AURORA, Colo. (KDVR) -- The drug used to sedate an Aurora man who had an altercation with police last August and later died should have been a lower dose, according to a report from the ambulance company that provided the drug that was administered by a fire department paramedic.
The Aurora Fire Rescue medic “administered 500 mg Ketamine IM to (patient’s) R deltoid prior to discussing (patient’s) weight and proper dosage with Falck medic,” the report said. “(Patient) had not been seen by Falck medic prior to administration of Ketamine due to darkness as well as multiple APD officers being on top of (patient).”
The report from Falck Ambulance refers to an incident involving Elijah McClain, a 23-year-old who had been approached by Aurora police officers last August, after a 911 caller said he looked suspicious wearing a black ski mask while walking down the street and swinging his arms.
Three officers surrounded McClain when he did not initially comply with their commands and two said they attempted a carotid hold on him when an officer alleged McClain tried to grab an officer’s gun.
In an effort to calm McClain after the altercation, an Aurora Fire Rescue lieutenant and an AFR medic suggested a 500mg dose of ketamine.
Because Aurora Fire Rescue does not currently carry the drug, a Falck Ambulance paramedic provided it. Aurora Fire medic Jeremy Cooper ultimately administered the drug.
Moments later, McClain went into cardiac arrest.
He died a few days later.
A coroner referred to the ketamine dose as “therapeutic” but said an unexpected reaction to the drug could not be excluded as a factor – among many other things - in McClain’s death. His cause of death was undetermined.
According to the ambulance report, buried in a 521-page investigative police report into the death of Elijah McClain, the “proper dose (of ketamine) should have been 350mg,” based on McClain’s size.
Aurora Fire Rescue protocol says the amount of drug that should be administered to a patient is five milligrams per kilogram of weight. Under that protocol, a 500mg dose would be appropriate for someone who weighs approximately 220 pounds.
An autopsy report showed McClain weighed 140 pounds during the examination after his death.
“They gave him an excessive dose of ketamine,” said Mari Newman, an attorney for McClain’s family, who notified the city of Aurora this week that she intends to sue.
In a letter to the city attorney’s office, she called the dosing decisions made by Aurora Fire Rescue personnel “shockingly wrong.”
“Each paramedic later would seek to justify his outrageously excessive dosage by saying that he was not in a position to make a reasonable estimate of Mr. McClain’s weight due to the poor lighting conditions, concealing clothing, Mr. McClain’s movements, and other factors that made visual weight estimation difficult,” she wrote.
The city of Aurora declined to comment due to the possibility of litigation.
Aurora Fire Rescue sent the following statement Friday afternoon:
"We continue to offer our sincere condolences to all those impacted by this tragic event.
There has been a thorough review by the coroner’s office of the incident that found the patient was exhibiting the signs and symptoms of excited delirium, a dangerous and often inexplicable condition, and suggested that the therapy for that condition, ketamine, had been properly administered and that the blood ketamine concentration was at a therapeutic level. There is no conclusive evidence that the care provided by Aurora Fire Rescue contributed to his death."
Meanwhile, the FOX31 Problem Solvers obtained video-recorded interviews with the Aurora first responders who were on the scene.
Lt. Peter Cichuniec told an Aurora police Major Crimes Unit detective that he was the person who ordered ketamine to be used on McClain because he thought McClain was displaying signs of the agitated medical condition called excited delirium.
“It’s a medical condition that this person has no control over their body at all. They’re not in their right state of mind,” he said.
Cichuniec said he estimated McClain’s weight to be about 190 pounds.
“Due to the darkness, struggling so much, what he was wearing, and not staying still, I estimated roughly 85kg,” he said.
Cichuniec said he requested 500mg because he was taught that a small person might require 300mg, a medium-sized person would likely require 400mg, and a large person should receive a 500mg dose.
“He was over the 400mg (dosing protocol) and with a 5cc syringe, we cannot measure – there’s no increments on there to measure exactly – so, I went up to the 500mg (dose) because of his agitated state and his signs and symptoms of excited delirium,” he said.
Cooper said his training taught him that “if you don’t know an exact weight, you can kind of go off generalized dosing of 300mg, 400mg, or 500mg, depending on the size of the patient. Five hundred (milligrams) being (a) large adult, 400mg being a smaller adult, and then 300mg being – I guess - an adolescent to a small adult.”
Ketamine is not FDA approved for the sedation of agitated patients, but many physicians say the drug is safe, important and an effective medication that can save a person’s life when they are a danger to themselves or to others.
In 2018, according to state records, the drug was administered 265 times with a total of 14 cases that involved one or more complication.