California Becomes First State to Prohibit Controversial ‘Excited Delirium’ Diagnosis, Informs the Orange County Register

California Makes Historic Move to Ban Excited Delirium as Cause of Death, Potentially Limiting Police Use of Excessive Force

In a landmark decision, California has become the first state to prohibit doctors and medical examiners from attributing deaths to the controversial diagnosis known as “excited delirium.” This move has been hailed as a “watershed moment” by human rights activists, as it could make it more challenging for police to justify the use of excessive force.

On October 8, Democratic Governor Gavin Newsom signed a bill that bans coroners, medical examiners, physicians, and physician assistants from listing excited delirium on death certificates or autopsy reports. Furthermore, law enforcement will no longer be allowed to use the term to describe a person’s behavior in incident reports, and testimony referring to excited delirium will be inadmissible in civil court. The law will take effect in January.

The term excited delirium has been around for decades but has gained increasing prominence in the past 15 years as a way to explain sudden deaths of individuals experiencing severe agitation, not caused by the police. It has been used as a legal defense in high-profile cases such as the deaths of George Floyd, Daniel Prude, and Angelo Quinto.

“This is a watershed moment in California and nationwide,” said Joanna Naples-Mitchell, a lawyer with the New York-based Physicians for Human Rights, who co-authored a 2022 report on the use of the diagnosis.

“In a wrongful death lawsuit, if excited delirium comes up, it’s a big hurdle for a family seeking justice if their family member was actually killed by the police,” Naples-Mitchell explained. “So, now it will be virtually impossible for them to present testimony on excited delirium in California.”

This legislation makes California the first state to officially reject excited delirium as a medical diagnosis. However, several national medical associations, including the American Medical Association and the American Psychiatric Association, have already discredited it. These organizations have noted that the term has been disproportionately applied to Black men in police custody. The National Association of Medical Examiners and the American College of Emergency Physicians are also moving away from supporting excited delirium as a cause of death.

In the case of Angelo Quinto, his mother called the Antioch police during a mental health crisis. Although she had already subdued her son by the time officers arrived, they held him to the ground until he lost consciousness. Quinto died three days later in the hospital. The Contra Costa County coroner’s office attributed his death to excited delirium. Quinto’s family has filed a lawsuit and is seeking to change the cause of death on his death certificate.

Quinto’s mother, Cassandra Quinto-Collins, testified in favor of the bill introduced by State Assemblymember Mike Gipson, which received bipartisan support and passed easily. Notably, the California Police Chiefs Association did not oppose the measure.

The problem with the excited delirium diagnosis lies in the fact that delirium is a symptom of an underlying condition, such as old age, hospitalization, surgery, substance use, or infections. Putting “excited delirium” as the cause of death oversimplifies and fails to address the true underlying issues, according to medical professionals.

While some entities in California have already restricted the use of excited delirium, such as the Bay Area Rapid Transit Police Department, changing decades of conditioning among law enforcement and emergency medical personnel will require systematic retraining.

This article was produced by KFF Health News, an editorially independent service of the California Health Care Foundation.