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The Medical Examiner Said He Died of ‘Excited Delirium.’ Medical Experts Say Police Strangled Him to Death.

Sterling Higgins died in a Tennessee jail in 2019 after officers pinned him to the floor. Two new medical experts’ reports describe the incident as homicide.

Sterling Higgins
Courtesy of Jennifer Jenkins

The Medical Examiner Said He Died of ‘Excited Delirium.’ Medical Experts Say Police Strangled Him to Death.

Sterling Higgins died in a Tennessee jail in 2019 after officers pinned him to the floor. Two new medical experts’ reports describe the incident as homicide.


In October 2019, the district attorney’s office in Tennessee’s 27th Judicial District announced it would not prosecute law enforcement officers in the death of 37-year-old Sterling Higgins in the Obion County Jail. A grand jury failed to indict the officers. DA Tommy Thomas noted that Higgins’s cause of death absolved the officers of wrongdoing. The medical examiner had ruled that Higgins fell into a state of “excited delirium”—which is described as a condition associated with overheating, super-human strength, and sudden death—after using methamphetamine. Higgins’s death was officially deemed an accident.  

But two recent independent investigations by forensic experts obtained by The Appeal point to a different cause of death: Both concluded that Higgins was suffocated by city police officers. Allecia Wilson, director of autopsy and forensic services at the University of Michigan and chief medical examiner of Washtenaw and Livingston counties in Michigan, found no evidence that Higgins exhibited signs of excited delirium, and pointed suffocation as a more likely culprit. The two reports were paid for by the law firm representing Higgins’s estate in a civil rights lawsuit. Obion County and the officers involved have denied any wrongdoing.

“He became unresponsive during a physical altercation with officers that compromised his ability to breathe,” wrote Wilson in her report in February. 

A separate, independent review by J.C. Upshaw Downs, the medical director of the physician assistant program at Charleston Southern University, in South Carolina, reached essentially the same conclusion in January.


Higgins was sure someone wanted to kill him. 

On the night of March 24, 2019, he called 911 from a convenience store in Union City, Tennessee. The dispatcher sent three officers. After observing Higgins, one of the officers suggested he be brought to the hospital for medical treatment, but the officers decided against doing so and left the store. 

Higgins, still scared for his life, was hiding in a cooler when the store clerk called 911 and the three officers returned. This time the officers arrested Higgins and brought him to the Obion County Jail, which did not have any medical professionals on site. 

What followed next was partially captured on video first reported by The Appeal in June 2020. 

Higgins is handcuffed, his hands behind his back. As a female officer walks by, he momentarily grabs ahold of her hair, but instantly loses his grip. Officers throw Higgins on the floor, grab him by the face and hair, while other officers restrain his legs and appear to step on him, with one of them using the wall as leverage. Another officer holds down Higgins’s head and neck. He goes limp, foaming at the mouth. Officers then put Higgins in a restraint chair and wheel him into a cell. They come in to check his pulse, and appear unable to find it. When EMTs arrived almost 10 minutes later, Higgins was dead. The entire episode took 30 minutes. 


That October, a grand jury, declined to indict. The jurors were not shown the footage of Higgins.

In a press conference that followed, Thomas, the Obion County DA, explained why he agreed with the grand jury’s decision

“My standard that I was looking at is to determine whether or not any of the officers were involved in conduct that rose to the extent of criminal behavior—did they do anything criminally to cause his death?” Thomas said. 

The DA definitely based his decision on the ME’s autopsy findings,” said Erik Heipt, who is representing Higgins’s family in a civil lawsuit. The Appeal contacted the Obion County DA’s office for comment, and had not received a response at the time of publication.  

The medical examiner’s finding was that excited delirium caused Higgins’s death. Excited delirium was coined in the 1980s by Charles Wetli, a medical examiner who later applied the theory to a series of cases where young women appeared to drop dead. Soon after, detectives concluded that they’d died after being suffocated by a serial killer. 

Even though some medical and legal experts believe that oxygen deprivation is a likelier explanation than dropping dead of excited delirium, the concept persists. The National Association of Medical Examiners considers it a valid cause of death, and so too did the independent medical experts who reviewed Higgins’s case. But its use, critics say, can absolve officers of potential wrongdoing, and implicitly blames the victim. 

“The victim had to be restrained and held on the floor with an officer laying across him until he stopped resisting,” wrote William Stone, Obion County’s medical examiner. Parts of the report found Higgins suffered “multiple blunt force injuries,” but excited delirium was the cause of death.

Wilson, the medical examiner in Michigan, based her report on the video footage and medical notes. 

Her report said Higgins didn’t exhibit signs associated with excited delirium. No evidence gathered by emergency medical services and medical records suggest overheating, noting that he stopped responding after an altercation in which police inhibited his breathing. 

“In this case, the type of force utilized, resulted in positional and mechanical asphyxia,” according to her report. She said Higgins’s injuries suggest he died from two different restraints, including a chokehold (mechanical) as well as a pressure on his back constricting his lungs (positional). “The matter of death is homicide,” she concluded. 

The second independent review by Downs, of Charleston Southern University, found a similar cause of death. 

“The subject exhibited paranoid behavior and was alive,” wrote Downs. “Minutes later, following the start of and during the uninterrupted continuation of restraint involving two officers–one of whom grabbed the subject’s neck and one of whom stood on the subject’s lower body–the subject died.” 

Downs found Higgins “received no immediate medical attention, which assured the subsequent outcome. Any opportunity to revive the subject was lost, since ideally trained medical help would have already been summoned prior to the fatal events.”

“The manner of death was homicide,” he concluded. 

Higgins’s estate’s lawsuit is ongoing.

“The bottom line is that Sterling Higgins was choked to death,” Heipt, the family lawyer, said. “After he became unresponsive, jail guards spent seven minutes strapping his limp and lifeless body into a restraint chair. They then wheeled him into a jail cell, where he remained for an additional 13 minutes without medical attention. By the time medics finally arrived, he was beyond saving.” 

“CPR could’ve saved his life. But there were no medical providers at the jail, and contrary to Tennessee law, none of the jail guards had CPR training. The death of Sterling Higgins was inhumane and unnecessary.”

CORRECTION: An earlier version of this article misquoted the findings in Allecia Wilson’s report. Wilson found that the “manner” of Sterling Higgins’s death was homicide, not the “matter.”