Paramedic convictions in Elijah McClain’s death spur changes for patients in police custody

DENVER — Medical providers in the US are rethinking the way they treat people in police custody after a jury made a rare decision last December, convicting two Colorado paramedics for their role in the 2019 death of Elijah McClain following an overdose of a powerful sedative.

With one of the paramedics set to be sentenced Friday at a hearing that allowed McClain’s mother to speak about her son’s death, the case has sent shockwaves through the ranks of paramedics across the U.S. and their profession engaged in the bitter battle for social justice, sparked by the 2020 murder of George Floyd by Minneapolis police.

McClain, a 23-year-old black massage therapist, was forcibly detained by police in the Denver suburb of Aurora as he walked home from a supermarket. After officers claimed McClain was resisting, paramedics injected him with the sedative ketamine. He went into cardiac arrest on the way to the hospital and died three days later.

The conviction of the ambulance crew and one of the police officers brought a small measure of justice to the victim’s family. Yet the case has also exposed gaps in medical procedures that experts say need to be addressed so that more deaths can be prevented.

“We didn’t realize how dangerous the restraint and chemical sedation of these individuals could be,” said Eric Jaeger, a paramedic and ambulance trainer in New Hampshire. “Whether good or bad, the criminal convictions draw attention to the problem.”

The response includes revisions to patient protocols aimed at improving the treatment of ketamine injections – or avoiding them altogether when alternative medicines are more suitable.

Some departments now require extensive patient assessments before and after ketamine injections. They have also warned against the use of ketamine on people stopped by police in the prone position – which increases the risk of fatal complications by making it harder for patients to breathe – and have stocked drug kits with alternative sedatives. And they have reminded their paramedics not to defer to police when making medical decisions.

In the McClain case, “a lot of these basic things weren’t done,” said Peter Antevy, medical director for several Florida fire departments.

“Everyone assumed people just did it. But with the advent of body cameras, you’re increasingly seeing people not doing these things,” he said. “We have to put the basic things in black and white.”

The changes have come relatively quickly in a profession where it can take up to a decade for the latest medical research to filter down to frontline paramedics, Jaeger said. Nevertheless, since McClain’s death, Jaeger has documented five similar cases in which patients died after receiving ketamine, most recently a 29-year-old man in Baltimore last summer.

In Aurora, the lawsuit against paramedics is accused by union officials of prompting some medical workers to scale back their duties.

The day after the rulings, Aurora’s fire chief temporarily suspended the requirement that firefighters also serve as paramedics, fearing the convictions would lead to a mass exodus of personnel.

To date, approximately 10% of the department’s certified paramedics have taken a pay cut and are no longer working as paramedics. They return to the role of emergency medical technicians, or EMTs, who cannot perform advanced life-saving measures.

Fire Chief Alec Oughton said there are enough paramedics left for each ladder truck and engine to have a paramedic assigned to it.

But the president of the International Association of Fire Fighters union said the convictions put lives in the city at risk because EMTs are not qualified to provide life-saving medicine, such as for patients suffering from a heart attack.

“Attorney General Phil Weiser’s legacy is that there will be fewer paramedics to respond to people who need help,” said union president Edward Kelly, referring to the attorney general charged by Colorado’s Democratic governor with reinstating investigating McClain’s 2020 death following protests. about the murder of George Floyd.

Initially, no one was charged in McClain’s death, mainly because the initial autopsy report failed to conclude why he died. The autopsy was updated in 2021 — after Weiser convened a grand jury to investigate the case — and it revealed that McClain died because he was given ketamine after being stopped by police.

Kelly said ketamine did not kill McClain, noting that the autopsy report shows the amount of the drug in his system was on the low end of what is normally considered safe.

A 2021 study co-authored by Antevy examined 11,000 cases of patients given ketamine for a year. The drug may have contributed to only two deaths outside a hospital setting, the researchers concluded.

“Ketamine, when used safely and correctly, is a lifesaving drug,” Antevy said.

Paramedic Peter Cichuniec — the senior medical responder on the scene during the altercation with McClain — faces a mandatory year-long prison sentence during Friday’s hearing before a state judge.

A jury in December found him guilty of negligent homicide and second-degree assault — the most serious verdict handed down against all the first responders charged in the case. The conviction for assault carries a prison sentence of five to 16 years.

Police had arrested McClain after a complaint about suspicious persons. After an officer said McClain reached for an officer’s gun — a claim disputed by prosecutors — another officer placed him in a neck hold, temporarily rendering him unconscious. Officers also detained McClain before paramedic Jeremy Cooper injected him with ketamine. Cichuniec said it was his decision to use the drug.

Prosecutors said the paramedics failed to perform basic medical checks, such as taking McClain’s pulse and checking his breathing before administering the ketamine. The dose was too high for someone his size – 64 kilos, experts testified.

Attorneys for the paramedics said they completed their training in administering ketamine after they diagnosed McClain with “excited delirium,” a controversial condition that some say is unscientific and has been used to justify excessive force.