While Aurora’s Elijah McClain may be perhaps the most well-known person who died as a result of an overdose of ketamine in Colorado, he’s far from the only one, nor the only Coloradan who has suffered long-term ill effects from the drug, according to testimony to the House Judiciary Committee.

Many who have experience with ketamine administered during police interactions aren’t satisfied with the steps to limit its use, as contained in an amended version of House Bill 1251, which was approved by the committee after a lengthy hearing.

One by one, the witnesses said the chemical restraint drug should be banned outside of a hospital setting.

That included McClain’s mother. Her attorney Qusair Mohamedbhai said no paramedic who was involved in McClain’s death has been held accountable. In a statement published Wednesday evening by the Aurora Sentinel, he said that anything less than a ban does not acknowledge the death of McClain.

“It’s a step in the right direction but we are past incremental change on the backs of our dead community members,” the statement read.

As introduced, HB 1251 would have required paramedics to obtain the weight of an individual before administering ketamine. But that proved to be logistically difficult, as many ambulances are not equipped with scales and other factors. Sponsors Rep. Yadira Caraveo, D-Thornton, and Rep. Leslie Herod, D-Denver, offered a rewrite of the bill that limits the use of ketamine in nonhospital settings and imposes sanctions, including criminal penalties, when it is improperly administered.

Those who administer ketamine must be trained in its use, must monitor vital signs and attempt to weigh the individual to ensure an accurate dosage. If they are unable to weigh the patient, the amended bill said at least five other people must agree with the weight calculation, although that was later amended down to two who are trained in weight assessments.

Ketamine and related “chemical restraint” drugs cannot be used to “subdue, sedate or chemically incapacitate” someone as a form of punishment or to facilitate an arrest, the amended bill now says. And “excited delirium” is not a justifiable emergency that would allow the use of ketamine, the amended bill says.

Under the measure, police officers would be banned from directing paramedics to administer ketamine, and paramedics would be banned from sole reliance on information from police officers in reaching a decision on the drug’s use.

Medical professionals objected to a requirement in the measure mandating paramedics to report to the state’s Peace Officer Standards and Training board when an officer tells them to administer ketamine, as well as requiring other police officers to either intervene or turn in their colleagues to the board when they witness such an action. The measure carries criminal penalties for the officer directing the use of a chemical restraint, or for officers who fail to intervene.

That won’t foster good communications between paramedics, other medical professionals and police officers, health care advocates testified Wednesday.

Committee members noted they were wading into medical practice, an area in which they have little experience.

The committee first heard from those who have seen firsthand the effects of ketamine, including Lakewood City Councilwoman Anita Springsteen, who witnessed her city’s paramedics* administer ketamine to her boyfriend during a police incident. Springsteen was not speaking on behalf of the city council.

The March 2020 incident involved Jeremiah Axtell, who was handcuffed at the time when he was injected with ketamine. Both Axtell and Springsteen said Axtell had said he was cooperating with police at least 40 times during the exchange. The incident was related to Axtell’s complaints about an assisted living facility across the street where overflowing garbage, including adult diapers, were causing problems, including animals rummaging through the trash. Springsteen said that while police reports described Axtell as “out of control,” she videotaped the incident which showed him being cooperative.

“There’s no appropriate use of ketamine. Ketamine should be banned,” Springsteen said.

Injected with ketamine twice, Axtell said he woke up in the morgue. He’s now one of several people who have filed lawsuits against police departments and paramedics over the drug’s use .

Another is Elijah McKnight, who is suing Arapahoe County and South Metro Fire after being injected with 750 mg of ketamine. He wound in intensive care as a result. McKnight acknowledged he had been combative with police officers in the August 2019 incident (the same month that Elijah McClain died). But he was injected only after being tased repeatedly, and then handcuffed by police officers, he said. By then, he said, he had agreed to cooperate.

“I support the bill but it’s not enough,” he told the committee.

In February 2020, Teresa Fuentes’ son died after being injected with ketamine at the Trinidad Correctional Facility. He had 843 mg of ketamine in his system, according to the autopsy, she said.

“Somebody should be made accountable for that,” she told the committee. “My grandchildren lost their father and I have lost my son.”

But most of the testimony on Wednesday came from those who objected, some strenuously, to the bill as rewritten.

Dr. Kevin McVaney is medical director for the Denver Emergency Medical Response System, which includes Denver Health Paramedics, the Denver Fire Department, the Denver Police Department and the Denver Communications Center. He told the committee that between 2006 and 2013, Denver had eight restraint-related deaths. The solution was to devise a comprehensive, “excited delirium” plan, which included early training with 911 dispatch, Denver Fire and Police, and that would alert someone to a behavioral emergency.

There have been no deaths in Denver since that plan was implemented, McVaney said.

“My fear with this bill is that if we move without knowing exactly what we’re doing, if we create a circumstance where law enforcement cannot work in cooperation and under the direction of paramedics in the field, what we will have is a return to our previous deaths,” he said.

Yolanda Amezcua, an EMS education coordinator with Denver Health, added that paramedics often have just seconds to identify and manage a situation where someone is agitated, combative or otherwise violent.

“This bill does not accurately reflect or consider the unique role and reality paramedics encounter as they provide care for patients exhibiting these extremely dangerous behaviors or medical emergencies outside of a hospital,” Amezcua told the committee. And the bill’s overly-broad language restricts clinical decision-making in circumstances where chemical sedation is the most appropriate means to safely treat potentially life-threatening situations, she said.

“The bill will put paramedics at increased unnecessary risk because it fails to consider or understand the dangerous situations we face when caring for extremely agitated, combative, or violent patients,” Amezcua said. She’s been in situations where her life was threatened by patients when called upon to render aid. One patient tried to bite her and break his own arm in order to injure her, she told the committee.

“There is not much time for dialogue (in those situations) because the fight is on,” she said. “However, our job is to make sure that we are not restraining the patient to the point to where they suffer respiratory failure.”

Other witnesses said reporting officers to the POST board is not appropriate, given that the POST board lacks an investigative function, and that reports should go to an officer’s supervisor.

Herod told the committee that the sponsors have worked with 50 different stakeholders, but it was clear that more negotiations are likely, prompted by requests from committee members on both sides of the aisle. Rep. Terri Carver, R-Colorado Springs, led the questioning on the bill and suggested several amendments, including one to strip out the reporting requirement to the POST board, as well as the language that would assess a misdemeanor on police officers who fail to intervene when another officer has directed the use of a chemical restraint.

These are serious medications with serious side effects, Caraveo told the committee at the end of the hearing, and should only be given only based on legitimate medical information, “and not under the influence of individuals who have no medical training.”

Herod pledged to continue to work on the bill, which passed on a 7-4 party-line vote and now heads to the full House.

Correction: An earlier version said Axtell was administered ketamine by the police; it was actually paramedics.