Quick thoughts regarding the New York AG's investigation into Daniel Prude's death

Sending social workers wouldn't have helped, but police departments must train officers to recognize excited delirium

Today the New York Attorney General’s Office announced that a grand jury in New York declined to indict any of the Rochester police officers involved in restraining Daniel Prude before his death. It turns out that Mr. Prude very likely died from excited delirium, not from a spit sock or from an excessive use of force. Nonetheless, New York AG Letitia James is trying really hard to make it sound like “the cops got away with it again”:

The criminal justice system has demonstrated an unwillingness to hold law enforcement officers accountable in the unjustified killing of unarmed African-Americans… One recognizes the influences of race, from the slave codes to Jim Crow to lynching to the war on crime to the overincarceration of people of color: Eric Garner, Tamir Rice, Breonna Taylor, George Floyd. And now Daniel Prude.

I haven’t read the whole report yet, because it’s 200 pages with exhibits. But I did read through the facts of the incident and the AG’s recommendations, so I want to quickly address two of her proposed reforms.

First, James suggests that New York should “establish mental health response units specifically trained and equipped to de-escalate mental health crises” - a proposal which seems totally divorced from the facts of this incident. Second, James recommends that police in New York should be trained to recognize the symptoms of excited delirium. This training is so obviously necessary that I’m surprised the Rochester Police Department (RPD) wasn’t already doing it.

Police safely detained Mr. Prude just hours before he died

Ms. James’s first recommendation suggests this incident would have ended differently if Daniel Prude had been treated by trained professionals who could have helped with his mental health crisis. The problem I have is that this is exactly what happened! The police took Mr. Prude to a hospital just hours before he died - and the hospital full of trained medical and mental health professionals immediately released him.

The AG’s report describes how on March 22 at 7 PM, Prude’s family called Rochester Police Department and told them Prude was “was ‘coming off of leaf’ [PCP] and hallucinating.” RPD came out and encountered Mr. Prude at his brother’s house:

Mr. Prude […] appeared highly agitated and was repeating statements of a paranoid nature. Throughout the incident, Mr. Prude said that people were going to kill him and that he wanted to die, while praying to “Jesus Christ” and “the Lord” throughout. Mr. Prude advised the EMT that he had consumed PCP, marijuana, and alcohol.

RPD succeeded in detaining Prude without incident and sent him to Strong Memorial Hospital for an involuntary mental health evaluation. The system worked! Except that the hospital discharged Prude just four hours after he arrived. He was back at his brother’s house by 11 PM. But Prude was still high on PCP, so at 3 AM he ran back out into the freezing Rochester weather wearing a tank top and no shoes - causing his brother to call the police yet again.

While the police were looking for Prude, he broke a plate glass window and cut himself to the point where he was bleeding. A witness called saw him defecate on himself, strip off the little clothing he was wearing, and run down the street. By the time a police officer found him, he was throwing items into the road and “appeared to be biting … garbage receptacles.”

Had Strong Memorial Hospital actually detained Prude even for 12 hours, he would probably still be alive. What’s worse, I can tell you from my own first-hand experience that this is how every single hospital I’ve ever dealt with treats a mental health referral from police - they pretty much always cut them loose right away. It wasn’t uncommon at all to send the same person to the hospital multiple times in a single shift, sometimes even three or four times a day.

Ms. James recommends New York pass a law that “would establish mental health response units specifically trained and equipped to de-escalate mental health crises — including those involving, or precipitated by, substance abuse.” My question is, what would be the point? Even assuming the new Mental Health Unit was better than police at peacefully getting Prude to the hospital, who’s to say he wouldn’t have just been released again? Would a mental health unit have provided better care to Prude on the street than the care he got in the hospital?

Some people have asked me before about the merits diverting some mental health calls to police. This case illustrates the very hard limits of that idea. The problem is not primarily that police are incapable of safely detaining seriously ill people. They problem is that once people are detained, they are almost always immediately released. The law of averages means that continually releasing dangerously ill people onto the street, where they inevitably decompensate and attract police attention again, will eventually result in a tragic outcome.

I also really doubt a lot of mental health professionals are interested in responding, without police backup, to a 911 call about a man who is: 1) high on PCP 2) smashing out plate glass store windows 3) running naked through the street 4) while covered in his own blood and feces and 5) throwing things. PCP is well known for making users both violent and impervious to pain, and several of the things Prude was doing that triggered 911 calls were criminal in nature. But the AG’s report insists it can be done, so I guess we’ll see if New York State can find any takers.

Police need training on excited delirium

RPD did not kill Daniel Prude with a spit sock. People seem to have gotten the idea that a spit sock is similar to the hoods Navy Seals put over the heads of insurgents or something. The reality is that spit socks are made of mesh and are entirely breathable, and are used in hospitals and by ambulance crews. The AG’s report notes there is no evidence a spit sock contributed to Prude’s death.

What did kill Prude was excited delirium. The medical examiner interviewed by the AG’s office provided a good summary of what excited delirium is:

Excited Delirium is a condition brought about by psychiatric illness or illicit drug use that causes certain physiological changes in the body. Those changes include but are not limited to, rapid breathing, increased heart rate, increased body temperature, and an increased demand for oxygen. The Medical Examiner advised that individuals experiencing Excited Delirium can sometimes manifest bizarre, paranoid, aggressive and violent behavior, and, because of the neurochemical changes occurring in the brain, will often display a reduced sensitivity to pain and a reduction in fatigue. She noted that because of the collective physiological changes occurring in the body, including the increased heartrate, increased respiration, and enhanced demand for oxygen, an individual experiencing Excited Delirium is more vulnerable to sudden cardiac or respiratory arrest than that person would be otherwise.

The officers involved in restraining Prude told the AG’s office they had heard of excited delirium, but didn’t really know anything about it in terms of symptoms or how to identify it. Apparently, the RPD academy training on excited delirium consists of these two Powerpoint slides:

From a training perspective, this is clearly not good enough. Excited delirium has been a well-known problem in the world of law enforcement for a long time. I received a full hour of training on excited delirium, and our agency had a dedicated response plan and policy so we could coordinate with medic units when we suspected it might be an issue. The AG’s office correctly identifies the absence of excited delirium training as a major training deficiency at RPD. The officers can’t be blamed for what they didn’t know, but the agency which failed to train them can be.

Police critics sometimes claim that excited delirium doesn’t really exist and is just a cover-up for police brutality when someone dies after a use of force. This is flatly incorrect. It requires disbelieving published medical research which has identified excited delirium cases as far back as as the 1850s. It requires believing that the American College of Emergency Physicians and National Association of Medical Examiners are wrong. And in this particular case, it would also require beliving that Letitia James is covering for the cops, which might be the wildest claim of them all.

I should also say that it’s not clear to me that RPD officers would have been able to do anything differently to avoid Mr. Prude’s death in this case if they had known about excited delirium. Prude was only restrained for a few minutes before an ambulance arrived. The paramedics who responded apparently did recognize the excited delirium symptoms at work, but didn’t feel the need to do anything differently. This is something the AG’s office notes with displeasure in their report.

But better training certainly couldn’t have hurt. And if a simple training can help prevent custodial deaths, that’s a win-win for cops and the public.