In Custody In Custody Deaths and Deaths and TASER UseTASER Use

A Medical Examiner A Medical Examiner PerspectivePerspective

OrOrThe Recent The Recent History of In History of In

Custody DeathsCustody DeathsWith the tale of two With the tale of two

cities…cities…

(at least)(at least)

Kornblum articleKornblum articleJournal of Forensic Sciences 1991; Journal of Forensic Sciences 1991; 3636

Los Angeles – 16 deaths after Los Angeles – 16 deaths after TASER useTASER use

13 had cocaine, PCP, or 13 had cocaine, PCP, or amphetamineamphetamine

Of the other 3; 2 were shot and 1 Of the other 3; 2 were shot and 1 died after a choke holddied after a choke hold

Ordog articleOrdog articleAnnals of Emergency Medicine Annals of Emergency Medicine 1987;161987;16

218 shot by TASER 218 shot by TASER 3 brought to hospital in asystole3 brought to hospital in asystole All three had high levels of PCPAll three had high levels of PCP By history went into arrest 5 min, By history went into arrest 5 min,

15 min, 25 min, after being shot by 15 min, 25 min, after being shot by TASERTASER

The common factor in the The common factor in the deaths reported appear to deaths reported appear to be the excited states of be the excited states of the individuals that are the individuals that are being shot by a TASER.being shot by a TASER.

Timeline of excited Timeline of excited delirium deaths.delirium deaths.

The first reported cases of The first reported cases of excited delirium came excited delirium came from Miami in 1985. from Miami in 1985. Journal of Forensic SciencesJournal of Forensic Sciences

7 cases 7 cases Bizarre psychotic behavior Bizarre psychotic behavior HyperthermiaHyperthermia HyperactivityHyperactivity Extreme exertion while fleeing or being Extreme exertion while fleeing or being

subdued by policesubdued by police Sudden deathSudden death

Excited delirium syndrome has Excited delirium syndrome has been found to be different than been found to be different than acute cocaine intoxication acute cocaine intoxication deaths.deaths.

Cocaine in low levels, or just metabolite Cocaine in low levels, or just metabolite presentpresent

History of chronic cocaine use, often with a History of chronic cocaine use, often with a recent bingerecent binge

They tend to use crack and IV cocaine more They tend to use crack and IV cocaine more than nasal insufflationthan nasal insufflation

They have bizarre, excited behavior They have bizarre, excited behavior Often have hyperthermiaOften have hyperthermia Have a lower incidence of seizureHave a lower incidence of seizure

Chronic cocaine users Chronic cocaine users have neurochemical have neurochemical abnormalities.abnormalities.

There are fewer dopamine (D2) There are fewer dopamine (D2) receptors in hypothalamus – this is receptors in hypothalamus – this is felt to explain why those who die are felt to explain why those who die are often hyperthermic.often hyperthermic.

Staley J, J. Pharmacol Exp Ther 1994; 27.Staley J, J. Pharmacol Exp Ther 1994; 27.

Cocaine induces changes Cocaine induces changes in number and in number and distribution of K2 opiate distribution of K2 opiate receptors within the limbic receptors within the limbic system which may explain system which may explain the psychotic symptoms the psychotic symptoms and violent agitation.and violent agitation.

Staley J, J. Neurosci; 1997Staley J, J. Neurosci; 1997

It is also recognized that It is also recognized that excited delirium is not just excited delirium is not just with chronic cocaine use and with chronic cocaine use and can be found with can be found with sympathomimetic, sympathomimetic, hallucinogenic and hallucinogenic and psychomotor stimulant psychomotor stimulant drugs.drugs.

A catecholamine mediated A catecholamine mediated excited delirium, similar to that excited delirium, similar to that seen with cocaine, is becoming seen with cocaine, is becoming increasingly recognized and has increasingly recognized and has been detected in patients with been detected in patients with mental disorders taking mental disorders taking antidepressant medication and antidepressant medication and in psychotic patients who have in psychotic patients who have stopped taking their stopped taking their

medications.medications.

Positional Asphyxia and Positional Asphyxia and Sudden DeathSudden Death

19881988Reay argued that the prone Reay argued that the prone restraint position restricts restraint position restricts chest and abdominal chest and abdominal movement placing an movement placing an individual at risk for individual at risk for hypoventilation, increased hypoventilation, increased CO2, and decreased oxygen CO2, and decreased oxygen and thus asphyxiation.and thus asphyxiation.

19921992Dr. Raey reports 3 cases of Dr. Raey reports 3 cases of “positional asphyxia” “positional asphyxia” occurring in individuals placed occurring in individuals placed in the prone restraint position in the prone restraint position in the back seat of a police in the back seat of a police car. car.

In all three cases the subjects In all three cases the subjects were violent and agitated were violent and agitated from drugs or psychiatric from drugs or psychiatric illness.illness.

19931993O’Halloran reports 11 cases of O’Halloran reports 11 cases of sudden death while prone sudden death while prone with 9 of the 11 in the hogtie with 9 of the 11 in the hogtie restraint position. All of the restraint position. All of the 11 were in an excited 11 were in an excited delirious state from acute delirious state from acute psychosis or drugs (mostly psychosis or drugs (mostly cocaine). cocaine).

Other investigators tried to Other investigators tried to argue that delirium, argue that delirium, intoxication, stress trauma, intoxication, stress trauma, catecholamine catecholamine hyperstimulation, hyperstimulation, hyperthermia, muscle hyperthermia, muscle fatigue, or exhaustion as fatigue, or exhaustion as opposed to asphyxiation opposed to asphyxiation from body positioning was from body positioning was the mechanism of death.the mechanism of death.

19981998Chan, using good science, Chan, using good science, demonstrated that no demonstrated that no evidence indicated evidence indicated hypoventilation or hypoventilation or ventilatory compromises ventilatory compromises occurred as a result of occurred as a result of body positioning in the body positioning in the restraint position.restraint position.

The study invalidated the The study invalidated the work of Dr. Raey.work of Dr. Raey.

Capsicum Capsicum Pepper SprayPepper Spray

Deaths after TASER Deaths after TASER

Cause or Cause or Association?Association?

The deaths that occur in The deaths that occur in custody are after TASER custody are after TASER electrical delivery rather electrical delivery rather than during or than during or immediately afterwards.immediately afterwards.

In the instruction manual In the instruction manual it tells instructors to it tells instructors to “forewarn volunteers that “forewarn volunteers that being hit with a TASER is being hit with a TASER is an act of physical an act of physical exertion”.exertion”.

The expanded “physical The expanded “physical exertion” by the muscle exertion” by the muscle contractions may have an contractions may have an exacerbation effect with exacerbation effect with the illicit drugs just as the illicit drugs just as fighting against restraints fighting against restraints or physical conflict does.or physical conflict does.

Orlando, FL 2000-PresentOrlando, FL 2000-Present

6 in custody cases (excluding GSW) 6 in custody cases (excluding GSW) 4 had excited delirium with cocaine4 had excited delirium with cocaine 1 had hyperthermia and excited 1 had hyperthermia and excited

behavior from LSDbehavior from LSD 1 had altercation with police and an 1 had altercation with police and an

extremely bad heartextremely bad heart 4 of these cases were shot by TASER4 of these cases were shot by TASER

San Antonio, TX 1997-San Antonio, TX 1997-20032003

15 in custody cases (excluding GSW)15 in custody cases (excluding GSW) 14 cases of excited delirium associated 14 cases of excited delirium associated

with cocaine usewith cocaine use 1 case of a struggle with police combined 1 case of a struggle with police combined

with a bad heartwith a bad heart 3 cases of excited delirium deaths 3 cases of excited delirium deaths

without police involvementwithout police involvement No TASER involvement in any of these No TASER involvement in any of these

casescases

In the end…In the end…

Each case will be evaluated Each case will be evaluated individuallyindividually

Each case will be treated with a Each case will be treated with a high degree of suspicionhigh degree of suspicion

Each case will have a complete Each case will have a complete autopsy looking for traumaautopsy looking for trauma

Associated factors will be noted but Associated factors will be noted but association and cause are two association and cause are two different thingsdifferent things

It is my belief that TASER It is my belief that TASER use is now associated with use is now associated with excited delirium deaths excited delirium deaths but there is no evidence but there is no evidence that they are the cause of that they are the cause of death.death.

According to the National According to the National Association of Medical Association of Medical Examiners, cocaine Examiners, cocaine excited delirium is a fatal excited delirium is a fatal disease. Thus, I believe disease. Thus, I believe these individuals would these individuals would have died with or without have died with or without being shot with a TASER.being shot with a TASER.