Forced injection of ketamine may have stopped heart
AURORA, Colorado––Mourners and protesters, including world-class violinists Ashanti Floyd and Lee England Jr., who flew in from New York City and Atlanta for the occasion, on June 27, 2020 played a variety of bowed instruments at City Center Park in Aurora, Colorado, in memory of Elijah McClain, 23.
McClain, a black vegetarian, animal lover, and massage therapist, was pronounced brain-dead on August 30, 2019, six days after being detained by three white police officers, handcuffed, put in a chokehold, and forcibly injected with ketamine.
A drug long used for many purposes, ketamine is probably best known within the animal care community as a veterinary sedative commonly used in doing spay/neuter surgery.
Reported the Aurora Sentinel, “A large and long Aurora protest against the death of Elijah McClain went from peaceful to disruptive to disorderly Saturday when police deployed tear gas against rowdy protesters they said were throwing rocks and bottles at cops. The scene was surreal and chaotic as musicians wandered among the tense scene of protesters and riot-gear-clad police, string music wafting with the sounds of havoc.
“As the protest devolved into mayhem,” the Sentinel account continued, “a dozen or so violinists and string musicians [continued to play] in honor of McClain, who had played his violin to shelter cats.
“Police demanded people disperse,” the Sentinel added, “but then allowed them to reconvene in an adjacent area for the violin vigil. More than 1,000 people remained and police apparently backed off their demands to end the protest.
Keeping the spotlight on shelter volunteer
The mourners and protesters participating in the violin vigil, hundreds of whom marched to the event from neighboring Denver, sought––successfully––to keep the spotlight on McClain.
Aurora pit bull advocates, almost all of them white, hoped to use the occasion to rally support for an ongoing campaign against a 1989 ban on keeping pit bulls within the city. The ban was affirmed in 2014 by 64% of the voters in a municipal election, but a public hearing on a repeal proposal was held on June 18, 2020. Despite the ban, pit bulls remain the breed most often involved in local biting incidents, according to Aurora animal control data, and the breed second most often impounded or owner-surrendered to the city shelter.
A self-taught violinist and guitar player, McClain, according to the Aurora Sentinel, often spent his lunch breaks performing for the cats and dogs at local animal shelters in hopes the music would help to calm them.
“Wouldn’t set a mouse trap”
“I don’t even think he would have set a mouse trap if there was a rodent problem,” friend Eric Behrens told the Sentinel.
McClain’s last words, like those of Minneapolis police violence victim George Floyd, who was choked to death on May 25, 2020, were captured on videotape of the incident.
Never accused or even suspected of having committed any crime, McClain was stopped simply for “suspicious behavior,” specifically wearing a ski mask on a warm evening because he suffered from anemia, which interfered with his ability to regulate his body temperature.
“I can’t breathe. I have my I.D. right here. My name is Elijah McClain,” he tried to explain to the police. “That’s my house. I was just going home. I’m an introvert. I’m just different, that’s all. I’m so sorry,” McClain pleaded. “I have no gun. I don’t do that stuff. I don’t do any fighting. Why are you attacking me?
“I’m a vegetarian. But I don’t judge people.”
“I don’t even kill flies,” McClain continued, to no avail. “I don’t eat meat. I’m a vegetarian. But I don’t judge people. And I respect all life. Forgive me. All I was trying to do was become better. I will do it. I will do anything. Sacrifice my identity. I’ll do it. You all are phenomenal. You are beautiful. And I love you. Try to forgive me … I just can’t breathe correctly.”
McClain’s death attracted only local attention, rallied by family and friends, until after the George Floyd case drew national notice of many similar deaths of black men and women at the hands of law enforcement personnel who allegedly overstepped their authority.
Eventually more than 3.5 million people signed online petitions asking Colorado governor Jared Polis to re-examine the case, which on November 22, 2019 had been closed without charges.
Polis on June 25, 2020 assigned Colorado attorney general Phil Weiser to investigate McClain’s death as a special prosecutor, to press criminal charges against the police officers involved “if the facts support prosecution,” Polis told media.
“Administered live-saving measures”?!!!
Aurora police officers Nathan Woodyard, Jason Rosenblatt, and Randy Roedema testified that McClain, who was listening to music as he walked, at about 10:30 p.m. on the night in question, ignored repeated requests from them to stop, and was carrying a plastic bag.
The bag, as it happened, contained a bottle of iced tea that McClain had just picked up at a corner store half a block away for his brother.
Officer Randy Roedema claimed McClain reached for one officer’s gun. All three officers then took McClain down to the ground, according to the police report. One officer put McClain in a carotid hold, meaning pressure is, applied to the side of a person’s neck to temporarily cut off blood flow to the brain.
“Due to the level of physical force applied while restraining the subject and his agitated mental state,” officers then called Aurora First Responders, who “administered life-saving measures,” according to media accounts based on the police report.
Police body cameras allegedly fell off
“Paramedics injected McClain with what they said was a ‘therapeutic’ amount of ketamine to sedate him, while officers held him down. McClain went into cardiac arrest on the way to the hospital,” summarized Claire Lampen of The Cut.
“One of the officers can also be heard threatening to set his dog on McClain if he “keep[s] messing around,” Lampen wrote. The officer claimed the 140-pound McClain “exhibited an extreme show of strength when officers tried to pin back his arms.
“Very little of the officers’ protocol can be seen, however,” Lampen added, “because all of their body cams allegedly fell off during the arrest.”
Officers Woodyard, Rosenblatt, and Roedema were placed on temporary administrative leave after McClain died, but were returned to normal duties after district attorney Dave Young informed Aurora police chief Nick Metz in writing that, “Based on the investigation presented and the applicable Colorado law, there is no reasonable likelihood of success of proving any state crimes beyond a reasonable doubt at trial. Therefore, no state criminal charges will be filed as a result of this incident.”
Rising use of ketamine by police
The use of ketamine to sedate McClain came against a backdrop of rapidly increasing use of the drug by first responders, both in Colorado and elsewhere in the U.S., even as ketamine has come under increasing restrictions abroad, including for veterinary use, because it is easily misused.
“Ninety fire departments and emergency medical service agencies across Colorado — including those in Aurora, Denver and Colorado Springs — have waivers from the Colorado Department of Public Health and Environment to use ketamine to treat excited delirium, according to data from the department,” reported Elise Schmelzer of the Denver Post on October 14, 2019.
“Law enforcement and medical professionals for years have struggled to safely handle those experiencing excited delirium — a sometimes fatal physical condition,” Schmelzer explained, that makes someone aggressive, unreasonable and seemingly impervious to pain.
“Excited delirium” is dubious diagnosis
But whether “excited delirium” is actually a medical condition distinct from the fight-or-flight response of a terrified person and/or from the effects of alcohol and drug abuse is in itself in debate.
The American College of Emergency Physicians has recognized “excited delirium” as a medical condition since 2009, despite admitting the difficulty of defining it.
Defenders of the use of the diagnosis “excited delirium,” often cited as a cause of deaths occurring in police custody, argue that the term has been medically described for more than 170 years.
Specifically, “excited delirium” is said to have been scientifically described since October 1849, when Luther Bell, a cofounder of the Association of Medical Superintendents of American Institutions for the Insane, dubbed it “Bell’s mania” in an article for the American Journal of Insanity.
Bell, however, specifically associated “excited delirium” with both delirium tremens, an extreme outcome of alcohol abuse, and several conditions which produce brain inflammation and high fever.
The American Psychiatric Association and World Health Organization do not recognize “excited delirium” as a distinct clinical condition.
“Use of ketamine should be approached with caution”
According to Colorado State Health Department guidelines, “Ketamine may be used for management of patients exhibiting such severe agitation that they are placing themselves and/or their providers in imminent danger. However, ketamine may be associated with high in-hospital intubation and ICU admission rates; therefore the use of ketamine should be approached with caution. Ketamine should not be used for patients who can be managed safely with traditional therapies.”
Continued Schmelzer, “Aurora Fire Rescue paramedics can use ketamine in the field to treat extremely agitated people, but Mari Newman, the attorney representing McClain’s family, said the 23-year-old was lying handcuffed and complacent on the ground when he was injected.
“Aurora Fire Rescue protocol for agitated and combative patients shows that ketamine only can be used if the patient is showing signs of excited delirium such as paranoia, hyper-aggression, hallucination, disorientation and overheating, according to the agency’s policies and procedures handbook obtained by the Denver Post, Schmelzer summarized.
“Agitation should be managed with conversation”
“Between August 2017 and July 2018, 427 patients in Colorado received ketamine for agitation, according to state data. Of those, about 3% had to be intubated before reaching the hospital because they struggled to breathe, and about 20% of all patients were intubated in the hospital,” Schmelzer wrote.
Therefore, Schmelzer explained, “The [Colorado state] guidelines state that paramedics should only intervene with ketamine if the person’s agitation is extreme and seems to stem from medical or psychological reasons. Otherwise, agitation should be managed with conversation or traditional medications such as benzodiazepines and anti-psychotics.”
Ketamine not internationally regulated
The World Health Organization Expert Committee on Drug Dependence recommended at the March 2016 meeting of the United Nations Single Commission on Narcotic Drugs that ketamine not be internationally regulated.
This followed the fourth World Health Organization review of ketamine use and abuse in ten years.
The WHO expert committee “concluded that ketamine abuse does not pose a global public health threat, while controlling it could limit access to the only anesthetic and pain killer available in large areas of the developing world.”
Pending proposals to more strictly regulate veterinary access to ketamine in 2015 prompted the American Veterinary Medical Association to repeatedly appeal to membership to submit letters of comment to the U.S. Food & Drug Administration supporting AVMA efforts to keep ketamine available.
“Date rape drug”
But ketamine possession was already banned or severely restricted by many and perhaps the majority of Convention on Psychotropic Substances member nations.
Most influentially, Russia banned ketamine entirely for five years, beginning in 1998, after it became notorious through illegal use as a date rape drug, and in connection with human trafficking, especially by the sex trade.
Similar legislation and regulations soon followed throughout eastern Europe.
First synthesized in 1962, ketamine received U.S. Food & Drug Administration approval as an anesthetic in 1970, and came into widespread use by U.S. military medical units to treat wounded soldiers in the field during the latter part of the Vietnam War.
Misuse of ketamine as a date rape drug was documented in the U.S. disco club scene soon afterward. Concern about the availability of ketamine gradually increased during the next two decades.
U.S. Controlled Substance Act
In July 2002 former Hornocker Wildlife Institute researcher Patrick Ryan, 51, was convicted on 36 criminal charges including kidnapping, aggravated battery with a deadly weapon, and 20 counts of rape.
Ryan had kept research assistant Jennifer Cashman heavily drugged for seven months in 1996-1997 by slipping ketamine and another animal tranquilizer, telazol, into her food at a bear research station in the Gila Wilderness of New Mexico.
Her subsequent civil suits against Ryan, Hornocker officials, the New Mexico Department of Game and Fish, and the drug makers were settled out of court. The terms were not disclosed.
While the widely publicized case was pending, the U.S. Food & Drug Administration in August 1999 placed ketamine on Schedule III of the U.S. Controlled Substance Act.