Ban on new sedative use by Aurora paramedics splits council conservatives over liability worries

FILE – This photo shows a vial of ketamine. In the wake of the death of Elijah McClain and other cases, Colorado’s health department says emergency workers should not use a condition involving erratic behavior by people as a reason to inject them with the drug ketamine. Most states and ambulance agencies can use ketamine when people exhibit the condition called excited delirium. Aurora fire officials banned the use of the drug. (AP Photo/Teresa Crawford, File)

AURORA | City lawmakers on Monday narrowly advanced a ban on the use of new sedatives by Aurora paramedics, responding to concerns from firefighters stemming from criminal charges brought against the two paramedics who treated Elijah McClain.

McClain died in 2019 after he was placed in a chokehold by Aurora police and injected with an overdose of ketamine by Aurora Fire Rescue paramedics, according to the indictment of medics Peter Cichuniec and Jeremy Cooper for manslaughter and criminally-negligent homicide.

The 23-year-old’s death didn’t just shake the public’s trust in Aurora police. Reforms of the fire service and its use of sedatives were included in a comprehensive consent decree agreement between the city and the Colorado Attorney General’s Office last year.

Ketamine was dropped from the roster of drugs used by Aurora paramedics after McClain’s death, and today, the only drug used as a sedative by AFR is Versed, also known as midazolam.

But midazolam can exacerbate breathing problems, which makes it a bad fit for patients who are heavily intoxicated, as Aurora Fire and Rescue Medical Director Eric Hill argued before a council subcommittee last month and again on Monday. A proposed new sedative, droperidol, does not affect breathing in the same way, Hill said, and until recently appeared to be on track to be introduced to paramedics.

Fire union officials told the City Council Monday that the charges against Cichuniec and Cooper have stoked fear among firefighters about the potential legal consequences of working with a new sedative. Council members sponsoring the proposed ban — Curtis Gardner and Danielle Jurinsky — said they believed it was a precarious time to be introducing a drug like droperidol.

“I feel like the timing of this is wrong,” Gardner said. “I do not agree that we should be introducing a new sedative while we have firefighters on trial.”

Gardner also said he had more general concerns about the application of chemical sedatives from a civil liberties perspective. Jurinsky said it was “unfortunate that I wasn’t on the council when this happened to our firefighters and our police officers,” referring to the charges brought against paramedics and police for McClain’s death.

“What this has done to firefighters, specifically our firefighters, is overwhelmingly change their morale and terrify them,” Jurinsky said.

Hill argued that having a drug which was safer to use in some cases than midazolam would allow paramedics to give better care to patients, which could reduce the potential liability faced by the city

“You want what’s better for the patient, because if the patient has a better outcome, that is safer for the paramedic,” he said.

Hill told Councilmember Juan Marcano that paramedics only sedate a patient whose life is in danger, whose behavior is making them unsafe to treat and who is unable to decide if they require treatment or not. That standard won’t change if droperidol is introduced, Hill said.

Marcano observed that the controversy around Cichuniec and Cooper’s use of ketamine had to do largely with the involvement that police had in McClain’s treatment — they concluded it was necessary to sedate McClain without trying to get his consent or ever talking to him, instead acting on the basis of statements by police.

Marcano also asked Hill whether he thought “excited delirium” was a legitimate diagnosis. McClain received the diagnosis before he was injected with ketamine.

Colorado’s health department announced last year that emergency workers should stop using ketamine on people who they have diagnosed with excited delirium, with an expert panel determining that the diagnosis was subjective and had been “associated with racial bias against African American men.”

Hill said the preferred term is now considered to be “hyperactive delirium,” which he said is a real medical emergency, associated with heartbeart irregularities, metabolic acidosis and aggression. He said that it was “slightly different” from the old diagnosis.

Former city attorney and council member Charlie Richardson told the council that one of the positive reforms to come out of the McClain incident was the mandate that police not recommend or encourage the use of sedatives in the field. He said police directing paramedics to sedate suspects was a “cultural issue” before the mandate.

“Honestly, that was a cultural issue, where the police might say, ‘Hey, we’re having trouble dealing with this person, can you knock them out for us?,'” Richardson said.

Marcano asked — and Gardner and Jurinsky agreed — that the ban apply specifically to chemical restraints rather than to all new sedatives

But not everyone agreed that halting the introduction of droperidol was necessary or the best way of shielding the city from liability.

After Hill spoke about the value of introducing a sedative that didn’t cause the same risk of respiratory depression and he and Pete Schulte from the City Attorney’s Office said the city could incur even more liability if it tried to phase out all sedatives, Councilmember Dustin Zvonek came out against the proposed ban.

“Just banning it, it’s great theater, but I don’t think it’s going to give the liability coverage that we’re looking for,” he said.

When asked by Zvonek whether he would support the city restricting the use of all sedatives by AFR, union leader Travis Pulliam said he thought the question should be left to voters.

Councilmember Steve Sundberg objected to the ban after getting clarification that Marcano’s amendment extended it to chemical restraints, and Mayor Mike Coffman also voiced opposition. Sundberg earned the support of the sponsors of the ban to reduce the duration from three years to one-and-a-half or two years.

Alison Coombs, Gardner, Jurinsky, Angela Lawson, Marcano and Ruben Medina all said they supported the ban. Since it earned the majority’s support, the item was scheduled to move forward from Monday’s study session for a formal vote.

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6 days ago

Medicines should only ever be used as medicine. They should only ever be administered by trained medical professionals. Trained medical professionals should know that they have a responsibility to administer the drugs ONLY if they have cause, and that cause must mean that the drug keep their patient alive. There are times when it is MEDICALLY necessary to sedate someone – and EMTs are responsible for knowing when it is necessary for their PATIENT.

The problem is that police officers don’t see people as patients, like EMTs do. A police officer see people as perps, as targets, as offenders. A police officer is focused on arresting someone, not saving them, and it’s easier to arrest a sedated person – so if a police officer can administer a drug (or use their authority to pressure an EMT into administering a drug), it’s likely that the substance was not administered for medical purposes. Police use ketamine (and they’ll use droperidol or versed) to knock out their perps and make them easy to arrest.

Let EMTs make the decisions they were trained to make, including the decision about what and when to administer sedative medicines to PATIENTS. Just don’t let the EMTs be coerced or pressured by police to use medicine as a weapon against perps.

Hypocrisy Monitor
Hypocrisy Monitor
5 days ago
Reply to  Berv

I rarely read such a well-considered case from the liberal side, but I agree. Sedation should be at the discretion of a medical professional. And the medical professional should discern whether the drug’s administration is necessary to protect the safety of the patient or the public safety officers.

4 days ago

Weird of you to assume I’m a liberal, but thanks, I’m glad we found some common ground.

I’ll only disagree that I don’t think it is the EMTs responsibility to protect the safety of the police officer. Their first responsibility must be to their patient, regardless of what the patient has allegedly done or what they are charged with or any part of the criminal justice process. Medical professionals must be impartial, focused on their roles as healthcare providers, and they should not be a tool for police to use for anything, even protection.

Jeff Brown
Jeff Brown
4 days ago

Why does the Sentinel think that splitting conservatives is the key news here? Sloppy. How about some research on the proposed drug and where it’s currently used.

This is a very tough issue and it’s refreshing to see our council members NOT retreating to their respective corners. Sometimes the best solution is to keep talking and looking at the data. What percentage of arrestees where sedation is in the patients’ best interests are also drunk, suggesting the need for a safer alternative?

4 days ago

If someone needs to be taken into custody, that’s the job of the police. Firefighters & paramedics should not be administering sedatives to people being detained.

4 days ago
Reply to  rose

Do a ride along sometime. Or visit an ED and observe out of control “patients”.
Then. Consider your opinion more educated.