by The practice of sedating people in police custody has quietly spread across the nation over the past 15 years, based on questionable science and backed by police-aligned experts, an investigation led by The Associated Press finds. Press.
At least 94 people died after being sedated and restrained by police from 2012 to 2021, according to findings by the AP in collaboration with FRONTLINE (PBS) and the Howard Center for Investigative Journalism. That’s almost 10% of the more than 1,000 deaths identified during the investigation of people being beaten by police in non-fatal ways.
Supporters say tranquilizers aid in the rapid treatment of drug-related behavioral emergencies and psychotic episodes, protect frontline responders from violence and are safely administered thousands of times a year to people with life-threatening conditions. to be taken to hospitals. Critics say forced sedation should be severely limited or banned, arguing that the drugs, given without consent, are too risky to administer during police encounters.
The injections spanned the country, from a desert in Arizona to a street in St. Louis to a house in Florida. They happened in big cities like Dallas, in suburbs like Lithonia, Georgia, and in rural areas like Dale, Indiana. They happened in homes, in parking lots, in ambulances and sometimes in hospitals when police contact occurred.
The possible role of sedatives in all 94 deaths could not be determined, which often involved the use of other potentially dangerous force on people who had taken drugs or drank alcohol. Medical experts told the AP that their effects could be negligible in people who were already dying; the final straw that triggered cardiac or respiratory failure in the medically distressed person; or the main cause of death when given in the wrong circumstances or mishandled.
Although sedatives were cited as a cause or contributing factor in a dozen official death rulings, authorities rarely even investigated whether injections were appropriate. Traditionally, medical officials viewed them as mostly benign treatments. Now some say they may play a bigger role than previously understood and deserve more scrutiny.
Here are the takeaways from the AP investigation:
THE NEW ARE disproportionately NON-BLACK
The investigation found that about half of the people who died after injections were black.
Behind the racial disparity is a controversial medical condition called agitated delirium, which has fueled the rise of out-of-hospital sedation. Critics say the purported symptoms, including “superhuman strength” and high pain tolerance, play into racist stereotypes about Black people and lead to biased decisions about who needs sedation.
Guidelines require paramedics to make quick, subjective assessments of the potential dangers to the people they treat. Only those who are considered to be at high risk of harming themselves or others are thought to be candidates for shots.
But the investigation found that injections were given to some of them whose behavior did not meet the bar – which had mostly already subsided or in rare cases even after death -. In some cases, paramedics cited fears that people would become violent on the way to hospitals.
The death of Elijah McClain in Aurora, Colorado, in 2019, brought attention to the practice. A paramedic convicted of giving McClain an overdose of ketamine was sentenced to five years in prison last month, and a second paramedic is scheduled to be sentenced Friday.
INJECTION ADMINISTERED AFTER OTHER FORMS OF RESTRICTION
Time and time again, the AP found that agitated people who were detained by the police, often handcuffed and officers pressing on their backs, struggled to breathe and tried to get free. Indicating combat, the paramedics administered sedation, further slowing their breathing. Cardiac and respiratory arrest often occurred within minutes.
Paramedics gave drugs to people who posed no threat to themselves or others, in breach of treatment guidelines. Medical practitioners often did not know whether other drugs or alcohol were in people’s systems, although some combinations have serious side effects.
Police officials have sometimes suggested that paramedics should give bullets to people they suspected of being detained, potentially abusing their powers.
Most of the people who died were restrained face down in handcuffs, which restricts breathing.
Experts say that administering sedatives to someone who is already struggling to breathe can be fatal, as the drugs slow down the respiratory drive. If they can’t get enough oxygen and blow off enough carbon dioxide, their heart can stop or they can stop breathing.
A FAST-PROOF STRATEGY BASED ON A CONCEPT THAT IS NOW DISCRETE
The use of sedation by emergency medical responders outside hospitals has expanded rapidly over the past two decades based on a now discredited theory. Law enforcement leaders in the 2000s were concerned about the number of people who died after being stunned by police Tasers and forcibly restrained.
They began promoting a new strategy asking officers to view encounters with highly agitated people, including those who have suffered psychotic episodes or high on drugs, as medical emergencies. Rather than use force to try to achieve compliance, officers were encouraged to call emergency medical services to sequester people and transport them to hospitals.
Supporters of this approach advanced a term to describe behavior they said put combatants at risk of sudden death: excited delirium.
The strategy gained momentum in 2009 when the American College of Emergency Physicians recognized agitated delirium and urged the rapid use of ketamine, midazolam and other drugs to treat it.
Agitated delirium protocols were quickly adopted by EMS agencies, although drugs such as ketamine have not been thoroughly studied in this area. The paramedics who injected McClain with ketamine said they were following one such policy.
Critics have argued that the concept of agitated delirium shifts the blame from the police in the deaths. The National Association of Medical Examiners and the American College of Emergency Physicians distanced themselves from the concept in 2023.
SEDATIVES ARE RARELY THE FOCUS OF DEATH INVESTIGATIONS
Police-involved deaths often result in news headlines and criminal investigations that focus on the use of force by officers. But the AP investigation found that medical personnel who administered sedation were often largely ignored.
News outlets have not previously reported that a sedative was used in nearly half of the deaths. Many reasons explain this lack of attention.
Police narratives omit the use of sedation due to medical privacy concerns. EMS treatment records are not subject to public records laws. Medical examiners view sedatives as treatments and rarely cite them as contributing factors to deaths. Investigators do not know the role that sedation plays and are not interested in diving into the complex details.
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Associated Press researcher Rhonda Shafner of New York contributed.
___ The Associated Press receives support from the Public Interest Foundation for reporting focused on criminal justice. Columbia University’s Ira A. Lipman Center for Journalism and Civil and Human Rights also supported this story in collaboration with Arnold Ventures. In addition, the AP Health and Science Department is supported by the Howard Hughes Medical Institute Science and Education Media Group. The AP is solely responsible for all matters.
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Contact AP’s global investigative team at investigative@ap.org or https://www.ap.org/tips/
___ This story is part of an ongoing investigation being conducted by The Associated Press in conjunction with the Howard Center for Investigative Journalism and FRONTLINE (PBS) programs. The investigation includes the interactive story Lethal Restract, a database and the documentary, “Documenting Police Use Of Force,” which premiered April 30 on PBS.
