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“This means if someone dies while being restrained in custody ... people can’t point to excited delirium as the reason and can’t point to ACEP’s endorsement of the concept to bolster their case,� said Dr. Brooks Walsh, a Connecticut emergency doctor who pushed the organization to strengthen its stance.

Earlier this week, California became the first state to bar the use of excited delirium and related terms as a cause of death in autopsies. The legislation, signed Sunday by Gov. Gavin Newsom, also prohibits police officers from using it in reports to describe people's behavior.

In March, the took a stand against the term, saying it should not be listed as a cause of death. Other medical groups, including the American Medical Association, had previously rejected excited delirium as a diagnosis. Critics have called it unscientific and rooted in racism.

The emergency physicians' 2009 report said excited delirium's symptoms included unusual strength, pain tolerance and bizarre behavior and called the condition “potentially life-threatening.�

The document reinforced and codified racial stereotypes, Walsh said.

The 14-year-old publication has shaped police training and still figures in police custody death cases, many involving Black men who died after being restrained by police. Attorneys defending officers have cited the paper to admit testimony on excited delirium, said Joanna Naples-Mitchell, an attorney and research adviser for Physicians for Human Rights, which produced on the diagnosis and deaths in police custody.

In 2021, the emergency physicians' paper was cited in the New York attorney general's report on the investigation into the death of , a 41-year-old Black man. A grand jury rejected charges against police officers in that case.

Excited delirium came up during of former Minneapolis police officer Derek Chauvin, who was later convicted in the death of George Floyd. This fall, the term resurfaced during the ongoing trials of police officers charged in the deaths of in Colorado and in Washington state. Floyd, McClain and Ellis were Black men who died after being restrained by police.

The emergency physicians group had distanced itself from the term previously, but it had stopped short of withdrawing its support for the 2009 paper.

“This is why we pushed to put out a stronger statement explicitly disavowing that paper,� Naples-Mitchell said. “It’s a chance for ACEP to really break with the past.�

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