Lakewood councilwoman calls on governor to stop sedation of agitated people with ketamine

Problem Solvers

LAKEWOOD, Colo. (KDVR) – A Lakewood city councilwoman is calling on the governor to place a moratorium on the use of ketamine to sedate agitated patients, after learning paramedics gave the drug to her boyfriend in January.

“I feel that it’s a violation of Constitutional rights,” said Councilwoman Anita Springsteen. “It’s invasive. It’s assault and battery.”

Springsteen showed medical records to the FOX31 Problem Solvers that revealed her boyfriend, Jeremiah Axtell, was sedated with a 450 mg dose of the drug in January. Prior to his injection, he had been involved in a verbal altercation with his neighbors over an ongoing dispute, and the neighbors called police. 

“I watched it on the (cellphone and surveillance) videos, and I still don’t believe it,” said Axtell, who had alcohol and marijuana in his system at the time of the incident. “I think ketamine should be erased from their arsenal altogether.”

Ketamine is a drug that is not FDA-approved to sedate agitated patients experiencing a condition called excited delirium, according to a spokesperson for the FDA, Nathan Arnold. However, an agency’s medical director can apply for a waiver from the state health department so its paramedics can administer the drug for that purpose.

According to state guidelines developed by Colorado’s Emergency Medical Practice Advisory Council – the group that makes recommendations to the state about whether an agency’s medical director should be approved for a waiver – excited delirium is a “rare medical emergency in which a person develops extreme agitation, aggressiveness, overheating, and exceptional strength that cannot be managed by routine physical or medical techniques.  Excited delirium patients lose their mental capacity to stop resisting and are truly out of control. This type of extreme exertion may result in sudden death.”

The guidelines suggest that “moderate to severe agitation should be managed with traditional sedatives including benzodiazepines and anti-psychotics. Extreme or profound agitation, which is uncommon, should be viewed as a behavioral emergency requiring prompt aggressive sedation to ensure patient and provider safety.”

Springsteen, who watched the events unfold in her driveway, said she watched her boyfriend try to comply with authorities. She said he was not delirious, nor physically aggressive as medical crews had reported.

“He was not violent, he was just loud, and that’s very different than somebody who is jumping at them and trying to strangle them and trying to get their gun or whatever their case may be,” she said. “I’m devastated by this.”  

Springsteen spoke publicly about the incident at the Lakewood City Council meeting on July 6 and sent a message to Gov. Jared Polis, asking for his involvement. 

“It is my responsibility as an elected official to relay the extent of this crisis to Gov. Polis and the Colorado attorney general, and I ask them to expand their inquiry,” she said.

Springsteen said her ketamine research led her to FOX31’s investigations into the cases of Elijah McClain and Elijah McKnight. McClain died after an altercation with Aurora police and a 500 mg ketamine administration by Aurora Fire Rescue paramedics. A coroner said it was possible McClain suffered an adverse reaction to the drug. However, the state health department told the FOX31 Problem Solvers on June 18, “there were no findings that would support an action against the provider’s certificate…there will not be any additional investigation.”

Meanwhile, McKnight spent several days, intubated, in an intensive care unit after two injections, totaling 750 mg, by a paramedic at South Metro Fire Rescue. McKnight’s case is currently being reviewed by SMFR and investigated by the state health department as a result of the Problem Solvers’ investigation.

“It’s so important to me that this come to light and that this not happen to other people,” said Springsteen.

Springsteen recorded several videos of the January incident in which Axtell is seen sitting on the ground and shouting at the first responders who arrived on the scene. He was yelling swear words at police officers, asking for their business cards. Fire personnel from West Metro Fire asked Axtell whether he was hurt, to which he replied, “No, I am not hurt.”

As Axtell was being transported to a gurney and surrounded by first responders he yelled, “Everybody! I will cooperate 100 percent.”

“I knew something was going to happen. I wanted everyone around to know what was wrong,” said Axtell. He said he was never physically combative, and he insists he never had a weapon, despite being charged with “felony menacing-real/simulated weapon,” according to court records.

“There are de-escalating techniques that providers use prior to going to any type of sedative medication. Once those are deemed not successful, then medications are indicated to treat these conditions,” said Jeremy Metz, the division chief of Emergency Medical Services for West Metro Fire.

Despite being presented with a notarized authorization from Axtell to speak about the medical care delivered to Axtell, Metz declined to speak specifically about the reasons Axtell received ketamine during an interview with the FOX31 Problem Solvers on Thursday. He said he wanted to get legal authorization first.

When asked if someone who says, “I will cooperate 100 percent,” was an indication of “extreme combativeness” that would require the use of ketamine, Metz said, “I would say that could be one part of an entire picture that’s going on with somebody, so I wouldn’t be able to make a comment on that.”

Although the state ketamine waiver grants a medical director permission to use the drug for the specific condition, excited delirium, Metz told the Problem Solvers, “ketamine can be used for combativeness.”

State EMPAC guidelines suggest “treatment of agitation, even severe agitation, should be with benzodiazepines and/or antipsychotics.” Ketamine should be considered when a patient “exhibits extreme or profound agitation placing themselves or providers in imminent danger, appears to lack the mental capacity to disengage from the struggle, (and) has no option other than being restrained.”

While many emergency physicians have indicated ketamine is a safe drug and an important tool for paramedics who may be in danger or have patients who are in danger, the state guidelines also say the drug is associated with “a significant potential for complications and may lead to the need for intubation.”

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