Colorado police don’t get to decide when to use ketamine to sedate people anymore

The high-profile death of Elijah McClain laid the groundwork for the legislation.
4 min. read
Candice Bailey speaks at a protest at Aurora’s municipal complex demanding justice for Elijah McClain. July 25, 2020.
Kevin J. Beaty/Denverite

Gov. Jared Polis signed legislation ensuring that ketamine, a powerful sedative, be administered solely under the discretion of medical professionals -- and not law enforcement -- on Tuesday.

The 12-page bill also outlines specific situations in which ketamine may be administered, sets forth new regulations for monitoring patients and specifically prohibits the use of ketamine for "excited delirium," a broad description applied to anyone aggressive, agitated, paranoid or disoriented.

"A recent American Medical Association Statement indicated that 'excited delirium' is a subjective diagnosis and should not be used until better diagnostic criteria exist," Governor Polis wrote in a signing statement.

A 2020 KUNC study analyzing two and a half years' worth data on ketamine usage for "excited delirium" found complications occurred in almost 17 percent of cases. The most common side effects were hypoxia, which is characterized by a severe lack of oxygen, and apnea, which is a temporary lapse in breathing.

"Excited delirium" is also the diagnosis which officers used to justify administering ketamine to Elijah McClain in 2019. McClain, then 23 years old, was not suspected of committing any crime when police approached him in Aurora. He was walking home after buying iced tea from a corner store.

Officers made contact with him and quickly put him into a chokehold, threatened to sic dogs on him and subdued him with their body weight. McClain was then injected with ketamine and went into cardiac arrest in the ambulance. He was declared dead three days later.

The city of Aurora launched an independent investigation into his death 11 months after the incident.

The resulting report was blunt regarding officials' use of ketamine, writing, "Aurora Fire appears to have decided to sedate Mr. McClain without conducting anything more than brief visual observation." They didn't examine or question McClain before administering the ketamine, despite the fact that McClain was "moaning, gagging" and "exclaiming in pain" as officers restrained him.

McClain was given a 500 mg dose of ketamine; He weighed 143 lbs., and the dose was calculated for a 220-lb. man.

According to a lawsuit filed by McClain's family, the ketamine dosage combined with the police's use of force killed McClain. An official autopsy was not able to pinpoint a single cause of death, but an adverse reaction to ketamine was not ruled out.

Aurora's report also found that examining McClain and measuring vital signs would have helped in "clinical decision making" during the encounter.

The new law outlines strict protocols for paramedics to follow. Weight assessments, which primarily determine dosage, will be noted more accurately and double-checked by other paramedics. The legislation also has a bystander clause. If officers see a colleague pressuring medical professionals to use ketamine, the witness may also be subject to charges, and officers who do intervene are shielded from retaliation.

Ketamine, despite its widespread criticism, is useful in situations that require quick sedation. If someone is a danger to themselves or others, ketamine can be injected into the muscle and subdue someone within 1-5 minutes. Other sedatives, like haldol, may take up to 10 minutes to work. Benzodiazepines like midazolam also have a slow onset unless administered through an intravenous line, which may be impossible to administer to someone in distress.

Nonetheless, State Rep. Leslie Herod of Denver, a lead sponsor of the bill, said she hopes the use of ketamine will be scrutinized further in the future. She has worked on the bill with McClain's mother Sheneen since last year's Black Lives Matter protests.

"There's more work to do," Herod said. "Miss McClain has made it very clear that she'd like to see a complete ban, and I think that we are headed in the right direction."

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