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A Matter of Restraint 

What an outside review of the Otto Zehm case should consider.

Two young women pull up to a drive-through ATM machine in a bank parking lot after dark one March evening, only to get a major fright when a large man walks between the ATM and the car. The man, who appears to have trouble speaking coherently, says something about $500 and reaches toward the open driver's side window, according to transcripts of Spokane Police interviews.

Roughly a half-hour later, the large man, identified as Otto Zehm, is on the floor of a nearby mini-mart, handcuffed and hogtied with a mask placed over his mouth and nose. He suddenly stops breathing after a fight that involved as many as seven police officers, who had been told he took money from the women at the ATM.

Zehm, it turns out, did no such thing. What happened during that intense half-hour that led to the death of the mentally disabled janitor, who has been described by nearly all who knew him as gentle and amiable? Zehm, who suffered from an undisclosed mental ailment, was also described as a good worker whose behavior had become increasingly erratic in the month before he died, apparently because he had stopped taking his medications.

Over the last four months, police and prosecutors have restricted information, issued wrong information and have had their actions second-guessed by an outraged community.

Mayor Dennis Hession hopes to address credibility questions with his recent call for an outside review of the matter. But there may be a larger credibility issue looming if the review does not address the manner in which Zehm was restrained and the use of a non-rebreather mask as a spit shield.

Research across the country into positional asphyxia -- or restraint asphyxia -- (sadly, deaths like Zehm's are not uncommon) seems a more likely place to probe for the cause of death than "excited delirium," which as yet has no real medical standing.

Here are a few points an outside review of Otto Zehm's death should consider:

Why did Spokane police and fire personnel appear to know so little about positional asphyxia issues during and after placing leg restraints on Zehm?

Large, often out-of-shape men suddenly dying in restraints after an extended fight with police is no secret and hasn't been for years. More than a decade ago, a study by Dr. Donald Reay of the King County medical examiner's office, showed the relation between suffocation and restraint in a prone position.

Despite years of evidence, research and discussion in places such as the International Chiefs of Police newsletter, officers left Zehm on his stomach with hands cuffed behind his back and attached by a strap to tightened leg restraints -- the classic hogtie position.

In statements to internal investigators, officers say Zehm kept rolling from his side to his stomach, yet the video shows little or no effort is made to herk Zehm back to a side position.

And then things got worse.

The mask: Can Fire Department EMTs give medical equipment to someone in another agency who intends an entirely different use for it?

In Zehm's case, the likelihood of prone-restraint breathing difficulties was compounded by a police decision to place a mask over his face as a spit shield.

The fire department EMTs told Spokane Police, according to transcripts, that Zehm was spitting a mix of blood and saliva and that it was "common practice" for EMTs to give police non-rebreather masks (sans the oxygen bag and tubing) to catch possibly infected spit.

Officer Erin Raleigh, who requested the mask, wrote in his report to Det. Terry Ferguson that it was in the event Zehm decided to spit, not that he was spitting.

The fire department also challenges the spit shield assumption and is investigating its own policies, which appear to have been ignored.

"The point of the whole investigation: Should a mask be used as a spit shield? Do we have a 'practice shift' between policy and what they do in the field?" says Brian Schaeffer, assistant chief of the Spokane Fire Department.

Charly Miller, an EMS educator and expert witness in restraint asphyxia cases, says in an e-mail, "Such an act is entirely inappropriate to national emergency medicine protocols and standards of care, unless 12 to 15 liters per minute of oxygen is running to the NRB mask!"

A non-rebreather is designed to work with an oxygen supply; the mask itself is too small to hold "a full breath" of air, she says. Without the oxygen hookup "... you can suffocate the patient."

"Even if the EMS types who responded didn't know better than to allow Otto to be kept on his stomach, they certainly were incredibly negligent to give the PD a NRB mask and allow it to be applied without oxygen running to it. ... Depending upon the information provided by case materials, it might be difficult to ascertain whether Otto was asphyxiated due to forceful-prone-restraint or due to NRB mask suffocation," she writes.

Was the transfer of information between 911 operators and police dispatchers appropriate?

There is a frustrating lack of time stamps and cross-linking of conversations on the audio of a 911 call made by the young women at the ATM and the printout of an "Incident History" dispatch log, both provided by police.

The two young women made strong initial statements to the 911 operator that they had been robbed.

Before entering the Zip-Trip to confront Zehm, Thompson specifically asked dispatchers "Just to confirm, he took her money."

"Affirm," a dispatcher replied.

A little while later a dispatcher says, "Now the complainant's advising she's not entirely positive that he did get her money." Where this comes from is unclear; there is no similarly worded declaration on the 911 audio.

Would Thompson's approach to Zehm have been different if there was doubt that a crime had occurred? Are there kinks to be ironed out in the way information gets from a caller to a dispatcher and then to an officer?

Did Officer Karl Thompson make the right tactical decisions during his initial contact with Zehm?

Much furor surrounds the surveillance tape that appears to show Zehm not holding a 2-liter Diet Pepsi bottle, as Thompson has claimed. Two things: The tape is so grainy and lurchy that it is likely inconclusive. And several witnesses who appear to have no reason to lie for police say they saw Zehm with a pop bottle or heard Thompson's orders to put a bottle down.

The bigger question is why Thompson chose to approach Zehm from behind with a drawn baton and then quickly go to a baton strike when Zehm turned around.

This may be as unfair as second-guessing someone who was charged by a bear in the woods, but there clearly deserves to be a discussion of what other approaches were available.

According to interview transcripts, the actions by the officers in the encounter were never challenged -- not even mildly -- during the department's internal investigation, which concluded they had committed no crimes.

The mask was used to prevent Zehm from spitting, but can you get HIV/AIDs from bloody spit?

"The risks are minimal," says Spokane Regional Health District HIV/AIDs supervisor Susan Sjoberg.

Saliva, with plenty of digestive acids, is not a great transmitter of the virus. Spokane County's most common exposure pathways are male-to-male sex (66 percent), male-to-male sex in conjunction with injected drug use (10 percent), injected drug use (9 percent) and heterosexual sex (7 percent).

Sjoberg says that "occupational exposures" -- police, EMTs, surgeons, ER nurses, boxing referees -- don't even show up as a percentage.

The mayor's call for review, as of Tuesday, had not cleared the city attorney's office.

"We support the mayor's decision on the outside review," says Teri Sloyer, an attorney at the nonprofit Center for Justice, which is representing Zehm's family. "What the Center wants is long-term, systemic change for more transparency and openness in the police department."

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