EXPLAINER: ‘Excited delirium’ and George Floyd

Posted at 8:03 PM, January 26, 2022 and last updated 7:44 PM, July 19, 2023

By STEVE KARNOWSKI Associated Press

ST. PAUL, Minn. (AP) — 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.

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.


FILE – This combination of photos provided by the Hennepin County Sheriff’s Office in Minnesota on June 3, 2020, shows, from left, former Minneapolis police officers J. Alexander Kueng, Thomas Lane and Tou Thao. (Hennepin County Sheriff’s Office via AP, File)

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.

FILE – In this image from surveillance video, Minneapolis police Officers from left, Tou Thao, Derek Chauvin, J. Alexander Kueng and Thomas Lane are seen attempting to take George Floyd into custody in Minneapolis, Minn on May 25, 2020. Prosecutors played videos from the scene of Floyd’s arrest Tuesday, Jan. 25, 2022 at the federal civil rights trial of three former Minneapolis police officers accused of violating Floyd’s civil rights as fellow Officer Derek Chauvin killed him. (Court TV via AP, Pool, File)

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.


This April 20, 2021, booking photo provided by the Minnesota Department of Corrections show Derek Chauvin, who was convicted in the murder of George Floyd, Jr. (Minnesota Dept. of Corrections)

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 Court TV’s full coverage of the death of George Floyd here: www.courttv.com/the-death-of-george-floyd-murder-trial/