Hyde's cause of death challenged

The inquiry into the death of a mentally ill Nova Scotia man heard testimony Wednesday from a clinical psychiatrist who challenged the concept of excited delirium, the controversial condition that is listed as Howard Hyde's official cause of death.

Dr. Joseph Noone, an expert on the clinical aspects of violent behaviour, said excited delirium is a term favoured by law enforcement officials and coroners, even though it is not accepted as a medical or psychiatric diagnosis.

He said those who use that term subscribe to an "ideology" that he doesn't accept.

"I'm not a fan of excited delirium," he testified. "It's a controversial term used strongly in certain areas.… There's a real concern that the term could be misused.

"It's very unsatisfactory from a psychiatry point of view."

The mysterious condition is characterized by several traits, including incoherence, paranoia and suddenly intense, violent behaviour marked by extraordinary strength, profuse sweating and an elevated heart rate.

In some cases, individuals die suddenly. Researchers have yet to determine why this happens.

The inquiry has heard that Hyde, a 45-year-old who was diagnosed with schizophrenia in his 20s, demonstrated most of the traits in the hours before he died on Nov. 22, 2007.

Causes of excited delirium may include schizophrenia and other psychiatric illnesses, drug intoxication, alcohol withdrawal and heat stroke, experts say.

Hyde soaked in sweat

Soon after he was arrested for an alleged assault, Hyde was shocked with a Taser stun gun up to five times when he tried to escape from the police station in downtown Halifax. Officers have testified that Hyde was soaked in sweat and possessed superhuman strength as he tried to flee the building.

Hyde was later taken to hospital where he was given medication, but he was released several hours later on the condition he get psychiatric help once he appeared before a judge.

But that never happened.

Hyde died the next day as guards at the Central Nova Scotia Correctional Facility wrestled him to the ground. He had refused to walk down a hallway because he thought there were "demons" at the other end.

Noone, manager of psychiatric intensive care at the Riverview Hospital in Coquitlam, B.C., produced a report for the inquiry that says use of the term excited delirium when describing cause of death can result in the deceased being labelled as the culprit.

"The attractiveness of the term may relate to some of its proponents having … the subjective perception that conducted energy weapon use and physical, mechanical restraint used by law enforcement officers deserves to be excluded or absolved as contributing in any way to an in-custody death," the report says.

"The deceased is identified as the culprit and must have had the condition of excited delirium."

Noone testified the term implies those in the throes of excited delirium "had something wrong with them" to begin with. "And if they died, they were going to die anyway.

"Excited delirium [proponents] say that people walk around in this state where they could drop at any moment. In my experience, they are not dropping at any moment."

He said he preferred the term emotionally disturbed person "because then you're not making any assumptions about what you've got or what you've think you've got.… There's no implications of diagnosis or cause."

Report criticizes term

An independent report commissioned by the RCMP also criticized the use of the term excited delirium.

The report, ordered after a Polish immigrant died following multiple shocks from a Taser by Mounties at Vancouver International Airport, said the condition is sometimes used as an excuse to justify firing stun guns.

Noone's comments followed testimony Monday from Dr. Christine Hall, an expert in excited delirium, who told the inquiry there were many warning signs suggesting Hyde was suffering from the condition as he was taken into custody.

Hall, a researcher and emergency room doctor based in Vancouver, said the "constant and repetitive nature" of Hyde's pacing inside a jail cell was a strong clue he was in a highly agitated state.

She stressed that excited delirium, a term coined by pathologists in the 1980s, is not a diagnosis but rather a condition stemming from an underlying disorder.

Hall also testified that she didn't believe the shocks from the Tasers caused Hyde's death.