Sudden Custody Death
Who’s right and who’s wrong?

Excited Delirium & SCDS
• The victims of SCDS usually have levels of
identifiable foreign agents in their system
that trigger abnormal behavior, actions,
reactions or personal conduct. They die in
ambulances, emergency rooms, trauma
centers and under the immediate care of
trained and highly skilled medical
personnel.

COCAINE Psychosis
• Original studies of these fatalities in custody began back in
the 80’s in Miami with Metro-Dade police. The studies
began as an attempt by medical examiners to understand
why people were dying in police custody. There was no
apparent reason for the death. So, why did they die?
• Studies broadened as examiners found these deaths were
not just occurring with police arrests
• Common denominator in these deaths… the level of
cocaine found post mortem in toxicology results

Research Findings
• 1. Overdose - 6 mg/l (milligrams per litre)
• 2. Cocaine psychosis victims as low as .6
mg/l
• Physiological symptoms..seizures, high
temps, dilated pupils
• High % had been “hog-tied”

HYPERTHERMIA
• Psychostimulant drugs such as amphetamines,
amphetamine derivatives, and cocaine can produce a
number of potentially lethal effects
• Psychostimulant overdoses can cause cardiovascular
compromise, seizures, and hyperthermia.
• Hyperthermia is a common result due to severe doses or
overdoses
• Hyperthermia also occurs in lower doses of
psychostimulants and may cause rhabdomyolysis.
• Activation of particular dopamine receptors in the central
nervous system may cause psychostimulant induced
hyperthermia.

Excited Delirium
• Continued fatality studies reveled behavioral similarities
between cocaine psychosis victims and those under the
influence of other drugs.
• Sometimes even the lack of having taken certain
prescription drugs could cause a similar response in
abnormal behavior (such as lithium in the case of certain
manic depressants)
• New term - excited delirium - came about

Symptoms and behavioral
patterns
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bizarre and aggressive behavior
dilated pupils
fear
high temps (106-108)
hiding behind things
irrational, incoherent speech
jumping into water

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panic
paranoia
profuse sweating
public disrobing
self-inflicted injuries
shivering
shouting

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seizures
unexpected physical strength
violent behavior (general)
violence towards others
violence towards objects (glass)
watch for more than one symptom

CASE HISTORIES
• 1. Minneapolis tree climber
• 2. Minneapolis man on Lyndale
• 3. Minneapolis north side
incident

Positional Asphyxia
• The position of the body interferes with the
person’s ability to breath.
• Interference with proper breathing produces
an oxygen deficiency (hypoxia) in the blood
which disturbs the body’s chemistry and
can create a condition for fatal rhythm
disturbance in the heart.

DR. Reay’s study
• Pub. 1988 - Am. J. Forensic Med. Pathology
• concluded that after exercise (or violent struggles)
blood oxygen levels decrease.
• “Hog-tie Restraints” prevent these levels from
rising again because it impairs the mechanical
process of inhaling and exhaling.
• Lactic Acidosis occurs and subject cannot exhale
enough of the carbon dioxide that builds up.

DR. Thomas Neuman’s study
• 1988 case - Price v. County of San Diego
• Tests conducted at UCSD Medical Center
• finding - blood oxygen levels do not decrease after
exercise (struggle). The blood maintains enough oxygen.
• hog-tie restraint impairs normal breathing to an extent but
does not affect blood oxygen or carbon dioxide levels.
• Methodological and logical flaws of Reay’s study were
explained
• Reay retracted his findings

U.S. Court of Appeals 10th Circuit

Cruz v. City of Laramie, WY
• Holding: Hog tie on suspects with diminished
capacity considered excessive force in Sec. 1983
action.
• Court’s understanding is that a hog tie is binding
legs to hands with 12 inches or less of separation.
• Did not reach the question as to whether all hog tie
restraints were a constitutional violation per se,
but did hold that applying this technique when a
subjects diminished capacity is apparent is
unreasonable.

Drugs, Death, and Blame
• Always keep in mind that people that exhibit symptoms
and behavioral patterns suggesting cocaine psychosis or
excited delirium are experiencing a medical emergency
• Manic depressants taking Lithium will sometimes
discontinue taking their meds. These subjects often appear
to be in a state of Excited Delirium and may well be.
• Excited Delirium is regarded as a “medical emergency
with a psychological presentation”
• BEWARE of SUDDEN TRANQUILITY
• Try to minimize the appearance of “mishandling” suspect.