UPDATE: Ketamine review incomplete, state revamps drug waiver program

Problem Solvers

DENVER (KDVR) — The state health department’s ketamine review, which was announced more than a year and two months ago, continues to be delayed, according to an update from Michelle Reese, a senior policy advisor with the Health Facilities and EMS Division of the Colorado Department of Public Health and Environment.

“It is still being finalized, but it’s getting very close,” said Reese, during the state’s Emergency Medical Practice Advisory Council meeting Monday morning.  

The health department gave a similar update in July, estimating that the review would’ve been completed by the end of that month.

“I don’t have an exact date that it’s going to be released, but it’s pretty close, so hopefully, maybe by the end of the month we will have that report out,” Reese said during Monday’s EMPAC meeting.

Reese said the state was working on creating a special section on CDPHE’s website in which people can click on various sections of the report, which will be in PDF form.

The review was announced in August 2020, after the Problem Solvers uncovered a handful of questionable cases involving the use of the drug, by paramedics, outside of a hospital setting.

At the time, the drug required a special waiver, recommended by the EMPAC and approved by CDPHE, before a paramedic could administer the drug under the guidance of a medical director.

Ketamine waivers that allowed agitated people to be sedated outside of a hospital setting were suspended in July, when a new state law, restricting the use of the drug in law enforcement settings, went into effect.

New waiver procedure

The state health department has also been reviewing and revamping the manner in which it handles all waivered drugs for emergency medical services in the state, in an effort to promote transparency and objectivity and to improve health equity.

“These are important decisions to be made, and they impact public safety,” said Randy Kuykendall, the outgoing Health Facilities and EMS Division director at CDPHE, “but also, to be able to monitor, as with any process improvement program, the outcomes, and determine when things are occurring correctly and be able to catch issues and problems very early in the process that might not have been seen earlier.”

Kuykendall said the waiver program has provided opportunities for the state to react more quickly to advances or changes in emergency medical treatment over time, but waivers have also caused a certain amount of “non-standardization” as well. There are different training approaches to some of the same procedures in various parts of the state, he said.

“The nimbleness of our system at times has given us opportunities to sometimes maybe move a little bit too quickly over time, and that’s one of the things we are trying very hard to start pulling back on and be a little bit more thorough in this new process,” he said.

Kuykendall said the time is now to make improvements in the statewide system to ensure every citizen receives the same level of care regardless of where they live. The new waiver process will include the enhanced data collection and analysis.

“Certainly, this past year has not been comfortable for any of us in a variety of ways. I think the accountability issues that are out there are real. That is exactly why the Division and the EMTS branch have gone through this process improvement process,” said Kuykendall.

New EMPAC members

Under the new law, restricting how ketamine is used on agitated people by paramedics, in law enforcement settings, additional medical professionals – including a psychiatrist and an anesthesiologist – were to be added to the EMPAC.

Monday morning, Dr. Kim Nordstrom, an emergency psychiatrist, and Dr. Dan Janik, an attending anesthesiologist, joined the council.

Some EMPAC members were not renewed for another term after serving two four-year terms.

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