NEW MALADY DEATHS IN POLICE CUSTODY 2016
COMPILATION AND COMMENTARY BY LUCY WARNER
NOVEMBER 18, 2016

I AM PRESENTING THIS MATERIAL COLD AND WITH VERY LITTLE OPINION OF MY OWN, BUT I THINK YOU WILL BE ABLE TO SEE WHERE ALL OF THESE ARTICLES LEAD. THERE WAS A STORY ANNOUNCED FOR TONIGHT'S LOCAL NEWS WHICH GRABBED MY ATTENTION ABOUT A NEW "MALADY" RELATED TO POLICE CUSTODY CASES. I DIDN'T FIND THAT PARTICULAR ARTICLE, BUT I THINK EXCITED DELIRIUM IS THE "ILLNESS" IN QUESTION.



EXCITED DELIRIUM –

Excited delirium - Wikipedia
https://en.wikipedia.org/wiki/Excited_delirium

“Excited delirium is a controversial proposed condition that manifests as a combination of delirium, psychomotor agitation, anxiety, hallucinations, speech disturbances, disorientation, violent and bizarre behaviour, insensitivity to pain, elevated body temperature, and superhuman strength.”


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http://www.slate.com/articles/news_and_politics/jurisprudence/2015/06/excited_delirium_deaths_in_police_custody_diagnosis_or_cover_up.html

Dying of Excitement
Police often blame suspects’ deaths on “excited delirium.” Is that a diagnosis or a cover-up?
By Dahlia Lithwick
JUNE 11 2015 1:32 AM

Photograph -- Medical examiners have cited “excited delirium” as the cause of death for several people in police custody, even when they had broken bones or police used Tasers to subdue them.
Photograph -- A restraint chair in the Fairfax County, Virginia, jail similar to one used to hold Natasha McKenna after deputies shocked her four times with a Taser on Feb. 3, 2015. She later died, and police are investigating. Photo by Washington Post/Getty Images


When Natasha McKenna was in police custody at the Fairfax County, Virginia, jail in February, the mentally ill woman was restrained by six deputies who, unable to subdue her, shocked her with a Taser. She died several days later. But as the Washington Post reported recently, when the Virginia medical examiner’s office ruled on the cause of death, the conclusion was that a rare and mysterious syndrome known as “excited delirium” had actually killed her, and not the Taser or the extreme force used by six officers against a woman suffering from schizophrenia and bipolar disorder who weighed just 130 pounds.

DAHLIA LITHWICK
Dahlia Lithwick writes about the courts and the law for Slate, and hosts the podcast Amicus.
“Excited delirium” is the name given to a condition in which a person, either as a result of mental illness or protracted use of stimulants such as cocaine or methamphetamines, becomes extremely violent; hyperaggressive; and is often found naked, agitated, incoherent, feverish, and displaying extraordinary strength. The phenomenon is reported most often in police encounters, requiring, on average, four officers to restrain the suspect. In approximately 10 percent of cases, according to the literature, the person with excited delirium may die suddenly. The heart or breathing simply stops. So when someone dies in that agitated state and no other cause of death is found, the medical finding is that excited delirium was the cause. It accounts for approximately 250 deaths in the United States each year, with one expert speculating that about 800 cases occur each year nationwide.

The obvious problem is this: What do we make of a syndrome that seems to occur almost unerringly when a police officer is choking, hog-tying, or stunning with a Taser someone with a mental illness or drug addiction? And why do many experts dispute that the diagnosis even exists? While excited delirium is used to explain a significant number of deaths occurring in police custody, the term has not been recognized as a genuine mental health condition by the American Medical Association, the American Psychological Association, or the World Health Organization. Excited delirium—which sounds, to the naked ear, something like “crazy-craziness”—is not found in the current version of the Diagnostic and Statistical Manual of Mental Disorders, either. Yet medical examiners and police departments keep claiming it as the cause of death of people in custody. In 2014, the International Association of Chiefs of Police issued a white paper that tried to bridge the gap, concluding, “Despite what it is called or whether it has been formally recognized, it is a real clinical concern for both law enforcement and the medical communities.” But is it a real medical phenomenon? Is it a convenient way to blame the victim, as civil liberties and prison reformers claim? Or is this a genuine syndrome that occurs largely in fights between the mentally ill and the cops? Now more than ever, when suspicious deaths in police custody are making headlines, should we consider excited delirium an illness or a cover for police abuse?

Medical examiners and police departments say it’s a genuine syndrome. The National Association of Medical Examiners has recognized the condition for more than two decades. And in 2008, the Council of the American College of Emergency Physicians declared that excited delirium is “a real syndrome of uncertain etiology.” Emergency room doctors and medical examiners insist that members of the larger mental health community don’t acknowledge the condition because they never see it.

All of this looks like it pits the medical and mental health community (minus ER docs) against the police and forensic investigators. And it raises questions about whether this diagnosis is that of a singular medical phenomenon or an imprecise post-hoc explanation for mysterious deaths that, almost invariably, as NPR noted, “involve people who are fighting with police.”

There may be a plausible, relatively innocent explanation for the fact that most deaths in excited delirium cases arise when the police are restraining someone. Doctors in hospitals have successfully tranquilized people with symptoms of excited delirium, and the patients have survived. But when cops—armed with nightsticks and Tasers—try to subdue someone with excited delirium by force, the person may die. This doesn’t mean cops are causing the deaths, but merely that they are not in a position to avoid them.


The genesis of the term excited delirium goes back to 1849, when it was used by Luther Bell to describe psychiatric patients who developed agitation and mania while in the grip of a fever, then died abruptly. Charles Wetli revived the term in the drug-addled 1980s to explain sudden death in recreational cocaine users. It was quickly adopted by police to explain cases like Tony Steele, who was high on cocaine and died suddenly in the back of a patrol car in 1991. Now excited delirium is diagnosed routinely. Nathaniel Jones died in police custody in 2003 after being wrestled to the ground and beaten with nightsticks; his death was blamed on excited delirium. Randy Escobedo’s autopsy in 2003 revealed two broken bones around his throat, eight broken ribs, and internal bleeding. The coroner ruled the cause of death excited delirium. Same ruling for Keith Graf in 2005 in Phoenix, Arizona. Patrick Lee in 2005 in Nashville, Tennessee. Or Polish citizen Robert Dziekanski at Vancouver International Airport in 2007. Or 35-year-old Efrain Carrion in 2010 in Connecticut. Or Kevin Campbell in Florida in 2011. Kevin L. Ellis in 2013.

Critics have blamed the uptick in excited delirium diagnoses largely on the Taser industry. In 2013, Amnesty International, the only organization that has compiled data on this issue, claimed there were 552 incidents since 2001 where a Taser was used on a victim who then died, yet autopsies cited Taser use as a cause or contributing cause of death in only 60 of those cases.. Excited delirium diagnoses have also protected Taser from liability in many use-of-force suits against the company. In a 2007 interview with NPR, Taser International spokesman Steve Tuttle said that each year his company “sends hundreds of pamphlets to medical examiners explaining how to detect excited delirium. Taser also holds seminars across the country, which hundreds of law-enforcement officials attend.” Tuttle went on to add: “We're not telling departments [that] excited delirium is always the cause of death following a Taser application. … We're simply pointing out the facts: that excited delirium is an issue out there, and they need to treat this as a medical emergency if they see these signs.” A piece in Mother Jones details the extent to which ER doctors and medical examiners get most of their information about excited delirium from Taser.

This kind of self-interested advocacy has enraged some mental health experts and prison reform advocates. Eric Balaban, senior counsel with the ACLU’s National Prison Project, told NPR that it could lead cops to use more force when they should be calming things down: “If police officers are being trained about this condition known as excited delirium, and are being told the people suffering from it have superhuman strength, and [these people] are being treated as if they are somehow not human, it can lead officers to escalate situations.”

At a Canadian public inquiry set up in 2008 to study the appropriateness of allowing cops to use Tasers, Mike Webster, a police psychologist, went further. He blamed Taser International for “brainwashing” cops and testified that “police and medical examiners are using the term [excited delirium] as a convenient excuse for what could be excessive use of force or inappropriate control techniques during an arrest.” He went on to add that members of the law enforcement community “have created a virtual world replete with avatars that wander about with the potential to manifest a horrific condition characterized by profuse sweating, superhuman strength, and a penchant for smashing glass that appeals to well-meaning but psychologically unsophisticated police personnel.”

The results of that two-year official 2009 inquiry, chaired by a retired British Columbia appeals court justice, Thomas Braidwood, concluded that the term excited delirium had been rejected by medical professionals and was being used to cover up actual causes of deaths in custody, especially those involving excessive restraint and Tasers. Braidwood wrote that it was “not helpful to characterize people displaying these behaviors as suffering from excited delirium. Doing so implies that excited delirium is a medical condition or diagnosis, when mental health professionals uniformly reject that suggestion.” Taser International sued to have the Braidwood findings quashed, but the company lost.

Critics have blamed the uptick in excited delirium diagnoses largely on the Taser industry.

Part of the ambiguity is that, much like in cases of sudden infant death syndrome, a medical examiner who diagnoses excited delirium can’t point to a clear cause of death in the autopsy. As Vincent Di Maio, a retired forensic pathologist, explains in his book on the subject, excited delirium is only determined after an autopsy “fails to reveal evidence of sufficient trauma or natural disease to explain the death.” You work backward to the diagnosis.

Researchers are still trying to find biological signals of excited delirium. Wired reported in 2009 that a study by Deborah Mash and colleagues at the University of Miami and published in Forensic Science International looked at samples of brain tissue for 90 people who had apparently died of excited delirium. The researchers found the signatures of two distinctive “biomarker” proteins that were common to all 90 cases. But subsequent research found that these proteins are evidence of drug use and not specific to excited delirium.

The ACLU is having none of it. Balaban told the Washington Post that the syndrome is simply an easy way to “whitewash” excessive use of force by cops on suspects with serious mental health problems. The notion that mentally ill or drugged suspects who are behaving wildly need to be restrained and beaten is finally getting deserved attention. A horrifying new study from Human Rights Watch shows the extent of abuse of mentally ill prisoners in the American prison and jail systems.

A note in the 2012 Saint Louis University Law Journal by Michael L. Storey blames journalists for perpetuating the idea that excited delirium is a myth. He wrote that they “favor controversy and blame rather than balance and exploration.” But any medical diagnosis that shifts blame from the living to the dead, and from cops onto victims, based on a condition that is diagnosed only in the absence of other clear causes is really not to be blamed on reporters. Apparently while we’re busy hog-tying the prisoner, we should pause to shoot the messenger as well.

Perhaps the final paradox of the excited delirium craze is that it may be leading to better police procedures in the long term. Whether excited delirium rests on junk science pushed by Taser International or is a legitimate diagnosis of a genuine disease, some police departments have begun to enact more effective law enforcement training. As Storey notes, cops in Dallas are being trained to call an ambulance when they come across a person displaying symptoms of excited delirium, and they are asked to defuse the situation with suspected mentally ill persons “by slowing things down, and using the suspect’s first name and trying to avoid the use of force.” By training cops to see excited delirium as a medical emergency instead of a fight to the death with a hulking superpredator, the police may be learning to better handle these crises using nonlethal force.

After Randy Escobedo died in police custody, the San Diego Police Department retrained its officers to ensure that suspects were never detained face down, and suspects were monitored after their arrests. In British Columbia, as a result of the Braidwood hearings, a cop is prohibited from deploying a Taser unless “the subject is causing bodily harm or the officer is satisfied, on reasonable grounds, that the subject’s behavior will imminently cause bodily harm.” In Toronto, a hospital has partnered with two downtown police divisions to create a “mobile crisis intervention team”—a police officer and a mental health nurse—to deal with emergencies involving emotionally disturbed people. If a diagnosis of excited delirium, whatever it is, works in the long term toward treating mental health crises as mental health crises rather than crimes, perhaps it’s a step toward more humane and safe policing.


The following are comments on the state of psychiatric science that may apply to this subject.:


https://books.google.com/books?id=MhDwBgAAQBAJ&pg=PA64&lpg=PA64&dq=deaths+in+police+custody+malady&source=bl&ots=Up-Nf0Koio&sig=7RVLBZ1xk4X3nFT7CHVgThRfjHE&hl=en&sa=X&ved=0ahUKEwir0MTUsLLQAhWL7YMKHZR8Dc8Q6AEINDAH#v=onepage&q&f=false

What Psychiatry Left Out of the DSM-5: Historical Mental Disorders Today
By Edward Shorter

(delirious mania and fatal catatonia) (malignant catatonia) (excited delirium vs. ) (catastrophic reaction)
(Stauder ) (1949 Ottar Lingjaerde Lier mental hospital in Oslo)

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http://journalistsresource.org/studies/government/criminal-justice/deaths-police-custody-united-states

CRIMINAL JUSTICE, PUBLIC HEALTH, RACE

Deaths in police custody in the United States: Research review
Tags: law, policing

Writers: John Wihbey and Leighton Walter Kille | Last updated: July 2, 2016

www.niemanlab.org/author/jwihbey/
John Wihbey is assistant director for Journalist's Resource at the Harvard Kennedy School's Shorenstein Center on Media, Politics and Public Policy. He is also ...


Research Findings

The deaths of black men at the hands of white police officers in recent years have raised a number of questions about the treatment of racial minorities within the criminal justice system, as well as about patterns of arrest-related deaths more generally. Some researchers are calling for Congressional-mandated government databases to be more thorough so they can better find patterns in the violent interactions between police and civilians.

The Baltimore Sun‘s 2014 investigation of these issues in that city revealed that “over the past four years, more than 100 people have won court judgments or settlements related to allegations of brutality and civil rights violations.” Other outlets, such as the Milwaukee Journal Sentinel, have pursued similar investigations in their region. Still, it remains unclear how much these stark events and figures are characteristic of larger patterns across American society.

The limited data available do not suggest a recent overall increase in the number of homicides by police or the racial composition of those killed, despite the high-profile cases and controversies of 2014-2015, according to a New York Times analysis. But a January 2015 report published in the Harvard Public Health Review, “Trends in U.S. Deaths due to Legal Intervention among Black and White men, Age 15-34 Years, by County Income Level: 1960-2010,” suggests persistent differences in risks for violent encounters with police: “The rate ratio for black vs. white men for death due to legal intervention always exceeded 2.5 (median: 4.5) and ranged from 2.6 (95 percent confidence interval [CI] 2.1, 3.1) in 2001 to 10.1 (95 percent CI 8.7, 11.7) in 1969, with the relative and absolute excess evident in all county income quintiles.”

Arrest-related deaths

The case of Freddie Gray, a 25-year-old Baltimore man who died in police custody on April 19, 2015 — now ruled a homicide — raises questions specifically about treatment during and immediately after initial arrest. A March 2015 report from the federal Bureau of Justice Statistics (BJS) concludes that the current Arrest-Related Death (ARD) program — which aims to track persons who die in custody in America at the state level — typically only counts about half, at best, of all deaths in police custody, and the coverage rate may be as low as 36 percent. Although that estimate increased in 2011 to somewhere between 59 percent and 69 percent, the “current ARD program methodology does not allow a census of all law enforcement homicides in the United States,” researchers conclude.

The BJS’s 2015 “Data Quality Profile” report shows that some states have not reported statistics to the federal government in a given year between 2003 and 2011, and a few states have not participated at all.

That said, the federal government has nevertheless attempted to collect as much state-level data as possible in the past: A federal census between 2003 and 2005 found there were 2,002 arrest-related deaths, and “homicides by state and local law enforcement officers were the leading cause of such deaths during this period (55 percent).” (There is no available statistical breakdown of how many of these homicides are the result of involuntary manslaughter or justified acts versus intentional acts that might fall into the category of murder — issues that might be settled years later in the courts.)

For the most recent period where statistics are available (2003-2009), the BJS found that 4,813 persons “died during or shortly after law enforcement personnel attempted to arrest or restrain them… About 60 percent of arrest-related deaths (2,931) were classified as homicides by law enforcement personnel.” However, among these 2,931 homicides by law enforcement personnel, 75.3 percent were reported to have taken place in response to a violent offense — constituting a force-on-force situation, such as an intervention with an ongoing assault, robbery or murder: “Arrests for alleged violent crimes were involved in three of every four reported homicides by law enforcement personnel.” Still, 7.9 percent took place in the context of a public-order offense, 2.7 percent involved a drug offense, and among 9.2 percent of all homicides by police no specific context was reported.

Other factors implicated in deaths at the state level are as follows, according to BJS:

Death in custody (BJS)

Further, from 2003 to 2009:

Of reported arrest-related deaths, 45 percent of persons allegedly engaged in assault immediately prior to or during the arrest…. Of reported persons who died during the process of arrest, 95 percent were male. About 42 percent were white, 32 percent were black/African American and 20 percent were Hispanic or Latino. More than half (55 percent) were between ages 25 and 44, and juveniles (persons under age 18) were about 3 percent of all arrest-related deaths.

The federal government also tracks fatalities in jails and prisons through its Deaths in Custody Reporting Program (DCRP); typically, the vast majority of deaths result from illness or suicide, with homicides and unnatural deaths attributed in only a few percent of cases. The state-level requirements for that reporting program expired in 2006, but a new bill was signed into law in 2014. (It is worth pointing out that jails — which see all manner of persons, from those right off the street to those awaiting trial — and prisons — where those convicted of crimes are deliberately and systematically placed — are quite different in their population and environment.)

Reporting on incidents

Experts involved in analysis of these incidents caution that the numbers can often hide meaningful context, and reporters would be well served to go beneath the surface and ask about how data is collected — and any potential holes or weaknesses in the data. Overall, states have varied in their methods of reporting law enforcement-related incidents of many kinds to the federal government, an issue recently addressed by FBI Director James Comey.

For an example of how data, or the lack of it, can matter — and mislead — see the series on prison rape written by David Kaiser for The New York Review of Books. Finally, for news reporters covering individual incidents, context can be crucially important, from the degree to which a neighborhood is a high-crime area, or where assaults on officers are common; to the level of police training to deal with, for example, violent and mentally ill persons; to the precise nature of the incident and whether it involved a suspect threatening public safety at the time of a violent intervention by authorities.

There is also a substantial body of government and academic research on these issues, including on the uses of restraints and other law enforcement practices that may be employed to manage persons detained: . . . .



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“Homicides by Police: Comparing Counts From the National Violent Death Reporting System, Vital Statistics, and Supplementary Homicide Reports”
Barber, Catherine; et al. The American Journal of Public Health, May 2016, Vol.106, doi: 10.2105/AJPH.2016.303074.

Summary: The report compares how different government databases track homicides by law enforcement officers and finds the National Violent Death Reporting System (NVDRS), run by the Center for Disease Control, the best available because it draws from multiple sources and “captures detailed coded data and rich narratives that describe the precipitating circumstances and incident dynamics for all suicides and homicides occurring in participating states.” The authors recommend the NVDRS be expanded to all 50 states. It currently tracks 32.

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“Race, Crime, and the Micro-Ecology of Deadly Force”
Klinger, David; Rosenfeld, Richard; Isom, Daniel; Deckard, Michael. Criminology & Public Policy, February 2016, Volume 15, doi: 10.1111/1745-9133.12174.

Research Summary: “Limitations in data and research on the use of firearms by police officers in the United States preclude sound understanding of the determinants of deadly force in police work. The current study addresses these limitations with detailed case attributes and a microspatial analysis of police shootings in St. Louis, MO, between 2003 and 2012. The results indicate that neither the racial composition of neighborhoods nor their level of economic disadvantage directly increase the frequency of police shootings, whereas levels of violent crime do—but only to a point. Police shootings are less frequent in areas with the highest levels of criminal violence than in those with midlevels of violence. We offer a provisional interpretation of these results and call for replications in other settings.”

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“Pattern of law enforcement–related injuries in the United States”
Chang, David C.; et al. Journal of Trauma and Acute Care Surgery, Volume 80(6), June 2016, doi: 10.1097/TA.0000000000001000

Conclusion: “The majority of law enforcement–related injuries are among white or black young men. Hispanic patients are more likely to be injured by a firearm than struck. When injured by firearm, white and black patients are more likely to die compared with Hispanic patients. Unfortunately, data about these injuries are scattered across multiple data systems. A uniform national system to aggregate these data sources is needed to better understand the scope of the problem, for both law enforcement personnel and civilians.”

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“Arrest-Related Deaths, 2003-2009: Statistical Tables”
Burch, Andrea M. U.S. Department of Justice, Bureau of Justice Statistics, November 2011.

Introduction: “From 2003 through 2009, a total of 4,813 deaths were reported to the Bureau of Justice Statistics’ (BJS) Arrest-Related Deaths (ARD) program. Of these, about 6 in 10 deaths (2,931) were classified as homicide by law enforcement personnel, and 4 in 10 (1,882) were attributed to other manners of death. Suicide and death by intoxication each accounted for 11 percent of reported arrest-related deaths, accidental injury for 6 percent, and natural causes for 5 percent (figure 1). Deaths with manners classified as undetermined or those in which manners were unknown represented about 6 percent of reported arrest-related deaths.”

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“Unexpected Arrest-Related Deaths in America: 12 Months of Open Source Surveillance”
Ho, Jeffrey D. Western Journal of Emergency Medicine, May 2009, Volume X, No. 2.

Abstract: “Introduction: Sudden, unexpected arrest-related death (ARD) has been associated with drug abuse, extreme delirium or certain police practices. There is insufficient surveillance and causation data available. We report 12 months of surveillance data using a novel data collection methodology. Methods: We used an open-source, prospective method to collect 12 consecutive months of data, including demographics, behavior, illicit substance use, control methods used, and time of collapse after law enforcement contact. Descriptive analysis and chi-square testing were applied. Results: There were 162 ARD events reported that met inclusion criteria. The majority were male with mean age 36 years, and involved bizarre, agitated behavior and reports of drug abuse just prior to death. Law enforcement control techniques included none (14 percent); empty-hand techniques (69 percent); intermediate weapons such as Taser device, impact weapon or chemical irritant spray (52 percent); and deadly force (12 percent). Time from contact to subject collapse included instantaneous (13 percent), within the first hour (53 percent) and 1-48 hours (35 percent). Significant collapse time associations occurred with the use of certain intermediate weapons.”

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“On the Problems and Promise of Research on Lethal Police Violence”
Klinger, David A. Homicide Studies, 2012, 16(1) 78-96, doi: 10.1177/1088767911430861.

Abstract: “We presently have little information about how frequently police officers shoot citizens or are involved in any sort of interaction in which citizens die. Despite this, however, researchers persist in using the limited data available on fatal police violence in various sorts of analyses. The current article outlines the liabilities in available counts of fatal police action, describes some of the problems posed by using such data, discusses why counting citizens killed by police bullets is not a sound way to measure deadly force, and offers some ideas for improving measurement of the use of deadly force and other police actions that lead to the death of citizens.”

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“Arrest-Related Deaths Program Assessment: Technical Report”
Banks, Duren; Couzens, Lance; Blanton, Caroline; Cribb, Devon. Bureau of Justice Statistics, U.S. Department of Justice, March 2015, NCJ 248543.

Executive summary: “The Bureau of Justice Statistics (BJS) designed the Arrest-Related Deaths (ARD) program to be a census of all deaths that occur during the process of arrest in the United States…. We found that over the study period from 2003 through 2009 and 2011, the ARD program captured, at best, 49 percent of all law enforcement homicides in the United States. The lower bound of ARD program coverage was estimated to be 36 percent. These findings indicate that the current ARD program methodology does not allow a census of all law enforcement homicides in the United States. The ARD program captured approximately 49 percent of law enforcement homicides, while the SHR captured 46 percent. An estimated 28 percent of the law enforcement homicides in the United States are not captured by either system. However, the methodology for identifying ARD cases has changed over the observation period. In 2011, the ARD program was estimated to cover between 59 percent and 69 percent of all law enforcement homicides in the United States, depending on the estimation method used. While this coverage estimate still does not result in a census, it does suggest improvements over time in the overall approach to identifying law enforcement homicides and reporting them to the ARD program.

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“Can TASER Electronic Control Devices Cause Cardiac Arrest?”
Kroll, Mark W.; et al. Circulation, 2014. 10.1161/circulationaha.113.004401.

Introduction: “The electronic control device (ECD) has gained widespread acceptance as the force option for law enforcement because of its dramatic reduction in both suspect and officer injury. At the same time, advocacy groups post statements on the Internet listing the hundreds of arrest-related deaths after ECD use with the implication that the ECD involvement was causal. Studies covering a total of >48 000 forceful arrests have consistently found suspect injury rate reductions of ≈65 percent. Of the 250 000 annual ECD field uses in the United States, only 1 in 4000 is involved in an arrest-related death.” The research looks at 12 cases of cardiace after ECD application. Results: ” These data suggest that the threshold of factual evidence for blaming a cardiac arrest on an ECD should be set very high. The published case reports have not met that threshold.”

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“The Effect of the Prone Maximal Restraint Position with and without
Weight force on Cardiac Output and other Hemodynamic Measures”
Savaser, Davut J.; et al. Journal of Forensic and Legal Medicine, August 2013, Vol. 30

Abstract: “Background: The prone maximal restraint (PMR) position has been used by law enforcement and emergency care personnel to restrain acutely combative or agitated individual. The position places the subject prone with wrists handcuffed behind the back and secured to the ankles. Prior work has indicated a reduction in inferior vena cava (IVC) diameter associated with this position when weight force is applied to the back. It is therefore possible that this position can negatively impact hemodynamic stability. Objectives: We sought to measure the impact of PMR with and without weight force on measures of cardiac function including vital signs, oxygenation, stroke volume (SV), IVC diameter, cardiac output (CO) and cardiac index (CI). Conclusions: PMR with and without weight force did not result in any changes in CO or other evidence of cardiovascular or hemodynamic compromise.”

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“Effect of Position and Weight Force on Inferior Vena Cava Diameter: Implications for Arrest-related Death”
Ho, Jeffrey D.; et al. Forensic Science International, 2011. doi: 10.1016/j.forsciint.2011.07.001.

Abstract: “Introduction: The physiology of many sudden, unexpected arrest-related deaths (ARDs) proximate to restraint has not been elucidated. A sudden decrease in central venous return during restraint procedures could be physiologically detrimental. The impact of body position and applied weight force on central venous return has not been previously studied. In this study, we use ultrasound to measure the size of the inferior vena cava (IVC) as a surrogate of central venous return in the standing position, prone position, and with weight force applied to the thorax in the prone position…. Conclusions: The physiology involved in many sudden, unexpected ARDs has not been elucidated. However, in our study, we found a significant decrease in IVC diameter with weight force compression to the upper thorax when the subject was in the prone position. This may have implications for the tactics of restraint to aid in the prevention of sudden, unexpected ARD cases.”

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“Evaluation of the Ventilatory Effects of the Prone Maximum Restraint (PMR) Position on Obese Human Subjects”
Sloane, Christian; et al. Forensic Science International, April 2014, 237. doi: 10.1016/j.forsciint.2014.01.017.

Abstract: “The study sought to determine the physiologic effects of the prone maximum restraint (PMR) position in obese subjects after intense exercise. We designed an experimental, randomized, cross-over trial in human subjects conducted at a university exercise physiology laboratory. Ten otherwise healthy, obese (BMI > 30) subjects performed a period of heavy exertion on a cycling ergometer to 85 percent of maximum heart rate, and then were placed in one of three positions in random order for 15 min: (1) seated with hands behind the back, (2) prone with arms to the sides, (3) PMR position. While in each position, mean arterial blood pressure (MAP), heart rate (HR), minute ventilation (VE), oxygen saturation (SaO2), and end tidal CO2 (etCO2) were measured every 5 min. There were no significant differences identified between the three positions in MAP, HR, VE, or O2s at at any time period. There was a slight increase in heart rate at 15 min in the PMR position over the prone position (95 vs. 87). There was a decrease in end tidal CO2 at 15 min in the PMR over the prone position (32 mmHg vs. 35 mmHg). In addition, there was no evidence of hypoxia or hypoventilation during any of the monitored 15 min position periods. Conclusion: In this small study of obese subjects, there were no clinically significant differences in the cardiovascular and respiratorymeasures comparing seated, prone, and PMR position following exertion.”

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“Excited Delirium Syndrome (EXDS): Defining Based on a Review of the Literature”
Vilke, Gary M.; et al. Clinical Reviews, February 2011.

Abstract: “Patients present to police, emergency medical services, and the emergency department with aggressive behavior, altered sensorium, and a host of other signs that may include hyperthermia, ‘superhuman’ strength, diaphoresis, and lack of willingness to yield to overwhelming force. A certain percentage of these individuals will go on to expire from a sudden cardiac arrest and death, despite optimal therapy. Traditionally, the forensic community would often classify these as ‘excited delirium’ deaths. Objectives: This article will review selected examples of the literature on this topic to determine if it is definable as a discrete medical entity, has a recognizable history, epidemiology, clinical presentation, pathophysiology, and treatment recommendations. Discussion: Excited delirium syndrome is characterized by delirium, agitation, acidosis, and hyperadrenergic autonomic dysfunction, typically in the setting of acute-on-chronic drug abuse or serious mental illness or a combination of both. Conclusions: Based upon available evidence, it is the consensus of an American College of Emergency Physicians Task Force that Excited Delirium Syndrome is a real syndrome with uncertain, likely multiple, etiologies


Writers: John Wihbey and Leighton Walter Kille | Last updated: July 2, 2016

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Keywords: sudden custody deaths, in-custody death, prone restraint, agitated delirium, comparative, historical, justifiable homicide, policing



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IS THE KNOWN PRESENCE OF RIGHTISTS ON THE FORCE A PROBLEM IN THE SECURING OF AMERICAN SOCIETY? I INSTINCTIVELY SAY YES. THE POLICE SAY OFFICERS CANNOT BE PUNISHED OR ELIMINATED FROM HIRING DUE TO THEIR SOCIAL OR POLITICAL BIAS.


Police officers disciplined for wearing Trump hats in uniform - CBS 5 ...
www.cbs5az.com/.../police-officers-disciplined-for-wearing-trump-hats-in-...
HOME · Local News ... SAN ANTONIO, TX (CNN) - More than a dozen San Antonio police officers are facing discipline .... data on how often law enforcement officers use force and how often civilians die in police custody. .... From battle wounds to diseases, a number of maladies ravaged the health of the U.S. presidents.


Police officers disciplined for wearing Trump hats in uniform
Posted: Oct 12, 2016 1:35 PM EDT
Updated: Oct 19, 2016 1:35 PM EDT

The video shows some of the officers who escorted Trump's motorcade wearing his trademark red hat. (Source: Donald Trump/Twitter/SAPD/CNN)
The video shows some of the officers who escorted Trump's motorcade wearing his trademark red hat. (Source: Donald Trump/Twitter/SAPD/CNN)
SAN ANTONIO, TX (CNN) - More than a dozen San Antonio police officers are facing discipline after appearing in a video while wearing Donald Trump hats.

The Republican presidential candidate tweeted the video.

It shows some of the officers who escorted Trump's motorcade wearing his trademark red hat.

You can see clearly they have Trump's slogan, "Make America Great Again."

Police Chief William McManus said the officers violated policy by participating in political activity while in uniform and would be disciplined accordingly.

San Antonio Mayor Ivy Taylor said she was deeply disappointed.

Copyright 2016 CNN. All rights reserved.


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Lawyer says California police acted reasonably in killing - CBS 5 - KPHO
www.cbs5az.com/.../lawyer-says-california-police-acted-reasonably-in-killi...
An attorney representing two Sacramento, California, police officers said that they ... discusses the shooting of his brother during a news conference Monday, Oct. 3, .... enforcement officers use force and how often civilians die in police custody. .... From battle wounds to diseases, a number of maladies ravaged the health of ...


http://ktar.com/story/1301737/lawyer-says-california-police-acted-reasonably-in-killing/

Lawyer says California police acted reasonably in killing
BY ASSOCIATED PRESS
Updated Oct 4, 2016 - 9:59 pm

Photograph -- Robert Mann, right, the brother of Joseph Mann, who was killed by Sacramento Police in July, discusses the shooting of his brother during a news conference Monday, Oct. 3, 2016, in Sacramento, Calif. Mann, accompanied by his sister, Deborah, center, and attorney John Burris are demanding that the officers involved in shooting of Joseph Mann, 50, be charged with murder and that the U.S. Department of Justice open a civil rights investigation of the Sacramento Police Department. (AP Photo/Rich Pedroncelli)


SACRAMENTO, Calif. (AP) — An attorney representing two Sacramento, California, police officers said that they faced a “terrifying situation” with a mentally disturbed man on drugs and acted reasonably when they made a split-second decision to shoot the knife-wielding man in July.

Legal experts, meanwhile, said a dashboard camera recording of the two officers discussing hitting Joseph Mann with their police car before appearing to try to run him down does not make it more likely that they will face criminal charges in the shooting.

Officers John Tennis and Randy Lozoya were trying to knock down the 50-year-old black man with their patrol car, not kill him, attorney Judith Odbert said in a lengthy written statement Tuesday.

The officers can be heard on the recording saying, “I’m gonna hit him” and “OK, go for it” before appearing to drive their cruiser twice at Mann, who managed to scramble out of its way both times. The officers then stopped the cruiser, got out and pursued Mann on foot.

Odbert said the officers hoped “to take the subject off his feet to prevent the need for any other force to be deployed,” the statement said.

When that didn’t work, the two officers left their vehicle and shot Mann 14 times.

Odbert said Mann was “throwing items at them, he was intentionally defiant and moving aggressively towards officers with his weapon.”

“Mr. Mann was not an unarmed black male minding his own business and shot for racial reasons,” she wrote.

Mann’s relatives have called for a federal civil rights investigation and said the two officers should be charged with murder.

John Burris, an attorney for the family, said Odbert’s account directly contradicts what video recordings show about the incident.

“She must be blind,” Burris said. “The videotape clearly shows that he was standing still and pointing in the direction of the officers and they ran up on him without any escalation.”

“Regardless of what they think or said this shooting was unjustified,” Burris said.

He previously said Tennis and Lozoya acted like “big game hunters closing in on an animal.”

Odbert called Burris’ allegations that the officers set out to kill Mann “character assassination” and said the officers acted because they feared Mann was moving toward an area with more people.

The attorney also said the officers are not racist. Tennis is white and Lozoya is Latino, and both have mixed-race children, she said. She said the two Sacramento officers have received lifesaving and valor awards, and that Tennis once ran into a burning building to rescue occupants.

Prosecutors will have to evaluate the use of the police car and subsequent shooting to determine whether force was justified in each case, said Philip Stinson, an associate professor in the criminal justice program at Bowling Green State University in Ohio.

The officers may have reasonably feared for their lives or public safety, justifying any decision to use their vehicle to hit the man, he said.

“If you and I mowed somebody over, prosecutors would start with the assumption it was murder or manslaughter and work back from there,” he said. “With a police officer, the assumption they start with is, ‘Was this a justified use of deadly force?'”

A 911 caller initially reported that Mann appeared to have a gun, and Odbert said that made it a more dangerous situation.

Police found a knife but no gun after Mann was killed.

“It’s ugly, but it’s not necessarily illegal,” Jonathan Blanks, a researcher at the Cato Institute who studies police prosecutions, said about the attempt to use the police vehicle to stop Mann. “At the heat of the moment, you’re angered, your adrenaline’s going up, if you think this guy is a danger you’re not going to necessarily go in there with kid gloves.”

Blanks pointed to a case in Arizona last year in which a police officer rammed an armed suspect who police say had embarked on a daylong crime spree before stealing a rifle and shooting it in the air near businesses. The encounter was also captured on a dashboard camera.

An internal review by the Marana Police Department just north of Tucson found that Officer Michael Rapiejko acted swiftly and correctly, and prosecutors declined to charge him.

Prosecutors rarely file charges against police officers in part because legal rulings have given police leeway in the use of lethal force, Blanks said.

When prosecutors do file charges, officers are rarely convicted.

“Police officers have a hero’s halo in the minds of many Americans,” said Jody Armour, a criminal law professor at the University of Southern California Gould School of Law.

In the Sacramento case, Armour said officers could plausibly argue they thought the suspect had a gun, so they used their vehicles to protect themselves and the public.

Thanawala reported from San Francisco. Associated Press writer Alison Noon also contributed to this story.

Copyright © The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.



EXCERPT – “If you and I mowed somebody over, prosecutors would start with the assumption it was murder or manslaughter and work back from there,” he said. “With a police officer, the assumption they start with is, ‘Was this a justified use of deadly force?'”

A 911 caller initially reported that Mann appeared to have a gun, and Odbert said that made it a more dangerous situation.

Police found a knife but no gun after Mann was killed.

“It’s ugly, but it’s not necessarily illegal,” Jonathan Blanks, a researcher at the Cato Institute who studies police prosecutions, said about the attempt to use the police vehicle to stop Mann. “At the heat of the moment, you’re angered, your adrenaline’s going up, if you think this guy is a danger you’re not going to necessarily go in there with kid gloves.”



JUST TO CLARIFY FOR THOSE WHO DON’T KNOW, THE CATO INSTITUTE IS A LIBERTARIAN THINK TANK FOUNDED BY THE KOCH BROTHERS. IT IS NOT, THEREFORE, UNBIASED INFORMATION WHEN REFERENCED IN THE ARTICLE ABOVE. FOR ENOUGH INFORMATION ON THE KOCH BROTHERS TO MAKE YOU TOSS YOUR COOKIES, READ THIS WHOLE SOURCEWATCH ARTICLE BELOW AND THE NYT WRITING AS WELL, IF YOU CAN STAND IT.



http://www.sourcewatch.org/index.php/Cato_Institute

Cato Institute

Follow the money in the Koch wiki.

Learn more about how the State Policy Network aids ALEC and spins disinformation in the states.

Learn more from the Center for Media and Democracy's research on climate change.

This article is part of the Tobacco portal on Sourcewatch funded from 2006 - 2009 by the American Legacy Foundation.


The Cato Institute is a libertarian think tank founded by Charles G. Koch and funded by the Koch brothers. It is headquartered in Washington, D.C. The Institute states that it favors policies "that are consistent with the traditional American principles of limited government, individual liberty, and peace."[1] Cato scholars conduct policy research on a broad range of public policy issues and produce books, studies, op-eds, and blog posts. They are also frequent guests in the media. The Cato Institute is an "associate" member of the State Policy Network, a web of right-wing “think tanks” in every state across the country.[2]

Where ideology and science part company, Cato favors ideology, as shown by an advertisement[3] published in newspapers in 2009 disputing the state of the science on climate change.[4]

Controversy and Conflict: Koch vs. Crane
(http://www.newyorker.com/news/news-desk/the-kochs-vs-cato,
THE KOCHS VS. CATO, By Jane Mayer , MARCH 1, 2012)


Koch Wiki

The Koch brothers -- David and Charles -- are the right-wing billionaire co-owners of Koch Industries. As two of the richest people in the world, they are key funders of the right-wing infrastructure, including the American Legislative Exchange Council (ALEC) and the State Policy Network (SPN). In SourceWatch, key articles on the Kochs include: Koch Brothers, Koch Industries, Americans for Prosperity, American Encore, and Freedom Partners.