Colorado Doctors' Group: Ketamine Safe, With More Oversight

Denver Post

An expert panel convened by Colorado's health department released a report Wednesday that found the sedative ketamine "is a safe drug" if used under specific circumstances, but recommended several steps the state should take to reduce medical harms and racist outcomes.

The panel, chaired by the state's chief medical officer and including seven other doctors, was a product of widespread outrage over the death of Aurora's Elijah McClain, who was violently arrested by police and then injected with ketamine by paramedics prior to his 2019 death.

Among many criticisms the city faced in its handling of the McClain case, an external investigation found that Aurora Fire paramedics seemed "to have accepted (police) officers' impression that Mr. McClain had excited delirium" — and thus the use of ketamine, a heavy sedative, was justified — "without corroborating that impression through meaningful observation or diagnostic examination."

Panel members were not asked to evaluate McClain's case in particular, but rather to probe whether and how the drug can be safely used in emergency settings in the future.

The recommendations in the panel's 126-page report include:

• Rejecting "excited delirium" as an acceptable excuse to administer ketamine to someone. The state already suspended this excuse in July in prehospital settings, and so the recommendation, if adopted, would not change current policy.
• Crafting standard doses based on body structure — small, medium, or large — of subjects. (Outside investigators have found McClain, who had a slight frame, was given a dose more appropriate for someone 80 pounds heavier than he actually was.)
• Close monitoring of people who'd received ketamine closely. "All ambulances should contain a checklist of actions for appropriate dosing and monitoring," the recommendations state.
• Standardizing ketamine practices among all emergency medical services providers through new statewide oversight.
• Analyzing whether there is disproportionate use of ketamine "for marginalized persons and communities of color in Colorado."

In a summary of its findings, the panel wrote that it "agreed that ketamine is a safe drug if used properly and monitored closely by properly trained and qualified paramedics.

"However, certain adverse events appear to have arisen primarily from the administration of ketamine and other sedatives to individuals who may not have a medical need for these medications and who could have been managed with a less assertive alternative," it continued. "Further, other societal and systemic factors at play may have allowed chemical restraints to be disproportionately applied to marginalized populations and communities of color in Colorado and across the nation."

Earlier this year the legislature passed a new law meant to restrict the use of ketamine in emergency situations.

That law, HB21-1251, requires responders to prove "medical emergency" before using ketamine to subdue someone suspected of criminal behavior; requires responders to weigh a person prior to administering ketamine, or, if that isn't possible, to confirm a weight assessment with at least two trained experts; and bans police from directing medical professionals to administer ketamine, or unduly influencing them to do so.

It's possible that state law will be supplemented by new policies proposed by the panel.

In a statement Wednesday, Jill Hunsaker Ryan, executive director of the Colorado Department of Public Health and Environment, said, "The department will take the panel's recommendations seriously to determine how to best protect the health and safety of Colorado residents."