Hennepin Healthcare Chief Medical Officer Dr. William Heegaard testified June 26 in front the Hennepin County Board about a halted study on the use of ketamine as a pre-hospital sedative. Heegaard also addressed an unreleased draft city study that raises questions about interactions between paramedics and police. Photo by Dylan Thomas

Yates to lead ketamine inquiry

Updated: July 12, 2018 – 4:23 pm

Sally Yates, a former deputy U.S. attorney general, will lead an independent review of the use of ketamine on people detained by Minneapolis police.

Mayor Jacob Frey and police Chief Medaria Arradondo had called for a third-party investigation after reporting by the Star Tribune raised questions about interactions between police and the emergency medical services personnel who administered the powerful sedative. Frey and Arradondo jointly announced Yates’ hiring June 22.

The Star Tribune obtained a copy of a draft report on the use of ketamine by Hennepin Healthcare and North Memorial Medical Center EMS crews over three years. Still in development by the city’s Office of Police Conduct Review, the report has not yet been released to the public, but according to the newspaper it describes police urging paramedics to use the sedatives, sometimes on people who were already restrained. In some instances, it caused serious heart and breathing problems.

The police department in May issued a memo to officers clarifying that, while police may request the use of ketamine, medical personnel have the final call, according to the Star Tribune and a statement released by Hennepin Healthcare, formerly Hennepin County Medical Center. According to Hennepin Healthcare, EMS crews have used ketamine since 2008 to treat “excited delirium,” a medical condition that poses a threat to both the patient and first responders, and EMS personnel began raising concerns in April about their interactions with police.

Hennepin Healthcare was studying the use of ketamine to treat excited delirium, but Dr. William Heegaard, the hospital’s chief medical officer, said it was never administered simply because of the study. While Heegaard said the study complied with ethical guidelines, concerns expressed by local elected officials and the public prompted the hospital to halt the work in June. Hennepin Healthcare also plans to hire a national expert to review the study and how it was conducted.

Michelle Gross of Communities United Against Police Brutality said the organization, which runs a 24-hour hotline, had received multiple reports of “coerced drugging” over the past few years.

“At first you think, you’ve got to be kidding me. It doesn’t even seem credible. But bit by bit we began to hear more and more of these cases,” Gross said in comments delivered June 21 before the City Council’s Public Safety and Emergency Management Committee. Especially concerning, she said, was that those who were given ketamine would sometimes wake up hours later in a jail cell or hospital bed with no memory of what happened to them.

“What people have told us pretty consistently is that incidents in which they were coercively injected involved verbal disagreements, verbal objection to the police conduct that they were experiencing but not physical resistance,” she said.

During a June 18 meeting of the City Council’s Public Health, Environment, Civil Rights and Engagement Committee, council members Phillipe Cunningham and Jeremy Schroeder said they were “appalled” by the draft study’s findings. The committee, chaired by Cunningham, voted to direct Office of Police Conduct Review staff to complete their study and report back to the Council by July 26.

“I think we as elected officials have to remember that we defend the people of this city, not the city itself. And when these things are happening, we need to take action quickly,” Schroeder said.

Council members also called for an independent review of the study, which Cunningham said was meant to “increase transparency” for the public and did not reflect a lack of faith in city staff. It was unclear whether the council would move ahead with a review separate from the one led by Yates.

Council Member Jeremiah Ellison, who is not a member of the committee but joined the meeting, said the draft report raised two important questions. The first was about the actions of Minneapolis police officers, he said.

“But then there’s the other part that’s equally as troubling, that we don’t have purview over, and that is the county’s role,” Ellison said, adding that he hoped the county would look closely at the actions of EMS personnel.

Called to appear before the Hennepin County Board June 26, Heegaard acknowledged concerns that arose over interactions between police and paramedics that were “not professional.”

Heegaard also pledged to take steps before restarting the study that would increase transparency and invite community input.

He said patients given a pre-hospital sedative were later presented a consent waiver that allowed them to join or opt out of the study. Asked by Hennepin County Commissioner Mike Opat how common that process of that “after-the-fact enrollment” was, Heegaard said the hospital was still reviewing its records.

“I understand that can be confusing to the community,” Heegaard said.

Heegaard said the hospital is seeing “record levels” of patients experiencing profound agitation, which can be life threatening. Of the four drugs commonly used to treat the condition, ketamine is the fastest acting, he said.

While overall sedative use is down at the hospital, the use of ketamine as a proportion of all sedative use is higher, he added. Heegaard also noted the hospital’s success in reducing side-effect rates with pre-hospital sedative use, including situations that require patients to be intubated.

In its June 15 statement, Hennepin Healthcare noted the results of one survey that found ketamine was carried by about a third of EMS crews nationwide. The hospital said that was “largely because of the research published on its safety and that it results in saving lives.”

“We only recently saw a copy of the draft report and met with the city to express concerns about what we believe are significant inaccuracies, based on limited interactions that were taken out of context,” the statement read. “Our concern is that misrepresentation about the use of ketamine could potentially set back improvements in how we care for profoundly agitated patients.”

Applied in hospital settings as an anesthetic, ketamine can cause hallucinations and impair a patient’s ability to think, according to the Mayo Clinic. It is also used illegally as a recreational drug and is sometimes referred to as “special K.”

According to Hennepin Healthcare, the draft study included details of four instances when ketamine was used by its EMS crews. The hospital reviewed those cases, determining all four followed protocol and were “medically justified.” The hospital plans to have the Quality Committee of the Hennepin County EMS Council conduct a separate review of those cases.

In the statement released by Frey and Arradondo, the police chief said Yates would “examine the MPD’s protocols and duty interactions” with emergency medical services personnel.

“Sally Yates’ record speaks for itself,” Frey added in the statement. “She has dedicated her life to unearthing the truth, and delivering justice.

“There’s no time to waste in launching our independent review of the interaction between Minneapolis cops and medical personnel, and I am confident that Ms. Yates is the highest caliber candidate to lead a thorough investigation.”