Honesty, Justice, and Trust

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I'm not the kind of person that immediately shouts for someone to lose their job when they do something wrong. We all make mistakes, and jobs are hard to come by nowadays.

But I'm also the kind of person that gets their dander up when organizations try to sweep problems under the rug, and whitewash a situation to cover their own backside.

I recently wrote about how two police officers in Tybee Island, Georgia tased a young autistic man who was sitting outside a restaurant waiting for his brother, who was inside. They not only tased him, but wrestled him to the ground, bruising him and breaking his tooth in the process. Originally, the police chief did what might be expected. He defended the actions of his men, and even went so far as to "blame the victim" and his family somewhat by saying that he was sorry that he had been left "unattended". That last statement, which implies that no one with any kind of disability that impairs communication should ever be left alone, even for a few minutes, got me (and a lot of other people, I'm sure) very upset. I don't realistically expect that the whole world will change overnight, and that the world and everyone in it will totally understand my autistic son as he grows up. I also don't think it unreasonable that he should not have to fear being beat up and tased for sitting on the curb outside a restaurant on a hot day.


Evidently there are some reasonable people living in Tybee, and some of them are actually in a position to do something. According to this article:

Tybee drops charges against autistic teen

WTOC11 reports that,

Tybee Island Mayor Jason Buelterman and Schleicher asked Police Chief Price James W. Price to have the GBI investigate the incident and make sure no laws were broken by police.

Many politicians, both local and national, would have followed on what the police chief originally said, and would have tried to cover up the situation and hope it would go away. I applaud the mayor and city manager, who asked a neutral party (the Georgia Bureau of Investigation-the state counterpart to the FBI) to look into the matter. As police officers themselves, the GBI would have an excellent understanding of what proper police procedure in such cases should be, as well as having practical experience in similar types of situations. Yet as a neutral party, they also understand that the public needs to have confidence in its law enforcement officers. Law abiding public citizens should not have to fear their own police force. When law enforcement officers "go too far", it impairs the ability of all other officers on the force in their ability to do their job. When you are in a job that serves the public, you need to be accountable to that public. You may not like it, but that's part of the job.

According to another recent article in the Savannah Morning News, "Tybee Police Learn About Autism", the two police officers that arrested Clifford, as well as a jailer, have both resigned their posts. The police chief has been suspended, and officers are now being sent for training on dealing with people with autism.

My hat is off to the city of Tybee, for stepping up and doing the right thing. Nothing will undo the damage that has been done. Clifford will forever more be afraid of the police, and it will be that much harder for him to react calmly the next time he interacts with them. But it looks as if the city is stepping up, doing what it can to prevent future similar occurrences, and weeding out a few bad apples (while sending an important message to the rest of the department).

I don't know if the police chief will keep his job, or if he should. I am not in a position to know what he knew, when he knew it, and what he has done in the interim. But I trust now that the people of Tybee will do the right thing, because of what they've done thus far. And if he does keep his job, I sincerely hope that he issues a much more heartfelt and all encompassing apology to Clifford and his family, for them having to have endured this.

Georgia Scores a Hat Trick

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In the game of hockey, a hat trick refers to when a single player scores three goals on the opposing team during the same game.

In the game of "how can we be the most discriminatory against autistics", the US state of Georgia has been in the news three times in the last two weeks. First it was charging a 14 year old autistic boy with felony terrorism charges for stick figure drawings he put on his homework. Then it was police using a taser on an 18 year old autistic young man who didn't answer their questions fast enough, and appeared different.

Today Georgia is in the news again, and again it's for tasing an autistic man. According to Fox News:

"Twenty-three-year-old D.J. Moran said multiple officers surrounded him, cuffed him on the ground and then tasered him, MyFoxAtlanta reports."

Of course, the multiple officers couldn't possibly handle this after they surrounded the man and were putting him on the ground, so they just had to taser him:

"Police officials released a statement saying, 'The officer used a taser when the suspect failed to cooperate by struggling and resisting, after being instructed to place his hands behind his back. The suspect only complied after the taser was used.' "

Fortunately, even though the police tried to cover themselves by charging the man with multiple felonies, a jury (who saw a police cruiser cam video of the event) saw things differently:

"Police charged Moran with multiple felonies, but a jury did not convict him."

So congratulations, Georgia! Guess I won't be spending any of my vacation dollars in your state this year.

Geogia-Zero Tolerance for Differences

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Evidently it's not safe to walk around (or sit) any place in Georgia while being autistic. At least not by yourself. Because if you do, you're fair game for being tased by the police. At least, that's what the police chief of Tybee Island, Georgia seems to think.

A little over a week ago, it was a 14 year old boy being arrested on felony terrorism charges for drawing threatening one inch stick figure drawings on his homework. Now it's an 18 year old autistic young man tasered after being confronted by police while he was sitting on the curb waiting for his brother and a friend to come out of a restaurant.

WMBF news reported yesterday on how 18 year old Clifford Grevemberg was waiting on the curb outside the Rock House Bar and Grill for his brother and a friend to come out, when he was approached by two policemen. According to the police report, Clifford was staggering while walking back and forth in front of the establishment, and when questioned, responded that he was waiting for his brother to come out with some food.

The police report said that one officer asked Clifford if he had been drinking, and he responded yes. Of course, they didn't ask him what he had been drinking. Unless he was asked if he had been drinking alcohol, my 10 year old son might have also responded in the affirmative, having drunken water, soda, or some other perfectly legal beverage. The officers then asked for identification (twice), and when Clifford turned and began to walk away, they grabbed his arm. Clifford, as might be expected, tried to retract his arm away from them, which gave these two police officers all the justification they thought they needed to taser him. Which they did while forcing Clifford to the ground, causing a bruised face and a broken tooth.

The Tybee police chief, in a statement given today, tried to explain away the incident by saying that Clifford gave the appearance of being intoxicated, and tasing him prevented further damage to both Clifford as well as the officers. He gave a backhanded apology, saying

"We are sincerely apologetic for the injuries suffered to Mr. Grevemberg. We are also sorry he was left unattended under the circumstances..."

In other words, if you are so brazen as to think that you have the right to walk or sit in a public place while being autistic (and you don't have an attendant immediately at your side), then you shouldn't complain when the police tase you and arrest you.

Death by Suffocation

photo credit-Steve Brandon

Kristina Chew referred on her blog to an article today about an autistic individual who died while being subdued by police. According to the article:

...Mitchell died in a hospital last July following a struggle with deputies at his Perris home. Deputies responded to the residence after his mother called 911 saying she needed authorities to pick up her son. ...

The article was prompted by the mother filing a wrongful death lawsuit against the police. As might be expected, there are two different versions of what caused the incident:

...Sheriff's officials contend Mitchell died from autism-induced "excited delirium syndrome," a condition that leads to sudden cardiac arrest. ...

..."That's what they always say," attorney Carl Douglas said.

Douglas believes Mitchell died of positional asphyxiation after several officers piled on top of him. ...

Before I go any further, let me state for the record that I am generally supportive of law enforcement. I have expressed concerns about their level of training and how police interact with autistics, but I have also given praise when I felt they deserved it. They have a tough job, and have to make some tough decisions in rapid succession. They also aren't always trained as well as they should be to deal with "special case" situations, such as dealing with autistics.

After seeing the post on Kristina's blog today and reading the article, I just had to make some comments.

As a physician, I had never heard the term "Excited Delirium Syndrome" until I heard it bandied about as a defense when subjects had died in police/emergency workers custody shortly after being forcibly subdued by them. And I had never heard autism ever mentioned as something that might induce such a "syndrome". Personally, I don't think it exists as a separate syndrome.

Excited delirium syndrome has been used when a person dies in custody after being forcibly subdued. Typically the person that died was also under the influence of illegal drugs such as PCP, cocaine, and methamphetamine. All of these drugs can put a stress on your heart before, during, and after a forcible struggle with the police. While I do understand that sometimes force is required to subdue violent individuals, I believe that there is inadequate recognition of the possible negative outcomes that can result from forcibly subduing someone, which results to force being reverted to too often, and more importantly, improper after care once force has been applied.

Here is what I think happens in a "typical" death from "Excited Delirium Syndrome":

1) Police are summoned to take into custody a violent or potentially violent person. Being the police, they are expected to actively take action to deal with someone, especially if they are actively violent at the time. Sometimes I think that they take physical action too quickly when the person they are dealing with is not actively violent. This may be due to what we term "production pressure" in medicine (the push to get things done so you can move on to other important things), or it may be due to inadequate training.

In a typical scenario, once police arrive they typically want to control the situation as quickly as possible. Lack of control means too many variables, and too many variables means too many chances for someone to get hurt. So they rapidly progress thru their "use of force continuum" until they get control of the situation. This continuum differs a little from jurisdiction to jurisdiction, but typically looks something like this (from Wikipedia):

1. Presence
2. Verbalization
3. Empty hand control
4. Intermediate weapons (e.g., chemical, electronic or impact weapons)
5. Deadly Force (any force likely to cause permanent injury or death)

What I believe typically happens is that the officer, thru physical presence (man standing confidently in uniform with gun) and verbalization (may start with asking for compliance, rapidly progressing to orders of compliance-"come here, turn around, get down on your knees, etc.)tries to get compliance from the subject. Not getting the desired result, I think most officers resort to

2) Hands on techniques. Usually these start innocently enough as a gentle laying of their arm on the suspects arm or shoulder to get them to comply or come along, but then progresses to joint locks, arm bars, hair pulls, and other techniques to coerce compliance. I think it is at this point that things start escalating quickly. The police officer involved certainly has a lot of endogenous epinephrine (adrenaline) flowing in his veins, making it more difficult for him/her to judge how much force they are applying and for how long. The subject, especially if they have a hard time understanding what is happening (either because of drug/alcohol intoxication, language difficulties or cognitive disabilities) also has gone into a "fight or flight response" and starts fighting for their life. The police officer(s) now involved sense what is a very disorganized scene and rapidly escalate their responses to gain control. This may involve choke holds (which have been banned from many departments) or may involve multiple people striking the subject and/or "piling on" them to subdue them. This leads to what is a critical juncture, namely

3) Loss of ability to breathe for the subject. If a person has not been fighting forcefully up to this point, then they certainly will now. I've seen 80 year old sweet grandmothers become markedly violent when they can't breathe. It's a primal instinct. We can only go 4 minutes at rest without breathing. This time is markedly shortened when we are also expending maximum energy in trying to regain our airway. Officers may or may not recognize that they have compromised a person's airway at this point. I suspect that they are focused on subduing the person, not getting hurt, and not letting anyone else get hurt.

Not being able to breathe, while rapidly using up all your oxygen will predictably lead to unconsciousness. There will be a short period of time where recognizing the person is unconscious, rapidly acting to get everyone off them and open their airway, and administering mouth to mouth resuscitation will revive them. This period will be fairly short in length, though, and probably missed, leading then to

4) Cardiac arrest. At this point the person has quit struggling and the officers have spent time applying handcuffs to their wrists (and possibly restraining ankles also) with the person in the face down position. This makes it difficult for them to recognize that the person has indeed arrested, and failure to quickly resuscitate the person leads to

5) Certain death.

In analyzing the above scenario, there are a few critical points where decisions made can end up snowballing into possibly catastrophic consequences. The first point is the initial laying on of hands by police. If a person is actively trying to hurt another, then the police's hands are tied. But if they are not hurting anyone else, then I think that staying verbal longer can avoid some negative outcomes. The gentle laying of your hand on someone's arm can be soothing to many, but it can lead to atypical reactions in some populations (like autistics). Most people with autistics in their immediate family know that touching them when they are excited is not usually a good thing. At the least they involuntarily pull away, at worst they may lash out (usually indiscriminately). So even though it may take longer (sometimes a lot longer) to talk someone down, if it resolves the situation then it's a good thing.

The second critical point in the above scenario is in recognizing that the person's airway has been compromised. This is admittedly very tough in what has now become a fluid violent situation, but I think that if there is increased awareness of this possibility that there will be increased recognition and proper treatment when it happens. I also think that the police might want to borrow something from medicine.

Whenever we run a "code" on a person, if possible we designate a person the team leader, and that person does not get involved with manual tasks such as chest compressions, starting IV lines, giving drugs, etc. Their main role is to make decisions and constantly reevaluate the entire situation. The senior police officer on the scene has to try (if possible) to not become physically involved. This is admittedly very tough when the situation is not in control, but there is a greater chance of someone recognizing when things are going awry when they are not physically involved in subduing the individual. If they have to become physically involved in subduing the individual, then they need to rapidly back out of that role as soon as possible.

The next critical step is one that I do not believe occurs at present. That is, immediately after a subject stops moving in such a situation, someone needs to verify that the person is breathing. Often I suspect that the police, having gone thru their own "fight or flight" response, are very jittery and coming down from this at this time, feeling a bit more relaxed as the suspect is restrained. But this is a critical point in the confrontation, when seconds lost can have disastrous consequences for the subject. While there may be a feeling of "they got what they deserve" for fighting back at the time, as police can also be injured in these events, I don't think that upon calm reflection any police officer would think that any person "deserved" immediate death on the street for resisting arrest. Increased recognition of loss of airway commonly occurring in these situations needs to be stressed in training of officers, as well as ways to recognize and deal with it to prevent further injury to the subject.

In light of the above, and since police officers are not really trained to act as first responders for medical issues, I would think that policy should be changed such that paramedics are on the scene before any person that is not violent is approached with physical measures. This suggestion will certainly result in a large uproar from those in emergency services. But I think that in terms of preventing lives lost it may be necessary.

An Encouraging Sign

photo credit-Steve Brandon

St. Louis Police Chief Joe Mokwa announced Monday that a special law enforcement task-force has been assigned to the Christian Ferguson case.

He was 9 years old when he mysteriously disappeared from the SUV his father was driving, at a north St. Louis intersection, on June 11, 2003. Dawan Ferguson told police that Christian was in his car when it was stolen. Dawan had gotten out of his vehicle to use a pay phone at Skinker and Page. ...

So begins a story from the online site of KSDK, a TV station in St. Louis, Missouri. It's not unusual that the police would take a close look at such a case.

...Mokwa said the new task-force will consist of a sergeant, two detectives, two FBI agents, and a command officer. ...

which are a lot of resources to devote to just one case. What's even more unusual is that they are doing so in a case where the victim was poor, black, and severely physically and developmentally disabled (as far as I know he was not autistic, but you get the point).

In this case, the father of the child reported that he stopped to use a pay phone, and left the child in the car. While he was reportedly on the phone he says that the car was carjacked. The empty car was found two hours later a few miles away.

There were many inconsistencies in the story, such as the fact that the father had a cell phone in the car at the time, and a witness who reported seeing the car at the place where it was found at approximately the same time that it was reported stolen. The police reportedly never believed the father's story, but have turned up no evidence of foul play thus far.

I've been critical, as well as worried, regarding how society and law enforcement deal with the death and treatment of disabled individuals. So I have to be even handed and give props to Chief Mokwa of the St. Louis police department for pursuing this case, even though the family is not wealthy or politically connected, and even though the child was severely disabled. The world would be a better place if there were more such individuals who recognized the humanity in all individuals, and who were willing to stand up for those without the power or means to stand up for themselves.

Lastly, let's hope that anyone that knows anything with regards to what really happened will stand up and be counted.

Pressure Applied to Autistics

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In a troubling incident in Tulsa, Oklahoma, a mother is accusing the school system of child abuse for "rolling up" her 7 year old autistic son when he was out of control. This incident is troubling for a couple of reasons. First, most likely this is an all too common scenario of untrained staff overreacting in an inappropriate manner.

...The mom told police the boy's face, neck and shoulders were covered with marks that appeared to be tiny broken blood vessels under his skin. We talked to the doctor who saw the boy that day. He said the injuries were likely from screaming while being in a tight restraint for a long time. ...

This description is consistent with the child having force applied to him (squeezed tightly) while he was "rolled up". It was fortunate that asphyxiation injury did not occur, which could have caused brain damage or death. Although the injuries in this case were certainly uncalled for and serious, they didn't warrant any medical attention, and the child has returned to school.

The parent may be absolutely correct in pursuing legal redress, but this case is also troubling in that stories like this only serve to paint all autistic kids as wild, violent, and out of control, which makes it easier to dehumanize them and leads to societal acceptance of further abuse.

I certainly sympathize with the mother. About 18 months ago I had a similar incident occur with Buddy Boy. Although he did not end up with petechiae, and it wasn't a part of his Positive Behavioral Support Plan, staff at the school wrapped him in a heavy rug while he was screaming at them that he didn't want to be wrapped up. Deep pressure only works if it's what the person is seeking to calm themself, not if they're just pissed off about some innane thing that you're doing to them.

But I hate to see these things made into police matters. I'm worried that the next time the child is perceived to be "out of control" that the school calls the police, who will treat the child as a criminal and taser them (or worse). I'd much rather the school district act responsibly and realize that this technique was absolutely wrong (and could have resulted in worse injury or death), apologize (I can dream), immediately have an IEP meeting to determine whether the Positive Behavioral Support Plan that was in place was followed, and whether that plan needs to be revised.

The school district has already lined up another parent of an autistic child to defend their practice. So even if the original child's Positive Behavioral Support Plan wasn't followed, and even if the district overstepped their bounds, this case is lost in the forum of public opinion, and the biggest losers are all autistics, who are further viewed as violent, out of control, subhuman creatures.

Joe is 211