Excited Delirium

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This episode includes descriptions of violence and sexual assault. Please use discretion. On December 23rd, 2020, Bella Quinto Collins was home from college to celebrate the holidays with her family in California. We had gone to my mom's work. They just had a small get-together, you know, masks on. And I grew up at my mom's work, really. So they're kind of like a second family. So we kind of spent the afternoon with them, I guess, and then came home. And we're just relaxing. A few months earlier, Bella's mother and Bella's two adult brothers had moved into a new house in a town called Antioch near San Francisco. When Bella and her mother Cassandra had come back from seeing Cassandra's colleagues that day, Bella's oldest brother, Angelo, was in his room sleeping. Cassandra says she went to his bedroom. Because there was a package for him, you know, a package that he's been waiting for for a while. So I knocked on his door and kind of woke him up. And he's like, oh, thank you, Mom. Just leave it there. and then, you know, he, I went out and he just went back to sleep. When the pandemic hit, Angelo, who was 12 years older than Bella, had lost his job and moved in with Cassandra. Before that, Angelo had joined the U.S. Navy. It was his dream career. But because of an allergy, he'd left during boot camp in 2019. Now he was trying to figure out what he wanted to do next. He liked gaming and was thinking about becoming a game designer. After talking to Angelo, Cassandra went to the living room, and at some point she fell asleep on the couch. Then, around 10 p.m., Angelo woke her up. And I said, yes, what do you want? You know, he goes, what's for dinner? and I was kind of upset about that because he, I mean, you know, he usually cooks for himself. He loves to cook. So when he asked me what for dinner is, I was like, what do you mean? You know, I was kind of upset because he woke me up from my sleep, my nap. he clearly wasn't himself um at a certain point i was on a zoom with my friend and he just kept coming into the room and like asking oh what's going on he seemed really worried it looked like the beginnings of an episode as we called it he'd had a couple of them throughout 2020 um in which he would just kind of act oddly, just not like himself, and really anxious and scared. But it was really infrequent, and then it almost seemed like he was normal the next day. The family says he'd started having these episodes after a head injury. Did this night seem different than other episodes that he had had? No, actually. It's actually the way we dealt with it, right? Yeah, we didn't have much tolerance for it at that point. In previous episodes, I'd say there were about five total throughout that year. he required patience when he was feeling that way, when he was afraid, when he was asking the same questions, when he looked past you and thought he saw something. He required a patience that spanned eight hours sometimes. A few months before, a neighbor had called the police because they'd seen Angelo trying to climb a fence. They said he was yelling. The police took him to the hospital. Cassandra says Angelo had been worried that maybe he had bipolar disorder or schizophrenia. She wanted him to see a psychiatrist so he could get help. She says that when he was having these episodes, he would ask her again and again if he was going to be okay. She'd often need to sit with him for a long time to calm him down. And we didn't have that patience that night, and I think that really escalated his anxiety. Over the next hour or so, Angelo seemed to get more and more scared and anxious. He wanted Cassandra and Bella to stay close to him. He locked arms with the two of them and started walking them around the kitchen. And that, of course, then heightened our anxieties. And I know that I was thinking in the moment, oh my gosh, he's getting really, really afraid. bella who was 18 at the time so she started to feel really worried at a certain point i had told him please you know let let go i'm going to call the police if you don't stop holding us and he just i could tell he couldn't understand what i was saying he kept on saying what's going on yeah what's going on and that you know that freaked me out bella called 9-1-1 to ask for help because i just felt like I had no other option. My dad was in Berkeley at the time, and I thought that's too far away. He wouldn't be able to get here fast enough. Bella told the 911 operator that her brother was, quote, being aggressive and hurting her mother. She said that Angelo had tried to pick up a hammer, so she had picked it up instead and had it with her. The operator asked her, do you know if he takes any drugs? And Bella replied yes. At one point in the call, someone yelled, stop it, stop it. At the end of the call, Bella said to the operator, sorry, thank you. What were you hoping the police would do to help once they showed up? Um, calm him down in a way that we couldn't. shortly after 11 p.m. two police officers arrived at their house the police dispatcher had told them about bella's call that she said her brother was hurting their mother the police said that when they arrived angela was being quote actively restrained by cassandra on the floor in a bear hug. Cassandra and Bella say that Angelo was calm. He wasn't trying to get away from me because I think that's what he wanted is for me to be there. He was just breathing heavily, but he was calm. He was very calm. And that's what the police officers saw when they came in the house. The police officers started to handcuff Angelo. They rolled him onto his stomach. According to the police, he started to struggle, and they bent one leg over the other to restrain him. Cassandra and Bella say Angelo didn't struggle. At some point, another two police officers showed up. Cassandra and Bella say that first one officer and then another had their knee on Angelo's neck. They say it went on for over four minutes. The police later said that an officer, quote, briefly for a few seconds, had a knee across a portion of Angelo's shoulder blade. We reached out to the Antioch Police Department for comment. We didn't hear back. What was he saying? Please don't kill me. Please don't kill me. The officers called an ambulance and asked for help with a mental health crisis. They asked for a code 2, meaning as quick as you can, but not an emergency. Two of the police officers later said they'd responded to Angelo's previous incident when he was trying to climb a fence. And one of them said that he thought Angelo had behaved in a similar way. He wasn't making sense. Cassandra decided to get her phone out to start recording what was going on. Because I wanted Angela to go to therapy and to go to a psychiatrist so that he could be properly medicated. Whenever I talked to him about his episodes, you know, he could not believe that he did that. so this particular time I made sure to record it, you know, so the next day I would have him listen to it, and he's going to go, okay, Mom. One of the police officers told Cassandra that Angela wasn't under arrest and that he would be transferred to a hospital for evaluation because it seemed like he might be a danger to himself or others. Cassandra said that Angelo hadn't been attacking them, but that he had been hallucinating and paranoid and didn't want to be alone. One of the police officers said, that's why he's going to the hospital, not to jail. Angelo had gone quiet. I asked them twice, actually, if he was asleep, because I want them to, you know, check on how he's doing. Angela was still lying on the floor with his hands handcuffed behind his back, and it became clear that he was unconscious. One of the police officers said, what's going on with him? And it actually became very quiet as soon as they saw, as soon as they flipped him and they saw blood coming out from his mouth and, you know, rolled up, his eyes rolled up to his head. It became very quiet. When Cassandra's video starts, two police officers are standing over Angelo, trying to communicate with him. They're wearing face masks and blue rubber gloves. The officers move Angelo onto his side, and one of them rubs his chest. There's blood on Angelo's face. What happened? Angelo? Angelo? Did you see you on any medication? Not that I know. Come on, can you take him, please? Please, please. The officers unlock the handcuffs and move Angelo onto a stretcher. Cassandra follows them. There's blood on the bedroom floor where Angelo had been lying face down. They start doing CPR on Angelo. Then they push the stretcher out of the house and into an ambulance. I'm Phoebe Judge. This is Criminal. When Angela was rolled out of the house on a stretcher, Bella says she thought he looked purple. Angela was rushed to the hospital. Cassandra and Bella had to stay back to answer questions from the police. They said they were going to take us to the police station. And I said, why? To be interviewed, they said. And I go, well, you know, they already did ask questions just a little while ago. And they said, don't worry, we're just, it's just going to be, you know, like, it's the same questions. At the police station, Cassandra and Bella were questioned separately about what had happened that night. Cassandra says a detective asked her if she had hit Angelo earlier, since he had a bloody nose. She answered no. While they were at the police station, Cassandra says she got a call from a doctor who was treating Angelo at the hospital. When she answered it, she says a police officer rushed over and told her to get off the phone. They said she'd get a chance to talk to the doctors later. As Bella and Cassandra had been on their way to the police station, Angelo's stepfather, Robert, arrived at the house. When I arrived, they were questioning me. Did he have something? Did he eat something he shouldn't have? Has he taken drugs? Is he allergic to something? He was told he couldn't enter the house. Their whole street was closed off. More police officers kept arriving, moving in and out of the house, which was marked off with crime scene tape. Police officers were standing guard around it. For hours, Robert stayed in the driveway with his dog, who had been in the car with him, and Angelo's younger brother, who'd come back after spending time at a friend's house. Around 6 that morning Bella and Cassandra got back from the police station Their house was still full of police and investigators Cassandra got a call from the doctor and she asked me to take it and I spoke with the doctor And he indicated to me that, you know, Angelo's brain was, you know, 98 or 99% dead. There was only a tiny portion of the brain stem left alive. the family went to the hospital to see angelo but because of covid protocols they were told they couldn't come inside when they got back home at around 8 30 in the morning the police had left when the family walked through the house there was still a smear of blood on the floor where angelo had been lying on his stomach and angelo's bedroom seemed to have been searched It's just like everything is upside down. It's been, you know, every last little thing has been tossed and turned and it's on the floor and it's just a mess. The police had taken things from Angelo's bedroom, including his cell phone and some photographs. In the kitchen, the family says they found a felony search warrant. The warrant said the police were authorized to take anything that, quote, tends to show that a felony has been committed or that a particular person has committed a felony. Robert says they were shocked. The police had told them that Angelo wasn't under arrest and hadn't committed a crime. That morning, on December 24th, the family kept calling the hospital, but they couldn't get permission. to visit Angelo. On the 25th, they called us and said we could, you know, come and visit him. So Robert and I went. Angelo was unresponsive. He was on a breathing machine, and his eyes were taped closed. He only had a faint heartbeat. I was reading him this Christmas card that everybody wrote on, And as soon as I was done, the nurse said, I'm sorry, I don't think he heard you or she said something. And I go, oh, isn't it that when you're in a coma, you can still hear, you know, you can still hear what other people are saying. So you kind of like constantly talk to them. And then she said, well, yeah, but in Angela's case, I don't think that is possible. The family says they felt like they couldn't get clear information from the hospital staff. Later, medical records cited in court documents said that when Angelo first arrived at the hospital, staff had been instructed by the police not to talk to them about Angelo's condition. A doctor had added it as a note to Angelo's medical record. I asked for Angelo's toxicology report, and the nurse smiled at me and said, I'm sorry, but we cannot provide that. And I'm like, what do you mean? What do you mean you can't provide it? Cassandra says she asked the nurse if it was because there was an investigation going on. And she remembers that the nurse nodded. so I was getting really upset and mad at that point I'm the mother I need to know I have to know and she said let me go to my supervisor and ask and so what she did is that she said she can't give it to us but she said I'm going to look at it on screen you might be able to see some of it over my shoulder and so she basically kind of showed it to us but she didn't want to give us or have any proof that she had given it to us but she let us see that there were no common substance of abuse found on the morning of December 26th they got a call from the hospital saying they should come visit Angelo as soon as possible in the car on their way there Cassandra says they talked about getting a lawyer Robert had already been making phone calls to friends and family to ask for recommendations. Cassandra didn't think they needed one. You know, I mean, I was on denial. But while I was, you know, with Angelo holding his hands, I was like, you know what, this is not right. And I looked at Robert and I said, you know what, go ahead, get a lawyer. Robert went out to the hospital parking lot and started making phone calls, trying to explain to people what had happened in the past three days. Eventually, he spoke with a civil rights attorney, who said he'd take the case. And then I came back, and they said Angelo is now, you know, he's going to pass. And the nurse said he's going to pass, and we waited about 20 minutes, and then at 1.30 or 1.40 p.m., he did. His heart stopped. the next day the family's new lawyers john burris and ben nissenbaum came to their house in antioch i think we're still having a hard time realizing what's happened but one of the first things that ben said he said basically that he thought they were going to blame it on excited delirium if they have nothing else they will say it was excited delirium Had you ever heard that term before? What did you think? I actually, the first thing, the first question I asked, what is that? What is excited deluge? For people who aren't that familiar with this term, what does it mean? If I told you it meant nothing, then I think that would be accurate. In terms of what it purports to mean, it's essentially that the body dysregulates itself in a fatal manner. So somehow the heart stops beating because the body becomes so unable to regulate itself. Had you ever handled other cases where it was used as a cause of death? Many, many. Many cases? I can think of at least a dozen. When people died during a police restraint, the immediate response invariably was, it wasn't the police, it was excited delirium. As if the person got so excited and became so delirious, they just spontaneously combusted. And I'd heard that so many times from the police over my career that I just knew that that's what was to be expected. We'll be right back. Support for Criminal comes from Bombas. This new year is the perfect time to upgrade your sock drawer with Bombas. I can't think of many better ways to motivate yourself to go on a morning walk before work or on a run or to the gym than a new pair of comfortable, thick, high-quality socks to put on before you head out the door. Bombas socks are made to support your feet for any activity. The new Bombas sports socks are engineered to be the perfect sock for all kinds of activities. There are pairs meant specifically for running, golf, cycling, hiking, yoga, and more. Also, compression socks for after your workout. And they've got socks for dressier occasions and slippers for errands or wearing around the house, too. I still wear Bombas socks I got three years ago. They've lasted incredibly well and somehow still don't slip down. You can head over to Bombas.com slash criminal and use code criminal for 20% off your first purchase. That's B-O-M-B-A-S dot com slash criminal, code criminal at checkout. Support for Criminal comes from Cachava. If you're looking for a new drink to help you reach your health and wellness goals, then you might enjoy Cachava. It's an all-in-one nutrition shake made with quality ingredients. It has no artificial flavors, colors, or sweeteners. It's non-GMO and includes no soy, no animal products, no gluten, and no preservatives. It's a whole-body meal made with plant-based protein, and it actually tastes good. Just two scoops provide 25 grams of protein, 6 grams of fiber, greens, adaptogens, and much more. It comes in six great flavors. Chocolate, vanilla, chai, matcha, coconut, acai, and strawberry. I'm always interested in trying new products that will help me get the nutrition I need. So I added a few scoops of vanilla-flavored cachava to my morning smoothie. I like the vanilla flavor, and it's easy to mix with different kinds of fruits, berries, or vegetables. Stick with your wellness goals. Go to cachava.com and use code CRIMINAL for 15% off. That's cachava, K-A-C-H-A-V-A dot com, code CRIMINAL. excited delirium is this term that has a really contentious history um a racist history and it's used to describe a collection of symptoms reporter renu ryazam but there's no diagnostic code for it there's no blood test for it there's no way to to test for it i should note delirium is a clinical term. It is something that people see in emergency rooms and hospitals. But the term excited delirium, it's kind of in some ways made up. It was first used in the 1980s. If you think about the 1980s in the U.S., there was a cocaine epidemic. It was gripping much of the country. And there was a South Florida forensic pathologist named Charles Wetley. In 1985, Charles Wetley co-authored a paper on what he called cocaine-induced psychosis and excited delirium. He looked at the deaths of seven people, mostly men, who had used cocaine. They'd all been restrained, usually by police, one of them by ER staff, and suddenly died. He wrote that all seven had intense paranoia, followed by, quote, bizarre and violent behavior and sometimes, quote, unexpected strength. And he said, these are people who are scared. They were violent. They were panicked. Then they were restrained. And then they died suddenly. And the problem with this theory is it was purely speculative. And it didn't look at the role that restraints might have played in these deaths. They didn't really identify any scientific evidence or any toxicology reports or any way to back up or test their idea. Then Charles Wettley started looking into a number of other cases. In the late 80s in South Florida, Miami, several black women were dying. And they were dying in the same area in Miami and in a really similar way. Twelve women were found dead between 1986 and 1988. Charles Wettley told reporters, The typical scene is in a cheap room, a clump of bushes, or an abandoned building. They were discovered naked from the waist down, and they all had trace amounts of cocaine in their system. An article in the Miami News quoted Wettley as saying, At first glance, it looks like she's been raped and murdered. But he said that wasn't the case. Wettley said the women likely died of cocaine psychosis. One newspaper article described it as, quote, sudden death from low levels of cocaine that caused the victims to go berserk and die within minutes. Some of the women were believed to have been sex workers. And he and his colleagues said that the combination of cocaine and sex is what led to these women's death. And he called it excited delirium. And, you know, he said that black women were more prone to dying this way and that it was this combination of the stimulation from the cocaine and the sex that led to their death. He told reporters that when they examined the women's bodies, there were no signs of assault. Quote, the autopsies have conclusively showed that these women were not murdered. At one point, he worked on a theory that rain in Peru had somehow tainted a shipment of cocaine. The police closed the cases. Many of the women who were found dead were from Jamaica, Haiti, and Puerto Rico. Most of them were in their 20s and 30s. But then, in 1988, a 14-year-old girl named Antoinette Burns was found dead, and she was found dead in much the same way that the other women had died. Wettley did the initial autopsy, and he once again said that she too died of excited delirium. And the Burns family pushed back. I mean, this was a young girl, 14. They said she wasn't a sex worker. She didn't do drugs. She was last seen hitching a ride to the movies with a neighbor. And the family really pushed back on this. But it wasn't until a toxicology report came back that Wettley's theory began to unravel. Antoinette Burns didn't have cocaine in her system. And after that, the chief medical examiner, so Wettley's boss, reviewed all the deaths of these women that Wettley had said died of excited delirium. And what he found was pretty startling. The chief medical examiner went back and looked at the photos from the autopsies of all the women who'd been found dead. He found lip and neck injuries and hemorrhaging in the eyes. He said that in many of these cases, the women had very, very clearly been strangled or asphyxiated to death. He said you could spot it a mile away. I mean, he said that these women, nearly 20 by this point, were actually homicide victims. And the police believed that a serial killer was responsible for their deaths. More women were found dead in 1989 But then in April of that year the deaths finally seemed to stop Months later police announced that they had a suspect in the cases A 33-year-old man named Charles Henry Williams, who'd been arrested on rape charges in April, right when the string of murders ended. But police said they didn't have enough evidence to charge him with the murders of the 32 women who they suspected him of killing over almost a decade. One of them was his neighbor, and four had been found dead near his home. They ended up charging him with one murder of a 19-year-old woman named Patricia Johnson. Ten days before the start of the trial, Williams died of AIDS while in prison, serving a sentence for rape. but Charles Wetley stuck to his theory that excited delirium was real and that at least some of the women in Miami had died from it you would think you know after the Antoinette Burns case after this kind of huge thing in Miami where this guy said oh all these people died of excited delirium and it turns out they had been murdered that the term would have completely fallen out of favor but eventually it reemerged When the Quinto Collins family's attorney told them about excited delirium syndrome, Bella says that like her parents, she'd never heard of it before. I thought that sounds really stupid. Does not sound very sophisticated at all. But he described to us his experience with excited delirium in the past. So after they told us about excited delirium, I said, I want a second autopsy. So it was, you know, I mean, I think the first thing is, how do you pay for this autopsy? The family said the independent autopsy ended up costing them $18,000. When it came back, it said Angelo had died of asphyxiation. They were still waiting to hear the results of the county's official autopsy. On January 13, 2021, they held a memorial service for Angelo in the garden of a local church. Months later, his family was notified that the county would hold a coroner's inquest. It's a hearing in which the county calls several witnesses. Attorney Ben Nissenbaum. Typically, the witnesses to the killing or death testify before jurors at the coroner's inquest. The jury at a coroner's inquest doesn't decide who is responsible for the death, only the quote, cause and manner of death. What the jury finds goes onto a death certificate. The jury determines whether the death was a homicide, a suicide, a natural death, or an accident. On the morning of August 20th, 2021, eight months after Angelo had died, the Quinto Collins family went to the local courthouse. The hearing was open to the public. Lots of people had showed up, friends and family, but also journalists. Bella says that the police officers, who are going to be giving statements that day, were already in the courtroom when the doors were open to the public. And then when we got the chance to come inside, my mom and I decided to sit right next to the officers. The court hearing wasn't led by a judge, but by a hearing officer, a lawyer named Matthew Guichard, who'd been contracted by the county. Guichard explained that in their county, Contra Costa County, the sheriff is also the coroner, meaning the sheriff determines the cause and manner of a person's death. and is part of arranging coroner's inquests. And when a person dies in police custody or during a police interaction, a coroner's inquest is required. California is one of just a few states where a county sheriff can also be the county's coroner. Matthew Guichard explained that this wouldn't be like a trial you might see in the movies. Quote, there won't be lawyers standing up and asking questions. He said he would be the one asking the witnesses questions, and that he had reviewed all of the documents, audio, and video recordings in the case. Attorney Ben Nissenbaum was in the courtroom with the Quinto Collins family, watching. We do get to submit questions, but the hearing officer can decide not to ask those questions. So the hearing officer has all the power. They can decide what the jury gets to hear. Six witnesses were called. The county's forensic pathologist, three of the police officers who were at the house in Antioch, a police detective, and a detective from the DA's office. Bella and Cassandra were not on the list of witnesses. Throughout that four hours of this inquest, they didn't mention my mother or myself by name. We were the mother and the sister, which just felt kind of odd because, you know, we weren't witnesses, but every aspect of the story involves the mother and the sister. The first witness was the pathologist who had performed Angelo's official autopsy. The family didn't know what the pathologist had found. They still hadn't seen the official autopsy report. But they did know the results of the independent autopsy that they had ordered and paid for themselves, which had concluded that Angelo had died of asphyxiation. The independent autopsy had found something called petechial hemorrhages on Angelo, small red marks often found in the eyes from broken blood vessels. Which is important because they tend to support a finding of an asphyxiation death. But the county pathologist testified that he had found no petechial hemorrhages on Angelo, and he didn't mention any other signs of asphyxiation. He went over the results of the toxicology report. It showed that Angelo had caffeine in his system and cotinine from cigarette smoking, as well as a drug for seizures, which is generally considered safe. Later, the Quinto Collins family's attorney pointed out that Angelo had been given anti-seizure medication at the hospital in the days before he died. The pathologist also found a drug called modafinil, which is also generally considered safe. It's used to treat narcolepsy, but people sometimes use it off-label to stay awake and alert longer. The pathologist said that the modafinil could have contributed to Angelo's death because, he said, there's a condition linked to drug use that kills people. He said, quote, it's poorly understood. It's called excited delirium syndrome. To which there was an audible reaction from the crowd. It was shocking, and it was laughable. And I laughed out loud, not on purpose, but I just had that reaction. And when I realized that I had done that, I thought, oops, and I walked myself out. The pathologist said that Angelo's cause of death was, quote, excited delirium syndrome due to acute drug intoxication, with behavioral disturbances due to arrest-related death with physical exertion. In the eight months since their lawyer had first told them about excited delirium, Robert says they'd all been learning more. As time went on, it became difficult to think that they would still blame excited delirium because even if you believed in the pseudoscience of excited delirium, Even if you were to read their own reports, Angelo didn't fit. That's why there was such a shock in the crowd, because we had all become much more informed about excited delirium. Typically, excited delirium was blamed on people that were taking Coke or meth or something. But to blame it on tobacco and cigarettes and this other thing that prevented you from sleeping, which had never had any deaths, meant that they had the flimpsiest case of excited delirium, even if you went by their own standards. Next, Gachard played Bella's 911 call to the jury, and three of the four police officers who had been at the house in Antioch the night Angelo was taken to the hospital testified. Two of the officers said that they'd had a knee on Angelo, but only very briefly. originally the police had said one officer had a knee on him then a detective with the DA's office testified that he had looked at Angelo's old incident when a neighbor had called the police because Angelo had been acting strangely trying to climb a fence the investigator said that according to the paramedics Angelo had had a fast heartbeat and he said a police officer had said that Angelo had admitted to being on meth. Gishard had said he thought a doctor at the hospital had believed the same thing. Then Gishard told the jury to not consider what had just been said about meth, because he said it was about a previous incident, and there was no evidence of meth in Angelo's blood, as the pathologist had previously testified. After the witness testimonies, Gishard reminded the jury that they would only be deciding on the cause of death, not who was responsible. They had four options, homicide, suicide, accident, or natural causes. The jury were told they didn't need to reach a unanimous decision, but a majority of them would have to agree. Gashard cleared the courtroom while the jury stayed back to deliberate. After about 15 minutes, they'd reached a unanimous decision. Were you surprised when the jury ruled it an accident? No, not at all. When I heard the testimony from the coroner that it was excited delirium, then that's what I expected would happen. And I felt like that was the intended, that was the purpose of it. The Quinto Collins family had filed a lawsuit against the city of Antioch, its police chief and the four police officers, who were at the family's house that night in December 2020. Months later, Ben Nissenbaum deposed the county's pathologist. The pathologist came to his office with a lawyer. What happened was I showed him the pictures from our autopsy that showed the particular hemorrhages in Mr. Kinto's eyes. And so he looked at them and he looked at them again and again and again and again. And Dr. Ogan actually acknowledged that, yes, those are petechial hemorrhages, and that in his view, they take time to develop, and that they simply hadn't developed at the time that he did Angelo's autopsy. What he said is that the restraint also played a role in Mr. Kinto's death. The pathologist said that if he had found the petechial hemorrhages when he did his autopsy, he would have added asphyxiation to his diagnosis. But he still believed the excited delirium diagnosis was right. We'll be right back. Thanks to Squarespace for their support. Making a website can be intimidating, especially because it's often the first thing people see about your business. 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After the idea of excited delirium was proposed in the 1980s it started gaining momentum In October 2008 a three conference on deaths that occurred in police custody was held at a hotel in Las Vegas It was sponsored by something called the Institute for the Prevention of In-Custody Deaths. Speakers included doctors, pathologists, and scientists. One of the speakers was Charles Wettley, the medical examiner who had theorized that the deaths of a number of women in Miami were due to excited delirium because they'd had cocaine in their system. In 1995, Charles Wettley had moved to New York, where he worked as a medical examiner. Even though Wettley's theories in Miami were unproven in those murder cases, he continued to talk about excited delirium. Reporter Renu Ryazam. And it continued to link cocaine use with excited delirium. He was just really convinced of this idea. And then this sort of idea really took off in a lot of different ways. When the 2008 conference in Las Vegas was announced, Charles Wetley was introduced as one of the doctors who had identified excited delirium, quote, in the cocaine wild 1980s. The conference promised that, quote, attendees will help make law enforcement, medical, and legal history through topic-specific breakout groups focused on arriving at a consensus about excited delirium. The conference was organized by a group that was started by a lawyer from Taser. They make stun guns. They say, hey, these stun guns don't kill people. They are an alternative to kind of other uses of force by police. In a later interview with Reuters, Charles Wettley said that he had studied deaths involving tasers, and in the vast majority of cases, those deaths were caused by excited delirium, not the taser shock. Quote, I've never seen a case where I could say that a taser actually contributed to the death. He told Reuters that taser had hired at many times to be an expert witness in lawsuits against the company. Renu Ryassam says that conference on in-custody deaths became a turning point. From that conference emerged what ended up being this really influential white paper, Unexcited Delirium. It's called the White Paper Unexcited Delirium Syndrome. So a white paper, it's like in this sort of medical or scientific context, a white paper is kind of like a detailed guide or report on a topic. The white paper was published by the American College of Emergency Physicians in 2009. The authors of the paper were 19 doctors, many of them professors of emergency medicine. A few of them had worked with Taser in some capacity. We reached out to Axon, the company that makes tasers for comment. We didn't hear back. So if you read the paper, you go back and read the 2009 white paper from the American College of Emergency Physicians. It sort of lays out what they think excited delirium is, and it presents this research. Of course, all the research is sort of circular. It's from the same group of experts that have been talking about theory in the first place. And they say, OK, there are no biological markers for excited delirium. Again, there's no tests or standard diagnostic criteria. But they lay out what they say are these features. As someone has superhuman strength, or really high pain tolerance, or rapid breathing, then they have excited delirium. The white paper listed other signs that someone might have excited delirium, such as a, quote, failure to respond to police presence, profuse sweating, and a, quote, attraction to glass or reflective surfaces. I had never heard of this thing called excited delirium, and I was troubled and curious. In 2020, Arjun Baiju was a medical student doing a research fellowship at a hospital in Rochester, New York, when a man named Daniel Prude was brought to the intensive care unit after an incident which included being restrained by police. Arjun didn't treat the man, but later he heard about him, and about how his autopsy had listed excited delirium syndrome as a cause of death. Arjun says he asked some of his professors about it, but none of them had heard about excited delirium syndrome. Groups like the American Medical Association, the American Psychiatric Association, and the WHO didn't recognize it. So Arjun started doing his own research. Well, I just started with Google, like everyone does. And the first things that came up were a lot of police training material. Manuals from police departments across the country, videos about it on YouTube for training purposes. Arjun says the training materials he found almost always mentioned superhuman strength and how to deal with it. Somebody with excited delirium can't be taken down with the normal de-escalation techniques, verbal cues. They say they need many officers. They say that they need many electroshocks. A news organization called New York Focus got access to Rochester police training materials on excited delirium, created in 2016, and found that a lot of it appeared to come from a poster published by the Institute for the Prevention of In-Custody Deaths, the organization that had been started by a lawyer at Taser. The poster had advice on how to capture someone with excited delirium. Quote, Taser electronic control devices have been shown to be the most effective for quickly capturing this category of individuals. In a police training presentation, a couple of slides had a list of behaviors to look out for. They included hallucinations and unfounded fear or panic, bizarre behavior, and, quote, saying, I can't breathe. The slides included photos, like one of a naked zombie with blood on its face, one of the Incredible Hulk, and one of the actor and comedian. Jordan Peele, with sweat running down his face. The slide explains the four stages of excited delirium. One, elevated body temperature. Two, agitation. Three, respiratory arrest. Four, death. One of the ideas is that people with excited delirium, quote-unquote, have reduced pain perception. and they cite instances of them smashing glass and withstanding multiple electroshocks. In that description are all these very loaded terms with all this baggage, like monster and animal-like behavior and extreme strength. And I think that plays on racial stereotypes, because overwhelmingly these are black men, young black men. The second angle is that this question of differences in pain perception has an embarrassing legacy in medicine, a long legacy of physicians believing that people of African descent have different pain perception, require less anesthetic, have literally thicker skin, have literally less sensitive nerve endings. So very gruesome things from surgery to experimentation to amputation were carried out under that guise. And I think that we see that legacy in this narrative of people with excited delirium having diminished pain response. The organization Physicians for Human Rights says that the deaths of black people and people of color have disproportionately been attributed to excited delirium. Excited delirium also came up in George Floyd's case. There's an officer on the tape saying, hey, we think maybe he has excited delirium. At trial, the defense attorney for Derek Chauvin, who was accused of killing George Floyd, said that Chauvin had been watching for signs of excited delirium as a, quote, reasonable police officer, because that's what police were trained to do. A Minneapolis police officer had testified that she trained new officers on how to recognize the syndrome. The prosecution called a doctor to testify. He said that he believed excited delirium is real, but that George Floyd had none of the symptoms. Derek Chauvin was convicted of killing George Floyd. After George Floyd's death and the deaths of a number of other men of color who had died in police custody in 2019 and 2020, supposedly from excited delirium, Renu says things began to change. I think what really changed the game was video footage of these deaths. And in particular, George Floyd's death. I think that caused a lot of people to take a look at this term. It forced a lot of groups that had been supportive of the term to turn away from it. And under pressure, the American College of Emergency Physicians in 2021, they started to backpill a little bit. And in 2023, the American College of Emergency Physicians retracted that 2009 white paper and they said we got it wrong. Renu says police departments across the country have since removed the term excited delirium from their training materials. But I'll give you an example of how just kind of banning the term may not be enough. So the Minneapolis Star Tribune, they reported that in training materials for the Minneapolis Police Department, there are these PowerPoint slides and the words excited delirium were crossed out and replaced with the term severe agitation with confusion and delirium in parentheses. So, yeah, this concept that, you know, that exists just with a different name. Six months before the white paper on excited delirium was withdrawn, Angelo Quinto's family tried to have the cause of death on his death certificate changed. After the county pathologist had sat down with Ben Nissenbaum and agreed that asphyxiation had been a contributing factor in Angelo's death, his family argued that Angelo's death should have been classified as a homicide. They were not successful. In 2021, California Governor Gavin Newsom signed eight new reform bills into law. One of them bans restraints that can cause asphyxiation. And in 2023, California became the first state to ban the term excited delirium, as well as related terms such as hyperactive delirium and exhaustive mania. What it's done is to change the way that the cases are resolved by coroners. And we've seen that have a real effect, I think, because now much more we see that coroners are including the restraint as part of the cause of death. In 2024, the Antioch City Council announced that they'd decided to settle with the Quinto Collins family for $7.5 million. After Angelo died on December 26, 2020, his family kept the presents they'd wrapped for him that Christmas. They never opened them. and his mother Cassandra told us that every year at Christmas they bring out Angelo's presents and put them under the tree. Since Angelo's death, the city of Antioch launched a new non-police crisis team that will respond to calls about people in a mental health crisis. Shortly after Angelo died, his sister Bella, who had called 911 that night, told reporters, quote, I asked the detectives if there's another number I should have called, and they told me that there wasn't, and that I did the right thing. But the right thing would not have killed my brother. She said, now there's somebody else to call. It's named after Angelo. The Angelo Quinto Community Response Team. www.criminal.com ThisisCriminal.com. 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