I am, and I apologize to the committee that the screen is behind you.
Again, like Dr. Dowling, I'd like to thank you for the opportunity to address the committee, Mr. Chairman, and advise that Ontario has a medical coroner system very similar in many ways to Alberta's, in that a physician investigates all deaths. We work closely with the forensic pathologists in our system. We investigate approximately 20,000 deaths per annum, and we investigate very much the same gamut of deaths that would be investigated in Alberta. It's very much a similar system.
I'm going to echo much of what Dr. Dowling has told you already, but I want to give you a bit of background.
As Dr. Dowling ably stated it, the taser, if it kills, ought to kill electrically. The risk is, of course, to the heart. The heart is an organ that has a conducting system that is primarily electrical. I have projected here, just to assist you, the normal electrocardiogram complex. That's a normal QRS complex you see there.
The risky time is here. If an electrical shock is delivered either from an abnormal beat in a heart--which can cause a natural sudden cardiac death--or from an external electric source that reaches the heart at that time in the cardiac cycle, it can induce a phenomenon that is illustrated here. On the left of this, you see what look like fairly normal QRS complexes--you've all seen this on television--but here an abnormal early impulse generates a condition known as ventricular fibrillation, which is an ineffective cardiac rhythm for pumping blood. That's the concern with the taser: could it do this? That's perhaps where we ought to focus our scientific interest in this device.
As Dr. Dowling said, the excited delirium is a conundrum for us. It is a medical emergency. I agree with what Dr. Dowling said; I think it can be fatal in and of itself. Therefore, it requires treatment--life-saving treatment. Unfortunately, to approach these individuals it is necessary for them to be restrained, because they are violent and agitated and may injure the personnel who are trying to help them in their confused state. We know that appropriate restraint properly applied may be associated with death, so the individual and the responding emergency personnel have a conundrum.
We also know--and again I'm echoing what Dr. Dowling says--that subjects of excited delirium do die without the application of taser. We know that subjects of excited delirium die without restraint. It is possible, and even likely, that taser and restraint deaths are simply associated and not causal; however, again, we don't know.
It's useful to look at research in two areas.
The Canadian Police Research Centre has looked at the use of tasers. In their conclusions they made a number of main points. The first is that definitive research or evidence that implicates a causal relationship between the use of conductive electrical devices--tasers--and death does not exist, but they did warn of the adverse events of multiple consecutive CED cycles--in other words, continuous or repeated application of the taser. Existing studies indicate that in humans, at least, the risk of cardiac harm to subjects from a conductive electrical device is very low. In a moment I'm going to give you some information that may assist you about that.
Excited delirium, though not a universally recognized medical condition--it's really a forensic condition--is gaining increasing acceptance as a main contributor to deaths proximate to CED use. Again, Dr. Dowling and I agree on that.
In 2005, the British Columbia PCC released its final report on the medical safety of tasers, and it made several recommendations. The first is that tasers should only be used against a subject who is actively resisting arrest or posing a risk to others, not someone who is passively resistant.
Further, officers should avoid shocking a subject multiple times, because that is linked to perhaps decreased safety with this device.
Following a taser shock, a subject should be restrained in a way that allows him or her to breathe easily. I will say, again echoing Dr. Dowling, that in the vast majority of the cases I've seen, this is a male condition. I'm trying hard to think of a female case, but I can't think of one.
Finally, tasers should be subject to mandatory reporting. Police should be required to file a report every time they're used. Again, I don't think anybody would argue with that.
The second area of research that I want to acquaint you with, if you're not already acquainted with it, is a synopsis of some of the recent academic research on conductive electrical devices.
Ho et al., in 2007, found that applying a taser to a normal resting human subject did not affect cardiac activity. That doesn't help us a great deal, because the people it's applied to, in practice, are not normal resting subjects. They are agitated, excited, often intoxicated individuals.
Levine et al., in 2007, found that taser caused an increased heart rate and EKG changes of uncertain significance in normal subjects. This is fairly typical of medical research conducted by multiple researchers, in that there may be contradictory findings. And when there's a contradictory finding, what's necessary is further research to resolve a conflict.
Lakkireddy conducted a very interesting study using a pig model, and a pig is not a bad animal model for the application of taser. Dr. Lakkireddy found that cocaine, as you'll see—as you've heard from Dr. Dowling, and in Ontario we found the same thing—is overrepresented in these deaths. Cocaine does not increase the risk of cardiac arrest due to ventricular fibrillation in tasered pigs. That's counterintuitive to me, but that is what was found.
McDaniel found that taser had a low probability of inducing ventricular fibrillation in pigs when applied at normal application energies.
But Walter et al. found, in 2008, that at eight times the usual dose applied in a transcardiac fashion—in other words, where the two electrodes of the taser were situated so that the current between them would pass through the heart—it would occasionally cause ventricular fibrillation and cardiac effects.
Similar results were found by Dennis et al. in 2007.
This is the same group. This is also fairly common in the medical literature: it looks like different authors publishing, but in fact it's the same group. They found that in two of the six pigs they applied taser to, ventricular fibrillation and death developed as a consequence—temporally related. Nanthakumar, in 2006, had a similar result. This is a Canadian study, and this is the one Dr. Dowling and I are familiar with, but they did find that at one to three times the normal dose—that is, the usual applied dose per kilogram in the field—ventricular fibrillation could result.
So in theory, at least, based on these pig studies, the taser could cause capture of the heart, electrical capture, and if at a vulnerable period in the cardiac cycle, could cause ventricular fibrillation. The question is whether it does in humans. The fact is that we have not seen it. In all the cases we've had in Ontario, similar to the Alberta experience, we have not found somebody who had a taser discharged at them and who then, within that 15-second interval, became suddenly unresponsive. That's not what we found, and I'll tell you what we found in a moment.
Why is there no definitive research? It's been alluded to frequently, but the fact is that it's unethical to place human subjects into an excited delirium state and then taser them. It couldn't be done, and so we don't have that information. Animal studies are also constrained because there are ethical constraints, obviously, on the suffering that can be induced in animals. Further, we don't know that the pig is an exact analogue to the human physiology, and therefore there's that problem as well. What we can conclude from animal studies is always below the ideal level of evidence that one would want.
So a randomized double-blind placebo-controlled trial, which is the gold standard in health research, is not possible with tasers, and we're not going to get that kind of evidence. Unfortunately, you won't be assisted by that in your work on this committee.
When is the taser, then, appropriately used? I would agree completely with Dr. Dowling that one of the real challenges is to ensure that tasers are used on the right subjects at the right time. Again, this is my view, not the view of the Office of the Chief Coroner in Ontario, but it should be used as a penultimate or second-to-last choice, when the only other option would be lethal force.
These states are often associated with what are known as toxidromes, particularly cocaine and acute psychosis, and that is the excited delirium state you've heard about. This is not only a mentally but a physiologically risky state due to the fact that the person is experiencing a very high metabolic rate—they're exercising at a furious pace. In very many cases, they're not conditioned athletes; they're not able to exercise this way safely. They're overheated—you've heard about the high temperature. They have a very high oxygen demand, and in particular, the heart is one of the highest-oxygen-demand organs in the body. They're acidotic because, as they exercise, they build up a substance called lactic acid, and that in itself is a risk for abnormal heart rhythms as well.
And then to add to this witches brew you've heard about, you have the effect of cocaine. In my view—I'm not sure what Dr. Dowling would say about this—there isn't a safe level for cocaine in the body. There is no such thing. You certainly hear recreational levels of cocaine being described by toxicologists, but in my view, in a person who is vulnerable, cocaine is always a risk and death is frequent when these individuals are restrained.
So the question then is whether it is the taser. In our experience—and I apologize, I've updated this information, because this was a fairly short turnaround time for us—we actually have had seven deaths in Ontario since 2004 associated with taser application. Four of those deaths were associated with cocaine toxicity. Two of them, like the case in Alberta that was described where the taser was discharged but failed, were associated with gunshot fatalities by law enforcement officials. One of them was associated with a psychotic state.
We have not seen a case, however, where the taser was discharged and the person became unresponsive within the 15-second interval that one would expect if it were the taser causing a cardiac dysrhythmia.
We have had several inquests where there have been taser recommendations as a consequence of the inquest by the inquest jury. In 2005, the Lamonday inquest jury made 17 recommendations. Lamonday was a 33-year-old male who was in an excited delirium state where tasers were applied to him and he was ultimately restrained and then subsequently died. The jury found that the medical cause of death was not the taser but a cocaine-induced excited delirium. They made a number of recommendations, one of which was that the Ministry of Community Safety and Correctional Services in Ontario should authorize all front-line officers to carry the taser, so convinced was the jury of the worth of the device.
In another inquest of death due to excited delirium where was taser was not used, that jury also recommended that the taser ought to be available for front-line use in Ontario.
The bottom line is that we don't know whether or not taser can cause death. I think it is fair to say that it's very likely and possible that the taser is not associated with these deaths; however, one cannot say that the taser is without risk. It's clearly an instrument that applies electrical shock. If applied in the anatomically vulnerable location across the heart with sufficient energy to a person who is vulnerable, it's quite possible that we could see a death. We don't have enough numbers now to know whether we can exclude that possibility.
