Thank you.
I'll just introduce myself briefly.
I'm going to read my notes, because I take a lot of artistic licence when I speak freely.
I'm Christine Hall. I'm a full-time emergency medicine specialist in Victoria, in the Vancouver Island Health Authority. That means I work shift, and lots of it, in an active, busy, tertiary care emergency room. I am a trauma team leader there as well as an educator.
Previously, I was program director for emergency medicine at the University of Calgary. I also hold a master's degree in epidemiology from the University of Calgary and am cross-appointed in the department of community health sciences through the faculty of medicine at the University of Calgary and also the faculty of medicine's department of surgery at UBC.
I work full-time; I'll just underline that. I do a lot of academic inquiry and research in this area on top of my full-time employment, which is why many questions remain unanswered and I don't get a lot of sleep.
Sudden death in custody is not new, and I think Dr. Butt has illustrated that quite well. Sudden death in custody is not restricted to the use of a conducted energy weapon, or taser, as we commonly refer to that device. Sudden deaths in custody still occur now without the use of conducted energy weapons. Sudden and unexpected death in agitated persons has been published for over a century in medical literature. The examination of sudden deaths in custody in a pre-hospital environment—in other words, on the street and before admission to hospital—has appeared formally in the medical literature in North America since the 1970s, and thus over three decades of research.
The problem of sudden death in custody is multi-faceted and it's complex. It's not as simple as evaluating the last thing that happened in a complicated series of events. We need to know scientifically which specific clinical or situational features predict the death of a restrained person. In the unpredictable deaths of these individuals—and these people are usually marginalized society members—drug intoxicated, alcohol intoxicated, and psychiatric issues prevail. The unpredictable deaths of these people are compelling and worthy of intense scientific scrutiny and not sensationalized conjecture.
I have no interest whatsoever in the forwarding of any specific restraint methodology or technology. My interest lies in evaluating the clinical problem that is sudden in-custody death. I have no shares in, no funding from, and I'm not getting any funding from Taser International. I never have had; I never will have.
Publication bias is rampant in Canada right now, and it's problematic for us in the scientific community. In the lay press, there are publications of details of every case of death proximal to the use of a conducted energy weapon in society, and that happens long before cases have been analyzed or causal relationships investigated. While the Canadian public certainly has the right to hear what's going on, I think the Canadian public is deserving of having that information in a context-specific manner. In other words, currently all negative outcomes are widely publicized and presented, with no discussion whatsoever on the non-lethal outcomes.
Scientific opinion subsequently presented with the data appropriately contextualized is commonly viewed as a cover-up. It is very difficult to scientifically refute theories that are generated with no responsibility to fact. It is almost impossible. Thus, there is a public notion that deaths proximal to police restraint with conducted energy weapons are on the rise or happen very frequently in Canada. That is not a scientifically based opinion. Scientifically, evaluation of all factors continues, and no causal relationship can clearly be drawn. Yet there is public demand for moratoriums and much public speculation about the specific danger of conducted energy weapons.
In Canada, since 2003, the deaths of people associated in any way with the use of a conducted energy weapon include 20 cases. In 2003, there were three cases; in 2004, there were six; in 2005, there were five; there was a single case in 2006; and there were five cases in 2007.
During that same interval, the population of Canada increased from 31.5 million to 32.8 million. Conducted energy weapons were possible in an expanding number of police agencies, and the incidence of methamphetamine and cocaine abuse did not remain the same.
These simple data are certainly not eloquently evaluated, and certainly that data has not been evaluated formally as yet, but this seems to belie the notion that sudden deaths following conducted energy weapon use is spiralling out of control or expanding in a disproportionate manner.
Each death is clearly important, but the intense interest in deaths following conducted energy weapons alone overrepresents these deaths in context. Other equally important persons have died in the same interval, following restraint that did not include conducted energy weapon use. The distraction of interest solely to the conducted energy weapon will necessarily direct us to an erroneous conclusion.
There is no sufficiently detailed national database in Canada that can be searched to determine what proportion of deaths related to conducted energy weapons is represented according to the denominator of all. Currently I am working on a protocol that's being imminently submitted, as we speak, to look at the last 15 years of coroners' records to evaluate the frequency and kind of sudden custody death in Canada.
In the U.S., in 2000, a law mandated the mandatory reporting of in-custody death, and very early evaluations of that data have begun.
I will have a snapshot of that data, if you like, later.
There is no such system in Canada, and my study will require the evaluation of coroners' records from basement boxes, from filing cabinets, and hopefully from some electronic databases. The protocol is being submitted even as we speak; funding has yet to be secured, as with all research venues.
The comprehensive review of all medical research to date is certainly outside the scope of my presentation, but I'd like to highlight a few things for you. It must be stressed that in order to appropriately evaluate medical research, there must be meticulous study of the methodology, results, findings, and limitations of every study. An appropriate review is not confined to scanning titles and conclusions. This commonly happens in popular discussion and very commonly occurs in legal proceedings.
I'm involved in the comprehensive review of the body of research to date by an international and multidisciplinary group to update the 2005 report generated by the Canadian Police Research Centre. The same agency is coordinating the effort. We anticipate release of that comprehensive report in the fall of this year. It is a daunting task. I've taken two months of clinical leave to get part of it done--at my own expense.
Animal studies are the cornerstone of much medical research, and the swine or pig model is a valid and credible model for the physiological study of some of the aspects of conducted energy weapon technology. My colleague is going to talk to you about the limitations of such things, I'm sure. However, animal models are not human models, and that limitation is cited by every author who publishes an animal study.
There were several studies investigating the relationship between conducted energy weapons and the capability to generate dysrhythmia, which were carried out as a necessary part of the device's development. Those data demonstrated a wide margin of anticipated safety in the application of the technology to humans. While all study with industry sponsorship deserves particular scrutiny, it is important to note that not all such data represents such a conflict of interest to nullify the findings.
Current animal studies have suggested that conducted energy weapons can generate potentially lethal dysrhythmia in the swine model. If someone will remind me, I'll explain to you the difference between dysrhythmia and a heart attack later--it's important.
There are many issues that have arisen in the translation of those animal studies to the human experience. For example, the generation of ventricular fibrillation, which is when the heart does not make an effective heartbeat--it fibrillates--has never been documented in an animal model without perfect chest application of conducted energy weapon probes in exact locations bracketing the heart.
Perfect dart placement is likely very difficult to achieve in a police interaction. However, police dart placement data have never been recorded or evaluated.
No ventricular fibrillation has been documented with limb or abdominal probe locations in any model, including models where only one probe was in the chest and the other was in a limb or in the abdomen. No ventricular fibrillation has been documented in any model with application of a device in the push or drive stun mode. Yet individuals have died in custody with non-chest probe placement and with the device used in push or drive stun mode. This to me suggests that other factors are at play.
In multiple studies of normal, healthy volunteers, including some with police members undergoing training, published by multiple authors, there has never been a demonstrated arrhythmia or cardiac event. These studies have included strenuous exercise--to physical exhaustion--in order to simulate the rigours of a pre-hospital struggle. However, authors are obviously unable to subject human volunteers to the metabolic difficulties of an acute psychiatric emergency or a drug intoxication.
Some field study does exist. Bozeman et al. evaluated 962 field applications of conducted energy weapons in all comers in true police situations. Those data were made public in October of 2007.
They found no or minimal injury in 99.7% of subjects who were subjected to a field application of a taser in a true police environment, with moderate or severe injury found in 0.3% of their cohort. The precision of those estimates is extremely high because of the large sample size.
While every death is certainly significant and devastating, few would argue that a 0.3% risk of moderate or severe injury is as high as we thought it could be. However, more research is obviously needed and is under way.
My research group and I have been collecting data in the city of Calgary for the past 18 months, and we will soon begin to collect the same data in Victoria and in two American centres. This restraint study investigates all features of the police interaction, including subject presentation and all methodologies of restraint, including taser, in a prospective manner.
I use the term “taser” because it's the only commercially available device at the moment; I mean “conducted energy weapon”.
On my return to Victoria next week, we'll begin to analyze the Calgary data, which include zero fatalities in 18 months of prospective study. In Calgary, conducted energy weapons are used by general duty officers.
Lack of funding prevents current expansion of this study to all urban Canadian centres, despite interest, or to the RCMP, because it's a massive organization with 40,000 members.
What's the current field experience with conducted energy weapons? In very short summary, to date there have been approximately 325 cases of death following the application of conducted energy weapons at any point during police interactions in North America. This is not to be confused with a proven causal relationship.
These cases must be interpreted with a number of questions. One, what is the denominator of field applications of conducted energy weapons on which that 325-case cohort falls? It is likely in the hundreds of thousands of applications, but there is no organized database to tabulate those applications.
Within the 325 cases, twenty are Canadian. Those data have the same problem with denominator: there is no organized method to record the number of CEW applications in the field.
All of these cases are counted or itemized as taser-related regardless of other features of the cases. The concept of confounding of the data by another factor--or that CEW is in itself a confounder--must be examined thoroughly to determine which features are consistent among in-custody deaths. For example, as Dr. Butt mentioned, the features of excited delirium are overwhelming in their presence, including delirium from psychiatric illness, drug or alcohol intoxication, or all of the above.
The second or third question is, what about the fatalities, in the same timeframe, in which conducted energy weapons were not used? As an example, in British Columbia, a review of coroners' records shows that there were 267 deaths in which police were involved in any way in the interval from 1992 to 2007; and eight of those involved a conducted energy weapon. Those data need to be explicitly examined, and the same should be done in each province. Thorough evaluation is pivotal.
What does the future hold? Future work will be undertaken on the physiological effects. However, it is unlikely that further work on animals or healthy volunteers will answer the question in the population of interest. The exposed population has situational features that cannot be duplicated in an experiment in a lab. Calls for moratoria on the use of conducted energy weapons “Until such time as independent and unbiased study...has been properly completed”—to quote from an article—effectively terminate the ability to conduct such research in the population of interest. A moratorium would in fact generate a catch-22 relationship in carrying out the very research the statement requests.
It's irresponsible to police agencies, to officers, and to subjects to discard a safe and effective restraint methodology based on conjecture. It is irresponsible to other persons who have died suddenly in custody, without the application of a conducted energy weapon, to focus solely on that method of restraint.
Thank you.