Putting an end to a racist ‘diagnosis’

The term “excited delirium” has been used for years by law enforcement and other first responders, including health care workers, to describe people who exhibit behavior that is considered “out of control.” This diagnosis has been applied again and again, even posthumously, as a justification for extreme, and sometimes deadly, interventions by law enforcement. It came up most recently in the trials of two police officers accused of causing the death of Elijah McClain, a Colorado man; both officers were acquitted this week.

But excited delirium is not an evidence-based medical diagnosis. The American College of Emergency Physicians recently withdrew a 2009 white paper endorsing the concept, and California has banned it as a cause of death. Other states may follow suit.

On this week’s episode, we are joined by Utsha G. Khatri, an assistant professor of emergency medicine and population health and policy at the Icahn School of Medicine at Mount Sinai, and emergency physician Brooks Walsh, who was involved with the campaign to get ACEP to withdraw the 2009 white paper. Khatri and Walsh speak about why the “excited delirium” label is both unnecessary and dangerous. 

“We recognize that some patients are confused. They’re not thinking clearly they might have risk for becoming violent either toward themselves or towards other staff,” Khatri said. “It is our job not just to keep them and everyone else safe, but also to most importantly find out what is causing them to act in this way.”

You can read Khatri’s First Opinion essay on the end of “excited delirium” here.

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