A matter of restraint

A lawsuit filed by the family of a man who died in police custody raises questions about how officers restrain individuals who are resisting arrest. On May 29, 2007, Ramel Henderson, then 51, lost consciousness while San Diego Police officers attempted to put him in what’s known as “maximum restraint,” where a subject is handcuffed and placed on his stomach while officers bind the person’s ankles and then attach the ankle cuff to a waist cord.

Henderson never regained consciousness and died several hours later at Paradise Valley Hospital in National City.

On Monday, Oct. 6, Anthony Willoughby, an L.A. attorney representing Henderson’s family, told a federal magistrate judge that  the police procedure violated Henderson’s civil rights.

Maximum restraint, as applied by the San Diego Police Department, is a modified version of so-called “hogtying,” where an unruly subject’s handcuffs and ankle cuffs are connected behind the person’s back. Hogtying has been banned by some law-enforcement agencies—including San Diego—after a number of hogtied subjects suffocated to death. According to the San Diego Police Department’s written procedures, even maximum restraint “should be used as a last resort.”

The fact that San Diego’s procedure is considered less lethal than hogtying doesn’t matter to Henderson’s father, Ocie.

“A rose is a rose is a rose,” he said. “If you look at what the cops say happened to Ramel, they did not do it right.”

At issue is the amount of time Henderson was left lying on his stomach while handcuffed. For the past two decades, law-enforcement, civil-rights and medical experts have debated, and never quite agreed, whether prone restraint compromises a person’s ability to breathe to the point of being lethal (one training expert advises that anytime a person is handcuffed face-down, an officer on scene should hold his or her breath as a way to determine when the subject should be rolled onto his side so he can get a good breath).

According to a narrative of events in the medical examiner’s report, police arrived at Henderson’s apartment at 8:36 p.m., after his girlfriend called 911, saying that he’d thrown a bottle at her. At 8:50 p.m., 14 minutes later, officers called for medical assistance after they noticed that Henderson had stopped breathing. At some point, while Henderson was handcuffed and officers were applying the leg restraint—failing the first time to properly attached the waist cord—one officer placed his right knee on Henderson’s upper back and his left knee on Henderson’s arm. Ocie Henderson believes that his son was struggling to breathe, not struggling against officers.

“If a person is face-down and kicking, he’s not kicking [at officers], he’s kicking because he can’t breathe,” Ocie said.

The more Henderson struggled, the more force officers applied—the autopsy report details multiple blunt-force injuries in addition to 10 fractured ribs, though the medical examiner’s report attributes the rib fractures to CPR.

In an article in the April 2006 issue of the FBI Law Enforcement Bulletin, Richard Parent, a police sergeant and researcher in use-of-force techniques, wrote, “To prevent incidents of positional asphyxia, police personnel should try to avoid pressing down on the trunk portion of the body during restraint.”

A review by the District Attorney’s Office, released on Sept. 29, concluded that officers were not criminally liable in Henderson’s death, though, as is standard, such reviews don’t look at policy or training issues. Police officials maintain that other risk factors contributed to Henderson’s death. According to a toxicology report, Henderson was high on cocaine at the time. And, according to the medical examiner, he had a partially blocked coronary artery that could have caused his heart to fail amid the stress of the altercation. The cause of death is listed as “complications of anoxic encephalopathy” (lack of oxygen to the brain) due to “cardiac arrest following altercations and during prone restraint.” Heart disease, cocaine and alcohol are listed as contributing factors.

Prior to 1998, it was widely held that prone restraint significantly compromised a person’s ability to take in oxygen and expel carbon dioxide, based on studies by King County (Seattle) Medical Examiner Donald Raey. Raey was an expert witness in a 1997 lawsuit against San Diego County, filed by the family of Daniel Price, who died after being hogtied and left on his stomach by Sheriff’s deputies. To refute Raey’s testimony, the county hired a team of UCSD researchers to study oxygen intake in people who were hogtied. The team concluded that while their study subjects found breathing more difficult, they were still able to take in enough oxygen. On the witness stand, Raey agreed that the study was valid; largely for that reason, the court ruled in favor of the defendants. On Jan. 14, 1998, the county issued a press release: “LEGAL VICTORY LIKELY TO HAVE NATIONAL IMPACT: ‘Positional Asphyxia’ Not Linked to Use of Hogtie to Restrain Suspect.”

There was one problem: The study didn’t—and couldn’t—replicate real-world conditions. Participants were all healthy males of normal weight who had no pre-existing medical conditions. The people most likely to die while being restrained tend to be—like Price and Henderson—overweight (Henderson was 5-foot-6, 199 pounds), under the influence of drugs and have a pre-existing heart condition.

John Peters, a former police officer who now heads the Institute for the Prevention of In-Custody Deaths, said it would be impossible to replicate in a lab what happens to a person physiologically during an altercation with police.

“Universities, medical doctors—any of us—can’t just go out and, say, go to the California state prison in Soledad and say to the volunteers, ‘We’re going to give you coke and ramp you up, and then you’re going to wrestle with some guys, and we’re going to hogtie you and, oh, by the way, you might die, but it’s in the interest of research,’” Peters said. “That isn’t permitted under any of the ethical guidelines. So what the courts have generally done is they’ve said, ‘OK we have to go with the existing research—we can’t go with what should have been or what could have been.

“There have been some courts that have said, ‘We’re not going to put a lot of weight on these studies.... But currently that’s the best that there is,” he added.

In 1998, Raey issued a statement maintaining that he believed there “are risks and hazards to restraint maneuvers.” An overweight individual, Raey wrote, “is at risk in the face-down position as well as a person with obstructive pulmonary disease…. The point is that street deaths are much different than controlled investigations. Not enough is yet known to say whether a method of restraint is free of any potentially lethal effects.”

In a phone interview, Raey, who retired in 1999, said that it’s still difficult to determine how or why a person dies while being restrained.

“There really isn’t any particular pathological finding you can point to to make the diagnosis of positional asphyxia,” he said. “It all depends so much on the timeline and the witness statements and how accurate those are—plus [in Henderson’s case] the fact that you’ve got significant pathological findings about heart disease and drugs, which really weighs against anything else going on. In its simplest terms, it’s really kind of a judgment call.”

San Diego Police Lt. Jim Collins said officers followed correct procedure when they restrained Henderson.

“Unfortunately, when people are under the influence of drugs, they’re overweight, they’ve got a heart problem already—they have several risk factors—and then they fight with the police, they resist, we have to do everything we can to get them into custody. We can’t take the time to say, ‘OK, what are your health conditions here? What’s your medical history?’ If they’re fighting us, we have to restrain them, and the officers did use all the approved techniques.”    

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