Minnesota lawmakers want to ban “excited delirium” training for police

Minnesota could be the next state to ban training for police officers on “excited delirium,” a term that has been rejected in recent years by major medical groups as pseudoscience to justify deaths in police custody.

Police officers inducing excited delirium during deadly interactions such as the killing of George Floyd have sparked a wave of criticism across the United States about the term’s legitimacy. Since October, Colorado and California have passed laws banning emergency responder use, and other state legislatures are poised to follow suit.

The DFL-led Minnesota House of Representatives passed a sweeping public safety bill in April with a provision that prohibits the state’s police accreditation board from providing, certifying or reimbursing training on excited delirium. There is currently no companion bill in the Senate, so whether the ban will take effect remains to be seen as both chambers negotiate the final version in the final weeks of the session, which ends May 20.

Excited delirium usually refers to a person who is obsessed with a potentially fatal form of agitation, sometimes fueled by drug abuse, and exhibits aggressive behavior, profuse sweating, public nudity, foaming at the mouth, and superhuman strength. In 2021, the American Medical Association released a statement rejecting the diagnosis as “a manifestation of systemic racism.” The American Psychiatric Association followed with a similar denial, and the National Association of Medical Examiners now says it should never be cited as a cause of death.

““Right now there is not a single medical association that considers excited delirium legitimate,” said Dr. Altaf Saadi, a neurologist at Massachusetts General Hospital, who has called for an end to use of the term in the United States.

The bill’s author, Jessica Hanson, DFL-Burnsville, declined an interview request for this story. In a committee hearing in April, she described excited delirium as a diagnosis “rooted in anti-Black racism.”

“The term excited delirium appeared out of nowhere in Florida in the 1980s,” Hanson said. “It has no scientific basis, no functional significance in medicine and no clear diagnostic criteria or symptoms.”

Minnesota’s largest professional police association has taken a neutral position on the bill, said Leslie Rosedahl, spokeswoman for the Minnesota Police and Peace Officers Association. In Minneapolis, Mayor Jacob Frey has already banned excited delirium in city police training.

A doctor in Miami first used the term in 1981 to describe a drug smuggler who died after a bag of cocaine burst in his digestive tract. The tear sent a “flood of cocaine” into the man’s body, and in the hours before his death, “his behavior became so dangerous that he had to be restrained by six hospital employees,” according to an article in the medical journal Psychology Medicine.

In the 1990s and 2000s, doctors and coroners began using the term more broadly, often to describe people who died in police custody or prison, including after the use of a stun gun.

Paramedics and police often encounter agitated, unpredictable people who are difficult to calm down and may pose a danger to themselves or others. Critics say excited delirium has become a vague umbrella term that describes a variety of unrelated causes and is used to justify the use of force and sometimes delay appropriate medical care to a person in distress.

“Medical support for this diagnosis collapsed,” said Dr. Jennifer Brody, an internal medicine and addictions specialist who teaches at Harvard Medical School. “There are simply no medical reasons to rely on.”

In the last five years, two high-profile cases of people dying in police custody have brought new attention to excited delirium in the medical community.

In 2019, Elijah McClain died after police in Aurora, Colorado, restrained him in a chokehold and paramedics injected him with an overdose of the sedative ketamine. The 23-year-old Black man was walking home after buying iced tea and apparently dancing to music on his headphones when a neighbor called 911 to say he was acting “awkward.” Afterward, the paramedics, who have since been convicted of criminal negligence, said they believed McClain was suffering from excited delirium.

The next year, Minneapolis police officer Derek Chauvin killed Floyd by kneeling on his neck. In a federal civil rights trial, three officers convicted in Floyd’s death testified at length that they believed Floyd may have been suffering from excited delirium. Officer Alex Kueng said he believed the condition could cause Floyd to “come back to life” and become a threat again, even after he became unresponsive. In a separate proceeding, Chauvin’s lawyer argued that his client behaved like a “reasonable police officer” watching for signs of excited delirium.

In previous Minneapolis police training, officers were told that excited delirium was an extreme form of agitation characterized by superhuman strength, bizarre speech and aggressive behavior. A training slideshow shown to the jury showed an image of officers subduing a man by pinning him with their knees, similar to how Chauvin restrained Floyd. Officer Thomas Lane, who spoke of excited delirium at the scene, said he was taught to restrain people in such a state to “stop a person from lashing out and keep them in place.”

Saadi said she had never heard of excited delirium before these cases, which led her to review the science.

“It is a convenient diagnosis because on the one hand it can be used to justify police brutality, but on the other hand it can also be used to explain sudden death in police custody,” she said. “So we saw it being used – in both directions.”