Bay Area Family's Advocacy Leads to California's Ban on 'Excited Delirium'

When Angelo Quinto’s family called 911 on Dec. 23, 2020, they wanted help. Quinto, a U.S. Navy veteran, was having a mental health episode.

Antioch police officers arrived at the home and pinned Quinto facedown on his mother’s bedroom floor. She says they handcuffed him and put a knee on the back of his neck for several minutes until he became unresponsive.

The coroner declared the cause of death (PDF) “excited delirium.” The controversial term describes a range of symptoms, from confusion to rapid breathing to fever.

The physical evidence, however, showed asphyxiation. No officers were charged for his death. Quinto’s mother, Cassandra Quinto-Collins, was in the room the whole time and watched her son stop breathing.

“It does not make any sense,” Quinto-Collins said. “But they get away with it. Do they think all the people are stupid, that they don’t understand what’s going on?”

The Quinto-Collins family started working toward legislation that would prevent this from happening to other families, eventually collaborating with Assemblymember Mike Gipson (D-Gardena), a former police officer, to introduce AB 360, which Gov. Gavin Newsom signed into law earlier in October.

“This is something that happens far too often,” said Bella Quinto-Collins, Quinto’s sister. “And not everybody is as fortunate as us in these circumstances to feel empowered enough to speak up or have the support of their immediate family to speak up. It was just really important to us that we shared the truth.”

California’s new law bans the use of “excited delirium” in a coroner’s report, a police report or a lawsuit. The bill passed almost unanimously and without any registered opposition.

“It was indisputable,” Gipson said. “When all the major, professional credible scientists — and those who study and license — say that this doesn’t exist.”

The American College of Emergency Physicians recently voted to discredit “excited delirium” as a medical syndrome, meaning no major American medical association is endorsing it.

State Sen. Kelly Seyarto (R-Murrieta), who gave the lone “no” vote on the California bill, did not return a request for comment.

“Excited delirium” first surfaced as a term of use in the 1980s in Miami, when a forensic pathologist named Dr. Charles Wetli used it to explain away the deaths of individuals in police custody by their use of cocaine.

He warned of “bizarre and violent behavior” and determined that 12 Black women, presumed sex workers, had died of “excited delirium.” (A later investigation found a serial killer had asphyxiated the women.)

The term soon made its way into police training materials, describing men in their 30s with “superhuman strength (PDF)” who were impervious to pain. The use of tasers, ketamine and positional restraints was recommended to subdue them.

So how did the idea of “excited delirium” gain acceptance?

“Really we can credit a small cohort of medical experts who often work as experts for law enforcement or for TASER International weapons manufacturer,” said Joanna Naples-Mitchell, U.S. research advisor for Physicians for Human Rights.

Of the deaths in police custody that were attributed to “excited delirium,” studies showed more than half (PDF) were of people of color — and 90% involved restraint.

“It’s very convenient,” said Dr. Altaf Saadi, a neurologist at Massachusetts General Hospital and assistant professor of neurology at Harvard Medical School. “It just puts together a whole host of different symptoms.”

Saadi said health professionals should be sent out on 911 calls, in case someone who is perceived to be experiencing “excited delirium” in fact has mental health issues that need to be addressed.

She said some restraint methods — like pressing down on a person’s back, as the Antioch officers did to Quinto — have been shown to cause serious issues, from stroke to cognitive issues to potential death.

The new law goes into effect Jan. 1, 2024. The Quinto-Collins family is relieved that “excited delirium” will no longer be recognized in California.

“It may not have helped our case,” Quinto-Collins said. “But it’s going to help the next Angelos, and the next family, so they won’t go through what we’re going through right now.”