What caused Roberto Curti’s death?

http://www.coroners.lawlink.nsw.gov.au/agdbasev7wr/_assets/coroners/m401601l4/curti%20decision%2014%20nov%202012.pdf

Name of Deceased: Roberto Laudisio Curti

File Number: 2012 / 00086603

 Hearing Dates: 8th – 19th October 2012

Date of Finding: 14th November 2012

 Coroner: NSW State Coroner, Magistrate Mary Jerram

 

 

The medical opinions

The pathologist from the Department of Forensic Medicine who performed the autopsy on Roberto Curti was Dr Isabella Brouwer. She was unable to provide a single direct cause of death from her examination.

She was however able to exclude possible factors such as injury, pre-existing cardiac disease, asphyxia (respiratory obstruction) and drug toxicity, apart from a low level of LSD.

A cardiologist, Dr Cooper, considered there was no evidence of him having developed the cardiac arrhythmia, ventricular fibrillation, a possible cause of death from the use of the Taser.

Professor Alison Jones a toxicologist gave evidence that the capsicum spray which had been used was not capable of causing his death, whilst the amount of LSD did not pose a threat to life directly.

Psychiatrist Dr Jonathan Phillips suggested that his disturbed, fearful, and paranoid behaviour was a likely reaction to the small amount of LSD he had ingested. In his opinion Curti was “running from his ‘demons’ perhaps with no destination other than to escape, believing people were out to kill him, and avoiding any attempt to stop or restrain him.”

Dr Phillips rejected a suggested diagnosis of “excited delirium” which he considered to be not a recognised psychiatric condition. Rather he suffered from an acute LSD induced psychosis.

The NSW State Coroner, Magistrate Mary Jerram expressed the following conclusion that “death clearly arose from complex and multi-factorial causes, with no confirmed single identifiable cause. Nevertheless it is impossible to believe that he would have died but for the actions of the police.”

In conclusion it is reasonable to say that

  • He inadvertently initiated his own death by ingesting a drug (LSD) of uncertain purity.
  • He developed an extraordinarily severe acute psychosis presumably in response to LSD; he exhibited delusional, paranoid and manic features.
  • His death followed police attempts to control him with the use of capsicum spray, and the repeated use of Taser guns, when physical restraint alone was unsuccessful.

Although there is much that is not known about the medical effects of Taser, it is accepted that

The Taser guns now employed by the police fire two probes which deliver high voltage (50,000V) but low current, electric shocks, calibrated to last only 5 seconds. They cause agonizing stimulation of nerves, and violent muscular contraction, causing the patient to fall uncontrollably. Ordinarily the victim  recovers quickly once the shocks have terminated.

Depending on the anatomical location of the Taser probes there may be untoward regional effects e.g. skin and muscle damage, potentially damage to the heart muscle, and if applied to the head, brain seizure.

In 90% of over 500 deaths documented by Amnesty International in the US, the victim was unarmed.

The most vulnerable were those with a pre-existing heart problem and those who had been using drugs and alcohol

Increasingly doctors are calling the cause of death in tasered victims “Excited delirium”. It is a descriptive diagnosis that is still not widely known and accepted; it is therefore somewhat controversial. It describes the state of many victims prior to their death after repeated tasering. “The patient is agitated, violent, sweats profusely, and is unusually strong and insensitive to pain. The victim’s heart races and eventually stops beating.”  Some suggest it is a condition independent of, rather than caused by Tasers.

More about “Excited delirium”

http://www.cbc.ca/news/background/tasers/excited-delirium.html

This clinical label does seem to  accurately describe Roberto Curti’s condition prior to his death.

Interestingly  this diagnosis was made in the years prior to the use of Taser guns for the terminal state of manic psychiatric patients, and drug addicts (particularly cocaine)  They were in a state of delirium, and death often resulted from attempts to forcibly subdue them. Psychiatric nurses were taught how to quieten them without physical restraint.

In my opinion the clinical features suggest that death is caused by stimulation of the brain stem, the centre of the autonomic nervous system which regulates heart, respiration, and temperature.

If this was the cause of his death, then the use of the Taser was contributory, rather than solely responsible for his death.

The amount of LSD in his blood was small, and his response so violent, that it begs the question as to whether Curti had also taken cocaine or some other stimulant.

Two issues

The Coroner’s findings are well-considered and welcome. I endorse them totally. However I believe there are two issues that are important to address.

The over-all safety of Taser guns. It would seem to be contra-indicated for them to be used on people who are psychiatrically disturbed or who are on drugs. It would also seem to be inappropriate to use them on middle-aged and elderly individuals who may have pre-existing cardiac disease. Further research should be considered to assess all the medical effects of Tasers.

The community should take stock of the enormous problem faced by our police force in dealing with the mentally ill. It is a problem which has escalated after the progressive closure of beds for mental illnesses. The police are not trained to handle often violent and irrational psychiatrically disturbed patients. Perhaps we should have specialist police officers with psychiatric nursing training!



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