What is 'excited delirium' and why does it show up in so many officer-involved deaths?

16-year-old Eric Parsa was in the throes of a violent autistic meltdown outside of a Metairie laser tag facility, when his mother, Donna Lou, agreed to have workers call 911 for help. 

He was hitting himself and his father in the parking lot when his parents tried to get him in their family car to go home. When Jefferson Parish Sheriff’s deputies arrived, one took him to the ground to try and get him to calm down.  

Deputies held Parsa in a prone position, face-down with his hands cuffed behind his back, leaning their bodyweight on his backside, for just over 9 minutes. That was too long. 

Parsa died just a few feet away from the family vehicle that was supposed to be his safe space to calm down. 

“It still seems like a nightmare that I'm going to wake up and say this is you know, this is just a really long, weird dream. It just doesn't seem real,” said Daren Parsa, Eric’s father. 

For Eric’s parents, it’s a nightmare that lingers with questions about exactly what led Eric to die that day continuing to haunt them. 

It took the Jefferson Parish coroner months to label how exactly Eric died. Immediately after the autopsy, the coroner’s office said his cause of death was “pending further studies.” 

They waited for toxicology tests to see if any drugs in his system made his heart stop. Ultimately, the chief pathologist for the J.P. coroner settled on an accidental death caused by “excited delirium due to an acute psychotic episode” in the setting of his autism.
The contributing factors she listed: obesity, the prone positioning and an enlarged heart. 

Eric’s parents, Daren Parsa and Donna Lou are both medically-trained psychiatrists. They said they had never heard the term ‘excited delirium’ before Eric died.

“From going through med school, that was a term I'd never heard before. I was never told that term in med school,” Lou said.

That's likely because excited delirium is not a psychiatric or medical diagnosis that has been recognized by the American Psychiatric Association or the World Health Organization on their lists of diseases.

It's a loosely-defined set of symptoms often used when someone is high on drugs or mentally ill and they enter a state of extreme agitation, sometimes with an elevated temperature.

Critics say the term is used to excuse excessive force by law enforcement because it’s so often used when people die in their custody. Instead of finding the root cause of what caused someone -- like Parsa -- to stop breathing or experience cardiac arrest, medical examiners blamed the agitated state from before the person was restrained.

“If there's a diagnosis that only happens when people die at the hands of police. A reasonable inference is that it is a way of avoiding accountability rather than seeking the truth,” said William Most, one of the Parsa family attorneys.

Eric was far from the only one who died of excited delirium since 2010. Our partners at KUSA in Denver tied the term excited delirium to more than 150 deaths nationwide since 2010.  

WWL-TV also looked back to 2010 and found in Louisiana, at least 10 deaths tied to excited delirium, including Ronald Greene.

The Union Parish Coroner initially listed "cocaine induced agitated delirium complicated by motor vehicle collision, physical struggle, inflicted head injury, and restraint" as Greene's cause of death.        

Later forensic reviews of his autopsy found the physical struggle failed to adequately account for the beating he took from Louisiana State Troopers.              

The same goes for Tommie McGlothen, a 44-year-old man who died in the back of a Shreveport Police car in 2020 and who was having a mental health crisis.   

The four Shreveport Police officers involved were acquitted of manslaughter in his death in a judge trial last year. A medical examiner testified in the trial that McGlothen would have died even if police hadn't beaten him and tased him because he was in a state of excited delirium.

“The term should just be taken out of the medical lexicon," said Dr. Michael Freeman, a forensic epidemiologist who co-authored a study on excited delirium. “There is no evidence that indicates excited delirium is inherently lethal in the absence of aggressive restraint."

We did find one other case in St. Charles Parish where Leroy Houston, Jr. was found dead in a drainage ditch in 2021.  

Sheriff’s records indicate the autopsy was conducted at the Orleans Parish Forensic Center. The pathologist found no indication of foul play, and that “Houston suffered from cardiac disease exacerbated by excited delirium from methamphetamines and benzodiazepines detected in his system.” 

Four major medical organizations have moved away from using the term excited delirium.
The American Medical Association in June published a statement saying, "Current evidence does not support ‘excited delirium’ as an official diagnosis, and opposes its use until a clear set of diagnostic criteria has been established".

“It's a collection of behaviors and symptoms. And I think that when allegations are made that the diagnosis is overused, it doesn't mean that the diagnosis doesn't exist,” said Jefferson Parish Coroner Dr. Gerry Cvitanovich.

Cvitanovich said he's seen the aftermath of it first-hand both as a former emergency room physician and as coroner.

“I think in most excited delirium deaths, the autopsy does not show a cause of death. So, you wind up doing an autopsy that doesn't show strangulation, doesn't show, you know, any trauma that would cause death, you know. And so, where do you go from there? You've got to go and look at the entirety of the presentation,” Cvitanovich said. 

He signed off on the excited delirium finding for Eric Parsa.

Jefferson Parish Sheriff Joe Lopinto, who recently settled the Parsa family’s family federal civil rights lawsuit, echoed that thought.

“I think excited delirium is a term that gets thrown around pretty loosely, but I think it's also a term that is because we just don't know what happened,” Sheriff Lopinto said.

And that's exactly why the state of California recently passed a law banning the use of excited or agitated delirium as an official cause of death.

Physician and California Assemblywoman Akilah Weber co-sponsored the bill.

“People are now saying you should not be using this because we don't know exactly what it is and we don't have medical evidence to support it and therefore that's why we're all talking about it. California has done something about it and hopefully other states will as well,” Weber said.

Medical organizations, including the National Association of Medical Examiners, are pushing for pathologists to find the root cause of what killed the person and list that as the diagnosis or cause of death instead of a catch-all term.

“I think we use it judiciously. We use it properly. And if, in the opinion of the pathologist we have a case where it comes up again, I will support them using it,” J.P. Coroner Cvitanovich said, “I also know that they're more likely going to follow up behind the recommendations of the national association of medical examiners and use the descriptive terms instead of the syndrome, because it's the same thing.”

We confirmed through in-custody death records that the Parsa case is the only one where Cvitanovich used excited delirium on a death certificate since 2010.  

But parents are asking Cvitanovich to take another look at it, not only because the medical organizations are recommending coroners move away from it, but because the meltdown Eric experienced prior to his death wasn’t unusual, and excited delirium usually is.

“The behaviors that we saw were typical for him. Those were his typical behaviors. Nothing different than when he had a meltdown or an outburst than to say this excited delirium thing, which is a term we never even heard of before,” Lou said. 

“If somebody came and asked us to look at it again, we wouldn't shut the door on. We'd talk to him. I'm not sure what we would do,” Cvitanovich. 

They also are hoping Cvitanovich will consider changing the manner of death to homicide. Not because they think the deputies killed Eric intentionally, but because legally, homicide is the killing of one person at the hands of another.  

And the pathologist testified in a deposition that Eric likely wouldn’t have died that day if the deputies had not held him prone.