AGITATED DELIRIUM OFTEN REQUIRES POLICE TO USE FORCE

The situation confronting Greenville police in the early morning hours of
March 7 was not a new one in law enforcement, and the officers had taken
classes to prepare themselves for it.

Eugene Allen Boseman, 41, was wearing only boxer shorts and behaving
erratically when police responded to a motel parking lot on Memorial Drive.
According to official reports, Boseman failed to respond to officers and
ventured into the travel lanes of the highway. After a struggle, he was
handcuffed, became distressed and died a short time later.

The Pitt County medical examiner reported that Boseman "died as a result of
agitated delirium caused by cocaine use, psychosis and stopping
antipsychotic medications." Obesity and heart disease contributed to the
death.

Police Chief Joe Simonowich said his officers followed state and
departmental procedures for dealing with mentally ill people. But officials
with local civil rights groups question whether officers dealt with the
situation the best way possible, or even had the proper training to handle
Boseman, who was black. They say the fact that seven officers responded to
deal with one man was in itself excessive.

As with all sworn law enforcement personnel in the state, Greenville
officers take an eight-hour block of instruction, required under the Basic
Law Enforcement Training curriculum, titled "Individuals with Mental Illness
or Retardation," Simonowich said.

According to the 45 pages of training material, the course is designed "to
present the student an overview of mental disorders, physical disabilities,
communication disorders and unusual behaviors a law enforcement officer may
encounter and to present methods and procedures to identify, to communicate
with, and to assist disabled or disordered persons with maximum safety and
efficiency."

Students completing the instruction block learn to identify general
characteristics of psychosis and how to behave when interacting with a
person with mental illness in order to maximize safety.

"The law enforcement officer must practice psychology on the street rather
than in a clinic, office or university setting," the training document says.
"The officer must make, in a minimum amount of time, decisions that would
baffle the academic behaviorist, decisions whose ultimate resolutions may
involve months or even years of debate and legal considerations."

Though a clinical assessment by an officer is not possible, "it is
imperative that every officer has the knowledge to identify, evaluate, and
control efficiently and safely a person requiring special consideration."

In addition to the BLET instruction, Simonowich said, "Within the
department, every year we're required to present a block of instruction on
retraining on use of force, and these same issues are reiterated within the
use of force curriculum."

In Simonowich's opinion, the responding officers followed state guidelines,
as well as departmental policy for dealing with emotionally disturbed
persons, which states, in part: "Police officers responding to calls
involving (emotionally disturbed persons) shall be prepared to take whatever
time is necessary to successfully take the person into custody without harm
to the person or the officer."

While the medical examiner found multiple bruises on Boseman's body
apparently resulting from the contact with officers, none of the injuries
contributed to his death, the examiner said.

Boseman, who was infected with the virus that causes AIDS, inflicted a deep
bite wound on one officer's hand. The officer is still undergoing treatment
related to that wound.

"They followed the use-of-force policy, by following the continuum of force,
from trying to talk him out of the street, to walk him out of the street,"
and eventually using a chemical spray and then physical force, Simonowich
said.

A daylong block of instruction is dedicated to such encounters because they
are not uncommon in law enforcement.

Boseman's case is strikingly similar to a case study published two years ago
in the journal of the National Association of EMS Physicians. The journal,
to protect the identity of people involved, did not report where or when the
incident occurred.

In that incident, a 45-year-old man with a history of schizophrenia was
found standing at the corner of a motel office, shaking his head violently,
hallucinating and resisting aid. Police and EMS were summoned and, after an
initial struggle, he was manually restrained and strapped to a gurney. He
went into cardiac arrest and died 22 minutes after arriving at the hospital.

Capt. Harold Medlock, training director for the Charlotte-Mecklenburg Police
Department, recalled an encounter about eight months ago where officers
there handcuffed a mentally ill man who had been trying to kick down the
door of a motel room to attack his wife and baby.

"Then he went into some type of seizure and died on the way to the
hospital," Medlock said.

Dr. David Ames, medical director of the Pitt County Mental Health Center,
said dealing with people in Boseman's state challenges health care providers
as well as law officers.

"Delirium is what we call a cognitive disorder, a brain disorder," he said.
"It's marked by impaired consciousness and severely impaired judgment."

Caregivers at the mental health center sometimes encounter patients who are
violent because of delirium or psychosis, he said.

"To be honest with you, what we do is call the police, because most of the
time clinicians don't feel very comfortable (approaching such patients),"
Ames said.

The very mental state that demands intervention simultaneously erects a
barrier against any assistance offered, he said.

"These people misinterpret what others are doing," he said. "They see people
as coming to hurt them, so they lash out."

In a situation where "something bad is going to happen" if the encounter is
not quickly resolved, "then I guess you just have to use force," Ames said.

Julie Smith, executive director of the nonprofit Pitt County Mental Health
Association, said agitated delirium can be triggered by the use of drugs
such as cocaine, withdrawal from alcohol or psychotic medications, or even
head trauma.

"Because of the violent behavior, the person needs to be restrained, not
just for their protection, but for the officers' protection or the EMS
(workers') protection," Smith, whose organization advocates for the mentally
ill, said. "It's different from just approaching someone who you just want
to take into custody."

Smith said she's witnessed an episode of agitated delirium, though she was
not directly involved with controlling the patient.

"Thank goodness, because it's a scary thing," she said.

Medlock said the Charlotte-Mecklenburg Police Department, the largest in the
state, provides training that is similar to that given by the Greenville
department, beginning with the BLET course.

"I teach that and have for the last eight years for our department," Medlock
said. "The BLET (course) is a fairly extensive block of instruction."

"I encountered a mentally disturbed fellow in 1980 who nearly beat me - not
to death, but he made a believer out of me," Medlock said. "I think that's
why I have such a particular interest in that subject. I want others to
recognize the signs I might have missed."

As for the number of officers required to deal with cases involving agitated
delirium or a similar condition, "Every situation you encounter is really
going to dictate the response: It could be two or three officers is
appropriate; it could be that 12 is appropriate," Medlock said.

According to the BLET training documents, "Substance abusers, especially
those on stimulants, may be impervious to pain and may exhibit extraordinary
strength." Such people "cannot be calmed down easily. Backup should be
requested and more than two officers may be necessary to prevent injury."

Wilmington police this week were undergoing special training for dealing
with mentally disturbed people, said Sgt. Benjamin Kennedy, training
coordinator for the department.

"This is something that we figure that officers need to have," he said. "We
deal with that all the time."

This is the first year the department has offered the special training for
dealing with mentally ill people, he said. The department periodically
schedules training tailored to situations officers might encounter.

Still, that instruction is anchored in the state course taken by all law
officers in the BLET program, Kennedy said. "Pretty much what's stated in
there is what all officers follow," he said.

Based on a State Bureau of Investigation examination of police action in the
Boseman case, the local district attorney said the seven officers who
participated in subduing Boseman would not be charged criminally.

After prompting by the local branch of the National Association for the
Advancement of Colored People, the officers were suspended with pay; they
returned to duty shortly after the district attorney's decision.

Charles Becton, a Raleigh lawyer hired by Boseman's family to pursue a
possible lawsuit against the city, declined to comment for this story.

As a result of the Boseman incident, the Greenville Police Department is
considering the purchase of nonlethal weapons, such as electric stun guns,
that could assist in subduing suspects, Simonowich said.

But Medlock, whose department is in the process of purchasing similar
equipment, said such devices won't eliminate the need for hands-on contact
with emotionally or mentally disturbed people. For a lot of them, "We are
the only resort," he said. "Ultimately, someone has to put their hands on
them."