The American medical profession changes a diagnosis on racialist grounds
Richard Pescatore II, D.O., editor in chief of Emergency Medicine News, in a June issue editorial titled "Anachronisms in Agitation," made a confession that should once again shake your confidence in the medical profession. He declared in essence that the well established medical diagnosis excited delirium is incorrect and should be discarded because of race politics and particularly anti-police politics, in my opinion. Dr. Pescatore explains:
The 2019 death of Elijah McClain, a 23-year-old Black man in police custody, led to a stark re-examination of the diagnosis, however, after excited delirium was postulated postmortem. The American Medical Association and American Psychiatric Association took strong stands against excited delirium as a diagnosis, taking issue with the lack of distinct diagnostic criteria and expressing concern over the label's retrospective application as a way to explain or justify law enforcement use of force.
A growing groundswell echoed these concerns, pointing out that some of the descriptors used in the 2009 report were more likely to be ascribed to Black people, and that excited delirium was increasingly eclipsed by a more nuanced understanding of pathophysiology and patient-specific factors [citing a 2023 article in the Western Journal of Emergency Medicine]. Prominent voices have since called for abandoning the term in lieu of the more descriptive hyperactive delirium with severe agitation.
Dr. Pescatore offers a distinction without a difference by his advocacy to abandon excited delirium in favor of hyperactive delirium with severe agitation, but the word game is really cover for something more sinister and political — and he admits what motivates him in this article and has motivated medical organizations. Here is the sinister motive, as well stated by the good doctor:
This shift was not simply a name change but a collective recognition of the misuse of excited delirium syndrome to justify or account for deaths in police custody. The National Association of Medical Examiners joined in recognition with its release of a position statement disowning the diagnosis in March. Symptomatic of systemic injustices and structural bias, the term excited delirium represents an outdated approach to the complex problem of severely agitated and delirious patients.
The controversial diagnosis of excited delirium must be abandoned in favor of the more descriptive and objective hyperactive delirium with severe agitation, and the astute emergency physician and educator should recognize the complexities and idiosyncrasies associated with patients who interact with law enforcement.
Evidence-based care requires interpreting patient clinical conditions within their environment, and knowledgeable management of patients with hyperactive delirium and severe agitation demands recognition of the systemic injustices that outdated labeling and approaches have exacerbated. [emphases added]
In the rest of the article, Dr. Pescatore provides excellent analysis and recommendations for treatment of the agitated delirium, excited delirium patient. The reality is that changing the name has not changed the recommended treatments or the possible complications, even death. One irony of the article is that Pescatore had to mention that one of the most respected columnists for Emergency Medicine News, recently deceased, was a major contributor and author for the Excited Delirium monograph, commissioned by the American College of Emergency Physicians. I assure the reader that the 2009 monograph was well done, and no amount of political nonsense makes the diagnosis of the research an anachronism. It has now been taken down, memory-holed. In my opinion, Dr. Pescatore is pathetic to bend to the racialist woke crowd.
Excited delirium is the same dangerous condition it was before it got renamed. To think that renaming it deserves the effort of organized medicine is emblematic of the political correctness operating at woke medical organizations. The American Medical Association (AMA) house of delegates and the American Psychiatric Association and now both Emergency Medicine Associations and other entities have "disowned" the diagnosis of excited delirium and publicly condemned using the diagnosis excited delirium in cases like that of George Floyd.
They also condemned using sedation and psych drugs on agitated and delirious individuals in emergency situations. These pronouncements were cheap shots that played to a woke racialist mob and ignored both medical science and the truth. That's no surprise, because, for example, the AMA Board of Trustees, in June 2020, declared their support for Critical Race Theory, equity (DIE), and anti-police campaigns.
Whenever an opportunity arises to violate Hippocratic principles and professional ethics and dump scientific principles, count on the pillars of the American medicine establishment to check their woke canon and hymnal. A medical profession that can mutilate children is certainly capable of deceit with regard to the known causes of death while resisting arrest — after all, the oppressive arm of the law and society is to be condemned when applied to those who claim oppressed status.
I wrote here at AT about George Floyd's death and the lethal reality of excited delirium that can cause lethal cardiac arrest. My position is that Mr. Floyd died of a well documented autopsy finding of terrible heart disease, and the combined effect of agitation, exertion, excitement, and intoxication with fentanyl, a potent sedative, and methamphetamine, a cardiac stimulant. In that article, I linked to a video demonstration that I produced to show the safety of the prone restraint.
Medical experts including Dr. Baker, the medical examiner for Hennepin County, caved to prosecutor and professional as well as the mob pressure, and Derek Chauvin was convicted. The effort to eliminate talk about excited delirium is an effort to intimidate law enforcement and enable bad guys, all in for a racialist agenda and even promoting incorporating racialist ideological nonsense in medical school curricula. The medical profession has been corrupted by the current political environment. Medical professionals are fast losing public confidence for good reasons — caving to the CRT mob, COVID, and tranny malpractice as just three examples.
Update from Dr. Dunn:
The George Floyd prosecution medical errors are now being played out in the NYC Jordan Neely death case. The case fits the excited delirium death scenario — right away, the race-hustlers, baiters, and media screamed Chokehold!, Chokehold! when there was no chokehold and Neely was agitated, with mental health problems and drug abuse as a history. Neely fit the criteria for excited delirium, or, in the new diagnosis, hyperactive delirium with severe agitation, and another black bad actor dies in an agitated state, and the white Marine, Daniel Penny, who restrained him, is accused of murder. Dr. Pescatore explains how we got to this point of medical profession corruption.
John Dale Dunn, M.D., J.D. is a retired emergency physician and inactive attorney in Brownwood, Texas.