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'Excited delirium' didn't kill Elijah McClain despite what initial autopsy suggested

A 9NEWS Originals investigation tried to better understand why the controversial "diagnosis" ended up in the initial autopsy of the man who died in 2019.

DENVER — In 2017, during a six-month stretch, the bodies of two men who died in law enforcement custody arrived at the Adams County Coroner’s Office for autopsies.

Both men were restrained facedown before they died. Both died shortly after fights with arresting officers. Both were autopsied by Dr. Stephen Cina, a forensic pathologist.

In each case, Cina determined the men died not from the restraint or the fights but from something known as “excited delirium.” That determination played an important role in clearing all officers of any criminal wrongdoing in both deaths.

Neither case received more than scant media attention.

Two years later, another body arrived at the Adams County Coroner’s Office for review. This time the case was much more high profile.

The man’s name was Elijah McClain. Once again, Cina led the autopsy.

It’s clear, this time, he struggled to find a cause of death. The autopsy he signed Nov. 7, 2019, listed both the cause and manner of death “undetermined.”

He still believed, however, that “excited delirium” might have been at play. Why else would he have mentioned the words three times in his opinion? 

“While on scene, [McClain] displayed agitated behavior and enhanced strength. These features are commonly seen in Excited Delirium,” he wrote.

“The patient’s sudden collapse after an intense struggle is commonly seen in 'excited delirium,'” he added.

Two weeks later, 17th Judicial District Attorney Dave Young cleared all officers of any criminal wrongdoing.

In 2020, 60 Minutes reporter John Dickerson asked Young about that decision.

“Did the 'excited delirium' being included in the autopsy make your job easier or harder in terms of making your final determination?” asked Dickerson.

“That’s a good question,” replied Young. “And the answer to that question is it made it easier.”

Years later, it’s still not clear why Cina suggested “excited delirium” had anything to do with McClain’s death. Neither he nor Adams County Coroner Monicia Broncucia-Jordan will answer our questions. Experts in the field of “excited delirium” said McClain’s death clearly had nothing to do with the controversial term. A casual review of the body camera recordings shows zero sign of any agitation or delirium prior to the restraint.

And, in 2021, when Cina amended his autopsy report following intense media attention on McClain’s death, he dropped the term completely from the report. A ketamine injection, the autopsy concluded, likely led to McClain’s death.

That same year, or two years after the local district attorney cleared everyone based on the “excited delirium” theory, a grand jury charged three Aurora Police officers and two fire paramedics.

Dr. Bill Smock, the police surgeon for the Louisville (KY) Police Department, wonders why it took so long for the story to shed its “excited delirium” skin.

“There was nothing there that says Elijah McClain had 'excited delirium,'” he told 9NEWS.

Alex Gutierrez died under a pile of officers March 16, 2017, in Adams County. The only officers who had body cameras failed to turn them on during the restraint.

When a firefighter showed up on scene, he saw Gutierrez’s body and asked if he’d been hit by a car.

Every one of the Thornton Police officers on scene initially “refused to make a statement,” according to 17th Judicial District Attorney’s Office review of the case. Instead, the report stated, they “demanded an opportunity to view all available evidence of the incident” before agreeing to talk. The officers ultimately relented a month later, but that initial decision, according to the DA review, threatened “to diminish the trust and respect of those citizens that we are privileged and honored to serve.”

And yet, even now, you’ll hardly see or read a mention of Gutierrez’s death anywhere. His daughter believes she knows why.

“Excited delirium,” said Avina De Luna.

“When did you find out about excited delirium?” I asked her.

“When I read it on my father’s autopsy report,” she said. Drug-induced “excited delirium” and not the restraint killed Gutierrez, concluded Cina in April 2017.

At that moment, she said, the investigation died, as well. “We still don’t know what truly happened,” she said.

Months later, a man named Paul Egli died under a trio of Adams County Sheriff deputies.

Once again, Cina concluded “excited delirium” and not the restraint was the cause of death. His nine-page autopsy reveals little evidence that backs up the “excited delirium” conclusion.

No mention of some of the supposed “telltale” signs of it. Things like hyperthermia. And superhuman strength. Instead, the autopsy relies on Egli’s erratic behavior.

“His admission urine toxicology screen was qualitatively positive for cocaine and cannabis,” wrote Cina.

Egli, Gutierrez and McClain are three of now more than 150 deaths since 2010 that 9NEWS has connected to the controversial term “excited delirium.”

No major medical organization currently recognizes it.  The American Medical Association and the American Psychiatric Association roundly criticized use of the term years ago.

For believers, "excited delirium" is marked by aggressive/nonsensical behavior, high body temperature, imperviousness to pain and “superhuman” strength.

Critics said it's used as a convenient excuse for when someone dies in law enforcement custody. Almost all of the deaths 9NEWS has identified happened during or not long after law enforcement restraint and/or use of a stun gun or ketamine injection.

“I am troubled by the use of 'excited delirium' as a medical diagnosis,” national EMS trainer Eric Jaeger told 9NEWS. “The key question, in my mind, isn’t whether 'excited delirium' exists. The key question in my mind is… what is killing all of these individuals if it is clearly not 'excited delirium?'”

Are some deaths classified “excited delirium” that are clearly not?

“Absolutely, and I think Elijah McClain’s death would be Exhibit A,” replied Jaeger.

After 9NEWS sent a copy of the Aurora Police body camera recordings, Smock said it took him a matter of seconds to recognize Elijah McClain was never suffering from “excited delirium.”

“Listen to what [McClain] says. He is interacting. He’s talking to the officers. Is his speech incoherent? No. It’s normal speech, so that was not 'excited delirium,'” said Smock.

It’s roughly the same message he delivered to a jury in Minneapolis in 2021 during the trial of the officer now convicted of murdering George Floyd.

“[Floyd] was conversing with the officers. He was telling them he couldn’t breathe. Was his speech understandable? Yes. Was he incoherent? No,” Smock told us.

“I don’t think [Floyd] had one of the 10 symptoms,” he added.

Smock said anyone with even a casual knowledge of what "excited delirium" is and, perhaps more importantly, is not can easily spot some characteristics.

“If you can understand somebody, and they’re having a conversation with you, is that 'excited delirium?' No. That is not. There is something else going on,” he said.

The first minute of the body camera recordings is filled with Elijah McClain’s own, easy-to-understand, words.

“Leave me alone.”

“You guys started to arrest me.”

“Please respect the boundaries that I am speaking.”

It’s not clear what parts of the body camera recordings Cina reviewed before coming to his conclusions. The Aurora Police Department, in a prepared statement, said, “A flash drive containing body-camera footage of the officers’ contact with Elijah McClain was provided to the coroner before the first autopsy report was published. Investigators also met with the coroner and offered them the ability to watch the body camera footage.”

The initial autopsy said Cina reviewed “body camera footage from the restraining officers.”

9NEWS asked the elected coroner of Adams County, Monica Broncucia-Jordan, a series of questions on July 10. Specifically, we wanted to know if Cina reviewed the first few minutes of the body camera recording that clearly shows a coherent and not agitated Elijah McClain.

She has refused to comment.

Ian Farrell teaches criminal law at DU Law School. He said the fact that Cina amended his autopsy makes the autopsy issue a potential problem during the criminal trials of the three officers and two paramedics.

“I wouldn’t be surprised at all to see it happen,” he said.  


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