Saturday, August 9, 2008

Controversy Over "Excited Delirium Syndrome"

Here's a link to my Channel 4 Action News report on "Excited Delirium Syndrome."

At the time I interviewed Dr. Cyril Wecht -- shortly after noon on Friday -- he had not been hired to do the independent autopsy on the body of Andre Thomas, the man who died after being tased by Swissvale police. District Attorney Stephen Zappala has said that Thomas' conduct before his death fits the symptoms of Excited Delirium Syndrome. That can include violent, erratic behavior and "superhuman" strength.

Shortly after 5 PM, as my TV report was airing, the Post-Gazette website posted a story quoting attorney Howard Messer as saying Wecht had been retained by Thomas' family. After spotting the PG's web report, I contacted Wecht around 6 PM. He confirmed that he had been hired for the autopsy less than an hour and a half earlier -- several hours after I had interviewed him.

The American Psychiatric Association's Associate Director, Division of Research, Dr. William Narrow, confirmed for me in a telephone interview that neither the American Medical Association nor his professional organization recognize the term "Excited Delirium Syndrome".

Dr Narrow: "In my experience, the term excited delirium has been used exclusively by law enforcement and in the legal world."

Dr. Narrow says it doesn't have a basis in medical terminology. I asked him if it was a pseudoscientific term. His answer: it doesn't have a basis in medical terminology.

Dr. Narrow: "It is a term that is to the best of my knowledge developed by a non-medical group -- i.e. The law enforcement and legal community -- and therefore, yes, it doesn't fall into what would be legitimate medical science."

Here's a quote from "Excited delirium: Does it exist?", an article in Perspectives in Psychiatric Care, Jul-Sep 2003, by Mary Paquette.

Paquette: "Even though the American Medical Association does not recognize this diagnosis as a medical or psychiatric condition, the National Association of Medical Examiners has recognized it for more than a decade... It is used by medical examiners in most major cities. Thus, there is a great deal of controversy regarding the use of this syndrome to explain sudden death while restrained."

This is a link to a New York Times story: "Deaths in Custody: Excited Delirium or Excessive Force?"

Finally, here are some breakout quotes from my interview with Dr. Wecht about Excited Delirium Syndrome.
Dr. Wecht:
• "I have had much reservation about this so-called entity for many years. The forensic pathology community is split on this."

• "As far as I am concerned, it is not an entity that exists in and of itself."

Whect says that when cocaine, meth-amphetamine, or an hallucinogenic is present, "one could theoretically argue that the state of excitement induced by a confrontation may produce death".

Dr. Wecht:
• "In the absence of drugs, in my opinion, this is pure scientific conjecture. It is a fiction that has created by a combination of medical examiners, coroners, forensic pathologists in those offices, district attorneys, law enforcement officers."

• "It gets them out of a difficult situation many times when you have these deaths occuring following police altercations in which there was no weapon, in which the person has no heart disease, in which there was quote 'erratic behavior' unquote."

• "The AMA and the American Psychiatric Association do not recognize this entity in the year 2008. It's been discussed now for many, many years. Certainly it has been revisited by the appropriate experts in these two national organizations, and I am with them. I do not recognize it or accept it at all in the absence of drugs."

• "I look at it skeptically, but I'm willing to review it when drugs are present -- specifically cocaine and amphetamines and other drugs that can alter behavior, but not in a central nervous system depressant fashion."

• "You cannot ignore the fact that nine out of ten of these cases involve victims who are members of a minority and cops who are white."

• "(It's ) a more acceptable way of saying -- almost like 'it's God's will'. In other words, it's something we could not have prevented. Hey, man he just got excited. In a state of delirious excitation -- he died. We don't really know why,we don't understand why, we can't demonstrate anything at autopsy."

• "It's convenient, and you need something you can sell. And you know what, to the public, generally out there, 'hey, man, it's another one of those excited delirium cases. Too bad'."

• "How come we don't have excited delirium cases, absent cocaine, amphetamines, et cetera, in situations that do not involve the altercations with police?"

• "They only seem to die when the altercation is with the cops. It's never an altercation with their brother in law, with their neighbor..."

The District Attorney and the Allegheny County Chiefs of Police Association distributed educational material to local law enforcement on Excited Delirium Syndrome in 2006. It included a link to this online video training on the topic, as well as an article called "10 Training Tips For Handling 'Excited Delirium'" prepared by the Force Science Research Center and posted on The website.


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