The national outage over authorities’ excessive use of force, especially against black men, may take law enforcement, first responders, politicians, and critics into a murky and nightmarish area — call it the unfounded medicalization of official control.
Two fatal flash point cases — involving African Americans George Floyd in Minneapolis and Elijah McCain (shown, right) in a Denver suburb — already have raised disturbing questions about “excited delirium,” a mental health description or diagnosis manufactured by authorities, and whether paramedics should be asked and then if they should administer powerful narcotics to individuals at police request.
As the nonprofit, independent Marshall Project on criminal justice reported about excited delirium:
“[It is] a controversial diagnosis often cited when people die in police custody. People with excited delirium are said to be aggressive and incoherent, and to have ‘superhuman strength,’ often after taking stimulant drugs such as cocaine or methamphetamine. Police groups and some experts say it’s a real condition, requiring immediate action and medical treatment. But critics, including some medical experts, have attacked the condition as junk science and say it’s often used as a convenient excuse to justify excessive police force.”
The arguing over the purported condition soon may not be academic, as legal experts believe Minneapolis police officer Derek Chauvin may rely on excited delirium as a defense for his lethal use of a knee on the neck of Floyd, fatally strangling him, the Marshall Project reported.
As the journalism nonprofit noted, “another officer asked Chauvin if they should roll Floyd onto his side. ‘I am worried about excited delirium or whatever,’ the officer told Chauvin, according to authorities. Chauvin refused to turn over Floyd, who was pronounced dead shortly after. The officer, Thomas Lane, was talking about a controversial diagnosis often cited when people die in police custody.”
The news site reported that excited delirium or its predecessors have floated around in law enforcement for a while now:
“Syndromes with similar characteristics but different names have appeared in scientific articles since the 1850s, according to the limited research available. Excited delirium didn’t emerge as a common diagnosis until the 1980s, with the rise in cocaine use. Some supporters of its use as a diagnosis say it’s a syndrome first responders must be trained to recognize, because it can cause people to die suddenly, leaving police wrongfully accused of excessive force.”
But here is where the issue becomes even more problematic — and, surprise, it has its roots in Minneapolis policing, too: When authorities call in medical first responders, aka paramedics, should they administer powerful drugs in settings that often are harried, fraught with emotion, and in which they may lack the time or expertise to make a difficult and full evaluation of an individual’s health?
This issue has erupted in the renewed investigation of the death of McCain, 23, a slight, bespectacled, violin-playing, and introverted African American man who was arrested and drugged in Aurora, a suburb of Denver.
After discussion with police, paramedics — saying they were following official protocols — followed officers’ chokehold restraint of McCain by injecting him 500 milligrams of ketamine, a potent narcotic often used mostly in animals. That dosage, experts say, would be appropriate to knock out a large man, and police claimed to the paramedics that McCain was 220 pounds.
He was 5-feet-6 and weighed 140 pounds, meaning, at best, he should have gotten a much lower injection of ketamine, perhaps 320 milligrams, experts say. But as one expert also told NBC News:
“Why anyone would be giving ketamine in that circumstance is beyond me,” said neuroscientist Carl Hart, chair of Columbia University’s psychology department. “The major problem here is we should never be ordering any medication, and no one should be taking or given it against their will.”
Colorado officials suddenly are finding that sedation of individuals in police control, notably by paramedics and with ketamine, is hardly rare or the exception, as NBC News reported:
“In Colorado, EMS providers are permitted to use ketamine for pain management and to treat a syndrome known as ‘excited delirium,’ but they must first obtain a waiver from the state health department. It is not uncommon for medics to use ketamine outside hospital settings to treat patients who appear agitated and may harm themselves or others, according to the state. Statewide, 427 people were given ketamine for agitation from August 2017 to July 2018, and about 20% of patients had to be intubated at a hospital, The Denver Post reported.”
The ketamine and excited delirium controversy may sound familiar, because it erupted in 2018 — in Minneapolis. The Star-Tribune reported then:
“Minneapolis police officers asked emergency medical workers dozens of times over three years to inject suspects and others with the powerful anesthetic ketamine, including some who were already restrained … In some cases, the drug caused heart or breathing failure and required those injected to be revived or intubated, according to the newspaper.”
The newspaper based its reporting on an internal review by law enforcement, with authorities denouncing the work’s disclosure while also stating that the practice of sedating individuals in custody should be discontinued.
In my practice, I see not only the harms that patients suffer while seeking medical services, but also the serious injury and death that can occur for innocent people due to authorities’ excessive use of force, as well as the damage that can be inflicted on patients and their loved ones by dangerous and harmful drugs.
Crime fighting is serious and dangerous work, and those who do it well and properly deserve credit and public support. But it is an unacceptable dodge to medicalize injuries or deaths that occur due to negligent, abusive, and even criminal behavior by those wearing uniforms and badges. The very argument that authorities deal with people with serious mental conditions and disturbance does not make the case for rough tactics. It says that critics must be heard about ensuring greater public safety by de-escalating difficult situations and increasing both the mental health care our society offers and the trained specialists who can help the mentally ill.
Complex and difficult circumstances cannot be dealt with, justly and fairly, with a sharper crack of ordinary citizens’ heads or bones, nor is it fair or proper to foist individuals’ serious mental health challenges on to paramedics for snap diagnoses and medication. It is wrong to drug up people to make them compliant, as too many friends and families have learned in so painful a way from nursing home abuse and neglect, including cases in which the old, sick, and disabled get over-medicated and turned into “compliant” zombies.
It is tough for police, by the way, to make righteous arguments about wrongful acts when they demonstrate the lack of control and good sense they condemn in those they arrest in harsh ways. The acting Aurora chief fired three officers, including one involved in the McCain case, which is still under belated re-investigation. The top cop acted after finding the officers and others in the department mocked lethal uses of force by re-enacting choke-hold incidents with each other, taking pictures of themselves, and posting them to social media.
We have much work to do to ensure that the enforcement of our laws is fair, equitable, free of racism, and just.