Excited delirium: When suspects 'scare themselves to death'
BY SAMUEL BRUCHEY. STAFF WRITER
Copyright 2006 Newsday, Inc.
Dennis Cherbavaz slipped into a coma and died in December 2003, three weeks after Suffolk County sheriff deputies pulled him from his car in Rocky Point, wrestled him to the ground and struck him with batons, according to sheriff accounts, autopsy reports and interviews with Cherbavaz's relatives and their attorney.
Three months later, David Glowczenski died hours after Southampton Village police officers tackled him outside his home, shot him with pepper spray and shocked him with a stun gun, according to interviews with Suffolk police homicide detectives who investigated the death, Glowczenski's relatives, their attorneys and an autopsy report.
When the Suffolk medical examiner's office investigated the incidents, it reached a surprising conclusion: The men, both diagnosed schizophrenics, had essentially scared themselves to death.
Specifically, the office found, the deaths were caused by a rare medical condition that is disputed even within the scientific community called "excited delirium." It was not the violence, experts found, but rather a collage of sudden and severe psychological changes associated with excited delirium - fear, paranoia, delusion - that overcame the men, caused their hearts to race and adrenaline to surge, and, ultimately, brought about their deaths.
To Cherbavaz's and Glowczenski's families, the explanation for the deaths were outlandish and incomprehensible.
"That's just ridiculous," said Glowczenski's sister, Jean Griffin, 32, of Hampton Bays. "To disregard the amount of torture David received and to just look at that element [excited delirium] is completely irresponsible. It's a slap in the face."
Cherbavaz's sister, Dorothy, 54, of White Plains, said she screamed at the medical examiner's office over the phone after reading her brother's autopsy report. "They just told me, 'Sometimes we find things about people we love that we never expected,'" she said.
Civil rights activists worry the condition can be cited to explain away a more troubling alternative - police brutality.
"A lot of the time it's used as a catch-all to describe death situations without looking at factors that may have contributed, such as police abuse," said Mark Schlosberg, director of the organization's police practices unit in California.
While acknowledging that excited delirium is uncommon, Suffolk Chief Medical Examiner Dr. Charles Wetli defended it. In scientific and medical circles, he is a proponent of the diagnosis. He has published articles in medical journals and is paid to testify as an expert on the syndrome in "four or five" cases each year, often to defend the police, he said.
"Excited delirium is an established fact," Wetli said. "It's nothing that I invented."
Experts familiar with the condition explained that it was excited delirium that would have spurred Cherbavaz, 50, to flee when sheriff deputies arrived at his apartment on Nov. 11, 2003, to serve order of protection papers filed by his sister. The deputies chased him until he was cornered in his car at an intersection. Surrounded, police accounts then show, Cherbavaz refused to exit his car and turned up the radio, spurring the confrontation that followed. And it was the same condition that compelled Glowczenski, 35, to push past police officers after they asked him to go with them to a mental hospital, as his worried mother had requested.
'The fuse was lit'
Once the condition took hold, these experts say, the deaths were all but inevitable.
"The fuse was lit," said Dr. Deborah Mash, a neurologist from Miami who reviewed Glowczenski's case at the request of Wetli's office.
In large part, events surrounding the deaths are not disputed. Law enforcement officials agree that the encounters escalated violently, but insist that appropriate, nonlethal force was used to subdue the men who they say resisted arrest. While a number of law enforcement officials spoke publicly at the time of the deaths, several officials familiar with the investigations declined comment for this story because of multimillion-dollar lawsuits filed by the men's families.
The condition, which is also called hypermania or acute psychosis, was cited in 2005 in more than 100 deaths in police custody nationwide, most involving stun guns, according to a study published last September by a group of Minnesota physicians.
But many experts believe the condition may not exist at all.
The American Medical Association does not recognize it as a cause of death, and locally, Nassau's chief medical examiner, Dr. Tamara Bloom, has not cited the condition in the past five years. She denied a request to be interviewed for this story.
Medical community split
Even medical examiners are divided over whether excited delirium is real. "If everyone is dying from excited delirium, then I have just one question," said Dr. Werner Spitz, a medical examiner from Michigan who believes the condition is real, but extremely rare. "Why are they all taking their last breath with six cops sitting on their back?"
Wetli, who said he does not fully understand how excited delirium causes death, said he has cited it "once or twice a year," mostly in police custody deaths. Wetli said he could not be exact on the number, and Suffolk's Department of Health declined to detail the number of deaths attributed to the condition.
He also refused to specifically discuss the Cherbavaz or Glowczenski cases because of the pending suits against the county. He said he learned about the syndrome in Miami in the early 1980s while examining the death of a drug smuggler, who had been unable to pass a cocaine packet he had swallowed. At the hospital he thrashed wildly, then died. A psychiatrist told Wetli it sounded like excited delirium.
His interest piqued, he examined other drug deaths and identified a series of behavioral changes he came to associate with the syndrome. He said victims often talk gibberish, grow paranoid and frightened, they hallucinate and become impervious to pain or improbably strong. As they are being subdued, they thrash about and refuse to calm down.
Internally, Wetli said, their heartbeats accelerate and their temperatures skyrocket. They reach levels of exhaustion that should cause the brain to shut the body down, but under excited delirium, Wetli said, the brain doesn't pay attention and the body refuses to stop until vital signs crash.
Other experts say they observe these same symptoms, but associate them with other medical conditions. Dr. Ronald O'Halloran, the chief medical examiner in Ventura County, Calif., said he often attributes them to asphyxiation. "It's clearly an area of controversy," he said, adding that he has investigated 10 deaths involving people in police custody and has not attributed any to excited delirium.
It remains a mystery
Some medical examiners, like Spitz, the Michigan medical examiner, say it is cited too frequently and misapplied. Even proponents acknowledge much about it remains a mystery. No one, for example, knows what makes a person susceptible.
Wetli said it can be associated with drugs or mental illness, especially those who fail to take prescribed medication. People with infectious diseases, such as meningitis, also are vulnerable, he said. Mash, the Miami neurologist, said it is caused by an underlying genetic defect that has not been discovered.
"We haven't found it yet," she said. "But we will."
As for what causes a person with excited delirium to die, Wetli said it could be an increase in the hormone noradrenaline, or a change in blood chemistry, or perhaps a reduction in potassium.
Steven Karch, a pathologist in Las Vegas and Berkeley, Calif., said he believes in most cases the mechanism is heart-related. Over time, drug use enlarges the heart and clogs blood vessels, he said. When such a person's heart races, it can kill them. "The extra stress that makes you think you are about to die is enough to kill you," Karch said. "That is my theory."
Without anything to substantiate the theories, relatives of Glowczenski and Cherbavaz, along with their attorney, Frederick K. Brewington, of Hempstead, say they remain unconvinced.
"It's an extraordinary coincidence, isn't it?" Glowczenski's brother-in-law, Syd Griffin, 39, said. "Excited delirium would be present in all the cases, but the police abuse has nothing to do with it."
With both Cherbavaz and Glowczenski, autopsies performed by the county medical examiner found police efforts to subdue them were not to blame. Both autopsy reports were reviewed by a reporter. Glowczenski's cited "acute exhaustive mania due to schizophrenia." Cherbavaz's autopsy noted that a "violent struggle while resisting arrest" took place, and concluded that death resulted from "schizophrenia with acute psychosis" coupled with a pre-existing heart condition. The autopsy also said he suffered "blunt impact trauma" to his arms, legs and abdomen but no sign of "major acute traumatic injury."
These results were attacked by experts hired by the family's attorneys. In Glowczenski's case, Rockland County Medical Examiner Dr. Lone Tanning cited "extensive evidence of excess force" in the death. Tanning said Glowczenski died from repeated Taser shocks, blunt force injuries and pepper spray. She labeled the death a homicide. She also said she believed Glowczenski was handcuffed and had his ankles tied, and that a "large man kneeled on his back."
While he is sympathetic to the emotions of victims' relatives, Wetli said he will continue to testify, lecture and write about the condition. Convinced the syndrome is real, Wetli met with Suffolk police Commissioner Richard Dormer in 2004, prompting the department to circulate a memo detailing its symptoms.
Even as he believes excited delirium is a real condition, Spitz, who has not been retained by either family, said many of these deaths linked to the condition are actually the result of asphyxiation. "They die because they cannot breathe," he said. "They have pressure on the back."
Then, pausing, Spitz added, "Why doesn't [excited delirium] happen when somebody is not restrained? You know what that means? It means it was a coincidence. I do not believe in coincidences."
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