Excited Delirium, the Use of Force and the Death of Natasha McKenna

Update: Taser’s role in the rise of excited delirium diagnoses is an important part of this story. H/T to @SusieMadrak

Last week, police in Fairfax County, Virginia, said a medical examiner determined that a 37 year old mentally ill black woman named Natasha McKenna died of ‘excited delirium’ in February after being tased and restrained by six armored sheriff’s deputies.

I had never heard of excited delirium before, so I dug into it a little bit. The American Psychiatric Association (APA) maintains a resource known as the Diagnostic and Statistical Manual of Mental Disorders, or the DSM. The DSM contains a diagnostic classification list that details all the diagnoses recognized by the APA. It’s a pretty big book that details many, many mental disorders and diagnoses. Delirium is a classified diagnosis, but excited delirium is not.

That’s because there is significant and decades-old debate in the medical and civil liberties communities over whether excited delirium is real or if it’s a scapegoat for police brutality. Back in 2003, the Los Angeles Times reported that in-custody deaths involving excited delirium diagnoses were thought to be on the rise:

Although no one tracks the number of suspected cases — nor are there any public records on the number of people who die in police custody — researchers suspect that the condition accounts for a half-dozen deaths in most major cities each year. By some estimates, excited delirium is now being ruled as the reason behind the majority off all in-custody deaths.

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According to neurologists and medical examiners who have researched the issue, excited delirium is an often-fatal condition that can occur in a small subset of people who use drugs, mostly stimulants like cocaine or methamphetamines, over a long period of time. Typically, as users continue to take the drugs, the number of drug receptors in the brain rises, which helps pump dopamine and other excess hormones out of the brain.

But in people at risk of excited delirium, there is a genetic fault that impairs the brain’s ability to increase those receptors, they say. After drug use, that can lead to a dangerously high level of hormones in a part of the brain known as the amygdala, which later can bring on delirium, paranoia and aggression. More often than not, that attracts the police.

In such instances, even a minimal struggle can lead to too much pressure on the heart or lungs and the person can die. Another problem: Long-term stimulant use can enlarge and weaken the heart, which can be overtaxed during a big adrenaline rush. “It’s a very dangerous toxic mix of events,” says Karch.

The excited delirium diagnosis originated in the early years of the War on Drugs in cases involving cocaine. It therefor comes directly to us from a law enforcement and forensic psychiatry setting. The diagnosis is not recognized by many mainstream associations like the APA. Most cases involve people in distress who are often suffering from mental illness or, as the LA Times noted, substance abuse and addiction — and the use of force against them by law enforcement, many times involving tasers or restraints.

Amanda Truscott, writing in the Canadian Medical Association Journal in 2008, explored the dynamic between excited delirium cases and the use of force. She defined it as “being characterized by agitation, incoherence, bizarre behaviour, high temperature, superhuman strength, a high tolerance for pain — and sometimes, the compulsion to break or bang on glass.”

She tells the story of Robert Dziekanski, who died in-custody after a confrontation with police at the Vancouver International Airport:

Dziekanski touched down in Vancouver on Oct. 14, 2007, following a 13-hour flight from Poland and for 8 hours roamed the immigration lounge, steadfastly insisting that his mother would soon meet him. She, meanwhile, awaited his arrival in the baggage claims area, while airport officials did nothing to ensure the pair could connect. Lost, confused and unable to speak English, Dziekanski used office chairs to build a makeshift barricade between a pair of glass doors as if to ensure that no one could remove him from his meeting place with his mother. Obviously frustrated, he began to throw computer equipment onto the floor and against a glass wall. The police were summoned and in stunning sequence of events captured on video by an eyewitness’s cell phone, Dziekanski was pinned the floor, shot by a taser and eventually died.

The police said medical examiners determined that Dziekanski died of excited delirium.

In cases where an ‘excited’ person is restrained, tased and pinned to the floor and later dies, the excited delirium diagnosis introduces a level of ambiguity that absolves officers of responsibility for that person’s death. While most rational people would read these stories and conclude that, justified or not, it was the struggle and use of force that killed these individuals, excited delirium diagnoses shift the blame to the victim.

After all, isn’t this the primary tactic in law enforcement and criminal justice that got us to this very point of mass incarceration and extreme racism and brutality on behalf of cops and corrections officers? I do not believe the excited delirium diagnosis is all that different from the “super predator” myth of the 1990’s that helped fill American prisons by dehumanizing young black men as animalistic and aggressive. Instead of being treated as patients or just people in need of a crisis intervention, those who are said to have died of excited delirium are similarly labeled as dangerous monsters that needed to be put down.

In light of all of this, it’s fair to say Natasha McKenna’s purported cause of death could probably use an outside 2nd opinion.

h/t my old friend Kirk Murphy for bringing this to my attention

Medical Examiner Says Mentally Ill Inmate Natasha McKenna Died of Excited Delirium

UPDATE: More on ‘excited delirium’ and its diagnosis in in-custody deaths involving the use of force.

According to the Fairfax County Police, a medical examiner has ruled that 37-year old inmate Natasha McKenna died of ‘excited delirium’ while in custody last February.

Natasha suffered from schizophrenia and bi-polar disorder, and was arrested on January 26th after she called 911 to report she had been assaulted. After taking her to the hospital, police realized they had a warrant for her arrest stemming from an alleged assault on a police officer a few weeks earlier.

After a few days behind bars, Natasha’s condition deteriorated rapidly to the point that jail officials felt it necessary to remove the distressed 5’3″, 130 pound woman from her cell using six armor-clad sheriff’s deputies, a spit hood, restraints and tasers.

It’s unclear whether Natasha was receiving any kind of mental health treatment prior to her detention, and there hasn’t been any indication yet of the quality of care she received behind bars.

If the Fairfax County Police were negligent in providing adequate mental healthcare to Natasha, and thereafter chose to use brute force, weapons and restraints to confront her, it’s not hard to see how she might die from a state of excited delirium.

Virginia woman dies in custody after being tasered, placed in restraints and anti-spit hood

On February 3rd, a 5’3″, 130 pound Virginia woman was killed after six deputies tased her before locking her in restraints with an anti-spitting hood over her head. Natasha McKenna, who was 37 years old and suffered from schizophrenia from a young age, went into cardiac arrest before ever leaving the jail and later died at the hospital.

McKenna called 911 on January 25th to report she had been assaulted. After she was taken to the hospital for an examination, police realized they had a warrant for her arrest stemming from an alleged assault against a an officer. Ten days earlier, at a Hertz car rental agency, employees had noticed McKenna was “being disruptive and acting strangely.” After she assaulted an officer, police secured an involuntary detention order against her and she was held at a local Inova hospital for treatment. She was eventually released.

With the warrant in one hand and McKenna in the other, Alexandria police took her to jail on the 26th. McKenna remained in that jail for the next several days waiting to be transferred. Her condition deteriorated rapidly. By February 3rd, when six sheriff’s deputies lined up outside her cell in body armor, McKenna resisted and a struggle ensued. It was then she was tasered and would eventually die.

The Alexandria City Police Department released details on its investigation of the incident yesterday, but there are several important questions left unanswered. Continue reading

Another Mentally Ill Inmate Dies in Restraint Chair, Sparking Lawsuit

On Wednesday, the Tri-City Herald reported that Franklin County, Washington is being sued for allegedly ‘inhumane and barbaric practices’ that have put mentally ill inmates in harms way.

The suit is being brought by Columbia Legal Services, a Seattle-based legal aid organization that is working on behalf of mistreated inmates at Franklin County Jail. Lawyers allege that Franklin County is one of the worst jails in the country. The mental health needs of inmates are ignored and they are instead “chained to a fence for days, pepper-sprayed without reason, left unsupervised in restraint chairs and forced into isolation.”

One story involved a man who bit off two of his fingers while chained to a fence in the booking area. After he came back from the hospital, they chained him to the fence again. The suit also accuses the jail of “placing inmates in isolation to live in ‘degrading and deplorable’ conditions; forcing inmates to sleep on concrete floors without blankets for extended periods of time; pepper-spraying inmates, then providing no medical attention or way to clean up; unconstitutionally locking inmates down for 23 hours a day; denying inmates access to family visits, phone calls and outdoor activities.”

Continue reading