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Colorado Lawmaker Will Give Peers Choice To Either Ban Or Rein In Ketamine Sedations

mcknight and axtell.jpg
Michael de Yoanna / KUNC
Elijah McKnight (left) and Jeremiah Axtell have something in common with Elijah McClain: paramedics in Colorado sedated them with ketamine during altercations with police.

Rep. Leslie Herod’s bill is a response to the death of Elijah McClain and comes after KUNC revealed more than 900 ketamine sedations for excited or agitated people around the state in 2.5 years.

The alleyways of Denver’s River North neighborhood are an explosion of color. Expressions of joy, love and social awareness are painted across the brick walls. Elijah McKnight and Jeremiah Axtell are here searching for a mural, but they can’t find it.

“Maybe the other side of this building?” McKnight wondered.

It’s the widely-seen painting of another Elijah — Elijah McClain, the Black man who died in 2019 after police stopped him in Aurora for looking “sketchy” and restrained him before paramedics administered ketamine to sedate him.

Family photo
Elijah McClain.

What happened to McClain makes Axtell “stop and think about what's right and what's wrong.”

“You know what?” Axtell said. “I think that’s better than what they think about.”

By “they,” he means the police officers and others accused in a civil rights lawsuit of killing McClain. Axtell, who is white, and McKnight, who is multiracial and identifies as Black, feel connected to McClain. Like McClain, both men were in confrontations with law-enforcement officers that went badly. And, like McClain, both men were in handcuffs as paramedics used ketamine to sedate them. Now they’re friends.

“He hit me up on Facebook,” McKnight said of Axtell.

“We both went through it,” Axtell added.

Last summer, KUNC and Reveal from the Center for Investigative Reporting told the stories of McKnight and Axtell, as well as Elijah McClain’s.

Our investigations revealed that paramedics sedated people in Colorado 902 times with ketamine in two and a half years. Paramedics are allowed to do this if a person shows signs of excited delirium — a medical syndrome, according to some emergency doctors, where people are extremely agitated, displaying incredible strength and so worked up that they could die.

Like the family of Elijah McClain, McKnight and Axtell argue in their own lawsuits that they did not have the extremely rare syndrome and that paramedics sedated them wrongly. McKnight was hospitalized for days after his sedation in 2019. Axtell said he’s struggled with a long list of physical problems since his incident in 2020.

Both said the sedations have left them with lingering psychological trauma.

“Like, you know, waking up paranoid and sweating and freaking out for no reason, having panic attacks,” McKnight said.

Axtell also complains of trouble sleeping.

“Last night I woke up probably 11 times,” Axtell said. “Every time I'm sweating at the back of my neck.”

Police in Lakewood detained Axtell following a heated exchange with neighbors. A paramedic with West Metro Fire sedated him, even though he can be heard on video filmed by his girlfriend saying that he is cooperating. Arapahoe County deputies encountered a drunken McKnight at a bus stop. After admitting he had warrants, he turned to run, but a deputy tackled him and tased him. Later, a paramedic with South Metro Fire Rescue injected McKnight with ketamine despite his pleas, recorded by deputies’ body cameras, not to have any drugs injected into his veins.

Officials in both jurisdictions declined to comment, citing pending litigation.

In Aurora, the city has argued in court filings that officials are not responsible for Elijah McClain’s death in 2019. The 23-year-old suffered cardiac arrest after a medic gave him what his family’s attorney describes as an excessive dosage. An autopsy was inconclusive about McClain’s death but could not rule out that ketamine might have played a role.

McKnight said McClain’s death has focused a spotlight on the sedations during police confrontations.

“The fact that ketamine is even being used and administered to people like that -- they just made that thing on their own, under the radar,” McKnight said.

A little-known group -- the Emergency Medical Practice Advisory Council -- issues waivers, which allow paramedics to use ketamine to sedate people, including during police confrontations.

That could change, depending on what Rep. Leslie Herod introduces in the upcoming legislative session that starts this week.

Colorado General Assembly
Rep. Leslie Herod.

“What we're seeing about the use of ketamine in the field is that they are not utilizing the appropriate medical protocols before administering the drug and that is why we're seeing the adverse effects and that is what needs to stop,” Herod said.

Herod, a Denver Democrat, said she plans to offer lawmakers a choice. The first option is a blanket ban on paramedics’ use of ketamine, and perhaps other drugs, that can be used to sedate people during police confrontations. The second option is a measure that would place hefty restrictions on how paramedics sedate people and outline when it is appropriate to do so.

“We're talking about these sedatives that are used to restrain people,” Herod said. “So we call them chemical restraints, but it is not a video game. It's not a sci-fi novel or something where someone is putting something over someone's mouth and gently leading them back. It is a harmful, very violent drug that can kill people if not administered correctly.”

An example of a restriction that’s not currently required would be for paramedics to weigh people before giving them ketamine, she said, citing concerns that McClain may have been overdosed.

“If you administer the drug outside of these safe ways and this safety protocol, then you will be committing a criminal offense,” Herod added. “At the end of the day, we cannot continue to allow its unabated use.”

Herod said she has support for her efforts from fellow Democrats, including a doctor in the legislature, as well as civil rights advocates.

Yet some are skeptical, including Sen. John Cooke, a Weld County Republican. He worried that the proposal could hamper the work of paramedics and police officers.

“Why are we limiting the tools for them to help a person out?” he said. “Because the long run, that's what they're trying to do, is help the person.”

Cooke is a former sheriff who worked with Herod last year on a raft of criminal justice reforms.

“I think by banning or limiting, it could cause further harm to the person.” Cooke said. “Because let's face it, if the person is that excited and has that much delirium, you're not going be able to control them and they might increase the use of force on the officer or the deputy or the paramedics and the more they escalate, the more law enforcement might have to escalate.”

Colorado emergency doctors who oversee ketamine programs for paramedics argue that sedatives can prevent deaths because extremely agitated people’s hearts may stop. Yet administering ketamine outside of a hospital also has risks. In the 902 cases examined by KUNC, complications arose almost 17% of the time. The most common one was hypoxia, a potentially life-threatening lack of oxygen.

“This is where it gets into some difficult areas,” said Dr. Randall Clark. “There may be circumstances in the field where the use of a sedative agent is appropriate if an individual is an immediate threat to themselves or others.”

Clark is with the Colorado Society of Anesthesiologists, the group that asked the state to suspend ketamine waivers pending the outcome of a thorough review announced last year by the state’s Department of Public Health and Environment. Clark said he would support a bill that looks at greater public accountability and scrutiny for the doctors overseeing waiver programs, along with stricter sedation criteria for paramedics.

“It needs to be done in a way that maximises the safety of the individual receiving those agents,” Clark said. “What we've seen in Colorado, and specifically because a lot of your reporting, is that this has become a relatively frequent occurrence.”

Dr. Mark Debard, a retired emergency physician from Ohio who helped define excited delirium and ways to treat it about a decade ago, told KUNC that he was stunned by the 902 cases in the state in two and a half years. Statistically speaking, he would expect to see just 57 cases in that time.

As for Jeremiah Axtell and Elijah McKnight, they’re hoping for a complete ban.

“Forced injecting people in the streets with ketamine is absolutely unacceptable,” McKnight said.

Axtell added, “Looking at what happened in the past and trying to decipher the right things to do, for her (Herod) to totally eliminate this act or any kind of forcible injection is kind of important to us.”

Axtell added that if paramedics weren’t allowed to sedate people, Elijah McClain might still be alive.

Their search for the Elijah McClain mural ends in disappointment. It was on the back wall of a brewing company, but it’s been painted over -- and later they learn that it’s been gone for months. There’s a sense of disbelief followed by a resolution to bring the mural back.

McKnight says he wants to find the artist to repaint it in a place where it won’t be painted over.

“I'm going to hire him to do that work,” McKnight said.

“Where can we get it permanent?” Axtell added.

Both feel somewhere in Aurora would be a better place for it. McKnight said if he had the money, he’d buy land and build an Elijah McClain Park where people can reflect on his life and untimely death.

A couple of blocks away sits a small black sign in front of an old building. In white letters, it says “I can’t breathe,” the words George Floyd uttered as he died under the knee of a police officer in Minneapolis.

McKnight noted that Elijah McClain said the same words, heard on body cameras, as police held him down before he was sedated.

As investigative reporter for KUNC, I take tips from our audience and, well, investigate them. I strive to go beyond the obvious, to reveal new facts, to go in-depth and to bring new perspectives and personalities to light.
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