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When people die in custody, doctors have been willing to provide a medically-backed excuse

A white paper adopted by ACEP has turned into an ally of those sued after someone dies during or after chemical or physical restraint, a 9NEWS investigation found.

COLORADO SPRINGS, Colo. — Despondent and intoxicated, Jerica Lacour sobbed as a team of paramedics strapped her into a gurney on a cold night in January 2018.

Seconds later, as a member of that team placed a spit mask over her face, the sobs turned to screams in a parking lot just east of Colorado Springs.

“Guess who gets ketamine!” shouted a paramedic.

It seemed to work. Lacour calmed. The team got her into the ambulance. 

That’s when her heart stopped. On the way to a hospital, a frantic attempt to restart Lacour’s heart failed.

Months later, the El Paso County Coroner’s Office concluded the ketamine injection led to Lacour’s death.

It seemed plausible, but after Lacour’s family filed a civil lawsuit against the paramedic who injected the ketamine, an alternative theory emerged.

“It is my professional medical opinion that Mrs. Lacour was in a state of excited delirium at the time she was administered ketamine,” Colorado Springs ER physician Dr. Jack Sharon told the medic’s defense team, according to a filing in the civil suit.

Lacour’s husband still doesn’t know what the term means. 

“I have no idea,” Anthony Lacour said. “I’ve never heard of it.”

To bolster his opinion, Sharon cited a study done by the American College of Emergency Physicians – an organization that represents nearly 40,000 emergency medicine physicians around the country.

Not only is excited delirium a real thing, said the ACEP study, but it can also lead to death.

That study – a white paper adopted by ACEP in 2009 – has turned into an ally of those sued after someone dies during or after chemical or physical restraint, according to a 9NEWS investigation.

Our investigation found the ACEP study cited in numerous court filings, police training manuals, FBI reports and state health department recommendations.

The message of those who cite it is simple. Don’t just believe us, believe ACEP.

“It’s this respectable medical organization saying people die from excited delirium,” California civil rights attorney Julia Sherwin said.

There’s just one big problem, Sherwin said. The study, she said, is nonsense.

“That paper has been used to exonerate people who kill others during the course of restraint,” she said.

This month, after prodding from physicians and lawyers like Sherwin, ACEP finally decided to rebuke its own report. But, as our investigation shows, damage has already been done.

Lacour’s case is simply one example of many.

RELATED: How ‘Excited Delirium’ might live on despite medical community’s renunciation

The paper's origins

Those who believe in excited delirium say it’s marked by such symptoms as severe agitation, imperviousness to pain, profuse sweating and superhuman strength.

Decades after doctors in south Florida popularized the term in the mid-'80s, however, the term remains hotly debated.

Undoubtedly, there are those who work in emergency rooms and policing who will swear they’ve seen it. Sometimes, they’ll say, it’s the “crazed” suspect or patient who remains unfazed by zaps from stun guns or streams of pepper spray.

Critics don’t try to discount those stories, but they often question whether it can lead to “sudden death.”

And that’s where the ACEP white paper comes in.

Born a year prior to its 2009 release, the white paper owes a good portion of its origin story to a 2008 conference of mostly pro-police speakers and attendees.

John G. Peters, the founder of the Institute for the Prevention of In-Custody Deaths, acknowledged his group played a big role. He said the list of the white paper’s authors proves it.

“Many of the names on it were at our conference,” Peters said.

That conference, the third annual for IPICD, billed itself as a way to mainstream the term “excited delirium.” It was held at an off-the-strip hotel and casino known as the Orleans.

“The 2008 IPICD Conference will be the first consensus conference that focuses upon excited delirium and response protocols. Attendees will help make law enforcement, medical, and legal history through topic-specific breakout groups focused on arriving at a ‘consensus’ about excited delirium,” read an August 2018 press release.

Last year, Physicians for Human Rights (PHR) published a study that discussed the backgrounds of the speakers as it probed the origins of ACEP’s involvement in the excited delirium debate.

“The conference speakers included TASER and/or restraint death defense experts and consultants,” read the PHR report. “Despite the close links between the paper’s co-authors and TASER, PHR has been unable to find conflict-of-interest statements or disclosures in connection with the conference or the resulting white paper.”

One of the speakers was Dr. Gary Vilke, a well-known defender of police restraint tactics. In 2020, Dr. Vilke, a San Diego emergency medicine physician, told 9NEWS he couldn’t recall the last time he had testified against law enforcement. He’s often paid tens of thousands per case and has worked on dozens of cases in the last decade, according to his own testimony.

In 2009, Vilke and other IPICD conference attendees signed their names to the ACEP white paper, and a medically backed explanation for in-custody deaths was born.

Vilke declined a new request for an interview.

“I don’t think most of [ACEP’s] members knew [the white paper] was a propaganda piece that came out of a propaganda conference funded by TASER experts and lawyers and so forth,” Sherwin said. 

Axon manufactures TASER stun guns.

Axon executives did not respond to calls or emails seeking comment on the white paper.

Report cited in multiple cases

In 2020, when Daniel Prude died after police restraint in Rochester, New York, the state’s attorney general called a grand jury to see if any officers would be charged in the high-profile case.

Her expert?

Dr. Gary Vilke. He said Prude didn’t die from the restraint, but from excited delirium.

“He noted that people suffering with this medical condition are particularly vulnerable to death by cardiac arrest, and he further concluded that it was this – cardiac arrest - that ultimately caused Mr. Prude’s death,” read a New York Office of the Attorney General report.

That report cited the ACEP report three times.

The officers were never charged.

When prosecutors cleared officers in the 2013 death of Linwood Lambert in Virginia, they cited the ACEP white paper six times.

“The term has been used to refer to a rare subcategory of delirium which has primarily been described after death in the medical examiner literature,” prosecutors wrote.

One of the symptoms, ascribed to the ACEP white paper, included “police noncompliance.”

A judge cited the white paper in filings after Dustin Barnwell died in 2011 after a botched intubation in Tennessee. He denied the request to exclude excited delirium testimony after writing, “it has been recognized a syndrome.”

After police tased Charles Todero 16 times in Indiana in 2016, a court filing in the civil case said “there is therefore support in the scientific community for the existence of excited delirium” due, in no small part, to American College of Emergency Physicians “consensus.”

When the International Association of Chiefs of Police issued a resolution about “mitigating liability,” it stated, “the American College of Emergency Physicians (ACEP) have recognized ExDS as a medical condition.”

A story on the FBI website says, “an expert panel convened by the American College of Emergency Physicians recognized ExDS [excited delirium syndrome] as a unique clinical syndrome amenable to early therapeutic interventions.”

We found the white paper cited in literature distributed by the Pennsylvania Department of Public Health, the state of Maine, and the city of Minneapolis.

After police in Honolulu, Hawaii, repeatedly tased and pepper sprayed Sheldon Haleck before he died in 2015, an expert hired by the defense told a jury Haleck’s death was due to excited delirium. Dr. Stacey Heil told the jury, “A task force got together from the American College of Emergency Physicians – that’s one of our professional societies – and they developed a task force to come together, review all of the literature to say that excited delirium syndrome indeed existed.”

In the end, the jury decided the officers involved in Haleck’s death weren’t responsible.

“The expert witness, she really pushed [excited delirium] a lot. She pushed that quite a lot,” said Verdell Haleck, Sheldon Haleck’s mother.

ACEP withdraws approval

Tired of stories like Sheldon Haleck’s, this year Dr. Brooks Walsh, an emergency medicine physician in Connecticut, decided it was finally time for ACEP to acknowledge its own role in the excited delirium debate.

“I believe this has done tremendous harm to our organization,” he said. “I believe it does harm to our credibility.”

At ACEP’s annual conference – held this year in Philadelphia – he helped author a resolution to officially have ACEP rebuke the 2009 white paper.

“As a member of ACEP,” he said, “I feel culpable.”

In October, ACEP’s board decided it was time.

On its website today, you can find the following words, “ACEP’s 2009 White Paper Report on Excited Delirium Syndrome is outdated and does not align with the College’s position based on the most recent science and better understanding of the issues surrounding hyperactive delirium. ACEP has withdrawn its approval of this paper. The term excited delirium should not be used among the wider medical and public health community, law enforcement organizations, and ACEP members acting as expert witnesses testifying in relevant civil or criminal litigation.”

It’s too late for the Halecks.

But not too late, potentially, for Jerica Lacour’s family. The case against the paramedic who injected Lacour with ketamine near Colorado Springs is set to go to trial in December.

Key to the defense, at least for now, is the idea that ACEP’s white paper supports use of the term “excited delirium.”

Now that the white paper is “outdated,” it’s not entirely clear what the defense will be.

RELATED: Discredited 'excited delirium' term still attached to past death investigations in Colorado, other states



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