The Saranac Lake village board, under the leadership of then-Mayor Rabideau and then-Manager Sweeney, voted to sign a contract with Lexipol on Aug. 10, 2020. Lexipol is a for-profit company that provides policy manuals, daily training bulletins and consulting services to public safety departments.

Despite promises to “engage the public” and hold hearings to present it to the public, the village quietly rubber-stamped and published the 605-page policy manual in October 2021.

In doing so, they endorsed no less than two policies (300.6 and 428.3) that accept “excited delirium” as a legitimate medical diagnosis.

“Excited delirium,” as defined by our policy manual, refers to “extreme agitation, violent irrational behavior accompanied by profuse sweating, extraordinary strength beyond their physical characteristics, and imperviousness to pain.”

It is usually diagnosed after some people, disproportionately Black men, die in police custody.

When you look to Lexipol for more information, you’ll find an article titled “8 facts about excited delirium syndrome (ExDS).” The article was published in May 2019 but has been recommended by Lexipol as additional reading at least as recently as October 2022.

The article is co-authored by Dr. Gary Vilke. Vilke doesn’t believe Derek Chauvin’s knee had anything to do with George Floyd’s death.

In an interview with a Minnesota NBC affiliate, Vilke said, “There’s bad optics there. Is it having a physiological effect on [Floyd]? That’s doubtful.”

The article includes a section titled “Media Myths Persist.” The authors claim the American Medical Association recognizes “excited delirium” as a legitimate medical diagnosis, citing a 2009 AMA resolution.

There are three problems with this:

First, the AMA passed a new policy opposing “excited delirium” as an official diagnosis in June 2021. Lexipol is two years behind one of the very organizations they’re citing. It doesn’t inspire much confidence in their ability to update our policy manual with the latest laws and “best practices.”

Second, the citation for the quote in the 2009 AMA resolution (exciteddelirium.org) had been redirecting website traffic to a yeast infection home remedy website (yeastdoc.com) from as early as November 2019 to as recently as September 2022. This does not seem like a source that should be cited in any context related to public safety.

Third, the quote has been deliberately taken out of context. The words, “Although not a validated diagnostic entity in either the International Classification of Diseases or the Diagnostic and Statistical Manual of Mental Disorders …” were removed.

It’s almost as if the authors of the piece were intentionally trying to hide dissenting opinion. Unfortunately for Lexipol and the ever-shrinking group of “excited delirium” proponents, hiding dissenting opinions is getting much harder to do.

The World Health Organization, American Psychiartic Association and American Academy of Emergency Medicine do not recognize “excited delirium.”

A 2022 report published by Physicians for Human Rights calls the term “scientifically meaningless.” In March 2023, the National Association of Medical Examiners posted a new statement saying that “excited delirium” should not be used as a cause of death.

In addition to the vagueness of the term, critics of “excited delirium” often highlight how it has been disproportionately applied to people of color who die in police custody. The data back up this concern.

A 2021 article published in Virginia Law Review searched several databases and found “that of 166 reported deaths in police custody from possible ‘excited delirum,’ Black people made up 43.4% and Black and Latinx people together made up at least 56%.”

The Physicians for Human Rights report concluded, “the term ‘excited delirium’ cannot be disentangled from its racist and unscientific origins.”

The term originated in the 1980s, when “excited delirium” was coined by Drs. Charles Wetli and David Fishbain in case reports on cocaine intoxication in the early to mid 1980s.

Dr. Wetli applied his “excited delirium” theory to explain how more than 12 Miami Black women, who were presumed sex workers, died after using small amounts of cocaine. Wetli theorized, “For some reason the male of the species becomes psychotic and the female of the species dies in relation to sex.”

To explain why all the victims were Black, Wetli speculated, “We might find out that cocaine in combination with a certain (blood) type (more common in Black people) is lethal.”

Investigators eventually held a serial killer responsible for the deaths, but that didn’t stop Wetli from defending his theory, despite having no scientific basis for doing so.

None of this made it into Lexipol’s content. However, the article “8 facts about excited delirium syndrome (ExDS)” cites Dr. Wetli.

I find it regrettable that people like Dr. Vilke and Dr. Wetli have more influence over our public safety policy than us — the taxpayers actually funding this contract.

The phrase “best practice” was thrown around a lot when the village board approved the contract with Lexipol in 2020. We’re now seeing the problem with using that phrase without any context or care.

What the village calls a “best practice” rejects overwhelming medical consensus while perpetuating medical racism. I don’t think that’s what Gov. Cuomo had in mind when he issued Executive Order 203, the New York State Police Reform and Reinvention Collaborative.

Ultimately, this commentary was written in response to two sentences in our policy manual. What else will we find as we dig a little deeper? Look out for next month’s commentary.

Note: If Lexipol archives their content, you can use the Wayback Machine at archive.org to view the content in its original form.

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David Lynch lives in Saranac Lake.

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Sources:

“Private Company Moves To Profit From New York’s Police Reforms,” https://theintercept.com/2020/08/09/new-york-police-reform-lexipol/

“Doctor tells jury in Derek Chauvin trial previous studies on deaths are ‘highly misleading,'” https://www.9news.com/article/news/investigations/derek-chauvin-trial-studies-previous-deaths-misleading/73-b906b207-b35c-4ad7-a1d7-fc67d669f342

“New AMA policy opposes ‘excited delirium’ diagnosis,” https://www.ama-assn.org/press-center/press-releases/new-ama-policy-opposes-excited-delirium-diagnosis

“5 Keys For Responding To ‘Excited Delirium’ Patients,” https://www.police1.com/officer-safety/articles/5-keys-for-responding-to-excited-delirium-patients-IEn5kaTNIz3fhork/

“Use Of Tasers By Law Enforcement Agencies,” https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/public/about-ama/councils/Council%20Reports/council-on-science-public-health/a09-csaph-tasers.pdf

“Medical examiners group steps away from ‘excited delirium,'” https://apnews.com/article/excited-delirium-police-custody-restraint-d75c5138fbed3c7911e0bd9bcde6c207

“‘Excited Delirium’ and Deaths in Police Custody: The Deadly Impact of a Baseless Diagnosis,” https://phr.org/our-work/resources/excited-delirium/

“Excited Delirium And Police Use Of Force,” https://www.virginialawreview.org/wp-content/uploads/2021/12/Obasogie_Book_107.pdf

“8 ‘Facts’ About Excited Delirium Syndrome (ExDS),” https://www.police1.com/police-training/articles/8-facts-about-excited-delirium-syndrome-exds-nutDY9i2C1ATmeV5/