March 2, 2007 -- Police and defense attorneys are squaring off over a medical condition so rare and controversial it can't be found in any medical dictionary — excited delirium. Victims share a host of symptoms and similarities. They tend to be overweight males, high on drugs, and display extremely erratic and violent behavior. But victims also share something else in common. The disorder seems to manifest itself when people are under stress, particularly when in police custody, and is often diagnosed only after the victims die.
Is excited delirium a real medical condition brought on by mental illness, drugs and the stress of being arrested? Or is it a convenient excuse to let cops off the hook for using brutal and deadly force?
Everyone in the court of inquiry that convened in New Brunswick, Canada, this week could agree on these facts: Kevin Geldart was a big man. So big that he couldn't even fit into the police cruiser on the night in 2005 when Royal Canadian Mounted Police found him in a bar talking to himself in a mirror and threatening people. Everyone also agreed that Geldart, 34, was mentally ill and that police, in an effort to restrain him, shot him multiple times with a Taser gun and sprayed him with pepper spray.
But just what caused Geldart's death — excited delirium or police brutality — has been left to the court to determine. Wednesday, forensic pathologist Dr. Ken Obenson told the inquiry that "on the balance of probabilities and considering the circumstances, I believe his death was caused by excited delirium."
The term "excited delirium" began showing up in coroners' reports and in the charts of emergency room doctors in the 1980s, on the coattails of the cocaine epidemic. Dr. Corey Slovis, a professor of emergency medicine and chairman of medicine at Vanderbilt University Medical Center, said patients become "wild and bizarre" and "are often found running down streets, screaming, and sweating until dehydration."
Slovis and others are convinced excited delirium is a "real clinical disorder." But the fact that the disorder seems to manifest most often when people are in police custody, and is often diagnosed only after the victims die, gives civil libertarians cause for concern.
Eric Balaban, a lawyer for the American Civil Liberties Union National Prison Project, says the cause for these arrestees' deaths is police brutality, not excited delirium.
"There remain many questions. Excited delirium still doesn't exist as a recognized diagnosis. It can't be found in any medical textbooks, and the AMA still doesn't recognize it as a diagnosis. Medical examiners only picked up the term to explain and whitewash excessive use of force by the police," he said.
The American Medical Association has "no official policy" on the disorder, AMA spokesperson Melissa Smith said.
Excited delirium can't be found in medical textbooks, dictionaries or on lists of standard diagnoses. There are also no official national statistics as to how often in-custody deaths are attributed to it. Three deaths last year in Dallas resulted in the state providing police with mental health training.
The International Association of Police Chiefs is also waiting for more evidence before weighing in formally. Wendy Balazik, the association's spokeswoman, said the organization has not yet taken a position on excited delirium as "it's not officially recognized in the medical literature. It's definitely on our radar," she said, adding, "It's an important issue and we're paying a lot of attention to it."
Physician: It's the Adrenaline That's Deadly, Not the Cops
Balaban said that what cops and medical examiners are call excited delirium is really just routine mental illness. "The symptoms — unpredictability and irrationality are also the symptoms of mental illness. The mentally ill living on the streets often self-medicate by using drugs. Officers need to recognize the symptoms of mental illness rather than treat it with weapons."
But physicians who have seen people in the throes of excited delirium insist it can't be mistaken for anything else.
Dr. Gary Vilke, an emergency room physician at the University of California at San Diego, said excited delirium causes police intervention, not the other way around. "These are people running around naked, breaking the windows of cars and getting the attention of police. … They are excited and delirious, hence the term. … Cops have to intervene, and a struggle is inevitable."
What's really killing these people isn't police brutality but an overdose of adrenaline, said Dr. Assaad Sayah, chief of emergency medicine at Cambridge Health Alliance. According to Sayah, when people are abused by cops, the trauma is obvious. Excited delirium deaths, he said, are "not related to an actual trauma to the patient." Patients are having a "physical response to an actual psychological problem resulting in their autonomic systems producing too much adrenaline. It's like having too much nitrous in a car; eventually the engine will blow up. If there's any pre-existing condition, or if the patient is under the influence, there is an increased risk."
The use of electric stun guns or Tasers has also raised alarms. Activists like the ACLU's Eric Balaban believe that it's in the best interests of both the police and Taser International, the company that produces the weapons, to insist that excited delirium is real.
"The problem is police departments may be using what they call 'excited delirium' as a training tool to teach rookies what to do when confronting aggressive arrestees. Cops are told arrestees under excited delirium have superhuman strength, and cops escalate the confrontation because they've been trained to believe their lives are in danger.
Taser International is currently being sued by the family of Frederick Williams, who died in May 2004, when prison guards shocked him five times with a Taser. The medical examiner could not determine an exact cause of death. Taser International claims neither its weapons nor excessive force were the cause of Williams' death, but blames his death instead on excited delirium. No drugs were found in Williams' body at the time of his death.
The doctors who spoke to ABCNEWS.com spoke to for this article all insisted that while excited delirium was real, it was not necessarily fatal. The physicians all emphasized the importance of training police to properly identify the symptoms and to get suspects medical attention as soon possible.
Sayah said he has found that the simple act of keeping patients on their backs, rather than facedown, often increases their chances of survival.
"Large numbers of officers are being trained to recognize the syndrome," said Slovis, who recommended that paramedics be called to a scene as soon as police recognize the symptoms of excited delirium.
"There is always room for abuse when anyone, police or otherwise, has the use of force at his disposal. Deaths in custody occurred before and can't all be attributed to abuse by Tasers. Those cases are tragic."