Excited Delirium | Criminal Podcast | Forensic Files

This episode includes descriptions of violence and sexual assault. Please use discretion.
On December 23rd, 2020, Bella Kimoto Collins was home from college to celebrate the holidays with her family
in California. >> We had gone to my mom's work. They just had a small get-together, you know, masks on. Um and
I grew up at my mom's work, really. So, they're kind of [music] like family. Um so, we kind of spent the afternoon with
them, I guess, [music] and then came home. And we're just relaxing. >> [music] >> A few months earlier, Bella's mother and
Bella's two adult brothers had moved into a new house in a town called Antioch, [music] near San Francisco.
When Bella and her mother, Cassandra, [music] had come back from seeing Cassandra's
colleagues that day, Bella's oldest brother, [music] Angelo, was in his room sleeping.
Cassandra says she went to his bedroom >> because there was a package for him. You
know, a package that he's been waiting for for a while. So, I knocked on his door
and kind of woke him up. And he's like, "Oh, thank you, Mom. Just leave it there."
And then, [music] you know, he I went out and he just went back to sleep. >> When the pandemic hit, Angelo, who was
12 years older than Bella, had lost his job and moved in with Cassandra. Before that, Angelo had joined the US
Navy. >> [music] >> It was his dream career, but because of an allergy, he'd left during boot camp
in 2019. Now, he was trying to figure out what he wanted to do next. He liked gaming and was thinking about
becoming a game designer. After talking to Angelo, Cassandra went to the living room and at some point she
fell asleep on the couch. Then, around 10:00 p.m., Angelo woke her up. >> And I said, "Yes, what do you want?" You
know. He goes, um, "What's for dinner?" And I was kind of upset about that because he I mean, you
know, he usually cooks for himself. He loves to cook. So, when he asked me what's for dinner is, I was
like, "What What do you mean?" You know, I was kind of upset cuz he woke me up from my
sleep, my nap. >> He clearly wasn't himself. Um, at a certain point I was on a Zoom with my
friend and he just kept coming into the room and like asking, "Oh, what's going on?" He seemed really worried.
It looked like the beginnings of an episode, as we'd called it. He'd had a couple of them throughout 2020.
Um, in which he would just kind of act oddly, just not like himself, and really anxious and scared.
Um, but it was really infrequent and then it almost seemed like he was normal the next day.
>> The family says he had started having these episodes after a head injury. Did this night
seem different than than other episodes that he had had? >> No, actually. Um, >> It's actually the way we dealt with it,
right? >> Yeah. We We didn't have much tolerance for it at that point. Um, in previous episodes I
I'd say there were about five total throughout that year. Um, he required patience when he was feeling
that way, when he was afraid, when he was asking the same questions, um when he looked past you and thought he saw
something, he required a patience that spanned 8 hours sometimes. >> A few months before, a neighbor had
called the police because they'd seen Angelo trying to climb a fence. They said he was yelling.
The police took him to the hospital. Cassandra says Angelo had been worried that maybe he had bipolar disorder or
schizophrenia. She wanted him to see a psychiatrist so he could get help. She says that when he was having these
episodes, he would ask her again and again if he was going to be okay. She'd often need to sit with him for a
long time to calm him down. >> And we didn't have that patience that night. And I think that really escalated
his anxiety. >> Over the next hour or so, Angelo seemed to get more and more scared and anxious.
He wanted Cassandra and Bella to stay close to him. He locked arms with the two of them and
started walking them around the kitchen. >> And that, of course, then heightened our
anxieties and I know that I was thinking in the moment, "Oh my gosh, he's getting
really, really afraid." >> Bella, who was 18 at the time, said she started to feel really worried.
>> At a certain point, I had told him, "Please, you know, let let go. I'm going to call the police if you don't stop
holding us." And he just I could tell he couldn't understand what I was saying. >> kept on saying, "What's going on? What's
going on?" >> And that, you know, that freaked me out. >> Bella called 911 to ask for help.
>> Because I just felt like I had no other option. My dad was in Berkeley at the time
and I thought that's too far away. He wouldn't be able to get here fast enough. >> Bella told the 911 operator that her
brother was, quote, being aggressive and hurting her mother. She said that Angelo had tried to pick
up a hammer so she had picked it up instead and had it with her. The operator asked her,
"Do you know if he takes any drugs?" And Bella replied, "Yes." At one point in the call, someone
yelled, "Stop it. Stop it." At the end of the call, Bella said to the operator, "Sorry. Thank you."
What were you hoping the police would do to help once they showed up? >> Um calm him down in a way that we
couldn't. >> Shortly after 11:00 p.m., two police officers arrived at their house.
The police dispatcher had told them about Bella's call, that she said her brother was hurting
their mother. The police said that when they arrived, Angelo was being, quote, actively
restrained by Cassandra on the floor in a bear hug. Cassandra and Bella say that Angelo was
calm. >> He wasn't trying to get away from me because I think that's what he wanted
is, um, for me to be there. He was just breathing heavily, but he was calm. He was very calm and that's what, uh,
the police officer saw when they came in the house. >> The police officer started to handcuff
Angelo. They rolled him onto his stomach. According to the police, he started to
struggle and they bent one leg over the other to restrain him. Cassandra and Bella say Angelo didn't
struggle. At some point, another two police officers showed up. Cassandra and Bella say that first one
officer and then another had their knee on Angelo's neck. They say it went on for over 4 minutes.
The police later said that an officer quote briefly for a few seconds had a knee across a portion of Angelo's
shoulder blade. We reached out to the Antioch Police Department for comment. We didn't hear
back. >> What was he saying? Please don't kill me. Please don't kill me. >> The officers called an ambulance and
asked for help with a mental health crisis. They asked for a code two, meaning as
quick as you can but not an emergency. Two of the police officers later said they'd responded to Angelo's previous
incident when he was trying to climb a fence. And one of them said that he thought
Angelo had behaved in a similar way. He wasn't making sense. Cassandra decided to get her phone out
to start recording what was going on. >> Cuz I wanted Angelo to go to therapy and
to go to a psychiatrist so that he could be properly medicated. >> [sighs and gasps]
>> Whenever um I talked to him about his episodes, you know, he could not believe that
he did that. So, this particular time, I made sure to record it, you know. So, the next day I would have him listen
to it and he's going to go, "Okay, Mom." >> One of the police officers told Cassandra that Angelo wasn't under
arrest and that he would be transferred to a hospital for evaluation because it seemed like he might be a danger to
himself or others. Cassandra said that Angelo hadn't been attacking them, but that he had been hallucinating and
paranoid and didn't want to be alone. One of the police officer said, "That's why he's going to the hospital,
not to jail." Angelo had gone quiet. >> I asked them twice actually if he was asleep
>> [snorts] >> cuz I want them to, you know, check on how he's doing. >> Angelo was still lying on the floor with
his hands handcuffed behind his back and it became clear that he was unconscious.
One of the police officer said, "What's going on with him?" >> It actually became very quiet as soon as
um they saw as soon as they flipped him and they saw blood coming out from his mouth
and you know, rolled up his eye, showed up his head. It became very quiet. >> When Cassandra's video starts, two
police officers are standing over Angelo trying to communicate with him. They're wearing face masks and blue
rubber gloves. The officers move Angelo onto his side and one of them rubs his chest. There's
blood on Angelo's face. >> What what what happened? >> Angelo. Angelo. Does he have any medications?
>> I Not that I know of. Come on. Come on, can you take him, please? Please, please.
>> The officers unlock the handcuffs and move Angelo onto a stretcher. Cassandra follows them.
There's blood on the bedroom floor where Angelo had been lying face down. >> [music]
>> They start doing CPR on Angelo. Then they push the stretcher out of the house and into an ambulance.
>> [music] >> I'm Phoebe Judge. This is Criminal. >> [music] >> When Angelo was rolled out of the house
on a stretcher, Bella says she thought he looked purple. Angelo was rushed to the hospital.
>> [music] >> Cassandra and Bella had to stay back to answer questions from the police.
>> They said they were going to take us to the police station and I said, "Why?"
Um to be interviewed, they said. And I go, "Well, you know, they already >> [music]
>> did ask questions just a little while ago." And they said, "Don't worry, we're
just It's just [music] going to be, you know, like It's the same questions." >> At the police station, Cassandra and
Bella were questioned separately about what had happened that night. Cassandra says a detective asked her if
she had hit Angelo earlier since he had a bloody nose. She answered, "No." While they were at the police station,
Cassandra says she got a call from a doctor who was treating Angelo at the hospital.
When she answered it, she says a police officer rushed over and told her to get off the phone.
They said she'd get a chance to talk to the doctors later. As Bella and Cassandra had been on their
way to the police station, Angelo's stepfather, Robert, arrived at the house. >> When I arrived, they were questioning
me. Did he have something? Did he eat something he shouldn't have? Has he taken drugs? Is he allergic to
something? >> He was told he couldn't enter the house. Their whole street was closed off.
More police officers kept arriving, moving in and out of the house, which was marked off with crime scene tape.
Police officers were standing guard around it. For hours, Robert stayed in the driveway
with his dog, who had been in the car with him, and Angelo's younger brother, who'd come
back after spending time at a friend's house. Around 6:30 that morning, Bella and
Cassandra got back from the police station. Their house was still full of police and
investigators. >> Cassandra got a call from the doctor. And uh she asked me to take it, and I
spoke with the doctor. And he indicated to me that, you know, Angelo's >> [gasps]
>> brain was, you know, 98% dead. There's only a tiny portion of the brain stem left alive.
>> The family went to the hospital to see Angelo, but because of COVID protocols,
they were told they couldn't come inside. When they got back home at around 8:30
in the morning, the police had left. When the family walked through the house, there was still a smear of blood
on the floor where Angelo had been lying on his stomach, and Angelo's bedroom seemed to have been
searched. >> It's just like everything is upside down. It's been, you know, every last little thing has been
tossed and turned, and it's on the floor, and it's just just a mess. >> The police had taken things from
Angelo's bedroom, including his cell phone and some photographs. In the kitchen,
the family says they found a felony search warrant. The warrant said the police were
authorized to take anything that, quote, tends to show that a felony has been committed or that a particular person
has committed a felony. Robert says they were shocked. The police had told them that Angelo wasn't
under arrest and hadn't committed a crime. That morning on December 24th, the family kept calling the hospital,
but they couldn't get permission to visit Angelo. >> On the 25th, they called us
and said we could, you know, come and visit him. So, um Robert and I went. >> Angelo was unresponsive. He was on a
breathing machine and his eyes were taped closed. He only had a faint heartbeat.
>> I was um reading him this Christmas card that everybody wrote on and um as soon as I was done, the nurse
said, "I'm sorry, I don't think he heard you." Or she said something and I go, "Oh, isn't
it that when you're in a coma, um you can still hear, you know, you can still hear what other people are saying? So,
you you kind of like constantly talk to them." And then she said, "Well, um yeah, but
in Angelo's case, I don't think that is possible." >> The family says they felt like they
couldn't get clear information from the hospital staff. Later, medical records cited in court
documents said that when Angelo first arrived at the hospital, staff had been instructed
by the police not to talk to them about Angelo's condition. A doctor had added it as a note to
Angelo's medical record. >> I asked for um Angelo's toxicology report. And the nurse smiled at me and said,
"I'm sorry, but we cannot provide that." And I'm like, "What do you mean? What do
you mean you can't provide it? >> Casandra says she asked the nurse if it was because there was an investigation
going on. And she remembers that the nurse nodded. >> So, I was getting, you know, like really
upset. And then mad at that point. I'm the mother. I'm, you know, I need to know. I have to know.
Um and she said, um let me go to my supervisor >> and ask. >> And so, what she did is that she said
she can't give it to us. But she said, I'm going to look at it on screen. You might be able to see some of it over
my shoulder. And so, she basically kind of showed it to us, but she didn't want to give us or
give any proof that he she'd give it to us. But she let us see that there were no
common substances of abuse found. >> On the morning of December 26th, they got a call from the hospital saying they
should come visit Angelo as soon as possible. In the car on their way there, Casandra
says they talked about getting a lawyer. Robert had already been making phone calls to friends and family to ask for
recommendations. Casandra didn't think they needed one. >> You know, I I mean, I was on denial.
But while I was, you know, with Angelo holding his hands, I was like, you know what? This is not
right. And I looked at Robert and I said, you know what? Go ahead. Get a lawyer.
>> Robert went out to the hospital parking lot and started making phone calls trying to explain to people what had
happened in the past 3 days. Eventually, he spoke with a civil rights attorney who said he'd take the case.
>> And then I came back and they said Angelo is now, >> [gasps and sighs] >> you know, he's he's he's going to pass.
And the nurse said he's going to pass. And we waited about 20 minutes and then at 1:30 or 1:40 p.m. he did. He um
his heart stopped. >> The next day, the family's new lawyers, John Burris and Ben Nisenbaum, came to
their house in Antioch. >> I think we're still having a hard time realizing what's happened, but one of
the first things that Ben said, he said basically they he thought they were going to blame it
on excited delirium. If they have nothing else, they will say it was excited delirium.
>> Had you ever heard that term before? What did you think? >> I actually the first thing the first
question I asked what what is that? >> [music] >> What is excited delirium? >> For people who aren't that familiar with
this term, what what does it mean? >> If I told you it meant nothing, then I think [music] that would be accurate.
>> Attorney Ben Nisenbaum. >> In terms of what it purports to mean, it's essentially that
the body disregulates itself [music] in a fatal manner. So so somehow the the heart stops beating because the body
becomes so >> [music] >> unable to regulate itself. >> Had you ever handled other cases where
it was used as a cause of death? >> Many. >> [music] >> Many. >> Many cases? >> I can think of at least a dozen.
When people died during a police restraint, the immediate response >> [music] >> invariably was it wasn't the police, it
was excited delirium. As if the person got so excited and became so delirious they
they just spontaneously combusted. And I heard that I'd heard that so many times uh from the police over my career
that I just knew that that's what [music] was to be expected. >> [music] >> We'll be right back.
>> Excited delirium is this term that has a really contentious history, um a racist
history. And it's used to describe a collection of symptoms. >> Reporter Renu Roy ism.
>> But there's no diagnostic code for it. There's no blood test for it. There's no
way to to test for it. I should note delirium is a clinical term. It is something that that people
see in emergency rooms in hospitals. But the term excited delirium, it's it's kind of in some ways made up.
>> It was first used in the 1980s. If you think about the 1980s in the US, there's a cocaine epidemic that was
gripping much of the country. And there was a South Florida forensic pathologist
named Charles Wetli. In 1985, Charles Wetli co-authored a paper on what he called cocaine-induced
psychosis >> and excited delirium. He looked at the deaths of seven people, mostly men, who'd used cocaine.
They'd all been restrained, usually by police, one of them by ER staff, >> [music]
>> and suddenly died. He wrote that all seven had intense paranoia [music] followed by quote bizarre and violent
behavior and sometimes quote unexpected [music] strength. >> And he said, "These are people who are
scared, they are violent, they are panicked, then they are restrained, and then they died suddenly."
And the problem with this theory is it was purely speculative, um and it didn't look at the role that restraints might
have played in these deaths. They didn't really identify any scientific evidence
or any toxicology reports or any way to uh back up or test their idea. >> Then, Charles Wetli started looking into
a number of other cases. >> In the late '80s in in South Florida, Miami, several black women were dying.
And they were dying in the same area in Miami, and in a really similar way. >> 12 women were found dead between 1986
and 1988. Charles Wetli told reporters, "The typical scene is in a cheap room, a
clump of bushes, or an abandoned building. They were discovered naked from the waist down, and they all had trace
amounts of cocaine in their system." An article in the Miami News quoted Wetli as saying,
"At first glance, it looks like she's been raped and murdered." But he said that wasn't the case.
Wetli said the women likely died of cocaine psychosis. One newspaper article described it as,
quote, "Sudden death from low levels of cocaine that caused the victims to go berserk
and die within minutes." Some of the women were believed to have been sex workers.
>> And he and his colleagues said that the combination of cocaine and sex is what
led to these women's death. And he called it excited delirium. And, you know, he said that black women
were more prone to dying this way, and that it was this combination of the stimulation from the cocaine and the sex
that led to their death. He told reporters that when they examined the women's bodies, there were
no signs of assault. Quote, the autopsies have conclusively showed that these women were not
murdered. At one point, he worked on a theory that rain in Peru had somehow tainted a
shipment of cocaine. The police closed the cases. Many of the women who were found dead
were from Jamaica, Haiti, and Puerto Rico. Most of them were in their 20s and 30s.
>> But then, in 1988, a 14-year-old girl named Antoinette Burns was found dead, and she was found dead in much the same
way that the other women had died. Um Wetli did the initial autopsy, and he once again said that she too died of
excited delirium. And the Burns family pushed back. I mean, this was a young girl, 14. They
said she wasn't a sex worker, she didn't do drugs. Um she was last seen hitching
a ride to the movies with a neighbor. And and the family really pushed back on this, but it wasn't until a toxicology
report came back, um that Wetli's theory began to unravel. Antoinette Burns didn't have cocaine in
her system. And after that, the chief medical examiner, so Wetli's boss, reviewed all the deaths of these women
that Wetli had said died of excited delirium. And what he found was pretty startling.
>> The chief medical examiner went back and looked at the photos from the autopsies
of all the women who'd been found dead. He found lip and neck injuries and hemorrhaging in the eyes.
He said that in many of these cases, the women had very, very clearly been strangled or asphyxiated to death. He
said you could spot it a mile away. I mean, he said that these women, nearly 20 by
this point, were actually homicide victims. Um and the police believed that a serial killer was responsible for
their deaths. >> More women were found dead in 1989. >> [music] >> But then, in April of that year, the
deaths finally seemed to stop. Months later, police [music] announced that they had a suspect in the cases.
A 33-year-old man named Charles Henry Williams, who'd been arrested on rape charges in April, right when the string
of murders ended. >> [music] >> But police said they didn't have enough evidence to charge him with the murders
of the 32 women who they suspected him of killing over almost a decade. One of them was his neighbor,
>> [music] >> and four had been found dead near his home. They ended up charging him with one
murder of a 19-year-old woman named Patricia Johnson. 10 days before the start of the trial,
Williams died of AIDS while in prison serving a sentence for rape. [music] But Charles Wetli stuck to his theory
that excited delirium was real, and that at least some of the women in Miami had [music] died from it.
>> You would think, you know, after the Antoinette Burns case, after this kind of
huge thing in Miami where this guy said, "Oh, all these people died of excited delirium." And it turns out they had
been murdered, >> [music] >> that the term would have completely fallen out of favor.
But eventually it reemerged. >> [music] >> When the Kianto Collins family's attorney told them about excited
delirium syndrome, Bella says that like her parents, she'd never heard of it before.
>> I thought, "That sounds really stupid. Um, does not sound very sophisticated at
all." But he described to us uh his experience with excited delirium in the past.
>> So, after they told us about excited delirium, I said "I want a second autopsy."
>> So, it was a, you know, I mean, I think the first thing is how do you pay for
this autopsy? >> The family said the independent autopsy ended up costing them $18,000.
When it came back, it said Angelo had died of asphyxiation. They were still waiting to hear the
results of the county's official autopsy. On January 13th, 2021, they held a memorial service for Angelo
in the garden of a local church. Months later, his family was notified that the county would hold a coroner's
inquest. >> It's a hearing in which uh the county calls several witnesses. >> Attorney Ben Nissenbaum.
>> Typically, the witnesses to the killing or death testify before jurors at the coroner's inquest.
>> The jury at a coroner's inquest doesn't decide who is responsible for the death,
only the quote cause and manner of death. >> What the jury finds goes into onto a death certificate.
The jury determines whether the death was a homicide, a suicide, a natural death, or an accident.
>> On the morning of August 20th, 2021, 8 months after Angelo had died, the Quintos-Collins family went to the
local courthouse. The hearing was open to the public. Lots of people had showed up.
>> [music] >> Friends and family, but also journalists. Bella says that the police officers who
were going to be giving statements that day were already in the courtroom when the doors were opened to the public.
>> And then, when we got the chance to come inside, my mom and I decided to sit right next
to the officers. The court hearing wasn't led by a judge, but by a hearing officer, a lawyer named
Matthew Guichard, who'd been contracted by the county. Guichard explained that in their county,
Contra Costa County, the sheriff is also the coroner, meaning the sheriff determines the cause
and manner of a person's death, and is part of arranging coroner's inquests. And when a person dies in police custody
or during a police interaction, a coroner's inquest is required. California is one of just a few states
where a county sheriff can also be the county's coroner. Matthew Guichard explained that this
wouldn't be like a trial you might see in the movies. Quote, "There won't be lawyers standing
up and asking questions." He said he would be the one asking the witnesses questions, and that he had
reviewed all of the documents, audio, and video recordings in the case. Attorney Ben Nissenbaum was in the
courtroom with the Quintos Collins family watching. >> We do get to submit questions, but the
hearing officer can decide not to ask those questions. So, the hearing officer has all the
power. You know, they can decide what what the jury gets to hear. >> Six witnesses were called. The county's
forensic pathologist, three of the police officers who were at the house in Antioch, a police detective, and a
detective from the DA's office. Bella and Cassandra were not on the list of witnesses.
>> Throughout that 4 hours of this inquest, They didn't mention my mother or myself
by name. We were the mother and the sister, which just felt kind of odd because, you know, we weren't witnesses,
but every aspect of the story involves the mother and the sister. >> The first witness was the pathologist
who had performed Angelo's official autopsy. The family didn't know what the pathologist had found. They still hadn't
seen the official autopsy report. But they did know the results of the independent autopsy that they had
ordered and paid for themselves, which had concluded that Angelo had died of asphyxiation.
The independent autopsy had found something called petechial hemorrhages on Angelo,
small red marks often found in the eyes from broken blood vessels. >> Which is important because
they tend to support a finding of an asphyxiation death. >> But the county pathologist testified
that he had found no petechial hemorrhages on Angelo, and he didn't mention any other signs of
asphyxiation. He went over the results of the toxicology report. It showed that Angelo had caffeine in
his system and cotinine from cigarette smoking, as well as a drug for seizures, which is
generally considered safe. Later, the Quinto-Collins family's attorney pointed out that Angelo had
been given anti-seizure medication at the hospital in the days before he died. The pathologist also found a drug called
modafinil, which is also generally considered safe. It's used to treat narcolepsy,
but people sometimes use it off-label to stay awake and alert longer. The pathologist said that the modafinil
could have contributed to Angelo's death. Because, he said, there's a condition linked to drug use
that kills people." He said, quote, "It's poorly understood. It's called excited delirium syndrome."
>> To which there was an audible reaction from the crowd. >> It was shocking, and it was laughable,
and I laughed out loud. Not on purpose, but you know, I just had that reaction. And when I realized that I had done
that, I thought, "Oops." And I walked myself [music] out. >> The pathologist said that Angelo's cause
of death was, quote, "excited delirium syndrome due to acute drug intoxication with behavioral disturbances due to
arrest-related death with physical exertion." [music] In the 8 months since their lawyer had
first told them about excited delirium, Robert says they'd all been learning more.
>> As time went on, it became difficult to think that they would still blame excited delirium because even if
you believed >> [music] >> in the pseudoscience of excited delirium, even if you were to read
their own reports, Angelo didn't fit. That's why there was such a shock in the crowd because we had all become much
more informed about excited delirium. Typically, excited delirium was blamed on people that were taking coke or meth
or something, but to blame it on tobacco >> and caffeine >> cigarettes and this other thing that prevented you
from sleeping, which had never had any deaths, >> Mhm. >> meant that they had the flimsiest case
of excited delirium, even if you went by their own standards. >> Next, Kishard played Bella's 911 call to
the jury. And three of the four police officers who had been at the house in Antioch the
night Angelo was taken to the hospital, testified. Two of the officers said that they'd had
a knee on Angelo, but only very briefly. Originally, the police had said one officer had a knee on him.
Then a detective with the DA's office testified that he had looked at Angelo's old incident when a neighbor had called
the police because Angelo had been acting strangely, trying to climb a fence. The investigator said that according to
the paramedics, Angelo had had a fast heartbeat. And he said a police officer had said
that Angelo had admitted to being on meth. Gishard had said he thought a doctor at
the hospital had believed the same thing. Then Gishard told the jury to not consider what had just been said about
meth because he said it was about a previous incident and there was no evidence of meth in Angelo's blood as
the pathologist had previously testified. After the witness testimonies, Gishard
reminded the jury that they would only be deciding on the cause of death, not who was responsible.
They had four options: homicide, suicide, accident, or natural causes. The jury were told they didn't need to
reach a unanimous decision, but a majority of them would have to agree. Gishard cleared the courtroom while the
jury stayed back to deliberate. After about 15 minutes, they'd reached a unanimous decision.
Were you surprised when the jury ruled it an accident? >> No, not at all. When I heard the uh
the testimony from the coroner that it was excited delirium, then I that's what I expected would happen.
And I felt like that was the intended and that was the purpose of it. >> The Kinto Collins family had filed a
lawsuit against the city of Antioch, its police chief, and the four police officers who were at the family's house
that night in December 2020. Months later, Ben Nissenbaum deposed the county's pathologist.
The pathologist came to his office with a lawyer. >> What happened was I showed him the
pictures from our autopsy that show the petechial hemorrhages in Mr. Kinto's eyes.
And uh so he looked at them and he looked at them again and again and again and again.
And uh Dr. Ogan actually acknowledged that yes, those are petechial hemorrhages and
that [laughter] in his view that they take time to develop and that they simply hadn't developed at the time
that that he did answer those uh autopsy. What he said is that the restraint also
played a role in Mr. Kinto's death. >> The pathologist said that if he had found the petechial hemorrhages when he
did his autopsy, he would have added asphyxiation to his diagnosis. But he still believed the excited
delirium diagnosis was right. >> [music] [music] >> We'll be right back. >> [music]
>> After the idea of excited delirium was proposed in the 1980s, it started gaining momentum.
In In 2008, a 3-day conference on deaths that occurred in police custody was held
at a hotel in Las Vegas. It was sponsored by something called the Institute for the Prevention of
In-Custody Deaths. Speakers included doctors, pathologists, and scientists. One of the speakers was Charles Wetli,
the medical examiner who had theorized that the deaths of a number of women in Miami were due to excited delirium
because they'd had cocaine in their system. In 1995, Charles Wetli had moved to New
York, where he worked as a medical examiner. >> Even though Wetli's theories in Miami were unproven
in that those murder cases, he continued to talk about excited delirium. Reporter Reynu Raism, and he continued
to link cocaine use with excited delirium. He was just really convinced of this idea.
And then this sort of idea really took off in a lot of different ways. >> When the 2008 conference in Las Vegas
was announced, Charles Wetli was introduced as one of the doctors who had identified excited delirium quote, in
the cocaine wild 1980s. The conference promised that, quote, attendees will help make law
enforcement, medical, and legal history through topic-specific breakout groups focused on arriving at a consensus about
excited delirium. The conference was organized by a group that was started by a lawyer
from Taser. >> They make stun guns. They say, "Hey, these stun guns don't kill people.
They're an alternative to kind of other uses of force by police." >> In a later interview with Reuters,
Charles Wetli said that he had studied deaths involving Tasers, and in the vast majority of cases, those
deaths were caused by excited delirium, not the Taser shock. Quote, "I've never seen [music] a case
where I could say that a Taser actually contributed to the death." He told Reuters that Taser had hired him
many times to be an expert witness in lawsuits against the company. Renu Raj >> [music]
>> says that conference on in-custody deaths became a turning point. >> From that conference emerged what ended
up being this really influential white paper on excited delirium. Uh it's called a white paper on excited delirium
syndrome. So, a white paper, it's like a in this sort of medical or scientific context,
a white paper is kind of like a detailed guide or report on a topic. >> The white paper was published by the
American College of Emergency Physicians in 2009. The authors of the paper were 19
doctors, many of them professors of emergency medicine. A few of them had worked with Taser in
some capacity. We reached out to Axon, the company that makes Tasers, for comment.
We didn't hear back. >> So, if you read the paper, you go back and read the 2009 white paper from the
American College of Emergency Physicians, it sort of lays out Okay, what they think excited delirium is, and
it presents this research. Of course, all the research is um it's sort of circular. It's from the same group of
experts that have been talking about the theory in the first place. Um and they say, "Okay, there are no
biological markers for excited delirium." Again, there's no tests or standard diagnostic criteria,
but they lay out what they say are these features. If someone has like superhuman
strength or really high pain tolerance or rapid breathing, then they have excited delirium.
>> The white paper listed other signs that someone might have excited delirium, such as a {quote} failure to respond to
police presence, profuse sweating, and a {quote} attraction to glass or reflective surfaces.
>> I had never heard of this thing called excited delirium, and I I was troubled
and curious. >> In 2020, Argen Bajwa was a medical student doing a research fellowship at a
hospital in Rochester, New York, when a man named Daniel Prude was brought to the intensive care unit after
an incident which included being restrained by police. Argen didn't treat the man, but later he
heard about him and about how his autopsy had listed excited delirium syndrome as a cause of death.
Argen says he asked some of his professors about it, but none of them had heard about excited
delirium syndrome. Groups like the American Medical Association, the American Psychiatric
Association, and the WHO didn't recognize it. So, Argen started doing his own research.
>> Well, I just started with Google, like everyone does, and the first things that came up were a lot
of police training uh material. Manuals from police departments across the country, videos about it on YouTube for
training purposes. >> Argen says the training materials he found almost always mentioned superhuman
strength and how to deal with it. >> Somebody with excited delirium can't be taken down with the normal de-escalation
techniques of verbal cues. They say they need many officers. They say that they need many electroshocks.
>> A news organization called New York Focus got access to Rochester police training materials on excited delirium,
created in 2016, and found that a lot of it appeared to come from a poster published by the
Institute for the Prevention of In-Custody Deaths, the organization that had been started by a lawyer at Taser.
The poster had advice on how to capture someone with excited delirium. Quote, "Taser electronic control devices have
been shown to be the most effective for quickly capturing this category of individuals."
In a police training presentation, a couple of slides had a list of behaviors to look out for.
They included hallucinations and unfounded fear or panic, bizarre behavior, and quote, "saying I
can't breathe." The slides included photos, like one of a naked zombie with blood on
its face, one of the Incredible Hulk, and one of the actor and comedian Jordan Peele with sweat running down his face.
The slide explains the four stages of excited delirium. One, elevated body temperature.
Two, agitation. Three, respiratory arrest. Four, death. >> One of the ideas is that
people with excited delirium, {quote} {unquote}, have reduced pain perception. And they cite instances of them smashing
glass and withstanding multiple electroshocks. Um in that description are all these
very loaded terms with all this baggage, like monster and and animal-like behavior and
extreme strength and um I think that plays on racial stereotypes because overwhelmingly these are
black men, young black men. The second angle is that this question of differences in pain perception
has an embarrassing legacy in medicine, a long legacy of of physicians believing
that people of African descent had different pain perception, require less anesthetic,
have a literally thicker skin, [music] have literally less sensitive nerve endings.
>> [music] >> So, very gruesome things from surgery to experimentation to amputation were
carried out >> [music] >> under that guise. And I think that we see that legacy in this narrative
of people with excited delirium having diminished pain response. >> The organization Physicians for Human
Rights says that the deaths of black people and people of color have disproportionately been attributed to
excited delirium. Excited delirium also came up in George Floyd's case. There's an officer on the tape saying,
"Hey, we think maybe he has excited delirium." At trial, the defense attorney for Derek
Chauvin, who was accused of killing George Floyd, said that Chauvin had been watching for signs of excited delirium
as a quote reasonable police officer because that's what police were trained to do.
A Minneapolis police officer had testified that she trained new officers on how to
recognize the syndrome. The prosecution called the doctor to testify. He said that he believed excited
delirium is real, but that George Floyd had none of the symptoms. Derek Chauvin was convicted of killing
George Floyd. After George Floyd's death and the deaths of a number of other men of color
who had died in police custody in 2019 and 2020, supposedly from excited delirium.
Renu says things began to change. >> I think what really changed the game was video footage of these deaths. And in
particular, George Floyd's death, I think that caused a lot of people to [snorts] take a look at this term. It
forced a lot of groups that had been um supportive of the term to turn away from
it. And under pressure, um the American College of Emergency Physicians in 2021,
they started to backpedal a little bit. And in 2023, the American College of Emergency Physicians retracted that 2009
white paper and they said, "We got it wrong." >> Renu says police departments across the
country have since removed the term excited delirium from their training materials.
>> But I'll give you an example of how just kind of banning the term may not be enough. Um
so, the Minneapolis Star Tribune, they reported that in training materials for the Minneapolis Police Department,
there are these PowerPoint slides and the words excited delirium were crossed out and replaced with the term severe
agitation with confusion and delirium in parentheses. So, yeah, this concept that
um you know, that exists just with a different name. >> Six months before the white paper on
excited delirium was withdrawn, Angelo Quinto's family tried to have the cause of death on his death certificate
changed. After the county pathologist had sat down with Ben Nissenbaum and agreed that
asphyxiation had been a contributing factor in Angelo's death, his family argued that Angelo's death
should have been classified as a homicide. They were not successful. In 2021, >> [music]
>> California Governor Gavin Newsom signed eight new reform bills into law. One of them bans restraints [music]
that can cause asphyxiation. And in 2023, California became the first state to ban
the term excited delirium, as well as related terms such as hyperactive delirium [music]
and exhaustive mania. >> What it's done is to change the way that the cases are resolved by coroners. And we've seen
that have a real effect, I think, >> [music] >> because now much more we see that coroners are including the
restraint >> [music] >> as part of the cause of death. >> In 2024, the Antioch City Council announced that
[music] they decided to settle with Angelo Quinto O'Connell's family for $7.5 million.
After Angelo died on December 26th, [music] 2020, his family kept the presents they'd
wrapped for him that Christmas. They never opened them. >> [music] >> And his mother, Cassandra, told us
that every year at Christmas, they bring out Angelo's presents and put them under
the tree. Since Angelo's death, the city of Antioch launched [music] a new non-police crisis team that will respond
to calls about people in a mental health crisis. Shortly after Angelo died, his sister,
Bella, >> [music] >> who had called 911 that night, told reporters, "Quote, I asked the detectives if there's
another number I should have called, and they told me that there wasn't, [music]
and that I did the right thing. But the right thing would not have killed my brother.
She said, "Now there's somebody else to call." It's named after [music] Angelo. The Angelo Quinto Community Response
Team. >> [music] >> Criminal is created by Lauren Spore and me. Nitty Wilson is our senior producer.
Katie Bishop is our supervising producer. Our producers are Susanna Robertson, Jackie Sajico, Lilly Clark,
[music] Lena Sillison, and Megan Cain. Our show is mixed and engineered by Veronica Somenetti.
Julian Alexander makes original illustrations for each episode of Criminal. You can see them at
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We hope you'll consider supporting our work by joining our membership program, Criminal Plus. You can listen to
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things we've been enjoying lately. To learn more, go to patreon.com/criminal. >> [music]
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>> [music] >> We're also on YouTube at youtube.com/criminalpodcast. Criminal is part [music] of the Vox
Media Podcast Network. Discover more great shows at podcast.voxmedia.com. I'm Phoebe Judge. This is Criminal.

When Angelo Quinto died, his family said police were responsible for his death. But a lawyer told them his official cause of death would likely be something called “excited delirium.”

Criminal is a show about people who’ve done wrong, been wronged, or gotten caught somewhere in the middle. Hosted by Phoebe Judge. Part of the Vox Media Podcast Network.

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Episode 355 originally published March 6, 2026. https://thisiscriminal.com/episode-355-excited-delirium-3-6-2026

Music in this episode: “Di Breun” by Blue Dot Sessions “Arbic Tallow” by Blue Dot Sessions “Bauxite” by Blue Dot Sessions “The Bus at Dawn” by Blue Dot Sessions “Road to Petersby” by Blue Dot Sessions “Line Exchange” by Blue Dot Sessions “Noe Noe” by Blue Dot Sessions “Brer Krille” by Blue Dot Sessions “Li Fonte” by Blue Dot Sessions “Gambrel” by Blue Dot Sessions

Brief Summary

Angelo Quinto died after police restrained him during a mental health crisis, raising questions about systemic failures in handling such situations.

Key points

A Family's Holiday Nightmare. Bella Kimoto Collins recounts a terrifying night when her brother Angelo's mental health crisis escalated, leading to a police call and tragic consequences.
The Shocking Diagnosis. Cassandra learns from doctors that Angelo's brain is 98% dead after the incident.
The Aftermath of Chaos. Cassandra describes the disarray in their home following the police's intervention.
The Miami Deaths. In the late '80s, several black women were found dead in Miami under similar circumstances.
Excited Delirium Theory. Wetli theorized that cocaine and sex led to the deaths of these women, calling it excited delirium.
Antoinette Burns Case. The death of a 14-year-old girl led to scrutiny of Wetli's excited delirium theory.

Episode highlights

Episode quotes

Please, you know, let let go. I'm going to call the police.

Bella's plea to her brother Angelo during a tense moment.

5:19WatchMay 1, 2026

Tension

85/ 100High tension

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