Police custody deaths in Maryland, USA: An examination of 45 cases

doi:10.1016/j.jflm.2007.10.005

Journal of Forensic and Legal Medicine

Volume 15, Issue 4, May 2008, Pages 227-230

https://doi.org/10.1016/j.jflm.2007.10.005 Get rights and content

Abstract

Previous published research suggests there are a diverse, yet relatively consistent, set of factors present in sudden, unexpected, and initially inexplicable deaths in police custody. This retrospective analysis examines police custodial deaths in Maryland, USA. Police custody death is operationalized to include deaths which occurred suddenly and unexpectedly during police/citizen encounters. Only deaths for which the cause was initially undeterminable are included. Suicidal hanging, police shootings and fatal pursuits are not included. Review of the records at Maryland’s Office of the Chief Medical Examiner indicates that 45 persons died suddenly and unexpectedly in the custody of the police, between 1990 and 2004. Commensurate with existing research, our analysis identifies multiple factors generally present in this type of police custody death. Although individual-specific, these factors include a relatively static constellation of behavioral (e.g., erratic and/or violent behavior, and physical struggle) and physical (e.g., stimulant abuse, natural disease, and obesity) dimensions. While the presence of these factors has been well-documented, their empirical significance, interactions and causal sequence have yet to be established. To increase the methodological rigor of subsequent research, we have developed a comprehensive, national custody death database by which multivariate models may be analyzed.

Introduction

Some of the most contentious and controversial medical examiner cases involve deaths that occur suddenly, unexpectedly, and seemingly inexplicably during arrest or while the decedent was in police custody.[1], [2], [3], [4], [5], [6] Initially, the cause and manner of these deaths are undeterminable; often, there are no anatomical findings at autopsy and most conclusions are predicated on physiologic processes.[2], [5], [7] The medical examiner must use all information garnered during the investigation to identify the cause or mechanism of death.[8], [9], [10], [3], [6]

Research, conducted over the last two decades, has identified a constellation of factors often present in these particular cases of sudden, unexpected, and initially unexplainable deaths. These factors include irrational and/or aggressive behavior,[1], [2], [11], [12] scuffle and/or physical exertion,[1], [2], [4], [13] the use of restraints and positioning,[4], [14], [15] natural disease,[3], [4], [11] and stimulants.[1], [2], [4], [16] This analysis examines this type of death that occurred in police custody in the state of Maryland to determine if study results buttress the extant research by highlighting the diverse, yet relatively consistent, set of salient factors.

Section snippets

Methods

A retrospective analysis of the records at Maryland’s Office of the Chief Medical Examiner (OCME) was conducted to identify all deaths that occurred suddenly, unexpectedly, and initially inexplicably, in police custody between 1990 and 2004. The jurisdiction includes 23 counties in the state, as well as Baltimore City. Police custody death was operationalized to include deaths which occurred during police/citizen encounters, including field interrogations, arrest procedures and detention.

Sociodemographic characteristics

Review of the records indicates that between 1990 and 2004, 45 individuals died suddenly, and unexpectedly while in police custody. Results show that an overwhelming majority of deaths that occurred in police custody involved males (93%, n = 42) and African–Americans (80%, n = 36). Of the male decedents, 79% were African–American. Only 7% of the study decedents were female, all of whom were African–American.

Approximately 78% of the deaths (n = 35) occurred in two, predominantly African–American

Discussion

Consistent with the present findings, previous research indicates that there are certain factors that may render individuals more susceptible to sudden, unexpected and seemingly inexplicable death in police custody.[9], [10], [19] Such predisposing factors include drug and/or alcohol intoxication, violent muscle activity, obesity, an enlarged heart, and cocaine-induced bizarre or frenzied behavior. The cardiotoxic effects of various drugs are well-documented in the literature, including

Conclusions

Commensurate with existing literature, our research identifies multiple factors which are generally present in sudden, unexpected, and initially inexplicable deaths occurring in police custody in the USA. Although individual-specific, these factors include a relatively static constellation of behavioral (e.g., erratic and/or violent behavior, and physical struggle) and physical (e.g., stimulant abuse, natural disease, and obesity) dimensions. While the presence of these factors in custodial

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Cited by (43)

Special topics: in-custody deaths, physical altercations, neglect (adult), approach to unexpected hemorrhage, and delayed and concealed homicides
2022, Principles of Forensic Pathology: From Investigation to Certification
There are a variety of special topics that arise in forensic pathology practice. Many of these involve challenging investigations with a potential for public controversy. They include: deaths in detention centers/correctional facilities/police custody, hyperactive delirium, suicidal behavior in law enforcement encounters, police investigations and the medical examiner/coroner, homicide by heart attack, suicidal behavior in the midst of a police encounter, physical struggle/altercations, neglect and abuse of the debilitated teen or adult, approach to hemorrhage of unclear origin, delayed homicides, and the approach to and challenges encountered in homicides with attempted concealment of bodies by dismemberment, fire, and burial. The investigation and certification of these deaths are discussed.
Minnesota Autopsy Protocol
2020, Journal of Forensic and Legal Medicine
Deaths in police custody
2018, Journal of Forensic and Legal Medicine
Deaths in police custody often attract a huge amount of public interest and are frequently associated with controversy related to causation. While systematic investigations of deaths in police custody are currently available for countries in Europe, North America and Australia, the different inclusion and exclusion criteria and the lack of a uniform definition limits their comparability.
Rates of death vary by age and gender with some similarities across different countries and continents. The male dominance is essentially due to the fact that around the world women are much less frequently taken into police custody than men.
Similarly, in the U.S., the most common cause of custody death was natural illness and disease progression such as heart disease and cancer; along with high rates of suicide deaths. In most European countries there is a considerable dominance of non-natural deaths. The causes of death are dominated by alcohol, drugs and medications, but suicide, injury and trauma are also common.
Deaths in custody require careful investigation to determine causality as well as culpability when appropriate. While many deaths may not be preventable, some are. Further systematic research of this issue, including detailed analyses and investigations of such cases, is necessary to develop general and specific preventative measures to reduce the risk of death in the custody population.
A prospective study of ketamine as primary therapy for prehospital profound agitation
2018, American Journal of Emergency Medicine
We investigated the effectiveness of ketamine as a primary therapy for prehospital profound agitation.
This was a prospective observational study of patients receiving 5 mg/kg of intramuscular ketamine for profound agitation, defined as a score of + 4 on the Altered Mental Status Scale (AMSS), a validated ordinal scale of agitation from − 4 (unresponsive) to + 4 (most agitated). The primary outcome was time to adequate sedation (AMSS < + 1). Secondary outcomes included need for additional sedatives, intubation frequency, complications associated with ketamine, and mortality.
Forty-nine patients were enrolled. Median age was 29 years (range 18–66); 76% (37/49) were male. Median time to adequate sedation was 4.2 min (95% CI: 2.5–5.9, range 1–25 min) and 90% (44/49) had adequate sedation prehospital. Seven patients (14%) received a second sedative prehospital. Intubation occurred in 57% (28/49) of patients. Mechanical ventilation lasted < 24 h in 82% (23/28) of patients, and < 48 h in 96% (27/28) of patients. A single physician intubated 36% (10/28) of the patients. Complications related to ketamine included hypersalivation (n = 9, 18%), vomiting (n = 3, 6%), and emergence reaction (n = 2, 4%). One patient died from complications of septic shock on hospital day 29, likely unrelated to ketamine.
In patients with prehospital profound agitation, ketamine provides rapid effective sedation when used as a primary therapy. Intubation was common but accompanied by a short duration of mechanical ventilation and appears to have been subject to individual physician practice variation.
Fatal and non-fatal burn injuries with electrical weapons and explosive fumes
2017, Journal of Forensic and Legal Medicine
While generally reducing morbidity and mortality, electrical weapons have risks associated with their usage, including eye injuries and falls. With the presence of explosive fumes or fuels there also exists the possibility of burn injury.
We searched for cases of fatal and non-fatal major burns with TASER^® electrical weapon usage where there was a possibility that the weapon ignited the explosion.
We confirmed 6 cases of fatal burn injury and 4 cases of major non-fatal burns out of 3.17 million field uses. The mean age was 35.5 ± 9.7 years which is consistent with the typical arrest-related death. Moderate, minor, and noninjurious fires — typically due to a cigarette lighters in a pocket, petrol, recreational inhalants, or body spray were also noted.
The use of electrical weapons presents a small but real risk of death from fatal burn injury. It also presents a small risk of major non-fatal burn injury. The ignition of petrol fumes dominates these cases of major fatal and nonfatal burns.
Fatal traumatic brain injury with electrical weapon falls
2016, Journal of Forensic and Legal Medicine
While generally reducing morbidity and mortality, electrical weapons have risks associated with their usage, including eye injuries and falls. With sufficient probe spread, an uncontrolled fall to the ground typically occurs along with the possibility of a fatal brain injury.
We analyzed possible risk factors including running and elevated surfaces with established head-injury criteria to estimate the risk of brain injury. We searched for cases of arrest-related or in-custody death, with TASER^® electrical weapon usage where fall-induced injuries might have contributed to the death. We found 24 cases meeting our initial inclusion criteria of a fatal fall involving electronic control. We then excluded 5 cases as intentional jumps, leaving 19 cases of forced falls. Autopsy reports and other records were analyzed to determine which of these deaths were from brain injury caused by the fall.
We found 16 probable cases of fatal brain injuries induced by electronic control from electrical weapons. Out of 3 million field uses, this gives a risk of 5.3 ± 2.6 PPM which is higher than the theoretical risk of electrocution. The mean age was 46 ± 14 years which is significantly greater that the age of the typical ARD (36 ± 10). Probe shots to the subject's back may present a higher risk of a fatal fall.
The use of electronic control presents a small but real risk of death from fatal traumatic brain injury. Increased age represents an independent risk factor for such fatalities.

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^☆: The authors received no grant support related to this submission.

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Published by Elsevier B.V.

Original CommunicationPolice custody deaths in Maryland, USA: An examination of 45 cases☆

Abstract

Introduction

Section snippets

Methods

Sociodemographic characteristics

Discussion

Conclusions

Am J Emerg Med

Clinics Lab Med

J Clin Forensic Med

Cocaine-induced agitated delirium, forceful struggle, and minor head injury: a further definition of sudden death during restraint

Am J Forensic Med Pathol

Factors associated with excited delirium deaths in police custody

Mod Pathol

Excited delirium syndrome: cause of death and prevention

Acute excited states and sudden death

Br Med J

Sudden death during arrest and phencyclidine

Am J Forensic Med Pathol

The pathology of cocaine abuse

Advances in pathology and laboratory medicine

Pepper spray and in custody deaths: international association of chiefs of police executive brief

Sci Tech

Medicolegal investigation of death

Unexpected death related to restraint for excited delirium: a retrospective study of deaths in police custody and in the community

Can Med Assoc J

Original Communication
Police custody deaths in Maryland, USA: An examination of 45 cases☆