1)A long thread in response to @iwashyna calling for physicians to use their expertise to evaluate the statement released yesterday by the Hennepin county attorney on the death of George Floyd.

2)I agree that when the prestige of the medical profession is used in service of injustice, then doctors must speak up. First, I will state the state the obvious: on May 25th, Minneapolis police killed George Floyd.

3) We know this from the now widely shared video. But the video we have all seen is not the only evidence.

4) The Washington Post ( https://www.washingtonpost.com/nation/2020/05/30/video-timeline-george-floyd-death/?arc404=true
) has compiled other bystander video and footage from store security cameras. These videos demonstrate three things:

5) First, George Floyd was in his usual state of health prior to his encounter with the Minneapolis police. Second, he became unresponsive while subjected to a dangerous restraint by officers.

6) Third, despite being unresponsive (a state which was obvious to onlookers) officers offered no assistance and maintained the restraint for nearly three minutes

7) Indeed, according to city officials it was 1 min and six seconds after Mr. Floyd became unresponsive before anyone checked for a pulse. When they did, they were unable to palpate one radially.

8) Despite this alarming finding (again, according to city officials) it was another nearly 2 minutes before Officer Chauvin removed his knee from Mr. Floyd’s neck

9)Let that sink in. Instead of offering assistance, the officer spent the first two minutes of a code (because that is what this would have been at this point if Mr. Floyd were in a medical facility) with his knee pressed into the patient’s neck.

10)Not withstanding the above, a statement of probable cause released by the city of Minneapolis goes to some lengths to avoid observing what we have all now observed

11) This document makes several remarkable statements. Among these:

12) “Mr. Floyd had underlying health conditions including coronary artery disease and hypertensive heart disease... his underlying health conditions and any potential intoxicants in his system likely contributed to his death.”

13) How does the potential presence of a thing cause death? I would have thought that the actual presence of a thing in a body was a perquisite for it contributing to death and that the absence of said thing would pretty much rule it out as a contributor.

14) There is more in the document that suggests what is afoot here. The statement notes “Mr. Floyd is over 6 feet tall and weighs over 200lbs”. At a different point the document quotes an officer saying “I am worried about excited delirium or whatever”.

15) Excited delirium is a controversial entity invoked most often by law enforcement (as opposed to medical practitioners outside the legal system) to explain the cause of death of persons in police custody (see, for example, J Forensic Sci 1985;30:873–80)

16) A 2018 review in Academic Emergency Medicine (Acad Emerg Med 2018 May; 25(5):552-565) noted that there is no actual medical definition of the syndrome but it is supposedly characterized by “superhuman strength” and imperviousness to pain

17) Excited delirium is useful for explaining the otherwise difficult to explain phenomenon of persons suddenly dying while restrained by police , but without having to attribute the death to any actions by the police.

18) Among the risk factors for excited delirium ? Being young, being male, being African-American… and being in police custody. In other words, this is pseudo-science and racism.

19) So here we have a supposed statement of fact issued by agents of the city of Minneapolis and Hennepin county which appears to be laying the groundwork to excuse the actions of other agents of the city of Minneapolis

20) As medical professionals it is our duty to speak accurately and precisely – this is evidence of systemic racism, not medical science.

21) If you think it extreme to allege that a medical examiner or forensic professional would speak unscientifically in service of an agenda, consider that the entire field of forensic science is known, for a fact, to be rife with such abuse.

22) In 2009 the National Academy of Science issued a damning report entitled “Strengthening Forensic Science in the U.S.” : https://www.ncjrs.gov/pdffiles1/nij/grants/228091.pdf

23) Notable findings in the report: “The simple reality is that the interpretation of forensic evidence is not always based on scientific studies to determine its validity”

24) “there is a notable dearth of peer-reviewed, published studies establishing the scientific bases and validity of many forensic methods”

25) the academy found that forensic science was not scientific at all and was rife with poor standards and conflicting agendas. “The forensic science enterprise lacks the necessary governance structure to pull itself up from its current weaknesses”

26) This and the terrible sin of racism, which has infected our country from its inception, is the context in which we must interpret the reported findings on Mr. Floyd’s killing

27) The Noble laureate Niels Bohr said that the removal of prejudice is the common aim of all science

28) As critical care physicians we are often confronted with problems that may not be within our power to solve. We may not be able to remove the stain of racism from our nation, but it is our charge to try. Fight on.