 Nov 30. Available here. (accessed 2008 Apr 15).

9. Basler R. Oh, we're playing LASER tag? Not TASER tag? My bad... London (UK): Reuters: 2007. Available here. (accessed 2008 Apr 15).

10. United Nations Office at Geneva. Committee against torture concludes thirty-ninth session. Geneva: United Nations, 2007. Available here.(accessed 2008 Apr 15).

11. Kroll M, Luceri RM, Calkins H. A very interesting case study involving a TASER conducted electrical weapon (CEW) used on a patient with a pacemaker. J Cardiovasc Electrophysiol 2007;18:E29-30.

12. Kroll MW, Calkins H, Luceri RM. Electronic control devices and the clinical milieu. J Am CoIl Cardiol 2007;49:732-3.

13. Randerson J. Stun gun makers sue experts over safety criticisms. Guardian (UK) 2006 Mar 9. Available here. (accessed 2008 Apr 15).

14. Truscott A A knee in the neck of excited delirium. CMAJ 2008;178:669-70.

15. Royal Canadian Mounted Police. Operational manual. Chapter 17.7: Conducted energy weapon. Ottawa: the Police, 2007. Available here. (accessed 2008 Apr 15).

16. Singh S, Wooltorton E. Increased mortality among elderly patients with dementia using atypical antipsychotics. CMAJ 2005;173:252.

Medical journal calls for independent studies on Taser safety

May 1, 2008
The Canadian Press

OTTAWA — Potential health risks of Taser stun guns must be independently studied, says the latest Canadian Medical Association Journal in a sardonic editorial that blasts the manufacturer for intimidation tactics.

Taser International funds much of the research it cites to support Taser safety while challenging and sometimes suing those who raise concerns, it says.

"Tasers are perfectly safe and have never, ever killed anyone," writes Dr. Matthew Stanbrook, an assistant professor, researcher and specialist in respirology at the Toronto Western Hospital.

"We know this because Taser International . . . says so, claiming 'the Taser . . . cannot stop the heart.' And Taser International is an honourable and, for most of its existence, very profitable company.

"So honourable, in fact, that they have sponsored research to prove the Taser's safety," he continues. "Just about all the research, as it turns out. Moreover, they pay for experts to travel across North America and spread the good news about how safe Tasers are and correct any misconceptions that might arise from events like deaths of suspects in police custody or immigrants in Vancouver's airport."

Stun guns are now the subject of several continuing or pending inquiries across Canada. The weapons came under intense scrutiny last fall when amateur video of the death of Polish immigrant Robert Dziekanski at Vancouver International Airport was released, to public outrage.

No comment from Taser International was immediately available. It has vigorously defended its devices in several lawsuits and stresses that the weapon has never been directly blamed for a death. It has, however, been cited repeatedly as a contributing factor.

Especially at issue is the unknown effect of zapping severely agitated suspects with up to 50,000 volts. The sudden deaths of several people who were in a heart-pounding state before being Tasered have been explained using the contentious, non-medically recognized term "excited delirium."

"It's troubling that it's trotted out so often as an explanation for these events given the uncertainty around it," Stanbrook said in an interview. Taser advocates, along with an RCMP training manual, go so far as to suggest it might be best to zap people in that condition so they may be quickly subdued and medically treated, he added.

"It seems that these deaths due to excited delirium only occur in the context of being confronted with a law-enforcement officer with or without a Taser. Delirium in general is a very common condition - we see it all the time in hospitals.

"It is rare if ever that people who are delirious in hospitals have sudden death. So this has really come out of nowhere as something that suddenly kills people and requires rapid intervention."

To recommend the Taser as a go-to management tool in such situations "seems to us bordering on the absurd," Stanbrook said."Another perspective . . . is this is exactly the situation in which someone is at risk of dying from the Taser."

He says federally funded, independent research is badly needed to get to the bottom of such questions. At the very least, there should be an unbiased review of police-confrontation deaths before and after Tasers were introduced to assess net harm or benefit.

More than 300 people in North America, including 20 in Canada, have died soon after being Tasered. The electronic guns are overwhelmingly popular with police, who say they avoid injuries to suspects and officers and are certainly a better option than firearms.

Amnesty International and other critics have called for a moratorium pending an independent and comprehensive safety review. They say "Taser creep" has led to the jolting of unarmed suspects as a matter of handy compliance rather than to defuse major threats.

A Canadian Press analysis of 563 Taser incidents reported by the RCMP between 2002 and 2005 revealed that more than 79 per cent of suspects were unarmed.

The reports also suggested a pattern of use by the Mounties as a quick means to keep relatively low-risk prisoners, drunks and unruly suspects in line. More recent reports released by the RCMP have been heavily censored to remove key details such as exact dates and injuries linked to the stun guns.