EXPLAINER: 'Excited delirium' and George Floyd

FILE -In this image from police body cam video, Minneapolis police officers attempt to remove George Floyd from a vehicle, on May 25, 2020, outside Cup Foods in Minneapolis. A paramedic who treated George Floyd on the day he was killed testified Wednesday, Jan. 26, 2022, at the federal civil rights trial of three former Minneapolis police officers that he wasn't told Floyd wasn't breathing and had no pulse when officers upgraded the urgency of an ambulance call. (Court TV via AP, Pool, File) (Uncredited)

ST. PAUL, Minn. – The issue of whether George Floyd was suffering from the disputed condition of “excited delirium” the day he was killed resurfaced Wednesday at the federal trial of three former Minneapolis police officers charged with depriving him of his civil rights.

Police arrested Floyd outside a corner store on May 25, 2020, for allegedly using a counterfeit $20 bill to pay for cigarettes. A panicky-sounding Floyd struggled and said he was claustrophobic as officers tried to shove the 46-year-old Black man into a police vehicle. After officers pinned Floyd to the ground, rookie Thomas Lane can be heard on body camera video saying he's concerned Floyd might be experiencing excited delirium.

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The defense for former Officer Derek Chauvin argued during his murder trial last year that the condition is real, and that Chauvin acted reasonably when he pressed his knee to Floyd’s neck for about 9 1/2 minutes to restrain him, even as Floyd said he couldn’t breathe and eventually became limp.

Chauvin was convicted of murder and manslaughter. He pleaded guilty in December to a federal civil rights charge. Now, Lane and former Officers Tou Thao and J. Alexander Kueng are on trial, charged broadly with depriving Floyd of his civil rights while acting under government authority.


It came up during the testimony of Derek Smith, a paramedic dispatched to the scene. Robert Paule, an attorney for Thao, asked Smith whether he was concerned about excited delirium — an agitated state in which someone is described as having extraordinary strength.

Smith acknowledged the dispute over whether excited delirium is a real condition, but indicated that he believes it is and has dealt with it. Smith said he did not observe it in Floyd, who was in cardiac arrest. He said his suspicion that Floyd had the condition was based on what officers told him.

Smith said it was his understanding that once someone with excited delirium goes into cardiac arrest, that person can't be revived.


Some medical examiners in recent decades have attributed in-custody deaths to excited delirium, often in cases where the person had become extremely agitated after taking drugs, having a mental health episode or other health problem. But there is no universally accepted definition of it and researchers have said it’s not well understood.

The American Psychiatric Association’s diagnostic handbook doesn’t list the condition and one study last year concluded it is mostly cited as a cause only when the person who died had been restrained.

During Chauvin’s murder trial last year, Dr. Bill Smock — an expert in forensic medicine who works as a police surgeon for the Louisville Metro Police Department in Kentucky and as a professor of emergency medicine at the University of Louisville — testified that he believes excited delirium is real. But he said Floyd met none of the 10 criteria developed by the American College of Emergency Physicians. A minimum of six signs are required for the diagnosis, he said.


Nicole Mackenzie, a Minneapolis police officer who trains other officers in medical care, testified in Chauvin's trial that new officers are taught how to recognize signs of excited delirium. Suspects may be incoherent, she said, exhibit extraordinary strength, sweat or suffer from abnormal body temperature, or seem like they suddenly snapped. They're taught that cardiovascular disease, drug abuse or mental illness can trigger excited delirium, she said.

But prosecutor Jerry Blackwell described it then as a “story” created by the defense to shift blame for Floyd's death.


A key question at Chauvin's trial was whether officers used reasonable force. Minneapolis police officials testified last year that Floyd was under control so force should have quickly ended.

Chauvin's attorney, Eric Nelson, emphasized that Floyd was bigger than Chauvin, suggesting that suspects can present a danger even when handcuffed, and that handcuffs can fail. A defense use-of-force expert, Barry Brodd, a former Santa Rosa, California, police officer, testified that Chauvin was justified in pinning Floyd to the ground because of his frantic resistance.

Paule, the attorney for Thao, has most aggressively raised the issue of excited delirium at the federal trial. He also urged jurors in his opening statement to take into account what preceded the restraint of Floyd, including his struggle with the officers.


Find AP’s full coverage of the death of George Floyd at: https://apnews.com/hub/death-of-george-floyd


This version corrects that Chauvin pleaded guilty to the federal charge in December, not November.

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