Nontraumatic In-Custody Homicidal Deaths in Harris County, Texas (2015-2019): Justification for a Separate Manner of Death Category

A subset of in-custody deaths, typically occurring in the precustody phase, arise from a combination of mechanisms, rather than a single anatomically or circumstantially demonstrable cause. This case series examined nontraumatic in-custody deaths that occurred over a 5-year period (2015-2019) in Harris County, Texas. Cases were identified as "in custody"or "during police intervention,"with a homicide manner; traumatic causes of death (eg, police shootings) were excluded. Sixteen cases were identified. The median age was 40 years, with an interquartile range of 35 to 50.5 years. All but one were male, and there were 8 (50%) Black, 5 (31%) White, and 1 (6%) Hispanic cases. Intoxicants were detected in all except 1 death that occurred after a prolonged hospitalization; stimulants were identified in 12 (75%). The cause of death for each was descriptive, representing the complex interplay of external forces with physiologic/toxicologic and disease-related mechanisms. This series is used as a backdrop for a discussion regarding the inadequacy of the current 5-category manner of death classification scheme and to suggest an alternative category of manner. This alternative category, specifically "legal intervention,"would be most useful for this subset of nontraumatic in-custody deaths but may have applicability for other types of in-custody deaths.