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Showing posts with label dr. margaret thompson. Show all posts
Showing posts with label dr. margaret thompson. Show all posts

Friday, October 15, 2010

Train police to recognize cocaine-induced delirium, inquest hears

As our friend over at Excited-Delirium said just yesterday: "Justice Braidwood (see Braidwood Inquiry) described 'excited delirium' as "unhelpful". It's looking more and more that the entire concept may be far worse than just a neutral "unhelpful". It's used to justify a response, but ignore the medical risks of whatever is ACTUALLY going on."

Even the RCMP has removed itself from the term "excited delirium."

It's time for ONTARIO to wake the hell up and extricate itself from the church of taser!!


October 15, 2010
Barb Brown, Hamilton Spectator

Ontario Provincial Police should equip every detachment with automatic defibrillators and ensure that all officers are trained to use them and to recognize a potentially fatal medical condition known as excited delirium.

These are among five recommendations jointly agreed to by coroner's counsel and lawyers with standing at the inquest into the sudden death of a 36-year-old Delhi man who was in the custody at the OPP's Norfolk detachment on June 23, 2008.

Jeffrey Marreel was arrested that morning for creating a public disturbance in the hamlet of Fisher's Glen, about 10 kilometres southwest of Port Dover. An autopsy concluded he died of a fatal cardiac arrest brought on by acute cocaine toxicity.

Dr. Margaret Thompson, an emergency room physician with expertise in cocaine poisoning and the rare, but related medical emergency known as "excited delirium," testified there was enough cocaine in Marreel's system to kill him. She said his aggressive behaviour, including attacking trees and traffic signs, hitting himself with a piece of metal, ranting and shouting incoherently, were indications that he was experiencing excited delirium, which was likely a contributing factor to his death.

The inquest heard Marreel exhibited "superhuman strength" and appeared impervious to pain as up to six police officer struggled to control and restrain him. A senior officer zapped Marreel with a Taser on stun mode several times, however, a report of a cardiologist who has researched Taser effects said the electroshock weapon did not appear to be a factor in Marreel's death.

Coroner's counsel Karen Shea argued that Marreel's death should be classified as an accident, as opposed to have occurred by natural causes, suicide, homicide and undetermined causes. Shea made five recommendations to the jurors at the inquest that were adopted by lawyers for the OPP and the provincial police officer's professional association. The lawyers recommend that:

--The OPP should equip all detachments with automatic emergency defibrillators and ensure officers are properly trained to use the machine.

--Ontario's Ministry of Health and Long Term Care and base hospitals responsible for the training paramedics ensure that all medical emergency personnel are trained to recognize excited delirium as a medical emergency that can potentially be fatal.

--The OPP and Ontario Police College enhance training to ensure that all new recruits of police services in the province are trained to recognize indicators and the potentially lethal effects of excited delirium.

-- The OPP provide updated training annually for its front-line officers on the recognition of excited delirium.

--Ontario's Ministry of Community Safety and Correctional Services issue directives to all police services in the province to ensure that all police officers receive annual training on the signs and risks associated with excited delirium.

Coroner Jack Stanborough told the jury it must reach a majority decision on each of five questions, including, who was killed, where, when, how and by what means? The jury retired to deliberate at 11:30 a.m.

Taser jolts didn’t kill man, coroner’s inquest hears

Every time an inquest is held in this province after a person was tasered and died, the coroner parades the same cast of characters, whose testimony goes completely unquestioned and is counterproductive to finding out what really caused the person to die.

If you dig a little deeper, you’ll see that cardiologist Paul Dorion has testified in the past that tasers aren’t quite as non-lethal as they might seem. But he's not being paid to say that here.

See, for example, this post:

Taser jolts didn’t kill man, coroner’s inquest hears


It’s pathetic that no one is at the inquest to ask these “expert witnesses” any tough questions!!

October 14, 2010
Barbara Brown, Hamilton Spectator

A Taser deployed by an OPP officer on a paranoid and out-of-control cocaine binger did not cause the Norfolk man’s fatal heart attack nearly one hour later, says a cardiologist’s report to a coroner’s jury.

Dr. Paul Dorian, a research scientist, cardiologist and pharmacologist, submitted his report to Coroner Jack Stanborough, but was not available to testify Thursday during a third day of evidence at the inquest in Hamilton into the death of Jeffrey Mark Marreel, 36.

The Delhi man suffered a fatal cardiac arrest while in police custody the morning of June 23, 2008, approximately 55 minutes after being jolted several times with a Taser on “stun mode.”

Marreel, who was erratic and agitated from a weekend of snorting, smoking and injecting cocaine, displayed almost “superhuman strength” and showed no response to the Taser or other pain during a struggle with up to six police officers.

Witnesses called Norfolk OPP because the man had been walking around destroying property and generally wreaking havoc near Fisher’s Glen Road and Front Road.

Marreel was eventually restrained by police and placed in the back of a cruiser, where he was briefly examined by a paramedic. He continued to be incoherent and combative and refused medical treatment for two lacerations to his head. Marreel was taken to Simcoe provincial police station.

The prisoner lost consciousness and was observed to have no vital signs. CPR efforts failed and the man was pronounced dead at Norfolk General Hospital.

Dorian noted there has been considerable debate about the potential for Tasers to have cardiac effects and possibly contribute to life-threatening cardiac arrhythmias. But to have this effect, he said, the Taser would have to be applied to the torso with its current path crossing the heart. In that situation, he said, the cardiac effect would occur “within seconds of application.”

“In (this) situation, the Taser application was approximately one hour prior to the observed loss of consciousness, and appears to have been applied to the subject’s extremities (two jolts to the back of the shoulder and one to the arm). In this circumstance, there is no possibility that the Taser application played any role in the subject’s subsequent cardiac arrest.”

Dorian concluded Marreel’s sudden cardiac death was caused by acute cocaine toxicity.

In other evidence, Dr. Margaret Thompson, a specialist in emergency medicine and medical director of the Ontario Poison Centre, said she believes excited delirium (once called cocaine psychosis) was a contributing factor in Marreel’s death, secondary to acute cocaine toxicity.

The paramedic who examined Marreel in the back seat of the police cruiser noted a somewhat elevated heart rate, but was not able to do a proper assessment because of his combativeness. Thompson said she would not have released such a patient from medical care, given that he was exhibiting symptoms of excited delirium can lead to sudden death.

Coroner’s counsel Karen Shea, Lorenzo Policelli, counsel for the Ontario Provincial Police and William MacKenzie, the lawyer for the police association, are to make closing arguments to the jury on Friday.

Tuesday, May 26, 2009

Inquest hears Taser didn’t stop man's heart

From a June 18, 2008 Canadian Press report entitled Taser damage questioned: Dr. Paul Dorian, a cardiologist and professor of medicine at the University of Toronto, says officers need to assume they may hurt someone when they use the Taser and treat all injuries seriously.

From a June 17, 2008 CBC News report entitled One-third of people shot by Taser need medical attention: probe: Dr. Paul Dorian, a cardiologist and a professor of medicine at the University of Toronto, said police officers need to assume they may hurt someone when they use a Taser and treat all injuries seriously. " He conducted a study on pigs on the effects on the heart of Taser shocks and found multiple hits with a stun gun can cause heart stress. "If there is injury and illness, as a physician, I would have to say those people, even if they are accused criminals, should be taken care of," he said.

From a June 1, 2008 Toronto Star report on the inquest into the death of Jerry Knight, entitled Tasers: More questions than answers: Dr. Paul Dorian, a cardiologist at St. Michael's Hospital and the author of the most recent Taser study, would never say it's impossible to meet a deadly fate at the end of a Tom A Swift Electric Rifle (Taser). But it's rare. According to his research, an analysis of the existing literature coupled with his own observations and study, the odds of a "death by Taser" are the same as dying from, say, living next to power lines, getting breast implants, or drinking from a bisphenol-leaching plastic water bottle. "It's unlikely," he says, acknowledging these concerns are real and should be taken seriously once they are put into perspective. "But never say never." It would take a confluence of factors, Dorian says, for a Taser to force a victim's heart into fatal contractions that outlast the Taser's jolt. Pre-existing heart damage is a must, he says. So is a surge of adrenaline through a victim's blood, which could be caused by drugs, such as the cocaine found in Knight's blood, alcohol, agitation, or the stress of facing police and the crackling end of a live Taser. To turn deadly, officers must shoot at close enough range for the weapon's two metal darts, barbed like fishhooks, to land next to, or right on, each of the victim's nipples, where the electricity from the Taser is most likely to disrupt normal pulses in the heart. "They have to penetrate the skin," Dorian says. "And the charge has to be sufficiently prolonged. "And if the Taser is to blame for a death, the victim would not hang on for a few hours, Dorian says. He would be dead within minutes, like Dziekanski ... Whatever the outcome, Dorian says, research shows Tasers are a potential health hazard, no matter what the odds against them causing someone's death. While everyone is trying to figure out if they kill, or if they're safe, he says, it would be wrong to continue using them without making any changes – or at least trying to minimize the risk. What about not shooting at someone's chest? he offers. Or, reconfiguring the device? "There's a lot of possibilities, but so far none have been discussed," he says. "Nothing in the world is safe. But we haven't taken this as seriously as we should."

From a May 7, 2008 CTV British Columbia report on the Braidwood Inquiry: Canadian medical researchers are disputing the theory that stun guns do not cause irregular heart rhythms that are sometimes fatal. Tests had shown that Taser shock could cause fibrillation -- a very rapid, irregular contraction of muscles fibers -- in any muscle, except the heart. "Bottom line is we think that assumption is incorrect," said Dr. Paul Dorian, a medical researcher from the University of Toronto. "Under certain circumstances, the Taser electrical discharges can, in fact, cause the heart muscle to beat and to beat very fast." Dorian and his team shocked six pigs with stun guns looking for signs of ventricular fibrillation (VF) and other adverse heart effects. The results echo a recent Chicago study, where prolonged stun gun shocks caused VF. Two pigs died in the Chicago study. One pig died of VF in Dorian's study and the other five pigs showed cardiac disturbance. When it occurs in humans, VF can be lethal, Dorian said. "When this rapid irregular heart rhythm occurs, the heart doesn't beat effectively," Dorian told CTV News. "No blood is pumped from it, and the victim, unless they get CPR and gets an electrical shock to the heart, will die within 10 minutes." In response to the Toronto study, manufacturer Taser International said it will present results from three cardiac studies of its own later this month at the Heart Rhythm Conference in San Francisco, California. "Taser International is dismayed by attempts to present this information as something it is not," the company said in a statement. "I can understand if they're dismayed," Dorian said. "I'm dismayed as well. Dismayed that we have a technology that potentially can cause harm."

From a May 3, 2008 Globe and Mail Editorial, entitled Tasers do affect the heart: ... the CMAJ study from the University of Toronto researchers found major weaknesses in the pig studies, and clear evidence, both in a study they did on pigs and in pig studies they reviewed, that the heart could be affected when the gun's two barbs struck in such a way that the electricity passed through the heart (without the barbs actually penetrating the heart). In one study, researchers opened a pig's chest when it was zapped and observed that the heart was affected. The stun gun could cause the pigs to abruptly lose their blood pressure. Two pigs died immediately after the stun-gun discharge in the study. As for the inquests, the CMAJ makes no reference to them, but in an interview, co-author Paul Dorian said that "as a scientist, I'm sympathetic to the difficulty of ascribing cause with very limited information." His study concludes: "It is inappropriate to conclude that stun gun discharges cannot lead to adverse cardiac consequences in all real world settings."

AND TODAY, IN A REPORT FROM THE ST. CATHARINE'S STANDARD (by Karena Walter) from the inquest into the death of James Foldi, tasered TWELVE (12) times by Niagara Regional Police:

It’s unlikely the jolts from a Taser to James Foldi’s back, thighs or legs had a direct effect on his heart, a coroner’s jury heard Tuesday.

Cardiologist Dr. Paul Dorian testified the Beamsville man would have difficulty moving after a few seconds of being hit with the stun gun if it directly affected his heart.

Jurors at the coroner’s inquest into the death of the 39-year-old man heard in earlier testimony by police that Foldi continued to run after being struck twice in the back with Taser probes on July 1, 2005.

Officers said once Foldi was tackled to the ground, he was hit again with a Taser in the drive stun mode on his calves and upper thighs but continued to violently struggle and yell.

A pathologist ruled he died of excited delirium due to acute cocaine poisoning.

A Taser strike is very painful because the electricity causes a direct stimulation of nerve endings, Dorian, from St. Michael’s Hospital in Toronto, told the inquest. He said it can also cause muscles to contract, like a major cramp.

It would be “extraordinarily unlikely” that the Taser had effects on heart muscles if a person continued to run or move after being hit with one, Dorian said.

But he did say there are possible indirect effects on the heart when a person is Tasered. Anything which causes serious pain can cause the heart to work harder, he [Dorion] said.

Niagara Regional Police were called to the Beamsville neighbourhood of Crescent Avenue and Village Park Drive around 2:30 a.m. on that July, 2005 day after reports of a person breaking into homes and yelling for help.

Jurors have heard that Foldi was bloodied and at one point ran into a bungalow, down a hall to a bedroom and jumped out a window. He then ran beside the house, smashed through a garage window, where he pounded on a vehicle with his fists.

He was eventually tackled to the ground outside and four officers struggled to handcuff him. A short time later he stopped breathing and died at the scene.

Toxicologist Dr. Margaret Thompson testified excited or agitated delirium is characterized by aggressive behaviour, “super-human” strength, high temperature, incoherence and imperviousness to pain.

After exhibiting agitated behaviour, the person collapses and dies, and in very few cases doctors are able to revive a patient, she said.

The condition is associated with severe psychiatric illness or abuse of substances, usually cocaine.

“Mr. Foldi got to a point of no return,” Thompson said. “By the time the ambulance got there and had him on a monitor, he had a flatline.”

Thompson, who is also medical director of the Ontario Poison Centre, testified she believed Foldi took a large amount of cocaine a few hours before his death.

Foldi had 1.3 mg of cocaine per litre of blood in his system when he died and 8.6 mg per litre of Benzoylecgonine, which reflects the metabolic breakdown of cocaine.

Based on those amounts, Thompson estimated Foldi had 10 mg of cocaine per litre of blood two or three hours before he died.

Thompson said cocaine has a short life and it’s unusual to find it in blood. When a person takes cocaine, half of the amount used is gone in 45 minutes, with most gone in about three hours.

The inquest continues today and is expected to hear testimony from other police officers and Beamsville residents.

A coroner’s inquest is mandatory when a person dies in police custody.