Accident or homicide? Medical rulings in arrest-related deaths can dictate what happens to police

Sitting alone in her car, Jen Dold was crying too hard to drive. She had just received a manila envelope with her brother’s autopsy report.

There it was, one devastating word: “accident.” The papers trembled in her hands.

Their mother had called 911 for help getting Dold’s 29-year-old brother, Alex, to the hospital because he was in a mental health crisis. Four sheriff’s deputies and two police officers shocked him with Tasers, wrapped an arm around his neck, punched and kicked him, then left him face down until they noticed he wasn’t breathing.

How could that be an accident? Dold was certain it was a homicide.

Angry and grieving in the parking lot outside the county medical examiner’s office 30 miles north of Seattle, Dold vowed to fight.

“No more silence or complacency,” she thought. “No sweeping it under the rug.”

In the United States, police rarely face criminal charges when civilians die after officers use physical force. Whether they do can depend on a system that operates after the initial attention passes: medical examiners and coroners who decide how and why someone died — what’s known as the manner and cause of death.

On TV dramas such as “CSI” or “Bones,” facts and established science determine whether a death was an accident or homicide. In reality, medical investigations involving police restraint deaths can be so riddled with inconsistencies, suspect science or conflicts of interest that even extensive force may matter little, an investigation led by The Associated Press has found.

That investigation identified 1,036 deaths over a decade after police used not their guns but physical blows, restraints or weapons such as Tasers that aren’t supposed to kill. Some people were causing little or no trouble, while others were committing violent crimes. Many died after officers broke widely known safety practices, or after medics injected them with powerful knock-out drugs, sometimes at the urging of police.

Accident was the most common conclusion of medical investigations in AP’s case database. Accidental rulings typically blamed preexisting conditions such as obesity or asthma, or drug use — even when in some cases blood testing did not detect lethal levels. Others faulted “excited delirium,” a controversial diagnosis discredited by major medical associations. Some medical officials based their decisions not on physical evidence, but instead on whether they believed police intended to kill.

Manner of death decisions are so pivotal that members of law enforcement and their allies push to shape them, with the multibillion-dollar company behind Tasers peppering medical officials with research it funded or wrote that downplays the dangers of its weapon.

The degree of physical and professional separation a medical official had from local law enforcement appeared to affect rulings. Deaths were ruled accidents more frequently when medical examiners or coroners were in the same community as the department under investigation, or when they fell under the control of law enforcement.

The mere location of a death has huge sway because each state designs its own system. Even within a state, county lines can matter. Death decisions are made in some places by doctors trained as forensic pathologists, in others by an elected coroner who may have no medical training and deep ties to local law enforcement.

“I call it a crazy quilt,” said Dr. Victor Weedn, the former chief medical examiner of Maryland who has written about failed attempts to bring national consistency. Concerned about medical examiners’ independence in police-involved deaths, he advocates for state health departments to take charge.

When deaths are ruled accidental, prosecutions of officers are exceedingly rare — of the 443 cases the AP identified, just two resulted in criminal charges. A family’s chances of winning a wrongful death lawsuit also become much tougher.

“I had a belief that the justice system was fair, that if you were a victim you’d get justice, and the perpetrator would be convicted of their crime — police officer or not,” Jen Dold said. “Sadly, we realized this was not the case.”

Jen Dold — 11 years older than Alex — had been more like a doting mother to him growing up. When his schizophrenia began at 19, and he started to believe people were whispering and lurking outside his house, she became his primary caregiver, shuttling him around and helping him financially.

One night in 2017, Alex Dold had an argument with his mother. He was in his late-20s, unemployed, living with her and off his medication. She had refused to give him more than his daily $30 from federal disability payments. So he yanked a lanyard around her neck, flipped the living room recliner where she sat, and left.

The county mental health department wouldn’t send someone, saying Dold wasn’t violent enough.

When Dold returned and sat down to watch television like nothing had happened, his mother called 911. She told the dispatcher her son was calm, yet needed hospital treatment.

Two Snohomish County sheriff’s deputies arrived. Dold acknowledged getting physical, but insisted his mother was fine and tried to close the front door.

Many police are trained to calm people in mental crisis. Instead, Deputy Bryson McGee pushed inside. McGee would later say Dold punched his face, something Dold’s mother, Kathy Duncan, who witnessed the interaction, denied.

Four backup officers joined the fight. Over 12 minutes, the group punched, kicked and hit Dold with a baton, shocked him with Tasers, pressed a knee to his face and pushed his head down with a flashlight, according to a 990-page police report.

Dold said he was submitting and cried out for his mother, who screamed that her son was mentally ill.

“It was the worst yelling, shouting I’ve ever heard,” one neighbor told an investigator.

After handcuffing Dold in the driveway, deputies left him face down, a position the Justice Department and others have long warned carries a suffocation risk. No one started proper resuscitation for at least 10 minutes.

Jen Dold didn’t trust the investigation from the beginning. The detectives who interviewed her focused on her brother’s mental illness, she thought to protect officers.

Seeking an ally, she contacted Snohomish County’s chief medical examiner, and was relieved when Dr. Daniel Selove told her by phone that he’d weigh police force.

Yet when Selove met her at his office, he explained that Dold died from an irregular heartbeat. While the Taser shocks and struggle were significant factors, Selove said, he didn’t believe the officers intended to kill her brother, so his death was an accident.

Whether to consider intent is a philosophical divide among forensic pathologists. Dold’s death illustrates how unevenly intent can be applied — Selove used it even though under his own office’s policies intent “need not be present or proven” for a homicide ruling.

For coroners and medical examiners, homicide doesn’t carry the same meaning as murder does in criminal law. Guidelines from the National Association of Medical Examiners say intent is a valid consideration, but restraint deaths may be classified as homicide without it — and doing so has “some value” to reduce any appearance of a cover-up.

Dr. J. Keith Pinckard, the organization’s president, said manner of death is an opinion meant to be used for vital statistics and public health, not a legal determination. Nonetheless, it has influence in court.

The significance of an accidental ruling quickly became clear when the local prosecutor cited it in exonerating the deputies and officers. It was one example among dozens AP found in which prosecutors referenced autopsy outcomes to close investigations, including other cases involving severe force.

Jen Dold figured the last chance to hold the deputies in her brother’s death accountable was a lawsuit.

Looking for a lawyer, the family found a promising lead. Seven years before her brother’s death, Deputy McGee — the first one into Dold’s home — had fired his Taser in a fatal struggle with another man in mental distress. Dold was not his first death on duty.

The county had settled that family’s lawsuit. The Dolds contacted the lawyer, who took their case but cautioned litigation would be arduous. Officers get protections, including qualified immunity, which shield them from liability. The accidental manner of death would not help.

As the lawsuit ground on, the attorney discovered something intriguing. The day after Alex Dold’s autopsy, Selove fired the doctor who did it.

Now it was February 2022. Jen Dold huddled with her mother and sister around a laptop to watch their attorney question Dr. Stanley Adams, a forensic pathologist who worked for the U.S. military before Snohomish County.

Their lawyer asked Adams to review Dold’s autopsy report. For the first time, Adams learned that, after he was fired, Selove had changed his conclusion from homicide and labeled it an accident.

“I have a little bit of heartburn with that because he took my correct answer and he changed it to an incorrect answer,” Adams said.

“Why do you say it’s a homicide?” the lawyer asked.

“Because when one human being does an action or neglects to do an action that caused the death of another, it really doesn’t matter about the intent,” Adams replied.

The family hugged.

“We just kept saying, ‘Did he really just say that? Did he really just say ‘homicide'?” Jen Dold recalled.

Adams told AP that under the settlement he reached over his termination, he couldn’t discuss his employment. But in a complaint filed with Snohomish County, Adams wrote he was fired for documenting Selove’s violations of county policies and guidelines of the National Association of Medical Examiners. Without saying which policies, Adams called the violations a “danger to public health and safety.”

In an interview, Selove said Adams’ homicide finding was unrelated to his firing. They disagreed over other matters, he said, but couldn’t elaborate due to the settlement. His office's policy on intent was a relic of a predecessor that he didn't need to follow, he said. And he never felt pressure from law enforcement in any restraint death, including one in 2015 where a detective was publicly accused of improperly influencing him.

The county offered Dold’s family around $1.5 million to end their case in 2023. Jen Dold wanted the settlement to require a change to homicide, but said the county wouldn’t budge. She finally relented.

“The process beat us down and we were ready for it to be over,” she said.

When a reporter reached Deputy McGee, who resigned within three months of Alex Dold’s death, he said never to call again and hung up. The deputy who responded with McGee resigned in 2019 after being accused of having sex on duty, according to police disciplinary records.

In the seven years since her brother’s death, the extent of the force troubles Jen Dold, as does the pain and fear he must have felt as he struggled to breathe.

A simple question haunts her: What if the medical examiner’s report was different by just one word — homicide?

While loved ones like Jen Dold want a homicide ruling, powerful institutions may not. The AP found attempts at influencing medical officials in other cases by elected and appointed officials — the police chief or sheriff, the mayor — as well as outside sources, such as Axon Enterprise Inc., the maker of Tasers.

In November 2021, the chief medical examiner in North Dakota was deciding how to rule the death of a 43-year-old man police encountered in a Bismarck neighborhood who was on methamphetamine, drenched in sweat and agitated because he believed his daughter was in danger.

Police video that has never been reported before shows Ryan Pederson, a local hockey club coach and single father, resisted when officers tried to handcuff him. Three of them fired their Tasers at nearly the same time, with one connecting.

Awakened by the commotion, a neighbor recorded police holding Pederson face down under a streetlight, remarking, “I think they George Floyded him.”

The autopsy was done by Dr. Barrie Miller, the state’s chief medical examiner.

Emails AP obtained show Miller spoke with Michael Brave, then a longtime Axon attorney, who late into a Friday night and over one weekend emailed her more than a dozen documents, including research papers and book chapters co-authored by company officials that downplayed the risks of Tasers.

“Great day!!” Brave wrote in one. “After our conversation I thought of a couple more documents you might want to have.”

He attached a checklist that tells forensic pathologists what evidence to collect during death investigations involving Tasers. Other materials described how the device works or discussed purported symptoms of excited delirium syndrome, such as “superhuman strength” and high pain tolerance.

Brave also sent a chart from a study he contributed to which argued that people rarely, if ever, die when police restrain them face down in what’s known as prone position — the way officers restrained Pederson. While police do use prone restraint every day without harm, AP’s investigation, done with the Howard Centers for Investigative Journalism and FRONTLINE (PBS), identified 44 deaths from 2012-2021 where a medical examiner or coroner ruled that prone restraint caused or contributed. In another 17 cases involving prone restraint, positional asphyxia or asphyxia due to restraint was cited as a cause or contributing factor.

Four days later, Miller ruled Pederson’s death was due to methamphetamine-induced “psychomotor agitation” and “physical exertion with physical restraint.” The cause mentioned neither Tasers nor officers. The manner was undetermined — one of five choices along with accident, homicide, natural and suicide.

Miller didn’t respond to multiple calls and emails seeking comment. She was fired this spring after police went to her office. Brave, now a partner in a Phoenix law firm, said Miller contacted him wanting information about how Tasers work. He said he wasn’t trying to influence her — he wanted her to have the correct information. An Axon official did not respond to messages.

Checklists like the one Brave sent Miller have long been an Axon strategy.

In a 2018 “Managing Your Medical Examiner” web presentation, a longtime member of the company’s board of directors, Mark Kroll, urged law enforcement officials and prosecutors to use a company-created checklist. The essence: Influence the manner of death ruling. “Control the narrative” by getting the deceased’s criminal and medical history. Drop in on the forensic pathologist and talk about cases. And if they are “hostile,” line up police-friendly experts to counter them.

Kroll left Axon this year. In an email to AP, he questioned how medical examiners arrive at a manner of death, saying their opinion is not “infallible truth” but rather “driven by personal biases, local politics, sex of the medical examiner, religion, and years on the job.” Noting the role drugs and preexisting conditions can play, he called some who die “walking time bombs.”

Axon has exerted influence in other ways. In autopsy reports, some medical officials shift culpability by citing company-funded research. And in the early 2000s, the company sent a chill through forensic pathology when, faced with product liability lawsuits, it launched a campaign to undermine rulings that Tasers caused or even contributed to deaths.

One important victory came after the company sued a medical examiner in Ohio who had partially blamed the device in three fatal encounters. A judge required the medical examiner to change the manner of death from homicide and remove Taser references in the cause.

“Dangerously close to intimidation,” the president of the National Association of Medical Examiners said at the time.

Pressure is a reality of forensic pathology. In a 2011 survey not specific to Taser or arrest-related deaths, 22% of the association’s members said elected or appointed officials had leaned on them to change cause or manner of death. And 25% of those who resisted said they “suffered consequences,” including being fired.

In a follow-up paper, the association said death investigations and decisions must be “independent from law enforcement and prosecutors,” and based on scientific evidence and research.

Cases in North Carolina and Vermont show what can happen behind the scenes.

Marcus Smith was having a mental health breakdown at a music festival in 2018 and approached Greensboro, North Carolina, police for help. When he panicked and tried to flee, officers pinned Smith, 38, face down to the ground, records show.

After an associate chief medical examiner for North Carolina ruled it a homicide, a police lawyer emailed the state’s chief medical examiner in correspondence marked highly confidential and said Smith’s death should have been undetermined because health problems, cocaine and alcohol could be to blame. He called the homicide classification “wrong and it is being used by those with ulterior motives and visions of monetary payouts … to baselessly vilify police officers.”

The police lawyer, Amiel Rossabi, told AP in an email that he “was not pressuring anyone” but was instead pointing out that, based on his research, the medical examiner was wrong. The chief medical examiner and the pathologist who performed the autopsy did not respond to emails and phone messages.

In March 2019, an officer’s punch fractured a 54-year-old man’s skull in Burlington, Vermont. Douglas Kilburn died days later. After a Vermont Health Department doctor called it a homicide, Burlington’s police chief questioned the finding in an email to the state health commissioner, saying he had conferred with the mayor.

The former chief, Brandon del Pozo, now an assistant professor of medicine at Brown University, told AP he sent the email after getting unsatisfying answers from the medical examiner about the degree of certainty that it was homicide. It could have been undetermined, del Pozo said. Former Mayor Miro Weinberger told AP that Kilburn’s death was tragic but the medical examiner’s report had “confusing and contradictory findings.”

Neither state office budged from its homicide ruling. No officer was charged, but lawsuits resulted in payouts of $2.5 million in North Carolina and $45,000 in Vermont.

An analysis by AP showed that death rulings can vary according to how close the medical examiner or coroner is to local law enforcement.

State offices such as in Vermont and North Carolina labeled as accidents about 30% of deaths. Local agencies investigating deaths in their own communities classified nearly 50% of deaths as accidents. That number was higher still when the local agency was part of law enforcement, such as Texas’ justice of the peace system or the sheriff-coroners in many California counties.

In one notable California restraint death, a forensic pathologist resigned after learning the sheriff changed the manner from homicide to accident. The ensuing controversy led San Joaquin County to create an independent medical examiner’s office.

The death of Kyle Briones in the sprawl east of Los Angeles shows how important the coincidence of where someone dies can be.

The 28-year-old was driving in the pre-dawn hours when a tire blew out. His car swerved and hit a street sign before stopping in a San Bernardino County farm field.

Briones survived the wreck — but not the night.

Ontario Police Department officers responding to a 911 call for an injured motorist pulled him from the car. Although there were no drugs or alcohol in his system, Briones was disoriented and wobbled as he walked. Police ordered him to sit. When Briones didn’t respond, officers shocked him with a Taser, threw him to the ground and placed him face down for more than six minutes, according to court records. The department did not respond to requests for comment.

By the time paramedics got to him, it was too late.

Had Briones crashed a mile down the road, across the line dividing San Bernardino and Riverside counties, what happened next might have gone far differently.

The two counties, known together as the Inland Empire, each have more than 2 million people and saw similar patterns in their arrest-related deaths — typically, people in mental health or drug emergencies died after a struggle. Each has a sheriff-coroner death investigation system.

Yet in these cases, they arrived at opposite conclusions. Among the 13 deaths AP identified from 2012-2021 in Riverside County, the coroner’s office classified 11 as homicides. The coroner’s division of the San Bernardino County Sheriff’s Department ruled on 12 deaths, labeling none a homicide.

In the Briones death, the chief forensic pathologist working for the San Bernardino County coroner blamed preexisting heart and lung conditions. Dr. Frank Sheridan said that — at 317 pounds and 5 feet, 11 inches — Briones was “morbidly obese.” He ruled the death natural.

The Briones family couldn’t understand. Their attorney hired as an expert witness a former medical examiner who had worked for Ventura County, on the other side of Los Angeles. He said Briones died because officers held him down with pressure on his back so he couldn’t breathe, and that it should be a homicide. The lawsuit settled for $2.75 million. Sheridan did not respond to requests for comment.

San Bernardino was one of 19 agencies in the United States that had four or more deaths in AP’s database and ruled none a homicide.

In Miami-Dade County, for instance, all deaths in AP’s data involving Tasers were ruled accidents. The one man who was shocked in Miami-Dade but whose death was not an accident died six years later — in neighboring Broward County, where a medical examiner called Derrick Blake’s death a homicide attributable to tasing.

All 16 deaths in Miami-Dade over the 10 years AP analyzed were accidents. Just one of Broward County’s four deaths was. Miami’s chief medical examiner declined to comment.

The 19 agencies with four or more deaths but no homicides cover at least 17 million people. One was the medical examiner’s office in Snohomish County, Washington. The same place where Jen Dold fought, to no avail, to reclassify her brother’s death.

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Weiss reported from Greenville, South Carolina; Mohr reported from Jackson, Mississippi; Dunklin reported from Dallas; Pritchard reported from Los Angeles and Kirkland, Washington. Contributing were Ryan J. Foley in Iowa City, Iowa; Martha Bellisle in Seattle; Rhonda Shafner in New York; Sean Mussenden in College Park, Maryland; Roxana Hegeman in Belle Plaine, Kansas; Jeff Martin in Atlanta; and Jennifer McDermott in Providence, Rhode Island.

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This story is part of the investigation “Lethal Restraint” led by The Associated Press in collaboration with the Howard Center for Investigative Journalism programs and FRONTLINE (PBS). The investigation includes an interactive story, database and the film “Documenting Police Use Of Force.”

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The Associated Press receives support from the Public Welfare Foundation for reporting focused on criminal justice. This story also was supported by Columbia University’s Ira A. Lipman Center for Journalism and Civil and Human Rights in conjunction with Arnold Ventures. The AP is solely responsible for all content.

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Contact AP’s global investigative team at Investigative@ap.org or https://www.ap.org/tips