All John Powell wanted to do was get to the car without getting wet. He jogged through the thick summer rain outside of North Memorial Hospital in Robbinsdale, Minnesota, and sat down in his sedan. It wasn’t long before he spotted a crew of police officers approaching him, guns drawn.
The 9-1-1 caller, a nurse at the hospital, had described a white or light-skinned Hispanic man who was sitting in a vehicle with a revolver. The 48-year-old Powell was Black, and merely there to visit a sick cousin with his wife and mother. Now he was on the ground, spitting out rainwater while cursing out the officers. The police soon knew they had the wrong man; the nurse even came downstairs to confirm. But they kept Powell down on the ground anyway, pressing him into the wet concrete with their body weight. Powell felt one officer stomp on his arm, sending a flash of pain up his torso. (The cop would later claim the shine of his car keys looked like a weapon.)
Soon, Powell was in the back of the patrol car, confused and belligerent about why he was being detained. He screamed and kicked the door, hoping he could attract the attention of his wife or anyone around. Two paramedics from North Memorial were summoned downstairs to help the police. Nobody asked Powell whether they could administer a shot of ketamine, a strong dissociative drug, to calm him.
“He stuck the needle in my arm, while I was sitting in the car, still. All I remember is falling over,” Powell told local news network KARE 11.
Powell was lucky it happened so close to an emergency room: Minutes after the shot, his breathing started to fail. He was rushed upstairs, this time in a gurney, for life-saving intubation. It took his wife three hours to find him despite not leaving the facility. “I started screaming,” she told the Minneapolis Star-Tribune. “I thought he was dead.”
A year later and a thousand miles away, in Aurora, Colorado, a waifish, introverted 23-year-old was walking home from a corner-store run when he attracted the attention of a nearby resident. They called 9-1-1, noting that a man in an open-faced ski mask who “looked sketchy” was walking around, waving his arms. The caller specified that they didn’t believe the man was armed or dangerous at all — just odd.
Three Aurora police officers — Nathan Woodyard, Jason Rosenblatt and Randy Roedema — rolled up on the young Black man at around 10:30 p.m. It took several crucial seconds for Elijah McClain, who was blaring music through his earbuds, to realize the police were calling out to him. Before he knew it, one of the men grabbed his arm.
He ripped it away, telling the trio he had a right to go home while continuing to walk. “I am an introvert, please respect the boundaries that I am speaking. Leave me alone,” he said.
But the officers leaped, surrounding him in a violent embrace. McClain squirmed and yelped, trying to stay upright. He heard someone yell something about a gun, then felt the world go sideways as his body slammed to the earth. At some point in the ensuing minutes, McClain felt a bicep closing against his throat, choking him to the point of blackout. When he regained consciousness, he vomited, then tried to apologize. “I’m sorry, I wasn’t trying to do that, I can’t breathe correctly,” he gasped.
After 15 minutes, the paramedics arrived. One of them injected him with 500 milligrams of ketamine. Within a minute or two, McClain was sedate and on a gurney. Not long after, the 23-year-old went into cardiac arrest while in the ambulance. He died three days later in the hospital.
The officers and the paramedics in Powell’s case were cleared of wrongdoing. So were all the responders in McClain’s story — at least until a groundbreaking uprising of Black Lives Matter protest and activism brought his story back to the forefront this summer. The broader public have rallied to his side because McClain’s death almost seems too horrible and on-the-nose to be true: A sweet kid who loved playing violin for stray cats, murdered by the state with a weapon that’s disguised as a medical cure. Three cops claiming in their paperwork that the 140-pound, 5-foot-6 man was “definitely on something” and had “crazy strength.” A lack of prosecution thanks to a framework that protects the blue line first and foremost. It’s hard to imagine how anyone could side with the police in his case.
And all that attention achieved something: More than 4 million people signed a petition calling for a new investigation, which is now underway with the guidance of the FBI and the Justice Department. One of the three officers involved in McClain’s case, Jason Rosenblatt, has already been fired — not for the death, but over a group cop selfie that mocked the incident.
Yet there are few answers around the issue of how and why law enforcement can deploy ketamine on people against their will. It’s unclear exactly how many agencies are allowed to use ketamine or other anesthetic drugs as a tool. What is clear is that it’s commonplace for police and paramedics to work in conjunction to sedate non-compliant people in states like California, Illinois, Ohio and Florida, against those both young and old. And while medical research suggests that ketamine is one of the safest drugs for sedation, biases and mistakes in police work make the drug a dangerous weapon in the wrong hands.
Ketamine is infamous as both a recreational drug and as “horse tranquilizer,” but in reality, it’s won favor in the medical world for its quick effects, relative safety and versatility. It’s been hailed as a breakthrough for emergency medical services and a boon for police who need to knock out people who are resisting too forcefully, putting themselves and officers at risk.
Minneapolis was one of the first cities to investigate the use of ketamine by police and paramedics, and found a massive increase in recent years — from just three documented injections in 2012 to 62 in 2017. Even more alarming was the finding that many people sedated against their will were involuntarily enrolled in clinical studies on ketamine being conducted by Hennepin Healthcare, the city’s largest medical center. The city report and additional reporting from the Star-Tribune revealed a number of cases where ketamine use led to hospitalizations.
One woman ended up getting drugged by medics during a routine welfare check, and woke up with a breathing tube in her throat 24 hours later. Another woman was caught on camera getting pepper-sprayed by police and shot with ketamine by a paramedic despite begging for an asthma inhaler. Her breathing stopped after the injection, and she had to be resuscitated. (“If she was having an asthma attack, giving ketamine actually helps patients and we’re doing a study for agitation anyway so I had to give her ketamine,” the unnamed paramedic told a police officer, per the report.)
Meanwhile, in Colorado, a state audit found that 427 patients received ketamine for “agitation” between August 2017 and July 2018, with about 20 percent of all patients requiring emergency intubation in the hospital due to problems with breathing. Police advocates have defended the use of sedatives on people who have “excited delirium” (aka “agitated delirium”), a medical condition that’s become a buzzy topic in policing because it can make people belligerent, unresponsive and violent. Critics of that logic say the phrase is conveniently covering up all kinds of police abuses, but Marc Futernick, medical director of the emergency department at California Hospital in Downtown L.A., stresses that there is an important purpose for sedating someone who is struggling.
The problem is that just holding someone down on the ground and letting them thrash can lead to an “absolute medical emergency,” Futernick says. Extreme physical strain can trigger problems in the kidneys and lungs, or lead to a heart attack, when prolonged under stress. “Those patients will die if you just allow that to continue, which is why when police restrain somebody like that, they’re typically calling paramedics to assess the situation, which may or may not require chemical sedation,” he notes. “Before we did this procedure, people used to die in the ER — just arresting while in a panic. I do think sedation is an appropriate intervention.”
Ketamine has become favored because it’s theoretically difficult to kill someone with the drug alone. Futernick notes it’s a popular anesthetic in developing nations because it can be used with relative safely even without advanced monitoring tools. While there is no single standard of dosage, one study claims 5 milligrams per kilogram of body weight (450 milligrams for a 200-pound person, for example) is the ideal dose for an injection. (McClain, 140 pounds in real life, was approximated as 200 pounds and injected with 500 milligrams.)
More importantly, sedation via ketamine is increasingly viewed by police forces as being safer than other “less-lethal” weapons used to restrain and control people. A National Institute of Justice report observes that there is mounting concern from police leaders that tools like Tasers can kill people who are experiencing “excited delirium.” “Less-lethal techniques that involve the use of blunt force may also pose risks; blunt trauma to a person can cause organ damage to the liver, kidneys, heart or brain, which could be permanent,” the report continues.
One senior LAPD officer, who asked to remain anonymous because they are not authorized to comment on the issue, recalled an incident in which a large man forcibly entered a detox program and assaulted a man in order to use the showers. About 10 officers responded to the scene, and it took 10 minutes of conversing (plus a cold bottle of water) to coax the man into handcuffs.
“He was calm and cooperative until he got to the hospital,” the officer says. “Once there, he became agitated, kicked out the window of my patrol car. I was able to calm him down again and talk him onto a hospital gurney. Once restrained, he became agitated again and tried to break out of his restraints, which would have spelled disaster. He was sedated by the medical staff and went to sleep. It prevented a major use of force.”
The officer claims that in his experience, sedation has been a “method of last resort,” with the call being made by medical professionals, not police. In Minneapolis, however, the city review found transcripts and reports in which police officers clearly asked paramedics to either inject ketamine or bring it to the scene, even when suspects appeared restrained or only mildly agitated. Hennepin Healthcare’s own investigation found that multiple paramedics had previously expressed concerns to hospital leadership that Minneapolis police officers were pressuring them in high-stress situations. It even found that in one instance, a police officer “appeared to threaten a patient with a potential medical intervention.”
This can be challenging for paramedics who lack medical experience or haven’t worked alongside police in a tense situation, Futernick says. “When the police lean on you and they really want something, even in my ER where I feel like I have all the power, it’s pretty persuasive. It takes resolve to stand up to them and say, ‘No, that’s not appropriate. No, I’m not going to give you that answer. No, I’m not going to go do that with the patient,” he says.
Many factors will color why a police officer or medic would decide to call for sedation, namely the level of training and the biases about the person they’re trying to restrain, adds Reef Karim, a medical physician and psychiatrist who has helped law enforcement agencies on mental health response. If a person lacks education in how to differentiate a dangerous suspect from one that’s just “lost in their own mind,” they’ll revert to their base instincts, Karim says.
“So a lack of consistent training means you’re going to freak out, and you’re either going to shoot or choke or sedate, just because you don’t know what’s going on with the person,” he continues. “I had a patient who ended up in agitated delirium because of a blood sugar issue, and they stormed toward me like they were going to attack me. If I was a cop, who knows what I would have done? But as somebody that’s trained, I just moved a little bit out of the way, and they headed straight toward the wall. Then I was able to calm them down just by talking to them.”
Because of these ethical issues, voices are calling for police to stay out of medical and other nonviolent incidents, but the solution isn’t so simple on the front lines. “Shane,” a medical worker who trained and worked as an EMT in Indiana, notes that law enforcement is sometimes necessary to keep medics safe and to calm a scene. The experiences can differ dramatically based on the individual police that show up, he adds.
“There have been times when the situation escalated because the people are afraid of cops, there’s yelling, and the medics are just trying to get people to the hospital,” he tells me. “In most experiences, however, the cops had excellent de-escalation tactics, which is surprising in a very conservative part of Indiana.”
The huge inconsistencies in how individuals are trained and respond to an aggressive suspect creates glaring problems for policing, Futernick and Karim say. While Futernick believes ketamine is safe in a clinical setting, he also suggests (like others have) that McClain died because of the combined effects of the physical and mental brutality he experienced that night: “It likely turned fatal because no one was managing his airway, or he got hypoxic, and he was already on the verge of cardiac arrest from the prolonged struggle when they pulled the trigger on ketamine.”
Karim suggests that police still should receive more education on mental health response, but again, acknowledges it leaves a lot to an individual’s biases and agenda. That’s also true of people who are agitated; many forms of temporary psychosis lead to extreme paranoia, typically about the government and authority figures, which would make just the presence of an armed cop a trigger for a meltdown, Karim notes. This is especially dangerous given the explosion of homelessness in major American cities, and high rate of mental illness and trauma in the unhoused population; police are often the first responders to calls about a disturbed or disruptive person. In that light, it’s especially troubling to see the eager, perverse enthusiasm Minneapolis police showed for using “Big K” on anyone who resisted.
“Even agitated delirium, this big subject of concern by police, is just an altered state where a person doesn’t know what they’re doing. It doesn’t mean they’re going to pick up a gun and start shooting people,” Karim says. “A police response might be the exact wrong thing.”
How McClain died is a perfect storm of policing, medicine and law — a cruel diorama of the American status quo, with the sins so clearly in view. Stopping a suspect with ketamine is safe and valuable on paper. But as with so many facets of policing, the framework that exists on paper can be, in the three-dimensional real world, stressed to the breaking point by bias and aggression. Sedating without consent is a necessary task in hospitals around the country. In the field, however, it turns out reckless police and reckless medics can kill someone with less noise and attention than a flurry of bullets — and far less transparency, too.
Eddie Kim
Eddie Kim is a features writer based in Los Angeles, covering social and cultural issues for MEL.
