“Excited Delirium” and Deaths in Police Custody
By Brianna da Silva Bhatia, et al.
On December 23, 2020, Bella Quinto-Collins called 911, seeking help for her 30- year-old brother, Angelo Quinto, who was agitated and exhibiting signs of a mental health crisis at their home in Antioch, California. When two police officers arrived, they pulled Quinto from his mother’s arms onto the floor. At least twice, Quinto’s mother, Cassandra Quinto-Collins, heard him say to the officers, “Please don’t kill me.” Bella and Cassandra then watched in disbelief and horror as the two officers knelt on Quinto’s back for five minutes until he stopped breathing. Three days later, Quinto died in the hospital. It was not until August 2021 that the family learned the official determination of cause of death: a forensic pathologist testified during a coroner’s inquest that Quinto died from “excited delirium syndrome.” Angelo Quinto, a Filipino-American Navy veteran, is one of many people, disproportionately people of color, whose deaths at the hands of police have been attributed to “excited delirium” rather than to the conduct of law enforcement officers. In recent years, others have included Manuel Ellis, Zachary Bear Heels, Elijah McClain, Natasha McKenna, and Daniel Prude. “Excited delirium” even emerged as a defense for the officers who killed George Floyd in 2020. An Austin-American Statesman investigation into each non-shooting death of a person in police custody in Texas from 2005 to 2017 found that more than one in six of these deaths (of 289 total) were attributed to “excited delirium.” A January 2020 Florida Today report found that of 85 deaths attributed to “excited delirium” by Florida medical examiners since 2010, at least 62 percent involved the use of force by law enforcement.6 A Berkeley professor of law and bioethics conducted a search of these two news databases and three others from 2010 to 2020 and found that of 166 reported deaths in police custody from possible “excited delirium,” Black people made up 43.3 percent and Black and Latinx people together made up at least 56 percent.7 When did the term “excited delirium” evolve to describe a distinct type of “delirium?" How did the corresponding term “excited delirium syndrome” become a go-to diagnosis for medical examiners and coroners to use in explaining deaths in police custody? What is the evidence that it is indeed a valid diagnosis? This report traces the evolution of the term from when it appears to have first been coined in the 1980s to the present. Physicians for Human Rights (PHR) reconstructed the history of the term “excited delirium” through a review of the medical literature, news archives, and deposition transcripts of expert witnesses in wrongful death cases. We evaluated current views and applications of the term through interviews with 20 medical and legal experts on deaths in law enforcement custody. Additionally, we spoke to six experts on severe mental illness and substance use disorders to better understand the context in which the term most often arises. Finally, we interviewed members of two families who lost loved ones to police violence for a firsthand account of the harms of the term’s continued use. This report concludes that the term “excited delirium” cannot be disentangled from its racist and unscientific origins. Dr. Charles Wetli, who first coined the term with Dr. David Fishbain in case reports on cocaine intoxication in 1981 and 1985, soon after extended his theory to explain how more than 12 Black women in Miami, who were presumed sex workers, died after consuming small amounts of cocaine. “For some reason the male of the species becomes psychotic and the female of the species dies in relation to sex,” he postulated. As to why all the women dying were Black, he further speculated, without any scientific basis, “We might find out that cocaine in combination with a certain (blood) type (more common in blacks) is lethal.”
New York: Physicians for Human Rights, 2022. 95p.