The Preventable Death of Ethan Saylor

My topic over the years has been social incompetence, particularly—but not exclusively—in vulnerable populations. Social incompetence can be defined in various ways, but one of them is “behavior towards others which results in unwanted social or physical consequences.” Recently, I have focused on a specific form of social incompetence, which I term “socially foolish action.” That can be defined as “behavior in a social context which ignores or fails to recognize serious risks that could have been foreseen.” A common form of social foolishness is gullibility (susceptibility to being duped), about which I wrote a 2009 book, “Annals of Gullibility.”

But social foolishness comes in many varieties besides failure to recognize or resist someone else’s malign or manipulative agenda. While social incompetence is typically thought of as residing in a particular person, sometimes it occurs as a result of the intersection of incompetent decisions made by two or more parties. The case described below, which resulted in the tragic death in January 2013 of Ethan Saylor, is an example of this latter phenomenon, although most of the public uproar has understandably been directed at the police officers who used the physical force that turned out to be the proximal cause of Ethan’s death.

Mr. Saylor, who at five foot six weighed nearly 300 pounds, was a 26 year-old man with Down Syndrome (DS), a chromosomal disorder which is a major cause of Intellectual Disability (ID, until recently known as Mental Retardation, or MR). People with DS typically have IQs in the 50’s or low 60’s (the usual ceiling for defining ID is 70-75), but Ethan’s IQ reputedly was around 40. This means that he was even more cognitively impaired than the average person with DS. As with all people with DS, Ethan had a recognizable pattern of facial features, a pattern which in earlier and crueler times caused people with DS to be termed “mongoloid.” Unlike the popular (but over-stated) stereotype of people with DS as uniformly placid, cheerful, and compliant, Ethan was described by his family as very friendly and loveable but also stubborn and prone to anger outbursts. However, like all people with DS (and for that matter, all people with ID), Ethan lacked the judgment to know what to do (and to recognize the risks) in a novel social situation such as the one that occurred in January 2013 in Frederick Maryland, a city of 65,000 located about 50 miles west of Baltimore and an equal distance northwest of Washington, DC.

The Facts, as Generally Known

All of the facts of the incident have not been publicly divulged, because of legal actions, and there are conflicting reports on some details. The basic story goes as follows. Ethan lived with his family, but he received supportive services including being taken on outings by aides. One day an 18-year-old female personal care worker who had been working with Ethan for three months accompanied him to the Regal cinema, located in the Westview Promenade shopping center. The film they watched was Zero Dark Thirty, about the pursuit and capture in Pakistan of Osama Bin Laden. I would have thought such a movie beyond the comprehension level of someone with Ethan’s IQ level, but presumably he enjoyed the non-stop nature of the action. Ethan (who reportedly always sat in the same seat in that theater) liked the film so much that he wanted to stay for another showing.

Here reports differ somewhat but it appears that Ethan (who had already had at least one other angry outburst that day) announced outside the theater that he did not want to leave. The worker was unable to get him to change his mind, so she apparently made two calls asking for advice, with Ethan’s mother telling her to wait him out while her agency supervisor gave the (to my mind, very bad) advice to leave him waiting outside the theater while she went to get the car. While the aide was away, Ethan re-entered the theater, intending to see the film again.

What happened next is that the theater manager told Ethan that he needed to either leave or purchase another ticket (variously described as costing $10 or $12). Ethan did not have any money on him, but Ethan’s mom Patti indicated in a recent speech that he tried making a cell phone call in an effort to figure out how to raise the cash. At some point, the theater manager called in mall security guards to eject Ethan from the theater. Three officers responded, all of them moonlighting Sheriff Deputies (one of them a lieutenant), who were not wearing their police uniforms. (Ethan idolized cops and would sometimes call 911 in an effort to chat). The young aide was not allowed back into the theater but she was overheard screaming that Ethan had Down Syndrome and that he hated to be touched. An officer apparently put his hands on Ethan and he responded by resisting both physically and verbally.

The autopsy noted various injuries on Ethan’s body, suggesting that substantial force was used. Among these were marks on his wrists, a result of his being cuffed behind his back (three linked sets of cuffs were used, apparently because of his obesity). A witness reported that Ethan was lying on the ground on his stomach while an officer was seen putting his knee on the young man’s back. Ethan was heard calling out words along the lines of “I want my mommy.” A fractured cartilage in Ethan’s larynx is an unusual injury that strongly indicates that a choke hold had been used. Rather quickly, Ethan stopped breathing and when this fact was pointed out by a bystander, the deputies initiated CPR and called paramedics. According to a report by the office of the Maryland Medical Examiner, the death was classified a homicide (defined as a death that would not have occurred except for the action of one or more people) and the cause of death was asphyxiation, with Ethan’s obesity and a cardiac condition likely contributing to the quickness with which he expired.

Aftermath of Ethan’s Death

Not surprisingly, this incident received intense news coverage in Maryland, but has also become a cause célèbre nationally among disability advocates, and especially within the Down Syndrome parent community. An ensuing internal police investigation cleared the officers of wrongdoing and a Grand Jury chose not to indict them for any crime. The U.S. Justice Department announced it is investigating to see if Ethan’s civil rights had been violated. Ethan’s family has filed a civil wrongful death lawsuit against the theater, the three officers, and the County. The family has asserted that the main motivation behind their lawsuit is to force the full facts of the incident to be divulged. Daniel Karp, an attorney in Baltimore who is representing the defendants, described the lawsuit as “the familiar hyperbole of a plaintiff that is suing for money.” I predict that Mr. Karp will learn, if he has not already, that attacking the bereaved parents of a man with Down Syndrome, who would still be alive but for the actions of his clients, is not a wise public relations move.

The Governor of Maryland, Martin O’Malley, met with Ethan’s parents and expressed deep concern about the incident, although he resisted their request for an independent state investigation. However, he did announce the appointment of a “Commission for Effective Community Inclusion of Individuals with Intellectual and Developmental Disabilities,” to be chaired by Dr. Timothy Shriver, a Maryland resident who is CEO of Special Olympics International. In spite of the broad title for this Commission, the Governor indicated that his main reason for establishing it was to bring about uniform training for police officers and other first responders regarding how to deal effectively in the future with challenging situations involving individuals with developmental disabilities.

Caregiving Essential Reads

How Couples Split Chores and Caretaking During COVID

What to Know About Being a Caregiver

Complexities Facing the Governor’s Commission

At first glance, the Commission’s task seems pretty straightforward, but on closer examination, the task is not so simple. To me there are three levels of complexity here: (a) how and when a responder is supposed to determine whether someone qualifies as a person with a developmental disability, (b) where one draws the line between offenses when potentially dangerous force is justified, regardless of whether someone has an apparent disability, and (c) whether training (and what kind of training) should also be offered to caregivers who sometimes are faced with similar situations or who, as in this case, might have been able to prevent the police becoming involved in the first place.

Determining Who has a Developmental Disability

One thing that is particularly shocking about the Ethan Saylor incident is that with his obvious facial features and clearly impaired speech, behavior and intellect, he might as well have been wearing a sign around his neck saying “I have Down Syndrome and have ID, so please handle me with kindness.” It is difficult to believe that the deputies (not to mention the theater manager who called them in) did not know that Mr. Saylor had DS or that they did not possess some rudimentary understanding of what that meant, but I suppose it is possible. In most cases, I believe that people with DS who are acting out will be treated more compassionately by first responders than is true of people with ID who are not as immediately identifiable as are people with DS. I do not know of any research to support that belief, but I am not aware of any other instance where someone with DS died as a result of excessive police force. Such outcomes happen routinely (usually without attracting much media interest), however, where the target of the police response has a more hidden form of impairment.

There is a natural tendency within disability advocacy groups to focus on individuals who possess the same disability label as their family member or clients and that has been the case here. Thus, the Down Syndrome Congress (a parent group) and the Down Syndrome Society (a professional group), not to mention Ethan’s family, have all issued public calls to action to ensure that no person with DS ever again suffers the same fate as Ethan. The problem, of course, is that DS makes up less than five percent of the population of people with ID (which has several hundred known possible causes), and in the vast majority of cases of ID there are no obvious external signs of disability and it usually takes a little time (certainly longer than one has in a police confrontation, where it is not uncommon for “normal” people to be agitated) before an individual’s limitations become apparent.

A recent trend in the ID field has been to expand the estimated size of the affected population, by increasing the IQ ceiling from 70 (the bottom two percent of the population) to 75 (the bottom five percent of the population) and by giving more diagnostic weight to “adaptive behavior” (how people actually function in the world). Furthermore, in most states, ID is part of a broader category of “Developmental Disabilities” (DD), which includes other forms of impairment such as Autism Spectrum Disorder (ASD), 60% of whom do not have IQs low enough to qualify as ID. Individuals within the broader DD population who do not quite qualify as having ID (such as the majority of individuals with ASD) have social incompetence tendencies which could make them almost as socially risk-unaware as Ethan Saylor. However, unlike Ethan, they do not have the outward signs of disability which might (but in his case did not) cause responders to adopt a non-coercive approach. What I am suggesting is that the Governor’s Commission needs to focus its efforts not on particular disability labels but on behaviors and behavior signs that are found in a much broader population of vulnerable people (including the mentally ill as well as intoxicated young people) who have a higher likelihood of behaving in a non-compliant or challenging manner towards first responders.

When is Force Justified?

A frequent question asked by critics of the police action in this case, is “how can anyone justify using deadly force over a measly movie ticket?” There are two implied preferred actions which go along with such a comment. The first implied preferred action, which assumes that Ethan’s disability was recognized and taken into account, is that he should have been allowed to stay put at least temporarily, until a parent or caregiver showed up to resolve the problem. The second implied preferred action, which assumes neither awareness of disability nor tolerance of non-payment, is that communicative rather than physical means should have been used to bring about compliance. Unfortunately, we do not know at this point whether and to what extent the officers tried to reason with Ethan but one can assume they did not do it for very long or (judging by the escalation to violence) very effectively.

Those who complain about the use of force for not paying for a movie ticket are missing the point that force was used because Ethan did not comply with the order to vacate the theater (resisting a police officer could be a crime) and, apparently, for striking out at the officers after one of them put his hands on him (attacking a police officer is definitely a crime, although Ethan likely lacked the rational intent to have ever been charged). Grand Jury proceedings are secret, but I will bet my house that the reason why none of the deputies was indicted or punished is that the jury as well as the department believed that the deputies were defending themselves against assaultive behavior by Ethan. He was a 300-pound man and one can assume he could do some damage if one of his punches or kicks connected. Still, whether or not one believes that the officers committed a crime, there is little doubt (at least in my mind) that the officers did not deal with the situation in a competent manner.

Remember that I defined social incompetence as behavior which results in unwanted but forseeable consequences. Surely, none of the officers wanted Ethan to die, none of them wanted to be sued for a lot of money, none of them wanted to bring their department into international disrepute, and none of them wanted to face a lifetime of scorn and (one would hope) feeling guilty. Yet those four outcomes, which might have been foreseen when one of them put Ethan in a chokehold so strong that it fractured his larynx, have all taken place.

Whatever the tolerance level that police departments have for using potentially deadly force (and apparently the tolerance level is fairly high in the Frederick County Sherrif’s department), one would like to think that are other departments and officers, including within the Frederick department, who would view the behavior of the three officers in this case as unprofessional. It was unprofessional because police officers, along with other professionals (such as therapists), are paid to accept a certain amount of abuse without responding in kind. They are also being paid to recognize when a subject is in an unstable state, and to practice responses intended to calm rather than inflame. Unfortunately, neither of those hallmarks of professionalism were demonstrated in this case.

What Can Be Learned from This Incident?

The death of Ethan Saylor resulted from a “perfect storm” of collective foolish (risk-unaware) behavior by three parties: (a) the police officers and the theater manager (who I am sure now wishes he had not called in the security guards/ police) who failed to appreciate the extent of Ethan’s limitations, and responded too quickly with force, (b) Ethan himself, who lacked the social intelligence to understand that resisting police while striking out at them can be a very dangerous thing to do, and (c) the young caregiver who by leaving Ethan alone, inadvertently put him in harm’s way and failed in her responsibility to serve as a buffer between a very brain-impaired young man and a complex social situation he lacked the ability to navigate on his own. Risk-awareness certainly contributed to the behavior of all three parties: in Ethan, by not understanding that saying “no” to a cop (and it is possible he did not even know the security guards were real cops) could get one arrested or killed; in the deputies (who, as mentioned, did not understand that by assaulting Ethan they were putting their careers, and even their freedom, at risk); and in the caregiver, who lacked the experience or wisdom (which one can define as advanced risk-awareness), to resist the terrible advice to leave Ethan alone while she went to get her car.

As in most cases of foolish behavior, emotion entered into the picture, and when that happens, judgment tends to suffer. For Ethan, judgment was impaired even in the absence of emotion, but here the emotion reflected his blind insistence on seeing the movie a second time and his knee-jerk angry response to being touched. For the caregiver, the emotion was frustration at being unable to get Ethan to leave and, presumably, a strong desire to resolve the stand-off. For the deputies, we do not know the role played by each of the three individuals, but most likely only someone in a very angry state would apply pressure sufficient to fracture a bone in a person’s neck. Police officers tend, as a rule, to impose their will physically on individuals who do not immediately follow their commands, and the level of coercion escalates substantially when someone strikes out at them. At this time, we do not know how angry or excited the individual deputies were, but it is safe to assume that through his words and deeds, Ethan activated an automatic coercive schema in one or more of the officers that involved a fair degree of annoyance. As mentioned above, truly professional officers would, in my judgment, have responded in a calmer and more “clinical” manner, especially once they recognized that they were dealing with a person with significant special needs.

It is not my desire to beat up on an 18-year-old caregiver who, most likely, will live with her role in this tragedy for the rest of her life. But one wishes she (and also the deputies) had been coached in the communicative skills needed to influence someone with stubborn fixation issues. In my 2012 book Elements of Discipline, I present a scenario similar to the one posed by Ethan, in which a child stubbornly insisted that adults bend to his will, and started to throw a tantrum when they did not immediately comply. Trying to head off those adults who would use force (thus escalating the situation and teaching that might makes right) and those adults who would cave in (thus teaching the child that emotional blackmail works) I used what has been termed “machine gun reflection” in which I rapidly asked a string of affective questions (“you really want to do this?” etc.) followed by a limit phrased as an “I-message” (“but the rule here is x because y”), followed by another reflective message about how the child felt about the imposed limit. Such an affectively-based method might not have worked as well with Ethan, but if skillfully applied I am pretty sure it would have quickly defused the situation (as it did in the case described in my book).

At one time, it was not uncommon for direct service workers in group homes, sheltered workshops or other ID facilities to use coercive methods (including, believe it or not, cattle prods) to impose their will on clients, even for the most minor (and sometimes non-existent) of offenses. In his book Gentle Teaching, John McGee showed how positive methods—involving respect for the individual, negotiation, and most importantly a literal “turning of the other cheek” (tolerance) in the face of aggressive outbursts—could resolve most situations peacefully and help clients to become more competent. Today, fortunately, physically coercive methods are not as commonly used in the ID field as they were formerly, but I do not believe that affective communicative skills are any more likely to be taught to direct care workers than they are to police officers or other first responders. If there is any lesson to be learned from this tragic case, it is that the first instinct of first responders, as well as direct care staff, when dealing with immature behavior exhibited by brain-impaired people like Ethan Saylor, is tolerance combined with gentle insistence involving negotiation, both done in a spirit of love and attempt to understand the individual and help him or her to regain self-control.

---

Copyright Stephen Greenspan