Aurora officials are debating how to regulate the use of sedatives by paramedics following the high-profile 2019 death of Elijah McClain, who died after a violent encounter with police that ended with paramedics injecting him with ketamine.
As two Aurora paramedics await trial for felony charges, including manslaughter, negligent homicide and assault, City Council members are grappling with how to manage the use of new medications that can be used as sedatives, including whether they should be allowed to be administered or if chemical restraints should be banned altogether. City Council members are expected to vote on a proposal Monday.
The administrative decision to include a new sedative — droperidol — into firefighters’ emergency services protocols and the pushback from the firefighters’ union had prompted City Council members Danielle Jurinsky and Curtis Gardner to call for a three-year moratorium on all new sedatives at a City Council study session Monday night.
Jurinsky said firefighters are afraid the use the new sedative, have something go wrong and potentially face charges (including manslaughter, negligent homicide and assault) like their colleagues, and Gardner said this was the wrong time introduce a new sedative.
“A medical director, deputy city manager and a city manager are never going to stand trial for murder for administering this sedative. … What this has done to firefighters, specifically our fighters, is overwhelmingly change their morale and terrify them, terrify them into administering sedatives,” Jurinsky said.
Ultimately, council members approved moving a proposal to a vote for a two-year ban on all chemical sedatives used to restrain patients as well as any new sedatives for medical purpose — though they cannot take a vote until next week’s regular meeting. But Jurinsky told The Denver Post on Tuesday that the exact measure is still being worked on after continued discussions with everyone involved.
“I have no idea how it’s going to end up,” she said. “My hope is to find a way to make sure that the firefighters in Aurora, in their paramedic and medical capacity, are protected.”
Much of the discussion has centered around McClain’s death — paramedics injected the 23-year-old with what investigators said was an overdose of ketamine. A grand jury indicted two paramedics and three police officers on charges in McClain’s death, and the use of sedatives to restrain patients is under scrutiny, according to the measure’s sponsors.
Aurora Fire Rescue has since forbidden the use of ketamine, and a consent decree agreement between the attorney general and the city states that the department can’t use ketamine in the field without agreement from the consent decree monitor. Paramedics also have to make all medical decisions independently from the police.
Union President Travis Pulliam told council members on Monday that the McClain case and following charges have scared his members who “don’t want to be the next firefighter charged with a crime for doing their job.”
“So just over a year later (after the charges were filed), we’re trying to introduce another sedative, and us as firefighters, we as their representatives, have a hard time with that,” Pulliam said. “A little history, what you’re going to hear later I’m sure, is that this is a safe medication. It’s used across the metro area. To me, that’s déjà vu. Whenever the word ‘droperidol’ is said, just replace it with ‘ketamine,’ and that’s what we were told five years ago.”
However, an expert panel convened by the state last year reported that ketamine “is a safe drug” if used in specific circumstances and dosages, but recommended rejecting “excited delirium” as an excuse to administer ketamine. In McClain’s case, an external investigation had found that paramedics seemed “to have accepted (police) officers’ impression that Mr. McClain had excited delirium,” and that they didn’t corroborate that through observation or a diagnostic exam.
Droperidol, typically used as an anti-nausea medication or tranquilizer and the drug the administration wanted to add as an option for Aurora paramedics, is not a substitute or replacement for ketamine, Aurora Fire Rescue Medical Director Dr. Eric Hill told council members on Monday night. It’s also different than the only other medication that Aurora Fire Rescue can use as a sedative, Versed, or midazolam.
Hill argued that the reason droperidol was being considered is because the overwhelming medical evidence indicates that it’s a safer choice than what’s currently used for patients who are alcohol-intoxicated to lessen risk of future complications, something all of the Denver Metro EMS directors agree with. He said the fire rescue averaged using midazolam with combative patients 13 times per month over the past six months.
“This medication is being proposed because we are causing increased risk to our firefighters and to our patients,” Hill said. “Their interests are the same … to make sure that the patient does well.”
Despite these assurances, Councilman Juan Marcano had concerns, leading to his amendment on Monday to instead ban all chemical restraints, so that the current medications can still be used for medical treatment but not for law enforcement purposes, he said in an interview. Marcano questioned the use of “excited delirium” being used as an excuse to sedate someone, which the American Medical Association has essentially called junk science, and its disproportionate use on Black men and people of color.
“From my perspective, that’s a civil liberties issue, on top of potentially getting into a complicated medical situation as we saw with Elijah,” Marcano said. “So I don’t think it’s appropriate to utilize medication as a chemical restraint, period, and my colleagues agreed with me.”
Although the council members were split on the issue of banning chemical restraints, the majority agreed to move it forward to next week’s meeting.
But next week’s proposal may look different.
Councilman Dustin Zvonek opposed both the initial idea of banning new sedatives and the amended version of banning all chemical restraints, which he called reckless.
“If we don’t allow any sedative, we are creating a serious safety issue for our residents and first responders,” Zvonek told The Denver Post. “It could very well lead to a mass exodus of the department if we tell them the only way they can address a resident who needs treatment and who is under the influence of a substance making them aggressive and abnormally strong, is to physically try to restrain them.”
Zvonek said he spoke to firefighters on Tuesday who are less concerned about the use of the new sedative than they are about having no chemical restraints available at all.
His proposal — which he hopes sponsors will agree to — is that the city allow droperidol to be introduced, but for the next one to two years, paramedics should be required to call in to the responding medical doctor if they plan to use it as a chemical restraint to get permission. He noted that there should be a clause to cover paramedics in cases of emergencies where they aren’t able to do so.
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