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Diagnosis used in high-profile police deaths has no medical basis, physicians group says

"Excited delirium" has appeared in the cases of George Floyd, Elijah McClain and others.
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A symbolic headstone for George Floyd at the Say Their Names Cemetery in Minneapolis on June 3.Nicholas Pfosi / Bloomberg via Getty Images file

A physicians group released a report Wednesday saying an increasingly common diagnosis at the center of some high-profile police deaths has no medical or psychiatric basis. 

The 95-page report, released by the nonprofit group Physicians for Human Rights, calls on Congress to investigate the diagnosis of “excited delirium” and urges professional organizations that have accepted the term to clarify that it is not “a valid medical diagnosis and cannot be a cause of death.”

The report’s authors add that the term — which authorities have said is exhibited through increased strength, incoherence and other behaviors — “cannot be disentangled from its racist and unscientific origins.”

The condition is not included in the Diagnostic and Statistical Manual of Mental Disorders or the International Classification of Diseases, nor is it recognized by the American Medical Association or the American Psychiatric Association, according to the report's authors, who said they conducted a review of medical literature and court depositions, as well as two dozen interviews with medical, legal, law enforcement and mental health experts.

Among those whose autopsies have included the diagnosis are Elijah McClain, 23, a Colorado man who died in 2019 after officers put him in a chokehold and injected him with ketamine, and Daniel Prude, who died after police in Rochester, New York restrained him. 

The report also highlighted the role of "excited delirium" in the murder of George Floyd. According to The Associated Press, a lawyer for former Minneapolis Police Officer Derek Chauvin raised it in his closing arguments to argue that Chauvin used objectively reasonable force when he knelt on Floyd’s neck for more than 9 minutes.

The lawyer, Eric Nelson, said Chauvin had been watching for signs of "excited delirium," the AP reported.

The term first appeared to have been used in the early 1980s to describe lethal cocaine intoxication among a small group of Black women who were presumed to be sex workers, the report says, adding that it later came to rely on "racist tropes of Black men and other people of color as having 'superhuman strength' and being 'impervious to pain,' while pathologizing resistance to law enforcement."

A researcher at the University of California, Berkeley, found that Black and Latino people accounted for 56 percent of 166 in-custody deaths that involved the condition from 2010 to 2020, according to the report.

The report's authors partly attributed the term's rising popularity among law enforcement officials, forensic pathologists and others in recent years to experts and researchers associated with Axon, the maker of Taser stun guns.

According to the report, a lawyer for the company and an expert who had worked with Axon hosted a 2007 conference at which attendees were told they would help make "law enforcement, medical and legal history" by creating a "consensus" on the condition.

What the report described as the conference's "results" were published in a 2009 white paper released by the American College of Emergency Physicians, or ACEP, a professional organization for emergency doctors.

The paper described the condition as a syndrome and said it was "particularly likely" in a person who displayed six or more features, including "pain tolerance, superhuman strength, sweating, rapid breathing, tactile hyperthermia, and a failure to respond to police presence." 

Since the 2009 paper’s release, ACEP has updated its disclosure requirements — a fact a spokesman for the group said was reflected in a paper published on the condition last year.

In a statement to NBC News, Axon said the company was not involved in advertising for the conference, nor was it aware of how those materials were assembled. The statement added that of the 19 experts who authored the ACEP white paper, none were Axon employees and three had been retained by the company for specific cases.

An ACEP official said earlier Wednesday that the 2009 paper acknowledged that the condition was real, but the official added that it was not "officially endorsed" by the group. In the 2021 paper, the organization changed the name of the condition to "hyperactive delirium."

In a statement Wednesday, the group attributed the shift in language to an effort to "better form consensus around a more medically accurate description of this condition."

"We recognize the term ‘excited delirium’ is increasingly being used in non-clinical medicine discussions and the term can produce a visceral and negative response, particularly among those in communities with complicated relationships with law enforcement or medicine," the statement said.

In a statement, Axon said the condition has been recognized by different names — "Bell's Mania" and "Profound Agitation" among them — and "has been the subject of hundreds if not thousands of studies and publications in the medical literature" over more than 150 years.

"There is no debate among knowledgeable medical professionals that some individuals will, after being in an unusual state of agitation, suddenly collapse and die," the company said. 

In Wednesday's report, the physicians group also called on the National Association of Medical Examiners to clarify its position on "excited delirium."

In an email, association president Kathryn Pinneri said the group "does not promote or support the diagnosis" of "excited delirium," nor does it consider it a valid cause of death. 

"If a person experiences an acute delirium prior to death, the underlying cause of death is the process that caused the delirium, such as acute cocaine toxicity, alcohol withdrawal, etc.," she said. "We agree that excited delirium is not a recognized medical diagnosis."