[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Forensic medicine](https://durgical.com/en/forensic-medicine/) › [Thanatology](https://durgical.com/en/forensic-medicine/areas/thanatology/) › Deaths in custody and during restraint # Deaths in custody and during restraint - Topic Every death of a person in State custody needs an independent investigation and a full medico-legal autopsy, even if it looks natural. Updated Nov 13, 2026 ## Key points - Death in custody (prison, police, arrest, transfer, closed institution): always a full medico-legal autopsy. - Minnesota Protocol: the State is presumed responsible for people who die in its custody. - Face-down restraint with agitation and stimulants: severe acidosis and cardiac arrest; the exact mechanism is debated. - A death that looks natural or like suicide still has to be investigated independently. - Decree 786 of 1990, art. 7(a): autopsies of people in the custody of an official authority are singled out. ## What it is A death in custody is the death of a person deprived of liberty or under the control of an authority: in a prison or police station, during arrest or transfer, or in institutions where the State exercises heightened control, such as psychiatric hospitals and care homes for children or older people. Causes range from natural disease and suicide to poisoning, injuries and deaths during physical restraint. Because of the control the State has over that person, the Minnesota Protocol sets a general presumption of State responsibility and requires a prompt, independent and impartial investigation. In Colombia, Decree 786 of 1990 singles out these deaths among the mandatory medico-legal autopsies. The exact mechanism of deaths during face-down restraint, often with extreme agitation and stimulant use, is still debated. ## Key facts - Groups of causes: natural disease, suicide (mostly by hanging), intoxication or withdrawal, injuries and restraint-associated deaths. - In face-down restraint, weight on the back and the posture limit breathing and venous return in a person with a very high metabolic demand. - Forensic series describe profound metabolic and respiratory acidosis in arrests during restraint, and stimulant use in most cases. - «Excited delirium» is a disputed cause of death: it describes a state but does not by itself explain the outcome. - No external injuries does not rule out violence: layer-by-layer dissection looks for deep bruising. - For the Minnesota Protocol, psychiatric hospitals and institutions for children, older people or migrants are also places of custody. ## Next step: what to do and document - If you treat a person in custody who dies or arrives without signs of life, do not issue a natural-death certificate: inform the Fiscalía at once for the inspection and the medico-legal autopsy. - Record in the medical record the time of arrival, who brought the person, the condition on arrival, the procedures done and what the escorts said, in their words. - Describe every injury, including handcuff or ligature marks, and do not let custodians be present at the examination or influence what you write. - Keep clothing, belongings and blood and urine samples under chain of custody, and request toxicology. - Ask for recordings to be preserved and record how long the restraint lasted, who took part and what drugs were given. ## Legal framework in Colombia - Decree 786 of 1990, art. 7(a): among mandatory autopsies, those of people in custody carried out or ordered by an official authority are singled out, such as prisoners or people in the care of protection bodies (compiled in Decree 780 of 2016, art. 2.8.9.7). - Decree 786 of 1990, art. 8, paragraph 1: if the death occurs in a health facility, the doctor hands the medical record to the director at once, because it is evidence and must be kept safe. - Minnesota Protocol (United Nations, 2016), para. 17: a death in custody is reported without delay to a judicial authority independent of the detaining authority. - Official text checked on 2026-11-13 at funcionpublica.gov.co. ## Test yourself Think of the answer, then tap the question to see it. ## What autopsy is needed for a person who dies in a police station, even if the death looks natural? A full medico-legal autopsy ordered by the authority; Decree 786 of 1990 singles out deaths in custody among the mandatory ones. ## Why does the Minnesota Protocol presume State responsibility for deaths in custody? Because the State controls the life of the person it detains; it must explain the death and investigate it promptly, independently and impartially. ## Which factors combine in cardiac arrests during face-down restraint? Extreme agitation and exertion, often with stimulants, causing severe acidosis, and a posture with weight on the back that limits breathing and venous return. ## Does the absence of external injuries rule out violence in a death in custody? No. The back, limbs and wrists must be dissected layer by layer to look for deep bruising, and toxicology and circumstances must be assessed. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/forensic-medicine/deaths-in-custody-and-during-restraint/) ## Elsewhere in DurgiPedia - [Mandatory reporting: public health, violence and abuse](https://durgical.com/en/medical-ethics/mandatory-reporting-public-health-violence-and-abuse/) - [Physical restraints: a last resort and their safe use](https://durgical.com/en/nursing/physical-restraints-a-last-resort-and-their-safe-use/) ## Connections ## Related 5 - [The Minnesota Protocol: investigating potentially unlawful deaths](https://durgical.com/en/forensic-medicine/the-minnesota-protocol-investigating-potentially-unlawful-deaths/) - [Examining detainees and documenting torture (Istanbul Protocol)](https://durgical.com/en/forensic-medicine/examining-detainees-and-documenting-torture/) - [Traumatic and positional asphyxia](https://durgical.com/en/forensic-medicine/traumatic-and-positional-asphyxia/) - [The medico-legal autopsy: when it is mandatory in Colombia](https://durgical.com/en/forensic-medicine/the-medico-legal-autopsy-when-it-is-mandatory-in-colombia/) - [Cause, mechanism and manner of death](https://durgical.com/en/forensic-medicine/cause-mechanism-and-manner-of-death/) ## Related conditions 3 - [Acute alcohol (ethanol) intoxication](https://durgical.com/en/conditions/acute-alcohol-intoxication/) - [Cocaine and sympathomimetic toxicity](https://durgical.com/en/conditions/cocaine-and-sympathomimetic-toxicity/) - [Suicidal behaviour and suicide risk](https://durgical.com/en/conditions/suicidal-behaviour-and-suicide-risk/) [← All of forensic medicine](https://durgical.com/en/forensic-medicine/) Educational content on forensic and legal medicine; not legal advice and no substitute for the technical guides of Colombia's National Institute of Legal Medicine and Forensic Sciences. Laws change: each page links the official text and says when it was last checked. For a real case, follow the guide in force and ask the competent authority. Sources: [Decreto 786 de 1990: autopsias clínicas y médico-legales y viscerotomías (compilado en el Decreto 780 de 2016)](https://www.funcionpublica.gov.co/eva/gestornormativo/norma.php?i=168508) (Función Pública, Gestor Normativo, 1990); [The Minnesota Protocol on the Investigation of Potentially Unlawful Death (2016)](https://www.ohchr.org/sites/default/files/Documents/Publications/MinnesotaProtocol.pdf) (Office of the United Nations High Commissioner for Human Rights (OHCHR), 2017); [Prone restraint cardiac arrest in in-custody and arrest-related deaths](https://pmc.ncbi.nlm.nih.gov/articles/PMC9546229/) (Journal of Forensic Sciences (PMC), 2022); [Incidents of sudden death during restraint of agitated individuals in Sweden between 1992 and 2024](https://pmc.ncbi.nlm.nih.gov/articles/PMC12967712/) (Journal of Forensic Sciences (PMC), 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/forensic-medicine/deaths-in-custody-and-during-restraint/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/forensic-medicine/deaths-in-custody-and-during-restraint/