On January 1, 2024, California became the first state to ban the use of the controversial “excited delirium” diagnosis, which has been frequently applied to law enforcement-related deaths, after a bill supported by the California Medical Association (CMA) became law.

Signed by Governor Gavin Newsom last year, Assembly Bill 360 eliminated “excited delirium” as a medical diagnosis and prohibits the term from being listed as a cause of death on a death certificate. Due to concerns that physicians would be limited when describing a patient’s behavior, CMA staff assisted in crafting language to clarify that only the term “excited delirium” is prohibited.

“For years, ‘excited delirium’ has been increasingly and inappropriately used as a diagnosis to obscure law enforcement involvement in deaths of individuals in custody,” said CMA President Tanya W. Spirtos, M.D. “The diagnosis is rooted in racism. AB 360 represents an important step in removing obstacles that interfere with safe, high-quality medical care.”

The term “excited delirium” dates back to the first half of the 20th century, but it has never been supported by rigorous scientific studies. Despite this lack of evidence, the American Medical Association (AMA) noted that “studies show that the term ‘excited delirium’ has been misapplied and diagnosed disproportionately in law enforcement-related deaths of Black and Brown individuals, who are also more likely to experience excessive sedative intervention instead of behavioral de-escalation.”

Excited delirium received fresh scrutiny following the death of George Floyd in 2020. In 2021, AMA adopted a policy opposing the use of “excited delirium” as a medical diagnosis.

In the time since California became the first state to prohibit the use of “excited delirium,” other states, including Colorado, Hawaii, Minnesota, and New York, are now considering their own proposals to curb the use of excited delirium, and some law enforcement agencies are excluding the term from training materials and manuals.