Excited delirium is a real risk, Nova Scotia report into taser death warns

See also NOVA SCOTIA REPORT ON "EXCITED DELIRIUM" MISSES THE ENTIRE POINT

September 7, 2009
OLIVER MOORE, Globe and Mail

Excited delirium is real and anyone showing symptoms of it should be "considered at risk of sudden death," according to a report commissioned by the Nova Scotia government.

The chairman of a panel of medical and mental-health experts dismissed as pointless the continuing debate over whether excited delirium, often cited in the deaths of people who have been tasered, actually exists.

"Does it exist as a medical diagnosis? That's a useless discussion - the phenomenon exists," Stan Kutcher, an expert in adolescent mental health at Dalhousie University's department of psychiatry, said. "The point is, what is this phenomenon, how can we best identify it, how can we best intervene?"

The panel's report warns that efforts to restrain someone suffering from excited delirium, which the report calls an autonomic hyperarousal state, may be risky. Medical personnel should be summoned as soon as possible, the panel recommends. "The state itself is a medical emergency," Dr. Kutcher said. "People in this state have a higher risk of death."

According to the report, given to the government in June and released publicly Friday, first responders should try to de-escalate the situation and negotiate when dealing with such a person. But if physical restraint proves necessary, it must be done as rapidly and safely as possible because a long struggle may pose greater risk to the subject.

The authors do not specify what form that restraint should take. That raised concerns for a lawyer acting for the family of Howard Hyde, a paranoid schizophrenic Dartmouth man who died in custody 30 hours after being tasered by police.

"From what I can see, the police [handling Mr. Hyde] felt that they were doing just that by using the taser," Kevin MacDonald said. "That's seen as the quickest and safest way to restrain someone."

Justice Minister Ross Landry said that more research needs to be done to determine whether there should be greater restrictions on how the stun weapons are used.

"I was a police officer for 30 years and I don't think this report takes away the need for the taser at this time," he said. "We're still trying to determine the relevance of the taser and what impact it has with regards to excited delirium."

The panel, which was struck last fall, included Nova Scotia chief medical examiner Dr. Matthew Bowes, who found that Mr. Hyde's death was caused by excited delirium because of his mental illness. It was tasked with cutting through what the government viewed as public confusion surrounding the condition.

Excited delirium, not taser, behind death of N.S. man: medical examiner

September 17, 2008
The Canadian Press

HALIFAX — Nova Scotia's medical examiner has found that the death of a man who suffered from paranoid schizophrenia and collapsed 30 hours after he was Tasered by police was not caused by the powerful stun gun.

Justice Minister Cecil Clarke released the long-awaited findings Wednesday, 10 months after the 45-year-old musician was arrested at his Dartmouth, N.S., apartment over a domestic dispute and later died in a police cell.

Clarke also said he would launch a fatality inquiry into the case to determine what happened to Hyde when he was taken into custody and if the man with a known history of mental illness should have instead been taken to a psychiatric facility.

"That will be a component of the inquiry because it's specific to the process of a person with a mental illness and the appropriateness of where they were and when," Clarke told reporters.

"That's why we need to have that independent assessment."

Medical examiner Dr. Matthew Bowes concluded that Hyde died of excited delirium due to paranoid schizophrenia. He said Hyde's coronary artery disease, obesity and the restraint used by police during a struggle were all factors in his death.

A recent independent report commissioned by the RCMP slammed the use of the term "excited delirium," which is used by police officers to describe combative, resistant suspects.

The report, ordered after a Polish immigrant died following multiple Taserings by Mounties at Vancouver International Airport last October, said the condition is not a recognized medical diagnosis and is used as an excuse to justify firing the 50,000-volt charge.

Some 20 people in Canada have died after they were Tasered.

Stephen Ayer of the Schizophrenia Society of Nova Scotia also criticized the finding, saying excited delirium is not a legitimate medical condition.

He said it should be referred to as acute agitation, a condition he says can be fatal if someone is not properly restrained.

"I'm finding it very surprising and extremely concerning that he would rule the death to excited delirium," he said. "It is well known that if you restrain an individual who is acutely agitated, that person can die.

"So how can he rule this as being accidental?"

Clarke said he recognized the controversy around the diagnosis, but added that the examiner's report was peer-reviewed and that he would monitor opinion from the medical community on the issue.

The province has held three separate investigations into the Hyde case to examine police conduct and the use of Tasers.

They found police acted appropriately, but Clarke later modified the rules for Taser use by police. He said the changes would restrict when officers deploy the guns and require a more rigorous explanation as to why they used one.

NDP justice critic Bill Estabrooks said the inquiry only prolongs a process that should have produced answers long ago on what happened to Hyde and why he ended up dying in a police cell.

"We have another layer of bureaucracy, we have another example of delay," he said. "We're not getting many answers today. Now we're going to have to wait even longer."

Hyde had been arrested at his home on Nov. 22 for spousal abuse and taken to police headquarters, where he was shot with a Taser more than once. He later died after struggling with guards in the Dartmouth jail.

In a government news release, excited delirium is described as a disorder characterized by extreme agitation, violent and bizarre behaviour, insensitivity to pain, elevated body temperature, and superhuman strength. It says not all of these characterizations are always present in someone with the disorder.

The fatality inquiry in Nova Scotia will be conducted by a judge, who will have the authority to hold public hearings and hear witnesses.

The independent RCMP report also suggested more attention be paid to factors that may affect risk of harm, including the subject's body weight, pregnancy, medical devices such as pacemakers, psychosis, ingestion of drugs and prolonged acute stress and exhaustion.

'Excited delirium', not taser, to blame for Hyde's death, M.E. says

September 17, 2008
The Chronicle Herald (Halifax, Nova Scotia)

It was excited delirium, not being zapped with a Taser, that killed Dartmouth resident Howard Hyde in November, Nova Scotia's chief medical examiner ruled today. Matthew Bowes met with the Hyde family today to tell them his findings, according to a government news release.

Mr. Hyde, who suffered from paranoid schizophrenia, died Nov. 22 about 30 hours after he was Tasered by Halifax police. He had been involved in a scuffle with jail guards at the Central Nova Scotia Correctional Facility in Dartmouth.

Dr. Bowes has concluded, however, that Mr. Hyde's death was an accident and that he died from excited delirium due to paranoid schizophrenia. "Atherosclerotic coronary artery disease, obesity and restraint during a struggle were all contributing factors," the government's news release.

Justice Minister Cecil Clarke is holding a news conference in downtown Halifax to explain Dr. Bowes's findings.

Excited delirium has been a controversial diagnosis in Taser-related deaths. The disorder is characterized by extreme agitation, violent and bizarre behavior, insensitivity to pain, elevated body temperature, and/or superhuman strength.

Dr. Bowes's examination found that Mr. Hyde did not die of asphyxiation due to restraint or of being Tasered by police the day before his death. "At my request, the case file was independently reviewed and summarized by Dr. Marnie Wood, a forensic pathologist who was not involved in the initial investigation," Dr. Bowes said in the release.

The province's medical examiner says this marks the end of his investigation.