By J.D. Velasco and Brian Day

San Gabriel Valley Tribune

EL MONTE, Calif. — During their encounter with schizophrenic El Monte resident Khoa Le last week, police used a controversial neck hold known as the carotid restraint, as well as other suppression tactics.

A short time later, Le was dead.

Though the carotid restraint has a long history of controversy — it has been banned by at least one major metropolitan police department and was part of a Supreme Court case in the 1980s — it is still in use in most local police departments.

And while some experts say the tactic is inherently unsafe, other experts and studies say it has gotten a bad rap.

The two officers involved in the Le incident also attempted to subdue the man with blows from flashlights and batons and shocks from a Taser. The Los Angeles County Coroner's office has not yet determined what killed Le, but his family and their attorney have described his encounter with officers as police brutality.

Officers arrived at the Le home June 14 after Le's sister called 911. She said her brother and father had gotten into a dispute. By the time officers arrived, family members said Le was calm. He was not armed.

The Los Angeles County Sheriff's Department, which is investigating the case, said the two officers involved used physical force in an attempt to detain Le, who continued to fight.

Not a standard choke hold

Known to many as a "sleeper hold," the carotid restraint hold describes the technique of grabbing a person around the neck from behind and using the bicep and forearm to squeeze down on the carotid arteries on both sides of the neck.

Pinching off the blood flow to the brain can result in a loss of consciousness within seconds.

"It's a hands-on technique that temporarily — anywhere from 15 to 30 seconds — renders someone unconscious," said Rocky Warren, a retired longtime Placer County sheriff's deputy and an expert witness in court cases involving police use of force.

It's different than the traditional "choke hold," in which the airway is compressed to induce unconsciousness, which area law enforcement agencies stopped using decades ago.

Though the carotid restraint is now favored over the standard choke hold, its use has not been without criticism.

The issue of neck restraints garnered controversy and reached the U.S. Supreme Court in 1983, when a man brought a suit against the Los Angeles Police Department after being placed in a choke hold, according to published reports.

Evidence presented at the trial showed 16 deaths due to various kinds of neck restraints carried out by LAPD officers between 1975 and 1982. Nine of the deaths were caused by carotid artery restraint holds, five of the deaths were attributed to airway chokes and in two deaths, it could not be determined which hold was used.

The court ultimately sided with the city, finding in a 5-4 decision that the plaintiff, Adolph Lyons, lacked legal standing.

Nonetheless, the LAPD revised its policies to ban the use of airway chokes and limit the use of carotid restraint holds to situations in which lethal force would be appropriate.

Restricted use

The controversy surrounding the technique has led many other law enforcement agencies to restrict its use as well.

After seven deaths were linked to the carotid restraint in San Diego between 1989 and 1992, San Diego police changed their policy to restrict the use of the technique to violent suspects and for no longer than 30 seconds.

Last year, the Denver Sheriff's Department completely banned the use of the hold, following the death of a jail inmate.

El Monte is among local police departments that allows use of the restraint, but only in limited circumstances.

While the carotid restraint is taught to officers as an option available to them, it is reserved for incidents that warrant a high level of force, El Monte police Chief Steve Schuster said.

"It's only to be used when the officer believes it's necessary to prevent serious injury or death to himself or another," Schuster said.

In addition, Schuster said, "The officer has to be trained specifically for the (carotid) restraint. All of our officers are."

El Monte police policy also mandates that anyone who is subdued with a carotid restraint hold must be given a medical examination by qualified medical personnel.

The restrictions on the use of the hold are due to the possibility of it injuring a detainee, according to policy.

The El Monte Police Department's policy closely mirrors that of other area law enforcement agencies.

In West Covina, the carotid restraint hold is an option available to officers, but its use is limited by policy only to situations when the officer or someone else is faced with an imminent threat, West Covina police Lt. Tommy Garcia said.

Pasadena police employ a similar policy allowing for the use of the carotid restraint hold when an officer is faced with an imminent threat, though it is considered a "higher level of force," Pasadena police Lt. Diego Torres said. Like in other area agencies, officers must be trained in the use of the technique and must report each use to their supervisors.

The Los Angeles County Sheriff's Department policy dictates that the carotid hold should be reserved for "assaultive" or "high risk" suspects, according to a report published by the Police Assessment Resource Center. Other tactics listed as appropriate in similar situations include impact weapons, Tasers and K-9s.

Safety debated

Warren, the use-of-force expert, said it's a "mistake" for police departments to treat the carotid restraint as a last resort and extreme measure to take.

The carotid restraint is a "reasonable technique" and "safe when used by a trained officer," he said.

Law enforcement agencies do themselves a disservice by treating the carotid restraint similarly to lethal force, he said, because classifying it that way increases the public perception that it's dangerous to use.

Warren's stance on the carotid restraint is backed by a 2007 study conducted by the Canadian Police Research Center, a law-enforcement think tank.

That report, the National Study On Neck Restraint In Policing, found that the restraint is not "completely risk free," but that there is no "medical reason to routinely expect grievous bodily harm or death following the correct application."

But Merrick Bobb, executive director of the Police Assessment Resource Center and special counsel to the Los Angeles Board of Supervisors, said that while the carotid restraint should be an option available to officers, it is not inherently safe.

"In our view, carotid restraints are a serious use of force and do pose a risk of death or serious injury," Bobb said. "Anything that deprives your brain of oxygen is dangerous."

"That's never something that should be done lightly. That's why we say the officer really needs to be faced with an imminent risk of death or serious injury."

Warren disagreed, saying the restraint "has gotten a bad rap."

"It's the same type of thing — (pepper spray) was causing deaths, the Taser was supposed to cause deaths, all these others police techniques and procedures were supposed to cause death — it's not the case," Warren said. "It's not the (lateral vascular neck restraint) or carotid. What's killing people is excited delirium."

Medical cause of restraint deaths?

The condition known as excited delirium was studied in 2009 by a task force of the American College of Emergency Physicians. The condition is associated with high pain tolerance, rapid breathing, sweating, agitation, elevated body temperature, unusual strength and noncompliance with police, the task force said.

A report by the task force describes the condition as "potentially fatal" and says it is associated with drug use or mental illness, "especially those conditions involving paranoia."

"Subjects are incoherent and combative, and the struggle is more severe than anyone anticipates," the task force wrote in its report.

Warren said people in such a state are physically unstable and can easily be pushed over the edge.

"They die very quickly. It does not take a lot," he said.

But whether the condition even exists is a matter of debate.

Excited delirium is not recognized by the American Psychiatric Association in the most recent Diagnostic and Statistical Manual of Mental Disorders. Though there is some speculation that it could be included in the next edition of the manual, due out in May 2013, officials with the American Psychiatric Association were not available to confirm that.

Bobb is in the camp of disbelievers. There's "no such medical diagnosis" as excited delirium, he said.

People who are fighting with police are often sweating and panting, but that's not something that would kill them, he said.

"Certainly the police have used it because they want to say this person didn't die because they were hit with a baton or was Tased," Bobb said. "That's a way of shifting blame."

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