Repercussions From Elijah McClain’s Death After Forcible Restraint and Ketamine Injection

The investigation of the tragic death of Elijah McClain in 2019 in Aurora, Colorado requires our review. A young, unarmed man, who had not committed a crime, was stopped while walking home from a store by a police officer. McClain was forcefully restrained on the ground, next subjected to a carotid control hold resulting in loss of consciousness and vomiting, and then was administered an overdose of ketamine for his alleged “excited delirium.” McClain’s pulse and breathing stopped in the ambulance, and he died days afterwards. As I followed this case until its judicial conclusions in December of 2023, I have found this tragedy alarming for several reasons, but mostly as the mother of a 23-year-old son like McClain. This case requires police to review excessive force, requires paramedics to review unlawful drug injection, and ultimately for citizens to advocate for informed consent for any drug, even with police suspects.

Excessive Force

“Who Killed Elijah McClain? Mixed Verdicts Reflect a Cascade of Ultimately Fatal Mistakes,” in Reason summarizes the investigation and court verdicts of the three police officers and two paramedics involved.

The cascade of events begins with a 911 caller who reports a “sketchy” suspect. In this case, the suspect is wearing headphones under a hat and ski mask, making movements to the audio, and over-dressed in warm clothes on a summer night, while walking home with a purchase of tea from a convenience store. The store had not reported a crime or a dangerous person. The investigation reveals that Elijah had a condition which causes cold in extremities.

The first responding officer fails to initiate an explanatory conversation with McClain, who does not hear the officer yell “stop,” and reasonably McClain is caught off guard and startled. The first mistake was escalating what should have been a consensual encounter, because probable cause for illegal activity was not established, and too quickly escalatied into an investigatory stop.

Two more officers join the scene, and they decide to frisk and detain McClain in a grassy area. This second mistake is escalating a stop into an arrest, again because probable cause has not been established that a crime has been committed.

McClain is then tackled, put in a carotid hold, loses consciousness, wakes up and vomits, and complains of difficulty breathing. A third mistake is neglect of McClain’s airway. The officers do not reposition McClain who is vomiting, with his hands cuffed, with downward pressure on his back, while still wearing a ski-mask. The autopsy reveals he aspirated some of the vomit.

Medical Malpractice with Ketamine

The final and fatal mistake is the action of two paramedics. The paramedics failed to assess McClain; they did not talk to him, assess his vital signs, or ask him his weight. The paramedics did not take into account that the suspect had just been placed in two carotid holds, and he had repeatedly vomited. The paramedics accepted the police officers’ diagnosis of “excited delirium.” After one minute of observation of a fully restrained and unarmed suspect, the paramedics decided to inject the sedative ketamine. Ketamine also suppresses respiration, and the drug is problematic for people with breathing difficulties. To add insult to injury, the paramedics over-administer 500 milligrams of ketamine, when 325 milligrams was the correct dose for the weight of a 140-pound person. Then they failed to monitor the suspect’s vital signs and breathing, and they did not recognize signs of overdose. McClain becomes unconscious, not sleepy, and stops breathing in the ambulance. Paramedics attempted CPR to revive him, but McClain never regained consciousness.

Legislative Changes and CDPHE Guidance on Ketamine

In 2021, Gov. Polis signed HB21-1251 into law. As reported by KDVR, the law added new requirements on when a paramedic can administer ketamine: after a verbal order from a medical supervisor (not a police officer’s request), after an accurate estimation of the patient’s weight to ensure proper dosage, with equipment on site to monitor vital signs, and an ambulance for rapid transportation to a hospital.

According to KUNC, just hours before this bill became law, CDPHE ordered a halt to paramedics using ketamine. KUNC investigations found that Colorado paramedics sedated agitated people 902 times in two and a half years for a rare condition called excited delirium — and complications arose in about 17% of cases. KUNC also reported the following medical opinions against the use of ketamine:

“National and state anesthesiologist groups say that using ketamine in the field is dangerous. The American Medical Association’s House of Delegates last month issued a statement saying that current evidence does not support ‘excited delirium’ as an official diagnosis. The AMA delegates also denounced excited delirium ‘as a sole justification for law enforcement use of excessive force.’”

In 2020, Aurora City Council banned the use of ketamine by paramedics. In 2022, Aurora City Council advanced a ban of other sedatives used by paramedics such as Versed (midazolam, which also depresses breathing) and droperidol (with a black box warning for cardiac arrest). However, the ban proposal was tabled due to uncertainty if the measure would decrease liability for the city and paramedics.

Repercussions

Juries convicted the two paramedics of criminally negligent homicide, convicted one police officer of criminally negligent homicide, and acquitted two other police officers. This article is not to further stigmatize these law enforcement officers who made mistakes, but to draw attention to factors which increase wrongful arrest, excessive force, and fatal use of a sedative injection.

1. Police training must periodically review procedures with an emphasis on de-escalation. McClain was stopped by police based on a “sketchy” description, without evidence of a crime or weapon. Elijah McClain reverberated in my heart one day in 2023 when my young-adult son told me about his frightful stop by Denver police. My son was walking to a coffee shop, and the police drove up to him and demanded that he get in the police car, while calling him by the wrong name. My son responded that he was not the person they thought he was. Police exited the vehicle and insisted that he matched the vague description (tall, wearing shorts and a t-shirt) while repeatedly misidentifying him by the wrong name. When my son reached to get his identification from his wallet, both officers put their hands on their weapons despite the fact that my son’s athletic shorts pocket did not have the capacity to hold a weapon. Clearly, our police need re-occurring training on how to identify and approach a suspect, and then differentiate between a non-threat from a threat.
2. Police need training on people with disabilities. We should consider that there are people with developmental disabilities and medical conditions which make them different in mannerisms and responses, but not dangerous. I have another adult son with a developmental disability, and he would be very confused in a police encounter and lack verbal skills to advocate for himself and answer basic questions. There is public speculation in McClain’s case that he was a high-functioning adult with an undiagnosed autism spectrum disorder, and his unique mannerisms and unusual dress may have contributed to the “sketchy” 911 caller’s report.
3. Paramedics need training on informed consent. Many people have medical contraindications to drugs and sedatives. McClain’s case necessitates that current guidelines need review for paramedics to inject any sedative without screening the patient for contraindications. A conversation between the paramedic and patient is essential to answer some basic questions. First, is it ethical to consider a sedative injection for someone who is already restrained? Second, is it safe to inject ketamine into a person who is suspected to be under the influence of other unknown drugs with potential drug interaction? Third, is it necessary? Symptoms of “excited delirium” which were not present in the McClain case while he communicated clearly and reacted to pain with police. Again, a simple conversation between the paramedics and the patient with the goal of informed consent would have brought clarity to this situation. McClain, at 140 pounds and in handcuffs, was not a threat to three larger police officers. The coroner could not rule out that McClain had an adverse reaction to ketamine.