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Experts Don't See Excited Delirium In Law Enforcement Stop That Ended With Ketamine Sedation

elijah_mcknight.jpg
Arapahoe County Sheriff's Office
Elijah McKnight was handcuffed by Arapahoe County deputies after turning away from them. A medic with South Metro Fire Rescue later gave him ketamine, a powerful sedative.

"They sound like they want to give him ketamine to control his behavior as opposed to treat excited delirium syndrome," said one doctor who reviewed police video.

Two medical experts say a man who was sedated after a confrontation with Arapahoe County deputies last year did not appear to be suffering from excited delirium as paramedics claimed in a report.

The experts reviewed video from deputies’ body-worn cameras from Aug. 20, 2019, the night deputies restrained Elijah McKnight as a paramedic from South Metro Fire Rescue gave him two doses of ketamine.

“He’s obviously understanding and answering their questions somewhat rationally,” said Dr. Mark Debard. “The big deal on this is they sound like they want to give him ketamine to control his behavior as opposed to treat excited delirium syndrome.”

Debard is a retired emergency physician from Ohio who helped define excited delirium and ways to treat it about a decade ago. He told KUNC and Reveal from the Center for Investigative Reporting that ketamine sedation can save the lives of patients experiencing excited delirium. People with the condition might be frenzied, impervious to pain, and so out of control that they can exert themselves to death.

South Metro Fire Rescue wrote in a report that McKnight was “uncontrollably combative and agitated,” a threat to himself and those on the scene and was sedated for “excited delirium.”

South Metro Fire Rescue and the Arapahoe County Sheriff’s Office declined to comment for this story.

McKnight, a barber who is interracial and identifies as Black, admitted he was drinking and intoxicated after a night of partying in Denver. A friend dropped him off at a bus stop in Arapahoe County where he laid down on the ground. Deputies, responding to a 911 call, roused him. The situation escalated as McKnight asked deputies repeatedly to call his father. He also stated that he had warrants and said he did not want to be arrested.

When a deputy reached out for McKnight’s arm, he turned to run. A deputy then used a Taser on McKnight and handcuffed him.

Joseph Baker, a critical care paramedic in Minnesota, also reviewed the body camera video for KUNC/Reveal. He noted that McKnight yelled and cursed at deputies and struggled with them while restrained. Yet, Baker said, that doesn’t mean McKnight had excited delirium. McKnight asked for the paramedic to help him in the video, stated his name clearly when asked, and answered a paramedic’s questions.

“I'm not seeing excited delirium,” Baker said. “In these situations where people are articulating who they are, where they are, what the situation is, how can you determine that this person is delirious?”

Baker said police in his state have pressured paramedics to diagnose people with excited delirium and then sedate them with ketamine. In August, he filed a lawsuit against his former employer, the City of Woodbury, Minnesota, alleging superiors retaliated against him after he refused a police officer’s pressure to sedate someone.

Other cases

On the body camera video, McKnight overheard medics and deputies talking about giving him ketamine.

“We can give him ketamine and he’ll be sleeping like a baby,” a medic said.

At that moment, McKnight told paramedics not to put anything into his veins, but they gave him two doses of the powerful drug. At the hospital, he was intubated and put on a ventilator that breathed for him. He woke up days later.

“My memory: It went from being pinned down like that to them pulling a tube out of my throat,” McKnight told KUNC/Reveal.

He disputed reports of the night by paramedics and deputies, which said that he was so strong he lifted a deputy off the ground with his leg while restrained.

“If they’re saying I’m being wildly combative and experiencing excited delirium, they made something up,” McKnight said. “They’re like, ‘Oh yeah. He’s lifting everybody off of the ground. He’s the Incredible Hulk.’”

McKnight admitted he was intoxicated that night and said he became agitated only after being tased and restrained by deputies. He said he feared for his life as deputies restrained him.

“I just felt like that was going to be the end of it — my life was in their hands,” McKnight said. “I’m thinking that they kill people all the time and get away with it. I’m about to be one of those victims. So I’m struggling.”

He is facing two felony assault charges — one for each deputy — and two misdemeanor obstruction charges. He said he is fighting the charges and considering a civil rights lawsuit.

Another Elijah — Elijah McClain, a 23-year-old Black man — died after a confrontation with police in Aurora in August of 2019. A paramedic with Aurora Fire Rescue sedated McClain using ketamine. The autopsy in his case was inconclusive, but it could not rule out the possibility that McClain had an unusual reaction to ketamine. In September, Aurora’s city council placed a moratorium on medics’ use of ketamine pending an investigation. His family has filed a lawsuit alleging wrongful death.

KUNC has reviewed the case of another man, Jeremiah Axtell, who was sedated by West Metro Fire Rescue paramedics following a confrontation with police in Lakewood. Axtell was in handcuffs when he walked with officers to a gurney. After announcing that he was being cooperative with police, a paramedic gave him a dose of ketamine.

Axtell initially faced felony charges but those have been dismissed, he said. He still faces a misdemeanor charge of obstructing an officer, which he is fighting, arguing that he is innocent. Axtell is also considering civil legal action against the city and fire agency for wrongful sedation and unnecessary risk to his health.

Almost 17% of the time, people diagnosed with excited delirium and dosed with ketamine in Colorado developed complications before they arrived at the hospital. Once at the hospital, 20% were intubated.

Civil rights concerns

Mark Silverstein, the legal director of the American Civil Liberties Union of Colorado, said sedating people during police confrontations raises complicated legal issues.

“Our Supreme Court has said a forcible injection of medication into a non-consenting person's body is a substantial interference with personal liberty,” Silverstein said.

He pointed to two U.S. Supreme Court cases: Riggins v. Nevada (1992) and Washington v. Harper (1990). The crux of the cases, he argued, is that the government cannot inject chemicals into somebody against their will.

“The courts would require a medical determination that it's necessary to prevent somebody from harming themselves or harming others,” he said.

More than 100 paramedic agencies across Colorado are allowed to use ketamine to sedate people with supposed excited delirium. In the past two and a half years, paramedics used ketamine 902 times for it.

That’s about 15 times higher than the rate that Dr. Mark Debard would expect.

“I came up with the number 57 as the number of expected cases, statistically speaking for Colorado in those two and a half years,” Debard said.

In late August, Jill Hunsaker Ryan, who directs Colorado’s public health department, announced a review of the waiver program that allows medics to administer the ketamine in the field.

“I am calling for the immediate and thorough review of the state’s ketamine waiver program,” she said in a written statement at the time. “Our agency will work with medical experts to study the use of ketamine in the field — as well as the state’s oversight mechanisms — and produce a public report. Patient safety and program transparency are top priorities.”

The report could be completed as soon as late November, but it is unclear exactly when it will be done. Hunsaker Ryan has declined requests for interviews through department spokespeople and the department has also declined to answer questions about the nature of the review and to name the medical experts involved in it.

National data on the use of ketamine to treat excited delirium does not exist. But, independent research by KUNC/Reveal shows that paramedic agencies in at least 34 states are allowed to sedate people with ketamine for excited delirium or related conditions, like extreme agitation, combativeness and exhaustive mania. Paramedics in several states can also sedate agitated patients with other drugs, like benzodiazepines.

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