What Does ‘Undetermined’ Mean?

Medical experts weigh in on the manner of Landon Payne’s death

Lane County Medical Examiner Daniel Davis performed an autopsy on Landon Payne on April 3, 2020. When he wrote his report, Davis ruled the cause of Payne’s death was a lack of oxygen to his brain due to cardiac arrest “during restraint by law enforcement.”

He then had to determine the manner of death, a finding that describes the events that brought about the cause of death. The standard choices are natural causes, accident, suicide, homicide or undetermined.

Payne’s death was clearly not a suicide or “natural” death. Davis had concluded police restraint had contributed to the cause of death. So the ruling for manner of death narrowed to accident, homicide or undetermined.

Davis chose “undetermined.” His ruling was important: A finding of “homicide” would have triggered an independent criminal investigation into Payne’s death.

EW provided three independent medical experts Davis’ report. Dr. Priya Banerjee, a board-certified forensic pathologist in Rhode Island, tells EW it’s not clear how Davis arrived at his finding of “undetermined.”

Banerjee says a medical examiner should strongly consider homicide as the manner of death in a case when the person dies while being restrained by police.

“If the police restraint is thought to have caused his death, then that would qualify as death at the hands of others,” Banerjee says.

Homicide as a manner of death, according to the National Association of Medical Examiners, “occurs when death results from a volitional act committed by another person to cause fear, harm, or death.” Intent to cause death is not required for a homicide ruling, nor does it mean the homicide was a criminal act.

Dr. Alfredo Walker, a forensic pathologist in Ottawa, Canada, says he believes Davis made what he considered the “safest” ruling.

Walker examined the video of sheriff deputies restraining Payne. He said that making a finding on manner of death would be difficult “no matter which side someone falls on. Any group of pathologists would be evenly distributed across those options.”

The national guidelines call on the medical examiner to consider what would have happened if the person had not been restrained by police.

“Would he have died right at that point in time had he not been restrained? Most likely not,” Walker said. “But what percentage contribution to his death was played by the restraint, that’s anybody’s call.”

Alon Steinberg, a cardiologist in Ventura, California, says he believes the deputies’ use of restraints “100 percent” contributed to Payne’s death.

Steinberg describes it as a “death from prone restraint in an agitated subject” — specifically from what he defined as “prone restraint cardiac arrest.”

“They were very careful on the examiner report almost never to use the word ‘prone,’ or that he was placed on his stomach, or anything like that,” Steinberg says. “I never know whether law enforcement officers are aware of the dangers of prone restraint or not. I think most often they just forget their training.”

Steinberg says some police textbooks point to medical evidence that restraining some people on their stomach can be safe. But police training often points to the risks.

Steinberg says in the cases he has reviewed involving prone restraint deaths, the death was usually not intentional by the law enforcement officers, “but they should know better.”

“This happens all the time, all over the country,” Steinberg adds. “The cops are putting these people in a prone position. And I’m not saying everyone dies, but there’s a small percentage of people who are vulnerable and at risk of dying. They die, and police blame other causes. We’re going to continue seeing cases like this, unfortunately.”

Steinberg says a medical examiner should ask if it was just random that Payne had cardiac arrest while being restrained.

“And the answer is, of course, it’s not. I would like to see that one. Prone restraint again was involved and contributed to death.”

This story was developed as part of the Catalyst Journalism Project at the University of Oregon School of Journalism and Communication. Catalyst brings together investigative reporting and solutions journalism to spark action and response to Oregon’s most perplexing issues. To learn more visit Journalism.UOregon.edu/Catalyst or follow the project on Twitter @UO_catalyst.

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