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Cause of Death
Not knowing this has confused some into thinking that when Floyd died of cardiopulmonary arrest, it was merely caused directly by an overdose of Fentanyl and not by not being held among the limited bodily positions outside of which he would be unable to breathe.
Not knowing this has confused some into thinking that when Floyd died of cardiopulmonary arrest, it was merely caused directly by an overdose of Fentanyl and not by not being held among the limited bodily positions outside of which he would be unable to breathe.
==Cause of Death==
It is widely believed that George Floyd died from a police officer's knee on his neck, whether due to asphyxiation or neck injury. However, the official autopsy report gives cardiopulmonary arrest as the cause of death. <ref>https://lawandcrime.com/george-floyd-death/authorities-just-released-george-floyds-complete-autopsy-report-read-it-here/</ref> It mentions "brute force injuries" from the scuffle and restraint during his arrest, but states that there were "no life-threatening injuries." Nonetheless, the report ruled it a homicide.
Regarding asphyxia, the county medical examiner's report found "no physical findings that support a diagnosis of traumatic asphyxia or strangulation," while a report commissioned by the Floyd family stated "asphyxiation from sustained pressure was the cause" of death. <ref>https://www.usatoday.com/story/news/nation/2020/06/01/george-floyd-independent-autopsy-findings-released-monday/5307185002/</ref>
The county autopsy included the following "Toxicology Findings: Blood samples collected at 9:00 p.m. on May 25th, before Floyd died, tested positive for the following: Fentanyl 11 ng/mL, Norfentanyl 5.6 ng/mL, ... Methamphetamine 19 ng/mL ... 86 ng/mL of morphine," but draws no conclusions therefrom, noting only that "Quantities are given for those who are medically inclined." This fentanyl concentration, with or without counting the norfentanyl metabolite, was at least one or two times the lethal overdose, according to one study where the highest dose survived was 4.6 ng/mL <ref>https://www.acsh.org/news/2017/02/02/fentanyl-overdose-dont-count-naloxone-save-you-10822</ref>
'''Excited Delirium Syndrome'''
An alternative hypothesis involves Excited Delirium Syndrome (EXD) as the cause of death. EXD typically starts a few minutes before death from a fatal drug overdose, in past years from cocaine or crack, more recently from fentanyl, or drugs laced with fentanyl, which is 50 times more potent than heroin.
According to an article in the Western Journal of Emergency Medicine (WJEM), 2011: <ref>https://westjem.com/articles/excited-delirium.html</ref> "Excited delirium (EXD) is characterized by agitation, aggression, acute distress and sudden death, often in the pre-hospital care setting. It is typically associated with the use of drugs. Subjects typically die from cardiopulmonary arrest... all accounts describe almost the exact same sequence of events: delirium with agitation (fear, panic, shouting, violence and hyperactivity), sudden cessation of struggle, respiratory arrest and death."
More video footage would help to judge whether Floyd's condition followed this sequence. One interpretation <ref>http://www.progressivepress.com/blog-entry/death-rides-fast-horse-black-life-shattered-dope</ref> is that the fear and panic phase started when he refused to get into the squad car, followed by shouting and hyperactivity for several minutes when he was restrained on the ground, then by "sudden cessation of struggle, respiratory arrest and death." There is a gap in the video footage available so far between the time he was standing on the sidewalk and lying in the street. One video shows him shouting on the ground <ref>https://www.nbcnews.com/news/us-news/new-video-appears-show-george-floyd-ground-three-officers-n1217476/</ref>. In a later video, he becomes exhausted and had stopped breathing as the ambulance arrived. <ref>https://www.facebook.com/darnellareallprettymarie/videos/1425398217661280/</ref>
'''Police Intervention and Intentions'''
The EXD diagnosis is controversial and in some quarters is viewed as an alibi for police brutality.
The WJEM authors note, "Since the victims frequently die while being restrained or in the custody of law enforcement, there has been speculation over the years of police brutality being the underlying cause. However, it is important to note that the vast majority of deaths occur suddenly prior to capture, in the emergency department (ED), or unwitnessed at home."
Regarding restraint, they note, "people experiencing EXD are highly agitated, violent, and show signs of unexpected strength so it is not surprising that most require physical restraint. The prone maximal restraint position (PMRP, also known as "hobble" or "hogtie"), where the person’s ankles and wrists are bound together behind their back, has been used extensively by field personnel. In far fewer cases, persons have been tied to a hospital gurney or manually held prone with knee pressure on the back or neck."
This latter position is what Chauvin was applying. It has been proposed that restraint helps to forestall injury and death by conserving the subject's energy. There are also views that restraint increases the likelihood of a fatal outcome.
In this video <ref>https://www.facebook.com/darnellareallprettymarie/videos/1425398217661280/</ref> Chauvin continued to apply the neck restraint although bystanders repeatedly objected, and even after Floyd stopped moving. As Floyd became exhausted, it could have been reasonable to relax the restraint to see if it was really necessary. Chauvin doesn't seem to respond to the bystanders to give a medical reason for the restraint. However, his actions are consistent with a belief that police should restrain the subject until medevacs arrive. Videos show the police focused on restraint, never beating or striking Floyd.
The charge sheet against Chauvin included this exchange between the two white officers on the squad: <ref>https://www.startribune.com/protests-build-anew-after-fired-officer-charged-jailed/570869672</ref>
"I am worried about excited delirium or whatever," Lane said.
"That’s why we have him on his stomach," Chauvin said."
It will be seen if this exchange is confirmed by video footage. "
According to this dialogue, Chauvin apparently was trying to follow the protocol recommended by WJEM. Since Floyd was on his stomach, Chauvin's knee pinned him at the side of his neck, and did not impede breathing.
The American College of Emergency Physicians’ White Paper Report on Excited Delirium Syndrome (ACEP, 2009) <ref>https://www.prisonlegalnews.org/media/publications/acep_report_on_excited_delirium_syndrome_sept_2009.pdf</ref> notes that "a law enforcement officer (LEO) is often present with a person suffering from ExDS because the situation at hand has degenerated to such a degree that someone has deemed it necessary to contact a person of authority to deal with it. LEOs are in the difficult and sometimes impossible position of having to recognize this as a medical emergency, attempting to control an irrational and physically resistive person, ... This already challenging situation has the potential for intense public scrutiny coupled with the expectation of a perfect outcome. Anything less creates a situation of potential public outrage. Unfortunately, this dangerous medical situation makes perfect outcomes difficult." In this situation, officers need to be policemen, paramedics and public relations experts all at once.
With a fatal overdose there is no good outcome possible, but there is no way for police to foresee that. Sometimes EXD can last longer, and it is not always fatal.
Perhaps the ACEP Task Force on EXD will update their report and provide guidelines to help police identify and deal with EXD while avoiding accusations of police brutality.
==New Jim Crow==
==New Jim Crow==