Excited Delirium

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May you know here. This week on a touch more, Judy Walken joins us to talk about her year off of the court but definitely not on the sidelines. We're also looking at the upsets coming out of the SEC tournament

and how that might impact selections Sunday and the intergenerational span of US players on display at the Shea Beliefs Cup. Plus, we have a surprise guest. You won't want to miss it.

“Check out the latest episode of our podcast”

to touch more wherever you get your podcasts and on YouTube. This episode includes descriptions of violence and sexual assault. Please use discretion. On December 23, 2020, Bella Kinto Collins was home from college to celebrate the holidays

with her family in California. We had gone to my mom's work. They just had a small get together, you know, masks on. And I grew up at my mom's work, really.

So they're kind of like a second family.

So we kind of spent the afternoon with them, I guess, and then came home and we're just relaxing. A few months earlier, Bella's mother and Bella's two adult brothers had moved into a new house in a town called Aniok near San Francisco. When Bella and her mother, Cassandra,

“had come back from seeing Cassandra's colleagues that day,”

Bella's oldest brother, Angela, was in his room sleeping. Cassandra says she went to his bedroom. Because there was a package for him, you know, a package that he's been waiting for for a while. So I knocked on this door and kind of woke him up and he said,

"Oh, thank you, Mom. Just leave it there." And then, you know, he, I went out and he just went back to sleep. When the pandemic hit, Angela, who was 12 years older than Bella, had lost his job and moved in with Cassandra. Before that, Angela had joined the US Navy.

It was his dream career. But because of an allergy, he left during boot camp in 2019. Now he was trying to figure out what he wanted to do next. He liked gaming and was thinking about becoming a game designer. After talking to Angela, Cassandra went to the living room

and at some point she fell asleep on the couch. Then around 10 p.m., Angela woke her up. And they said, "Yes, what do you want?" He goes, "What's for dinner?" And I was kind of upset about that

because he usually cooks for himself. He loves to cook. So when he asked me what for dinner is, I was like, "What do you mean?" I was kind of upset because he woke me up from my feet, my nap.

He clearly wasn't himself. At a certain point, I was on a zoom with my friend and he just kept coming into the room and asking, "What's going on?" He seemed really worried. It looked like the beginnings of an episode as we'd called it.

He'd had a couple of them throughout 2020. And what you would just kind of act oddly, just not like himself and really anxious and scared. But it was really infrequent and then it almost seemed like he was normal the next day. The family says he'd started having these episodes after a head injury.

Did this night seem different than other episodes that he had had?

It's actually the way we dealt with it, right?

“Yeah, we didn't have much tolerance for it at that point.”

In previous episodes, I'd say there were about five total throughout that year. He required patience when he was feeling that way. When he was afraid, when he was asking the same questions, when he looked past you and thought he saw something. He required patience that spanned eight hours sometimes.

A few months before a neighbor had called the police because they'd seen Angelo trying to climb offends. They said he was yelling.

The police took him to the hospital.

Cassandra says Angelo had been worried that maybe he had bipolar disorder or schizophrenia. She wanted him to see a psychiatrist so he could get help. She says that when he was having these episodes, he would ask her again and again if he was going to be okay. She'd often need to sit with him for a long time to calm him down. And we didn't have that patience that night.

“And I think that really escalated his anxiety.”

Over the next hour or so, Angelo seemed to get more and more scared and anxious. He wanted Cassandra and Bella to stay close to him. He locked arms with the two of them and started walking them around the kitchen. And that, of course, then heightened our anxieties. And I know that I was thinking in the moment, oh my gosh, he's getting really, really afraid. Bella, who was 18 at the time, so she started to feel really worried.

At a certain point, I had told him, please, you know, let go. I'm going to call the police if you don't stop holding us. And he just, I could tell he couldn't understand what I was saying. He kept on seeing what's going on. What's going on?

And then, you know, that freaked me out. Bella called 911 to ask for help. Because I just felt like I had no other option. My dad was in Berkeley at the time. And I thought that's too far away. He wouldn't be able to get here fast enough.

Bella told the 911 operator that her brother was, quote, being aggressive and hurting her mother. She said that Angela had tried to pick up a hammer, so she had picked it up instead and had it with her. The operator asked her, do you know if he takes any drugs and Bella replied yes? At one point in the call, someone yelled, stop it, stop it. At the end of the call, Bella said to the operator, sorry, thank you.

What were you hoping the police would do to help once they showed up? Calm him down in a way that we couldn't. Shortly after 11pm, two police officers arrived at their house. The police dispatcher had told them about Bella's call that she said her brother was hurting their mother. The police said that when they arrived, Angela was being, quote, actively restrained by Cassandra on the floor in a bear hug.

Cassandra and Bella say that Angela was calm.

“He wasn't trying to get away from me because I think that's what he wanted is for me to be there.”

He was just really heavily, but he was calm. He was very calm, and that's what the police officers saw when they came in the house. The police officers started to handcuff Angela. They rolled him onto a stomach. According to the police, he started to struggle, and they bent one leg over the other to restrain him. Cassandra and Bella say, Angela didn't struggle. At some point, another two police officers showed up.

Cassandra and Bella say that first one officer, and then another had their knee on Angela's neck.

They say it went on for over four minutes. The police later said that an officer, quote, briefly for a few seconds, had a knee across a portion of Angela's shoulder blade. We reached out to the Anniac Police Department for comment. We didn't hear back. What was he saying? Please don't kill me. Please don't kill me.

The officers called an ambulance and asked for help with a mental health crisis. They asked for a code too, meaning as quick as you can, but not an emergency. Two of the police officers later said they'd responded to Angela's previous incident when he was trying to climb offence.

Cassandra decided to get her phone out to start recording what was going on.

Because I wanted Angela to go to therapy and to go to a psychiatrist so that he could be properly medicated. Whenever I talked to him about his episodes, he could not believe that he did that. So this particular time, I made sure to record it. So the next day, I would have him listen to it and he's going to go, "Okay, Mom." One of the police officers told Cassandra that Angela wasn't under arrest, and that he would be transferred to a hospital for evaluation.

Because it seemed like he might be a danger to himself or others. Cassandra said that Angela hadn't been attacking them, but that he had been hallucinating and paranoid and didn't want to be alone.

“One of the police officers said, "That's why he's going to the hospital, not to jail."”

Angela had gone quiet.

I asked them twice, "Actually, if he was asleep, because I want them to, you know, check on how he's doing."

Angela was still lying on the floor with his hands, handcuffed behind his back, and it became clear that he was unconscious. One of the police officers said, "What's going on with him?" It actually became very quiet as soon as the saw, as soon as he flipped him, and he saw blood coming out from his mouth. And, you know, rolled up, his eyes rolled up, his head. It became very quiet.

When Cassandra's video starts, two police officers are standing over Angela, trying to communicate with him. They're wearing face masks and blue rubber gloves.

The officers move Angela on to his side, and one of them rubs his chest.

There's blood on Angela's face. What happened? Angela. Angela. Can you see it on any medication?

Please, please. The officers unlock the handcuffs and move Angela onto a stretcher. Cassandra follows them. There's blood on the bedroom floor where Angela had been lying face down. They start doing CPR on Angela, then they push the stretcher out of the house and into an ambulance.

I'm Phoebe Judge. This is criminal. When Angela was rolled out of the house on a stretcher, Bella says she thought he looked purple. Angela was rushed to the hospital. Cassandra and Bella had to stay back to answer questions from the police.

“They said they were going to take us to the police station, and I said, why?”

To be interviewed, they said, and I go, well, you know, they already did ask questions just a little while ago. And they said, don't worry, we're just, it's just going to be, you know, like, it's the same questions. At the police station, Cassandra and Bella were questioned separately about what had happened that night. Cassandra says it attacked a pastor if she had hit Angela earlier, since he had a bloody nose. She answered, no. While they were at the police station, Cassandra says she got a call from a doctor who was treating Angela at the hospital.

When she answered it, she says a police officer rushed over and told her to get off the phone. They said she'd get a chance to talk to the doctors later. As Bella and Cassandra had been on their way to the police station, Angela's stepfather Robert arrived at the house.

“When I arrived there questioning me, did he have something? Did he eat something he shouldn't have? Has he taken drugs? Is he allergic to something?”

He was told he couldn't enter the house. Their whole street was closed off. More police officers kept arriving, moving in and out of the house, which was marked off with crime scene tape. Police officers were standing guard around it.

And Angela's younger brother, who'd come back after spending time at a friend's house.

“Around 6.30 that morning, Bella and Cassandra got back from the police station.”

Their house was still full of police and investigators. Cassandra got a cough from the doctor, and she asked me to take it, and I spoke with the doctor. And he indicated to me that Angela's brain was 98 or 99% dead. There was only a tiny portion of the brainstem left alive. The family went to the hospital to see Angela, but because of COVID protocols, they were told they couldn't come inside.

When they got back home at around 8.30 in the morning, the police had left. When the family walked through the house, there was still a smear of blood on the floor where Angela had been lying on his stomach.

“And Angela's bedroom seemed to have been searched.”

It's just like everything is upside down. It's been, you know, every last little thing has been tossed and turned and it's on the floor and it's just a mess. The police had taken things from Angela's bedroom, including a cell phone and some photographs. In the kitchen, the family says they found a felony search warrant. The warrant said the police were authorized to take anything that, quote, "Tens to show that a felony has been committed or that a particular person has committed a felony."

Robert says they were shocked. The police had told them that Angela wasn't under arrest and hadn't committed a crime. That morning, on December 24, the family kept calling the hospital, but they couldn't get permission to visit Angela.

“On the 25th, they called us and said, "We could, you know, come and visit him."”

So, Robert then I went, "Angelo was on responsive. He was on a breathing machine and his eyes were taped closed. He only had a faint heartbeat." I was reading him, "This Christmas card that everybody wrote on." And as soon as I was done, the nurse said, "I'm sorry, I don't think he heard you or she said something." And I go, "Isn't it that when you're in a coma, you can still hear, you know, you can still hear what other people are saying." So, you kind of like constantly talk to them.

And then she said, "Well, yeah, but in Angela's case, I don't think that is possible." The family says they felt like they couldn't get clear information from the hospital staff.

Later, medical records cited in court documents said that when Angela first arrived at the hospital,

staff had been instructed by the police not to talk to them about Angela's condition. A doctor had added it as a note to Angela's medical record. I asked for Angela's toxicology report in the nurse smiled at me and said, "I'm sorry, but we cannot provide that." And I'm like, "What do you mean? What do you mean you can't provide it?" Cassandra said she asked the nurse, "If it was because there was an investigation going on."

And she remembers that the nurse nodded. So, I was kidding, you know, like really upset and mad at that point. I'm the mother. I need to know. I have to know." And she said, "Let me go to my supervisor and ask." And so, what she did is that she said she can't give it to us. But she said, "I'm going to look at her on screen. You might be able to see some of it over my shoulder."

And so, she basically kind of showed it to us, but she didn't want to give us or you have any proof that she'd give it to us.

But she'd let us see that there were no common substance abuse found. On the morning of December 26th, they got a call from the hospital saying they should come visit Angela as soon as possible. In the car on their way there, Cassandra says they talked about getting a lawyer. Robert had already been making phone calls to friends and family to ask for recommendations. Cassandra didn't think they needed one. You know, I mean, I was on denial.

But when I was, you know, we'd dance a little holding his hands. I was like, "You know what? This is not right."

Robert went out to the hospital parking lot and started making phone calls, trying to explain to people what had happened in the past three days. Eventually he spoke with a civil rights attorney who said he'd take the case. And then I came back and they said, "The Angela is now, you know, he's going to pass." And the nurse said he's going to pass and we waited about 20 minutes and then at one thirty or one forty p.m. he did, he had his hard stuff. The next day, the family's new lawyers, John Burris, and Ben Nissenbaum came to their house in Anniac.

“I think we're still having a hard time realizing what's happened.”

But one of the first things that Ben said, he said basically, he thought they were going to blame it on excited delirium.

If they have nothing else, they will say it was excited delirium. Have you ever heard that term before? What did you think? I actually was fristing the first question I asked, "What is that?" What is excited delirium? For people who aren't that familiar with this term, what does it mean? If I told you to invent nothing, then I think that would be accurate.

Attorney, Ben Nissenbaum. In terms of what it purports to me, it's essentially that the body dysregulates itself in a fatal manner. So somehow the heart stops beating because the body becomes so unable to regulate itself. Had you ever handled other cases where it was used as a cause of death? Many. Many. Many cases.

I can think of at least a dozen when people died during a police restraint. The immediate response invariably was, it wasn't the police, it was excited delirium. As if the person got so excited and became so delirious, they just spontaneously combusted.

“And I heard that I'd heard that so many times from the police over my career that I just knew that that's what was to be expected.”

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and it's used to describe a collection of symptoms. Reported re-new rise.

“But there's no diagnostic code for it. There's no blood test for it.”

There's no way to test for it. I should note delirium is a clinical term. It is something that people see in emergency rooms and hospitals. But the term excited delirium, it's kind of in some ways made up.

It was first used in the 1980s.

If you think about the 1980s in the US, there's a cocaine epidemic. There's a South Florida forensic pathologist named Charles Wedley. In 1985, Charles Wedley co-authored a paper on what he called cocaine-induced psychosis and excited delirium. He looked at the deaths of seven people, mostly men, who'd use cocaine. They'd all been restrained, usually by police, one of them by ER staff,

and suddenly died.

“He wrote that all seven had intense paranoia, followed by, quote, "bizarre and violent behavior."”

And sometimes, quote, "unexpected strength." And he said, "These are people who are scared, they're violent, they're panicked."

Then they're restrained, and then they died suddenly.

And the problem with this theory is it was purely speculative. And it didn't look at the role that restraints might have played in these deaths. They didn't really identify any scientific evidence or any toxicology reports or any way to back up or test their idea. Then Charles Wedley started looking into a number of other cases. In the late '80s, in South Florida, Miami, several black women were dying.

And they were dying in the same area in Miami, and in a really similar way. Twelve women were found dead between 1986 and 1988. Charles Wedley told reporters,

“"The typical scene is in a cheap room, a clump of bushes, or an abandoned building."”

They were discovered naked from the waist down, and they all had trace amounts of cocaine in their system. In article in the Miami News, quoted "Wetley is saying,

"At first glance, it looks like she's been raped and murdered."

But he said, "That wasn't the case." Wedley said the women likely died of cocaine psychosis. One newspaper article described it as quote, "Sut in death from low levels of cocaine, the cause of the victims to go berserk and die within minutes."

Some of the women were believed to have been sex workers. And he and his colleagues said that the combination of cocaine and sex is what led to these women's death. And he called it "excited's worry." And, you know, he said that black women were more prone to dying this way, and that it was this combination of the stimulation from the cocaine and the sex that led to their death.

He told reporters that when they examined the women's bodies, there were no signs of assault. "The autopsys of conclusively showed that these women were not murdered." At one point, he worked on a theory that rain and Peru had somehow tainted a shipment of cocaine. The police closed the cases. Many of the women who were found dead were from Jamaica, Haiti and Puerto Rico.

Most of them were in their 20s and 30s. But then, in 1988, a 14-year-old girl named Antoinette Burns was found dead. And she was found dead and much the same way that the other women had died. Wethley did the initial autopsy, and he once again said that she too died of excited dunyrium. And the Burns family pushed back.

I mean, this was a young girl 14. They said she wasn't a sex worker, she didn't do drugs. She was last seen, hitching a ride to the movies with a neighbor. And the family really pushed back on this. But it wasn't until a toxicology report came back.

That Wethley's theory began to unravel. Antoinette Burns didn't have cocaine in her system. And after that, the chief medical examiner, so Wethley's boss, reviewed all the debts of these women that Wethley had said died of excited dunyrium. 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 had been found dead. He found lip and neck injuries and hemorrhaging in the eyes.

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.”

And 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.”

They 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 Wetley 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. When the Kinto 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. It does not sound very sophisticated at all, but he described to us his experience with excited delirium in the past. So after the 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 esphyxiation. They were still waiting to hear the results of the county's official autopsy. On January 13th, 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 calls in manner of death.

What the jury finds goes into a death certificate, 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 Kinto 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 were going to be giving statements that day were already in the courtroom when the doors were open 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. The court hearing wasn't led by a judge, but by a hearing officer. A lawyer named Matthew Gishard, who had been contracted by the county. Gishard explained that in their county, "Contra Costa County, this 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 inquest."

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 Gishard explained that this wouldn't be like a trial you might see in the movies.

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 a Kinto 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 are at the house in Anniac, a police detective, and a detective from the DA's office. Bell 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 is felt kind of odd because, you know, we weren't witnesses, but every aspect of this 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 esphyxiation. The independent autopsy had found something called particular 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 dad.”

But the county pathologist testified that he had found no particular 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 a system and codenine from cigarettes smoking. As well as a drug for seizures, which is generally considered safe. Later, the Kinto Collins family's attorney pointed out that Angelo had been given anti-seasor medication at the hospital in the days before he died. The pathologist also found a drug called Modafino, 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 Modafino could have contributed to Angelo's death. Because he said, "There's a condition linked to drug use, the kills people." He said, "It's poorly understood. It's called Excited Delirium Syndrome." To 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 hoops, 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 a rest-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.

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.

“That'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 Tabaco, and categories, and this other thing that prevented you from sleeping, which had never had any deaths, meant that they had the flimpsiest case, Excited Delirium, even if you went by their own standards. Next, Excited Delirium played Bell as 911 called to the jury, and three of the four police officers who had been at the house in Anniac, the night Angelo was taken to the hospital testified.

Two of the officers said that they'd had a neon Angelo, but only very briefly. Originally, the police had said one officer had a neon hem.

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.

“Gishard had said he thought a doctor at the hospital had believed the same thing.”

Then Gishard 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. After the witness testimonies, Gishard reminded the jury that they would only be deciding on the cause of death, not who is 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. Gishard cleared the courtroom while the jury stayed back to deliberate. After about 15 minutes, they'd reach a unanimous decision. Were you surprised when the jury ruled it in accident? No, I don't know.

“When I heard the testimony from the coroner that it was excited to the area, then that's what I expected would happen.”

And I felt like that was the intended, and that was the purpose of it. The Kintau Collins family had filed a lawsuit against the city of Aniok. It's 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. Let's show the particular hemorrhages in Mr. Kintau'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 particular hemorrhages. And that in his view, they take time to develop and that they simply hadn't developed that the time that he did answer those autopsy.

What he said is that the restraint also played a role in Mr. Kintau's step. The pathologist said that if he had found the particular hemorrhages when he did his autopsy, he would have added asphyxiation to his diagnosis. But he still believed the excited delirium diagnosis was right. We'll be right back.

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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 Hotel Amos Vegas. It 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 Wettley, the medical examiner who had theorized that the deaths of a number of women in Miami were due to excited delirium,

In 1995, Charles Wettley 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.”

The reporter re-new Ryasm, and it continued to link cocaine use with excited delirium. He was just really convinced of this idea, and then that 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, "in the cocaine wild 1980s." The conference promised that, "attendees will help make law enforcement medical and legal history through topics 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 help people. They aren't alternative to kind of other uses of force by police."

“In a later interview with Reuters, Charles Wettley 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.

"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 at many times to be an expert witness in lawsuits against the company. Reuters says that conference on in custody deaths became a turning point. From that conference emerged, what ended up being this really influential white paper on excited delirium. It's called the white paper on excited delirium syndrome. So a white paper is like in this sort of medical or scientific context, a white paper is kind of like a detailed guide or a 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 common. 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. It sort of lays out 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 I've been talking about theory in the first place. And they say, okay, there are no biological markers for excited delirium. Again, there's no taser standard diagnostic criteria. But they lay out what they say are these features as someone has like 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, "Fail your to respond to police presence, profuse sweating, and a quote attraction to glass or reflective surfaces."

I had never heard of this thing called excited delirium, and I was troubled and curious.

In 2020, Arjan 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, Arjan 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. Arjan 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 Arjan started doing his own research. 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.

Arjan 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 of verbal cues.

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 Incustity Deaths, the organization that had been started by a lawyer at Taser. The poster had advice on how to capture someone with excited delirium. "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 Peel, with sweat running down his face. The slide explains the four stages of excited delirium. One elevated body temperature, two agitation, three respiratory arrest, four death. One of the ideas is that people with excited delirium, quote, "have reduced pain perception." And they cite instances of them smashing glass and with standing multiple electroshocks.

In that description are all these very loaded terms with all this baggage, like monster and animal, like behavior and extreme strength.

“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.

Along legacy of physicians believing that people of African descent have different pain perception, required less anesthetic, have literally thicker skin, have literally less sensitive nerve endings. So very gruesome things from surgery, to experimentation, to amputation, we're 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.”

A Minneapolis police officer had testified that she trained new officers on how to recognize the syndrome. The prosecution called the 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 died in police custody in 2019 and 2020, supposedly from excited delirium, renew says things began to change. I think what really changed the game was video footage of these deaths.

“In particular, George Floyd's death, I 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.”

Under pressure, the American College of Emergency Physicians, in 2021, they started to backpull a little bit. In 2023, the American College of Emergency Physicians retracted that 2009 white paper, and they said, "We got it wrong." Reno says police departments across the country have since removed the term excited delirium from their training materials.

So yeah, this concept that exists with a different name.

Six months before the white paper, an excited delirium was withdrawn, Angela Kinto's family tried to have the cause of death on his death certificate changed. After the county pathologist had set down with Ben Nissenbaum and agreed that suffixiation had been a contributing factor in Angela's death, his family argued that Angela'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, Ben's restraints that can cause suffixiation.

And 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 included in the restraint as part of the cause of death.”

In 2024, the Annie Oxity Council announced that they decided to settle with the Kinto Collins family for $7.5 million.

After Angela died on December 26th, 2020, his family kept the presence they'd wrapped for him that Christmas. They never opened them.

And his mother Cassandra told us that every year at Christmas, they bring out Angela's presence and put them under the tree. Since Angela's death, the city of Annie Ox launched a new non-police crisis team that will respond to calls about people in a mental health crisis. Shortly after Angela died, his sister Bella, who had called 911 that night, told reporters, "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."”

It's named after Angela. The Angela Kinto Community Response Team.

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