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American College of Emergency Physicians withdraws position on excited delirium

The group said the term should not be used by members who testify in civil or criminal cases

By Carla K. Johnson
AP Medical Writer

A leading doctors group on Thursday formally withdrew its approval of a 2009 paper on “excited delirium,” a document that critics say has been used to justify excessive force by police.

The American College of Emergency Physicians in a statement called the paper outdated and said the term excited delirium should not be used by members who testify in civil or criminal cases. The group’s directors voted on the matter Thursday in Philadelphia.

“This means if someone dies while being restrained in custody ... people can’t point to excited delirium as the reason and can’t point to ACEP’s endorsement of the concept to bolster their case,” said Dr. Brooks Walsh, a Connecticut emergency doctor who pushed the organization to strengthen its stance.

[EARLIER: American College of Emergency Physicians reconsiders position on excited delirium]

Earlier this week, California became the first state to bar the use of excited delirium and related terms as a cause of death in autopsies. The legislation, signed Sunday by Gov. Gavin Newsom, also prohibits police officers from using it in reports to describe people’s behavior.

In March, the National Association of Medical Examiners took a stand against the term, saying it should not be listed as a cause of death. Other medical groups, including the American Medical Association, had previously rejected excited delirium as a diagnosis. Critics have called it unscientific and rooted in racism.

[RELATED: Medical examiners group: ‘Excited delirium’ should not be listed as cause of death]

The emergency physicians’ 2009 report said excited delirium’s symptoms included unusual strength, pain tolerance and bizarre behavior and called the condition “potentially life-threatening.”

The document reinforced and codified racial stereotypes, Walsh said.

The 14-year-old publication has shaped police training and still figures in police custody death cases, many involving Black men who died after being restrained by police. Attorneys defending officers have cited the paper to admit testimony on excited delirium, said Joanna Naples-Mitchell, an attorney and research adviser for Physicians for Human Rights, which produced a report last year on the diagnosis and deaths in police custody.

In 2021, the emergency physicians’ paper was cited in the New York attorney general’s report on the investigation into the death of Daniel Prude, a 41-year-old Black man. A grand jury rejected charges against police officers in that case.

Excited delirium came up during the 2021 trial of former Minneapolis police officer Derek Chauvin, who was later convicted in the death of George Floyd. This fall, the term resurfaced during the ongoing trials of police officers charged in the deaths of Elijah McClain in Colorado and Manuel Ellis in Washington state. Floyd, McClain and Ellis were Black men who died after being restrained by police.

[RELATED: Defense attorneys continue to shift blame on medics in Elijah McClain’s death]

The emergency physicians group had distanced itself from the term previously, but it had stopped short of withdrawing its support for the 2009 paper.

“This is why we pushed to put out a stronger statement explicitly disavowing that paper,” Naples-Mitchell said. “It’s a chance for ACEP to really break with the past.”