"Excited delirium": legitimate diagnosis or another name for "police brutality"?

Every so often -- as with the administration of the death penalty, for example -- medical science and law enforcement procedures overlap in interesting ways. So it is with this story -- dateline Dallas, Sept. 25, from the AP (courtesy of MyWay):

Police found 23-year-old Jose Romero in his underwear, screaming gibberish and waving a large kitchen knife from his neighbor's porch.

Romero kept approaching with the knife, so officers shocked him repeatedly with a stun gun.

Then he stopped breathing. His family blames police brutality for the death, but the Dallas County medical examiner attributed it to a disputed condition known as "excited delirium."

Excited delirium is defined as a condition in which the heart races wildly - often because of drug use or mental illness - and finally gives out.

Medical examiners nationwide are increasingly citing the condition when suspects die in police custody. But some doctors say the rare syndrome is being overdiagnosed, and some civil rights groups question whether it exists at all.
"For psychiatrists, this is a rare condition that occurs once in a blue moon," said Warren Spitz, a former chief medical examiner in Michigan. "Now suddenly you are seeing it all the time among medical examiners. And always, police and police restraint are involved." * * *

The chief psychiatric reference book, The Diagnostic and Statistical Manual of Mental Disorders [link], does not specifically recognize "excited delirium" as a diagnosis. The International Association of Chiefs of Police [link] says not enough is known about it.

"It is not a recognized medical or psychiatric condition," said spokeswoman Wendy Balazik. "That is why we don't use it and have not taken a position on it."

Dr. Matthew D. Sztajnkrycer [link], an emergency room doctor for 10 years and associate professor at the Mayo Clinic in Minnesota, said he has seen cases of excited delirium but has many questions about it.

"It is not like a heart attack where you can just get a blood test and know you have the right diagnosis," he said. "Part of the problem is that post-mortem there is a paucity of physical evidence."

Expect a bucketful of litigation over this concept in policy-brutality cases in the coming years. For further reading on this topic, take a look at:

• "Excited Delirium Syndrome: Cause of Death and Prevention," by DiMaio and DiMaio;
• O'Halloran RL, Lewman LV. Restraint asphyxiation in excited delirium. Am J Forensic Med Pathol, 1993;14(4):289-295
• M. S. Pollanen, D. A. Chiasson, T. J. Cairns and J. G. Young, Unexpected death related to restraint for excited delirium: a retrospective study of deaths in police custody and in the community. Canadian Medical Association Journal, 1998;158:1603-1607