Excited Delirium

When Angelo Quinto died, his family said police were responsible for his death. But a lawyer told them his official cause of death would likely be something called “excited delirium.” You can read more of Renu Rayasam's reporting on "excited delirium" at KFF Health News. Arjun Byju's article for Current Affairs is: Excited Delirium: How Cops Invented a Disease. Reporter Chris Gelardi obtained Rochester Police Department training materials on "excited delirium" for New York Focus. You can read more here. Reuters has investigated Taser's interest in "excited delirium." You can find the investigation here. Say hello on Facebook, Instagram and TikTok. Sign up for our occasional newsletter. Follow the show and review us on Apple Podcasts. Sign up for Criminal Plus to get behind-the-scenes bonus episodes of Criminal, ad-free listening of all of our shows, invitations to virtual events, special merch deals, and more. We also make This is Love and Phoebe Reads a Mystery. Artwork by Julienne Alexander. Check out our online shop. Episode transcripts are posted on our website. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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• 2:02Speaker 03

  This episode includes descriptions of violence and sexual assault. Please use discretion.

• 2:10Speaker 03

  On December 23rd, 2020, Bella Quinto Collins was home from college to celebrate the holidays with her family in California.

• 2:19Speaker 04

  We had gone to my mom's work. They just had a small get-together, you know, masks on. And I grew up at my mom's work, really. So they're kind of like a second family. So we kind of spent the afternoon with them, I guess, and then came home. And we're just relaxing.

• 2:43Speaker 03

  A few months earlier, Bella's mother and Bella's two adult brothers had moved into a new house in a town called Antioch, near San Francisco.

• 2:53Speaker 03

  When Bella and her mother Cassandra had come back from seeing Cassandra's colleagues that day, Bella's oldest brother, Angelo, was in his room sleeping. Cassandra says she went to his bedroom.

• 3:05Speaker 05

  Because there was a package for him, you know, a package that he's been waiting for, for a while. So I knocked on his door and kind of woke him up. And he's like, oh, thank you, Mom, just leave it there. And then, you know, he, I went out and he just went back to sleep.

• 3:28Speaker 03

  When the pandemic hit, Angelo, who was 12 years older than Bella, had lost his job and moved in with Cassandra. Before that, Angelo had joined the US Navy. It was his dream career. But because of an allergy, he'd left during boot camp in 2019. Now he was trying to figure out what he wanted to do next. He liked gaming and was thinking about becoming a game designer.

• 3:55Speaker 03

  After talking to Angelo, Cassandra went to the living room. And at some point, she fell asleep on the couch. Then, around 10:00 PM, Angelo woke her up.

• 4:07Speaker 05

  And I said, yes, what do you want? You know, he goes, um, what's for dinner? And I was kind of upset about that because he, I mean, you know, he usually cooks for himself. He loves to cook. So when he asked me what for dinner is, I was like, what, what do you mean? You know, I was kind of upset because he woke me up from my sleep, my nap.

• 4:40Speaker 04

  He clearly wasn't himself. Um, at a certain point, I was on a Zoom with my friend and he just kept coming into the room and like asking, oh, what's going on? He seemed really worried. It looked like the beginnings of an episode, as we called it. He'd had a couple of them throughout 2020, in which he would just kind of act oddly, just not like himself and really anxious and scared. But it was really infrequent. And then it almost seemed like he was normal the next day.

• 5:18Speaker 03

  The family says he'd started having these episodes after a head injury. Did this night seem different than, than other episodes that he had had?

• 5:31Speaker 04

  No, actually.

• 5:34Speaker 05

  It's actually the way we dealt with it, right?

• 5:37Speaker 04

  Yeah, we, we didn't have much tolerance for it at that point. Um, in previous episodes, I, I'd say there were about five total throughout that year. He required patience when he was feeling that way, when he was afraid, when he was asking the same questions, um, when he looked past you and thought he saw something. He required a patience that spanned eight hours sometimes.

• 6:06Speaker 03

  A few months before, a neighbor had called the police because they'd seen Angelo trying to climb a fence. They said he was yelling. The police took him to the hospital. Cassandra says Angelo had been worried that maybe he had bipolar disorder or schizophrenia. She wanted him to see a psychiatrist so he could get help. She says that when he was having these episodes, he would ask her again and again if he was going to be okay. She'd often need to sit with him for a long time to calm him down.

• 6:38Speaker 04

  And we didn't have that patience that night. And I think that really escalated his anxiety.

• 6:46Speaker 03

  Over the next hour or so, Angelo seemed to get more and more scared and anxious. He wanted Cassandra and Bella to stay close to him. He locked arms with the two of them and started walking them around the kitchen.

• 7:01Speaker 04

  And that, of course, then heightened our anxieties. And I know that I was thinking in the moment, oh, my gosh, he's getting really, really afraid.

• 7:11Speaker 03

  Bella, who was 18 at the time, saw she started to feel really worried.

• 7:17Speaker 04

  At a certain point, I had told him, please, you know, let, let go. I'm going to call the police if you don't stop holding us. And he just, I could tell he couldn't understand what I was saying.

• 7:30Speaker 03

  Yeah, because he kept on saying, what's going on?

• 7:32Speaker 04

  Yeah.

• 7:33Speaker 03

  What's going on?

• 7:34Speaker 04

  And that, you know, that freaked me out.

• 7:36Speaker 03

  Bella called 911 to ask for help.

• 7:39Speaker 04

  Because I just felt like I had no other option. My dad was in Berkeley at the time, and I thought, that's too far away. He wouldn't be able to get here fast enough.

• 7:53Speaker 03

  Bella told the 911 operator that her brother was, quote, "being aggressive and hurting her mother." She said that Angelo had tried to pick up a hammer, so she had picked it up instead and had it with her. The operator asked her, "Do you know if he takes any drugs?" And Bella replied, "Yes." At one point in the call, someone yelled, "Stop it, stop it." At the end of the call, Bella said to the operator, "Sorry, thank you." What were you hoping the police would do to help once they showed up?

• 8:29Speaker 04

  Um, calm him down in a way that we couldn't.

• 8:35Speaker 03

  Shortly after 11:00 PM, two police officers arrived at their house. The police dispatcher had told them about Bella's call, that she said her brother was hurting their mother.

• 8:49Speaker 03

  The police said that when they arrived, Angelo was being "actively restrained" by Cassandra on the floor in a bear hug. Cassandra and Bella say that Angelo was calm.

• 9:02Speaker 05

  He wasn't trying to get away from me. Because I think that's what he wanted, is for me to be there. He was just breathing heavily, but he was calm. He was very calm. And that's what the police officers saw when they came in the house.

• 9:23Speaker 03

  The police officers started to handcuff Angelo. They rolled him onto his stomach. According to the police, he started to struggle, and they bent one leg over the other to restrain him. Cassandra and Bella say Angelo didn't struggle. At some point, another two police officers showed up.

• 9:44Speaker 03

  Cassandra and Bella say that first one officer, and then another, had their knee on Angelo's neck. They say it went on for over four minutes. The police later said that an officer, "briefly for a few seconds", had a knee across a portion of Angelo's shoulder blade. We reached out to the Antioch Police Department for comment. We didn't hear back.

• 10:10Speaker 03

  What was he saying? "Please don't kill me. Please don't kill me." The officers called an ambulance and asked for help with a mental health crisis. They asked for a code 2, meaning "as quick as you can, but not in emergency".

• 10:27Speaker 03

  Two of the police officers later said they'd responded to Angelo's previous incident when he was trying to climb a fence. And one of them said that he thought Angelo had behaved in a similar way. He wasn't making sense.

• 10:43Speaker 03

  Cassandra decided to get her phone out to start recording what was going on.

• 10:48Speaker 05

  Because I wanted Angelo to go to therapy and to go to a psychiatrist so that he could be properly medicated.

• 10:58Speaker 05

  Whenever I talked to him about his episodes, you know, he could not believe that he did that. So this particular time, I made sure to record it, you know. So the next day, I would have him listen to it and he's gonna go, "Okay, Mom."

• 11:24Speaker 03

  One of the police officers told Cassandra that Angelo wasn't under arrest and that he would be transferred to a hospital for evaluation because it seemed like he might be a danger to himself or others. Cassandra said that Angelo hadn't been attacking them, but that he had been hallucinating and paranoid and didn't want to be alone. One of the police officers said, "That's why he's going to the hospital, not to jail."

• 11:54Speaker 03

  Angelo had gone quiet.

• 11:57Speaker 05

  I asked them twice, actually, if he was asleep because I want them to, you know, check on how he's doing.

• 12:09Speaker 03

  Angelo was still lying on the floor with his hands handcuffed behind his back, and it became clear that he was unconscious. One of the police officers said, "What's going on with him?"

• 12:22Speaker 05

  It actually became very quiet as soon as they saw, as soon as they flipped him and they saw blood coming out from his mouth and, you know, rolled up, his eyes rolled up to his head. It became very quiet.

• 12:43Speaker 03

  When Cassandra's video starts, two police officers are standing over Angelo, trying to communicate with him. They're wearing face masks and blue rubber gloves. The officers move Angelo onto his side, and one of them rubs his chest. There's blood on Angelo's face.

• 13:02Speaker 05

  What happened?

• 13:07Speaker 06

  Angelo.

• 13:09Speaker 06

  Angelo. You see any medication?

• 13:13Speaker 05

  I... Not that I know of. Come on, Kenny, take him, please.

• 13:16Speaker 06

  You got a narcotic?

• 13:17Speaker 05

  Please, please.

• 13:18Speaker 06

  Yeah, we got a chart.

• 13:24Speaker 03

  The officers unlock the handcuffs and move Angelo onto a stretcher. Cassandra follows them. There's blood on the bedroom floor where Angelo had been lying face down.

• 13:36Speaker 03

  They start doing CPR on Angelo. Then they push the stretcher out of the house and into an ambulance. I'm Phoebe Judge. This is Criminal.

• 13:56Speaker 03

  When Angelo was rolled out of the house on a stretcher, Bella says she thought he looked purple. Angelo was rushed to the hospital. Cassandra and Bella had to stay back to answer questions from the police.

• 14:09Speaker 05

  They said they were gonna take us to the police station. And I said, "Why?" "To be interviewed," they said. And I go, "Well, you know, they already did ask questions just a little while ago." And they said, "Don't worry, we're just... It's just gonna be, you know, like, it's the same questions."

• 14:30Speaker 03

  At the police station, Cassandra and Bella were questioned separately about what had happened that night. Cassandra says a detective asked her if she had hit Angelo earlier, since he had a bloody nose. She answered, "No."

• 14:46Speaker 03

  While they were at the police station, Cassandra says she got a call from a doctor who was treating Angelo at the hospital. When she answered it, she says a police officer rushed over and told her to get off the phone. They said she'd get a chance to talk to the doctors later.

• 15:04Speaker 03

  As Bella and Cassandra had been on their way to the police station, Angelo's stepfather, Robert, arrived at the house.

• 15:11Speaker 07

  When I arrived, they were questioning me. Did he have something? Did he eat something he shouldn't have? Has he taken drugs? Is he allergic to something?

• 15:19Speaker 03

  He was told he couldn't enter the house. Their whole street was closed off. More police officers kept arriving, moving in and out of the house, which was marked off with crime scene tape. Police officers were standing guard around it. For hours, Robert stayed in the driveway with his dog, who had been in the car with him, and Angelo's younger brother, who'd come back after spending time at a friend's house.

• 15:47Speaker 03

  Around 6:30 that morning, Bella and Cassandra got back from the police station. Their house was still full of police and investigators.

• 15:57Speaker 07

  Cassandra got a call from the doctor, and she asked me to take it. And I spoke with the doctor, and he indicated to me that Angelo's brain was 98 or 99% dead. There was only a tiny portion of the brain stem left alive.

• 16:17Speaker 03

  The family went to the hospital to see Angelo, but because of COVID protocols, they were told they couldn't come inside. When they got back home at around 8:30 in the morning, the police had left.

• 16:32Speaker 03

  When the family walked through the house, there was still a smear of blood on the floor where Angelo had been lying on his stomach. And Angelo's bedroom seemed to have been searched.

• 16:42Speaker 07

  It's just like, everything is upside down. It's been, you know, every last little thing has been tossed and turned, and it's on the floor. And it's just a mess.

• 16:55Speaker 03

  The police had taken things from Angelo's bedroom, including his cellphone and some photographs.

• 17:03Speaker 03

  In the kitchen, the family says they found a felony search warrant. The warrant said the police were authorized to take anything that, quote, "tends to show that a felony has been committed or that a particular person has committed a felony."

• 17:20Speaker 03

  Robert says they were shocked. The police had told them that Angelo wasn't under arrest and hadn't committed a crime.

• 17:30Speaker 03

  That morning, on December 24th, the family kept calling the hospital, but they couldn't get permission to visit Angelo.

• 17:39Speaker 05

  On the 25th, they called us and said we could, you know, come and visit him. So, um, Robert and I went.

• 17:51Speaker 03

  Angelo was unresponsive. He was on a breathing machine, and his eyes were taped closed. He only had a faint heartbeat.

• 17:59Speaker 05

  I was, um, reading him this Christmas card that everybody wrote on. And as soon as I was done, the nurse said, "I'm sorry, I don't think he heard you," or she said something. And I go, "Oh, isn't it that when you're in a coma, um, you can still hear, you know, you can still hear what other people are saying?" So you kind of like constantly talk to them. And then she said, "Well, um, yeah, but in Angelo's case, I don't think that is possible."

• 18:43Speaker 03

  The family says they felt like they couldn't get clear information from the hospital staff. Later, medical records cited in court documents said that when Angelo first arrived at the hospital, staff had been instructed by the police not to talk to them about Angelo's condition. A doctor had added it as a note to Angelo's medical record.

• 19:05Speaker 05

  I asked for Angelo's toxicology report. And the nurse smiled at me and said, "I'm sorry, but we cannot provide that." And I'm like, "What do you mean? What do you mean you can't provide it?"

• 19:20Speaker 03

  Cassandra says she asked the nurse if it was because there was an investigation going on. And she remembers that the nurse nodded.

• 19:29Speaker 05

  So I was getting, you know, like, really upset and mad at that point. I'm the mother, I'm, you know, I need to know. I have to know. Um, and she said, "Um, let me go to my supervisor and ask."

• 19:46Speaker 07

  And so what she did is that she said she can't give it to us, but she said, "I'm going to look at it on screen. You might be able to see some of it over my shoulder."

• 19:57Speaker 07

  And so she basically kind of showed it to us, but she didn't want to give us or have any proof that she had given it to us. But she let us see that there were no common substances of abuse found.

• 20:09Speaker 03

  On the morning of December 26th, they got a call from the hospital saying they should come visit Angelo as soon as possible. In the car on their way there, Cassandra says they talked about getting a lawyer.

• 20:23Speaker 03

  Robert had already been making phone calls to friends and family to ask for recommendations. Cassandra didn't think they needed one.

• 20:31Speaker 05

  You know, I mean, I was on denial. But while I was, you know, with Angelo holding his hands, I was like, you know what? This is not right. And I looked at Robert and I said, you know what? Go ahead, get a lawyer.

• 20:46Speaker 03

  Robert went out to the hospital parking lot and started making phone calls, trying to explain to people what had happened in the past three days.

• 20:56Speaker 03

  Eventually, he spoke with a civil rights attorney who said he'd take the case.

• 21:01Speaker 07

  And then I came back and they said Angelo is now, you know, he's going to pass. And the nurse said he's going to pass. And we waited about 20 minutes and then at 1:30 or 1:40 PM, he did. He, um, his heart stopped.

• 21:20Speaker 03

  The next day, the family's new lawyers, John Burris and Ben Nissenbaum, came to their house in Antioch.

• 21:28Speaker 07

  I think we're still having a hard time realizing what's happened. But one of the first things that Ben said, he said basically that he thought they were going to blame it on excited delirium. If they have nothing else, they will say it was excited delirium.

• 21:44Speaker 03

  Had you ever heard that term before? What did you think?

• 21:48Speaker 05

  I actually, the first thing, the first question I asked, what is that? What is excited delirium?

• 21:59Speaker 03

  For people who aren't that familiar with this term,

• 22:03Speaker 03

  what does it mean?

• 22:06Speaker 08

  If I told you it meant nothing, then I think that would be accurate.

• 22:10Speaker 03

  Attorney Ben Nissenbaum.

• 22:12Speaker 08

  In terms of what it purports to mean,

• 22:16Speaker 08

  it's essentially that the body dysregulates itself in a fatal manner. So somehow the the heart stops beating because the body becomes so unable to regulate itself.

• 22:34Speaker 03

  Had you ever handled other cases where it was used as a cause of death?

• 22:39Speaker 08

  Many, many.

• 22:41Speaker 03

  Many cases?

• 22:42Speaker 08

  I can think of at least a dozen. When people died during a police restraint, the immediate response invariably was it wasn't the police. It was excited delirium. As if the person got so excited and became so delirious, they they just spontaneously combusted. And I heard that I'd heard that so many times from the police over my career that I just knew that that's what was to be expected.

• 23:22Speaker 03

  We'll be right back.

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• 25:48Speaker 09

  Excited delirium is this term that has a really contentious history, a racist history, and it's used to describe a collection of symptoms.

• 26:02Speaker 03

  Reporter Rainu Raiasam.

• 26:04Speaker 09

  But there's no diagnostic code for it. There's no blood test for it. There's no way to test for it. I should note, delirium is a clinical term. It is something that people see in emergency rooms and hospitals. But the term excited delirium, it's kind of, in some ways, made up.

• 26:23Speaker 03

  It was first used in the 1980s.

• 26:27Speaker 09

  If you think about the 1980s in the US, there was a cocaine epidemic. It was gripping much of the country. And there was a South Florida forensic pathologist named Charles Wetley.

• 26:39Speaker 03

  In 1985, Charles Wetley co-authored a paper on what he called cocaine-induced psychosis and excited delirium. He looked at the deaths of seven people, mostly men, who'd used cocaine. They'd all been restrained, usually by police, one of them by ER staff, and suddenly died. He wrote that all seven had intense paranoia, followed by, quote, "bizarre and violent behavior", and sometimes, quote, "unexpected strength".

• 27:13Speaker 09

  And he said, "These are people who were scared. They were violent. They were panicked. Then they were restrained, and then they died suddenly." And the problem with this theory is it was purely speculative, and it didn't look at the role that restraints might have played in these deaths. They didn't really identify any scientific evidence or any toxicology reports or any way to back up or test their idea.

• 27:39Speaker 03

  Then Charles Wetley started looking into a number of other cases.

• 27:44Speaker 09

  In the late 80s, in South Florida, Miami, several black women were dying. And they were dying in the same area in Miami, and in a really similar way.

• 27:54Speaker 03

  12 women were found dead between 1986 and 1988. Charles Wetley told reporters, "The typical scene is in a cheap room, a clump of bushes, or an abandoned building."

• 28:08Speaker 09

  They were discovered naked from the waist down, and they all had trace amounts of cocaine in their system.

• 28:14Speaker 03

  An article in the Miami News quoted Wetley as saying, "At first glance, it looks like she's been raped and murdered", but he said, "That wasn't the case." Wetley said the women likely died of cocaine psychosis. One newspaper article described it as, quote, "Sudden death from low levels of cocaine that caused the victims to go berserk and die within minutes."

• 28:43Speaker 03

  Some of the women were believed to have been sex workers.

• 28:46Speaker 09

  And he and his colleagues said that the combination of cocaine and sex is what led to these women's death. And he called it excited delirium. And, you know, he said that black women were more prone to dying this way and that it was this combination of the stimulation from the cocaine and the sex that led to their death.

• 29:08Speaker 03

  He told reporters that when they examined the women's bodies, there were no signs of assault. Quote, "The autopsies have conclusively showed that these women were not murdered." At one point, he worked on a theory that rain in Peru had somehow tainted a shipment of cocaine. The police closed the cases. Many of the women who were found dead were from Jamaica, Haiti, and Puerto Rico. Most of them were in their twenties and thirties.

• 29:40Speaker 09

  But then, in 1988, a 14-year-old girl named Antoinette Burns was found dead. And she was found dead in much the same way that the other women had died. Wetley did the initial autopsy, and he once again said that she too died of excited delirium. And the Burns family pushed back. I mean, this was a young girl, 14. They said she wasn't a sex worker, she didn't do drugs, she was last seen hitching a ride to the movies with a neighbor. And, and the family really pushed back on this. But it wasn't until a toxicology report came back, that Wetley's theory began to unravel. Antoinette Burns didn't have cocaine in her system.

• 30:22Speaker 09

  And after that, the chief medical examiner, so Wetley's boss, reviewed all the deaths of these women that Wetley had said died of excited delirium. And what he found was pretty startling.

• 30:35Speaker 03

  The chief medical examiner went back and looked at the photos from the autopsies of all the women who'd been found dead. He found lip and neck injuries and hemorrhaging in the eyes.

• 30:47Speaker 09

  He said that in many of these cases, the women had very, very clearly been strangled or asphyxiated to death. He said, "You could spot it a mile away." I mean, he said that these women, nearly 20 by this point, were actually homicide victims. And the police believed that a serial killer was responsible for their deaths.

• 31:10Speaker 03

  More women were found dead in 1989. But then, in April of that year, the deaths finally seemed to stop. Months later, police announced that they had a suspect in the cases. A 33-year-old man named Charles Henry Williams, who'd been arrested on rape charges in April, right when the string of murders ended. But police said they didn't have enough evidence to charge him with the murders of the 32 women who they suspected him of killing over almost a decade. One of them was his neighbor, and four had been found dead near his home. They ended up charging him with one murder

• 31:52Speaker 03

  of a 19-year-old woman named Patricia Johnson. 10 days before the start of the trial, Williams died of AIDS while in prison, serving a sentence for rape. But Charles Whetley stuck to his theory that excited delirium was real and that at least some of the women in Miami had died from it.

• 32:15Speaker 09

  You would think, you know, after the Antoinette Burns case, after this kind of huge thing in Miami where this guy said, "Oh, all these people died of excited delirium, and it turns out they had been murdered," that the term would have completely fallen out of favor. But eventually, it reemerged.

• 32:35Speaker 03

  When the Quinto Collins family's attorney told them about excited delirium syndrome, Bella says that, like her parents, she'd never heard of it before.

• 32:45Speaker 04

  I thought, "That sounds really stupid." Does not sound very sophisticated at all. But he described to us his experience with excited delirium in the past.

• 32:55Speaker 05

  So after they told us about excited delirium, I said, "I want a second autopsy."

• 33:01Speaker 07

  So it was a, you know, I mean, I think the first thing is, how do you pay for this autopsy?

• 33:06Speaker 03

  The family said the independent autopsy ended up costing them $18,000. When it came back, it said Angelo had died of asphyxiation. They were still waiting to hear the results of the county's official autopsy. On January 13, 2021, they held a memorial service for Angelo in the garden of a local church.

• 33:34Speaker 03

  Months later, his family was notified that the county would hold a coroner's inquest.

• 33:40Speaker 08

  It's a hearing in which the county calls several witnesses.

• 33:46Speaker 03

  Attorney Ben Nissenbaum.

• 33:48Speaker 08

  Typically, the witnesses to the killing or death testify before jurors at the coroner's inquest.

• 34:00Speaker 03

  The jury at a coroner's inquest doesn't decide who is responsible for the death, only the "cause and manner of death."

• 34:08Speaker 08

  What the jury finds goes onto a death certificate.

• 34:15Speaker 08

  The jury determines whether the death was a homicide, a suicide, a natural death, or an accident.

• 34:27Speaker 03

  On the morning of August 20, 2021, eight months after Angelo had died, the Quinto Collins family went to the local courthouse. The hearing was open to the public. Lots of people had showed up, friends and family, but also journalists. Bella says that the police officers, who were going to be giving statements that day, were already in the courtroom when the doors were open to the public.

• 34:54Speaker 04

  And then when we got the chance to come inside, my mom and I decided to sit right next to the officers.

• 35:02Speaker 03

  The court hearing wasn't led by a judge, but by a hearing officer, a lawyer named Matthew Gichard, who'd been contracted by the county. Gichard explained that in their county, Contra Costa County, the sheriff is also the coroner, meaning the sheriff determines the cause and manner of a person's death and is part of arranging coroner's inquests. And when a person dies in police custody or during a police interaction, a coroner's inquest is required.

• 35:37Speaker 03

  California is one of just a few states where a county sheriff can also be the county's coroner.

• 35:45Speaker 03

  Matthew Gichard explained that this wouldn't be like a trial you might see in the movies. Quote, "There won't be lawyers standing up and asking questions."

• 35:56Speaker 03

  He said he would be the one asking the witnesses questions, and that he had reviewed all of the documents, audio and video recordings in the case.

• 36:06Speaker 03

  Attorney Ben Nissenbaum was in the courtroom with Akinto Collins' family, watching.

• 36:12Speaker 08

  We do get to submit questions, but the hearing officer can decide not to ask those questions. So the hearing officer has all the power. You know, they can decide what the jury gets to hear.

• 36:28Speaker 03

  Six witnesses were called. The county's forensic pathologist, three of the police officers who were at the house in Antioch, a police detective, and a detective from the DA's office. Bella and Cassandra were not on the list of witnesses.

• 36:45Speaker 04

  Throughout that four hours of this inquest, they didn't mention my mother or myself by name. We were the mother and the sister, which just felt kind of odd because, you know, we weren't witnesses, but every aspect of this story involves the mother and the sister.

• 37:03Speaker 03

  The first witness was the pathologist, who had performed Angelo's official autopsy. The family didn't know what the pathologist had found. They still hadn't seen the official autopsy report. But they did know the results of the independent autopsy that they had ordered and paid for themselves, which had concluded that Angelo had died of asphyxiation. The independent autopsy had found something called petechial hemorrhages on Angelo, small red marks often found in the eyes from broken blood vessels.

• 37:40Speaker 08

  Which is important because they tend to support a finding of an asphyxiation death.

• 37:47Speaker 03

  But the county pathologist testified that he had found no petechial hemorrhages on Angelo, and he didn't mention any other signs of asphyxiation.

• 37:59Speaker 03

  He went over the results of the toxicology report. It showed that Angelo had caffeine in his system and cotinine from cigarette smoking, as well as a drug for seizures, which is generally considered safe. Later, the Quinto Collins family's attorney pointed out that Angelo had been given anti-seizure medication at the hospital in the days before he died. The pathologist also found a drug called modafinil, which is also generally considered safe. It's used to treat narcolepsy, but people sometimes use it off-label to stay awake and alert longer. The pathologist said that the modafinil could have contributed to Angelo's death because,

• 38:43Speaker 03

  he said, "There's a condition linked to drug use that kills people." He said, quote, "It's poorly understood. It's called excited delirium syndrome."

• 39:01Speaker 04

  To which there was an audible reaction from the crowd.

• 39:05Speaker 08

  It was shocking and it was laughable. And I laughed out loud, not on purpose, but you know, I just had that reaction. And when I realized that I had done that, I thought, oops, and I walked myself out.

• 39:20Speaker 03

  The pathologist said that Angelo's cause of death was, quote, "Excited delirium syndrome due to acute drug intoxication with behavioral disturbances due to arrest-related death with physical exertion."

• 39:37Speaker 03

  In the eight months since their lawyer had first told them about excited delirium, Robert says they'd all been learning more.

• 39:45Speaker 07

  As time went on, it became difficult to think that they would still blame excited delirium because even if you believed in the pseudoscience of excited delirium, even if you were to read their own reports, Angelo didn't fit. That's why there was such a shock in the crowd because we had all become much more informed about excited delirium. Typically, excited delirium was blamed on people that were taking coke or meth or something. But to blame it on tobacco-

• 40:13Speaker 03

  And caffeine.

• 40:14Speaker 07

  -cigarettes and this other thing that prevented you from sleeping, which had never had any deaths, meant that they had the flimsiest case of excited delirium, even if you went by their own standards.

• 40:28Speaker 03

  Next, Gachard played Bella's 911 call to the jury, and three of the four police officers who had been at the house in Antioch the night Angelo was taken to the hospital testified. Two of the officers said that they'd had a knee on Angelo, but only very briefly. Originally, the police had said one officer had a knee on him. Then a detective with the DA's office testified that he had looked at Angelo's old incident, when a neighbor had called the police because Angelo had been acting strangely, trying to climb a fence. The investigator said that according to the paramedics, Angelo had had a fast heartbeat. And he said a police officer had said

• 41:11Speaker 03

  that Angelo had admitted to being on meth. Gachard had said he thought a doctor at the hospital had believed the same thing. Then Gachard told the jury to not consider what had just been said about meth, because he said it was about a previous incident, and there was no evidence of meth in Angelo's blood, as the pathologist had previously testified. After the witness testimonies, Gachard reminded the jury that they would only be deciding on the cause of death, not who was responsible. They had four options: homicide, suicide, accident, or natural causes. The jury were told

• 41:56Speaker 03

  they didn't need to reach a unanimous decision, but a majority of them would have to agree. Gachard cleared the courtroom while the jury stayed back to deliberate. After about 15 minutes, they'd reached a unanimous decision. Were you surprised when the jury ruled it an accident?

• 42:18Speaker 08

  No, not at all. When I heard the...

• 42:24Speaker 08

  The testimony from the coroner that it was excited delirium, then that's what I expected would happen. And I felt like that was the intended, that was the purpose of it.

• 42:37Speaker 03

  The Kinto Collins family had filed a lawsuit against the city of Antioch, its police chief and the four police officers who were at the family's house that night in December 2020. Months later, Ben Nissenbaum deposed the county's pathologist. The pathologist came to his office with a lawyer.

• 42:58Speaker 08

  What happened was I showed him the pictures from our autopsy that showed the petechial hemorrhages in Mr. Kinto's eyes. And so he looked at them and he looked at them again and again and again and again. And Dr. Ogan actually acknowledged that, yes, those are petechial hemorrhages. And that, in his view, they take time to develop and that they simply hadn't developed at the time that that he did Angelo's autopsy. What he said is that the restraint also played a role in Mr. Kinto's death.

• 43:40Speaker 03

  The pathologist said that if he had found the petechial hemorrhages when he did his autopsy, he would have added asphyxiation to his diagnosis. But he still believed the excited delirium diagnosis was right.

• 44:01Speaker 03

  We'll be right back.

• 44:20Speaker 03

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• 46:23Speaker 03

  After the idea of excited delirium was proposed in the 1980s, it started gaining momentum. In October 2008, a three-day conference on deaths that occurred in police custody was held at a hotel in Las Vegas. It was sponsored by something called the Institute for the Prevention of In-Custody Deaths. Speakers included doctors, pathologists, and scientists. One of the speakers was Charles Wetley, the medical examiner who had theorized that the deaths of a number of women in Miami were due to excited delirium because they'd had cocaine in their system.

• 47:03Speaker 03

  In 1995, Charles Wetley had moved to New York, where he worked as a medical examiner.

• 47:09Speaker 09

  Even though Wetley's theories in Miami were unproven in those murder cases, he continued to talk about excited delirium.

• 47:18Speaker 03

  Reporter Rainu Ryasim.

• 47:20Speaker 09

  And he continued to link cocaine use with excited delirium. He was just really convinced of this idea. And then this sort of idea really took off in a lot of different ways.

• 47:29Speaker 03

  When the 2008 conference in Las Vegas was announced, Charles Wetley was introduced as one of the doctors who had identified excited delirium, quote, "in the cocaine-wild 1980s." The conference promised that, quote, "attendees will help make law enforcement, medical, and legal history through topic-specific breakout groups focused on arriving at a consensus about excited delirium." The conference was organized by a group that was started by a lawyer from TASER.

• 48:04Speaker 09

  They make stun guns. They say, hey, these stun guns don't kill people. They are an alternative to kind of other uses of force by police.

• 48:16Speaker 03

  In a later interview with Reuters, Charles Wetley said that he had studied deaths involving tasers, and in the vast majority of cases, those deaths were caused by excited delirium, not the taser shock. Quote, "I've never seen a case where I could say that a taser actually contributed to the death." He told Reuters that TASER had hired him many times to be an expert witness in lawsuits against the company.

• 48:46Speaker 03

  Raynu Reisem says that conference on in custody deaths became a turning point.

• 48:53Speaker 09

  From that conference emerged what ended up being this really influential white paper, "Unexcited Delirium." It's called the White Paper on Excited Delirium Syndrome. So a white paper, it's like in this sort of medical or scientific context, a white paper is kind of like a detailed guide or report on a topic.

• 49:14Speaker 03

  The white paper was published by the American College of Emergency Physicians in 2009. The authors of the paper were 19 doctors, many of them professors of emergency medicine.

• 49:28Speaker 03

  A few of them had worked with TASER in some capacity. We reached out to Axon, the company that makes TASERS for comment. We didn't hear back.

• 49:39Speaker 09

  So if you read the paper, you go back and read the 2009 white paper from the American College of Emergency Physicians, it sort of lays out, okay, what they think excited delirium is, and it presents this research. Of course, all the research is sort of circular. It's from the same group of experts that had been talking about the theory in the first place.

• 50:00Speaker 09

  And they say, okay, there are no biological markers for excited delirium. Again, there's no tests or standard diagnostic criteria, but they lay out what they say are these features. If someone has like superhuman strength, or really high pain tolerance, or rapid breathing, then they have excited delirium.

• 50:20Speaker 03

  The white paper listed other signs that someone might have excited delirium, such as a, quote, "failure to respond to police presence," profuse sweating, and a, quote, "attraction to glass or reflective surfaces."

• 50:36Speaker 10

  I had never heard of this thing called excited delirium, and I was troubled and curious.

• 50:43Speaker 03

  In 2020, Arjun Bajju was a medical student doing a research fellowship at a hospital in Rochester, New York, when a man named Daniel Prude was brought to the intensive care unit after an incident which included being restrained by police. Arjun didn't treat the man, but later he heard about him and about how his autopsy had listed excited delirium syndrome as a cause of death.

• 51:10Speaker 03

  Arjun says he asked some of his professors about it, but none of them had heard about excited delirium syndrome. Groups like the American Medical Association, the American Psychiatric Association, and the WHO didn't recognize it. So Arjun started doing his own research.

• 51:30Speaker 10

  Well, I just started with Google, like everyone does. And the first things that came up were a lot of police training material, manuals from police departments across the country, videos about it on YouTube for training purposes.

• 51:46Speaker 03

  Arjun says the training materials he found almost always mentioned "superhuman strength" and how to deal with it.

• 51:53Speaker 10

  Somebody with excited delirium can't be taken down with the normal de-escalation techniques, verbal cues. They say they need many officers. They say that they need many electroshocks.

• 52:06Speaker 03

  A newest organization called New York Focus got access to Rochester Police Training Materials on excited delirium, created in 2016, and found that a lot of it appeared to come from a poster published by the Institute for the Prevention of In-Custody Deaths, the organization that had been started by a lawyer at TASER. The poster had advice on how to "capture" someone with excited delirium. Quote, "TASER electronic control devices have been shown to be the most effective for quickly capturing this category of individuals." In a police training presentation,

• 52:48Speaker 03

  a couple of slides had a list of behaviors to look out for. They included hallucinations and "unfounded fear or panic", bizarre behavior, and quote, "saying, 'I can't breathe.'"

• 53:03Speaker 03

  The slides included photos, like one of a naked zombie with blood on its face, one of the Incredible Hulk, and one of the actor and comedian Jordan Peele with sweat running down his face. The slide explains the four stages of excited delirium. One, elevated body temperature. Two, agitation. Three, respiratory arrest. Four, death.

• 53:30Speaker 10

  One of the ideas is that people with excited delirium, quote-unquote, have reduced pain perception. And they cite instances of them smashing glass and withstanding multiple electroshocks. In that description are all these very loaded terms with all this baggage, like monster and animal-like behavior and extreme strength. I think that plays on racial stereotypes because overwhelmingly, these are black men, young black men.

• 54:13Speaker 10

  The second angle is that this question of differences in pain perception has an embarrassing legacy in medicine, a long legacy of physicians believing that people of African descent have different pain perception, require less anesthetic, have literally thicker skin, have literally less sensitive nerve endings. So, very gruesome things from surgery to experimentation to amputation were carried out under that guise. And I think that we see that legacy in this narrative of people with excited delirium

• 54:57Speaker 10

  having diminished pain response.

• 55:00Speaker 03

  The organization Physicians for Human Rights says that the deaths of black people and people of color have disproportionately been attributed to excited delirium.

• 55:11Speaker 03

  Excited delirium also came up in George Floyd's case.

• 55:16Speaker 09

  There's an officer on the tape saying, hey, we think maybe he has excited delirium.

• 55:21Speaker 03

  At trial, the defense attorney for Derek Chauvin, who was accused of killing George Floyd, said that Chauvin had been watching for signs of excited delirium as a "reasonable police officer" because that's what police were trained to do.

• 55:37Speaker 03

  A Minneapolis police officer had testified that she trained new officers on how to recognize the syndrome.

• 55:46Speaker 03

  The prosecution called a doctor to testify. He said that he believed excited delirium is real, but that George Floyd had none of the symptoms. Derek Chauvin was convicted of killing George Floyd.

• 56:02Speaker 03

  After George Floyd's death and the deaths of a number of other men of color who had died in police custody in 2019 and 2020, supposedly from excited delirium, Renou says things began to change.

• 56:16Speaker 09

  I think what really changed the game was video footage of these deaths. And in particular, George Floyd's death. I think that caused a lot of people to take a look at this term. It forced a lot of groups that had been supportive of the term to turn away from it. And under pressure, the American College of Emergency Physicians in 2021, they started to backpedal a little bit. And in 2023, the American College of Emergency Physicians retracted that 2009 white paper and they said, we got it wrong.

• 56:53Speaker 03

  Renou says police departments across the country have since removed the term excited delirium from their training materials.

• 57:01Speaker 09

  But I'll give you an example of how just kind of banning the term may not be enough. So the Minneapolis Star Tribune, they reported that in training materials for the Minneapolis Police Department, there are these PowerPoint slides and the words excited delirium were crossed out and replaced with the term severe agitation with confusion and delirium in parentheses. So yeah, this concept that, you know, that exists just with a different name.

• 57:34Speaker 03

  Six months before the white paper on excited delirium was withdrawn, Angelo Quinto's family tried to have the cause of death on his death certificate changed. After the county pathologist had sat down with Ben Nissenbaum and agreed that asphyxiation had been a contributing factor in Angelo's death, his family argued that Angelo's death should have been classified as a homicide. They were not successful.

• 58:05Speaker 03

  In 2021, California Governor Gavin Newsom signed eight new reform bills into law. One of them bans restraints that can cause asphyxiation. And in 2023, California became the first state to ban the term "excited delirium", as well as related terms such as "hyperactive delirium" and "exhaustive mania."

• 58:33Speaker 08

  What it's done is to change the way that the cases are resolved by coroners. And we've seen that have a real effect, I think, because now, much more, we see that coroners are including the restraint as part of the cause of death.

• 58:54Speaker 03

  In 2024, the Antioch City Council announced that they'd decided to settle with the Quinto Collins family for $7.5 million. After Angelo died on December 26, 2020, his family kept the presents they'd wrapped for him that Christmas. They never opened them. And his mother Cassandra told us that every year at Christmas, they'd bring out Angelo's presents and put them under the tree.

• 59:28Speaker 03

  Since Angelo's death, the city of Antioch launched a new non-police crisis team that will respond to calls about people in a mental health crisis. Shortly after Angelo died, his sister Bella, who had called 911 that night, told reporters, "I asked the detectives if there's another number I should have called, and they told me that there wasn't, and that I did the right thing. But the right thing would not have killed my brother." She said, "Now there's somebody else to call." It's named after Angelo, the Angelo Quinto Community Response Team.

• 1:00:23Speaker 03

  Criminal is created by Lauren Spoor and me. Nadia Wilson is our senior producer. Katie Bishop is our supervising producer. Our producers are Susannah Robertson, Jackie Sajikko, Lilly Clark, Lena Silasen, and Megan Kinnane. Our show is mixed and engineered by Veronica Simonetti. Julian Alexander makes original illustrations for each episode of Criminal. You can see them at thisiscriminal.com. And you can sign up for our newsletter at thisiscriminal.com/newsletter. We hope you'll consider supporting our work by joining our membership program, Criminal Plus. You can listen to Criminal, This is Love, and Phoebe Reads a Mystery without any ads. Plus, you'll get bonus episodes. These are special episodes with me and Criminal co-creator Lauren Spoor, talking about everything from

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