A group of South Carolina lawmakers hopes to curb the controversial use of the drug ketamine to incapacitate criminal suspects after lawmakers say a lack of supervision is putting people at risk of serious injury or death.
Ketamine, a powerful anesthetic, has long been used in emergency medicine and veterinary medicine, and researchers are studying its effects on depression and PTSD. But the drug has been under intense scrutiny in recent years for its use as a kind of chemical restraint to sedate combative people in clashes with authorities.
Cases such as Elijah McClain and Elijah McKnight in Colorado and James Britt in Mount Pleasant fueled the discussion about the possible dangers of the drug. McClain and Britt died after being arrested by the police and injected with ketamine at the request of the police. McKnight was also injected after meeting the police. He was hospitalized and placed on life support, but he survived.
These cases prompted federal deputy Jerry Govan Jr., an Orangeburg Democrat, to begin examining the issue. What he found worried him.
“What worries me about these situations is that when I started asking questions, there was no consistency,” said Govan. “Some people use it (ketamine) and some don’t, and it is difficult to register people, especially when you speak to the authorities. Outside the register, some people in the police community question the reason, indicate that there is no need.”
He and two other state representatives – Leola Robinson, D-Greenville and Patricia Henegan, D-Marlboro – are sponsoring the bill, which would make it a misdemeanor for paramedics or police to inject ketamine “into a crime suspect as a means of incapacitating him. “, according to the current language of the legislation.
The crime would be punishable by up to three years in prison, according to the bill.
“I think this bill is important because it provides a good basis for discussion,” said Govan.
Govan said he expects the project to be examined by his colleagues for debate. Members of the medical community, emergency medical services and law enforcement will have ample opportunities to provide information, he said.
“Where there is a need to improve, we will improve,” said Govan. “Where it is necessary to adjust, we will adjust. But we need to have a serious dialogue.”
In South Carolina and other states, police can ask a paramedic to inject ketamine into a suspect to calm the person down – a procedure that many police officers and the emergency medical community say is necessary for the suspect’s safety as well. officers and medical staff.
They cite a contested condition known as “excited delusion”, in which a suspect can suddenly become violent, agitated and have no understanding of what is going on. But there is no medical consensus on whether the excited delusion exists.
Although it is cited as a diagnosis by law enforcement authorities and the American College of Emergency Physicians, other medical organizations, including the American Medical Association, do not consider it a valid condition.
William Tatum, president of the SC EMS Association and EMS communications supervisor for Prisma Health in the Greenville area, said that ketamine was approved by the state’s Medical Control Committee for use by emergency medical services in South Carolina in 2016.
There is strong supervision of its use, said Tatum.
All EMS personnel are authorized to administer the drug to a patient who meets the diagnostic criteria under a permanent state order, he said. Its use, however, varies among more than 260 emergency medical services across South Carolina.
It is up to the medical control doctor who oversees each agency to approve the drug, said Tatum. Some doctors allow ketamine to be used in the field, but others feel it is not appropriate outside the hospital.
This led to a patchwork quilt across South Carolina, where some paramedics have ketamine and others don’t, he said.
The association’s president said that ketamine is safe when administered properly and that, as medical professionals, EMS personnel have the authority not to inject someone with the drug, even if a police officer or deputy sheriff asks.
When it comes to combative patients, Tatum said ketamine is the last resort, only to be used if a suspect is not responding to all efforts to lower the level of the encounter.
“If you are faced with a patient who is kicking and screaming … that person does not need to be in the back of an ambulance on the move, without restrictions,” said Tatum. “Featuring a neutral part with EMS, these (tactics) often work. Delirium of excitement reaches the point of incomprehension of what is happening. They have no idea what is going on ”.
According to the pharmaceutical company Pfizer, ketamine is a general anesthetic that can be used as a sole sedative for some procedures or in combination with other medications.
The drug’s manufacturer warns against the use of ketamine in anyone with a known history of allergic reaction to the drug or in anyone for whom high blood pressure is a risk. The company also warns that the drug may cause a sharp drop in breathing rate.
The case of James Britt, who died after a Charleston County paramedic injected him with ketamine in September 2019, shows these risks.
Mount Pleasant officials responded to a report of a man urinating on a road and found Britt, who was visibly drunk, according to a police report of the incident. The police tried to calm him down, but ended up preparing to arrest him.
Law enforcement officers wrestled the six-foot-two-pound man, placing him in handcuffs and chains on his legs, police said.
In the images from the body camera, Britt can be heard saying, “I can’t breathe” as the police pinned him face down on the floor.
After paramedics arrived and gave him 500 milligrams of ketamine – the maximum dose allowed by county guidelines – several police officers noted in their reports that his condition had deteriorated as he prepared to be transported to East Cooper Medical Center. Britt died after more than two weeks in the hospital.
His death was considered homicide, according to the autopsy report. Its main causes of death were listed as “containing asphyxiation and toxic effects of ketamine”.
A wrongful death lawsuit filed by the Britt family closed at $ 3 million in September. No one was charged with Britt’s death.
Tatum said he and other EMS staff recognize that the use of ketamine in law enforcement situations is controversial, but it is important to remember that the drug has valid and beneficial medical uses.
He is also concerned about the possible unintended consequences if the bill is passed as it is written now.
“I understand the premise behind what they are saying,” said Tatum. “It shouldn’t be used to incapacitate someone. We strongly support anything that says that we don’t need to go there and give anything that has an adverse reaction to a patient … but there was no contact with the EMS Association of lawmakers. in person. ”
The project is worrying EMS officials across the state, who fear criminal consequences for giving someone the drug, and may postpone the administration, even if it is in a situation where it is necessary to save someone’s life, he said.
“What could be a reaction to that, if it was to force it, is that I am not going to give this medicine that could benefit a patient because I could end up in prison,” said Tatum. “Studies have been done where there is a reason to give this medicine.”
In the meantime, the president of the EMS Association said that he hopes to participate in the discussion around the ketamine bill and is confident that the medical community, law enforcement and lawmakers can come together to draft legislation that everyone agrees with. .