What is excited delirium and why is it the cause of death for many restrained by police?

profile photo
By Yosi Yahoudai
Founder and Managing Partner

California lawmakers aim to ban the term as a growing list of medical experts say ‘excited delirium’ should not be listed as a cause of death

ANTIOCH, Calif. — Angelo Quinto had many titles; a beloved big brother and son, a United States Navy veteran, an artist.

But one title his family never thought he’d have is victim.

A 911 call for help in Dec. 2020 led to his mother — the woman who brought him into the world — watched as he was taken out of it.

A series of events led to the 30-year-old’s death. One was 12 months earlier at the start of 2020.

“He was assaulted at the Berkeley-Oakland border in January 2020,” said his father, Robert Collins. “He woke up in the hospital and had no memory of that day. He was in really bad shape… after that he had some instances of being really paranoid.”

Angelo decided to move home to Antioch with his mother and sister.

“I left the Bay Area because I was dealing with a lot of my own stuff. My own personal issues. It got too intense for me,” Angelo said in a self-blog video he recorded during that time period. “Now I feel like I’m coming back to my own, in a way.”

He continued to infrequently struggle with intense bouts of paranoia after moving back home. His family describes them as “episodes.”

“It was maybe four times in the entire year,” said his sister, Bella Quinto-Collins.

Angelo began experiencing an episode on Dec. 23, 2020.

“There was only my mom and I,” Bella recalled. “He kept holding us together with his arms (interlinked) and looking around, wondering what’s happening.”

In a recording of the 911 call, Bella is heard telling the operator her brother was being aggressive.

“I was just thinking, ‘He doesn’t know what’s going on. What if he accidentally hurts us and then he’s so afraid so he doesn’t call anybody for help?'” Bella said.

So Bella called 911, asking for help.

By the time Antioch police officers arrived at the home, his mother Cassandra Quinto-Collins, said she was able to both comfort and control Angelo.

“His head was on my shoulder, (I had him in a) bear hug,” described Cassandra.

“When the officers came in they asked, ‘Who was the call even for?'” Bella said.

Yet Antioch police officers took Angelo from his mother and held him down in a prone position with their weight on top of him, the family said.

Prone is a position where the individual is lying flat, chest down and back up.

RELATED: Deadly restraints by local police continue to happen as policies go unchanged, costing taxpayers millions

“He said, ‘Please don’t kill me. Please don’t kill me,'” said Bella.

Cassandra began recording towards the end of the incident, leaving her phone on the bed. In our report, ABC10 showed portions of the video with the family’s permission.

“Well that recording only caught at least the last 4.5 minutes of the restraint,” said Bella. “And that’s the point after he was already unresponsive.”

They’re unsure exactly how long officers stayed on top of Angelo, but Cassandra and Bella said it was so long officers had to do it in shifts.

“One officer that was kneeling on the back of his neck got tired and was replaced, the same position, even after I asked them if he (Angelo) was asleep,” Cassandra said.

Angelo was still being held down even as he fell silent.

In the cell phone video, an officer can be heard noting Angelo “calmed down a lot” and asking, “Angelo, are you going to be calm still?”

Officers flipped Angelo over, noticing blood pooled beneath his face.

“I knew when I saw him, when they flipped him over… when they flipped him on his side… I knew he was dead,” said Cassandra.

While Angelo wasn’t technically brain dead, he was no longer the man his family knew. It took 72 hours for him to be officially pronounced dead at the hospital.

“A day later we heard for the first time the term ‘excited delirium,'” said Robert.

It’s what the Contra Costa County Coroner determined was Angelo’s cause of death.

“At that time I was like, ‘What is that?'” Cassandra recalled.

To believers, excited delirium can be marked by agitation, aggression, high body temperature and, on occasion, sudden death. In short, the body can get so worked up, so excited, that it shuts down, the heart stops and the person dies.

ABC10’s sister station in Denver, 9News (KUSA), has led the nationwide investigation into excited delirium. Our joint investigation found excited delirium has been named as the cause of death for a number of cases just like Angelo’s.

“Why is excited delirium coming up almost exclusively in the context of restraint deaths?” asked Physicians for Human Rights researcher and attorney, Joanna Naples-Mitchell. “It’s got to be more than a coincidence.”

After studying excited delirium, the Nobel Peace Prize winning organization Physicians for Human Rights called it “scientifically meaningless” and a way to “justify aggressive police tactics.”

“Excited delirium is not a valid medical or psychiatric diagnosis and should not be used as a cause of death,” said Naples-Mitchell.

They’re not alone in this opinion. In fact, leading medical organizations like the American Psychiatric Association, World Health Organization and American Medical Association do not even recognize excited delirium as a condition.

California Assemblymember and former law enforcement officer Mike Gipson (D-65) agrees.

“I would have to conclude that it’s made up to cover up,” said Gipson.

While death by excited delirium is not all that common, it is happening across the nation.

“There’s been some research done that about 166 people who have been characterized as dying from excited delirium,” said Gipson.

Some are right here in Northern California.

Public records requests filed by ABC10 uncovered there have been two excited delirium deaths in Sacramento County in the last 10 years, one in Stanislaus County, and six in Contra Costa County — one of those is Angelo’s.

In Contra Costa County, the sheriff also acts as the coroner. His office determined Angelo died from excited delirium. However, when the family commissioned a separate autopsy from private forensic pathologist Dr. Bennett Omalu, he determined Angelo died from positional asphyxia.

Positional asphyxia became widely known after the murder of George Floyd in 2020 when a police officer in Minnesota kept his weight on Floyd in a prone restraint for over nine minutes.

This restraint has also killed others, including here in Northern California, as well as across the nation.

Nearly two decades ago, the U.S. Department of Justice issued a warning officers should get suspects off their stomachs after handcuffing them because of the risk of positional asphyxia.

It’s an alarming practice that has lead to deaths nationwide, according to a finding from an investigation led by our sister station KUSA in Denver. One of these cases, his family said, is Angelo’s.

“It seemed to us clear this was an asphyxiation death, even then,” said Robert.

“When they have nothing else, they say excited delirium,” said Cassandra.

Because of Angelo, Bella and her parents set their minds to ending excited delirium as an accepted cause of death.

“I want Angelo’s case to be the last excited delirium case,” said Cassandra.

Assemblymember Gipson and Angelo’s family partnered to create the bill AB 360.

“If someone dies at the hands of police officers (or) any law enforcement, that the cause of death is actually what the medical examiner’s office has concluded without any fabrication, without any undue influence to cover something up,” said Gipson. “Let the chips fall where they may. If it’s the police’s fault, let’s call for it.”

It would be a first. No city or state has outlawed excited delirium.

“California leads the way,” said Gipson. “We hope that this will be a trendsetter for other states to follow.”

While the bill has a long journey to become law, it’s received bipartisan support. Gipson hopes Governor Newsom signs it later this year.

Angelo’s family still lives in the same house where the incident that led to his death occurred. They use his room as a place to remember him. The altar set up in his room has his artwork and photos of him.

“This is also a place where he had a new beginning. He felt very hopeful and inspired and that’s the energy we feel here, not from his death,” said Bella.

“Angelo’s not here to tell his story,” said Cassandra. “So we’re here to tell his story. We are his voice.”

[embedded content]

author photo
About the Author
Yosi Yahoudai is a founder and the managing partner of J&Y. His practice is comprised primarily of cases involving automobile and motorcycle accidents, but he also represents people in premises liability lawsuits, including suits alleging dangerous conditions of public property, third-party criminal conduct, and intentional torts. He also has expertise in cases involving product defects, dog bites, elder abuse, and sexual assault. He earned his Bachelor of Arts from the University of California and is admitted to practice in all California State Courts, and the United States District Court for the Southern District of California. If you have any questions about this article, you can contact Yosi by clicking here.