Excited Delirium

Summary

Criminal – "Excited Delirium" (March 6, 2026)

Podcast by Phoebe Judge | Vox Media Podcast Network

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Episode Overview

This episode examines the death of Angelo Quinto in police custody and the controversial diagnosis of "excited delirium," which is often cited in such deaths. Using the Quinto Collins family's harrowing story as a starting point, host Phoebe Judge, the family, attorneys, and experts explore the fraught history, racial undertones, and lack of medical legitimacy surrounding the term "excited delirium." The episode also documents the family's quest for answers, legal developments, and recent reforms prompted by cases like Angelo’s.

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Key Discussion Points & Insights

1. The Night of Angelo Quinto's Death

• Setting: December 23, 2020, Antioch, California.
• Family context: Angelo (30s), Bella (18), and mother Cassandra, newly moved into their home. Angelo had a history of anxiety and “episodes” following a head injury.
• That night, Angelo’s anxiety escalates. He becomes increasingly paranoid, causing distress in the family.
  • Bella: "He required a patience that spanned eight hours sometimes." (05:03)
• Call to police: Bella dials 911 after Angelo restrains family members. She reports he’s acting aggressive and had tried to use a hammer.
• Police arrive, restrain Angelo face-down, handcuffing him. Family claim police put knees on Angelo’s neck for several minutes; police say only “brief” restraint (08:49). Angelo pleads, "Please don't kill me" (09:37), then becomes unresponsive.
• Angelo is transported to hospital, where he is declared mostly brain-dead; he dies on December 26.

Memorable Moment

• Cassandra: "As soon as they flipped him and they saw blood coming out from his mouth... It became very quiet." (11:48)

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2. Aftermath and Quest for Answers

• The family experiences opaque communications with police and hospital. Hospital staff reportedly barred by police from sharing details with the family (18:09).
• Family commissions an independent autopsy for $18,000, which concludes Angelo died of asphyxiation.
• The official county autopsy provides a different controversial diagnosis: "excited delirium syndrome." The family’s reaction: shock and deep skepticism. (32:09)

Notable Quote

• Bella (on hearing the term): "I thought that sounds really stupid. Does not sound very sophisticated at all." (32:09)

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3. Excited Delirium: Origins and Controversy

Historical Origins

• Coined in 1980s amid US cocaine epidemic by forensic pathologist Dr. Charles Wetli.
• Originally used to explain sudden deaths of people found with cocaine in their systems, often involving police restraint.
  • Wetli theorized, without clear evidence, that the victims died from their “excited delirium” rather than violence or restraint.
• The term is later discredited in a notorious Miami serial killer case — where Wetli wrongly classified strangled, predominantly Black female victims as "excited delirium" deaths. (29:04–30:35)
  • Renu Ryesum (Reporter): "[Wetli] said that Black women were more prone to dying this way... It was the combination of cocaine and sex that led to their death." (28:11)

Institutionalization of the Term

• Popularized in police and medical contexts despite lack of diagnostic criteria or biological markers (25:13–25:48).
• Promoted via a 2009 "white paper" by American College of Emergency Physicians, some of whom had links to Taser manufacturer Axon (46:22–48:06).
• Used to attribute deaths in police custody to the victims, rather than to the methods of restraint.

Training Materials and Racial Stereotyping

• Police materials consistently describe victims as having "superhuman strength," tolerance to pain, and non-compliance, reinforcing racial stereotypes (50:22–53:52).
  • Arjun Baiju (Doctor, on the narrative): "In that description are all these very loaded terms with all this baggage, like monster and animal-like behavior... that plays on racial stereotypes because overwhelmingly, these are Black men." (52:24)
• Materials even include "I can’t breathe" as a sign of excited delirium, a phrase widely recognized from the George Floyd case (51:20).

Medical Rejection and Legal Shifts

• Professional organizations like the AMA, APA, and WHO do not recognize "excited delirium."
• 2021–2023: White paper retracted; increasing legal and medical rejection of the term.
  • Renu: "...the American College of Emergency Physicians retracted that 2009 white paper, and they said, we got it wrong." (55:45)
• 2023: California becomes first state to ban use of the term in official contexts (56:26).

Memorable Quote

• Ben Nissenbaum (attorney): "If I told you it [excited delirium] meant nothing, then I think that would be accurate." (21:32)

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4. The Coroner’s Inquest and Legal Outcome

• Coroner’s inquest in August 2021: Official pathologist blames "excited delirium syndrome" for Angelo's death, referencing mild stimulant drugs rather than illicit substances. Crowd reacts with disbelief (38:25).
• Jurors, told only to decide cause and manner—not responsibility — rule Angelo’s death an accident. (41:42)
• In later depositions, pathologist admits restraint played a role and, had certain blood markers (petechial hemorrhages) been found earlier, asphyxiation would have been part of diagnosis (42:23–43:04).

Memorable Moment

• Ben Nissenbaum: “Even if you believed in the pseudoscience of excited delirium... to blame it on tobacco and cigarettes and this other thing that prevented you from sleeping, which had never had any deaths, meant that they had the flimsiest case..." (39:09)

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5. Reform, Family Impact, and Moving Forward

• 2021–2024: California bans the term; restraining practices causing asphyxiation are outlawed.
• Settlement: Antioch City settles with Quinto Collins family for $7.5 million (57:46).
• Reform: City launches non-police crisis response team—the "Angelo Quinto Community Response Team"—to handle mental health calls.
  • Bella: "Now there’s somebody else to call. It’s named after Angelo." (58:40)
• The family still brings out Angelo’s Christmas gifts every year in his memory (57:46).
• The episode ends with a reflection on the family’s loss and ongoing efforts for justice and systemic change.

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Notable Quotes & Timestamps

• “Please don’t kill me. Please don’t kill me.” – Angelo Quinto, during police restraint (09:37)
• “As soon as they flipped him and they saw blood coming out from his mouth...It became very quiet.” – Cassandra Quinto Collins (11:48)
• “If I told you [excited delirium] meant nothing, then I think that would be accurate.” – Ben Nissenbaum, attorney (21:32)
• “[Wetli] said that Black women were more prone to dying this way...It was the combination of cocaine and sex that led to their death.” – Renu Ryesum (28:11)
• “I thought that sounds really stupid. Does not sound very sophisticated at all.” – Bella Quinto Collins, on hearing about ‘excited delirium’ (32:09)
• “Now there’s somebody else to call. It’s named after Angelo.” – Bella Quinto Collins (58:40)

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Timestamps for Major Segments

• 01:45–12:50: The night of the incident and family’s experience with police response
• 13:34–18:46: Aftermath, hospital process, lack of transparency
• 20:12–22:00: Family meets with attorneys, introduction to “excited delirium”
• 25:13–32:00: Reporting on history, origins, and misuse of “excited delirium”
• 35:53–43:04: Coroner’s inquest, autopsies, legal challenges
• 46:00–54:00: Entrenchment of the term in policing, racialized stereotypes, and medical backlash
• 55:09–58:40: National reforms and impact, legacy and remembrance

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Episode Tone & Style

The episode is empathetic, somber, and investigative. It weaves the family’s personal loss together with critical journalistic inquiry and legal critique, grounding systemic analysis in intimate human experience.

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For Further Listening or Action

• California’s ban on “excited delirium” and similar diagnostic terms marks a major step forward in policing and public health reform.
• The Angelo Quinto Community Response Team serves as a local model for non-police mental health crisis intervention.

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This summary reflects sensitive material including police violence and contested causes of death. Discretion advised.

Transcript

[Phoebe Judge]

Support for criminal comes from BetterHelp. International Women's Day is coming up and BetterHelp wants to remind all the mothers, grandmothers, aunts and sisters out there that you deserve to take care of yourself as much as you take care of others. If you want help getting connected with a therapist, you could try betterhelp. Your emotional well being matters. Find support and feel lighter in therapy. Sign up and get 10% [e-mail] criminal that's betterhelp.com criminal support for criminal comes from Squarespace. If you're a business owner, you know that it matters how you present your business online. Squarespace has the tools you need to customize your website and advertise all the kinds of services you provide. Plus, you can choose the colors and fonts you like. Go to squarespace.com criminal for a free trial, and when you're ready to launch, use the offer code criminal to save 10% off your first purchase of a website or domain. I'm Phoebe Judge. I'm Lauren Sporer. And Lauren. Next Thursday, March 12th, we'll be taping an episode of Criminal Plus Together live on Patreon.

[Bella Quinto Collins]

We'll be answering your questions and talking

[Phoebe Judge]

about the three things we've been enjoying lately. And I've been really trying to get a good batch of trivia questions to ask everyone.

[Bella Quinto Collins]

You can be there by Signing up

[Phoebe Judge]

for Criminal [e-mail] Criminal See you there. This episode includes descriptions of violence and sexual assault. Please use discretion. On December 23, 2020, Bella Quinto Collins was home from college to celebrate the holidays with her family in California.

[Bella Quinto Collins]

We had gone to my mom's work. They just had a small, you get together, you know, masks on. And I grew up at my mom's work, really, so they're kind of like a second family. So we kind of spent the afternoon with them, I guess, and then came home and we're just relaxing.

[Phoebe Judge]

A few months earlier, Bella's mother and Bella's two adult brothers had moved into a new house in a town called Antioch, near San Francisco. When Bella and her mother, Cassandra, had come back from seeing Cassandra's colleagues that day, Bella's oldest brother Angelo, was in his room sleeping. Cassandra says she went to his bedroom

[Cassandra Quinto Collins]

because there was a package for him. You know, a package that he's been waiting for for a while. So I knocked on his door and kind of woke him up and he's like, oh, thank you, Mom. Just leave it there. And then, you know, he, I went out and he just went back to sleep.

[Phoebe Judge]

When the pandemic hit, angelo, who was 12 years older than bella, had lost his job and moved in with cassandra. Before that, Angelo had joined the u. S. Navy. It was his dream career, but because of an allergy, he'd left during boot camp in 2019, now he was trying to figure out what he wanted to do next. He liked gaming and was thinking about becoming a game designer. After talking to Angelo, Cassandra went to the living room, and at some point, she fell asleep on the couch. Then around 10pm Angelo woke her up.

[Cassandra Quinto Collins]

And I said, yes, what do you want? You know, he goes, what's for dinner? And I was kind of upset about that because, I mean, you know, he usually cooks for himself. He loves to cook. So when he asked me what for dinner is, I was like, what do you mean? You know, I was kind of upset because he woke me up from my sleep, my nap.

[Bella Quinto Collins]

He clearly wasn't himself. At a certain point, I was on a zoom with my friend, and he just kept coming into the room and, like, asking, oh, what's going on? He seemed really worried. It looked like the beginnings of an episode, as we'd called it. He'd had a couple of them throughout 2020 in which he would just kind of act oddly, just not like himself and really anxious and scared, but it was really infrequent, and then it almost seemed like he was normal the next day.

[Phoebe Judge]

The family says he had started having these episodes after a head injury. Did this night seem different than other episodes that he had had?

[Bella Quinto Collins]

No, actually,

[Cassandra Quinto Collins]

it's actually the way we dealt with it. Right.

[Bella Quinto Collins]

Yeah. We didn't have much tolerance for it at that point. In previous episodes, I'd say there were about five total throughout that year. He required patience when he was feeling that way, when he was afraid, when he was asking the same questions, when he looked past you and thought he saw something. He required a patience that. That spanned eight hours Sometimes.

[Phoebe Judge]

A few months before, a neighbor had called the police because they'd seen Angelo trying to climb a fence. They said he was yelling. The police took him to the hospital. Cassandra says angelo had been worried that maybe he had bipolar disorder or schizophrenia. She wanted him to see a psychiatrist so he could get help. She says that when he was having these episodes, he would ask her again and again if he was going to be okay. She'd often need to sit with him for a long time to calm him

[Bella Quinto Collins]

down, and we didn't have that patience that night. And I think that really escalated his

[Phoebe Judge]

anxiety over the next hour or so. Angelo seemed to get more and more scared and anxious. He wanted Cassandra and Bella to stay close to him. He locked arms with the two of them and started walking them around the kitchen.

[Bella Quinto Collins]

And that, of course, then heightened our anxieties. And I know that I was thinking in the moment, oh, my gosh, he's getting really, really afraid.

[Phoebe Judge]

Bella, who was 18 at the time, says she started to feel really worried

[Bella Quinto Collins]

at a certain point. I had told him, please, you know, let, let go. I'm going to call the police if you don't stop holding us. And he just. I could tell he couldn't understand what I was saying.

[Cassandra Quinto Collins]

He kept on saying, what's going on? What's going on?

[Bella Quinto Collins]

And that, you know, that freaked me out.

[Phoebe Judge]

Bella called 911 to ask for help

[Bella Quinto Collins]

because I just felt like I had no other option. My dad was in Berkeley at the time, and I thought, that's too far away. He wouldn't be able to get here fast enough.

[Phoebe Judge]

Bella told the 911 operator that her brother was, quote, being aggressive and hurting her mother. She said that Angelo had tried to pick up a hammer, so she had picked it up instead and had it with her. The operator asked her, do you know if he takes any drugs? And Bella replied, yes. At one point in the call, someone yelled, stop it. Stop it. At the end of the call, Bella said to the operator, sorry, thank you. What were you hoping the police would do to help once they showed up?

[Bella Quinto Collins]

Calm him down in a way that we couldn't.

[Phoebe Judge]

Shortly after 11pm, two police officers arrived at their house. The police dispatcher had told them about Bella's call, that she said her brother was hurting their mother. The police said that when they arrived, Angela was being, quote, actively restrained by Cassandra on the floor in a bear hug. Cassandra and Bella say that Angelo was calm.

[Cassandra Quinto Collins]

He wasn't trying to get away from me because I think that's what he wanted is for me to be there. He was just breathing heavily, but he was calm. He was very calm. And that's what the police officer saw. When they came in the house, the

[Phoebe Judge]

police officers started to handcuff Angelo. They rolled him onto his stomach. According to the police, he started to struggle and they bent one leg over the other to restrain him. Cassandra and Bella say Angelo didn't struggle. At some point, another two police officers showed up. Cassandra and Bella say that first one officer and then another had their knee on Angelo's neck. They say it went on for over four minutes. The police later said that an officer, quote, briefly for a few seconds Had a knee across a portion of Angelo's shoulder blade. We reached out to the Antioch Police Department for comment. We didn't hear back. What was he saying?

[Bella Quinto Collins]

Please don't kill me. Please don't kill me.

[Phoebe Judge]

The officers called an ambulance and asked for help with a mental health crisis. They asked for a code 2, meaning as quick as you can, but not an emergency. Two of the police officers later said they'd responded to Angelo's previous incident. Police when he was trying to climb a fence. And one of them said that he thought Angelo had behaved in a similar way. He wasn't making sense. Cassandra decided to get her phone out to start recording what was going on.

[Cassandra Quinto Collins]

Because I wanted Angela to go to therapy and to go to a psychiatrist so that he could be properly medicated to never. I talked to him about his episodes. You know, he could not believe that he did that. So this particular time, I made sure to record it, you know, so the next day I would have him listen to it, and he's going to go, okay, Mom.

[Phoebe Judge]

One of the police officers told Cassandra that. That Angela wasn't under arrest and that he would be transferred to a hospital for evaluation because it seemed like he might be a danger to himself or others. Cassandra said that Angelo hadn't been attacking them, but that he had been hallucinating and paranoid and didn't want to be alone. One of the police officers said, that's why he's going to the hospital, not jail. Angelo had gone quiet.

[Cassandra Quinto Collins]

I asked him twice, actually, if he was asleep, because I want them to, you know, check on how he's doing.

[Phoebe Judge]

Angelo was still lying on the floor with his hands handcuffed behind his back. And it became clear that he was unconscious. One of the police officers said, what's going on with him?

[Cassandra Quinto Collins]

It actually became very quiet as soon as they saw. As soon as they flipped him and they saw blood coming out from his mouth and, you know, rolled up. His eyes rolled up to his head. It became very quiet.

[Phoebe Judge]

When Cassandra's video starts, two police officers are standing over Angelo trying to communicate with him. They're wearing face masks and blue rubber gloves. The officers move Angelo onto his side, and one of them rubs his chest. There's blood on Angelo's face.

[Arjun Baiju]

What?

[Cassandra Quinto Collins]

What happened?

[Phoebe Judge]

Angelo.

[Cassandra Quinto Collins]

Angelo.

[Ben Nissenbaum]

Is he on any medication?

[Cassandra Quinto Collins]

Not that I.

[Arjun Baiju]

Come on.

[Robert]

Come on.

[Renu Ryesum]

Can you take him?

[Cassandra Quinto Collins]

Please, please, please.

[Phoebe Judge]

The officers unlock the handcuffs and move Angelo onto a stretcher. Cassandra follows them. There's blood on the bedroom floor where Angelo had been lying face down. They start doing CPR on Angelo. Then they push the stretcher out of the house and into an ambulance. I'm Phoebe Judge. This is criminal. When Angelo was rolled out of the house on a stretcher, Bella says she thought he looked purple. Angela was rushed to the hospital. Cassandra and Bella had to stay back to answer questions from the police.

[Cassandra Quinto Collins]

They said they were going to take us to the police station. And I said, why? To be interviewed. They said. And I go, well, you know, they already did ask questions just a little while ago. And they said, don't worry. We're just. It's just going to be, you know, like it's the same questions.

[Phoebe Judge]

At the police station, Cassandra and Bella were questioned separately about what had happened that night. Cassandra says a detective asked her if she had hit Angelo earlier since he had a bloody nose. She answered no. While they were at the police station, Cassandra says she got a call from a doctor who was treating Angelo at the hospital. When she answered it, she says a police officer rushed over and told her to get off the phone. They said she'd get a chance to talk to the doctors later. As Bella and Cassandra had been on their way to the police station, Angelo's stepfather, Robert, arrived at the house.

[Robert]

When I arrived, they were questioning me. Did he have something, did he eat something he shouldn't have? Has he taken drugs? Is he allergic to something?

[Phoebe Judge]

He was told he couldn't enter the house. Their whole street was closed off. More police officers kept arriving, moving in and out of the house, which was marked off with crime scene tape. Police officers were standing guard around it for hours. Robert stayed in the driveway with his dog, who had been in the car with him, and Angelo's younger brother, who'd come back after spending time at a friend's house. Around 6:30 that morning, Bella and Cassandra got back from the police station. Their house was still full of police and investigators.

[Robert]

Cassandra got a call from the doctor and she asked me to take it. And I spoke with the doctor and he indicated to me that, you know, Angelo's brain was, you know, 98 or 99% dead. There was only a tiny portion of the brain stem left alive.

[Phoebe Judge]

The family went to the hospital to see Angelo, but because of COVID protocols, they were told they couldn't come inside when they got back home at around 8:30 in the morning, the police had left. When the family walked through the house, there was still a smear of blood on the floor where Angelo had been lying on his stomach. And Angelo's bedroom seemed to have been searched.

[Robert]

It's just like everything is Upside down. It's been. You know, every last little thing has been tossed and turned, and it's on the floor, and it's just. Just a mess.

[Phoebe Judge]

The police had taken things from Angelo's bedroom, including his cell phone and some photographs. In the kitchen, the family says they found a felony search warrant. The warrant said the police were authorized to take anything that, quote, tends to show that a felony has been committed or. Or that a particular person has committed a felony. Robert says they were shocked. The police had told them that Angelo wasn't under arrest and hadn't committed a crime. That morning on December 24, the family kept calling the hospital, but they couldn't get permission to visit angelo.

[Cassandra Quinto Collins]

On the 25th, they called us and said we could, you know, come and visit him. So Robert and I went.

[Phoebe Judge]

Angelo was unresponsive. He was on a breathing machine, and his eyes were taped closed. He only had a faint heartbeat.

[Cassandra Quinto Collins]

I was reading him this Christmas card that everybody wrote on. And as soon as I was done, the nurse said, I'm sorry, I don't think he heard you. Or she said something. And I go, oh, isn't it that when you're in a coma, you can still hear, you know, you can still hear what other people are saying, so you kind of, like, constantly talk to them? And then she said, well, yeah, but in Angela's case, I don't think that is possible.

[Phoebe Judge]

The family says they felt like they couldn't get clear information from the hospital staff. Later, medical records cited in court documents said that when Angelo first arrived at the hospital, staff had been instructed by the police not to talk to them about Angelo's condition. A doctor had added it as a note to Angelo's medical record.

[Cassandra Quinto Collins]

I asked for Angela's toxicology report, and the nurse smiled at me and said, I'm sorry, but we cannot provide that. And I'm like, what do you mean? What do you mean you can't provide it?

[Phoebe Judge]

Cassandra says she asked the nurse if it was because there was an investigation going on. And she remembers that the nurse nodded.

[Cassandra Quinto Collins]

So I was getting, you know, like, really upset and mad at that point. I'm the mother. I'm, you know, I need to know. I have to know. And she said, let me go to my supervisor and ask.

[Robert]

And so what she did is that she said she can't give it to us, but she said, I'm going to look at it on screen. You might be able to see some of it over my shoulder. And so she basically kind of showed it to us, but she didn't want to give us or have any proof that she had given it to us. But she let us see that there were no common substances abuse found.

[Phoebe Judge]

On the morning of December 26th, they got a call from the hospital saying they should come visit Angelo as soon as possible. In the car on their way there, Cassandra says they talked about getting a lawyer. Robert had already been making phone calls to friends and family to ask for recommendations. Cassandra didn't think they needed one.

[Cassandra Quinto Collins]

You know, I mean, I was on denial. But while I was, you know, with Angelo holding his hands, I was like, you know what? This is not right. And I looked at Robert and I said, you know what? Go ahead, get a lawyer.

[Phoebe Judge]

Robert went out to the hospital parking lot and started making phone calls, trying to explain to people what had happened in the past three days. Eventually, he spoke with a civil rights attorney who said he'd take the case.

[Robert]

And then I came back and they said, Angelo is now, you know, he's. He's. He's going to pass. And the. The nurse said, he's going to pass. And we waited about 20 minutes. And then at 1:30 or 1:40pm he did. He. His heart stopped.

[Phoebe Judge]

The next day, the family's new lawyers, John Burris and Ben Nissenbaum, came to their house in Antioch.

[Robert]

I think we're still having a hard time realizing what's happened. But one of the first things that Ben said, he said basically that he thought they were going to blame it on excited delirium. If they have nothing else, they will say it was excited delirium.

[Phoebe Judge]

Had you ever heard that term before? What did you think?

[Renu Ryesum]

I.

[Cassandra Quinto Collins]

Actually, the first thing. The first question I asked was, what is that? What is excited delirium?

[Phoebe Judge]

For people who aren't that familiar with this term, What. What does it mean?

[Ben Nissenbaum]

If I told you it meant nothing, then I think that would be accurate.

[Phoebe Judge]

Attorney Ben Nissenbaum, in terms of what

[Ben Nissenbaum]

it purports to mean, it's essentially that the body dysregulates itself in a fatal manner, so somehow the heart stops beating because the body becomes so unable to regulate itself.

[Phoebe Judge]

Had you ever handled other cases where it was used as a cause of death?

[Ben Nissenbaum]

Many, many, many cases. I can think of at least a dozen. When people died during a police restraint, the immediate response invariably was, it wasn't the police. It was excited delirium. As if the person got so excited and became so delirious, they. They just spontaneously combusted. And I heard that. I had heard that so many times from the police over my career that I just knew that that's what was to be expected.

[Phoebe Judge]

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[Renu Ryesum]

Excited Delirium is this term that has a really contentious history, a racist history and it's used to describe a collection of symptoms. Reporter Renu Ryesum but there's no diagnostic code for it. There's no blood test for it there's no way to test for it. I should note, delirium is a clinical term. It is something that. That people see in emergency rooms and hospitals. But the term excited delirium, it's kind of in some ways made up.

[Phoebe Judge]

It was first used in the 1980s.

[Renu Ryesum]

If you think about the 1980s in the US there was a cocaine epidemic. It was gripping much of the country. And there was a South Florida forensic pathologist named Charles Wetley.

[Phoebe Judge]

In 1985, Charles. Charles Wetley co authored a paper on what he called cocaine induced psychosis and excited delirium. He looked at the deaths of seven people, mostly men, who had used cocaine. They'd all been restrained, usually by police, one of them by ER staff, and suddenly died. He wrote that all seven had intense paranoia followed by, quote, bizarre and violent behavior and sometimes, quote, unexpected strength.

[Renu Ryesum]

And he said, these are people who are scared, they were violent, they were panicked, then they were restrained, and then they died suddenly. And the problem with this theory is it was purely speculative, and it didn't look at the role that restraints might have played in these deaths. They didn't really identify any scientific evidence or any toxicology reports or any way to back up or test their ide.

[Phoebe Judge]

Then Charles Wetley started looking into a number of other cases in the late

[Renu Ryesum]

80s in South Florida, Miami. Several black women were dying, and they were dying in the same area in Miami. And in a really similar way, 12

[Phoebe Judge]

women were found dead between 1986 and 1988. Charles Wetley told reporters, the typical scene is in a cheap room, a clump of bushes, or an abandoned building.

[Renu Ryesum]

They were discovered naked from the waist down, and they all had trace amounts of cocaine in their system.

[Phoebe Judge]

An article in the Miami News quoted Wetley as saying, at first glance, it looks like she's been raped and murdered. But he said that wasn't the case. Wetley said the women likely died of cocaine psychosis. One newspaper article described it as, quote, sudden death from low levels of cocaine that caused the victims to go berserk and die within minutes. Some of the women were believed to have been sex workers.

[Renu Ryesum]

And he and his colleagues said that the combination of cocaine and sex is what led to these women's death. And he called it excited delirium. And, you know, he said that black women were more prone to dying this way and that it was this combination of the stimulation from the cocaine and the sex that led to their death.

[Phoebe Judge]

He told reporters that when they examined the women's bodies, there were no signs of assault. Quote, the autopsies have conclusively showed that these women were not murdered. At one point, he worked on a theory that that rain in Peru had somehow tainted a shipment of cocaine. The police closed the cases. Many of the women who were found dead were from Jamaica, Haiti and Puerto Rico. Most of them were in their 20s and 30s.

[Renu Ryesum]

But then in 1988, a 14 year old girl named Antoinette Burns was found dead. And she was found dead in much the same way that the other, other women had died. Wetley did the initial autopsy and he once again said that she too died of excited delirium. And the Burns family pushed back. I mean, this was a young girl, 14. They said she wasn't a sex worker, she didn't do drugs. She was last seen hitching a ride to the movies with a neighbor. And the family really pushed back on this. But it wasn't until a toxicology report came back that Wetley's theory began to unravel. Antoinette Burns didn't have cocaine in her system. And after that, the chief medical examiner, so Wetley's boss reviewed all the debts of these women that Wetley had said died of excited delirium. And what he found was pretty startling.

[Phoebe Judge]

The chief medical examiner went back and looked at the photos from the autopsies of all the women who, who'd been found dead. He found lip and neck injuries and hemorrhaging in the eyes.

[Renu Ryesum]

He said that in many of these cases, the women had very, very clearly been strangled or asphyxiated to death. He said you could spot it a mile away. I mean, he said that these women, nearly 20 by this point, were actually homicide victims. And the police believed that a serial killer was responsible for. For their deaths.

[Phoebe Judge]

More women were found dead in 1989. But then in April of that year, the deaths finally seemed to stop. Months later, police announced that they had a suspect in the cases. A 33 year old man named Charles Henry Williams, who'd been arrested on rape charges in April, right when the string of murders ended. But police said they didn't have enough evidence to charge him with the murders of the 32 women who they suspected him of killing over almost a decade. One of them was his neighbor and four had been found dead near his home. They ended up charging him with one murder of a 19 year old woman named Patricia Johnson. Ten days before the start of the trial. Williams died of AIDS while in prison serving a sentence for rape. But Charles Wetley stuck to his theory that excited delirium was real and that at least some of the women in Miami had died from it.

[Renu Ryesum]

You would think, you know, after the Antoinette Burns case, after this kind of huge thing in Miami where this guy said, oh, all these people died of excited delirium and it turns out they had been murdered, that the term would have completely fallen out of favor. But eventually it re emerged.

[Phoebe Judge]

When the Quinto Collins family's attorney told them about excited delirium syndrome. Bella says that, like her parents, she'd never heard of it before.

[Bella Quinto Collins]

I thought that sounds really stupid. Does not sound very sophisticated at all. But he described to us his experience with excited delirium in the past.

[Cassandra Quinto Collins]

So after they told us about excited delirium, I said, I want a second autopsy.

[Robert]

So it was a. You know, I mean, I think the first thing is, how do you pay for this autopsy?

[Phoebe Judge]

The family said the independent autopsy ended up costing them $18,000. When it came back, it said Angelo had died of asphyxiation. They were still waiting to hear the results of the county's official autopsy. On January 13, 2021, they held a memorial service for Angelo in the garden of a local church. Months later, his family was notified that the county would hold a coroner's inquest.

[Ben Nissenbaum]

It's a hearing in which the county calls several witnesses.

[Phoebe Judge]

Attorney Ben Nissenbaum.

[Ben Nissenbaum]

Typically, the witnesses to the killing or death testify before jurors at the coroner's inquest.

[Phoebe Judge]

The jury at a coroner's inquest doesn't decide who is responsible for the death, only the, quote, cause and manner of death.

[Ben Nissenbaum]

What the jury finds goes into onto a death certificate. The jury determines whether the death was a homicide, a suicide, a natural death, or an accident.

[Phoebe Judge]

On the morning of August 20, 2021, eight months after Angelo had died, the Quinto Collins family went to the local courthouse. The hearing was open to the public. Lots of people had showed up, friends and family, but also journalists. Bella says that the police officers who are going to be giving statements that day were already in the courtroom when the doors were open to the public.

[Bella Quinto Collins]

And then when we got the chance to come inside, my mom and I decided to sit right next to the officers.

[Phoebe Judge]

The court hearing wasn't led by a judge, but by a hearing officer, a lawyer named Matthew Guichard, who'd been contracted by the county. Guichard explained that in their county, Contra Costa county, the sheriff is also the coroner, meaning the sheriff determines the cause and manner of a person's death and is part of arranging coroner's inquests. And when a person dies in police custody or during a police interaction, a coroner's inquest is Required. California is one of just a few states where a county sheriff can also be the county's coroner. Matthew Guichard explained that this wouldn't be like a trial you might see in the movies. Quote, there won't be lawyers standing up and asking questions. He said he would be the one asking the witnesses questions and that he had reviewed all of the documents, audio and video recordings in the case. Attorney Ben Nissenbaum was in the courtroom with a Kinto Collins family watching.

[Ben Nissenbaum]

We do get to submit questions, but the hearing officer can decide not to ask those questions. So the hearing officer has all the power. You know, they can decide what. What the jury gets to hear.

[Phoebe Judge]

Six witnesses were called. The county's forensic pathologist, three of the police officers who were at the house in Antioch, a police detective and a detective from the DA's office. Bella and Cassandra, were not on the

[Bella Quinto Collins]

list of witnesses throughout that four hours of this inquest. They didn't mention my mother or myself by name. We were the mother and the sister, which just felt kind of odd because, you know, we weren't witnesses. But every aspect of the story involves the mother and the sister.

[Phoebe Judge]

The first witness was the pathologist who had performed Angelo's official autopsy. The family didn't know what the pathologist had found. They still hadn't seen the official autopsy report. But they did know the results of the independent autopsy that they had ordered and, and paid for themselves, which had concluded that Angelo had died of asphyxiation. The independent autopsy had found something called petechial hemorrhages on Angelo. Small red marks often found in the eyes from broken blood vessels, which is

[Ben Nissenbaum]

important because they tend to support a finding of an asphyxiation death.

[Phoebe Judge]

But the county pathologist testified that he had found no petechial hemorrhages on Angelo and he didn't mention any other signs of asphyxiation. He went over the results of the toxicology report. It showed that Angelo had caffeine in his system and cotinine from cigarette smoking, as well as a drug for seizures, which is generally considered safe. Later, the Quinto Collins family's attorney pointed out that that Angelo had been given anti seizure medication at the hospital in the days before he died. The pathologist also found a drug called Modafinil, which is also generally considered safe. It's used to treat narcolepsy, but people sometimes use it off label to stay awake and alert longer. The pathologist said that the Modafinil could have contributed to Angelo's death because he said there's a condition linked to drug use that kills people. He said, quote, it's poorly understood. It's called excited delirium syndrome.

[Bella Quinto Collins]

To which there was an audible reaction from the crowd.

[Ben Nissenbaum]

It was shocking and it was laughable. And I laughed out loud, not on purpose, but, you know, I just had that reaction. And when I realized that I had done that, I thought, oops, and I walked myself out.

[Phoebe Judge]

The pathologist said that Angelo's cause of death was, quote, excited delirium syndrome due to acute drug intoxication with behavioral disturbances due to arrest related death with physical exertion. In the eight months since their lawyer had first told them about excited delirium, Robert says they'd all been learning more.

[Robert]

As time went on, it became difficult to think that they would still blame excited delirium because even if you believed in the pseudoscience of excited delirium, even if you were to read their own reports, Angelo didn't fit. That's why there was such a shock in the crowd, because we had all become much more informed about excited delirium. Typically, excited delirium was blamed on people that were taking coke or meth or something. But to blame it on tobacco and cigarettes and this other thing that prevented you from sleeping, which had never had any deaths, meant that they had the flimsiest case of excited delirium, even if you went by their own standards.

[Phoebe Judge]

Next, Kashard played Bella's 911 call to the jury. And three of the four police officers who had been at the house in Antioch the night Angelo was taken to the hospital testified two of the officers said that they'd had a knee on Angelo, but only very briefly. Originally, the police had said one officer had a knee on him. Then a detective with the DA's office testified that he had looked at Angelo's old incident when a neighbor had called the police because Angelo had been acting strangely, trying to climb a fence. The investigator said that according to the paramedics, Angelo had had a fast heartbeat. And he said a police officer had said that Angelo had admitted to being on meth. Gashard had said he thought a doctor at the hospital had believed the same thing. Then Gashard told the jury to not consider what had just been said about meth because he said it was about a previous incident and there was no evidence of meth in Angelo's blood, as the pathologist had previously testified. After the witness testimonies, Gashard reminded the jury that they would only be deciding on the cause of death, not who was responsible. They had four homicide Suicide, accident, or natural causes? The jury were told they didn't need to reach a unanimous decision, but a majority of them would have to agree. Gushard cleared the courtroom while the jury stayed back to deliberate. After about 15 minutes, they'd reached a unanimous decision. Were you surprised when the jury ruled it an accident?

[Ben Nissenbaum]

No, not at all. When I heard the. The testimony from the coroner that it was excited delirium, then I. That's what I expected would happen. And I felt like that was the intended. That was the purpose of it.

[Phoebe Judge]

The Quinto Collins family had filed a lawsuit against the city of Antioch, its police chief, and the four police officers who were at the family's house that night. In December twenty, twenty months later, Ben Nissenbaum deposed the county's pathologist. The pathologist came to his office with a lawyer.

[Ben Nissenbaum]

What happened was I showed him the pictures from our autopsy that showed the particular hemorrhages in Mr. Kinto's eyes. And so he looked at them, and he looked at them again and again and again and again. And Dr. Ogan actually acknowledged that, yes, those are particular hemorrhages and that in his view, they take time to develop and that they simply hadn't developed at the time that he did Angelo's autopsy. What he said is that the restraint also played a role in Mr. Kento's death.

[Phoebe Judge]

The pathologist said that if he had found the petechial hemorrhages when he did his autopsy, he would have added asphyxiation to his diagnosis. But he still believed the excited delirium diagnosis was right. We'll be right back. Thanks to Squarespace for their support. Making a website can be intimidating, especially because it's often the first thing people see about your business. If you want to build a website that makes a great first impression on people, you. You don't need years of coding experience. You just need Squarespace. It's the all in one website platform made to help you stand out online. Squarespace has the tools you need to make your website look exactly how you want it to look, sell your services, and get paid. No matter what business you're in. You can choose from a library of templates designed by professionals, or if you don't want to scroll through all the template options. Squarespace's blueprint AI can build a website for you in just a couple of minutes based on a few prompts. It'll pull from different templates. To create the website you need, go to squarespace.com criminal for a free trial. When you're ready to launch, use the offer code criminal to save 10% off your first purchase of a website or domain.

[Ben Nissenbaum]

I'm RJ Decker, the private investigator uncovering the Sunshine State's darkest secrets.

[Phoebe Judge]

Tuesdays, it's the premiere of ABC's hottest new crime show. RJ Freakin Decker.

[Cassandra Quinto Collins]

As I live and breathe, he's a private eye.

[Ben Nissenbaum]

It's not a standard murder. Some finger and a public mass trying

[Renu Ryesum]

to get sent back to prison.

[Arjun Baiju]

Today you go to prison one time

[Ben Nissenbaum]

and suddenly it's all the jokes.

[Phoebe Judge]

RJ Decker Series premiere Tuesdays on ABC and stream on Hulu. After the idea of excited delirium was proposed in the 1980s, it started gaining momentum. In October 2008, a three day conference on deaths that occurred in police custody was held at a hotel in Las Vegas. It was sponsored by something called the Institute for the Prevention of In Custody Deaths. Speakers included doctors, pathologists and scientists. One of the speakers was Charles Wetley, the medical examiner who had theorized that the deaths of a number of women in Miami were due to excited delirium because they'd had cocaine in their system. In 1995, Charles Wetley had moved to New York where he worked as a medical examiner.

[Renu Ryesum]

Even though Wetley's theories in Miami were unproven in those murder cases, he continued to talk about excited delirium reporter Renu Riasum and it continued to link cocaine use with excited delirium. He was just really convinced of this idea and then this sort of idea really took off in a lot of different ways.

[Phoebe Judge]

When the 2008 conference in Las Vegas was announced, Charles Wetley was introduced as one of the doctors who had identified excited delirium quote in the cocaine wild 1980s. The conference promised that, quote, attendees will help make law enforcement, medical and legal history through topic specific breakout groups focused on arriving at a consensus about excited delirium. The conference was organized by a group that was started by a lawyer from Taser.

[Renu Ryesum]

They make stun guns. They say, hey, these stun guns don't kill people. They're an alternative to kind of other uses of force by police.

[Phoebe Judge]

In a later interview with Reuters, Charles Wetley said that he had studied deaths involving Tasers and in the vast majority of cases those deaths were caused by excited delirium, not the Taser shock. Quote, I've never seen a case where I could say that a Taser actually contributed to the death. He told Reuters that Taser had hired him many times to be an expert witness in lawsuits against the company. Renu Riasum says that conference on in custody deaths became a turning point.

[Renu Ryesum]

From that conference emerged what ended up being this really influential white paper, Unexcited delirium. It's called the white paper on excited delirium syndrome. So a white paper, it's like, in this sort of medical or scientific context, a white paper is kind of like a detailed guide or report on a topic.

[Phoebe Judge]

The white paper was published by the American college of emergency physicians in 2009. The authors of the paper were 19 doctors, many of them professors of emergency medicine. A few of them had worked with taser in some capacity. We reached out to axon, the company that makes tasers, for comment. We didn't hear back.

[Renu Ryesum]

So if you read the paper, you go back and read the 2009 white paper from the American college of emergency physicians. It sort of lays out, okay, what they think excited delirium is, and it presents this research. Of course, all the research is sort of circular. It's from the same group of experts that have been talking about the theory in the first place. And they say, okay, there are no biological markers for excited delirium. Again, there's no tests or standard diagnostic criteria, but they lay out what they say are these features as someone has, like, superhuman strength or really high pain tolerance or rapid breathing, Then they have excited delirium.

[Phoebe Judge]

The white paper listed other signs that someone might have excited delirium, such as a, quote, failure to respond to police presence, profuse sweating, and a, quote, attraction to glass or reflective surfaces.

[Arjun Baiju]

I had never heard of this thing called excited delirium, and I. I was troubled and curious.

[Phoebe Judge]

In 2020, Arjun Baiju was a medical student doing a research fellowship at a hospital in Rochester, New york, when a man named Daniel Prude was brought to the intensive care unit after an incident which included being restrained by police. Arjun didn't treat the man, but later he heard about him and about how his autopsy had listed excited delirium syndrome as a cause of death. Arjun says he asked some of his professors about it, but none of them had heard about excited delirium syndrome. Groups like the American medical association, the American psychiatric association, and the WHO didn't recognize it. So Arjun started doing his own research.

[Arjun Baiju]

Well, I just started with Google, like everyone does, and the first things that came up were a lot of police training material, Manuals from police departments across the country, videos about it on YouTube for training purposes.

[Phoebe Judge]

Arjun says the training materials he found almost always mentioned superhuman strength and how to deal with it.

[Arjun Baiju]

Somebody with excited delirium can't be taken down with the normal De escalation techniques of verbal cues. They say they need many officers. They say that they need many electroshocks.

[Phoebe Judge]

A news organization called New York Focus got access to Rochester police training materials on excited delirium, created in 2016, and found that a lot of it appeared to come from a poster published by the Institute for the prevention of in custody deaths, the organization that had been started by a lawyer at Taser. The poster had advice on how to capture someone with excited delirium. Quote, taser electronic control devices have been shown to be the most effective for quickly capturing this category of individuals in a police training presentation. A couple of slides had a list of behaviors to look out for. They included hallucinations and unfounded fear or panic, bizarre behavior, and, quote, saying, I can't breathe. The slides included photos like one of a naked zombie with blood on its face, one of the Incredible Hulk, and one of the actor and comedian Jordan Peele with sweat running down his face. The slide explains the four stages of excited delirium. One, elevated body temperature, Two, agitation. Three, respiratory arrest, four, death.

[Arjun Baiju]

One of the ideas is that people with excited delirium, quote, unquote, have reduced pain perception. And they cite instances of them smashing glass and withstanding multiple electroshocks. In that description are all these very loaded terms with all this baggage, like monster and animal like behavior and extreme strength. And I think that plays on racial stereotypes because overwhelmingly, these are black men, young black men. The second angle is that this question of differences in pain perception has an embarrassing legacy in medicine, A long legacy of physicians believing that people of African descent have different pain perception, require less anesthetic, have literally thicker skin, have literally less sensitive nerve endings. So very gruesome things from surgery to experimentation to amputation were carried out under that guise. And I think that we see that legacy in this narrative of people with excited delirium having diminished pain response.

[Phoebe Judge]

The organization Physicians for Human Rights says that the deaths of black people and people of color have disproportionately been attributed to excited delirium. Excited delirium also came up in George Floyd's case.

[Renu Ryesum]

There's an officer on the tape saying, hey, we think maybe he has excited delirium.

[Phoebe Judge]

At trial, the defense attorney for Derek Chauvin, who was accused of killing George Floyd, said that Chauvin had been watching for signs of excited delirium as a, quote, reasonable police officer, because that's what police were trained to do. A Minneapolis police officer had testified that she trained new officers on how to recognize the syndrome. The prosecution called a doctor to testify. He said that he believed excited delirium is real, but that George Floyd had none of the symptoms. Derek Chauvin was convicted of killing George Floyd. After George Floyd's death and the deaths of a number of other men of color who had died in police custody in 2019 and 2020, supposedly from excited delirium, Renu says, things began to change.

[Renu Ryesum]

I think what really changed the game was video footage of these deaths, and in particular, George Floyd's death. I that caused a lot of people to take a look at this term. It forced a lot of groups that had been supportive of the term to turn away from it. And under pressure, the American college of emergency physicians, in 2021, they started to backpedal a little bit. And in 2023, the American College of Emergency Physicians retracted that 2009 white paper, and they said, we got it wrong.

[Phoebe Judge]

Renu says police departments across the country have since removed the term excited delirium from their training materials.

[Renu Ryesum]

But I'll give you an example of how just kind of banning the term may not be enough. So the Minneapolis Star Tribune, they reported that in training materials for the Minneapolis police department, There are these PowerPoint slides, and the words excited delirium were crossed out and replaced with the term severe agitation with confusion and delirium in parentheses. So, yeah, this concept that, you know, that exists just with a different name.

[Phoebe Judge]

Six months before the white paper on excited delirium was withdrawn, Angelo Quinto's family tried to have the cause of death on his death certificate changed after the county pathologist had sat down with Ben Nissenbaum and. And agreed that asphyxiation had been a contributing factor in Angelo's death. His family argued that Angelo's death should have been classified as a homicide. They were not successful. In 2021, California Governor Gavin Newsom signed eight new reform bills into law. One of them bans restraints that can cause asphyxiation. And in 2023, California became the first state to ban the term excited delirium, as well as related terms such as hyperactive delirium and exhaustive mania.

[Ben Nissenbaum]

What it's done is to change the way that the cases are resolved by coroners. And we've seen that have a real effect, I think, because now much more, we see that coroners are including the restraint as part of the cause of death.

[Phoebe Judge]

In 2024, the Antioch City council announced that they'd decided to settle with the Quinto Collins family for $7.5 million. After Angelo died on December 26, 2020, his family kept the presents they had wrapped for him that Christmas. They never opened them and his mother Cassandra told us that every year at Christmas they bring out Angelo's presents and put them under the tree. Since Angelo's death, the city of Antioch launched a new non police crisis team that will respond to calls about people in a mental health crisis. Shortly after Angelo died, his sister Bella, who had called 911 that night, told reporters, quote, I asked the detectives if there's another number I should have called and they told me that there wasn't and that I did the right thing but the right thing would not have killed my brother. She said, now there's somebody else to call. It's named after Angelo. The Angelo Quinto Community Response Team. Criminal is created by Lauren Spohr and me. Nadia Wilson is our senior producer. Katie Bishop is our supervising producer. Our producers are Susanna Roberson, Jackie Sajiko, Lily Clark, Lena Sillison and Megan Kinane. Our show is mixed and engineered by Veronica Simonetti. Julian Alexander makes original illustrations for each episode of Criminal. You can see [e-mail] and you can sign up for our [e-mail] Newsletter we hope you'll consider supporting our work by joining our membership program Criminal. Plus, you can listen to Criminal this is Love and Phoebe reads a Mystery without any ads. Plus you'll get bonus episodes. These are special episodes with me and Criminal co creator Lauren Spohr talking about everything from how we make our episodes to the crime stories that caught our attention that week, to things we've been enjoying lately. To learn more, go to patreon.com criminal we're on Facebook at thisisCriminal and Instagram and TikTok at Criminal underscore podcast. We're also on YouTube at YouTube.com criminalpodcast Criminal is part of the Vox Media Podcast Network. Discover more great shows at podcast voxmedia.com. i'm Phoebe Judge. This is Criminal.