DENVER (KDVR) – A legislative bill aimed at creating more accountability when paramedics’ use ketamine to sedate people outside of a hospital setting is headed to Colorado’s House of Representatives Tuesday.
“This bill might be controversial. Some folks might not like it, but at the end of the day, it might save lives,” said Rep. Leslie Herod (D), one of the bill’s co-sponsors.
Herod said she was compelled by the case of Elijah McClain, who died days after paramedics sedated him with ketamine following a violent police altercation in which officers attempted to subdue him with a carotid hold.
A coroner could not rule-out the possibility that McClain had an adverse reaction to the drug, but an independent physician consultant hired by the City of Aurora, where the incident occurred, later said she found no definitive evidence the drug led to McClain’s death.
“We have a duty to ensure there are no more Elijah McClain’s in the state of Colorado again,” said Herod.
Ketamine leads to lawsuits against medics
Herod said she was also affected by two other incidents uncovered by FOX31 Problem Solvers’ investigations, including the cases of Elijah McKnight and Jeremiah Axtell.
Medics sedated both men with ketamine after separate police incidents in 2019 and 2020 respectively.
McKnight spent several days in an intensive care unit after being sedated with two doses of the drug.
In body camera video first uncovered by the Problem Solvers, a sheriff’s deputy can be heard asking the medical crew “you guys can’t give him anything, can you?” To which a paramedic replied, “We can give him ketamine, and he’ll be sleeping like a baby.”
Axtell received the drug after telling authorities he would fully cooperate with their commands.
Both McKnight and Axtell have filed federal lawsuits against the medical providers who administered the drug and others who were involved.
What’s in the bill – Restrictions on police
In Colorado, ketamine is not administered by police in any situation.
However, Herod’s bill, which is co-prime-sponsored by pediatrician Yadira Caraveo, would restrict a police officer’s influence on a patient’s medical care.
Herod said if a police officer were to request that a suspect be sedated, a paramedic would be required to report that person to the Peace Officer Standards and Training board. Herod said an officer could lose certification if they attempt to influence a medic.
“The bill prohibits a peace officer from compelling, requesting causing, directing, or influencing an emergency medical service provider (EMS provider) to administer a chemical restraint. An EMS provider shall confidentially report a peace officer’s violation to the P.O.S.T. board within 10 days of the occurrence, and a peace officer shall not retaliate in any way against an EMS provider for reporting the incident,” a draft of the bill says.
Recently, consultants also recommended that the City of Aurora develop a better transition plan for when a person transitions from a police suspect to a medical patient.
“The transition of patient care…can be a common source of information loss which creates the potential for patient care errors,” the Aurora consultants told the City.
What’s in the bill – Required monitoring equipment
Herod’s bill would also prevent medics from administering ketamine to a patient outside of a hospital setting unless they have all the equipment necessary to accurately assess a patient’s weight and to monitor their vital signs.
“The bill requires an agency that uses a chemical restraint to ensure that a person administering ketamine, haloperidol, or any other medication that is severely dependent on the weight of an individual or may result in a severe or adverse reaction with improper dosage in a nonhospital setting does so when staff trained in the administration of such medication can monitor the vital signs of the individual and weigh the individual to ensure accurate dosage,” the bill draft says.
A FOX31 Problem Solvers investigation in 2020 revealed medics administered the weight-based drug to McClain after overestimating his weight. They provided him with a dose that would have been more appropriate, according to their own medical protocols, for someone who weighed 220 pounds.
McClain weighed 140 pounds.
“There was not evidence from the coroner – or any of the records – that accurate dosing would have changed his outcome,” said Dr. Melissa Costello, the independent physician consultant who was hired by the City of Aurora to investigate
McClain’s medical treatment prior to his death.
The Colorado Society of Anesthesiologists and the American Society of Anesthesiologists have previously expressed concern over whether the drug is being properly monitored out of a hospital setting.
“Ketamine is a potent analgesic, sedative and general anesthetic agent which can elevate blood pressure and heart rate, and can lead to confusion, agitation, delirium, and hallucinations,” said the American Society of Anesthesiologists in a public statement in July. “These effects can end in death when administered in a non-health care setting without appropriately trained medical personnel and necessary equipment.”
In McClain’s case, Costello found medics on the scene did not have all of the appropriate equipment available when they arrived to provide treatment, and they failed to do a complete assessment of McClain prior to sedating him.
“The presence of equipment could potentially have prompted further assessment,” said Costello during her February presentation to Aurora City Council. “It’s hard to stand over a bunch of equipment and not feel some compunction to begin to use some of that. Additionally, there was not a pre-sedation ‘check-off’ to verify that all of their equipment that they require for sedation under their protocol was present and at Mr. McClain’s side.”
Costello said one of the medical monitoring machines that is typically used during sedation, a capnography monitor, was not in the proper location and caused a delay in application. Costello said that may have provided some useful information over the course of McClain’s care.
Other tools, she said, including a cardiac monitor and equipment used to track a patient’s vital signs were not applied until McClain was already in cardiac arrest, inside an ambulance.
“We lost the opportunity, potentially, to intervene if there had been something indicated on the cardiac monitor that he was clinically declining,” said Costello.
While Costello said she could find no evidence that ketamine led to McClain’s death, she did say the sedation may have played a factor in the medics’ ability to treat his deteriorating condition.
“If anything, the ketamine may have contributed to some difficulties on the part of the paramedics after his sedation of assessing the fact that he was continuing to decline,” she said.
EMS physician reaction
Some medical professionals who have not yet read the bill say they’re concerned that legislators are getting involved in regulating ketamine, a drug that many emergency medical services providers have said is an important tool in critical situations.
“I believe that our legislators want to do the right thing for all of the citizens. I also believe that legislators should not be getting in the business of dictating medical practice because that is not their field of expertise,” said Dr. E. Stein Bronsky, a Colorado Springs Medical Director and an emergency physician. “We should leave medical decisions up to the medical professionals.”
Bronsky said the current system for handling ketamine in the state involves “excellent guidelines and protocols that have been fully vetted.”
He said there are ways to improve how law enforcement and medical officials work together and communicate in the field, to ensure patient safety.
“What we need to work on is to make sure that everybody understands their place,” he said. “We want law enforcement to be able to ask for help when they need help, but we want the EMS professional, the medical professional, to be the one who is deciding the clinical appropriateness of how they may help.”
Bronsky said he feels strongly that people who have experience working in the field of emergency medical services, outside of a hospital, are the best people to make decisions on how and when different drugs or protocols should be used in the field.
He said continuous training is essential for improvement.
“Give them the tools they need to make good clinical judgement decisions in the field. I do not believe that necessarily changing a dose of the medication or a little element is the answer, although that does seem like a simple answer. I don’t believe that those are the things that would make a difference.”