Critical testimony could be out of reach for Ronald Greene committee

History and accuracy of ‘agitated delirium’ are in question

By: - April 28, 2022 6:00 am
Special committee wants Gov. Edwards' text messages in Greene case

Officials from the Union Parish coroner's office are expected to appear Thursday before a Louisiana House committee looking into allegations of a coverup in the death of Ronald Greene in State Police custody nearly three years ago. (File photo Michael M. Santiago / Getty Images)

Thursday’s meeting of the special legislative committee investigating allegations of a coverup in the death of Ronald Greene in Louisiana State Police custody has the potential to produce some of the most revealing testimony yet. But one of the most critical witnesses in the case is not expected to attend.

Committee chairman Rep. Tanner Magee said he does not expect former Union Parish Coroner Abbie Moon, who handled the initial death investigation, to be there. Rep. Mandie Landry, who is also on the panel, said she was told Moon was dealing with some sort of legal problems and could not attend.  


Moon was arrested March 14 in Lincoln Parish on 21 counts of obtaining a controlled substance by fraud, according to the Ruston Daily Leader. The newspaper reported that Moon worked as a registered nurse at Northern Louisiana Medical Center and allegedly took narcotics from the hospital pharmacy. Contact information for Moon’s attorney was not listed. 

The committee instead expects to hear from the current coroner, Renee Smith, or one of Smith’s deputy coroners, according to Landry. 

Greene, who is Black, died on May 10, 2019 after leading troopers on a vehicle pursuit that police said ended when he collided with a tree.    

There are differing or unclear accounts as to Greene’s initial cause of death and autopsy. Smith, the current Union Parish coroner who was not in office when the initial death investigation took place, reportedly told the Associated Press that the file in her office listed the 49-year-old’s death as accidental due to cardiac arrest and injuries from the car wreck with no mention of the struggle with troopers. 

However, a copy of the initial autopsy report obtained by CNN did not list any manner of death such as accident, homicide, suicide, natural or undetermined. The autopsy report noted blunt object trauma and lacerations to Greene’s head were “inconsistent with motor vehicle collision,” yet the coroner still included the car wreck among the factors that killed Greene.

The autopsy report said Greene died from “cocaine induced agitated delirium complicated by motor vehicle collision, physical struggle, inflicted head injury, and restraint.” It also noted that no police incident report or details about the collision were provided despite repeated requests.   

For more than two years, State Police leaders and other officials referred to the autopsy report when fielding questions as to why charges had not been filed against troopers seen on video beating, kicking, choking and dragging Greene as they used stun guns to handcuff and shackle him.

Gov. John Bel Edwards pointed to the coroner’s ruling this past September, when he questioned the notion that a cover-up took place. During his monthly “Ask the Governor” radio interview, Edwards described the troopers’ actions as “criminal” and excessively brutal but questioned whether State Police tried to conceal Greene’s cause of death. 

“The issue would be: Did he die from injuries sustained in the accident?” Edwards said in the interview. “Obviously, he didn’t die in the accident itself because he was still alive when the troopers were engaging with him. But what was the cause of death? I don’t know that that was falsely portrayed.”

The uncertainty of ‘agitated delirium’ 

Some of the confusion over the initial manner of death and autopsy report may stem from how autopsies are handled in rural areas like Union Parish, where coroners such as Renee Smith are lay people who conduct death investigations and make final rulings on causes of death but do not actually perform the autopsies.

Moon, the former coroner, is also not a physician or pathologist, the only two professionals allowed to perform autopsies in Louisiana. State law allows someone who’s not a doctor to hold the office of coroner if no physicians qualify to run. According to the lawsuit filed by Greene’s daughter, his autopsy was outsourced to a pathologist out of state, though the exact location is not specified. Still, as the coroner of Union Parish at the time of Green’s death, Moon remained responsible for the official ruling on Greene’s death. 

The coroner from the parish where the death occurred is ultimately responsible for the overall investigation to determine the cause of death and issue the final report that is filed with the state’s Vital Records Registry, according to Yancy Guerin, chief deputy coroner for West Baton Rouge Parish. Guerin, who is not involved in the Greene case, said coroners conduct death investigations by collecting evidence from not only an autopsy but from other basic methods of inquiry such as visiting the scene and reviewing photos or videos. 

Even though a pathologist who performs an autopsy will often include their opinion on an autopsy report, the coroner doesn’t have to agree with it and can insert a different cause of death if, for instance, the coroner has stronger evidence that refutes a borderline or debatable pathology finding, though Guerin said this rarely happens. 

Listing an automobile accident and “agitated delirium” as causes for a suspicious death when they cannot be substantiated by the autopsy, such as in the Greene case, would require some other evidence such as that obtained from a scene investigation, Guerin explained. Rather than accepting at face value what law enforcement, family members or others might say, the coroner or deputy coroner should conduct an independent scene investigation, which might include talking to witnesses and officials, taking photos or basic measurements, assessing the damage to the vehicle and obtaining dispatch or ambulance records, among other things, Guerin said.

While the initial autopsy report claimed information from police was lacking, it still noted “agitated delirium” — a finding that Guerin said almost exclusively comes from the police. 

“Agitated delirium,” also known as “excited delirium,” is generally defined as being in a highly agitated or combative state. It is a controversial diagnosis rejected by the American Medical Association and most other national and international medical organizations.

“I’ve only ever seen it listed for someone who dies in police custody,” Guerin said, adding that he does not use it in his jurisdiction.

History of the diagnosis

Key symptoms used to support an excited delirium diagnosis — such as perspiration, elevated heart rate and confusion — are broad enough to be found in most cases of deaths in police custody, according to research from Physicians for Human Rights.  

The cause of excited delirium is often attributed to the use of cocaine or other stimulants, and Black people are disproportionately diagnosed with excited delirium despite similar rates of cocaine use across races, according to the research. Decades of case studies have yet to prove a biological pathway linking excited delirium to sudden death, the physicians’ group concluded.

Medical examiner Dr. Charles Welti coined the term in 1985 as part of his theory to explain why 12 Black women, who were presumed sex workers, died in Miami after ingesting small amounts of cocaine. It was later determined all of the women actually died by asphyxiation — the work of a serial killer whom police eventually caught, the research article said.

Nevertheless, a small group of researchers and legal experts working for TASER International, the company that produces the line of electroshock weapons used by law enforcement, popularized the excited delirium theory by populating medical literature with articles encouraging its acceptance by physicians and police chiefs, according to Physicians for Human Rights.

Because there is no blood test or clear clinical method of diagnosing agitated or excited delirium, it’s a judgment call that would come from police officers telling a coroner that the victim was confused, agitated, sweaty and combative. Police will often directly suggest agitated delirium as the cause of death, and some coroners are willing to accept it as an easy catch-all explanation to quickly close the case on a suspicious death that might otherwise require a lot of work to determine, Guerin said. 

Cremation in question 

Another aspect of the Greene case lawmakers might probe is the cremation of his body.

Coroners have to issue a permit to allow the cremation of a body in Louisiana, and state law prohibits coroners from issuing a cremation permit if there are any “suspicious circumstances” surrounding the death or any reasonable possibility that a crime occurred. 

Guerin said it’s a state law that some coroners have long ignored without consequence, but the law was written specifically to preserve evidence that might have been overlooked during an initial death investigation or autopsy, he said. 

During a February press conference with the NAACP, Greene’s mother, Mona Hardin, said the coroner released her son’s body for cremation before Hardin learned of the details surrounding his death and despite her request that he be embalmed and buried. She did not say when exactly the cremation took place.

It’s unknown if the FBI’s opinion as to the cause of death will prompt Smith, the current Union Parish coroner, to list Greene’s manner of death as homicide. Smith could not be reached for comment this week. 

Earlier this month, John Belton, district attorney for Lincoln and Union parishes, announced plans to convene a grand jury to consider criminal charges against the troopers and anyone else involved in crimes related to Greene’s death or the alleged cover-up. 

The cremation makes it impossible to conduct any subsequent independent autopsies that might be requested by future defendants facing indictment.

ER doctor, review question troopers’ accounts

In November 2021, an FBI review of the original autopsy, which did not include a second examination of the body, excluded the car wreck and “agitated delirium” as causes of death. The review instead shifted part of the blame to the state troopers by citing the multiple strikes to Greene’s head, the restraining of Greene face down for a prolonged period (more than nine minutes) and Greene’s ingestion of cocaine as contributing factors, according to the AP.

The FBI’s review confirmed what Greene’s family and people outside of law enforcement had claimed early on in the case before the body camera footage went public. In September 2020, the AP reported that the family first noticed signs of violence when they were allowed to view Greene’s body; his face and head were covered with deep bruises and lacerations. 

Photos of Greene’s body, initially shared on social media by the NAACP and published by the AP, showed crescent-shaped gash marks on Greene’s face and scalp. Photos of his vehicle showed minor damage to the rear quarter panel, and the airbag did not deploy.

The emergency room doctor who first examined Greene, according to his medical report, noted that information he received about Greene’s death from different law enforcement personnel seemed “disjointed” and “does not add up,” according to the lawsuit filed by Greene’s daughter.

Landry said lawmakers hoped to get answers to some critical questions surrounding the Greene case at Thursday’s hearing such as why the Union Parish coroner listed the car wreck as a cause of death even though it was inconsistent with the pathology findings and in spite of the minor damage to Greene’s vehicle and the suspicions the ER doctor noted. Also of interest to Landry is how “agitated delirium” made it onto the autopsy report when such a diagnosis would require a description of Greene’s behavior yet the report noted police did not respond to requests for information. 

Committee member Rep. Edmond Jordan said members also want to hear from the EMTs who tried unsuccessfully to revive Greene, but Jordan could not say when or if they will testify. 

The FBI’s autopsy review, which included an analysis of “black box” data from Greene’s vehicle, concluded that Greene’s fractured breastbone and ruptured aorta likely resulted from chest compressions administered by the EMTs and not a result of the low-speed crash, according to an AP report.


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Wesley Muller
Wesley Muller

Wes Muller traces his journalism roots back to 1997 when, at age 13, he built and launched a hyper-local news website for his New Orleans neighborhood. In the years since then, he has freelanced for the Times-Picayune in New Orleans and worked on staff at the Sun Herald in Biloxi, WAFB-9News CBS in Baton Rouge, and the Enterprise-Journal in McComb, Mississippi.