Mayor Frey: Hennepin Healthcare doctor failed to follow directive on 'excited delirium' training

Minneapolis Mayor Jacob Frey blamed a Hennepin Healthcare physician for failing to follow through on a directive to provide medical training to police that removed lessons on "excited delirium," a controversial diagnosis for severe agitation rejected by many doctors.

In an interview Monday, Frey said he was "irate" when he learned from a Star Tribune article that a Police Department training video, given to officers last fall, still included mentions of excited delirium, cited studies on it and suggested officers merely call the syndrome by another name.

"The direction we gave was very clear. We wanted this to be a substantive — not a cosmetic — change," said Frey. "I directed very clearly to move away from excited delirium as both a term and a concept. … The video you're referencing was not in line."

Leadership for Hennepin Healthcare also issued an apology Monday saying they "failed to follow through on our promise to no longer teach excited delirium and to be intentional in addressing systemic racism."

"We are extremely sorry for the further harm this has caused to our community," said the letter, signed by Hennepin Healthcare CEO Jennifer DeCubellis, Chief Medical Officer Dr. Daniel Hoody and Chief Health Equity Officer Dr. Nneka Sederstrom.

"Systemic racism is deeply imbedded in law enforcement and health care systems, including ours," the letter continued. "We failed to address it here when we had the opportunity and, in doing so, have caused further pain and mistrust."

The training video, obtained through a public records request, featured Hennepin Healthcare's Dr. Paul Nystrom teaching that the terminology "excited delirium" has become "triggering" for the public, suggesting they call it "severe agitation with delirium" or another euphemism. "That being said, the condition exists," he says. "We all agree the entity exists"

"I wouldn't go to an operating room and tell an anesthesiologist how to practice," says Nystrom, who moonlights as a sworn police officer. "Most of us don't appreciate somebody else getting in our lane when they don't do the things that we do."

Last year, the American Medical Association (AMA) publicly rejected excited delirium, calling the diagnosis a vague umbrella term and the "manifestation of systemic racism" used to justify excessive police force and unneeded sedatives, disproportionately on people of color.

Excited delirium has become a central part of the defense for three former Minneapolis police officers currently on trial in federal court in connection with George Floyd's death. One of the former officers, Thomas Lane, wondered aloud if Floyd was suffering from excited delirium as they detained him. Over the past three weeks, attorneys for Lane, J. Alexander Kueng and Tou Thao have pored over slideshows and cross-examined police witnesses on the teaching of excited delirium, suggesting the officers were only following their training.

Earlier this month, the Police Department and Frey's office contacted the Star Tribune claiming that the training was updated last year, after the AMA published its new policy rejecting the diagnosis. But a group of doctors who evaluated the video at the request of the Star Tribune called the changes "window dressing" and a "superficial adjustment in language" filled with shoddy research that attempts to debunk, rather than adopt, the AMA recommendations.

After the story published online Saturday, Frey, who initially did not comment, issued a statement saying he had "directed the department to immediately terminate their contract with Dr. Nystrom."

"I'm furious," he said, when asked to comment about this discrepancy. "That requires all of us to step up to make this right."

Frey said the city will continue to work with Hennepin Healthcare on medical training.

In a separate interview Monday, Interim Minneapolis Police Chief Amelia Huffman said Nystrom gave an outline of the training in person to department command staff, but it didn't include "this digression into really his thoughts about the controversy" that made it into the final training video.

"This was a very lengthy digression in this video that did not meet what we asked for ...," said Huffman. "That portion of the content didn't speak to any of our needs and wasn't appropriate."

DeCubellis, of Hennepin Healthcare, said she couldn't comment on personnel issues related to Nystrom, but she said the video featured statements about excited delirium that were "not appropriate."

"That is why we are urgently this week working to get another version of that training into MPD's hands and make sure that we own that," she said. "That is our error inside our walls."

The letter signed from the hospital's leadership also pledged to immediately "review and amend or terminate" the medical directorship contract with Minneapolis police "to ensure we can provide medical directorship and education in a way that the community expects and deserves." The hospital system also vowed to connect with community leaders and advance "internal education on systemic racism."

The apology letter ends with a quote from Black poet and civil rights activist Maya Angelou: "'Do the best you can until you know better. When you know better, do better.' We will do better."