California has become the first state to ban doctors and medical examiners from attributing deaths to the controversial diagnosis known as excited delirium, which one human rights activist hailed as a turning point that could make it harder for police to justify excessive force.

Democratic Gov. Gavin Newsom signed a bill into law in October. 8 to prohibit coroners, medical examiners, physicians, or physician assistants from reporting excited delirium on a person’s death certificate or in an autopsy report. Law enforcement agencies may not use the term to describe a person’s behavior in an incident report, and testimony referencing excited delirium will not be admitted in civil court. The law will come into effect in January.

The term excited delirium has been around for decades, but has become increasingly used over the past fifteen years to explain how someone experiencing severe agitation can die suddenly, through no fault of the police. It was cited as a legal defense in the 2020 death of George Floyd in Minneapolis; Daniel Prude in Rochester, NY; and Angelo Quinto in Antioch, California, among others.

This is a turning point in California and across the country, said Joanna Naples-Mitchell, an attorney with the New York-based Physicians for Human Rights, who co-authored a 2022 report on the use of the diagnosis.

When excited delirium is involved in a wrongful death lawsuit, it’s a major hurdle for a family to get justice if their relative was actually killed by police, Naples-Mitchell said. So now it will be effectively impossible for them to bear witness to the excited delirium in California.

Although the new law makes California the first state to no longer recognize excited delirium as a medical diagnosis, several national medical associations have done so

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has already discredited it. As of 2020, the American Medical Assn. and the American Psychiatric Assn. have dismissed excited delirium as a medical condition, noting that the term is disproportionately common

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applied to black men in custody. This year, the National Assn. of medical examiners have rejected excited delirium as a cause of death, and the American College of Emergency Physicians is expected to vote this month on whether to formally reject its 2009 position supporting excited delirium as a diagnosis. That white paper proposed

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Individuals in a mental health crisis, often under the influence of drugs or alcohol, can exhibit superhuman strength as police attempt to control them, and subsequently die from the condition.

In Quinto’s case, his mother, Cassandra Quinto-Collins, had called Antioch police two days before Christmas because her son was experiencing a mental health crisis. She had gotten him under control by the time they arrived, she said, but officers held her 30-year-old son down until he passed out.

In a moving home video made by Quinto-Collins, which was broadcast nationally after his death, she asked police what happened as her son lay unconscious on the ground, hands behind his back in handcuffs. He died in hospital three days later.

The Contra Costa County Coroner’s Office, part of the Sheriff’s Office, blamed Quinto’s death on excited delirium. The Quinto family has filed a wrongful death lawsuit against the county and is seeking to change the cause of death on his death certificate.

Quinto-Collins also tested in favor of the bill, AB 360, introduced by state Assemblymember Mike Gipson (D-Carson). It sailed through the Legislature with bipartisan support. No organization has formally opposed the measure, including the California Police Chiefs Assn., whose executive director declined to comment this week.

There’s a lot more work to be done, but it’s a unique window into some of the corruption, some of the things we’ve allowed to happen under our noses, said Robert Collins, Quinto’s stepfather. I think it’s significant that California is putting an end to it.

Part of the problem with an excited delirium diagnosis is that delirium is a symptom of an underlying condition, medical professionals say. For example, delirium can be caused by old age, hospitalization, major surgery, substance use, medications or infections, says Sarah Slocum, a psychiatrist in Exeter, NH, who co-authored a review on excited delirium published in 2022.

You wouldn’t just put a fever on someone’s death certificate, Slocum said. It is therefore difficult to name excited delirium as a cause of death, even though there is something underlying it and causing it.

In California, some entities had already restricted the use of excited delirium, such as the Bay Area Rapid Transit Police Department, which bans the term in its written reports and policy manual.

But these changes face decades of conditioning among law enforcement and emergency medical personnel, who have learned that excited delirium is real

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how to deal with someone suspected of having the disease.

Systematic retraining is needed, said Abdul Nasser Rad, director of research and data at Campaign Zero, a nonprofit focused on criminal justice reform that helped write California’s law. There are significant concerns about how officers are trained and how EMTs are trained on this issue.

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