This story was originally published by KUNC. More at kunc.org.
A growing number of people want Colorado officials to pause or ban medics from using ketamine on people during escalated confrontations with police. The list includes two men who were given the powerful anesthetic when medics and police decided they showed signs of “excited delirium” or extreme “agitation.”
“I felt like it was over,” said Elijah McKnight, a multiracial man who identifies as Black. He spent days intubated in the hospital after being given ketamine by fire medics after a conflict with Arapahoe County Sheriff’s deputies last summer.
“I thought I was dying that day, by the police, on purpose,” said Jeremiah Axtell, who is white with long hair and tattoos. He was given the drug by fire medics in January after yelling and cursing at Lakewood police.
Both men share a similarity to Elijah McClain, the 23-year-old Black man whose death after a confrontation last year with Aurora officers has placed worldwide attention on police brutality. Like McClain, both men were already handcuffed when medics gave them ketamine.
“Several doctors told me they saved my life and that I was, like, pretty much dead,” McKnight said. “The cops were sitting there, still trying to take me to jail for three days.”
Axtell’s story is similar: “I wake up in a chair, sitting up, in a room that didn’t have a bathroom. I think it was the morgue.”
Axtell doesn’t remember getting the injection, just being in a strange room and realizing two police officers were watching him. When he asked them if he could go to the bathroom, they told him that he had already gone four times.
Just like McClain, the medics’ rationale for giving both Axtell and McKnight ketamine was the same. The drug, when used outside of hospitals in law-enforcement situations, is meant to calm or sedate extremely excited people.
Excited delirium is potentially life-threatening, according to some emergency doctors around the country, including dozens in Colorado. In a previous KUNC investigation, one doctor said that people with the condition are essentially so agitated that they “exercise themselves to death.”
In a civil rights lawsuit filed this week in federal court in Denver, McClain’s family named an Aurora Fire Rescue medic and his superior, along with several officers and the City of Aurora.
McClain was walking home, waving his arms, perhaps dancing, the night of Aug. 24, 2019, when officers approached him in response to a 911 call about someone appearing “sketchy.” The suit says after police brought him to the ground and restrained him, medics “falsely, recklessly, and intentionally claimed that (McClain) was experiencing so-called ‘excited delirium.’”
Though the official autopsy was inconclusive, the suit says that McClain was given an overdose of ketamine that exacerbated his condition, brought on by police brutality, including two carotid holds, contributing to his death.
The suit also states that first responders ignored McClain’s attempts to communicate with them. The first three words in the suit are his, as recorded by police body cameras: “I can’t breathe.”
Additional cases surface
Axtell and McKnight’s cases involve separate fire agencies, yet their experiences at times mirrored McClain’s. Both allege they attempted to reason with officers and medics, but were ignored before they were given the drug.
On the night of Aug. 20, 2019, Elijah McKnight was drinking with friends in downtown Denver. Afterwards, he got a ride from friends who dropped him off at a bus stop, where he fell asleep. Arapahoe County deputies, responding to a call about a man on the ground, woke him up. At first, McKnight didn’t cooperate.
“No, that means I’m going to get arrested and I’m going to be in jail,” he said, according to deputies’ body camera footage.
He asked deputies to call his father but the situation escalated when a deputy reached for McKnight’s arm. He turned away and attempted to run. Within seconds, the officer tackled McKnight to the ground. He laid on his back but the deputy pointed a Taser at him and told him to turn over.
“Turn around!” the deputy ordered. “Get on your stomach now. You’re going to get tased.”
McKnight did not turn and the deputy used the Taser. McKnight screamed and turned over.
“I will not move again,” McKnight repeated several times.
Deputies handcuffed him, but they did not put him into a patrol car to take him to jail. Instead, someone from South Metro Fire Rescue approached him.
“I’m with the fire department,” the fire worker said. “What’s your name?”
McKnight, asked for help, and gave his name twice and then answered a long list of questions, including the name of the president and how many quarters are in $1.
“Let me up, please,” McKnight said. “Just let me up so I can answer your questions.”
The fire worker declined, telling McKnight that he is “a little too hyped up right now.”
“I am being cooperative,” McKnight told him.
“You are. You are,” the fire worker said.
After more questions, workers brought over a gurney.
One of the first responders said, “We can give him ketamine.”
McKnight overheard them.
“Don’t give me anything!” he pleaded. “Don’t inject anything into my veins.”
But a medic gave him ketamine anyway. McKnight slowed, yet his legs continued to jerk and he struggled. About nine minutes later, a medic gave McKnight a second shot.
The arrest affidavit said medics concluded that McKnight had excited delirium.
The condition is considered a “rare medical emergency,” one where a person develops “extreme agitation, aggressiveness, overheating, and exceptional strength that cannot be managed by routine physical or medical techniques.” That’s according to Colorado’s Emergency Medical Practice Advisory Council, which advises the state’s department of public health on guidelines for using ketamine in this way.
McKnight told KUNC he was not experiencing excited delirium. Rather, he feared for his life.
“I thought I was going to die,” he said.
On Jan. 28, Jeremiah Axtell’s frustrations with the assisted living center by his girlfriend’s house boiled over in Lakewood. He yelled at workers there, complaining about their trash. Workers alleged that Axtell threatened them. When police arrived, Axtell retreated to the driveway because he wanted to get what was happening on camera. His girlfriend, Anita Springsteen, an attorney and member of the local city council, recorded with her cell phone.
Video shows Axtell sitting cross-legged in Springsteen’s driveway, handcuffed. The way the handcuffs were on caused him pain and he complained about it to officers.
“What the (expletive) is wrong with you people?” Axtell yelled at police.
They asked him if he would cooperate with them.
“Are you going to go?” an officer asked.
“Yes,” Axtell replied. “Wherever you want me to go.”
At another point he stated, “I’ll just get up and go in the car,” and, “We don’t need to do this anymore. This hurts, bro.”
It appeared officers were going to arrest Axtell. They helped him up from the ground. He walked with them toward a patrol vehicle. But they didn’t put him inside. Instead, the video shows West Metro Fire Rescue workers bringing a gurney over.
Officers and medics encircled Axtell at the side of the gurney. He shouted, “I will cooperate 100%.”
He then sat on the gurney and laid back. A medic left the circle holding a hypodermic needle, the video shows.
On camera, Springsteen sounded shocked: “They gave him a sedative?”
Police reports describe Axtell as “agitated” — even “belligerent” — but also calm at moments. The definition of excited delirium in Colorado’s guidelines for medics additionally states that “excited delirium patients lose their mental capacity to stop resisting and are truly out of control.”
Axtell told KUNC he was not out of control.
“I was complying,” he said. “I was 100% in compliance.”
KUNC requested interviews with the doctors who hold ketamine for excited delirium waivers for the fire agencies involved in the Axtell and McKnight cases — Dr. Pete Vellman (West Metro Fire) and Dr. John Riccio (South Metro Fire). Through a spokesperson, they declined to comment.
The two are among 25 Colorado doctors to sign a position paper last month voicing continued support for the use of ketamine to treat excited delirium.
Ketamine waiver program continues
On Monday, the board tasked with establishing guidelines and issuing/renewing waivers permitting agencies to use ketamine for excited delirium met in a public Zoom meeting. Vellman and Riccio’s waiver renewals were approved by the Emergency Medical Practice Advisory Council, or EMPAC.
But not before Springsteen had her say during a two-minute public comment period: “I’ve asked Gov. (Jared) Polis to ban the use of ketamine. If you renew ketamine waivers today, you will be complicit with deaths like those of Elijah McClain.”
McKnight also participated, after some discussion about the waivers. He questioned the honesty of the waiver renewal discussion, which failed to mention the complications in his case.
“I noticed that when you guys were reviewing South Metro Fire, who injected me with 750 milligrams (of ketamine), while I was cuffed and after they said I was alert… that when you were talking about complications, Dr. Riccio did not mention my situation,” he said.
Nicole Johnston, a member of Aurora’s City Council, which is mired in issues surrounding Elijah McClain’s death, spoke not about the case, but in general terms. She asked the board to pause the state’s waiver program that allows ketamine’s use for excited delirium.
“My ask of you today is to put a moratorium on new waivers while you further examine this issue, and potentially put standardized systems in place” Johnston said. “I also ask that you suspend existing waivers for 90 days in the use of law enforcement-involved EMS responses.”
One member of the board, Vice President Diana Koelliker, a doctor, seemed to give credence to the critics.
“I do think that as we move forward, it’s important for us to continue to kind of scrutinize this — how much we’re using it and for which indication,” she said. “I think that is worth our time.”
But specific cases never came up for discussion and despite the criticisms, every waiver on the agenda was renewed. Five new waivers were also approved.
KUNC requested an interview with Randy Kuykendall, who directs the emergency medical services division of the Colorado Department of Public Health and Environment, which issues the waivers. Kuykendall regularly attends EMPAC hearings, but did not respond to our request.
Some medical doctors object strongly to the use of ketamine for excited delirium. The Illinois-based American Society of Anesthesiologists opposes the use of ketamine or any other sedative/hypnotic agent to chemically incapacitate someone in situations involving police. ASA president, Dr. Mary Dale Peterson, told KUNC there are many concerns, including dangerous side effects.
“The ones that I’ve seen in the reports from Colorado — hypoxia is one, so it can cause respiratory depression, in the brain, or it can cause sleep apnea,” she said.
Used improperly, ketamine can cause death, she added. It is extremely useful to doctors, but should be used “inside a hospital, where somebody is being monitored and where there is a physician and everybody else around,” she said.
KUNC, in a prior investigation, identified 902 cases where medics across Colorado used ketamine on people with supposed excited delirium over two and a half years. In 17% of those cases, there were complications, some potentially life-threatening.
Both McKnight and Axtell feel the use of ketamine on them was disproportionate to the situations they were in with police, as well as unnecessarily risky considering the statistics.
Axtell said he is left feeling, “dehumanized, abused, brutalized, raped kinda, attempted murdered kinda.”
As for McKnight, he comes back to the feeling of “fearing for my life.”
Both men are facing criminal charges and both say they are innocent. Both wonder if ketamine and allegations of excited delirium could hurt their defenses in court. And both say the state public health department should do more to intervene in cases like theirs.