DC9 case: Medical examiner's cause of death ruling is rare, controversial

The D.C. medical examiner's ruling that 27-year-old Ali Ahmed Mohammed died of "excited delirium" marks one of the rare times the diagnosis has been made in a case that has not involved allegations of police brutality.


The D.C. medical examiner ruled that Ali Ahmed Mohammed died outside of DC9 due to 'excited delirium.' (Photo: Samuel Corum)

Mohammed died in the early morning hours of Oct. 15 following an altercation with five men who worked at U Street area nightclub DC9. The five men, four employees and a co-owner of the bar, chased after Mohammed after he allegedly threw at least one brick through the club's front window. D.C. Police Chief Cathy Lanier initially said Mohammed died as a the result of a "savage beating" that appeared to be a case of "vigilante justice," but attorneys for the five men insisted Lanier had gotten it wrong, that Mohammed had merely been restrained while they waited for police to arrive.

D.C.’s U.S. Attorney dropped all charges against the five defendants on Nov. 5, citing the fact that the autopsy investigation was at that point incomplete.

On Tuesday, the medical examiner's office released a statement listing the manner of Mohammed's death as a homicide, and the cause of death as "excited delirium associated with arrhythmogenic cardiac anomalies, alcohol intoxication and physical exertion with restraint." There was no mention of any trauma that might have resulted from a beating in the ruling.

But the very existence of a disorder called excited delirium is controversial among forensic pathologists, according to Michael Baden, a former chief medical examiner for New York City. Baden frequently testifies at trials where the results of autopsies require further interpretation.

"Excited delirium is one of these conditions that is disputed," says Baden. "It's a niche diagnosis."

How small a niche? In the vast majority of cases where the diagnosis is made, it's been reached by a medical examiner investigating the cause of death of someone who died while in the custody of authorities. Described by researchers at the University of Miami as including symptoms such as "bizarre and/or aggressive behavior, shouting, paranoia, panic, violence toward others, unexpected physical strength, and hyperthermia," excited delirium has only existed as a diagnosis since the 1980s and isn’t universally accepted by the wider medical community. It more commonly comes up in civil cases brought against law enforcement officials who are accused of using excessive force. It's also usually linked to drug and/or alcohol use, and has been cited in cases where death occurred after the use of a Taser.

In Lewis v. City of West Palm Beach, for example, the family of Donald George Lewis filed suit after Lewis died in 2005 while in the custody of five police officers. The officers, who testified that Lewis had resisted arrest, hog tied and applied pressure to Lewis' back in order to subdue him. Palm Beach County medical examiner Michael Bell later determined that Lewis had been under the influence of cocaine at the time of his arrest, and concluded that the cause of his death was "sudden respiratory arrest following physical struggling restraint due to cocaine-induced excited delirium."


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