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MICHELE NORRIS, Host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Michele Norris.

MELISSA BLOCK, Host:

And I'm Melissa Block.

Many police departments and medical examiners are using the term excited delirium to explain why some people suddenly die in police custody. It's a controversial diagnosis. Many civil liberties groups question whether it really exists.

We're going to hear about excited delirium today and tomorrow on the program. Tomorrow, we'll hear how police departments are training officers to deal with it, and the role Tasers play.

Today, NPR's Laura Sullivan introduces us to the controversy over excited delirium.

LAURA SULLIVAN: The patrol car pulls up quickly to the parking lot of a White Castle in Cincinnati. The grainy video from the dashboard camera shows a 350-pound man stumbling around, yelling.

NATANIEL JONES: Are you going to tell me what's going on?

Unidentified Man #1: Settle down.

SULLIVAN: The man is 41-year-old Nathaniel Jones, a father of two who worked in a group home. He's arguing with two officers. He seemed confused. He can't keep his balance. The officers close in. Jones says something about a white boy and something about his mother.

JONES: This is (unintelligible), white boy with a stick.

Man #1: Back up. Back up. Back up.

JONES: My mama told me to listen.

Man #1: Get down.

SULLIVAN: The officers order him to get down, but they can't seem to catch Jones. He throws his body at one of the officers, and out come the nightsticks.

Unidentified Man #2: Put your hands behind your back. Put your hands behind your back.

SULLIVAN: They strike him about 40 times. Jones is on the ground when more officers arrive with their nightsticks. Jones calls out for his mother.

JONES: Mama.

Man #2: Put your hands behind your back.

JONES: Mama.

SULLIVAN: That's the last thing Jones says. He stops moving. The eight officers stand back to catch their breath. And then comes the question: Is he breathing?

NORRIS: Sir? I don't see him breathing.

SULLIVAN: Jones died a few minutes later. The coroner found that Jones did not die from excessive police force but from a number of causes, such as heart failure, obesity, drug use and asphyxiation.

He later told reporters his death could have been the result of something called excited delirium.

DEBORAH MASH: Someone who's disproportionately large, extremely agitated, threatening violence, talking incoherently.

SULLIVAN: Deborah Mash is a professor of neurology at the University of Miami.

MASH: Tearing off their clothes. And it takes four, five or six officers to bring him out of harm's way. That's excited delirium.

SULLIVAN: Mash says the phenomenon came to light in the 1980s, when cocaine burst on to the scene. Most victims have cocaine or drugs in their systems. Nathaniel Jones had smoked cocaine and PCP. Mash says victims become irrational. Their body temperatures rise so fast their organs fail, and then they suddenly die.

MASH: It's definitely real. And while we don't really understand precisely what causes this, we do know that it is the result of a neurochemical imbalance in the brain.

SULLIVAN: The problem is nearly all the reporting cases of excited delirium involve people who are fighting with police. And that's more than a little problem, says Eric Balaban of the American Civil Liberties Union.

ERIC BALABAN: I know of no reputable medical organization - certainly not the American Medical Association - or the American Psychiatric Association that recognizes excited delirium as a medical or mental-health condition.

SULLIVAN: He's right. Excited delirium is not recognized by professional medical associations, and you won't find it listed in the chief psychiatric reference book.

BALABAN: Officials are using excited delirium as a means of whitewashing what may be excessive use of force and inappropriate use of control techniques by officers during an arrest.

SULLIVAN: The International Association of Chiefs of Police hasn't accepted it, either, saying not enough information is known. But every year, it is showing up on more and more medical examiners' autopsy reports.

VINCENT DI MAIO: What these people are dying of is an overdose of adrenaline.

SULLIVAN: Dr. Vincent Di Maio was, until recently, the chief medical examiner in San Antonio. Di Maio says he saw three to five cases of excited delirium a year, and says there are probably several hundred cases nationwide.

DI MAIO: What typically happens is, finally, the officers get the handcuffs in, they bind the feet; and everyone stands back and they're panting. And then someone says, he's not breathing.

SULLIVAN: Di Maio says it's often the very act of resisting that sends people prone to excited delirium over the edge. If they were in a field, alone, running around hysterical, Di Maio says they may still die. But he says fighting makes death far more likely. And because most people are in public places, not in fields, that means they're usually fighting with the police. Di Maio says civil liberties groups then wrongly blame the officers for the death.

DI MAIO: They buy into this mode that if somebody dies, somebody's got to be responsible. And of course, it can't be the person who's high on coke and meth.

SULLIVAN: But even with an extensive autopsy, there is no definitive way to prove someone died of excited delirium.

Dawn Edwards of the Oakland, California, police watchdog group, the Ella Baker Center, says if police decide to take a person into custody, they need to make sure the person stays alive, whatever the condition of the person's brain or body temperature or their agitated state.

DAWN EDWARDS: They want the victim to be looked at as the cause of his or her own death. The bottom line is that these people are dying at the hands, or in the custody, of police officers.

SULLIVAN: We'll hear more on that from the police perspective tomorrow. Several medical doctors interviewed by NPR said there is a way to calm someone down who has the symptoms that have come to be known as excited delirium. Doctors at the emergency room at the Vanderbilt University Hospital in Nashville have tranquilized three people. Their heart rates and body temperatures were soaring. And they woke up fine.

But that's in a hospital, with doctors and intravenous drugs. Police officers are not allowed to administer medicine. They have only their nightsticks, Tasers, pepper spray, or their own bodies - which may make the situation worse.

Because excited delirium doesn't show up in an autopsy, it is the subject's behavior that determines the diagnosis. And if there aren't any witnesses, only the police can describe what happened.

Videos of excited delirium incidents are rare. And as officers made clear at the end of the tape of Nathaniel Jones dying in the White Castle parking lot, they're not always eager to have the cameras on.

Unidentified Man #4: (Unintelligible) on my head and no one has (unintelligible).

SULLIVAN: As the ambulance crew straps Nathaniel Jones to a gurney, the officers standing in front of the patrol car ask whether anyone left their onboard VR - video recording - devices on.

NORRIS: I know it's on. I left it on, but I turned the mic off.

SULLIVAN: The officer swears and rushes to his car. He shuts the video off and the tape goes dead. But even with a video, a medical examiner, a dozen witnesses and an autopsy, exactly how and why Nathaniel Jones died still seems to depend on whom you ask.

Laura Sullivan, NPR News.

BLOCK: Tomorrow, we'll hear about the role of Taser International in spreading information about excited delirium.

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