Excited Delirium in the Courtroom
Although not an official cause of death, the term “excited delirium” appears with some regularity in situations involving in-custody deaths.
The term simply describes any situation in which a prisoner dies while in custody following a situation on the street, moments after officers have taken the individual into custody, or upon arrival at a jail. Although there is no specific medical diagnosis, it is a death that occurs after an individual who is impaired by a stimulating drug, mentally ill, or both, engages in a physical struggle. These struggles with law enforcement often are prolonged and the individual is either restrained or a Taser is used – in both cases causing a sudden cessation of most movement. It is sometimes linked to positional asphyxia as well, when an individual is restrained in a position that impairs breathing in some way. In some contexts, it is also referred to as “exhaustive mania.”
The syndrome, although not well understood, is triggered when the mental illness or drug use causes heart rates and body temperatures to soar. It is usually diagnosed as an exclusion, when the pathologist rules out other issues and is aware of the individual’s actions prior to death. The actual cause of death may be listed as some form of a cardiorespiratory event, and excited delirium may not even be mentioned as a contributing factor.
Excited delirium comes up in the law enforcement context typically in use of force cases. It is almost certainly brought under 42 U.S.C. 1983, as a possible violation of the Fourth Amendment. In all such cases, the standard for qualified immunity, in which the officer (and the agency, ultimately) will be dismissed is objective reasonableness. In other words, was the officer’s conduct rational under the circumstances? It does not require that the officer select what may be, in hindsight, the best option. Instead, it requires a reasonable option in what is often a heat-of-the-moment decision when time for deliberation may be lacking.
Two Kentucky cases illustrate the point. In Sheffey v. City of Covington, 564 Fed.Appx 783 (6th Cir. 2014), for example, Leroy Hughes, a huge man, was spotted carrying a handgun near two elementary schools. Finding his overall behavior odd, a witness called police.
Officers located and tried to stop Hughes to speak to him, but he was uncompliant. Believing Hughes was possibly intoxicated or mentally ill, additional officers arrived and attempted to convince him to show his hands and get on the ground, to no avail. When he approached one of the officers aggressively, officers deployed Tasers, which proved ineffective. With further aggression, officers forced him to the ground and engaged in a lengthy struggle to gain control. Use of the Taser’s drive-stun mode also was ineffective, even on exposed skin. (He was tased at least twice in probe mode, and eight times in drive-stun mode.)
When he was finally handcuffed and shackled to prevent kicking, he was searched and a handgun with additional loaded magazines were found.
Within moments, however, he exhibited signs of medical distress and officers called for EMS. Both the officers and EMS attempted resuscitation, but he died at the hospital. The medical examiner attributed his death to several overlapping causes, including excited delirium. His estate, through Sheffey filed suit, alleged excessive force, but the trial court ruled in favor of the officers on summary judgement.
“[Excited delirium] describes any situation in which a prisoner dies while in custody following a situation on the street, moments after officers have taken the individual into custody, or upon arrival at a jail. Although there is no specific medical diagnosis, it is a death that occurs after an individual who is impaired by a stimulating drug, mentally ill, or both, engages in a physical struggle.”
The Sixth Circuit Court of Appeals agreed that despite the tragic result, the officers’ actions were eminently reasonable when faced with a large, combative, non-compliant subject. Even though the underlying, possible, criminal charge (carrying a concealed weapon without a permit) was relatively minor, it was reasonable because of Hughes’ odd behavior and proximity to a school.
The Court also reasoned that although he was subjected to a Taser multiple times, it was reasonable, given his lack of response, for officers to believe that the Taser was ineffective. And when they realized that the Taser wasn’t working as expected, despite direct contact with skin, they stopped using it. Finally, the Court discounted Sheffey’s argument that they could have just continued to wrestle with him until he gave up. The Court also agreed the officers’ awareness that he was possibly mentally ill should have been considered as well, but the officers could not have been aware of his actual mental disability, as they could only base their beliefs on his behavior.
In a series of cases over the years, courts have held that although mental illness should be “considered to some extent,” it has to be viewed from the perspective of the officers on the scene. The ruling in favor of the officers was upheld.
In another Kentucky case, Cook v. Bastin, 590 Fed. Appx. 523 (2014), officers engaged with Roland Campbell, a young man with both non-verbal autism and severe intellectual disability. He was living in a group home, where he had displayed an increasing degree of agitation and other self-injuring behaviors.
Unable to control his behavior, his resident caregiver called for help from other staff; eventually, they had to resort to calling the police. Officers observed self-injuring behavior. Campbell was digging his fingers into an electrical socket, for example, and had destroyed a room before their arrival. After an extended struggle with multiple officers and staff, Campbell collapsed and fell unconscious; he died at the hospital. His cause of death was attributed, in part, to excited delirium.
In a similar analysis, the district court, and eventually the Sixth Circuit, agreed that despite his estate representative’s arguments as to actions the officers “should have” taken, all that was required was that the officers take a “reasonable approach.” Despite the argument that one of the caregivers, who assisted in the restraint, may have laid on top of Campbell, leading to a possibly-fatal compression, the Court agreed the officers reasonably believed that the help of the caregiver might prove useful, since Campbell was familiar with him. The Court upheld the summary judgment in favor of the officers.
In any case involving an apparently-impaired or mentally-ill subject, particularly when the subject become combative, officers should be aware of the potential for a catastrophic, cascading physiological reaction to the stress of the encounter that may lead to death. In such cases, there will almost certainly be litigation, and officers must expect to be questioned extensively about their actions and choices. However, in the majority of these cases, if their actions are reasonable, the officer will ultimately be exonerated, as will their agency, by extension.
The unintended death of any individual is always a tragedy, but in cases where the death is due to what is commonly called “excited delirium,” the specific facts of each case will be considered. In such cases, agencies should ensure that a full and detailed investigation is completed promptly in anticipation of such litigation.
