Medical experts uncertain about ketamine review status 2 months after it was announced

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DENVER (KDVR) – Medical experts who had hoped to be involved in a thorough review of state policies that allow for paramedics to administer the sedative, ketamine, to agitated patients say they’re still in the dark about the plans for the review.

“We don’t understand why it has taken now nine weeks since the announcement of the review taking place to release any information on how this will be done. Really it should have been accomplished much sooner, before this,” said Dr. Randall Clark, an anesthesiologist who has spoken publicly about concerns on behalf the Colorado Society of Anesthesiologists and the American Society of Anesthesiologists.

In August, CDPHE announced it would conduct a review of its ketamine waiver program after the FOX31 Problem Solvers reported extensively on three questionable incidents involving a ketamine administration, including the cases of Elijah McClainElijah McKnight, and Jeremiah Axtell.  The state health department also said it would not publicly comment again until the review was complete, and it announced the review could last a minimum of 12 weeks.

For that reason, the FOX31 Problem Solvers filed an open records request for emails sent to or from Dr. Eric France in which the topic of ketamine was discussed.

In one message, dated Sep. 2, France contacted Clark to alert him about the review process. “There will be a call for candidates to send us a letter of interest and resume,” he wrote. “I will be sure that we send it on to you once our process is finalized. I will be out next week so expect it to come the week of 14th or 21st.” Clark said he never received a letter or a request for a resume.

Instead, Clark said he received a notification that he had been added to an online group called CDPHE Ketamine Review Panel followed by a Sept. 28 email from a health department employee indicating the notification was a mistake.

“Last week you may have received an email from ‘CDPHE Ketamine Review Panel’. The email states that you have been added to the ‘CDPHE_Ketamine Review Panel group’ and you could access the group member list. If you clicked on the link you were denied access to the list. This email has understandably caused confusion for recipients so we want to explain what we think happened,” the email, signed by Karen Osthus, a policy advisor for the Office of Policy and Regulatory Development, said.

“Last week we created a contact list that includes, among other names, a list of email addresses of persons who may be interested in participating in the panel. We did not intend for any message to be sent.  However, due to a technological glitch, the system generated the email you received. We want to clarify that you are on our contact list but no panel members have been chosen. We apologize for the confusion. Please let us know if you would like your information removed from the list,” she said.

Clark said he hasn’t received any additional correspondence related to the review panel.

The state health department declined to speak further about the review but did confirm that the review is still being handled by the health department.

“I think we’re going to get to a better place, but it needs the state agencies to be relatively open in looking at how we’ve gotten to this point,” said Clark, “and we’re hoping that the CDPHE chief medical officer and other officials there will be as forthcoming as possible. We’re all in this to help protect the public.”

“We are not waiting for the state to progress forward on this,” said Anita Springsteen, a Lakewood City Councilwoman who believes her boyfriend, Axtell, received an unnecessary dose of ketamine after interacting with law enforcement officials earlier this year. “It is extremely frustrating that there continues to be this lack of transparency,” she said.

Springsteen said she has been organizing her own group of stakeholders – including medical professionals and legal, policy-making experts – who have met with or plan to meet with some state legislators to discuss how to proceed.

“The CDPHE is supposed to be protecting the public, and is supposed to be facilitating accountability, and I think that a long enough period has gone by that we should have heard something by now,” she said. “I have a lot of concerns about why we are not looking at this with more urgency.”

The FOX31 Problem Solvers also obtained an email sent to CDPHE by the Colorado Psychiatric Society on Sept. 9.

“As providers who at times care for patients who are acutely agitated and in need of immediate treatment to prevent harm to themselves and others, we understand the need for such EMS protocols. Simultaneously, we are aware of the potential harms that may arise from the use of chemical restraint and medications emergently used to treat excited delirium,” said the letter, signed by Dr. Elizabeth Lowdermilk, the legislative chair of the Colorado Psychiatric Society.

“We strongly support the development of a multidisciplinary committee to review the existing ketamine protocols for excited delirium. We believe the committee needs to include experts in the use of ketamine such as anesthesiologists and providers involved in treating individuals for which ketamine may be considered such as EMS providers and emergency physicians. In addition, we request that experts in the treatment of acute agitation such as psychiatrists be included.”

According to Anna Weaver, executive director of the Colorado Psychiatric Society, CPS has been contacted by CDPHE but “we do not know the makeup of the review committee.”

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