George Floyd is not alone. 'I can’t breathe' uttered by dozens in fatal police holds across U.S.

Corrections & clarifications: A previous version of this story incorrectly reported the percentage of Black detainees who stated that they could not breathe. More than half were Black men; three in four were nonwhite.

In Columbus, Georgia, a 300-pound police officer sat on Hector Arreola’s back while another held a knee to his neck and kept him face down outside his neighbor’s house for six minutes until he stopped moving and later died.

In Phoenix, four police officers placed the weight of their bodies on Muhammad Abdul Muhaymin’s head, neck, back and limbs as he lay face-down and handcuffed before going into cardiac arrest and dying.

Three officers in Aurora, Colorado, tackled Elijah McClain as he walked home with groceries, using a stranglehold around his neck and handcuffing him as he pleaded and vomited. He was removed from life support days later.

In all three cases, the unarmed men uttered the same phrase as police wrestled them into custody.

“I can’t breathe.”

Their warnings were ignored.

The phrase has become an international rallying cry against police brutality after the high-profile deaths of Eric Garner in 2014 and George Floyd on Memorial Day. But across the country, dozens of people have died in police custody under similar circumstances.

USA TODAY examined 32 fatal police encounters since 2010 in which victims said they couldn’t breathe while being restrained. The incidents, which were identified by combing through court cases and media reports, are by no means a complete account.

At least 134 people have died in police custody from “asphyxia/restraint” in the past decade alone, even though many apparently did not — or could not — express difficulty breathing, according to a review of Fatal Encounters, a searchable database of people who died while interacting with police.

That list, too, is likely an undercount. The 2013 passage of the Death in Custody Reporting Act requires the federal government to track fatal detentions, arrests and incarcerations. But it has not yet been implemented. Separately, the FBI in 2019 began collecting use-of-force data from the nation’s 18,000 police agencies, but it has yet to publish any data, and less than half of agencies have participated in the voluntary program, the FBI said.

The incidents examined by USA TODAY show that officers in agencies big and small use restraint tactics that heighten people’s risk of death. These tactics include neck holds designed to render a person unconscious, pressing or laying on a person’s back to keep them face down, and tasing them repeatedly into compliance.

Some cases, like that of 18-year-old Nicholas Dyksma, involved the same knee-to-neck hold that killed Floyd. Dyksma died in 2015 after Harris County, Georgia, deputies tased him, placed him in handcuffs and held a knee on his neck until he stopped breathing.

Dyksma was white. But in more than half of the 32 incidents USA TODAY analyzed, the victim was a Black male; three in four were nonwhite. Many were stopped for minor infractions, or because they fit the description of a suspect, or because they were acting erratically due to drugs or mental illness. Sometimes, the victims requested police assistance themselves.

Few repercussions

In virtually every case, the officers involved faced little repercussion outside being placed on temporary administrative leave pending the outcome of an investigation.

Just five cases resulted in demotion or firing, although some agencies do not release that information, so the count could be higher. Five cases also led to criminal charges for the officers involved, but those charges were later dropped in all but two cases.

One of those two cases stemmed from Floyd’s death; all four officers have been charged but not yet adjudicated. The other involved the 2012 killing of 35-year-old Alesia Thomas.

In Thomas’ case, Los Angeles police officer Mary O'Callaghan hit, kicked and shoved Thomas after she was restrained by her hands and feet and placed in a patrol car, court records show. O’Callaghan was convicted of assault and sentenced to three years behind bars.

The majority of officers, however, were found to have used reasonable force during the encounters. Such was the conclusion of the Los Angeles County District Attorney in a review of the 2017 death of Jonathan Andrew Salcido while being detained by four Whittier Police Department officers.

Salcido’s mother called police because her son was suffering from delusions, and multiple officers piled on top of the man to restrain him in the prone position, asphyxiating him, according to the family’s civil complaint.

“The officers never struck or kicked Jonathan, and their use of a baton as a level to extricate his arms was reasonable and appropriate under the circumstances,” the report concluded. “Because the officers used objectively reasonable force to overcome Jonathan’s resistance to their lawful duty of detaining him for his own safety, they did not commit an assault under the color of authority.”

Most of those killed suffered from underlying health conditions, mental illness or were under the influence of drugs or alcohol — factors that could have heightened their distress and complicated their ability to understand or comply with police orders, a review of the cases found.

Studies dating back decades have shown that mental illness and drug intoxication increase the risk of death by “positional asphyxia” if placed face down with the hands cuffed behind the back. Positional asphyxia is the medical term for when the body’s position prevents adequate oxygen intake, leading to unconsciousness, disturbed heart rhythm, heart attack or death.

Some agencies have adopted policies banning officers from placing people in the face-down position — also called a “prone position” — for longer than necessary to gain control.

But deaths continue to occur, experts said, in large part because of a lack of training.

Minneapolis police officers were supposed to get training on the dangers of prone restraint as part of a lawsuit settled with the family of David Smith in 2013.

Smith, who was mentally ill, was restrained on his stomach by two officers at a YMCA where he’d been acting erratic. One officer put a knee on Smith’s back and held him down for about four minutes until he stopped breathing. The Hennepin County medical examiner’s office said he died of “mechanical asphyxia.”

But a police department spokesman told the Star-Tribune this month he didn’t know whether all officers received that training. The agency did not respond to multiple interview requests by USA TODAY.

“The biggest problem is police agencies don’t have the manpower, financial commitment, or the time to train officers in the myriad of issues they are asked to deal with,” said Jim Glennon, the owner and lead instructor for Calibre Press, publisher of some of the most popular police training programs in the country.

In many instances, officers were exonerated due to the very risk factors that made the restraint especially deadly. Deaths were blamed, for example, on cocaine intoxication, obesity and heart disease, with restraint listed only as a contributing factor — the conclusion being that victims died primarily from those conditions and not from being held down by police.

'Excited delirium'

Some cited a controversial condition called “excited delirium,” which is characterized by aggressive activity, confused and unconnected thoughts or speech, hallucinations, and extraordinary strength and endurance when struggling, according to researchers. At least nine cases reviewed by USA TODAY cited this phrase.

“The general term excited delirium I don’t think can be used or should be used in the vast majority of deaths like this. I think they’re often asphyxiated,” said Douglas Zipes, a professor of medicine at Indiana University, speaking about the Floyd case and others analyzed by USA TODAY.

'Excited delirium' cited as factor in many fatal police restraint cases.

The term was used in the 2015 case of Roy Nelson Jr., who died whimpering in a parking lot in Hayward, California, as officers held down the man with a history of schizophrenia to handcuff and place him in a full-body restraint device. He told them he could not breathe, to which they responded “relax.”

The officers involved faced no discipline, but the city agreed to settle a civil suit filed by Nelson’s family for $1 million.

"No one has cited to me an excited delirium case that doesn't involve the police,” said Adante Pointer, the attorney for Nelson’s family. “For me, that in and of itself says something. If this is some phenomenon related to exertion, you'd think there would be more cases of excited delirium that don't involve the police."

A least 25 of the 32 of the incidents resulted in wrongful death claims against the law-enforcement agencies that collectively cost taxpayers millions of dollars to defend and, in many cases, to settle.

New York City paid $5.9 million to settle a lawsuit brought by the family of Eric Garner, the 43-year-old father who was fatally restrained by police on suspicion of unlawfully selling cigarettes. Garner’s death, which was captured on video by bystanders, sparked national outrage and turned his last words — “I can’t breathe” — into a slogan against police brutality.

In at least one case, an officer who was cleared of wrongdoing in a fatal restraint incident went on to be convicted of other crimes later.

The Harris County, Georgia, deputy who put his knee to Dyksma’s neck in 2015 was was found guilty two years later for sexual assault and sodomy of women during traffic stops. Thomas Pierson is now serving a sentence in the Walker State Prison.

His case bears a striking resemblance to the 2016 conviction of former Oklahoma City police officer Daniel Holtzclaw, who also was sentenced to prison for sexually assaulting women during traffic stops. Just three years earlier, he and other officers handcuffed and hogtied Clifton Armstrong until the man stopped breathing. Armstrong, who had schizophrenia, had called 911 himself requesting medical assistance.

USA TODAY could find no record of Armstrong saying he could not breathe, and he is therefore not included in the newspaper's case count.

Families in pain

For the families of the victims, the exoneration of officers involved in their deaths deals a harsh blow. Their loved ones are gone while those who choked, knelt on or tased them continue to patrol the streets where they live.

“We are battling a city that has failed to acknowledge or talk about this incident,” said Rodrigo Arreola, a retired Army sergeant whose 30-year-old son was killed by Columbus, Georgia, police. “It’s been extremely difficult for us to move on.”

The officers involved in Hector Arreola’s death returned to work within days, his family said, while they've been waiting more than three years for the District Attorney’s office to make a decision about investigating the case.

Hector Arreola had called 911 twice himself that early morning in January 2017, requesting police assistance and saying someone was threatening his life.

When officers arrived, they found him acting strangely and decided to arrest him for disorderly conduct. They discussed evaluating him for mental illness or "drug-induced mental health issues," court records show. But Arreola resisted and a struggle ensued.

One officer held down Arreola by the neck and upper back while the other sat on his lower back and buttocks, according to the family’s attorney, Mark Post. He said the struggle continued for six minutes and that officers stayed on top of him for two additional minutes after he was cuffed.

Sixteen times, court records show, Hector Arreola told police he couldn’t breathe. Officers responded that he could. Arreola passed out and was taken to the hospital. He was removed from life support the next day.

An autopsy found methamphetamine and amphetamine in his system, but the family argued in a lawsuit that drugs did not kill Arreola; police did.

All the officers were exonerated.

The Columbus Police Department and District Attorney’s office did not respond to USA TODAY’s requests for comment.

“This is a systemic problem. It’s no longer an isolated problem,” Rodrigo Arreola said. “How many more times do we have to witness these horrific acts before we learn our lesson? I think it’s time.”

The family of David Smith, the man whose 2010 death was supposed to prompt more training for Minneapolis police, expressed similar sentiments through their attorney, Jeff Storms.

“The fact that the officers who killed David Smith were not even subjected to a trial by a jury of their peers left the family feeling as if David’s life did not matter to our system of justice,” Storms said. “David’s family lacks peace because justice was not served. And the lack of justice for David and others left our Black communities exposed to further usurpation of their rights, dignity, and lives.

“The dangers of prone restraint have been widely known in the medical and law enforcement community for decades. Anyone who says differently is lying."

‘If you can talk, you can breathe’

Police in Arreola’s case said that because he was able to tell officers he couldn't breathe, he was, in fact, able to breathe, according to court documents.

That argument was repeated in several cases reviewed by USA TODAY.

Kansas City, Kansas, police officers used it during the fatal restraint of Craig McKinnis during a May 2014 traffic stop. The 44-year-old died of positional asphyxia after two officers tackled him to the ground, put leg shackles on him and put his arms behind his back, according to court records.

McKinnis told the officers multiple times he could not breathe.

“If you can talk, you can breathe,” one responded, court records show.

McKinnis’ death was ruled accidental. There were no criminal charges and the two officers still work at the department today.

Nancy Chartrand, the department’s public information officer said the officers were “unaware he truly was in duress.”

But medical professionals say just because someone can speak, it does not mean they have enough oxygen to keep their organs functioning.

Paramedic trainer Steve Cole said he’s heard a version of “if you can talk, you can breathe,” from first responders for years.

“I have said it. And, sadly, I have been wrong,” he wrote in a blog post on the police training site CalibrePress.com in 2015. The post was republished in the wake of Floyd’s death. Cole works for Ada County Paramedics in Boise, Idaho, and declined to comment for this story.

“This is perhaps one of the most lethal misconceptions in both EMS and law enforcement,” he wrote in the post.

A typical breath volume for an adult male is 500 to 700 cubic centimeters of air, Cole wrote. But the larynx, where sound is produced, requires just 50 to 100 cubic centimeters of air movement to produce sound.

When in a prone position, a person can lose 40% of their breath volume, Cole noted. The loss is compounded if they’re struggling, when their body needs even more oxygen.

“The reality,” Cole wrote, “is some of these patients may be speaking the truth with their last breath.”

Zipes, the Indiana University professor of medicine, said someone can't carry on long conversations if unable to breathe properly, but they might have enough air to communicate respiratory distress.

If someone says they can’t breathe, he said, that’s a tell-tale sign something’s wrong.

Policy changes

Months after McKinnis’ death, the Kansas City, Kansas, Police Department updated its use-of-force policy to include guidance on placing people in the prone position. It now says any pressure on the torso and abdomen must be removed and the person rolled onto the side “as soon as the subject is restrained and it is safe to do so, even if the subject is continuing to struggle.”

Any indication of breathing trouble, the policy adds, requires officers to roll the person over to the side or sit them up and call paramedics immediately.

Numerous law-enforcement agencies have announced proposed changes to their use of force policies in the weeks since Floyd’s death.

Denver, Houston and Phoenix are among those that put an immediate ban on tactics like chokeholds and strangleholds — sometimes referred to as carotid artery restraints —designed to render a person unconscious.

The Minneapolis City Council unanimously voted to end the use of all chokeholds and neck restraints, and a Hennepin County judge ordered the police department to adopt that and other immediate changes.

The legislatures in California and New York are considering bills that ban neck restraints and chokeholds statewide.

But those particular holds, as well as the knee-to-neck move used on Floyd, accounted for just one-third of the fatal incidents reviewed by USA TODAY. Other cases, including that of Ben Anthony C de Baca, didn’t involve the neck.

C de Baca, 47, was restrained outside a Walmart in 2016 after destroying property during a schizophrenic episode. Officers handcuffed him and put him on his stomach with his legs pinned behind his back. A spit shield was put over his face. He struggled and said “They are going to kill me” and “I can’t breathe.”

Body camera footage shows two officers fist bump as emergency personnel perform CPR on the unresponsive C de Baca. The autopsy ruled the death a homicide, and the official cause was excited delirium due to cocaine intoxication complicated by means of physical restraint.

“You look at the video, and you say, ‘It’s clear to me how this guy died,’” said Ahmad Assed, the lawyer who represented the family of C de Baca in a civil suit against multiple police agencies in New Mexico. They settled for an undisclosed amount last year.

"They put him on his stomach, shackled his legs, basically had three, four officers handling him while he’s on the floor, placed a spit sock inappropriately, in addition to that,” Assed. “And then he ended up non-responsive for three or four minutes.”

Inadequate training

Arrests can often be messy, including when narcotics are involved, but officers should be trained in the warning signs of asphyxia, said Kevin Robinson, a lecturer in the School of Criminology at Arizona State University who served on the Phoenix Police Department for more than 36 years.

“Police officers have to completely and totally understand that if you throw somebody you believe is under the influence of narcotics or may have a mental illness," Robinson said, "if you throw them in the back of your police car or face down, you have to realize this could be detrimental to the person’s overall health.”

Even when policies restrict certain restraints or instruct officers to stop using them when suspects go into distress, experts say it requires extensive training to put into practice.

It needs to be a reflex, said Glennon, the Calibre Press owner and instructor.

A third-generation law enforcement officer who retired from the Lombard, Illinois, Police Department after 29 years of service, Glennon said it’s tough to determine how many of the more than 18,000 U.S. law enforcement agencies adequately train on the dangers of prone restraint.

But his estimate would be very few.

A survey of more than 800 law enforcement agencies conducted by Calibre Press in 2016 found that about 60% conduct control-tactics training annually or less frequently. More than 10% never conducted that kind of training.

“They do the bare minimum,” Glennon said. “And they certainly don’t do it enough to create procedural memory, which is a combination of the mind, the body and being able to react efficiently under a stressful event.”

Mental health factors

In at least half of the cases examined by USA TODAY, victims suffered from mental illness or drug-induced psychosis and were either committing no crime or acting out as a result of their condition when the police encounter began.

In 2017, Muhammad Abdul Muhaymin Jr. tried to take his dog with him to the bathroom at a west Phoenix community center. An employee stopped him and someone called the police. Although the situation was initially calm, a struggle ensued after officers told Muhaymin they’d discovered a warrant and tried to get him to drop his dog so they could arrest him.

At least four officers held him down. Some put their knees on his neck and head. He eventually stopped breathing and died. The 43-year-old suffered from post-traumatic stress disorder, acute claustrophobia and schizophrenia, according to court documents.

None of the 10 officers connected to his death were charged. They were found to have operated within the department’s policy and still work for the Phoenix Police Department. A $10 million lawsuit is still pending.

Mental health calls have long made up a large portion of the work police officers handle on a daily basis. In recent years more departments have embraced mental health training for officers and are examining their policies.

“Did law enforcement even need to be called?... Do we have to actually transport that person?” said Ron Bruno, executive director of Crisis Intervention Team International, a non-profit that promotes community partnerships between law enforcement and mental health professionals.

The CIT model, known as the "Memphis Model" was first developed in 1988. The goal is to train first-responders to handle individuals in mental health crises in a way that promotes safety and connects them with appropriate treatment rather than the criminal justice system.

“If you can drive their emotions down, their ability to reason goes up,” Bruno said. The goal in these situations is to “talk the person into custody” rather than force them.

Last year the University of Memphis CIT Center reported there were 2,700 CIT programs across the U.S. representing about 16% of all police agencies, according to a 2019 review of research on CIT effectiveness.

Some studies have shown some positive outcomes, including a reduction of stigma in police officers and more individuals being diverted from jail to treatment. However, a 2014 study of actual use-of-force incidents showed no measurable difference between officers with CIT training and those without it.

'That could have been me'

The victims in cases reviewed by USA TODAY are gone, using their last words to try to save themselves. But multiple people have survived such encounters, and they say trauma still haunts them, especially in the wake of Floyd's death.

In November of 2014, MacNore Cameron was arrested outside the police station in Ferguson, Missouri, where he’d joined a Black Friday protest over the death of Michael Brown. In that moment — handcuffed, face down — he felt an officer press a knee to his neck.

Cameron said he doesn’t remember the physical pain or how long he struggled to breathe, but he recalls images flashing through his mind of everything he loved: his sisters, his wife, his life to that point.

All those emotions came back last month as he watched footage of George Floyd die.

Cameron, now 29, said he’s angered by the brutality of the specific tactical move used on him, Floyd, and many other Black men by law enforcement.

“It just brought all those emotions right back up because that could have easily, easily been me. Dead in the street,” he said. “The knee on the neck maneuver happens to many Black men, and women and children in our United States. I’m not an anomaly.”

It also happened to 19-year-old Jaylan Butler last year.

Butler stepped off the bus he was riding with his Eastern Illinois University swim teammates to stretch his legs at a highway rest stop. Unbeknown to Butler, police were searching for a suspect matching his description.

Suddenly officers surrounded the teen and shoved him face down to the ground. One put his knee on Butler’s neck and a gun against his head, according to a lawsuit Butler filed against the Moline Police Department.

“Put yourself in my shoes and lie face down on the ground, grab your wrists, and try to get up. It is undeniably difficult,” he said in a statement posted to the ACLU of Illinois web page. “The situation is already controlled — there is no need for more force.”

In the statement, published June 1, Butler called for an end to chokeholds and other deadly restraint tactics even as video of officers using those holds on protesters in cities across the country emerged.

“I know how fortunate I am that my life did not end on the cold ground alongside a highway in Illinois. I am lucky,” he said. “Mr. Floyd’s family is suffering the pain that generations of people who look like us have experienced.”

Contributing: Kenny Jacoby, Christine Stephenson, Caroline Anders, Dennis Wagner, Grace Hauck, Alessandro Marazzi Sassoon, Uriel J. Garcia

This article originally appeared on USA TODAY: George Floyd not alone. Dozens said I can’t breathe in police holds