Ketamine cases raise questions over boundaries between police and paramedics

For years, Hennepin Healthcare has sought to be a global pioneer in researching a powerful sedative called ketamine as a safer alternative to similar drugs, and its first responders began carrying it a decade ago.

Now the hospital's leadership is defending the drug after its paramedics and Minneapolis civil rights investigators independently expressed concern that Minneapolis police officers urged medical responders to use it to subdue members of the public when responding to difficult calls.

The concerns, detailed in a draft report obtained last week by the Star Tribune, have brought national attention to the boundaries between police and paramedics when both respond to emergencies that require split-second decisionmaking. On Friday, Hennepin Healthcare leadership ordered an independent review of the cases involving their EMS personnel.

The draft study, conducted by Minneapolis's Office of Police Oversight Review, included descriptions and transcripts from body cameras showing officers asking paramedics to sedate people with ketamine or bring it to the scene. The report questioned why ketamine was necessary in cases when the person was already restrained or did not appear severely agitated, and why police officers made suggestions about medical treatment.

Hennepin County Chief Public Defender Mary Moriarty said a few of her office's clients have been sedated with ketamine during police encounters, and they are reviewing those cases now. "It's disturbing that they would be doing that on the street at the direction of law enforcement," Moriarty said.

Dr. William Heegaard, chief medical officer for Hennepin Healthcare (formerly HCMC), said Friday that ketamine can save lives, particularly when dealing with those showing signs of "excited delirium," a condition in which the person is severely agitated and aggressive.

"It is probably the most commonly used anesthetic in the world," he said. "I personally have used it in Papua New Guinea and places like that when I was doing surgeries. It is a medication that is complex. It can be abused, and unfortunately that happens with almost all medications."

Heegaard said four cases described in the report involved Hennepin Healthcare paramedics administering ketamine. He said paramedics voiced concerns to hospital staff in April — before they knew about the report — that Minneapolis police officers were urging them to use ketamine in scenarios that require snap decisions on treatment.

The hospital brought these concerns to police, and in May police command staff sent a memo saying officers "shall never suggest or demand EMS Personnel 'sedated' a subject. This is a decision that needs to be clearly made by EMS Personnel, not MPD Officers."

Mayor Jacob Frey reiterated this, saying "cops shouldn't direct medical professionals on health-related issues, and medical professionals shouldn't listen to them."

The draft report shows several instances of police specifically requesting ketamine and talking casually about the drug with paramedics between 2016 and 2018. The report includes examples of officers calling ketamine "the Big K," making a suggestive "injection motion" and telling a person the paramedics will "[shove] a needle in your ass."

"MPD officers have sometimes requested that ketamine be used before EMS is able to make an independent determination," the draft report states. "MPD officers acting as a decisionmaker on medical issues is not a best practice when a medical professional is being called to the scene."

The number of documented ketamine injections during Minneapolis police calls increased from three in 2012 to 62 last year, according to the report. Some given ketamine suffered serious medical complications and needed to be intubated, it found.

Ketamine is a powerful anesthetic agent that induces a trance-like, sometimes hallucinatory, dissociative state.

It was approved for humans in 1970, and its common applications include pain treatment and sedation. Recent studies found it could be useful in treating serious depression.

Its effects have also made it a popular recreational drug, sometimes called "Special-K."

Dr. Solomon Snyder, a neuroscience professor at Johns Hopkins School of Medicine, compared the effects to those of LSD, and said it hasn't been more widely used in depression cases because of its risks.

"If you take it, you'll be out of your head," he said. "So even if it's good for depression, you have to do it very carefully."

The stigma associated with the drug prevented it from being more widely used in emergency departments for years, said Dr. Michael Abernethy, a professor at the University of Wisconsin and an authority on ketamine. He said it is now a routine sedative for medical workers across the country, considered a safer alternative to drugs like morphine and fentanyl.

"I mean, it's night and day, the safety margin," he said.

Because the drug takes hold in minutes, ketamine is used in the field for out-of-control and violent patients, Abernethy said. "We're not talking about the drunk guy who's being mouthy and swinging at people, but behavioral emergencies when a person is a true danger to themselves or people around them."

Minneapolis police Sgt. Griffin Hillbo, the department's medical support coordinator and a trained paramedic, said ketamine is a valuable tool when dealing with people considered a danger to themselves.

"If we don't use it and they exhaust themselves and they die, then what?" he said.

He disputed the notion that paramedics administered the drug only at officers' behest. "They're not telling them to do that, they're not ordering paramedics to do that," he said. "They still have to follow their own [procedures] and policies."

Yet the city's draft report shows many examples of police asking for the drug. It does not identify the officers, paramedics or civilians involved.

In one instance, an officer said, "When EMS gets here just tell 'em to bring the ketamine in."

In another, an officer said, "They should just get to the point where they give us tranquilizer guns, we just walk in and 'doot doot.' "

In a separate interaction, police struggled for a half -hour with a combative man telling them to "kill me" and "taze me," according to the report. An officer told EMS the man "needs a shot right now." A few minutes later, an officer said: "What did they give him? Hopefully it's ketamine." After the person continued to resist, an officer said: "Could we have used a better drug, maybe? How about ketamine?" And then: "You gonna give him the 'Big K?' Should've given him the 'Big K' the first time we came in."

The oversight report includes only excerpts from these interactions, and in some cases provides few details as to the nature of the incident or what happened next. Heegaard and city officials have questioned the accuracy of the draft, including whether it provides appropriate context and descriptions of medical procedures.

The Star Tribune requested reports corresponding to eight incidents, but Minneapolis would not release them Friday, listing them as "unavailable." State law requires certain incident and response data and arrest data to be available at all times.

Staff writer Libor Jany contributed to this report. Andy Mannix • 612-673-4036