Deaths in police custody in the United States: Research review

United States (JR) – The case of Freddie Gray, a 25-year-old Baltimore man who died in police custody on April 19, 2015 — now ruled a homicide — has raised a number of questions about the treatment of racial minorities within the criminal justice system, as well as about patterns of arrest-related deaths more generally.

The Baltimore Sun‘s 2014 investigation of these issues in that city revealed that “over the past four years, more than 100 people have won court judgments or settlements related to allegations of brutality and civil rights violations.” Other outlets, such as the Milwaukee Journal Sentinel, have pursued similar investigations in their region. Still, it remains unclear how much these stark events and figures are characteristic of larger patterns across American society.

The limited data available do not suggest a recent overall increase in the number of homicides by police or the racial composition of those killed, despite the high-profile cases and controversies of 2014-2015, according to a New York Times analysis. But a January 2015 report published in the Harvard Public Health Review, “Trends in U.S. Deaths due to Legal Intervention among Black and White men, Age 15-34 Years, by County Income Level: 1960-2010,” suggests persistent differences in risks for violent encounters with police: “The rate ratio for black vs. white men for death due to legal intervention always exceeded 2.5 (median: 4.5) and ranged from 2.6 (95% confidence interval [CI] 2.1, 3.1) in 2001 to 10.1 (95% CI 8.7, 11.7) in 1969, with the relative and absolute excess evident in all county income quintiles.”

Arrest-related deaths

The Freddie Gray case raises questions specifically about treatment during and immediately after initial arrest. A March 2015 report from the federal Bureau of Justice Statistics (BJS) concludes that the current Arrest-Related Death (ARD) program — which aims to track persons who die in custody in America at the state level — typically only counts about half, at best, of all deaths in police custody, and the coverage rate may be as low as 36%. Although that estimate increased in 2011 to somewhere between 59% and 69%, the “current ARD program methodology does not allow a census of all law enforcement homicides in the United States,” researchers conclude.

The BJS’s 2015 “Data Quality Profile” report shows that some states have not reported statistics to the federal government in a given year between 2003 and 2011, and a few states have not participated at all.

That said, the federal government has nevertheless attempted to collect as much state-level data as possible in the past: A federal census between 2003 and 2005 found there were 2,002 arrest-related deaths, and “homicides by state and local law enforcement officers were the leading cause of such deaths during this period (55%).” (There is no available statistical breakdown of how many of these homicides are the result of involuntary manslaughter versus intentional acts that might fall into the category of murder — issues that might be settled years later in the courts.)

For the most recent period where statistics are available (2003-2009), the BJS found that 4,813 persons “died during or shortly after law enforcement personnel attempted to arrest or restrain them… About 60% of arrest-related deaths (2,931) were classified as homicides by law enforcement personnel.” However, among these 2,931 homicides by law enforcement personnel, 75.3% were reported to have taken place in response to a violent offense — constituting a force-on-force situation, such as an intervention with an ongoing assault, robbery or murder: “Arrests for alleged violent crimes were involved in three of every four reported homicides by law enforcement personnel.” Still, 7.9% took place in the context of a public-order offense, 2.7% involved a drug offense, and among 9.2% of all homicides by police no specific context was reported.

Other factors implicated in deaths at the state level are as follows, according to BJS:

Death in custody (BJS)

Further, from 2003 to 2009:

Of reported arrest-related deaths, 45% of persons allegedly engaged in assault immediately prior to or during the arrest…. Of reported persons who died during the process of arrest, 95% were male. About 42% were white, 32% were black/African American and 20% were Hispanic or Latino. More than half (55%) were between ages 25 and 44, and juveniles (persons under age 18) were about 3% of all arrest-related deaths.

The federal government also tracks fatalities in jails and prisons through its Deaths in Custody Reporting Program (DCRP); typically, the vast majority of deaths result from illness or suicide, with homicides and unnatural deaths attributed in only a few percent of cases.  The state-level requirements for that reporting program expired in 2006, but a new bill was signed into law in 2014. (It is worth pointing out that jails — which see all manner of persons, from those right off the street to those awaiting trial — and prisons — where those convicted of crimes are deliberately and systematically placed — are quite different in their population and environment.)

Reporting on incidents

Experts involved in analysis of these incidents caution that the numbers can often hide meaningful context, and reporters would be well served to go beneath the surface and ask about how data is collected — and any potential holes or weaknesses in the data. Overall, states have varied in their methods of reporting law enforcement-related incidents of many kinds to the federal government, an issue recently addressed by FBI Director James Comey.

For an example of how data, or the lack of it, can matter — and mislead — see the series on prison rape written by David Kaiser for The New York Review of Books. Finally, for news reporters covering individual incidents, context can be crucially important, from the degree to which a neighborhood is a high-crime area, or where assaults on officers are common; to the level of police training to deal with, for example, violent and mentally ill persons; to the precise nature of the incident and whether it involved a suspect threatening public safety at the time of a violent intervention by authorities.

There is also a substantial body of government and academic research on these issues, including on the uses of restraints and other law enforcement practices that may be employed to manage persons detained:



“Arrest-Related Deaths, 2003-2009: Statistical Tables”
Burch, Andrea M. U.S. Department of Justice, Bureau of Justice Statistics, November 2011.

Introduction: “From 2003 through 2009, a total of 4,813 deaths were reported to the Bureau of Justice Statistics’ (BJS) Arrest-Related Deaths (ARD) program. Of these, about 6 in 10 deaths (2,931) were classified as homicide by law enforcement personnel, and 4 in 10 (1,882) were attributed to other manners of death. Suicide and death by intoxication each accounted for 11% of reported arrest-related deaths, accidental injury for 6%, and natural causes for 5% (figure 1). Deaths with manners classified as undetermined or those in which manners were unknown represented about 6% of reported arrest-related deaths.”


“Unexpected Arrest-Related Deaths in America: 12 Months of Open Source Surveillance”
Ho, Jeffrey D. Western Journal of Emergency Medicine, May 2009, Volume X, No. 2.

Abstract: “Introduction: Sudden, unexpected arrest-related death (ARD) has been associated with drug abuse, extreme delirium or certain police practices. There is insufficient surveillance and causation data available. We report 12 months of surveillance data using a novel data collection methodology. Methods: We used an open-source, prospective method to collect 12 consecutive months of data, including demographics, behavior, illicit substance use, control methods used, and time of collapse after law enforcement contact. Descriptive analysis and chi-square testing were applied. Results: There were 162 ARD events reported that met inclusion criteria. The majority were male with mean age 36 years, and involved bizarre, agitated behavior and reports of drug abuse just prior to death. Law enforcement control techniques included none (14%); empty-hand techniques (69%); intermediate weapons such as Taser device, impact weapon or chemical irritant spray (52%); and deadly force (12%). Time from contact to subject collapse included instantaneous (13%), within the first hour (53%) and 1-48 hours (35%). Significant collapse time associations occurred with the use of certain intermediate weapons.”


“On the Problems and Promise of Research on Lethal Police Violence”
Klinger, David A. Homicide Studies, 2012, 16(1) 78-96, doi: 10.1177/1088767911430861.

Abstract: “We presently have little information about how frequently police officers shoot citizens or are involved in any sort of interaction in which citizens die. Despite this, however, researchers persist in using the limited data available on fatal police violence in various sorts of analyses. The current article outlines the liabilities in available counts of fatal police action, describes some of the problems posed by using such data, discusses why counting citizens killed by police bullets is not a sound way to measure deadly force, and offers some ideas for improving measurement of the use of deadly force and other police actions that lead to the death of citizens.”


“Arrest-Related Deaths Program Assessment: Technical Report”
Banks, Duren; Couzens, Lance; Blanton, Caroline; Cribb, Devon. Bureau of Justice Statistics, U.S. Department of Justice, March 2015, NCJ 248543.

Executive summary: “The Bureau of Justice Statistics (BJS) designed the Arrest-Related Deaths (ARD) program to be a census of all deaths that occur during the process of arrest in the United States…. We found that over the study period from 2003 through 2009 and 2011, the ARD program captured, at best, 49% of all law enforcement homicides in the United States. The lower bound of ARD program coverage was estimated to be 36%. These findings indicate that the current ARD program methodology does not allow a census of all law enforcement homicides in the United States. The ARD program captured approximately 49% of law enforcement homicides, while the SHR captured 46%. An estimated 28% of the law enforcement homicides in the United States are not captured by either system. However, the methodology for identifying ARD cases has changed over the observation period. In 2011, the ARD program was estimated to cover between 59% and 69% of all law enforcement homicides in the United States, depending on the estimation method used. While this coverage estimate still does not result in a census, it does suggest improvements over time in the overall approach to identifying law enforcement homicides and reporting them to the ARD program.


“Can TASER Electronic Control Devices Cause Cardiac Arrest?”
Kroll, Mark W.; et al. Circulation, 2014. 10.1161/circulationaha.113.004401.

Introduction: “The electronic control device (ECD) has gained widespread acceptance as the force option for law enforcement because of its dramatic reduction in both suspect and officer injury. At the same time, advocacy groups post statements on the Internet listing the hundreds of arrest-related deaths after ECD use with the implication that the ECD involvement was causal. Studies covering a total of >48 000 forceful arrests have consistently found suspect injury rate reductions of ≈65%. Of the 250 000 annual ECD field uses in the United States, only 1 in 4000 is involved in an arrest-related death.” The research looks at 12 cases of cardiace after ECD application. Results: ” These data suggest that the threshold of factual evidence for blaming a cardiac arrest on an ECD should be set very high. The published case reports have not met that threshold.”


“The Effect of the Prone Maximal Restraint Position with and without
Weight force on Cardiac Output and other Hemodynamic Measures”

Savaser, Davut J.; et al. Journal of Forensic and Legal Medicine, August 2013, Vol. 30

Abstract: “Background: The prone maximal restraint (PMR) position has been used by law enforcement and emergency care personnel to restrain acutely combative or agitated individual. The position places the subject prone with wrists handcuffed behind the back and secured to the ankles. Prior work has indicated a reduction in inferior vena cava (IVC) diameter associated with this position when weight force is applied to the back. It is therefore possible that this position can negatively impact hemodynamic stability. Objectives: We sought to measure the impact of PMR with and without weight force on measures of cardiac function including vital signs, oxygenation, stroke volume (SV), IVC diameter, cardiac output (CO) and cardiac index (CI). Conclusions: PMR with and without weight force did not result in any changes in CO or other evidence of cardiovascular or hemodynamic compromise.”


“Effect of Position and Weight Force on Inferior Vena Cava Diameter: Implications for Arrest-related Death”
Ho, Jeffrey D.; et al. Forensic Science International, 2011. doi: 10.1016/j.forsciint.2011.07.001.

Abstract: “Introduction: The physiology of many sudden, unexpected arrest-related deaths (ARDs) proximate to restraint has not been elucidated. A sudden decrease in central venous return during restraint procedures could be physiologically detrimental. The impact of body position and applied weight force on central venous return has not been previously studied. In this study, we use ultrasound to measure the size of the inferior vena cava (IVC) as a surrogate of central venous return in the standing position, prone position, and with weight force applied to the thorax in the prone position…. Conclusions: The physiology involved in many sudden, unexpected ARDs has not been elucidated. However, in our study, we found a significant decrease in IVC diameter with weight force compression to the upper thorax when the subject was in the prone position. This may have implications for the tactics of restraint to aid in the prevention of sudden, unexpected ARD cases.”


“Evaluation of the Ventilatory Effects of the Prone Maximum Restraint (PMR) Position on Obese Human Subjects”
Sloane, Christian; et al. Forensic Science International, April 2014, 237. doi: 10.1016/j.forsciint.2014.01.017.

Abstract: “The study sought to determine the physiologic effects of the prone maximum restraint (PMR) position in obese subjects after intense exercise. We designed an experimental, randomized, cross-over trial in human subjects conducted at a university exercise physiology laboratory. Ten otherwise healthy, obese (BMI > 30) subjects performed a period of heavy exertion on a cycling ergometer to 85% of maximum heart rate, and then were placed in one of three positions in random order for 15 min: (1) seated with hands behind the back, (2) prone with arms to the sides, (3) PMR position. While in each position, mean arterial blood pressure (MAP), heart rate (HR), minute ventilation (VE), oxygen saturation (SaO2), and end tidal CO2 (etCO2) were measured every 5 min. There were no significant differences identified between the three positions in MAP, HR, VE, or O2s at at any time period. There was a slight increase in heart rate at 15 min in the PMR position over the prone position (95 vs. 87). There was a decrease in end tidal CO2 at 15 min in the PMR over the prone position (32 mmHg vs. 35 mmHg). In addition, there was no evidence of hypoxia or hypoventilation during any of the monitored 15 min position periods. Conclusion: In this small study of obese subjects, there were no clinically significant differences in the cardiovascular and respiratorymeasures comparing seated, prone, and PMR position following exertion.”


“Excited Delirium Syndrome (EXDS): Defining Based on a Review of the Literature”
Vilke, Gary M.; et al. Clinical Reviews, February 2011.

Abstract: “Patients present to police, emergency medical services, and the emergency department with aggressive behavior, altered sensorium, and a host of other signs that may include hyperthermia, ‘superhuman’ strength, diaphoresis, and lack of willingness to yield to overwhelming force. A certain percentage of these individuals will go on to expire from a sudden cardiac arrest and death, despite optimal therapy. Traditionally, the forensic community would often classify these as ‘excited delirium’ deaths. Objectives: This article will review selected examples of the literature on this topic to determine if it is definable as a discrete medical entity, has a recognizable history, epidemiology, clinical presentation, pathophysiology, and treatment recommendations. Discussion: Excited delirium syndrome is characterized by delirium, agitation, acidosis, and hyperadrenergic autonomic dysfunction, typically in the setting of acute-on-chronic drug abuse or serious mental illness or a combination of both. Conclusions: Based upon available evidence, it is the consensus of an American College of Emergency Physicians Task Force that Excited Delirium Syndrome is a real syndrome with uncertain, likely multiple, etiologies.


This report prepared by  and for Journalist’s Resource.