Citizens also want state to pause ketamine waiver program during review
On Saturday, the top public health official in Gov. Jared Polis’ cabinet announced a “thorough review” of the system that allows medics to sedate extremely agitated people in confrontations with police. This week, an architect of Colorado’s sweeping law enforcement reform bill is hinting at further action.
“We have to look at the proliferation of the use of ketamine throughout Colorado and we need to rein it in,” said Rep. Leslie Herod, a member of the Black Democratic Legislative Caucus.
She questioned medics’ use of ketamine, a powerful anesthetic, on Elijah McClain one year ago today after police officers in Aurora tackled him and placed him in a carotid hold as he pleaded with them. Though he was in handcuffs, a medic gave McClain ketamine and several days later he died in a hospital. In a federal civil rights lawsuit, McClain’s family argues that the combination of police brutality and ketamine killed him, though the official autopsy was inconclusive.
Herod said her concern is medics acting outside of policy without repercussions for their actions.
“That needs to change,” she said. “So we will be looking at and addressing the use of ketamine in Colorado and hopefully we will have bipartisan and a broad base of support to move the effort forward.”
Herod didn’t offer any specifics. She was instrumental in Senate Bill 217, the bipartisan police accountability bill that passed amid massive Black Live Matter marches earlier this year. Among its many provisions, the law bars chokeholds and requires police to wear cameras and disclose footage.
Herod’s push comes at the same time as a “thorough review” into the system of state waivers that allow medics to use ketamine on people during confrontations with police. On Saturday, Colorado Department of Public Health and Environment executive director Jill Hunsaker Ryan announced the review. She declined a request for an interview, but in the announcement said, “patient safety and program transparency are top priorities.”
The review is expected to take at least 12 weeks and is expected to produce a final report.
Few other details were available about the review, including how a committee for it will be overseen by the department’s chief medical officer. The committee will “consist of [Emergency Medical Services] provider(s), pharmacist(s), [Emergency Room] doctor(s), anesthesiologist(s), and others,” the announcement said without naming anyone.
Emergency doctors can obtain waivers from the state to get special permission for medics to use the ketamine outside of a hospital setting for something called “excited delirium.” The condition is defined in state guidance as a “rare medical emergency,” one where a person develops “extreme agitation, aggressiveness, overheating, and exceptional strength.” The definition also states that ketamine should be used only when someone cannot be managed by “routine physical or medical techniques.”
Yet KUNC interviewed two men — Elijah McKnight and Jeremiah Axtell — who had confrontations with police and reviewed video of them being sedated by medics. Just like Elijah McClain, both men were already in handcuffs when they were dosed. And both men said they were not experiencing excited delirium, but instead trying to get officers to listen to them — a claim also made by McClain’s family in a civil lawsuit.
McKnight spent several days in intensive care after medics gave him ketamine following a confrontation with deputies in Arapahoe County. Two weeks ago, he testified at a public Zoom meeting for the Emergency Medical Practice Advisory Council, or EMPAC, which approves ketamine waivers. He said it appeared the state heard his concerns in calling for the review.
“I just need them to understand that the protocol was not followed and they should end the forced injecting of people in the streets,” McKnight said.
McKnight said the state should thoroughly investigate his case.
Anita Springsteen has also called on the state to investigate the case of Axtell, her boyfriend. who was dosed following a confrontation with police in Lakewood. Springsteen said she sent state officials videos of what happened to Axtell after KUNC’s story ran and now wonders if her complaint was a factor in the announcement of the review.
Springsteen said the state should do more than just review medics’ use of ketamine for excited delirium.
“There needs to be a moratorium on the use of ketamine and the use of other chemical restraints now,” she said, “Today. I also believe this does not go far enough.”
Springsteen is concerned that people could be harmed or even die as the state conducts its review.
Medics used ketamine 902 times on people with supposed excited delirium. KUNC was the first to report that information and the state subsequently released it publicly. Hunsaker Ryan cited those numbers again over the weekend in justifying the state’s review.
Of those 902 cases, there were complications almost 17% of the time. The most common was hypoxia, a severe lack of oxygen that is potentially life-threatening.
Aurora city council member Nicole Zipsie Johnston, speaking as a private citizen, called the review a step in the right direction, but like Springsteen, said she wanted more.
“There should be a moratorium on granting future waivers and putting a hold on the current waivers that have been approved,” Johnston said, adding that the review should also look at the definition of excited delirium. “We need to really be clear on when that’s administered and make sure there’s medical reasoning behind it.”
The American Society of Anesthesiologists opposes the use of ketamine outside of a hospital by medics for excited delirium. ASA president Dr. Mary Dale Peterson said the review needs to make clear distinctions between ketamine for excited delirium and other, uncontested medical reasons for using the drug, such as pain relief for someone hurt in a car crash.
“All of the circumstances of when ketamine is given — when it’s given, how much, how a person is monitored afterwards, etc. — really deserves some scrutiny,” she said.
Peterson added that her organization would work with the state in reviewing the program.
One EMS provider has stopped using ketamine for excited delirium — Northglenn Ambulance. The provider suspended its program in May. The head of that agency noted that medics rarely used ketamine for excited delirium and also noted controversy surrounding it.
