Another ketamine case: man sedated after refusing to give driver’s license

Problem Solvers

MANITOU SPRINGS, Colo. (KDVR) – Video of a 2019 Manitou Springs traffic stop shows a man refusing to hand over his driver license, being detained, and eventually, sedated with ketamine as he continues to express frustration and shout expletives at authorities.

“Looking back on it, I think it’s absurd, and it should’ve never happened. It didn’t need to happen,” said 60-year-old Steven Reycraft.

Reycraft, who recently testified during a House Judiciary Committee hearing against the use of ketamine to sedate agitated people, said he believed he was sedated by a medic after his struggle with police because he was questioning authority.

“They didn’t like the fact that I was challenging their professionalism, and I was,” Reycraft said.

The police encounter

According to the American Civil Liberties Union of Colorado’s Know Your Rights training guide, if you are driving and pulled over for a traffic violation, an officer can require you to show your license, vehicle registration and proof of insurance.

Body-camera footage shows Reycraft refusing to hand over his driver license during a minor traffic stop. After more than seven minutes of discussion about the issue, police detained Reycraft by taking him to the ground and handcuffing him.

During the takedown, Reycraft suffered a scrape on his forehead that caused him to bleed.

“Every time they wrenched my arm, it hurt a lot, but I was more incensed by what I was witnessing,” Reycraft said of his encounter with police.

The Manitou Springs Police Department declined an interview with the Problem Solvers but issued a statement.

“For the safety of our community, public safety employees, and everybody involved, it is standard police practice to implement a reasonable use of force within the confines of the law when someone is resisting a detention. 

“The MSPD takes any use of force extremely seriously, and as a team, reviews every use of force incident by our officers to ensure that we are remaining vigilant and focused on the betterment of our community,” said Alex Trefry, a spokesperson for Manitou Springs.

The sedation

Medics arrived at the scene and administered two types of sedatives, including ketamine, a drug that has become a controversial choice in Colorado after a handful of high-profile cases in which the drug was used to sedate someone.

Currently, the state health department is privately reviewing the drug and how it is regulated in the state.

Although many medical professionals have said the drug is a safe medical tool when monitored and used appropriately in a pre-hospital setting, a few cases in which the drug was administered involved patients who suffered adverse or deadly outcomes.

Recently, Colorado’s General Assembly passed a bill that would increase regulations for how and when ketamine is used on people who have been involved in police altercations, and it would restrict a law enforcement officer’s influence over a medic.

Although Reycraft did not suffer a physical, adverse reaction, he told the Problem Solvers he did not believe there was a medical reason for his sedation.

“I’m saddened, because it happens to other people,” Reycraft said.

The video

Body-camera video obtained by the Problem Solvers shows a paramedic responding to the scene and assessing Reycraft as he sat cuffed on the ground, shouting at the law enforcement officers who detained him.

The medic eventually approached a police officer to ask whether Reycraft had been acting erratically prior to the medical crew’s arrival on the scene.

“No, he’s one of these people that doesn’t want to give his name and (he’s saying) he has the right not to, and all this other stuff,” the officer replied.

The paramedic responded by explaining her medical plan to the officer.

“I’m going to sedate him, because I don’t like that you guys are having to hold him down,” she said. “I’m going to give him Versed though. I’m not going to give him ketamine, because he’s not ‘excited delirium,’” she said, referencing the extremely agitated condition for which medics are allowed to administer the drug.

However, after two doses of Versed, the medic proceeded to inject ketamine into Reycraft’s buttocks while he was cuffed and strapped to a gurney.

“The fact that police can influence the health provider to the point where the health provider forgets their oath of helping people, it’s absurd,” Reycraft said.

“I think his case is a very good example of the misuse of ketamine because, specifically, the paramedic said when she walked up that it was not excited delirium and that she was not going to give him ketamine,” said Anita Springsteen, an attorney who is representing Reycraft.

Springsteen protests the use of ketamine in Colorado after her boyfriend, Jeremiah Axtell, received a dose from West Metro Fire Rescue medics in 2020.

State ketamine guidance

The Colorado Department of Public Health and Environment is the agency that grants waivers to medical directors, enabling them and the paramedics who practice under them to administer ketamine to agitated patients in a pre-hospital setting.

According to state guidance, “the goal of agitation management is directed at providing the greatest amount of safety for patients and providers while using the most humane and respectful treatments. Agitation that is not thought to be due to an underlying medical or psychological etiology should be managed by police or other public safety providers. EMS providers should not engage in restraining people for law enforcement purposes.”

Emergency medical services perspective

The Manitou Springs Fire Department would not participate in an on-camera interview about the incident and told the Problem Solvers they destroyed their 2019 ketamine protocol, so it cannot be reviewed.

“The Manitou Springs Fire Department and all of our EMTs undergo extensive training regarding medicine administration and patient care, with methods approved by doctors and experts in the field, Trefry said. “It would be outside of our Code of Ethics to comment on any inquiries regarding any member of the public, or the care that they receive.” 

In Colorado, EMTs do not administer ketamine unless they are also a paramedic.

Scott Sholes, the president of the Emergency Medical Services Association of Colorado, said the administration of ketamine in Reycraft’s case was appropriate after reviewing Reycraft’s medical records (with Reycraft’s permission), documentation related to the case, and body-camera video. 

“We see the paramedic do her best to assess this patient. She decides, at the start, not to give ketamine,” Sholes said. 

Sholes, who has more than four decades of emergency experience, explained that he believes the medic approached the police officer to verbally express her medical plan because “she was thinking out loud,” he said. “In that situation, I think law enforcement is considered part of that team.”

Sholes said he observed the medic appropriately following a progression of steps before she administered the more aggressive sedative.

“That progression is to use a milder sedative first, which was Versed, at a fairly low-dose for his size and weight. She waits five minutes. There’s really no change. She tries it again. That’s within their protocol, and then at some point, when they do move (Reycraft) to the stretcher, he’s still straining against the restraints,” Sholes said.

He said he believes the medic decided to give the ketamine to Reycraft so he would be better prepared for transportation to the hospital.

“One of our big concerns is to prevent the escalation of their agitation, and I think that’s why – that they’re seeing that a milder sedative is having no effect (on Reycraft). He’s continuing to escalate the agitation,” said Sholes.

He said it is more difficult to manage a “truly combative” patient in the confines of an ambulance.

“When these patients are sort of in our custody — in our care — we have a responsibility for trying to prevent them from harming themselves, and so when he’s struggling like that against the handcuffs and maybe could injure someone or maybe injure himself, we have concerns about putting him in the back of the ambulance and driving him down the road, simply, partially managed. That’s why I think it was a good decision to move to the ketamine as a stronger sedative, and as we saw, he calmed down and was safely transported,” Sholes saod.

State guidance vs. protocol

Sholes described Reycraft’s level of agitation as “moderate to severe,” at the point in time when the patient received the ketamine.

The most current state guidance on ketamine, published in 2019, however, advises medical professionals 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.”

“First of all, I think there’s some confusion…with the state guidelines, and where that falls within the waiver process,” Sholes said. 

“Manitou Fire, like all of us who have a waiver for ketamine for extreme agitation, must produce a current protocol and then training documents and quality assurance records and that sort of thing in order to maintain that waiver. The process is even greater to get the initial waiver,” Sholes said. “Their protocol has been reviewed and approved, and so, the medic working under that protocol correctly assessed that patient as progressing as their agitation was getting worse, and they want to prevent that patient from harming themselves or others during transport.”

Sholes said part of the challenge is “how we’re defining it,” explaining the conflict between state guidance and individual agencies’ protocols.

The health department

The health department continues to decline interviews while it is privately reviewing its own ketamine regulations and policies.

“We need all of the information to be shared. It needs to be shared accurately, and it needs to be vetted thoroughly. CDPHE has this panel reviewing ketamine use in Colorado, and there’s been a long delay, first getting it started, and now, having any result from that,” said Sholes. “Now is the time for that. I’m a little bit distressed that it is taking so long,” he said, explaining that the state has not fully vetted the use of ketamine statewide nor the tragedies that have been linked to the drug.

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