Police
Are Conducting War Against The American People
Police
Are Conducting War Against The American People
A
report published two days ago in the journal, Injury Prevention,
concludes:
“US
police killed or injured an estimated 55,400 people in 2012.”
Perils
of police action: a cautionary tale from US data sets
- Ted
R Miller1,2,
- Bruce
A Lawrence1,
- Nancy
N Carlson3,
- Delia
Hendrie4,
- Sean
Randall2,
- Ian
R H Rockett5,
- Rebecca
S Spicer1
- 1Pacific
Institute for Research and Evaluation, Calverton, Maryland, USA
- 2Faculty
of Health Sciences, Centre for Population Health Research, Curtin
University, Perth, Australia
- 3University
of the District of Columbia, Washington DC, USA
- 4School
of Public Health, Curtin University, Perth, Australia
- 5Department
of Epidemiology and Injury Control Research Center, School of Public
Health, West Virginia University, Morgantown, West Virginia, USA
- Correspondence toDr
Ted R Miller, Principal Research Scientist, Pacific Institute for Research
and Evaluation, 11720 Beltsville Drive, Suite 900, Calverton, MD 20705,
USA; miller@pire.org
- Received 10 March 2016
- Revised 12 April 2016
- Accepted 15 May 2016
- Published
Online First 25
July 2016
Abstract
Objective To
count and characterise injuries resulting from legal intervention by US law
enforcement personnel and injury ratios per 10 000
arrests or police stops, thus expanding discussion of excessive force by police
beyond fatalities.
Design Ecological.
Population Those
injured during US legal police intervention as recorded in 2012 Vital
Statistics mortality census, 2012 Healthcare Cost and Utilization Project
nationwide inpatient and emergency department samples, and two 2015 newspaper
censuses of deaths.
Exposure 2012
and 2014 arrests from Federal Bureau of Investigation data adjusted for
non-reporting jurisdictions; street stops and traffic stops that involved
vehicle or occupant searches, without arrest, from the 2011 Police Public
Contact Survey (PPCS), with the percentage breakdown by race computed from
pooled 2005, 2008 and 2011 PPCS surveys due to small case counts.
Results US
police killed or injured an estimated 55 400
people in 2012 (95% CI 47 050 to 63 740 for cases
coded as police involved). Blacks, Native Americans and Hispanics had higher
stop/arrest rates per 10 000 population than white non-Hispanics and Asians. On
average, an estimated 1 in 291 stops/arrests resulted in hospital-treated
injury or death of a suspect or bystander. Ratios of admitted and fatal injury
due to legal police intervention per 10 000
stops/arrests did not differ significantly between racial/ethnic groups. Ratios
rose with age, and were higher for men than women.
Conclusions Healthcare
administrative data sets can inform public debate about injuries resulting from
legal police intervention. Excess per capita death rates among blacks and youth
at police hands are reflections of excess exposure. International
Classification of Diseases legal intervention coding needs revision.
Background
Of
necessity, police sometimes injure or kill a felon to protect the public or
themselves. Police use of undue force is an enduring tinderbox issue in
America.1–4 In
the aftermath of the Civil War, adoption of the 14th Amendment to the
Constitution and 18 US Code Sections 241 and 242 and 42 US Code Section 1983
provided protections against police use of excessive force or other punishment
without due process of law. A unanimous US Supreme Court affirmed the
applicability of these protections to the police-abetted murder of civil rights
workers Schwerner, Chaney and Goodman in Mississippi in 1964.5
Police
instructors often teach officers about force continuums where police response
progressively adjusts to match the changing level of suspect resistance.6–8 Some
have started teaching de-escalation techniques.9
Legal
protections and training, however, cannot prevent every abuse of power or
police loss of control out of anger or fear. Recently, US press and public
outcry protested police shootings of unarmed citizens and potentially negligent
deaths in police custody.10 Discussion
has focused almost exclusively on fatalities, driven by Federal Bureau of
Investigation (FBI)11 statistics
on deaths due to legal intervention by law enforcement personnel (hereafter
called legal police intervention), and by newspaper-compiled censuses that
reveal the FBI reports omit half the fatalities.12 ,13 Periodic
Police Public Contact Surveys (PPCS) also find that blacks are more likely than
whites or Hispanics to experience physical force during a police-initiated
stop.14
Vital
statistics and healthcare claims administrative data sets contain a wealth of
untapped information about the extent and nature of suspect/bystander injury
resulting from legal police intervention. The International Classification of
Diseases (ICD), 9th and 10th revisions, define legal intervention as ‘injuries
inflicted by the police or other law-enforcing agents … in the course of
arresting or attempting to arrest lawbreakers, suppressing disturbances,
maintaining order, and other legal actions’. Some of these injuries involve
undue force.
This
article uses ICD-coded national data to close information gaps. It estimates
non-fatal injuries resulting from legal police intervention. It adds insights
by comparing injuries from legal police intervention versus assault and using
police arrest and stop counts as denominators to compute injury ratios.
Methods
We
used SAS V.9.4 to analyse 2012 unit record data on non-fatal injury from the
Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample
(NIS) and Nationwide Emergency Department Sample (NEDS).15 ,16 We
extracted and cleaned injury cases from NIS and NEDS following published
procedures,17 and
coded the injuries by body region and by Abbreviated Injury Severity threat to
life using ICDmap90 software.18 Legal
police intervention cases were identified by ICD, 9th Revision, Clinical
Modification (ICD9-CM) external cause codes E970–E977. To identify taser
injuries, we searched for an electroshock diagnosis in the case (ICD9-CM
diagnosis 994.8). We estimated lifetime medical costs for each case using
methods and cost factors from the online WISQARS (Web-based Injury Statistics
Query and Reporting System) model.19 Unlike
ICD10, WISQARS non-fatal data20 code
intent separately from mechanism. Multiyear WISQARS counts had wide CIs and
were too thin to provide stable estimates by demographics or for many
mechanisms. They did yield insight into mechanisms where the ICD10-CM coding
system that replaced ICD9–CM in 2015 inappropriately lacks legal police
intervention codes.
Fatalities
Deaths
from legal police intervention are underidentified or undercounted in US Vital
Statistics, FBI Supplemental Homicide Reports, and Bureau of Justice Statistics
Arrest-Related Deaths programme data.21–24 A
modified capture-recapture modelling approach suggested each captured 46–49% of
these fatalities,21 ,24 while
comparisons with National Violent Death Reporting System (NVDRS) data for 16
states suggested a 48–58% capture.24 The
Washington Post used daily press searches and supplemental
crowdsourcing to track US firearm deaths due to police action during 2015,
verifying and detailing each identified death.12 The
Guardian25compiled
a similar list that added non-firearm deaths, as well as deaths in custody and
deaths in crashes where police vehicles were at fault.13 Consistent
with the capture-recapture models, both found about twice as many legal police
intervention incidents as the three national reporting systems. Several
epidemiological studies found systematically searched newspaper accounts a
credible injury data source.26–30 We
therefore relied primarily on homicide estimates by demographic group from the Guardian data,25 excluding
41 deaths in custody (primarily cardiovascular or other health crises) and 33
in crashes. For half of the 24 cases with missing demographic data, we
back-filled this information from the Washington Post listing.
Demographic
tabulations
We
tabulated data by victim age group, sex, race and Hispanic ethnicity, rurality,
mechanism (eg, firearm), and, for hospital admissions, by alcohol and drug
involvement of the person injured. All tables were run in SAS V.9.4., applying
sample weights to the HCUP data, which are public use samples of approximately
20% of all US discharges.
Data
deficits limited our analysis of race-ethnicity. NEDS cannot supply nationally
representative race-ethnicity estimates because many states do not either
identify race and ethnicity or collect emergency department (ED) data centrally.
We therefore restricted the race-ethnicity analysis to fatal and
hospital-admitted injuries.
Denominators
As
denominators for producing injury ratios, we used the sum of FBI-tabulated
arrest data, adjusted for non-reporting,31 and
2011 PPCS-based national estimates (which we computed using STATA V.11) of
police street stops without arrest and of traffic stops where a person or
vehicle was searched but the person stopped was not arrested.32 In
2012, FBI arrest data largely excluded Alabama, the District of Columbia,
Hawaii, Illinois (except Chicago and Rockford) and New York City, and lacked
demographic detail for Florida. Online search provided arrest data that we
manually added for three of these jurisdictions: Hawaii,33 Alabama34 and
New York City.35 ,36 We
adjusted the remaining FBI-reported data to US estimates under the assumption
that arrest rates by region for the 82% of the US population covered by the FBI
data and our supplements were representative of arrest rates in those regions
in frequency and demographics. The FBI only began collecting Hispanic origin in
2013 arrest data, with reporting much more complete in 2014 than 2013. We
supplemented the 2014 data11 with
a racial breakdown for New York City.37 ,38 Our
analyses classified all minority Hispanics (eg, five of the deceased) by their
minority race. We assumed white Hispanics would constitute the same 28.6% of
arrested whites in 2012 as in 2014. Although we used 2011 stop counts, because
2011 PPCS data were sparse for some racial groups, we distributed them using an
average percentage breakdown by race that we computed from pooled 2005, 2008
and 2011 surveys.32,39 To
test significance of ratio differences, we computed pairwise bivariate CIs
between related demographic categories (eg, male vs female).
Results
The
Guardian25 counted
1069 deaths from police intervention during 2015, including 1015 by firearms.
By comparison, the Washington Post40 firearm
death count was 990 and Bureau of Labor Statistics capture-recapture modelling
estimated annual deaths due to legal police intervention averaged 928 in
2003–2009 and 2011.21
In
2012, an estimated 55 400 people were killed or hospital-treated in legal
police intervention incidents (table 1,
95% CI 47 050 to 63 740). About 2%
(1063) suffered fatal injuries, 5% (2665, 95% CI 2386 to 2944) were
hospital-admitted but survived, and the remainder (51 678,
95% CI 43 330 to 60 116) were
treated in the ED and released. Firearms accounted for 95% of fatalities and
23% of hospital admissions. Virtually all other fatalities involved
electromuscular disruption by tasers, with most of these deaths not immediate.
Of more than 1700 taser-involved incidents, an estimated 65 resulted in
hospital admission and 48 were lethal. Medicolegal investigations, however,
concluded that the large majority of these deaths were not caused by the taser.
A 2011 blue-ribbon medical panel review of medicolegal findings on deaths after
electromuscular disruption suggests those determinations probably were
accurate.41
View this table:
Table 1
Number
of people treated in hospitals or killed annually due to legal police
intervention by mechanism of injury, USA
Police
use of tear gas, mace or pepper spray rarely resulted in hospital admission.
The large majority of non-fatal injuries stemmed from blows or blunt objects.
Cases involving sharp objects generally would involve police wounding someone
while seizing his or her weapon. Because the ICD lacks an appropriate cause
code, these figures exclude both people bitten by police dogs, an estimated
4200 people annually (95% CI, 2000 to 6500) according to 2010–2013 WISQARS
online data, and injuries by mechanisms where WISQARS could not provide stable
counts. WISQARS data also suggested HCUP might be underascertaining struck by/against
injuries, but the WISQARS sample includes just 66 hospitals.
Estimated
lifetime medical costs for injuries from legal police intervention in 2012
totalled $231 million (2012 dollars, not tabulated). Modelled lifetime medical
costs averaged $9550 for a fatality, $36 550
for an admitted survivor and $2390 for a patient treated in the ED and
released.
In
every age group, the estimated probability of hospital admission among legal
police intervention injuries (5.0%) was lower than among other assault injuries
(7.5%, not tabulated) in 2012. The AIS threat-to-life profile for legal police
intervention was lower than for assaults. Among patients coded as
hospital-admitted survivors of legal police intervention, 43% faced only a
minor threat to life (AIS-1) and 23% a moderate threat (AIS-2). Hospital
admissions for assault and legal police intervention, however, had similar
injury profiles and virtually identical modelled lifetime medical costs per
case. Gunshot wounds were significantly more likely to be lethal if they
resulted from legal police intervention than from assault (40% vs 26%).
Among
patients coded as hospital-admitted survivors of legal police intervention in
2012, 49% tested positive for alcohol, drugs or both (not tabulated). The
remainder either was not tested or tested negative.
Exposure
and ratios of injury to exposure
As table 2 shows,
in 2012, arrests accounted for an estimated 12.3 million (76%) police
interventions with a substantial potential for violence, street stops for 2.8
million (18%) and traffic stops involving searches for 1.0 million (6%). The
people who were least likely to be arrested when stopped were over age 65
years, Asian/Pacific Islander or living in non-metropolitan areas. Those with
the highest arrest rates per 10 000 population were ages 15–29 years, black or Native American.
View this table:
Table 2
Arrests
and at-risk police stops in 2011 and rates per 10 000
population
Table 3 provides
demographic breakdowns of injury counts and ratios per 10 000
police stops/arrests. The differences in fatal plus non-fatal injury ratios by
sex and by age group are significant at the 95% confidence level. An estimated
1 in every 291 stops/arrests resulted in a death or medically treated injury of
the suspect or bystander, a ratio of 34 per 10 000
stops/arrests. The coding does not differentiate bystanders from suspects. The
male injury ratio per 10 000 stops/arrests was more than twice the female
ratio, with even larger differentials for hospital-admitted and especially for
fatal injuries. The estimated injury ratio rose initially with age, peaked at
ages 30–44 years, then declined. The estimated hospital-admitted injury ratio
rose steadily with age, while the estimated fatality ratio rose through age 30
years, then plateaued. Those aged 65 years and over had the highest probability
of dying if injured during a stop/arrest. The injury ratio was almost three
times as high in metropolitan as in non-metropolitan counties.
View this table:
Table 3
Number
of people treated in hospitals or killed due to legal police intervention,
injury ratios per 10 000 stops/arrests and percentages of injuries that were
fatal by demographics, USA
Both
estimated hospital-admitted and fatal injury ratios per 10 000
stops/arrests did not differ significantly between racial/ethnic groups. The
low hospitalisation ratio for Native Americans suggests that HCUP coding of
this racial group is incomplete, with many mixed race individuals probably
folded into Other Race.
Uncertainty
of the estimates
The
estimates reported here are far from exact. The non-fatal incident counts are constrained
by identification error resulting from faulty cause coding, but SEs for these
HCUP counts as coded are just 5–8% of the mean. Our denominator estimates of
arrests and stops without arrest, however, have wide uncertainty ranges. SEs
for the PPCS estimates in table 2 are
about 10% of the mean for estimates above 1 000 000
but rise to 30% of the mean for estimates around 100 000.32 Worse,
we can only guess at the uncertainty in the arrest count because that
uncertainty results from (1) lack of reporting by some jurisdictions, even
entire states, with estimating their data unavoidably requiring the
questionable assumption that their arrest rates by demographics are similar to
rates in jurisdictions that chose to report, and (2) an unknown amount of
undercounting by some jurisdictions that did report.42
Discussion
On
average, an estimated 34 people were killed or medically treated for injury by
law enforcement per 10 000 stops/arrests. That ratio is surprisingly
consistent by race/ethnicity. Blacks have high arrest and stop rates,43 ,44 and
per capita are much more likely than whites to die at the hands of police.40 However,
when blacks are stopped or arrested, they are no more likely than whites to be
injured or die during that incident.
Consistent
with our findings, simulation studies find police are no more likely to fire on
unarmed blacks than unarmed whites,45 and
high rates of black speeding citations per capita result from high violation
rates.46–48 A
systematic review identified 10 studies that found suspect race/ethnicity did
not predict use of force or its escalation.6 However,
one study found blacks were more likely than whites to face force during
compliance checks.7 The PPCS
survey also found that blacks were more likely to experience physical force and
to perceive the threat of force during a stop, although few respondents
actually were injured by the force applied.14 The
large majority of incidents that those stopped perceived as undue force was
stops where officers shouted at or threatened people, presumably to deter
resistance.
Frequent
police stops of young men have caused many black and some Hispanic mothers to
teach their sons where to put their hands if approached by an officer, how to
move and not move, to ask permission before reaching for their wallet, and to
respond to police rudeness with respect.49 Those
talks may have protective effects.
High
severity among the elderly
The
high hospital admission and death ratios among the injured elderly are
consistent with their broader injury patterns.50 They
may result from brittle bones that are vulnerable in a police scuffle. Some
deaths also may represent suicidal situations where someone deliberately forces
an officer to pull the trigger or an officer acts to stop a domestic
murder-suicide.12 More
research clearly is needed on police handling of elderly stops/arrests, and on
why they often lead to serious injury or death.
Judicious
use of force
A
core police role has long been considered judicious but not undue use of
psychological and physical force to maintain order.4 ,51–54 Police
also are trained to survive. The statistics suggest that their training is
largely protective, but violence occasionally escalates.55 We
found that in 2012, legal police intervention resulted in an estimated 54 300
people being medically treated for non-fatal injury and 1000 deaths. During
2012 an estimated 67 000 law enforcement personnel were assaulted, with an
estimated 18 600 medically treated for injury and 48 killed31(FBI,
2012, tables 35 and 76, adjusted to account for non-reporting jurisdictions).
Except
in firearm incidents, injuries from legal police intervention posed a lower
threat to life compared with medically treated assault injuries. This finding suggests
the police usually were not out of control when they physically confronted a
suspect. The Washington Post census of people killed by police
estimated 74 per cent of victims were actively shooting at, aiming weapons at,
or (sometimes unarmed) attacking the police.40 Still,
1 in 11 people who died due to law enforcement action in 2015 were unarmed. As
case studies indicate,56 steps
such as community-oriented policing, body cameras and incident investigation
using surveillance methods drawn from public health may de-escalate the violence.
Problems
with administrative data coding and multistate analyses of firearm homicide
Counts
of Vital Statistics firearm mortality from legal police intervention are
undercounts, as the newspaper enumerations showed. Vital Statistics legal
police intervention appropriately excluded cases where police had been
convicted, or remained under investigation, for use of excessive force (coded,
respectively, as homicide and undetermined intent). They also failed to code
police involvement in an estimated 450 shootings annually. If those deaths
incorrectly were registered as homicides, they would artificially inflate
firearm homicide counts by 4%. Since misreporting rates vary widely between
states,21 and
may be substantially lower in NVDRS states, this problem may have skewed all
recent cross-sectional time series analyses of firearm homicides. Research is
urgently needed to determine the intent logged for these firearm deaths,
including extending the recent capture-recapture modelling effort21 to
incorporate Vital Statistics data.
Our
taser counts are tenuous because neither morbidity nor mortality coding assigns
a code exclusively to taser. WISQARS suggests legal police intervention was not
codable for perhaps 10 000 injuries, primarily from dog bites, falls or
foreign bodies. Consistent with that estimate, dog bites accounted for
one-eighth of all reported injuries from legal police intervention in
Miami-Dade county, Florida and Richland county, South Carolina.57 The
injury coding also leaves ambiguities in the unknown number of cases where
police only inflicted a portion of the person's injuries. For example, if
police broke up a fight by tasering a brawler who already had suffered a knife
wound and a broken nose, the medical record would simply catalogue the
electroshock and physical injuries, and report that they occurred in a legal
police intervention incident.
Other
limitations
The
available arrest data are incomplete, especially information about Hispanic
origin. This deficit forces us to make the imperfect assumption that available
data are representative. Similarly, the sample is thin on the racial
distribution of traffic stops, so the Asian/Pacific Islander and Native
American estimates are unstable. ED data were not coded by race, and the coding
of Native Americans was suspect in the inpatient data.
Conclusion
and recommendations
Healthcare
administrative data sets clearly have value in informing public debate about
injuries resulting from law enforcement. Drilling further into the data,
especially with discharge censuses rather than a national sample, linking
discharges to unit record data on arrests, and possibly applying
capture-recapture modelling, would detail the picture sketched here. Available
state data urgently need to be tapped.
Given
the frequency and potential lethality of these cases, the US clinical
modification to ICD10,58 and
ideally ICD10 itself, should add a code for legal intervention by taser. Legal
intervention also should be a codable intent for dog bites, human bites, falls
(as the PPCS finds the most common physical contact with police is a push),
foreign bodies and transport.
FBI
arrest data are incomplete due to late or incomplete police department
reporting or refusal to report. Using local data posted to the internet, we
were able to add unreported data from Alabama, Hawaii and New York City, and
saw indications that the District of Columbia had the missing data in its
information system. To support accurate research, on injury risk during arrest
and on number of people arrested, we urge mandatory reporting of arrests to the
FBI. Moreover, we strongly suggest that the FBI update its arrest data tables a
year after the original closing date, in order to incorporate reports received
after its deadline.
Given
a national history of racism, the excess per capita death rate of blacks from
US police action rightly concerns policy analysts, advocates and the press. The
excess appears to reflect exposure. Blacks are arrested more often than whites,
and youth more often than the elderly. However, blacks are not more likely than
non-Hispanic whites to be killed or injured during a stop/arrest, and youth
have the lowest injury ratios. Ratios aside, even one person unnecessarily
killed or injured by the police is one too many, and every racial/ethnic group
has mourned losses from undue force. As the US struggles to reduce citizen
injuries during police contacts, it would seem prudent to train at-risk groups
about appropriate behaviour during police stops.
What
is already known on this subject?
- Minorities have a higher chance of being stopped
by police, arrested and being killed by police than non-Hispanic whites.
- Untapped health data describe non-fatal injuries
inflicted during legal intervention by police.
- Injury risk for those stopped or arrested by
police has not been analysed.
What this study adds?
- During legal interventions in 2012, US police
fatally injured 1000 people, with an estimated 54 300
surviving hospital-treated injuries.
- Estimated injury risk was 1 per 291
stops/arrests.
- While minorities were more likely to be
stopped/arrested by police, the probability of being killed/injured during
a stop/arrest did not vary by race.
Footnotes
- Contributors TRM
and BAL led study conceptualisation with inputs from the other authors.
BAL and SR cleaned and analysed the healthcare data. TRM analysed the PPCS
and arrest data. TRM drafted the paper. All other authors reviewed it,
suggested changes in analyses and presentation, and approved the final
manuscript.
- Competing
interests None
declared.
- Provenance and peer review Not
commissioned; externally peer reviewed.
- Data sharing statement All
data used are public use files available to anyone from the file
distributors.
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