Medical director dismisses report critical of police, EMS administration of ketamine
The report said that Hennepin Healthcare EMS providers, in the presence of police, injected suspects of crimes and others who already appeared to be restrained
Hennepin County EMS ALS protocol 3420 (Behavioral Emergencies) authorizes personnel to administer ketamine if a patient “is profoundly agitated with active physical violence to himself/herself or others evident, and usual chemical or physical restraints may not be appropriate or safely used.”
We encourage our members to review their excited delirium syndrome treatment protocols, read research on the efficacy of ketamine and anticipate local media inquiries about police and EMS care of profoundly agitated individuals, including the use of ketamine. Read more about how EMS leaders, educators and field providers are responding to this incident here.
By Andy Mannix
MINNEAPOLIS — Minneapolis police officers have repeatedly requested over the past three years that Hennepin County medical responders sedate people using the powerful tranquilizer ketamine, at times over the protests of those being drugged, and in some cases when no apparent crime was committed, a city report shows.
On multiple occasions, in the presence of police, Hennepin Healthcare EMS workers injected suspects of crimes and others who already appeared to be restrained, according to the report, and the ketamine caused heart or breathing failure, requiring them to be medically revived. Several people given ketamine had to be intubated.
These are among the findings of an investigation conducted by the Office of Police Conduct Review, a division of the city’s Department of Civil Rights. The draft report has been circulated narrowly within City Hall, but not disseminated to the public. The Star Tribune has obtained a copy.
The number of documented ketamine injections during Minneapolis police calls increased from three in 2012 to 62 last year, the report found, including four uses on the same person. On May 18, around the time the draft report was completed, Minneapolis Police Cmdr. Todd Sauvageau issued a departmental order saying that officers “shall never suggest or demand EMS Personnel ‘sedated’ a subject. This is a decision that needs to be clearly made by EMS Personnel, not MPD Officers.”
Minneapolis police previously had no policy addressing the drug, and the department manual classifies it as a “date rape drug” for its powerful sedative impact and ability to erase or alter memory.
Hennepin Healthcare staff are authorized to use ketamine when a patient is “profoundly agitated,” unable to be restrained and a danger to themselves or others, according to their policy. But the report found examples when EMS workers used the drug on people who did not appear to fit this description.
“In many cases, the individual being detained or arrested was not only handcuffed, but strapped down on a stretcher in an ambulance before receiving ketamine,” the report states. It raises a “concerning question” over why these people are given the drug before they are transported to the hospital, “given the immediate effects on breathing and heart function that the drug induces.”
The draft report prompted sharply different reactions among local officials. A statement included in the report from Hennepin EMS Medical Director Jeffrey Ho and Minnesota Poison Control System Medical Director Jon Cole dismissed the findings of the report as a “reckless use of anecdotes and partial snapshots of interactions with police, and incomplete information and statistics to draw uninformed and incorrect conclusions.”
“This draft report will prevent the saving of lives by promoting the concept of allowing people to exhaust themselves to death,” Cole and Ho wrote.
Minneapolis Police Chief Medaria Arradondo would not comment on the specifics of the draft, but credited it for changing his department’s approach to interacting with EMS workers.
“We have that in place now,” Arradondo said. “That policy really defines and clarifies that we do not want our officers providing recommendations or suggestions to EMS personnel.”
Mayor Jacob Frey said all medical decisions highlighted in the draft report were made by Hennepin County medical professionals. He said it was necessary for the city to clarify in policy that police are not to give input to EMS and hospital professionals beyond factual information.
“Our policy should be clear,” he said. “Cops shouldn’t direct medical professionals on health-related issues, and medical professionals shouldn’t listen to them.”
‘He just hit the K-Hole’
Ketamine is an anesthetic agent that some researchers believe can be effective in treating depression. Studies, including some conducted by researchers at Hennepin Healthcare (formerly Hennepin County Medical Center), show it can be useful for trained medical practitioners to sedate and transport patients to the hospital who are agitated or combative.
It is also a common club drug, known colloquially as “Special K.” Its side effects include delirium, quickened heart rate and respiratory problems, especially in high doses.
Hennepin Healthcare has been a leader in ketamine research, and its EMS personnel have been using it since 2008, according to its statement.
To evaluate how the sedative was being used, the Office of Police Conduct Review investigators looked for mentions of the word in police reports, and then reviewed body camera footage from those cases.
“Multiple videos showed individuals requiring intubation after being injected with ketamine, and [police] reports indicate that multiple individuals stopped breathing and/or their hearts stopped beating after being injected with ketamine,” the report said.
The police encounters that led to EMS using ketamine ranged from cases of obstruction of justice to jaywalking, according to the report. One man was dosed with ketamine while strapped to a stretcher and wearing a spit hood.
The report found that officers regularly instructed the medical staff to administer the ketamine.
“Between 2016 and 2017, MPD officers explicitly asked EMS to provide ketamine, either when calling for EMS services or upon arrival of the ambulance eight times,” states the report. “Also, MPD officers assisted EMTs while they injected individuals with ketamine” by physically holding them down while the EMS gave the shot. Many were in handcuffs, and some were in spit hoods.
In one case, Minneapolis police and EMS workers responded to a 911 call about a man who appeared to be in the throes of a mental health crisis.
Four Minneapolis police officers and two EMS personnel responded to the incident and decided to sedate the man, according to the report authors, who reviewed body camera footage of the incident. Upon seeing the needle, the man, who is not named but described as 5 feet 3 to 5 feet 5 with a light build, said he did not want the shot. “Whoa, whoa that’s not cool!” he pleaded. “I don’t need that!”
Regardless, the man was injected with the drug two times and secured to a chair, the report states. Shortly after, he became nonverbal and unintelligible, prompting one officer to remark, “He just hit the K-hole,” a slang term for the intense delirium brought on by ketamine.
When the man began to regain consciousness, the officer asked the EMS responder — all unnamed in the report — how much more ketamine he had with him, according to the report.
“I can draw more,” said the EMS staff.
“You’re my favorite,” replied another EMS officer.
They injected him with another dose of ketamine.
“We’ll have to end up putting a [breathing] tube in,” the officer stated.
On the way to the hospital, the man lost consciousness and stopped breathing, according to the report.
He regained his pulse and began breathing again sometime later at the hospital.
In a statement Thursday, Kelly Spratt, chief ambulatory officer for Hennepin Healthcare, said ketamine has “fewer side effects than other drugs and can ultimately save lives.”
Spratt said the incidents in the report account for only a small percentage of those involving ketamine each year. His office has recently reviewed the draft and believes it contains inaccuracies, he said, though he did not provide specifics.
“We believe the draft report contains data that is private and, as we assess that, we won’t respond to questions about specific cases cited in the report,” he said. “We have reviewed the four cases mentioned in the draft report that involve use of ketamine by Hennepin EMS and have concluded that those met the protocol and were medically justified.”
Dosed while handcuffed
In a separate case detailed in the report, police sprayed an intoxicated woman in downtown Minneapolis with mace, and she appeared to have an asthma attack. The woman, who was not actively resisting police, asked for an asthma pump. Instead they handcuffed her to a stretcher and gave her ketamine, the report said.
Shortly before the body camera video cut out, an EMS worker asked, “What does ketamine do to asthmatics?”
In this case, it stopped the woman’s breathing, according to the report. She was resuscitated later at the hospital.
“It is also important to note that it appears no crime was committed, no threat to the safety of officer or paramedics was evident, and the individual was located less than six minutes from HCMC at the time she received a ketamine injection,” the report said.
Velma Korbel, director of the Department of Civil Rights, said her office will work on completing the draft. But she praised the quick response from the Police Department in implementing a new policy once the police oversight office of her department brought its findings to the department’s command staff.
“It worked exactly the way it’s supposed to work,” said Korbel. “I have nothing but kudos for the Police Department’s response to this.”
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