Rochester Cops Were Offered Training on Discredited Diagnosis Connected to Daniel Prude’s Killing

Authorities cited excited delirium in other notorious Black Lives Matter-era deaths in police custody, including those of George Floyd, Elijah McClain, and Angelo Quinto. The purported diagnosis had become so popular among first responders that, in Rochester, paramedics speculated even before they saw him that Prude was likely experiencing the condition, according to the state investigation.

Yet in the last four years, a vast swath of the U.S. medical establishment has rejected excited delirium as a diagnosis. Six leading national medical associations have fully disavowed it, while another two have distanced themselves from it. Floyd’s home state of Minnesota, McClain’s Colorado, and Quinto’s California have barred public officials from citing the syndrome.

Medical experts say excited delirium is a theory, not a recognized disease with a specific physiological cause. And they have argued it can obscure the actual causes of deaths, especially when police are involved.

Now, a training document obtained through a public records request by New York Focus and The Intercept sheds new light on how the disavowed diagnosis infiltrated the Rochester Police Department before Prude’s death.

Advocates and researchers blame the initial popularization of the excited delirium diagnosis on a corporate-backed campaign to absolve cops of responsibility for deaths in their custody. In Rochester, the training document, created in 2016 and last edited in late 2020, lifts directly from materials disseminated by an organization linked to Taser, producer of the eponymous stun gun. The document warns officers that the syndrome’s sufferers experience a “diminished sense of pain” that could render police batons ineffective. And it claims that “saying ‘I can’t breathe’” is a sign of excited delirium.

“It displaces any sort of blame from the perpetrator of violence — in this case, the police — to the person who’s on the receiving end, but under the guise of this diagnosis,” said Altaf Saadi, a neurologist at Massachusetts General Hospital, of the training document. Saadi, who has done research on how excited delirium rose to prominence, reviewed the training materials for New York Focus and The Intercept.

The document comes to light as New York grapples with its role in promoting excited delirium as a cause of death. After Prude died, state Attorney General Letitia James encouraged first responders to embrace the disputed concept.

“Personnel must be trained to recognize the symptoms of excited delirium syndrome and to respond to it as a serious medical emergency,” she recommended in a 2021 report.

It’s unclear how many police departments in the state have trained officers on the theory — though the largest one has. Last year, New York Focus uncovered New York City Police Department training materials that provide guidance on excited delirium similar to what is in the Rochester document. (The NYPD did not respond to a request for comment.)

Internally, the attorney general’s office has softened its stance.

In a statement, the office said, “Causes of death are solely determined by medical examiners, not OSI” — James’s Office of Special Investigation — “however we have not recognized ‘excited delirium’ or similar terms as a cause of death for several years because we are acutely aware of the scientific discourse and concerns regarding the term.” Her office did not comment on her use of the term in the Prude investigation or her guidance that officers should be trained on the theory.

With James avoiding a full-throated rejection of excited delirium, state lawmakers are taking up the fight. Citing New York Focus’s report on the NYPD, Assemblymember Jessica González-Rojas introduced legislation in March to ban government agencies from referencing excited delirium.

“The term has been debunked by the major medical associations,” said González-Rojas. “It’s something that has to be done.”

She said, “It’s pseudoscience that all too often provides cover for fatal police tactics.”

The company hired experts who testified in police killing trials that the syndrome, and not stun guns or other uses of force, caused the victims’ deaths. Some of the same experts inundated medical journals with studies making the same arguments. Taser, now known as Axon, did not respond to a request for comment.

Taser concentrated much of its advocacy on medical examiners, whose autopsies play a key role in legal proceedings for police killings. Between 2000 and 2017, medical examiners listed excited delirium as a factor in at least 276 deaths that followed Taser use, a Reuters investigation found. (Little to no public data exists on how many overall deaths are attributed to excited delirium.)

Joye Carter Rush, a forensic pathologist and former longtime medical examiner, remembers receiving Taser materials on excited delirium, including the 2005 book. The dedication jumped out at her.

Taser’s medical examiner advocacy was peculiar, Carter Rush said, because there’s no special way for medical examiners to diagnose the syndrome. Rather, as a “syndrome,” it’s a list of simultaneous symptoms.

“There is no such medical disease as excited delirium,” Carter Rush said.

Excited delirium is sometimes linked with drug use, but the behaviors police have come to associate with it can result from a wide variety of underlying causes, medical experts said.

“Maybe they have dementia, maybe they have autism with behavioral issues,” said Saadi, the neurologist. “If they’re having fever and muscle rigidity” — among excited delirium’s listed symptoms — “it could be encephalitis. There’s literally so many different diagnoses.”

That murkiness is what prompted some of the top medical associations, including the American Medical Association and the American Psychiatric Association, to fully disavow the diagnosis.

Excited delirium’s reputation for endowing sufferers with super strength and imperviousness to pain can fuel more aggressive police responses, Saadi said.

“‘Superhuman strength’ and ‘unlimited endurance’ we know are racist tropes that have been typically used against Black men,” said Saadi. “It sends the message that it is okay to justify having this super aggressive escalation when that is often not the case.”

The training file’s metadata indicates that it was created in 2016 and last edited in late 2020, meaning it was likely offered to officers before Daniel Prude’s death.

The metadata also shows that the file was created by the Monroe County Office of Mental Health’s former chief of clinical and forensic services, Kimberly Butler, who also headed the county team that accompanies police on mental health crisis calls.

Butler, who did not respond to interview requests, resigned in 2020 after it was revealed that she sent privileged information about Prude’s mental health care to Rochester police officials after his run-in with the cops. She was one of at least 16 public officials, including the Rochester police chief, to resign, retire, or get fired in connection with their handling of the Prude case.

Both the Rochester Police Department and the Monroe County Office of Mental Health said that they don’t currently offer the excited delirium training. (The police department sent the file to New York Focus and The Intercept in response to a request for “currently used” training materials related to excited delirium.)

“It was co-sponsored by the county Office of Mental Health, and we do have officers who attend Office of Mental Health trainings, but I have no idea if they still use it or not,” Greg Bello of the Rochester Police Department said.

A spokesperson for the county Office of Mental Health said that the training document is from a prior administration — the current director took over in February 2021 — and the office can’t be sure when the last time it was used. Neither the police nor the mental health office responded to follow-up questions about their stances on excited delirium.

In an interview with New York Focus and The Intercept, Peters, a longtime police administrator, said he now agrees with many of the medical establishment’s concerns about the diagnosis. The IPICD has recommended against using the term for nearly 15 years, he said. The organization now teaches officers to address what it calls “agitated chaotic events,” while leaving medical diagnoses to medical professionals.

The IPICD’s website, however, still boosts the theory. An advertisement for a current institute police training course, for example, decries pushback against excited delirium as a result of “post-George Floyd societal culture.”

The IPICD also still publishes the informational poster that appears to have inspired the Rochester training presentation. The poster is nearly two decades old and cites the 1980s cocaine research. Peters said that he planned on replacing the poster after the IPICD’s annual conference in November, but it remains on the group’s website.