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Despite Decades of Warnings, People Are Still Dying After Police Hold Them Face Down

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Karen Sutherland stands in Park View Cemetery, where her son Shayne is buried, in Manteca, San Joaquin County, on Feb. 24, 2024. (Beth LaBerge/KQED)


n a Thursday morning in October 2020, less than five months after George Floyd was held on his stomach by Minneapolis police until he died, Shayne Sutherland called 911 from a convenience store in Stockton, California, and asked for a taxi.

When the operator told Sutherland he’d dialed 911, he said someone was trying to rob him.

Stockton Police Officers Ronald Zalunardo and John Afanasiev arrived at the store about 15 minutes later. In the meantime, a store employee had called 911, saying Sutherland was threatening him with a wine bottle.

In body camera footage that captured the officers’ response, Sutherland seems fidgety, and his speech is difficult to understand at times, but he doesn’t appear violent, and he isn’t armed. He cooperates with police, addressing Zalunardo as “sir” and sitting against a wall outside the store as instructed.

The officers question Sutherland. When he tells them he can’t remember why he’s under court supervision, Afanasiev says, “The drugs probably have something to do with it.”

“How long you been using meth,” Zalnunardo asks. Sutherland stutters and says he’s been using cocaine.

Sutherland briefly stands, then sits when ordered to do so. A minute later, he stands up again. This time, the officers tackle him to the ground and hold him belly-down — a position known as prone restraint. Thirty seconds later, his hands are cuffed behind his back.

That could have been the end of the encounter. Experts say prone restraint can be a safe, effective way to subdue someone and get them into handcuffs — so long as they’re quickly placed in a “recovery position” on their side or in a seated position to allow them to breathe more easily.


But Zalunardo and Afanasiev didn’t do that. The body camera footage shows them holding Sutherland belly-down for more than eight minutes. For nearly half that time, Afanasiev lays across Sutherland’s back. Sutherland panics, alternating between moaning and screaming for help as Zalunardo, who uses his baton and body weight to help keep Sutherland’s shoulder down, repeatedly tells him, “Relax!”

“Please let me breathe,” Sutherland begs, his voice barely decipherable. In between shrieks and gasps, he calls out, “Mom!” He begs for help. “Please let me live.”

Before the officers notice that he’s turning colors and losing consciousness, Sutherland, his mouth bloody from being slammed and scraped against the ground, sputters: “I’m f—ing dead.”

Another five-and-half minutes pass before officers roll Sutherland onto his side and begin to render aid.

Sutherland was declared dead 47 minutes later at a hospital.

Exclusive findings: ‘It’s deeply concerning’

As far back as the 1990s, medical experts and law enforcement officials have been aware of the dangers of prone restraint. A number of organizations and law enforcement agencies, including the U.S. Department of Justice, the Chicago Police Department and the New Orleans Police Department, warned officers of these dangers and advised them on how to minimize risks.

Many training manuals have since been updated to address the risks of prone restraint and the importance of using the recovery position. Ohio State Police officers are forbidden from using prone restraint. A Nevada law forbids the practice. In California, a law that became effective in 2022, AB 490, bans any maneuvers that put people at risk of being unable to breathe due to the position of their body, or positional asphyxia, a common cause of death in prone restraint cases.

But a new review of law enforcement data shows that, despite growing awareness of the dangers of prone restraint, in California, the problem is pervasive. After the passage of AB 71 in 2015, California began tracking data about when people died after police use of force. Between 2016 and 2022, at least 22 people have died in the state after being restrained stomach-down by law enforcement officers, according to a new analysis of currently available state use-of-force data by the California Reporting Project, The California Newsroom and The Guardian. Our examination also included police reports, death investigations, district attorney reviews, body-worn camera footage, 911 calls and lawsuits.

Read more on how we reported this story

Other key findings:

  • Nineteen of the 22 people who died following prone restraint tested positive for meth.
  • Five died after May 2020, when Minneapolis police murdered George Floyd.
  • Two of those people died after AB 490 went into effect.
  • All 22 cases involved people in crisis — either struggling with addiction, mental illness or otherwise behaving erratically.
  • Almost half of those who died were Latino, followed by white people — a trend that reflects larger use-of-force data in California.
  • Two of those who died were armed, but not with guns.

“We really shouldn’t have any of these deaths,” said Seth W. Stoughton, a former police officer in Tallahassee, Florida, who teaches criminal law and procedure at the University of South Carolina’s Joseph F. Rice School of Law. “Any time there’s prolonged prone restraint, something’s going wrong. It should not happen.”

“My general disgust [is] that we’re still having to talk about this,” he said. ”It’s a little depressing that we’re coming up on 30 years of making the same mistake over and over again. That’s really frustrating.”

“It’s deeply concerning to learn about the deaths of individuals in California due to positional asphyxia, even after it was banned by AB 490,” wrote California Assemblymember Mike Gipson, who was the primary author of the bill, in an emailed response to the findings. “These incidents underscore the urgent need for comprehensive training and accountability measures within law enforcement agencies.”

Others who have died following prone restraint by California police officers between 2016 and 2022 include:

  • Isabel De La Torre, died on March 26, 2022, after her partner, who was five months pregnant, called 911 in Clovis, California, because she believed De La Torre was unconscious, according to official records and court documents. When De La Torre awoke, her partner hung up the phone, but Clovis police officers responded anyway. De La Torre tried to turn the officers away, hiding in a bathroom, writhing and screaming, allegedly holding a knife. When she came out of the room, officers ordered a police dog to bite her, bringing her to the ground, where officers handcuffed her and held her in the prone position for more than three minutes. She died of positional and compressional asphyxia due to prone restraint, according to the Fresno County Sheriff-Coroner. Her family sued the department for wrongful death and is set to receive a $1.9 million settlement.
  • Mario Gonzalez, who died on April 19, 2021, in Alameda, California. When police responded to a call about a man sitting in a park and talking to himself, officials said they found Gonzalez so intoxicated he couldn’t speak in full sentences. He refused to take his hands out of his pockets, according to official reports, leading two officers to hold him down on his stomach while another held his legs. Body camera footage of the incident shows officers repeatedly telling each other not to put too much force on him, but they continued to hold him prone after he was handcuffed. He died of the “toxic effects of methamphetamine” after suffering a cardiopulmonary arrest, according to the Alameda County Coroner’s Bureau. His family sued the city of Alameda, the officers involved in Gonzalez’s death and the police chief at the time and won a settlement of $11 million. In 2023, the Alameda County district attorney reopened her office’s investigation into whether the officers acted criminally.
  • Edward Bronstein, who died on March 31, 2020, in Altadena, near Los Angeles. California Highway Patrol officers had detained Bronstein in an L.A. County station on suspicion of driving under the influence. When Bronstein declined to give a blood sample, officers forced him face down onto a mat, at which point he said, “I’ll do it willingly,” a video of the incident shows. An officer can be heard saying, “It’s too late.” Five officers continued to pin Bronstein to the ground. As they drew blood, Bronstein screamed, “I can’t breathe” and “Let me breathe” multiple times before his breathing and pulse stopped. Officers performed CPR to no avail. In 2023, the Los Angeles County district attorney charged a CHP sergeant, six officers and a nurse with involuntary manslaughter and assault under the color of authority. His family was awarded a $24 million settlement in a civil wrongful death suit.

And there may be more deaths beyond the 22 we found. While the state receives data from law enforcement agencies for deaths that occur after police use of force, it isn’t necessarily complete. That’s because agencies don’t always submit data to the state as they’re required to do, or data is otherwise excluded from the state’s use-of-force database. For example, Angelo Quinto died in 2020 after Antioch police officers held him prone, but his case is not in the database. Gipson, the assemblymember, said Quinto’s death was the impetus for the new legislation.

Despite the passage of AB 490, training manuals for the Antioch Police Department, Stanislaus County Sheriff’s Department and the Sonoma County Sheriff’s Department say that positional asphyxia is “the subject of debate among experts and medical professionals.”

Karen Sutherland sits by her son Shayne’s gravesite at the Park View Cemetery in Manteca, San Joaquin County, on Feb. 24, 2024. (Beth LaBerge/KQED)

The science of prone restraint: ‘You’re just watching a preventable death’

When a person is lying prone on a hard surface, their chest cavity is compressed and breathing becomes difficult, especially when their hands are cuffed behind their backs. Add the body weight of one or more police officers, and compression increases, restricting the movement of the ribcage and diaphragm, which are vital for the inhalation of oxygen and exhalation of carbon dioxide. The lack of proper ventilation puts stress on many parts of the body, including the heart, as noted in a 2002 study by Disability Rights California.

The warnings go even further back. In a 1995 bulletin (PDF), the U.S. Department of Justice cautioned law enforcement officers about the deadliness of positional asphyxia. “As soon as the suspect is handcuffed, get him off his stomach,” it reads.

The bulletin  outlines how subjects on drugs are at higher risk of death in the position, noting that “cocaine-induced bizarre or frenzied behavior… may increase a subject’s susceptibility to sudden death by effecting an increase of the heart rate to a critical level.” It also said that “drugs and/or alcohol” pose a “major risk factor” because “subjects may not realize they are suffocating.”

The bulletin explains that suspects restrained in a prone position often appear to be resisting officers when, in fact, they’re fighting, perhaps involuntarily, to get oxygen and carbon dioxide in and out of their bodies as their chest is squeezed. As the memo reads: “The individual experiences increased difficulty breathing. The natural reaction to oxygen deficiency occurs — the person struggles more violently. The officer applies more compression to subdue the individual.”

“It’s horrible because you’re just watching a preventable death, and you know the person’s suffering,” said Dr. Alon Steinberg, a California cardiologist who studies prone restraint and has viewed hours of footage of people being held stomach-down by police.

Steinberg, who serves as an expert witness, believes that cardiac arrests following prone restraint might be caused by more than just a lack of oxygen in the heart muscle. When someone can adequately breathe, the expulsion of carbon dioxide regulates the level of acid in the blood. But when breathing and blood flow are restricted, acid can build and cause cardiac arrest, as Steinberg and forensic pathologists Dr. Victor Weedn and Dr. Peter Speth proposed in a 2022 study.

Dr. Daniel Wohlgelernter, a cardiologist who has also testified in a number of prone-restraint cases, agrees. He pointed out that putting someone in prone restraint when they are in a hyperactive state — as people often are when on stimulants or in crisis — can exacerbate acidosis and cause a “double whammy.”

“We have carbon dioxide accumulation, development of lethal or potentially lethal metabolic acidosis at the same time that we have deprivation of oxygen,” he said.

Despite widespread agreement about the dangers of positional asphyxia caused by prone restraint, some studies have argued that the restriction of airflow caused by prone restraint is not, in most cases, enough to kill.

Medical and legal experts have pointed out flaws in the studies, which have been done on healthy, sober individuals in police-free environments and don’t duplicate a real-life prone-restraint scenario.

“Studies like that, if they actually had the potential to kill anyone, would never be approved by an institutional review board,” said Joanna Naples-Mitchell, an attorney with Physicians for Human Rights. “So it’s not something that’s actually possible to model in the real world in a safe way.”

Karen Sutherland holds a necklace with her son Shayne’s fingerprint and name at Park View Cemetery in Manteca, San Joaquin County, on Feb. 24, 2024, where Shayne is buried. (Beth LaBerge/KQED)

Sorting out causes of death: ‘Alive and fine’

Of the 22 deaths we found where people died after being held stomach-down, coroners and medical examiners attributed acute methamphetamine toxicity to 10 deaths. Coroners are usually elected, and few places require them to have a medical background.

Wohlgelernter and Steinberg are skeptical of those determinations. Both were adamant that in the prone restraint cases they’ve reviewed, methamphetamine, on its own, was not to blame for deaths.

“In no cases did I see that the individuals were destined to die on that day, if not for the interaction with law enforcement and the prone restraint compressive asphyxia,” Wohlgelernter said.

Steinberg pointed out that while people can overdose on meth, those who wind up dead after being restrained face down were “alive and fine” before they had a run-in with police.

“They’re alive beforehand. They’re alive for a few minutes in the prone position, and then after a prolonged episode of restraint, people die,” he said.

Dr. Odey Ukpo, chief medical examiner-coroner for Los Angeles County, where seven deaths following prone restraint were attributed to meth use or toxicity, said it’s more complicated.

“What some people don’t realize is that a cause-of-death [determination] is a medical opinion,” he said. “It’s based on deductive reasoning.”

For instance, Ukpo said he looks for signs of petechiae, a dot-like pattern of blood in the eyes or on the gums, before ruling whether someone died of asphyxia.

To Seth Stoughton, the University of South Carolina law professor and former police officer, who wrote an amicus brief (PDF) about the dangers of positional asphyxia that was submitted to the U.S. Supreme Court in 2022, causes of death are beside the point. Prone restraint, he argues, is so easy to perform safely that it should never lead to deaths in the first place, no matter who’s being restrained.

“Whether they’re dying of oxygen deprivation or metabolic acidosis is irrelevant,” he said. “People are still dying! And if you flip them over to their side, they don’t!”

Stoughton served as an expert witness in the case against Minneapolis police officer Derek Chauvin for the murder of George Floyd. He says that if officers take the proper precautions to manage the scene and protect themselves, someone in handcuffs on their side is not a great danger.

“We’re talking about literally the difference between taking someone from their stomach and rolling them 90 degrees onto their side,” he said. “If there is any increase in risk at all [to officers], it is so marginal that it is vastly outweighed by the potential of saving that person’s life.”

In addition to training officers to use the recovery position as a matter of routine, experts say officers can keep an eye out for warning signs when restraining people prone.

Wohlgelernter says officers should watch for changes in alertness, speech or physical movements.

Steinberg argues that the use of prone restraint should be limited.

Justin M. Feldman, principal research scientist at the Center for Policing Equity, said that some incidents escalate because of officers’ bias against people who abuse drugs.

“I think they fundamentally don’t respect people they view as addicts or tweakers or whatever the pejorative might be, and treat them accordingly without respect for their lives,” Feldman said.

For Peter Moskos, a criminologist with John Jay College of Criminal Justice and former Baltimore police officer, there should be a greater focus on preventing the events that lead people into the hands of police by getting them the help they need, such as jobs, housing, drug treatment and mental health care.

“At some point, it would have been nice if someone could have pulled a switch track and diverted that person, whether it’s community, family, other government agencies, anything,” he said. “But once you get to that point [of a police encounter], it’s kind of too late to offer an ideal solution.”

Shayne Sutherland and his mother, Karen, in 2019. (Courtesy of Karen Sutherland)

‘He knew he was dying’

The San Joaquin County medical examiner’s office determined that Shayne Sutherland’s cause of death was cardiac arrest due to “acute methamphetamine toxicity” with a contributing factor of “physical restraint by law enforcement.” In other words, meth, not police, was primarily responsible for Sutherland’s death.

Sutherland’s family wasn’t satisfied with the medical examiner’s findings or with the Stockton Police Department’s response to his death. In October 2021, they filed a federal civil rights lawsuit against the city of Stockton, Officers Zalunardo and Afanasiev and former Stockton Police Chief Eric Jones. The suit alleges wrongful death, excessive force and interfering with Sutherland’s constitutional rights by force.

“They did not have that right to judge him that morning,” his mother, Karen Sutherland, said. “They did not have that right to do what they did.”

Families of people in California who have died following prone restraint have won at least $41 million in civil suits across the state, according to court documents and press reports.

In the year leading up to her son’s death, Karen managed to get Shayne into rehab for a stint, but finding mental health care and ongoing treatment was a struggle. When people like Shayne reach out for help, she said, “They’re turned away, or they’re told they have to wait.”

“[But] when you have a mental health problem, you can’t wait,” she said.

Last December, Karen pulled into Park View Cemetery in Manteca — about 20 minutes south of Stockton — and walked to her son’s grave. Sitting on a blanket, she talked about Shayne’s life: his “teddy bear” lovability; the fishing and camping trips with his two kids, Shayne Jr., 8, and Demi, 7; coaching the Manteca Chargers youth football team.

She talked about the hard times, too: the cocaine and meth addiction; the split with the mother of his children; the “little, petty, stupid, whatever crimes” that, she said, “are in no way in any comparison of any type of magnitude of the crime that those two police officers committed that day when they killed my son.”

“I’ve always been able to handle things,” she said. “I’m a very strong person, but not when this happened. This broke me — completely shattered me.”

After Shayne’s death, Stockton PD determined that Zalunardo and Afanasiev acted within policy. The only issue the investigation raised was that Zalunardo left his baton “unsecured on the ground near the suspect” when administering aid.

The Stockton Police Department did not respond to our requests for comments and interviews with the officers.

Karen has watched the footage of Shayne’s final encounter with police. But she says she’ll never turn on the sound, because others have told her what she’d have to hear.

“He knew he was dying,” she said. “He was being tortured. And knowing that tortures me every second, man. Every second.”

Karen chose this particular grave site because of the morning sun that hits it each day. She’s come to believe that God reached down to stop Shayne’s suffering — not just at the hands of police, but in life.

In the winter sunshine, the top of Shayne’s headstone reads: “God reached down and rescued me.”

This story was published in partnership with the Guardian.

Additional reporting by Bella Arnold, Hanisha Harjani, Simmerdeep Kaur, Grace Marion, Adam Solorzano and Krissy Waite of Berkeley Journalism’s Investigative Reporting Program; Leila Barghouty, Jacqueline Munis and Camryn Pak of Stanford University’s Big Local News; and Brian Krans of The California Newsroom.  

The California Newsroom is a collaboration of public media outlets throughout the state, with NPR as its national partner. The California Reporting Project collected police records. 

This project was completed with the support of a grant from Columbia University’s Ira A. Lipman Center for Journalism and Civil and Human Rights in conjunction with Arnold Ventures.  

How We Reported This Story

Since the 1990s, experts have warned that restraining someone prone, or on their stomach, can kill them. When someone is agitated, on stimulants or acting erratically, they are also more likely to die if officers use prone restraint, according to medical experts. Former police officers and criminologists say that putting someone on their side or seated after they’re handcuffed saves lives.

In 2020, Antioch police officers held Angelo Quinto down on his stomach after responding to a call from his family. His death inspired California legislation, which went into effect in 2022, that prohibits officers from using techniques such as prone restraint that “involve a substantial risk of positional asphyxia.”

The California Newsroom and The California Reporting Project wanted to better understand how many people were dying after officers used prone restraint in the Golden State.

Since the passage of state law AB 71, California law enforcement agencies submit anonymized data to the state Department of Justice’s Use of Force Incident Reporting database when officers seriously injure or kill people. That data contains information listing the types of force officers used and whether someone died. Currently, the data includes incidents that occurred from 2016 to 2022. Although people can die from prone restraint after being otherwise injured, we wanted to focus on cases where the cause of death was more clear. We filtered the data to incidents where someone died and officers used a control hold but did not use a gun, Taser or carotid restraint. Outside of carotid holds, the data does not distinguish between specific types of restraint.

To better identify the decedents, reporters then combined the use-of-force data with data from California’s Death In-Custody database. To ascertain whether officers specifically used prone restraint on those decedents, we used public record requests to obtain records and body camera footage from law enforcement agencies, district attorneys, medical examiner/coroners and oversight agencies about the incidents. We also obtained lawsuits in cases where loved ones sued local authorities. Two people reviewed those records, and an editor checked that work. We were unable to obtain enough records on four people’s deaths and excluded them from our analysis. Through our reporting, we determined five were incorrectly marked as not having been tased and removed them from our analysis. We also found that two people did not clearly die after a prone restraint and cut them from our analysis.

However, we know that this data was incomplete because it did not include Angelo Quinto. We had records showing that officers used prone restraint, so we included him in our analysis despite his not appearing in the state’s use-of-force data.

Justin Feldman, principal research scientist at the Center for Policing Equity, says that it’s not uncommon for prone restraint deaths to go unreported. In a study, he found that in more than half the cases when police kill someone, it’s not documented on the death certificate and so may not be properly recorded.

Feldman said the “number one predictor” of misreported deaths was when officers didn’t shoot someone, such as when they used prone restraint or a Taser.

Two police departments would not release police reports to the California Reporting Project because the death investigations found the men died of other causes, such as methamphetamine toxicity.

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