Anyone else seen this diagnosis?


'Excited delirium' is ruled in death of man who struggled with police

Web Posted: 06/06/2007 02:06 AM CDT

Brian Chasnoff and Lomi Kriel
Express-News
A man who stopped breathing after he struggled with San Antonio police last month died after his cocaine intoxication developed into a controversial condition known as excited delirium, medical examiners have ruled.

Michael Olveda, 28, died May 7 after a scuffle with police, instigated when he refused to show them his identification and resisted their attempts to handcuff him.

A prolonged struggle ensued that left Olveda with a bloody nose, and after he was handcuffed, police noticed he wasn't breathing.

His autopsy, released Tuesday by the Bexar County district attorney's office, said Olveda had multiple abrasions on his face, arms and legs but they "alone were not life-threatening injuries."

Marks on his forearms were "consistent with handcuff restraint."


Olveda, the medical examiners wrote, died as a result of "cocaine intoxication causing Excited Delirium Syndrome."

Described as an overdose of adrenaline that's often exacerbated by drugs, the condition is characterized by sudden death after a physical struggle.

Although accepted by a growing number of medical examiners, excited delirium isn't recognized by the American Medical Association or listed in the chief psychiatric reference book.

Critics call it "junk science" that can obscure questionable police tactics.

Between 2001 and 2006, the Bexar County medical examiner's office ruled 25 people died of excited delirium � 22 of those deaths occurred during or after the subject was restrained by police or medical personnel.

Kevin Stouwie, an attorney for relatives of Olveda, questioned whether Olveda would have died had it not been for the effects of his struggle with police.

"Perhaps if he just had cocaine in his system and no struggle with police, we wouldn't have a dead 28-year-old," he said.

Olveda was standing outside his brother's apartment when police arrived at 515 Riverside Drive, responding to a call about a man outside the Riverside Apartments complex who was "screaming at someone."

When the arriving officer asked Olveda for ID, he refused and began to act "belligerent" toward an officer who tried to handcuff him for safety reasons, according to a police report. Olveda began struggling with that officer as three other officers arrived to assist, the report said.

At least three witnesses to the encounter later told a reporter that the officers struck Olveda in the face while subduing him.

The officers realized after they had handcuffed Olveda that he had stopped breathing, the report said. A police spokeswoman said at the time that it appeared Police Department policy was followed.

But Stouwie questioned the reasons for the struggle.

"What justification did the police officers have to engage in this 20-minute struggle," he asked.

"There was no crime he was suspected to have committed."

Police spokesman Sgt. Gabe Trevino said the Police Department initiated a routine internal investigation into the officers' actions. He added that "it's no secret there was a physical confrontation between the suspect and several officers. When that happens, more than likely there are going to be physical injuries to the officers and the suspect."

Medical examiners recently ruled that excited delirium also killed another man who died during a struggle with San Antonio police in March. Police said Sergio Galvan, 35, attacked an officer who then squirted him with pepper spray before another officer stunned him three times with a Taser.

Galvan also was high on cocaine during the struggle, medical examiners said.

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"Perhaps if he just had cocaine in his system and no struggle with police, we wouldn't have a dead 28-year-old," he said.

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Or, perhaps if there was just a struggle with police and no cocaine in his system, he wouldn't have died. Why is it that no one ever wants to blame the druggie?

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Why is it that no one ever wants to blame the druggie?

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Perhaps some people don't want to blame the dead guy because they believe that you take your victim as you find him.

I blame the guy for fighting with the police. I'm sure it is a real drag to be handcuffed if you believe yourself innocent but you've got to know that fighting won't help matters.

Yes, and what if the police had shown up and then just left because he wouldn't identify himself....and he hurt himself or someone else? I'm sure the news that time would have been lazy officers that don't want to do their jobs!! Or don't care about people on drugs...or any number of other reasons that are of course not the doped out guy's fault.

That's what I took from Gretchen's post, too, a sense that the news would rather go with an angle that blames police. It's because that's an established narrative; it's not some magnanimous desire to take the victim as they find him.

Note that the Bexar County medical examiner is the co-author of a book on the topic:
Di Maio, Theresa D. and Vincent J.M. Di Maio., Excited delirium syndrome; cause of death and prevention. CRC / Taylor & Francis, 2006, 144 pages, $69.95, Hardcover, RC520
"Theresa Di Maio, an RN, and Vincent Di Maio, the Chief Medical Examiner of Bexar County, Texas, argue that when individuals die while resisting restraint, excited delirium syndrome, not positional asphyxia, is usually the cause of death. Using case studies, they refute previous findings of positional asphyxia. In addition to explaining the cause and history of the disease, they identify individuals most at risk, discuss prevention and assess the role of first responders, investigators and mental-health professionals."

He retired.

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Although accepted by a growing number of medical examiners, excited delirium isn't recognized by the American Medical Association or listed in the chief psychiatric reference book.

Critics call it "junk science" that can obscure questionable police tactics.

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True, it's not a diagnosis, it's a syndrome. For it to become a medical diagnosis, it would need to find its way into the ICD9. For it to become a psychiatric diagnosis, it would need to find its way into the DSM IV. This will only happen when research yields enough empirical data to substantiate and scientifically delineate the mountain of anecdotal and observational evidence we continue to see. But there are two huge obstacles here: First, the hardest place to study a syndrome is in a dead guy. Second, research takes funding and funding is often based on the potential for return.

Obviously, there are factions within our society that do not want to see this syndrome become a diagnosis. In the 70s, chemical mace was alleged to have killed a number of suspects. In the 80s, it was OC spray. For a while positional asphyxia took the fall, until D. Reay's findings were eviscerated by a UCSD Medical Center study (see Ann Price v County of San Diego). And now, to quote retired Capt. Greg Meyer of the LAPD, it's the Taser's turn in the barrel.

In a significant number of cases, those allegedly killed by these devices and procedures were demonstrating the same behaviors and symptoms we now associate with excited delirium. They were sweating profusely, often had removed their clothing, were speaking of ambiguous entities that were after them, had excessive heart rates (even prior to a struggle), and had, in many cases, been using cocaine or meth. They have been described by the officers attempting to subdue them as having "super human" strength (coincides with the "adrenaline overdose" theory). Many of those who arrive at an ER alive have extremely elevated body temperatures. A common summary offered by the arresting officers is, "He was fighting like hell, then he relaxed, and then we realized he wasn't breathing." These common factors all point to something, and it's not manufactured by a police equipment company or taught in an academy.

John Henry Death Syndrome?