He Died Face Down: Was It Positional Asphyxia or Police Misconduct?
A restrained suspect dies face down—was it a tragic medical event or the result of excessive force? In this episode of Ten on Tactics, I dissect the controversial topic of positional asphyxia: what it is, how it occurs, and why courts and experts remain deeply divided. This legal breakdown explores real court cases, conflicting medical evidence, and the high-stakes legal implications for law enforcement.
7/20/20251 min read
When a suspect dies while handcuffed, face down, and struggling with police, the questions that follow are as urgent as they are complex: Was the restraint justified? Or did it cross the line into misconduct?
In our latest Ten on Tactics episode, we tackle one of the most contentious and misunderstood topics in law enforcement: positional asphyxia—also known as postural asphyxia. It’s a condition where the body’s position interferes with the ability to breathe, especially when someone is restrained in a prone position with pressure on their torso.
From a medical standpoint, positional asphyxia can be fatal, especially in individuals who are obese, intoxicated, or in a state of excited delirium. But proving that it was the actual cause of death is incredibly difficult. As the video outlines, there is no universal forensic marker for positional asphyxia. Many autopsies in these cases yield inconclusive or overlapping signs—making legal attribution a challenge.
We review real-world legal cases like Rodriguez v. City of Hampton, where the death was ruled a homicide due to asphyxia, and Lewis v. West Palm Beach, where the court found no clear evidence that prone restraint impaired breathing. These cases highlight the lack of consensus in both medicine and law.
What’s more, these deaths often occur during mental health calls or welfare checks, where suspects haven’t committed a crime. Courts increasingly expect officers to use de-escalation techniques first—and may scrutinize the use of force more harshly when the subject isn’t violent or fleeing.
In this breakdown, you’ll learn:
How positional asphyxia is defined and medically understood
Why experts often disagree on its role in in-custody deaths
The legal standards courts apply in civil rights and use-of-force cases
How officer training is evolving in response to these risks
At the core of this debate lies a haunting question: If the science is unclear and the law is divided, who decides what justice looks like?
