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A woman leaves flowers at the site where George Floyd died May 25 while in police custody, in Minneapolis, Minnesota.

As George Floyd Died, Officer Wondered About “Excited Delirium”

Now experts say the controversial diagnosis may become part of the police defense.

In the final moments of George Floyd’s life, as he laid face down and Minneapolis police officer Derek Chauvin knelt on his neck, another officer asked Chauvin if they should roll Floyd onto his side. “I am worried about excited delirium or whatever,” the officer told Chauvin, according to authorities. Chauvin refused to turn over Floyd, who was pronounced dead shortly after.

This article was published in partnership with Slate.

The officer, Thomas Lane, was talking about a controversial diagnosis often cited when people die in police custody. People with excited delirium are said to be aggressive and incoherent, and to have “superhuman strength,” often after taking stimulant drugs such as cocaine or methamphetamine. Police groups and some experts say it’s a real condition, requiring immediate action and medical treatment.

But critics, including some medical experts, have attacked the condition as junk science and say it’s often used as a convenient excuse to justify excessive police force. The diagnosis has an especially contentious history in Minneapolis.

Now the controversy over excited delirium is likely to heat up, as some legal and policing observers are predicting it could become part of Chauvin’s defense against the charges he faces in Floyd’s death, including second-degree murder.

“There’s a high probability that one or more of the officers will assert excited delirium as a defense,” said Geoff Henley, a Dallas lawyer who is representing the family of a man who died there at the hands of police in 2016, under circumstances similar to Floyd’s. “When there’s criminal charges against the police, they don’t ever come empty handed.”

The Hennepin County Medical Examiner’s office in Minnesota this week ruled Floyd’s death a homicide caused by “cardiopulmonary arrest complicating law enforcement subdual, restraint, and neck compression.” The report also cited coronary artery disease and hypertension as contributing factors, and revealed Floyd had the painkiller fentanyl in his system and had recently used meth. Authorities said he also tested positive for coronavirus in early April, and again after his death, but appeared asymptomatic. An independent autopsy concluded he died when his breathing was obstructed by the pressure officers put on his neck and back.

Neither report mentioned excited delirium.

Syndromes with similar characteristics but different names have appeared in scientific articles since the 1850s, according to the limited research available. Excited delirium didn’t emerge as a common diagnosis until the 1980s, with the rise in cocaine use.

Some supporters of its use as a diagnosis say it’s a syndrome first responders must be trained to recognize, because it can cause people to die suddenly, leaving police wrongfully accused of excessive force.

“The people who say that it’s just a cover-up for excessive use of force, well, it’s not a cover-up. It’s real,” said John Peters Jr., who heads an organization that trains police departments on excited delirium.

Peters said it was shocking that Chauvin dug his knee into Floyd’s neck in the first place, and even more concerning that the officer didn’t remove it when Floyd said repeatedly that he couldn’t breathe. “That should have been the trigger to consider Mr. Floyd not a prisoner, but a patient,” Peters said.

Critics of excited delirium argue that it’s not a legitimate cause of death, and that police too often use it as an excuse after an arrest turns deadly. They note, for example, that it’s disproportionately cited in cases where black and Hispanic men die in custody.

“Excited delirium, which is not a medical diagnosis, has a long history of being used to absolve law enforcement of responsibility in the death of people, especially people of color,” said Dr. Homer Venters, the former chief medical officer of the New York City jail system.

The National Association of Medical Examiners and the American College of Emergency Physicians consider excited delirium a medical condition. But several other groups, including the American Psychiatric Association, the American Medical Association and the World Health Organization, do not recognize it. Some medical-journal articles conclude it’s a real phenomenon with causes that are not completely understood. The diagnosis is used at times in cases not involving police, but much less frequently.

Minneapolis police have a controversial history involving excited delirium. An independent review commissioned by the city attorney found that between 2016 and 2018, officers were deciding that some people they encountered had excited delirium, apparently without consulting medical experts. According to the Minneapolis Star Tribune, police would ask that emergency medical personnel use the powerful sedative ketamine on people—at times against their will and while they appeared to be restrained, or in some cases, when they were not accused of committing a crime. Some people stopped breathing after getting injected and had to be put on a ventilator.

The scandal widened when the newspaper reported that people drugged were then enrolled, without their consent, in the Hennepin County Medical Center’s study of ketamine. The lead researcher, Dr. Jeffrey Ho, was a part-time sheriff’s deputy in rural Minnesota and also the head of paramedics at the Hennepin medical center, where he oversaw responses to 911 calls in Minneapolis. The Star Tribune reported that Ho was also a paid advocate for the Taser stun gun, and testified in several lawsuits against Taser, saying it wasn’t police use of the stun gun that were killing people, but rather, excited delirium.

Ho, through a hospital spokesperson, declined to comment Thursday.

Police departments or other authorities have blamed excited delirium as a cause of death when people die after being tased. In 2017, West Milwaukee police used their stun guns more than a dozen times in less than 10 minutes against Adam Trammell, who died inside his own home. That same year, Oakland police restrained and tased Marcellus Toney, a 45-year-old truck driver, after he allegedly resisted arrest and attacked an officer. He also died. In 2019, a federal jury ruled that Honolulu officers did not use excessive force when they pepper sprayed and used stun guns on Sheldon Haleck, who later died. Attorneys for the officers argued that Haleck died from excited delirium, and not because of the officers’ actions.

Many other cases using it as a diagnosis do not involve tasers. In the 2016 death of Tony Timpa, investigated by The Dallas Morning News, police officers responded after the 32-year-old man called 911 for help because he had schizophrenia and had recently gone off of his medication. According to video of the incident, officers pinned him facedown for at least 14 minutes. At one point, one officer asked if they should turn Timpa on his side, as in Floyd’s case, but that request was ignored. A medical examiner wrote Timpa’s death was caused by a combination of cocaine and stress from physical restraint, “sometimes referred to as excited delirium syndrome.”

Henley, the lawyer for Timpa’s family in a civil lawsuit against the city, said he’s noticed a lot of parallels between Timpa’s death and Floyd’s.

“Police are trained across the nation that the most harmful restraint, especially for someone who may have used drugs or is in a mental health crisis, is the prone restraint,” Henley said, describing a person being held face down on the ground. “Cops are trained not to do this. And you damn sure don’t get on top of them and push them into the ground.”

If the condition is raised as defense in the Floyd murder case, it will not work, said Glenn Kirschner, a former assistant U.S. attorney for the District of Columbia. Excited delirium can only be used successfully in cases where the restraint was lawful, he said, but the restraint in Floyd’s case was unlawful. That makes the officers criminally liable, he said.

“It will not be a winning defense. It will be a red herring, used largely to confuse jurors,” he said.

Despite the controversy surrounding excited delirium, there are best practices that police are supposed to follow in suspected cases, including that such people shouldn’t be restrained on their stomachs the way Floyd was, because that makes it harder to breathe. In 2015, the International Association of Chiefs of Police put out a resolution encouraging departments to establish procedures for how to handle and treat excited delirium cases as medical emergencies.

Medical examiners, coroners and other officials who make rulings on causes of death are also divided about the concept. According to a 2019 investigation by the newspaper Florida Today, about two thirds of medical examiner officers in Florida had mentioned excited or agitated delirium in autopsy reports. But several offices told the newspaper they avoid it because it doesn’t have scientific value. Florida Today’s review of 85 deaths attributed to excited delirium over a decade found that 62 percent involved use of force by law enforcement, and the remainder had no law enforcement actor or were unclear. Most cases involved stimulants like cocaine or methamphetamine.

But for people whose toxicology results came back negative, the newspaper found that “the only common denominator in virtually every case was the involvement of law enforcement.”

Alysia Santo Twitter Email is a staff writer. She has investigated criminal justice issues including for-profit prisoner transportation, the bail industry, victim compensation and the sexual abuse of people behind bars. Her reporting has spurred state and federal investigations, and was awarded Harvard’s Goldsmith Prize for Investigative Reporting in 2021. She is also a three-time finalist for the Livingston Award and was twice named runner-up for the John Jay College/H.F. Guggenheim Prize for Excellence in Criminal Justice Reporting.