The Vancouver Police Department has no plans to change training on “excited delirium” following a coroners inquest that found that officers who beat and restrained Myles Gray caused his death.
In inquest testimony, five of the officers who beat, kicked, punched, choked and held Gray down suggested the 32-year-old business owner was suffering from a condition called excited delirium.
Many of the other officers who testified didn’t use the term excited delirium, but listed the symptoms of the condition when they described how Gray looked and acted when they confronted him in a suburban backyard.
For nearly 40 years, some medical experts and law enforcement have pushed the theory that excited delirium is a medical condition that can cause death.
But there is growing evidence that deaths attributed to excited delirium are usually caused by police restraints, leading to asphyxiation when an agitated person can’t recover from physical exertion because restraints interfere with breathing.
Increasingly, the diagnosis has been questioned by medical researchers and advocates. It’s no longer used as a cause of death by the BC Coroners Service and it is not recognized by the American Medical Association or the American Psychiatric Association.
Dr. Michael Freeman, an expert in forensic medicine from the United States, describes excited delirium as “a black eye on the forensic sciences” with racist origins. In the mid-2000s, excited delirium was heavily pushed by Taser, the company that makes conducted energy weapons.
“What we found in our research was the more aggressive the restraint, the more likely the person was to die,” Freeman told The Tyee. Freeman is a co-author of a 2020 study published in Forensic Science, Medicine and Pathology that analyzed 168 cases of excited delirium syndrome.
The study found that 90 per cent of fatal cases also involved police restraining the person.
“And the more likely that somebody died, the more likely it was going to be called excited delirium.”
That raises the question, Freeman said, of whether excited delirium is “a label that you put on a death when someone dies during aggressive restraint by police, because it's exculpatory... so that there's never any responsibility for using overly aggressive tactics.”
The coroners inquest jury heard from the forensic pathologist who did the autopsy on Gray in 2015. Dr. Matthew Orde originally listed excited delirium as one of a number of possible causes of death.
But on the stand, Orde said he no longer believes excited delirium is a useful description, and recent medical studies show it’s unlikely to cause death on its own.
“I don't think [Gray] would have died when he did had it not been for the police interaction on that day,” Orde testified.
Orde said that the way Gray was restrained — face-down on his stomach, handcuffed with his wrists behind his back and his ankles tied together — increased the risk that he would be unable to take full breaths and recover from the physical exertion of his violent struggle with 10 police officers, leading to heart failure.
Gray was also seriously injured, with broken bones in his throat, ribs, nose and eye socket, as well as bruises all over his body and ruptured testicles.
But while the inquest jury recommended police wear body cameras and improve training for responding to people in mental health crisis, jurors did not include any recommendations related to excited delirium or restraining a person thought to be suffering from excited delirium.
In response to a question from The Tyee about whether the VPD would change what officers are taught about excited delirium and restraints, Sgt. Steve Addison said officers receive training on “how to recognize and respond to people exhibiting symptoms of what is often referred to as excited delirium. This training includes the medical risks associated.”
Addison added that the VPD received two recommendations from the inquest jury and is now reviewing those.
Mike Massine, a retired police officer, testified at the inquest as an expert in police training and use of force. Massine was senior program manager with the Ministry of Public Safety, overseeing use of force and standards of training for police departments in B.C.
Massine said police are trained that people showing signs of excited delirium must be brought to hospital for their own safety because it’s believed their agitated state may be fatal. “That requires physical restraint, that’s the unfortunate thing,” he told the inquest.
According to the ministry, police are taught that “extreme” cases of excited delirium are supposed to be treated as a medical emergency. If restraints have to be used to contain the person, police are taught that the person needs to be monitored closely until they receive medical attention.
But it’s the way those restraints are applied that can cause death when someone is assumed to be suffering from excited delirium, Freeman said.
“Asphyxia causes a ventricular tachyarrhythmia, which is when the heart cannot effectively pump blood, and that's when the person becomes unconscious. That can happen when somebody is in a prone position and they cannot recover their ability to breathe,” Freeman said.
“So saying that you're protecting somebody by keeping them from breathing normally, it's beyond ridiculous. That's why it's a myth, and it should not be taught.
“What should be taught is that once you restrain a person, once you get them restrained face down, you turn them on their side and they go into a recovery position in all cases.”
The ministry said that when training is updated, “findings from this and other recent coroners inquests will be considered during this process.”
During the inquest, Orde said he prefers the term “acute agitated behavioural disturbance” and said it should be used to describe behaviour, not as a medical diagnosis.
Gray was acting erratically and aggressively the day he was killed, but his family believes Gray, who had been diagnosed with bipolar disorder in his teens, was having a manic episode.
Ian Donaldson represented the Gray family during the inquest. Donaldson initially planned to call Freeman as an expert witness to counter Dr. Christine Hall, a B.C.-based doctor who has advised police on excited delirium and wrote policies and procedures on excited delirium for the BC Ambulance Service.
But that changed when the presiding coroner, Larry Marzinzik, decided not to call Hall as a witness. That decision came shortly after Donaldson had informed the BC Coroners Service that he planned to ask for Freeman to be included as a witness, according to Donaldson. The coroners service said decisions about which witnesses to include are made by the presiding coroner and the reasons are confidential.
Hall did not respond to a request to comment for this story made through her employer, Island Health.
Donaldson said he’s satisfied with what Orde told the jury about excited delirium and he hopes things are changing when it comes to deaths in police custody.
“Hopefully through these events and external events, like other scientific bodies reaching conclusions, this is one little bit along the way to putting excited delirium out there with repressed memories and other junk science,” Donaldson said.
“Because we don't want to be making serious decisions based on junk science because it sounds good.”
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