Elijah McClain was injected with ketamine while handcuffed. Some medical experts worry about its use during police calls.

As state and federal inquiries widen into the case of Elijah McClain, a young Black man who died last summer after Colorado police placed him in a chokehold, the decision by paramedics to inject him with a powerful sedative while he was handcuffed has raised questions about its use during police calls and whether such medical treatment violates a person's rights.
Fire and emergency medical services officials in the Denver suburb of Aurora have said a preliminary review found that medics' actions on the night police detained McClain, 23, were "consistent and aligned with our established protocols." But some medical and legal experts worry that ketamine — or any form of an anesthetic — raises too many unknowns and that it should not be used to subdue someone in a police action.
"Why anyone would be giving ketamine in that circumstance is beyond me," said neuroscientist Carl Hart, chair of Columbia University's psychology department. "The major problem here is we should never be ordering any medication, and no one should be taking or given it against their will."
McClain's death has drawn new attention amid high-profile fatal encounters involving law enforcement against Black Americans, leading to protests. Colorado Gov. Jared Polis has appointed a special prosecutor to re-evaluate the case.
Just after 10:30 p.m. on Aug. 24, McClain, a massage therapist, was buying iced tea from a corner store, his family said. They said he wore ski masks because he had a blood condition that made him feel cold.
Three Aurora police officers were called to the area on a report of a suspicious person wearing a mask and waving his arms.
Bodycam video showed officers ordering McClain to stop. He responded that he was an introvert and to "please respect the boundaries that I am speaking."
After questioning him, the officers grabbed McClain. Then one of them said he believed McClain had reached for one of their holstered guns, and McClain was brought to the ground. Police said in a statement that he "resisted contact, a struggle ensued, and he was taken into custody."
The officers took McClain to the ground using a carotid control hold, a type of chokehold meant to restrict blood to the brain to render a person unconscious. Aurora police banned carotid control holds last month, and chokeholds have been prohibited by police departments across the country in the wake of the death in May of George Floyd, a Black man pinned by his neck while in Minneapolis police custody.
McClain "briefly went unconscious," according to a report the local district attorney, Dave Young, completed last fall. McClain could also be heard in the police video telling the officers, "I can't breathe, please," and he vomited while he was on the ground.
A medic told officers that "when the ambulance gets here, we're going to go ahead and give him some ketamine."
The officers responded, "Sounds good," and they told the medic that McClain appeared to be "on" something and that he had "incredible strength."
An Aurora Fire Rescue medic injected McClain with 500 milligrams of ketamine, according to the district attorney's report.
The coroner found that McClain's death was due to "undetermined causes," and according to Young's report, the "evidence does not support the prosecution of a homicide." McClain had marijuana in his system along with the ketamine, which the coroner suggested was a "therapeutic level."
But the coroner did not rule out that the chokehold, in addition to the ketamine, might have contributed to his death.
"Although there is no evidence to support ketamine overdose," according to Young's report, the coroner "could not exclude the possibility that Mr. McClain suffered from an unexpected reaction to the drug."
The medic at the scene estimated that McClain weighed 220 pounds, Young's report said. But the coroner said he was 5 feet, 6 inches tall and weighed 140 pounds.
According to documents shared by Aurora Fire Rescue, the standard dose of ketamine is 5 milligrams per each kilogram of a person's weight. That would mean that instead of 500 milligrams of ketamine, McClain should have received about 320 milligrams.
The ketamine was given via syringe into his right shoulder, according to Young's report.
"After approximately two to three minutes, Mr. McClain calmed down," the report said. "He was placed on a gurney, his handcuffs were removed, and he was placed into soft restraints ... and loaded into the ambulance."
About seven minutes after he received the ketamine, McClain had no pulse in the ambulance and went into cardiac arrest, the report said. Medics were able to revive him, but he was later declared brain dead, and he was taken off life support less than a week later.
Young declined to press charges.
"Under the circumstances of this investigation, it is improbable for the prosecution to prove cause of death beyond a reasonable doubt to a jury," Young wrote in a letter to Aurora's police chief.
Mari Newman, an attorney for McClain's family, said that the ketamine was unnecessary and that she wants a thorough investigation.
"The Aurora medics had no right to inject Elijah with ketamine at all," she said. "He was handcuffed, crushed against the ground by officers much larger then he was, and he was not fighting. He was begging for his life, vomiting and trying to breathe. And they certainly had no right to involuntary inject him with a dose intended for someone over twice his size."

What does ketamine do?

Ketamine, if administered properly, can be safe, said Jason Varin, an assistant professor at the University of Minnesota College of Pharmacy.
In lower doses, it can be used to treat acute pain, Varin said, while at higher doses, it becomes a dissociative anesthetic, which means that not only does it help physically, but that a person's reality — feelings, thoughts and understanding of what is occurring — is also "disconnected" and he or she may have limited memory of what is happening.
Ketamine is known as the street drug "Special K" because of how it induces a trancelike state, which is often referred to as a "K-hole." Variations of ketamine have been approved by the Food and Drug Administration to treat depression.
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