ANTIOCH - For decades medical examiners around the nation have relied on a controversial explanation when people die in police custody: Excited delirium.
And when a forensic pathologist in Contra Costa County last month ruled the death of Angelo Quino was the result of excited delirium – it intensified a debated about the validity of a medical diagnosis that is increasingly being rejected by top medical professionals and organizations.
"I think we need to stop using the term excited delirium," said Michael Freeman, a forensic epidemiologist and professor of forensic psychiatry at Oregon Health & Science University School of Medicine.
Some medical literature loosely describes excited delirium as a state when a person is agitated, aggressive and distressed -- often when they are on drugs.
Freeman said the term is too often used as a way to explain when people die while being restrained by law enforcement when there’s no obvious cause present in an autopsy.
He co-authored a study in 2020 that looked at published cases of excited delirium and found the diagnosis rarely, if ever, happens independent of police involvement.
"There is no really good evidence that excited delirium exists in the absence of restraint," he said. "Basically, 98% of the cases restraint was described and most of the time it was quite aggressive restraint."
In fact, his research showed that in cases where restraint was more aggressive, people had higher chances of dying in cases blamed on excited delirium.
"I do not think that excited delirium is a valid diagnosis – I think it is used largely to white wash excessive force used by police – period," said Dr. Michael Baden, the former New York City Chief Medical Examiner.
He said the diagnosis gives cover to law enforcement, who often work closely with prosecutors and pathologists.
"If you say it’s excited delirium, than that’s the end of it and the district attorney doesn’t have to prosecute and everybody is happy of course except the family," he said.
The increasing attention around excited delirium prompted the American Medical Association to reject the term earlier this year. What’s more, neither the World Health Organization, nor the American Psychiatric Association recognize excited delirium.
Baden said restrain asphyxia or compression asphyxia are often overlooked in cases chalked up to excited delirium. Many medical experts say that people can die from lack of oxygen when pressure is put on their back and they’re in a prone position.
And law enforcement agencies in California and beyond train officers to be aware of such risks.
Even experts who recognize excited delirium as valid diagnosis told KTVU that pathologist must rely more on evidence in the moments before a person dies in police custody to determine cause and manner of death. In many cases, there are often no obvious signs a person dies from asphyxia in the autopsy alone.
But even as skepticism has increased around excited delirium as a valid condition, a forensic pathologist in Contra Costa County last month ruled that Quinto, a 30-year-old former Navy sailor, died from excited delirium while being restrained by Antioch police in December.
Quinto was experiencing a mental health crisis, and just like in other cases, police held him face down in a prone position for several minutes before he stopped breathing and was later pronounced dead.
KTVU obtained a copy of the coroner’s report through a public records request. Buried in the report, Dr. Ikechi Ogan wrote that "prone position with weight on the back may have played an additional role."
He also conceded that "excited delirium syndrome is a poorly understood physiologic response."
Ogan found that the pharmaceutical drug Modafinil contributed to Quinto’s death, but the drug is an anti-narcolepsy stimulant, which doesn’t appear to have any history of fatal overdoses.
In a press conference following a coroner’s inquest into Quinto’s death, in which a jury determined the death was the result of an accident, family attorney John Burris blasted the finding.
"Even the doctor recognizes it’s junk science but then he uses it as the basis to say it’s the cause of death here," Burris said.
The Contra Costa County Sheriff’s Office declined to comment for this story. Dr. Ogan did not return messages.
Evan Sernoffsky is an investigative reporter for KTVU. Email Evan at firstname.lastname@example.org and follow him on Twitter @EvanSernoffsky