Rep. Caraveo: In the wake of unnecessary deaths, it’s past time to regulate ketamine in police situations

Police brutality has plagued communities across our state and country for decades, yet recent high-profile cases have forced lawmakers to re-examine the relationship between police officers and the public. 

Since the passage of Senate Bill 217 in 2020, the Colorado General Assembly has continued to examine the ways in which our laws are not protecting Coloradans during interactions with police officers. 

As a pediatrician, one practice that has personally concerned me has been the use of ketamine, a powerful anesthetic, in situations involving law enforcement. 

The science surrounding ketamine is complicated, yet the data reflects the high risks associated with its administration outside a hospital. In one study, 30.5% of patients who received ketamine in a pre-hospital setting were eventually intubated in a hospital emergency department. That’s over 16 times the rate of intubation when ketamine was administered in an emergency department.

Another study found that endotracheal intubation — insertion of a tube into the windpipe through the mouth or nose — was undertaken for 63% of patients who received ketamine in pre-hospital settings. 

Ketamine dosage is based on an individual’s weight, and since the drug has a narrow therapeutic dosage window — the amount that can be administered safely and effectively — small errors can cause irreparable harm. 

The federal government has scheduled ketamine as a controlled substance due to these risk factors, meaning that emergency service providers have to seek waivers to administer ketamine because the drug is outside of their standard scope of practice.

Meanwhile, there are many common practices in these pre-hospital settings that are not adequately substantiated. Ketamine is often used when paramedics determine that a patient is experiencing “excited delirium,” a condition of extreme agitation. 

Although “excited delirium” is a term conventionally used in emergency medical technician protocols and is often cited by law enforcement, it is actually a dubious diagnosis.  The American Medical Association, the American Psychiatric Association and the World Health Organization all do not recognize “excited delirium” as a legitimate condition.

Despite these concerns, regulations surrounding the use of ketamine are not strong enough.  In Colorado, the state’s Emergency Medical Practice Advisory Council oversees the waiver process, and despite numerous incidents, they have never denied nor revoked a waiver for ketamine. 

While their rules explicitly state that law enforcement cannot encourage paramedics to administer ketamine, law enforcement has either blatantly asked for its use or has pressured paramedics to do so. 

Combined with the lack of statute concerning ketamine, there are few safeguards in place to prevent abuses of the system and to protect Coloradans.

Elijah McClain’s death in Aurora after being injected with ketamine exemplifies the inexcusable influence that law enforcement exerts in these pre-hospital settings. Despite this high-profile incident, Coloradans continue to die due to unacceptable administration of ketamine when law enforcement is on scene. 

In September 2020, months after protests swept across Colorado in response to McClain’s death, the father of Hunter Barr, a 26-year-old Colorado Springs man, called 911 to seek medical help for his son, who had taken LSD that morning.

Paramedics arrived after law enforcement had pinned Hunter on the ground outside of his home, and they quickly administered two doses of ketamine. The overdosage rendered him unconscious, and he died a few hours later in the hospital after suffering cardiac arrest.

Both Elijah and Hunter should be alive today. In these incidents, the presence of law enforcement complicated the necessary delineation between “patient” and “suspect,” impacting the care administered by paramedics. 

EMT professionals and other organizations attest that ketamine should still be allowable in pre-hospital settings. Yet if we are to allow the continued use of ketamine, we must strengthen laws to separate the responsibilities of EMT professionals from those of on-scene police officers.

That is why I am proud to carry House Bill 1251 with state Rep. Leslie Herod, a champion for criminal justice reform, in this year’s legislative session. The measure passed out of the House Judiciary Committee on Thursday.

If my bill is signed into law, it would ensure that law enforcement cannot explicitly or implicitly pressure paramedics to administer ketamine. Paramedics would be barred from using ketamine to treat “excited delirium” or other questionable conditions across all situations. 

Paramedics could administer ketamine in clearly defined justifiable emergencies, yet if law enforcement is present, they have to account for the patient’s weight, conduct appropriate medical assessments, and receive permission from their medical director before use. 

HB 1251 also would address the ketamine waiver process by changing the composition of the Emergency Medical Practice Advisory Council. 

Together, these common-sense measures would promote a deliberate approach to ketamine administration that will save lives in pre-hospital settings.

The outcry from Coloradans over the last year has highlighted a system built on unsound medical practices and a lack of proper regulations. We cannot continue to administer ketamine in these law enforcement situations without safeguards for patients. 

Regardless of their status as a suspect or not, no one deserves intubation or death simply because of an interaction with the police. By passing HB 1251, we can take a critical step towards rebuilding the trust between police officers, paramedics and the public.

Dr. Yadira Caraveo, Democrat of Thornton, represents District 31 in Adams County in the Colorado House of Representatives. She is a practicing pediatrician.