Excited Delirium

29:47And after that, the chief medical examiner, so Wettley's boss, reviewed all the debts of these women that Wettley had said died of excited delirium. And what he found was pretty startling. The chief medical examiner went back and looked at the photos from the autopsies of all the women who'd been found dead. He found lip and neck injuries and hemorrhaging in the eyes. He said that in many of these cases, the women had very, very clearly been strangled or asphyxiated to death. He said you could spot it a mile away. I mean, he said that these women, nearly 20 by this point, were actually homicide victims.

30:29and the police believed that a serial killer was responsible for their deaths. More women were found dead in 1989. But then, in April of that year, the deaths finally seemed to stop. Months later, police announced that they had a suspect in the cases. A 33-year-old man named Charles Henry Williams, who'd been arrested on rape charges in April, right when the string of murders ended. but police said they didn't have enough evidence to charge him with the murders of the 32 women who they suspected him of killing over almost a decade. One of them was his neighbor, and four had been found dead near his home.

31:16They ended up charging him with one murder of a 19-year-old woman named Patricia Johnson. Ten days before the start of the trial, Williams died of AIDS while in prison, serving a sentence for rape. But Charles Wettley stuck to his theory that excited delirium was real and that at least some of the women in Miami had died from it. You would think, you know, after the Antoinette Burns case, after this kind of huge thing in Miami where this guy said, oh, all these people died of excited delirium and it turns out they had been murdered, that the term would have completely fallen out of favor. But eventually it reemerged.

32:01When the Quinto Collins family's attorney told them about excited delirium syndrome, Bella says that like her parents, she'd never heard of it before. I thought, that sounds really stupid. Does not sound very sophisticated at all. But he described to us his experience with excited delirium in the past. So after they told us about excited delirium, I said, I want a second autopsy. So it was, you know, I mean, I think the first thing is, how do you pay for this autopsy? The family said the independent autopsy ended up costing them$18 ,000. When it came back, it said Angelo had died of asphyxiation.

32:43They were still waiting to hear the results of the county's official autopsy. On January 13, 2021, they held a memorial service for Angelo in the garden of a local church. Months later, his family was notified that the county would hold a coroner's inquest. It's a hearing in which the county calls several witnesses. Attorney Ben Nissenbaum. Typically, the witnesses to the killing or death testify before jurors at the coroner's inquest. The jury at a coroner's inquest doesn't decide who is responsible for the death. Only the, quote, cause and manner of death. What the jury finds goes onto a death certificate.

33:39it, the jury determines whether the death was a homicide, a suicide, a natural death, or an accident. On the morning of August 20th, 2021, eight months after Angelo had died, the Quinto Collins family went to the local courthouse. The hearing was open to the public. Lots of people had showed up, friends and family, but also journalists. Bella says that the police officers, who were going to be giving statements that day, were already in the courtroom when the doors were opened to the public. And then when we got the chance to come inside, my mom and I decided to sit right next to the officers.

34:28The court hearing wasn't led by a judge, but by a hearing officer, a lawyer named Matthew Guichard. who'd been contracted by the county. Guichard explained that in their county, Contra Costa County, the sheriff is also the coroner, meaning the sheriff determines the cause and manner of a person's death and is part of arranging coroner's inquests. And when a person dies in police custody or during a police interaction, a coroner's inquest is required. California is one of just a few states where a county sheriff can also be the county's coroner. Matthew Guichard explained that this wouldn't be like a trial you might see in the movies.

35:16Quote, there won't be lawyers standing up and asking questions. He said he would be the one asking the witnesses questions and that he had reviewed all of the documents, audio and video recordings in the case. Attorney Ben Nissenbaum was in the courtroom with the Quinto Collins family, watching. We do get to submit questions, but the hearing officer can decide not to ask those questions. So the hearing officer has all the power. You know, they can decide what the jury gets to hear. Six witnesses were called. The county's forensic pathologist, three of the police officers who were at the house in Antioch, a police detective, and a detective from the DA's office.

36:07Bella and Cassandra were not on the list of witnesses. Throughout that four hours of this inquest, they didn't mention my mother or myself by name. We were the mother and the sister, which just felt kind of odd because, you know, we weren't witnesses, but every aspect of the story involves the mother and the sister. The first witness was the pathologist who had performed Angelo's official autopsy. The family didn't know what the pathologist had found. They still hadn't seen the official autopsy report. But they did know the results of the independent autopsy that they had ordered and paid for themselves, which had concluded that Angelo had died of asphyxiation.

36:55The independent autopsy had found something called petechial hemorrhages on Angelo, small red marks often found in the eyes from broken blood vessels. Which is important because they tend to support a finding of an asphyxiation death. But the county pathologist testified that he had found no petechial hemorrhages on Angelo, and he didn't mention any other signs of asphyxiation. He went over the results of the toxicology report. It showed that Angelo had caffeine in his system and cotinine from cigarette smoking, as well as a drug for seizures, which is generally considered safe. Later, the Quinto Collins family's attorney pointed out that Angelo had been given anti-seizure medication at the hospital in the days before he died.

37:48The pathologist also found a drug called modafinil, which is also generally considered safe. It's used to treat narcolepsy, but people sometimes use it off-label to stay awake and alert longer. The pathologist said that the modafinil could have contributed to Angelo's death because, he said, there's a condition linked to drug use that kills people. He said, quote, it's poorly understood. It's called excited delirium syndrome.

38:27To which there was an audible reaction from the crowd. It was shocking and it was laughable. And I laughed out loud, not on purpose, but I just had that reaction. And when I realized that I had done that, I thought, oops. and I walked myself out. The pathologist said that Angelo's cause of death was, quote, excited delirium syndrome due to acute drug intoxication with behavioral disturbances due to arrest-related death with physical exertion. In the eight months since their lawyer had first told them about excited delirium, Robert says they'd all been learning more. However, as time went on, it became difficult to think that they would still blame excited delirium because even if you believed in the pseudoscience of excited delirium, even if you were to read their own reports, Angelo didn't fit.

39:26That's why there was such a shock in the crowd because we had all become much more informed about excited delirium. Typically, excited delirium was blamed on people that were taking Coke or meth or something. But to blame it on tobacco, cigarettes, and this other thing that prevented you from sleeping, which had never had any deaths, meant that they had the flimsiest case of excited delirium, even if you went by their own standards. Next, Kishard played Bella's 911 call to the jury. And three of the four police officers who had been at the house in Antioch the night Angela was taken to the hospital testified.

40:06Two of the officers said that they'd had a knee on Angelo, but only very briefly. Originally, the police had said one officer had a knee on him. Then a detective with the DA's office testified that he had looked at Angelo's old incident, when a neighbor had called the police because Angelo had been acting strangely, trying to climb a fence. The investigator said that according to the paramedics, Angelo had had a fast heartbeat, and he said a police officer had said that Angelo had admitted to being on meth. Gachard had said he thought a doctor at the hospital had believed the same thing. Then Gachard told the jury to not consider what had just been said about meth, because he said it was about a previous incident, and there was no evidence of meth in Angelo's blood, as the pathologist had previously testified.

41:03After the witness testimonies, Gachard reminded the jury that they would only be deciding on the cause of death, not who was responsible. They had four options, homicide, suicide, accident, or natural causes. The jury were told they didn't need to reach a unanimous decision, but a majority of them would have to agree. Gashard cleared the courtroom while the jury stayed back to deliberate. After about 15 minutes, they'd reached a unanimous decision. Were you surprised when the jury ruled it an accident? No, not at all. When I heard the testimony from the coroner that it was excited delirium, that's what I expected would happen.

41:56And I felt like that was the intended, that was the purpose of it. The Quinto Collins family had filed a lawsuit against the city of Antioch, its police chief and the four police officers, who were at the family's house that night in December 2020. Months later, Ben Nissenbaum deposed the county's pathologist. The pathologist came to his office with a lawyer. What happened was I showed him the pictures from our autopsy that showed the patechial hemorrhages in Mr. Kinto's eyes. And so he looked at them, and he looked at them again and again and again and again. And Dr. Ogan actually acknowledged that, yes, those are petechial hemorrhages, and that in his view, they take time to develop, and that they simply hadn't developed at the time that he did Angelo's autopsy.

42:59What he said is that the restraint also played a role in Mr. Kinto's death. The pathologist said that if he had found the petechial hemorrhages when he did his autopsy, he would have added asphyxiation to his diagnosis. But he still believed the excited delirium diagnosis was right.

43:27We'll be right back.

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44:27Whatever your thing, it could be anything. Canva helps you make that thing a thing. Canva is a simple online tool thing. It's a way to design with our magic AI tool things. You can social media your thing, generate images or videos of your thing, make decks for presentations to show your thing. Whatever needs to be done for your thing, Canva can make it an even better and bigger thing. Canva, the thing that makes anything a thing. After the idea of excited delirium was proposed in the 1980s, it started gaining momentum. In October 2008, a three-day conference on deaths that occurred in police custody was held at a hotel in Las Vegas.

45:14It was sponsored by something called the Institute for the Prevention of In-Custody Deaths. Speakers included doctors, pathologists, and scientists. One of the speakers was Charles Whetley, the medical examiner who had theorized that the deaths of a number of women in Miami were due to excited delirium because they'd had cocaine in their system. In 1995, Charles Whetley had moved to New York, where he worked as a medical examiner. Even though Wettley's theories in Miami were unproven in those murder cases, he continued to talk about excited delirium. Reporter Renu Ryazom. And he continued to link cocaine use with excited delirium.

45:59He was just really convinced of this idea. And then this sort of idea really took off in a lot of different ways. When the 2008 conference in Las Vegas was announced, Charles Wettley was introduced as one of the doctors who had identified excited delirium. quote, in the cocaine-wild 1980s. The conference promised that, quote, attendees will help make law enforcement, medical, and legal history through topic-specific breakout groups focused on arriving at a consensus about excited delirium. The conference was organized by a group that was started by a lawyer from Taser. They make stun guns. They say, hey, these stun guns don't kill people.

46:46They are an alternative to kind of other uses of force by police. In a later interview with Reuters, Charles Wetley said that he had studied deaths involving tasers. And in the vast majority of cases, those deaths were caused by excited delirium, not the taser shock. Quote, I've never seen a case where I could say that a taser actually contributed to the death. He told Reuters that taser had hired him many times to be an expert witness in lawsuits against the company. Renu Ryassam says that conference on in-custody deaths became a turning point. From that conference emerged what ended up being this really influential white paper, Unexcited Delirium.

47:36It's called the White Paper Unexcited Delirium Syndrome. So a white paper, it's like in this sort of medical or scientific context, a white paper is kind of like a detailed guide or report on a topic. The white paper was published by the American College of Emergency Physicians in 2009. The authors of the paper were 19 doctors, many of them professors of emergency medicine. A few of them had worked with Taser in some capacity. We reached out to Axon, the company that makes tasers for comment. We didn't hear back. So if you read the paper, you go back and read the 2009 white paper from the American College of Emergency Physicians.

48:21It sort of lays out, okay, what they think excited delirium is. And it presents this research. Of course, all the research is sort of circular. It's from the same group of experts that have been talking about theory in the first place. And they say, okay, there are no biological markers for excited delirium. Again, there's no tests or standard diagnostic criteria. But they lay out what they say are these features. If someone has superhuman strength, or really high pain tolerance, or rapid breathing, then they have excited delirium. The white paper listed other signs that someone might have excited delirium, such as a, quote, failure to respond to police presence, profuse sweating, and a, quote, attraction to glass or reflective surfaces.

49:12I had never heard of this thing called excited delirium, and I was troubled and curious. In 2020, Arjun Baiju was a medical student doing a research fellowship at a hospital in Rochester, New York, when a man named Daniel Prude was brought to the intensive care unit after an incident which included being restrained by police. Arjun didn't treat the man but later he heard about him and about how his autopsy had listed excited delirium syndrome as a cause of death Arjun says he asked some of his professors about it but none of them had heard about excited delirium syndrome Groups like the American Medical Association the American Psychiatric Association and the WHO didn't recognize it So Arjun started doing his own research.

50:05Well, I just started with Google, like everyone does, and the first things that came up were a lot of police training material, manuals from police departments across the country, videos about it on YouTube for training purposes. Arjun says the training materials he found almost always mentioned superhuman strength and how to deal with it. Somebody with excited delirium can't be taken down with the normal de-escalation techniques, verbal cues. They say they need many officers. They say that they need many electroshocks. A news organization called New York Focus got access to Rochester police training materials on excited delirium, created in 2016, and found that a lot of it appeared to come from a poster published by the Institute for the Prevention of In-Custody Deaths, the organization that had been started by a lawyer at Taser.

51:04The poster had advice on how to capture someone with excited delirium. Quote, Taser electronic control devices have been shown to be the most effective for quickly capturing this category of individuals. In a police training presentation, a couple of slides had a list of behaviors to look out for. They included hallucinations and unfounded fear or panic, bizarre behavior, and, quote, saying, I can't breathe. The slides included photos, like one of a naked zombie with blood on its face, one of the Incredible Hulk, and one of the actor and comedian, Jordan Peele, with sweat running down his face.

51:53The slide explains the four stages of excited delirium. 1. Elevated body temperature 2. Agitation 3. Respiratory arrest 4. Death One of the ideas is that people with excited delirium, quote-unquote, have reduced pain perception. And they cite instances of them smashing glass and withstanding multiple electroshocks. In that description are all these very loaded terms with all this baggage, like monster and animal-like behavior and extreme strength. And I think that plays on racial stereotypes because overwhelmingly these are black men, young black men. The second angle is that this question of differences in pain perception has an embarrassing legacy in medicine, A long legacy of physicians believing that people of African descent have different pain perception, require less anesthetic, have literally thicker skin, have literally less sensitive nerve endings.

53:14So very gruesome things from surgery to experimentation to amputation were carried out under that guise. And I think that we see that legacy in this narrative of people with excited delirium having diminished pain response. The organization Physicians for Human Rights says that the deaths of black people and people of color have disproportionately been attributed to excited delirium. Excited delirium also came up in George Floyd's case. There's an officer on the tape saying, hey, we think maybe he has excited delirium. At trial, the defense attorney for Derek Chauvin, who was accused of killing George Floyd, said that Chauvin had been watching for signs of excited delirium as a, quote, reasonable police officer, because that's what police were trained to do.

54:13A Minneapolis police officer had testified that she trained new officers on how to recognize the syndrome. The prosecution called a doctor to testify. He said that he believed excited delirium is real, but that George Floyd had none of the symptoms. Derek Chauvin was convicted of killing George Floyd. After George Floyd's death and the deaths of a number of other men of color who had died in police custody in 2019 and 2020, supposedly from excited delirium, Renu says things began to change. I think what really changed the game was video footage of these deaths. And in particular, George Floyd's death.

54:59I think that caused a lot of people to take a look at this term. It forced a lot of groups that had been supportive of the term to turn away from it. And under pressure, the American College of Emergency Physicians in 2021, they started to backpill a little bit. And in 2023, the American College of Emergency Physicians retracted that 2009 white paper, and they said, we got it wrong. Renu says police departments across the country have since removed the term excited delirium from their training materials. But I'll give you an example of how just kind of banning the term may not be enough. So the Minneapolis Star Tribune, they reported that in training materials for the Minneapolis Police Department, there are these PowerPoint slides and the words excited delirium were crossed out and replaced with the term severe agitation with confusion and delirium in parentheses.

56:02So, yeah, this concept that, you know, that exists just with a different name. Six months before the white paper on excited delirium was withdrawn, Angelo Quinto's family tried to have the cause of death on his death certificate changed. After the county pathologist had sat down with Ben Nissenbaum and agreed that asphyxiation had been a contributing factor in Angelo's death, his family argued that Angelo's death should have been classified as a homicide. They were not successful. In 2021, California Governor Gavin Newsom signed eight new reform bills into law. One of them bans restraints that can cause asphyxiation.

56:53And in 2023, California became the first state to ban the term excited delirium, as well as related terms such as hyperactive delirium and exhaustive mania. What it's done is to change the way that the cases are resolved by coroners. And we've seen that have a real effect, I think, because now much more we see that coroners are including the restraint as part of the cause of death. In 2024, the Antioch City Council announced that they'd decided to settle with the Quinto Collins family for$7.5 million. After Angelo died on December 26, 2020, his family kept the presents they'd wrapped for him that Christmas.

57:51They never opened them. and his mother Cassandra told us that every year at Christmas they bring out Angelo's presents and put them under the tree. Since Angelo's death, the city of Antioch launched a new non-police crisis team that will respond to calls about people in a mental health crisis. Shortly after Angelo died, his sister Bella, who had called 911 that night, told reporters, quote, I asked the detectives if there's another number I should have called, and they told me that there wasn't, and that I did the right thing. But the right thing would not have killed my brother. She said, now there's somebody else to call.

58:39It's named after Angelo. The Angelo Quinto Community Response Team.

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