Czech cardiologist: Drug users have broken health, breathing problems introduced during an arrest can have tragic results

"The use of drugs undermines one's health, and any eventual stressful situation can end tragically. That can also apply in the case of an intervention by police," Dr Petr Neužil, head of the cardiology department at the Na Homolce Hospital in Prague, recently told the editors of news server iROZHLAS.cz.  

The news server contacted the physician after the Czech Police published the preliminary results of the autopsy according to which they say the death of Stanislav Tomáš in Teplice last Saturday was due to both pathological changes to his coronary arteries and the influence of an amphetamine substance, namely methamphetamine; according to Dr Neužil, who says he specializes in heart disease among those dependent on drugs, cocaine or methamphetamine users are prone to heart arrhythmia. "They are frequently living with cardiomyopathy in various phases of development, so pressure and stress is a problem for them," he said, adding that for such people, complications then develop over time that can be life-threatening. 

In Dr Neužil's view, stressful situations (which being arrested by the police undoubtedly is) can be critical for such people. If the detainee has a problem breathing - for example, because officers are kneeling on him while he is prone - the heart can stop. 

The state of health of a long-term addictive substances user then also complicates attempts to save the user's life: The heart valve infections so frequent among the users of injection drugs, along with the drug's disruption of their cellular metabolism, means they do not respond to resuscitation. "That would most probably not happen to a healthy person," Dr Neužil estimated. 

Since he does not know the details of what specifically happened in Teplice, Dr Neužil said he cannot comment on that case. Medical examiner Alexander Pilin of Charles University's First Faculty of Medicine also did not want to comment on the case in Teplice.

"I saw the video, but it's difficult to express a view on that basis alone," Dr Pilin told the weekly magazine RESPEKT. According to him, an autopsy can determine whether a person has died of strangulation in more than one way. 

"There are general signs of choking, in this case it would be a blue color in the face caused by the pressure on the chest and neck. After choking, the blood throughout the body is also dark and fluid," the expert said.    

The autopsy report that police have based their conclusions on to rule out the idea that their intervention could have contributed to the death of Mr Tomáš is just a preliminary one; if the medical examiner performing the autopsy has concluded the intervention by police was not a cause of death, then a toxicological analysis is run to establish the amount of toxic substances in the blood. "After that, they test whether the level of the toxicity was a fatal one," Pilin said, adding that producing a complete autopsy report takes about one month. 

Dr Pilin also said that only the doctors who have performed the autopsy and the police are allowed to see the report when it is ready, but if the case were to make it to court and the report were to become part of the investigation file, the attorney for the injured parties would also acquire access to the information. There is currently a debate underway abroad about the proportionality of interventions by police against persons experiencing psychotic episodes or those under the influence of alcohol and/or drugs. 

According to a study published this year in the journal Medicine, Science and the Law, persons who are kept on their bellies during arrest experience problems breathing and eventually also heart problems. In some states in the USA, police officers are specially trained to be able to handle such situations.