Police and the Presumption of Ignorance

How police officers use their ignorance of visible health risks as a shield for brutality

The shocking regularity of police killings of unarmed black men in the U.S. has spurred intensive efforts in communities across the country to reimagine and reform police training and policy. The Biden administration has asked Congress to institute federal standards for these reforms, with both Democrats and Republicans issuing proposals. Yet a perplexing blind spot persists amid all these efforts and discussions: there is a “presumption of ignorance” of police officers regarding the most basic and clearly visible health risks of the citizens they are sworn to protect and to serve.

I first noticed this in 2014 when I watched the video of New York City police officer Daniel Pantaleo tackling the unarmed Eric Garner to the ground in a chokehold, as other officers present compressed his chest, leading to Garner’s death. As a former medical writer, I was horrified not only at the excessive brutality of the four officers on the scene, but also at the spectacle of appalling ignorance they displayed in so violently assaulting a man of Garner’s obvious, morbid obesity (Garner was 6 foot 3 inches and 395 pounds at the time of his death), and then ignoring his 11 gasping cries that he could not breathe.

What guided my perception of this incident was the published data on obesity as a risk factor for hypertension, cardiovascular disease, and stroke that I had toiled over in my job. Garner’s black race, male sex, and middle age (Garner was 43) were additional risk factors that multiplied the chances of an “event.” The video of the incident was for me like watching police officers take down an obviously pregnant woman or bash around a 90-year-old. And that was not just my impression. The New York City medical examiner’s office determined that the choke hold and chest compression applied by the officers, with Garner forced to a prone position that further impeded breathing, caused his death by triggering an asthma attack, which led to fatal cardiac arrest, with obesity, chronic asthma, and hypertension as contributing factors.

Pantaleo was never prosecuted in criminal or civil court because the illegality of his actions, vis a vis police policy and training, was determined to be unclear, although the city paid $5.9 million to Garner’s family to settle a wrongful death claim. The New York City Police Department did hold a disciplinary trial to decide Pantaleo’s status. Stuart London, the police union attorney leading Pantaleo’s defense team, claimed Garner’s health risks were exculpatory to his client, as described by The Washington Post:

“[Garner] died from being morbidly obese,” London declared, prompting shocked snickers and disgusted head shakes in the courtroom. Pantaleo, sitting with his attorneys, remained silent. “He was a ticking time bomb that resisted arrest. If he was put in a bear hug, it would have been the same outcome.”

But the officers did not put Garner in a bear hug; they choked him to death. The underlying premise of London’s argument was that the police officers could not possibly have known Garner’s risks.

That is patent nonsense.

Garner’s “morbid obesity” was perfectly visible to the officers. It is intuitive and axiomatic that a grossly overweight person “could have a heart attack” when placed under extreme physical or emotional stress. The labored breathing of overweight people with even minor exertion is also a common observation. Shortly after Garner’s death, I happened to see a Family Guy scene where a cruel joke was made of the noisy breathing of a roomful of overweight people. So, the Pantaleo defense was essentially implying that NYPD officers have a lower common-sense knowledge of health risks than is presumed of the audience of a cartoon TV comedy.   

Preposterous as it is, this notion was dramatized in macabre and tragic fashion in the case of George Floyd this past year. As police officer Derek Chauvin kneeled on Floyd’s neck for nine and a half minutes, two other officers kneeled on the rest of his body, and one officer stood by protecting them. This while a group of concerned onlookers pleaded with them to stop their abuse in their common-sense—and correct—perception that Floyd was in life-threatening distress. The officers all remained stonily oblivious to these pleas and to Floyd’s own desperate protests.

During Chauvin’s murder trial, the medical examiner of Hennepin County, where Floyd’s death occurred, testified that the 46-year-old Floyd had hypertension, a condition highly common in African-American men, and related cardiovascular disease, which contributed to his death. Why shouldn’t our police forces be trained to account for possibilities like this? It seems obvious that they should.

But Chauvin’s defense mainly focused on a different factor: the purported presence of drugs in Floyd’s system. The defense argued that this is what caused his death (much like Garner’s morbid obesity), also suggesting that the drugs in his system made Floyd more dangerous to the officers and thus necessitated harsh treatment of him. But rudimentary knowledge of the way drugs can wreak havoc with the body’s vital systems, such as causing a racing heartbeat or cardiac arrhythmia, should have told the officers to avoid severely stressing Floyd’s cardiovascular system.

So, in a twist to the Garner case’s absurdity, the defense in the Floyd case was arguing that the officers could discern that Floyd might be on drugs, and that they could understand that this factor made him potentially dangerous to them, but they could not grasp the danger of the drugs to Floyd when they severely stressed him.

Call it selective presumption of ignorance.

Several possibilities other than sheer ignorance of health risks may explain the police behavior in these cases.

Given that Pantaleo and Chauvin were white, and both victims were large black men, it is possible that fear and racism clouded the officers’ judgment. Had Garner and Floyd been white, the officers conceivably might have recognized their potential vulnerabilities and acted accordingly. The excessively violent approach taken by the officers and their sustained disregard of the victims’ distress in each case suggests it was not their health risks that were overlooked—it was their humanity.

Police officers might also be hardened to the point of obliviousness to health risks by the harsh exigencies of crime-fighting, or may simply feel that they should not be burdened with such considerations, even in managing unarmed suspects.

The underlying problem, as revealed by the Garner and Floyd cases, is that there is no professional training and standard for recognition of health risks by police officers. The presumption of ignorance of health risks also tends to go unchallenged by police abuse prosecution lawyers and other justice advocates who are concerned that any acknowledgement of underlying health risks of victims might weaken the case for the guilt of the offending officer. Consequently, the police are provided a convenient shield from responsibility for their brutality, and the public is left at higher risk of harm from abusive officers.

It should be noted that police are typically trained to manage medical crises on the scenes of violent crimes or accidents and to interact efficiently with medical personnel. Police recruits in New York City receive fairly extensive training in managing individuals with mental health crises, in part because such encounters can be dangerous for the officers. They are also trained in administration of first aid and medical emergency/trauma response skills, such as cardiopulmonary resuscitation; use of a defibrillator, tourniquet, and hemostatic agent; and administration of intranasal naloxone for opium overdoses.

There is a theme here, though: almost all are responses to injury after the fact. There is virtually no training for recognition of visibly high-risk individuals other than those with mental health problems. Based on a conversation I had with a former NYPD officer, now a college professor in criminal justice, NYC police officers are generally encouraged simply to use their common sense in this regard, with specific recommendations for more gentle treatment of pregnant women and the elderly. There are no specific guidelines for obese people.      

As demonstrated by recent cases of police brutality with tragic consequences, such vague, common-sense standards are inadequate. Formal training in community health risks must be incorporated into police reforms to deter, and hold officers accountable for, needless or excessive harm to unarmed and visibly vulnerable citizens in police custody. The tacit presumption of ignorance must be eradicated and replaced with a presumed knowledge that at least mildly exceeds, not falls below, the consciousness of the average citizen.

The objections and complaints are predictable: “What, we have to be doctors now?” But recognition of visible health risks falls right in the domain of expert observation, which is the very soul of police work. I remember the time I was stopped on the street for a misdemeanor (I’ll skip the details) and how meticulously one of the officers visually sized me up: my clothes, grooming, deportment, possibly even guessing at my economic status, occupation, and area of residence. I could virtually hear the well-honed profiling circuitry in the cop’s brain buzzing. An informed view of a suspect’s visible health characteristics would be perfectly germane to classic police observation, and one that relates directly to public safety.

Basic training in epidemiology would also be relatively efficient. Police departments would simply have to provide data, typically available from city, county, state, or federal health agencies, showing the community prevalence, and major, observable (when applicable) symptoms of the most common diseases (typically cardiovascular disease, stroke, cancer, diabetes, and respiratory disorders). Officers could be expected to know major risk factors for each disease (e.g., age, sex, race, ethnicity, smoking, weight, activity levels, diet, drug use, etc.). They could be trained in the effects of multiple risk factors for each disease, and perhaps expanded training on the health risks of certain drugs. Most of these data can be provided via tables and graphics like simple bar charts that are routinely produced by public health agencies.

Clearly, police officers cannot be held responsible for recognition of health risks that are not visually apparent and observable on sight. But the most common visible health risk, obesity, is a major concern, with a current rate of 42 percent among U.S. adults. Police must understand the risks of this epidemic, which include increased rates of hypertension, heart disease, stroke, type 2 diabetes (itself a cardiovascular risk), and breathing problems. Such knowledge could help officers connect with citizens more compassionately and see their humanity. 

At the least, expanded health risk training should help produce some spark of recognition among police officers of a foreseeable medical crisis in a person in custody. Even if officers willfully ignore such signs, documentation of health risk training can help hold them responsible for any death or injury caused by their behavior, rather than allowing them to hide behind an unstated presumption of ignorance.

It is time to hold police officers formally accountable for a reasonable, basic knowledge of health risks among the citizens they are sworn to protect and to serve.