The George Floyd murder trial at Hennepin County District Court in Minneapolis is the latest in a series of court cases involving the deaths of people who were either physically restrained or electrically incapacitated while being detained by police officers. Such sudden and unexpected deaths after relatively aggressive methods of restraint, either at the scene, in police custody, or later in hospital, inevitably raise the question of who should take the blame for the resulting tragedy. Civil liberties groups and racial equality campaigners may claim that excessive force was dispensed by law enforcement officers, while those directly involved in making such arrests may state that their responses were proportionate, made in the heat of the moment, and justified by the threat of serious harm from the person in question.
The prosecution in the Floyd case is accusing Minneapolis police officers of killing Floyd by positional asphyxiation, while the defence is deflecting the blame back onto the deceased himself, whose pre-existing medical illnesses and chronic drug abuse allegedly provoked cardiac arrest during the emotional and physical stress of resisting arrest . The murder trial was precipitated by the Hennepin County Medical Examiner’s post-mortem report, back in June 2020, that Floyd died of “cardiopulmonary arrest complicating law enforcement subdual, restraint, and neck compression”, making his death a homicide. Arteriosclerotic and hypertensive heart disease, fentanyl intoxication, and recent methamphetamine were listed as other significant conditions contributing to Floyd’s demise- information which the defence is relying upon to build its case. Graphic evidence from smartphone and bodycam video recordings, eye- witness accounts, and expert testimony have been presented to Judge Peter Cahill, lawyers, and carefully selected jurors to help them with their decision-making.
Deaths following forcible restraint broadly fall into two broad categories. While misjudged police actions can deprive a suspect of oxygen from positional or compressional asphyxiation that proves to be fatal, the deceased’s behaviour and actions may equally be alleged to have provoked law enforcement officers into action in the first place. The particular combination of characteristics described in some of the deceased in the moments leading up to their disastrous encounters with the police is often referred to as excited delirium- a term that was first used in 1985. When conclusive post-mortem evidence for the cause of death is lacking, which is often the case, there may be conflicting opinions about what went wrong. This is because of differing perspectives on issues of law-and-order, especially those related to the unfair treatment of certain minorities within the criminal justice system.
Excited delirium may be invoked, sometimes controversially, as part of the defence when people die following forcible restraint. This condition, although recognised by some healthcare and law enforcement professionals, isn’t listed in the 10th edition (1992) of the WHO’s International Classification of Diseases, nor in the Diagnostic and Statistical Manual (DSM-5) (2013) of the American Psychiatric Association. But on the other hand, an American College of Emergency Physicians Task Force released a White Paper Report in September 2009, describing excited delirium as a “unique syndrome which may be identified by the presence of a distinctive group of clinical and behavioural characteristics that can be recognised in the pre-mortem state”. Excited delirium is also recognised as a distinct entity by the National Association of Medical Examiners and even features in coroners’ reports and investigations by police regulators from the UK and elsewhere.
Irrespective of whether excited delirium is accepted as a diagnosis or not, those who die after forced restraint frequently share some characteristics in common. Subjects are typically males in their thirties, predominantly black or Hispanic, and often physically well-built or obese. They may be under the influence of a psychostimulant drug such as cocaine, methamphetamine, phencyclidine or a synthetic cathinone. They are described as being hyperactive, aggressive, confused, and paranoid. Incoherent shouting, profuse sweating, foaming or drooling at the mouth, feeling hot to the touch, heat intolerance- leading to undressing or even nudity, and a remarkable insensitivity to pain coexist with prolonged and strenuous attempts to resist arrest, often with shows of superhuman strength.
Extremely agitated people can die from asphyxia as they are being subdued. Forcible restraint in a prone, face-down, position may restrict their breathing, as may the strangling grip of a chokehold or the localised pressure from a knee on the neck or the weight of a body on the chest. Many police training documents emphasise that while a face-down position may facilitate the application of handcuffs, the face-up position should be resumed as soon as the handcuffs are on. Asphyxiation, either positional or compressional, typically produces a bluish discolouration (cyanosis) and swelling of the face. Air hunger may lead to complaints of an inability to breathe. The noisy, gurgling and gasping, breathing of a partially obstructed airway is soon replaced by the silence of total airway obstruction and respiratory arrest, at which point the subject gives up the struggle and rapidly fades away.
Excited delirium is considered to be a medical emergency, just like some other conditions that closely resemble it, such as those caused by drug reactions or substance abuse. This means that the victim should be promptly transported to hospital once suitably restrained. The aims are to rapidly sedate and cool down the victim, while simultaneously propping up the circulatory system by the infusion of intravenous fluids. There is always a window of opportunity to save life, as excited delirium is most unlikely to lead to death at the scene of an incident, in a person who has not been restrained.
There have been long-standing concerns within certain circles in America over the disproportionate use of heavy-handed tactics while apprehending black and Hispanic suspects. The George Floyd case is being seen as a test case for frontline policing during racially sensitive situations in the US and the outcome will be eagerly awaited by many. It remains for the jury to decide whether Floyd was indeed murdered, thereby signalling the need for improvements in the ways police respond to potentially high-risk suspects within their communities. Given the mixed track record of community policing in America, the prognosis remains uncertain, at least for the time being.
Ashis Banerjee