Excited delirium inquiry finds standardized system needed

A fatality inquiry judge who lookedinto the death of a man who died while in custody of Calgary police says Canada needs a standardized system to prevent so-called excited delirium deaths, including a national database.

Its just one of nine recommendations released Tuesday into the mans death after Calgary police used a stun gun to arrest him three years ago.

Officers found Gordon Bowe from Castlegar, B.C., behaving erratically in the basement of a vacant house in the southeast community of Fonda Park in 2008.

Police described Bowe as jumping and diving off walls, saying he fought against officers for several minutes during the arrest then was "very still and did not look like he was doing well."

Bowe was being restrained by four city police officers who had been called to investigate a possible break and enter. The 30-year-old had also been shocked with a Taser, although the stun gun did not appear to work.

The medical examiner's report said Bowe's death was caused by excited delirium due to high levels of cocaine, not the use of a Taser.

At the time, Bowe's family said the arresting officers should have recognized the state he was in and treated him accordingly.

On Tuesday, Bowe's father-in-law John Chernenkoff said the family believes the inquiry is still incomplete.

"There were other issues that we presented that weren't addressed but that might be due to the limitations of the fatality inquiry," he said.

But Chernenkoffhopes to see the inquiry's recommendations put into place.

"We lost a family member, we can't change that, so all we could do was to try and change things so the same situation doesn't reoccur."

Provincial court Judge Heather Lamoureux had nine recommendations, including theCanadian Association of Chiefs of Police create a database to record and share details about deaths due to excited delirium.

"For the same rationale as a provincial system is required, similar reporting on a national scale would provide an enormous amount of data upon which the Canadian police chiefs could conduct research," wrote Lamoureux.

Officials with the organization were unavailable for comment.

More training needed

Another key recommendation is that all police agencies in Alberta train their officers annually in the identification and management of excited delirium incidents, and that training should involve real case studies and scenario-based training.

Lamoureux noted Calgary police are already training officers about the condition, but it's not being done throughout the province.

The report also suggests that all 911 call takers and dispatchers providing services to police agencies receive updated training on excited delirium.

Another finding was thatall police agencies and EMS should create a common terminology and front-line police officers communicate directly with responding EMS members on a common radio channel using the term "excited delirium."

"We know that this isextremely difficult to deal with thosethat are suffering from excited delirium and you can never guarantee how these things will play out, or what the outcome may be," said Calgary Police ServicesChief Rick Hanson.

The inquiry also recommends that police consistently report all excited delirium cases, including Taser impact locations, to allow for better research.

"One that is immensely important is standardizing the procedure that is used provincially and across Canada to get data, common data,that is useful for the medical world and police world to react better to," said Hanson.

Excited delirium, also known as autonomic hyper-arousal, is characterized by increased strength, paranoia and suddenly violent behaviour. It is further marked by profuse sweating and an elevated heart rate.

Dr. Christine Hall, an expert on excited delirium from Victoria, is attempting to document all excited delirium cases across the country which involved police restraint.

Hall testified last year at the inquiry there is insufficient data to determine whether all cases of excited delirium lead to death. But she said the risk of death increases with physiologic stress, such as a physical encounter with officers.

She suggested police need to better recognize the symptoms of the condition and try to reduce the stress of people they are placing under arrest.

"It was Dr. Hall's observation that more time must be taken to teach police that individuals who 'give up' suddenly during a physical interaction with police may in fact be in need of urgent emergency care," said the judge's report.

Controversial diagnosis

Two years ago, a judge examining the death of a man Tasered by Halifax-area jail guards ruled out the cause of death as excited delirium. The judge in that case, Anne Derrick, ruled Howard Hyde died because jail guards applied restraint techniques that interfered with his breathing. Hyde was a longtime paranoid schizophrenic.

Derrick noted there is considerable controversy within the medical community as to whether excited delirium is a legitimate condition.

The issue came under scrutiny during the public inquiry into the death of Polish immigrant Robert Dziekanski, who died in 2007 after he was Tasered by a Mountie at Vancouver International Airport.

A subsequent independent report commissioned by the RCMP also criticized the use of the term excited delirium. It said the condition is sometimes used as an excuse to justify firing stun guns.

In 2009, the RCMP restricted the use of stun guns to cases involving threats to officers or public safety, because officers had been instructed to use the weapons to subdue suspects thought to be in a state of excited delirium.

That term no longer appears in RCMP operational manuals, because the force believes officers can't be expected to diagnose it.