State chief medical officer says ‘more to come’ on Colorado ketamine program

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DENVER (KDVR) – Ketamine caused complications in 24% of Colorado cases where medical professionals used the drug to sedate extremely agitated patients in 2019, according to new data analyzed and released by the Colorado Department of Public Health and Environment (CDPHE).

Two of those cases included the incidents of Elijah McClain, who died a few days after being sedated with the drug following a police altercation, and the case of Elijah McKnight, who spent more than a week in the hospital, including a few days on a ventilator after receiving a ketamine injection.

The most common complications included hypoxia – a condition in which tissues do not receive adequate oxygen – and other, unnamed complications, followed by a breathing problem called apnea.

The annual data was presented during a virtual meeting for Colorado’s Emergency Medical Practice Advisory Council. The 11-member group, made up of emergency physicians and experts, makes recommendations to CDPHE about whether an agency should be granted a waiver to administer the drug for an extremely agitated condition called excited delirium.

The state previously released data to the FOX31 Problem Solvers showing the drug had been administered 457 times in 2019, but Monday, the state clarified three of those cases were eliminated after further review of their data. The two agencies that administered the drug the most: one sedated people more than 90 times, and the other gave the drug to patients approximately 117 times in 2019. 

In 2018, the drug was administered 265 times statewide for excited delirium.

“I do think that as we move forward, I do think it’s important for us to kind of scrutinize this for how much we are using it and how much indication. I think that is worth our time,” Dr. Diana Koelliker said, a council member.

A handful of citizens attempted to express their personal questions and concerns about the use of the drug during a morning public comment portion of the day-long meeting, including Nicole Johnston, the Mayor Pro-Tem for the City of Aurora. Johnston said she was representing herself and not the city during the meeting.  

“I personally do not support the use of ketamine in involved police incidents,” Johnston said, whose city has been threatened with a lawsuit over the use of ketamine on Elijah McClain.

“I am respectfully asking the committee that you specifically consider law enforcement-involved responses with ketamine.” Johnston asked the council to put a moratorium on new ketamine waivers and consider putting standardized systems into place.

She told the FOX31 Problem Solvers, she would also like the state to temporarily suspend current waivers — like the one that had been granted to the medical director for Aurora’s Fire Rescue – for at least 90 days while they examine data related to how fairly the drug is being administered and the number of complications involved.

“I think it’s the responsibility of the state to address this,” she said. 

Anita Springsteen, a Lakewood City Council member, said she would like the state to ban the use of ketamine. “If you renew ketamine waivers today, you will be complicit with deaths like that of Elijah McClain,” she said. 

Springsteen’s boyfriend, Jeremiah Axtell, had been injected by West Metro Fire Rescue paramedics in January. “Paramedics and Lakewood police officers boldy lied in their reports, claiming Axtell was uncontrollable and could not be placed in a police car. Although, neither of those was true,” she testified, pointing to video footage she took of the incident, showing Axtell telling first responders that he would cooperate with them.  

Springsteen said she believes paramedics are not following protocol and are being influenced by police.

Elijah McKnight, who spent time on a ventilator and in the intensive care unit in 2019 after South Metro Fire Rescue paramedics injected him while he was intoxicated, was passed-over during his first attempt to speak during Monday’s public comment period. McKnight raised his hand during the Zoom meeting, but no one called on him.

“They just skipped over me, which isn’t fair,” he said. McKnight said he had hoped to testify prior to EMPAC’s vote to renew South Metro Fire Rescue’s waiver to administer the drug on agitated patients.

“I had my hand raised because I wanted to make a public comment, but they skipped over me,” he said. McKnight was able to testify during the second public comment session – nine hours later — and requested that CDPHE re-open his case, even though the department already officially determined paramedics followed protocols in his case. “I definitely request that CDPHE re-open that investigation and come to the correct conclusion.”

Although a moderator initially allowed a few people to comment about ketamine during the morning public comment session, he later instructed participants that comments about ketamine were to be reserved for the afternoon public comment session, after EMPAC votes on ketamine waivers.

“I would remind participants that comments during this period should be limited to items not on the agenda. Ketamine is on the agenda for later this afternoon,” he said. “If you have comments for ketamine use, we request that you reserve your comments for the later public comment period later this afternoon.”

Dr. Randall Clark, the first Vice President of the American Society of Anesthesiologists who has previously expressed concerns about state protocols, the manner in which the drug administration is monitored, and the quantities that are given to patients, postponed his comments due to the moderator’s instructions. However, he did not speak again during the meeting.

Springsteen testified a second time during the afternoon session to express disappointment in how the public comment section of the meeting was handled, “I am astounded that you put public comment after voting on waivers. Two hours later – shaking off everybody who wants to do public comment on this issue.”

Roland Flores, who identified himself as an anesthesiologist at the University of Colorado, said he had some “very serious concerns about the complication rate that is associated with this act.” He said he was concerned about “possible human rights violations.”

Outside of public comment, at least one physician testified to the importance of using the drug when paramedics encounter agitated patients who may be dangerous.

The state health department also said it would start tracking the race and ethnicity of the people to whom the drug is administered, data it currently does not keep.

Most of the people who were sedated by paramedics with ketamine were men, with nearly 34% of people between the ages of 20 and 29 and 30.4% of people between the ages 30 and 39.

“More to come about our approach and thought about how best to oversee and provide, to learn and get new insight about the ketamine program given the attention that it certainly is getting locally and nationally,” Dr. Eric France said, CDPHE’s Chief Medical Officer, who briefly spoke during the meeting.

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