OKLAHOMA CITY, Okla. Milisha Thompson did not die from the toxic level of cocaine in her system.
The struggle she had with Oklahoma City police and the Taser shocks they delivered didn't kill her, either.
Instead, Thompson, 35 - a schizophrenic homeless woman who passed away in the back of an ambulance May 19 - died of all of the above. And then some.
Friday, the state medical examiner's office ruled Thompson's death accidental, saying she died of "excited delirium due to cocaine toxicity," a catchall term for a variety of symptoms known to lead to in-custody deaths.
"A good definition," said Kevin Rowland, chief investigator for the medical examiner, "is a person who is usually under the influence of a stimulant type drug such as cocaine, amphetamines or PCP that can cause them to experience delirium, psychosis (and) violent behavior toward self and others."
"They usually experience extraordinary strength, which is usually followed by a period of calm and quiet, then a sudden cardiac arrest. They do not respond to resuscitative efforts.
In an earlier interview, Thompson's husband, Marvell Thompson, blamed police for her death. He said officers used excessive force and killed "an innocent woman."
He could not be reached for comment Friday.
About 5:30 p.m. on May 19, police received word of illegal drug sales taking place outside the City Rescue Mission at 800 W California Ave.
Video evidence In a surveillance video released last month by police:
Milisha Thompson can be seen standing along the wall of the mission fidgeting with her wig while two officers talk to the alleged drug dealers. She appears to behave erratically - entering the mission, then emerging to sprint across the street toward the officers before turning away, knocking a man down and running at the officers again.
She grabs one by his body armor, breaking his necklace, and both officers take her to the ground and handcuff her. During the struggle, the officers zap her at least twice with the Taser, a device that disrupts muscular function by means of electrical current.
According to witnesses, Milisha Thompson lost consciousness a short time later. Attempts to revive her were unsuccessful, and she died en route to a hospital.
Controversial diagnosis In other cases, Amnesty International and the American Civil Liberties Union have taken issue with the "excited delirium" diagnosis, saying the term is not used by medical or psychological professionals and implying it is a made-up condition designed to protect police and the Taser industry.
The American Medical Association hasn't taken a side. Officials there say they don't know if it's real or not; they haven't formed a policy on it.
But police and medical examiners across the country have taken to the term. Last year, a nationally recognized forensic pathologist, Vincent DiMaio, co-authored a book on the condition. And Oklahoma City police Sgt. Rob High, who teaches uses of force at the police academy, said he's heard medical doctors lecture on the subject.
Much of the controversy centers on how dangerous Tasers are and what role they play in in-custody deaths.
Taser use defended Steve Tuttle, spokesman for Taser International, insists the devices are safe, especially compared with other use-of-force options available to police.
"The day that I want my kid to have a baton smashed over his head compared to a 5-second Taser application is a cold day in hell," he said.
Tuttle said Tasers have been found to be a "possible contributing factor" in several deaths, but have never been named a cause of death. The company has never lost a lawsuit, he said.
"We don't have a Taser problem," Tuttle said. "We have a serious drug problem in the U.S., given the number of people who are overdosing."
In this case, at least, drugs likely played a significant role.
Drug use cited In a document filed in Oklahoma County District Court, police said "Milisha Thompson was using drugs for approximately three days prior to this incident occurring. We were also advised Milisha was a resident at the City Rescue Mission and during her two-year stay, she has been kicked out of the mission several times for drug use and behavior problems."
Rowland said she had so much cocaine in her system that if she had simply been found dead, her death would have been attributed to an overdose.