Raul Pinet Jr.'s case is a homicide that mixes drugs, police restraint and "excited delirium syndrome."
Raul Pinet Jr. died Aug. 6 at the Onondaga County Justice Center jail. His death, attributed to cocaine-induced excited delirium, has been ruled a homicide. A brain disorder, cocaine and police restraint — they were all at play when Raul Pinet Jr. died in custody three weeks ago, according to the Onondaga County medical examiner.
In a short news release last week, Dr. Robert Stoppacher cited those causes but made no mention of the manner of Pinet’s death — accident, suicide, natural or homicide.
It was a homicide caused by cocaine-induced excited delirium syndrome, according to Pinet’s death certificate. Homicide is rarely used to classify such deaths, according to experts.
The weight that each of the three factors played in Pinet’s death after arriving at the Onondaga County Justice Center jail will be examined by four investigations and a possible lawsuit.
At the center of the debate will be the concept of excited delirium syndrome. It’s a condition that was first noted under another name in 1849 in mentally ill people, then resurfaced in the 1980s with the popularity of cocaine.
Neither Stoppacher nor District Attorney William Fitzpatrick would explain the rationale behind calling Pinet’s Aug. 6 death a homicide, nor the weight given to each of the three contributing factors.
View full sizeRaul Pinet Jr.'s death certificate.Even the country’s top experts can’t agree on the basics of excited delirium: whether it should be classified as homicide or accidental, whether it’s a brain condition that’s genetic or caused by frequent drug abuse, or whether it even exists.
The forensic pathologist credited with first noting the syndrome in the mid-1980s, Dr. Charles Wetli, said such deaths should never be classified as homicides. They should be called accidental, as a drug overdose would be, because part of the syndrome is the brain’s response to the frequent use of cocaine, said Wetli, a former Suffolk County medical examiner who’s in private practice in New Jersey.
The struggle with police is also part of the syndrome, Wetli said. In the few cases where victims died when not restrained, they died after jumping off a bridge, running into traffic or drowning in a lake, Wetli said. When police do get involved, they’re caught in a dilemma, he said.
“If they don’t restrain him, the guy runs out in traffic and is killed, and the cop gets blamed for not restraining him,” Wetli said. “If the cop does restrain him and he dies, the cop gets blamed for killing him because he restrained him. For the poor cop, it’s a no-win situation.”
Dr. Vincent DiMaio, a former San Antonio medical examiner who wrote a book on excited delirium, says such deaths should be classified as homicides because they almost always involve police restraint.
But the public often mistakenly holds police responsible because their intervention comes right before death, he said. Death would’ve occurred anyway due to the normal physiological reactions of the body to stress and drugs, DiMaio wrote in the book he co-authored with his wife, Theresa.
“Essentially, it’s an overdose of adrenaline,” Vincent DiMaio said in an interview.
Deborah Mash, a neurology professor at the University of Miami who has studied excited delirium for 20 years, said such deaths are rarely called homicides. Of the 105 she’s studied at the school’s Excited Delirium Education, Research and Information Center, all were classified accidental, Mash said.
The death of Raul Pinet Jr. that occurred earlier this month at the Onondaga County Justice Center jail, 555 South State St., Syracuse, has been ruled a homicide caused by cocaine-induced excited delirium syndrome.Pinet’s death certificate says he died from sudden cardiac arrest caused by cocaine-induced excited delirium syndrome. It lists “prone restraint” as a significant condition contributing to death but not related to the cardiac arrest.
In a section asking for a description of how the injury occurred, Dr. Abraham Philip wrote, “complications of use of illicit drug and confrontation with law enforcement.” Philip is the pathologist in the medical examiner’s office who performed the autopsy.
The death certificate does not spell out how homicide was determined to be the manner of death. Homicide means another person caused someone’s death, but not always criminally. Pinet’s death will likely be a justifiable homicide, Sheriff Kevin Walsh said.
“That’s what we’re looking at from our standpoint,” Walsh said. His office has completed its investigation and sent its findings to the district attorney’s office.
“It was justified because our use of force was within the law and was within the policy,” he said. The deputies had to use force because Pinet was struggling so violently, Walsh said. Other agencies investigating are the district attorney’s office, Syracuse Police Department and the state Commission of Correction.
A Syracuse police spokesman could not be reached to disclose the status of that agency’s investigation.
A lawyer for Pinet’s family, Janet Izzo, said she couldn’t comment on the medical examiner’s ruling because she hasn’t seen the autopsy report. Pinet’s widow, Tashara Pinet, plans on filing a claim against the county and the Syracuse Police Department to preserve her right to sue, Izzo said.
The sheriff’s office determined deputies acted properly, Walsh said. No deputies ever got on Pinet’s back to subdue him, Walsh said. They used three emergency restraint belts — one around his shoulders and arms to avoid chest compression, one around his hips to avoid pushing his diaphragm into his lungs, and one to hold his legs, Walsh said.
“Everything was done as safely as possible to control somebody who’s in a cocaine-induced excited delirium situation,” Walsh said.
Pinet was released from state prison in June after serving half of an 18-month sentence on a drug conviction. He served a two-to-six year prison sentence ending in 2005 for another drug conviction.
After Syracuse police arrested Pinet on a charge of attempted burglary Aug. 6, he fought violently with officers, police said. When he arrived at the jail, he continued to fight, police said.
Deputies got the restraint belts around him and placed him in a padded room, Walsh said. When they cut the belts and his clothes off of him, Pinet was still struggling, Walsh said. Walsh said he did not know whether Pinet was still conscious when deputies left the room.
Deputies observed Pinet for four to five minutes in the room before realizing something was wrong, Walsh has said.
Mash’s research shows that people with excited delirium have a faulty brain regulation of the heart. The brain chemistry goes chaotic and that leads to a fatal arrhythmia, because the brain controls the heart, she said. So it’s a neuro-cardiac event, she said.
The syndrome limits the brain’s ability to develop a tolerance for a drug such as cocaine, Wetli said. When that person goes on a binge, the brain gets overwhelmed with dopamine, and he or she doesn’t have the ability to cope with the drug’s effects the way most people can, he said.
Mash has seen some cases where someone died without police involvement, and others without drug involvement. But most have those contributing factors, she said. She believes the condition is genetic.
“The way I look at this is you’re walking around with a loaded gun,” said Mash, who has studied under a federal grant through the National Institute on Drug Abuse. “That gun may never fire. But if you use drugs, or have these other contributing environmental issues, you’ve cocked that gun, you’ve put the bullet in the chamber.”
Police often are wrongly held responsible, simply because they’re the ones applying the necessary restraint to the out-of-control subject, she said.
“Look, nobody would even have been there if the person wasn’t in the state of excited delirium,” Mash said. “And, by the way, what are the police supposed to do?”
Mash has been studying brain samples from people who died of excited delirium, to look for markers that would confirm that as the cause. Often medical examiners ask for her help, but she said she has not yet heard from Onondaga County officials.
Stoppacher found that Pinet’s cocaine use caused him to become disoriented, agitated and violent. It was apparently the first time someone’s death was attributed to excited delirium in Onondaga County, Walsh said.
The excited delirium label has drawn mixed acceptance among forensic pathologists. Some say it’s used as a scapegoat for deaths caused by police.
Dr. Werner Spitz, the former medical examiner in Detroit, said these types of cases should be labeled homicides because the officers, not the cocaine, cause the deaths.
“The only reason cocaine plays a role in so many of these cases is that it brings the police,” Spitz said. He reviewed Stoppacher’s news release about his findings in Pinet’s death.
“It would seem to me that he strongly suspects the inability to breathe had a lot to do with this case,” Spitz said.
Fitzpatrick said he’ll review the evidence and decide whether to present the case to a county grand jury. His office is also investigating the Nov. 12 death of inmate Chuniece Patterson at the jail, he said. She died of a ruptured ectopic pregnancy.
Contact John O’Brien at jobrien@syracuse.com or 470-2187.