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Cops And The ‘K-Hole’

The death of 23-year-old Elijah McClain in 2019 has drawn new outrage and grief in recent weeks as the nation grapples with police violence, especially directed at Black Americans. It has also highlighted the co-opting of emergency medicine by cops who use it as their enabler.

McClain, a slightly built massage therapist and violinist, died last summer after what police claimed was a violent encounter. All the evidence that has since publicly emerged indicates that the violence was entirely one-sided on the part of the Aurora, Colorado police, who were initially cleared after an investigation by local prosecutors. Gov. Jared Polis has now appointed a special prosecutor to reevaluate the case in the face of intense public pressure. Federal authorities are also reviewing the actions of the police officers involved to see whether a civil rights investigation is warranted. At this writing, none of the officers have been charged, although one has been fired and others are on administrative leave.

McClain was walking home from a convenience store when police were called to investigate a suspicious person wearing a ski mask. (His sister later said he sometimes wore an open-faced head covering because he was anemic and easily became cold.) Three officers confronted him; one told him he was stopped because he was “being suspicious.”

Within 15 minutes, the officers had thrown him to the ground and applied a carotid hold, a type of chokehold the Aurora police department has since banned. McClain can be heard on body camera audio pleading with officers that he is “just different.” His last words are as agonizing to read as they are to hear on the recording the police released months after his death.

When firefighter paramedics arrived at the scene of McClain’s arrest, he was already handcuffed and on the ground. If McClain was agitated, there was little mystery as to why, but he was also clearly no threat to the law enforcement officers. Yet the police encouraged the EMTs to administer ketamine, saying that McClain was fighting with unusual strength and had reached for an officer’s gun. A spokeswoman for the Aurora police has since said that officers cannot order the use of ketamine; application is left to the discretion of a medic.

Ketamine is an anesthetic, used for both humans and animals, and is generally safe in proper doses in a medical setting. It is also sometimes a drug of abuse, with users seeking to get lost in a “K-hole,” a dissociative state. Increasingly, ketamine seems to have a third use in disabling civilians during encounters with law enforcement. The Cut recently reported that, although there is no publicly available data reflecting how often medics use ketamine with law enforcement officers present, a 2018 article in the Minneapolis Star Tribune documented at least 62 cases the year prior. In Colorado, 90 fire departments and emergency medical agencies can legally use ketamine on people who they register as aggressive or agitated. The Denver Post reported that Colorado medics gave 427 people ketamine due to agitation from August 2017 to July 2018. About 20% of these individuals needed intubation because of their struggles to breathe after receiving the drug.

EMTs administered a dose of 500 milligrams of ketamine to McClain. That dose reportedly led him to lose consciousness. On the way to the hospital, he went into cardiac arrest. While the coroner’s report said the cause of McClain’s death was “undetermined,” some medical and legal experts believe that ketamine was instrumental in his death. McClain’s family decided to take him off life support less than a week later, after his medical team declared him brain dead.

Dr. Robert Glatter, a New York City-based emergency physician, told The Cut that someone in McClain’s position should never have been given ketamine. The officers had put McClain in a carotid hold that rendered him temporarily unconscious; McClain also had anemia. These two factors meant he was already having trouble getting enough oxygen. Under these circumstances, Glatter said, the conditions were right for ketamine to cause cardiac arrest.

Aside from any criminal consequences arising out of McClain’s death, lawmakers should prohibit the use of ketamine and other sedatives by EMTs on police calls except when in direct contact and under the instructions of a physician. EMTs are highly skilled, but they aren’t doctors. The paramedic who administered ketamine to McClain reportedly misjudged his weight by more than 100 pounds, affecting the dosage. Police officers, for their part, are unqualified to dictate whether it is appropriate to give someone a powerful sedative. In McClain’s case and others like it, the choice to use ketamine is a potential case of medical malpractice committed by individuals who aren’t licensed to practice medicine.

If you go to a physiotherapist’s office for a simple massage, you need to provide a detailed medical history. But law enforcement officers across the country have been documented instructing EMTs to inject a potentially dangerous drug (which keeps the police’s hands clean) when they know nothing about the individual they are dosing. Besides the potential danger to people with anemia, hypertension or preexisting heart problems, giving ketamine to individuals taking certain psychiatric medications could cause life-threatening drug interactions. People who have recently been drinking or taking other nonprescribed drugs may also face serious side effects.

Several lawyers have suggested that police deploy ketamine, like many law enforcement tools, more often and for lesser reasons against Black people. Some have theorized that it is a way for officers to avoid having to defend the use of a Taser or other means of subduing a suspect. Since the decision is, in theory, the medic’s, officers can deny responsibility. The stark fact is that police should not be directing or even advising EMTs to use ketamine on anyone. Without knowing a suspect’s health conditions, other medications or medical history, such applications roll the dice on potentially lethal side effects. Medical professionals have warned as much.

As Carl Takei, a senior staff attorney for the American Civil Liberties Union, told NBC: “Any time that an EMT is administering a medication against a person’s will, that raises medical ethics issues, as well, that are not resolved simply because a police officer wanted them to do it.”

McClain’s death fits a sickeningly familiar pattern of unarmed Black men who die at the hands of police, but it is a disservice to him to merely add him to a list of names. McClain was, by all accounts, a sweet and gentle young man who met the police that night because he simply stood out a little bit. He was “just different,” in his own words. I want to see him for the individual that he was – the sort of young person I would want to know. Now, for no good reason, I never can.

Elijah McClain was assaulted first with a chokehold, and then again with a syringe. If nothing else comes from his death, let’s at least make sure that unqualified police can no longer use other hands to wield a needle that – for good reason – is not in their tool belt.

Larry M. Elkin is the founder and president of Palisades Hudson, and is based out of Palisades Hudson’s Fort Lauderdale, Florida headquarters. He wrote several of the chapters in the firm’s book, Looking Ahead: Life, Family, Wealth and Business After 55. His contributions include Chapter 1, “Looking Ahead When Youth Is Behind Us” and Chapter 4, “The Family Business."

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