A pair of Colorado paramedics will soon be sentenced for their role in the 2019 death of Elijah McClain, as their industry reckons with the implications of their unprecedented criminal convictions.
In December, a jury found Pete Cichuniec and Jeremy Cooper guilty of criminally negligent homicide for their decision to sedate McClain with ketamine while he was being aggressively restrained by Aurora police officers.
Cichuniec – who was also convicted of second-degree assault – is scheduled to be sentenced March 1. Cooper’s sentencing is scheduled for April.
Prosecutors successfully argued that the paramedics did not properly assess McClain and administered the drug based on an incorrect medical diagnosis.
While McClain received a “therapeutic” dose of the commonly used sedative, he died of “complications of ketamine administration following forcible restraint,” according to an amended autopsy report.
“I believe that Mr. McClain would be alive but for the administration of ketamine,” the forensic pathologist who evaluated the case, Dr. Stephen J. Cina, wrote in the amended report, more than a year after McClain’s original autopsy found his cause of death to be “undetermined.”
In January, a judge also sentenced Randy Roedema, a former Aurora Police officer who was convicted of criminally negligent homicide and third-degree assault for his role in the physical altercation, to 14 months in jail and four years of probation.
The incident, which led to massive protests and a $15 million civil settlement between McClain’s family and the city of Aurora, has heightened the public’s awareness of similar incidents and has increased public scrutiny of how ketamine is used to calm agitated people who are already being physically restrained by police.
Following the incident, a Colorado Ketamine Investigatory Review Panel found “ketamine is a safe drug if used properly and monitored closely by properly trained and qualified paramedics. However, certain adverse events appear to have arisen primarily from the administration of ketamine and other sedatives to individuals who may not have a medical need for these medications and who could have been managed with a less assertive alternative.”
In Colorado, paramedics are no longer permitted to use the medication to sedate people who they consider to be agitated or combative, but agencies in most other states continue to utilize it for that reason.
What is ketamine?
Ketamine, a dissociative anesthetic, has been used for decades for various purposes including anesthesia and pain management.
In more recent years, paramedics have been permitted to use ketamine in many states to sedate agitated people in a pre-hospital setting with the goal of preventing the patient from worsening their medical condition and helping them access important medical treatment.
Medical toxicologists say it presents few adverse side effects when administered and monitored appropriately.
"I couldn't think of a medicine that I'd rather give in an uncontrolled situation, meaning not on a monitor, not in an intensive care unit," Dr. Daniel Brooks, a medical toxicologist who serves as medical director of Banner Poison and Drug Information Center in Phoenix, told Scripps News in 2023.
"When you don't know what the patient's history is, you know, they're not able to tell you, 'This is my weight; this is my past medical history; this is my cardiac function; these are the four medications that I'm taking at home; this is the illicit drug that I used two hours ago,' when you don't have any of that information, I think it's safest to use the drug that's got the least drug interactions and the least likely to cause acute effects," he said. "And that would be ketamine."
“Ketamine is an excellent medication because it sedates patients relatively quickly, and so, it’s faster than many of the other sedatives that we use,” said Dr. Andrew Monte, the chief scientific officer of Rocky Mountain Poison and Drug Safety, Colorado’s poison control center. Monte is also a professor of emergency medicine and medical toxicology at the University of Colorado Anschutz Medical Campus.
Reevaluating protocols
However, following McClain’s death, many agencies are reevaluating their protocols and training procedures to ensure paramedics are conducting more thorough assessments of patients before and after administering the medication and to make sure the circumstances in which a patient is given the drug are appropriate.
“The incident has certainly brought increased scrutiny to the use of ketamine by paramedics,” said Nick Nudell, the president of the American Paramedic Association, in an email.
“We have noticed a trend towards more comprehensive training and re-evaluating protocols to ensure that administrations are justified and documented thoroughly,” he said.
Implications for other paramedics around the country
Medical professionals around the country are calling the criminal convictions of the two Colorado paramedics “unprecedented” as most cases involving questionable medical care are settled with civil proceedings or discipline.
Many paramedics watched the criminal trial unfold with anticipation.
“For the most part, in the health care side of things, when there’s medical error, that’s handled in civil court. There’s lawsuits involved. They sort through those issues, and generally, there’s financial penalties,” said Scott Sholes, the president of the Emergency Medical Services Association of Colorado.
The group represents more than 1,700 people and dozens of agencies throughout the state.
“The criminal piece is really, really rare, and exceptionally rare in EMS,” he said. “That’s gotten some people’s attention, and got us to look at what’s happening and why that’s happening and how do we go ahead and address that and prepare our staff members — our EMTs and paramedics — to safely provide care and not end up with any kind of either civil or criminal penalties?”
“The conviction underscores the importance of thorough training for administering medications in the field,” said Nudell. “It is a somber reminder of the profound responsibility EMS providers hold and the potential consequences of their actions.”
Sholes said some medics are now raising concerns about administering various medications in the field.
“Could they be held liable for that? Certainly, those questions come up, which is why we want to make sure that we’re adequately training people to assess and to monitor patients, both before and after they provide any care,” he said.
“For most of the folks who understand that they do the best they can for their patients, and they want to be out there advocating every single day, every single time, for their patients, (the criminal convictions are) not that scary. They see (those) as the result of not doing what you should be doing on behalf of your patients,” Sholes said.
“EMS clinicians are committed to saving lives and ensuring patient safety, however some may now approach calls with the fear that rare errors concerning medication and quality of care will be viewed as criminal offenses,” said José Cabañas, president of the National Association of EMS Physicians.
“The relationship between communities and Emergency Medical Services is essential to appropriate prehospital medical care. This is why we believe potential errors in medical care are best handled through the civil system as malpractice rather than through the criminal legal system, when they are medical errors without proven criminal intent by the EMS clinicians.”
How police and paramedics interact
The McClain case and others, like the 2019 death of Jamie Britt , has shined light on the role paramedics play when approaching a patient who is physically restrained by or struggling with police.
Britt, whose autopsy said he died of restraint asphyxia and the toxic effects of ketamine, was held prone for nearly 20 minutes by Mount Pleasant, South Carolina, police officers while they attempted to arrest him for public intoxication.
Charleston County paramedics injected Britt with ketamine about 15 minutes after police took him into custody.
No one was criminally charged in that case, but it resulted in millions of dollars in settlements with the city and county and Britt’s family.
“Restraint applied to a patient is just a very, very dangerous environment,” said Sholes. “So, we have to be careful when we go ahead and give medications and then have to be very, very careful about monitoring after that. And that’s a key takeaway from many of these situations.”
“Several cases in 2019 demonstrated weaknesses in some EMS practices that led to poor outcomes and deaths for some patients,” said Cabañas. “Though NAEMSP had a position statement on patient restraint since 2002, that statement was subsequently updated in 2021 to address these national weaknesses. Since then, there have been many conference presentations, webinars, publications, and media postings to increase awareness of safe practices in caring for agitated patients. NAEMSP and other EMS organizations continue to plan additional education to improve these practices.”
Sholes said body cameras have been vital for teaching and training first responders how to properly assess, monitor and treat patients who are involved in situations like these.
He said there is also a need for new policies and procedures that clearly delineate when a person in police custody becomes a medical patient.
“One of the things that we’ve seen as a failure on some of the EMS practioners’ side (is) to intervene when they believe that that subject is a patient – to get in and conduct an assessment and help direct care from there,” Sholes said.
“We now are developing a whole new generation of EMS providers whose role and duty is to always advocate for their patients under all circumstances," he said.
Nudell said the relationship between police and paramedics is an area of “significant discussion” within the emergency medical services field. “It is critically important for paramedics to understand the context in which they are administering care, including the duration and conditions of police restraint, as it may influence their clinical decision-making.”
Another questionable case in Mississippi
Among the families across the country that paid close attention to the outcome of the McClain case is the family of Jonathan “Stewart” Blahut, who died in September 2022.
He was high on methamphetamine when police held him face-down for more than 25 minutes and a paramedic sedated him with ketamine in Gautier, Mississippi.
According to an autopsy, the state medical examiner said the “toxic effects of methamphetamine” caused Blahut’s death.
But the 27-year-old’s family began to question that explanation after watching police videos showing the final hours of his life.
“I think about him all day every day … what he had to go through, that was inhumane,” said his mother Jeanette Blahut. “Him sitting there hollering for mama as he was dying.”
Stewart Blahut's sister, Alaina Hand, said she called authorities seeking help for him that day after he called her and sounded as though he was running through the woods. She tracked his phone’s location and provided it to police, and now says she feels guilty for calling 911 after watching the video from his final encounter with first responders.
“I don’t see how somebody could watch the video and think that it was OK, and nothing should be done,” Hand said.
“The video shows a deliberate indifference to Mr. Blahut’s life, and we are going to work to secure justice for his family and to prevent this from happening again,” said Dan Boles, a South Carolina attorney working with the family.
What the body camera shows
The body camera footage shows Gautier officers responding to calls that Blahut was naked, running through the woods and swimming in a bayou.
Video shows police pulling Blahut out of the water into their boat and handcuffing him.
Police then dragged him onto a nearby dock and forcefully held him face-down — in the prone position – for more than 25 minutes as they told him to stop fighting them.
While he was restrained, Blahut admitted he had taken methamphetamine. After restraining him for several minutes, police asked for an ambulance to be dispatched because it was “hard to hold him,” and they wanted paramedics to sedate him.
Later, Blahut is heard yelling, “Help! Paramedics! They’re killing me! I can’t breathe!”
Officers had been holding Blahut prone for roughly 18 minutes when an Acadian Ambulance Service paramedic sedated him with ketamine.
Officers continued to hold him face-down while waiting for the drug to take effect, while it appeared the paramedic stood several feet away. Police asked the paramedic if they would be able to put Blahut on the gurney face-down, and the paramedic explained that was not allowed because it could cause him to stop breathing.
“But if he stops breathing, he’s not fighting anymore,” the paramedic added.
After holding him prone for roughly 26 minutes, police flipped an unresponsive Blahut onto the gurney. An officer wrote in his report, “I noticed that the male was a light shade of blue and did not appear to have a rising or falling of the chest.”
Ambulance records provided to Scripps News by the Blahut family show the paramedic did not document Stewart’s vital signs until 17 minutes after she documented giving him a dose of ketamine. Though the paramedic documented he had a pulse and was breathing at that point, hospital records said he was in cardiac arrest by the time he arrived via ambulance.
Medical toxicologist reviews the case
Scripps News asked Dr. Andrew Monte to review Blahut's toxicology report and the body camera video.
Monte said the fact that Blahut removed his clothes indicated his body temperature was dangerously high due to the methamphetamine he ingested.
“There are multiple things that likely contributed to this person’s death,” Monte said. “This person’s methamphetamine concentration was exceptionally high and clearly contributed to this patient’s death ... However, there is likely a contribution of being restrained because that exacerbates the toxicity of methamphetamine.”
Monte explained that meth increases a patient’s metabolic rate.
“In order to deal with that increased metabolic rate, what ends up happening is the patient has to breathe faster in order to get rid of some of the acid that’s produced. So, if you constrict someone’s breathing, then unfortunately, they’re not able to get rid of that acid as easily. That can actually send you into a downward spiral, and that unfortunately is what happens when people are restrained.”
As for the potential role of ketamine in Blahut's death, Monte said the toxicology results showed a therapeutic amount of the sedative was administered, but it may have been complicated by the prone restraint.
“It is possible that ketamine can depress respirations further if somebody is already having a hard time breathing,” Monte said. “The perfect option is to actually get somebody sedated and then monitor their breathing without actually having them fight against anybody.”
Gautier’s police chief did not respond to repeated questions from Scripps News about the department’s training on the dangers of prone restraint and whether anyone from the department conducted an internal review of the case.
The department turned the case over to the Mississippi Bureau of Investigation to review.
The MBI report indicates the bureau closed its investigation and turned the findings over to the district attorney. The MBI report said the investigator obtained the body camera video, but the report does not describe the video in any detail.
The state did not respond to Scripps News’ questions about whether the medical examiner reviewed the body camera video before determining Blahut’s cause of death. However, the state medical examiner and her staff “remain open to reviewing any additional evidence that may be submitted,” Bailey C. Martin, a spokesperson for the Mississippi State Medical Examiner’s Office, said in an email.
The paramedic who administered ketamine to Blahut did not respond to requests for an on-camera interview, but told Scripps News by phone she believes she did nothing wrong and said her superiors told her she handled the case correctly.
Acadian Ambulance Service said it could not comment on Blahut's treatment due to state and federal privacy rules. It released a general statement saying, in part:
“When called upon to assist law enforcement officers, and when they confirm that it is safe to access the patient, we will assess the situation and the patient based on information provided by law enforcement and the physical and mental presentation of the patient. If indicated, we will administer chemical sedation to individuals who present a threat to themselves or others. The physical restraint of a combative person is not considered within the scope of practice for our EMS professionals and is handled by law enforcement under their training and protocols.
Upon administration of any medication to a patient, Acadian medical personnel are trained to monitor a patient’s vital signs as clinically indicated. Acadian utilizes state of the art medical equipment that our EMS professionals are trained on the proper use and function of as well as trained to interpret the data provided thereby…
The endemic use of illicit drugs has created many challenges for both law enforcement and EMS professionals. Our medics are trained and committed to providing the best medical care possible to all our patients, regardless of the nature of their medical condition.”
The Blahut family said they thought for months that Stewart died of a drug overdose after receiving his autopsy report, which did not mention he was restrained by police and sedated with ketamine before he died.
Now the family is pushing for the case to be reopened and reconsidered, the same way Elijah McClain’s cause of death was amended in Colorado.
“If my son would not have come into contact with them, he would be alive today,” Jeanette Blahut said.
“We’re trying to get justice,” Alaina Hand said. “I think he’d be proud of us.”
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