In the tragic case of Sheldon Haleck, his parents believe that his only “crime” was jaywalking. However, a confrontation with Honolulu police in 2015 led to him being pepper-sprayed, shocked with a Taser, and restrained. Haleck became unresponsive and eventually succumbed, leaving his family devastated.
While an initial autopsy ruled Haleck’s death a homicide, the officers involved in his restraint raised a controversial defense: “excited delirium.” “Excited delirium” is a diagnostic theory that has been used in legal cases to explain sudden deaths during encounters with law enforcement.
Despite mounting opposition from most prominent medical groups, it has been cited as a defense in high-profile cases like George Floyd’s, Daniel Prude’s, and Angelo Quinto’s deaths. It is also a key argument in the trial of two police officers involved in the 2019 death of Elijah McClain in Aurora, Colorado.
The American College of Emergency Physicians (ACEP) is set to vote in October on whether to disavow its 2009 position paper supporting “excited delirium” as a valid diagnosis. The proposed resolution also calls on ACEP to discourage physicians from promoting this theory as expert witnesses in criminal and civil trials.
Critics argue that “excited delirium” is a pseudoscience that has been used to justify police misconduct. Major medical societies, including the American Medical Association and the American Psychiatric Association, do not recognize it as a valid medical condition. The National Association of Medical Examiners rejected it as a cause of death this year, and it is not listed in the “Diagnostic and Statistical Manual of Mental Disorders.”
The controversy surrounding this theory has persisted due to ACEP’s 2009 white paper, which suggested that individuals in a mental health crisis, often under the influence of drugs or alcohol, can exhibit superhuman strength when police try to control them, leading to their death. This theory was widely cited in court cases across the U.S., with courts and judges often accepting it without adequate scrutiny.
Critics argue that ACEP’s position has contributed to police tactics that lead to deaths. Between 2009 and 2019, Florida medical examiners attributed 85 deaths to excited delirium, with at least 62% involving the use of force by law enforcement.
While ACEP issued a formal statement this year stating that it no longer recognizes the term “excited delirium” and provided new guidance for managing patients with delirium and agitation, it has not withdrawn the 2009 white paper. The upcoming ACEP vote could be a significant step in keeping the theory out of courtrooms.
If passed, the resolution would call on ACEP to clarify in writing that the 2009 white paper is inaccurate and outdated and withdraw its approval. Despite the lack of a scientific basis for “excited delirium,” some in the medical community expect a heated debate before the vote.
Emergency physicians understand the challenges of managing patients with agitation and delirium but increasingly feel that the theory has caused harm and injustices. While this resolution cannot bring back individuals like Sheldon Haleck, it may prevent future cases from relying on a controversial theory that has been criticized as pseudoscience.
News Reference
KFF Health News, “Police Blame Some Deaths on ‘Excited Delirium.’ ER Docs Consider Pulling the Plug on the Term” Police Blame Some Deaths on ‘Excited Delirium.’ ER Docs Consider Pulling the Plug on the Term. – KFF Health News.
