Amid calls for justice for Elijah McClain — a 23-year-old Black man who died after he was stopped by police in Aurora, Colorado, and placed in a carotid hold by an officer — the use of ketamine during his arrest has also drawn scrutiny.
McClain's family says he was walking home last August when officers responded to a call of a suspicious person acting erratically. Colorado Gov. Jared Polis on Thursday appointed a special prosecutor to re-examine the case following intense public pressure and an online petition that garnered more than 3 million signatures.
Adams County district attorney Dave Young's office declined to file criminal charges in November, but in the wake of the killings of George Floyd, Ahmaud Arbery, Breonna Taylor and Rayshard Brooks, there has been renewed interest in McClain's case.
An autopsy was unable to determine whether McClain's death was an accident, due to natural causes or a homicide; however, medical and legal experts told USA TODAY that the injection of ketamine may have played a role. In medical settings, ketamine is routinely used for its rapid and anesthetic effects, but it is also used illicitly as a hallucinogen.
Here's what to know about the use of the drug during arrests and its risks.
Can ketamine or other sedatives be used during an arrest?
Yes, said Geoffrey Henley, a Dallas attorney in the case of Tony Timpa, who died during an arrest in which officers pinned his shoulders, knees and neck to the ground as he pleaded for help. Timpa was also dosed with a sedative.
Henley said, citing precedent from previous cases, that paramedics or other emergency medical professionals are generally allowed and protected under qualified immunity principles to administer sedatives to patients during an arrest following proper medical judgments. In general, past cases have not established clearly that using sedatives during an arrest is an example of excessive force, Henley said.
Henley said administering sedatives is often the protocol in some cases during which officers are subduing someone they believe to be resisting arrest. The goal is to prevent the person from struggling and thrashing, which can cause injury or distress and elevate their heart rate.
"It's unfortunate, and it's tragic," Henley said. "With respect to the ketamine, it very well may have been reckless by the EMTs. I wonder about that, but I think it's going to be difficult to make such a claim."
Although rare, it is also possible that someone's adrenaline levels rise so high during an arrest that it causes cardiac arrest, said Dr. Douglas Zipes, a professor of medicine at Indiana University.
According to Aurora Fire Rescue's department policy, ketamine is considered appropriate to administer to a patient who shows signs of "excited delirium," a condition characterized by aggressive activity, confused and unconnected thoughts or speech, hallucinations, and extraordinary strength and endurance when struggling.
According to a flowchart of the department's policy, the "goal is rapid tranquilization in order to minimize time struggling."
But "excited delirium" isn’t a recognized diagnosis in the American Psychiatric Association’s leading diagnostic manual, commonly known as the DSM or the International Classification of Diseases (ICD-9) of the World Health Organization. The American College of Emergency Physicians and the National Association of Medical Examiners do recognize it.
For decades, critics have pointed to the fact that the term is applied almost exclusively to in-custody deaths or deaths that otherwise involve law enforcement.
Why was Elijah McClain arrested, injected with ketamine?
On Aug. 24, 2019, the Aurora Police Department received a call around 10:30 p.m. about a "suspicious man" wearing a ski mask, according to a release. Officers arrived and tried to stop McClain, who they said was "actively resisting" and trying to grab one of their guns.
McClain told the officers that he was going home and asked that they "please respect my boundaries." Police said McClain had ignored their initial command to stop, but McClain told the officers he was stopping his music so he could listen, according to a report of the incident from the district attorney's office.
Police put McClain in a carotid hold, applying pressure around his neck, restricting blood flow to the brain. McClain briefly went unconscious.
According to the district attorney's report, the Aurora Fire Department was called to the scene, per police policy for when a carotid hold is used.
When fire personnel and medics arrived at the scene of McClain's arrest, a fire medic requested that McClain be injected with ketamine to sedate him.
Fire medic Jeremy Cooper told investigators that he requested ketamine following the fire department's protocol for when someone shows signs of "excited delirium."
The District Attorney's report says that Cooper requested 500 milligrams of ketamine.
In a statement, Aurora Fire Rescue said an investigation into its personnel's actions during McClain's arrest found that "the actions of the responders were consistent and aligned with our established protocols. In fact, the initial findings indicate that our personnel demonstrated a high level of technical skill and professionalism while providing care to the patient."
The report from the Adams County Coroner's Office could not make a conclusion on what caused McClain's death.
The report said it was possible McClain had an "idiosyncratic drug reaction," which can occur when a drug is administered at therapeutic levels but still has an unexpected reaction. His death could have been due to natural causes if he "had an undiagnosed mental illness that led to Excited Delirium," or homicide could have been the cause if the carotid hold led to arrhythmia, the report said.
The report also listed several contributing factors, including the combination of intense physical exertion and a narrow left coronary artery.
Is ketamine dangerous in these cases?
Ketamine, under appropriate dosage levels and with otherwise healthy patients, is generally considered safe, said Dr. Robert Glatter, an emergency physician in New York City.
But there are circumstances under which administering ketamine could have adverse and potentially lethal effects, including if a patient has hypoxia, or low oxygen levels, is dehydrated or has low blood pressure, Glatter said.
The use of the carotid hold in combination with the ketamine injection could have created "dangerous conditions" for McClain, Glatter said.
"These drugs do carry risks and, with certain types of patients under certain types of stressors, they can have adverse consequences and they can be lethal," he added.
Zipes, who reviewed the district attorney's and coroner's report cited a number of possible complications that can cause health issues when ketamine is used during an arrest: Injecting the drug too quickly or without proper monitoring, an unknown medical history and possible interactions with other substances in the patient's system. The coroner's report says McClain was also found to have marijuana in his system.
"No one can really say with absolute certainty what the cause was. My gut is it's related to the ketamine," Zipes said.