Sudden In Custody Death Syndrome is listed as the official cause of death for some 33 prisoners in California who died following the application of standard restraint techniques. After viewing the videotape of one such death, some prison reform advocates are convinced that Sudden In Custody Death Syndrome is simply a quasi- medical term for "Oops, we killed him!" PNS commentator Richard R. Korn is a former corrections administrator and professor of criminology (retired); Terry A. Kupers, M.D., is a forensic psychiatric consultant; and Corey Weinstein is a medical doctor who works with the Pelican Bay Information Project.

SAN FRANCISCO -- If you're overweight, on drugs or easily excitable, getting arrested may be injurious to your health. You may be at risk of incurring "Sudden In Custody Death Syndrome" -- a term newly-minted by corrections officials for "Oops, we killed him!"

A 25-minute videotape that documents a man being put to death while in custody reveals what the syndrome is really about. This true-life snuff film -- shot on July 25, 1995 in a Santa Clara, Calif., county jail -- was recently leaked to prison reform advocates by a source who insists on anonymity. The victim wasn't being formally executed nor was he scheduled to die. The filmmaker didn't know the events he was filming would end in death. The video was merely recording California correctional officials carrying out a routine procedure to transport people under restraint.

Joseph Leitner, who suffered severe and long-standing mental illness complicated by drug abuse, had been taken to jail because of "outstanding warrants." He had informed the intake social worker that he was under county mental health care and that, when anxious, he tended to slap his own face. The social worker ordered that he be restrained and taken to a safety cell in the jail's psychiatric unit.

The video shows an unresisting Leitner being forced onto the floor face down by five guards and put into a double hammer-lock position. He cries out in pain. He is stripped naked. He injures his lip and begins bleeding from the mouth. The guards throw a blanket over his head and twist it at the neck, apparently fearful of coming into contact with the blood. Then with his body still in a double hammer-lock, they pull up on his arms and legs and carry him "suitcase" style to the psych unit. He bucks a few times.

Once at the unit, the officers heave Leitner, still in manacles, onto a bed. Four and a half minutes elapse before they return to check on him and discover he has stopped breathing. They apply CPR but he never regains consciousness.

The official cause of Leitner's brain death is Sudden In Custody Death Syndrome -- also cited as the cause of death for 32 other people who died in custody in California, according to the ACLU. The term is increasingly used in cases where jail inmates or arrestees succumb after being placed in restraints. Those at highest risk for the syndrome have just engaged in violent struggle, failed to respond to pain compliance controls, are handcuffed while in a prone position with their faces down, are drunk, overweight or over 50, or have been silent for an extended period. The restraint techniques typically involve rough physical handling (such as "suitcasing") and/or the use of pepper spray.

Manufacturers of pepper spray recommend that after its use the person sprayed be exposed to fresh air and not be placed face down or left in a small confined space such as a police van or jail cell. Nevertheless official procedure throughout California often involves spraying into a prison cell, or chaining after being exposed to pepper spray.

Sudden In Custody Death Syndrome focuses blame on the physical frailties of the victim which make him or her vulnerable to the procedure used. But the Leitner video leaves no doubt that the victim's brain death was caused by excessive force. It is impossible not to wonder whether there was comparable excess during the 32 other incidents of Sudden In Custody Death Syndrome in California. How many were "suitcased"? How many were "blanketed"? How many died as a result of police officer or prison guard brutality, and how many by officers merely following procedure?

As long as Sudden In Custody Death Syndrome remains on the books, overworked, often undertrained staff will have no incentive to apply alternative procedures -- such as on-the-spot psychological counseling or having a jail nurse apply tranquilizers. Instead, they will continue to use restraint techniques designed to protect them at any cost. If the person in custody dies as a result, there's now a quasi-medical term that exempts them from responsibility. No need for even an "Oops, we killed him!"